Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
10-07-14 (2)
�. J, 1505610140 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 0 3 1 9 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 0 3 1 7 2 0 1 4 0 3 1 4 1 9 3 5 Decedent's Last Name Suffix Decedent's First Name MI . OR N E R MERLE L (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 OVALS BELOW 0 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 Telepkeye Number � R MARK THOMA S E S Q U I R E 7 1 7 � 6 2 co -0 cS G,3o REGISTI�OEWIEPS USE NLYCn O? _—D y First Line of Address : ri 1 0 1 S MARKET STREET ; ; Q Second Line of Address F--+ ` w ri cra City or Post Office State ZIP Code DATE FILED MEC HA NI CSB' URG PA 17055 Correspondent's e-mail address: RMARKTHOMAS@GMAIL.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,.corre5f nd complete.Declaration of rer other than the personal representative is based on all information of which preparer has any knowledge. SIGN WF PERSON RESP SIB FOR LING RETURN PATE 01 e� O A05DRESS 42,1 P WNEE DIRNE MECHANICSBURG PA_ 17050 SIGN EPA T HAN REPRESENTATIVE T ADDRESS 101 S. MARKET STREET MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 r i 1505610240 REV-1500 EX(FI) RECAPITULATION 1. Real Estate(Schedule A) . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 . 0 0 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . ... . . . . . . .. . . .. ... . . . . . 2. 5 3 2 4 2 , 1 4 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 4. Mortgages and Notes Receivable(Schedule D) . .. . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . . . . 5. 4 2 2 3 2 • 0 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 1 7 1 4 5 6 , 8 6 7. Inter-Vivos Transfers&Miscellaneous Nn-Probate Property , (Schedule G) n Separate Billing Requested . . . .. . . 7. 2 9 1 1 8 7 3 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . ... . . . . . . . . . . . . . . . . 8. 2 9 6 0 4 9 • 7 9 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . .. . . .. . . . . . . . . 9• 2 8 3 8 0 . 4 0 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . .. . . . . . . . . . 10. 2 9 5 . 0 8 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . ..... . . . . . . . . . . . . . 11. 2 8 6 7 5 . 4 8 12, Net Value of Estate(Line 8 minus Line 11) . . . . . . . . .. . ... . . . . . . . . . . . .. . 12. 2 6 7 3 7 4 . 3 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made.(Schedule J) . . . . . . . . . . . . . . . .. ... . . 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . .. . . .. . . . . 14. 2 6 7 3 7 4 . 3 1 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 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.0 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate x.12 2 6 7 3 7 4 . 3 1 17. 3 2 0 8 4 . 9 2 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . 19. 3 2 0 8 4 . 9 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 00319 DECEDENTS NAME MERLE L. ORNER STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) _ 32,084.92 2. Credits/Payments A.Prior Payments 28,000.00 B.Discount 1,473.64 Total Credits(A+B) (2) 29,473.64 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,611.28 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 ...................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................... ❑ c. retain a reversionary interest ..................................................................................................... Eld d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 21 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ 09 3. Did decedent own an"in trust for"or payable-upon-death bank account 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 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 i; is 3 percent[72 P.S.§9116(a)(1.1)(i)]. 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 [72 P.S.§9116(a)(1.1)(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. 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[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[72 P.S.§9116(a)(1)). • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Secfion 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER MERLE L. ORNER 21 14 00319 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Nationwide Funds-Account# NW-0003242-1306831400 52,088.94 2,636.080 shares-$19.76 Merle L. Orner- Reference 00545217 Z SAVINGS BONDS-SERIES EE D55431744EE 1,15320 TOTAL(Also enter on Line 2,Recapitulation) 53 242.14 If more space is needed,insert additional sheets of the same size ,REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MERLE L. ORNER 21 14 00319 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAMES) ADDRESS RELATIONSHIP TO DECEDENT A. GLENN I ORNER 421 PAWNEE DRIVE BROTHER MECHANICSBURG, PA 17050 s. RAY ORNER 55 LONESOME ROAD BROTHER NEWVILLE, PA 17241 C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 8/4/06 PNC BANK ACCT#31700398282 9,191.53 50. 4,595.77 2 A. 4/28/03 MEMBERS 1ST ACCT#229513-00 118.22 50. 59.11 3 A 4/28/03 MEMBERS 1 ST ACCT#229513-41 5,257.22 50. 2,628.61 4 A. 7/28/12 MEMBERS 1ST ACCT#229513-42 1,150.99 50. 575.50 5 A 1/22/09 MEMBERS 1 ST ACCT#229513-52 9,669.23 50. 4,834.62 6 A 9/3/10 MEMBERS 1ST ACCT#229513-53 72,404.04 50. 36,202.02 7 A 1/11/07 MEMBERS 1ST ACCT#229513 9,876.21 50. 4,938.11 8 A 8/27/02 CENTRIC BANK ACCT#3011026 4,803.97 50. 2,401.99 9 A 2/28/11 CENTRIC BANK ACCT#3043189 14,802.91 50. 7,401.46 10 A 3/9/11 CENTRIC BANK ACCT#3043486 6,825.46 50. 3,412.73 TOTAL(Also enter on Line 6,Recapitulation) $ 171 456.86 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent MERLE L. ORNER 21 14 00319 Decedent's Name Page 1 File Number Schedule F-2-Jointly-Owned Property LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 11 A 3/22/11 CENTRIC BANK ACCT#3043882 10,002.63 50. 5,001.32 12 A 3/22/11 CENTRIC BANK ACCT#3043890 10,002.63 50. 5,001.32 13 A 4/16/11 WELLS FARGO CD ACCT 3451 10,002.96 50. 5,001.48 14 A 1/24/02 ACNB BANK CD ACCT#158316 18,005.75 50. 9,002.88 15 B 2/6/03 ACNB BANK CD ACCT#158344 12,501.37 50. 6,250.69 16 A, B 2/7/13 21 LONESOME ROAD, NEWVILLE 146,470.00 33.33 48,818.45 151,000 TAX ASSESSMENT X .97 COMMON LEVEL RATION 17 A, B 7/8/82 PROPERTY NEWVILLE 76,000.00 33.33 25,330.80 SUBTOTAL SCHEDULE F-2 104,406.94 GRAND TOTAL SCHEDULE F-2 $ 171,456.86 'REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MERLE L. ORNER 21 14 00319 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIPTO DECEDENTAND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIF APPLICABLE) VALUE 1. SECURITY BENEFIT ANNUITY 29,118.73100.00 29,118.73 TOTAL (Also enter on Line 7,Recapitulation) $ 29 118.73 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MERLE L. ORNER 21 14 00319 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EGGER FUNERAL HOME 9,235.34 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: R. MARK THOMAS, ESQUIRE 10,000.00 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: 398.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. LEGAL AD-CUMBERLAND LAW JOURNAL 75.00 8 LEGAL AD- PATRIOT NEWS 173.78 9 CENTURY LINK 45.62 10 ADDITIONAL SHORT CERTIFICATES 25.00 11 AUTO INS.