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HomeMy WebLinkAbout02-10-15 (2) ry i� Pennsylvania 1505614105 EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 : RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY F05132014 –�� 12141922 Decedent's Last Name _ (Suffix Decedent's First Name _ MI Scholz — �— 1 Henry---- (If Applicable)Enter Surviving Spouse's Information Below LL---- Spouse's Last Name _ SSu�ifiix��{ Spouse's First Name MI —._— —,---- l _.^ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 1.Original Return p . 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) C=:) 4.Agriculture Exemption(date of C= 5.Future Ihterest Compromise(date of O 6. Federal Estate Tax-Return Required death on or after 7-1-2012) death after 12-12-82) 7.Decedent Died Testate Q 8.Decedent Maintained a Living Trust 1 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) O 10.Litigation Proceeds Received O 11.Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13.Business Assets C=) 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NameDaytime Telephone Number James Scholz _ W ;(717)576-9160 First Line of Address �40Argali Lane ------------ —^---^��___`--.� Second Line of Address City or Post Office .__ State ZIP Code - —T - _ _— q "' -:0. Mechanicsburg Pa 1 17055– - _ m C) m co, Correspondent's email address: PSujim83@gmail.com ;Z. .rn r7 I77 © cn :I ' REGISTER OF WII LSI`)_7SE�ONLY-i^ REGISTER OF WILLS USE ONLY DATE FILED•MMDDYYYY � 177 tw ,•9,... �� _ a s_ DATE FILED STAMP PLEASE USE ORIGINAL FORM ONLY Side 1 41i1�iiiii 1 150561410.5 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Henry J Scholz RECAPITULATION 1. Real Estate(Schedule A). .. ...................................... 1. 76,500.00 2. Stocks and Bonds(Schedule B) ...... ................................. 2. 1 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 4. Mortgages and Notes Receivable(Schedule D) ........................... 4. b. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. i 3,000.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. t 27,038.97 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 1 20,045.29 (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 126,584.26 i 9. Funeral Expenses and Administrative Costs(Schedule H)................. .. 9. ; 27,209.49 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. ; 1,839.63 i 11. Total Deductions(total Lines 9 and 10)................ ................. 11. : 29,049.12 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. i 97,535.14 1 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) ......... ............... 13. 1 1,000.00 I 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. { 96,535.14 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or __.. -..-----__....___.�___.__..__.___._.__�__ _..._.. ---------__._..__._-_ transfers under Sec.9116 ���" i (a)(1.2)X.0_ 15. 16. Amount of Line 14 taxable i at lineal rate X.0 45 96,535.14 ' 16. ' 4,344.08 17. Amount of Line 14 taxable at sibling rate X.12 17. . E 18. Amount of Line 14 taxable at collateral rate X.15 18. i 19. TAX DUE .. ...... ................. ................................ 19. 4,344.08 i 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (*D Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true, correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNREJOF PERSON RE ON BLE R FILI R T N 0 CINIE IADDRE Izo SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS Side 2 ��I� �I��� 15 5614205 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Henry J. Scholz STREETADDRESS 227 12th Street CITY STATE ZIP New Cumberland Pa 17070 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 4,344.08 2. Credits/Payments A.Prior Payments 5,000.00 B.Discount 217.20 (See instructions.) Total Credits(A+B) (2) 5,217.20 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) 873.12 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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.............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ M 2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 0 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ 0 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ E ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[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 step-parent 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 Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) pennsylvania SCHEDULE 'A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL'ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Henry J. Scholz 2014-00524 All real property owned solely or as a tenant in common must•be reported at fair market value..Fair market value is defined as the price at which property would be exchanged between a willing buyer and a"willing seller,neither being compelled to buy or sell;both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a•copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' Sale of Home @ 22712th New Cumberland(As per Settlement Statement Line 400) 76,500.00 TOTAL(Also enter on Line 1,Recapitulation.) $ 76,500.00 If more space is needed,use additional sheets of paper of the same size. REV-i5o9 EX+(oi-io) bipennsylvania SCHEDULE F OEPARTMENTOFREVENUE ,JOINTLY OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Henry J.Scholz 2014-00524 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A.James P.Scholz , 40 Argali Lane Son Mechanicsburg, Pa. 17055 B. C. JOINTLY OWNED PROPERTY: LEITER 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 DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 02/01/04 M&T Bank Checking Acct#76117391 591.01 50 295.51 2. 02/01/04 M&T Bank Money Market Acct#15004225218921 53,486.92 50 26,743.46 TOTAL(Also enter on Line 6, Recapitulation) $ 27,038.97 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) i pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND _- INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER .Henry J. Scholz 2014-00524 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 RELATIONSHIP To DECEDENT AND DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IF APPLICABLE) VALUE 1, M&T Bank IRA Acct#35004201741459 12,332.26- 100 12,332.26 2 M&T Bank IRA Acct#35004201741441 7,713.03 100 7,713.03 TOTAL(Also enter on Line 7,Recapitulation) $ 20,045.29 If more'space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) q I pennsylvania SCHEDULE H idi DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Henry J. Scholz 2014-00524 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Parthemore Funeral Services 10,654.09 2: St Theresa Mercy Service(Funeral Lunch) 100.00 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: 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: 343.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7• ADMINISTRATIVE COSTS Lines 7 thru 27 (See Addition Seet for all costs) 16,111.99 B. 9. 10. . . . . . . . . . .. 11. 12. TOTAL(Also enter on Line 9, Recapitulation) $ 27,209.49 If more space is needed,use additional sheets of paper of the same size. ADDITIONAL-SCHEDULE H ADMINISTRATIVE COSTS Estate of Henry J. Scholz - File Number 2014-00524 ITEM# DESCRIPTION AMOUNT 7 1%Real estate transfer tax on sale of decedents home as per line 1203 Settlement sheet $765.00 8 New Cumberland Boro Trash/Sewer on sale of decedents home per line 1303 Settlement Sheet $115.24 9 Seller Paid Settlement Cost on sale of decedents home per line 506 Settlement Sheet $1,500.00 10 Sewer on sale of decedents home as per line 514 Settlement Sheet $41.65 11 City Taxes on sale of decedents home as per line 406 Settlement Sheet -$91.32 12 School Taxes on sale of decedents home as per line 409 Settlement Sheet -$703.20 13 Garbage Fee on sale of decedents home as per line 410 Settlement Sheet -$17.62 14 WSSD Real Estate Taxes after death on decedents home $1,174.47 15 UGI Gas Utility fees after death on decedents home from May thru November 2014 $97.20 16 PPL Electric fees after death on decedents home from May thru November 2014 $174.69 17 PA Water fees after death on decedents home from May thru November 2014 $184.48 18 Home Owners Insurance fees after death on decedents home from May thru November 2014 $357.50 19 Quarterly Trash and Sewer Bills after death on decedents home from May and August 2014 $230.48 20 Grass cutting service fees after death on decedents home from May thru November 2014 $780.00 21 Heating Oil fees after death on decedents home from May thru November 2014 $999.22 22 Mark Heckman Home Appraisal after death on decedents home July 2014 $400.00 23 Home repair Item cost after death on decedents home-Home Depot 9/1/2014 $198.02 24 Roof and Gutter replacement after death on decedents home Sept 2014,Century Spouting $9,421.69 25 Cumberland Country Recorder of deeds after death,Original 1965 deed on decedents home $230.00 26 2006 Ford Taurus Title Transfer on decedents vehicle after death on decedents vehicle $56.00 27 2006 Ford Taurus Pa Inspection on decedents vehicle after death on decedents vehicle $63.49 28 Estate Notice-Advertisement Three weeks Cumberland Law Journal $75.00 29 Estate Notice-Advertisement Paxton Herald $60.00 TOTAL ADMINISTRATIVE COSTS Lines 7 thru 29 $16,111.99 FUNERAL EXPENSES A Lines 1 and 2 $10,754.00 PROBATE FEES Line 4 $343.50 TOTAL SCHEDULE H COSTS(Line 9,Recapitulation) $27,209.49 REV-1512 EX+(12-12) pennsyWania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Henry J. Scholz 2014-00524 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 Dr.Raymond C.Grandon MD 131 State Street Harrisburg Pa 17101 142.55 2. Home Instead Senior Care,5002 Lenker Street,Mechanicsburg Pa 17050 589.76 3. Pinnacle Health 1000 N Front St,Wormleysburg Pa 17043 11.12 4. Holy Spirit Hospital,Camp Hill Pa,17011 1,094.40 5. Quantum Imaging @ HSH Camp Hill Pa,17011 1.80 TOTAL(Also enter on Line 10,Recapitulation) $ 1,839.63• If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) t pennsylvania SCHEDULE DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Henry J. Scholz 2014-00524 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).] I. Thomas H.Scholz-One Honora Drive,Bear De.19701 Son 16.66% 2. Carol A.Markel-1109 Highland Dr.Mechanicsburg Pa.17055 Daughter 16.66% 3. Donald R.Scholz-201 Kensey Road,Plymouth Mtg.Pa 19462 Son 16.66% 4. M.Sue Lefevre-3 Theresa Drive,Conestoga Pa.17516 Daughter 16.66% 5. James P.Scholz-40 Argali Lane Mechanicsburg Pa 17055. Son 16.66% 6. Heather A.Scholz-318 Lynly Lane,Newark De.19711 Grand-Daughter 16.66% Liniage of John P.Scholz-Deceased Son 0% 7. David E.Scholz-Deceased no Liniage Son 0% 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. Hospice of Central Pa $1000.00 TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 1000.00 If more space is needed,use additional sheets of paper of the same size. `r LAST WILL AND TESTAMENT OF HENRY J. SCH OLZ/ I, Henry J. Scholz, of 229 12t' Street, New Cumberland, County of Cumberland, Pennsylvania,being of sound mind and memory,do hereby make,publish and declare this to be my Last Will and Testament. FIRST: I hereby revoke all Wills and Codicils thereto by me at any time heretofore made. SECOND: I direct that all my legal debts, my funeral expenses and the costs of administration of my estate be paid as soon as practicable after my death. I direct that my Executor or Executrix pay out of my estate,as a general charge thereon,all inheritance,estate,succession and other taxes,together with any interest or penalty thereon assessed by reason of my death with regard to all properties and assets subj ect to such taxes,whether or not such property and assets pass under this Will. THIRD: I give,devise and bequeath all of my estate,real,personal or mixed,tangible or intangible, of whatsoever kind and wheresoever situated, together with any property to which I may have any power of disposition or appointment and whether acquired during or after my lifetime, to my children,David Scholz,John Scholz,Thomas Scholz,Carol Markel,Donald Scholz,Mary Scholz and James P. Scholz,to share and share alike,in equal parts,provided such child survives me for a period of thirty(30) days. If any ofmy children, David Scholz,John Scholz,Thomas Scholz,Carol Markel,Donald Scholz,luny Scholz and James P.Scholz are deceased at the time of my death or do not survive me for a period of thirty (30) days, but are represented by living issue, such issue shall take, per stirpes,the legacy to which his or her parent, David Scholz,John Scholz,Thomas Scholz, Carol Page 1 of 6 Iaai8dals�// Markel,Donald Scholz,Mary Scholz and James P.Scholz would have been entitled if then living. At the sole discretion of my Executor or Executrix, the share of any minor child shall be selected and held by my Executor or Executrix for delivery to such child at termination of minority; or in the sole discretion of my Executor or Executrix, may be delivered either to the minor or to another to hold for the minor during minority,and the receipt of the minor or such other person shall operate as a complete discharge of my Executor or Executrix. FOURTH: My Executor or Executrix, shall have the following powers in addition to those vested in them by law and.by other provisions of my Last Will and Testament, applicable to all property, whether principal or income, including property held for minors, exercisable without court approval, and effective until actual distribution of all property: 1 1 direct that my Executor or Executrix and his/her successor, shall not be required to give bond for the faithful performance of his/her duties in any jurisdiction. 2. My Executor or Executrix shall receive compensation for the performance of his/her functions hereunder in accordance with the Pennsylvania Estates Practice standard schedule of fees in effect from time to time during the period over which the services are performed. 3. To allocate receipts and expenses to principal or income or partly to each as he/she from time to time thinks proper in his/her sole discretion. 4. To borrow money from any person or institution and to mortgage or pledge any or all real or personal property as my Executor or Executrix in his/her sole discretion shall choose,without regard for the dispositive provisions of this instrument. 5. To compromise any claim or controversy. Page 2 of 6 InNal"F 6. To make distribution in cash or in kind,or partly in cash and partly in kind, and in such manner as he/she may determine, and at valuations finally to be, fixed by him/her. 7. To invest in all forms of property (including stock or other securities and common trust funds and mortgage investment funds), without restriction to investments authorized for Pennsylvania fiduciaries,as he/she deems proper, without regard to any principle of diversification or risk. 8. To sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases,for such prices and upon such terms or conditions as he/she deems proper. 9. To exercise any law-given option to treat administrative expenses either as income tax or as estate tax deductions, without regard to whether the expenses were paid from principal or income. 10. All shares of principal and income hereby given shall be free from anticipation,assignment,pledge or obligation of the beneficiaries and any of them, and shall not be subject to any execution, attachment, levy or sequestration or other claims of the creditors of said beneficiaries or any of them. FIFTH: I do hereby make, constitute and appoint my son, James P. Scholz the Executor of this my Last Will and Testament. Should he fail to qualify or cease to act,I appoint my daughter,Carol Markel of Mechanicsburg,Cumberland County,Pennsylvania,as Executrix of this my Last Will and Testament. Page 3 of 6 In IN WITNESS WHEREOF, 1, Henry J. Scholz, Testator above named, have hereunto subscribed my name and affixed my seal this /_:z day of January 2004. Henry�410h7oRz Signed, sealed,published and declared by the above-named Henry J.Scholz as and for his Last Will and Testament,in the presence of us and each of us,who,at his request.and in his presence and in the presence of each other,have hereunto subscribed our names as witnesses thereto the day and year last written above. 11 1 WITNESS ADDRESS S' ADDRESS Page 4 of 6. in itia is COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF DAUPHIN 1, Henry J. Scholz, the Testator, whose name is signed to the attached or foregoing instrument,having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament;and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by Henry J. Scholz,the Testator, this /,;-I day of January 2004. Henry NOTARYeBLIC My Commission Expires Notarial Seal Dorothy M.SCON 11401-* ulft Harrisburg, Dauphin,Cunty My Commission Expires soot.ii,=4 Member,Ponnsytvania Assoclaffon OfNotades Page.5 of 6 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF DAUPHIN We, and the witnesses whose names are signed to the attached or foregoing instrument,being duly qualified according to law,do depose and say that we were present and saw the Testator sign and execute the instrument as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Last Will and Testament as a witness;and that to the best of our knowledge the Testator was at the time 18 or more years of age,of sound mind- and under no constraint or undue influence. IaSworn to or affirmed and subscribed to before me by I 131 6 ban and zZ Llfa witnesses, this li),fi-,,day of January 2004. 9 f WI'TNES'S TNES NOTARY PUALIC My Commission Expires: Notarial Seal 0 Dorothy M.Scott,Ngtary Public a, Dauphin county 6 Harri�pbt�.,rg, Dauphin opunty My Commission Expires Sepi.9-1,p.604 a4ember,PennsyivaniaAsso-.iationofNotag,gs Page 6 of 6 Inffia& 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 4, NO: CD' 019520 SCHOLZ JAMES P 40 ARGALI LANE MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold __________ ________ r 101 $5,000.00 .ESTATE INFORMATION: SSN: FILE NUMBER: 2114-0524 DECEDENT NAME: SCHOLZ HENRY.J t DATE OF PAYMENT: 08/08./2014 POSTMARK DATE: 08/08/2014 i COUNTY: CUMBERLAND f j DATE OF DEATH: 05/13/2014 TOTAL AMOUNT PAID: $5,000.00 REMARKS: r CHECK# 1002 INITIALS: DB1 SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS TAXPAYER L.Settlement Charges 700. Total Real Estate Broker Fees Paid From Paid From Division of commission(line 700)as follows: Borrowers Seller's 701. $ to Funds at Funds at 702. $ to Settlement Settlement 703. Commission paid at settlement 0.00 704. 800. Items Payable in Connection With Loan 801. Our origination charge $ 750.00 (from GFE#1) 802. Your credit or charge(points)for the specific interest chosen $ -153.00 (from GFE#2) 803. Your adjusted origination charges (from GFE#A) 597.00 804. Appraisal fee to Servicel-ink(fka LSI)P.O.C."B($600) (from GFE#3) -80.00 805. Credit report to CBClnnovis P.O.C'B(34.80) (from GFE#3) -17.40 806. Tax service to First American Real Estate Tax Service (from GFE#3) 77.00 807. Flood certification LPS National Flood Services (from GFE#3) 5.00 808. 809. 810. 811. 900. Items Required by Lender to Be Paid in Advance 901. Daily interest charges from 11/19/14 to 12/01/14 @$ 8.17 /day (from GFE#10) 98.04 902. Mortgage insurance premium for months to (from GFE#3) 903. Homeowner's insurance for 1 years to Millville Mutual Ins.Co. (from GFE#11) 436.00 904. 905. 