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Home My WebLink About03-17-15 T 1505610101 REV-1500 Ex(°1-1°' enns lvania OFFICIAL USE ONLY PA Department of Revenue peo.a Y County-Code Year File Number Bureau of Individual Taxes TME OF REVENUE INHERITANCE TAX RETURN - - ----_ -- — – PO BOX rg,PA 1 I, , Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY r— 7 11/04/2012 10/05/1963 Decedent's Last Name Suffix Decedent's First Name MI BUTLER I RICHARD (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Qlb 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 B. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LrAndrew H. Shaw, Esquire (717)243-7135 REGiSTER'OF WILLS-UjSE ONLY First line of address r~ r F200 S. Spring Garden St D i -11 Second line of address Suite 11 .........-_......... -.--...._.... --. —._.__.—......—....._..._.. _. DATE FILED-D Uj ? City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's e-mail address: andrew@ashawlaw.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE-49f PE SON RE PONS LE FOR FI ING RETURN DATE ADDRESS 320 Mountain Road, N ille, PA 17241 SIGNATURE' F PRt O R THAN REPRESENTATIVE DATE ADDRESS 200 S. Spring Garden Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: Richard S. Butler ^®� RECAPITULATION 1. Real Estate(Schedule A). ............................................ 1. 0.00 2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sale-Proprietorship(Schedule C) .... . 3. 0.00 4. Mortgages and Notes Receivable(Schedule D) .. .. .. .......... .. ......... 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. 12,835.00 6. Jointly Owned Property(Schedule F) C) Separate Billing Requested ....... 6. 107,129.71 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C7 Separate Billing Requested.... .. .. 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)................. ..... ....... 8. 119,964.71 9. Funeral Expenses and Administrative Costs(Schedule H)..... ..... .. .. ... .. 9. 10,476.50 r 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1).............. 10. 152,542.36 11. Total Deductions(total Lines 9 and 10)................................. 11. 163,018.86 12. Net Value of Estate(Line 8 minus Line 11) . . .. .... ........ ....... ...... . 12. 43,054.15 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) .. .. .. ... .. . ... .... .. .. . 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) .... .. ........ .. ... .. . .. 14. 0.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 00 0.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 45 0.00 16. 0.00 17. Amount of Line 14 taxable at sibling rate X.12 0.00 17. 0.00 18. Amount of Line 14 taxable at collateral rate X.15 0.00 18 0.00 19. TAX DUE ............ ...... ..... .... .. ..... ... . ... .... ....... ..... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Richard S. Butler STREETADDRESS 320 Mountain Road CITY STATE ZIP Nevvville PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 0.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 Total Credits(A+B (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line I +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... F1 FRI b. retain the right to designate who shall use the property transferred or its income;............._........................... El Fx� c. retain a reversionary interest;or..................................................................................................................... R )c d. receive the promise for life of either payments,benefits or care?............ ................................... Z 2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?..............-..........-....._..............-............................................ El FRI 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ...................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent V2 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(1.2)F2 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-1508 EX+(6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Richard S. Butler 21-12-1216 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH F-11 Personal Effects T 500.001 2. 2010 Chevrolet Impala , 10,588.00 3. 1995 Ford F150 1,747.00 JI I TOTAL(Also enter on line 5,Recapitulation) $ 12,835.00 (If more space is needed,insert additional sheets of the same size) 2010 Chevrolet Impala LTZ Sedan 4D Trade In Values-Kelley Blue Book Page 1 of 3 i Popular at KBB.com > > > > > > >LTL Sedan 4D Chevrolet Impala 2020 Your Blue Book®Value i LTZ Sedan 4D J; mileage:67000 tits car Private Party Value _ Wien trading in at a dealership when selling the car yourself vcf z;r Excellent $12,888 Shop for your Very Good $12,438 New Cars You Might Like Good Offer $11,988 Fair $10,588 Sett your current car Be the first to know (updatedweeldy) when values change Helpful resources from kbb.com Write a Review Check Specs Sett Your Car 1,111E THE Aaft 104L Cars for Sale Get a Used Car Report near Newville !XURE Get the Information You Need on This yp Before You Buy for Sale Near You ; Below Blue Book Value* f • *Basedon the Suggested Retai Vatue Excellent I condirion and the Gorse v-ehicle configuraton. http://www.kbb.com/chevrolet/impala/2010-chevrolet-impala/ltz-sedan-4d/?vehicleid=25... 