- NATIONWIDE 605.40 12 POSTAGE 12.26 13 COMMONWEAL VEHICLE REGISTRATION 58.50 14 LANDEX DOWNLOADS 17.75 15 BRICKERS AUCTION FEES &COMMISSION 4,380.00 16 ADAMS- ELECTRIC ON 21 LONESOME ROAD, NEWVILLE, PA 130.04 17 PROPERTY TAX-21 LONESOME ROAD-SHIRLEY ARMOLD TAX COLLECTOR 1,793.46 18 PROPERTY TAX- NORTHMOUNTAIN ROAD 97,92 TOTAL(Also enter on Line 9,Recapitulation) $ 28,380.40 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent MERLE L. ORNER 21 14 00319 Decedent's Name Page 2 File Number Schedule H -Funeral Expenses&Administrative Costs-67. ITEM NUMBER DESCRIPTION AMOUNT 20 NATIONWIDE HOME OWNERS 834.00 21 CENTURY LINK 44.58 22 ADAMS ELECTRIC- LONESOME ROAD, NEWVILLE, PA 62.44 23 ADAMS ELECTRIC 85.26 24 ADAMS ELECTRIC 60.61 25 ADAMS ELECTRIC 87.66 26 CENTURY LINK 44.67 27 CENTURY LINK 44.71 28 CAR INSPECTION 67.90 SUBTOTAL SCHEDULE H-B7 1,331.83 'V REV-1 512 EX+(12-12) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MERLE L. ORNER 21 14 00319 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 1. ADAMS ELECTRIC 183.08 183.08 2 QUARTERLY LIFE INSURANCE DUE 1/27/14 112.00 INVESTORS LIFE INSURANCE CO 3031297448 TOTAL(Also enter on Line 10,Recapitulation) $ 295.08 If more space is needed,insert additional sheets of the same size. r }REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MERLE L. ORNER 21 14 00319 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. GLENN I ORNER Sibling 50.00 421 PAWNEE DRIVE MECHANICSBURG, PA 17050 2 RAY A ORNER Sibling 50.00 55 LONESOME ROAD NEWVILLE, PA 17241 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. e REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 28.000.00 Discount: 1.473.64 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 through 1991 1992 1993 through 1994 1995 through 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 through 2014 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG.PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT I JI0. CD Q 19287 ORNER GLENN 1 421 PAWNEE DRIVE MECHANICSBURG, PA 17070 I ACN ASSESSMENT AMOUNT CONTROL NUMBER ---------- -------- 101 $28,000.00_ ESTATE INFORMATION: SSN: 171-28-2943 i FILE NUMBER: 2114-0319 DECEDENT NAME: ORNER MERLE L DATE OF PAYMENT: 06/12/2014 POSTMARK DATE: 06/12/2014 COUNTY: CUMBERLAND DATE OF DEATH: 03/17/2014 TOTAL AMOUNT PAID: $28,000.00 REMARKS: RECEIPT TO ATTY CHECK# 106 INITIALS: DMB SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS { TAXPAYER I COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND I, LISA M. GRAYSON, ESQ. Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 8th day of April, Two Thousand and Fourteen Letters of ADMINISTRATION in common form were granted by the Register of said Count,-, on the j estate of MERLE L ORNER late of UPPER FRANKFORD TOWNSHIP /First,Middle,Last] in said county, deceased, to GLENN/ ORNER (First,Middle,Last) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 25th day of July Two Thousand and Fourteen. File No. 2014- 00319 PA Fi1e No. 21- 14- 0319 Date of Death 3/17/2014 - r 1 Ren of Wills Depu NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL Nationwide Fends"' On Your Side"' R MARK THOMAS ESQUIRE April 29, 2014 101 S MARKET ST MECHANICSBURG PA 17055-6328 REFERENCE NUMBER:00545217 NATIONWIDE FUND INSTIT SERVICE CLASS ACCOUNT NUMBER: 1306831400 MERLE L ORNER Dear R. Mark Thomas: Thank you for contacting Nationwide Funds. We understand this is a difficult time for you and are sorry for your loss. The following table shows the value of the account as of the close of business on March 17, 2014: Date 'All of`Shares Nit Asset Vafue Total Value 03/17/2014 12,636.080 $19.76 $52,088.94 If you need additional assistance, please feel free to call one of our shareholder services representatives.They are available Monday through Friday from 9 a.m.to 8 p.m. ET at 800-848-0920. Since 1933 Nationwide Funds has guided shareholders through all types of economic environments and circumstances.We are dedicated to providing the long-term investment solutions and quality service you need as you work toward your financial goals. Sincerely, Julia Wolf Nationwide Funds Nationwide Funds distributed by Nationwide Fund Distributors LLC(NFD), Member FINRA, King of Prussia, PA. U.S. Savings Bond Transaction Customer Copy Redemption Date: 6/3/2014 Issue Redemption Backup Series Denomination Date Value Interest Withholding 1 EE $500.00 Jun / 1983 $1,153.20 $903.20 $0.00 Total: 1 Bond(s) $1,153.20 $903.20 $0.00 The interest earned on Series EE bonds issued on or after January 1990 may be wholly or partially exempt from Federal income tax under the provisions of the U.S. Savings Bond Education Benefit Program. For further information concerning the benefits and restrictions that apply, please contact the Internal Revenue Service. ANK 244888 LNCNB B DATE: 6/3/2014 OFFICIAL CHECK MERLE ORNER ESTATE ***One Thousand One Hundred Fifty Three Dollars and Twenty Cents*** $ ***$1,153.20 Teller#: 1567 REMITTER: BOND REDEMPTION 48500041046 REV-485 EX(05-04) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY 3" NameSuffix First Name MI ORNER MERLE L ADDRESS OF DECEDENT STREET. CITY: STATE: ZIP CODE: ®21 LONESOME RD NEWVILLE PA 17241 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX "AME:GLENN E ORNER STREETADDRESS: CITY: STATE: ZIP CODE: 421 PAWNEE DR MECHANICSBURG PA 17050 NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: GLENN E ORNER BROTHER STREETADDRESS: CITY: STATE: ZIP CODE: 421 PAWNEE DR MECHANICSBURG PA 17055 b. NAME: RELATIONSHIP: RAY ORNER BROTHER STREETADDRESS: CITY: STATE: ZIP CODE: 55 LONESOME RD NEWVILLE PA 17241 c. NAME: RELATIONSHIP: DONNA ORNER SISTER IN LAW STREETADDRESS: CITY: STATE: ZIP CODE: 421 PAWNEE DR MECHANICSBURG PA 17055 NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: ACNB BANK STREETADDRESS: CITY: STATE: ZIP CODE: 39 CARLISLE RD NEWVILLE PA 17241 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY GLENN ORNER 6/3/14 11:44 am DATE OF CONTRACT TO RENT BOX ONUMBEROFBOX [M TITLE UNDER WHICH BOX IS REQUESTED 02/21/2000 660 NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX a. NAME: b. NAME: STREETADDRESS: STREETADDRESS: CITY: STATE: ZIP CODE: CITY: STATE: ZIP CODE: NAME A D TITLE OF EMP EE TAKING THE INVENTORY alb A WAS A WILL IN THE BOX? ❑ YES NO If yes, a. Date of will: b. Name and address of personal representative,if named in the will NAME: STREETADDRESS: CITY: STATE: ZIP CODE: i i c. Name and address of attorney,if any NAME: i STREETADDRESS: CITY. STATE: ZIP CODE: 48500041046 48500041046 'REV-485 EX SAFE DEPOSIT BOX INVENTORY Page of _ INSTRUCTIONS (1) Cash:Report total only. (2) Stocks: List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government: Number of items,date of issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds: Designate by name,amount,serial number,or other designation.(Bearer Ponds) (5) Bank and Savings and Loan Passbooks: State name of depositor,number of book, last date appearing in book, name of bank and branch,and balance. (6) Jewelry,Coins,Stamps,Manuscripts,etc:List and describe as fully as possible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280601 HARRISBURG,PA 17128-0601 ITEM NO. ITEM DESCRIPTION `b 554-31 U � 5D O :qq .. vm u e -j Q I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSO RECEIVING COPY OF CORR CT AND COMPLETE TT E BEST OF MY KNOWLEDGE AND BELIEF. SAFE PO BOX INVEN Y: SIG AT E PRINT ME INT LAME AND CHECK A PRIATE BOX BELOW: 4�U, _ � UY i !ten Y-1 r C)rs;Q e_C- PRINT TITLE DATE /� DATE CHECK APPROPRIATE BOX: ��1 U�lX "`��1 (�`-(�/J Executor(trix) ❑Administrator(trix) <� i t El Estate Representative Joint owner of safe deposit box NOTE:Attach additional 8'h"x 11."sheet(s)if necessary or use duplicates of this page of form. The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities.The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. M&T Bank 499 Mitchell Road,Millsboro,DE 19966 Records Management Phone 888-5024349 Fax (302)934-2955 June 12,2014 R. Mark Thomas Attorney at Law 101 South Market Street Mechanicsburg, PA 17055-3851 Re: Estate of Merle L. Omer Social Security: 171-28-2903 Date of Death: March 17,2014 Dear Sir or Madam: Per your inquiry on June 9, 2014,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: I Type of Account Checking Account Account Number 723126 Ownership(Names ot) Glenn L Orner(POA) Merle L. Omer Ray A. Orner(POA) Opening Date 0910111967 Balance on Date of Death S 10,92699 Accrued Interest .07 Total $10,927.06 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the High Street Carlisle at 717-240-4536. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement Sincerely, Valatie Mercer Records Management l , RRICKERS AUCTION o �n►ission - Complete Sale Service 93 T x C Rei.,,Mechanicsbur95 PA 17055 766-,5785 '85 Addm" 'goo At Pubft Soft o t--Y 12--- 17 TOW-Chocks . Team Cook cash Aftw Pay=* E. a� �t►eAc# CSWIM Aft. TOW Ex r; �rJ APPRAISAL Personal !roperty of 1162L6 OAS Eu.. f-----5779 ie IVEW 'x 1LLe r V May. 2. 2014 2: 35PM - PNC Bank No, 1820P. 1P G;?NC May 2, 2014 R Mark Thomas Esq Attorney At Law 101 South Market Street Mechanicsburg,PA 17055-3851 RE: Merle L Omer SSN: 171-28-2903 DOD: 03-172014 Dear Mr. Thomas: In response to your request for Date of Death(DOD)balances for the customer noted above, our records show the following: Certificate of Deposit Account# 31700298282 Established: 08-04-2006 MERLE L ORNER GLENN I ORNER DOD balance: $9,191.04 +0.49 accrued interest Interest paid 01-01-2014 thru 03-17-2014 53.40 YTD 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(1-888-7622265)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 we of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exemptfrom disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for 1P - 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 1 of 1 A MEMBERS ^�� FEDERAL CREDIT UNION � REGULAR SAVINGS ACCOUNT: 8ucountNumberlGuffix 229613-00 Date Account Established 04/28/2003 Principal Balance atDate ofDeath $118.21 Accrued Interest to Date ofDeath $$1 Total Principal and Accrued Interest $118.22 Name ofJoint Owner Glenn|.Omer Date Joint Ownership Established 04/28D003 / � CERTIFICATE OF DEPOSIT: AomnuntNvmber/Guffix 22951341 Date Account Established 0703/2013~ ` Principal Balance a,Date nfDeath $5.25526 Accrued Interest tnDate ofDeath $1.86 Total Principal and Accrued Interest $5.25722 Name ufJoint Owner Glenn|.Omer Date Joint Ownership Established 04/202003 / *Opened by Transfer of Funds from the Regular Savings Account 229513-00 originally established on 04/28/2003 CERTIFICATE OF DEPOSIT:� AcnountNumber/Gvffix 22951342 Date Account Established 10/28/2013° Principal Balance at Date ofDeath $1.150,81 Accrued Interest toDate ofDeath *.68 Total Principal and Accrued Interest $1.150.99 Name ofJoint Owner Glenn|.Omer Date Joint Ownership Established 07/203012 °moUoverhnmCe�i�ootenfDopu»it229513'56originally emab|inhedOD2�2012 CERTIFICATE OF^/ A�vu6�wumuemsuffix� 229e13'62 Date Account Established 02/21/2012^ Principal Balance ouDate ofDeath $9.657.53 Accrued Interest tnDate ofDeath $1.70 Total Principal and Accrued Interest $9.669.23 Name ofJoint Owner Glenn iOmer Date Joint Ownership Established 01/22/2009 °Rollover from Certificate ofDeposit 22g513'4Voriginally established 01/22/2009 CERTIFICATE OF DEPOSIT:/ Auoovn\Numbar/Guffix 229513~53 Date Account Established 04/02/2012~ Principal Balance auDate o[Death $72.3e8.17 Accrued Interest tuDate ofDeath *15.87 Total Principal and Accrued|n*enom $72.404.04 Name nfJoint Owner Glenn|.Omer Date Joint Ownership Established 0903/2010 ^Rollover from Certificate ofDeposit 229o13'83originally established 09/03/2010 CERTIFICATE OF DEPOSIT: ^/ � AuoountNvmber/Guffix 229513-54 Date Account Established 01/11/2007* Principal Balance atDate o[Death $9.871.88 . Accrued Interest to Date of Death $4.33 Total Principal and Accrued Interest $9.870.21 Name nfJoint Owner Glenn 1.Omer Date Joint Ownership Established 01/11/2007 *Opened byCheck Deposit Estate of: Merle L.ome, MEMBERS 1arFEDERAL CREDIT UNION Date ofDeath:03/17/2014 Social Security Number: 171'28'2903 Leigh nne Stallings Lending Insurance Support Supervisor April 18.2V14 50O0Louise Drive ° B{1Box 4O ~ Mechanicsburg,Pennsylvania 17055 ° (80C) 283-2328 ° wrncouezo6czo1at.urg CENTRIC We Revolve Around You. April 17, 2014 R. Mark Thomas, Esq. Attorneys At Law 101 South Market Street Mechanicsburg PA 17055 Re: Merle L. Orner, Deceased Address:21 Lonesome Rd., Newville, PA 17241-9732 Date of Death:03/17/14 Social Security Number: 171-28-2903 Dear Mr.Thomas: At the time of Mr. Orner's passing he had held five accounts with Centric Bank. All five accounts were established as joint accounts at their original opening date. In accordance with your request I provide you with the following information: Account#1: A. Account title—Merle L Orner, jointly held with Glenn Orner B. Opening date—08/27/02; renewed 08/27/07; renewed 8/27/12 C. Date of death balance-$4,800.00, accrued interest$3.97;total balance $4,803.97 D. Account number—3011026 E. Type of account—Certificate of Deposit, 60 month term Account#2: A. Account title—Merle L Orner, jointly held with Glenn Orner B. Opening date—02/28/11; renewed 02/28/13 C. Date of death balance-$14,800.00, accrued interest$2.91;total balance$14,802.91 D. Account number-3043189 E. Type of account—Certificate of Deposit, 24 month term Account#3: A. Account title—Merle L Orner, jointly held with Glenn Orner B. Opening date—03/09/11; renewed 03/09/13 C. Date of death balance-$6,823.63, accrued interest$1.83; total balance $6,825.46 D. Account number-3043486 E. Type of account—Certificate of Deposit, 23 month term 4320 Linglestown Road Harrisburg,PA 17112 T 717.657.7727 F 717.657.7748 www.centricbank.com x CENTRIC BANK We Revolve Around You. Account#4 A. Account title—Merle L Orner, jointly held with Glenn Orner B. Opening date—03/22/11; renewed 03/22/13 C. Date of death balance-$10,000.00, accrued interest$2.63;total balance$10,002.63 D. Account number-3043882 E. Type of account—Certificate of Deposit, 24 month term Account#5 A. Account title—Merle L Orner, jointly held with Glenn Orner B. Opening date—03/22/11; renewed 03/22/13 C. Date of death balance-$10,000.00, accrued interest$2.63;total balance$10,002.63 D. Account number-3043890 E. Type of account—Certificate of Deposit, 24 month term If any further information is needed with regards to the Estate of Merle L. Orner I would be happy to assist. Thank you. Sincerely; {P y Joseph Rebarchak AVP, Branch Manager N M LS#586413 Centric Bank 4320 Lingtestown Road Harrisburg,PA 17112 T 717.657.7727 F 717.657.7748 www.ce ntricb ank.coin Customer Correspondence MAC P6102-03A E P.O.Box 6995 Portland,OR 97228-6995 Date of Death Balance Request Response Form Decedent: Merle L Orner Case number: 80539864 Date of death: Monday,March 17,2014 Completed by: Mary Dugan Requested by: RMark Thomas Contact number: 540-562-9029 Mail: ioi S Market St Date: April 15,2014 Mechanicsburg,PA 17055 Principal balance Interest paid Account title Affiliation Account type Account number. year to date of Accrued Date of death as of date of death interest balance death Merle L Orner Joint Owner Certificate of deposit xzxxmxxxxx3451 $10,000.00 $6.8o $2.96 $10,002.96 Glenn I Orner Joint Owner -Opened o8/19/i996 -Account converted from WachoAa as a jointly owned account on 04/16/2011 Note:Money Market Checking and Money Market Access accounts pay dividends only. Comments: Please be advised,we were unable to locate the account number ending in 6398,which was referenced in your letter. There was no Safe Deposit Box found. -11-� ACNB BANK April 15, 2014 R. Mark Thomas Attorney at Law 101 S Market St Mechanicsburg PA 17055 RE: Estate of Merle L Omer Dear Mr. Thomas: The following information is being provided as per your request: Acct. Type Account No. Balance at Accrued Ownership Date D.O.D. Interest to Opened/Joint D.O.D. Certificate of 158344 $12;500.00 $1.37 Jt w/Ray A Omer 2/6/03 Deposit Certificate of 158316 $18,000.00 $5.75 Jt w/Glenn I Omer 1/24/02 Deposit Safe Deposit 803/660 Individual 2/21/00 Box (Newville Office) Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information,please contact me at(717)339-5122. Sincerely, Barbara J W er '4 ACNB Bant Deposit Ser ices Representative 11 acnb.com -acribbusiness.com- P.O.Box 3129,Gettysburg,PA 17325 -Phone 717.334.3161 •Toll Free 1.888.334.ACNB(2262) 2014 Statement:of Real Estate Taxes Control No:043-0007 Bill Date: _.. 