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE#9) 765.99 1002. Homeowner's insurance 3 months @$ 36.33 per month $ 108.99 1003. Mortgage insurance months @$ per month $ 1004. Property taxes months @$ per month $ 1005. County Property Tax 11 months @$ 66.13 per month $ 727.43 1006. School Tax 6 months @$ 97.87 per month $ 587.22 1007. months @$ per month $ 1008. Aggregate Adjustment .$ 657.65 1100. Title Charges 1101. Title services and lender's title insurance (from GFE#4) 923.50 1102. Settlement or closing fee Gregory R.Reed $630.00 $ 1103. Owner's title insurance Penn Attorneys (from GFE#5) 26.25 1104. Lender's title insurance (Ends.100,300,9.1)Penn Ally $ 1105. Lender's title policy limit $ 61,500.00 1106. Owner's title policy limit $ 76,500.00 1107. Agent's portion of the total title insurance premium $ 0.00 1108. Underwriter's portion of the total title insurance premium $ 218.50 1109. Penn Attorneys Closing protection letter$75.00 '1110. 1111. 1200. Government Recording and Transfer Charges 1201. Government recording charges (from GFE#7) 184.00 0.00 1202. Deed$ 75.00 Mortgage$ 109.00 Releases$ 1203. Transfer taxes (from GFE#8) 765.00 765.00 1 1204. City/County tax/stamps Deed$ 765.00 Mortgage$ 1205. State tax/stamps Deed$ 765.00 Mortgage$ 1206. 1207. 1300. Additional Settlement Charges 1301. Required services that you can shop for (from GFE#9) 1302. Robin Gasparetti-Tax Certificate 10.00 1303. New Cumberland Borough-Trash/Sewage 115.24 1 1304. - 1305. 1306. 1307. 1308. 1309. rr. Total Settlement Charges(enter on lines 103,Section J and 502, 3,790.38 880.241 Paid outside of closing by borrower Paid outside of closing by seller Previous editions are obsolete Page 2.f 3 HUD-1 E OR PRIN TT)Certificate of Title must be submitted within 20 days,unless the purchaser is a registered dealer holding the vehicle for resale. > FEOERALWARN 1 NG TO COMP E E OR FROAND G D NG A FALSE STATEMENT-MAYESUiLEAGEIN CONNECTION WITH LTIN f4NES'OR IMPR SONMENT.E._TRANSFEROE.OWNERSHiP:,FAILURE CD 3 Raol rorrd d lora mwl camploti lemm MV27A or MV276 -' :LAST ' ' FIRST MIDDLE NAME'': ASSIGNMENT-(�F r1Tl '•en r n trod by Mw.a pu chaser is NOT,A realstered tleeler, .Secll n l acthe front of Ihls loan must ba comilotod. PURCHASER OR FULL M I ' f`^,may- Rr CD INYe certify,td,the best of my/our knowledge that the adorneter reading is BUSINESS NAME ! t i f m TENTH u5 tirl CO•PURCHASE,R 2 'X miles;and rehects the aetual mileage of the vehielo, f pi STREET,,01- ! _ unless ane bf.the Eoliowing,boxes Is checked "ii,, I ADDRESS pSC,.. oReflects fhb amount of mileage i a��t`*,WNOT the actual mileage CRY:..l�" 'In excess of-Its mechanical Ilmfls:' N WARNING:Odometer discrepancy ! ! INde further certify that iho vehicle is froe'of any ondumbrbnce and that the ownership Is hereby -- PURCHASE PRIC transferred to the person(s)or the dealer listed. 5TATE 21P OR DIN (, O+> CZ w SUBSCRIBED ANO'SWORN7 h c ,fu 1 z b111 N" +r'il �fA` Q.Gy��t L0.8EF ME • MO.� ` DAY YEA Fff+IIS tl. fl l',' -PURCHASER SIG AY�RE — lyr 1 III ln" h?N m p I 'r'rtKr.,. fit l4.hb'15T '. CO-PURCHASER SIGNATURE" CD Q •:J - PURCHASER AND/ Q CO PURCHASER MU Y` ,G. �Y• 6 rn W COMMONWEALTH OF PENNSYLVANIA H DP H t � C/3 Notariat Seal i hP h1 ,i rVcl')� w+i p Dustin L.Shannon, Notary-Public. sisNAT Carroll-Twp:. Perry C4Unt'y My Commission Expires Jan:28;20E5 a .y,at Q h NEMBER,'PENNSYLVANIA ASSOCIATION OF NOTARIES ' SELLER AND/OR SIGNATURE of co HANDPR NT NAME HERE+' f ! • 1must be completed. EF I/We certlfy,to the best cf my/our knowledge that the odometer reading is .`', : :• '' LAST FIRST" MIDDLE NAME CD ._x rmles,and ref(sms lhalectual mileaga of the vehlCie PURCHASER OR FULL 77 f•— BUSINESS NAME unless one dol the follnwing boxes is checked r -. - ,+ r r M' CO-PURCHASER 'r ' ) i < 'Reflects lhe'amount of mileage s WNOT the actual mileage -0 in excess of Its mechanical llnots r t. t'WARNING:Odometer miles, - ,STREET IAV&further certify that the vehlcla is free of any edoumb74hite and that the ownership is hereby ADDRESS• - - @ E - Qi transferred to the pomon(s):or the dealer;listed . :CITY - - SUBSCRIBED AND SWORN ,I E TO BEFORE:ME ""'" 'Ir x 't/yTArE' b xq any PuaGHasE PRICE MO. . DAY,:yht:~ _.:YEAR a�9'`'.'. -. ;.+`,ta:a`i'`;:, ZIP OR OiN W O r,I I III 1 s tl�.�llli ill,..� ��I IhVy fy I int':it h,i I, y.'• SIGNATURE OF PERSON AO INISTERIN60ATH ll'G I,h., ar l.�r. (?ir. I.,•+r ilr I_.':,�� EL PURCHASER SIGNATURE O tr'n kr~i,,�' ih vlf°�"- - .. C LL1 CO-PURCHASER SIGNATURE n :PURCHASER ANDIORCD . - CO-PURCHASER MUST ANDPRI- NAME HE - � h 1i11r''.' II I'1a,4 ill; )Illirl r.�4u�; c :i it I t I t t J ' 411 h1", 1 ki r+ry„ Ar SiENATUAE OF"SELLE I— SELLER MUST9ti Ir! r r� "rt`S' CA - •HANDPRINT NAME HERE ` in _ r r • O Ylwe certify,to the best pf mytour knowledge Thai the odomoier teacHng is. LAST FIRST MIDDLE NAME, w TENTHS - ; r rD }{mllos�and reflects;thle actual mileage of the vehicle, 'PURCHASER OR FULL r y ` BUSINESS NAME r fr1 unless one,of•the following boxes is Checked t'(§ �' r+i .: c. -. .1 r<p g. 'Reflects the iimovntoi mlleago.;" "i 4s NOT the aefuai milee CO•PUROHASER ge O'in-excess oTUs'mechanical limits''• �;�, WARNING;OdometerdiscrepancySTREET to IM/e,furlher certify that the vehicle Is free of any oneJmbrore0 and that the ownershlp is hereby ADDRESS `r h transferred to the person(s)or the dealer listed 1 '.;.+ �•• CD CITY SUBSCRIBED AND SWORN y vh TO BEFORE ME - J y' h Ill '^STATE h�' ZIP CD PURCHASE PRICE p MO DAY' YEAR v I I 4R DIN 4."KCo ' 3Af �ri:.I".y SIGNATURE OF PER$ONJADMINISTERING OA JH II ,'"^} 1 q+' iq .y:`.,�..� PURCHASER SIGNATURE Q I in (J} Ep `CO.PUR ER SIGN RE- - W .'.CORPURGHASERMUST'.: ;J;cdy 11>y,' Ig1f1p11 t"Ill,. ,R I r _ z, - ANDP ME E a. y♦ a kll , Vr 11 I o iSpb ,�q�pAJt. 'y5 Q °S16N TIRE OF SELLER A^h„lilt 141,kh,',. P1hi}.. m ~ I SELLER MUSTi✓fiy4;(ir' tC1 HANDPRINT NAME HERE ♦ ! • i . G e colD INde certify,to the best of my/our knowledge that the odometer'reeding Is .! y, •'- -.: LAST FIRST. MIDDLE NAME:. .. .. r a ' TENTHS .. _.. _h X m{t is and redacts.the actual rn teage of the vahtcte PURCHASER OR FULL! -n^'r: - < 6`'t ri�,1 j BUSINESS NAME ' C unless one ot•the tellowmg boxes Is cheoked I � i d - - CO-PURCHASER ri Reflects the amount of mtloage.; J Is NOT the actual milespe in excess of its mechanical f lmi(s? , !P,WARNING:Odometer discrepancy STREETp vWa further codify that the vehicle Is treat of any oncumbQ,Ce and that the-ownershlp is hereby ADDRESS. transferred to the persons)octhe dealer listed. . „ P CITY w SUBSCRIBED AND,SWORN TO BEFORE ME; O,STATE ub G)”' ZIP PURCHASE PRICE 0 MO-•'- OAY.,w'.. +.YEARp.+._t .k:iC .Ni'., ?tuM1iti`!.,tA, _ onow SIGNATURE OF PERSON'AOMINI57EBIN G OATN�I I I tN I hh{y I IP;hl l a +I PURCHASER SIGNATURE- J W '- „. '+/f"I t"�,i ",�"'�'r�krr fie i�1hlly s �1 :5..'•� '-•" - '-.. . . A W - ',PURCHASER AND/OR" • C0.PUR ASESIGNATURE Ilny 1 D a ., CO-PURCHASER MUST" I'lk t" 7y L�fll!• yr"di; u d _ - ANOPAINT NAME HERE.v O- > Q - SIGNATU`E OF S�LLER l',}� }1 u -•,� r t— - - SELLER MUST u) - ..:HANDPRINT NAME HERE r, CHECfC HERE.IF APPLICATION;FOR DEM51 1176E AND,, COM ,L, TE„SECTIONrp ♦ a FOR INQUIRIES CALL: (800)724-2440 ACCOUNT TYPE MYCHOICE PREMIUM CHECKING 00 0 06113M NM 017 ACCOUNT NUMBER STATEMENT PERIOD 000004021 FIDS1549DO1705271405 02 000000 P 761 27,2014 1T391 APR.26 MAY. HENRY J SCHOLZ BEGINNING BALANCE $1,167.78 r� DEPOSITS&CREDITS 13,978.65 �. 0 JAMES P SCHOLZ 22712TH ST LESS CHECKS&DEBITS 14,224.74 NEW CUMBERLAND PA 17070-1608 INTEREST 0.03 4-SS5§tR.V.J4E CHAFtGES� 0.00. MP $921.72 $921.72 INTEREST EARNED FOR STATEMENT PERIOD $0.02 HIGHLAND PARK INTEREST PAID YEAR TO DATE $0.10 ACCOUNT SUMMARY BEGINNING DEPOSITS&OTHERCHECKS PAID OTHER DEBITS(-) CURRENT ENDING BALANCE CREDITS + INTEREST PD BALANCE NO. AMOUNT NO. AMOUNTNO. AMOUNT $1,167.78 6 $13,978.65 10 $13,911.22 5 $313.52 $0.03 $921.72 AGOGJUNT:ACTTY.ITY POSTING. - DEP.OSITSt& TFIER WITHDRAWALS& DAILY DATE TRANSACTION DESCRiPliON ;CREDITS((+ OTHER DEBITS:-)) BALANCE 04/26/2014 BEGINNING BALANCE � $1,167.78 04/28/2014 M&T ATM CASH WITHDRAWAL ON 04/27 4i$130.00 344 SOUTH TENTH STREET,LEMOYNE, PA 17043 t1,037.78 04/30/2014 CHASE 000920601 PENSION '1+'$442:80 1,480.58 05/02/2014 SSA TREAS 310 XXSOC SEC 521.00 3,001.58 05/05/2014 CHECK NUMBER 5852 W43.50 2,208.08 05/06/2014 CHECK NUMBER 5856 1"250.00 05/06/2014 CHECK NUMBER 5854 �1 198.40 759.68 05/12/2014 VERIZON FINANCIA PAYMENTS 000000000005855 68.67 591.01 05/14/2014 WEB XFER FROM SAV 15004225218921 /12,000.00 12,591.01 05/19/2014 CHECK NUMBER 5857 v/31,97 05/19/2014 CHECK NUMBER 5858 .06 05/19/2014 CHECK NUMBER 58594.20 05119/2014 CHECK NUMBER 5861 10.00 05/1912014 CHECK NUMBER 5862 17115.24 4.09 1,626.69 05/20/2014 CHECK NUMBER 5860 V/4. 1,511.45 // 05/27/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE REFUND 14.95 05/27/2014 WAIVE ADD-ON FEE:CHKS/SAFE DEPOSIT BOX t/4.95 05/27/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE WAIVER e�44.95 05/27/2014 INTEREST PAYMENT a�0.03 05/27/2014 CHECK NUMBER 5864 V589.76 05/27/2014 M&T ADD-ON FEE:NON M&T ATM FEE WAIVER /4.95 05/27/2014 1 M&T ADD-ON FEE:NON M&T ATM FEE REFUND 1 1 14.95 PAGE 1 OF 2 LOOS(6/12) FOR INQUIRIES CALL: (800)724-2440 ACCOUNTTYPE HENRYMYCHOICE PREMIUM CHECKING ACCOUNTNUMBER STATEMENT PERIOD .76117391 APR.26-MAY.27,2014 J SCHOLZ JAMES P8CHOLZ ACCOUNT ACTIVITY POSTING TRANSACTION DESCRIPTION DEPOSITS&OTHER WITHDRAWALS& DAILY DATE CREDITS OTHER DEBITS(-) BALANCE 05/27/2014 M&TADD-ON FEE:CHKS/SAFE DEPOSIT BOX /4.95 921.72 ENDING BALANCE $921.72 CHECKS PAID SUMMARY CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT 5852 05/05/14 793.50 5854* 05/06/14 1,198.40 5856* 05106/14 250.00 5857 05/19114 38.97 5858 05/19/14 17.06 5859 05119114 44.20 5860 05/20/14 115.24 5861 05/19/14 210.00 5862 05/19/14 10,654.09 5864* 05/27/14 589.76 ANNUAL PERCENTAGE YIELD EARNED=000m YOU HAVE THE FREEDOM TOUSE YOUR M&TosB|TCARDTws\mxJ-YOU WANT*rTHE � REGISTER-CHOOSING EITHER^nnE0r0R"ose|7�AND YOU WILL NOT 8sCHARGED ANY ° ��TTR�NSxCr0mp��S^0NY0unPonCH�SES/NTH� EVEN VYHENYOU GET CASH � U.S.,, = BxC0^M&rDOES NOT CHARGE FEES FOR USING YOUR M&TDEBIT CARD FOR PURCHASES|N THE u.S.;HOWEVER,FEES WILL APPLY|pYOU USE YOUR CARD OUTSIDE THE u.S.. INCLUDING ONLINE PURCHASES WITH xMERCHANT LOCATED OUTSIDE OpTHE u.S.(N ADDITION,OTHER FEES,INCLUDING INSUFFICIENT FUNDS AND OVERDRAFT FEES,MAY APPLY TDYOUR DEPOSIT ACCOUNT ACCORDING rDTHE TERMS opYOUR ACCOUNT.MEMBER FDIC. � , . . PAGE OF L008(6/1w FOR INQUIRIES CALL: (800)724-2440 ACCOUNT TYPE j MY_CHOICE MONEY MARKET 00 0 06113M NM 017 - — ACCOUNT NUMBER STATEMENT PERIOD P 15044225218921 APR.26-MAY.26,2014 000000573 I=1DST549D01705231405 07 000000 - "BEGINNING BALANCE $53,486.92 M-l` HENRY J SCHOLZ DEPOSITS&CREDITS 0.00 JAMES P SCHOLZ 227 12TH ST LESS CHECKS&DEBITS 12,000.00 INTEREST. 7.55 NEW CUMBERLAND PA 17070-1608 ....: xLESS:SERVIC CHARGES: 0.00 t5tt3t `$ LINLCE °* $41,494.47 INTEREST EARNED FOR STATEMENT PERIOD $8.23 HIGHLAND PARK INTEREST PAID YEAR TO DATE $44.38 ACCOUNT SUMMARY BEGINNING DEPOSITS&OTHER WITHDRAWALS& CURRENT ENDING BALANCE CREDITS + OTHER DEBITS INTEREST PAID BALANCE NO. AMOUNT NO. AMOUNT $53,486.92 0 $0.00 1. $12,000.00 $7.55 $41,494.47 a N ACCOUNT ACTIVITY N g POSTING DEPOSITS&OTHER WITHDRAWALS& DAILY DATE TRANSACTION DESCRIPTION CREDITS + OTHER DEBITS - BALANCE 4 _ 04726/2014 BEGINNING BALANCE - - $53,486.92 -- g 05/14/2014 WEB Y.FER TO CHK 00000076117391 12,000.00 41,486.92 A N 05/23/2014 INTEREST PAYMENT 7.55 41,494.47 4 LL ENDING BALANCE $41,494.47 fl m ANNUAL PERCENTAGE YIELD EARNED=0.20% o S 0 0 h e a 0 a ~`PAGE 1 OF 1 L008 Wl2) M&T. A" One M&T Plaza,Buffalo,New York 14240 Highland Park July 3, 2014 000000549 FTDA10N MO90704140203 01 000000 'Y 549 Fv.. HENRY J SCHOLZ 40 ARGALI LN MECHANICSBURG PA 17055 Re: -RetirementAccount-Closing-Notice Account_# 35004201741459 Dear Henry J Scholz, , We are writing to confirm that on 07/02/14, your Retirement account was closed or transferred. At that time, the balance was$12,332.16:' If you are receiving scheduled distributions, the above account has been. closed and internally transferred to another. Individual Retirement Accouii.t in your plan to accommodate your next, distribution. We'd like to remind you that AMT Bank is committed to providing you with solutions to all your financial needs. To find out more about the many wars we can help you with those'needs, simply stop by any M&T Bank office or call the M&T Telephone banking Center at 716-626-1900 or 1-800429-1924.. Or if you'd like, visit the M&T website at www.mandtbank.com. Thank you for banking with M&T Bank. 0 i M&T, ALI. One M&T Plaza,Buffalo,New York 14240 Highland Park July 3, 2014 000000548 FTDA10NMO90704140203 01 000000 548 HENRY J SCHOLZ 40 ARGALI LN MECHANICSBURG PA 17055 Re: 'Retirement Account Closing Notice Account.# 350042.01741441 Dear Henry J Scholz, We are writing to confirm that on 07,02/14; your Retirement account was closed or transferred. At that time, the balance was $7,713.03. If you are receiving scheduled distributions, the above account has been closed and internally transferred to another Individual Retirement Account in your plan to accommodate your next distribution. We'd like to remind you that M&.T Bank is comin.itted to providing ,,ou with solutions to all your financial needs. To find out more about the many ways we Ivan help you with those needs, simply stop by any M&T Bank office or call the M&T Telephone Flanking Center at 716-626-1900 or 1-800-8.29-1924. Or if you'd like, visit the M&T website at www.mandtbank.com. Thank you for banking with M&T Bank. Retirement Plan Statemenj 111 �_. �0"g� s;_��._.. 01-01-14to12-31-14 1 INDIVIDUAL RETIREMENT ACCOUNT M&T TELEPHONE BANKING CTR M&T BANK AS TRUSTEE FOR PO BOX 767 BUFFALO, NY 14240 000010079 JOB11580 800-829-1924 ` - 6113 26,604 �• ESTATE OF HENRY J SCHOLZ C/O JAMES P SCHOLZ, EXEC. 40 ARGALI LANE MECHANICSBURG PA 17055 SIICEt�MlEi 16-0538020iRT#�t? TE�� " --- a a —_, w nx .. 1 :... 4 :. ACCOUNT NO 35-006439185001 ACCOUNT TYPE M&T MKT ADV 01-01-14 BEGINNING BALANCE .00 07-02-14 TRANSFER IN TO BENEFICIARY 20 ,045.29 20 ,045.29 07-02-14 DEATH WITHDRAWAL 20 ,045 .29- .00 07-02-14 TAX WITHHELD-DEATH WITHDRAWAL .00 .00 07-02-14 STATE TX W/H-DEATH WITHDRAWAL . 00 .00 PLAN SUMMARY BEGIN PLAN BAL . 00 DISBURSEMENTS 20 , 045 .29 PLUS DEPOSITS 20 , 045.29 FED TAX WITHHELD . 00 NET INTEREST . 00 ST TAX WITHHELD . 00 LESS DEDUCTIONS 20 ,045 .29 TOTAL PLAN VALUE .00 2014 IRA CONTRIBUTION INFORMATION THE FOLLOWING IS YOUR FORM 5498 TOTALS. BECAUSE THE AMOUNTS ARE ZERO, NO REPORTING TO THE I .R .S HAS OCCURRED BOX 1 - IRA CONTRIBUTIONS IN 2014 OR 2015 FOR 2014 0 .00 BOX 2 - 2014 ROLLOVER CONTRIBUTIONS 0 .00 BOX 5 - FAIR MARKET VALUE OF PLAN AT END OF 2014 0 .00 1007(wia) A Family Tradition of Cavin 1 RTHEMORE Fune & Cremation Services, Inc. Mr.James P.Scho � 5/13/2014 40 Argali Lane Mechanicsburg,PA 1, 0k 13D3 Bridge-Street For The Services of Henry John Scholz P.O.Box-431. New Cumberland,PA 17070 . We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. The following PH:(717)774-7721 is an itemized statement of the services;facilities,automotive equipment and merchandise that you selected FX:(717)774-5546 when making the funeral arrangements. www.parthemore.com Terms Due Date . Account# Net 30 6/12/2014 6866.0 Description Amount 0.00 . Traditional Funeral Service 6,695.00 Gilbert W.Parthemore 4014 Solid Poplar Casket 1,999.00 Founder Sacred Heart Stationery Set 165.00 Gilbert J.Parthemore Total Services and Merchandise 8,859.00 Supervisor 0.00 Death Notice,Harrisburg Patriot 279.27 Stephen K.Parthemore 6 Certified Copies of Death Certificate 36.00 President,CFSP Clergy Honorarium 200.00 Organist Honorarium 130.00 Bruce R.Parthemore 3 Altar Servers at$10 each 30.00. Pre-Need Coordinator,CPC Flowers,Casket Spray 212.00 Grave Opening 1,085.00 Total Cash Advances 1,972.27 Immediate Pay Discount-Thank you! -177.18 Professional Memberships: ® Pennsylvania Funeral Directors Association a\i F? VI 13 I: R Order of..the G61den Rule e Total $10,654.09 Payments/Credits -$10,654.09 HH Balance Due $0.00 SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM A2 - FUNERAL LUNCH DONATION lir JA E IS P.:Fir-- 0 L 7 5�4 r� 7 -1 1 ni i i a�P;ir —71) r; Axa ev I is—'p 3 9 IfE. :=rr- 7" 5";,Y im 0 '�- '—% �r were -MAC; o A r , 0 Ir T "fJ Ll B,g RECEIPT FOR PAYMENT ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 5/29/2014 Cumberland County - Register Of Wills Receipt Time: 08 :30 :01 One Courthouse Square Receipt No. : 1078147 Carlisle, PA 17d1--3 SCHOLZ HENRY J Estate File No. : 2014-00524 Paid By Remarks : JAMES P SCHOLZ HMW ------------------------ Receipt Distribution ------------------------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15. 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE , 23 . 50 BUREAU OF RECEIPTS & CNTR ,M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Cash343 . 50 , Total Received. . . . . . . . . B43 . 50 SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM 14- WSSD REAL ESTATE TAXES a-,rem:;:.:.u,,,`�"�si$.`.�a.'3'_-.v..�...:. �.S?..:.:_ �..a.,�'• .,.-�;,:a®:^w:sa:,s� ,...,:a"�:,:c+ae�:(ar.��..�-�..{ •C7' G i F-36q'HOU �("{'tie�Ft�•s"'1 � ���@i^ �.. �„�M„7fls�.. a� �� F� p+� ST7 �ams tei ` � B. rata $ 391.49 $ 391.49 a�P'=...-,.:x�rxrs�rr�cs-�r�cr�.»a::�{.�xa^:�'s.'a••�.�..�..,:'r-..�': :z,_:_,=.—�s3r =Qr:ti:� ^• $ 391.49 $1,174.47 !fir?! 5 � t3_eR3�tii 1pj2JLLf, wadaadAii I p� � C131 li 30p 2I S 54; a t 6 2 Sl2 6r1t;'t,1310-5 ;,,air-���.��-�•-�•:a-, -�� -��.���-�-••, .::--}t.:�x;-���d�;��-�-:_:_.,�-.. L� INSTALLMENT PAYMENT 1 NEW CUMBERLAND PAYABLE ROBIN GASPERETTI,T/C (717)774.7424 ononcru TO: 1113 BRIDGE STREET PROPERTY ID NEW CUMBERLAND,PA 17070-1634 26230541243 TAX SCHOOL-INSTALLMENT PAYMENT 1 • • • RATE 9.68 ON OR BEFORE FACE DATE FACE 391.49 BY 08/31/2014 391.49 TAXING WEST SHORE SCHOOL DISTRICT NET AUTHORITY FOR: 227 12TH STREET 121,330 TO: SCHOLZ,HENRY J&MARY 22712TH STREET NEW CUMBERLAND PA 17070 6 f IF DUE DATE IS MISSED,INSTALLMENT PLAN IS NOT AN OPTION. BILL DATE- 07/01/2014 DUE DATE-08/31/2014 BILL#010223 DELINQUENT BILLS ARE TURNED OVER TO TAX CLAIM ON 12/3112014 TAXPAYER'S COPY --IAK--Y�AR:2U14=1'5-REAL ESTATE TAX NOTICE - .. . INSTALLMENT PAYMENT 2 NEW CUMBERLAND PAYABLE ROBIN GASPERETTI,T/C (717)774-7424 ononcru TO: 1113 BRIDGE STREET PROPERTY ID NEW CUMBERLAND,PA 17070-1634 26230541243 TAX SCHOOL-INSTALLMENT PAYMENT 2 Iffl• R" • RATE 9.68 ON OR BEFORE FACE DATE AFTE FACE 391.49 BY 09/30/2014 391.40 PENALTY 430.64 AFTER 09/30/2014 430.64 TAXING WEST SHORE SCHOOL DISTRICT NET AUTHORITY FOR: 227 12TH STREET 1/ 121,330 TO: SCHOLZ,HENRY J&MARY 227 12TH STREET NEW CUMBERLAND PA 17070 z4o 114 IF DUE DATE IS MISSED,INSTALLMENT MUST BE PAID.AT PENALTY. BILL DATE- 07/01/2014 DUE DATE-09/30/2014 BILL#010223 DELINQUENT BILLS ARE TURNED OVER TO TAX CLAIM ON 12131/2014 TAXPAYER'S COPY TAX YEAR:2014-15 REAL ESTATE TAX NOTICE" INSTALLMENT PAYMENT 3 NEW CUMBERLAND PAYABLE ROBIN GASPERETTI,T/C (717)774-7424 .,^PROPERTY ID TO: 1113 BRIDGE STREET NEW CUMBERLAND,PA 17070-1634 26230541243 TAX SCHOOL-INSTALLMENT PAYMENT 3 • • • URN,. RATE 9.68 ON OR BEFORE FACE DATE AFTER PEN E FACE 391.49 BY 10/31/201 399.49 PENALTY 430.64 AFTER 10/31/2014 430.64 TAXING WEST SHORE SCHOOL DISTRICT NET AUTHORITY FOR: 227 12TH STREET121,330 TO: SCHOLZ,HENRY J&MARY �/- �111�Z(� 227 12TH STREET NEW CUMBERLAND PA 17070 CI/ D o5 IF DUE DATE IS MISSED,INSTALLMENT MUST BE PAID AT PENALTY. 