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HomeMy WebLinkAbout09-10-14 t 1505611185 • •r EX(02-11)(R) REV-1500 OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21 14 0173 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Dale of Death MMDDYYYY Date of Birth MMDDYYYY 12092013 09221932 Decedent's Last Name Suffix Decedent's First Name M I SHERICK CAROL P (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) © 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK E . HALBRUNER , ESQ - 717-731-9600 REGISTER OF WILLS USE ONLY _N c s m First Line of Address p rn� h O 2109 MARKET STREET rn n o Second Line of Address 7 r, O v CJ O DARE City or Post Office State ZIP Code ,._. FILE ° CAMP HILL PA 17011 r o r o co Correspondent's e-mail address: M • HALBRUNER&HHGLLP - COM Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete. Declaration of preparer other than the PersonjIt representative is based an all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN X DATE SCOTT W• SHERICK M 9/5/2014 ADDRESS 121 WILLOW LAKE DRIVE CARLISLE, PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVEx �� - _ 9/5/2 014 MARK E . HALBRUNER, ESQ • ADDRESS 2109 MARKET STREET CAMP HILL , PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 1505611285 REV-1500 EX(FI) Decedent's Social Security Number Decedent Name SHERICK CAROL P RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 245,000 .00 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2, 2 ,643 - 32 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3, 0 . 00 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4, 0 -00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. 27,892-94 6. Jointly Owned Property(Schedule F) E] Separate Billing Requested , , , , 6, 0 •130 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested . . . . 7. 2221452 .20 B. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , 8 497,988 - 46 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 27,788 .25 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , . . 10. 1231712 . 17 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11, 1511500- 42 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12, 346,488 .0 4 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13, 0 . 00 14. Net Value Subject to Tax(Line 12 minus Line 13) . 14. 346,488 .04 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0_. 0-00 15. 0 .00 16. Amount of Line 14 t xable atlinealra-X.O 49 3461488 .04 16. 15,591. 96 17. Amount of Line 14 taxable at sibling rate X.12 0.00 17. (1 -011 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 1$ 0 .00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 15,591 .96 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OU4648 3.000 REV-1500EX(FI) Page File Number Decedent's Complete Address: 21 14 0173 DECEDENTS NAME SHE RICK CAROL P STREETADDRESS 1555 REVERE DRIVE CUMBERLAND CITY STATE ZIP IMECHANICSBURG PA 17050- Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 15,591.96 2. Credits/Payments A.Prior Payments 18,300 -00 B.Discount 779 .60 Total Credits(A+B) (2) 19,079 .60 3. Interest (3) 0 .110 4. if Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) 3,487- 64 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0. 00 Make check payable to: REGISTER OF WILLS, AGENT, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN°X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . ❑❑ b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ d, receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ EZ 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 7 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? . ❑ EXI 4. Did decedent own an individual retirement account,annuity,or other non-probate property,which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ® ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT As PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent 172 P.S.§9116(a)(1 J)(i)]. For dales of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 PS.§9116 (a)(11)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. Far dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent(72 P.S.§9116(a)(1.2)). • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 172 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or far the use of the decedent's siblings is 12 percent 172 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent In common with the decedent,whether by blood or adoption. OU4571 2.000 REV,502 EX.pen) SCHEDULE A peWWNrOF arria CL'-PMRtF.NfOF REVENUE IN1ff3RANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Carol P Sherick 21 14 0173 All real property owned solely or Be a tenant In common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing sailer,neither being compelled to buy or sell,both having reasonable knowledge of the relevant tads. Real property that Isjohfttycwned with right of survivoship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. REM Include a copy of the deed showing deoedenfs interest if owned as tenant in comma, VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Real Estate located at 1555 Revere Drive, Mechanicsburg, Cumberland County, Pennsylvania, Parcel 1DN10-15-1282- 077; contract sales price 245,000.00 TOTAL (Also enter on Line 1,Recapitulation.) $ 245,000.00 2w4995 2.000 If more space Is needed,use additional sheets of paper of the same size. REV45Ui EX-(642) pennsylvania SCHEDULE B INHE RITANCE R IT N ANCE CE REVENUE TAX RETURN STOCKS & BONDS INH RESDENT DECEDENT ESTATE OF FILE NUMBER Carol P. Sherick 21 14 0173 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. U.S. Savings Bonds; 13 bonds; Series EE; see inventory 2,643.32 TOTAL (Also enter on Line 2,Recapitulation) $ 2,643.32 2W46e6 2.000 If more space Is needed,insert additional sheets of the same size REV-ISM E*(08,12) pennsylvania SCHEDULE E CEPARTMENT OF REVENUE CASH,BANK DEPOSITS&MISC. ",45WAKE TAX RE RESMeECEnEM�RN OE PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Carol P. Sherick 21 140173 Include the proceeds of higatiM and the date the proCeeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Citizens Bank, Checking Account #xxxxxx0598 25,633.59 2 Credits to Estate (Seller) as listed on Settlement Sheet for sale of real estate (prepaid taxes, association dues, sewer & refuse) 2,159.35 3 Cumberland County VA benefit paid to Malpezzi Funeral Home; refunded to Estate by Malpezzi 100.00 TOTAL(Also enter on line S.Recapitulation) E 27,892.94 2 WOs 2.000 If more space Is headed,use additional sheets d paper of the same size. REV-1510 EX+(08-09) SCHEDULE G Pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF - FILE NUMBER Carol P. Sherick 21 14 0173 ThIs schedule must t>e completed and filed if the answer to any of questions 1 through 4 on page three of the REV-15001s yes. DESCRIPTION OF PROPERTY ITEM !E{pETIGNWEOFTIETRN6FEREE.l IR REUTIOMMVTO OECWEMAM DATE OF DEATH % DECUS EXCLUSION TAXABLE NUMBER TEMTEOFTRN6ER A7 A0. OF THE DEED FOR REX ESTATE. VALUEOFASSET INTEREST Is M UCABL VALUE 1 Ohio National Life Insurance Company, non-qualified Annuity Contract No. E1588674; Annuitant and owner is Carol P. Sherick; Beneficiaries are Steven J. Sherick and Scott W. Sherick; 508 each 151,037.00 100.0000 0.00 151,037.00 2 RBC Wealth Management, IRA Account No. 311-61134; Beneficiares are Scott W. Sherick and Steven J. Sherick; 508 each. 71,415.20 100.0000 0.00 71,415.20 TOTAL(Also enter on line 7,Recapitulation)S 222 452.20 If more space Is needed,use addttional sheets of paper of the same size. OW45AF 2.000 REV-1511 Ex+1 pe SCHEDULE H Pennsylvania DEPPRTMENTOF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Carol P. Sherick 21 14 0173 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t Malpezzi Funeral Home, funeral bill 3,680.88 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Names)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 2,500.00 3. Family Exemption: (If Decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 408.50 5. Accountant Fees: S. Tau Return Preparer Fees: 185.00 7. 1 Cumberland Law Journal, publication of estate notice 75.00 2 Patriot News Co. , publication of estate notice 173.24 Total from continuation schedules . . . . . . . . . 20,765. 63 TOTAL(Also enter on Line 9,Recapitulation) $ 27 788.25 9W46AG 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Carol P. Sherick 21 14 0173 Schedule H Part 7 (Page 2) 3 RSR Realtors, realtor's commission paid at closing as listed on Settlement Sheet for sale of real estate 6,125.00 4 ERA-NRT,LLC, realtor's commission paid at closing as listed on Settlement Sheet for sale of real estate 7,350.00 5 Secured Land Transfers, LLC, notary fee paid at closing as listed on Settlement Sheet for sale of real estate 10.00 6 Secured Land Transfers, LLC, wire transfer fee paid at closing as listed on Settlement Sheet for sale of real estate 45.00 7 Cumberland County Recorder of Deeds, 1% realty transfer tax paid at closing as listed on Settlement Sheet for sale of real estate 2,450.00 8 Michael Langan, Tax Collector, school real estate taxes paid at closing as listed on Settlement Sheet for sale of real estate 2,133.56 9 Brandywine Homeowner's Association, Inc. , homeowner's association fee paid at closing as listed on Settlement Sheet for sale of real estate 85.00 10 Black 6 Bleu Restaurant, funeral meal 372.62 11 PP&L, electric bill paid 3/5/14 60.56 12 PP&L, electric bill paid 3/31/14 68.76 13 PP&L, electric bill paid 4/13/14 24.08 14 PP&L, electric bill paid 6/1/14 30.81 15 PP&L, electric bill paid 7/6/14 30.10 16 PP&L, electric bill paid 8/7/14 59.47 17 PP&L, electric bill paid B/30/14 31.17 18 Pa American Water, water bill 1/23/14-2/24/14 19.09 19 Pa American Water, water bill 2/25/14-3/6/14 12.08 20 Pa American Water, water bill 3/7/14-3/19/14 2.33 Total (Carry forward to main schedule) 18,909.63 Estate o£: Carol P. Sherick 21 14 0173 Schedule H Part 7 (Page 3) 21 Pa American Water, water bill 3/20/14-4/21/14 16.01 22 Pa American Water, water bill 4/22/14-5/19/14 15.00 23 Pa American Water, water bill 5/20/14-6/19/14 15.00 24 Pa American Water, water bill 6/20/14-7/21/14 15.00 25 Pa American Water, water bill 7/22/14-8/20/14 15.00 26 UGI, gas bill 1/30/14-3/3/14 126.85 27 UGI, gas bill 3/3/14-4/1/14 85.21 28 UGI, gas bill 4/1/14-5/1/14 49.34 29 UGI, gas bill 5/1/14-6/2/14 27.56 30 UGI, gas bill 6/2/14-7/1/14 22.41 31 UGI, gas bill 7/1/14-8/1/14 21.40 32 UGI, gas bill 8/1/14-8/21/14 11.61 33 Brandywine Homeowner's Association, May 2014 fees 75.00 34 Brandywine Homeowner's Association, June 2014 fees 75.00 35 Brandywine Homeowner's Association, July 2014 fees 75.00 36 Brandywine Homeowner's Association, August 2014 fees 75.00 37 Hampden Township, trash and sewer paid 5/14/14 200.56 38 Hampden Township, trash and sewer paid 7/6/14 155.05 39 Morrison Funeral Home, payment for Death Certificate for decedent's daughter 9.00 40 AC Rimmer, purchase filter 55.00 41 AC Simmer, water heater repairs 716.00 Total (Carry forward to main schedule) 1,856.00 REV-1512 Ext(1 SCHEDULE pen nsylvania CEPAR7MEN70F REVENLIE DEBTS OF DECEDENT, NHERITANCE TM RETURN MORTGAGE LIABILITIES& LIENS ftESIDEM OECEeENT ESTATE OF FILE NUMBER Carol P. Sherick 21 14 0173 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t Chase Mortgage, mortgage payoff paid at closing as listed on Settlement Sheet for sale of real estate. 116,333.79 2 Chase Mortgage, mortgage payment 2/1/14 983.00 3 Chase Mortgage, mortgage payment 3/1/14 983.00 4 Chase Mortgage, mortgage payment 4/1/14 983.00 5 Chase Mortgage, mortgage payment 5/1/14 983.00 6 Chase Mortgage, mortgage payment 6/1/14 983.00 7 Chase Mortgage, mortgage payment 7/1/14 983.00 8 Chase Mortgage, mortgage payment 8/1/14 983.00 9 Holy Spirit Hospital, medical bill 201.27 10 Azizkhan Internal Medicine Associates, medical bill 20.54 11 Pulmonary 6 Critical Care Medical Associates, medical bill 28,46 12 Camp Hill Emergency Physicians, medical bill 29.79 13 Charles R. Inners, MD. , medical bill 7.77 14 Cummings Associates, PC, medical bill 38.30 15 Quantum Imaging & Therapeutic Associates, medical bill 4.64 16 Azizkhan Internal Medicine Associates, medical bill 68.70 17 Capital Cardiovascular Associates, medical bill 3.00 18 Nittany Valley Medical Associates, PC, medical bill 3.91 19 Mechanicsburg Area Meals on Wheels, payment for November' 2013 meals 91.00 TOTAL(Also enter on Line 10,Recapitulation) $ 123,712:17 2W46AM 2.000 If more space is needed,insert additional sheets of the some size. REV-1S13 EX-( SCHEDULE J penns nsylvania DEPART WOFREVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Carol P. Sherick 21 14 0173 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON($)RECEIVING PROPERTY Do Not List Trustees) OF ESTATE I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. Scott W. Sherick 121 Willow Lake Drive Carlisle, PA 17015 General Bequests: 111,226.10 33.333334% of Residue: 41,345.28 Son 152,571.38 2 Steven J. Sherick 4$05 Shasta Way Mechanicsburg, PA 17050 General Bequests: 111,226.10 33.333334% of Residue: 41,345.28 Son 152,571.38 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1e OF REV-1500 COVER SHEET,AS APPROPRIATE. (( NON-TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 5. B_CRARTTABLEAND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, E 0.00 SW46AI 2.000 If more space is needed, use additional sheets of paper of the same size, Estate of: Carol P. Sherick 21 14 0173 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 Jesse W. McKlveen 12700 North 74th Lane Peoria, AZ 85381 16.6666669 of Residue: 20,672.64 Grandson 20,672.64 4 Christopher S. McKlveen 13712 North 79th Lane Peoria, AZ 85381 16.6666669 of Residue: 20,672.64 Grandson 20,672.64 ,, ii j LAST WILL AND TESTAMENT I, CAROL P. SHERICK, a citizen and resident of 'the City' of Oil' j 1! City, Venango County, Pennsylvania, being of sound and disposing ` I mind, memory, and understanding, do hereby make, publish, and j �1 declare this instrument as and for my Last Will and Testament, hereby making null and void any and all other wills or instruments 1� a 31 in writing in the nature thereof by me at any time heretofore made. FIRST: I hereby order and direct my Executor/Executrix, ahereinafter named, to pay all my just debts, expenses of last illness, funeral expenses, including the reasonable cost of a grave marker, costs costs of administration of my estate, and all inheritance taxes or taxes in the nature thereof assessed against my estate, as �psoon after my death as may be convenient and practical. SECOND: I hereby give, devise, and bequeath all of my estate, ° whether real or personal, and wheresoever situate, to my beloved \� husband, WILLIAM G. SHERICK, absolutely; if he shall not survive me, I then give, devise, and bequeath all of my estate, as aforesaid, to my beloved children, AMY G. OCHALEK, SCOTT W. SHERICK prp and STEVEN J. SHERICK, share and share alike, absolutely; if any of € Iry my said beloved children shall not survive me, leaving a child or children surviving, then the share of my estate to which said deceased child of mine would have been entitled shall vest in his 1 or her children, share and share alike, per stirpes, absolutely; if j any of my said beloved children shall not survive me, leaving no i child or children surviving, then the share of my estate to which Esaid deceased child of mine would have been entitled shall vest in s is i'? S i I'' I his or her brothers or sisters, or their children surviving them ] A '. share and share alike, per stirpes, absolutely. THIRD: I hereby authorize and empower my Executor/Executrix, ' 1 3 i hereinafter named, to sell any property of which I may die seized, whether real,real, personal or mixed, or to which I may be entitled at 1 the time of my death, either at public or private sale, for such � jprice or prices and on such terms and conditions as my y jExecutor/Executrix shall deem to be for the best interests of my estate, and to execute, acknowledge and deliver such deeds or other d e instruments in writing necessary or expedient in order to effect { such sale, without any liability on the part of the purchaser or purchasers thereof to see to the application of the purchase money. s; FOURTH: I hereby authorize and empower my Executor/Executrix ' 1hg to retain and hold any property, real or personal, of which I may i die seized, as my Executor/Executrix shall deem to be for the best interests of my estate, and to distribute the same in such manner as my Executor/Executrix shall deem to be for the best interests of my estate. FIFTH: I hereby nominate, constitute and appoint SCOTT W. SHERICK, Mechanicsburg, Pennsylvania, his successors or assigns, as i� ; and for the Testamentary Guardian of all real and personal property ?j passing to any persons under the age of twenty-one (21) years of q 1f, age in my Will, the proceeds of insurance or annuity contracts on Ig my life, . and all other property or property rights to which said 13 1 ;{ beneficiary may be entitled at the time of my death, giving and PAGE 2 i it )7i I i i i { �I ,'I granting to him as Testamentary Guardian the power to retain any l; property, real or personal, received by him in kind; and the power 1 IIj and authority to sell the same upon such terms and conditions as he 3 l believes advisable, giving good title to any real estate thus sold; tithe power and authority to invest in such stocks, bonds, and/or other investments in which he deems advisable, without being limited to those investments in which guardians are by law required to invest guardianship funds; and granting and giving to him in this capacity the power and authority to disburse to and for the J benefit of the beneficiary so much of the income and principal of \ the beneficiary's estate as he in his sole discretion deems t advisable for the beneficiary's comfort, maintenance, and complete education, including preparatory, college and post graduate or professional training, and to aid the beneficiary in the event of illness, injury or other emergency wherein money is needed. Notwithstanding the laws of Pennsylvania to the contrary, the Guardian shall hold, retain and distribute the assets so held by said Guardian in accordance with the provisions of this paragraph until said beneficiaries shall respectively attain the age of twenty-one years. SIXTH: I hereby nominate, constitute, and appoint my beloved husband, WILLIAM G. SHERICK, as and for the Executor of this, my = Last Will and Testament; if he shall not survive me, or shall be i j unable or decline to act, I then nominate, constitute, and appoint (I SCOTT W. SHERICK, as and for the Executor of this, my Last Will and PAGE 3 I t I Testament; if he shall not survive me, or shall be unable or 1! decline to act, I then nominate, constitute, and appoint STEVEN J. diSRERICK, as and for the Executor of this, my Last Will and jjTestament; said Executor/Executrix to act without bond. 1 1 IN WITNESS WHEREOF, I have hereunto set my hand and seal to j this, my Last Will and Testament contained in four (4) pages, each z day of i1page bearing my signature, this I Y if 1993. { � •2t' L ' Je. ...e%. (SEAL) d� CAROL P. SHERICK 4" �y r {� 1 a< I 9y S f= r i ?� d i si jl i) PAGE 4 s; I iy s i{ � ii I � i ii Signed, sealed, published and declared by the said CAROL P. li SHERICK, as and for her Last Will and Testament in the presence of { i1us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. �� , 1i� ✓�%Oyu.,—. Residing at 4/ .c` ' ( 2 ' G �. i`L'A66:t. - Residing at `L _._......_ ./.�.._.._... / Residing at I j E� 1 4 { i z itl i ?3 i ii `t3 1 :E � i i I; j AFFIDAVIT i 1, { Commonwealth of Pennsylvania I� ss. j tl County of Venango We, CAROL P. SHERICK, BRUCE T. ROSEN, I and L )/ j , the Testatrix and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, and that she signed willingly (or willingly directed another to sign for her) , and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness, and that to the best of their knowledge, the Testatrix was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. f Testatrix.? wi g ss Witness Witness � Subscribed, sworn to and acknowledged before me, by CAROL P. ISHERICK, the Testatrix, and subscribed and sworn to before me by the above witnesses, this "` day of ) c:! <,..y.