7/01/20 Assessed Land Improvement Mineral Total 41,5 10 0i Values 00 91600 151,100 SHIRLEY J.ARMOLD,TAX COLLECTOR. Homestead Exclusion 1 10,078. 650 MOHAWK ROAD BIG SPRING S.D. Discount Face Penaltti( NEWVILLE, PA 17241 Rates .012977101 .01297710 2 96 Temp-Return Service Requested SCHOOL R/E 1 1,960.84 Homestead Credit 130.78 rsc: ASSESSAO-43000231 MAP NO: 43-04-0387-037A TAX AMOUNT DUE -----> $1,793.46 $1,830,06 $21013 21 LONESOME ROAD I ACRES 1.1150 DEED 0029V291 if Paid On or After i 7/01/2014 9/01/2014 11/01/202 If Paid On or Before 1 8/31/2014 10/31/2014 12/31/204 IF TAXES ARE ESCROWED FORWARD TO MORTGAGE COMPANY RESIDENTIAL I FAMILY 1.00 FEE FOR ADDITIONAL RECEIPTS IF NOT PAID BY 12J31114 THIS BILL WILL BE Ix ORNER MERLE L& RAY A ,YER &GLENN I ORNER RETURNED TO TAX CLAIM 21 LONESOME ROAD NEWVILLE PA 17241 TIGE TUESDAY 5PM-8PM THURS I I AIVI-5PM )URS! OTHER DAYS BY APPOINTMENT PHONE 717-776-5065 CLOSED JAN&FEB Return Bill with Payment.For a Receipt, Tax Collector Signature Date Paid Amount Paid Enclose a self-addressed stamped enve 1IRLEY ARMOLD,TAX COLLECTOR Bill No: 751 2014 Statement of Real Estate Taxes Control No:043-00075 101111111 _EW44)ate: 7/01/201, (ABLE Assessed Land Improvement Mineral Total Values 41,500 109,600 0 l 151,100 SHIRLEY J.ARMOLD,TAX COLLECTOR Homestead Exclusion moo,s 650 MOHAWK ROAD BIG SPRING S.D. Discount Face Penalty NEWVILLE,PA 17241 Rates .01297710 01297710 2 10% Temp-Return Service Requested SCHOOL R/E 1,960.8d — Homestead Credit 130.70- ;C: ASSESS.NO-43000231 _ MAP NO: 43-04-0387-037A TAX AMOUNT DUE-----> $1,793.46 $1,830.06 $2,013.0 21 LONESOME ROAD ACRES 1.150 DEED 0029V/291 If Paid On or After —77U—I—/2014 9/01/2014 _11/01/2014 If Paid On or Before 10/31/2014 12/31/2014 IF TAXES ARE ESCROWED FORWARD TO MORTGAGE COMPANY RESIDENTIAL I FAMILY 1.00 FEE FOR ADDITIONAL RECEIPTS IF NOT PAID BY 12/31/14 THIS BILL WILL BE ORNER MERLE L&RAY A ER &GLENN I ORNER RETURNED TO TAX CLAIM 21 LONESOME ROAD NEWVILLE PA 17241 NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property. As an eligible homestead and/or farmstead property owner,you have received CIE TUESDAY 5PM-8PM THURS 11 AM-5PM tax relief through a homestead and/or farmstead exclusion which has been provided RS: OTHER DAYS BY APPOINTMENT under the Pennsylvania Taxpayer Relief Act,a law passed by the Pennsylvania General PHONE 717-776-5065 Assembly designed to reduce your property taxes. CLOSED JAN&FEB Return Bill with Payment.For a Receipt, Tax Collector Signature Date Paid Amount Paid Enclose a self-addressed stamped envelo If paying in installments use the coupons below to submit payments.If paying in full use ONLY the 1 ST coupon below to submit payment. YEAR 2014 DATE 7/01/2014 BILL# 751 TAXYEAR 2014 DATE 7/01/2014 BILL# 751 TAX YEAR 2014 DATE 7/01/2014 BILLft 751 ABLE TO PAYABLE TO PAYABLE TO 3LEY J.ARMOLD,TAX COLLECTOR SHIRLEY J.ARMOLD,TAX COLLECTOR SHIRLEY J.ARMOLD,TAX COLLECTOR MOHAWK ROAD 650 MOHAWK ROAD 650 MOHAWK ROAD VVILLE,PA 17241 NEWVILLE,PA 17241 NEWVILLE,PA 17241 ITROL# MAP# CONTROL# MAP# CONTROL# MAP# 000757 43-04-0387-037A 043 000757 43-04-0387-037A 043 000757 43-04-0387-037A C DES PES -ONESOME ROAD 21 LONESOME ROAD 21 LONESOME ROAD 20—L a0m_OOL _a9HOOL SPRING S.D. si i BIG SPRING S.D. BIG SPRING S.D. PAYER TAX PAYER TAX PAYER IER,MERLE L&RAY A ORNER,MERLE L&RAY A ORNER,MERLE L&RAY A PLEASE RETURN COUPON PLEASE RETURN COUPON PLEASE RETURN COUPON ;T WITH FIRST OR FULL PAYMENT 2ND WITH SECOND PAYMENT 3RD WITH THIRD PAYMENT $610.02 ONORBEFORE 8/31/2014 $610.02 ON OR BEFORE 9/30/2014 $610.02 ONOR BEFORE 10/31/2014 $671.02 AFTER 8/31/2014 $671.02 AFTER 10/31/2014 $671.03 AFTER 10/31/2014 OR .PAYMENT AMOUNT PAY BY SCOUNT $1,793.46 8 31 2014 %CE $1,830.06 10 31 2014 /31 :NALTY $2,013.07 *12/31/*2014 i I�arte( o. t13�® -43 7-a37,4 r 003ARQ i J MADE THE ` -rk day of .G in the year of our Lord two thousand thirteen BETWEEN Merle L. Omer, Cumberland County, Pennsylvania, Grantor, And Merle L. Omer, Ray A. Omer and Glenn 1. Omer, as Tenants in Common, Cumberland County, Pennsylvania, j Grantees, ! WITNESSETH, that in consideration of ane ($1.00)--------------------------------- ------------------------------------------------------------------------------------=-------------Dollar lawful money of the United States of America unto him well and truly paid by the said parties of the second part, at and before the sealing and delivery of these presents, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, enfeoffed, released, conveyed and confirmed, and by these presents grant, bargain, sell, alien, enfeoff, release, convey and confirm unto the said parties of the second part, their heirs, and assigns, ALL that certain tract of land situate in Upper Frankford Township, Cumberland County, Pennsylvania, and the improvements thereon erected, more particularly bounded and described as follows: BEGINNING at a point, a nail, in the center of Township Road No. 426, said point being 771 feet north of the intersection of said Township Road and . Legislative Route 21001, thence over the center of said Township Road North 30 degrees West 222.35 feet to a point, a nail, thence over lands now or formerly of Grantors North 65 degrees East 239.22 feet to a stake; thence over same South 22 degrees 13 minutes East 227.80 feet to a stake; thence over same South 66 degrees 39 minutes 30 seconds West 208.86 tc a point, a nail in the center of Township Road 426, the place of BEGINNING. Containing 1.15 Acres more or r ' ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 - +' 717-240-6370 - sn s; x Instrument Number-201304307 Recorded On 2/7/2013 At 3:02:08 PM *Total Pages -4 *Instrument Type-DEED Invoice Number- 128847 User ID -BMM *Grantor-ORNER,MERLE L *Grantee- ORNER,MERLE L *Customer-GLENN ORNER *FEES STATE WRIT TAX $0.50 Certification Page STATE JCS/ACCESS TO $23.50 JUSTICE DO NOT DETACH RECORDING FEES - $11.50 RECORDER OF DEEDS This page is now part PARCEL CERTIFICATION $10 .00 FEES of this legal document. AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 BIG SPRING SCHOOL $0. 00 DISTRICT UPPER FRANKFORD TOWNSHIP $0.00 TOTAL PAID $62.00 ICertify.this to be recorded i n--C:umbedaad.County PA CU ,o '74- /D EDS RECORDER O 1750 *-Information denoted by an asterisk may change during the verification process and may not be reflected on this page. 003ARQ II I'I II I II I II11 I i ILII II I II III I I I I I III III 2014 Statement of Real Estate ill ate Taxes Control No: 043-7/010/2() 007 III I III BDate: Assessed Preferred Land Imbrovement Mineral Total gYASL.E Values 7,700 0 0 1 1 7,700 SHIRLEY J.ARMOLD,TAX COLLECT u BIG SPRING S.D. Discont Face T Penaitv Rates 01297710 2 650 MOHAWK ROAD SCHOOL R/E 10 NEWVILLE,PA 17241 97.92 99.92 -09.5 Temp-Return Service Requested TAX AMOUNT DUE_____> $97.92 $99.92 $109. eSc ASSESS.NO-43000176 MAP NO: 43-04-0387-012. If Paid On or After 7/01/2014 9/01/2014 11/01/207 NORTH MOUNTAIN ROAD if Paid On or Before 8/31/2014 10/3.1/2014 12/31/201 ACRES 73.920 DEED 0029V/287 IF TAXES ARE ESCROWED FORWARD TO MORTGAGE COMPANY 1.00 FEE FOR ADDITIONAL RECEIPTS IF NOT PAID BY 12/31/14 THIS BILL WILL BE MOUNTAIN 10+ACRES VACANT LAND RETURNED TO TAX CLAIM Ix ORNER, MERLE L& RAY A ,YER &GLEN I ORNER V LONESOME ROAD NEWVILLE PA 17241 :FILE TUESDAY 5PM-8PM THURS 11AM-5PM )URS: OTHER DAYS BYAPPOINTIMENT PHONE 717-776-5065 CLOSED JAN&FEB Return Bill with Payment.For a Receipt, Tax Collector Signature Date Paid Amount Paid Enclose a self-addressed stamped enve ORLEY ARMOLD,TAX COLLECTOR Bill No: 750 1111 2014 Statement of Real Estate Taxes Control No:043-000751 HII Bill Date. 7/01/201 Assessed Preferred Land improvement mineral Total YABLE Values 7,7001 0 0 1 7,700 SHIRLEY J.ARMOLD,TAX COLLECTOR BIG SPRING S.D. Discount Face Penalty 650 MOHAWK ROAD Rates .01297710 2 % 10 NEWVILLE,PA 17241 SCHOOL RJB 1 97.9299.92 109.91 Temp-Return Service Requested TAX AMOUNIT DUE-----> (:,97.92 $99.92 $109.9- SC: ASSESS.N0-43000176 MAP NO: 43-04-0387-012. If Paid On or After 7/01/2014 1 9/01/20141 11/01/2034 '_1101120 NORTH MOUNTAIN ROAD If Paid On or Before 8/31/2014 1 10/31/2014IT12/31/,014 ACRES 73.920 DEED 0029V287 IF TAXES ARE ESCROWED FORWARD TO MORTGAGE COMPANY 1.00 FEE FOR ADDITIONAL RECEIPTS IF NOT PAID BY 12/31/14 THIS BILL WILL BE MOUNTAIN 10+ACRES VACANT LAND RETURNED TO TAX CLAIM ORNER, MERLE L& RAY A 'ER &GLEN I ORNER 21 LONESOME ROAD NEWVILLE PA 17241 ICE TUESDAY 5PM-8PM THURS 11 AM-5PM IRS: OTHER DAYS BY APPOINTMENT PHONE 717-776-5065 CLOSED JAN&FEB $_ Return Bill with Payment.For a Receipt, Tax Collector Signature Date Paid Amount Paid Enclose a self-addressed stamped envelo If paying in installments use the coupons below to submit payments.If paying in full use ONLY the 1ST coupon below to submit payment. YEAR 2014 DATE 7/01/2014 BILL# 750 TAX YEAR 2014 DATE 7/01/2014 BILL# 750 TAX YEAR 2014 DATE 7/01/2014 BILL# 750 PAYA13LETO PAYABLETO R LEY J.ARMOLD,TAX COLLECTOR SHIRLEY J.ARMOLD,TAX COLLECTOR SHIRLEY J.ARMOLD,TAX COLLECTOR MOHAWK ROAD 650 MOHAWK ROAD 650 MOHAWK ROAD VVILLE,PA 17241 NEWVILLE,PA 17241 NEWVILLE,PA 17241 TTROL MAP# CONTROL# MAP# CONTROL# MAP 000756 43-04-0387-012. 043 000756 43-04-0387-012, 043 000756 43-04-0387-012, �c DESC DESQ RTH MOUNTAIN ROAD NORTH MOUNTAIN ROAD NORTH MOUNTAIN ROAD OOL SCHOOL SCHOOL SPRING S.D. BIG SPRING S.D. BIG SPRING S.D. PAYER TAX PAYER TAX PAYER ER,MERLE L&RAY A ORNER,MERLE L&RAY A ORNER,MERLE L&RAY A T WITLEASE RETURN COUPON EASE RETURNPW RETURN COUP ____� ; PPL H FIRST OR FULL PAYMENT 2ND WITH SECOND PAYMENTCOUPON PLEASE 3RD WITH THIRD PAYMENTON $33.31 ON OR BEFORE 6/31/2014 $33.31 ON OR BEFORE 9/30/2014 $33.30 ON OR BEFORE 10/31/2014 $36.64 AFTER 6/31/2014 $36.64 AFTER 10/31/2014 $36.63 AFTER 10/31/2014 OR PAYMENT AMOUNT PAY BY BY iCOUNT $97.92 8 31 2014 CE $99.92 10 31 2014 MALTY $109.91 �12/31/2014 / / (IZ 202T—Warranty Deed, Two Acknowledgments Henry Hail, Inc., Indiana, Pa. "d? 67 a a AALI AAM it SM t _X IF I I 'S 4' MADE THE day of July in the year of our Lord one thousand nine hundred eighty-two (1982) BETWEEN CAROLINE B. ORNER, widow and single woman, of R.D. 3, Box 161A, Newville, Upper Frankfort Township, Cumberland County, PA 17241 Grantor AND CID MERLE L. ORNER of R.D.3, Box 161 A , Newville, Cumberland County, PA 17241, RAY A. ORNER of R.D.3, Box 158, Newville, Cumberland County, PA 17241, LO and GLEN I. ORNER of 421 Pawnee Drive, Mechanicsburg, Cumberland County, C-11.1 Pennsylvania 17055, Grantees CX=O of the second. part, `WITNESSETH, that the said part y of the first part, for and in consider- ation of the sum of One and No Hundredths ($1.00) ------------------------------ --------------------------------------------------------------Dollars, lawful money of the United States of America unto them well and truly .paid by the said part ies of the second part, at and before the sealing and delivery of these presents, the receipt whereof is hereby acknowledged, have granted, bargained, sold, aliened, enfeoffed, released, conveyed and confirmed, and by these presents grant, bargain, sell, alien, enfeoff, release, convey and confirm. unto the said part ies of the second part, their heirs, and assigns, ALL that certain tract of land situate in -Upper Frankford Township, Cumberland County, PA, bounded and described as follows: Beginning at a point in the center of a -public road' on the line of land.formerl of Thomas Dunbar ' and now of Howard Delong; thence North 36 degrees West 24.6 perches to a stone; thence by the same, South 42 degrees West, 19.4 perches to a stone; thence by the same, North 34 3/4 degrees West, 48.4 perches to a stone; thence by the same, South 47 1/4 degrees West, 21.2 perches to a stone heap; thence by lands formerly of G.W. Bloser and now or formerly of Earl Coxey, North 38 degrees West, 162 perches to stones; thence by land formerly of Woodburn and now or formerly of Joseph Erford's heirs, North 67 1/2 degrees -Fast, 65 perches, more or less, to sotnes; thence by land formerly of Andrew Oiler, and now or formerly of Mervin Gayman's heirs, South 33 1/2 degrees East, 138 perches to a post at a stone heap; thence by the same, North 42 degrees East, 21.2 perches to a stone; thence by land formerly of ,Jacob Bloser and Martin Paiden and now or formerly of Wayner Salisbury, South 38 11/2 degrees East, 74.6 perches, more or less, to a point in the center of the public road aforesaid; thence Southwesterly along the public road, 38 perches, more or less to the place of BEGINNING. BEING the same tract of land which John Oiler and Mary M. Oiler, his wife, by deed dated December 29, 1947 and recorded in the Office of the Cumberland County Recorder of Deeds in Deed Book "R", Volume 13, page 423, granted and conveyed to C.E. Orner and Caroline Orner, Grantor herein. oo .-OL9 Pc i 287 . a Fl Z-3 N f0 Z2 CAROLINE B. ORNER, Q GRANTOR TO { MERLE L. ORNER, RAX A. n #" ORNER and RAY A. ORNER cp n til _ i iJ N LJ ° GRANTEES 0Zt Q. rrl �; o „ m co ro c WARRANTY u�i O + w N. a ALL that certain txaCt of (D a o R land sa,tuate. in Upper Frank- ford Townshp, (,Formerly, Frank_ �' V Q ford Township! Cmnberland . - County, bounded and described as follows-. • N ^J CO o Cki fZ m F cCO� l/ la} (G �. i 15 Big Spring Avenue NEWVILLE, PENNSYLVANIA 17241 F. CHARLES EGGER, Supervisor 717-776-3414 FRANK C. EGGER, Funeral Director March 25, 2014 Funeral Bill for Merle L. Omer Date of service March 20, 2014 Professional Services $4,580.00 18 gauge blue Sterling casket $2,185.00 12 Guardian burial vault $1,190.00 Register book $150.00 15 Death certificates $6.00 a piece $90.00 Valley Times Star obituary $50.00 Sentinel obituary $128.34 Cemetery opening $600.00 Clergy offering $50.00 Flowers $212.00 Total $9,235.34 yl I ` j RECEIPT FOR PAYMENT ------------------- -------------------- LISA M. GRAYSON, ESQ. Receipt Date : 4/08/2014 Cumberland County - Register Of Wills Receipt Time : 09 : 58 : 35 One Courthouse Square Receipt No. : 1077545 Carlisle, PA 17913 ORNER MERLE L Estate File No. : 2014-00319 Paid By Remarks : R MARK THOMAS Ci --------------- --------- Receipt Distribution -- -- ----- --------------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 310 . 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 RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 3323398 . 50 Total Received. . . . . . . . . B98 . 50,/" RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 4/10/2014 Cumberland County - Register Of Wills Receipt Time : 12 : 16 :49 One Courthouse S�uare Receipt No . : 1077599 Carlisle, PA 17 13 ORNER MERLE L Estate File No . : 2014-00319 Paid By Remarks : R MARK THOMAS DB1 - ------- - --- -- - ------- -- Receipt Distribution ----- --- ---------------- Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 332425 . 00 Total Received. . . . . . . . . H5 . 00 V CUMBERLAND LAVH JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 May 9, 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.