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Home My WebLink About05-21-15 J � pennsylvania 1505618403 �••ex(a�ia� RE V-1500 OFFICIFL IISE ONLY ��„�oa, vaa, ��e��moe. Bureauonntlividualraxes INHERITANCETAXRETURN PO BOX 280601 Harrisburg,PA 1�128-o6ot RESIDENTDECEDENT 21 13 0590 ENTER DECEUENT INFORMATION BELOW Social Securi�y Number Date of Dea�h �oovwv Da�e of Bitlh MMDDvnv OS 23 2013 04 02 1924 Decedenfs Las�Name Suffix pecetlenPs First Name MI ROSS LEOTA G Qi Applicable)Ente�Surviving Spouse's Inbrmadon Below Spouse's Last Name Suffix Spouse s First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH TME REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. OriginalReWm � 25upplemen�alReWm ❑ 3. RemaintlerRe�um(tla�aoftleaN priar�o t2-13-8'n � d_ AgncWWrzlE�mptim<daleof ❑ 5. FUWreInlereslCompmmise(tleleol ❑ 6, FederalESYaleTaxReWmRequlretl 4eat�onoreXer]-1-2012) tleathafler@-02-8� � 1. Oece4enlDietlTes�ale ❑ B. DecetlenlMainlaineJaLivingTmsl Q 9. To�alNumberolSaleDepos��Boxes (AVac�copya(wllp (HHacM1copyofVus�J — ❑ �0- G�IgafionPeaceetlsRecelvetl ❑ 11. NonFmbaleTrensiereeReNm ❑ 12. �efereaVEleclionofSpousalTmsis (SCM1etlule F antl G Assels Only) ❑ ia. eosioesanase�s ❑ ia. sn��e��ssoieeener�c�ary (No�ms�imomea� CIXtR6PIXJ0FN'i'-THISSECMMIMIlSTBECOMPLEIm N1CIXtRE5PIX10FHLE0NDCONFIDQJMLTA%INFORM1UlpNSlKK1LDBEqFECI�IO: Name Dayfime Telephone Number RICHARD A ROSS Firs�Line of Atltlress 2532 ARCONA RORD Secontl Line ot NtlOress LityorVoslOffice State ZIPCotle MECHANICSBURG PA 17055 � �, ' m CorresponOenPsemallatltlress r' � � �� —^"�-- NEGISTER dF WILL E ON4Y"1 � J REQI6TER0=VJiLL5U5EONLY , , �� LL l � T (. �l m _r. o0 0 � � DRTE FILED STNMP Side 1 L I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 1505618403 1505618403 � l`\� J1505618411 RE�_,�EX DxedenPs Social5ewrity Numbe� oe�eoem�mame: ROSS, LEOTA G. RECAPITULATION 1. RealEstate(ScheduleA).. ......__ ..___. ______. t. 2. SlocksandBonds(SchetluleB) ____ __..... ..........._ Z, 3. Closely Heltl Corporation, Patlnership or Sole-Pmprietors�ip(Schedule C)........_.... 3. 4. Mortgages antl Notes Receiva�le(Schetlule D) ._...... ............. 4. 5. Gasq Bank peposits antl Miscellaneous Perwnal Property(Schetlule EJ._______. 5. 4 , 3 4 6 . 3 2 6. JointlyOwnedPmperty(SchetluleF) ❑ Separa[eBillingRequestetl.._........_ 6. ]. Inter-Vims Transfers 8 Miscellaneous Non-Pmba�e Pmperty (Schetlule G) ❑ Separate Billing Requestetl.............. ]. 8. Total Gross Asse[s(rotal Lines 1 �hmugh]) ____. .____. _ 8. 4 . 3 4 6 � 3 2 9. Poneal Evpenses antl HdminisVa[ive Costs(Schetlule H).___.............._..........._.... 9. 1 , 1 5 4 . 2 5 1�. DebisotDecedent,MortgageLiabilitiesantlLiens(Schetlulel).______ .__.. ._ .__ �o� 11. Total Oetluctiore Qotal Lines 9 and 10)...... ......... .. ..... . . . . i t. 1 . 1 5 4 . 2 5 12 Ne[Valueo(Estate(LineBminusLinell). ......... ............. 12. 3 . 192 � 07 13. CharitableanGGovemmentalBeques�s/Sec9113Tms�storwhich an eleclion lo tax has not been matle(Schedule J) ......... ............. 13. 3 1 9 � 2 2 14. NetValueSubjecttoTaz(Linel2minusLinel3) ....__. ..__..__.. t4. 2 . 872 � 85 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amoun[of Line 141axable at ihe spousal tax ra�e,or hansfers under Sec.9116 �a>�iz�x oo is. i6. Amounto(LinelAtaxa�le al lineal rate x .045 2 , 8 7 2 � 8 5 16. 12 9 . 