11/28/2012 Q/5112 Kelley Blue Book !!Uith t4I,n Gl,�PZ Card,you cart. GM Card >Ft,-m-s,S Ca 'A 2-t: adverh9mmt why ads? Your Blue Book®Value 1995 Ford F150 Regular Cab Style:Short Bed Mileage:104000 Private Party Value Vehicle Highlights Excellent MPG:City 12/Hwy 17 Max Seating:3 $2,472 Doors:2 Engine:V8,5.0 Liter Very Good $2,322 Drivetrain:2WD Transmission:Automatic Good EPA Class:Standard Pickup Trucks Body Style:Pickup $2,247 Country of Origin:United States Country of Assembly:United States Fair $1,747 Your Configured Options Our preselected options,based on typical equipment for this car. J Options that you added while configuring this car. Engine Accessory Packages Entertainment and Instrumentation V8,5.0 Liter XL AM/FM Stereo Transmission Comfort and Convenience Wheels and Tires Automatic Air Conditioning Steel W heels Drivetrain Steering 2WD Power Steering New Cars You Might Like • 2013 Ford FISO Regular Cab -•.".;?gal 2013 GMC Sierra 1500 Regular Cab 2013 Chevrolet Silverado 1500... WdNIN_khh rnm/fnrdNlSn_ran.dar_rahllQQ5_fnrA_f9Sn_rPrndar_rahlshnrt-hed/?vehicleid=7647&intent=tr... 1/2 REV 15o9 EX+(oi-io) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE IJOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Richard S. Butler 21-12-1216 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 X Roy W. Butler '320 Mountain Road, Newville, PA 17241 Father Reba C. Butler Mother B.Scott W. Kelly [T20 Mountain Road, Newville, PA 17241 Friend _. 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 DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 04/18/11 Real Estate»at 320 Mountain Newville,PA17241 �w 214,200.0 1. A. �_j — _- 0 L50 107,100.00 { r 2B. 05/26/06 IF' NC Bank Account#50-0491 5024 59.41 E:50] 29.71 E-1 E_j El 0 Ej 1:1 El -11 -El 0 =1 El E] 1:1 L_El E-1 = 1 _ El D El I 0 El �� _ E:1 El El Cl E-1 TOTAL(Also enter on Line 6, Recapitulation) $ 107,129=71 If more space is needed, use additional sheets of paper of the same size. •'' i �- j.k p rF '1 l�. NA /" 1 � 1 y..� �� "t /y�ry i n._ �, .. ti�,j .y��ij�i�t��{•yi�,t•'" `��l,' t'�[ ',_id ' f .x l f 1,."R i .�k t MT- 'N i� .�'1 .tw � 1. Y t.,�1 Y� �• .�.� �, '•y � t�.E.t JJ r a t 1d'"t370 MONNTATN ROAD PIN:15 04 0393 02tiB f 4 1-}�;�"� 'r t ", ' •.�-A t d .,A^ i�; Deedbcak:201111932 ., y"j�Ar -•�, 4 ^c„ Owner:B(M FR,ROY W&RFBA C iw Y �, M ✓ !llyyy �y l�.p Land Use Code:115 C. 4 Y. `, � ;'��• t Property Type:AC ,.► ,•�y; {"�3'•+ f:' t •t a c Acrcagc:10.18 ti7►.lCSr "� r; .J.° �,'�►! p" Square Feet:1200 A .� ..s+. ! 1, {- S i.,t, `x.►1f Taxahle Status:T d �. Cledn&Green Status:A - r' t e 1' Land Assessed Value$:57300 Building Assessed Value 4:156900 ,� rfy t •.STM p�+•3-"'•• {: "• ",,,. . t'ta,;.;�," ,, ',;,'. I', Total Asses sed Value$:214200 •mss+ .-'�e, ,y+ �$C� •• • 1 • 1 1 1 1 .r'" _ 1 •11 �. - -• • 1 1 1' 11 11 • • • 11 • 0028V4 Tax I.D.: 15-04-0393-026B THis DEED MADE THIS 80day of in the year of our Lord two thousand and eleven (20.11). BETWEEN ROY W. BUTLER and REBA C. BUTLER, husband and wife, of 320 Mmintain Road, Newville, Cumberland CoOtity, Pennsylvania .17241, hereinafter referred to as Grantor AND ROY W. BUTLER, REBA C. BUTLER, husband and wife(an undivided one-half interest), and RICHARD S. BUTLER(and undivided one-half interest) all presently of 320 Mountain Road, Ncwvil1c, Cumberland County, Pennsylvania 17241, hereinafter referred to as Grantees WITNESSETH, that for and in consideration of the sum of ONE DOLLAR ($1.00), hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and convey, in fee simple to the said Grantees,their heirs and assigns, ALL that certain tract of land situate in bower Mifflin Township, Cumberland County, Pennsylvania, bounded and described in accordance with Subdivision Plan for Isabelle D. Donaghy, prepared by Carl D. Bert, Registered Surveyor, dated June 4, 1976, a copy of same being recorded in the hereinafter named Recorder's Office in Plan book 28, Page 70 as follows: BEGINNING at a railroad spike in the original centerline of Thirty-three (33) feet wide Township Road, T-383, at the dividing line between Lots Nos. 2 and 3 as shown on said Subdivision Pl=.; thcnec'along said dividing tire, Nor,h 46 dcgrecs 39 minutes 39 seconds Wc st, it distance of Fivd.11-uadred Sixty-nine and Eighty-nine Hundredths (569.89) feet to apoint; thence continuing along said dividing line, North 38 degrees 46 minutes 02 seconds West, a distance of Eight Hundred (800) feet to an iron pin in line of other land retained by Isabelle D. Donaghy-, thence along said line of other land retained by Isabelle D. Donaghy, North 47 degrees, 50 minutes 00 seconds East, a distance of Three Hinidred Eleven and Sixty-six Hundredths(311.66) feet to an iron pin; thence still along other land retained by the said Isabelle D. Donaghy, 'South 40 degrees' 04 minutes 12 seconds East, a distance of One Thousand Five Hundred Twenty-five and Forty- four Hundredths (1,525.44) feet to an iron pin in or .near the original right-of-way of Township Road, T-383; thence in said Townshvp Road, T-383, and continuing along the centerline thereof, South 82 degrees 38 minutes 51 seconds, West , a distance of Two Hundred Fifty-six and Sixty- aine Hundredths (256.69) feet to a railroad spike; thence continuing along the centerline of said Township Road, T-383, South 60 degrees 55 minutes 55 seconds West, a distance of Forty-nine and Seventeen Hundredths (49.17) feet to a railroad spike at the dividing line between said Lots WEIGLE & ASSOCIATES. P.C. -ATTORNEYS AT LAW - 126 FAST MNG STREET - SHIPPENSBURG, PA 17257-1397 Nos. 2 and 3, the place of BEGINNING. CONTAINING 10.18 10 acres and being all of Lot No. 2 as shown on said Subdivision Plan recorded as afbreszid. SO much of the above described premises as lies within Twenty-five (25) feet of the original centerline of Thirty-Three (33) feet wide Township Road, T-383 is hereby dedicated as a portion of the right-of-way of said Township Road, T-383. And the said Grantors hereby covenant and agree that they will warrant specially the property hereby conveyed. BEING the same real estate whiL;h Isabelle D. Donaghy, widow, by Deed dated July 30, 1976, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book U26, Page 250, conveyed to Roy W. Butler and Reba C. Butler, husband and wife who are the Grantors herein. THIS IS A CONVEYANCE FROM HUSBAND AND'WIFE TO HUSBAND, WIFE AND SON AND IS THEREFORE EXEMPT FROM PENNSYLVANIA