00 BILL DATE-07/01/2014 DUE DATE-10/31/2014 BILL#010 23 DELINQUENT BILLS ARE TURNED OVER TO TAX CLAIM ON 12131/2014 TAXPAYER'S COPY SCHEDULE H - ADMINISTRATION COST LINE ITEM 15 — UGI GAS UTILITY r7; 05as s� WEHR11 D.ScHolz c Baa J44?51E F* €A1C AuL 1 I AWE'S P.Elmoiz is i 76I173A114 5a 56 x:03.1302'9554: 716 17 V" a e:a -q4wa� fIH 3:5 i9t2 mr4 F= ji `�-�{Y C 'f. ' �'! .-..... 9a' !. WTBsn41 I.H .� i.�reCYfYI'S- ! P�(dJI{y}� + --1:1 '�JJiCI. 03'i,3d7a �'�3 i 61 !! er ,--a» -_ - $ 17.06 if MdiE'8.? N6L q d.0 VE)mA'"OWLZ w-m !o rrr€5 +► *' urrEs t�.�cwo � # .. . $ 13.24 f{� $ 11.47 4 —� � *' 1 :� _ NI&TBank n �.�. i + �— .---— $ 11,47 _ t 10.50 f s k its t." mums i+ $ $ 11.49 44,f $ 11.47 doI&so, 95K: ��a�� �z�xe�r�Y i:og130iR55r 96Itp Ewliag:� -- --.. .._ $ 10.50 xEt M,� t l ca�sa 7o- NEHl3ea sG�1 cap U04 f 2 J111Yp .t3:4H$i } - .t48E5P::CHLa3:8 .",/_..rl_f G -- c "'�&d ,c Bill Information-UGI balance your bill was................ $17.06 r4C $Q The aeiIuCJ1 �Iµ; Thank you For your payment of.................................... -17.06 213153199004 Billip+q Summary for Service to; Your balance as of 06/02/2014 .00 HENRYJ SCHOLZ 22712TH ST NEW CUMBERLND PA 97070 Rate Classification: Residential General Current Bill Information-UGI Utility Billing Period: Customer Charge.............................................................. 8.55 04/28/2014 to 05128/2014(30 days) Commodity Charge(5 CCF at$0.62000)................. 3.10 Remote DeviceRead Distribution Charges(First 5 CCF at$0.33200)...... 1.66 uestions? PA State Tax Surcharge................................................. -0.07 Total Current all 800-276-2722 write to UGI at UGI Utility chargeseowed thislbilll ..................... 13.24 $13.24 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(06/2312014)..................................... $13.24 `Your current UGI charges include ! V7�D State taxes totaling about$0.43. dry } (,�I� Meter Information-Text Read Date dune 27,2014 Meter Reading Information Deter Number Previous Reading Present Reading CCF Used 1205722 2482(remote) 2487(remote) 5 Messages from UGI 'Your current price to compare is$0.66159/CCF. Your total annual usage is 94 CCF. Your average monthly usage is 7 CCF. 'Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. 'Save time.Save the planet Sign up to view and pay your UGI bills online at www.ugi.com. 'Your bill does not display a usage graph because your average daily usage is too low. If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. • ... r i rt� .�"i c i TrJ. i. Past Bill Information-UGI Utility Cl stomerNgin, ea s sEs vat The account balance on your last bill was ...r.......... $18.02 Thank you for your payment of................................... -18.02 213153199004 Billing Summary for Service to: Your balance as of 05/01/2014 ....... 0.00 HENRY J SCHOLZ 22712TH ST NEW CUMBERLND PA 17070 Rate Classification: Residential General Current Bill Information-UGI Utility Billing Period: Customer Charge............................................................ 8.55 03/27/2014 to 04/28/2014(32 days) Commodity Charge(9 CCF at$0.62111) ............... 5.59 Remote Device Read Distribution Charges(First 9 CCF at$0.33444) .... 3.01 Questions? PA State Tax Surcharge................................................. -0.09 -276-2722 or write to UG(at Total Current Charges-UGI Utility............................. 17.06 Call 800 PQ BOX -276- UGI Utility charges ovred this bill ..................... ........................................................... -$17.06 3009 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(05/2212014)..................................... $17.06 *Your current UGI charges include State taxes totaling about$0.55. C%/ S 5� Meter Information-Next Read Date May 29,2014 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used .1205722 2473(remote) 2482(remote) 9 Messages from UGI ■Your current price to compare is$0.62045/CCF. ■Your total annual usage is 96 CCF. Your average monthly usage is 8 CCF. ■Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. ■Save time.Save the planet Sign up to view and pay your UGI bills online at www.ugi.com. ■Your bill does not display a usage graph because your average daily usage is too low. ` If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. s� t Past Bill Information-UGI U61i� �U�tQ17j2C�yrl7b�r����,j �= The account balance on oar las t ill was................ $13 24 AAs sExv,e y Thank you for your payment of,...........__..................... -13.24 213153199004 Billingg Summary for Service to: Your balance as of 0710112014 00 HEN SCHOLZ »....... 22712TH ST NEW CUMBERLND PA 17070 Rate Classification: Residential General Current Bill Information-UGI Utility Billing Period: Customer Charge.............................................................. 8.55 to 06!2612014(29 days} Commodity Charge(3 CCF at$0.66000) .... .... ... 1.98 05/2812014 Remote Distribution Charges(First 3 CCF at$0.33333)...-. 1.00 Remote to 0 Read PA State Tax Surcharge.................................................. -0.06 Questions? Call 800-276-2722 or write to UGI at UGI Utility chargegseowed this bill .................................. ............1 .47 PO BOX 13009 ........_.......:..........,... 11.47 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(07/2212014).................................... $11.47 Y" `Your current UGI charges include State taxes totaling about$0.37. Paid Meter Information-Neit Read Date July 29,2014 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1205722 2487(remote) 2490(remote) 3 Messages from UGl =Your current price to compare is$0.661591CCF. ■Your total annual usage is 92 CCF. Your average monthly usage is 7 CCF. ■Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. a Give back to the heroes in our community during our Summer of Heroes Sweepstakes,going on until July 31.Like our Faceboak page to u donate$1 to Keystone Wounded Warriors.www.facebook.com/ugiutilities uc ° a Save 50%or more on your heating bills when you switch to natural gas.Visit www.ugi.com/calculator for a personalized savings estimate. a Are you or anyone you know planning to build a new home?Visit www.findnbuild.com for valuable tips and a free mobile app. a Save time.Save the planet.Sign up to view and pay your UGI bills-online at www.ugi.com. a Your bill does not display a usage graph because your average daily usage is too low. _ If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information Is on the back of this bill. t IN 'r J lyti 4 n t aAki;ti�� Past Bill Information-UGI Utility Gustotner limper ie ca s see v.ce The account balance on your last bill was................ $11.47 v,... .,u.s•.,,•.: .n....:L ..i.N.r.. e..:.,. Thank you for your payment of..................................... -11.47 213153199004 Billing Summary for Service to: Your balance as of 07/31/2014................................... 0.00 HENRYJSCHOLZ 22712TH ST NEW CUMBERLND PA 17070 Rate Classification: Residential General Current Bill Information-UGI Utility Billing Period: Customer Charge.............................................................. 8.55 06/2612014 to 07/28/2014(32 days) Commodity Charge.(3 CCF at$0.65667)................. 1.97 Remote Device Read Distribution Charges(First 3 CCF at$0.33667)...... 1.01 Questions? PA State Tax Surcharge....................................... -......... -0.06 Cue(800-276-2722 or write to UGI at Total Current Charges-UGI Utility............................... 11.47 PO BOX 13009 UGI Utility charges owed this bill ............ .................................................................... V47 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(08/21/2014)..................................... "Your current UGI charges include State taxes totaling about$0.37. Cv-: 5883 Meter Information-Next Read Date August 27,2014 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1205722 2490(remote) 2493(remote) 3 Messages from UGI ■Your current price to compare is$0.66159/CCF. ■Your total annual usage is 90 CCF. Your average monthly usage is 7 CCF. •Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. N ■Save 50%or more on your heating bills when you switch to natural gas.Visit www.ugi.com/calculator for a personalized savings estimate. 0 ■Are you or anyone you know planning to build a new home?Visit www.findnbuild.com for valuable tips and a free mobile app. ■Save time.Save the planet.Sign up to view and pay your UGI bills online at www.ugi.com. •Your bill does not display a usage graph because your average daily usage is too low. If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. r Past Bill Information-UGI Utility �GUSt0111@�!�lUfil�Bjr'- ';� GA5 3EHVlCE The account balance on your last bill was................ $11.47..°.:"':`'"." ,•r"'u...s,-•i.r,.^�' .-f-:.` Thank you for your payment of..................................... -11.47 213153199004 Billing Summary for Service to:. Your balance as of 08/29/2014................................... 0.00 HENR`FJ SCHOLZ 22712TH ST NEW CUMBERLND PA 17070 (date Classification: Residential General Current Bill Information-UGI Utility Billing Period: Customer Charge.............................................................. 8.55 07/28/2014 to 08/26/2014(29 days) Commodity Charge(2 CCF at$0.66500)................. 1.33 Remote Device Read Distribution Charges(First 2 CCF at$0.33500)...... 0.67 Questions? PA State Tax Surcharge.................................................. -0.05 ll 800-276-2722 or write to UGI at Total Current Charges-UGI Utility............................... 10.50 Ca Ca BOX -276- UGI Utility charges owed this bill ..................................................-.............................. 3009 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(09/19/2014)..................................... $10.5 Your current UGI charges include State taxes totaling about$0.34. , s gam Meter Information-Next Read Date September 26,2014 4, Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1205722 2493(remote) 2495(remote) 2 Messages from UGI Your current'price to compare is$0.66159/CCF. Your total annual usage is 87 CCF. Your average monthly usage is 7 CCF: Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. N Are you or anyone you know planning to build a new home?Visit www.findnbuild.com for valuable tips and a free mobile app. 0 Did you know?Homeowners save$1,500 a year an average when they switch to natural gas heat.Visit www.ugi.com/calculator for a p6 sonalized estimate. "Save time.Save the planet.Sign up to view and pay your UGI bills online at www.ugi.com. ■Your bill does not display a usage graph because your average daily usage is too low. b If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. ,5 31 4'iSS�'i iYiTy, a�, rR A 1Tj Past Bill Information-UGI Utili GIS' tOiW { it 1�IU�1�r �,�na OAS set�vlcp The account balance on your last.bill was................ $ 10.50 ro:.:-,. ..°,. „�.�,,,..zF Billingg Summary for Service to: Thank you for your payment of..................................... -10.50 213153199004 Bilk J SCH maw Your balance as of 09/30/2014.....:.............................�0.00 HENLZ 22712TH ST NEW CUMBERAD PA 17070 Rate Classification: Residential General Current Bill Information-UDI Utility Billing Period: Customer Charge.............................................................. 8.55 08/26/2014 to 09/25/2014(30 days) Commodity Charge(3 CCF at$0.65000)................. 1.98 Remote Device Read Distribution Charges(First 3 CCF at$0.34000)...... 1.02 Questions? PA State Tax Surcharge.................................................. -0.06 Total Current Call 800-276-2722 or write to UGI at UG Utility chargesowed thesbill Utility .......................... 11.49 Pi)BOX 13009 ..................................................... $11.49 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(10/21/2014)..................................... $11.4 `Your current UGI charges include State taxes totaling about$0.37. 10 /6 Meter Information=Next Read Date October 27,2014 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1205722 2495(remote) 2498(remote) 3 Messages from UGI %Your current price to compare is$0.66159/CCF. +Your total annual usage is 87 CCF. Your average monthly usage is 7 CCF. 'Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. 'Are you or anyone you know planning to build a new home?Visit www.findnbuild.com for valuable tips and a free mobile app. q +Did you know?homeowners save$1,500 a year on average when they switch to natural gas heat.Visit www ugi.com/calculator for a $ personalized estimate. +Save time.Save the planet.Sign up to view and pay your UGI bills online at www.ugi.com. +Your bill does not display a usage graph because your average daily usage is too low. 10 N If you pay at a payment agent please take your entire bill. Make check payable to UGI. Deep this part for your records. Important information is on the back of this bill. ANEV Past Gill Information'UGI Utilelt�aiJl#I$C Etli��l ely r,: sa s $FnYre The account balance on your last bill was . ............. $11.47 ###in Saamma ry for Service to: Thank you for your payment.of..............................."....... -11.47 213153199004 HENR�d SCm Your balance as of 11126/2014........................... .. .. 0.0 22712TH ST NEW CUMBERLND PAS 17070 Rate Classification: Residential General Current Bill Information-UGI Utility Billing Period: Customer Charge...._..........................................:.......:....... 8.55 10124/2014 to 11/19/2014(26 days} Commodity Charge(2 CCF at$0.66500) ................._ 1.33 Final Read Distribution Charges(First 2 CCF at.$0..33500}........ 0.57 Questions?R2 PA State Tax Surcharge..............................._................_.. -0.05 Udtiiagthis Iltilitx .........................................." 0.5 Call 800-276-2722 or write.to UGI at PO BOX 13009G1 Utility charges owed bil# . ............._........,....... Reading,PA 19612-3009 Total Amount Doe,Please Pay by Glare pate(1211712014)................................_..... `Your current.UGI charges include State taxes totaling about$0.34. Meter Reading Information Meter Number Previous Reading =2503(final) CCF Used 1205722 2501(remote) 2 Messages from UGI Your current price to compare is$0.65159 ICCF. t Your total annual usage is 82 CCF. Your average monthly usage is 6 CCF. "`thank you for your business. You have maintained an excellent payment history with UGI. This bill may be used as a credit reference for obtaining future utility service. h i Help prevent pipeline damage,accidents and service disruptions.Cali 811 before you dig. M m Your bill does not display a usage graph because your average daily usage is too low. o If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the Geatck of this bill. N Past Dill Information-UGI Utilityu CIIS a€aler 'bit cn s ssn v,cF The account balance on your last bill was................ $11.49 Thank you for your payment of.................._................. -11.49 213153199004 Billingg Summary for Service to: Your balance as of 10/29/2014...................................�-0�0 t HENF J SCHOLZ 22712TH ST NEW CUMBERLNO PA 17070 Rate Classification: Residential General Current Dill Information"-UGI Utility Dialing Period: Customer Charge.................................._................... 8.55 09/25/2014 to 10/24/2014(29 days) Commodity Charge(3 CCF at$0.65667)................. 1.97 Remote Device Read Distribution Charges(First 3 CCF at$0.33667)....... 1.01 Questions? PA State Tax Surcharge.................................................. -0.06 Total Current Char -UGI Call 800-276-2722 or write to UGI at UGI Utility chargeseowed this€boll ............................. 11.47 PQ SOX 13009 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Date(11/1912014)..................................... $11.47 .`Your current UGI charges include State taxes totaling about$0.37. (20 .` Meter Information:Next Read Date November 25,2014 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1205722 2498(remote) 2501(remote) 3 Messages from UGI ■Your current price to compare is$0.66159/CCF. ■Your total annual usage is 82 CCF. Your average monthly usage is 6 CCF. ■Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. ■ Like us on Facebook at www.facebook.com/ugiutilities for ways to save energy,holiday entertaining tips and exclusive offers. 0 a ■Save time.Save the planet.Sign up to view and pay your UGI bills online at www.ugi.com. ■Your bill does not display a usage graph because your average daily usage is too low. If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is an the back of this bill. SCHEDULE H -ADMINISTRATIVE COSTS LINE ITEM 16 - PPL ELECTRIC r . k�.NPYdd.E�C314'�T k!•a� �ie �—�$�� tiCltRliJ.S4'rkYLZ c+M-! •. _' �3 .,��7D 40E:P, 6i5t2 , --- ` 2i.+3` - J4 Efi P.Prs t' i� A�T Iltf, w+ ... ' f.`raFaf -C _ i .» 111f i- ir icrc�i.'���,:j2A'L4P:i$ iti�A'dra msda r+fl j#3;pWir.Sa.A.. '�7:;�ii? :qra585? e:1331 ?q:G ry. t iF ��'Sr7563 9- 38.97 27.46 22.08 $ 23.96 CDi1.10pg9Sit 6.v 4 7 llff.W 15898 6F19it,sp,rm _ - $ 16.25 l $ 17.17 see trr: 6c � =j $ 15.99 Jdk�6fSPiJ?s acts—d# JAMES P;S $ 12.81 rA.7"» 17,74 7 $ 174.69 t. 'M332 ' .. •aphi^' - i tgsGo! 76&0 ai4#�a� , 0-5-.4" ; - _.. Nos ilC�ittY J.�;EiC?2l ���� :.'� ����. ►{rrprM,��G6I6312 d0-CA ra °i �i91 w AAMES¢. '/ .�. tom* j,'� �.+# { i¢ j;���s.{� _-. » 1�' L� --a. �'v�jrurrl�..,���� . '_......<.—�•.._—��F.��_6�r " or Ift'�lnk e 4.. 0lq�5ru`-. a i?.