2 8 1]. AmountofLinel9tavable atsiblingrate X ]2 1]. 18. qmow�otLinel4taxable at collateral ra[e % .15 18. 19. TNXOUE .___......... ........... .__.... ______. 19. 129 . 28 20. FILL IN THE OVAL IF VOII ARE REOUESTING A REFUND OF AN OVERPAYMENT ❑ Unde�penetlles o(pe�jury,I Eeclare I have examinetl Pis�eWm,Indutling accompanying scM1edules antl slalemen�s,antl�o IM1e besl ol my knowletlge antl beliel, il is Ime,correct and comple�e.Declaralion o�preparer oNer�M1an�M1e person responsible lorlling�M1e reNm is basetl on all informa�ion olwM1icM1 preparer M1as anyknowletlge. SIGNATURE O_ F P�FRSON.RE�PONTSI6LE FOR FlLING RETURN Richard A.Ross �AT%Z /� 7�+�C4,�� G/ Tr�J[ nooaess 2532 Arcona Road, Mechanicsburg, PA 17055 SIGNHTl1RE OF PREPNRER OTHER THAN REPRESENTNTNE onie A��RESS I IIIIII IIIII(IIII"III IIII�IIIII IIIII IIIII IIIII III'I IIII I'll Side 2 L1505618411 1505618411 � eev-tSooEXaagea FileNum4er 21 - 13 - 0590 DecedenPs Complete Address: DECEOENTSNAME Ross, Leota G. sTREernoorzEss 22T Messiah Circle, #6-D GTY STATE ZIP Mechanicsburg PA 77055 Tax Payments and Credits: L Taxpue(Page2,linel9! l�) ��9'�8 2. Creads�Paymenis A_ Prior Paymen5 B. Discoun� TotelG�etlits(H +e) (2) 0.00 3. Interasl (3) 0.00 q. If Line 2 is grea!er Ihan Line i t Line 3,en[er the difference. This is the OVERPAVMENT. (4) Check box on Paqe 2,Line ZO�o request a refuntl 5. It Line 1 +Cine 3is greate'�han Line 2 enter�he tlifference. Thisisthe TA%DUE. �5� �2 9.2$ Make Check Payable to: REGISTER OF WILLS, AGENT. ... . :: . . .. ....� :.�=i . ,.,,,,. ,.i , ��! r ' , PLEASE ANSWER THE FOLLOWING QUESTIONS BV PLACING AN "X" IN 7HE APPROPRIATE BLOCKS 1. Did tlecedent make a Vansfer antl�. Yes No a. re�ainNevseorincomeofthepmpehyhansferretl _. _ __ + b. retain[he right lo tlesignale who shall use�he propertytransferred on�s ncome _ ._., 8 x c . retaln a reversionaryinteresi:or ........ ._ .. .. . x tl. recerve Ihe pmmise for life o(either paymen[s,benefAs or wre9 .. ... ..... x 2. If tlea[h occurred afler�ec 12, 1982 4 tl decedenl tansfer propetly wlih n one year of tleeth wlihout recelving atlequate mnsideralion� ..__... _....... .._... __..._ .__... ❑ x❑ 3. D�itlGecetlentownan"in�mstfar" orpaya�leupondeathbankaccounlorsecurHyathisorhertlea�h4_._.____. ❑ x❑ 4. Ditl tlecetlent own an mtlivitlual retirement account,annu ty or other non-pmba�e propetly w�ch rontains a�enelciary tlesignation?_. _..._.. .__.... ..__. . . __....._ ❑ ❑x IF TME ANSWER TO ANY OF THE ABOVE�IIESTIONS IS YES,YOU MUST COMPLETE SCHEOULE G PND FILE IT AS PART OF THE RETURN. :. :. x � .,i C .... � .. . .. e ..,.�. �- . .......� .... .. .. . . . e .. . ...... .. . .. . . . .. . .. . ., .. ......... . Fortlatesoftlea[honorafterJulY 1 1994antlbeforeJa 1995.thetax at Imposedon�henelvalueoftran fersroorforthe� se �tM1 survNingspouse is 3 percent[72 P 5 §9118(aJ(1 1)(i)� Por dales of tleath on or after January 1,1995,the lax ra�e imposetl on ihe net value of hansfers ta or lor�he use of�he suniving spouse is 0 pement 4]2 P.S.§8116(a)(1.1)(il)J_ The sla�o�e does not exempt a transfer to e surviving spovse fmm tex,antl ihe sta�utory requirements for dlwlosure of as�saritl iling e[ax raturn are shll appllcable even if Ihe survNing spouse Is ihe anly benefloiery_ For tlatas o(death an or after Juty 1,2000�. •The tax ra�e imposetl on the net value of tans�ers fmm a tleceasetl chiltl 21 years of age or younger a�tleath�o or fo�Ihe use of a naWral parenl,an atloptive parent.or a step-parenl of�he chiltl is 0 percent�]2 PS.