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Home My WebLink About09-16-14 J 1505611185 REV-'1500 EX(02-11)(Ft) PA Department of Revenue OFFICIAL USE ONLY Bureau of IndMtlual Tams County Code Year Fee Number PO BOX 280601 INHERITANCE TAX RETURN 21 14 0092 Namsbury,PA 171284801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYI'YY 12072013 05311927 Decedent's Lest Name Suffix Decedent's First Name M I HARDING CYRUS W (if Applicable)Eder Surviving Spouse's Idormatjon Below Spouse's Lest Name Suffix Spouse's First Name M I 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) L-! 4.Umfied Estate ❑ 48. Future Interest Compromise(date of ❑ B. Federal Estate Tax Return Required death after 12.12.82) ® 8. Decedent Died Testate ❑ 7. Decedent Maintained a LMng Trust S. Total Number of Safe Deposit Boxes (Attach Copy of Nmq (Attach Copy of Trust.) ❑ S.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to Tax under Sea 9113(A) Between 12-31-91 and 1.1-95) (Attach Schedule 0) CORRESPONDENT- TIES SECTIONMUSTSE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOUilUE DIRECTEb TOx Norm Daytime T"phone Numb.em I = rn CRAIG A - HATCH, ESQUIRE 717--§:@960Q:rj m r' O rn RE$diTET1 DFX RIS bar q � y r t" MM First Line of Address a c7"? C} 2109 MARKET STREET ° r ZE — c> Second Una of Address T "a tom+ rr- M W {n CS t t-+ City or Post Office State ZIP Code DATE FILED - CAMP HILL PA 17011 Correapandam'a Somali address: C -HATCH@HHGLLP -COM Under penalties of perjury,I declare that I have asamined this return,including ascmnponying schedule and statements,and to the beat of my hnaWedge and belief, It fs true,correct and Complete.Declaration of preparer other then the PerawairepremilKiPmAbased on of wh!EhArtsildrar has my xnoaledgo. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN .r DAT / DILMUS LYLE JARRETT, III, EXECUTOR ,i / {(� ADDRESS PO BOX 36 QUANTICO 1856 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Xo��-- DATE CRAIG A - HATCH, ESQ. Gay ADDRESS 2109 MARKET STREET MP HILL, PA 17011 PUEJWE USE O IG OR Side 1 1505611185 010141147 3A 1505611185 �., i� 1505611285 REV-1 Boo Fit(FI) I RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 9 0•0 0 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . p $601797 - 63 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , • . , 3 $0-00 4. Mortgages and Notes Receivable(Schedule D) . . . . 4 90•00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. $901155- 62 6. Jointly Owned Property(Schedule F) Separate Billing Requested . . , , 5 $0•0 0 7. Inter•Vivos Transfers 8 Miscellaneous Non-Probsta Property (Schedule G) El Separate Boring Requested . . . . 7. $791597 . 01 S. Total 0 rose Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8. $230,550.26 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, $16,232-69 10. Debts of Decedent, Mortgage LlabBgies,and Liens(Schedule 1) , , , , . . . . . 10. $1458 • 63 11. Total Deductions(total Lines 9 and 10), , , , , , . . . . . 11 *17,291-32 12. Net Value of Estate(Line 8 minus Line 11) , , , . 12 *213,258 . 9 4 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , . . . . . . 13 $0 . 013 14. Net Value Subject to Tax(Line 12 minus Line 13) , . . . . . . . . . . 14 02131258 - 94 TAX CALCULATION•SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers unrger Sec.9118 (a)(1.2)X.041 $0.00 15. $0 .00 18. Amount of Line 1g taxable at lineal rate X.0 P $1421598 . 17 15. $61416 . 92 17. Amount of Line 14 taxable at sibling rate X.12 $0 . 0 0 17 *0 - 0 0 18. Amount of Line 14 taxable at collateralroteX.15 $70,660 .78 19. $101599 . 12 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. $17,016 . 04 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 7 Side 2 1505611285 1505611285 J 0A4848 8.000 REV-1500 EX(FI) Page 3 File Number Decadenrs Complete Address: 21 14 0092 DECEDENT'S NAME STREETADDRESS 824 LTSBURN ROAD CUMBERLAND CITY STATE ZIP CAMP HILL PA 17011- Tax Payments and Credits: 1. Tax Due(Page 2,Una 19) {i) $17,016-04 2. Credt ufPsymems A,Prior Payments $17,020-12 S.Discount _ so .00 Total Craft(A+B) (2) 517,020.12 3. Interest (3) $0.00 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) *4 -08 5, if Line 1 +Lina 3 Is greater than Line 2,enter the difference.This is the TAX DUE. (5) $0.110 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 shelf use the prop"transferred or its Income . . . . . . . . . . c, retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . d. receive the promise for life of aahar payments,benefits or care? . . . . . . . . . . . . . . . . . . y 2. If death occurred after Dec.12,1082,did decedent transfer property within one yaw of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an"in trust for"or payable-upon-death bank aunt or security at his or her death? . 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 O AND FILE IT AS PART OF THE RETURN. Far dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate Imposed on the not value of transfers to or for the use of the surviving spouse is 3 percent 172 P.S.§9115(a)(1.1)(1)). For dates 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 172 P.S.§911S(a)(1.1)(101.The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for dieclosure of assets and filing a tax return are still applicable even If the surviving spouse is the only beneficiary. For 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 172 P.S.§91 16(a)(1.2)]. • The tax rate Imposed on the not value of transfers to or for the use of the decedents lineal beneficiaries Is 4.5 percent,exoW as noted In(72 • The tax rate Imposed on the net value of transfers to or for the use of the decedents siblings Is 12 percent(72 P.S.§9118(a)(1.3)j.A staling Is defined, under Section 9102,as an Individual who has at least one parent in common with the decedent whether by blood or adoption. 5144671 2oW REV-1507 D1.(3,12) DBEPAARRTTMEN Pennsylvania SCHEDULE B INHERMANCETAX RETURN STOCKS& BONDS RESDENTDECEDENT ESTATE OF FILE NUMBER Cyrus W Harding 21 ld 009 All property Jointly owned with AgM of surVlvOMhlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I Edward Tones IRA No. 61697224 $69,382.53 2 Edward Jones Brokerage Acct. No. 89613018 $11,615.10 ) TOTAL (Also enter on Line 2,Recapitulation) S $60,797.63 2w1626 2.030 If more space is needed,Insert addillonsi ahsets of the same size REV-15d5EX- OM4 Pennsylvania SCHEDULE E t1EPARTMWoF REVENUE CASH,SANK DEPOSITS&MISC. PE�SIOWDECEDENr�� PERSONAL PROPERTY ESTATE OF: FII.B NUMBER: Cyrus W. Harding 21 14 0092 7ndUds tha proeends ot!lNgstlmr end the tlatethe piw,eeds rare reodVSd bythe estrde. All ro a oln owned wlth rl ht of eurvlvomhl must be dischreed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. PNC Hank Savings Acct. No. 5005741257 $90,154.81 Interest accrued to 12/7/2013 $0.81 I TOTAL(Also enter online 5,Recepltula6m) $ $90,155.62 2W46AD tow It more speee Is needed,uae edalond*mb of papa of the sums dre. +m+.tEOaEx.tOwa� Pennsylvania SCHEDULE F INNERRANCE T"%RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Cyrus W Harding 21 iQ 0092 tranaaetbecameJo tv*`*dwhNnOR Opearof the decederds date ofdaaMhmuatberepwMan8chedtdaa SU VWMJ0MT8NANf(S)NAAQS) AMMS faATON"TO DECRIBC A Jarrett, III, Dilmus Ly1 PO Boa 36, Quantico, BID 21856-0000 Nephew JOINTLY OWNED PROPERTY: MW StAaE �u¢w,eu 00SCRIPTIONOMORRIV xavxt"tMUe t}ATECF ffAiH OF EOTEOFUEATN VALtEOFASSET g4 84T'sN NtJ6B2 Teresa JOatr aDr rr.nowny�c.Trxa.a¢m�a�w�etrrrsa�a ire ie O 1T' JEOF it ii 1 i TOTAL..