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Home My WebLink About08-13-15 GOMMOrvwEA'�irv OF PFnNSVLVArvIA FEV-1162 F%111�961 VPPiMENT OF qN[9.[ BUaEAp OF INONIoIIPL f4%ES V! 280fi01 HAPPISBOPG,PP P48Lfi0i PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFlCIAL RECEIPT NO. CD 021237 NAUMANSHANE 147 SALEM CHURCH ROAD MECHANICSBURG, PA 17050 ACN ASSESSMENT AMOUNT CONTROL NUMBER 15140199 519.73 ESTATE INFORMATION: SSN: FILE NUMBER: 2115-OHS$ I DECEDENTNAME: SPOTTS FLORENCE V DATEOFPAYMENT: 09/10/2015 I POSTMAFK DATE: OH/�3/ZO15 I couNrv: CUMBERLAND I DATE OF DEATH: 05/25/2015 I TOTAL AMOUNT PAID: 519.73 REMARKS: CHECK# 91998 INITIALS: CJ sen� RECENED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS i �l— o�aF.�� oF �wo,��ow� ..xEs Pennsylvania lnheritance Tax j �� PennSY�Vallla rv0 Ba% 290601 OEPAPTMENT OF PEVENIIE w�urz�seuxaan v�ze-oso� Information Notice RECORp � J��xp��erResponse Fi�eNo.2i��,•S��Lb�+J3 RE^!S-'" �. - ..�;:_� 5 ncN isiaoiss - onreo�-za-zais � .±,� �f" 3 �1 Type of Account � i O�� _ . Es�ateo�FLORENCEVSPOTTS Savings � X Checking ��J�� Da�e of Dea�h OS-25-2015 Tmst KAREN A NAUMAN �� CountyCUMBERLAND Certificate 147 SALEM CHURCH R� MECHANICSBURG PA 17050 LITIZENS BANK OF PENNSVLVANIA provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: AccounlNo.6208841074 Date Established 11-03-2004 HEGISTER OF WILLS Accoun�Balance $ 1,824.73 1 COURTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 50 Amount Subject�o Tax $91237 Tax Rate X 0.045 Po�ential Tav Due g q�.pg NOTE': If�au paymenls are made within three mon[hs of the deceden�'s da[e of death.deduct a 5 percent discoun�on the tax Wi�h 5% Discount(Tax x 0.95) $(see NOTP) due. Any inheritance tax due will become delinquent nine monihs after�he date of death. PART StEp 1 : Please check the appropriate boxes below. 1 A �No tax is due. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceetl ro Step 2 on reveise. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g �The information is The above information is correct, no tletluctions are being taken,and payment will be sent correc�. wi�h my response. PioCeed to Step 2 on ieverse. Do not CheCk any ofhe/fwxe5. p �The tax rate IB incorred. � 4.5% I am a Ilnael beneficiary(parent,chlltl, grantichild, etc.) of[he deceasad. (Select correct tax rate at righ�,antl comple�e Patl � �p� I am a sibling o�the deceased. 3 on reverse.) � 15% All othar rela�ionships(including none). p Changes or deductions The information above is incorrect andlor debis and dedudions were paid. listed. Complete Part 2 and part 3 as appropriafe on the back ol this lorm. - E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tac form ReWm filed by the esta[e representative. REV-1500. ProceedtoStep2onreverse. Donotcheckanyotherboxes. � Please sign and date [he back of the form when finished. � PART Debts and Deductions 2 Allowable debts and deductions must meet both of the following criteria: A. The deceden[was legally responsible for paymenL and Ihe estate is insufficient ro pay the deductible items. B. You paid ihe debts after the dea[h of ihe tlecedent and can fumish pmot of payment if requested by ihe depatlment. Qf additional space is required, you may atlach 8 1/2'x 11"sheels o�paper.) Date Paid Payee Description Amount Paid L-Jk -lS �F , A,'- - !'..: � `/$� C / n _ i l 7� ��>fSr�, i5,�' � c . '�'- � - / - si >, 7�. o �.� � �;� - Total (En�er on Line 5 0�Tax Calculation) $ �y` -� PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 ,or y g ( ) ( ) percent taxable(Line 3), please obtain a written torre<tion irom the tinancial instituticn arttl atlach it�o this form. L Enter the date the account was established or titled as i[exis[ed at[he date of death. 2 Enter the total balance of the accow�including any interes�accmed at the da�e of death. 