REALTY TRANSFER TAX. UNDER AND SUBJECT to existing covenants, agreements, conditions, easements, restrictions and rights of record,to the extent valid and enforceable and still applicable to the above described premises. IN WITNESS WHEREOF, Grantors have hereunto set their hands and seals the day and year first above written. Signed, Sealed and Delivered in the Presence of ce RO�--Y�W. BUTLER C REBA C.BUTLER WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 FAST KING STREET - SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENN YLV IA SS COUNTY OF On this, the *ay of e 2011, before me, a Notary Public in and for said County and State, the undersiified officer, personally appeared Roy W. Butlex',: C.Butler,known to me for satisfactorily proven)to be the persons whose names arv. the within instrument, and acknowledged that they executed the same for thews;, ' . contained. ", IN WITNESS WHEREOF, I hereunto set m. hand and official seal. Notal yy - blic COMMONWEALTH OF PEN SYLVANIA NOTARIAL SEAL Jerry A.Weigle,Notary Public City of Shippensburg„Cumberland County My Commission Expires October 7,2014 I do hereby certify th the tete ost office ess of the within named Csrantees is 37-0 :- �`7 2-L4 ttorney! gent for t"xrantee WEIGLE & ASSOCIATES. RC. -ATTORNEYS AT LAW - 126 EAS!' KING STREET - SHIPPENSBURG. PA 172&7-1347 ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE,PA 17013 717-240-6370 = Instrument Number-201111832 Recorded On 4/21/2011 At 11:52:01 AM *Total Pages-4 *Instrument Type-DEED Invoice Number-85748 User ID-KW *Grantor-BUTLER,ROY W *Grantee-BUTLER,ROY W •Customer-WEIGLE&ASSOCIATES "FEES STATE WRIT TAR $0.50 Certification Page STATE JCS/ACCESS TO $23.50 JUSTICE DO NOT DETACH RECORDING FEES — $12.00 RECORDER OF DEEDS This page is now part PARCEL CERTIFICATION $10.00 FEES of this legal document. AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 BIG SPRING SCHOOL $0.00 DISTRICT LOWER MIFFLIN TOWNSHIP $0.00 TOTAL PAID $62.50 I Certify this to be recorded in Cumberland County PA �y of cuts@ A �o RECORDER O D EDS nao *-Information denoted by an asterisk may change during the verification process and may not be reflected on this page. 0028V4 III 1111111111111111111 I I I Workplace Checking Account Statement PNC Bank Primary account number:50-0491-5024 Page 1 of 3 For the period 10/23/2012 to 11/23/2012 Number of enclosures:0 RICHARD BUTLER O_ For 24-hour banking,and transaction or interest rate information,sign on to SCOTT KELLY PNC Bank Online Banking at pnc.com. 320 MOUNTAIN RD 'Q' For customer service call 1-888-PNC-BANK NEWVILLE PA 17241-9770 Monday-Friday: 7AM-10 PM ET Saturday&Sunday: 8 AM-5 PM ET Para servicio en espanol,7-866-ROLA-PNC Moving? Please contact us at 1-888-PNC-BANK ® Write to:Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD tenninal:1-800-531-1648 For hearing impaired clients only Workplace Checking Richard Butler Scott Kelly Regular Checking Account Summary Account number: 50-0491-5024 Overdraft Protection has not been established for this account. Please contact us if you would like to set up this service. Overdraft Coverage -Your account is currently Opted-In. You or your joint owner may revoke your opt-in or opt-out choice at any time. To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraftsolutions. Call 1-877-588-3605,visit any branch,•or Sign on to PNC Online Banking,and select the"Overdraft Solutions"link under the Account Services section to manage both your Overdraft Coverage and Overdraft Protection settings. Balance Summary 69,943--points balance as of November 23, 2012 For CheckCard xxxx xxxx xxxx 5474 Beginning Deposits and Checks and other Ending balance other additions deductions balance 30.65 2,787.15 2,257.36 560.44 Average monthly Charges balance and fees 579.65 .00 Transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 6 21 1 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 10 10 0 Activity Detail Deposits and Other Additions There were 12 Deposits and Other Additions Date Amount Description totaling $2,787.15 10/23 50.00 ATM Deposit 105 Noble Blvd Carlisle PA 10/26 1,038.69 Direct Deposit-Payroll PA Treasury Dept XXXXXXXXXXXI 390 Deposits and Other Additions continued on next page Workplace Checking Account Statement For the period 10/23/2012 to 11/23/2012 r3For 24-hour information,sign on to PNC Bank Online Banking RICHARD BUTLER on pnc.com• Primary account number:50-0491-5024 Account number:50=0491-5024-continued Page 2 of 3 Deposits and Other Additions -continued Date Amount Description 10/29 100.00 ATM Deposit 105 Noble Blvd Carlisle PA 11/05 276.54 ATM Deposit 105 Noble Blvd Carlisle PA 11/05 15.00 ATM Deposit 105 Noble Blvd Carlisle PA 11/09 1,038.68 Direct Deposit-Payroll PA Treasury Dept XXXXXXXXXXX1381 11/13 60.00 ATM Deposit 105 Noble Blvd Carlisle PA 11/19 120.24 ATM Deposit 105 Noble Blvd Carlisle PA 11/19 15.00 ATM Deposit 105 Noble Blvd Carlisle PA 11/23 50.00 ATM Deposit 105 Noble Blvd Carlisle PA 11/23 15.00 ATM Deposit 105 Noble Blvd Carlisle PA 11/23 8.00 Direct Deposit Credit Checks and Substitute Checks Check Date Reference Check Date Reference number Amount paid number number Amount paid number 338 450.00 10/29 086446526 408* 111.13 11/09 086075084 339 161.00 10/29 086486759 409 195.00 11/14 084606437 340 25.00 11/06 083324490 410 350.00 11/23 086080978 *Gap in check sequence There were 6 checks listed totaling $1,292.13 Banking/Check Card Withdrawals and Purchases There was 1 Banking Machine Withdrawal Date Amount Description totaling $20.00 10/23 23.01 5474 Check Card Purchase Mega Trucking Inc 10/23 20.00 ATM Withdrawal 105 Noble Blvd Carlisle PA There was 1 Check Card/Bank card PIN POS 10/23 6.22 5474 Check Card Purchase Sheetz Carlisle PA purchase totaling $62.10 . 