(Also order on tine 6,Recapitutatton) $ $0.00 eNVSAE 2.000 If more apace Is needed,use add:tlonal sheets of paper of the same size. REV-1610 EX a(06-09) . pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND MNERTANCE TAX RETURN MISC.NON-PROBATE PROPERTY RE61Df34f DECEDENT ESTATE OF _ _Cyrus W. Harding FILE NUMBER 21 id 0092 Th is schedule must be completed end filed If the answer to any of que800ne T through 4 on page three of the REVA500 Is yes. IPTX)N OF PRO lY ITEM smnBra,waornEmuecrn�n�ms�,ne.meomoRree,r,,,� DATE OF DEATH % DECO'$ EXCLUSION TAXABLE NUMBE I roaB.sx Berate VALUEOFASSET INTEREST OFAPPUCAEP.M VALUE t Edward Jones Polaris II A - Class Platinum Annuity No. P43A7535394 Owner/Annuitant: Cyrus W. Harding $79,597.01 100.0000 $0.00 $79,597.01 Beneficiaries: Sandra Kay Jones (158) , Linda G. Anastasi (158) , Holly Lynn Crompton (108) , I Matthew David Jones (108) , Cory Allen Jones (108) , Megan Marie Keenan (108) , Cyrus W. Jarrett, Sr. (108) , Mary Carolyn J. Lowman (108) , Dilmus Lyle Jarrett, III (108) TOTAL(Also enter on line 7,Recapitulation)$ $79,597.01 If mare.space Is needed,u.se additional.sheet d PapM of me same eke. BW�Wf 2.000 REV-1511 EX-(1108) pennsylvania SCHEDULE H WARn.IENrOF REVENUE FUNERAL EXPENSES AND INIVATANCE TAX RETURN ADMINISTRATIVE COSTS REEOENr DECEDENT ESTATE OF FILE NUMBER Cyrus W. Harding 4 OOO� Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: f, Mussel-an Funeral Home 6 Cremation Services funeral goods s services not covered by prepaid allowances $231.67 Total from continuation schedules . . . . . . . . . $24.00 a ADMINISTRATIVE COSTS: I. Personal Representative Commissions: $8,802.43 Nams(s)of Personal RepresentaM(s)Dilmue L_vle Jarrett rrr Street Address PO Box 36 City Quantico State MD ZIP 21856 Years)Commisslon Paid: 2014/2015 2. Attorney Fees: $3,000.00 3. Family Exemption:(If decedent's address Is not the same as cialmant's,attach 00anation.) Clalmsm Street Address city State ZIP Relationship of Claimant to Decedent 4, Probate Fees: $358.50 S. Accountant Fees: S. Tie Return Preparer Fees: 7. 1 Mileage 6 Travel Expenses $3,495.54 2 V.S. Postal Service postage $34.66 Total from continuation schedules . . . . . . . . . $285.89 TOTAL(Also enter on Line 9,Recapitulation) $ $16,232.69 OW46AG 2.000 If more space Is needed,use add'dionei sheets of paper of the same elm. Estate of: Cyrus W. Harding 21 14 0092 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Lebanon VA Medical Center medical bill $24.00 Total- (Carry forward tc main schedule) $24.00 Estate of: Cyrus W. Harding 21 16 0092 Schedule H Part 7 (Page 2) 3 Miscellaneous costs to clean and clear out decedent's apartment. $250.89 d Federal Express priority shipping $35.00 Total (Carry forward to main schedule) $285.84 REV-1512 EX•(12.12) pennsylvania SCHEDULE I °EFIRTEMOF REVENUE DEBTS OF DECEDENT, IMm ENTOE rN(REtURN R'ENroECE RtS DFM MORTGAGE LIABILITIES&LIENS ESTATE OF FILE NUMBER Cyrus W. Harding 21 1d 0092 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses. nT-!m VALUE AT DATE "JtgER OESCRIFTION OF DEATH 1. West Shore EMS — ALS emergency medical transport $1,020.86 2 Verizon phone service $37.77 TOTAL(Also enter on Line 10.Recapitulation) $1,058.63 ZW4aAN 2.000 If more space Is needed,Insert additional sheets of the same size. REV-1513 FJN( a SCHEDULE J . Pennnsns ylvania DEP"RnA `r°FREVENUE BENEFICIARIES INFERITANCE TAX RETURN RESDENrDECEDENY ESTATE OF: FILE NUMBER-' Cvrus W. Hardina 21140092 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustees) OF ESTATE ! TAXABLE DISTRIBUTIONS(trutues outlOM spousal dtsidosltons mM!renders under Sec.9115(s)(1.3).) 1. Dilmus Lyle Jarrett, III PO Box 36 Quantico, DID ,21856-0000 Edward Jones Polaris II A - Class Platinum Annuity No. P43A7535394 Owner/Annuitant: Cyrus W. Harding Inventory Value: $7,959.70 30% of Residue: $40,096.58 Nephew $48,058.28 ENIERO0LLARAFX7UNTS FOR MIROBLMOFS SHOWNABOVE ON LINES 157fiOUGH 19 OF REV-1500 COVER SHEET,AS APPROPRIATE. tI NON-TAXABLE DISTRIBUTIONS A SPOUSAL DISTRISLIn"UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN. 1. a owuABLr ANDGOVERwENAL OtSTR7aunomH 1. TOTAL OF PART it-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. f $0.00 sw4em 1000 It more space is needed.use add0tonet sheets of paper of the same sire. r Estate of: Cyrus W. Harding 21 14 0092 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 2 Sandra Kay Jones 323 Rosemount•,Avenue New Cumberland, PA 17070 Edward Jones Polaris II A - Class Platinum Annuity No. P43A7535394 Owner/Annuitant: Cyrus°W. Harding Inventory Value: $11,939.55 208 of Residue: $26,732.39 Stepdaughter $38,671.94 3 Cyrus William Jarrett, Sr. 32415 Huntly' Circle Salisbury, YID 21804 Edward Jones Polaris II A - Class Platinum Annuity No. P43A7535394 Owner/Annuitant: Cyrus W. Harding Inventory Value: $7,959.70 2.5 of Residue: $3,341.55 Nephew $11,301.25 4 Cory Allen Jones d21�Yoder Road Elverson, PA 19520 Edward Jones Polaris II.A - Class Platinum Annuity No. P43A7535394 Owner/Annuitant: -Cyrue. w. Harding, Inventory Value: $7,959.70 58 of Residue: $6,683.10 Step-Grandson $14,642.80 Estate of: Cyrus W. Harding 21 14 0092 Schedule J Part 1 (Page 4) Item No. Description Relation Amount 8 Mary Carolyn J. Lowman 249 Phoenix Drive Chamberaburg, PA 17201 Edward Jones Polaris II A - Class Platinum Annuity No. P43A7535394 Owner/Annuitant: Cyrus W. Harding Inventory Value: $7,959.70 2.5 of Residue: $3,341.55 Niece $11,301.25 9 Linda G. Anastaai 324 Dorwart Circle Etters, PA 17319 Edward Jones Polaris II A - Class Platinum Annuity No. P43A7535394 Owner/Annuitant: Cyrus W. Harding Inventory Value: $11,939.55 58 of Residue: $6,683.10 Stepdaughter $le,622.65 05) LAST WILL AND TESTAMENT OF CYRUS W. HARDING I, CYRUS W. HARDING, now of 824 Lisburn Road, Camp Hill, Pennsylvania, 17011, do publish and declare this to be my Last Will and Testament, hereby revoking all other prior wills and codicils made by me. FIRST: Family Background and Appointment of Executor. (A) Family and Background Information. I am not currently married. I have no children. (B) Appointment of Executor. I appoint as my Executor and Successor Executor(all hereinafter referred to as Executor)under this Will, the following named persons to serve without bond and without being required to account to any Court: Executor: My nephew, DILMUS LYLE JARRETT 11I. Successor Executor: My step-granddaughter, HOLLY LYNN CRUMPTON. SECOND: Funeral and Last Illness Expenses• Taxes. (A) Expenses of Funeral and Last Illness. I direct my Executor to pay my funeral expenses and the expenses of my last illness from my estate. (B) Taxes. I direct my Executor to pay any and all estate, inheritance, succession, legacy, transfer and other death taxes or duties, by whatever name called, including any and all interest and penalties thereon, imposed under the laws of any jurisdiction by reason of my death, upon or with respect to any and all property included in my gross estate for the purpose of such taxes, whether such property passes under or outside of this Will, out of my residuary estate, without being prorated or apportioned among or charged against the respective devises, legatees, beneficiaries, transferees, or other recipients of any such property or charged against any property passing or which may have passed to any of them. The Executor shall not be entitled to reimbursement for any portion of any such taxes from any such person. THIRD: Tangible Personal Property. Except for those items excluded below and those LAST WILL AND TESTAMENT Or CYRUS W.HARDING PAGE 2 items enumerated in the Letter of Instruction,my tangible personal property, including but not limited to clothing,jewelry, heirlooms, furniture, household furnishings, personal effects, motor vehicles, and all other similar articles, which I own, and the insurance thereon, shall be given to my nephew, DILMUS LYLE JARRETT, II1. Tangible personal property shall not include: (1) any and all property used by me in any business, (2) cash on hand or on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness, and(5) any life,health or accident insurance policies. Notwithstanding any other provisions in this Article THIRD, I may leave a separate, dated and unsigned Letter of Instruction, which I shall place with my Will, containing directions as to the ultimate disposition of certain of the property bequeathed under this Article THIRD, and such Letter of Instruction shall determine the distribution of such items. FOURTH. Residuary Gifts. (A) I give, devise and bequeath all the rest, residue and remainder of my estate, of every kind and character,real,personal and mixed,tangible and intangible, and wherever situated, including any lapsed or renounced legacies or devises(and including any property over which I may have a power of appointment), in the fallowing amounts to the respective named and designated beneficiary: (1) TWENTY PERCENT (20%) of the residue of my estate shall be distributed to my stepdaughter, SANDRA FLAY JONES, (2) THIRTY PERCENT(30%) of the residue of my estate shall be distributed to my nephew, DILMUS LYLE JARRETT,I11, (3) TWO AND ONE HALF PERCENT (2'/z%) of