- R. Mark Thomas, Esquire RE: Merle L. Orner 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: April 25, May 2, and May 9, 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 PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA : : ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: April 25, May 2, and May 9, 2014 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Lisa Marie Coyne, tditor SWORN TO AND SUBSCRIBED before me this 9 day of May, 2014 Notary Orner,Merle L., decd. Late of Newville,Upper Frankford Township. COMMONMEALTH OF PENNSYLVANIA Administrator: Glenn 1. Orner, 421 Pawnee Drive, Mechanics- NOTARIAL SEAL burg, PA 17050. DEBORAH A COLLINS Attorney: R. Mark Thomas, Es- Notary Public quire,Attorney at Law, 101 South CARLISLE 9080..CUMBERLAND CNTY Market Street,Mechanicsburg,PA F My Commission Expires Apr 28.2018 J 17055. The Patriot-News Co. * 2020 Technology Pkwy t4 LA atr 1 o 1' ,,wXtuj o Suite 300 A Mechanicsburg, PA 17050 Now you know Inquiries - 717-255-8213 R. MARK THOMAS 101 SOUTH MARKET STREET MECHANICSBURG PA 17055 S"TATEMENT ALL CHARGES ARE NET ACCT# NAME AD ORDER# DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT 35242 R.MARK THOMAS 0002297553 04/29/14 XXX BASIC AD CHARGE $56.26 35242 R.MARK THOMAS 0002297553 05/06/14 XXX BASIC AD CHARGE $56.26 35242 R.MARK THOMAS 0002297553 05/13/14 XXX BASIC AD CHARGE $56.26 AFFIDAVIT CHARGE $5.00 TOTAL: $173.78 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 The Patriot-News Co. 2020 Technology Pkwy t4e - ���ui2e 300 0Yechamicstxurg, PA 17050 - NOW you know Inquiries - 717-2S5-8213 R. MARK THOMAS 101SOUTH MARKET STREET K8ECH/\N|CSBURG PA 17055 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1928 Commonwealth ofPennsylvania, County ofDauphin} ns Marianne K8iUer, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place ofbusiness at202OTechnology Pkwy, Suite 30O. inthe Township of Hampden. County of Cumberland, State of Pennsy|vania, owner and publisher ufThe Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854. and September 18th. 1049. respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/Community Weekly editions which appeared on the date(s) indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character ofpublication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf ofThe Patriot-News Co. aforesaid byvirtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book^[W^. Volume 14, Page 317. PUBLICATION COPY This md# 0002297553 ran on the dates shown below: April 3S, 2O14 May O6, 3di4 May 13, 2W14 ESTATE t' � �~ ^' ` *' '�'� ' ' ' ' ~-^�/` z>^ .~e ~LLetters Administration on the ="� offA-D, P j1MvJ eceased,have been granted to the ndersigned,all�ersons knowing iemselves to be indebted to said estate I /III make Payment immediately and iose having to!ms will Present them JM0 T Ivia )r settlement to: Glenn 1.Orner "Notary Public'--' 421 Pawnee Drive Mechanicsburg PA 77050 - - -1 ' zo� ~`- '-~m`-nm'pwn��c . CenturyUnke Account Number: 314073400 Page: 1 of 8 Bill Date: Apr. 04.2014 Hello, CAROLINE B QRNER Monthly Account Account Summary Previous Balance 43.71 Payment Received Mar. 17. 2014 -43.71 Balance Forward .00 .l3: :3t'�; ?r' ,:Yl o.. ; 'ter not ?x•�n�;,'?�};x�_' Current Charges (see below) 45.62 •` . Total Amount Due $45.62 Payment Due By May 02, 2014 The Due Date On This Bi!!Applies To Current Charges Only e F st a vh key :�,s " �.�'' Current Charges Summary ' `� """` "" ` "' T ac r : v +.� mri !a e L v a x t �{,t^�-�� �s e a "`e Voice 24.30 � r �u,� sa:��� �_:. _�� -.�t� •.mss, Other Companies 18.03 Taxes, Fees,and Surcharges 3.29 Total Current Charges $4 .62END RISING RAT ''- Get High-Speed Internet and Unlimited Nationi'- ; Calling at a price that wont change for 3 year C 3 years. 1 price. 0 contract. Call 888.258,0362 Need Anything? Call us: Product.Services and Billing 1-800-201-4099 Repair Service 1-800-788-3600 Visit us: centurylink.com -*D1 GAcF cnl n TGA r)u^^= .,n❑P ....._,,.,� ..�.,_........._...m0. _......_..__._ z .c. 5 'IwEf3S.#IPT(3 t0M13PS '44- Get Get a 3-year price guarantee today. Gall 888.258.0362 Click centurylink.com/nocontract fi =WCenturyLink� See next page for details. b5lCenturyLinki, Account Number: 314073400 Page: 1 of 6 , Bill Date: Jun.04.2014 Hello, CAROLINE B ORNER Monthly Account Summary Previous Balance 44.67 Payment Received-May 22.2014 -44.67 Balance Forward .00 Your Q,:n,"Ln,,ur!: *iffl jusqw: Current Charges(see below) 44.67 Total Amount Due $44.67 Payment Due By Jun.30, 2014 csoh%RIK_ji_N ti The Due Date On This Bill Applies To Current Charges Only CD Current Charges Summary Voice 24.30 Other Companies 17.08 Taxes,Fees,and Surcharges 3.29 00 Total Current Charges $44.67 END RISING RATE* Q Get High-Speed Internet and Unlimited Nation," C4 Calling at a price that won't change for 3 years:: CD, CD _4 3 years. 1 price. 0 contract. Call 888.258.0362 Need Anything? Call us: Product,Services and Billing 1-800-201-4099 8i 1 , PAn,;j ir.,,STj-C Fee 1-800-788-3600 For an explanation of t, please call 1 800 222-0300. Total Other Charges and Credits 7.61 Taxes and surcharges Description Amount Interstate Gross Receipts + applicable UCC 0.70 PA Gross Receipts Surcharge Intrastate 0.03 State and Local Taxes 0.79 Total taxes and surcharges 1.52 7 CenturyUnk- Account Number: 314073400 Page- 1 of 6 Bill Date: Jul.04,2014 Hello, CAROLINE B ORNER Edb Monthly Account Summary Previous Balance 44.67 Payment Received-Jun. 19.2014 -44.67 Balance Forward .00 Current Charges(see below) 44.71 '91, Total Amount Due $44.71 1 kW OtUPRIJ = � i�. t qW- !Ari69 CIA Payment Due By Aug.01, 2014 klynx& The Due Date On This Bill Applies To Current Charges Only A M� L C Current Charges Summary a 43 C Voice 24.38 C Other Companies 17.08 Taxes, Fees,and Surcharges 3.25 C, C, C, Total Current Charges $44.71 END RISING RfAXTIB..- Get High-Speed Internet and Unlimited Natio Calling at a price that won't change for 3 years_,' C, C, 3 years. I price. 0 contract. Call 888.258.0362 Need Anything? Call us: Product,Services and Billing 1-800-201-4099 Repair Service 1-800-788-3600 Visit us: centurylink.com • Unli•mited Calling features like Caller ID and Voicemail SPEEDS,UPTO,10 MlBPS. g►veiyoiXlythe sp*W *P ell to surf,shop and more. IN-0171M M-FIT, Get a 3-year price guarantee today. Call 888.258.0362 Click centurylink.com/nocontract rr CenturyLink- See next page for details. '7 Centu ryLi n k° Account Number. 314073400 Page: 1 of 6 Bill Date: Aug.04,2014 W Hello, CAROLINE B ORNER Monthly Account Summary Previous Balance 44.71 Payment Received-Jul.25.2014 -44.71 Balance Forward .00 'Guv CF 'i i' 11.!41'; i,?,•. 1: ia' f ! c.i Current Charges(see below) 44.58 Total Amount Due $44.58 r IrvG�• tti'a'_. : i.{t= i', J:I:.Z, .,c�eJiA! PL Payment Due By Sep.02,2014 ik f!�"-F't-K�a.,Oz�:1y :e*&4t' The Due Date On This Bill Applies To Current Charges Onlya t +!Lt1'1lhlL lgamwofU�qjfi Current Charges Summary © o Voice 24.36 0 0 0 Other Companies 16.97 N Taxes, Fees,and Surcharges 3.25 Total Current Charges $44.58 END RISING RATE Get High-Speed Internet and Unlimited Nation. r �` .• m Calling at a price that won't change for 3 years:; e M N + f 3 years. 1 price. 0 contract. Call 888.258.0362 Need Anything? Call us: Product,Services and Billing 1-800-201-4099 Repair Service 1-800-788-3600 Visit us: centurylink.com 01 GA CC r:nl M Tr_pq UCDC: AAIB 0CT11010 TUic 13�0T1r hi 1A1rU vry io MA V%6="1 .+. FOR CHANG ESTATE OF MERLE L ORNER ��6117 Z ZO D Please c GLENN I ORNER, EXECUTOR 421 PAWNEE DR. /� �Slueld� 4'00 MECHANICSBURG,PA 17050 DATE 58 v PAY TO THE ORDER OF w• �' 1-/F"_` ' u DOLLARS L'1 rte. >023349 . M Balnk Mychoice Plus CAROLINE B 21 LONESON NEWVILLE,F ""d"""'D raO""° MEMO r� (V ` /�jy�l _ 'Z:G NP x:0313029551: 986347166111'0110 `----urrazray-raz-r�•�u1717'[JU0[II]ODDUO 0000-000000.0'0f780414000000445871000000 Nationwide YOUR AUTO BILL. On Your Side Merle L Orner Page 1 of 2 Date prepared March 20,2014 Billing account 5801506362 Questions? Contact SHOEMAKER INS AGENCY INC at 717-776-7229 Merle L Orner Visit us online Go to nationwide.com to view and 21 Lonesome Rd pay your bill,report claims and Newville, PA more. 17241-9732 Please make your Amount due payment by April 13, 2014 DESCRIPTION AMOUNT r Mlhimnthl 'oaymentg r�cluclesx�$5 bOzrYj5Callment'fee*k� .�� v,� s 'c $105::90 ' :T>•11i1'ee}motl"th pay;`ni ' � 7:79 ayine.nt iia fu111:1 as�norii stalI ftent, r Your last payment of$588.40 was received on October 2,2013. Premium details POLICY AND POLICY NUMBER FOR COVERAGE PERIOD BALANCE PAYMENT Members only benefits Auto 1966 CHEV IMP 04/13/14-10/13/14 $605.40 $100.90 Farm bureau.members 5837A 493580 1967 CHEV XXXXXXXX ,cce.;v e special savings or. —— --- --- -- -- --- many Nationwide policies. Account information Contact your agent for details. 