�irt� 06 -E 6t*��l t sgt,5n :,. A.41 L 33ey A . ' a) Questions?Please Visit us online at Page 1 contact us by May 27. U pplelectric.com 1p1-800-DIAL-PPL •:;-•N (1-800-342-5775) 07820-79001 May 27, 2014 $38.97 PPL Electric Utilities M-F:8am to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of May 5,2014 $0.00 HENRY J SCHOLZ Charges: 227 12TH ST Total PPL Electric Utilities Charges $21.37 NEW CUMBERLAND, PA 17070 _. Total Dominion Energy Solutions Charges $17.60 Meter:12508779 Your next meter reading is on or about Jun 3,2014. Total Charges $38.97 This section helps you understand your year-to-year Amount Due By May 27,2014 $38.97 electric use by month. Meter readings are Actual unless Account Balance $38.97 otherwise noted. ®2013 ❑2014 PPL Electric Utilities' price to compare for your rate is$0.08754 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec. Visit papowerswitch.com 30 or www.oca.state.pa.us for supplier offers. Y Z0 Your Message Center 15 • With paperless billing,you can receive and pay your PPL Electric Utilities bills online.The process is free, a 10 quick,convenient and secure.To learn more or sign up, visit ppielectric.com. a 5 j j • Information about appliance energy use and tips on ° saving energy are available through the Energy Library F M A M J J A 5 0 N D on our Web site, ppielectric.com/e- power 0 Months a Before digging around your home or property,you should always call the state's One Call notification WDvIft RIM ' B system to locate any underground utility lines. You can • [gj 1e p RAW, do this by simply dialing 811,which will connect you to May 2014 30 211 7 52F the One Call system. Be safe and call 811 before you �c7. dig. May 2013 30 177 6 53F •• VW19 W• f Payment Methods May 2 Actual 5197 Online at: ®By phone:1-800-342-5775 Apr 2 Actual 4986 ppielectric.com or call BiIIMatrix(service fee applies) E at 1-800-672-2413 to pay using Visa, - 30 Days kWh Billed 211 MasterCard, Discover or debit card. • r ® By Mail: Correspondence should be sent to: Jun 2013- May 2014 3750 313 2 North 9th Street Customer Services _ CPC-GENN1 827 Hausman Road Jun 2012- May 2013 2720 227 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill-1 Questions?Please Visit us online at Page 1 ._ ® contact us by Jun 25. ` U pplelectric.com 1-800-DIAL-PPL �� (1-800-342-5775) 07820-79001 Jun 25,2014 $27.46 PPL ElectricUtllitiee M-F:Sam to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Jun 4,2014 $0.00 HENRY J SCHOLZ Charges: 227 12TH ST Total PPL Electric Utilities Charges $18.12 NEW CUMBERLAND, PA 17070 Total Dominion Energy Solutions Charges $9.34 Meter: 12508779 ' Your next meter reading is on or about Jul 2,2014, Total Charges $27.46 This section helps you understand your year-to-year Amount Due By Jun 25,20]4 $27.46 electric use by month. Meter readings are,actual unless Account Balance $27.46 otherwise noted. ® 2013 ®2014 PPL Electric Utilities' price to compare for your rate is$0.09036 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 30 or www.oca.state.pa.us for supplier offers. : 25'20 Your Message Center 0 15 a With paperless billing,you can receive and pay your PPL Electric Utilities bilis online. The process is free, 10 quick, convenient and secure.To learn more or sign up, avisit pplelectric.com. r 5 • Information about appliance energy use and tips on ° saving energy are available through the Energy Library o J F M A M J J A s o N D on our Web site, pplelectric.com/e-power Months a Before digging around your home or property,you should always call the state's One Call notification •i '1'� i � (" '` system to locate any underground utility lines. You can •, g C � . t„-p, do this by simply dialing 811,which will connect you to the One Call system. Be safe and call 811 before you Jun 2014 32 112 =4 63F dig. Jun 2013 32 158 5 63F •• Vim aomyn Payment Methods - r Jun 3 Actual 5309 Online at: ®By phone:1-800-342-5775 May 2 Actual 5197 pplelectric.com or call BiIIMatrIx(service fee applies) at 1-800-672-2413 to pay using Visa, 32 Days kWh Billed 112 MasterCard, Discover or debit card. • • • ® By Mail: Correspondence should be sent to: Jul 2013-Jun 2014 3704 309 2 North 9th Street Customer Services - CPC-GENN1 827 Hausman Road Jul 2012-Jun 2013 2742 229 Allentown, PA 18101-1175 Allentown,PA 18104-9392 Other important information on the back of this bill-� ;..•' - Questions?Please Visit us online at Page 1 contact us by Jul 24. ` ppielectric.com 1-800-DIAL-PPL PP (1-800-342-5775) 07820-79001 Jul 24,2014 $22.08 PPL Electric 1J411tiee M-F:Sam to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Jul 3,2014 $0.00 HENRY J SCHOLZ Charges: 22712TH ST Total PPL Electric Utilities Charges $16.66 NEW CUMBERLAND, PA 17070 Total Dominion Energy Solutions Charges $5.42 Meter: 12508779 - Your next meter reading Is on or about Aug 1,2014. Total Charges $22.08 This section helps you understand your year-to-year jAmount Due By Jul 24, 2014 $ electric use by month. Meter readings are actual unless Account Balance e--1/ � $22.08 otherwise noted. E] 2013 ❑2014 PPL Electric Utilities' price to compare for your rate is$0.08754 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 90 or www.oca.state.pa.us for supplier offers. Z25 20 Your Message Center 0 15 a With paperless billing,you can receive and pay your PPL Electric Utilities bills online.The process is free, so quick,convenient and secure.To learn more or sign up, avisit pplelectric.com. 5 o Information about appliance energy use and tips on a ° saving energy are available through the Energy Library F M A M J J A 5 0 N D on Our Web site, ppielectric.com/e-power a Months +� Before digging around your home or property,you should always call the state's One Cali notification system to locate any underground utility Tines. You can • .. . ? I I ► a ,� r do this by simply dialing 811,which will connect you to Jul 2014 29 65 2 73F the One Call system, Be safe and call 811 before you dig. Jul 2013 29 150 5 71F . r Payment Methods Jul 2 Actual 5374 Online at: (i)By phone: 1-800-342-5775 Jun 3 Actual 5309 ppielectric.com or call BIIIMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 29 Days kWh Billed 65 MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: Aug 2013-Jul 2014 3619 302 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Aug 2012-Jul 2013 2779 232 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important Information on the back of this bill -� ,'.• ::�.'. Questions?Please Visit us online at Page 1 •••`•`••:,;'._ ® contact us by Aug 25. pplelectric.com 1-800-DIAL-PPL ' PP� •: Man'f1�6 �(1-800-342-5775) 07820-79001Aug 25,2014 $23.96 PPL Electric Utilities M-F:Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Aug 4,2014 $0.00 HENRY J SCHOLZ Charges: 227 12TH ST Total PPL Electric Utilities Charges $17.20 NEW CUMBERLAND, PA 17070 Total NRG Retail Solutions Charges $6.76 Meter: 12508779 Your next meter.reading is on or about Sep 2, 2014. Total Charges $23.96 This section helps you understand your year-to-year Amount Due By Aug 25,2014 electric use by month. Meter readings are?ctual unless Account Balance $23.96 otherwise noted. [e d. ©2014 PPL Electric Utilities'price to compare for your rate is$0.09036 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 30 or www.oca.state.pa.us for supplier offers. i Y 20 Your Message Center Cx NoQSo a e With paperless billing,you can receive and pay your 8jq 15 PPL Electric Utilities bills online.The process is free, a 10 quick,convenient and secure.To learn more or sign up, a 5 visit pplelectric.com. I_ ( e Information about appliance energy use and tips on ° saving energy are available through the Energy Library J F M A M J J_ A S ° N D on our Web site,pplelectric.com/e-power Months a Before digging around your home or property,you should always call the state's One Call notification ONAW •' system to locate any underground utility lines. You can ,. • MWi► . 9 do this by simply dialing 811,which will connect you to Aug 2014 30 81 3 75F W I the One Call system. Be safe and call 811 before you dig. Aug 2013 30 246 8 77F = Payment Methods . Aug 1 Actual 5455 ,/�, Online at: By phone: 1-800-342-5775 Jul 2 Actual 5374 _ U pplelectric.com or call BIIIMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 30 Days kWh Billed 81 MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: Sep 2013-Aug 2014 3454 288 2 North 9th Street Customer Services CPC 827 Hausman Road _ Sep 2012-Aug 2013 2822 235 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill 4 i ® Questions?Please , Visit us online at Page 1 contact us by Sep 24. pplelectric.com 1-800-DIAL-PPL C]IDGYG'h 1 PP (1-800-342-5775) 07820-79001 Sep 24, 2014 $16.25 PPL Electric utmnee M-F:8am to 5pm Your Electric Usage Profile Billing Summary (Billing detains on back) Service to: Balance as of Sep 3,2014 $0.00- HENRY J SCHOLZ Charges: 22712TH ST Total PPL Electric Utilities Charges $15.00 NEW CUMBERLAND, PA 17070 Total NR.G Retail Solutions Charges $1.25 Meter:12508779 Your next meter reading is on or about Oct 2, 2014. Total Charges $16.25 This section helps you understand your year-to-year Amount Due By Sep 24,2014 $ electric use by month. Meter readings are,actual unless Account Balance C-4 5 9 ¢j ` $16.25 otherwise noted. ❑2013 ❑2014 PPL Electric Utilities'price to compare for your rate is$0.08814 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 30 or www.oca.state.pa.us for supplier offers. 20 Your Message Center b F • With paperless billing,you can receive and pay your 15 PPL Electric Utilities bills online.The process is free, 10 quick,convenient and secure.To learn more or sign up, a visit pplelectric.com. 5 • Information about appliance energy use and tips on g 0F M A M J A s o N D saving energy are available through the Energy Library o on our Web site, pplelectric.com/e-power Months a Before digging around your home or property,you should always call the state's One Call notification G e:`� ii � system to locate any underground utility lines. You can o i u do this by simply dialing 811,which will connect you to Sep 2014 32 15 0 72F the One Call system. Be safe and call 811 before you dig. Sep 2013 29 135 5 71F = a I Payment Methods Sep 2 Actual 5470 Online at: ®By phone: 1-800-342-5775 Aug 1 Actual 5455 ppielectric.com or call BiliMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 32 Days kWh Billed 15 MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: Oct 2013-Sep 2014 3334 278 2 North 9th Street Customer Services _ CPC-GENN1 827 Hausman Road Oct 2012-Sep 2013 2658 222 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other.important information on the back of this bill 4. ` ;•` Questions?Please Visit us online at Page 1 �'•'° ''�:�•.. \,V contact us by Oct 24. pplelectric.com ;t- 1-800-DIAL-PPL ° ' s P '; ' - (1-800-342-5775) 07820-79001 Oct 24, 2014 $17.17 ol,Electric Utilities M-F:8am to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Oct 3,2014 $0.00 -IENRY J SCHOLZ Charges: 22712TH ST Total PPL Electric Utilities Charges $15.25 UEW CUMBERLAND, PA 17070 Total NRG Retail Solutions Charges $1.92 Meter: 12508779 Four next meter reading Is on or about Oct 31,2014. Total Charges $17.17 rhls section helps you understand your year-to-year jAmount Due By Oct 24,2014 $ electric use by month. Meter readings are a0tual unless Account Balance - $17.17 otherwise noted. 2013 ®2014 PPL Electric Utilities' price to compare for your rate is 0.08956 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 30 or www.oca,state.pa.us for supplier offers. 25 20 Your Message Center is a With paperless billing,you can receive and pay your E PPL Electric Utilities Mils online.The process is free, E so quick, convenient and secure.To learn more or sign up, 5 visit pplelectric.com. 0 ; e Information about appliance energy use and tips on ID J F M A M J J A s o N o saving energy are available throwh the Energy Library o on our Web site,pplelectric.comle-power Months a Before digging around your home or property,you should always call the state's One Call notification AMUDsystem to locate any underground utility lines. You can • p t I , do this by simply dialing 811,which will connect you to Oct 2014 30 23 1 66F the One Call system. Be safe and call 811 before you dig. Oct 2013 33 122 4 65F �. .; Payment Methods ..:. Oct 2 Actual 5493 Online at: ©By phone: 1-800-342-5775 .W Sep 2 Actual 5470 ppieiectric.com or call BIIIMatrlx(service fee applies) at 1-800-672-2413 to pay using Visa, 30 Days kWh Billed 23 MasterCard, Discover or debit card. � .. ® By Mall: Correspondence should be sent to: Nov 2013-Oct 2014 3235 270 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road �. Nov 2012-Oct 2013 2537 211 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill t `. Questions?Please Visit us online at Page 1 contact us by Nov 24. U pplelectric.com :br 1-800-DIAL-PPL Bill r r Date . Due PPI .. (1-800-342-5775) 07820-79001 Nov 24,2014 WL electric utilities M-F:Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details ori back) Service to: Balance as of Nov 3,2014 $0.00 HENRY J SCHOLZ Charges: 22712TH ST Total PPL Electric Utilities Charges $14.91 NEW CUMBERLAND,PA 17070 Total NRG Retail Solutions Charges $1.08 Meter:12508779 Your next meter reading is on or about Dec 2,2014. Total Charges $15.99 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless Account Balance $15.99 otherwise noted. ®2013 ■2014 PPL Electric Utilities'price to compare for your rate is$0.08956 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 30 or www.oca.state.pa.us for supplier offers. x zo Your Message Center p �$ • With paperless billing,you can receive and pay your PPL Electric Utilities bills online.The process is free, 10 j quick,convenient and secure.To(earn more or sign up, [; visit pplelectric.com. S 0 FL • Information about appliance energy use and tips on saving energy are available through the Energy Library J F M -.A M J J a s o N D on our Web site,pplelectric.com/e-power Months • Before digging around your home or property,you should always call the state's One Call notification Vf6nthly Days Average AveragekWh system to locate any underground utility lines. You can BilledComparison kWh/Day . do-this.by simply dialing 811,which will connect you to Oct 2014 29 13 0 57F the.One Call system. Be safe and call 811 before you dig. Oct 2013 29 560 19 56F Billing Period Payment Methods Oct 31 Actual 5506 Online at: d By phone:1-800-342-5775 — Oct 2 Actual 5483 i U pplelectric.com or call BillMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 29 Days kWh Billed 13 MasterCard,Discover or debit card. By Mail: Correspondence should be sent to:Yearly Comparison 'Total U�e Avg,Monthly 'I _ Nov 2013-Qct 2014 2688 224 2 North 9th Street Customer Services — CPC-GENN1 827 Hausman Road Nov 2012-Oct 2013 2818 235 Allentown, PA 18101-1175 Allentown, PA 181049392 — Other important information on the back of thi Questions?Please Visit us online at Final Bill Page 1 °'•`"'° � contact us by Dec 12. ppielectric.com Bill Acct.No. Due Date Amount Due - 1-80D-DIAL-PPL PIP (1-800-342-5775} 07820-79001 Dec 12,2014 :. ',`_$12 81 ^ ,r$' PPL Electric UtllMos M-F:Sam to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Nov 21,2014 $0.00 HENRY J SCHOLZ Charges: 22712TH ST Total NRG Retail Solutions Charges $2.25 NEW CUMBERLAND,PA 17070 Total PPL Electric Utilities Charges $10.56 Meter:12508779 Total Charges $12:81 This section helps you understand your year Amoul►t.Due ByrDec 12;204 r , 's.. ,�- a, electric use by month. Meter readings are actual unless Account Balance ( � $12.81 otherwise noted. 2413 �2014 PP!Electric Utilities'price to compare for your rate is 0.08956 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 30 or www.oca.state.pa.us for supplier offers. 25 Your Message Center 20 • Information about appliance energy use and tips on 15 saving energy are available through the Energy Library so 4 on our Web site,ppleiectric.com/e-power 5 • Before digging around your home or property,you should always call the state's One Call notification a n x system to locate any underground utility lines. You can J F . M _A M J J A S O N D do this by simply dialing 811,which will connect you to 4 Months the One Call system. Be safe and call 811 before you dig. Monthly Days - : •: We-appreciate the opportunity to have served you. ComparisonkWh ,, Because you have paid your bills within 30 days over the pest year,you have established an excellent Nov 2014 20 27 1 42F payment record with PPL Electric Utilities. Nov 2013 32 616 19 41F Billing •- ,• Payment Methods Nov 20 Actual 5533 Online at: Q By phone:1-800-342-5775 pplelectric.com or call BillMatrix(service fee applies) Oct 31 Actual 5506 at 1-800-672-2413 to pay using Visa, -- 20 Days kWh Billed 27 MasterCard,Discover or debit card... • ® By Mail: Correspondence should be sent to: LT12 North 9th Street Customer Services Dec 2013-Nov 2014 2099 175 CPC-GENN1 827 Hausman Road Dec 2012-Nov 2013 3299 275 Allentown,PA 18101-1175 Allentown,PA 18104-9392 Other important information on the back of this bill 4 SCHEDULE H -ADMINISTRATIVE COSTS LINE ITEM 17 - PA AMERICAN WATER !'l�'I�Y.P.S .�a4q � 5515'9 ea�n��?'.�fibt2 9F!it1 .�gEo�`p r r szntt;x.• i"__._ .�.�... `�# �a �,S�sy�'mr�fr t*w .�' .,. ��.. y ^•-W-tt-wLttik 877 " ncY c e•4, =�—crs " anx a m SBBs $ 44.20 m2 ;��+ �#�� ,u &m �MtIA. $ 37.05 �o # $ 16.02 L�,,,—sir _ "HL7L �_ _OLl +z�,»+fiv1.IJ.i35 L•p "- t. _. �FL4� �3��.•_ �..v.—. _ __ Ir:[LlA�J dim � � �';I{�k .... -,rt=___.•_�' - $ 10.90 r 1M1AiflsT�t�c xua � r 35.92 16.02 40 AIAf7E9,55w _7Fi$,44105A77 _ et3 �a�43�9 4 G? qja` Sf95 ... - _ - --- - - - $ 15.00 9.37 "B"Ynbeft 1 1-1 of -.. _.. TR xeg.+iiE �Ebf9��1�F���� •9f `i3Y a7 C}� , MAWS P.SCM12tF .07 Ks�rr a,ti �. 7e:1.�.... !�[]•�J,��G��9�5�e �6Gi�'� '�*'rd�'9�4, t'F73.1itp�9�5*'� 9�o��`?a9��'���li' � .... 715NAY,{4•'6LMt� rn,rn + -. -_ �St - C1+1 N"yr#d.9GmEit:t 00.64 j Sens I F*na�`.rl�' �/.1 ��yy�� J. S.f_.^. EL{—••+Y{L�-r•+1—. 6Jt. �ri AJ r....—_ ; l' .. i+ �-X..4.S.....�a..au,z.w.m•.u*----_• (If`d RFl � ,.�—=ut ,,,�}yFi1.4F=+L'1 BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:May 2,2014 For Service To:227 12TH ST • Due Date:May 27,2014 For Account 1024-210035378728 • Billing period:Apr 03 to May 01(29 Days) Prior Balance • Next reading on or about:May 30,2014 Balance from last bill 47.27 • Customer Type:Residential Payments as of Apr14.Thank you! -47.27 • Meter Reading Measurement: Balance Forward 0.00 1 unit=100 gallons of water • Billing Measurement: 100 gallons(CGL) Current Water Service 15.00 • Water Service Charge Meter No. N090866513 • .Water Usage Charge($1.0.2140000x 10.00) 10.21 Size of meter 5/8" • Total Water Service Related Charges 25.21 Current Read 233(Actual) Protection Program Plans Previous Read 223(Actual) • Customer Protection Water Line 5.50 Total water used this 10 units • Customer Protection Sewer Line 9.50 billing period (1,000 gallons) Customer Protection In Home 3.99 Total Protection Program Plans 18.99 Total Water Use Comparison(in 100 gallons) TOTAL CURRENT CHARGES 44.20 • Current billing period 2014: 10.00 CGL Same billing period 2013: 9.00 CGL TOTAL AMOUNT DUE � $44.29 Billed Use Graph(100 gallons) 25 Pay your bill online:www.water.paymybill.com 20 (1) Pay by phone:24-hours a day,every day at 1-866-271-5522 $ Pay in person:Residential customers may obtain a listing of 15 payment locations by visiting www.amwater.com/myh2o 10gj Pay by mail:Remit your payment to the address shown above 5 2' M J J A S 0 N D J F M A M 2 tJ� 0a u u u e c o e a 'e a p a 0 3 y n I g p t v c n b r r y 4 Important messages from Pennsylvania American Water • Approximately 4.44 percent,or$ 1.96,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 05/27/2014 will be.subject to a 1.50%penalty. v Questions about this bill?Cali our 24-Hour Customer Service Center:1-800-5657292 www.pennsylvanlaamwater.com 666250279822 017478/017571 ACRJ3G ETM1C003 1 4 (ACRJ3G 0174780101900) BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:June 3,2014 For Service To:227 12TH ST • Due Date:lune 25,2014 For Account 1024-210035378728 • Billing period:May 02 to Jun 02(32 Days) Prior Balance • Next reading on or about:Jun 30,2014 • Balance from last bill 44.20 • Customer Type:Residential • Payments as of May19.Thank you! -44.20 • Meter Reading Measurement: Balance Forward — Q�0.00 1 unit=100 gallons of water — i.�v' • . Billing Measurement:100 gallons(CGL) Current Water Service (J • Water Service Charge � 15.00 Meter No. N090866513 • Water Usage Charge($1.02140000 x 3.00) 3.06 Size of meter 5/8u • Tota!Water Service Related Charges 18.06 Current Read 236(Actual) Protection Program Pians Previous Read' 233(Actual) • Customer Protection Water Line � Total water used this 3 units • Customer Protection Sewer Line �}ivf 9.50" billing period (300 gallons) i Customer Protection In Home 1f1 3.99 "��cj,,, Total Protection Program Plans """"VVVV 18.99 Total Water Use Comparison(in 100 gallons) TOTAL CURRENT CHARGES 37.05 • Current billing period 2014: 3.00 CGL • Same billing period 2013: 8.00 CGL TOTAL AMOUNT ®UE $37.05 . Billed Use Graph(100 gallons) 25 Pay your bill online:www.wa#er,paymybill.com 20 „_ _„_ U Pay by phone:24-hours a day,every day at 1-866-271-5522 Pay in person:Residential customers may obtain a listing of 15 payment locations by visiting www.amwater.com/myh2o 101 Pay by mail:Remit your payment to the address shown above 5 ` � V_ Va 2 J J A S O N D J F M A M J 2 0 u u u e. c o e a e a p a' u 0 3 n ( g p t v c n b r r y n 4 1 to Important messages from Pennsylvania American Water • Approximately 4.44 percent,or$ 1.65,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 06/25/2014 will be subject to a 1.50%penalty. /_�. ��• ” � CeI>c L/ A -A\11 ao Questions about this bill?Cali our 24-Hour Customer Service Center:1-800-565-7292 www.pennsylvaniaamwater.com 642500258973 042812/042963 ACRQ4V ETMIC0061 (ACR04V 0428120101100) ................ .......... ............... ................... ------- 3ILLING PERIOD AND METER READINGS BILLING SUMMARY Billing date:July 1,2014 For Service To:227 12TH ST Due Date:July 23,2014 For Account 1024-210035378728 Billing period:Jun 03 to Jun 30(28 Days) Prior Balance Next reading on or about:Jul 31,2014 Balance from 1a 'l 37.05 • Customer Type:Residential Payments ask1u�3.Thank you.! -37.05 • Meter Reading Measurement: Balance Fo0.00 1 unit=100 gallons of water Current Water Service L ,ofiQ'740 :L5oo . . fIUT Meter No. N090866513 Water Usage Charge($1,02140000 x 1.00) Size of meter 5/8" Total Water Service Related Charges 16.42 Current Read 237(Actual) Protection Prog Plans P"'V Previous Read 236(Actual) Customer tic,Water Line 5.5 Total water used this I units Customer.ProAction Sewer Line 0 billing period (100 gallons) V3 Customer Prtektion in Home 9 0 Total Protedtion Vrogram Plans IM9, Total Water Use Comparison(in 100 gallons) TOTAL CURRENT CHARGES 35.01 • Current billing period 2014: 1.00 CGL • Same billing period 2013: 8..00 CGL TOTAL AMOUNT DUE $35.01 Billed Use Graph(100 gallons) 25 Pay your bill online:www.water.paymybill.com 20 Pay by phone:24-hours a day,every day at 1-866-271-5522 15 Pay in pdrson:Residential customers may obtain a listing of payment locations by visiting www.amwater.com/myh2o 10 Pay by mail:Remit your payment to the address shown above 5 2 1 J' A S 0 N D I F M A M 1 2 0 u u u e c o e a e a P a u 0 I n I g P t v c n b r r y n I 4 Important messages from Pennsylvania American.Water • Approximately 4.44 percent,or$ 1.55,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 07/23/2014 will be subject to a 1.50%penalty. ,ar.= Questions about this bill?Call our 24-Hour Customer Service Center:1-800-565-7292 www.pennsylvaniaamwater.com 627500325:145 013680/013778ACRT8J ETMIC002 123 (ACRTSJ 0138800101700) BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:August 19,2014 For Service To:227 12TH ST • Due Date:September 10,2014 For Account 1024-210035378728 • Billing period:Aug 02 to Aug 17(16 Days) Prior Balance • Customer Type: Residential . Balance from last bill 19.62 • Meter Reading Measurement: TOTAL PAST AMOUNT-DUE IMMEDIATELY 19.62 0 1-unit=100 gallons of water Current Water Service Billing Measurement: 100 gallons(CGL) . Water Service Charge 1.89 Meter No. N090866513 o Water Usage Charge($1.02140000x 3.00) 3.06 Size of meter 5/811 . Total Water Service Related Charges 10.95 Current Read 241(Actual) Adjustments 'Previous Read 238(Actual) . Courtesy Adjustment-Water Wig, 0M05 Total water used this 3 units . Total Adjustments billing period (300 gallons) TOTAL CURRENT CHARGES 10.96 Total Water Use Comparison(in 100 gallons) TOTAL AMOUNT DUE $30.52 • Current billing period 2014: 3.00 CGL • Same billing period 2013: 6.00 CGL 1,t Pay your bill online:www.water.paymybill.com Billed Use Graph(100 gallons) 25 (I Pay by phone:24-hours a day,every day at 1-866-271-5522 Pay in person:Residential customers may obtain a listing of 20 payment locations by visiting www.amwater.com/myh2o 15 Pay by mail:Remit your payment to the address shown above 10 5 2 A SO N D J F M A M J J A 2 0 u e c o e a- e a p a u u u 0 1 g p t v c n b r r y n I g 1 3 4 important messages from Pennsylvania American Water - Attention Pet Owners:At Pennsylvania American Water,we care deeply'about our em*ployees'safety.From time to time,our field staff must access your property to read the water meter or perform service work.When we do,we ask that you keep your pets inside in a separate room or on a leash at safe distance from the meter for the duration of the service visit.Keeping your pets secure for this brief amount of time goes a long way to prevent bites.even the most gentle,well-mannered pets can become protective and aggressive around people it doesn't know. Thanks for helping to keep our employees safe. • Have you recently changed your primary phone number?If you have, please update your account Information online using My H2O Online at www.amwater.com/myh2o or call us at the number below so that we can update our records. Final Bill*** This is your final bill for service.It has been our pleasure to serve you. • The due date pertains to current charges only.Any past due balance should be paid immediately. • Approximately 4.44 percent,or.$0.48,of state taxes are included in your current bill. • Any portion of the water charges which is not paid as of 09/10/2014 will be subject to a 1.50%penalty. Questions about this bill?Call our 24-Hour Customer Service Center:1-800-565-1292 www.pennsylvaniaamwater.com 600000811142 049189/049411 ACRZ4W ETIVII C007 12 (ACRZ4W 0491890101300) BILLING PERIOD AN D METER READINGS BILLING SUMMARY ^ Billing date:September 2,2014 For Service To:227 12TH ST ^ Due Date:September 24,2014 For Account 102422UU05GG6D4G ^ Billing period:Aug I8tnAug 2S(12Days) Prior mmmnco " Next reading onmvabout:Sep 30,2O14 Balance from ^ Customer Type: Residential Balance Forward 0'00 ^ Meter Reading Measurement: ounwnmw��,�nmi�o 1un�=1O0gaUnnmnfw�er ' ^ ��te,�er�m�h��� og� ^ BUUng��ousummen�1U0gaUunoK%GU ' , Water (\Du Meter No. N090866513 ^ Total Water Service Related Charges ----�5.92 Size of meter 5/8" 4djustmen'ts Current Read 238(Actual) ^ Service Activation Fee 30.0 Previous Read 238(Estimated) ^ Total Adjustments ' -----30.00 Total water u ed this 0 units TOTAL CURRENT CHARGES billing period (0 gallons) Total Water Use Comparison(in 1O0gallons) ^ TOTAL AMOUNT DUE " Current billing period 2014- . 0.O8CGL r' " Same billing period 2013:. 0.00 CGL Pay your bill online:www water.paymybill.com Billed Use Graph(100 gmlywma) Pay by phone:24-hours a day,every day at 1-866-271-5522 5 Pay in person:Residential customers may obtain a listing of payment locations by visiting www.amwater.com/myl12o 4 Pay by Mail:Remit your payment to the address shown abov) a _ y u lot e « oowoJrwAwJ J Au ' nve000aoupuuvv « imnt " « » » ' ' ' n / � x | a * � Important messages from Pennsylvania American Water ° Attention Pet Owners:A1Pennsylvania American Water,we care doop|y'aUuut our employees'safety.From time 1ntime;our field staff must access your property toread the water metororpurfonnservicewmrk.VVhenwedn.*eaahthotyouhoepynurpotsinsiUeinaseparate room ornnaleash atsafe distance from the meter for the-duration of the service visit.Keeping your pets secure for this brief amount of time goes olong*way topnvantbhss.�mnthe mmtgentle,we|�mannom�pe��can become puteobmm � protective and Thank oforhelping tnkeep our employees safe. _ ^ Have you recently changed yourprimary phone number?If you have,please update your account information online using MyH20Online at www,amwater.com/myh2o or call us at the number below so that we can update our records. •Approximately 4.44 percent,or$1.59,of state taxes are included in your current bill. ' Any portion of the water charges which is not-paid as of 09/24/2014 will be subject to a 1.50%penalty. ~ The reading used for this bill corrects the previous estimated reading. Questions about this bill?Call our 24-HourCustomer Service Center:1-800-565-7292 wvww.Venn��vanio�nnwater�om 100001049792 047711m*805xoac45ETM 1oomI muo245 0477110101104 -- ' . ` ' BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:October 1,2014 For Service To:227 12TH ST • Due Date:October 23,2014For Account 1024-220005665046 • Billing period:Aug 30 to Sep 30(32 Days) Prior Balance • Next reading on or about:Oct 31,2014 . Balance from last bill 35.92 • Customer Type:Residential . Payments as of Sep25.Thank you! -35.92 • Meter Reading Measurement Balance Forward 0.00 I unit=100 gallons of water Current Water Service • Billing Measurement:100 gallons(CGL) • Water Service Charge 15.00 Meter No. N090866513 o Water Usage Charge($1.02140000 x 1.00) 1.02 Size of meter 5/8'! o Total Water Service Related Charges 16.02 Current Read 239(Actual) TOTAL CURRENT CHARGES 16.02 Previous Read 238(Actual) Total Water used this I units TOTAL AMOUNT DUE �6.01 billing period (100 gallons) Total Water Use Comparison(in 100 gallons) -TJ Pay your bill online:www.water.paymybill.com • Current billing period 2014: 1.00 CGL (3) Pay by phone:24-hours a day,every day at 1-866-271-5522 • Same billing period 2013: 0.00 CGL Pay in person:Residential customers may obtain a listing of payment locations by visiting wwW.amwater.com/myh2o Billed Use Graph(100 gallons) Pay by mail:Remit your payment to the address shown above 5 4 e-inq r7 3 2 11D lb 2 S 0 N D J F M A M J J A S 2 0 e c o e a e a p a u u u e 0 I p t v c n b r r y n I g p I 4 Important messages from Pennsylvania American Water • Have you recently changed your primary phone number?If you have,please update your account information online using My H2O Online at www.amwater.com/myh2o or call us at the number below so that we can update our records. • Approximately 4.44 percent,or$0.71,of state taxes are included in yourcurrent bill. • Any portion of the water charges which is not paid'as of 10/23/2014 will be subject to a 1.50%penalty. Questions about this bill?Call our 24-Hour Customer Service Center:1-800-565-7292 www.pennsylvaniaamwater.com 618750491304 0I86OQIOM23 ACS69G ETMIC003 12 (ACSSSG 0188000101300) BILLING PERIOD AND METER READINGS BILLING SUMMARY • Billing date:November 4,2014 For Service To:227 12TH ST • Due Date:November 26,2014 For Account 1024-220005665046 • Billing period:Oct 01 to Oct 31(31 Days) Prior Balance • Next reading on or about:Nov 26,2014 . Balance from last bill 16..02 • Customer Type:Residential . Payments as of Oct20.Thank youl -16,02 • Meter Reading Measurement: Balance Forward 0.00 I unit=100 gallons of water Current Water Service • Billing Measurement:100 gallons(CGL) o Water Service Charge 15.00 Meter No. N090866513 . Water Usage Charge($1.02140000 x 0.00) 0.00 Size of meter 5/8" . Total Water Service Related Charges 15.00 Current Read 239(Actual) TOTAL CURRENT CHARGES 15.00 Previous Read' 239(Actual) Total water used this 0 units TOTAL AMOUNT DUE K�;-�19-00 bMing period (6 gallons) Total Water Use Comparison(in 100 gallons) Pay your bill online:www.water.paymybill.com • Current billing period 2014: 0.00 CGL C2 Pay by phone-.24-hours a day,every day at 1-866-271-5522 • Same billing period 2013: 0.00 CGL Pay in person:Residential customers may obtain a listing of payment locations by visiting www.amwater.com/myh2o Billed Use Graph(100 gallons) Pay by mail:Remit your payment to the address'shown above 5 4 3 01 2 2 0 N D J F WA M J J A S 0 2 0 c o e a e a P a u u u e c 0 1 t V c n b r r y n I g p t 1 3 4 Important messages from Pennsylvania American Water • Have you recently changed your primary phone number?If you have, please update your account information online using My H2O Online at www.amwater.com/myh2o or call us at the number below so that we can update our records. • Approximately 4.44 percent,or$0.67,of state taxes are.included in your current bill. • Any portion of the water charges which is not paid as of 11/26/2014 will be subject to a 1.50%penalty. • Save time.Save money.Sign up for paperless billing and pay your bill online!It's a convenient,secure and environmentally friendly way to receive and pay your bill.To get started,log on to www.amwater.corh/myh2o. Questions about this bill?Call our 24-Hour Customer Service Center:1-800-565-7292 www.pennsylvaniaamwater.com 658750670001 024489/024737 AOSM FTMIC004 1 (AdS9B1 0244890101100) BILLING PERIOD AND METER READINGS BILLING SUMMARY , Billing date:December 5.2U14 For Service To:22712THST ~ Due Date:December 29,2014 For Account 1024-220005665046 ° Billing period:Nov 01noNov 18(19Days) Prior Balance ° Customer Type:Residential ~ Balance from last bill 15.00 ° Meter Reading Measurement: . Payments as of Nov13.Thank youl -15.00 1unit=1OOgallons ofwater Balance Forward 0.00 , Billing Measurement: 100 ga|lono(CGU Current Water Service Meter No. N090866513 ^ Wate,Senx000marge 9.37 Size of meter 5/8" ^ Water Usage Charge($1.o2140oomxo.m) b»u Current Read 239(Actual) ^ Total Water Service Related Charges -----9.37 Previous Read 239(Actual) TOTAL CURRENT CHARGES 9.37 Total water used this 0 units billing period (0 gallons) TOTAL AMOUNT DUE Total Water Use Comparison(in 1O0gallons) , ' ° Current billing period 2014: 0,00 CGL 1,16 Pay your bill online:www.water.paymybill.com " Same billing period 2O13: 0.00 CGL (1) Pay by phone:24-hours a day,every day at 1-866-271-5,522 f Pay in person:Residential customers may obtain a listing of Billed Use Graph(108gallons) payment locations by visiting www.amwater.com/myh2o o Pay by mail:Remit your payment to the address shown above4 o 2muJrmAmJ Jxoow2 « " oaoap- avuuonuo xvvnu , r ' v / uot " 1 o * y | Important messages from Pennsylvania American Water ^ Have you recently changed your primary phone number?If you have,please update your account information online using MyH2OOnline atwww.amwat :oom/myh2ooroaUun'otthonumberbo|uwaothatweoanupdatanurrecords. ^ *+* Final Bill**+ This isyour final bill for service.|thas been our p|o�sumt000moyou. ^ Appmxim�e|y4.44pnvoentor$O.42.of�atotaxes are included�yourcurrent bill. Any portion of the water charges which is not paid as of 12/29/2014 will be subject to a 1.50%penalty. Go paperless.Reduce clutter with paperless billing,and save time and money with our automatic payment program.These are convenient, secure and environmentally friendly ways to receive and pay your bill.To get started,log on to www.amwater.com/myh2o. Questions about this bill?Call our 24-HourCustomer Service Center: www.ponnsydvaniaamwatar.cum 100001.21e1e5 uum4wzwe271xcoox,ETM Icv06 I moaoxv 0533440101100) - ' ' ' SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM 18 - 227 Home Owners Insurance ALL FUNDS WERE REMOVED FROM CHECKING ACCOUNT ELECTRONICLY NO CANCLELED CHECKES AVAILABLE SEE ATTACHED BILL STATEMENTS AND CHECKING ACCT 76117391 WITHDRAW MAY 19TH .$ 71.50 JULY 21ST $ 71.50 AUG 19TH $ 71.50 SEPT 18TH $ 71.50 OCT 20TH $ 71.50 357.50 t FOR INQUIRIES CALL: (800)724-2440 ACCOUNT TYPE MYCHOICE PREMIUM CHECKING 00 0 06113M NM 017 ACCOUNT NUMBER STATEMENT PERIOD 000007425 PIDS1549DO1706271406 04 000000 p 76117391 MAY.28-JUN.27,2014 HENRY J SCHOLZ BEGINNING BALANCE $921.72 JAMES P SCHOLZ DEPOSITS&CREDITS 3,465.04 40 ARGALI LN LESS CHECKS&DEBITS 1,362.99 MECHANICSBURG PA 17055 0.03 CESS SERVIC '.,t-FLkR 0.00 $3,023.80 INTEREST EARNED FOR STATEMENT"PERIOD $0.03 HIGHLAND PARK INTEREST PAID YEAR TO DATE $0.13 ACCOUNTSUMMARY BEGINNING DEPOSITS&OTHER CHECKS PAID OTHER DEBITS 0CURRENT ENDING BALANCE CREDITS(+) INTEREST PD BALANCE NO. AMOUNT NO. AMOUNT NO. AMOUNT $921,72 6 $3,465.04 8 $1,276.64 4 $86.35 $0.03 $3,023.80 ACCOUNT ACTIVITY POSTING DEPOSITS&OTHER WITHDRAWALS& DAILY TRANSACTION DESCRIPTION DATE CREDITS f+) OTHER DEBITS BALANCE 05/28/2014 BEGINNING BALANCE $921.72' 05/28/2014 WEB XFER FROM SAV 15004225218921 /$3,000.00 9 05/28/2014 CHECK NUMBER 5865 - 3,821.72 $100.001 05/3012014 CHASE 000920601 PENSION A42.80 4,264.52 0 06/03/2014 CHECK NUMBER 5863 142.551/ 4,121.97 06/11/2014 CHECK NUMBER 5866 =156.00 06/1112014 CHECK NUMBER 5867 789.22 00'00 3,176.75 6 06/20/2014 M&T ATM CHECK DEPOSIT 7.3!A Z 344 SOUTH TENTH STREET,LEMOYNE, PA 17043 3,184.14 06/2312014 CHECK NUMBER 5869 37.05' 06/23/2014 CHECK NUMBER 5870 -27.46 3,119.63 06/24/2014 CHECK NUMBER 5868 13.24 06/24/2014, _ - TRAVELERS PL CHECK PYMT 00000000.00058-71 71.50 3,034.89 06/25/2014 CHECK NUMBER 5872 11.12 3,023.77 06/27/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE WAIVER 4.95%0001 06/27/2014 WAIVE ADD-ON FEE;NON M&T ATM FEE REFUND 4.95-oof 06/27/2014 WAIVE ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.95,000 06/2712014 INTEREST PAYMENT 0.03 06/27/2014 M&T ADD-ON FEE:NON M&T ATM FEE REFUND 4.95,o 001* 06/2712014 M&T ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.95, 06/2712014 M&T ADD-ON FEE:NON M&T ATM FEE WAIVER 4.95 O'e 3,023.80 ENDING BALANCE $3,023.80 PAGE 1 OF 2 Lw8wl2) 1 • FOR INQUIRIES CALL: (800)724-24.40 ACCOUNT TYPE MYCHOICE PREMIUM CHECKING 00 0 06113M NM 017 ACCOUNTNUMBER STATEMENT PERIOD 000004090 FIDS1549DO1708271408 02 000000 P 76117391 JUL.26-AUG.27,2014 HENRY J SCHOLZ BEGINNING BALANCE $1,668.44 JAMES P SCHOLZ DEPOSITS&CREDITS 121.50 40 ARGALI LN LESS CHECKS&DEBITS 251.78 MECHANICSBURG PA 17055 ,INERST" 0.02 ESS SERVIGI=CHA`ttCFS` 0.00 irDlNla BAl 4N"C,f~..Y:.f n: $1,538.18 `r1-,,: ;.mss.,.: �<b ;-x•<e INTEREST EARNED FOR STATEMENT PERIOD $0.01 HIGHLAND PARK INTEREST PAID YEAR TO DATE $0.16 ACCOUNT SUMMARY BEGINNING DEPOSITS&OTHER CHECKS PAID OTHER DEBITS(-) CURRENT ENDING BALANCE CREDITS + INTEREST PD BALANCE N0. AMOUNT NO. AMOUNT NO. I AMOUNT $1,668.44 5 $121.50 3 $165.43 4 1 $86.35 $0.02 $1,538.18 M ACCOUNT ACTIVITY POSTING TRANSACTION DESCRIPTION DEPOSITS&OTHER WITHDRAWALS& DAILY DATE CREDITS W OTHER DEBITS - BALANCE 0 --07/26/2014 BEGINNING BALANCE $1',664.44 ` g 08/04/2014 M&T ATM CHECK DEPOSIT44.94 344 SOUTH TENTH STREET,LEMOYNE,PA 17043 1,713.38 � 4 08/06/2014 TRAVELERS PL CHECK PYMT 000000000005880 (/$71.50 ; 1,641.88 0 08/11/2014 M&T ATM CHECK DEPOSIT X61,71 344 SOUTH TENTH STREET,LEMOYNE,PA 17043 1,703.59 08/13/2014 CHECK NUMBER 5882 , If30.00 46 08/13/2014 CHECK NUMBER 5883 A 1.47 1,562.12 o n 08/19/2014 CHECK NUMBER 5884 23.96 1,538.16 o 08/27/2014 WAIVE ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.95. 08/27/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE WAIVER 4.95 08/27/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE REFUND 4.95 08/27/2014 INTEREST PAYMENT 0.02 08/27/2014 M&T ADD-ON FEE:NON M&T ATM FEE WAIVER &''4.95 08/27/2014 M&T ADD-ON FEE:NON M&T ATM FEE REFUND 4.95 08/27/2014 M&T ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.95 1,538.18 ENDING BALANCE $1,538.18 CHECKS PAID SUMMARY CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT 5882 08/13/14 130.00 5883 08/13/14 11.47 5884 08/19114 23.96 ANNUAL PERCENTAGE YIELD EARNED=0.00% PAGE 1 OF 2 M(6/12) M&T Bank FOR INQUIRIES CALL: (800)724-2440 ACCOUNT TYPE MYCHOICE PREMIUM CHECKING 00 0 06113M NM 017 ACCOUNTNUMBER 000003067 FIDS1549DO1709261409 05 000000 P Thi i 7391 AUG.28 SEP.26,20i 4 " HENRY J SCHOLZ BEGINNING BALANCE $1,538.18 JAMES P SCHOLZ DEPOSITS&CREDITS 364.85 40 ARGALI LN LESS CHECKS&DEBITS 770.65 MECHANICSBURG PA 17055 INTEREST 0.01 3LSS'SER1/ICEHARG�ES- 0.00 1�[I?1NJ3A1 AICFr $1,132.39 �F INTEREST EARNED FOR STATEMENT PERIOD $0.00 HIGHLAND PARK INTEREST PAID YEAR TO DATE $0.17 ACCOUNT SUMMARY BEGINNING DEPOSITS&OTHER CURRENT ENDING BALANCE CREDITS + CHECKS PAID OTHER DEBITS{-} INTEREST PD BALANCE NO. I AMOUNT NO. AMOUNT NO.