-, , 1993. i! Notary Public i , NOTARIAL SEAL I�I ANRA L SPEECE,Notary Public i OII Ciry,Venango County,Penn. My Commission Expires Feb.27,1995 I k | w \ 55 (DOk �k k \ � j8Ek § »77 � § § \ ) § §)® § | § § / w ° 2�k� w e I § 2 %7� � COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG.PA 17128-0801 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018857 SHERICK SCOTT W 121 WILLOW LAKE DRIVE CARLISLE, PA 17015 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $18,300.00 ESTATE INFORMATION: SSN: FILE NUMBER: 2114-0173 DECEDENT NAME: SHERICK CAROL DATE OF PAYMENT: 03/06/2014 POSTMARK DATE: 03/06/2014 COUNTY: CUMBERLAND DATE OF DEATH: 12/09/2013 TOTAL AMOUNT PAID: $18,300.00 REMARKS: CHECK# 100 INITIALS: CJ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS TAXPAYER A.SOVement Statement U.S.Department of Housing OME Approval No.2502 MS and Urban Development B.Type of Loan f RI-IS 11 (Cam.Unins. 6.file Number: T.Loan Number. 8.Mortgage Insurance Case Number: 4.1 ]VA $,I I Conv,tns. 401402372-SK C. NOTE:This form is furnished to give you a statement of actual seatement costs.Amounts paid to and by the sa tiemem 090M are shown,hams marked-(p o-r were paid..hide of the closing:Nay wo shown here Nr informational purposes and are not Included in minute 0.Name mud Md..of Eomavmr E Name and Address,of Seller F,Rama and Addmu of Lender WILLIAM J.5MYERS AND CAROL J. SCOTTW.SHERICK,EXECUTOR OF $MYERS ESTATE OF CAROL P.SHERICK A/K/A CAROL SHERICK 6185 RIVENDALF COURT MECHANICSBURG,PA 17050 121 WILLOW LAKE DRIVE CARLISLE,PA 17015 G.Property Location H.Settlement Agent 1555 REVERE DRIVE, SECURED LAND TRANSFERS,LLC MECHANICSBURG,PA 17050 P1a1 of SYwa ment I.BaBlement Dete 08212014 PARCE COUNTY;CUMBERLAND 3915 268xXet street PARCEL i0,:FiAMP ENTO Hill, PA 20011 Okhursement Dale gwzlrz9t4 TOWNSHIP:HAMPOEN TOWNSHIP Camp J.SUMMARY OF DORROWER'S TRANSACTIONS K.SUMMARY OF SELLER'S TRANSACTIONS 100.Gross Amount Due From Sommer 400.Gross Amount Due To Sets, 101,Contract Saks Price $245,0)000 401.Contract Seles Price 5245,00100 102.Personal Property 402.Personal PmpeM 103,Settlement Charges to Bonower 0040. Adjustments For ttsms Paid By Seller In Advance Adjustments For Items Paid By Wier In Advance 113.Chril'con Taxes 413.Cdyrrown+'axes 114.County Taxes 628.24yr 8212014 to 1112015 $228.19 414.County Taxes 626.24yr 8!212014 N 1112015 $228.19 115.School Taxes 2,133.56yr 81212014 to 7/12015 $1,83545415.School Taxes 2,IM.561yr 8/21/2014 to 7112015 $1,83545 118.Assessments 416.Assessmenta 119. 419. I22 Assoc Dues 75blUma to 81212014 to 9112014 $26,6114M.Assoc Ones 7500%mo for 82112014 b 962014 $26.51 123.Sewer and RRNse 155.0&gtr for 62112014 to $69.10 423.Sewer and Refuse 156,0510tr for 8212014 to 68910 IN12o14 10/12914 120.Groaa Amount Due From Borrower $251,779.35 420.Groaa Amount Due To Saner S247,159.35 200,Amounts Paid By Or in BebaB Of Borrower 600.Reductions in Amount Due TO Still 201.Deposit or eamost money $2,500,00 501.Excess Deposits 202 Principal 502.Settlement Charges to Seller $18,198.56 203.Existing U mn(s)Taken Subject io W3 ExlNirg Loans)Taken Subject N 204. 504,Payoff Fbat Mortgage N Chase $116,33379 Adjustma ifs For Rime Unpaid By Seiler Adjustments For Items Unpaid By Sailer 210, 510. 211, 511. 212, 512. 213.CSyIlowO Taxes 513.CiyRaxn Taxes 214.County Taxes 514.County Taxes 21 B.Assessments 518.Assessments 219.HOA -151a, 220.Duyers Total Credib S2,500.001520.SPIISYs Total Charges $134,532.35 300.Cash At Settloment FromRo Borrower 1600.Cash At Settlement To/From Sailer 301,Grose AmouM Over From Borrower pine 120) $251,7T9,30 601.Gees Amount Due To Sailor(life 420) i 5247,159,35 302.Lass Amounk Paid By*vr Bonovow pore 220) 52,`.m9.00 602.Loss Dedupiom:to Amt.Ow To SMkr ptere 520} ! $t3+.83235 003,Cash[X]From[ ]To Borrower $249,279,361603.Cash[X j To[ ]From Seller I $112,627.00 /01402372-SK Page 2 L.Sanhmonl Shhmenl 700.TMI Sole Commission 216000.00®8.6%.1306.00 OMehn of Commission(Iles 700)As Follows: Paid From Boneweh Paid From Sellers 701.$6125.00 to RSR Rashes Funds At Settlement Furls Al Sentiment 702.$7350.00 to ERA-NRT,LLC 703.Commission paid at settlement 613.05.00 800.Items Payable In Connection With Loan 801.Loon Origination Fee 802.Loan D scmrm 803.Appraisal Fee 801,Cre08 Report 805.Lender Inspection Fee 800.Rama Re9ulrad By Lender To Be Paid In Advance Tot.Interest 902.Morgage Insurance PRmium 1 803.Hazard Ins.Pmmium 1000.Rsssrns Deposited With Lander 1001.Hazard Ins.Resew 1002.Mortgage Ina.Reserve 1003.City Properly Taxes 1004.County Property Taxes 1010.Aggregate Accounting Adtustnnrw 1100.This Changes 1101.SattbmerVClesing Fee to SM,ed Land Transfers.LLC S/p0.00 1102.Abstract M Tdb Search t 103.THIS examina0on 1104.THIS Insurance Binder 1105.Dowmenl preparation 1106.Seder Nolary Fee to Seared Lend Transfers.LLC 610.00 $10.00 1107.Attorney Fee 1108.Title Ins.Total to Sassed Lend Transfers,LLC 61,625.00 1109.Lenders Coverage 6(S) 1110.Owners Coverage$245000.00(61625.00) 1118.Woo Transfer Fed Woo Payoff to Secured Land Transfers.LLC $45.00 1200.Gowmment Recording And Transfer Charges 1201.Recording Fees for Deed 77.00;Resorting F.for Morlpega 677.00 1202.CltyCOUmy TesfSlamps 2150.00 52,15000 1203.State Deed Tax 2450.OD $2.450.00 1300.Addiffonal Settlement Charges 1305.20112015 School Taxes to Michael Langan,Tax Collator 52.133.56 1307.August HOA Due end Lsfe Fee to Brandywine He...Asaoeatbn,Inc 585.00 1308,Regale Credit to Scot W.Shedrk $358.00 1400.Tobl SeRlvment Charge, S4.620.001 $18,186.56 I have carefully mAwed the HUPI Sallkment Statement and to the best of my knowledge and bellef h Is tme and accurate statement of all receipis and disbunemenls made on my axeunt or by me In this transaction.I herder a.Mity that I hew receWed a mpy of the HUP1 Sealemem Stakment. BUYERS/ ///� SELLERS �9.iA� '/ 4�.-s✓ Est le ooff/a[U P.ShedcR eM1/a Cam!Stara / /+ trellis.J.SInters I ' y.✓' 1 // '7 /.1� A,14 i17 3't-`.' Jcibl- `� By: cetl W.Strand,EI[BadM .l Carol HUD-I Stn J. The, vnc S lh t t, tenement wfech'I Rave Prepared Is o bus and acaaate a000urrt of mis transaction.I Raw ausnd a wall puso and turps to lb Cis0undd In pa:ardanca with mb alotdmenl. $.plants A a t4.///( �r^, Doh :w '""I0 0821.2011 U R;3 cr.T Tax Parcel No.: 10-15-1282-077 Lot 84,Phase 1,PB 90,PG 42 2006 JUL 18 AM 10 07 DEED MADE the, day of July,2006. BETWEEN FISHING CREEK VALLEY ASSOCIATES, L.P., a Pennsylvania limited partnership ("Grantor"), AND WILLIAM G. SHERICK and CAROL P. SHERICK, husband and wife, (collectively, "Grantee"), WITNESSETH That the Grantor, in consideration of TWO HUNDRED FIFTY-FIVE THOUSAND ONE HUNDRED FORTY AND no/100 ($255,140.00) DOLLARS, paid by the Grantee to the Grantor, the receipt whereof is hereby acknowledged, does hereby grant and convey to the Grantee: ". ALL THAT CERTAIN Unit, being Unit No. 84 (the "Unit"), of Brandywine, A Planned Community(the "Community"),such Community being located in Hampden Township, Cumberland County, Pennsylvania, which Unit is designated in the Declaration of Covenants and Restrictions for Brandywine, A Planned Community (the "Declaration") and Declaration Plats and Plans recorded as an exhibit thereto in the Office of the Cumberland County Recorder of Deeds in Nliscellaneous Book 716,Page 1231,together with any and all amendments thereto. TOGETHER with the undivided Allocated Interest appurtenant to the Unit as more particularly set forth in the aforesaid Declaration,as last amended. TOGETHER with the right to use any Limited Common Elements appurtenant to the Unit being conveyed herein, pursuant to the Declaration and Declaration Plats and Plans,as last amended. UNDER AND SUBJECT to a certain Declaration of Easements dated March 28, 2005, and recorded in Cumberland County Miscellaneous Book 716,Page 1226;to the Declaration;to any and all covenants, conditions, restrictions, rights-of-way, casements and agreements of record in the aforesaid Office; and to matters which a physical inspection or survey of the Unit and Common Elements would disclose. Sl-"� -44' (000 fee o I I C1 1Z - 1 004 275 PACE3494 BEING part of the same premises which Gladys M. Watts,by her deed dated September 30, 2003 and recorded in the Office of the Cumberland County Recorder of Deeds in Record Book 259, Page 3673, granted and conveyed unto Fishing Creek Valley Associates, L.P., a Pennsylvania limited partnership, Grantor herein. THE GRANTEE, for and on behalf of the Grantee and the Grantee's beirs, personal representatives, successors and assigns, by the acceptance of this deed, covenants and agrees to pay such charges for maintenance,repair, replacement and other expenses in connection with the Common Elements, as may be assessed against him, her,them, it, or against the said Unit, from time to time by the Executive Board of Brandywine Homeowners Association, Inc. in accordance with the Pennsylvania Uniform Planned Community Act, 69 Pa. C.S. 5101 et seq. (the"Act"),and further covenants and agrees that the Unit conveyed by this deed shall be subject to a lien for all amounts so assessed, except insofar as Section 5407(c) of the Act may relieve a subsequent unit owner of liability for prior unpaid assessments. This covenant shall rum with and bind the Unit hereby conveyed and all subsequent owners thereof. ` AND the Grantor shall and will SPECIALLY WARRANT the property hereby conveyed. — IN WITNESS WHEREOF,the Grantor has caused this Deed to be executed as of the day and year first written above. FISHING CREEK VALLEY ASSOCIATES, L.P., a Pennsylvania limited partnership By: REY, INC.,a Pennsylvania corporation, its Managing General Partner By: &r� 4k Paul C.Heplef Vice President - �cannX. M� isr '}• �� Ti*1 I�St N A V �� f J7 q y CC S l 6 * 1 D III 1A .6 y Gn Mg L. N O • i �" T •fV V ✓•d p C.II •C C N N N S _ .. y ci 2 0 00 275 PACE3495 N O V1 I..n •� N W i L•1 000 OOp pOO Gi•^JOO 0„ COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN On this, the IA day of July, 2006, before me, a Notary Public, the undersigned officer, personally appeared Paul C. Hepler, who acknowledged himself to be the Vice President of REY, INC., a Pennsylvania corporation (the "Corporation"), said Corporation being the Managing General Partner of FISHING CREEK VALLEY ASSOCIATES, L.P., a Pennsylvania limited partnership (the "Partnership"), and that he as such officer, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the name of the Corporation by himself as such officer in the Corporation's capacity as Managing General Partner of,and as authorized by,the Partnership. IN WITNESS WHEREOF,I have hereunto set my hand and official seal. Notary Public COMMONWEALTH OFPENNS LVANIA rNatyw sew Merlon T.FWv,Notary Pthk Hen�rfen TwF.OnbNarM Carnal MyCMvdl bnE0aOaL19.2009 Member,PemwM trenh Awodatlon of No4nes CERTIFICATE OF RESIDENCE I hereby certify that the precise residence and com�plletteee post office/address of the within Grantee is: 155-5- AttereeyorAgent for end' 275 FACE-34% I C '!I:", t`,is be recorded In Cun;ber}and County PA -0-3 - Recorder of Deeds -IT' CI) w+ Q Q Q Q Q Q Q Q Q Q Q IN N Z < � � � � < < � < < < O K�. m 10 N N N N N N N N N_ N N N N N O O N N O O O 0 0 0 0 0 0 O O C C y V LL c N w N O T O V EL a N M V V 00 y 0 iy d « O j'-N C C m N N N 0 c 2 d 00 d p 0 0 0 0 0 0 O O O O O r y 0 0 0 0 ( 0 o e o 0 0 0 o O M_, O 0 c (0 (D 7 O m O OaO OD O aay ay Y (U to In In LIJ t() In In In 0 0 In In O C 2 N L6 aOcZ °t o o (n _ • a N ° r 0 O U w (p O O c C N J 0 v vv a my �Y.a ° imam 0 V' V V 0 V 0 V' N N N N N_ m E .. (D CO (O0 (O0O0MMMr NnEKa N C) 0000000 L6 L6 LO CO W �o co Ow M M M M M M M M . 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Sh'erTbk " _ ,•"�°`°°",• , 1 DE - .4483,: 4 j .SERFS EE y C 51912 701 'E � I � . AT'}wC'1MTUWI'W.NEpE6F WILL MY '.. r WNIe85tf E FIRST DAY CIF "IS THE William Gordon Sherick 19542.8581 Dec. ,x.993_ 345 A 1"heny 11V8K' Oil City* PA 16301 Mrr. Carol P. Sheris wN MNMm( -bIINMP pX x C51 916 6 3 I EE 3 SERIES EE h5 � um I � ' AT-Tlt'MMUWIT'NEpEOFwIW MY MUMMON tssuE onYE - 'WNttX tE THE flR6i ant OF III �=%w TU - , Carol P. Sherl,ck 203-24 0753 NOVa48rM.a - 306 Allegheny Ave. J fintY&sr Oil City} PA 16301 O;R: >V:illiat O. dherick Nay 2.1 1983: it t.wunirm�imnn..n..e' w.x..+wwlxnm -__-.• C51 912 6 2 3. E E SERIES EE SEP-02-2014 TUE 10;06 PM lemoyne retail FAX N0. 7177244239 P. 03 1 YYM _ DD DD AT.TNLNANRITY NGXLOFWILI.PAT ISSUE IRATE WHICH IS THE FIRST OAT OF William Gordon Sherick 195-22-8581 Nov. 1983 ? 306 Allegheriy: Abe': ^" Oil..City, PA 16301 �99! 6BL' fi'.s1'f;+fai;a ' IeeW.�r*amrie or Mrs. Carol P. Sherick e YT " �1 .�pv'tINO Cy 9 13'B3 I 1-151896 577 EE 9 i sI.IIIEs EE f, L 1 I �I _ L _ I �- rj I D'FOR /���p�'AT T�NC NAINNITV HRRyE:Oy�G WILLMY L/' 1 /.ygpS7p �`� ISSUE DATE wuluI 1.THE Flai ner or ;pk r 1X7 -15a-3 1 'eih" 1 0 T��' Carol P. gheriak 203-24-0753 --="•:x-^I-- 306 Allegheny Ave. NpBTHWEST Oil City, PA 16301 SANK William G. Sherick ei1WN.iN! ncT, 24 19,83 SERIES EE �'y C51 89 5 407 E E 0 D Y� AT TML NAT+IM?Y HEREOF WILL PAY I ISSUE DATE WHICH IS TMF Flgsi OAY OF , Tn wialiam C.ordua Shericic. 195 2.3�8581 Octobor lg$3 .,.III I ({LONTn, 1-vuwl-- �6� A1,x A �$�et�y MI'11u'e. oil Ci.ty,:::Fa. lfa3©i Or L-Ir.s4 Carol 't. Slaeri Gk 31 Y7"'• BKNK �Ia?e � NIIITe.cne � lOMPMP. C517945'1 EE �A..- wnniilOnnwuev f,�wWl nM1 ..cotta I �SEP-02-2014 TUE 10:06 PM iemoyne retail FAX N0, 7177244239 P. 04 I 117 I ihTTNHM:rTNMIry HENH9r W14l MYMY _:lrM WHICH IS THE ilNa OAY 4i SEPT 1993 Carol P'. S.heriek' ;K�03-24-O'n^53 306 Allegheny Ave. xppRTMW Oil City, PA 16301 6ANK OR, _ tll�CffV;°or illia'm Q. Sheriek M: Ma.T.M SEP 26 1993,x' II •- '� TM.ro�,pu.4NM, ro Mn4biMMMMi. C 517 914 6 2 EE, SERIES EE a Y _ I � � M .-h. ' I Af iNEMMWIITY.NE?3W'W�41:cL iAT - I! ISSUE 7CIAT�r AUG 306 111 6- hen}i ti'vs r x R7lfW6ST d Qpl Qa ,:yr P/1 Tr23QT JolC't�f1;"TiG" + 1 AUG .29 1953,; u.nxn� i»ulww, C 517 8 0 0 J�9 EE »w» "T"w.MO... i SF tms EE :5 A� W . Fj - IMMIX� �': «rmM.*y+,n�par�.rJ/�rt�H�+�c(�u�eywaurw+ 1SSU 0 TE { 1'f �.� . . WYIIGi Is THE FIxST 0.1 PF TO w i 17,iem '�c�s^tyd�orr ��IrS.ck 1,h5»�M�;� 8�$1 . 4etob�rzl9$3 1 M I6 i 't.• 1..4, ' x. 134 567, 896 EE NIATNIIN`1A "p t��Y,iRryl�nWi SEWES EE : SEP-02-2014 TUE 10:06 PM lemoyne retail FAX N0, 7177244239 P. 05 .. _ 115 - - .xE�YH11YHEr1E� WI�A�.V ISSl1E DATE f . : WI4pH I; K,6'IPSVbAT OF A William Gordon ,r 4c). .y 195 `'0,1,531 Sapl 1J33 Oil City, PA 16301 "),j!-'Th or Mrs. Carol P. 'Sherick 1 SUES FmF.�_�., L 133 639 9 31 E E M=v v I F = _ AT IH6 RMF{IPIYr rGRrgI Wlµ.Y ISSt1E DATE WHILYr IS THG[IPSr o L. 09 Gordon Sherick 195 22ZFf l A� U k X99 ;F 306 Allbgt nk4 Aue':', '. Oil City, PA 16301 SQUTH SIDE;DFFICF FIRST.,A°g1{p3S . . . .. . I C' aerick Mrs. arol 1'. SI AU G 29.198'3 ou CITV.Pa. j I,,T r �e�lmw� L. 133 639 930 EE s Its EE I SEP-02-2014 TUE 10;06 PM lemoyne retail FAX N0. 7177244239 P. 06 F c 1 ONYtAI S Yt - d ( 1 _ Al THE 4eTYRITY NCR[op WILL I.V ISSUE DATE , WVICN IS iN1,YIIIiT OlY 0!Carol P . Sherick 203-24-0753 = 306 Allegheny Ave, 9bFTHYIEST Oil City, PA 16301 AANKa Q.QR j OR OIL CITY, PA. William 0. Sherick 1"QO i JAN 30 1984 C52079 054EE SERIES EE i°I' �"�S.is�y t,�N..l.��.rp,e•.- -----N.,..»W,.r�vin,..,.,a.IS�,M....�.,....,..." __.. _--'� - °c I AT THE VLiupIT NEflEQi Ny,�LL PAY WHICH 11SS yE ATE •. XE{'IP'vi OAY OF- William Gordon Sherick 195-22-8581 Januarys 1984 _ 306 Allegheny Avenue Oil City, Pa. 16301 or Mrs, carol P. Sherick {ILrvy.inNP .�..,�;.�q _ nrge.el..�WW.. C 6 0 6 6 9 4 7 SERIES EE ��N ,. . � `Y y . 4 EE Citizens Bank Online® Page 1 of 1 n Ili fn^ H. Home Manage Accounts Transfer Money Pay Bills & People Service Center Manage I Account History Online Statements Image Search Account History Account: Circle Checking with Interest-noo=0598 Bal. $25,633.59 Shortcuts... Current Account Features Manaae Features eStatements ■ Standard Overdraft Practices Preferences) •View eStatemenl: • View eNotices • Go Paperless Circle Checking with Interest - xxxxxx0598 (Account Type: Checking) - Account Summa Available Balance $25633.5 . Customize the Transaction History view by using thi Last Statement Balance: $32,241.04 below. Last Deposit Amount: $1,522.00 Last Statement Date: 11/27/2013 From To Or Last Deposit 12/03/201 09/12/2013 '12/10/2013 iP Select.. st Activity Date: 12/09/2013 Drype All Transactions VIEW Transaction History QI Date_ Description_ .> _ Ref. #_ _ Debit(-)_ ��_ Credit(+)_ Balance 12/09/2013 Check 3276 $35.47 $25,633.51 12/09/2013 Check 3269 $300.00 $25,669.0( 12/06/2013 Check 3277 $127.55 $25,969.0( 12/04/2013 Check 3271 $2,000.00 $26,096.6' 12/03/2013 Check 3270 $1,000.00 $28,096.6' 12/03/2013 Direct Deposit $1,522.00 $29,096.6, I Memo: SSA TREAS 310 XXSOC SEC 12/02/2013 Preaulhorized Debit $17.00 $27,574.6 �....,.. ,_....._...� _ sv httns://www4.citizensbankonline.com/efs/servlct/efs/default.isn 12/10/13 A,Se0lenronl Shtemonl US.Department of Housing OMB Approval No.2502-MS and UNan Development B.Type of Loan I.1 1 FHA 2.1 )FINS 3.1 j Conv.Unha. B,file Num0or. 7.Loan Number. 18.Mortgage Insurance Case Nunmec 4.1 I VA 5.( 1 C..Ins. 401402372-SK C. NOTE:This form Is fumished to 91va you a statement of equal setiement casts,Amounts paM to and by the s ldnerent agent am shown.Xoms marked'(p.o.c.)'wcm paid outside of the dosing:they am shmvn here for Informational purposes and ere not MdWed in ma Intel . D.Nam and Address or Borrower E Namo end Address of Seller I F.No.and Address of Lands, VWLUAM J.SMYERS AND CAROL J. SCOTT W.SHERICK,EXECUTOR OF SMYERS ESTATE OF CAROL P.SHERICK AIWA CAROL SHERICK 6185 RIVENDALE COURT MECHANICSBURG.PA 17050 121 WILLOW LAKE DRIVE CARLISLE,PA 17015 G.Property Location H.Sattlem at Agent 1555 REVERE DRIVE, SECURED LAND TRANSFERS,LLC MECHANICSBURG.PA 17050 Sus I.Settlement Data 08/2111014 COUNTY:CUMBERLAND Sus F.3rKet Street PARCEL ID:10-1&1282 477 Hi 11e 1?A I,OGll Disbursement Date 0821/2014 TOWNSHIP:HAMPDEN TOWNSHIP �P J.SUMMARY OF BORROWER'S TRANSACTIONS K.SUMMARY OF SELLER'S TRANSACTIONS 100.Gross Amount Duo From Borrower 400.Gross Amount Due To Seller 101.Dented Saks Price $245,000.00 401.Comisa Sales Price $245,000.00 102.Personal Properly 402.Personal Properly 103.Battlement Charges to Bon ehm 51.620.00 403. Adjuslmonb For Moms Palo By Sallor In Advance AOjustnlanb For Items Palo By Seller In Advance 113.Ciy/fown Texts - 413.Ciyrtown Tues 114.County Tares 628.24yr 8412014 to 1/12015 5228.19 414.County Taxes 626.24fyr&212014 to 1112015 $228.19 115.School Taxes 2,133.56/yr&112014 to 7112015 $1,835A5 415.School Taxes 2.13156yr 82/2014 to 7/12015 $1.835.45 s 118.Assessments 416.As" 18. s1B. 122.As&=Dues 75.DOBno for 8412014 to 902014 $26.61 422.Aswc Dues 75.00lmo Ire 8212014 to&12014 $26.61 123.Sewer end Refuse 155.05/00 for 8212014 to 86910 42 .Swer a W Refue 155.050ir fo 8212014 to 1&12014 1&12014 888.10 120.Gross Amount Due From Ban., $251,779.35 420.Grose Amount Due To Seiler $247,159.35 200.Amounts Paid By Or In Behalf Of Borrower 600.Reductions In Amount Due To Seller ' 201.Deposit or earnest money $2.500.00 501.Excess DeposBs 202.PdogDel 602 Settiamsrd Charges m Salle, $18,18846 203.Existing Loan(a)Taken Star l0 503.Existhg Loans)Taken SW)eq to 204. 504.Payoff First Mortgage to Chase $116,333.79 Adjustments For Items Unpaid By finite, Adjustments For Items Unpaid By Seller 210. SID. 211. 511. 212. 512. 213.Ciyrtovm Taxes 513.CiyROwn Taxes 214.County Taxes 1514.Count'Taxes 218.ASStssmmts SIB.Asaeasmmts 219.HOA I ISIS. 220.Buyers Total Crudites 52.500.00$20.Sellers Total Charges $134,532.35 300.Cash At Strummer FreMTo Borrower 600.Cash At Ssl0anant TalFrom Seller 301.Gross Amount Due From Borrower(fine 120) $251,779.35 601.Gross Amount Due To Seller(line 420) $20.159.35 302.Leas Amounts Paid Byror Banower(Arse 220) $2,500.00 1602.Less Deduglons In Amt.Dun To Seller Oft 520) $134.532.35 303.Cash 1 X)From 1 I To Barrowor I 5240,278151603.Cash I X)To( j From Seller I $112,827.00 401402372-SK Page L.SeOtamanl Statement 7S0,Total Sale Commbalon 246000.00 @ 6.6%e 13476.00 OMSion of Commlaslon Vim 700)As Folaws' Paid From Barman's Palo Fran Saaeh 701.6612500 to RSR Remoa Funds At Settlement Fads At Settlement 702.