the residue of my estate shall be distributed to my nephew, CYRUS WILLIAM JARRETT, SR. (4) FIVE PERCENT (5%) of the residue of my estate shall be distributed to my step grandson, CORY ALAN JONES. (5) FIFTEEN PERCENT (15%) of the residue of my estate shall be distributed to my step granddaughter, HOLLY LYNN CRUMPTON. LAST WILL AND TESTAMENT OF CYRUS W. HARDING PAGE 3 (6) FIVE PERCENT(5%) of the residue of my estate shall be distributed to my step great granddaughter, MEGAN MARIE KEENAN. (7) FIFTEEN PERCENT(15%) of the residue of my estate shall be distributed to my step grandson, MATTHEW DAVID JONES. (8) TWO AND ONE HALF PERCENT (2'/s%) of the residue of my estate shall be distributed to my niece, MARY CAROLYN JARRETT LOWMAN. (9) FIVE PERCENT(5%) of the residue of my estate shall be distributed to my stepdaughter,LINDA G. ANASTASI. In the event that any of the above-named beneficiaries predecease their distribution, their respective share shall not pass to their issue,but shall instead be distributed pro rata among the remaining named beneficiaries above. (B) Distributions During Administration. Prior to final distribution of my estate, the Executor, in his discretion, may make partial distributions to one or more beneficiaries or Trusts. As a consequence, the Executorship and any Trusts created under this Will may exist contemporaneously. A distribution may be made subject to any indebtedness or liability of my estate. FIFTH: Spendthrift Provision. No beneficiary shall have the power to anticipate, encumber or transfer his or her interest in the estate in any manner other than by the valid exercise of a power of appointment. No part of the estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. SIXTH: Powers of Executor. In addition to the powers and duties as may have been granted elsewhere in this Will, but subject to any limitations stated elsewhere in this Will, the Executor shall have and exercise exclusive management and control of the Estate and shall be vested with the following specific powers and discretion, in addition to the powers as may be generally conferred from time to time upon him by law: (A) In the management, care and disposition of the Estate, the Executor shall have the power to do all things and to execute such deeds and instruments as may be deemed necessary or LAST WILL AND TESTAMENT OF CYRUS W. HARDING PAGE 4 proper, including the following powers, all of which may be exercised without order of or report to any Court: (1) To sell, exchange or otherwise dispose of any property, real, personal or mixed, at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Estate, and to grant options, including any option for a period beyond the duration of the Estate. (2) To invest all monies in such stocks, bonds, securities, mortgages, notes, choses in action, real estate or improvements thereon, and any other property as the Executor may deem best, without regard to any law now or hereafter enforced limiting investments of fiduciaries. (3) To retain for investment any property deposited with the Executor hereunder. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security. (5) To use attorneys, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Estate and to agree to any rescission or modification of any contract or agreement affecting the Estate. (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging,pledging or conveying any property of the Estate, including the power to borrow at a reasonable rate of interest. (8) To retain and carry on any business in which the Estate may acquire an interest, to acquire additional interest in any such business, to agree to the LAST WILL AND TESTAMENT OF CYRUS W.HARDING PAGE liquidation in kind of any corporation in which the Estate may have an interest. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that such security is a Estate asset and the Executor shall be responsible for the acts of such nominee. (B) In making distributions from the Estate to or for the benefit of any minor or other person under a legal disability, the Executor need not require the appointment of a guardian, but shall be authorized to pay or deliver the same to the custodian of such person, to pay or deliver the same to such person without the intervention of a guardian,to pay or deliver the same to a legal guardian of such person if one has already been appointed, or to use the same for the benefit of such person. (C) In the disbursement of the Estate and any division into separate trusts or shares, the Executor shall be authorized to make the distribution and division in money or in kind, or both,regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established by the Executor shall be binding and conclusive on all persons taking hereunder. The Executor may in making such distribution or division allot undivided interests in the same property to several trusts or shares. (D) The Executor shall have discretion to determine whether items should be charged or credited to income or principal or allocated between income and principal as the Executor may deem equitable and fair under all circumstances, including the power to amortize or fail to amortize any part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity or sale of any asset,whether purchased at a premium or at a discount, as income or principal or apportion the same between income and principal, to apportion the sales price of any asset between income and principal, to treat any dividend or other distribution of any investment as income or principal, or apportion the same between income and principal, to charge any expense against income or principal or apportion the same, and to provide or fail to provide a reasonable reserve against depreciation or obsolescence on any assets subject to depreciation or obsolescence, all as the Executor may reasonably deem equitable and just under all the circumstances. SEVENTH. Rights and Liabilities of Executor. LAST WILL AND TESTAMENT OF CYRUS W.HARDING PAGE 6 (A) No bond or other security shall be required of any Executor. (B) This instrument always shall be construed in favor of the validity of any act or omission by any Executor, and any Executor shall not be liable for any act or omission except in the case of gross negligence,bad faith or fraud. Specifically, in assessing the propriety of any investment of the estate, the overall performance of the entire estate shall be taken into account. (C) Each Executor shall be entitled to receive reasonable compensation for services actually rendered to my estate, in an amount the Executor normally and customarily charges for performing similar services during the time which he/she performs the services. EIGHTH: Tax Elections. In determining the estate, inheritance and income tax liability relating to my Estate, the Executor's decision as to all available tax elections shall be conclusive on all concerned. In accordance with IRC Section 2632(a)and without regard to whether a Federal estate tax return is actually filed,my Executor shall allocate so much of the Federal Generation Skipping Transfer(GST) exemption amount as will fully exempt any generation skipping transfer which may occur under this Will. NINTH: Defmitions and General Provisions. (A) Survival. Any beneficiary who dies within sixty(60)days after my death shall be considered not to have survived me. (B) Trust Estate. "Trust Estate"means all assets, however and wherever acquired, including income, which may belong to a Trust at any given time. (C) Children. Except for discretionary distributions which may be made unequally among a group of persons and distributions pursuant to a valid exercise of a Power of Appointment, in making a distribution to the children of any person,the property to be distributed shall be divided into as many shares as there are living children of the person and deceased children of the person who left children who are then-living. Each living child shall take one share and the share of each deceased child shall be divided among his then-living descendants in the same manner. A posthumous child shall be considered as living at the death of his parent. (D) Code. Unless otherwise stated, all references in my Will to section and chapter C/�. G't��l LAST WILL AND TESTAMENT OF CYRUS W. HARDING PAGE numbers