10/24 20.00 5474 Check Card Purchase Sheetz Carlisle PA There were 21 other Banking Machine/Check 10/25 5.00 5474 Check Card Purchase Saylor's Market Card deductions totaling $499.57 10/29 106.00 5474 Check Card Purchase Kruger's Rental Servic 10/29 62.10 POS Purchase Aldi 71091 Carlisle PA 10/29 31.80 5474 Check Card Purchase Wal-Mart#2574 Carlis 10/29 25.01 5474 Check Card Purchase Sheetz Newville PA 10/29 25.00 5474 Check Card Purchase Sheetz Newville PA 10/29 21.99 5474 Check Card Purchase Sheetz Shippensbur PA 10/29 20.01 5474 Check Card Purchase Sheetz Newville PA 10/29 13.01 5474 Check Card Purchase Win Supercenter#5358 t 10/30 9.77 5474 Check Card Purchase Saylor's Market 11/02 20.00 5474 Check Card Purchase Sheetz Newville PA 11/02 10.01 5474 Check Card Purchase Mega Trucking Inc 11/05 20.01 5474 Check Card Purchase Sheetz Newville PA 11/08 25.00 5474 Check Card Purchase Saylor's Market 11/13 35.00 5474 Check Card Purchase Sheetz Newville PA 11/13 18.95 5474 Recurring Check Card Onstar 888-4Onstar M 11/15 25.04 5474 Check Card Purchase Sheetz Shippensbur PA 11/19 18.74 5474 Check Card Purchase Wm Supercenter#2574 11/23 20.00 5474 Check Card Purchase Vcn*Pennsylvania Vital Online and Electronic Banking Deductions There were 4 Online or Electronic Banking Date Amount Description Deductions totaling $375.56 10/29 75.00 Web Pint Single-Online Pmt GM Card Srvcs 000000885191751 Online and Electronic Banking Deductions continued on next page Workplace Checking Account Statement For the period 10/23/2012 to H/23/2012 /23/2012 (�For 24-hour information,sign on to PNC Bank Online Banking RICHARD BUTLER on pnc.com. Primary account number:50-0491-5024 Account number:50-0491-5024-continued Page 3 of 3 Online and Electronic Banking Deductions -continued Date Amount Description 10/29 30.00 Web Pint Single-CC Pymt GE Capital 601918309859267 10/29 25.00 Web Pint Single-Online Pmt Hsbc Card Srvcs 000000885183726 11/13 245.56 Web Pint Single-Vzw Webpay Vz Wireless Ve 3903841 Other Deductions There was 1 Other Deduction totaling, Date Amount Description $8.00 11/23 8.00 Calculated Service Charge Type We Daily Balance Detail Date Balance Date Balance Date Balance Dale Balance 10/23 31.42 10/29 99.19 11/06 305.94 11/14 773.98 10/24 11.42 10/30 89.42 11/08 280.94 11/15 748.94 10/25 6.42 11/02 59.41 11/09 1,208.49 11/19 865.44 10/26 1,045.11 11/05 330.94 11/13 968.98 11/23 560.44 Enroll in online statements today through online banking,and have access to your checking and saving statements for up to 6 years. Enroll today by visiting the Customer Service Tab in online banking. Stock Up on PNC Bank Visa®Gift Cards this Holiday The PNC Bank Visa®Gift Card is perfect for everyone on your gift list.PNC Bank Visa Gift Cards are easy to purchase at most of our branch locations.They come with a gift card carrier of your choice to highlight the special occasion. To learn more,visit your local PNC Bank branch or pnc.com/giftcard. Visa®is a registered trademark of Visa USA,Inc. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Richard S. Butler 21-12-1216 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' ,Fogelsanger-Bricker Funeral Home, Inc. 9,097.001, 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: 1,30.0..00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 79.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. i — -- -- — _ TOTAL(Also enter on Line 9, Recapitulation) $ 10,476.50 If more space is needed,use additional sheets of paper of the same size. FUNERAL PURCHASE CONTRACT 4110 (STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED) (Charges are only for those items that you selected or that are required.If we are required by law FOGELSANGER-BRICKERFUNERALHOME,INC. or by a cemetery or crematory to use any Items,we will explain the reasons in writing below.) NORMAN H.BRICKER,Supervisor Section 13.204 of the Rules and Regulations of the Pennsylvania State Board of Funeral Directors requires this P.O.Box 336•112 West King Street No. contract to be signed by the person or persons arranging for the funeral service and by the funeral director. FEDERATED ` SHIPPENSBURG,PENNSYLVANIA 17257 (A) OURSERVICE: Date M (717)532-2211 �/• - :�^�� BASIC SERVICES OF FUNERAL DIRECTOR&STAFF ...... $ w Full name of deceased_ �(>>K�C7 Age EMBALMING ............... $� - P( leas PRI o If you selected a funeral that may require embalming, = such as a funeral with viewing,you may have to pay for Date of Death //- Deceased is .� P arranging person arran in of services. /' v LL a embalming. You do not have to pay for embalming you (G Relationship) .Z w dm not approve 1I you selected arrangements such as (B) CASH ADVANCE ITEMS: Total(A)Forward $ 00 d w Z a direct cremation or immediate burial. If we charged u-U LL for embalming, we will explain why below. We charge you for our services in obtaining: REASON FOR EMBALMING: a Opening Grave.. ..J•. � ..................... $ Z L)2 Newspaper Notices Out-of-Town.................. $ 231a so;:X a a OTHER PREPARATION OF THE BODY .................. $ ✓ Airfare............................................. $ 0 0¢ USEOF FACILITIES,STAFF&EQUIPMENT: Funeral Ceremony(conducted at Funeral Home). . . ... .. . . .. $ ✓ Clergy/Mass Offering... .fat•.trtAyNit. .,.c-.WP.... $ 1 t6,oc, �e Visitation/Viewing (Conducted at Funeral Home)............ $ ✓ Certified Copies of Death Certificate. "_?.:�.�a.°ti....... $ �}-QO Memorial Service(Conducted at Funeral Home) ,r}$ Flowers ..T'�xLL..SR 4 ! 4....................... $ f L . $ Organist/Soloist .................................... $ USEOFSTAFFANDEQUIPMENT: $ Funeral Ceremony(conducted at another facility)............ $ w+ $ Visitation/Viewing ( conducted at another tacuity)........... $ Memorial Service ( conducted at another facility ) ............ $ Graveside Service... $_�� $ 5 $$ y1$ a (C) OTHERITEMS: Total(B) $ S,12.00 $ Total(A)&(B) TRANSFER OFREMAINSTOFUNERALHOME............ $ $ ( Miles Transported) Total(C) $ $ AUTOMOTIVE EQUIPMENT: '"''' Casket Coach(Hearse)........................:.... $ Total(A)(B)&(C) Family Car....................................... $ 4 ' LESS: Preneed Adjustment / Allowance❑INS❑TR $( ) Flower Car or Floral Disposition ...................... $_.11, Payment / Date ( ) $( ) Lead Car/Clergy Car.............................. $ ✓ Other (Specify) $( ) :% Car for Pallbearers ................................. $ BALANCE$ MISCELLANEOUS MERCHANDISE: Acknowledgment Cards..1-44*1.................. $ LEGAL,CEMETERY,CREMATORY OR OTHER REQUIREMENTS COMPELLING THE PURCHASE OF ANY ITEMS LISTED ABOVE: �' Visitors Register .4^,L i= .j�,. T ms`s,.-,••-..•,,- $ �/ The under purchasef(s rebyattesttothe ollowing:(1)UWedid( )did not( )authorize embalming of the above MemoryFolde rs.....'.`.... $ named deceased.(2)I/We were shown a Casket Price List and an Outer Burial Container Price List before the showing of caskets `...```..````.. and outer burial containers.(3)IIWe were given/offered for retention a General Price List upon the beginning of a discussion of PrayerCards..................................... $ funeral arrangements and/or selection of services and merchandise. r� CASKET l;'C i ewrrrh i $ , ao TERMS:Net due 30 days.A charge of A %per annum( / O %per month)for unanticipated late payment will be charged on any amount unpaid after due'8ate. Purchaser(s)agrees to pay reasonable attorney's ie S acrt costs and other costs of collection if incurred in the collection of this debt. , t'the -�'' ��—� } -- OUTER BURIAL CONTAINER(As Selected) $ �+ L� 1,or we,having read the above,accept and approve same,and jointly and severally promise to make full paymeitrefot'Each purchaser understands that this promise to jointly and severally make full payment means the Funeral Home has t>6 ri ht collect the entire amount fron) anyone or more of the purchasers without resort to any claim against any other purchasers.This fight ext is regid ss of whether or not one or more of the purchasers have agreed among themselves how much each will contribute to make full pa t. ipt of a copy of thi trat t is Receptacle(other than casket) $ acknowledged. _ - --- MR. Wearin A area MRS.. ' 9 PP $ _ . MISS Monument Engraving $ •T'ghature- Purchaser)s)' - Strebt Address S.S.No. ',f City '- St to Zij5 Cotte FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME .............. $ CRMN RECEIVING OF REMAINS FROM ANOTHER FUNERAL HOME.............. $ Signature of Purchaser(s) Street Address City and State Zip Code DIRECT CREMATION(As Selected)................................... $ Signature of Purchaser(s) Street Address City and State Zip Code IMMEDIATE BURIAL(As Selected) .........I......................... $ -> We agree to provide the service&merchandise indicated above. S-7 PA Total(A) $ Fogelsanger-Bricker Funeral Home, Inc By RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date : 11/20/2012 Cumberland County - Register Of Wills Receipt Time : 15 : 08 : 25 One Courthouse Square Receipt No. : 1072151 Carlisle, PA 17613 BUTLER RICHARD S Estate File No. : 2012-01216 Paid By Remarks : REBA C BUTLER WZ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 20 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 16 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 1142 64 . 50 Total Received. . . . . . . . . 64 . 50 REV-1512 EX+(12-08) Q5' SC177 pennsytvania HEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT " INHERITANCE TAX RETURN MORTGAGE LIABILITIES DECEDENT, RESIDENT DECEDENT ESTATE OF FILE NUMBER Richard S. Butler 21-12-1216 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 Mortgage with Embrace Home LoansT 148,490.31; �2. GE Capital Retail Bank Care Credit Dental ." 374.20 3 [Verizon Wireless c _ 404.651 4.f Encompass Home and Auto Insurance Company - TM- �. _ 1113 EA5. HSBC Card Services �2629.51 [:6�. UNION Plus Credit Card 532.36 F-1t El F El D E I _ �. TOTAL(Also enter on Line 10 Recapitulation)) $Reca 952,542.36"; If more space is needed,insert additional sheets of the same size. NOTE FHA Case No. State of Pennsylvania 446-1053798-703 February 7. 2012 [Date] 320 Mountain Rd, Newville, PA 17241 [Property Address] 1. PARTIES "Borrower" means each person signing at the end of this Note, and the person's successors and assigns. "Lender" means Embrace Home Loans, Inc. and its successors and assigns. 2. BORROWER'S PROMISE TO PAY; INTEREST In return for a loan received from Lender, Borrower promises to pay the principal sum of one hundred forty-ni ne thousand nine hundred eighty-five and 00/100 Dollars(U.S. $ 149,985.00 ), plus interest, to the order of Lender. Interest will be charged on unpaid principal, from the date of disbursement of the loan proceeds by Lender, at the rate of four and one-eighth percent( 4.125 %)per year until the full amount of principal has been paid. 3. PROMISE TO PAY SECURED Borrower's promise to pay is secured by a mortgage, deed of trust or similar security instrument that is dated the same date as this Note and called the "Security Instrument." The Security Instrument protects the Lender from losses which might result if Borrower defaults under this Note. 4. MANNER OF PAYMENT (A) Time Borrower shall make a payment of principal and interest to Lender on the first day of each month beginning on Apri 1 1 , 2012 . Any principal and interest remaining on the first day of March , 2042 , will be due on that date, which is called the "Maturity Date." (B) Place Payment shall be made at 25 Enterprise Center, Newport, RI 02842 or at such place as Lender may designate in writing by notice to Borrower. (C) Amount Each monthly payment of principal and interest will be in the amount of U.S. $ 726.91 This amount will be part of a larger monthly payment required by the Security Instrument, that