$7350.00 to ERA-KRT,LLC 703.Commiaslan paid at settlement 3/3A75.DO 800.Irma Payable In Connection With Loan 801.Loan Orl9luman Fee 802.Lem Dim m 803.Appretsal Foe 804,Cmdt Report 805,Lender Ins xaalon Fea 900.hams Required By Lander To BE Pad in Advance 901.Imerest 802.Mon9alle InsunnFd Pmnm4n 9_0_3.Haul Ins.Pmmlum 1000.Resems Oopotha d WIN Londe, toot.Haunt ms.Ream 1002.Mortgage Ina,Resem 1003,City Preachy Taxes 1004.County PmpORy,Taxes 1010.A99MM Amounting Adpnimani 1100.TRIG Charges 1101.SentememlCloeaq Fee to Seamed Lend Tranaias.LLC S100.D0 11ox.Anaaa a ciao Saafcn 1101Tkleemnampthfn 1104.Two Inwaanp Blida 1 105.Doxemeal preparation 1109.Seler Notary Fee to Seoned LEM Tr maten,LLC $10.00 $10.00 t10T.AOOmey Fee 1106,Two tax.read to Seamed UM Tmnxles.uC 31.925.00 1109,Landee.Earnings 3($) 1110.Oa Ws Cowtage$245000.00($1625.00) 1119.Wan TraMtof Fee Wm Pay01110 Seared LIM Tnnsfen,LLC 345.OD 1200.Coninann t RaeOhIES And Transfer Charges 1201.RadEn in9 Fens for Dead 77.00;Accenting Fine for MMga90 37700 1202,CMiCOUMY Tax/Sumps 246000 $2.450.00 1203.State Doetl Tax NSO.OD 1- $245000 4300.Addffl l Somewhere Chary" 1305.201412015 SCtda Taxes to yekin i Langan,Tax CodmW, 32.133.68 1307.August HOA Ow am Late Fee to B.ad w n,Hommnnen Auooatbn,Im. 385.00 1308.Repetf Crest to Stott W.Sh thok $358,Op _1400.TObiS"lomant Charges $482000 31819856 i hard canifft feWaned the HUD�i Someemra StZMmem aM to the mat of my knaNCC9e aM bellef it E,had aM mountd statement Adam moetpt6 am dts mwhols made an my amount of by me to Nis inneealon.i$areal oeltIfy NM 1 have toomm a may of IM HUDA Scul"MM Statement. BUYERS fn/ ,f/ SELLERS `_ � l�na_/ F;• �^"}- Eataffi of CatM P.Stdd[k aA/a Carol Shama W1oam n S// f if nn "Y d - ,.nxrtst.r' - 9Y: am W 9Mrx3,.F�teat� pf'� Carl A Smyen 61 The HUSettkm t btemenl whlal'I haw pnperM is a hue am aaanata acaum of Nk tnnsaabn.I maw au6M awYl cause Vd fads to be tlisbunM In a0001f1anW WIN Nix statement. S.Wovrte A e t� I n Oahe 1 -i. 0621/1014 OD 4 . . / / |k [ # ! | � ` � 0. ! ; } f ' : }• i ! Z.8 ! % . ! { | Ln\ ` § � , ) ! rm \ rn � ! § \� } j \ G■. � ! < ` ) / ) ? ° § ) \ . o§ / , SEP-02-2014 TUE 02:43 AM lerroyne retail FAX N0. 7177244239 P. 02 _ RBC Wealth Management Renaissance Place,2nd Floor 635 North 12th Street Lemoyne,PA 17043.1225 • Phone: 717-724.4200 Toll Free:800-480-7497 Fax: 717.724.4239 September 2, 2014 Stacey L. Nace, Paralegal HALBRUNER, HATCH &GUISE, LLP 2109 Market Street Camp Hill, PA 17011 Dear Stacey: Per our conversation, this letter confirms that the attached statements printed on December 10th, 2013 show the date of death account values as of December 91h, 2013 for Carol P Sherick. As always, please let me know if you need any additional information. Sincerely Q� Patricia L. Sherick Registered Client Service Associate Enclosures RSC Wealth Management,a division of RBC Capital Markets.LLC,Member NYSE/EINRAISIPC. RBC Wealth Management' �d• I 12/10/13 3:14:04 PM Account Workbook 9 Pa e 1 Belaneea 31131134 10 Growth Pending Be[ 71,415.20 Total AoCt Value 71,415 CAU CSI 03 07 2 Portfolio Val 71,415 CAROL P SHERICK Sweep TPMXX MMF Balance 19,425.00 Funds Available 19,425.00 INDIVIDUAL RETIREMENT ACCOUNT Home 717/761-2142 Fed Call RBC CAPITAL MARKETS LLC CUST 1555 REVERE DRIVE Cell 717/7124643 MECHANICSBURG PA 17050.2246 Cash Value Market Value Value Type 1 51,990.20 19,424.97 Fed-Call Type 2 Maint-Call Short Option Requirement Trades Today Buying Power Pend Prin SMA Other Equity% MMF Pend Int 0.03 Net Equity 19,424.97 C/A-Type 2 19,425.00 oral Acct Value 71,415.20 MTD Margin Interest Pending VISA Chgs Div/Interest Commissions—12 month Credit Interest Annuities Alternative Investments Required Minimum Dist 3,678.48 This valuation reflects securities owned by you on our r,=us resulting from transactions processed through RBC Wealth Management,a division of RBC CaPital Merkets,LLC,Member NYSENINRNSIPC,or supplemental irdomalien supplied by you.The prices indicated are oblalned from sources we consider reliable but are not guaranteed. RBC Wealth Managements' e 12/10/13 3:14:13 PM Account Workbook Page 1 Positions 311-61134 10 Growth Pending Bel 71 415.20 Total Accl Value 71,415 CAU CSI 03 07 2 Ponfollo Val 71,415 CAROL P SHERICK Sweep TPMXX MMF Balance 19,425.00 Funds Avallable 19,425.00 INDIVIDUAL RETIREMENT ACCOUNT Home 717/761-2142 Fed Cell RBC CAPITAL MARKETS LLC CUST 1555 REVERE DRIVE Cell 717/7124843 MECHANICSBURG PA 17050-2246 --T- '_ Settlerlient Indicator 119Y424 97 PRIME iMONEY MARKET FUND TPMXX Previous Mkgt Z�u97 Mkt Pri0C0e. Type This valuation ronoots securities owned by you on our records resulting from transactions processed through ROC Wealth Management,a division of RBC Capital Markets,I.I.C.Member NYSEIRNROVSIPC,or supplemental Information supplied by you The Prices indicated ere obtained from sources we consider reliable but are not guaranteed. 1 . RBC Wealth Management' 1 12/10/133:14:22 PM Account Workbook e Pa e 1 Positions 311-61136 10 Growth Pending Bal 1,118.38 Tot�ACCl Values 1116 CAU CSI 03 07 2 Portfolio\7al 151 037 J CAROL P SHERICK Sweep TPMXX MMF Balance 1,118.3b�un s vatlable 1,118.36 1555 REVERE DRIVE Home 7171761-2142 Fed Call MECHANICSBURG PA 17050-2246 See Notes Cell 7171712-4843 _.tom__-.. ._ _____T___._._,__ _.T�. .__� f Settlement Indicator iQty_ }Description _ Symbol�Previous Mkt Value mkt Price Type 1 �1.� _ 1118.361PRIME MONEY MARKET FUND ITPMXX1 1,118.36 1 00': 1 . _._ This valuation reflects securities owned by you on our records resulting from transactions processed through RBC Wealth Management,a division of RBC Capital Markets,LLC,Member NYSE/FINRA/SIPC,or supplemental information supplied by you.The prices indicated are obtained from sources we consider reliable but are not guaranteed i * RBC Wealth Management' s 12/10/13 3:14:29 PM Annuity: 311-61136 Page 1 OHIO NAT'L LIFE INS.CO. Fund Name Fund Code Fund Units Value Percent OHIO NATL LIFE INS CO MFS Mid Cap Growth 132 C4 351.629000 4,542.86 3.03% ONCORE VALUE FLEXIBLE PREMIUM Bryton Growth Port 253 C4 270.724100 4,586.13 3.06% ANNUITY Bristol Portfolio 255 C4 249.267300 4,675.22 3.12% Money Market Portf 300 C4 465.062800 5,767.67 3.85% Policy Number: E1588674 Morgan Stanley UIF 317 C4 265.475900 7,260.29 4.84% CUSIP: 677413-30-4 Equity Portfolio( 960 C4 926.499800 10,838.20 7.23% Issue Date: 07/19/2006 International Port 331 C4 1,304.860100 16,194.03 10.80% Maturity Date: / / Fidelity VIP Equit 990 C4 937.329200 16,595.69 11.07% Valuation Date: 12106/2013 Neuberger Berman M 363 C4 1,178.274200 16,637.98 11.10% Initial Premium: $200,000.00 Goldman Sachs Larg 327 C4 1,135.309000 16,789.85 11.20% Total Premium: $200,000.00 Janus Aspen Series 173 C4 1,469.617000 21,411.17 14.28% Contract Value: $149,918.35 PIMCO Total Return 338 C4 1,411.676000 24,619.26 16.42% This valuation reflects securities owned by you on our records resulting from transactions processed through RBC wealth Management,a division of RBC Capital Markets, -l-C,Member NYSE/FINRNSIPC,or supplemental information supplied by you.The prices indicated are obtained from sources we consider reliable but are not guaranteed. Malpezzi Funeral Home 8 Market Plaza Way (717)697-4696 Mechanicsburg, PA 17055 www.MalpezziFunera]Home.com Jeremy J.Shartzer,FD Michael J.Malpezzi,Owner,FD Kyle C.Knipe,FD December 13,2013 Scott W. Sherick 121 Willow Lake Drive Carlisle, PA 17015 This is the final statement for the funeral services of Carol P. Sherick We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way. PROFESSIONAL SERVICES: Direct Cremation $2,620.00 FUNERAL HOME SERVICE CHARGES $2,620.00 SELECTED MERCHANDISE: ' Transporter Cremation Container $175.00 Brass Um $425.00 25 Acknowledgement Cards $15.00 100 Memorial Folders $45.00 THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE THAT YOU HAVE SELECTED $3,280.00 CASH ADVANCES: At the time funeral arrangements were made, we advanced certain payments to others as an accomodation. The following is an accounting of those charges. Certified Death Certificates $30.00 Newspaper Notices-Patriot $245.88 Newspaper Notices-Derrick $125.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $400.88 SUB-TOTAL $3,680.88 INITIAL PAYMENT/DISCOUNT/CREDITS $0.00 TOTAL AMOUNT DUE BY January 10,2014 $3,680.88 If you have any questions or concerns regarding this bill,please call our office at(717)697 -4696. CuKe. Cry VA � �, ssa . Ss 'PA0 12 G VJ i y"'Z �''PASSOanr°`� CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 April 4, 2014 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Mark E. Halbruner, Esquire RE: Carol P. Sherick Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: March 21, March 28, and April 4, 2014 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 ~ Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director RECEIPT FOR PAYMENT LISA M. GRAYSON, ESQ. Receipt Date : 2/25/2014 Cumberland County - Register Of Wills Receipt Time : 15 : 39 : 18 One Courthouse Square Receipt No. : 1077116 Carlisle, PA 17613 SHERICK CAROL Estate File No. : 2014-00173 Paid By Remarks : SCOTT SHERICK CJ -------------- - Receipt Distribution ---------- ----- ----- - -- - Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN ------------ --- - Check# 4967 $408 . 50 Total Received. . . . . . . . . $408 . 50 r--�� 710 Bridge Street New Cumberland, PA 17070 Phone: (717) 774-8129 Boreman & Babb CERTIFIED PUBLIC ACCOUNTANTS INVOICE BILL TO DATE INVOICE # Carol Sherick 4/1/2014 1401634 c/o Scott Sherick 121 Willow Lake Drive Carlisle, PA 170151 TERMS Due on receipt DESCRIPTION QTY RATE AMOUNT 2013 FEDERAL INCOME TAX RETURN 115.00 115.00 Schedule A - Itemized Deductions 40.00 40.00 Schedule B - Interest and Dividends 10.00 10.00 PA 40 - PENNSYLVANIA STATE RETURN 40.00 40.00 PA Schedule SP - Special Tax Forgiveness 5.00 5.00 Fee Reduction - Current Year Only -25.00 -25.00 P ID Check i Ar-aunt�. Total $185.00 401402372.SK L SODlpmpnt SUlamant 700.Tatar Saw CM MgSR r,243000.00 IDDWty.Sb6n t 2pi 5.yOsp b n . ]q p)As FoAOwa: n 1fgA00 pettl F B FurdY Al Se2wmPeam 9 02 1-MrS,plm(hne to R5R Reason ]02f73WAm ERAdRT LLC Pb From SZ. 703.Comm % Daw al aHlyment 808 llama Payable In CDGOam/a0 with Loan / 313A]5.00 7 801,loan Oepmalbn Fa frez Lean Diacaanl 803.Appraisal Fee 804.Credit Regain 805.LtMat mYpM M,Fm 800,1UmY la. 0y Leryat To 8e PaM in Aeaanm Intmeal 802.S,lal amsunnm pronNum 903.wiard Ina.PrarttlUp 1000.Raasrvai IApgslUtl WIN Untlo] 1001.wiaN tnf.Raservo 1002-m lro,Reserva 1003.Cih Propety TeseY tC04.County Property Tana 1010,Apprpgattl Aezpan]tn9 Adjustmars 1100.TMa-'air ttOt.5eswmem]Clmhp cab bSomme Lard Tnnsfon,44C 1102.AbsOact m Tttb Search 3100.00 1103.Thar onMnalbn t t0a.T0w humanm Birder 1105.1)ommen(praDmafton 1106.Serer NotWy FMIo$emredilld Ir fe .LLC t 187.Attamet.Fop 7 . 11$8.Tsb tns.T $to.00 mai m Semmd U+d Tnrissin,LLC a16.OD 1109,LoWeYa Covanpe S(f} f 1.625.00 tttO.OI I I "A 1 11 f24500800(51625.00) t 119Wae Tramfm I"t11n Pay01110 Segaed tantl 7nrrswn,LLC t 1200.GOVammant RaCOMine Antl Tnnsfst CMryaa '�33 1201.RemM FeOf M u5'� ,7 ^g DeM 77.00:Remd'nq Fina(m mortgage 1202.Cih,COUnfy Tav5lamq 2450.00 377.00 1203.Slaw poae Tas 2450A0 112,400 1300.AediOanal$o0lmnant Cerrgw 58 52,450.00 t 1305,2014nC155Ma01 Tax"in MkAeel Langan,Tar CoOeolp � lIJ 1307.AU9vR 110A Due ane Uw Faam , 1308.Repair Cnae Io Sp01t W Shoetw Rameownen AYaoUaSOn,Inc, t 52.13156 1400,Tab]SaWe"ni Chartres so all 7 S358.00 1 1 e" caMYQ DUM a,dy NUPt 5amials Statemem argroNa bear a]my kno,Ywtlpe and beM/0yIM Bn0 tavraU aMlermm$4,620,00 Me"pro my amaeni or b2 me In IMO fnnaealon.I$Jfihef ceNfy Nall neae recelvee o W o7Ure NUD�1 SCO ft$,t9P,$g BUYERS bmerlt 51MaMean. pta erd tlybarae111ann SELLERS N1M/aJm n Estate W P.Sha/ gr"'CafW�Sasn" Ca Ml J.Smyon •.• 8}: W SnerwL,Eaemlar The 24140.1 Sellwm t Mtemenl rl how propane y•bue:np amass"apmunt of 1Ms fnafatlba,i 1 M caused or aCpp(da(KpaAN Nrs atamnlCm, arA UY90 ihp lWp a ro x eybunetl N s<$leme{r w e i• Dm r '.j 0$21/1014 k Statement Statement U.S.Department of Naustng OMS Appmval No 2502-0285 and Umsn Oovatopmont B Tym or Won 1.1 1 FHA 2.1 1 RHS 3.( j Corn,.Unhu. 6.Fit.Number: 7,Loan Number, 8.Mortgage Insurance Can Numbaf: 4,j IVA 5.1 )Caw.ins. 401402372-SK C, NOTE:This form is furnished ID Bit you a statement of actual sel0ement ease.Amounts pap to Anti by use 6e umment agent am sham.Dams 1 markcd'(P.o.c.)'were pail weal.of the dating:they are alfewn ham far Inbrms9orlal purpnses aw am MI fuctwed in IM totals. 0.Hama and Addmss of Bowowot £Hearn are Addmss of Seib, F.Name and Address at Londe, WILLIAM J.SHYERS AND CAROL J' SCOTT W.SHERICK EXECUTOR OF SMYERS ESTATE OF CAROL P.SHERICK AtIVA CAROL SHERICK 6165 RIVENDALE COURT MECHANICSSURG,PA 17050 124 HALLOW LAKE DRIVE CARLISLE,PA 17015 G.Property Wee lon H.Soofement Agem j 1555 REVERE DRIVE, SECURED LANDTRANSFERS,LLC MECHANICSBURG,PA 17050 - egeootSOlUpmant I.Settlement Otto 061212014 COUNTY:CUMBERLAND 3yj5 �s7a @L $tCCiDG PARCEL 10:10,15.1282-077 H.illP21 10011 Oblmvament Oae 06211Mt4 TOWNSHIP:HAMPOEN TOWNSHItP CaW J.SUMMARY OF BORROWER'S TRANSACTIONS N.SUMMARY OF SELLER'S TRANSACTIONS 100.Gross Amount Due From Sorr , 400.Gross Ameunt Due To Sale, 101.Conbett Sates Pdm 1 5245,000.00 401.Carried Sates Prim 5246.. SO 102.Personal Property 402.Personal Property 103.Somement Changes to 80O w $4,820.00 403. Adjustments For Rom Paid By$otter in Advance Adjustments For Items Paid By Seller 10 Advance 1 113.CIb7TOwn Taxes 413.City7TOwn Tams 114,Courtly Texas 625.24/x,82120/4 to 1710015 5228.19 414.Cwrdy Taxes 526,246,8210014 to 1112015 5228.19 115.SCImn1 Taxes 2d33.56tyr 6/2112014 to 712015 51,835AS 415.Schwl Tans 2,133.55x,8121/1014 to 7110015 $1,335.45 J 118,Assessments Q8.Aseessments 110, A6. 122.Assoc Cass 75.00hno fur 82172014 to 9ti2R14 526.814M,ASnc O14 76.050o tar 3210014 to&10014 $26.61 123,Sewn,anal Refuse 155.0500 fur 821f201410 423.Sewer AM Refine 155,051gtf fur 621 F2R14 a 1 1512014 $86.10 1MI2011 $6840 1 r 723 Grow Amount Due From Sorrosver 5251.778.35 420.Gross Amount Due To SABA, 5247.159,35 200,Anmurrta Paid By Or to Behalf Of Bonawor 800.ReduetiCms in Amount Due To Sofa ' 1 201.Deposit m eamo5l money $2,500.00 501.Excess,Deposits 202,PerNiwl 502 Satltomte Cluirgas m Solbr 51319835 201 Existing Loan(&)Taken Sub)ep to 503 Exetbg Won(s)Taken Suged to 204. 504.Payoff Flat Mortgage to Chan 1118.333.79 Adjustmene For Roma Unpetd By Saf e, Adjmbrente For It..Unpaid By Sam, 210. 51D. 211, 511. 212. 512. 211 Cf a.Taxes 511C0y7Taen Tsxas 214.County Taxes $14.County Taxes t 21&Aaeaaements 518.AsseeameMs 210,HOA Isis. q 220.Buyele Total Cfallla _ 52,500,00'820.SoIbYa TObi Charge/ ' 5134,53235 300,Cash At Soestoment From2o Borrower 6w,Cash At Sotgo.M To/pm.Selo, _ 1 301,GmssAmwnt Due From Bonawer OiM 720) 5251,171,15 601,Grow Amount Due To Seer(Wle 420) $247,159.35 302.Lea*Amwmt Paid SyfFOr Bortowe,(Lisa 2201 52,500,00 M.Less Oedudian,M Amt.OW To SABA,(One 520) 5134,532.35 305.Cash[X)Fmm t j To Bonower I S249,279.3SI603.Cash t X)To[ )From Setle, I $112,627.00 �.'Y' J � W lzx:, � �a;',1w:.- .1 p- �. aW M'. 'P.. .eY 'h4���"t.� .'� �a. � .,•r:.»�. Sti @�.,�_ •;; ,<' a-..r4 M :a €. �,. � ,;fi :�, :� '�� �� �. A' 1 .�. ,E" 3. q 5 R. � �i'Sµ._f p .r � �� �" 'i M1 :y 4. k' f. F � � ' ti �Yy 'a V�" 3 IS l c _ y,� _ . ^L � ♦ _ � � ��.,�s�}r- Yi+ :i, .2u• ��t__� �.�Iw'� lw�i'„YFI,�,M 'K��+� '�'�IS.. � _ "ate. mot. ., Questions?Please Visit us online at ° 3 l4 6 ` � Page 1 © contact us by Mar 11. - pplelectric.com - - 1,800-DIAL-PPL _ ppfi `(1=800342-5775) 31495-28015 Auto Pay PPL 6lednc umnie• M-F:8am to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Feb 21,2014 $0.00 CAROL SHERICK Charges: 1555 REVERE DR Total VERDE Energy USA Charges $39.29 MECHANICSBURG, PA 17050 Total PPL Electric Utilities Charges $21.27 Meter:88939876 Your next meter reading is on or about Mar 20,2014. Total Charges $60.56 This section helps you understand your year-to-year utdmatic Bill'Paymeni on.Mar 14,2014 $60:56 electric use by month. Meter readings are actual unless Account Balance $60.56 otherwise noted. 2013 �2014 PPL Electric Utilities'price to compare for your rate is$0.08754 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 54 or www.oca.state.pa.us for supplier offers. 45 Your Message Center q 3e • VERDE ENERGY USA RATE$0.1819/KWH v a 18 • With paperless billing,you can receive and pay your a 9 PPL Electric Utilities bills online.The process is free, visit ,convenient c i d secure.To learn more or sign up, o s 6 i t M A M J 1 A 5 O N D • information about appliance energy use and tips on ° Months saving energy are available through the Energy Library on our Web site,ppielectric.com/e-power Monthly • • Take showers instead of baths to save energy and kWh Comparison Billed kWh/Day Temp. water. It takes about 30 gallons of water to fill an Feb 2014 30 216 7 23F average bathtub.A 5-minute shower uses about 20 gallons. Low flow shower heads can cut your hot water Feb 2013 30 695 23 29F use in half. e Billing Period Type Reading Payment Methods Feb 20 Actual 77746 / Online at: By phone:1-800 342-5775 Jan 21 Actual 77530 lJ pplelectric.com or call BillMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 30 Days kWh Billed 216 MasterCard, Discover or debit card. Yearly Comparison Total Use Avg. Month[%* ® By Mail: Correspondence should be sent to: Mar 2013-Feb 2014 9490 791 2 North 9th Street Customer Services CPC-GENNS 827 Hausman Road Mar 2012-Feb 2013 11222 935 Allentown, PA 18101-1175 Allentown, PA 181049392 a information on the back of this bill 4 Pd . 3 j31 C� ` qq i �(�8 7�0 ® Questions? Please /� Visit us online at Page contact us by Apr 11. pplelectric.com PPS 1-800-DIAL-PPL Due (1-800-342-5775) 31495-28015 Apr 11, 2014 $68.76 n L El ti c anti.• M-F:Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Mar 21, 2014 $0.00 CAROL SHERICK Charges: 1555 REVERE DR Total PPL Electric Utilities Charges $22.13 MECHANICSBURG, PA 17050 Total VERDE Energy USA Charges $46.63 Meter:88939876 Your next meter reading Is on or about Apr 22, 2014. Total Charges $68.76 This section helps you understand your year-to-year jAmount Due By Apr 11, 2014 $68.76 electric use by month. Meter readings are actual unless Account Balance $68.76 otherwise noted. 02013 02014 PPL Electric Utilities' price to compare for your rate Is$0.08754 per kWh. This-changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 54 or www.oca.state.pa.us for supplier offers. Z' 4s x 36 Your Message Center o 27 • VERDE ENERGY USA RATE$0.1919/KWH m to • With paperless bllling,you can receive and pay your a 9 PPL Electric Utilities bills online.The process Is free, o quick,convenient and secure. To learn more or sign up, visit pplelectric.com. I F M A M I i A s o N D • -Information about appliance energy use and tips on Months saving energy are available through the Energy Library on our Web site, pplelectric.com/e-power Monthly '' • Clean the coils on the back or bottom of your kWh/Day Comparison Billed refrigerator every 3 months. Dust covered coils waste Mar 2014 28 243 9 33F energy. Mar 2013 1 28 577 21 36F Billing Period Type Reading Payment Methods Mar 20 1 Actual 77989 Online at: By phone: 1-800-342-5775 ° Feb 20 Actual 77746 U pplelectric.com or call BIIIMatrlx(service fee applies) at 1-800-672-2413 to pay using Visa, 28 Days kWh Billed 243 MasterCard, Discover or debit card. Tota Use Avg.Monthly ® By Mall: Correspondence should be sent to: Apr 2013- Mar 2014 9156 763 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Apr 2012- Mar 2013 11213 934 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill ® Questions?Please Visit us online at Final Bill Page 1 contact us by Apr 28. l J pplelectric.com Bill Acct.No. Due Date Amount Due 1-800-DIAL-PPL ppi• (1-800-342-5775) 31495-28015 Apr 28,2014 $24.08 ML Ef•eleo unmi•• � M-F: Barn to 5pm Your Electric Usage Profile I Billing Summary (Billing details on back) Service to: �l (� Balance as of Apr 7,2014 $0.00 CAROL SHERICK /nI1. 1 Charges: 1555 REVERE DR I v ' Total PPL Electric Utilities Charges $9.69 MECHANICSBURG, PA 17050 )J Total VERDE Energy USA Charges $14.39 Meter:88939876 }Y/�-Y Total Charges $24.08 This section helps you understand your year-to-year jAmount Due By Apr 28, 2014 $24.08 electric use by month. Meter readings are actual unless Account Balance $24.08 otherwise noted. ® 2013 02014 PPL Electric Utilities' price to compare for your rate Is$0.08754 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com. 54 or www.oca.state.pa.us for supplier offers. 45 Your Message Center as • VERDE ENERGY USA RATE$0.1919/KWH 0 27 18 • With paperless billing,you can receive and pay your a PPL Electric Utilities bills online.The process is free, 9 quick,convenient and secure. To learn more or sign up, o visit pplelectric.com. 1 F M A M 1 1 A S 0 N D • Information about appliance energy use and tips on f Months saving energy are available through the Energy Library on our Web site, pplelectric.com/e-power Monthly Days Average Avera • We appreciate the opportunity to have served you. kWh/Day kWh Comparison Billed Because you have paid your bills within 30 days over Apr 2014 15 75 5 42F the past year,you have established an excellent payment record with PPL Electric Utilities. Apr 2013 30 1 606 20 47F Billing Period Type Reading Payment Methods Apr 4 Actual 78064 /� Online at: ®By phone: 1-800-342-5775 Mar 20 Actual 77989 U pplelectric.com or call BIIIMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 15 Days kWh Billed 75 MasterCard, Discover or debit card. Yearly Corhiparlson Total Use Avg.MonthlOM ® By Mall: Correspondence should be sent to: May 2013-Apr 2014 8625 719 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road May 2012-Apr 2013 11241 937 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill 4 ® Questions?Please `/c� Visit us online at Page 1 3 contact us by Jun 11. �J pplelectric.com 1-800-DIAL-PPL Due ' Due 1.PPS - (1-800-342-5775) 31495-28024 Jun 11,2014 $30.81 ei.ane uunu•. M-F:Sam to Spm - Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of May 21,2014 $0.00 CAROL SHERICK-ESTATE Charges: 1555 REVERE DR Total PPL Electric Utilities Charges $30.81 MECHANICSBURG, PA 17050 Meter:88939876 Total Charges $30.81 Your next meter reading is on or about Jun 20, 2014. jAmount Due By Jun 11,2014 77T3Y81 This section helps you understand your electric use by Account Balance $30.81 month. Meter readings are actual unless otherwise PPL Electric Utilities'price to compare for your rate Is$0.08754 per kWh. noted. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com This graph shows the average number of kWh you used or www.oca.state.pa.us for supplier offers. each day. You used 136 kWh in 33 days, or an average of 4 kWh a day. Your Message Center The average daily temperature for your area last month . With paperless billing,yyou can receive and pay your was 58F. PPL Electric Utilities Ills online.The process Is free, ® 2014 quick,convenient and secure.To learn more or sign up, 6 visit pplelectric.com. s • Information about appliance energy use and tips on saving energy are available through the Energy Library r 4 on our Web site, pplelectric.com/e-power 3 • Before digging around your home or property,you a z should always call the state's One Call notiflcation system to locate any underground utility lines. You can 1 do this by simply dialing 811,which will connect you to o the One Call-system. Be safe and call 811 before you J F M A M J 1 A S O N D dig. Months May 21 Actual 78264 Payment Methods Apr 18 Actual 78128 /rr� Online at: ®By phone: 1-80D-342-5775 _ t,J pplelectric.com or call BIIIMatrix(service fee applies) 33 Days kWh Billed 136 at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other-important information on the back of this bill 4 �d . 71� cwt 5aj� ' © Questions?Please ,/� Visit us online at Page 1 contact us by Jul 11. l J pplelectric.com ppI 1-800-DIAL-PPL Bill Acct.No. Due Date Amount Due (1-800 342-5775) 31495-28024 Jul 11, 2014 $30.10 PPL Elm ft umre•. M-F: Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Jun 20, 2014 $0.00 CAROL SHERICK-ESTATE Charges: 1555 REVERE DR Total PPL Electric Utilities Charges $30.10 MECHANICSBURG,PA 17050 Meter:88939876 Total Charges $30.10 Your next meter reading Is on or about Jul 22, 2014. mount Due By Jul 11, 2014 $30.10 This section helps you understand your electric use by Account Balance $30.10 otedMeter readings are actual unless otherwise PPL Electric Utilities'price to compare for your rate Is$0.09036 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com This graph shows the average number of kWh you used or www.oca.state.pa.us for supplier offers. each day. You used 128 kWh in 30 days,or an average of 4 kWh a day. Your Message Center The average daily temperature for your area last month With paperless billing,you can receive and pay your was 69F. PPL E• lectric Utilities 9111!online.The process is free, 02014 quick,convenient and secure. To learn more or sign up, 6 visit pplelectric.com. 2 5 • Information about appliance energy use and tips on x saving energy are available through the Energy Library 4 on our Web site, pplelectric.com/e-power ° a • Before digging around your home or property,you a z should always call the state's One Call notification a system to locate any underground utility lines. You can t do this by simply dialing 811,which will connect you to o the One Call system. Be safe and call 811 before you 1 F M A M 1 J A S O N D dig' Months Billing Period Type Reading Jun 20 Actual 78392 Payment Methods May 21 Actual 78264 Online at: ®By phone: 1-800-342-5775 `/� pplelectric.com or call BIIIMatrlx(service fee applies) 30 Days kWh Billed 128 at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. = ® By Mail: Correspondence-should be sent to: e 2 North 9th Street Customer Services — CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104-9392 _ Other important information on the back of this bill -j ® Questions?Please Visit us online at Pd Ct J 7 Page 1 contact us by Aug 12. <J pplelectric.com 1-800-DIAL-PPL Bill Acct.No. Due Date Amount Due PP (1-800.342-5775) A 1 $59.47 PPL El a do umn•. ' M-F:Sam to 5pm 31495-28024 ug 2,2014 Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Jul 22, 2014 $0.00 CAROL SHERICK-ESTATE Charges: 1555 REVERE DR Total PPL Electric Utilities Charges $59.47 MECHANIC58URG, PA 17050 Meter:88939876 Total Charges $59.47 Your next meter reading Is on or about Aug 20, 2014. Amount Due By Aug 12, 2014 $59.47 This section helps you understand your electric use by Account Balance $59.47 month. Meter readings are actual unless otherwise noted. PPL Electric Utilities' price to compare for your rate is$0.09036 per kWh. This changes the 1st of Mar,Jun,Sept, and Dec.Visit papowerswitch.com This graph shows the average number of kWh you used or www.oca.state.pa.us for supplier offers. each day. You used 364 kWh in 32 days,or an average of 11 kWh a day. Your Message Center The average daily temperature for your area last month • With Paperless billing,you can receive and pay your was 75F. PPL E ectrlc Utilities bills online.The process Is free, 02014 quick,convenient and secure. To learn more or sign up, 24 visit pplelectric.com. 20 • Information about appliance energy use and tips on saving energy are available through the Energy Library = 1s on our Web site, pplelectric.com/e-power ° 12 • Before digging around your home or Property,you a should always call the state's One Call notification a system to locate any underground utility lines. You can 4 do this by simply dialing 811,which will connect you to o -the One Call system. Be safe and call 811 before you 1 F M A M 1 J A S O N 0 dig. Months J-Billing Period Type Reading Jul 22 Actual 78756 Payment Methods Jun 20 Actual 78392 /aa Online at: By phone: 1-800-342-5775 �J pplelectric.com ©or call BIIIMatrlx(service fee applies) _ 32 Days kWh Billed 364 at 1-80D-672-2413 to pay using Visa, - MasterCard, Discover or debit card. ° ® By Mall: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104-9392 = Other Important information on.the back of this bill -� © Questions?Please Visit us online at Final Bill Page 1 contact us by Sep 11. pplelectric.com 1-800-DIAL-PPL Due '' Due PPS •4. (1-800-342-5775) 31495-28024 Sep 11, 20147' 37177 ei.e'n�uuire.. M-F: 8am to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Aug 21,2014 $30.32 CAROL SHERICK-ESTATE Charges: 1555 REVERE DR Total PPL Electric Utilities Charges $0.85 MECHANICSBURG, PA 17050 Meter:88939876 Total Charges $31.17 Amount Due By Sep 11,2014 $31.17 This section helps you understand your electric use by Account Balance $31.17 month. Meter readings are actual unless otherwise PPL Electric Utilities'price to compare for your rate Is$0.09036 per kWh. noted. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com This graph shows the average number of kWh you used or www.oca.state.pa.us for supplier offers. each day. You used 3 kWh in 1 days,or an average of 3 kWh a day. Your Message Center The average daily temperature for your area last month . information about appliance energy use and tips on was 75F. saving energy are available through the Energy Library 02014 on our Web site, pplelectric.com/e-power 24 • Before digging around your home or property,you 20 should always call the state's One Call notlficatlon is system to locate any underground utility lines. You can do this by simply dialing 811,which will connect you to g 2 12 the One Call system. Be safe and call 811 before you f o dig. a e • Dishwashers use about 13 gallons of hot water per 4 load.That's less than washing dishes by hand.Always o use full loads on the shortest cycle. When washing i F M A M 1 1 A 5 0 N D dishes by hand,don't let the hot water run continuously. Months Billing Period Type Reading Aug 21 Actual 78887 Payment Methods Aug 20 Actual 78884 ldi Online at: By phone: 1-800-342-5775 t J pplelectric.com or call BIIIMatrix(service fee applies) 1 Days kWh Billed 3 at 1-800.672-2413 to pay using Visa, MasterCard, Discover or debit card. By Mall: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENNS 827 Hausman Road -3' J Allentown, PA 18101-1175 Allentown, PA 18104-9392 TTT Other important Information on the back of this bill Questions?Please Ab V€sit us online at Page 1 pp� P•` \�/ contact us by Sep 10. U pplelectric.com 1-8MDIAL-PPL Bill Acct.No. Due Date Amount (1-800.34to5om) M-F.Sam to Sp 31495-28024 Sep 10,2014 $30.32 r•r�Etecsnc unrre.. Your Electric Usage Profile Billing Summary (Frilling details on back) Service to: Balance as of Aug 20,2014 $0,40 CAROL SHERICK-ESTATE Charges: 1555 REVERE DR Total PPL Electric Utilities Charges $30.32 MECHANICSBURG, PA 17050 Meter:88939876 Total Charges $30.32 Your next meter reading Is on or about Sep 19,2014. Amount Due By Sep 10, 2014 $30.32 This section helps you understand your electric use by Account Balance $30.32 month.. Meter readings are actual unless otherwise PPL Electric Utilities'price to compare for your rate Is$0.09036 per kWh. This graph shows the average number of kWh you used This changes the 1st of Mar,Jun,Sept, and Dec. Visit papowerswitch.com each da . You used 128 kWh In 29 days,or an average or www.ocastate:pa.usfnr supplier offers. of 4 kWh a day Your Message Center The average daily temperature for your area last month • With paperless billing,you can receive and pay your was 72F. PPL Electric Utilities bills online.The process is free, E2014 quick,convenient and secure.To learn more or sign up, 24 visit pplelectric.com. 20 + Information about appliance energy use and tips on saving energy are available through the Energy Library = is on our Web site,ppielectric.com/e-power 12 • Before digging around your home or property,you a 8 should always call the state's One Cal a 4 system o h s by simply dialing 11,which will onnect you to 0 the One Call system. Be safe and call 811 before you J r M A M J J A 5 O N D dig. Months Billing Period Type Reading Aug 20 Actual _ 78884 Payment Methods Jul 22 Aduai� 78756 lc� Online at: By phone:1-800-342-5775 _ C J ppielectric.com or.cail BiilMatrix(service fee applies) 29 days kWh Billed 128 at 1-800.672.2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services - CPC-GENN1 827 Hausman Road Allentown, PA 18101.1175 Allentown, PA 18104.9392 - Other Important information on the back of this bill 4 � Retum this stub in the envelope provided with a check payable to PPL Electric Utilities. ff P '!:• Due Date PPL FHa ft UU M*& - 31495-28024 1 Sep 10, 2014 $34.32 Amount Enclosed: AV 01 006669 662798 32 A•'6DGT ❑D[1�F1[IF]F1!„ill H'Il4'€II€'It'tMrti'€iitliin€t li1€"€fulq'Irrpd i€L_J+� CAROL SHERICK-ESTATE LAKE DR PPL ELECTRIC UTILITIES 121 WILLOW LAKE Go SCOTT CK 2 NORTH 9TH STREET CPC-GENN1 CARLISLE,PA 17015-9164 ALLENTOWN, PA 18101-1 175 1'1111 1111111111"1'11111 lllLl”IIl'1'IPIIIIIIIIIII'llll'llllll 1 7300000303230000030326 3144528024 BILLING PERIOD AND METER READINGS BILL NG SUMMARY • Billing date:February 26,2014 Far Service To:1555 REVERE OR • Due Date:March 20,2014 For Account 1024-210031032709 Billing period:Jan 23 to Feb 24(33 Days) Prior Balance . Next reading on or about:Mar 20,2014 • Balance from last bill 20 45 • Customer Type:Residential • Payments as of Fable.Thank vnul 20 • Meter Reading Measurement: 45 eFOrward 000 1 unit=100 gallons of water • Billing Measurement:100 gallons(CGL) Current water service • water Service charge 15.00 rbilling r No. N082483811 • Water Usage Charge($1.02140000 x 4.00) 4.Q9 of meter 5/8• ' Total water service Related Charges 19.09 nt Read 2,241(Actual) TOTAL CURRENT CHARGES 19.09 ous Read 2,237(Actual) water used this 4 units TOTAL AMOUNT DUE $19.09 period (400 gallons) Tot al Water Use Comparison(in 100 gallons) Pay your bill online:www.water.paymybiti.com ' • -Current billing period 2014: 4.00 CGL ( ) Pay by phone:24-hours a day,every day at 1-866.271-5522 • Same billing period 2013: 24.00 CGL f Pay in person:Residential customers may obtain a listing of Billed Use Graph(200 gallons) payment locations by visiting www.arnwater.com/myh2o� Pay by mail:Remit your payment to the address shown above 16 10 5 6 0 e a P a u u u e a o e a e 0 �� �'1p"` X133 ` l (� 0 3 b r r y n 1 g p t v c n b 1 4 Important messages from Pennsylvania American Water • Approximately 4.44 percent,or$0.85,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 03/20/2014 will be subject to a `1,550%penalty. s is o 1 `cr..I p7U Questions about this bill?Call Our 24-H0 ur Customer Service Center.1.800-565.7292 www.pennsyivaniaamwater.com 01964MIOSMACR84METMIC003 n 6262WI73862 G4CR9tM tli66esotot8aD} BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:March 11,2014 For Service To: 1555 REVERE DR • Due Date:April 2,2014 For Account 1024-210031032709 • Billing period:Feb 25 to Mar 06(10 Days) Prior Balance Customer Type:Residential Balance from last bill 19.09 • Meter Reading Measurement: TOTAL PAST AMOUNT-DUE IMMEDIATELY 19.09 1 unit=100 gallons of water • Billing Measurement 100 gallons(CGL) current water service ervsce Water usag Charge .93 \ Meter No. N0$2483811 • Water Usage Charge(51.02140000 x 7.00) 7.15 J} Size of meter 5/8• • Total Water service Related Charges 12.08 Current Read 2,24$(Actual) TOTAL CURRENT CHARGES 12.08 Previous Read 2,241(Actual) -' Total water used this 7 units TOTAL AMOUNT DUE * $31.17 billing period (700 gallons) Total Water Use Comparison(in 100 gallons) FIpmayment your bill online:www.water.paymybill.com • Current billing period 2014: 7.00 CGL by phone:24-hours a day,every day at 1-866-271.5522 • Same billing period 2013: 12.00 CGL in person:Residential customers may obtain a listing of Bitted Use Graph(100 gallons) locations by visiting www.amwater.corrrjmyh2o by mall:Remit your payment to the address shown above 9 Ism 0 #MhAi 3 2 M A M / J A S O N O 1 F M 2 0 a a a u u u e c o e a e a 0 3 r r y n I g p t v c n b r 11 Important messages from Pennsylvania American Water • ***IMPORTANT WATER QUALITY INFORMATION: • Your annual Water Quality Report can be viewed electronically at www.amwater.com/cer/mechanicsburg.pdf,If you prefer a paper copy to be sent to you,please contact our Customer Service Center at 800-5657292. • ***Final Bill*** This is your final bill for service.it has been our pleasure to serve you. • The due date pertains to current Charges only.Any past due balance should be paid immediately. • Approximately 4.44 percent,or$0.54,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 04/02/2014 will be subject to a 1.50%penalty. • Sign up for paperless billingl it's a convenient and environmentally friendly way to receive your water and/or wastewater bill.Users must i" enroll online.To get started,visit www.amwater.com/myh2o.GC to Account Detail and click on the green Paperless Billing button.Follow the steps,press submit and-you're enrolled) Questions about this bill?Call our 24-Hour Customer Service Center:)-800.565-7292 www.pennsylvaniaamwater.com 633750169189 0314111031679 ACRCAX ETM IC00412 (ACRC9x 031411010t3e0) 1.: s PEN N S Y L V A N IA 000102421003 10327090000000000000?99013 AMERICAN WATER 1024-210031032709 PC Box 371412,Pittsburgh,Pa.15250-7412 Due Date April 17,2014 For Service To:1555 REVERE DR Total r $7.99 L3 Cheek this box for address changes and • . $8.11 after 4/17/14 If Paid After note new address on back. Amount Enclosed S Lr•II.4111yy1•y•Ih^•rl•11I"Pd1°I1°dllydhl'I'llr 0143531 AS 0.403 14353N14353N14556 5004 ACRON9002 1•IIr1111.11111..•II'11.1.1d'1e•••h•13F11•••!Id•d°••1111! CAROL SHERICK PENNSYLVANIA AMERICAN WATER 1555 REVERE DR LT 84 PO BOX 371412 MECHANICSBURG, PA 17050-2246 PITTSBURGH,PA. 15250-7412 Please tear along the dotted line and return thlS P9nlon wnh your payment. BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:March 26,2014 For Service To: 1555 REVERE DR Due Date:April 17,2014 For Account 1024.210031032709 • Billing period:Feb 25 to Mar 06(10 Days) Prior Balance • Customer Type:Residential • Balance from last bill 19.09 • Meter Reading Measurement • Payments as of Mar18.Thank yowl -19.09 1 unit=100 gallons of water Balance Forward 0.00 • Billing Measurement: 100 gallons(CGL) Cancelled Bill Meter No. N082483811 • Cancelled invoice Period 02/25/2014-03/06/2014 Size of meter 5/8" • Cancelled Invoice Amount 31.17 Current Read 2,244(Actual) • Reason for Reversal:Final Read Correction Previous Read 2,241(Actual) Total Amount Reversed 31.17 Total water used this 3 units Rabin(02/2S/2014-03/06/2014) billing period (300 gallons) Water Service • water service Charge 4,93 Total Water Use Comparison(in 100 gallons) • water Osage Charge($1.02140000 x 3.00) 3.06 • Current billing period 2014: 300 CGL • Total Water Service Related Charges 7,99 • Same billing period 2013: 12.00 CGL TOTAL CURRENT CHARGES 7,gg Billed Use Graph(100 gallons) \_ 1s TOTAL AMOUNT DUE 1-$7.98. Pay your bill online:www,water.paymybill.com 9 ( ) Pay by phone:24-hours a day,every day at 1-B66-271-5522 6 t Pay In person:Residential customers may obtain a listing of 3 payment locations by visiting www.amwater.com/myh2a Pay by mall:Remit your payment to the atlpressshowxrobove-•--» 2 M A M I I A S 0 N D 1 F M 2 ry1 0 a p a u u u e c o e a c a 0 ////��11 j� 1 i A �t 3 Y n I 8 P t v c n b r 4 I • V` Vt Important messages from sylvanla Am can Waters • ***IMPORTANT WATER QUALITY INFORMATION: _ • Your annual Water Quality Report can be viewed electronically at www.amwater.com/ecr/mechaniesbu u prefer a paper copy to be sent to you,please contact our Customer Service Center at 800.565-7292. • ***Final Bill*** This is your final bill for service.It has been our pleasure to serve you. • Approximately 4.44 percent,or$0.35,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 04/17/2014 will be subject to a 1.50%penalty. • Sign up for paperless billings It's a convenient and environmentally friendly way to receive your water and/or wastewater bill. Users must enroll online.To get started,visit www.amwater.com/myh2o.Go to Account Detail and click on the green Paperless Billing button.Follow the '- steps,press submit and you're enrolled[ Questions about this bill?Call our 24-Hour Customer Service Center:1-800-S6S-7292 www.pennsylvaniaamwater.com 014353t014556ACROMETMtC002 2 6 (ACRON9 0/63530191!03) 100000755950 BILLING PERIOD AND METER READINGS BILLING SUMMARY Biking date:March 26,2014 For Service To: 1555 REVERE DR • Due Date:April 17,2014 For Account 1024-220003114658 Billing period:Mar 07 to Mar 19(13 Days) Prior Balance • Next reading on or about Apr 21,2014 Balance from last bill 0= Customer Type:Residential Balance Forward 0.00 • Meter Reading Measurement: 1 unit=100 gallons of water Current Water Service • Billing Measurement 200 gallons(CGL) Water Service Charge 6.41 • Water Usage Charge(81.02140000 x 0.00) 0,00 Meter No. N082483811 Total Water Service Related Charges 6,41 Size of meter 5/8' Adjustments Current Read 2.244(Actual) • Service Activation Fee 30.00 Previous Read 2,244(Actual) • Total Adjustments 30.00 Total water used this 0 units TOTAL CURRENT CHARGES 36.41 billing period (0 gallons) Total water Use Comparison(in 100 gallons) TOTAL AMOUNT DUE $36.41 Current billing period 2014: 0.00 CGL • Same billing period 2013: 0.00 CGL Pay your bill online:www.water.paymybill.com Billed Use Graph(100 gallons) m Pay by phone:24-hours a day,every day at 1-86&271-5522 5 . + Pay in person:Residential customers may obtain a listing of payment locations by visiting www.amwater.com/myh2o 4 Pay by mail:Remit your payment to the address shown above 3 2 1 41 O a p a u u u e c c o e 2- M A M A S N D a F M 2 �• J� `'}1 {/V`' ^� "l� u u e e a 0 t{U�} {li/ 1 r r y n i g p t v e n a r 1 3 4 . Important messages from Pennsylvania American Water JI 3 • ***IMPORTANT WATER QUALITY INFORMATION: fOl GL-4 • Your annual Water Quality Report can be viewed electronically at www.amwater.com/ccr/mechanicsburg.pdf.If you prefer a paper copy to be sent to you,please contact our Customer Service Center at 800-565-7292. • Approximately 4.44 percent,or$1.62,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 04/17/2014 will be subject to a 1.5046 penalty. • Sign up for paperless billingl It's a convenient and environmentally friendly way to receive your water and/or wastewater bill. Users must .enroll online.To get started,visit www.amwater.com/myh2o.Go to Account Detail and click on the green Paperless Billing