§9116(a)(12)]. •The�a¢rate imposetl on the iet value of Uansfers to or fo��he use of the decedenFs lineal beneficiaries is 4 5 percen[,ewcept as noletl in[2 P S.§9N6(a)(1)j. •The taM rale im osetl on the ael value of transfers to or for Ihe usa o/Me decedenPs siblings is 12 peroent[]2 P S.§911 fi(a)(1 3)]. A slbllnq is tlafinatl untler Section�102,as an IMlvltlual who has at least one parent In common with Ihe decedenl.whe�her by blood or atloption. � pennsylvania l SCHEDULE E �� `°"��"-" °'p`°E�°E CASH, BANK DEPOSITS AND MISC. �tiHER�,AH�E�Ax aE,�an� �Es.oE"�°E=�°r"' PERSONAL PROPERTY I — _ _ _ —_ __. . -- -- __ _ _ -.-- .... - -- – - --- -- .. . _ _ . ._ -- -' --.. FILE Nl1MBER ESTATEOF Ross, LeotaG. ,2i - i3-o5s0 Indutle Ihe proceeds of litigalion antl ihe date the pmceetls were receivetl by the estale.All property jointlyowned with�he nght o( survivorehip must be tlisclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Naturel gas rights per Lease with Ergo for an interest in a well situate in MorrisTownship, 4,271.32 Greene Counry, Pennsylvania. No bona fide sales or appraisals available, so value determined by 2 tlmes payment recerved In 12 months prior to Decedenfs death(2012) ($2,135.fi6 x 2) 2 Natural gas rights per Lease with Leatherwood for an in[erest in a well situate in Morris 75.00 Township, Greene County, Pennsylvania. No bona fide sales or appraisais available, so value de[ermined by 2 [imes payment received in 12 months prior to DecedenCs death (2012) ($37.50 x 2) � TOTAL(Also enter on Line 5, Recapitulation) 4,346.32 RE0.1511 E%��0&19� --� pennsylvania � S��/��E�H�p � DEPFRTM[AiOFRE�cNIIE �p/�r�p/��J/C�/Jy�� INHERCFNGET�1%XEi0R4 ��IIVGIiN� RE51]t4iUEGE�GNT � � -��- � -- iFILENUMBER ESTATE OF Ross, Leola G. _ 21 - 13-0590 _ �ecedenPs tlebts must be reported on Schetlule L _ NUMBER I � DESCRIPTION I— AMOUNT � . FUNERALE%PENSES: . . _ _ . - ----� A. _ — — B. AOMINISTRATIVE COSTS: �. Pereonal Represenlative's Commissions Name of Psrsonal Reprasenlative(sJ IS�reet Adtlress Ciry State Zip I Year(s)CoinmissionPaitl g AtlomeysFees 3_ Famiy 6cemptiort. QPoecetlenfs atltlress Is not the same es claimanfs,etlach explanation) Qaimant Streel Address City State _ Zip Relationship of Glaimanl lo�ecetlenl 4. Probate Fees 5. Accountanfs Fees 6. Tax Retum Preparers Fees �_ ' O�M1erAdminishativeCasis I � . RegisterofWills-SupplementalFilingFee 15.00 See attached I 1.13925 � TOTAL(Also enter on line 9, RecapiNlalion) � 1,15425 RE415fl E%r�OB�ll� .�� pennsylvania ; ��yH I � �E � a��E �H� k�As� A��a� FuneralF�rses8 p`� . °E .:-��• Ahrdr�ish-atioeCosScantirxKd ��. _ �.__ ._' . _. _ _.. -- _ ��.�FILENUMBER _— : ESTATE OF Ro55, LeOta G. . I p� - 13-0590 _ — � � _ 2 UPS -Ovemight Mails to Beneficiaries for Assignment of Rights 581.75 �eene Counry Recorder of Deeds 57.50 4 , Brinser, Wagner 8 Zimmerman - Preparation of Assignment of ftights, eta 500.00 I i Page 2 of Schedule H REV-1613 E%�(01-ID� y��: pennsylvania SCHEDULE J � �F�AA,MEN-��-kE�E.