shall be applied to principal, interest and other items in the order described in the Security Instrument. (D) Allonge to this Note for payment adjustments If an allonge providing for payment adjustments is executed by Borrower together with this Note, the covenants of the allonge shall be incorporated into and shall amend and supplement the covenants of this Note as if the allonge were a part of this Note. [Check applicable box] ❑Graduated Payment Allonge ❑Growing Equity Allonge ❑Other [specify] 5. BORROWER'S RIGHT TO PREPAY Borrower has the right to pay the debt evidenced by this Note, in whole or in part, without charge or penalty, on the first day of any month. Lender shall accept prepayment on other days provided that Borrower pays interest on the amount prepaid for the remainder of the month to the extent required by Lender and permitted by regulations of the Secretary. If Borrower makes a partial prepayment, there will be no changes in the due date or in the amount of the monthly payment unless Lender agrees in writing to those changes. 2011-1958303 100049700011910862 0120 FHA Pennsylvania Fixed Rate Note-10/95 Wolters Kluwer Financial Services VMPO-1R(PA)(0707) Page 1 of 2 Initials: 6. BORROWER'S FAILURE TO PAY (A) Late Charge for Overdue Payments If Lender has not received the full monthly payment required by the Security Instrument, as described in Paragraph 4(C) of this Note, by the end of fifteen calendar days after the payment is due, Lender may collect a late charge in the amount of four percent( 4.000 %)of the overdue amount of each payment. (B) Default If Borrower defaults by failing to pay in full any monthly payment, then Lender may, except as limited by regulations of the Secretary in the case of payment defaults, require immediate payment in full of the principal balance remaining due and all accrued interest. Lender may choose not to exercise this option without waiving its rights in the event of any subsequent default. In many circumstances regulations issued by the Secretary will limit Lender's rights to require immediate payment in full in the case of payment defaults. This Note does not authorize acceleration when not permitted by HUD regulations. As used in this Note, "Secretary" means the Secretary of Housing and Urban Development or his or her designee. (C) Payment of Costs and Expenses If Lender has required immediate payment in full, as described above, Lender may require Borrower to pay costs and expenses including reasonable and customary attorneys' fees for enforcing this Note to the extent not prohibited by applicable law. Such fees and costs shall bear interest from the date of disbursement at the same rate as the principal of this Note. 7. WAIVERS Borrower and any other person who has obligations under this Note waive the rights of presentment and notice of dishonor. "Presentment" means the right to require Lender to demand payment of amounts due. "Notice of dishonor" means the right to require Lender to give notice to other persons that amounts due have not been paid. 8. GIVING OF NOTICES Unless applicable law requires a different method, any notice that must be given to Borrower under this Note will be given by delivering it or by mailing it by first class mail to Borrower at the property address above or at a different address if Borrower has given Lender a notice of Borrower's different address. Any notice that must be given to Lender under this Note will be given by first class mail to Lender at the address stated in Paragraph 4(B)or at a different address if Borrower is given a notice of that different address. 9. OBLIGATIONS OF PERSONS UNDER THIS NOTE If more than one person signs this Note, each person is fully and personally obligated to keep all of the promises made in this Note, including the promise to pay the full amount owed. Any person who is a guarantor, surety or endorser of this Note is also obligated to do these things. Any person who takes over these obligations, including the obligations of a guarantor, surety or endorser of this Note, is also obligated to keep all of the promises made in this Note. Lender may enforce its rights under this Note against each person individually or against all signatories together. Any one person signing this Note may be required to pay all of the amounts owed under this Note. This is a contract under seal and may be enforced under 42 PA. C.S. Section 5529(b). BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Note. (Seal) (Seal) Richard S Butler -Borrower -Borrower (Seal) (Seal) -Borrower -Borrower (Seal) (Seal) -Borrower -Borrower (Seal) (Seal) -Borrower orrower 2011-1958303 100049700011910862 0120 VMPO-1R(PA)(0707) Paget of 2 4WPO Box 77404 Statement Date: 11/16/12 embrace7 Ewing,NJ 08628 Account Number: 0036583029 1111110 home loans STATEMENT ENCLOSED Payment Due Date: 11/01/12 Balances Principal Balance* $148,490.31 4 0403250 00002053 09CLST 0954550 XD AF05AB-img-D Escrow Balance $381.03 RICHARD S BUTLER Year-to-Date 320 MOUNTAIN RD Interest Paid $3,593.68 NEWILLE PA 17241-9770 Taxes Paid $2,838.74 Payment Information Interest Rate 4.1250% Current Payment $1,156.82 Past Due Amount $1,156.82 Unpaid Late Charges $46.27 Other Fees Total Amount Due $2,359.91 Property Address: 320 MOUNTAIN RD *This is not a payoff amount NEWVILLE, PA 17241 Website:www.loanadministration.com Transaction Activity Since Last Statement Transaction Due Trans Eff Total Optional Description Date Date Date Received Principal Interest Escrow Insurance Unapplied Fees MIP/PMI DISE 03113 11/02 $135,06 -$135.06 CENLAR LATE CHG ASSESSED 11/12 11/16/12 11/16/12 -$46.27 Important Messages This statement reflects accumulated past due months. Please contact your loan counselor at 1-888-686-5461. Thank you in advance for paying timely. You save by avoiding late charges. For 24 hour access