button. Follow the steps,press submit and you're enrolled! Questions about this bill?Call our 24-Hour Customer Service Center:1-800-565-7292 www.pennsylvaniaamwater.com 100000755984 010319lP14521 ACRDN9 ETM1D00225 (ACR0N9 01431e0107100) BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:April 23,2014 For Service To:1555 REVERE DR • Due Date:May 15,2014 For Account 1024-220003114658 • Billing period:Mar 20 to Apr 21(33 Days) Prior Balance • Next reading on or about:May 20,2014 • Balance from last bill $6.4; * Customer Type:Residential Payments as of Apr16.Thank you! -2.33 Meter Reading Measurement: TOTAL PAST AMOUNT-DUE IMMEDIATELY 34.08 1 unit=100 gallons of water • Billing Measurement:100 gallons(CGL) . Wa water Service -,� Water Service Charge 15.00 Meter No. N082483811 " water Usage Charge($1.02140000 x 1.00) 1.02 Size of meter 4 _ 5/8. • Total Water Service Related Charges 16.02 Current Read 2,245(Actual) Adjustments Previous Read 2.244(Actual) • Balance Transfer .4,03 Total water used this 1 units 210031032709,Date 04/15/2014 billing period (100 gallons) Service Activation fee -30.00 • Total Adjustments 34.09 Total Water Use Comparison(in 100 gallons) TOTAL CURRENT CHARGES -18.07 • Current billing period 2014: 1.00 CGL • Same billing period n 0.00 CGL 8 TOTAL AMOUNT DUE y► $16.01 Billed ed Use Graph(100 gallons) 5 Pay your bill online:www.water.paymybill.com 4 m Pay by phone:24-hours a day,every day at 1-866-271-5522 # Pay in person:Residential customers may obtain a listing of 3 payment locations by visiting www.amwater.com/myh2o 2 Pay by mail:Remit your payment to the address shown above 1 2 A M A $' O N D F M A 2 u u a G� .] /�+ (,.,V•-' �ry,gQ 0 p a u u u e c o e e e e r n ! t p e 3 y g P v c n D r r 4 Important messages from Pennsylvania American Water • ***IMPORTANT WATER QUAUTY INFORMATION: •Your annual Water Quality Report can be viewed electronically at www.amwater.com/ccr/mechanicsburg.pdf.If you prefer a paper copy to be sent to you,please contact our Customer Service Center at 800.565-7291 • The due date pertains to current charges only.Any past due balance should be paid immediately. • Approximately 4.44 percent,or$0,80-,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 05/15/2014 will be subject to a 1.50%penalty. • Sign up for paperess billingl It's a convenient and environmentally friendly way to receive your water and/or wastewater bill. Users must enroll online.To get started,visit www.amwater.com/myh2o.Go to Account Detail and click on the green Paperless Billing button.Follow the steps,press submit and you're enroiledl Questions about this bill?Call our 24-Hour Customer Service Center:1-80G-56S-7292 www.pennsylvaniaamwater.com 03077aW09e9ACRaPx ETM1Co0412 tACROPx M07700101300) 621250277979 �V BILLING PERIOD AND METER READINGS BILLING SUMMARY T Billing date:May 23,2014 For Service To: 1555 REVERE DR • Due Date:June 16,2014 For Account 1024-220003114658 • Billing period:Apr 22 to May 19(28 Days) Prior Balance Next reading on or about:Jun 19,2014 • Balance from last bill 16.01 • Customer Type:Residential Payments as of May&Thank youl -16.01 Meter Reading Measurement: Balance Forward 0 00 1 unit=100 gallons of water • Billing Measurement:100 gallons(CGL) Current Water service • Water Service Charge 15.00 Meter No. 'N082483811 • water Usage Charge($1.02140000 x 0.00) 0.00 Size of meter 5/8° • Total Water service Related Charges 15,00 Current Read 2,245(Actual) TOTAL CURRENT CHARGES 15.00 Previous Read 2,245(Actual) Total water usedthls 0units TOTAL AMOUNT DUE $15.00 billing period (0 gallons) Total Water Use Comparison(in 100 gallons) Pay your bill online:www.water.paymybill.com • Current billing period 2014: 0.00 CGL Q Pay by phone:24-hours a day,every day at 1-866-271-5522 • Same billing period 2013: 0.00 CGL 4 Pay in person:Residential customers may obtain a listing of Billed Use Graph(100 gallons) payment locations by visiting www.amwater.com/myh2o s Pay by mail:Remit your payment to the address shown above 4 3 2 1 2 M 1 J A S O N D J F M A M 2 0 a u u u e c o e a a a a e 0 1 y n I g p t v c n b r r y 1 3 4 Important messages from Pennsylvania American Water • Approximately 4.44 percent,or$0.67,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 06/16/2014 will be subject to a 1.50%penalty. 50go 113�. Questions about this bill?Call our 24-Hour Customer Service Center:1-800-565-7292 www.pennsylvaniaamwater.com 020569/020903 ACRNK7 ETMiC0031 6 (ACRNK7 0205690101900) 628750281398 I BILLING PERIOD AND METER READINGS BILLING SUMMARY Billing date:June 24,2014 For Service To: 1555 REVERE DR Due Date:July 16,2014 For Account 1024-220003114658 • Billing period:May 20 to Jun 19(31 Days) Prior Balance • Next reading on or about:Jul 21,2014 • Balance from last bill 15.00 • Customer Type:Residential Payments as of JunS.Thank youl -15.00 Meter Reading Measurement: Balance Forward 0.00 1 unit=100 gallons of water • Billing Measurement:100 gallons(CGL) Current water Service • Water Service Charge 15.00 nperiod N082483811 • water usage Charge($1.02140000x 0.00) 0.00 er 5/8• • Total Water Service Related Charges 15.00 ad 2,245(Actual) TOTAL CURRENT.CHARGES 15.00 ead 2,245(Actual) used this 0 units TOTAL AMOUNT DUE $15.00 od 10.gallons) Total Water Use Comparison(in 100 gallons) Pay your bill online:www.water.paymybill.com • Current billing period 2014: 0.00 CGL m Pay by phone:24-hours a day,every day at 1-866-271-5522 • Same billing period 2013: 0.00 CGL } Pay in person:Residential customers may obtain a li0ng of Billed Use Graph(100 gallons) payment locations by visiting www.amwater.com/myh2o 5 2 Pay by mail:Remit your payment to the address shown above 4 3 2 1 5�31� 2 1 1 A $ O N D 1 F M A M 1 2 0 U a 11 e c e e a a a p a U 0 3 n I g p t v c n b r r y n 1 4 Important messages from Pennsylvania American Water . • Approximately 4.44 percent,or$0.67,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 07/16/2014 will be subject to a 1.50%penalty. Questions about this bill?Call our 24-Hour Customer Service Center:1-800-565.7292 www.pennsylvaniaamwater.com 018221/018340ACRSJE ETM10003123 605000629225 (ACRSJE 0182210101700) I r BILLING PERIOD AND METER READINGS �~ BILLING SUMMARY • Billing date:July 23,2014 For Service To: 1555 REVERE DR • Due Date:August 14,2014 For Account 1024-220003114658 • Billing period:Jun 20 to Jul 21(32 Days) Prior Balance • Next reading on or about:Aug 20,2014 • Balance from last bill 15.00 • Customer Type:Residential • Payments as of Jul9.Thank youl -15.00 • Meter Reading Measurement: Balance Forward 0.00 1 unit=100 gallons of water Current Water service • Billing Measurement:100 gallons(CGL) Water Service Charge 15.00 Meter No. N082483811 • water usage Charge($1.02140000 x 0.00) 0,00 Size of meter 5/8? • Total Water Service Related Charges iS.00 Current Read 2,245{Actual} TOTAL CURRENT CHARGES 15.00 Previous Read 2,245(Actual) Total water used this 0units TOTAL AMOUNT DUE $15.00 billing period (0 gallons) Total Water Use Comparison(in 100 gallons) Fpayment your bill online:www.water.payrnybill.com • Current billing period 2014: 0.00 CGL by phone:24-hours a day,every day at 1.866-271.5522 • Same billing period 2013: 0.00 CGL In person:Residential customers may obtain a listing of Bitted Use Graph{1QQ gallons) locations by visiting www,amwater.com/myh2o s by mail:Remit your payment to the address shown above 5 6 3 P� � 9// -7 ( �_ # 2 1 2 J A S 0 N D 1 F M A M J 1 2 0 u u e c o e a e a_ p a u u 0 1 1 g P t v c n b r r y n 1 1 3 4 Important messages from Pennsylvania American Water • Attention Pet Owners:At Pennsylvania American Water,we care deeply about our employees'safety.From time to time,our field staff must access your property to read the water meter or perform service work.When we do,we ask that you keep your pets inside in a separate room or on a leash at safe distance from the meter for the duration of the service visit.Keeping your pets secure for this brief amount of time goes a long way to prevent bites.Even the most gentle,well-mannered pets can become protective and aggressive around people it doesn't know. Thanks for helping to keep our employees safe. • Have you recently changed your primary phone number?if you have,please update your account information online using My H2O Online at www.amwater.com/myh2o or call us at the number below so that we can update our records. • Approximately 4.44 percent,or$0.67,of state taxes are included in your current bill. fG' ' • Any portion of the water charges which is not paid as of 08/14/2014 will be subject to a 1.50%penalty. Questions about this bill?Call our 24-Hour Customer Service Center 1-800-565-7292 www.pennsylvaniaamwater.com 0204371020637 ACRVOC ETMIC003124 (ACRVOC 0204370101B00) 633750341201 i r.1,. BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:August 22,2014 For Service To:1555 REVERE DR • Due Date:September 15,2014 For Account 1024.220003114658 • Billing period:Jul 22 to Aug 20(30 Days) Prior Balance • Customer Type:Residential • Balance from last bill 15,0p • Meter Reading Measurement: Payments as of Aug12.Thank yowl -15.00 1 unit=100 gallons of water Balance Forward 0,00 • Billing Measurement:100 gallons(CGL) current Water service Meter No. _ N082483811 • Water Service Charge 15.00 Size of meter 5/8" • Water Usage Charge($1.02140000 x 0.00) 0.00 Current Read 2,245(Actual) • Total Water Service Related Charges 15.00 Previous Read 2,245(Actual) TOTAL CURRENT CHARGES 15,00 Total water used this 0 units billing period (0 gallons) TOTAL AMOUNT DUE $15.00 Total Water Use Comparison(in 100 gallons) • Current billing period 2014: 0.00 CGL Pay your bill online:www.water.paymybill.com- • Same billing period 2013: 0.00 CGL CD Pay by phone:24-hours a day,every day at 1-866-271-5522 + Pay In person:Residential customers may obtain a listing of Billed Use Graph(100 gallons) 5 payment locations by visiting www.amwater.comjmyh2o Pay by mail:Remit your payment to the address shown above 4 — 3 2 1 � �ZV I, V Lllr 5 2 A S 0 N 0 J F M A M J 1 A 2 0 u a c o e a e a p a u u u 0 r /i 1 g p t v c n a r r y n I g 1 3 4 Important messages from Pennsylvania American Water • Attention Pet Owners:At Pennsylvania American Water,we care deeply about our employees'safety.From time to time,our field staff must access your property to read the water meter or perform service work.When we do,we ask that you keep your pets inside in a separate room or on a leash at safe distance from the meter for the duration of the service visit.Keeping your pets secure for this brief amount of time goes a long way to prevent bites.Even the most gentle,well-mannered pets can become protective and aggressive around people it doesn't know. Thanks for helping to keep our employees safe. • Have you recently changed your primary phone number?If you have,please update your account information online using My H2O Online at www.amwater.com/myh2o or call us at the number below so that we can update our records. • ***Final Bill*** This is your final bill for service.It has been our pleasure to serve you. • Approximately 4.44 percent,or$0.67,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 09/15/2014 will be subject to a 1.50%penalty. Questions about this bill?Call our 24-Hour Customer Service Center.1-800-565-7292 www.pennsylvaniaamwater.com 030457/030857 ACRZUF E7Mt000112 (ACR2UF 030467010130a) 612500569152 i Yyr r.If 1 � Past Bill information-UGI utility tt$tQt7'12r`Ctt(iir r• sr:rirr The account balance on your last bbl was._..___. $120.63 —�-- — CAROLS Summary for Service to Your balance a5 of payment 3/06/2014 $ 217429410012 CAROL 1555 REVERE O ESi 1555 REVERE DR MECHANICSBURG PA 17050 Rate Classification: Current Bill Information-UGI Utility Residential Heating Customer Charge.--------__.___________________w 5.55 j Billing Period: Commodity Charge(130 CCF of$0.62054)_ 80.67 1 01/3012014 to 03/03/2014(32 days) Distribution Charges{First 50 CCF at$0.33400) _. 16.70 Remote Device Read Distribution Charges Nerd 80 CCF at$0.25963).-. 21.57 Questions? PA State Tax Surcharge._.._._,..______.__________. -0.64 Call 800-276-2722 or mite to 11131 at Total Current Charges-UGI Utility------- 1209 1'b BDX 13009 UGI Uglify charges owed this bill __ _.._ _ _ _ $126.8: Reading.PA 19612.-3009 Total Amount Due,Please Pay by Due Date(09/27/2014).___..„»..___------ $126.81 Your current UGI charges include State taxes totaling about$4,08. Meter Information-Next Read Date April 2,2014 5.511 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used 4.95 1366404 4535(remote) 4665(remote) 130 4.40 3.85 Massages from UGI 3.30 •Your current price to compare is$0.62045/CCF. 2'75 •Your total annual usage is 686 CCF. Your average monthly usage is 57 CCF. 2.20 1.65 •We can make your energy costs easier on your budget with our 12 month Budget Billing 1.10 plan. Your monthly payment would be approximately$61.00. For more information 0.55 about this plan call UGI. 0.00 111telp prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. F M A M J J A S 0 N D J f `Sam time.Save the planet Sign up to view and pay your UGI bills online at www.ugi.com. 2013 Months 2014 (Jt -1gq � 1 D Last This ivi�r p5 Average Year Year 1D,O CCF/day 3.57 $06 Daily temperature 32°F 270F If you pay at a payment agent please take your entire bill. Make check payable toUGL Keep this part for your records. Important Information Is on the back of this bill. 1 I j Owe Past Bill Information-UGI Utility ir rrirrrr The account balance on your last bill was.,.______. $125.85 - -- I Thank u for your a Billing Summary for Service to: you Yo P ymeM of__......_..__.._.._.._...._. 126.85 217429414012 CAROLgSHERICK EST Your balance as of 04104/2014.................___...... S C/0 SCOTT SHERICK 1555 REVERE DR MECHANICSBURG PA 17050 Rate Classification: Current Bill Information-UGI Utility Residential Heating Customer Charge._.._..______..__......___..___„__......_. 8.55 Billing Period: Commodity Charge((83 CCF at$0.62048) ._....___. 51.50 0310312014 Remote DeviceR ad 014(29 days) Distributi on Charges(N First ext 33 CCF at$0.26939) 1 .-. 8.89 Questions? PA State Tax Surcharge ............. -0.43 Call 800-276-2722 or write to UGI at Thal Current Charges-UGI Utility 85.2 PQ BOX 13009 UGI Utility charges oared this h{it ________.._ $85.21 Reading,PA 19612-3009 Total Amount One,Please Pay.by Due Date(04/25/2014).....____.._________ $85.21 `Your current UGI charges include State taxes totaling about$214. Meter Information-Next Read Date May 2,2014 5.50 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used 4.95 1366404 4665(remote) 4748(remote) 83 4.40 3.85 Messages from UGI 3,30 •Your current price to compare is$0.62045/CCF. 2.75 •Your total annual usage is 672 CCF. Your average monthly usage is 56 CCF. 2.20 1.65 •We can make your energy costs easier an your budget with our 12 month Budget Billing 5.10 plan. Your monthly payment would be approximately$59.00. For more information 0.55 about this plan call UGL � 1 0.00 •Help prevent pipoline damage,accidents and service disruptions.Call Bt l before you dig. M A M J J A S 0 N 0 J F M- 'Save Ume.Sava the planet Sign up to view and pay your UGI bills online at www.ugi.com, 2013 Months 2014 Last This Average Year Year CCF/day 2.86 Daily temperature 38°F If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important Information is on the back of this bill. }' f5j • GIB 50 i 3 57 &I`l Past Bin Information-UGI utiutY Customer tum6er- ssr rrrrrrr The account balance on your last bill was.-..___-_. $85,21 ­ Billing Somme Wank you for your payment of.._..___....__,--______. -85.21 217429410012 CAROL SHERICK EST Your balance as of 05/06/2014...,_____-__.._____-- "�- C/O SCOTT SHERICK 1555 REVERE DR MECHANICS6UR0 PA 17050 Rafe Classification: Residential Heating Current Bill Information-UGI Utility Billing Period: Customer Charge-----------------------....__-_- 8-55 04tRemote4 to 05101/2014(30 days) Distribution Commodity Charges(First 43 CCF at$0.33419) ... 14.37 Remote Device Read PA State Tax Surcharge...__..________,.__ _ .. -0.25 Questions? - ------� Call 800-276-2722 or mite be UGI at Total Current Charges-UGI Utility.,_.,__.,_--__-___. 49.34 PO BOX 13009 UGI Utility charges owed this hill ----------__.--------—_-___„..__-_-....__-- $49.54 Reading.PA 19612-3009 Total Amount Due,Please Pay by Due Date(05/27/2014)------...,...________.... $49.34 'Your current UGI charges include Slate taxes totaling about$1.59. 5.50 Average CCF Per Oat Meter Information-Rex(Read Date June 3,2014 Meter Number Previous Reading Present Reading CCF Used 4.95 1366404 4748(remote) 4791(remote) 43 4.40 3.85 Messages from UGI 3,30 •Your current price to compare is$0,62045/CCF. 2.75 •Your total annual usage is 679 CCF. Your average monthly usage is 56 CCF. 2.20 1,65 •We can make your energy costs easier on your budget with our 12 month Budget Billing 1.10 plan. Your monthly payment would be approximately$58.00. For more information 0.55 about this plan call UGI. 0,00 •Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig, A M J J A S 0 N D J F M A `Save time.Save the planet Sign up to view and pay your UGI bills online at www.ugi.com. 2013 Months 2014 Last This Average Year Year CCF/day 218 1.43 Daily temperature 46°F 52°F If you pay at a payment agent please take your entire bill. Make check payable to DGI. Keep this part for your records. Important Information is on the back of this bill. I c eff Past Bill Information-UGI Utility Omer Number! r ire rirr The account balance on your last bill was ............ $49.34 CUSt Billing Summary for Service to: Thank you for your payment of.................................. -49.34 217429410012 CAROL SHERICK EST Your balance as of 06/05/2014 ................................ 6 C/O SCOTT SHERICK 1555 REVERE OR MECHANICSBURG PA 17050 Rate Classification: Residential Heating Current Bill Information-UGI Utility Billing Period: Customer Charge....................................._.._............... 8.55 05/01/2014 to 06/0212014(32 days) Commodity Charge(20 CCF at$0.62300)............ 12.46 Remote Device Read Distribution Charges(First 20 CCF at$0.33450). 6.69 Questions? PA State Tax Surcharge.-......-......_............................. -0.14 -Call 800-276-2722 or write to UGI at Total Current Charges-UGI Utility.............-.............2Y.3G PO BOX 13009 UGI Utility charges owed this bill ......................_........................-............. $27.56 Reading,PA 19612-3009 Total Amount Due,Please Pay by one Date(06/Z6/2014)....__..................-....... $27.56 `Your current UGI charges include State taxes totaling about$0.89. Meter Information-Next Read Date July 2,2014 5.50 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used 4.95 4.40 1366404 4791 (remote) 4811 (remote) 20 3.85 Messages from UGI 3.30 . •Your current price to compare is$0.66159/CCF. 2.75 •Your total annual usage is 675 CCF. Your average monthly usage is 56 CCF. 2.20 1.65 •We can make your energy costs easier on your budget with our 12 month Budget Billing 1.10 plan. Your monthly payment would be approximately$61.00. For more information 0.55 about this plan call UGI. 0.00 •Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. M J J A S 0 N D J F M A M •Save time.Save the planet Sign up to view and pay your UGI bills online at www.ugi.com. 2013 Months 2014 )(' I -Last This f 5� � Average Year Year CCF/day 0.80 0.63 If you pay at a payment agent please your entire bill. Make check payable to UGI. Daily temperature 63'F 63°F P Ya Keep this part for your records. Important information is on the back of this hill. Past Bill Information-UGI Utility � . •"" C b Customer Num r.r rre rirr The account balance on your last ill was .................. $27.56 � "- Billing Summaryry for Service to: Thank you for your payment of..............................._...... -27.56 217429410012 CAROL SHERICK EST Your balance as of 07/07/2014 ................._..,..............�>,f C/O SCOTT SHERICK 1555 REVERE OR MECHANICSBURG PA 17050 Rate Classification: Residential Heating Current Bill Information-UGI Utility Billing Period: Customer Charge................_................................_............ 8.55 06/02/2014 to 07/01/2014(29 days) Commodity Charge(14 CCF at$0.66143)................ 9.26 Remote Device Read Distribution Charges(First 14 CCF at$0.33643)3333.. 4.71 Questions? PA State Tax Surcharge..................................................._ -0.11 Total Current Charges-UGI Utili ...................I............�2 POI BOX 13003 722 or write to UGI at UGI Utility charges owed this bill................. . $22.41 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(0712812014)............