are to those of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any subsequent federal tax laws applicable to my estate. (E) Other terms. The use of any gender includes the other genders, and the use of either the singular or the plural includes the other. (F) Captions. The captions set forth in this Will at the beginning of the various divisions hereof are for convenience of reference only and shall not be deemed to define or limit the provisions hereof or to affect in any way their construction and application. (G) Powers of Appointment are Exercised. By this Will I exercise any Power of Appointment which I may possess at my death. IN WITNESS WHEREOF, I, CYRUS W. HARDING,the Testator,have to this my Last Will and Testament, typewritten on eight(8)pages, including the Acknowledgment and Affidavit, set my hand and seal this 31' day of October, 2013. C US W. HARDING Signed, seated,published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request, as witnesses hereto, in the presence of the said Testator, and in the presence of each other. Each of us further declares that he or she believes the Testator to be of sound mind and memory. The preceding instrument consists of this and seven (7) other consecutively numbered typewritten pages including the Acknowledgment and Affidavit. Gi zesiding atj�rGG (priT, e) f { residing at L ��1'L� (print name) ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND The Testator and the witnesses whose names are signed and subscribed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge, depose and say to the undersigned authority, that the Testator signed and executed the instrument as his Last Will in the presence of the witnesses; that he signed it willingly or willingly directed another to sign it for him; that he executed it as his free and voluntary act for the purposes therein expressed; that each of the witnesses were present and saw the Testator sign and execute the instrument as his Last Will; that each subscribing witness in the hearing and sight of the Testator signed the will as witnesses; and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. 4' k, Testator Volitness Witness Sworn to or affirmed, subscribed to, ow and ackn ge'd, before me by the above-named Testator and witnesses, this 315` day of October, 201 COMMONWEALTH OF PENNSYLVANIA pt Public i NotaeW sea '< Teri L.Walker,Notarl y Public Commission Expires: Lemoyne Boro,Cumberland County ` toy commission Expires ran.20,2415 _. 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W O 7 A V q a S @ o Q C a O S � C @ � 0 91 1 @ C t CS N N Q C7 O O C CL to p y G x 0 0 N N O W O do {� CyO z .Nr CD < m m C o mg OD 0 CL yy 0 0 F- w v O fi 8m M � < a @ R a 'g m @a e w a ° CD ro m c m N aa, a �.c Ski c L v N c ac°wi o_ 2 m as $ o rD 3 a N PA REV-1500 SCHEDULE E CASH, BANK DEPOSITS & MISCELLANEOUS PERSONAL PROPERTY Z PN January 30, 2014 D Lyle Jarrett III PO Box 120 Quantico, MD 21856 RE: Name: Cyrus W Harding SSN: DOD: 12-07-2013 Dear Mr.Jarrett: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: nt a.ti'ot 6n LCu-/st7O ,Account#5114119205 !R>c Pal-d wrfl Sh/� a fio� /j/��•u v� CYRUS W HARDING Established: 12-23-2011 DLYLEJ DOD balance: $19,680.04 + 0.10 accrued iinterestARRETT lII Savings Account Account#5005743.257 Established: 10-08-2009 DOD balance: $90,154.81 +0.81 accrued me est HARDING Safe Deposit Box The decedent maintained safe deposit box#0113T CYRUS W HARDING located at: D LYLE JARRETT III New Cumberland Branch 331 Bridge St New Cumberland, PA 17070 717-774-2982 Page 1 of 2 Please note that this office provides date of death balances for deposit accounts(IRAs, CDs, Checking and Savings). We do not process any financial transactions or Provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK(1-888-762.2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. if the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this foxed document. Page 2 of 2 PNC January 30, 2014 D Lyle Jarrett III PO Box 120 Quantico, MD 21856 RE: Name: Cyrus W Harding SSN: DOD: 12-07-2013 Dear Mr. Jarrett: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account $d.4'ot Qn 2C-rr IS[7� , TRx /pat'd wrfl, Sn�urvY�G�ori yO>i'u { Account#5114119205 CYRUS W HARDING Established: 12-23-2011 D LYLE JARRETT III DOD balance: $19,680.04 +0.10 accrued interest Savings Account Account#5005741257 CYRUS W HARDING Established: 10-08-2009 DOD balance: $90,154.81 + 0.81 accrued interest Safe Deposit Box The decedent maintained safe deposit box#0113T CYRUS W HARDING located at: D LYLE JARRETT III New Cumberland Branch 331 Bridge St New Cumberland, PA 17070 717-774-2982 Page 1 of 2 Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 2 of 2 ca w H > r Q w a p � r lf1 Q' N N u J to Q p C I' Q wz p2 .yNUN .y 1 3 W Q ' J f W W rNoy _GQ $ W y d G.f p C '. oza o Z� U I w T L +' V `. F N T 'paI . F qH = I- FF- J 2Z'Q oC sa ¢ p G W GLL UHa 6 S U z q 0 - Ul H ~ J of - O Q' i C A M Z n p Hr 1 aLL o Q '� b W � N .-• c co 1�' Lll rm PO w i a� 'z x SaUl < M w li LLIW2 U ° H >'mp T Oaz . 'E O G - , 7E ��..Q w Frj _ a0- °n S G cwi a to O CD ri ZD c ywm°rc Q �1 z rc U ii NOTICE OF INHERITANCE TAX pennsylva ni BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE _lot PO Box 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128,0601 JOINTLY MELD OR TRUST ASSETS DATE 05-19-2014 ESTATE OF HARDING CYRUS W DATE OF DEATH 12-07-2013 FILE NUMBER 21 14-0092 COUNTY CUMBERLAND SSN/DC D L IIIJARRETT ACN 14108312 PO BOX 36 APPEAL BY DATE:07-18-2014 QUANTICO MD 21856-0036 (See reverse side underObjec&ns) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS E REY-1548 EX AFP C12-13) -----------------..__ -------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF .DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 05-19-2014 ESTATE OF: HARDING CYRUS W DATE OF DEATH:12-07-2013 COUNTY:CUMBERLAND FILE NO. : 21 14-0092 S.S/D.C. NO. : ACN: 14108312 TAX RETURN WAS: C- ) ACCEPTED AS FILED CX) CHANGED. SEE ATTACHED NOTICE JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK NA ACCOUNT NO. : 5114119205 TYPE OF ACCOUNT: ( )SAVINGS ( X) CHECKING ( )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 12-23-2011 Account Balance 19,680.04 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 01500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 9,840.02 UPPER. PORTION OF THIS NOTICE Debts and Deductions -' .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 9,840.02 REGISTER OF WILLS AT THE Tax Rate Y .15 ABOVE ADDRESS. MAKE CHECK. Tax Due 1 ,476-.00 OR .MONEY ORDER PAYABLE TO: - "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 04-16-2014 CDO19045 . 00 1,435.13 - PAYMENT MUST BE MADE BY 09-08-2014*. TOTAL TAX PAYMENT 1,435.18 . - BALANCE +OF TAX DUE 40.82 INTEREST AND PEN. .DO TOTAL DUE 40..82 * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUNn, SEE REVERSE SIDE OF THIS FnP" r,+o *•�--^---- -- RE✓--1410 EX(01.10) . r pennsylvania INHERITANCE TAX DEPARTMENT OF REVENUE EXPLANATION BUREAU OF INDIVIDUALTMES OF CHANGES - PO Box 289601 " HARRISBUBCa.PA 1 2 . 60 DECEDENTS.NAME FILE NUMBER Cyrus W'Harding 2114-0092 REVIEWED BY - Amber/Agent 192 AcN 14108312 ITEM CE EXPLANATION OF CHANGES The deductions that were provided have been disallowed. The claimed bills pertaining to the credit card bill,phone bill, and other debts are not allowed against the jointly held accounts. These expenses are probate deductions,which the estate attorney, executor' or executrix are required to claim; the decedent's estate will have to reimburse you for these paid debts. This account can be reported and paid on the Inheritance tax return. • .1 Y 1 ar. A'` i .{"£. 