to your loan information please visit www.loanadministration.com. If there's ever an issue with your bill or you have a question concerning your account, don't hesitate to contact our Customer Service Department toll-free at 1-888-686-5461. Someone will be happy to assist you. We look forward to serving you with all your home financing needs. Important Information Please include your account number on all correspondence. Payments Qualified Written Requests Tax Bills IMPORTANT DRAFTING PO Box 986 PO Box 77423 6053 S.Fashion Square Drive INFORMATION:IF YOUR PAYMENTS *000IC2' Newark NJ 07184-0986 Ewing,NJ 08628 Suite 200 ARE AUTOMATICALLY DRAFTED Murray,UT 84107 FROM YOUR CHECKING OR Insurance Collections All Other Correspondence SAVINGS ACCOUNT,THE DRAFT PO Box 202028 PO Box 77407 PO Box 77404 WILL OCCUR ON YOUR SCHEDULEDDRAFT DATE PROVIDED YOUR Florence,SC 29502-2028 Ewing,NJ 08628 Ewing, NJ 08628 LOAN IS CURRENT OR PREPAID FAX 843-413-7133 FAX 609-538-4017 FAX 609-638-4005 TWO DAYS PRIOR TO YOUR SCHEDULED DRAFT DATE. Website:www.loanadministration.com Customer Service/Pay By Phone:1-888-686-5461 6 SC0308-000 E-mail:customerserVice@loanadministration.corn See Reverse Side For Additional Important Information Please return this portion with your payment Make Checks Payable To: XD Richard S ButterJl� 320 Mountain Rd Check this box if your address or MEOW RECOVERY SERVICES, LLC 200 Coon Rapids Blvd.,Suite 200 Coon Rapids, MN 55433-5876 Phone: 888-420-2510 Fax: 763-235-4055 12/31/2012 To Whom It May Concern: We are filing a claim on a probate/estate filed in reference to the individual listed below. AscensionPoint Recovery Services, LLC is filing this claim on behalf of GE Capital Retail Bank-CARE CREDIT DENTAL. Please see our claim form (enclosed)for details. Decedent Information: Case Number: 21-2012-1216 Balance: $374.20 Date of Death: 11/04/2012 Name: RICHARD BUTLER If you have any questions please feel free to contact our office at your convenience. Respectfully, AscensionPoint Recovery Services, LLC ---------------------------------------------------------detach coupon----------------------------------------------------- Reference No: 1101539 Phone Number:888-420-2510 PLEASE SEND PAYMENTS&CORRESPONDENCE TO: ANDREW H.SHAW 200 SOUTH SPRING GARDEN ST ASCENSIONPOINT RECOVERY SERVICES, LLC CARLISLE, PA 17013 200 COON RAPIDS BLVD.SUITE 200 COON RAPIDS, MN 55433-5876 CVRLTR_v1.1_20121120 NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF RICHARD BUTLER , DECEASED No. 21-2012-1216 To the Clerk of the Orphans' Court Division: Enter the claim of AscensionPoint Recovery Services,LLC on behalf of GE Capital Retail Bank-CARE CREDIT DENTAL XXXXXXXXXXXX2678 (Claimant) in the amount of$ $374.20 against the above entitled Estate. The Decedent,who resided at 320 MOUNTAIN RD.NEWVILLE.PA (Street Address) 17241-9770,died on 11/04/2012. Written notice of said claim was given to (Date of Death) ROY W.BUTLER. (Personal Representative or his/her counsel) at 320 MOUNTATN RD.NEWVILLE PA 17241, (Address) on 12/31/2012. (Date) fLj,�,ln�.w APRS Representative (Claimant) 200 Coon Rapids Blvd. Suite 200 (Street Address) Coon Rapids, MN 55433-5876 (City,State,Zip) Robin LeDonne—IL Bar#6294763 (Claimant's Counsel) 200 Coon Rapids Blvd. Suite 200 (Address) Coon Rapids, MN 55433-5876 888-420-2510 (Telephone) CLMFRMPA v1.1 20121120 verize—t'lwireiess . PO BOX 4003 Manage Your Account&View Your Usage Details j Account Number Date Due ACWORTH,GA 30101 My Verizonwww.vetizonwireless.com .;•. t111 Address Changad?—gr:w, Invoice Number 16803342357 10002968 01 AT 0.371 "AUTO T4 0 2023 17241-977020 1 E PHIL2304 '"wick Bill Su"" att-t Sep 24"Oct 23 1111111311111111111111111111111111111111111111111'11111111111Jill RICHARD BUTLER Previous Balance(see back for details) $406.00 320 MOUNTAIN RD Payment—Thank You —$160.44 NEWVILLE,PA 17241-9770 Balance Forward Due Immediately $245.56 Account Charges and Credits Includes Late Fee of$5.00 $5.00 Monthly Access Charges $139.16 Verizon Wireless'Surcharges and Other Charges&Credits $4.81 Taxes,Governmental Surcharges&Fees $10.12 Total Current Charges Due by November 18,2012 $159.09 Total Amount Due $404.65 Our records indicate your account is past due. Please send payment now to avoid service disruption. Pay from Wireless I Pay on the Web _v Questions: _ .:) My Verizon at www.vej,izonwireless.com :11 • 1 / 1 *611 from / VE ver!Mpwireless Bill Date October 23, 2012 Account Number 221798695-00001 Invoice Number 6803342357 RICHARD BUTLER Total Amount Due 320 MOUNTAIN RD Make check payable to Verizon Wireless. 404.65 NEWVILLE,PA 17241-9770 Please return this remit slip with payment. $ ®❑1:1 ■ 1:11:1 P.O.BOX 25505 LEHIGH VALLEY, PA 18002-5505 ® Check here and fill out the back of this slip if your billing address IIIII�111�1'111111111111II1I111111I11111111�I1111111�1111�1111111 has changed or you are adding or changing your email address. 6803342357010221798695000010000159090000404650 t+10 T t�F;t a:1k acc�:r Fi v1d rra!tiirly fiilriber„tr,'14 be I'e.l.ained to enable Faure pavclents by ptuxte nr amine.To opt out,gall 1--856-344--0401. • �/' vel"lZoiillrwireless Invoice Number Account Number Date Due Page 6803342357 221798695-00001 Past Due 2 of 8 Get Minutes Used Get Data Used Get Balance -- Explanation of Charges Payments Verizon Wireless'Surcharges Previous Balance $406.00 Verizon Wireless' Surcharges include (i) a Regulatory Charge (which helps defray various government charges we pay including Payment—Thank You government number administration and license fees); (ii) a payment Received 10/14/12 —160.44 .sem Federal Universal Service Charge (and, if applicable, a Slate Universal Service Charge)to recover charges imposed on us by Total Payments —$160.44 the government to support universal service; and (iii) an Balance Forward Due Immediately $245.56 Administrative Charge, which helps defray certain expenses we incur, including charges we or our agents pay local telephone companies for delivering calls from our customers to their Account Charges and Credits customers,fees and assessments on our network facilities and services, and costs and charges associated with new cell site Late Fee 5.00 construction, local number portability, and other government Subtotal $5.00 mandates. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to ® change from time to time. Account Monthly Access Charges Taxes,Governmental Surcharges and Fees Nationwide Talk Share 700 10/24—11/23 50.00 Includes sales, excise and other taxes and governmental 18%Access Discount($50.00+$9.99) 10/24—11/23 —10.80 surcharges and fees that we are required by law to bill Subtotal $39.20 customers.These taxes, surcharges and fees may change from time to time without notice. Total Account Charges and Credits $44.20 Late Fee Information A late payment applies for unpaid balances.The charge is the greater of$5 or 1.5%per month,or as permitted by law. Verizon Wireless'Other Charges and Credits Includes charges for products and services,and credits owing. Correspondence Address_Verizon Wireless 20 Alexander Drive PO Box 5029 Wallingford, CT 06492-2458 -------------------------- ------------- Automatic ---Automatic Payment Enrollment for Account:221798695-00001 RICHARD BUTLER By signing below,you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due on your account.The check you send will be used to setup Automatic Payment.You will be notified each month of the date and amount of the debit 10 days in advance of the payment. I understand and accept these terms.This agreement does not alter the terms of your existing Customer Agreement.I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account.To withdraw your authorization you must call Verizon Wireless.Check with your bank for any charges. 1.Check this box. 2.Sign name in box below,as shown on the bill and date. 3.Return this slip with your check for this month's payment. -1 ❑ I I I Changing your billing address for Account:221798695-00001 RICHARD BUTLER Use this space or sign in to My Verizon at vzw.com/changeaddress to change the mailing address where we send your bill.If we do not have your most recent email address,provide it below and we'll use it to tell you important information about your Verizon Wireless service.Allow 2 billing cycles for the address change to take effect. Confirming or changing your service address New Address For each of your mobile numbers,in order to bill taxes and City surcharges correctly we need a service address-which is a street address(not a PC Box)that is the home or primary State/Zip business address of the person who uses that number.To Work Phone Home Phone confirm or change the service address for any of your mobile numbers,sign in to My Verizon at vzw.com/serviceaddress. Email Order#:2023 Copy#:04 Control#:10002968-00009115 H Encompass Home and Auto Insurance Company 11/05/12 05:05 PM Payment Receipt Agent Name: JEFFREY L BOUDER INS AGENCY Agent Number: 114308 Customer Name: RICHARD'BUTLER Agent Address: 19 SOUTH HIGH ST Customer Address: 320 MOUTAIN RD NEWVILLE,PA 17241 NEWVILLE, Pennsylvania 17241 Agent Phone Number:(717)776-4051 Payment Date: 11/05/2012 Payment Time: 05:05:19 Amount Received: $111.33 Method of Payment: Check *** The above amount(s)will be applied to the following policy(ies) *** Policy/App Number Eff Date Amt Applied 0281312466 04/05/2012 $111..33 Conditions of Receipt 1) Any policy which has been cancelled,our acceptance of this payment does not (a) reinstate the policy, or (b) afford coverage for any accident, occurrence, or loss which took place before this receipt was issued. A refund will be provided if coverage is not reinstated. Notification will be provided if the coverage is reinstated. 2) If we mailed a cancellation notice or notice of termination and your check or other remittance is not honored upon presentation, your policy terminates on the date and time shown on the cancellation notice or the notice of termination and this receipt is of no effect. This means we will not be liable for claims or damages after the date and time indicated on the cancellation notice or notice of termination. Agent Signature [[11[11 III{I VIII III[[11111 lilll Alli 11111 VIII[1111 VIII IIIiI VIII 11111 VIII VIII 11111 VIII I[III VIII 11111111111 III Illi 14308000185009533290PA 4326976 — ----------------------------------------------------------------------------------------------------------------------------------------- HSBC Account Number: 5466-4100-2403-4214 New Balance $2,629.51 Minimum Payment Due $187.00 Payment Due Date 11/14/2012 Include account number on check to HSBC Card Services. Do not send cash. Please send your payment 7 to 10 days prior to the payment due date to ensure timely delivery. 100 AMOUNT ENCLOSED HSBC CARD SERVICES RICHARD S BUTLER PO BOX 71107 320 MOUNTAIN RD CHARLOTTE NC 28272-1107 r NEWVILLE PA 17241-9770 �IIII��II��II�IIIIIIII�I�II�III�I��II�IIIII�I�III�IIIII�IIIII��I 00262951000187000005466410024034214001005 ------------------------------------------------------------------------------------------------------------------------------------------ Account Number: 5480-4200-3356-1596 -,I d ` New Balance $532.36 e= intiiepublicservice a Minimum Payment Due $64.00 Payment Due Date 11/10/2012 Include account number on check to UNION PLUS Credit Card. Do not send cash. Please send your payment 7 to.10 days prior to the payment due date to ensure timely delivery. 010 AMOUNT . ENCLOSED UNION PLUS CREDIT CARD RICHARD S BUTLER PO BOX 71104 320 MOUNTAIN RD CHARLOTTE NC 28272-1104 NEWVILLE PA 17241-9770 II��IIIIII�III��I�II��IIIIII��II�II��IIII�I1lIIII�IIII�IIII 00053236000064000005480420033561596000107