_.............I....._. $22'.41 Your current UGI charges include State taxes totaling about$0.72. P f �V Meter Information-Next Read Date August 1,2014 5.50 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used 4'85 1366404 4011 (remote) 4825(remote) 14 4.40 3.85 Messages from UGI 3.30 •Your current price to compare is$0.66159/CCF. 2'75 'Your total annual usage is 674 CCF. Your average monthly usage is 56 CCF. 2.20 1.65 •We can make your energy costs easier an your budget with our 12 month Budget Billing 1.10 plan. Your monthly payment would be approximately$62.00. For more information 0.55 about this plan call UGI. 0.00 •Help prevent pipeline damage,accidents and service disruptions.Call 611 before you dig. J J A S C N D J F M A M J •Give back to the heroes in our community during our Summer of Heroes Sweepstakes, 2013 Months 2014 going on until July 31.Like our Facebook page to donate$1 to Keystone Wounded Warriors.www.fambook.com/ugiutilities •Are you or anyone you know planning to build a new home?Visit www.findnbuild.com for Last This valuable tips and a free mobile app. Average Year Year CCF/day 0.48 0348 If you pay at a payment agent please take your entire bill. Make check payable to UGI. Daily temperature 72°F T3°F Keep this part far your records. Important information is on the back of this bill. past Bill Inf6Finati6h•uGi UtiU ttyy mer Number Theaccount balance eri your lastbiliwas.....__-__. $2241 [CUStO- - - • - � • 1 -= - Thank you for your taymehl of.._____------_______- -2241 217429410012 ' CAROL SHERI ma`r".fof 9eitrict to: Your balahce as of CAROL$HERICK EST CIO SCOTT SHERICK 1555 ANICSB OR MECHANICSRURG PA 77050 ttate Classification: Residential Hosing curtest Bill IdWinatidh-U91 utility Billing 014i6d: Customer Charge.............._...,.__..____...._......__..__. 8.55 01/01/2614 to00/01/2014(at days) Commodity Charge( 13CCFat$0.66000) .....__.._. 8.58 Estimated Read Distribution Charges(First 13 CCF at$0.33592) _. 4.38 Qdesti6tio_ ._ PA State Tax Surcharge._.._.._r:...--------.-------:..... -0.11 Call 800-276-2722 of wiite to UGI at Total Current Charges-UGI Utility_..___________... 2T. '6 - PD BOX 13009 UW utility cNatges owed this I __.._..__ __......____...._______________.._...-- $21.40 Reading,PA 19612-3009 Total Areoudt Due,Please Pay by Due Date(08/27/2014) $21.40 Your current UGI charges inblude State taxes totaling abdut$0.69. Meter Infofrfiatidh-Nlixt hbad Data Septeh3liet 2,2014 9 5g Average CCF Per tray Meter Number Previous Reading Present Reading CCF Used 4.95 4.40 1366404 4825(remote) 4838(estimated) 13 3.86 Messages from UGI 3.30 •Your current•prise to compstb is$0.66159/CCF. 2.76 ` 2.20 Your total annual usage is 676 CCF. Your average monthly usage is 56 CCF. 1,65 s We can make your energy costs easier on your budget with our 12 month Budget Billing 1.10 plan. Your mbhthly payment would be apprmomately$62.00. For more inforihat on 0.53 about this plan call UGI. 0.00 'Help prevent pipeline damags,accidents and service disruptions.Call 811 before you dig. J A_S 0 N M J F M A M J J •Are you or anyone you know planning to build a new home?Visit www.fndnbuild.cam fdr 2015 Months 2014 valuable tips and a free mobile app. + =Estimated Usage 'UGI's SumPnet Reading program promotes reading and childhood literacy.We're giving $1 D Amazon gift card to the first 200 children who participate.Visit Last This www.facebobk.cam/ubiutilitidsfor details. Average Year Year i Save tima Save the planet.Sign up to view and.pay your UGI bills online at w- .ugi.com. CCF/day 0.42 Wily tAmperalure 73°F If you pay it a payment agent please take your @Afire bill. Make check payable to UGI. Keep this patt for your records. ItriPortaM information is.en the back of this(dill. 1 r �d . q4 !� �4-� Past Bill Information-UGI tl6lity Customer Number, , Ri rrrr The account balance an your last iit was._.._____„ $21.40 - - Thankyouforyourpaymentof___..„..__.._.._..____„ -21.40 2174294it3Q12 BillingSummal1yyfurServiceto: Your balance as of 08/2512014________..______.._„-6UB CARpL SHERICK EST C/o SCOTT SHERICK 1555 REVERE DR ME:HANICSBURG PA 17050 Rate Classification: Residential Healing Current Rill Intonation-UGI Utility Billing Period: Customer Charge------------------------------------- 5.70 0810112014 to 0812112014(20 days) Commodity Charge(6 CCF at$0.66000)--------- 3.96 Final Read Distribution Charges._____.„..........._......__________„ 201 Questions? PA State Tax Surcharge.__„..„.__...._......_...„.______„ -O.p6 Call 800-276-2722 or write kt UGI at Total Current Charges-UGI Utildy__......_.._..__.........�1.-D'I Ca BOX -276- UGI Utility charges owed this bill__........ ......._.._„..„„__.._____».__._____..__ , $11.6' Reading.PA 19612-3009 Total Amount Rue,Please Pay by Due Date(0911512014)----------------- . S 11.6` 'Your current UGI charges include State taxes totaling about$037. Meter Reading information 5.50 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used 4.95 4.40 1366404 4838(estimated) 4844(final) 6 3.85 Messages tram UGI 3.30 •Your current price to compare is$0.66159 tCCF. 2.75 aYour total annual usage is 676 CCF. Your average monthly usage is 56 CCF. 2.20 1.65 •Thank you for your business. You have maintained an excellent payment history with UGL 1,10 This bill may be used as a credit reference for obtaining future utility service. 0.55 •Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. 0.00 ASONDJFMAMJJA 2015 Months 2014 • =Estimated Usage Last This Average Year Year CCF/day 0.42 0.30 . Maily temperature 74°F 71°F If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. adikti., l3 Anne Dat aid: 1 Check No.: Amount Paid: $ � mers Association I Please keep this stub for your records n April 29,2014 MAY 2014 RE: Check#5003 Please be advised that we received check#5003in the mail on April 15, 2014. We are not able to process it because the Pay to the Order is made out to Sterling Property Management. Please make sure that when paying your monthly fees, your check is made payable to Brandywine Homeowners Association Homeowners Association. I have notated your account so no late fees will be charged for the month of January. Please correct this error and send the check back in. Also, you had a$75.00 credit on the account so April's HOA has been taken care of. Please only mail a check for May, if you have not already. If you have any questions regarding this matter, please feel free to contact me. Sincerely, Sterling Property Management, Inc. for Brandywine Homeowners Association Jennifer Holtry Chief Association Officer Enclosure CK- Sod-T 1Z ,4,,^d 337 Lincoln Street - Carlisle, PA 17013 (717) 258-5800 - Fax (717) 258-5805 SterlingPMI@comcast.net Associations-spm@comcast.net a 4 r i Date Paid: Check No.: 6oi5 Amount Paid: $ -7 5• Please keep this stub for your records I I JUNE 2014x' --------------------------------- ra .v.4 eft �i^'rig I --------------------------------------- Date Paid: � I Check No.: Amount Paid: $ 5' I Please keep this stub for your records I I JULY 2014 ---------------------- --------------------------------------- Date Paid: Check No.: Amount Paid: $ �� Please keep this stub for your records AUGUST 2014 ' ' 1 HAMPDEN TOWNSHIP 230 S SPORTING HILL ROAD £ 1 MECHANICSBURG,PA 17050 1 (717)761-0119(Township Office) (717)909-7145(Utility Billing) ��` OPIE cod PAST DUE NOTICE WILLIAM G SHERICK RE: Account Number 100475-000 1555 REVERE DR Account Name WILLIAM G SHERICK MECHANICSBURG, PA 17050-2246 Service Location 1555 REVERE DR Past Due Amount $185.05 Additional Charge $15.51 Amount Due $200.56 Due Date Saturday,May 31,2014 Dear Customer: 0510112014 Payments received after April 30,2014 are not reflected on this statement. If you have already made your payment,please disregard this notice and accept our thanks. Payment of the past due balance is due by May 31,2014 in order to avoid additional penalties and interest. We accept cash, checks, Visa and Mastercard. Credit card payments may be made on our website found below. Checks returned by the bank are subject to a$30.00 fee. Please contact our office with any questions. Sincerely, PAID Utility Billing Hampden Township 230 S. Sporting Hill Rd. MAY 14 2 0{ Mechanicsburg, PA 17050 www.hampdentownship.us HAMPDEN TOWNSHIP UTILITIES Payment AMOLINTOUE it o u p o ni PAST DUE AMOUNT $185.05 ACCOUNT •' • LATE CHARGE $15. PLEASE RETURN THIS PORTION ALONG WITH YOUR PAYMENT TOTAL AMOUNT DUE BY 5/3112014 200.56 PLEASE MAKE,CHECK PAYABLE TO: AMOUNTENCLOSED HAMPDEN TOWNSHIP ACCOUNT: 100475-000 REMIT PAYMENT TO: V lsol SERVICE ADDRESS: 1555 REVERE DR BILLING DATE: 05/01/2014 Hampden Township 230 S.Sporting Hill Rd. DUE DATE: 05131/2014 Mechanicsburg, PA 17050 WILLIAM SHERICK www.hampdentownship.us 1555 REVERE DR MECHAN C BURG, PA 17050-2246 ItiIIVU�III�BI�WII�IIIIII���III�I�tlI�WIIItl�901IVlll� Printer Friendly Page 1 of 1 Hampden Township Date: . 5/14/2014 3:37:00 PM Your Account Number: 100475-000 Amount Paid: $200.56 Your reference number is : 241690559 .tint https://hampden.merchanttransact.com/secure/recelptPf.aspx?CustomerldentityId=XBaM... 5/14/2014 5035 Account HAMPDEN TOWNSHIP Statement 230 S SPORTING HILL ROAD ACCOUNT INFORMATION 1 MECHANICSBURG,PA 17050 (717)761-0119(Township olfice) ACCOUNT: 100475-000 9F P (717)909-7145(Utility Billing) SERVICE ADDRESS: 1555 REVERE DR pF0 E coM�`^ SERVICE PERIOD: 7/12014 to 9/302014 BILLING DATE: 7/12014 DUE DATE: 7131/2014 METER READING WILLIAM SHERICK C/O SCOTT SHERICK NO ACTIVE METER FOUND 121 WILLOW LAKE DR. CARLISLE, PA 17015 SPECIAL MESSAGE CURRENTCHARGES Any portion of the sewer and/or trash charges which is not Residential Sewer �4O.2 paid by 07/312014 is subject to a penalty of 10%. All Trash Service .80 r eturned checks are subject to a fee of$30.00. . Non Sufficent Funds 00 TO MAKE YOUR PAYMENT ONLINE PLEASE GO TO WWW.HAMPDENTOWNSHIP.US TOTAL CURRENT CHARGES 185.05 HISTORY USAGE NO USAGE HISTORY PREVIOUS BALANCE 155.05 PAYMENTS RECEIVED -355.61 ADJUSTMENTS 170.56 ADDITIONAL BILLING 30.00 CURRENT CHARGES 155.05 TOTAL AMOUNT DUE 155.05/ ✓ Payment rAAMOUNTDUE ('•npinnn TOTAL AMOUNT DUE BY 7131/2014 155.05 a �I q 7 orr/Sol, FUNERAL HOME, INC. 110 Petroleum St. Oil City, PA 16301 Phone: (814) 677-4000 Michael D. Morrison, Supervisor February 21, 2014 Scott Sherick 121 Willow Lake Dr Carlisle, PA 17015 Dear Scott: We finally received from Vital Records today the certified copy of Amy Ochalek's death certificate which you requested. We are enclosing the same. The cost for this certificate is $9.00 which should be remitted to Morrison Funeral Home upon your receipt of this letter. If we can be of further assistance,please do not hesitate-to contact us. Sincerely, r_ Michael D. Morrison Supervisor Enclosure a�� ad�oc��a 00 ;. 'H �� : � s� � TTe � m�A� m� � p4 ���� � p .T. Eli� 5� n : o $ z3¢., R '1gp � p s ci � 5 1r, A { a o O u'S u L7 Q# tit " ; 9� F Zw -ri Z� m °' 2 151 .: o. 5 n�a, tnr n > 4 �*im � � N s. 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N Y ?gym m i,!3m g '''f:.^ j. �(a m .7� r� .?' o ..^_d G � VVO 0 d z z K y ' (fl '7 i (C7.7 0 m - s p -COW 1 w � 0-n a sm- < 55° "'�cio ? o Xch Z j J ��...�ram z fm i DEW M fj mm9ymFo o v 3] � � Z m T y y oz o y �'%. �.+ Z p P m .r oQV O4r�o a � S 4a „ py� Z_ V - A AN O • > OC pD ya cbib" C n 11� � x �m m� mm K 4O b Y . .. m 1• C .F 0<0a \ \S N ❑ mni O H ` m � A.Settlement Statement U.S.Department of Housing OMB Approval No.2502-0265 and Udum Development B.Type of Loan 1.1 1 FHA 2.1 J RHS 3.1 I Conv.Unins. B.File wnflor. 17.Loan Numder. 18.Mortgage Insurance Case Num m 4.1 I VA 5.1 1 Conv.Ins, 401402372.5K C. NOTE:This fame is WnIished to g'we you a statement of actual settlement casts.Amounts paid b and by the sedkmam agent am shown,ttoms marked!'(p.oe)'were paid outside of the closing:they are mown here for Informt onal purposes and am not Indus"in the(Nela. D.Name and Addms of Borrower E.Name and Address of Sailot I F.Nam and AOdress of Lender WILLIAM J.SMYERS AND CAROL J. 5COTT W.SHERICK.EXECUTOR OF SMYERS ESTATE OF CAROL P.SHERICK AM/A CAROL SHERICK 6185 RIVENDALE COURT MECHANICSBURG.PA 17050 121 HALLOW LAKE DRIVE CARLISLE.PA 17015 G.Frontally Locatbn H.SnWmen Agent 1555 REVERE DRIVE, SECURED LAND TRANSFERS,LLC L MECHANICSBURG,PA 17050 e I.Sefk ent Data 082101 COUNTY:CUMBERLAND 3PY1e$f Strtet PARCEL ID:10-151282-077 bill, PA 10011 Otahartomem ono aemre614 TOWNSHIP:HAMPDEN TOWNSHIP �� J.SUMMARY OF BORROWER'S TRANSACTIONS IK.SUMMARY OF SELLER'S TRANSACTIONS 100.Gross Amount Due From Borrower 1400.Groan Amount Due To Salk, 101.Converted Sobs Prkn $245.000.00 401.Contact Sales Price 52.5.000.00 102.Personal Property 402.Personal Property 103.Settlement Charges to Bone &4.620.00 403. Adlusmnta For Rams Paid By Sellerin Advance Ad)ustmenb For Items Paid By Seller In Advance 113.CXytTawn Tales 413.Cltyrtoim Tosses 114.County Taxes 6N.241yr 8212014 to 1 112015 5228.19 414.County Taxes 626.24/yr 8212014 to IIIRO15 $228.19 115.School Taxes 2.133.56tyr WL2014 to 7112015 $1.835.45 415,School Taxes 2.13356yr 8212014 to 7/12015 !1.83565 118.Asxanments 418.Asaessmerls 18. 119. 122.Assoc Oues 75.00Ano for 8212014 to 9112014 $26.61 422.Assoc Dues 75.0dmo for 8212014 to 9/12014 $26.51 123.Sewer and Refuse 155.OSrgtr for 6212014 10 569.10 423'Sewer am Refuse 155.OSIgtr for 8212014 to $88.10 10112014 1¢11201. 120.Gros,Amount Duo From Borrower $251.779.35 420.Groan Amount Des To Setter $247,159.35 200.Amounts paid By Or fn Bohag Of Borrower 600.RoducUons In Amount Due To Seller ' 201.Dapult or earmst rnmy $2,500.00 501.Excess Deposits 202.Prm al 602 Sedtammt Charges W Selby 318,198.56 203.E1NtIIlg Loan(s)Taken SuD:ed to 503.Existing Loans)Taken SuOJest to 204. SOa.payoff First Mortgage to Chase 5116,333.79 Ad)ustnronts For Rerm Unpaid By Seller Adjuatmenb For Mms Unpaid By Salk, 210. 510. 211. 511. 212. 512. 213.Cit,17.Taxes 513.CIIyRown Taxes 214.County Taxes 514.County Taxes 218.Assessments 518.Assessments 219.HOA 16m 228.Boyne.Total Credits $2,500.001520.Settees Total Charges S134,532.35 _300.Cash At SeOlemenl FroMfo Bonow tr 600.Cash At SeUkm*M TolFrom S,Itar 381.Gross Amount Due From Dormer(gne 120) 3251,779.35 601.Goss Amount Duo To Seller(Ina 420) !2/7.159.35 302.Less Amounts Paid BylFW Bonower(line 220) 52,500.00 602.Less Deductions In Amt.Des To Sugar(line 520) 3134.532.35 303.Cash I X I From 1 I To Hanover 1 $249,279.351603.Cash(X I To f I From Sellar 1 $112,627.00 40/402372-SK Page 2 L,SMV..nt SbLmanl 700.Total Sale Commission 248000.00 @ 5.5%e 13475.00 Oivalen of Commision(Of 700)As Folows: Paid Fixed Bomman's Pald Finest Sead's 701,$$12400 to RSR Rest= Funds At Sentemem Funds At Samemem 702.57350.00 to ERA-NRT,LLC 703,Commission paid at settlement $13.475.00 $00.Items Payable In Connection With Loan $01.Loan OdgMation Fee 802.Loan Oacoum $03,Appraisal Fee 804.Creda Report $O5.tends,Inspection Fee 900.Morn Resists,!By Lander To Be Paid 1.AMance 901.Interest 902,Mortgage Msum ns Premium 903.Haws,Ins,Pmmlun 1000.Reasrvi s Ov"ifted Wi a Lander 1001.Havard ins.Raerw 1002,Mortgage Ina,Reserve 1005.City Properly Taxes 1004.County Property Tam 1010.Apgnegate Accounting Adjustment 1100.Tnla CMrg" 1101.ScosemenWINing Fee an Speared Lend Tnnsfam,LLC $100.00 $1g2.ADSbnpor TdM Seartn 1103.710k exam psi 1104.Tills ft s rra"Rirger 1105.Cocument prepmation 1108.Selef tblary Fee to Secured Land TramfCn,LLC Slom 51000 1107.Alma ny Fee 1105.TOO led,Toad to Secured LeM Tranafon,LLC 31,925.00 1109.Landers Covamge 5(S) 1110.0-cues Courage$245000.00($1825.00) 1119,Wirt Translor Fee Win,Pays"to SaGned Land Tremfcrs,LAC S45.W 1200.Govammani F4,001 ing And Tn di Charges _1201.Recording Fees for Deed 77.00;Recandkg Fees for Morgago 577.00 1202,City/County Tax/Stamps 2450.00 $2..50.00 $203.State Does Tax 2450.W 22,450,00 1300.AddtSonal Satt4meat Charges 1304 20142015 School Taxes to Michael Langan.Tax Colkrtor 32.133.59 1307.August HOA Due and Late Fee to Bmmywfty Homeawmn Association,Inc. $55 00 1308.Repair Credit to Scott W.Sheds $358.00 1400.Total Saldemeat Changes 114.620.001 S18.196% 1 muss o mefully nevkwed the hVD4 Seelemenl Statement and to tie test of my Imouladge and b,shi8 a Vue and acW rare sheamem of all teceipis and dtlauraemam9 made On my account or by me In this IMnsadlon.I Wher cards Nat I nave Meshed a Way of the HUD,1 Settlement Ststeeme. BUYERS (nj SELLERS EskMIN tbt P.SnericsAva Carat�S}ttedck t Mason 1,SIMM% j u-.met+ 8 1 ar:boon w.snana.Exewtpr Cae J.Smyvn Thx,HUa1Settle 1 telemenI,Mi I haft metamtl Isom and amaata aeuuM at9datronsachm i have uusedmwilum Me fWstoW disbutsedln attofdanm with this sudement, Dab "'•"^ F� 0821/2014 �i-T 1 _ 99118 Page 1 of 3 Customer CHASE ® Monday ay Fridayice 88am mi d im (1ET) Hearing Impaired(1TY) 1-800-582-0542 chase.com IIhillrllrlrrlllurlllrhrl111PI1111111IIIrIrIIIIIrIIIruI 99118MWD Z00914C- YREaRENCCP3 Mortgage Loan Statement WILLIAM G SHERICK Loan Number 4502272500 CAROL P SHERICK Statement Date 01/02/2014 1555 REVERE DR MECHANICSBURG PA 17050-2246 Property Address 1555 Revere Drive Mechanicsburg,PA 17050 Total Payment Due $983.00 Payment Due Date 2/1/2014 A late charge of$33.74 may apply if received after 02/16/2014. Loan Overview Total Payment For This Billing Period Includes Original Principal Balance $127,500.00 Unpaid Principal Balance $117,269.35 Principal $198.34 Interest Rate 4.87500% Interest $476.41 Escrow Balance $2,157.76 Escrow Payment(Taxes and Insurance) $308.25 Total Monthly Payment $983.00 Past Payments Breakdown Fees/Charges $0.00 Paid Since Last Statement Paid Year-to-Date Total Payment Due $983.00 Principal 5797.54 $197.54 Interest $477.21 $477.21 Escrow Payment(Taxes and Insurance) $308.25 $0.00 Total $983.00 $674.75 Transaction Activity Since Your Last Statement (Including Fees/Charges) Transaction Date Description Total Received Principal Interest Escrow Fees Unapplied Funds 01102/2014 PAYMENT $983.00 $197.54 $477.21 $308.25 Important Messages Your 2013 IRS Form 1098(Mortgage Interest Statement)is enclosed. It is also available to view and print on chase.com/raxStatement. If your mortgage loan servlcing transferred to Chase this year,and you would like to see,your previous payment history,please call the number at the top of this statement. We've Improved your mortgage statement by adding more details about your account. Please see the enclosed guide for quick and easy tips for reading your newly improved statement. , Chase has many programs and benefits available to most the unique needs of our military customers,their families and beneficiaries. For more Information,visit ChaseMllitary.com or call 1-877-469-0110. Overseas call collect 1-318-3403308. TTY: 1-800-582-0542. If you receive or expect to receive an Insurance claim check for damages to your home,you can visit chase.comAnsuranceClaim for Information about our claim process. If you have any questions,please call us at 1-866-742-1461 Monday through Friday from 8 a.m.to midnight and Saturday , from 8 a.m.to 8 p.m. Eastern Time. -N 08946 Page 1 of 2 Customer CHASE Chi ® Monday rday Friday Seam midnight Hearing Impaired(TTY) 1-800.582-0542 � 3. chase.com IIrr11�II��IIrrrllllhlrl�Pll�rd��J�rlrLlldll�'��III�'I�II�r 08846 MIND 202411 C- SHE NCC P3 Mortgage Loan Statement WILLIAM G SHERICK Loan Number 4502272500 CAROL P SHERICK Statement Date 01/24/2014 1555 REVERE DR MECHANICSBURG PA 17050-2246 Property Address 1555 Revere Drive Mechanicsburg,PA 17050 Total Payment Due $983.00 Payment Due Date 3/112014 A late charge of$33.74 may apply if received after 03/16/2014. Loan Overview Total Payment For This Billing Period Includes Original Principal Balance $127,500.00 Unpaid Principal Balance $117,071.01 Principal $199.15 Interest Rate 4875000/6 Interest $475.60 Escrow Balance S2,466.01 Escrow Payment(Taxes and Insurance) $308.25 Total Monthly Payment $983.00 Past Payments Breakdown Fees/Charges $0.00 Paid Since Last Statement Paid Year-to-Date Total Payment Due $983.00 Principal 5798.34 $395.88 Interest 5476,41 $953.62 Escrow Payment(Taxes and Insurance) $308.25 $0.00 Total $983.00 $1,349.50 Transaction Activity Since Your Last Statement (Including Fees/Charges) Transaction Date Description Total Received Principal Interest Escrow Fees Unapplied Funds 01124/2014 PAYMENT $983.00 $198.34 5476.41 $308.25 Important Messages If your mortgage loan servicing transferred to Chase this year,and you would like to see your previous payment history,please call the number at the top of this statement. We've Improved your mortgage statement by adding more details about your account. Please see the enclosed guide for quick and easy Ups for reading your newly Improved statement. Chase has many programs and benefits available to meet the unique needs of our military customers,their families and beneficiaries. For more I Information,visit ChaseMilitary.com or call 1-877-469-0110. Overseas call collect 1-318-340-3308. TTY: 1-800-582-0542. If you receive or expect to receive an Insurance claim check for damages to your home,you can visit chase.comAnsurenceClalm for Information about our claim process. If you have any questions,please call us at 1-866-742.1461 Monday through Friday from 8 a.m.to midnight and Saturday from 8 a.m.to 8 p.m.Eastern Time. V Please detach and return the borrom portion of this statement with your payment using the enclosed envelope. V 13471 Pagel off Customer CHASE imp Mo daay Friday riIce 6 .ammie imt(ET) �d 3Xatit' c1z, Hearing Impaired(TTY) 1-600582-0592 ® chase.com �Irlr�l�llll��l�'1��II1rl11rlll�l�l�1r111��rrllrr�llrrrrll�llllll 13471 r.1wo Zossl4c- an2 Mortgage Loan Statement WILLIAM G SHERICK Loan Number 4502272500 CAROL P SHERICK 1555 REVERE DR Statement Date 02/27/2014 MECHANICSBURG PA 17050-2246 Property Address 1555 Revere Drive Mechanicsburg,PA 17050 Total Payment Due $983.00 Payment Due Date 4/1/2014 A late charge of$33.74 may apply If received after 04/16/2014. Loan Overview Total Payment For This Billing Period Includes Original Principal Balance $127,500.00 Unpaid Principal Balance 5116,871.86 Principal $199.96 Interest Rate 4.875000% Interest $474.79 Escrow Balance S2,774.26 Escrow Payment(Taxes and Insurance) $308.25 Total Monthly Payment $983.00 Past Payments Breakdown Fees/Charges $0.00 Paid Since Last Statement Paid Year-to-Date Total Payment Due $983.00 Principal $199.15 $595.03 Interest $475.60 $1,429.22 Escrow Payment(Taxes and Insurance) $308.25 5924.75 Total $983.00 $2,949.00 Transaction Activity Since Your Last Statement(Including Fees/Charges) Transaction Date Description Total Received Principal Interest Escrow Fees Unapplied Funds 02/27/2014 PAYMENT $983.00 $199.15 $475.60 $308.25 Important Messages If your mortgage loan servicing transferred to Chase this year,and you would like to see your previous payment history,please call the number at the ! top of this statement. Your mortgage loan payment—your way!Choose any one of our services:automatic payments,online bill pay,over the phone,by mail,or in person. Visit chase.com/WaysToPay for more information about your payment options. Chase has many programs and benefits available to meet the unique needs of our military customers,their families and beneficiaries. For more r Information,visit ChaseMilitary.com or call 1-877-469.0110.Overseas call collect 1-318-340-3308.TTY:1-800-582-0542. I If you receive or expect to receive an insurance claim check for damages to your home,you can visit chase.comAnsuranceClalm for information about our claim process.If you have any questions,please call us at 1-866.742-1461 Monday through Friday from 8 a.m.to midnight and Saturday from 8 a.m,to 8 p.m. Eastern Time. , V Please detach and return the bottom portion of this statement with your payment using the enclosed envelope. V 08480 Page 1 of 1 ® °tlay riiee m (CHASE i Customer Friday 8 am. T)B h E Pd • )!