= AMOUNT $1,538.18 4 1 $364.85 7 1 $684.30 4 1 $86.35 $0.01 $1,132.39 ACCOUNT ACTIVITY POSTING DEPOSITS&OTHER WITHDRAWALS& DAILY DATE TRANSACTION DESCRIPTION CREDITS + OTHER DEBITS - BALANCE 08/28/2014 BEGINNING BALANCE - $1,538.18 09/02/2014 CHECK NUMBER 5885 $10.9011/ 1,527.28 009/03/2014 TRAVELERS PL CHECK PYMT 000000000005886 09/03/2014 CHECK NUMBER 5888 391.491 1,064.29 09/04/2014 CHECK NUMBER 5887 115.24 949.05 09/11/2014 CHECK NUMBER 5889 104.001000, 09/11/2014 CHECK NUMBER 5891 16.2 828.80 09/12/2014 CHECK NUMBER 5890 10.50 818.30 09/15/2014 WEB XFER FROM SAV 15004225218921 $350.00% 1,168.30 09/25/2014 CHECK NUMBER 5892 35.92 1,132.38 09/26/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE WAIVER 4.95%- 09/26/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE REFUND 4.95109 09/26/2014 WAIVE ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.95 09/26/2014 INTEREST PAYMENT 0.01 09/26/2014 M&T ADD-ON FEE;NON M&T ATM FEE REFUND 4.9 09/26/2014 M&T ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.9 09/26/2014 M&T ADD-ON FEE:NON M&T ATM FEE WAIVER 4.95 1,132.39 ENDING BALANCE $1,132-39 CHECKS PAID SUMMARY CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT 5885 09/02/14 10.90 5887" 09/04/14 115.24 5888 09/03/14 391.49 5889 09/11/14 104.00 5890 09/12/14 10.50 5891 09/11/14 16.25 5892 09/25/14 35.92 PAGE 1 OF 2 L008(6/12) M&T Bank FOR INQUIRIES CALL: (800)724-2440 ACCOUNT TYPE MYCHOICE PREMIUM CHECKING 00 0 06113M NM 017 ACCOUNT NUMBER STATEMENT PERIOD 000003836 FIDS1545ID111710211410 02 000000 P .76117391 SEP.27-OCT.27,2014 } HENRY J SCHOLZ BEGINNING BALANCE $1,132.39 ' JAMES P SCHOLZ DEPOSITS&CREDITS 1,014.85 40 ARGALI LN LESS CHECKS&DEBITS 261.03 INTERESY 0.01 MECHANICSBURG PA 17055 �,LESS;S.ERYIC0.00 6 m h it`•x.. )"N�INGBALl1xCE r $1,886.22 INTEREST EARNED FOR STATEMENT PERIOD 3:0.01 HIGHLAND PARK INTEREST PAID YEAR TO DATE 30.18 ACCOUNT SUMMARY BEGINNING DEPOSITS&OTHER CHECKS PAID OTHER DEBITS{-) CURRENT ENDING BALANCE CREDITS + INTEREST PD BALANCE NO. I AMOUNT NO. AMOUNT NO.. AMOUNT $1,132.39 4 $1,014.85 4 $174.68 4 $86.35 $0.01 $1,886.22 ACCOUNT ACTIVITY POSTING TRANSACTION DESCRIPTION DEPOSITS&OTHER WITHDRAWALS& DAILY DATE CREDITS + OTHER DEBITS - BALANCE 09/27/2014 ,BEGINNING BALANCE -$1;132.39- ; (09/30%2014 TRAVELERS PL CHECK PYMT 000000000005893 ""$71.50 1,060.89 10/01/2014 M&T ATM CHECK DEPOSIT $1,000.0 344 SOUTH TENTH STREET,LEMOYNE,PA 17043 2,060.89 10/07/2014 CHECK NUMBER 5894 1/130.00 1,930.89 10/20/2014 CHECK NUMBER 5897 6.02 1,914.87 10/21/2014 CHECK NUMBER 5895 J49 10/21/2014 CHECK NUMBER 5896 V -17 1,886.21 10/27/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE WAIVER 4.95 10/27/2014 WAIVE ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.95 10/27/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE REFUND 4.95 10/27/2014 INTEREST PAYMENT 0.01 10/27/2014 M&T ADD-ON FEE:NON M&T ATM FEE WAIVER 4.95 10/27/2014 M&T ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 4.95 10/27/2014 M&T ADD-ON FEE:NON M&T ATM FEE REFUND 4.95 1,886.22 ENDING BALANCE $1,886.22 CHECKS PAID SUMMARY CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT 5894 10/07/14 130.00 5895 10/21/14 11.49 5896 10/21/14 17.17 5897 10/20/14 16.02 ANNUAL PERCEI\TAGE YIELD EARNED=0.00% PAGE 1 OF L008(6/12) FOR INQUIRIES CALL: (800)724-2440 ACCOUNT TYPE MYCHOICE PREMIUM CHECKING 00 0 06113M NM 017 ACCOUNT NUMBER STATEMENT PERIOD 000007720 FIDS1549DO1711261411 03 000000 p 76117391 OCT.28-NOV.26,2014 HENRY J SCHOLZ BEGINNING BALANCE $1,886.22 JAMES P SCHOLZ DEPOSITS&CREDITS 17.57 40 ARGALI LN LESS CHECKS&DEBITS 284.81 0.02 MECHANICSBURG PA 17055 LESS0.00 SERVIal x. $1,619.00 INTEREST EARNED FOR STATEMENT PERIOD $0.01 HIGHLAND PARK INTEREST PAID YEAR TO DATE $0.20 Njo ACCOUNT SUMMARY BEGINNING DEPOSITS&OTHER CHECKS PAID OTHER DEBITS CURRENT ENDING BALANCE CREDITS W _-T A-MOUNT NO. AMOUNT INTEREST PD BALANCE NO. AMOUNT NO. $1,886.22 4 $17,57 4 $198.46 4 $86.35 $0.02 $1,619.00 ACCOUNT ACTIVITY POSTING TRANSACTION DESCRIPTION DEPOSITS&OTHER WITHDRAWALS& DAILY DATE CREDITS W OTHER DEBITS BALANCE 10128/2014 BEGINNING BALANCE -$1,886.22 11/12/2014 M&T ATM CHECK DEPOSIT $2.72- 5528 CARLISLE PIKE,MECHANICSBURG,PA 17055 (11/12/2014 TRAVELERS PL CHECK PYMTOOOOO0000005898 $71.50 11/12/2014 CHECK NUMBER 5900 15.99 1,801.45 11/13/2014 CHECK NUMBER 5899 11.47 11/13/2014 CHECK NUMBER 5901 15.00 1,774.98 11/25/2014 CHECK NUMBER 5902 156.00 1,618.98 11/26/2014 WAIVE ADD-ON FEE:NON M&T ATM FEE WAIVER 1 11/26/2014 WAIVE ADD-ON FEE;NON M&T ATM FEE REFUND 11/26/2014 WAIVE ADD-ON FEE:CHKS/SAFE DEPOSIT BOX X5 11/26/2014 INTEREST PAYMENT 0.02 11/26/2014 M&T ADD-ON FEE:NON M&T ATM FEE REFUND 11/2612014 M&T ADD-ON FEE:CHKS/SAFE DEPOSIT BOX 11/26/2014 M&T ADD-ON FEE:NON M&T ATM FEE WAIVER -/1,619.00 ENDING BALANCE $1,619.00 CHECKS PAID SUMMARY CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT 5899 11/13/14 11.47 5900 11/12/14 15.99 5901 11/13114 15.00 5902 11/25/14 156.00 ANNUAL PERCENTAGE YIELD EARNED=0.00% PAGE 1 OF 2 L008(6/12) Homeowners TRAVELERSAccount Bill ALAN HOSTETLER AGTS Account No. 981388205 300 S PROGRESS AVE HARRISBURG PA 17109 Please refer to this billing account number 02398 when calling or making payments. Big Billing Date: MAY 19,2014 Due Date: JULY 08,2014 QUESTIONS? CALL US: HENRY J SCHOLZ - 227 12TH ST Automated Billing davlisng aned Payment Information 1-800-550-7716 NEW CUMBERLAND PA 17070-1608 e 'w 'k Claim Service 1-800-252-4633 Policy Questions or Change of Address (717) 657-3141 To view or pay your bill online visit mytravelers.com Watch the Travelers Championship, June 19 - 22, 20141 Top golfers on the PGA TOUR will compete at the Travelers Championship in Cromwell, CT. Tune in for great action and excitement as the pros face four of the most challenging finishing holes in golf. Visit TravelersChampionship.com for more information. Policy Payment Information Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Homeowners 981388205 633 1 07/08/14 to 07/08/15 $66.50 $798.00 227 12TH ST Service Charge This Month $5.00 Total ' $71,50 $798.00 j?''0 Please read important information on reverse side. Please detach and mail the lower portion of this bill with your payment in the enclosed envelope to TRAVELERS,PO BOX 660307,DALLAS,TX 75266-0307. Thank you. AW TRAVELERS J Homeowners Account Bill ALAN HOSTETLER AGTS Account No. 981388205 300 S PROGRESS AVE HARRISBURG PA 17109 Please refer to this billing account number oosat when calling or making payments. 818 Billing Date: JULY 21,2014 Due Date: AUGUST 08,2014 QUESTIONS? CALL US: HENRY J SCHOLZ 227 12TH ST Automated Billing and Payment Information 1-800-550-7716 NEW CUMBERLAND PA 17070-1608 Available 7 days a week Claim Service 1-80.0-252-4633 Policy Questions or Change of Address (717) 657-3141 To view or pay your bill online visit mytravelers.com Visit trvon' esource.com today to learn more about insurance-, Ever wonder about your insurance... What protection do I need? What drives the costs? How can I prevent losses? Visit trvonesource.com to view short videos on these and other topics. Policy Payment Information Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Homeowners 981388205 633 1 07/08/14 to 07/08/15 $66.50 $731 .50 227 12TH ST Service Charge This Month $5.00 $5.00 Total ' $71.50 $736.50 Please read important information on reverse side. Please detach and mail the lower portion of this bill with your payment in the enclosed envelope to TRAVELERS,PO BOX 660307, DALLAS,TX 75266-0307. Thank you. Homeowners TRAVELERS) Account Bill ALAN HOSTETLER AGTS Account No. 981388205 300 S PROGRESS AVE HARRISBURG PA 17109 Please refer to this billing account number 01989 when calling or making payments. 818 Billing Date: AUGUST 19,2014 Due Date: SEPTEMBER 08,2014 QUESTIONS? CALL US: HENRY J SCHOLZ 227 12TH ST Automated Billing and Payment Information 1-800-550-7716 NEW CUMBERLAND PA 17070-1608 Available 7 days a week Claim service 1-800-252-4633 Policy Questions or Change of Address (717)657-3141 To view or pay your bill online visit mytravelers.com Visit trvonesource.com today to learn more about insurance Ever wonder about your insurance... What protection do I need? What drives the costs? How can I prevent losses? Visit trvonesource.com to view short videos on these and other topics. Policy Payment Information Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Homeowners 981388205 633 1 07/08/14 to 07/08/15 $66.50 $665.00 227 12TH ST Service Charge This Month $5.00 $5.00 Total (171.50 $670.00: Please read important information on reverse side. Please detach and mail the lower, portion of this bill with your payment in the enclosed envelope to TRAVELERS,PO BOX 660307,DALLAS,TX 75266-0307. Thank you. ice► Homeowners TRAVELERS Account Bill ALAN HOSTETLER AGTS Account No. 981388205 300 S PROGRESS AVE HARRISBURG PA 17109 Please refer to this billing account number o2tas when calling or making payments. 818 Billing Date: SEPTEMBER 18,2014 Due Date: OCTOBER 08,2014 QUESTIONS? CALL US: HENRY J SCHOLZ 227 12TH ST Automated Billing and Payment Information 1-800-550-7716 NEW CUMBERLAND PA 17070-1608 _ _ Available 7 days a week Claim Service 1-800-252-4633 Policy Questions or Change of Address (717) 657-3141 To view or pay your bill online visit mytravelers.com Visit trvonesource.com today to learn more about insurance Ever wonder about your insurance... What protection do I need? What drives the costs? How can I prevent losses? Visit trvonesource.com to view short videos on these and other topics. Policy Payment Information Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Homeowners 981388205 633 1 07/08/14 to 07/08/15 $66.50 $598.50 227 12TH ST Service Charge This Month $5.00 $5.00 Total ' $71.50 $603.50 CK 5��i3 Please read important information on reverse side. Please detach and mail the lower portion of this bill with your payment in the enclosed envelope to TRAVELERS,PO BOX 660307,DALLAS,TX 75266-0307. Thank you. AM TRAVELERHomeowners Account Bill ALAN HOSTETLER ACTS Account No. 981388205 300 S PROGRESS AVE HARRISBURG PA 17109 Please refer to this billing account number 05825 when calling or making payments. gig Billing Date: OCTOBER 20,2014 Due Date: NOVEMBER 08,2014 QUESTIONS? CALL US: HENRY J SCHOLZ 227 12TH ST Automated Billing and Payment Information 1-800-550-7716 NEW CUMBERLAND PA 17070-1608 Available 7 days a week Claim Service 1-800-252-4633 Policy Questions or Change of Address (717)657-3141 To view or pay your bill online visit mytravelers.com Visit trvones.ource.com today to learn more about*ins u-'rance' Ever wonder about your insurance... What protection do I need? What drives the costs? How can I prevent losses? Visit trvonesource.com to view short videos on these and other topics. Policy Payment Information Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Homeowners 981388205 633 1 07/08/14 to 07/08/15 $66.50 $532.00 227 12TH ST Service Charge This Month $5.00 $5.00 Total $71.50 $537.00 12) '50 Please read important information on reverse side. Please detach and mail the lower portion of this bill With your payment in the enclosed envelope -107. i`flank you. SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM 19 - QUARTERLY TRASH AND SEWER BILLS nL��1 _ :`.c�;�.,.^�..�r,.�.M�enc�sa-:-�a.f��.n.tis:,��^.s�s:anara� -..,..-:aa�,..c:�_. .cn;�px�ti �aa�z•`.0 .1 E =u Py SIP,if 0 67 _5 j_Jj-, .. F:�ti IGi��� ,�d,. fly y� �$ • 6^ _i •• ..j, p 1), deg $ 115.24 .aM 3130?9 5 SC 14 L.1` liep SP 60 $ 115.24 $ 230.48 lima P.sCROLZI Xti OA d ? t _ :i tL 7-w AC.COUNT SUAWMARY (Please keep this portion for your records) Account Number: 56225~66225 Billinq Period Usage Units Service Address: ��712TH8T ' Sewer JAN FEB MAR 3'800 Customer Name: SCHC)[Z. HENRY Trash APR MAY JUN 1 BILL DATE: 511/2014 DUE DATE: 6/1/2014 IF PAID ON OR BEFORE DUE DATE IF PAID AFTER DUE DATE BAL FWD $0.00 BAL FWD $0.00 Sewer 76.64 Sewer $80.47 Trash 38.60 Trash $40.53 TOTAL DUE $1 5.24 TOTAL DOE $121.00 Make check payable to: New Cumberland Borough 1120 Market Street, PO Box 220, New Cumberland PA 17070 Payment Drop Box: Located next to the main entrance of the Borough Office.Payments placed in the drop box after 4:30 PM will not be credited until the next business day. Sewer/Trash Payments: All payments are due by 4:30 PM on the due date. Payments received after that date are considered late and are subject to a 5%penalty.This-includes the drop box payments-and U.S. Mail postmarked after the due date. Non-sufficient Funds: A fee of$20.00 will be charged for checks returned due to insufficient funds. Delinquent Charges: A civil claim will be filed and additional costs,fees and charges will be assessed if account is not paid within 90 days of due date. Questions: If you have any questions,please contact our office at(717)774-0404. Our office hours are Monday through Friday,8:30 AM to 4:30 PM.This office is closed on Saturday,Sunday and E-mail:info@newcumberiandborough.com aoemaMossaqas mn �C�����T ��������� (Please keep this portion for your records) Account Number: 56225-68225 Billing Period Usage Units Service Address: 22712TH8T Sewer APR MAY JUN 1.400 Customer Name: SCHOLZ. HENRY Trash JUL AUG SEPTLBILL DATE: 8/1/2014 1 . DATE: 9/1/2014 � IF PAID ON OR BEFORE DUE DATE IF PAID AFTER DUE DATE ' BAL FWD $0.00 BAL FWD $0.00 Sewer 7664 Sewer $80.47 Trash 38.60 Trash $40.53 TOTAL DUE 1 U.24 TOTAL DUE $121.00 11 Make check payable to: New Cumberland Borough 1,120 Market Street, PO Box 220, New Cumberland PA 17070 Payment Drop Box: Located next to the main entrance of the Borough bfte. Payments.placed in the drop box after 4:30 PM will not be credited until the next.business day. Sewer/Trash Payments: All payments are due by 4:3G PM on the due date. Payments received after that date are u�� Mail postmarked after the due date. Non-sufficient Funds: Afee of$2O.OUwill b charged for checks returned due to insufficient funds. Delinquent Charges: /\civildoimviUbefi\ndooc|edditiuno|oosts,heuoendchargeuwiUbouoonooedifacuountis not paid within 98 days ofdue date. Questions: |fyou have questions, please contactour offitecd(717)T74-O4O4. Our office hours are | K8ondaythvoughFhduy.8:3DAMhj4:3OPKj.Thiso0uaisdoaedonGatunday, Sundoyand | SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM 20 - GRASS CUTTING SERVICE NEW[J.ttMMA c&N HEl,4w-JBL'4= t;-- tFy -g.smmzmay, P-.'WWtz uzvw ?N", m s: =Wi iT nk &� ol no 3 i 9 a 9 5 6. ,v; +58`99 JAMER-k&em= flAlK AJ F-p- j C4Td Maamk a q LP SB&'- diEwiYJ.E0.H0-'Z i4t P.Emlotz 'floe, !.MM&T,Mnk 190 Ng 614 op ;,jE $ 156.00 $ 104.00 $ 130,00 $ 104.00 $ 130.00 $ 156.00 1 $ 780.00 32( Spy Q 166. 00 Sc 0 L 0 9f 4 �, /$,* YM '711�5- #1 ;14 � cl) ��11 /! �r q/ 00 lo Al/ c dp it ir v, I r o O"K ,y11 ; aqq v SCHEDULE H -ADMINISTRATIVE COSTS LINE ITEM 21 - HOME HEATING OIL 5061, 210.00 . ==-- kiLLARK 8 $ 7$9.22 WT& . k $999.22 • fig . MEN Rf-JFiclarAZ JAMB PAJ>i0LZ' _71M IT zz `dLeA.412 Ao 4+`■ _. a SIM bo Sall Page 1 of 2 Superior Plus - BUDGET STATEMENT Energy Services DUE May 20,2014 Total Amount due $210.00 Budget Statement Statement Date: May 01, 2014 How to contact us: Account Number: 355455 ®Your local service center: Previous Balance: $481.67 SUPERIOR PLUS ENERGY SVC Summary of your account HARRISBURG DIV Current Balance:$999.22 80 SOUTH 40TH STREET HENRY J SCHOLZ HARRISBURG,PA 17111 RE:HENRY J SCHOLZ/227 TWELFTH ST/./NEW CUMBERLAND PA 170701608 TEL:(717)564-1440 DATE REFERENCE DESCRIPTION QTY PRICE AMOUNT FEIN 16-0736353 4/5/2014 551078 HEATING FUEL#2 186.6 3.899 $727.55 (�www.superiorplusenergy.com 4/14/2014 0 PAYMENT M&T—R ($210.00) J% Toll Free 1-888-666-8687 `24 hours a day,7 days a week. To pay by Credit Card or ACH please visit www.superiorplusenergy.com We accept the following credit cards: Discover YOUR BUDGET PLAN 1 VISA Current Budget: $210.00 $�D Mastercard Prior Budget Balance: $0.00 � Non—Budget Charges: $0.00 Billing Inquiries and Disputes Address: \ SUPERIOR PLUS ENERGY SERVICES INC. TOTAL AMOUNT Gj`� ATTN.BILLING DISPUTES, 112 Broad Street DUE NOW: $210.00 Montoursville PA 17754 DvID:0002240993 Reminder: Visit Did you know that Superior Plus Energy Services is also your local propane expert? www.superiorplusenergy.com/disclosures Call today to speak with an Energy Solutions Representative to find out more! Refer for descriptions of fees your friends and we'll reward you all! Up to$500 each per year! surcharges terms and conditions. Visit http://www.superiorplusenergy.com/referral—program to learn how easy it is to claim your rewards! Important Messages:A service charge of 1.5%per month(18%annual percentage rate)will be assessed on all invoice amounts not paid within terms. We appreciate your business! If payment ha= made, please disregard. For Your Records: Payment Amount: ?Z/lp'CD Check#: Date: Sl L5' Page I of 2 Superior Plus BUDGET SETTLEUP Energy Servkes DUE June 20,2014 Total Amount due $789.22 Budget Settleup Statement Date:June 01, 2014 How to contact us: Account Number: 355455 Your local service center: Previous Balance: $999.22 SUPERIOR PLUS ENERGY SVC Summary of your account HARRISBURG DIV HENRY I SCHOLZ Current Balance: $789.22 80 SOUTH 40TH STREET RE:HENRY J SCHOLZ/227 TWELFTH ST/./NEW CUMBERLAND PA 170701608 HARRISBURG,PA 17111 TEL:(717)564-1440 DATE REFERENCE DESCRIPTION QTY PRICE AMOUNT. FEIN 16-0736353 5/19/2014 0 PAYMENT M&T-R ($210.00) www.superiorplusenergy.com Toll Free 1-888-666-8687 k24 hours a day,7 days a week. To pay by Credit Card or ACH please visit www.superiorplusenergy.com We accept the following credit cards: Discoverzmv� IF�.— tl '—�n VISA mcnNe.-w Mastercard Billing Inquiries and Disputes Address: SUPERIOR PLUS ENERGY SERVICES INC. ATTN. BILLING DISPUTES, 112 Broad Street This Our annual Budget Settlement Statement.All Debit balances are due by the 20th. If you have a credit it will be applied to your budget for the coming Montoursville PA 17754 you office.If you have any questions,please do not hesitate to contact your local ice. Thank you for using Superior Plus Energy for all your Heating needs. DvID:0002266204 Reminder. Visit Looking to convert over to propane?We are your local propane expert! Call today www.superiorplusenergy.cotnidisclosures to speak with an Energy Solutions Representative to find but more! Refer your friends for descriptions of fees and We'll reward you all. Up to$500 each per year.Visit http://Www.superiorplusenergy.com/referral-program to learn how easy it is to claim surcharges terms and conditions. your rewards! Important Messages:A service charge of 1.5%per month(18%annual percentage rate)will be assessed on all invoice amounts not paid within terms. We appreciate your busj-vess I If payment has been made, please disry7,rj For Your Records: Payment Amount: Check Date:- SCHEDULE H -ADMINISTRATIVE COSTS LINE ITEM 22 - 227 HOUSE APPRAISAL -ter:-�-a-'-..•:z�.n.� �.... �-�.,'_.� �m� �a� ,. ,`�i°; ..d+n—,F�F:r. bold- 4010 W 'Ba : b 1Y ty pk 9 El n � g �• :- ��` ! y� nom! axr��, S a -a Ft:.' �n E a?sS 9 R• Vo Mark Heckman Real Estate Appraisers 1309 Bridge Street, New Cumberland,PA 17070 File No.227 12th INVOICE File Number:227 12th 07/28/2014 Mr.James Scholz 40 Argali Lane Mechanicsburg,PA 17055 Invoice#: 227 12th Order Date 07/15/2014 Reference/Case#: PO Number: 227 12th Street New Cumberland,PA 17070-1608 Single Family Resid,Appraisal Report $ 400.00 -------------- Invoice Total 400.00 State Sales Tax 9 $ 0.00 Deposit ($ 400.00 Deposit ($ Amount Due $ 0.00 Terms: Thank you for your payment Please Make Check Payable To: Mark Heckman Real Estate Appraisers 1309 Bridge Street New Cumberland,PA 17070 Fed.I.D.