��E ,„„Eq:,qN�t.r,„RE,,,a„ BEN EFICIARIES ESTATE OF FILE NUMBER Ross. Leota G. 21 - 13-0590 RELATIONSHIPTO SHPREOPESTATE AMOUNTOFESTATE NUMBER NAMEANDADDRESSOFPERSON(5) DECE�ENT (Wortls) ($$$) REGEIVINGPROPERTY oouovosrtmzme(s� I TAXABLEDISTRIBUTICNS�inclutleoutrighlspousal dlsVlbutions,antltansfers untlerSec.9116(a)(1 2)j 1 J. Ronald Ross Son 18% Residue 574.57 243 Atlantic Road Gioucester,MA 09130 2 Richard A. Ross Son 18% Residue 574.57 2532 Arcona Road Mechanicsburg, PA 17055 3 William Ross Son 16% Residue 574.57 1224 Hunters Woods Drive Hagerstown, MD Enter tlollar amounts for disVibutions shown above on lines 15 ihrough 18 on Rev 1500 coversheet,as appropriate. II. NON-TAXABLE DISTRIdUTIONS A. SPOl1SAL DISTRIBUTIONS UN�ER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOTTHKEN B.CHARITABLE NND GOVERNMENTAL DISTRIBUTIONS 1 Brethren in Christ Founda[ion, Grantham, PA 10% Residue 31922 (For distribufion to eleven charitable/tax-exempt en[ities) TOTAL OF PART II-ENTER TOTAL NON-TA%ABLE DISTRIBUTIONS ON IINE 13 OF REV-1500 COVER SHEET 519.22 REV-1A0 EX��01-00� .� � pennsylvania SCHEDULE J � �E�AR'ME�,�F�V�.�uE gENEFICIARIEScontinued �..vHEa�.AN�E-Ax R�,�AN ESTATE OF IFILE NUMBER Ross. Leota G. pi - 13-0590 RELATIONSHIPTO SHAREOfESTATE AMOUNTOFESTATE NUMBER NAMEANDF��RESSOFPERSON(S) DECE�ENT (Wo�ds) ($$$) RECEIVINGPROPERTY oorvoe��z�*ms�eeisi I TAXPBLEDISTRIBUTIONS[inclutleouhigh�spousal tlishibutions,andtransfers under Sec.B116(a)(1 2)� 4 TimothyRoss Son 18% Residue 574.57 4590 East 136Ih Place Thomton, CO 80602 5 Catherine Rahter Daughter 18% Residue 574.57 Go 1281 East Allen Street Lancaster, OH 43130 Page 2 of Schedule J t71��E � ' �� XX �� LEOTA G. ROSS, a/k/a LEOiA H. ROSS LAW OFFlCES BRINSER, WAGNER & ZIMMERMAN 6 EAST MAIN STREET-SECOND F�OOR � P. O. BO% 323 PALMYRA, PENNSYWANIA I�O�B O 1]) 838-6348 �' P^f9 .. .� � � _ � �{.'� � E$ �� ; �3 � �'r_it.', . P�� , ��: � � "� ' M. . .�. , . „ .,:. . .�:, . ., . . WILL OF LEOTA G. ROSS I. LEOTA G. ROSS, a/k/a LEOTA H. ROSS, currendy ol Upper Allen Township. Comberland County, Pe�nsylvania, bei�g of sound mind a�d disposing memop�. realizing the unceriainty of this tife, but «�ith confidence in God and trust in i[is So�, my Lord and Savior, Jesus Chrisi, who dieti for my sins upon the cross and rose again to redeem me and �ive me etemal life, do hereby make, publish and declarc this to be my I.ast Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. [ direct that all my just debts and funeral expenses be paid from the assets oC my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes [hat may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taYes were expenses of administiation and all property includable in my taxable estate whether or not passing under ihis Will shall be free and clear thcreof. III. I i�tend to keep with this my Will a separate memorandum conceming disposition of certain items of tangible personal property. I bequeath the items on said memorandum m the persons designated. IV. I bequeath the remainder of my tangible personal property unto my children, to be divided among themselves as they agree upon. V. All the rest, residue and remainder of my es[ate, of whatever nature and wherever simate, including properiy over which I hold a power of appointmenL I devise a��d bequeath as follows: A. Ten percent (10%) unto the Brethren in Christ Foundation. Grantham, Pennsylvania, to be used for the chazi[able purposes I intend to outline to it by way of sepazate instructions. B. Ninery percent (90%) to be divided equally among my childreq namely, J. Ronald Ross, Riohard Ross, William Ross, Catherine