1. r E 't SI f . F ft g x e E s'e1- Page. 1_... September 2, 2014 w LYLEJARRETT f , PO BOX 120 6540 QUANTICO RD QUANTICO, MD 21856 RE: Contract Number: P43A7535394 Line of Business: NON-QUALIFIED Deceased: CYRUS HARDING Dear MR.. JARRETT, On behalf of the American General Life Insurance Company, we wish to express our sincerest condolences for your loss. As you requested, the following information is being provided for the above- referenced contract. This date-of-death value must be confirmed by an original certified death certificate. Date of Death: December 7,22013 Contract Value: $79,597.01 PLEASE NOTE: This is not the actual death benefit payment amount Should you have any questions or require further assistance, please contact our Annuity Service Center, Monday through Friday 5:00 AM to 5:00 PM Pacific Time at 1-800-445-7862, Sincerely, Annuity Claims Department Policy Owner Services Annuity Service Canter PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COSTS Musselman Funeral Home and Cremation Services 324 Hummel Avenue Lemoyne, PA 17043 Tel: 717-763-7440 Fax: 717-730-9798 Brian G. Musselman, Supervisor Clifford D. Forester Sr. Funeral Director D.Lyle Jarrett III P.O. Box 120 Quantico;MD 21856 Dear D.Lyle, Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found our services,so far,to be of the highest standards that we always try to achieve. The following is a summary of the service charges as previously explained and provided in written form on the services for. CYRUS W. HARDING $Prepaid Embalming $Prepaid other Preparation of Body $Prepaid Total Funeral Service Selected Use of Facilities&Staff for Visitation $Prepaid Use of Facilities&Staff for Ceremony at Funeral Home $Prepaid Transfer of Remains to Funeral Home $Prepaid Hearse/Funeral Coach - $Prepaid - Service/Utility Vehicle $Prepaid Canny Acknowledgement Cards $Included Register Book $Included Memorial Folders $Included CASH ADVANCES Certified Copies of Death Certificate $30-00 Clergy Honorarium $ 100.00 Newspaper Notice Patriot News $21537 Casket Spray$225+tax $238.50 Honor Guard Donation $75.00 CASH ADVANCE TOTAL $654.07 LESS: Credits granted $427.40 Pre Need Credits $427.40 TOTAL OF SERVICES $231.67 BALANCE DUE $231.67 If there are any questions or concerns that remain unanswered,please call me. Sincerely, The Patriot-News Co. 2020 Technology Pkwy theoa �*�* Suite 300 .Ii,9IV 1W11 Mechanicsburg, PA 17050 Now you know Inquiries - 717-255-8213 HALBRUNER, HATCH & GUISE, LLP 2109 MARKET STREET CAMP HILL PA 17011 STATEMENTALL CHARGES ARE NET ACCT# NAME AD ORDER# DATE EDITION ADDTL. INFO TYPE OF CHARGE AMOUNT 245301 HALBRUNER.HATCH&GUISE, LLP 0002290402 02118/14 XXX 245301 HALBRUNER, HATCH&GUISE, LLP 0002290402 02125/14 XXX Harding BASIC AD CHARGE $39.46 245301 HALBRUNER,HATCH&GUISE.LLP 0002290402 03104/14 XXX Harding BASIC AD CHARGE $39.46 Harding BASIC AD CHARGE $39.46 AFFIDAVITCHARGE $5.00 TOTAL: $123.38 This is not an invoice. Please do not remit payment from this Statement. An invoice will be generated at the end of the month. --Thank you. NOTE: This Statement replaces the Order Confirmation which we previously sent with Proofs of Publication E p O ,t CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 February 28, 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: Craig A. Hatch, Esquire RE: Cyrus W. Harding 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: February 14, February 21, and February 28, 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 : 1/28/2014 Cumberland County - Register Of Wills Receipt Time : 12: 01 :49 One Courthouse Square Receipt Tim 2 : 01 :42 Carlisle, PA 17913 HARDING CYRUS W Estate File No. : 2014-00092 -- Paid By Remarks : D LYLE JARRETT III HMW ------------------- ----- Receipt Distribution -------- ------- --------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 210 . 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 AUTOMATION FE & CNTR M.D FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY INH TAX RETURN 15 .00 CUMBERLAND COUNTY GENERAL FUN ---------15 . 00 CUMBERLAND COUNTY GENERAL FUN Check# 1190 $ $308 . 50 Total Received. ... . . . . . . 308 . 50 LOWESS HONE CENTERS, INC. " 5500 CARLISLE PIKE MECHANICSBURG, PA 17050 (717) 610-9230 - 10.00% OFF MILITARY- PERSONAL USE DISCOUNT SALE - j18IR11 — SALE — ICI phNr�IU1`hlpIyy9 SALES#: S2223SO2 1694755 TRANS#: 9619139 12-09-13 'II��'i; R11CI�III�I® 13.48 . IIU�pII _ -1.50 7.18 CLUB N[4DIAC'2 A>w Ra.iGA 7.98 DID rgau�„�, -0.80 ( el 10 ) 3. £-066 Ala by!_„ ur nx n auutrPN6li PF 2.68 j 0.I I�fsJ r IdCI 2.98 DISCOUNT EACH -0.30 12/01/13 14:153 3175 i ENVIRONMENTPL. 119r:11VS:{y(Cl i SUBTOTAL: 23.34 E 578328 HFI�t StJA:14SI` 3.36 IV TAX: 1.40 E 968794 R11)Ulf 2FF 5.96 IV INVOICE 09125 TOTAL: E 119176 EX SKIM :11-1 3.09 N LCC: E 119176 DC 5011 14[1LF" 3.09 14 E 606697 SCRA'F1.- F'" 6.78 14 TOTAL DISCOUNT: 2.60 E 5 AR(.. =i!"° 8 N LCC:XXXXXXXXXXXX6250 AHOUNT:24.74 AUTHCD:001192 CO' SNIPED REFID:619160222309 12/09/13 14:59:20 AL E 886473 FRi11'CAY UCF` 6.£46 N LBA/P0: 824 E 932807 GF1 X 120i' F I'E8 l4 E 932807 GFLE:X5,t0i: I'' 4.£8 I4 E 744638 5'TI_IIIA. F' 9.Se 14 tri— E 155411 RF C-1E:000R f 15.58 I4 E 15.411 RF C-E[L)ul+ f'' 6.98 N STORE: 2223 ERMINAL: 09 " 12109/1314:59:46 E 457334 CLFJI-NI•f['J=:_Sala 5.981'1 # OF ITEMS PURCHASED: 3 TAX I l, i.�IAL� 90 EXCCLLUIDES�I FEES, ISSEERRUICESLI'AND u�SPECIAL fORDER�ITEMpSII ! _ IIWOU�IIA�BH�U��III'IRV191� �II IIR1101�4�III��uII�I�IYIII Ildll6 i TER#ROVAL## 001045`rl 'ftE:])I7 9161 THANK YOU FOR MOPPING LOWE'S. C kl5 A: IDLE 13.CO . _ SEE REVERSE SIDE FOR RETURN POLICY. Visit Samsci Lb.scm Eo >ae�s�. ycavr savings STORE MANAGE#:- JIM DUNKELBERGER �. t.r r.l,I,.)I_.�II 14 WE HAUE THE LOWEST PRICES, GUARANTEED! I TCT# 7724 1651 5-D?5 5244 9815 IF YOU FIND A LOWER PRICE, WE BILL BEAT IT BY 108. IIIIIIIIIIIIIIIIiI IIIIIII IIIIIIII IIIlilllllilllll IIIIIIIIIIIIillllIII SEE STORE FOR DETAILS. " Please tell un<tlsou+.ynsr::.k,oppin�;sup erienre # YOUR OPINIONS COUNT! # IN RETURN FOR YOUR"rilhEYCU COULD RECEIVE ONE OF FIVE S1,000 5a AI'?.CLUB SHOPPING CARDS # REGISTER FOR A CHANCE TO VIM A $ Must be 18 or older and a Ire7nl ri,mcleut of thna 6o U 1 or $ $5,000 LOVE'S GIFT CARD! $ DC to enter.No wind sa nc,:r:.sarytc enter or win.To $ iREGISTRESE PARA TENER LA OPORTUNIDAD BE OANAR UNA # enter without pm'crw ni and rnr ooial roles visit unvw.entrysurerpsann ucluL.com $ TARJETA BE REGALO DE LOVE'S DE $5000! # Sweepstaken penocl ranch xi the date show in the $ official rubes.Surrc1'111413t to taken within $ R1'O Wealrs of tcday. # REGISTER BY COMPLETING A GUEST SATISFACTION SURVEY # Este encue;da ismaiun eo nncwmtm ea espanol an Is $ WITHIN ONE WEEK AT: www.lowes.cam/survey # P:iyim!dulnlemst. # Y 0 U R I D If 09125 2223 343 # j *xx cff_;R cxx;Y taro . # Il # NO PURCHASE NECESSARY TO ENTER OR WIN. # " # VOID WHERE PROHIBITED. MUST BE 18 OR OLDER TO ENTER. # "# OFFICIAL RULES 8 WINNERS AT: www.Mwes.cam/suroey STORE: 2223 TERMINAL: 09 12/09/13 14:59:46 Jet r�Ci1�ie . ('rY Lw Yecc Co,n Vi u.. J 4 o w.c\ vn e<< �F �ew,s r �d�reSS eS v� Jove L- 0_ es � L /I,(rn�J'►')J e �r�)ne�re,SS o� 6e��yp�5 4/ vVe e E v�lce� o 1101,77 —Ck rn day e Customer Receipt (For use by Rural Carriers and Highway.Contract Routes only) Amount(Written Out) zo ��/�. [J—' -•— C`---� /100 Dollars V Check Here for Temporary Receipt P.mount(In Numbers) El (Payment Received—Total Cost Not $ Yet Calculated) ��•' Purpose 1 By(Signature) (MM/DD ) Ln 0 PS Form 1096, ctober2009 PSN 7530-02-000-7346 ASPS Mardela Goose Creek, 3 24948 Ocean Gateway Mardela Springs, Md 21837 Texas Roadhouse 04/02/2014 04/02/2014 12:29:09 pM 1101 Lower Allen Drive Register: 1 Trans #: 8044 Op ID: 11 Camp Hill, PA 17011 Your cashier: KESHA I Server: PM BAR DOB: 04/02/2014 I UTZ RIPPLE CHIP 6.502 $2,79 99 07:46 PM 04/02/2014 i UTZ POTATO CHIPS 6.SOZ $_0 79 A3Lyle/1 4/40062 SALE UTZ SBO RIPPLE CHIP 6.50 $0 79 99 I UTZ POTATO CHIPS 6.50Z $_0.79 MC 4194324 Card #XXXXXXXXXXXX0248 Magnetic card• present: JARRETT D Card Entry Method: S Subtotal = $4.00 Approval: 05477Z Total -----$4.00 Amount: $ 16.59 Change Due = $-1.00 ' + Tip: C-? Cash $5.00 +Ii = Total: I agree to pay the--above THANK YOU 4 total amount according to the 10-546-2078 card issuer agreement, X GUEST COPY I j WELCOME TO AREBY' S ! MILLSBORO, DE 1-302-934-ri710 I ORDER 30 TAKE OUT _ MID BEEF' 3.42 j with swiss .50 MID BEEF/COMBO 3.42 with swiss .50 CRISPY CHIY;CO 3.52 3 POTATO CAKES 5.67 3 PEPSI 5.07 ! SUBTOTAL 22.10 TOTAL 22.10 CASH 50.00 CHANGE 27.90 Thu Apr 03 12:55 T= I C=120 - MANAGER MELHORH.KAREM Fwd:U-. . travel confirmation–April 02,2014–(itin#13156333478) - - 4/3/14'5:29 PI Fwd: Travelocity"travel confirmation - April 02, 2014 - (Itin# 13166333478) Cduntry I�rtn _: Wit' B Carison� arrisburg es : ec anres urg From: Wed Apr12fttra'a�ttA`�1gl2 � 4m3f'��Pa�i- 9, T633347s To: lylejarrett@mindspring.com Subject: Fwd: Travelocity travel confirmation -April 02, 2014 -(Itin# 1315633347.8) Date: Apr 3, 2414 5:28 PM. Sent from my iPhone Begin forwarded message: From: "Travelocity" <travelocQe travelocity com> Date:April 2, 2014, 5:35:65 PM EDT To: <lyleiarretf(&minds rina.com> Subject: Travelocity travel confirmation -April 02,2014. (Itin#13156333478) varxpPageStartTime=new DateO.getTimeo; var xpBeaconServerUrl = "/clientLog"; var xpLogKey = "page.Itin.Email.Callback%7Cf694184a-a26c-44b3-ae57- 186d101a5247%7C145245d7fdb%7Ca0654fece683af5523384203219cf569";varxpGuid = "d518e9fb69cd47c091621288bae054ee"; var xpData="'; var xpBuildVersion = "release-2014-04-r1-5529- 1002654'; trayelo_lty Thank you for booking-with Travelocity! Your booking is confirmed. You can manage your reservation or review your itinerary online for the most up-to-date information. Country Inn & Suites By Carlson, Harrisburg West BOOKED _ Wed Apr/2/2014-Thu Apr/312014 , 1 room 11 night Your reservation reconfirm is booked. No need to calf us to reconfirm this reservation. price Summ ry View hotel details Total $97.01 " 4943 Gettysburg Rd, Mechanicsburg, PA, 17055 Collected by Travelocity .United States of America Tel: 1 (717)796-0300, Fax: 1 (717)796-0800 Room Price $97.01 1.night $89.00 ........ ..................................................................._..... ...... Taxes&Fees $8.01 All prices auoted in USD. http://webmaii.c.earthlink,net/wam/printable.jsp?msgid-112495&x 2044679683 Page 1 of 2 CHECK NO:. " DATE NO.PERSONS AMOUNTOFCHECK 929989 ' Ja�as�t� f - �� ' .. e1c, -1-3 SOPHIA'S ON MARKET Left Count Check Tab CGv Server Time Date 194421 48 1 122 8:54:35 AM 12/14/2013 ------=------------ ----------------- - - — GUEST # 1 ------------------------------------- T_ Egg Sandwich 3.00 J{r Guest Receipt — Bacon 1,00 v`l J VDate Amount Gues s + - Sub Bagel 0.75 1d�r/ U�(o �yc3 CZ y; 1 Pumpkin Scone 2.95 t — 11 1 Egg Sandwich 3.00 --- Bacon : - 1.00 a ... Sub ,Bagel � 0.75 Add Onion 0.50 Free Snack McFlurry or Cone Add Green Pepper 0.50 Go To www.McDonaldsFeedback.com 1 Side Homefries 2,50 and tell us about Your visit. 1 Cheese Omelet 5.25 Validation Code: Bacon 2.00 Limit one per customer per visit. 1 Southwest Omelet 6.50 . Valid at participating locations only. 1 Side Sausage 2.25 Not valid on promotional receipts. ------ 298 Tilghman Road Food Sub-Total ;_31,95 : Salisbury 2 Bottled Water 3.00 MD 2 Coffee (Small) 3.00 21601 ! 1 THANK YOU i 1 1 Beverage Sub-Total 6.00 TEL# 410-341-8683 $tore# 18346 SUB TOTAL 37.95 . SALES TAX 2.10 KS# 13 Dec.13'13 (Fri) 13:27 CHECK T-0-_ T-A-_ L 4_6_.__0_5 NFY sroE , KVS Order 08 THANK YOU 4-10,60 rie QTY ITEM TOTAL Lindsay 2 McF 2.00 1 S French Fries 1 .00 --------=------------------------------- 1 S Water 0.10 Master Card 48.05 GRATUITY 8.00 Subtotal 3.10 -------------------------------------- Tax 0.19 Take-Out Total 3.P9 Cash Tendered 5.00 _._. Change 1 .71 McDonald's #18346 i ✓ Reprint Closed Check Ponzetti ' s Salisbury 1053 N.Salisbury Blvd, Salisbury, MD 21801 ILYLE - ------ ---------------- - CHK# 147 ' -------------- Pizza # 12/27/2013 5:03:31 PM 5 GUESTS 0 - -------- --------------------------- Take Out 1 1 16" Cheese Pizza 14.92 Mushrooms SUBTOTAL: Pepperoni TAX: 14,92 PIZZA 0.90 TOTAL : ----------- $15 , 82 Cash Change 20.00 ------------------------------ 4.18 CLOSED -`------- ------------------ 12/27/2013 5_22_14 PM Thank You ! I 1 Date Amount Guests 391833 Guest Reeeipt f` I 7777 j 'I/ BACK STR'L a d L L TUE DEC71BER 10,2013 CHECK #500513- 1 1Hrs Fm< ;HOPPING WE:_S MARKET 1025 TABLE #14 1 Reach Fries $3.99 ray LOUrh>_r Read 1 Brewed Tea PR. lion 2 Burger $1 .89 T17-T3T-Toe' $13.98 SUB-TOTAL TA $19.86 Y , ODRY WFS Brianna I Ti : $1.19 `21 _ 05 20:58 2 CUSTOMERS -b " 5'`19 ils THANK YOU FOR 44'2 LARGE SALAD B.39 B I YOUR PATRONAGE! "9,* YOU H611F r r fJ SEP'?ED 9.00 L0.11) a1 'i. TOTRI, N!JMBE:P OF ITEMS !TOLD = 1 12105.1 0:i:35pm 125 5 193 104 .- i .. I s �I RSM S . 11S HOW OUR WEIS HOPPERS CLUB •:' - acsu„ Sfl\IE YOU S3'S EVERYDAY Ti°�•,.,Nl ;tip ' ' ' S'`'""` i"•" I ii-SIT US ONL 11lE OT: wui.ue ismarke'a.com Thank YOU For Choosing. OUR RECEIPT PAPER ! Papa John's Pizza IS 8PR FREE! Restaurant #0795 _ 12-08- 13 Name: Mile 01 i 1 ° 2 5 _tl.---•--- ----- oust#: 62067 0 1 %;1 ° 0 0 Phone#: (717)111-1111 sec: p/u 01 1 . 25. order #: 0095 - In Person/Carryout �p Out Time: 1 0 ° 0 7 ST TF V'1N� OU 1 <10 14" Original 14.0u 2 0 ° 1 0 CA FOR SHOPPING Al +Pepperoni +Mushrooms 10 ° 0 3 CG ROYAL FARMS +1 Garlic cups 0 3 I +1 Pepperoncii,; Peppea No 0 0 3 5 1 . 1 0 7655 Ocean Gateway ------------ 1 3 -2 2 Easton MD 21601 subtotal: 14.50 410-770-9263 Discount: 2.50 Descripti5n Otv Amount Tax: 0-77 --_- XL CHEETOS CRUNCHY/FL 3 . 1 $01.49 Total : 12.72 ITALIAN WRAP PLU6013,/EA 1 $4.79 COFFEE 240Z PLU205/EACH 1 $1.59 twelve dollars and 721100 cents Sub Total $9.87 Tax $0.38 0374 12/08/2013 08:23pm Total $10.25 Cash $20. 00 ----------------------------------------- Change $175 REG: 3 CSH:h, )amen TRAN:7696 12/7/2013 7:07:49 Site:Roval Farms 053 L I NM4 I RI O• Cj C7 5- P C L^ O a EL � welcome to Rutter's Farm Store 0008 129 LeadersHeightsRd York Pennsylvania SALE RECEIPT 717-741-4057 tore #30643 tko 01/28/14 20:20:11 ubway Sandwiches & Salads 1 24 OZ COFFEE $1 .59 801 Autumn Grove Court alisbury MD 21804 Sub Total.. $1.59 .10-860-5180 Tax $0.10 Trans# 231 Clerk 05 Dwr ID ROT 012814 -Receipt # 0000876081 Rp- REG-MAIN Total $1 69 - ITEM --- QTY PRICE MEMO PLU m UNA fr 1 TO$ 5.00$5RegFT10217 Cash $2.00 5AaRgFT 1 $ O.00$5RegFT1261O 'URK Y fr I TD$ 5.00$5RegFT10223 CHANGE ME $0.31 ;5AnyRgFT 1 $ 0.00$5RegFT12610 SUBTOTAL $ 10.00 Sales Tx $ 0.60 WHY GO ANYWHERE ELSE 'AKE-OUT **TOTAL $ 10.60 REG#1 CSH# Kah]DR# I TRAN# 3192448 ;ash AMT TEND $ 15.00 1/28/2014 4:59:08 PM ST# 0008 -------- CHANGE DUE$ 4.40 (Customer Copy) low'd we do? Get a free cookie. ake 1 min survey at www.tellsubway.com i i 647 E; Cf1Rl_ISI_E PIKE ' MECHWCSBURG, FA 17050 (777" 791-4500 O1/28i1a OPA 176211 ).43 ib C= 8.49 /lb WI S/S WING Fn7R 3.65 T . . TH 0,22 •_+ BoullICE 3.87 CFSH 20.00 CHANGE t6.13 . 011281'.9 12:58 pm 95. 22 87 176211 Fvehg day you get OLO bar Thai& you! CUSTOMER COPY Oo o ao J4 � --Q zzi ct -z Qp- et RZ )- 5 ✓y ��99 01O )° � In o f� o tYb v�o Gb n c o JO Oo \ r ct CUSTOMER COPY Rental Agreement Cover Sheet PENSKE Rental Agreement#:44664331 HOUSEHOLD LOCAL Created by T.EVANS Pick Up Date: 12126H3 03:55 PM Completed by: T.EVANS Expected Return Date: 12/27/13 03:55 PM 2417 Roadside Assistance: Entered At.,. 7043-25 Actual Return Date: 12/27/13 03:55 PM 1.800.526-0796 Status: COMPLETED Customer Name: LYLE JERRETT _ Created On: 12/26/13 08:55 PM Changed On: 12/26/13 08:55 PM BILLING INFORMATION Invoice#: PO#: Billing Cycle:Weekly Bill Start Date:12126/13 03:55 PM _ Remit To: PENSKE TRUCK LEASING CO.,L.P.-P.O,BOX 827380 PHILADELPHIA, PA 19182-7380 USA CHARGES - Type Quantity Unit of Meas Rate Charge Unit#:9162836 1 Day $59.98 $59.98 Mileage Out:55,892 In:56,308 416 Miles $0.2700 $112.32 Discounts Applied: Special Discount LDW$0 Responsibility 1 Day $17.00 $17.00 environmental fee 1'Day @.$2.00 - $2.00 SUBTOTAL: $191-30 TAXES MD SHORT TERM RENTAL TAX $15.30 TOTAL DUE: $206.60 PAYMENTS AND REFUNDS Pay Type Trans .Date Card# Approval Code VI - PYMT 12/28/2013 xxxxxxxxxxxx0713 005279 on 12/26/2013 Ems,5 0Z- PAYMENT: /$206.601 NET DUE: $GAO Customer acknowledges that Customer has read,or been given an opportunity to read,the Rental Agreement,including this Cover Sheet,the General Terms and Conditions,as well as any attachments hereto and agrees to be fully bound by its terms. To the extent the Customer had purchased Limited Damage Waiver coverage,Customer acknowledges reading,understanding,and agreeing with the disclosures,exclusions,an, terms and conditions applicable to Limited Damage Waiver as set forth in Attachment D to the Rental Agreement. By: Customer/Authorized Signatory Page 2 / CUSTOMER COPY Rental Agreement Cover Sheet PENS/rl 7 Rental Agreement#:44664331 HOUSEHOLD LOCAL Created by T.EVANS Pick Up Date: 12126/13 03:55 PM Completed by: T.EVANS Expected Return Date: 12127113 03:55 PM 2417 Roadside Assistance: Entered At: 704325 Actual Return Date: 12127/13 03:55 PM 1-800.526.0798 Status: COMPLETED CUSTOMER INFORMATION PICK UP/DROP OFF LOCATION LYLE JERRETT DELMAR AUTO OUTLET INC.