#: Thank you for using our services PH(717)774-7202 FAX(717)774-0383 EMAIL heckmanappraisers@comcastnet SCHEDULE H - ADMINISTRATION COST' LINE ITEM 23 - HOME REPAIR ITEMS More sawing. a More drying;" 6000 CARLISLE PIKE, MECH PA 17055 STORE MANAGER TEDD B TERRY(717)795-9602 4120 00010 25402 09/01/14 08:50 AM CASHIER MARTHA - MJU349 073088141026 TOILET SEAT <A> 17.48 STA-TITE WHT PLASTIC RND TOILET SEAT MAX REFUND VALUE $15.73 732291231619 GB DUAL FLUS <A> 98.00 GLAC BAY WHT DUALFLSH TOILET 2PC MAX REFUND VALUE $88.20 648846002613 FILT 10-14GA <A> 13.98 SHOPVAC/GENIE 10714GAL BAG FLTRS MAX REFUND VALUE $12.58 648846002583 3 DRY FILTS <A> 5.58 SHOPVAC/GENIE REUSABLE FILTERS 3PK MAX REFUND VALUE $5.02 648846002576 FOAM SLEEVE <A> 4.78 SHOPVAC/GENIE FOAM FILTER SLEEVE MAX REFUND VALUE $4.30 080776118697 ECOFLOW CH <A> 12.75 E/0 DELTA ECOFLOW SHOWERHEAD CH MAX REFUND VALUE $11.48 078477564967 GFCI <A> 15A IVORY NYLON DUPLEX GFCI OUTLET 2512.58 25.16 MAX REFUND VALUE $22.64/2 697285605749 ANGLE STOP <A> 9.72 1/2"X3/8"OD SHARKBITE ANGLE STOP LF MAX REFUND VALUE $8.75 032888002906 SUPPLY LINE <A> 7.98 3/8"ODX7/8"BCX20" BRAID TLT SUP LINE MAX REFUND VALUE $7.18 749306818017 TOILET KIT <A> 10.96 KORKY OUIETFILL FILL VALVE & FLAPPER MAX REFUND VALUE $9.87 078477151259 WALL PLATE <A> 1.18 JUMBO-1 GANG 1 TOGG-IVORY MAX REFUND VALUE $1.06 ---Mover 10% off, Max $200--------- 207 57 10% off, Max $200 -20.76 MUST RETURN ALL ITEMS FOR A FULL REFUND ------------------- SUBTOTAL 186.81 SALES TAX 11.21 9 .XXXXXXXXXXXX3889 MASTERCARD $198.02 AUTH CODE 07318Z/5103643 TA IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiillillllllll IIIIIIII 4120 10 25402 09/01/2014 4509 RETURN POLICY DEFINITIONS POLICY ID DAYS POLICY EXPIRES ON A 1 90 11/30/2014 THE HOME DEPOT RESERVES THE RIGHT TO LIMIT / DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN IN STORES FOR DETAILS. SCHEDULE H -ADMINISTRATIVE COSTS LINE ITEM 24- 227 ROOF AND GUTTER REPLACEMENT -°r'F' ��.-x.:;�a -. .. �,°+��-°0�...+.t�nr>•^as'�at��r:Ya�r;°.:asr-: ;�.. e - ... _H �-.;. a..ast..,,,e.T� bae. �+y.0,. le ,gyp $iS w ° _ 9�"t �°; SO 4 G akin � `Ailt frl� 2 5;s 6 �: .tea+'°-".�'��w,,:mas :.�� _ :3-�vs�.-��r��:>,�:.>;s;,,,a.sa�crr�a*.s.�r�.'.x'sr�:'ti,�rr. ..:'•.x�n.-�a-���i1 �arRz.sacr'&Es.mom. `�+'Y`r'A6Cii5 i ��g -�•i>�r —.•1�>���'��.°ti5 iv'`t��ie�� s{..�°i���i-��- a� �s'*�a°at� - 4 3 F X'.e d-.t}i"tom • � �� �� �yy�j..�vwr n ERIfS m .y Mi r r Centu�ipb"u`ti�ng.C . 2447oSouth Market Street • za-bethtown, Pa 17022 J0p# 1275.6.6 367;6693 653-2000 533 4186 CUSP ID 411920 '� . Invoice Date /18/2014 DuelDate 4128/2014 Jim Scholz 40 Argali Ln Mechanicsburg PA 17055- Please detach and return portion above dotted line. Net:10 days 1.5%after 30 days RE: Supply and Install Gutter and Roof as per contract: $9,421.699 Deposit $0.00 Sub Total _ $9,421.69 Tax $0.00 Total Due Invoice Notes: f,,�d Please Call to pay by MasterCard Visa or Discover Gtr $7,585.00 Contract to supply and install roofing and spouting r I i Extra- $1,191.69-Removed 2nd Layer Roofing,21 2/3sq $110.00-Removed 3rd Layer Roofing,2sq $390.00 Remove and Reinstall siding to replace existing flashings, 6 1/2 Man Hours $120.00-Replace wood on roof deck and renail remaining,2 Man Hours $25.00 - I Sheet 1/2" 4ply CDX $1,836.69 Total Extras $9,421.69 Total Due Century Spouting Co:, Inc: 'ThuurrsdaySeptern_, ber 18,,2014:. u �Page-10o611 ..r .... SCHEDULE H -ADMINISTRATIVE COSTS LINE ITEM 25 - Recorder of Original Deed r P.9 ;'�_ F ' '&X, Waw b:.aiL 1_1 �a- i' E'-t:rre-`a,:. mm,T-mmm # L _ - '.E%e:��rQaa`tiiErj, [;ali- 4i""�,��"i' .c r'.: •. �- CUMBERLAND COUNTY RECORDER OF-DEEDS 'RECEIPT Inv Number: 171646 Invoice Date: 11104/2014 10:52:56 AM RECEIPT Reg/Drw ID: 0301 Customer: Last Change: Receipt By:COUNTER By: KW JAMES SCHOLZ 40 ARGALT LN MECHANICSBURG,PA 17055 Chg# Charge/Payment/Fee Description Amount Inst#/Inst Date Municipality 1 DEED $231.00 201425423 NEW CUMBERLAND Grantor-HILL,ELIZA J 11/0411410:53:11 AM BOROUGH-2ND Grantee-SCHOLZ,HENRY J Total Pages:5 WARD Consideration- $7,500.00 Tax Basis- $7,500.00 Return.Via-MAIL PARCEL IDENTIFICATION NUMBER 26-23-0541-243- _ Fee Detail: AFFORDABLE HOUSING FEE $11.50 COUNTY RECORDING FEE $11.50 IMPROVEMENT rEE-COUNTY $2.00 IMPROVEMENT FEE-RECORDER $3.00 JCS/ATJ/CJEA FEE $35.50 PARCELS FEE $15.00 STATEMENT OF VALUE FEE $1.00 STATE REALTY TAX $75.00 STATE WRIT FEE $0.50 MUNICIPAL TAX-NEW CUMBERLAND $1.00 NEW CUMBERLAND2 MUNICIPAL REALTY TAX FEE $37.50 SCHOOL DISTRICT REALTY TAX - $37.50 TOTAL CHARGES $231.00 PAYMENTS CHECK: 1006 $230.00 TOTAL PAYMENTS $230.00 AMOUNT DUE $231.00 PAYMENT ON INVOICE '($230.00) BALANCE DUE $1.00 UNDERPAYMENT DUE COUNTY ($1.00) Date:Nov 4,2014 10:54:13 AM Page 1 SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM 26- 2006 FORD TAURUS TITLE TRANSFER .—tom:m:...�.;�_.;a. ._...,::�?-�.:�:�. .�.s���....=..-,�+?.�"��-.�. ,_,•,,,_-:>_...—•,-s...�.,... •�t.�;::.�-r,��?-..�-»- -,�,"'?' JAMES P. SCHOLZ � ELAINE B. SCHOLZ 3199 44ARGALiLANE MECHANICSBURG,PA 11055 ;j Pay to the Order br—, *!; Ileu7SVLVANIA arATe CfjPL£3YM'GRED1T UN10f t F,p _ -PSE1 ....FtkF3R SSIJFIG.PA 17110 910 �* 23138 11161: 04SCI L.ts13S3 20, 3 L99 ,'000D0056 s #III4IIIliIIIIIIIII �IIIIIIIIIIIIIIIIIIIIIIIIIIIIlillllllll 'z 0B 010-1 to rn:m �t CUSTOMER #: 1019 914 170333 L , 13 , SMITH UNIT# 6 *INVOICE* LINCOLN JIM SCHOLZ 1100 MARKET ST LEMOYNE, PA 17043 40 ARGALI LN (717) 761-6700 (800) 422-3673 www.lbsmithford.com MECHANICSBURG, PA 17050 PAGE 2 HOME: 576-9160 CONT:576-9160 BUS : CELL: SERVICE ADVISOR: 213 RUSSELL GIBBONS ..........:.. Oa. OH YEAH. GREEN ".06 .FORD TAURUS 1FAFP56U66A243415 DGZ1477 30849/30849 T972 ..... . EL :15'A7ES`<: ::PRki>aJ: TE t111i4.R `EX : PRO ED:;3 >. : >: O..NO,..;>::>::'..;:::: : RATEs;:>::>:: ?:::>:>'F?A' M NT' c::`?:<:::> Ifil 'bA. E: >; .:........................................A................. ..,.......R..........:.....:..........1VItS..................................P.........................:......................................Y....6...................:....................fi.:........... ....................................................................................................................................................................................................................................................................... 18MAROG D 03MAR06 1 14 : 00 02SEP14 93 . 00 CASH 02SEP14 0,.::0..:ENt .:. ta.aY.:.:::::::::.::;:::: OPTIONS: ENG:3 . 0 LITER EFI 05 :28 02SEP14 13 : 03 02SEP14 LINE 0PCODE TECH TYPE HOURS LIST NET TOTAL AT THIS TIME. 255 CP O . QO 0 . 00 0. 00 PARTS : 0 . 00 LABOR: 0 . 00 OTHER: 0 . 00 TOTAL LINE E: 0 . 00 30849 COMPLETED **************************************************** II ....... F i I II C I I { '.I 1 P, WARRANTY DISCLAIMER: ALL PARTS A 5 AND ACCESSORIES ARE SOLD AND ALL REPAIRS ARE DEALERSHIP AS-IS. THE DEALERSHIP HEREBY EXPRESSLY DISCLAIMS ALL SERVICE DEPT. ........................................ . .................................... WARRANTIES, EXPRESS AND —I17PLIED, INCLUDING ANY IMPLIED WARRANTIES OF HOURS LABOR AMOUNT 59. 90 MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE, AND NEITHER ASSUMES NOR AUTHORIZES ANY OTHER PERSON TO ASSUME FOR IT ANY LIABILITY IN CONNECTION WITH THE MON-FRI PARTS AMOUNT 0. 00 SALE OF PARTS OR PRODUCTS OR THE REPAIR. THE ONLY WARRANTIES ON PARTS AND ACCESSORIES OR REPAIRS ARE THOSE WHICH MAY BE OFFERED BY THE MANUFACTURER OR THE 7:30AM TO 6PM GAS,OIL,LUBE 0 , 00 ORIGINAL IABLE FOR PERFORMANCE UNDER OR NSUCHLWARRANTIES.CUSTOMER SHALL NOT BEY SUCH MANUFACTURER OR R SHALL BE LENTITLED TO SAT SUBLET AMOUNT 0 , 00 RECOVER FROM THE DEALERSHIP ANY CONSEQUENTIAL DAMAGES, DAMAGES TO PROPERTY, $AM TO 4PM MISC. CHARGES " Q, Q Q DAMAGES FOR LOSS OF USE, LOSS OF TIME, LOSS OF PROFIT OR INCOME, OR ANY OTHER INCIDENTAL DAMAGES. TOTAL CHARGES 59. 9 0 By signing below, you acknowledge that you were notified of and authorized the ALL PARTS ARE NEW Dealership to perform the services/repairs itemized in this Invoice and that you received UNLESS OTHERWISE LESS INSURANCE 0 . 00 (or had the opportunity to inspect)any replaced parts as requested by you.The vehicle INDICATED. ret is I urned to you in exchan a for our payment of the Amount Due. SALES TAX 3 .59 DATE CUSTOMER SIGNATURE AUTHORIZED DEALERSHIP REPRESENTATIVE SIGNATURE PLEASE PAY THIS AMOUNT De_RAP,©2006 ADP 103/091 SERVICE INVOICE TYPE 2-2S12C-"AS-IS"-PENNSYLVANIA L U 5-1-OMER COPY CUSTOMER #: 1019914 170333 L ■ B a . S M I T H UNIT# 6 I.NVOICE �`� M LINCOLN * * f JIM SCHOLZ 1100 MARKET$T LEMOYNE, PA 17043 40 ARGALI' LN (717) 761-6700 ($00)422-3673 www.lbsmithford.com MECHANICSBURG, PA 17050 PAGE 1 HOME:576-9160 CONT:576-9160 BUS: CELL: SERVICE ADVISOR: 213 RUSSELL GIBBONS . .. ......._.........................................._.......... . ........ ......._ . ........:.:::...::::::::.::.::..:;?��.........:::::::::.: :.::..L1G�ffS� GREEN 06 FORD TAURUS IFAFP56U66A243415 DGZ1477 30849/30849 T972 ..................,�....�.......................................���..... ..... .. ..:.:.:..:.....8O .S�tJ............... .............Pa. . .,...................... 3k7 ...............1y�. E1�f3'.>:.;:::::.;:;�::.::::(.t�.:::: .?: ;c:>.;::::::.:: 18MAR06 DII03MAR061 1 14: 00 02SEP14 93 . 00 CASH 02SEP14 > ..:.:.........:O.tEN.t t}.:. :::.: OPTIONS: ENG:3 . 0 LITER EFI 05 :28 02SEP14 113 : 03 02SEP14 i LINE OPCODE TECH TYPE HOURS LIST NET 'TOTAL A`_COMPL'ETE STATE INSPECTION 03 COMPLETE STATE INSPECTION 255 CP 0 .30 19. 95 19. 95 PARTS: 0. 00 LABOR: 19. 95 OTHER: 0.00 TOTAL LINE A: 19. 95 30849 completed EMISSION TEST � 'B COMPLETE � � 22 COMPLETE EMISSION ION TIEST,1�r it � +! 255 CP 0 5� I�;; ;� �� SIF i I t € ! }� {'t ('y (}j'� yC + ' ,, 4 1) I' �,, 3 9. 9 5 3 9- 95 PARTS: �/. V L7 LABOR ii. i '" 1' l l� f c�, f I �i i r1,1 'iil,€ ir�l� it1 39i �95R ( OTEII I !;,I 5 ;OT300,1 I�TO,I'AtFL LINE B: 39. 95 30849 COMPELTED � I *47rkN. �r'*SSR**ik*Ircyyr C CHECK RADIO VOLUME IS INT INOP t.; `..,: w "' ,;. �. _..a.. F..., MISC COULD NOT DUPLICATE ">!":`a' r! s�; ;'r_. ,r>j. '_V, 255 CP 0 . 00 0, 00 '0, 00 PARTS: 0. 00 LABOR: 0.00 OTHER: 0 .00 TOTAL LINE C: 0. 00 30.849 COULD NOT VERIFY ISSUE D COMPLIMENTARY CAR WASH 29 COMPLIMENTARY CAR WASH 255 CP 0. 00 '` 0. 00 0. 00 PARTS: 0. 00 LABOR: 0.00 OTHER 0 . 00 TOTAL LINE D: 0. 00 30849 COMPLETED E COMPLETED MULTI-POINT INSPECTION REPORT '-CARD- 40 99P COMPLETED MULTI-POINT INSPECTION REPORT CARD- 40 255 CP 0.30 n :` _ ': is :: :; 0 . 00 0. 00 GBATT BATTERY CHECKS G06'I5' 255 CP 0 . 00 0. 00 0. 00 GBK BRAKE LINING WEAR CHECKED. BRAKES WEARING OK AT THIS TIME 255 CP 0. 00 0. 00 0. 00 GTIRE TIRE TREAD WEAR CHECKED. TIRES WEARING -OK . WARRANTY DISCLAIMER: ALL PARTS, RSHIP AS-I' WARRANTIES, EXPRESS AND MERCHANTABILITY AND FITNESS FOF IMPORTANT AMOUNT . AUTHORIZES ANY OTHER PERSON TO. AMOUNT SALE OF PARTS OR PRODUCTS OR•. ACCESSORIES OR REPAIRS ARE THOSE ORIGINAL PARTS DISTRIBUTOR AND( O1L,LUBE LIABLE FOR PERFORMANCE UNDER SU You may receive a survey from Ford Motor vT AMOUNT RECOVER FROM THE DEALERSHIP A DAMAGES FOR LOSS OF USE, LOSS --_INCIDENTAL DAMAGES. Company shortly. Your Complete Satisfaction is our CHARGES By signing below, you acknowle CHARGES Dealership to perform the services/ goal. If for any reason you cannot give.us an NsuRANCE (or had the opportunity to inspect) is bE returned to you in a chane DATE "Excellent Rating" please contact your service )TAX CUSTOMER SIGN4 • SE Y ancena before mailing thesurvey.Steve V 'AMOUNT Tman L.B. Smith Ford Lincoln 717-761-6700. Dea eI YCAP @2006 ADP(03/09) SERVICE n. COPY SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM 28 -Estate Notice advertisement. JAMEt P SCHOLZ FXEGUTOR i�5+kiiLvY_i Lti_ p{j Jj st�cti�` .� 0.1 Ct4hNIIC"'cC+lAa,E,PA 17US FY �� _w�:� �1+►"� ��1. --.. �� :°"�17Ati.A._'41,_ ._tom ;may: +paras aac� V�.p*.'Cl34302g5St: 96SE,2 i5 46ii'was LMV 5 CUMBERLAND LAW JOURNAL'.-01/80/15.. Executor: Thomas A. Owen, 30 Attorneys: Bradley L. Griffie, Es- Herlihy Drive,Mahwah,NJ 07430. quire,Griffie&Associates. Attorney: Scott W. Morrison, Es- quire,6 West Main Street,P.O.Box Wayne,Wallace L.,deed. 232,New Bloomfield,PA 17068. Late of Hampden Township. Executrix:Michele L.Bricker. Powless,Winifred,deed. Attorneys: David M. Watts, Jr., Late of South Middleton Township. Esquire,McNees Wallace&Nurick Executor:Todd Powless c/o Robert LLC, 100 Pine Street, P.O. Box G.Frey,Esquire,5 South Hanover 1166,Harrisburg,PA 17108-1166, Street,Carlisle,PA 17013. (717)232-8000. Attorneys:Frey and Tiley. Schuster,Eugene N.,deed. Witmer,Nancy J.,deed. Late of North Middleton Township. Late of Lower Mifflin Township. Executrix: Monteen C. Bard c/o Executor:John C.Cooke c/o Rob- Martson Law Offices,10 East High ert G.Frey,Esquire,5 South Han- Street,Carlisle,PA 17013. over Street,Carlisle,PA 17013. Attorneys: Hubert X. Gilroy, Es- Attorneys:Frey and Tiley. quire,Martson Law Offices. ..THIRD PUBLICATIflN.—T Schweitzer,Lois A.,deed. Claba h Edward J.a/k/a Edward Late of the Township of Upper Al- � len. James Ciabaugh,deed. Executor:Karl M. Schweitzer. Late of Monroe Township. Attorneys: Jessica F. Greene,Es- Co-Executors: Edward J. Cla- quire, Keystone Elder Law P.C., Baugh,Jr.and Molly A.Hoch c/o 555 Gettysburg Pike,Suite C-100, Charles E. Shields,III,Esquire,6 Mechanicsburg, PA 17055, (717) Clouser Rd., Mechanicsburg, PA 697-3223, 17055. Attorney: Charles E. Shields, III, Snyder,Ethel I.,dec'd. Esquire,6 Clouser Rd.,Mechanics- Late of West Pennsboro Township. burg,PA 17055. Co-Executrices: Doris M. Laugh- man and Sharon S. Bitner c/o pecker,Mildred M.,deed. Roger B.Irwin,Esquire,354 Alex- Late of Cumberland County. ander Spring Road,Suite.1, Car- Executrices:Phyllis A.Lindsay and lisle,PA 17015. Susan R.Decker. Attorneys:Salzmann Hughes,P.C. Attorneys: Michael A. Scherer, Stambaugh,Kathryn G.,deed. Esquire, Baric Scherer LLC, 19 Late of Carlisle. West South Street, Carlisle, PA Executors:Stanley Stambaugh 17013,(717)249-6873. and Craig Stambaugh. Attorney: Richard G. Scheib, Es- Hinkley,Sherman R.,dec'd. quire,4813 Jonestown Road,Suite Late of Cumberland County. 102,Harrisburg,PA 17109. Administratrix: Monica Gail de- Mariano. Stevens,Marlin L.,deed. Attorney:Debra K.Wallet,Esquire, Late of Monroe Township. 24 North 32nd Street,Camp Hill, Executrix: Lisa M. Stevens c/o PA 17011. Bradley L. Griffie,Esquire,Griffie &Associates,200 North Hanover Kauffman,Dorothy 0.,deed. Street,Carlisle,PA 17013. Late of Mechanicsburg Borough. 12 L)UV 5 CUMBERLAND LAW JOURNAL A 01/30/15* Executor:Robert M.Knoble. Attorneys: Joel R. Zullinger, Es- Attorneys: William C. Dissinger, quire, Zullinger—Davis, P.C., 14 Esquire, Dissinger & Dissinger, North Main Street, Suite 200, 400 South State Road,Marysville, Chambersburg,PA 17201. PA 17053,(717)957-3474. Scholz,Henry J.,dec'd. Martin,Jerome,deed. Late of New Cumberland enough. Late of Cumberland County. Executor:James P.Scholz. Executrix:Shirley E.Kirkessner. Attorney: Robert T. Balaban, Es- Attorneys: Michael A. Scherer, quire, 27 N. Front Street,Harris- Esquire, Baric Scherer LLC, 19 burg,PA 17101,(717)920-9565. West South Street, Carlisle, PA 17013,(717)249-6873. Wagonhurst, D'Arcy C. a/k/a D'Arcy Charney Wagonhurst, Myers,Richard E.,deed. decd. Late of Carlisle Borough. Late of Silver Spring Township. Executor:Edward J.Mezewski. Executor:Douglas Theodore Char- Attorney: Joanne Marino Mc- ney,78 Fox Fire Lane,Lewisberry, Greevy, Esquire, 137 S. West PA 17339. Street,Carlisle,PA 17013. Attorneys: David H. Stone, Es- Orris, Margery L. a/k/a Margery quire,Stone LaFaver&Shekletski, P.O.Box E,New Cumberland,PA Louise Orris,deed. 17070. Late of Lower Allen Township. Executor: Frederick L. Orris c/o Wolf,Rodney F.,decd. Charles E. Shields,III,Esquire,6 Late of Carlisle Borough. Clouser Rd., Mechanicsburg, PA Executrix:Asonia Wolf c/o Robert 17055. Attorney: Charles E. Shields, III, G.Frey,Esquire,5 South Hanover Esquire,6 Clouser Rd.,Mechanics- Street,Carlisle,PA 17013. burg,PA 17055. Attorneys:Frey and Tiley. Paxton,Robert E.,deed. CORPORATE NOTICE Late of South Middleton Township. Executrix: Tammy J. Kuhn c/o NOTICE IS HEREBY GIVEN that Martson Law Offices,10 East High Articles of Incorporation were filed Street,Carlisle,PA 17013. with the Department of State of the Attorneys: Hubert X. Gilroy, Es- Commonwealth of Pennsylvania, at quire,Martson Law Offices. Harrisburg, PA,effective January 9, 2015,for: Rasp,Charles R.,deed. MTG HOMES INC. Late of Newville. 1604 Wyndham Road, Camp Hill, Executrix:Audrey M.Sebum,104 PA 17011. Windrush Lane, Mechanicsburg, The corporation has been incor- PA 17055. porated under the provisions of the Attorney: Wayne F. Shade, Es- Business Corporation Law of 1988, quire, 53 West Pomfret Street, as amended. Carlisle,PA 17013. Jan.30 Reese,Genevieve R.,deed. NOTICE Late of Hopewell Township. Executor: Timothy S. Reese, 55 Hassinger Road, Newburg, PA NOTICE IS HEREBY GIVEN that 17240. Articles of Incorporation were filed on 13 SCHEDULE H - ADMINISTRATIVE COSTS LINE ITEM 29 -Estate Notice Advertisement. JAMES P S+ 1 OL7, PW_:CU 0;.R �;�EC#ri+k4iit'_.` 3r�1"i,Fly I G•t P j �' 11 alb �:•����.-e'er ��.1� � ��,'��� ' � _ .. . .. _ ,� N,. _,- The Paxton Herald,January 28,2015,Page 7,Section 1 LEGAL NOTICES LEGAL SERVICES . PUBNOT'CE LIC HEARING ESTATE NOTICE ESTATE NOTICE WEST HANOVER NOTICE IS estame GIVEN Esase,l late Susc Ron", CHARLES E•. PETRIE TOWNSHIP that Letters Testaments N 'ftta.tl,Isla of Gloria A.Rohon- Iho Estate of Ann J. na7Ownshlp,Oauphfn County, Krushinskl AKA Ann E Penns 11. HEARING BOARD Krushlnskl AKA Ann Lebers of Administration on s Notle t is hereby ggIvan that Krushinski AKA Anna J. said asuae having been Attorney al L.BW Installment the West Hanov.rTownsht Krusldnsid lata of Harrisburg, ed to Judith Ballots alT per- Evening r Zoning Hearing Board wiP. PennsylvanW(died December sons Indebted to sa(re.' O Appointments 3528 Brisban St.,Hbg Payments hold O public h°erin99 on 8,201)haw°been medic are requested to make pay Acceptable Th�ay February 12,2%,at the un herslgned.All persons recut,told those hating claims AVailable 561-1939- p 6:30 PM in the Municipal having.farms agafnsl said Fs- against Bald estpte aro ro- INITiAL fONSULTATION FREE Baildingat 7,7,All.nla t tate ora requested to make quested to present tiro same, Bwd.,Nartishurg,PA 77772 to such claims known to the un• lvtlhout delay,to oils.the 1.11-A demgto I�da�°� A^�woF'a" 5o FULL RANGE OF FAMILY LEGAL SERYItES "2°'S•D3,°la^^° •°r¢"°'• ower.Requesting wrianees questetl to make payment tAAT•IIiEW L pWENS.ESO. to Seclfon 19550 195.57 vnthoul detay to: 25951nterstata Drive,Sufto tot •No-FaWi Dirome_Slarfing at$700(mbbg Qq reel BANKRUPTCY 52;195-53,195-94.195-0597o Executor. HarrMburg,PAt7"o WILL •Chapter7,13._..__. __.S!atGng 11151200.00 construct a single family Joseph F.KrushinaM Or to: fl,-0„g located M K Fatrvitie 264 Aquta Crock Roatl Judith Ballets .•Husband&Wild�..._._.....___.._..._._..5150.00 i»I�kzO Aw,Harrisbu, PA 17112,tax 6legorq VA 2854 14 Birchwood Drive •HMWHospOal Vi5I1._.........__....._........._575.00 'Child Support Hearirg____.__slarfing at 5250.00 parcel 1168-°2 wit In the BE . Crto: Harrisburg,PA 17109 •Probe' FslateS.._.._....(FoeNbe detami •TBe Search__._-r...._.__....__.__.._--5250A0 iBusin¢ss Enterprise)zoning Aromey:Sean E Lederer, ts,,®,z� Id'B h dismct. FsgNre •Pomxol AKamep.._.......,,„......._._._.„._575.00 'Name Changes.........____.._.„._._..__.5450.00 Copies of the apPlicatfon 5011 Ltxust lone NOTICE OF SALE DEWS&BUSINESS LEGALSERVICES IRIMIt amp0ofmcost.o2mll and the west ManOverTmw. ' Hartiaburg;+PA'I7f09 .ytpdpg ,•,•___._.......