Rahter and Timothy Ross, or their issue per stirpes. � ..,L _,.j-�n , � r � -1- � � . .. . . � � ,r�..;L ` Provided, however, the shaze of my daughter, Catherine, shall be held in trust for hec benefit by my hereinafter-named Trustee pursuant to the terms and conditions set forth in Pazagraph VI below. VI. In [he event that any assets of my esta[e pass into a trust fund for the benefit of my daughter, Catherine, as set forth above, said assets shall be held pursuant to the following specific terms and condi[ions: A. The primary pucpose of ffiis Trust is ro provide for the suppod, maintenance, welfaze and comfort of my daughter, Catherine, beyond what she may receive from Govemmen[al agencies. However, my Trustee may, in his sole discretion, also make expenditures from it for the benefit of my other children as he deems necessary and proper. B. My Trustee may make a one-time distribution to my daughter, Catherine, in the arnount of One Thousand Dollazs ($1,000). This provision is to be exercised in his soie discretion and is not mandatory. C. Any amounts distributed at the sole discretion of my Trustee to or for Catherine's benefit may be used onl to supplement but not supplant any govemmental benefits to which Catherine may be otherwise entitled. In the event that any govemmen[al agency, federal, state or local, would require distribution of either income or principal on her behalf, or in the event Yhat . government funds to which she would otherwise be entitled would be terminated because of this Trust, or in the event this fund would preclade her from receiving said government funds, this Trust shall immediatety terminate and be distributed pursuant to Subparagraph D below. The Federal Govemment, Commonweal[h of Pennsylvania and State of Ohio, and any subdivision thereof, or their agencies and departmenfs, are specifically prohibited from taking any income or principal of this Trust. D. Upon Catherine's death, any funds then remaining, both principal and income, shall pass unto her issue per stirpes. If she is not I survived by any issue, the balance shall pass as though she had predeceased me. VII. In addition to such other powers and duties as may have been granted elsewhere herein, my fiduciazies hereunder shall have the following powers and duties: _� � � �_ -z- ��> �-��J �. A. To invest any funds at any time held in trusc, in an}' stocks, bonds, notes, mutual fund shazes, or other sewrities or properties, real a� personal, or in one or more common trust funds, or collective trust Cunds es[ablished by the Trustee, or in securities issued by the Trustee; notwithstanding that such investments may not be of the character allowed to fiduciazies by statute or general rules of law, it being my intention to give him the broadest imestment powers possible, including the power to retain any property which is placed in [mst hereunder. B. To retain or to lease, sell, exchange or otherwise dispose of any property, real or personal, at any time held by him, for cash or upon credit, in such manner and on such terms and conditions as he may deem best, and no person dealing with him shal] be bound ro see to the application of any moneys paid. C. To borrow or loan money for any purpose in connec[ion with the administration of the property held by him upon such terms and with such security as he may determine necessary. D. To