(7043-25) P.O.BOX 120 8307 DICKERSON LANE QUANTICO,MD 21856 USA SALISBURY, MD 21801 USA Day(757)630-3520 Voice (410)8963167 Fax(410)896-2289 DRIVER NAME(S): LYLE JERRETT TRAVEL SCOPE: Intrastate This lessor cooperates with all Federal,State,and local law enforcement officials nationwide to provide the identity of customers who operate this rental CMV UNIT INFORMATION Unit#:9162836 Max.Payload:4,700 lbs. Rented With Damage:NO 1215- 16FTSAG LIGHT HICUBE Height:10/1.6 in. Returned With Damage:NO License#:2077101 Mileage Out 55,892 License State: IN Mileage In:56,308 License.Exp:01/31/2014 Fuel Out: 1/4 Owning Location:0723-10 Fuel In: 1/4 NO HAZARDOUS MATERIAL BEING TRANSPORTED Please verify the above fuel level is correct.Customers who return vehicles with less fuel than when rented will be charged$8.00/gallon to refuel vehicle. X Initials OPTIONAL PROTECTION PLANS Limited Damage Waiver/LDW$0 Responsibility *ACCEPTED* Rates:$476.00/month $119.001week ,$17.00/day Supplemental Liability _ *DECLINED* Personal Accident Insurance *DECLINED* Cargo Insurance *DECLINED* THIS CONTRACT OFFERS, FOR ADDITIONAL CHARGE OPTIONAL VEHICLE PROTECTION TO COVER YOUR FINANCIA RESPONSIBILITY FOR DAMAGE OR LOSS TO THE RENTAL VEHICLE. THE PURCHASE OF OPTIONAL VEHICLE PROTECTIO IS OPTIONAL AND MAY BE DECLINED. YOU ARE ADVISED TO CAREFULLY CONSIDER WHETHER TO PURCHASE TH.' PROTECTION IF YOU HAVE A RENTAL VEHICLE COLLISION COVERAGE PROVIDED BY YOUR CREDIT CARD O AUTOMOBILE INSURANCE POLICY.BEFORE DECIDING WHETHER TO PURCHASE OPTIONAL VEHICLE PROTECTION, YO MAY WISH TO DETERMINE WHETHER YOUR CREDIT CARD OR VEHICLE INSURANCE AFFORDS YOU COVERAGE FO DAMAGE TO THE RENTAL VEHICLE AND THE AMOUNT OF DEDUCTIBLE UNDER SUCH COVERAGE. Page 1 3/7/142:03 y;�iiy -a1 The Delaware E-ZPass Customer Service Center has moved to the historic business district of downtown Dover.The new location at 22-24 West Loockerman Street is _ conveniently located near shopping, restaurants, and public parking. Come visit our new walk-in facility and see our new home! r DELAWARE www.EZPassDEcom Phone 1-888-EZPassDE(1-888-397-2773)Fax 1-302-677-7274 Page : 1 of 3 E-Vass Activity Statement "THIS IS NOT A BILL' Account Number: 4010000802764 LYLE JARRETT, III Account Type: Individual P. O. BOX 120 Replenishment Method: Automatic Recharge-CC QUANTICO, MD 21856- Replenishment Amount: $45.00 Customer Since: 7/23/2007 v t 3 Statement Date: 3/712014 Sc/ Statement Period: 11/23/2013 to 2/22/2014 ACCOUNTSUMMARY t Beginning Balance Tolls Other Charges Fees Payments Credits Ending Balance 50.61 -230.62 0.00 0.00 .4170.00 39.00 28.99 ACCOUNT DETAIL Date Transaction Transponder/ Date&Time Entry Plaza Lane Exit Plaza- Lane Class Amount Balance Posted Lic.Plate Beginning Balance 50.61 11/23 Pennsylvania Turnpike 01900244668 11/20/1314:41 Lebanon-Lancaster 2 Harrisburg West Shore 5 1 -1.69 48.92 Commission Toll - - 11/23 Pennsylvania Turnpike 01900244668 11/20/1311:40 Harrisburg West Shore 2 Lebanon-Lanpaster 5 1 -1.69 47.23 Commission Toll - - - 12107 Pennsylvania Turnpike 01900244668 12/04/13 10:23 Harrisburg West Shore 2 Lebanon-Lancaster 5 1 -1.69 45.54 Commission Toll - 12107 Pennsylvania Turnpike 01900244668 12/04/13 14:36 Lebanon-Lancaster 2 Harrisburg West Shore 7 1 -1.69 43.85 Commission Toll 12107 Maryland 01900244668 12/05/13 15:30 ••• °• Lane Memorial Br 003 002 -6.00 37.85 Transportation _ Authority Toil 12/08 Pennsylvania Turnpike 01900244668 12/05/13 12:21 Lebanon-Lancaster 2 Harrisburg East Shore 9 1 -1.69 36.16 Commission Tall - - - - 12108 Pennsylvania Turnpike 01900244668.1 210511 3 11:10 Harrisburg West Shore 2 Lebanon-Lancaster 5 1 -1.69 34.47 Commission Toll 12/08 Pennsylvania Turnpike 01900244668 12/05/13 13:21 Harrisburg East Shore 3 Harrisburg West Shore .5 -1 -1.02 33.45 Commission Toll 12111 Pennsylvania Turnpike 01900244 Lebanon-Lancaster 2 Harrisburg West Shore 7 1 9t` 31.76 Commission Toll - . . 12111 Pennsylvania Tumpike 01900244 ' Harrisburg West Shore 2 Lebanon-Lancaster 5 1 30.07 Commission Toll 12/11 Maryland 01900244 t =6: "' Lane Memorial Br 003 002 A 24.07 Transportation - Authority Toll 12/17 Maryland - 01900244 - •° °' Lane Memorial Br . 002 002 - `0 18.07 Transportation Authority Toll _ - -12128 Maryland 019002446627 k3,A:- ••• Lane Memorial Br 002 002 _;>"fra r 12.07 Transportation `g- n Authority Toll - - - 01/15 Smart Tea.Virainia Toil 01900244668 01/1311409:51 '"" •`• CBST:North Toll Plaza 8 1 -13.00 -0.93 https://acct.ezpassde.com/Reserved.ReportViewerWebControl.axd?Repo...t&ZoomPa-100&ReloadDocMap=true&Search5tartPage=O&LinkTarget= top Page 1 of; ✓� �11,3� t bgoa losT�zceV.��' 9/7/142:03 01/15 Smart Tag,Virginia Tall 01900244668 01/13/1416:32 ••• °• CBBT:South Toll Plaza 9 65 -5.00 -5.93 01/15 Prepaid T611-Credit 01/15/1418:18 125.00 119.07 Card Payment - _ 01/18 Smart Tag,Virginia Toll 01900244668 01/16/14 15:11 .•` - •••CBBT:North Toll Plaza 8 1 -13.00 106.07 01/19 Smart Tag,Virginia Toll 01900244668 01117/14 15:44 "` - '•• CBBT:South Toll Plaza 7 1 -13.00 93.07 01/25 Smart Tag,Virginia Toll 01900244668 01123/14 10:35 `., — CBBT:North Toll Plaza - 8 1 -13.00 - 80.07 01126 Smart Tag,Virginia Toil 01900244668 01124114 12:55 — — CBBT:South Toll Plaza 7 1 -13.00 - 67.07 01/30 Maryland 01900244 •'• Lane Memorial Br 008 - 002 A = 61.07 Transportation - - Authority Toll - 01/31 Pennsylvania Turnpike 0190024466 • 8 X58 Harrisburg West Shore 2 Harrisburg East Shore 7 1 1= 60.03 Commission Toll - 0 & -,-,i 01/31 Pennsylvania Turnpike 01900244 Harrisburg East Shore 1 Harrisburg West Shore 7 1 Commission Toll - - 02104 Delaware DOT Toll 01900282238 02103/14 17:53 Dover Plaza 40 Dover Plaza - 40 2 -1.00 57.99 02/04 Delaware DOT Toll 01900282238 02/03/14 18:17 Biddies Plaza 40 Biddies Plaza 40 2 -1.00 56.99 02/05 Delaware DOT Toll 01900282238 02/04114 17:44 Dover Plaza 40 Dover Plaza 40 2 -1.00 55.99 02105 Delaware DOT Toll 01900282238 02104/14 07:51 Dover Plaza 41 Dover Plaza - 41 2 -1.00 54.99 02/05 Delaware DOT Toll 01900282238 02/04/14 18:07 Biddies Plaza 40 Biddies Plaza 40 2 -1.00 53.99 02105 Delaware DOT Toll 01900262238 02/04/14 07:28 Biddies Plaza 41 Biddies Plaza 41 2 -1.00 52.99 02/06 Delaware DOT Toll 01900282238 02105114 17:40 Dover Plaza 40 Dover Plaza 40 .2 -1.00 51.99 'Credit Card Customers—* Take no action as your account will replenish�automatically. https://acct.ezpassde.com/Reserved.ReportVi ewerWebControl.axd?Repo...WoomPa-100&ReloadDocMap=true&SearchStartPage-0&LinkTarget=_top Paget oft Credit Cards rvmnayc your nuwwn unnuv:. imouue: von cnase.cou nom CHASE!'i www.chase.corn/creditcards 1-800.283.1211.e on your mobile browser AOGOUNT SUMMARY j PAYMENT fN_FORMATION: Account Number; 4408 0399 9834 2073 New Balance $142.01 Previous Balance S0,00 Payment Due Date 01/15/14 Payment,Credits $0.00 Minimum Payment Due $25.00 Purchases +$142.01 Late Payment'Warning: If we do not receive your minimum payment Cash Advances $0.00 by the date listed above,you may have to pay a late fee of up to$35.00 and your APR's will be subject to increase to a maximum Penalty APR Balance Transfers $0.00 of 29.99%. Fees Charged $0.00 Minimum Payment Warning: If you make only the minimum payment Interest Charged 0.00 ach period,you will pay more in Interest and it will take you longer to New Balance f $142.01 p y off your balance. For example: Opening/Closing Date 11/19/13- 12/18113 Credit Access Line $24,300 If you make no You will pay off the And you will end up additional charges using balance shown on paying an estimated Available Credit $24,157 this card and each this statement in total of... Cash Access Line $4,860 month you pay... about... Available for Cash $4,860 Only the minimum 6 months $148 Past Due Amount $0.00 payment Balance over the Credit Access Line $0.00 If you would like information about credit counseling services,call / -866-797-2685. AARP:REWARDSSUMMARY - Previous rewards balance S 1,490 To redeem rewards or ask questions,please call +3X Rewards earned on travel - 0 1-800-283-1211.You can also redeem your rewards +Rewards earned for all other purchases 143 online at www.chase.com/aarp -Total rewards available for redemption 1,633 411 Rewards will expire on statement in June 2016 With your AARP Visa card you earn 3 rewards for every$1 you spend on travel and 1 reward for every$1 you spend on all other purchases. Use your AARP Visa Card for all your purchases and watch your rewards add upl - ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description $Amount PURCHASES 11/18 THEO'S BAR&GRILLE CAMP HILL PA - 73.55 11/20 FIRESIDE NEW CUMBERLAN PA 48.16 12/03 SHELL OIL 57544268600 NEW CUMBERLAN PA 20.30 2013.Totals Year-tc-Date Total fees charged in 2013 $0.00 Total Interest charged in 2013 $0.00 . Year-to-date totals reflect all charges minus arty refunds applied to your account. I 0000001 FIS33339 C 4 000 N Z 18 13/12/18 Page 1 of 2 00009 MA DC 14698 36210000040981459801 0007 ® GM Card GM MasterCard Account Staten Account Number 5437 0003 1198 2, YRUS W HARDING Page 1 of 2 From November 10_2013 to December 11,2 VIIIVV� I�VV�VIVIV)IVI Previous Balance $97.01 New Balance $6 r +- Payments _ - $97.01 Minimum Payment Due $2- Other Credits - $0.00 Payment Due Date January 5,21 Purchases/Debits + $68.40 Balance Transfers + $0.00 Late Payment Warning:If we do not receive your minimum payment by the - Cash Advances + $0.00 date listed above,you may have to pay a late fee of up to$35.00 and your All Past Due Amount $0.00 may be increased to the Penalty APR of 29.40%. Fees Charged + $0.00 . Interest Charged + New Balance 68.40 Minimum Payment Waming:lf you make only the minimum payment each period,you will pay more in interest and it will take you longer to pay off your o Credit Limit 300.00 balance.For example: Credit Available $231.60 Cash Advance Limitt $75.00 - — Cash Advance Available $75.00 If you make no additional You will pay off the And you will end up payin s Statement Closing Date December 11,2013 charges using this card balance shown on an estimated total of... Days in Billing Cycle 31 and each month you pay... this statement in 4 TCash Advance Limit is a portion of Total Credit Limit. about... Only the minimum 3 Months $70 6 - Payment . col. If you would like information about credit counseling services call d 1.866569-2227. Questions? - Payment Address:Capital One Card Services, PO Box 71107,Charlotte, N 24-Hour Automated Account Information 1-800-947-1000 28272-1107 Espanol 1-800-947-1000 Billing Inquiries:Customer Center,P.O.Box 80082,Salinas,CA 93912-00; Lost or Stolen Card - 1-800-374-0001 Manage Your account online at www.gmcard.com Outside USA Collect 1-702-243-1567 TDD/HeI Impaired ,. 1-800-280.5352 1 111 101 III , �N.�III� � �ll1l1l�l��d�' i� OEM! r 11 reminder,you may pay your credit card bill online or through our automated phone system for no fee. I � 11111gi 1 � ' I Trans Date Post Date Description of Transaction or Credit Reference Number Amou 0 11/25113 11/25/13 PAYMENT-THANK-YOU B112513AO11492691005601 -$91 TIm�Ioopltmtapmmll Payment l�NII��IFor lmlll�IRmThis IIO�I�P�ImIIe�rriiol!�dIImIIImIIpmIImII�IIml�mpmlppl �� ImII�IpmII�I Im�III�p�mI In ��Ii�II�IINnIII ��mIpI�MIIImIIIpIII�IIIImIIpgl��m�Ilm�Iml-IImI$ImI19u7��.( MEN I�tlIWW11it IIIIIIfnlilllllfWIfWWIiIIIIIIIIIUIIftiulfllltlWIIIIInItIIIIIYIIIIIIItitlUl i o NWIiWIWII81gIIIIIiVIIIINIIU I ,'iIIIIVIitlllli EMI MI 1 WU 1, 'I INIIIIIilllllihhlllllitllll�lMI Trans Date Post Date Description of Transaction or Credit Purchase Type Reference Number - Amou 11120/13 11722113 SHELL OIL 57544268600 NEW - MT133260176000010024334 $22: CUMBERLAN PA 11/20/13 11122113 WEIS MARKETS#125 SH CAMP HILL MT133260178000010027963 $45.1 PA Total Purchases For This Period $68.• 19MEM O.MIN U Iml I III IM 101 Trans Date Post Date Description of Fees Reference Number Amon - Total Fees For This Period $ ( 16 1 in I �� pmmi lIllI1,!EtNPW o 1 I u W tl1I3IMI WW 11 i ffi1I0 11p_ Description of Interest Charge Annou, INTEREST CHARGE ON CASH ADVANCES $O.0 De Detach and relum bottom portion with your payment —_— 1002005 '10 W00000201 SrMr91 D28051 aGA1 — —__See reverse side for important lnPormatlon PA REV-1500 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES and LIENS �7 LE BANON IN MEDICAL' CENTER (595) VAO LJ,S, Department 1700 5 LINCOLN MEDICAL LEBANON 'PA 1 704 2-7 597 U4VeteransAffairs ,c STATEMENT QUESTIONS OR ADDRESS CHANGE? 1oz 0441648 60 0011165 0022329 call 1-866-4o8-2657 �� III�I� III�I"I��II'II'�I'I�I�II�IIIIII I�I ��I�� III "III��I Methods of payment ONLINE: www.pay.goy CYRUS W HARDING - BY MAIL: t0 the address below PD eCx 205 IN PERSON: at the VA Medical Center NEW CUMBERLAND PA 17070-0205 PAY BY PHONE: 1-888-827-4817 Statement reflects payments received by 02/W/2014. 'PATIENT NAME: CYRUS W HARDING LpCF�L;,VAS vESSAGE ACCOUNT NUMBER 595 0000 0000 67048 HARDI STATEMENT DATE 02/14/2014 - . jr BALANCE PBEYIOUS LA C PAYMENTS RCEVED _NW AR6 6 ' "CHAR6Pky?BALANGE SUMMARY .' _oo .00 15.00 CaBY oa/1i/koy4 _ z4.00 . DESCRIPTION - -- AMOU . BILLING EFERENCE OUTPATIENT CARE VISIT DATE: 11/20/2013 700 595-K409MFZ PAYING BY MAIL OR IN PERSON? DETACH THE COUPON BELOW. DO NOT INCLUDE ANY CORRESPONDENCE WITH PAYMENT. / LEBANON VA MEDICAL CENTER (595) VA «« LJ,�;7, '�'epal'tlnen� 1700 S LINCOLN AVE - } A.�' p LEBANON PA 17042-7597 Of Ve1�e.ra.nS Aftairs STATEMENT QUESTIONS OR ADDRESS CHANGE? toz 0131648 00 0009262 0018523 Caiti-866-408-2657 ' '111i1�'III�I"I��II'11'�I'I�I�II�IIIIII'1�1'��I��'lll�"111��1 Methods of payment ONLINE: www.oay.gov CYRUS W HARDING BY MAIL: to the address below B 205 NEW W CU MBERLAND PA 17070-0205 IN PERSON: at the VA Medical. Center NE PAY BY PHONE: 1-888-827-4817 Statement reflects payments received by 01/10/2014 PATIENT NAME: CYRUS W HARD I NG LOCAL':VA'S MESSAGE. ACCOUNT NUMBER: 595 0000 0000 67048 HARDI STATEMENT DATE: 01/14/2014 ACCOUNT -2-:PREVIOljS-ALAN PAYMENTSAECEIVED - NEW.CHARGES " ' "TO AVOID LATE` : '-`BALANCE .. SUMMARY �""1.P.• . `• CHARGES_PAY BALANCE X75:.00 15.00- 39.00 BY. 02/08/20141 - 9.00 - DESCRIPTION ,'AMOUNT;. -REFERENCE,:., OVERPAYMENT CREDIT DECREASE 15.00- 595-K407N1Q OUTPATIENT CARE VISIT DATE: 10/10/2013 15.00 595-K409B2E OUTPATIENT CARE - 595-K409B2E COPAY RX#3547361C FILL DATE: 10/10/2013 9.00 595-K409B3Z DRUG:ALBUTEROL 90MCG (CFC-F) 2000 ORAL INK DAYS:30 QTY: I PHY:WABNICK RICHARD CHG:$9.00 �j _ PAYING BY MAIL OR IN PERSON? DETACH THE COUPON BELOW. DO NOT INCLUDE ANY CORRESPONDENCE WITH PAYMENT. WEST SHORE EMS - ALS DIXOYER r'° VISA' nLiu_ste-rca 205 GRANDVIEW AVE STE 211 CAMP HILL, PA 17011-1708 ON REVERSE SIDE WEST SHORE EMS Phone#: (800) 367-0512 Federal Tax ID: 23-2463002 OHOLY SPNIT HEALTH SYSTEM PATIENT NAME: CYRUS HARDING INSURANCE: NOVITAS SOLUTIONS, INC. CRED UNITED AMERICAN INSURA NONE CALL NUMBER: 1203551A DATE OF CALL: 02/2412012 FROM: MANORCARE HEALTH SERVICES To: HARRISBURG HOSPITAL ACCOUNT SUMMARY CYRUS HARDING PO BOX 205 TOTAL CHARGES: 1020.86 NEW CUMBERLAND, PA 17070 PAYMENTS/ADJUSTMENTS: 1020.86 PLEASE PAY THIS AMOUNT: 0.00 DETACH ALONG PERFORATION AND RETURN STUB WITH PAYMENT DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT ALS EMERGENCY LEVEL 1 A0999 1.0 967.62 967.62 20GTT TUBING A0394 1.0 14.72 14.72 ANGIOCATH (14-24) A0394 1.0 6.72 6.72 CARDIZEM 25MG VIAL A0394 1.0 2.40 2.40 EKG ELECTRODES (1) A0398 10.0 0.80 8.00 EXTENSION SET 8"NEEDLELESS A0394 1.0 12.52 12.52 NEEDLES(ALL) A0999 1.0 0.76 0.76 NSS 0.9% 1 000c Bag A0394 1.0 3.48 3.48 OP SITE A0394 1.0 1.92 1.92 SALINE PREFILLED SYRINGE A0394 1.0 2.56 2.56 SYRINGE(3CC) A0394 1.0 0.16 0.16 Total Charges DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Bad Debt Write Off 06/29/2012 1020.86 Denied by Insurance-UNITED AMERICAN INS- 04/10/2012 0.00 Denied by Medicare 03121/2012 0.00 Total Credits 1020.86 PLEASE PAY THIS AMOUNT-INVOICE DUE UPON RECEIPT --► RETURNED CHECK FEE-$31.00 $0.00 [PATIENT NAME: HARDING, CYRUS CALL NUMBER: 1203551A AMOUNT PAID: 02/21/2014 IMPORTANT MESSAGES: WEST SHORE EMS -ALS 205 GRANDVIEW AVE STE 211 CAMP HILL, PA 17011-1708 Account Number-_ Amount Due 717737-3676 828 o5Y $37.77 G/■z.on _£ Account Information CIS} TfkYF2pn:CENif�mYYECJ�f71#' „ Y�'� Statement Date: 1411!13 ' s "3hap'"�i7lA.$v'!.#ulapay CYRUS W HAROING Acsovat iyes Ifcpar Phone: 717-737-3676 .r O/rflcm,'aoNT�2jFP0"Y{CN�$ef2lVS � ,. ' f 3u�graeatoaay -.6op`apekiss w:; -�• s* r . „ Account Summary Previous Balance a�'a.,...;....•.•:s.r..:.e<..:-,n,:..,..:,.._�.M.,_....,..,,.u.t...:.�..a^,.:a..: $36.63 Payment Received Nov 15 -$36.63 et# nR; �fs• Balance Forward $oD Review Your Services Did you know you could be eligible for savings with New Charges Verizon services?Call us at 1-888-851-7527 today. Current Activity $26.20 Verizon representatives are standing by help review your account. 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