00 Insuring company for account 5801506362 is as follows: / POLICY NUMBER POLICY TYPE INSURING COMPANY 5837A 493580 Auto Nationwide Mutual Insurance Company l Additional information • To keep you protected,we're always on the lookout for insurance fraud. If,you know or 1 suspect someone is committing insurance fraud,please notify us.You can contact our anonymous Fraud Hotline at 1.800.474.7633 anytime,or email c f� rptfraud@Nationwide.com. b See reverse side for additional information I:u i i* iu 24 5 51: 986 34 ? L66 511'0099 soccu ry auE IF YOU WANT TO...THEN CONSIDER... INSTALLMENT FEE Pay in full Paying your premium for the entire policy No fee period in one payment. Pay over time Making individual payments online, by phone $5.00 per by mail or in person. payment. Pay at least the Choosing Easy Pay EFT to have your No fee minimum amount month) due each month Y premium automatically debited from your bank account. Learn more at nationwide.com. Selecting our Easy Pay Recurring Bank Card $5.00 per option to have your monthly payment automatically charged to your credit card. payment Sign up at nationwide.com. . ..... 20.50201101 Adams Electric Cooperative,Inc. 33120002 2050201101 05/0 2/2014 1338 Biglerville Road ACCOUNT SUMMARY P.O. Box 3605 Previous Balance: 183.08 wo! Gettysburg, PA 17325-0605 Payments Received: -183.06 Balance Forward: 888/232-6732 A Tcvchlrone E Total Basic and Non-Basic Charges: 87.66 `I; ' acx"e adamsec.coop �.�'� ACCOUNT BALANCE 87.66 21 LONESOME ROAD NVL Cycle 01 :.... ::::::::.::::::::..::.:.:::::.::::::::.:::::::::::::.:::::::.:;:;<.:::;:.;:::.: 367 ::1L1N[i:::; E)UIP 294 1993 1 AV 0.378 4 1993 APR 13 2246 72 52 2207 MERLE L ORNER C-7 P-11 21 LONESOME RD 1471 NEWVILLE PA 17241-9732 MAR 14 1664 54 36 73 APR 14 669 22 51 A M J J A S O IN D J F M A I III II In ll I n II I III ll Inll I I I II l u METER# Date/pi.ev Rd DatePres Rd' Mult KYVH f?em Rd Dem<Bllled` P.F. Rate Rate Classification 33120002 03/31 20375 1 04/30 21044 1 i 669 1 .000 i .000 i 0 1 RHW32 I RESIDENTIAL W/wTR HT _. . . BILLINGDETAIL BASIC CHARGES NON-BASIC CHARGES Energy Supply prices and charges are set by your electric generation supplier.Your current price to compare is$0.06919. Adams Electric Cooperative Inc. 888/232-6732 1338 Biglerville Road Gettysburg, PA 17325-1055 ENERGY SUPPLY: Energy charge 669 kwh @ .07290 48.77 WPCA 669 kwh @ .00200 1.34 Load control credit -5.00 TOTAL ENERGY SUPPLY 45.11 DISTRIBUTION: Access Charge 28.50 Distribution charge 669 kwh @ .02100 14.05 TOTAL DISTRIBUTION 42.55 TOTAL BASIC CHARGES 87.66 Your cooperative and its generation and transmission (G&T) supplier have allocated their margins for 2013. These allocations are subject to future retirements as financial conditions permit. Your portions of the allocations are as follows: Co-op: $98.82 G&T: $,00 savlrlya udvn w nieniueib when eiieiyy 5UPply vww urvN. be stopped at any time. Price to Compare (PTC): Price to Compare (PTC): This Balance Forward: The amount carried forward from your per kilowatt-hour (kwh) amount applies to the Energy previous electric bill. Supply section. Members would use this to shop for an alternative energy generation supplier (EGS) if an EGS ever chose to serve Adams Electric. The PTC listed represents a blended average for each spec'Ific rate class. District Offices Individual PTC charges will vary based upon rate class 1380 Biglerville Road, Gettysburg, Pa. and electricity use. 204 West King Street, Shippensburg, Pa. Distribution Charge: The charge to deliver electricity over 200 Trinity Road, York, Pa. the co-op's distribution system. A monthly access charge, Office hours: Monday - Friday, 8 a.m. to 4 p.m. representing the cost of the distribution lines and Closed major holidays. equipment in place, is included on each bill whether or not Services/Billing: 888/232-6732 or 717/334-2171 any electricity is used. Billing assistance available by phone weekdays until 5 p.m Emergency Service: 1-800-726-2324 adamsec.coo p ................ ....... ............. ......... ......... ................ ...... .... NE :m .O.R. A; ... . . .... ...... . . ................. ... M.... .......... .. I..... . . .. . ..... ............ .......... T .. ...... .................... I ...........11,1,111,11,1,11,1*1,11 .. . ....... ... .............. ............ .. : .... . ...... ......iii., The cooperative reads your meter each month using an 9 SmartHub: Visit aclamsec.coop and click on Pay My Bill automated meter reading (AMR) system which allows the to pay electronically. View your bill, payment and billing co-op to bill you accurately and saves the co-op money. history, and electricity use. Update contact information All bills are due by the due date shown on the front of and turn off your paper bill too. the bill. This date applies to current charges only and does *By mail: Send your check or money order to not extend the due date for previous charges. Unless you Adams Electric, 1338 Biglerville Rd., P.O. Box 3605, are on budget billing or have a credit, the amount shown as Gettysburg, PA 17325-0605. Detach the lower portion of the bill and return it with payment by the due date. Write "Balance Forward" is past due and subject to a 1.5% your account number on your check or money finance charge. Non-payment of past due amounts may order. Make sure Adams Electrics address shows through result in service disconnection. the return envelope window. We offer the following payment options: •Inerson* Pa at any of the three district offices listed •Auto Bank Draft: Sign up and have payments below. Night deposit boxes are available after hours. automatically deducted from a bank or credit union Adams Electric is NOT responsible for cash placed in the account. night deposit boxes. •By Phone: Call toll-free 877/487-1460 and select the nr%rront mom i nntinn Ploncn h=%in%ini ir =n-int rit imknr In.4- .._L__ ..1__ ...J 2050201101 DATE BILLED METER NUMBER.- ACCOUNT NUMBER 06/03/2014 33120002 2050201101 A941% Adams Electric Cooperative,Inc. 1338 Biglerville Road ACCOUNT SUMMARY P.O. E30X 3605 Previous Balance: 87.66 Gettysburg, PA 17325-0605 Payments Received: -87.66 Balance Forward: 0.00 Total Basic and Non-Basic Charges: 60.61 888/232-6732 A Tm6mtone Erxmryp cmmralwe ACCOUNT BALANCE 60.61 adamsec.coop ................. .................................. ST........ JSE�+I 21 LONESOME ROAD NVL Cycle 01 .. Ku H ORY........ ...... wax 3678 MONTH` ...... 2942- 2013 1 AV 0.378 4 2013 MAY 13 1143 38 62 2207 MERLE L ORNER C-7 P-11 21 LONESOME RD , 1471- NEWVILLE PA 17241-9732 APR14 669 22 51 73 MAY 14 387 12 62 I IJ A S ON D J F M A METER# Date/Prev Pres Rdg Mult KWH Dern Rdg Dem Billed [ P.F. Rate Rate Classification 33120002 04/30 21044 105,131 214 387 .000 .0001 0 1 RHW32 RESIDENTIAL W/WTR HT BILLING DETAIL BASIC CHARGES NON-BASIC CHARGES Energy Supply prices and charges are set by your electric generation supplier.Your current price to compare is$0.06919. Adams Electric Cooperative Inc. 888/232-6732 1338 Biglerville Road Gettysburg, PA 17325-1055 ENERGY SUPPLY: Energy charge 387 kwh @) .07290 28.21 WPCA 387 kwh @ .00200 0.77 Load control credit -5.00 TOTAL ENERGY SUPPLY 23.98 DISTRIBUTION: Access Charge 28.50 Distribution charge 387kwh g .02100 8.13 TOTAL DISTRIBUTION 36.63 TOTAL BASIC CHARGES 60.61 The cooperative reads your meter each month using an •SmartHub: Visit adamsec.coop and click on Pay My Bill automated meter reading (AMR) system which allows the to pay electronically. View your bill, payment and billing co-op to bill you accurately and saves the co-op money. history, and electricity use. Update contact information All bills are due by the due date shown on the front of and turn off your paper bill too. the bill. This date applies to current charges only and does •By mail: Send your check or money order to not extend