�'/ . I I en O/1 Hearing Impaired(TTY) 1-800-582-0542 VO" 1F'Y (,I ® chase.com rrI1dII�IIId�IJll��lr�'I'�'III'll��urllrllll'IPnrIItItIIIII 08490 MWD 20951<C- 891 PA T% Mortgage Loan Statement WILLIAM G SHERICK Loan Number 4502272500 CAROL P SHERICK Statement Date 03126/2014 1555 REVERE DR MECHANICSBURG PA 170502246 Property Address 1555 Revere Drive Mechanicsburg,PA 17050 Total Payment Due $983.00 Payment Due Date 5/12014 A late charge of$33.74 may apply if received after OSr1612014. Loan Overview Total Payment For This Billing Period Includes t Original Principal Balance $127,500.00 Unpaid Principal Balance $116,671.90 Principal $200.77 Interest Rate 487500°/, Interest $473.98 Escrow Balance $2,468.79 Escrow Payment(Taxes and Insurance) $308.25 Total Monthly Payment $983.00 Past Payments Breakdown FeestCharges $0.00 Paid Since Last Statement Paid Year-to-Date Total Payment Due $983.00 Principal $199.96 5794.99 Interest $474.79 $1,904.01 Escrow Payment(Texas and Insurance) $308.25 $1,233.00 Total $983.00 $3,93200 Transaction Activity Since Your Last Statement (Including Fees/Charges) Transaction Date Description Total Received Principal Interest Escrow Fees Unapplied Funds 03'18t2014 TOWNSHIP TAX PAID $613.72 03!26'2014 PAYMENT $983.00 $199.96 $474.79 $308.25 Important Messages The year-to-date amount in the Past Payments Breakdown of your February statement may have been incorrect.Your March statement lists the correct amount.We apologize for any Inconvenience. If your mortgage loan servicing transferred to Chase this year,and you would like to see your previous payment history,please call the number at the top of this statement. Your IRS Form 1098(Mortgage Interest Statement)Is available on chase.com(raxStatement.Most accounts can be viewed online. Important Notice To Servicemembers And Their Dependents:If you or any owner or occupant of your home Is a federal or state Military Servicemember who is,or within the last year was,on active duty or active service,or a dependent of such a Servicemember,you may be entitled to certain legal rights and protections.For more information,please call us at 1-877-469-0110. If you receive or expect to receive an insurance claim check for damages to your home,you can visit chasa.comllnsurenceClaim for information about our claim process.If you have any questions,please call us at 1-866-742-1461 Monday through Friday from 8 a.m.to midnight and Saturday from 8 a.m.to 8 p.m. Eastern Time. V Please detach and return the bottom portion of this statement with your payment using the enclosed envelope. V 05867 Page 1 of 1 Customer Service �e p CHASE !% MondFri 8 m raay a a.m. (ET) , AIL 8x j Hearing Impaired(TTY) 1.8 -582.0642 anase.com ill,IUlId14hNt„)IIlI(h11�411IIIh�h�rd�dlll����I„p, Mortgage Loan Statement oseaa enw0 Z10014 C- an2 as WILLIAM G SHERICK Loan Number 4502272500 CAROL P SHERICK Statement Date 0411812014 1555 REVERE DR MECHANICSBURG PA 17050-2246 Property Address 1555 Revere Drive Mechanicsburg,PA 17050 Total Payment Due 598100 Payment Due Date 6/1/2014 A late charge of 533.74 may apply if received after 0671672014. Loan Overview Total Payment For This Billing Period Includes Original Principal Balance $127,500.00 Unpaid Principal Balance $116,471.13 Principal $201.59 Interest Rate 4.675000/6 interest 5473.16 Escrow Balance 52,777.04 Escrow Payment(Taxes and Insu(ance) $308.25 Total Monthly Payment $983.00 Past Payments Breakdown FwsXhargw SOAR Paid Since Last Statement Paid Year-to-Date Total Payment Due $983.00 Principal 5700.77 5995.76 Interest $473.98 52,377.99 Escrow Payment(Taxes and Insurance) 5308.25 $1,541.25 Total $983.00 $4,915.00 Transaction Activity Since Your Last Statement (including Fees/Charges) Transaction Data Description Total Received Principal Interest Eacrow Fees Unapplied Funds 0471 8/2014 PAYMENT 5983.00 5200.77 5473.98 $308.25 Important Messages It your mortgage Icon servicing transferred to Chase this year,and you would like to see your previous payment history,please rail the number at the top of this statement. Sign up for automatic mortgage payments and also be entered Into a grand-prize drawing for=,OOO,plus drawings for$1,000 every other week. Enroll today at chase.com/WinWithAutopay. Important Notice To Servicemembem And Their Dependents:If you or any owner or occupant of your home is a federal or state Military ' Servicemember who is,or within the last year was,on active duty or active service,or a dependent of such a Servicemember,you may be entitled to certain legal rights and protections.For more information,please call us at 1.877-469.0110. ' If you receive or expect to receive an Insurance claim check for damages to your home,you can visit chase.comllnsuranceClelm for information about our claim process,If you have any questions,please call us at 1.866.742-1461 Monday through Friday from 8 a.m.to midnight and Saturday ' from 8 a.m.to 8 p.m-Eastern Time. LAY V Please detach and return the bottom portion or this statement with your payment using the enclosed envelope. 7 04991 Page 1 of I Customer CHASE / � ® Monday Sbyae 86ammapm`(1ET) Rearing Impaired(TTY) 1.800-582-0542 ® chasomom "1�iilili'I�II�.rI,Ilslir11j'.�II�I��IIrirll�irr�rrrll�jllil�i.r 04941 MWO Z141140 BR2A3 Mortgage Loan Statement WILLIAM G SHERICK Loan Number 4502272500 CAROL P SHERICK 1555 REVERE DR Statement Date 05121/2014 MECHANICSBURG PA 170502246 Property Address 1555 Revere Drive Mechanicsburg,PA 17050 Total Payment Due $Payment Due Date A late charge of$33.74 may apply if recelve er 07/16/2014. Loan Overview Total Payment For This Billing Period Includes Original Principal Balance 5727;500-00 Unpaid Principal Balance 5116 269 54 Principal $202.40 Interest Rate 4.875000/6 Interest 5472.35 Escrow Balance 53,085.29 Escrow Payment(Taxes and Insurance) $308.25 Total Monthly Payment $983-00 Past Payments Breakdown Fees/Charges $0.00 Paid Since Last Statement -Paid Year-to-Date Total Payment Due $983.00 Principal 5201.59 $1,197.35 Interest $473.16 $2,851.15 Escrow Payment(Taxes and Insurance) $308.25 $1,849.50 Total 5983:00 $5,898.00 Transaction Activity Since Your Last Statement (Including Fees/Charges) Transaction Date Description Total Received Principal Interest Escrow Fees Unapplied Funds 05121/2014 PAYMENT 5983.00 5201.59 $473.16 5308.25 Important Messages It your mortgage loan servicing transferred to Chase this year,and you would like to see your previous payment history,please call the number at the top of this statement. Sign up for automatic mortgage payments and also be entered Into a grand-prize drawing for$30,000,plus drawings for 51,000 every other week. Enroll today at chasacom/WinW€thAutopay. Important Notice To Servieemembers And Their Dependents:If you or any owner or occupant of your home is a federal of state Military Servicemember who is,or within the last year was,on active duty or active service,or a dependent of such a Sen icemember,you may be entitled to certain legal rights and protections.For more information,please call us at 1-877-469.0110. If you receive or expect to receive an insurance claim check for damages to your home,you can visit chase.comAnsuranceClaim for Information about our claim proeaas,if you have any questions,please call us at 1-866-742.1461 Monday through Friday from 8 a.m.to midnight and Saturday from 8 a.m.to 8 p.m.Eastern Time. ,r K V Please detach and return the bottom portion of this statement with your payment using the enabled envebpe. r 3. a oil ;z`.1 07988 Page 1 of t CHASE �� Customer Service 1-888.848.9136 �r ® Monday-Friday 8 a.m.-midnight(ET) {y �/, Saturday 8 a.m.-8 p.m.(ET) Yd 6.J, t1 Hearing impaired(TTY) 1-800-582-0542 ehase.com qr(Irk'11!(t(tlylr�rlltil��titl'(t(1('Ilit�t!('P'l�i�lil(gr,l ardsaMwcz+rerac- aaa Mortgage Loan Statement WILLIAM G SHERICK Loan Number 4502272500 CAROL P SHERICK Statement Date 06125/2014 1555 REVERE DR Property Address 1556 Revere Drive MECHANICSBURG PA 170562246 Mechanicsburg,PA 17050 Total Payment Due $983.00 Payment Due Date 08/0172014 A late charge of$33.74 may apply it received after 0 811 61201 4. Loan Overview(as of 06/25/2014) Total Payment For This Billing Period Includes Original Principal Balance $127,500.00 Unpaid Principal Balance $116,067.14 Principal $20323 Interest Rata 4.87500% Interest $471.52 Escrow Balance $3,393.54 Escrow Payment(Taxes and Insurance) $308.25 Total Monthly Payment $983.00 Past Payments Breakdown FeestCharges $0.00 Paid Since last Statement Paid Year-to-Date Total Payment Due $983.00 Principal $202.40 $1,399.75 Interest $472.35 $3,323.50 Escrow Payment(Taxes and Insurance) $308.25 $2,157.75 Total 5983.00 $6,881.00 Transaction Activity Since Your Last Statement (Includes Fees/Charges) Transaction Date Description Total Received Principal Interest Escrow Fees Unspoiled Funds 06/25/2014 PAYMENT $983.00 5202.40 $472.35 $308.25 Important Messages It your mortgage loan servicing transferred to Chase this year,and you would fike to see your previous payment history,please calf the number at the top of this statement Your mortgage loan payment—your wayl Choose any one of our services:automatic payments,online bill pay,over the phone,by mail,or In person. Visit chase.comlWaysToPay for more information about your payment options. Important Notice To Servicemembers And Their Dependents:if you or any owner or occupant of your home is a federal or state Military Servicemember who is,or within the last year was,on active duty or active service,or a dependant of such a Servicemember,you may be entitled to certain legal rights and protections.For more Information,please call us at 1.877-469.0110. If you receive or expect to receive an insurance claim check for damages to your home,you can visit chase.00mAnsuranceClaim for information about our claim process.If you have any questions,please call us at 1-666.742-1461 Monday through Friday from 8 a.m.to midnight and Saturday from 8 a.m.to 8 p.m. Eastern Time. V Please detach and return the bottom portion of this statement with your payment using the enclosed envelope. r q7 important UriOLY we have received the explanation of benefits from your insurance company(s) and have applied whatever payments and/or adjustments are appropriate. Please make payment forthe balance due of$236.79 OR take advantage of a The Spirit I SMP n 15% prompt payment discount and remit $201.27 on or before 01/12/2014. Here are 3 convenient ways to pay: 46587655 1. Make payment online at www.hsh.org. CAROL P SHERICK 2. Mail tear-off coupon below with payment 1555 REVERE DR in the enclosed envelope. MECHANICSBURG PA 17050-2246 3. Call Customer Service below to make payment by phone. Account Summary I Charge Summary Patient Name: Sherick ,Carol P Previous Balance: $35,782.45 Statement Date: 12/13/13 Total New Charges: $24,641.34 Service Date(s): 11/08/13-11/15/13 Payments/Adjustments: $60,187.00- Account Balance: $236.79 Account Number. 46587655 Please Pay This AmouD20127 $236.79 OR Medical Record Number. 620097 Discounted Amount of paid on or before 01/12/2014 Insurance Information Contact Us Please call Customer Service at 717-763-2138 Ins. 1: MEDICARE I/P to add or make corrections to your insurance Ins. 2: BLUE SHIELD P information, or to make arrangements for a -Ins. 3: payment plan. If you are unable to make Ins. 4: payment, please contact the Patient Financial Advocate's Office at(717) 763-2885 to discuss N financial assistance options. W J a 0 Please Note: Your physicians will bill separately for professional services. Account #: 14027 Please Pay: $20.54 Due Date: 01/06/14 Date Description Charges Insurance Patient Balance Balance CAROL P. SHERICK 10# 14027/SUPRIYO U. GHOSH MD 10/24/2013 OFFICE/OTHER OUTPATIENT (EST Pr) LEV JOS= 105.00 0.00 10/24/2013 PULSE/EAR OXIMETRY FOR OXYGEN SATURATION; SINGLE 27.00 27.00 0.00 --> DETERMINATION 10/24/2013 ADMINISTRATION INFLUENZA VACCINE 24.00 24.00 0.00 10/24/2013 FLUZONE HIGH DOSE INFLUENZA VACCINE 33.00 33.00 0.00 10/24/2013 VENIPUNCTURE 7.00 7.00 0.00 10/24/2013 B-TYPE NATRIURETIC PEPTIDE 50.00 SO.00 0.00 10/24/2013 BLOOD COUNT; COMPLETE (CBC) W DIFF 11.50 11.50 0.00 10/24/2013 COMPREHENSIVE METABOLIC PANEL 17.00 17.00 0.00 10/24/2013 SOME OR ALL E-PRESCRIBING GENERATED 0.00 0.00 0.00 11121/2013 HIGHMARK CONTRACTUAL ADJUSTMENT FROM HIGHMARK BLUE SHIELD 0.00 0.00 11/21/2013 PATIENT RESPONSIBILITY - THIS AMOUNT IS YOUR COINSURANCE AS STATED -20.54 20.54 -> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR -> RESPONSIBILITY. PLEASE REMIT PAYMENT. 11/13/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 208.60 0.00 11/13/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -4.25 0100 11/13/2013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -41.11 0100 BALANCE TICKET #265295 .00 20.54 PAID itJ13/13 cz, * Lt'-r48 Important Message About Your Account Total Balance 20.54 Insurance Pending .00 Amount Due 20.54 For Billing Questions a Make Checks (7171 724-2126 Payable To: Azizkhan Internal Medicine Assoc, PACE I OF 1 .,,,__„„,_PDA042 000ss R 5�ix Pulmonary&Critical Care Med Asso PC Account#: 292870 Pagqr 1631 N Front St Harrisburg, PA 17102 717 234-2561 MMEDICA Carol Sherick Q 12/27/2013 292870 28.46 ———————————————— --------—--- Carol Sherick 1555 Revere Dr Mechanicsburg, PA 17050 Patient Insurance TOTAL Balance Balance Carol Sherick 292870 Voucher: 958460 12/12/2012 99232 Sbsq Hosp Care Pr D 25 Min 110.00 01/24/2013 887151796 Medicare Payment 54.71 01/24/2013 887151796 Medicare Adjustment 41.61 01/2412013 887151796 Medicare Transfer 01/3012013 DO BCBS Payment 10.94 01/30/2013 DD BCBS Transfer 10/29/2013 check 3261 Self Pay Check Payment 2.74 0.00 Voucher: 1226430 11/11/2013 99223 H/P Level 3 280.00 12/05/2013 888360004 Medicare Payment 152.31 12/05/2013 888360004 Medicare Adjustment 85.72 12/05/2013 888360004 Medicare Adjustment 3.11 12/05/2013 888360004 Medicare Transfer 12/11/2013 DO BCBS Payment 31.09 12/11/2013 DD BCBS Transfer 7'77 This represents the Co-Insurance amount due. Please remit payme . AMOUNT TO PAY 12/27/2013 Continued on Page 5 PULMONARY AND CRITICAL CARE MEDICINE ASSOCIATES, P.C. 1831 N.FRONT STREET• HARRISBURG,PA 17102•TELEPHONE:(717)2342561 2808 OLD POST ROAD•HARRISBURG,PA 17110•TELEPHONE:(717)8204549 t ulmonary&Critical Care Med Asso PC Account#: 292870 Page` 1631 N Front St Harrisburg, PA 17102 717 234-2561 MMEDICA JAJJJKW Carol Sherick 12/27/2013 292870 28.46 -- ------=----_ — --------------------------- Ca—rol—Sherick 1555 Revere Dr Mechanicsburg, PA 17050 Patient Insurance TOTAL Balance Balance Carol Sherick 292870 Voucher: 1228670 11/12/2013 99232 Sbsq Hosp Care Pr D 25 Min 110.00 12/09/2013 888370186 Medicare Payment 53.84 12/09/2013 888370186 Medicare Adjustment 41.32 12/09/2013 888370186 Medicare Adjustment 1.10 12/09/2013 888370186 Medicare Transfer 12/23/2013 DD BCBS Payment 10.99 12/23/2013 DD BCBS Transfer 235 This represents the Co-Insurance amount due. Please remit paymen . Voucher: 1228680 11/13/2013 99232 Sbsq Hosp Care Pr D 25 Min 220.00 12/09/2013 888370186 Medicare Payment 91.54 12/09/2013 888370186 Medicare Adjustment 103.24 12/09/2013 888370186 Medicare Adjustment 1.87 12/09/2013 888370186 Medicare Transfer 12/23/2013 DD BCBS Payment 18.68 12/23/2013 DD BCBS Transfer 4.67 This represents the Co-Insurance amount due. Please remit paymen . AMOUNT TO PAY 12/27/2013 Continued on Page 6 PULMONARY AND CRITICAL CARE MEDICINE ASSOCIATES, P.C. 1631 N.FRONT STREET•HARRISBURG,PA 17102•TELEPHONE:(717)234-2561 2808 OLD POST ROAD-HARRISBURG,PA 17110•TELEPHONE:(717)9204549 ,/"pulmonary &Critical Care Med Asso PC Account#: 292870 Page; 1631 N Front St Harrisburg, PA 17102 717 234-2561 MMEDICA Carol Sherick ------ 12/27/2013-----292870 ----- 28.46—_ ------------------ ---- --- --r l Carol Sherick 1555 Revere Dr Mechanicsburg, PA 17050 Patient Insurance TOTAL Balance Balance Carol Sherick 292870 Voucher: 1226450 11/17/2013 99223 H/P Level 3 280.00 12/05/2013 888360004 Medicare Payment 152.31 12/05/2013 888360004 Medicare Adjustment 85.72 12/05/2013 888360004 Medicare Adjustment 3.11 12/05/2013 888360004 Medicare Transfer 12/11/2013 DD BCBS Payment 31.09 12/11/2013 DD BCBS Transfer 7.77 This represents the Co-Insurance amount due. Please remit peymen . Voucher: 1235170 11/18/2013 99232 Sbsq Hosp Care Pr D 25 Min 110.00 12/17/2013 888397956 Medicare Payment 53.84 12/17/2013 888397956 Medicare Adjustment 41.32 12/17/2013 888397956 Medicare Adjustment 1.10 12/17/2013 888397956 Medicare Transfer 12/23/2013 DD BCBS Payment 10.99 12/23/2013 DD BCBS Transfer 2.75 This represents the Co-Insurance amount due. Please remit paymen . AMOUNT 12/27/2013 TO PAY Continued on Page 7 PULMONARY AND CRITICAL CARE MEDICINE ASSOCIATES, P.C. 1631 N.FRONT STREET•HARRISBURG,PA 17102•TELEPHONE:(717)2342561 2808 OLD POST ROAD•HARRISBURG,PA 17110•TELEPHONE:(717)920-4549 I I� I .erick Revere Dr tihanicsburg, PA 17050 Patient Insurance TOTAL Balance Balance Carol Sherick 292870 Voucher-: 1234440 1-1/26/2013 99232 Sbsq Hosp Care Pr D 25 Min 110.00 12/17/2013 888397956 Medicare Payment 53.84 12/17/2013 888397956 Medicare Adjustment 41.32 12/17/2013 888397956 Medicare Adjustment 1.10 12/17/2013 888397956 Medicare Transfer 12/23/2013 DD BCBS Payment 13.74 0.00 Voucher: 1234570 11/27/2013 99232 Sbsq Hosp Care Pr D 2S Min 110.00 12118/2013 888404269 Medicare Payment 53.84 12/18/2013 888404269 Medicare Adjustment 41.32 12/18/2013 888404269 Medicare Adjustment 1.10 12/18/2013 888404269 Medicare Transfer 12/23/2013 DD BCBS Payment 10.99 12/23/2013 DD BCBS Transfer 2.75 This represents the Co-Insurance amount due. Please remit payment . AMOUNT 28.46 0.00 28.46 TO PAY 12/27/2013 Your prompt payment is greatly appreciated. PULMONARY AND CRITICAL CARE MEDICINE ASSOCIATES, P.C. 1831 N.FRONT STREET•HARRISBURG,PA 17102•TELEPHONE:(717)2342561 2808 OLD POST ROAD•HARRISBURG,PA 17110•TELEPHONE:(717)8204548 0 STATEMENT OF ACCOUNT' (1) I CAMP HILL EMERGENCY PHYSICIANS Statement Date: January 02,2014 PO BOX 13693 ACCOUNT NUMBER: HYP46587655 I PHILADELPHIA, PA 19101-3693 (Patient Name:CAROL P SHERICK ' Tax ID#: 204667340 Account Balance: $29.79 Amount Pending Insurance: $0.00 itlydlrrlbttllhll'r16rri6rl{hI11111141 If41tIIr4<<tltl Amount Due From Patient(Current): $29.79 082516-0000046587655-06 Amount Due From #BWNJFDB Patient(Past Due): $0.00 #OOOOOOHYP8140273# Pay This Amount•. $29.79 CAROL P SHERICK 1555 REVERE DR PLEASE REMIT PAYMENT BY"PAYMEN MECHANICSBURG PA 17050-2246 DUE BY"DATE.THANK YOU. Please rek to coupon below for payment Instructions. Pay your bill securely online anytime at www.MyMedicalPayments.com Date IT Description Charge Paid By Paid By Paid By Amount Due From PATIENT First ins. Offu r Ins. Patient Adjusted Insurance BALANCE 11106113 1 99485 EMERGENCY EVAL 6 MGMT(LVL 5) $1,303.00 DX786.05 DR.PFISTERERMOLY SPIRIT HOSPITAL 12174113 MEDICARE CONTRACTUAL ALLOWANCE $-1,13aA7 1204113 ',-DICARE Sequestration 2%Cud 52 120Mt3 MEDICARE PAYMENT 5130. 