make any distribution hereunder in cash, in kind or partly in cash and partly in kind. E. In general, to exercise all powers in the management of property hereunder which an individual could exercise in the management of similar property owned in his own right upon such teans and conditions as he may deem best, and to execute and deliver alI instruments and to do all acts which he may deem necessary or proper to carry ou[the purposes of the[rust. VIII. No interest of any beneficiary of my estate, either in income or principal, shall be subject [o anticipation or to pledge, assignment, sale or transfer in any manner, nor shal] any beneficiary have power in any manner to charge or encumber his interes[, either in income or principal, nor shall the interest of any beneficiary be liable or subject in any mazmer while in the possession of my fiduciazies hereunder for the liability of such beneficiary, whether such liability arises from his debts, contracts, torts or other engagements of any type. IX. My amoun[s which aze payable to a beneficiary under this Will may, at the discretion of my fiduciaries hereundeq be paid to the guardian of the person and/or property of such beneficiary, to [he person who has custody of such beneficiazy, or direcdy to such beneficiary, or may be applied for the use or benefit of such beneficiary. The receip[ of such guazdian, custodian, or beneficiary or evidence of the application of such amounts, shali be a fut( and complete dischazge of my fiduciaries hereunder to the extent of such payment or appli J tion. T7ils paragraph shall be applicab(e to payments of income as well as principal. q -3- (i�Y/�,��'�(:�--�-3.�.n '�, X. I appoint my son, J. Ronald Ross, Exewror of this my Will. In the event that he fails �' to qualify or ceases to act as Executor, I appoint my son, Richard A. Ross, Executor of this my Will. XI. I appoint my son, J. Ronald Ross, as Trustee of any trusts created by this my Will. In the event that he fails to qualify or ceases to act as Trustee, I appoint my son, Richard A. Ross, as Trustee in his place. XII. I direct that no bond be required of my fiduciary for the faithfu] performance of his � duties in any jwisdiction. IN WITNESS WHEREOF, I, LEOTA G. ROSS, herewith set my hand to this my Last Will, typewritten on four (4) sheets of paper including the attestation clause and signamres of wimesses, this 1 L`�"' day of �`1'1'�,i�k;E�� 2010. ��t�/.,.��if�fiAL) LEOTA G. ROSS Signed by LEOTA G. ROSS, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and a[ her reques[, this ��`k" �ay of '�?'�x:.'V� , 2010. �,�i =� !-:%��=residing at� 7�z� l%1% 'Y� -�v '�i-c�,�� .�i'1. ��L.t, residingat "� � -4- COMMONWEALTH OF PENNSYLVAN[A . COUNTY OF � . WE, LEOTA G. ROSS,GERALD J. BRINSER and P71 C�4ffr1D A • a055 , the testatrix end the witnesses, respeceively, whose nemes are signed to thc attached or foregoing instrument, being first duly affirmed, do hereby declero to the undersignW authority that the testatrix signed and executed the instrument es her Last Will and that she signed willingly(or wi(lingly direc[ed another to sign for her),end that she executed it es her free end voluntary ect for the purposea therein expressed, and thet each of the wifiessce, in the presence end hearing of the tutaaix, signed the Will es wimessas and that to the best of our knowledge the testatrix wes et that time eighteen yeers of age or older, of sound mind and under no constraint or undue influence. � l .