-._._.....5 a1575LLW shift Ordinances am awil.bte a+,,aa a• OF STORED Juvenile Delouse,Protection from Abuse&DUI A-t far{rnspenion during lxrslness ITEMS •Custody Order by Agreement...._.Slatting at c65D.00 hoursatthe Muntnp.Build• ESTATE NOTICE AUCTIONN7RCE: E-amilladdress:PetrfttewCaolcom prldgrcnamrat Ing. - NOTICEISHEREBYGIVEN Rt.22 Stor-All,local ad al Serving Panmylvanb ler nromiFpn 30 years Nle en 4st,det e,}eny,Kt lmptegM O!br5rin.pq•rtd 88vv onler ol; I hat ichors of administration 6740 Allentown Blvd.,Harris• ne�^'ryr'°`�' Wass HanovnTownshlp have been grenrad to the f°I• burg,PA 17112.Is the ovmeroi MASTER CARD AND VISA PAYMENTS ACCEPTED FOR LEGAL SERVICES zvnhig Hearing Board- t 1 DaNel Rosario Ia"b"' to e.An cersans in- °se f-service facility,which Piam,kg AdmMist r ' tlOMetl to the saltl Estate are has been Maned to: mqulmd to mako payment, Name UnRP cold th_Ie fin c1i,, Orfs nyder CORPORATE mends to Present the samep°ntenis In the 1°esed without delay to the Adminis• a c.(s)will m sore to satiny NOTICE tretor/Attomeynamed below. the owner-s II¢n far unpold +•^"`"•""" NOTICE IS HEREBY GIVEN Estate at Lintla M.DeFrank, remaiTho seta will be beta by ,�•^-. '•`� CRIMINAL DEFENSE mat Arudea of m.e oreuo. ,ate of Dauphin Counts,PA, vrenv.sloragebaltles.eom on '-1 CaTlIl9l \, have been s of I with the Da- Dred: November 8, 2014; February tq 2015 '� State or Federal-Felony p.nm¢ntcf5tateoftheCom- Atlminlatrator:Stephen M: &!_-1 DeFran A �-� Misderiteanor•Summafy momv¢allh°f to of at �d ey EiquIre ESTATE NOTICE e�.,,,ct3,P.c Firearm Violation•Homicide Har isburg,Pennsylvanla,Tor DA CIE ZUCKER ME 8-NI& I^^ •"'•"'s the IT se of Incorporating MMF3I,LLC NOTICE IS HERESY GIVEN A Full Service law Firm sr�- Probation&Parole Violation the below named domestic 635 COT Saeot,5ulte101 that Lettere Testamentary In Traffic-Theft-Sex Offenses business.orpomtlOn ph ppj7p43 the Estate of Helen w1'om'scaringilmvc°m-,/ suanttothe provisions of the Updegqrroovve,deceased,lata or ••+•,n..,;,_..,...-.---' Drug Offenses-Pardons Business corpOrMion Law of the Tovmship m Lower Assault•Burglary 1988,asamendcd. STATE NOTICE swamis,Coanry°f Do hln r i Ex un ements•DUII.:n°"a"° °orPo an NOTICE IS HEREBY GIVEN end Commonwealth o1 Penn• FREE p g Oudkted Medical Clinics syNanto,having been granted �.. [/F� of Pennsyhania,P.C. that Letters Testamentary In to the undersigned•alt per- f!•w =_COM1SOItatlOn_ John M. n,El the Ellet.ct HenryJ.Scholz, sons Indebted to sold estate �.,, ---. •FAMILY'LAW STEv"E°i�s&LE` deceased,late o}New Cum- aro mqu..led t°make Imine- .�r,•' , ,_ 620 Freedom Business Center beriand Borough,Pennsylva- date ppayment and those haw- f, S,5 :n nis,have been grented to tiro Ing claims will present them I. i' �w telephone Divorce•'l:u5tpdy•$Uppprt Kine a Prussia,PA 19406 undersiggned.ASI persons in- forpayr,nmtto: —'Cdtls6ltatiaal Alimony•PFA's•Adoption debred to said Estato am re• Baroam Campben,Co-Erceaddx -y0r =z,., Settiemelits•Litigation quested t°make Immediate 724 Cn Avenue "` ESTATE NOTICE paym ant and those Im 1.8 tAitldlMam,PA 1705'/ ,�-- "'r•'- NOTICE IS HEREBY GIVEN claims Or demands to present And to: i',hVr>SAJ WW.W.scarin9iI8W.COrn; ' gw,e},�Testamenbry,have De-y oto: settlement without Debra a-Cof,exutrh - been granted in the Estate of 111 Lakesltle Odw Robert B.Maein re Onner Prosecretar.Op¢r22 erie»ce Mlldrgd K.Macomber aka xeeutar:James P.Scholz MiddlMmm,PA 17057 �— •� Mntlred Mae Macomber,lore al RobMT..Bafabao Es^Oq I°ye Or toe - HARRISBURG OFFICE: Lower Paxton Township, 27H.FroM street Jamas H.Tumer•Fs irt3 NEWPORT OFFICE: CARLISLE OFFICE: DauphinCounty,Pennsylw- Malls PA 17101 TURNER AND o•cbNr�ELL •2000 Linglestown Rd., nis,who died onNwember "7j;92gg , a7atNOMFmntStreet On The Square, Suite 106,Hb PA 17110 20NNanovBrSt, n,2m4.toExecutor: Hanlsburg*PA 77170 14 S.2nd Street g•' Suite 201 , James R.Glppinger "•'�•' can Call(717)657-7770 or Carlisle,PA 17013 3631 NOM F Ont Sbect ESTATE NOTICE 7t 567-0380 1.877-LAW-2555(To6 Free) p17)960-0074 Hardsburg PA17110 NOTICE IS HEREBY GIVEN ESTATE NOTICE ( » sale epstat.are rctudf ed to that Lett..7astament.ry on' NOTICE IS HEREBY GIVEN q the Estate o/DorothyY S.Wn- that Letters Testamentary In - maks ppaayymmell and those haw- holm,died October e,2°74), the Estate of Doris Elaine Ing calms almso Sarno demands to Tate of�auphin County,P.m,- Holmes,late of SlvataraTown- ESTATE NOTICE ESTATE�NOTICE ESTATE NOTICE � totheFxecutororhisrd- motionsyhryraNa,were Jan- syhlvanla,tlied NovemIT 0 NOTICE IS HEREBY GIVEN NOTICE IS HEREBY GIVEN NOTICE IS HEREBY GIVEN tamely—ad berorr- Emh 2,2°15 to Cir,tly Wilhelm 2014)having been gmnt°tl to thelEstte o1 Rose Lefever the EstnteT Ota Jo"me9 E 1hotFstet°of Fmn B Donlan CgIDWFINL K° EAii�NS pC =mans indebted to the tiro undemigned,all persons who dl°d Oecember 3,2014, Ja.kson,Jr,who died Novato• lato oT Middletown Borough, 3G{1 Nonh From SkeM deced.M aro required to make Indebted tore said estate are fate of East Hanov¢rTovmsNp, b.r 4,2014 late Of Swotma Dauphin County Pennsylva- hnmediate payment entl Uros. roquirM t°mak°Immediate Dauphin C°unly,Penmsylva- Township,bauphin County, nf¢,dcceaaed,Taving been H "1�9'>P.m si12,t ' haWng cta mI s or tlemands to P9Ymeni and th°so having ell nfa,were granted on D°earn- pannaylvapia,were granted on granted to the undersigned,all presentthem vAmout tl.lay to: dawns wnl present them tvilM her 12,2074,to Paulin°L. Ntwember 2l,2014 o Marissa mons Indebted to said e9• EsmM of D,mri SWimehn ted dday to: Smith,at Gfentvllle,P.nns t- ,",� ESTATE NOTICE hY Y M.Jackson of If.rrisburg, requested to make ire d°Hazen Elder law• Cherfe N.Dlninni vania. Pennsylvania medlar°payments,and those NOTICE IS HEREBY GIVEN 200°Linglestown Road, 5641 Fordham Avmu¢ All Persons Indebted t° All persons Indebted to having claims will present that Letters TestamenFta�ryon SNta 2D2 Harrisburg,PA 17111 Rose ewr.re req,restedm questetl to Jackson,Jr. tFJt.cNor.DennlsGWdh.y rwho diedeD°copember l8 24 far Hadsburg,PA17110 Executrix mak°immatl'.'a ppaym.ntto Or to: And lo: her estate.Atlditlonaily ell payment to his estate.Addt- 3508 RWggOTop Court late of Susqu.hanno�own- CindytY'Ih.im Fmharth, Mark W Holmes I-.having claims against Pondliy, all those having t-ouisvike,KY 40241 ship,Dauphin Counts,Pon.- Cindy ESeminaaryry Awamu. Rose LeTow,must present claims against James E J. Orto: sylvanla,were gmMetl to Jan• do Harem Eider pLaaq RitlunoM,VA 23227 the Peru.atemem to: son r.must pr.sent them for Eel Richard Etzwe0e6 Es ire uary 2,2015,to Mary M: 2000 u^°I°simvnSURe 202 Or to: °CmOr Peru.. 10%RS ape Road Mads MJaticson,ExecutdA Har051N.From slmcm �Pnaueder,of Hershey,Pennsyl- Hamsburg(PA 2711100. A.Mark W MrOR1ry GOf to:ranNlne,PA 17028 BOft S etr'Tomas Court Soto 12 """tgze,pi,¢.,00i L S°paeder a o requested to 310 W.Chacolsle Ar Ch DM.Applin ESWWfro. Har15purg PA 17109 meka Immedmte payment to ESTATE NOTICE Mmah PA 17033 JAN L BRON/N A ASSf)CIVS Tel.ph—.-Ri341 5550 ESTATE NOTICE h�estate.wing claims Ionauy,all In h NOTICE IS HEREBY GIVEN Phone(71°533-0868 845 SirThomas 6Cuomun�SA,'tt/a2 ��'21 NOTICE IS HEREBY GIVEN An.L Spaetlertm st present that LettersTastomentorY were t•''¢''t'�' Moms 7{i341.5550 CORPORATE that Letters of Administration Dam for settlement to: ggranted to Melanie Ann Weller' ESTATE NOTICE Attorney for EstMo have been granted In the fol- J rine A.K. Fs Ire fn the Estate of John H.Weller ,.�,212t, NOTICE =Estate.All pemons It JAN L BROWN 8 A5SOGA Jr.aka John H.Weller,Isle of NOTICE IS HEREBY GIVEN NOTICE IS HEREBY GIVEN d¢hted to the sa,rl Estate are 845 SUThomas Court SunO 12 Lower P.zion Township, that Letters Testamentary.on ESTATE NOTICE lhM a GartiRcatO of AWhorily roqutred to make pa Ment, Harrisburrgg,,SA us Dauphin Cbunttyy�Pennsylve- the Estate of Ruth B.Jones, for a Fomf Business Co o- and rhos.bowing claims or 7173413550 nfa wino died onl)¢cer 26, who died Nowmher 18,2014; NOTICE IS HEREBY GIVEN ref°n was/iced In the Depart• tlemantls to present.lhe same ¢e,z�.aau 20f4. OR persons Indebted to lata Of Lower Paxton town• that LettersT¢atam¢nt.rryy in menlof 5mto ct lire Cammor,• vdl"our d.fay to the Adminls- ESTATE NOTICE the saltl Estate am inquired to ship,Dauphin County,Penn- the Estate of Fay°E MuI, wealth of t eof the C nfa for Irstor/Abomey named belom make payment,and those haw- Sylvania,ware rrmtetl on No- °k°Faye Elizabeth Munen,of Infra toted Resources Estate Of IT L Shuey,into Ing c'a'ms or demands to vember 24 2074 to Norma Lower Paxton Township, Hotdin s Inc.Tho atldress O1 °}pauphin County,PennsWva- NOTICE IS esteHEREBY GIVEN present tiro same without Jones Durf.y of Wazhaw, Dauphin Count1yy,,P.nnsylva- 9 nfa tlied:Decemhor 2 2 14; th.t LetereTastamentary on S. to the Personal Repro- NOM Carolina and Nagorlo B. nfa,tleeeasetl,having b.an ifs principal oNieO under the Atlinlnlstrator Jodi LS tiro Estate of Charlotte L. sentative or attorney named Mamin of Harrisburg,Permsyl. pgemMad to Ne undemigr d an laws of Its jurisdiction Is 300 �"�'' Horvath who died November belmr. M"` Ann W9_F CT All persons tntlebdod to Ruth Estate ore equested to make ratio Tttcl amo of 1. ef-dorpo- p��Carc11rZuckerE°5fqq°Wm {v�nsftipt DauLower hin County 1302 AvenueF B.Jones aro re .°sled t° I--that. moons Commercial R. Is DALEY ZUCKER M�tLTONe q Paym.nt and those tared OKico Provid, is Unded MINER,LLC Pennrylvanie were grJntW ori Danville,PA 17021 male Immetliate ppayment to having are ms t°present the 635 N.121h Suite 107 Oerember 9,r2014 t°Eliz.= her estate.Add(tional all same Without dot to cmporato Servlaes tnc In the. Slicer. K Zeiders,of Harrisburg, Or to: IY aY county o1 DauohM.The Corps- In orpo- LamOYne,PA 17043 fl;nn IvaNa ry' 'Joan D:Seibert,Esquire putltB.Jones must present .Ewtyn J. PutC Fx O m retlon is filed In compliance '�'�'z-" All persons indebted to .CALUJYELL 8 KEARtvS,PC, BW wire tiro requirements Of the Charlotte L Horvath are ro- 3631No ,%R, &PC memforsettlem..it.: CampH0LPA17011 ¢pIiceblep rovislonoflSPa CORPORATE Hartishuin,PA1711D Norma Jones Detlev and Or to: �54124(b� quested to make Immediate "1•t1,31.t3, 'Marfodo e.Marld, Egmbelh g,p,gp�Fsp�7rO ,,� NOTICE eymentt°herestme.Addi- Co-FJre 5, SKARIATOSZONac LLC NOTICE IS HEREBY GIVEN "ovally, °II those bowing do Jan L Brown is Associates 17 South 2rM Stmct,Flom6 that GO BLUE 11 INC.has claims egalnst Charlotte L. 845 SlrThomas Court Suits 12 Horvath must present them for Hanish PA 17109 Harrisburg,PA 77701 bren'Ineorporated untl¢r the setgemenl to: 31211„ ��rroo��lalOn9 O}th0 Bu""33 Te,.phone:7 7341555° corporation taw of 19Be. Elizabeth K Zeltlera,E,. bb` t-tarot to BUTLER LAW FIRM 2718 Cdfmh1 Road 1007 Mumma Road,SuRO 101 Harrisburg,PA 17112 More Legal Notices.& Legal Services., �"°"�PA �d�°�'^pp°^'EaqWuin JAN L BRUhyN&gSnb&7ES 845 SlrThamasCaurL Sune 12 Hantsbu PA 17109 Page 6, Section s CPSA SCHEDULE I - MEDICAL COST LINE ITEM 1 - DR RAYMOND GRANDON r�.�� �r:�,caaa�%�s,���.sti.r.��s:.;:v,`.s.eC.r.�Ta�rs:a.�.�_w_-..y� �-�•-_ �-� rJAWES K SCHCXZ. a ' m`73 e3•`C" _. .mss,..,... WALE W ' I j e _ S » s srp r PLS �41410G, i L �E3liAi1 �� � ,;._.���-e�s�r—:. s-.�<�r���.'�.s�a�:•.�r�—�r-����q--.sere:--�e"s:'m.ri.*�"��e'� •. . . 4 �.�T�l,i��• yam. • �Q�i]fil.n zi 1f. 0 'B CPT4 01/14/14 99214 Office Visit Level 4 G 1 105.00 101.95 Patient:Scholz,Henry J-554 03/18/2014 Highmark Blue Shield 0.00 Statement enclosed,patient responsible 04/08/2014 Novitas Solutions 0.00 3.05 04/21/2014 Highmark Blue Shield 0.00 02/25/14 99214 Office Visit Level 4 G 1 105.00 20.21 Patient:Scholz,Henry J-554 03/18/2014 Highmark BIue Shield 0.00 0'00 03/18/2014 Patient Payment Other insurance must be filed first 04/14/2014 Novitas Solutions 44.61 3.96 Applied towards deductible 04/23/2014 Highmark Blue Shield 36.22 03/25/14 99214 Office Visit Level 4 G 1 105.00 20.39 Patient:Scholz,Henry J-554 04/14/2014 Novitas Solutions 79.93 4.68 04/28/2014 Highmark Blue Shield 0.00 5/17 MESSAGE:SEE REVERSE SIDE IF AN INSURANCE MESSAGE APPEARS-Ah- PLEASE PAY 142.55 ° Please pay within 30 days...thank you Henry J.Scholz 10 160.76 142.55 a• y,. 1 ul Raymond C Grandon MD• 131 State Street•Harrisburg,PA 17101-1027 52 SCHEDULE i - MEDICAL COST LINE ITEM 2 - HOME INSTEAD SENIOR CARE .N&r9-a -k-- � in .� '' a6i r'-fi rer r"ie� Vis'•�aYea yv�a dal Ing i c:&A;N rJ Us l IP,7 e• .er.•' $T � �. s i � r ., a ., .yy..' 'Sri�,a,r�•'..ryr���7s A evl im ,�, `!1��•k�';'; „^'� ..e°J; -a: mei �� h•r + •-..•w: :mac•! :!ir-.+:_ m� DETAILED INVOICE. Home%-hmrostead - --- 0 Service For: Henry Scholz(L2) Zo ter, &f lo'ev-LoAaZ. Billed To : Mr.Jim Scholz 5002 Lenker Street Invoice#: 2011-0514-1 Mechanicsburg,PA 17050 Invoice Date : 5/15/2014 (717)731-9984 Service Period :May 01,2014-May 15,2014 www.Homelnstead.com .Date From To Type CAREGiver. Miles Service Qty. Rate, SubTotal 5/1 9:00am 1:1 Spm Normal Evans,Amanda Hourly Svc.,Level 2 4.25 $20.95 $89.04 5/2 9:00am 1:00pm Normal Smith,Lana Hourly Svc.,Level 2 4.00 $20.95 $83.80 5/4 9:00am 1:00pm Weekend Smith,Lana Hourly Svc.,Level 2 4.00 $23.05 $92.20 5/5 9:45am 1:15pm Normal Evans,Amanda Hourly Svc.,Level 2 3.50 $20.95 $73.33 5/6 9:00am 1:00pm Normal Evans,Amanda Hourly Svc.,Level 2 4.00 $20.95 $83.80 5/7 9:00am 1:00pm Normal Evans,Amanda Hourly Svc.,Level 2 4.00 $20.95 $83.80 5/8 9:00am 1:00pm Normal Smith,Lana Hourly Svc.,Level 2 4.00 $20.95 $83.80 Total27:75 Miles: 0.00 @ $0.59 = $0.00 Miscellaneous Charges: _ $0.00 Addition..alChargc&!Credits: _ $0.00 Service Deposit Applied: _ $0.00 Current Invoice Total: _ $589.76 Total Amount Due: $589.76 Due Date: Due upon Receipt *All Overdue Invoices are Subject to an 18%Annual Service Charge Please Retain For Your Records SCHEDULE I - MEDICAL COST LINE ITEM 3 - PINNACLE HEALTH '�?:�'=ts+'�i!D?'.t-.��c,�r-$+•�_w�.:,ieS��'f�-�af'...":^—'e'7'-a."''x�,:.w"�r�F:..___ - _aL;z_�s i • BL�S� 15 JAMES P;st:cmm. z i • „ I ve Pei AIN Ja 0"1130 29 5 _ - �- ' •'s.�"�,1`a��—�.:�ti."ev-YeP'�'i�T3�ri1i,JC�:..�^���i,d��:r. -�":-s.isr��-. _... . 1 ----------------------------------------------- ----------------------- --------------------------------- MESSAGES EXPLAINED -------------•----------------_------------------------•- ® BELOW 0-1--s-ervice Description CPT Dx *** Thank you for your prompt payment. Please call 717-731-8315 with any *** *** Suestions. *** ***** **�'::k:'r**t.-.':*«:r:k4:'.*rr*::*:r*:':**:'tt.�*�c�'c':1:*:k$t�k4:*:r9:J[std:*s:*�.�r;':****;i.;l•1c**;l•*irk:*::�:*�'.:':o:'k�:;':-Y* Ins Pay/Ad' against Ins pending 6.84 0.00 -6.84 03/06/14 1 9 L PROGRAM EVAL PACER, DUAL 93280 V45.01 135.00 04/11/14 BC/BS OUT OF Payment 0.00 05/20/14 MEDICARE PA Payment 44.28 05/20/14 Accept Assign Adj . -78.52 05/20/14 Accappt Assign Adj . -0.90 06/09/14 BC/BS OUT OF Payment 0.18 11.12* L-The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment. TATE LAST PAID AMOUNT • - 1 ® ® • 1 . getionsal UmwTot 00/00/00 0.00 11.12 0.001 0.00 0.00 0.00 -6.84 1 0.00 4.28 1KE PINNACLEHEALTH CARDIOVASCULAR INST, • , .; ' " IECK INC 'YABLETO. 1000 N FRONT ST Payment Due Upon Rec 11.12* WORMLEYSBURG, PA 17043-1034 Ph: (717)- Acct#: 57264 PAT# 1-HENRY J SCHOLZ PRV# 9-SMITH, MICHAEL F, MD, FA Dater ' 06/12/14 Page 1 of 1 Impartlant Message, We have received the explanation of benefits T�T from your insurance company(s)and have 1 .1 applied whatever payments and/or adjustments are appropriate. Please quake payment for the balance due of$1,216.00 OR take advantage of TheSpirit f C g a 10% prompt payment discount and remit $1,094.40 on or before 07/13/2014. Here are 3 convenient ways to pay: 4/927009 1: wr Make payment online at ww .hsh.org. HENRY J SCHOLZ 2. Mail tear-off coupon below with payment 227 12TH ST in the enclosed envelope. NEW CUMBERLND PA 17070-1608 3. Call Customer Service below to make payment by phone. a , , Patient Name: Scholz ,Henry J Previous Balance: $13,822.85 Statement Date: 06113/14 Total New Charges: $3,468.1.1 Service Date(s): 05108/14-05/09/14 Payments/Adjustments: $16,074.96- Account Balance: $1,216.00 Account Number: 47927009 Please Pay This Amount: $1,216.00 OR Medical Record Number: 048251 Discounted Amount f$1,094.40 paid o or before 07113M14 AM 5_0,9 i a1Con-tactSe Please call Customer Service at 717-763-2138 /zl� Ins. 1: MEDICARE I/P to add or make corrections to your insurance ,J Ins. 2: BLUE SHIELD S information, or to make arrangements for a 14 Ltq Ins.3: payment plan. If you are unable to make Ins. 4: payment, please contact the Patient Financial Advocate's Office at(717) 763-2885 to discuss financial assistance options. Please Note.Your physicians will bill separately for professional services. Payment Submitted Page 1 of 1 walh'Tbu W6 011a Payment Request Subrhitted Thank you for your payment. The following payment request has been submitted. Reference ID: 160319987054 Date and Time: 07/02/201413:01:40 (CDT) Authorization number: 042492 Customer Name: HENRY SCHOLZ Patient Account Number: 47927009 Date of Service: 050814 Payment Method: Master Card************4444 Payment Amount $1,094,40 Total Payment Amount $1,094.40 https://secure4.billerweb.com/smg/]3il-terC.onsole/inetSrv?type=WizardService&action--pay... 7/2/2414 SCHEDULE I - MEDICAL COST LINE ITEM S - QUANTUM IMAGING 0 li141 3 �4f•NE !� r!1 7'. . ,�4 i1iTr73 , -ME!- 74 UN 4 E ' .�+��^aa:a:-p+xcr�:�a�s�rn n,J 3r •xaao nna . � can�X ®oma . J 4 . , A 31 Patient: HENRY J SCHOLZ Account: 15071 Services Rendered At: HOLY SPIRIT HOSPITAL Proc Payments Date Code Description Charge Ad"ustments Balance 5/8/2014 71010 CHEST SINGLE VIEW FRONTAL 36.00 1.80 6/2/2014 PMT MEDICARE-NOVITAS SOLUTIONS 7.16 6/2/2014 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 27.01 6/13/2014 PMT BC/BS OUT OF STATE-BLUE CARD 0.03 � a -7 [ Q ell �g Current 31 -60 61 -90 91 -120 Over 120. BALANCE DUE $1.8 0.00 1.80 0.00 0.00 0.00 PAY BY Due Upo THIS ACCOUNT BALANCE IS YOUR RESPONSIBILITY. For billing questions call: (717)932-5955 PLEASE REMIT PAYMENT IN FULL OR CALL OUR or: (877)932-5955 OFFICE IF PAYMENT ARRANGEMENTS AND/OR Fax: (717)932-4856 INSURANCE INFORMATION IS NECESSARY. Office Hours: 8:00 AM -4:30 PM To.pay your bill online and register for eStatement STATEMENT please visit us at: www.qita.com IIIIIIIII'IIIIIIIIIIII��IIII�I�1IlIIIIIIIIIIIIIIII�IIIIIIIII SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION 19670-10 SCHEDULE J - NON-TAXABLE DEDUCTIONS LINE ITEM 11 B - CHARITABLE CONTRIBUTIONS ---------- EST4N Of HIMIRT j!PMPLZ - 7 JAPES FISCHOUN EXECUTT-31; Ph. 4"MAr L-1 11 L jnx_"-P,-7%vLesa;;o1 iwwd �A of a&ki 2S ?k 6is WD 40 A 4 LE al tt Oka 3£i e9" 'ftnn MLi-nk 41012 7 .20 LA 1-2 31 as Thank you for your gift of $IeW This hasI �uminated a sparkling light on the Hospice of Central Pennsylvania's "Tree of Light. " Throughout the Holiday Season we invite you to view our glowing trees at Front & Walnut Streets in Harrisburg, on, the Square in Carlisle and 110 Rte. 61 S in Schuylkill Haven. An acknowledgement of your thoughtfulness has been sent to those whom you designated. Date: We view the entire amount of your contribution as tax-deductible. Hospice of Central Pennsylvania is a 501(c)(3)non-profit organization-donations to which are tax deductible to the fullest extent of the Imv.The official registration and financial information of Hospice of Central Pennsylvania may be obtained from the Pennsylvania Department of State by calling toll free within Pennsylvania,1-800-732-0999. Registration does not imply endorsement.