1227113 BLUE SHIELD CONTRACTUAL ALLOWANCE 40. 12027113 BLUE SHIELD CLAIM DENIED-DEDUCTIBLE $3.52 $29.75 TOTALS: $1,303.00 $130.56 43.52 $0.00 -$1,139.13 $0.00 f2B.7B Important Messages: This statement Is he the direct treatment andtor supeMsion of Care You recentiY steamed from an Emergency Physician at Holy Spirit Hosptai.The tees for this Ciro physloon ere Nited sepaatefy Thom any hospital charges mother prMessionai l tees tar Hhich you may also m responaihie. Therefore,should you receive a bill h«n the fhhoossphet or other physicians for charges In connection with this visit,It will not include the items listed on this smw=L "Payment Plans"Accepted Questions about this statement?JLlame de Lunes a Viernes? Call 1-800455-2470 Monday through Friday 9:30AM -4:OOPM. Your automated system access code is 0801-46587655, or you can send email to billing_questions@emcare.com. g 364 o,-sao6 y� Please detach and return bottom Donlon with vour remittance. 4044 i i 1 DATE DR PATIENT DESCRIPTION CHARGES CREDITS 11/16/13 ci Carat HS-H&P-Levet 5 375.00 12/03/13 Plan Payment:888354066 Highmark Medicare Svcs -152.31 12/03/13 Adj:Medicare Adjustment Highmark Medicare Svcs -180.72 12/03/13 Adj:Adjustment . Highmark Medicare Svcs -3.11 $38.86 c 12/12/13 Plan Payment:992243632 - Highmark Blue Shield -31.09 $7.77 coinsurance *Amounts pending with insurance are not included in the balance due. You will be billed once your insurance responds to our claim. ACCT: 084108.00 CURRENT 30-60 DAYS 60-90 DAYS 90.120 DAYS OVER 120 DAYS INS BALANCE 0.00 0.00 0.00 0.00 1 0.00 PATIENT BALANCE 7.77 0.00 0.00 0.00 0.00 CHARLES R INNERS MD I PATIENT DU 7 STERLING GLEN WAY MECHANiCSBURG, PA 170502709 717-249-2482 $7.77 1� y 16466-v937•TYK000BKY000012 IflI�II�IIMI�IIII�fl�I��IIIINIIII�IIl�l�6Q�lllll9nl9�llll CUMMINGS ASSOCIATES, PC (717)236-4682 1617 NORTH FRONT STREET .. 6;L HARRISBURG,PA 17102-2414 p:cith:! S`o�•r Carol P.Sherick 100775 01/06/14 1 MED BS 1555 Revere Or Mechanicsburg, PA 17050 CPT4 11/27/13 99222 Hosp.Adm./moderate Complexity CC 1 225.00 5.29 Patient: Sherick,Carol P- 100775 Servicing Provider:Cary Cummings MD '3 ,;!:;. : 12/16/2013 Highmark Medicare Services 103.73 94.81 12/24/2013 Highmark Blue Shield p;,;yh111.7r•,r 11/28/13 99232 H/s Subsequent Hosp Care, Interme CC 2.75 Patient:dhcrick,Carol P- 100775 Servicing Provider:Cary Cummings MD 1?:1612013 Highmark Medicare Services 53.84 12.42 12/24/2013 Highmark Blue Shield 10.99 i 1129/13 99232 H/s Subsequent Hosp Care, Interme CC " 1 80.00 2.75 Patient: Sherick,Carol P- 100775 Servicing Provider: Cary Cummings MD -12/17/2013 Highmark Medicare Services 53.84 12.42 12/24/2013 Highmark Blue Shield 10.99 11/30/13 99232 H/s Subsequent Hosp Care, Interme CC 1 '80.00� 2.75 Patient: Sherick,Carol P- 100775 Servicing Provider.Cary Cummings MD - " 12/1712013 Highmark Medicare Services 53.84 12.42 12/2412013 Highmark Blue Shield 10.99 12/01/13 99232 H/s Subsequent Hosp Care,Interme CC 1 80.00 2.75 Patient: Sherick,Carol P- 100775 , Servicing Provider: Cary Cummings MD 12/17/2013 Highmark Medicare Services 53.84 12.42 12/24/2013 Highmark Blue Shield 110.99 {iiie+�rtcmv ****** Centinue On Next Page ****** Cummings Associates, PC• 1617 North Front Street•Harrisburg,PAI U-11.02-2414 158 CUMMINGS ASSOCIATES, PC (717)23¢,,]682 1617 NORTH FRONT STREET ' HARRISBURG,PA 17102-2414 , Carol P.Sherick 100,775 011.0¢(14. 2 MED BS 1555 Revere Dr Mechanicsburg,PA 17050 CPT4 12/02/13 99232 H/s Subsequent Hosp Care,Interme CC t 80.00 2.75 Patient: Sherick,Carol P- 100775 Servicing Provider: Cary Cummings MD 717121 ; 12/18/2013 Highmark Medicare Services "'''53.84' " 12.42 .12/24/2013 Highmark Blue Shield 10.99 12/03/13 99232 H/s Subsequent Hosp Care,lnterme CC 1 80.00 2.75 Patient: Sherick,Carol P- 100775 Servicing Provider: Cary Cummings MD . 12/19/2013 Highmark Medicare Services 53.84 12.42 01/02/2014 Highmark Blue Shield 10.99 12/04/13 99232 H/s Subsequent Hosp Care,Interme CC 1 80.00 2.75 Patient: Sherick,Carol P- 100775 Servicing Provider: Ca ry Cummings MD 12/20/2013-Highmark Medicare Services .I.tr. 53.84 12.42 01/02/2014 Highmark Blue Shicld 10.99 12%05/13 99232 H/s Subsequent Hosp Care,lnterme CC I 0.00,. 2.75 Patient:Sherick,Carol P- 100775 . Servicing Provider: Cary Cummings MD 12/20/2013 Highmark Medicare Services 53.84 12.42 01/02/2014 Highmark Blue Shield 10.99 12/06/13 99232 H/s Subsequent Hosp Care,Interme CC 1 80.00' 2.75 Patient:Sherick,Carol P- 100775 Servicing Provider: Cary Cummings MD ? 12/24/2013 Highmark Medicare Services 53,.84:: 12.42 01/02/2014 Highmark Blue Shield ;�`. 1 01°9 ****** Continue On Next Page ****** Cummings Associates,PC• 1617 North Front Street•Harrisburg,PA: 171'02-2414 159 ev,,.tl CUMMINGS ASSOCIATES,PC (717)236-4682 1617 NORTH FRONT STREET HARRISBURG,PA 17102-2414 Carol P.Sherick - 100775 01/06/14 3 MED BS 1555 Revere Or - Mechanicsburg,PA 17050 .i"e14 - l. CPT4 12/07113 99232 H/s Subsequent Hosp Care,Interme CC I $x.00 2.75 Patient:Sherick,Carol P-100775 Servicing Provider: Cary Cummings MD . 12/24/2013 Highmark Medicare Services 53.84 12.42 01/02/2014 Highmark Blue Shield 10.99 12/08/13 99232 H/s Subsequent Hosp Care,Interme CC 1 80.00 2.75 Patient: Sherick,Carol P- 100775 Servicing Provider: Cary Cummings MD 12/24/2013 Highmark Medicare Services - 53.84 12.42 01/02/2014 Highmark Blue Shield 10.99 12/09/13 99238 Hospital Discharge Day Mgt-30 Mi CC 1 4 OQ 2.76 Patient: Sherick,Carol P- 100775 10077. I ' . Servicing Provider: Cary Cummings MD 01/02/2014 Highmark Medicare Services 54.02 22.20 01/06/2014 Highmark Blue Shield 11.02 :y,i•. i 38.30 Due and payable upon receipt �. Carol P..Sherick 100775 1,195.00 903.07 38; 0.Tl . Cummings Associates,PC• 1617 North Front Street•Harrisburg,PA 17102-2414 160 PAYMO BY VMk MM WERCARD OR OISIcOM,141 LCUMMUDW DO NOT SEND PAYMENTS TO THIS ADDRESS De t. 19687 " O aDR P O Box 1259 Oaks,PA 19456 uusTnauDSanon I�IIII�IIi�i�llilllilllilllllll�llllll�0i�ll�ill> ��`�" For billing questions call: (717)932-5955 STATEMENT DATE PAY THIS AMOUNT ACCOUNT NO. or: (877)932-5955 1124/2014 Continued 11449 Fax: (7,17)932-4856 Office Hours: 8:00 AM - 4:30 PM CHARGES AND CREDITS MADE AFTER STATEMENT SHOW AMOUNT To pay your bill online and register for eStatements, DATE WILL APPEAR ON NM STATEMENT PAID HERE please visit us at: www.gita.com MAKE CHECKS PAYABLE/REMIT TO:�w II111111111 1111111111,1111.1111-IIIIII III-II I'II1111111I911IT1 19070-1 Quantum Imaging and Therapeutic Associates CAROL P SHERICK PO Box 62165 1555 REVERE DR Baltimore,NID 21264-2165 MECHANICSBURG PA 17050-2246 1..11 11111 It III III III l III lulllnIII till III till llnIIIIIIlull 0 Please check box it above address is Incorrect or Insurance PLEASE DETACH AND RETURN TOP PORTION WITH Information has changed,and Indicate charges)on reverse side. YOUR PAYMENT IN ENCLOSED ENVELOPE Patient: Carol P Sherick Account: 11409 Services Rendered At: HOLY SPIRIT HOSPITAL Date Proc Payments Code Description Charge Ad'ustments Balance 11/8/2013 71010 CHEST SINGLE VIEW FRONTAL 36.00 0.35 12/9/2013 PMT MEDICARE PART B-NOVITAS 6.80 1 21912 01 3 CR Adjustment MEDICARE PART B-NOVTAS 27.46 1212012013 PMT HIGHMARK PPO BLUE 1.39 11/14/2013 71020 CHEST 2 VIEWS PA& LATERAL 46A0 0.41 12/13/2013 PMT MEDICARE PART B-NOVITAS 8.11 12/13/2013 CR Adjustment MEDICARE PART B-NOVITAS 34.82 12/20/2013 PMT HIGHMARK PPO BLUE 1.66 11/16/2013 71020 CHEST 2 VIEWS PA& LATERAL 45.00 0.41 12/18/2013 PMT MEDICARE PART B-NOVITAS 8.11 12/18/2013 CR Adjustment MEDICARE PART B-NOVITAS 36.89 12/30/2013 CR Adjustment MEDICARE PART B-NOVITAS -2.07 1/10/2014 PMT HIGHMARK PPO BLUE 1.66 11/1612013 70450 CT SCAN BRAIN W/O CONTRAST 198.00 1.60 12/18/2013 PMT MEDICARE PART B-NOVITAS 31.42 1 211 8/201 3 CR Adjustment MEDICARE PART B-NOVITAS 166.58 12/30/2013 CR Adjustment MEDICARE PART B-NOVITAS -8.02 1/1012014 PMT HIGHMARK PPO BLUE 6.42 11/23/2013 71020 CHEST 2 VIEWS PA&LATERAL 45.00 0.41 1 212 6/2 01 3 PMT MEDICARE PART B-NOVITAS 8.11 12/26/2013 CR Adjustment MEDICARE PART B-NOVITAS 34.82 1/10/2014 PMT HIGHMARK PPO BLUE 1.66 11/2512013 71020 CHEST 2 VIEWS PA&LATERAL 45.00 0:41 12/2612013 PMT MEDICARE PART B-NOVITAS 8.11 12/26/2013 CR Adjustment MEDICARE PART B-NOVITAS 34.82 1/10/2014 PMT HIGHMARK PPO BLUE 1.66 11/2812013 71010 CHEST SINGLE VIEW FRONTAL 36.00 0.35 12131/2013 PMT MEDICARE-NOVITAS SOLUTIONS 6.80 12/31/2013 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 27.46 1/10/2014 PMT HIGHMARK BCBS 363 1.39 12/1/2013 71010 CHEST SINGLE VIEW FRONTAL 36.00 0.35 BALANCE DUE Continued PAY BY THIS ACCOUNT BALANCE IS YOUR RESPONSIBILITY. For billing questions call: (717)932-5955 PLEASE REMIT PAYMENT IN FULL OR CALL OUR or: (877)932-5955 OFFICE IF PAYMENT ARRANGEMENTS AND/OR Fax: (717)932-4856 INSURANCE INFORMATION IS NECESSARY. Office Hours: 8:00 AM-4:30 PM To pay your bill online and register for eStatement �' InIIII��y � � '�I���_I •) STATEMENT please Visit us at: www.gita.com II (I Ii 11 SEE REVERSE SIDE FOR IMPORTANT BELLING INFORMATION 19674_i raven: caroi v snencK Account: 11409 Services Rendered At: HOLY SPIRIT HOSPITAL Date Code Description Charge AdiuPayments tments Balance 12/31/2013 PMT.MEDICARE-NOVITAS SOLUTIONS 6.80 1 2/3112 01 3 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 27.46 1110/2014 PMT HIGHMARK BCBS 363 1.39 12/3/2013 71010 CHEST SINGLE VIEW FRONTAL 36.00 0.35 1/2/2014 PMT MEDICARE-NOVITAS SOLUTIONS 6.80 1/2/2014 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 27.46 1/10/2014 PMT HIGHMARK BCBS 363 1.39 Current 31 -60 61 -90 91 -120 Over 120 BALANCE DUE $4.64 0.00 4.64 0.00 0.00 0.00 PAY BY Due Upon Receipt THIS ACCOUNT BALANCE IS YOUR RESPONSIBILITY. For billing questions call: (717)932-5955 PLEASE REMIT PAYMENT IN FULL OR CALL OUR or: (877)932-5955 OFFICE IF PAYMENT ARRANGEMENTS AND/OR Fax: (717)932-4856 INSURANCE INFORMATION IS NECESSARY. -Office Hours: 8:00 AM - 4:30 PM To pay your bill online and register for eStatement IIIIIIIIIIOIIII IIII I��I��IIIIII II IIIIulllll STATEMENT please visit us at: www.gita.com II SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION 19670-2 Azizkhan Internal Medicine Assoc. Statement Date: 01/15/14 Account #: 14027 Date Description Charges Insurance Patient Balance Balance 11/15/2013 HOSPITAL DISCHARGE DAY MGMT<30 MIN 115.00 115.00 0.00 1210612013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -78.20 0.00 12/06/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -6.03 0.00 12/06/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 295.39 0.00 12/17/2013 HIGHMARK CONTRACTUAL ADJUSTMENT FROM HIGHMARK BLUE SHIELD 0.00 0.00 12/17/2013 HIGHMARK PAYMENT FROM HIGHMARK BLUE SHIELD -60.30 0.00 12/17/2013 PATIENT RESPONSIBILITY - THIS AMOUNT IS YOUR COINSURANCE AS STATED _ ,_ ,. 15.08 _15._08. _.,-,. --> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR --> RESPONSIBILITY. PLEASE REMIT PAYMENT. BALANCE TICKET #HSH029193 .00 15.08 CAROL P. SHERICK ID# 14027/REZA G AZIZKHAN JR DO 11/17/2013 INITIAL HOSPITAL CARE NEW/EST LEVEL 210.00 210.00 0.00 12/17/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -3.11 0.00 12/27/2013 HIGHMARK PAYMENT FROM HIGHMARK BLUE SHIELD -31.09 0.00 12/27/2013 PATIENT RESPONSIBILITY - THIS AMOUNT IS YOUR COINSURANCE AS STATED -7.77 7.77 --> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR --> RESPONSIBILITY. PLEASE REMIT PAYMENT. 12/17/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 152.31 0.00 12/17/2013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -15.72 0.00 BALANCE TICKET #HSH029238 .00 7.77 CAROL P. SHERICK ID# 14027/STEVEN A PROPHET MD 11/18/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 11/19/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 11/20/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 .0.00 11/21/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 12/17/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -4.40 0.00 12/27/2013 HIGHMARK CONTRACTUAL ADJUSTMENT FROM HIGHMARK BLUE SHIELD 0.00 0.00 12/27/2013 HIGHMARK PAYMENT FROM HIGHMARK BLUE SHIELD -43.96 0.00 12/27/2013 PATIENT RESPONSIBILITY - THIS AMOUNT IS YOUR COINSURANCE AS STATED -11.00 11.00 --> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR --> RESPONSIBILITY. PLEASE REMIT PAYMENT. 12/17/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 215.36 0.00 12/17/2013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -65.28 0.00 BALANCE TICKET #HSH029239 .00 11.00 CAROL P. SHERICK ID# 14027/STEVEN A PROPHET MD 11/22/2013 SUBSEQUENT HOSPITAL CARE LEVEL 3 110.00 110.00 0.00 11/23/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 11/24/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 12/17/2013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -43.61 0.00 12/17/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -3.78 0.00 12/17/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 185.32 0.00 12/27/2013 HIGHMARK CONTRACTUAL ADJUSTMENT FROM HIGHMARK BLUE SHIELD 0.00 0.00 12/27/2013 HIGHMARK PAYMENT FROM HIGHMARK BLUE SHIELD -37.83 0.00 12/27/2013 PATIENT RESPONSIBILITY - THIS AMOUNT IS YOUR COINSURANCE AS STATED -9.46 9.46 --> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR PAGE 2 OF 1 000000 PDX017 Account #: 14UL/ Please Pay: "UJU Uue Uate: UL/U:)/14 Date Description Charges Insurance Patient Balance Balance CAROL P. SHERICK ID# 14027 1REZA G AZIZKHAN JR 00 11/16/2013 INITIAL HOSPITAL CARE (CONSULT) 145.00 145.00 0.00 12/19/2013 HIGHMARK PAYMENT FROM HIGHMARK BLUE SHIELD -21.17 0.00 12/19/2013 PATIENT RESPONSIBILITY - THIS AMOUNT IS YOUR COINSURANCE AS STATED -5.29 5.29 -> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR --> RESPONSIBILITY. PLEASE REMIT PAYMENT. 12/06/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 103.73 0.00 12/06/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -2.12 0.00 12/06/2013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -12.69 0.00 BALANCE TICKET #HS013844 .00 5.29 CAROL P. SHERICK ID# 14027/STEVEN A PROPHET NO 11/09/2013 INITIAL HOSPITAL CARE MEW/EST LEVEL 210.00 210.00 0.00 11/10/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 12/06/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -4.21 0.00 12/17/2013 HIGHMARK CONTRACTUAL ADJUSTMENT FROM HIGHMARK BLUE SHIELD 0.00 0.00 12/17/2013 HIGHMARK PAYMENT FROM HIGHMARK BLUE SHIELD -42.08 0.00 12/17/2013 PATIENT RESPONSIBILITY - THIS AMOUNT 15 YOUR COINSURANCE AS STATED -10.52 10.52 -> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR --> RESPONSIBILITY. PLEASE REMIT PAYMENT. 12/06/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 206.15 0.00 12/06/2013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -32.04 0.00 BALANCE TICKET #HSH029192 .00 10.52 CAROL P. SHERICK ID# 14027/SUPRIYO U. GHOSH MD 11/11/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 8S.00 0.00 11/12/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 11/13/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 Important Message About Your Account Total Balance 68.70 t� f�S /� - Insurance Pending ,00 t `tf ) 7 _t Amount Due 68,70 tZ For Billing Questions Call Make Checks (717) 724-2126 Payable To: Azizk6an Internal Medicine Assoc. von042 PAGE 1 OF 1 OA��01 Azizkhan Internal Medicine Assoc. Statement Date: 01/15/14 Account #: 14027 Date Description Charges Insurance Patient Balance Balance --> RESPONSIBILITY. PLEASE REMIT PAYMENT. BALANCE TICKET #HSH029240 .00 9.46 CAROL P. SHERICK ID# 14027/REZA G AZIZKHAN JR DO 11/25/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 11/26/2013 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00 11/27/2013 . HOSPITAL DISCHARGE DAY MGMT<30 MIN 115.00 115.00 0.00 12/17/2013 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC —45.56 0.00 12/17/2013 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC —3.83 0.00 12/17/2013 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 187.71 0.00 12/27/2013 HIGHMARK CONTRACTUAL ADJUSTMENT FROM HIGHMARK BLUE SHIELD 0.00 0.00 12/27/2013 HIGHMARK PAYMENT FROM HIGHMARK BLUE SHIELD —38.32 0.00 12/27/2013 PATIENT RESPONSIBILITY — THIS AMOUNT IS YOUR COINSURANCE AS STATED —9.58 9.58 --> BY YOUR INSURANCE CARRIER. THIS BALANCE IS YOUR --> RESPONSIBILITY. PLEASE REMIT PAYMENT. BALANCE TICKET #HSH029241 .00 9.58 PAGE 3 OF 1 PDxon a aao DATE OF DOCTOR CHARGE INSURANCE PATIENT SERVICE NAME CODE DESCRIPTION CHARGES RECEIPT RECEIPT ADJUST BALANCE 11/22/13 MAN 9301ORSE ECG INTERP/REP HOLY SPIR 25.00 6.29 .00 17.10 1.61 11/25/13 PRANESH 99231 SUES HOSP VISITLOW15 65.00 35.30 .00 28.20 1.50 11/26/13 PRA14ESH 99231 SUES HOSP VISITLOWIS 65.00 35.30 .00 20.20 1.50 __-_..________________________________________________________________________________ PLEASE PAY THIS AMOUNT: 3.00 cS . CI ` mot C �aali`� Billing Phone: 717-724-6462 AMOUNT DUE 3.00 �!'1I�UlllNI�(11�IIi�llll��'�il 11l(llll�INi!!I! STATEMENT SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION 91014284 •3251768 ........ . ....... ................ .............. ... . ......... . ........ ... ........... ........ ........... ........... ......... ........... . ......... C .............. C........ ............. .. .. .. .. .. .......... PREVIOUS BALANCE 0 . 00 145 . 00 0 . 00 .2/06/13 MCAR PMT -76 . 58 .2/06/13 MCAR ADJ -48 . 89 2/06/13 ICN: 1813325441070 2/18/13 INS PMT -15 . 62 2/18/13 ICN: 20008695307 1/15/13 Balance 3 . 91 REMARKS If you should have any questions regarding your account, please contact our office during normal business hours . OUR OFFICE NOW ACCEPTS PAYMENT BY CREDIT CARD - VISA, MASTERCARD AND DISCOVER. 0 . 00 0 . 00 0 3 . 91 Nittany Valley Medical Associates PC 301 Science Park Road, Suite 119 State College, PA, 16801 Phone: 814-272-5805 Fax: 814-272-0110 1 Mechanicsburg Area Meals on Wheels Invoice P O Box 1093 Mechanicsburg PA 17055-1093, Pnu..697-loll Date Invoice u 12/1/2013 8981 Bill To Ship To CAROL SHERICK 1555 REVERE DR MECHANICSBURG,PA. 17050 Description Qty Rate Amount NOV.MEALS 13 7.00 91.00 ��1 ►0 i Z/49 13 Total this Invoice $91.00 Payments/Credits $0.00 Total Balance $91.00 O p O (Dr 9 Cd CD y 0 K r _ G) • C co (C C CD = O C7 Y o a. 0 H 0 = fxn 0 f = r�i m CD C CD rn - C/) s(D N o o ;F f0 .2S cn G� 0 ' -»� ��' `A � c w Crf dp r i-+ M y ti �. rxm o yov O r co N C.) p —� -�7 "O T� ? N m i O � i �C eD o {fl O� OD o Law Offices of (��( �WJ & �1l�J SE, LLP 2109 MARKET STREET•CAMP HILL, PENNSYLVANIA 17011 MARK E.HALBRUNER (717)731-9600• FAX:(717) 731-9627 BRANCH OFFICE: CRAIG A.HATCH,CELA CeniOee as an Elder Law Agom"b/ CORRESPONDENCE ADDRESS: 3 WEST MONUMENT SQUARE.SUITE 304 the National Elder Law Foundation Camp Hill Office LEWISTOWN,PA 17044 CLIFTON R.GUISE WEB SITE: (717)248-6909 Also Admitted to practice before the www.hhgllp.com STACEY L MACE U.S.Patent d Trademark Office Paralegal JOHN N.MCCULLOUGH TRACI L.SEPKOVIC Paralegal IX Counsel TRACI L.HILFERDING Paralegal l b( September 8, 2014 .A oN Lisa Grayson, Register of Wills � 0 Cumberland County Courthouse n y Co One Courthouse Square, Room 102 Carlisle, PA 17013 n vzi -j rrI o A o a o _o -3 RE: Estate of Carol P. Sherick 7 h+ File No. 21-14-0173 r r- m v Dear Ms. Grayson: wo co CD on I am enclosing a Pennsylvania Inheritance Tax Return, Inventory and Status Report for ' filing in the above estate. Please date stamp the extra copy of each document and return them to me using the envelope provided. Thank you for your assistance. Sincerely, Mark E. Halbruner, Esq. MEH:sln Enclosures cc: Scott W. Sherick, Executor