the due date for previous charges. Unless you Adams Electric, 1338 Biglerville Rd., P.O. Box 3605, are on budget billing or have a credit, the amount shown as Gettysburg, PA 17325-0605. Detach the lower portion of g g the bill and return it witha ment b the due date. Write "Balance Forward" is past due and subject to a 1.5% your account number on your check or money finance charge. Non-payment of past due amounts may order. Make sure Adams Electrics address shows through result in service disconnection. the return envelope window. We offer the following payment options: •In person: Pay at any of the three district offices listed •Auto Bank Draft: Sign up and have payments below. Night deposit boxes are available after hours. automatically deducted from a bank or credit union Adams Electric is NOT responsible for cash placed in the account. night deposit boxes. •By Phone: Call toll-free 877/487-1460 and select the correct menu option. Please have your account number Rate schedules and options are available upon request. available. ;'" €x'11 1. '"►..... .ti 9Z's8 S30UVHO 31SVG 1V101 ZO'zb NOu.newisia ltl.LOl ZS'£t 00tzo' tP 4MM b179 a6te4o uoa1nglj1s10 09'9Z 961e40 SS900V :NOI1n81a1S1a bz'£b Alddns AJu3N3 IV141 00'5- llpaao 101lu03 peol 6Z't OOZOO' (9)4MK bb9 VOdM 96'9b 063/-0' @D 4M3i bb9 a6je4o d61au3 :AlddnS A983N3 ggo t-S3£L t dd'6angsAp9!D peon{811lAi91619 8££t Z£L9-Z£Z/888 'oul an1tea9doo0 ouloa13 swept' '61690'0$st aiedwoo of aoud luanno inoA-jallddns uogl?jau96 ouloale anon(Aq las am sa6ae4o pue saoyd AlddnS Abiau3 S308VH3 OISV13-NON S3!DHVHO 3ISV8 1IV130 ON117118 1H u1M/M 1di mgaiS3a ZEM148 0 000' 1000. bb9 t I stozz of/s0 tEmtz tE/SO z000rtec uolleolpsselo Bleu ales 'A'd : P611M waa J 6P8 wa0 I HM>I I ilnW I 6Pu Md/84e0 6Pu Aa d/ale0 #u313W W v W A r u u o s V r 111�11�1�111'll'�1"I�II�I�l�1i�1111III IIII Jill 111111111111Jill u 0 OL lZ bb9 bl Nf1C' Z9 at Lee bt AVW ZEL6-TVZLT dd 311IAA3N 1Lb1 ad 3WOS3NOi TZ razz TT-d 6-0 N3NH0 i 31H3W ZL 0z tt9 EtNnr 8OOZ V 8LE'O AV Z 8WZ 7!\tf AttlGl;. tti iflOi<+I t0 a o/I O I O AN 0d u l 1 3W S 1 Z S O 3NO d000-oeswepe 9Z'98 30NVIVEI1Nn000v > (anraviadocr��raci3 xarnFyanol� Z£L9 ZEZ�888 9Z'99 :sa6aey0 31seg-u0N pue olseg Pe101 ` *� 00'0 :paeMJo_A aoueleg 19'09- :paA1909H sluaw/ed 19'09 :aoueleg snolAaad 5090 S3ELt bci `S09£C k09 XlleJ X09 �adwwns INno��b peol3 a„lA,a,6ie Beet -oul `sAlle.iadoo0 opioela swept tOLLOZOSOZ Z000ZLee 17LOZ/ZQ/LQ 1d39Wf1N 1Nf10bOV 839W1'1N U313W (331118 31VQ WMZ090z 2050201101 Adams Electric Cooperative, Inc. 08/91/2014 33120002 2050201101 1338 Bigiarville goad ACCOUNT SUMMARY P.O. Box 3645 Gettysburg, PA 17325-0605 Previous Balance: 85.26 Payments Received: -85.26 Balance Forward; 0.0t3 c Total Basic acid Non-Basic Charges: 130.04 388,232-6732 A Tra�he Ecu� mrgy1)a_"P_-,a:ive � adamsec.coop ACCOUNT BALANCE 130.04 ^- 21 LONESOME ROAD NVL Cycle 01 dAtI- M(?TdTt3: 3tYVi4 i#AJLY .. 294Z. . _ 2001 1 AV 0.378 4 .2001 JUL 13 778 25 77 2207- _ MERLE L ORNER C-7 P-9 21 LONESOME RD 1471 NEWVILLE PA 17241-9732 ,JUN14 644 21 70 tt 7 �iti�iNfliittliil��il�tihlinlliilltiitiriii�nlnt'1rIt11�1It� JUL14 .1111 36 73 J A S O N D J F M A M J J METER# Date/Prev Rdg Date/Pros Rdg Mult ; KWH Dem Rdg Dem Billed . P.F. Rate Rate Classification 33120002 06/30 22075 107/31 231861 1 1111 000 000 0 RHW32 l RESIDENTIAL W/WTR HT BILLING DETAIL $ BASIC CHARGES NON-BASIC CHARGES j 1 Energy Supply prices and charges are set by your electric generation supplier.Your current price to compare is$0.06919. r r Adams Electric Cooperative Inc. 888/232-6732 1338 Biglerviile Road Gettysburg,PA 17325-1055 j? ENERGY SUPPLY: 1 Energy charge 1111 kwh @ ,07290 80.99 WPCA 1111 kwh @ .00200 2.22 Load control credit -5.00 TOTAL ENERGY SUPPLY 78.21 DISTRIBUTION: Access Charge 28.50 Distribution charge 1111 kwh @ .02100 23.33 TOTAL DISTRIBUTION 51.83 + 6 TOTAL BASIC CHARGES 13G G4µ- c `" `t~ ESTATE OF MERLE L ORNER 60 6117 111 13 GLENN I ORNER, EXECUTOR C7UNT NUMBER Are these 421 PAWNEE DR. MECHANICSBURG,PA 17050DATE j �,$Shields 2050201101 Primary s r Business FAY TO THE 1j _ MabilelC ORDER OF. - /d d C>�Cr Q�vt S. fi` l��`J 130. 4 Addl Woi �'� I y 7 ✓% �P /�` I after the c�hae date Add[cell DOLLARS 19, m M&T Bank ' MyChoice Pius MEMO 1:03 130 29551: 9863ti ? 166 11r=0 1 1 1 14080120148 2050201101 DATE BILLED METER Nl IMRFR ©c 1'11 INT NI iMRFR 04/02/2014 33120002 2050201101 Adams Electric Cooperative,inc. - 1338 Biglervitle Road AGC:OUNT SUMMARY P.O. Box 3605 Previous Balance: 204.94 Gettysburg, PA 17325-0605 Payments Received: -204.94 c� Balance Forward: 0.00 888/232-6732 Total Basic and Non-Basic Charges: 183.08 ACCOUNT BALANCE 183.08 ; adamsec.c000 21 LONESOME ROAD NV L C cle 01 IH1J5 .,>. Y Y ASG::-: 367 KvY:1i.s.::71N> ; 2942- 1732 2 AV 0.378 4 1732 MAR 13 1312 44 39 2207 MERLE L ORNER C-8 P-13 21 LONESOME RD 1471 NEWVILLE PA 17241-9732 FEB 14 1892 68 29 73 I11 11111111nI 11 t 111111111111111 MAR 14 1664 54 36 0. II111111111111MAMJ JASON D J F ^� I IIII I I I III II u l l 11 METER# Date/Prev.Rdg. ' Date/Pres Rdg 1. Mult KWH Dem Rdg Dem Billed P.F. Rate Rate Classification 33120002 02/28 18711 03/31 20375 1 1664 .0001 .0001 0 1 RHW32 RESIDENTIAL W/WTR HT BILLING DETAIL BASIC CHARGES NON-BASIC CHARGES Energy Supply prices and charges are set by your electric generation supplier.Your current price to compare is$0.06919. Adams Electric Cooperative Inc. 888/232-6732 1338 Biglerville Road Gettysburg, PA 17325-1055 l(}3 ENERGY SUPPLY: Lj Energy charge 1664 kwh @ .07290 121.31 ' 1 WPCA 1664 kwh @ .00200 3.33 Load control credit -5.00 TOTAL ENERGY SUPPLY 119.64 DISTRIBUTION: Access Charge 28.50 Distribution charge 1664 kwh @ .02100 34.94 TOTAL DISTRIBUTION 63.44 _ TOTAL BASIC CHARGES 183.08 I //p ocean PART NO. DESCRIPTION PRICE PENNSYLVANIA STATE INSPECTION G. A. FARLLING'S GARAGE STICKER NO./ ,- General Auto Repairs ...✓'� I. ( REGISTRATION NUMBER 654 Bloserville Road f " Newville, PA 17241 j-. SERIAL NO. 717-776-3614 NAMEn DATE AM YEAR 8 MAKE /4` t/ 7 ADDRESS ✓ PHONES l Yes TYPE J f �. "i �r pt5t�iCyti�L' No. ' MILEAGE _ j �I / )// /77— WRIf1LNBY PROMISED A.M. r• L.t IAF. /, 1t'/clU/!/Z /�7 / l P.M. RF r? LF: (OPER.No !/ .II.NS T R U C T 10 N SLABOR TIRES RR j~ IR�`o eo I{ 'y ,J e-01C4, 22-17/6//f/l? I If INSPECTED BY o f l ft ¢O o „4 :P r•' a< HORN WIPERS MIRROR r^� F HEAD LIGHTS AUXILIARY LAMP l I CANDLE POWER R L �j REAR LICENSE H BST OPLAMP$ ff T r i S BACK UP LAMPS / STOP LAMPS TURN SIGNALS GLASS S T WHEEL PLAY L✓" I E E SUSPENSION 1 R I ALIGNMENT N G EXHAUST SYSTEM 8 APPROVED V TOTAL PARTS R BRAK H SA WHEEL / K PULLED OUTSIDE REPAIRS S %LUJING BUMPERS.FENDERS. INTERNAL SUMMARY FRAME / NOT RESPONSIBLE FOR LOSS OR DAMAGE TO CHARGE COST BRAKE ADJ. �v, CARS OR ARIICLFS LEFT IN CARS IN CASF OF FIRE R E STEERING THEFT, OR ANY OTHER CAUSE BEYOND OUR TOTALLABOR 1 C A S �� CONTROL. D TIOTAL PARIS , ACCESSORIES _ OUTSIDE I hereby authorize the above repair work to he REPAIRS r CLEAR.LAMPS done along with the necessary material and hereby grant you ondtor your employees per A(CFSSORIEc T IDC NT.LAMPS mission to operate the car.truck or vehicle herein R described on streets.highways or elsewhere for INSPECTION ((� SIDE MARKERS the purpose of testing and/or inspection An ex FEE U press mechanic's lien is hereby acknowledged on p v K REFLECTORS above car,truck or vehicle to secure the amount , FLARES AND of repairs thereto JJJ I S FLAGS I FIRE TAX EXTINGUISHER TOTAL ACCESSORIESF J,x TOTAL 671 6 4 - NRG� 4nf\ ft ACTCV MnAVC V Investors Life Insurance Company of North America PO Box 700 Jacksonville, IL 62651-0700 1-800-925-6000 PAYMENT NOTICE MERLE L ORNER 21 LONESOME ROAD NEWVILLE RD3 PA 17241 POLICY NO. INSURED DUE DATE DESCRIPTION AMOUNT 3031297448 MERLE L ORNER 01/27/14 QUARTERLY PREMIUM DUE $112.00 AMOUNT DUE $112.00 IMPORTANT INFORMATION: SEE REVERSE SIDE FOR OUR PRIVACY POLICY RETAIN THIS PORTION FOR YOUR RECORDS II III