�S%`�/�1� L OTA G.ROSS �s- -�� "�,�,a �.�-� �rrxsss Subscribed, swom or a�rmed and acknowledged before me by LEOTA Q. ROSS, the testetrix, GBRALD J.BRINSER and P11�N/tRP fl � �� H'��ses, this I(u4t'' dey of l'nNIcM , 2010. 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SenAe� :GERALDBRWSER ReceivM:CHARLESEVANS � BRINSEfi WAGNER AND Z PA��RA pp��p�g SURFSIDE BEACH SG 295�5 1ZFA�0042210015d66 Ne#OayAir 15220 103 Lette� 25.00 Residential �eRer Residential Surcharge 3.50 FuelSumharge L43 .. Total 29 93 1s�ret:FOSS S2pdef :GERALDBRINSER R¢ceiVecWILLIAMRU550 BRINSER WAGNER AND Z PALMYRA PA 1]0]8 PITTSBURGH PA 15220 7otal UPS Shipping Document 9 P�kMJHs) ��-�� Total Out6ound 9 Psckage(s) 29Zn � Delivery Service Invoice Invoica date M3fCh 7, 2015 �� ' Invoica number OOOOFA7004105 llJ Slilpper number FA7004 �� Page 3 0l 4 Outbound UPS Shippinp Document , _____ Pickup ZIP Billea Da[s Tracking Nunibxr Service Gode Zone. WeigL� Charge 03/02 J2343690213 Nex[DayNi� 1]0]8 102 Letler 2100 COrtIlR2IGId� �B��B( Fuel Surchargz �-�4 Tolal 2��'� 1sIreI:R055 � 5¢I1tlCf :WIW�MRO55 Rec¢iveeGERALDBAINSFR BPINSER WAGNEq AND ZIM MER MD 21]40 PALMVFA PA 1�0�8 J23A3690222 NextDayAir t]0]8 106 LeNer 3035 Gomrrercial Le[ter Fuzl Surcharge 1 O6 Total 3i 41 lsl reL FO55 ' $entl¢� :CATHERWERAHTERGO RecC1VM:GERAL�8RIN5ER BPINSER WNGNEP HNU Z OH 43t30 PALMVRA PA 1]018 J236369023t NexiDayAir Ii0]8 i05 Letler 3230 Commercial Lensr Lustomer Wxight 0.1 -- FuelSurcharye �-�3 �' Total 33 43 $endef :TIMOTHVR�55 � Recervtt:GEflALD6RM5ER = BPWSERWAGNERANDZIfviMEFl =_ FL3D50 PALMVPAPAI�O]e — J2343690:A2 NextDayAir 1]0]A 10d Letler 3035 �� Gommercial = LeYtar = Fuel Sumharga �46 = ToWI ��" 3t41 Sepdet :GHARLESEVANS - Heceivcv:GEflALDBRINSER � BRINSEP.WAGNEF AND ZIM�AER SG 29S/� PqLMVRA PA 1]0]8 03I03 J234369�204 NextDay liir 1]0]8 106 Lxtter 3035 Cammercial Lener Wel Surcharge 1 06 To1al "'�4� 5¢flde� :J.RONALDFOSS � ReceNecGEFNLDBHINSER BHINSER WAGNER AN�ZIM MER LVNNFlEID MA 01940 PALMVRA PA AO]e J2343690268 Next Day Air I?0]8 103 Lsher 25�0 Comrtiarcial Letter FUeI Surcharga 0.88 To�al �� 2588 Sender .JEANHOUSE . Rece{verGERALDBRINSER 6AINSER WAGNER ANO ZIM tdER KEYSVILLE VR 2394; PALMYRA PA 1'0]B oo:sai vx � Delivery Service Invoice � Imoice da�e March 7, 2015 ' Invoica number OOOOFA7004105 Shipparnumber FA7004 Paga 4 ot 4 Outbound UPS Shippin9 DoCumenl(continued) — -- pilled Pickup Z�P� Charge pa�e Tracking NumGer Serviw Goda Zme Wei9ht. ___ p9;OF � � J2143o4�2;� Nex[�ayltir 1]0�9 1(13 Letler 2`v.00 Commercial Leuar FuxlSuecharge __ �88 Tolal 25 88 Se�det :WIWAMFU550 � RecElvecG[RALll8RIN5EF BRIPlSEF WAGNER AND ZIM MEP °ITTSBURGH PA 1522& PALMVfiA PA i]0]e Total UPS Shipping Document _ � P�k�s�__ . p�'�° Total OutboUnd i Package(s) Z��-�O Receipt M 102929 Port 1 Date : 03-20-2015 iice 09:27 ae. Issued By : SXELB4 DONNA J. iHARP (Ar,i�NG) REGISiER/RECOAOER GAEENE CO�NiY Issuatl ia: BRINSER NAGNER ZIMNERNAN LEOiA G RO55 ESiAiE Inst Na. iype Oescription lOiAL � 2015000017fi� ASGM ASGXi 57.50 Book 47A PaAe 457- 473 Ite�irea Check Listing: _ Check CAeck Ho. Aeount 1 5107 9.50 A�aunt Oue = 57.50 - Aaoum Char9etl f .�0 - Paid by Check f 57.50 - PeiA hy Cash f .00 = CAange f ,00 # iNANK YOU! OONNA J. 1HAAF (ACiING) GREEXE COIIXiY, PA