3. En�er�he percen�aqe of�he account�hatistaxable to you. a. First,determine the percentage owned by the decedem. i. Accounts that are held "in tms�for"ano�her or others were 100%owned by�he decedent. ii. Por joint accounts established more than one year prior ro the date of death, (he percentage taeable is 100%divided by�he�o�al number of owners induding the decedenc (For example:2 owners=50%, 3 owners=33.33%, 4 owners =25%,etc.) b. Next,divide the decedent's percen�age owned by�he number of surviving owners or bene�iciaries. 4. The amoun[subject to tax is determined by multiplying ihe account balance by ihe percent taxable. 5. Enter[he�o�al of any deb(s and deductions claimed�mm Part 2. 6. The amount�axable is de�ermined 6y su6tracting the debts and detluctions from the amount subject to lax. Z Enter the appropriate tax rate irom S[ep 1 based on your rela[ionship to the tlecedent. If indicating a different tax rate,ple s�ate O(fiCiel US3 Of11y DAAF your relationship to the decedent�[.�i�. . P/\pePa�(�p@�j Of.:flBVCfiI]@ � 1. Date Established 1 � 2. AccountBalance 2 S j7,?`I ) 5 PA�� 3. PercentTaxable 3 X � S'O � 2 4. Amount Subject�o Tax 4 $ �/� /„Z . �) 3 .. 5. Debts and Deductions 5 - `/S G . 7 3 Q 6. Amount Taxable 6 $ `/ /.� �. �- �� $ . 7. Ta� Rate 7 X Cj , %)t/S 6 . 8. 7ax Due 8 $ 1C- ) 7 � - 8 9. WithS% Discount(Taxa .95) 9 x � �j, ' . . . .St@P 2: Sign antl tlate below. Return 74Y0 completed and signed copies to the Register of Wills listed on the fmn�of this form, along with a check for any payment you are making. Checks must be made payable ro"Re9ister ot Wills, Agent" Do not send payment direcity ro the Department oi Revenue. Under penalty of perjury, I dedare ihat the tacts I have reporled above are irue, correct and complete m the best of my knowledge and belief. � Work ?/ 7 �GS - `/1/,J� 1�G�k�L C'� � /✓ a�.�,_ Home 7/ 7, j�Y��G �YC � � 1 - �S� Taxpayer Signa[ure Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-4473020 a�a�.� oF ,Nor�,ow� .<,Es Pennsylvania lnheritance Tax �' pennsylvania P� BO% 280601 OEPAPTMENTOF FEVENIIE HARF[S6VR6 PR ll12B-0601 Information Notice And Taxpayer Response °`�-"" `� '�""` `�` "� RECOR��^ , ��I^EOP Fi�eNo.zi-� iti-[ 9�� ncN i si ao2oo REGIS . - - - ."iii ; onreo�-za-zoie �� U �� 3 C� TypeofAccount �' . � Estate of FLOFENCE V SPOTTS Savings �RPH',�. . �. _ Checkmg � Date of Death OS-25-20�5 Tmst KANEN A NAUMAN ��NR:;� � . ..� ' COuntyCUMBERLAND C¢rti�icate 147 SALEM CHURCH RD � MECHANICSBURG PA 17050 CITIZENS BANK OF PENNSVLVANIA provided the department with Ihe information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment antl Forms to: AccounlNo.6245599275 Date Established 11-03-2004 REGISTER OF WILLS Accoun[Balance $3,973.91 1 W URTHOUSE SOUARE Percen�Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $1,986.96 Tax Rate X 0.045 Potential T� Due g gg.q� NOTE`. If tax paymenis are made within ihree months of the With 5%DiscouN (Tax x 0.95 see NOTP decedenfs da�e ot death,deduct a 5 percen�discount on the tax ) ${ ) due. Any inheritance t�due will become delinquent nine monihs afler ihe tlate of death. PART St2p 1 : Please check ihe appropriate boxes below. 1 A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Pioceed to Step 2 on reverse. Do nof check any other 6oxes and disregard the amount shown above as Potenfial Tar Due. g �'The information is The ahove information is correct, no detluctions are being taken, and payment will be sent correct. wi[h my response. Pmceed fo Sfep 2 on reverse. Do not check any other boxes. � �The tax rate is incorrect. � 4.5% I am a lineal beneticiary(parent,child, grentichild, etc.)of the deceased. (Seled correct�ax rate at righ�,and wmple�e Part � �p e I am a sibling of Ihe deceased. 3 on reverse.) � 15% All o�her relationships (including none). p ❑Changes or deductions The information above is inwrrec�and/or debts and deductions were paid. listetl. Complete Part 2 and part 3 as appropriate on the back ol fhis lorm. E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with ihe PA Inheritance Tax inheritance�av form Fetum filed by the es�ate represenlative. REV-1500. Proceed to Step 2 on reverse. Do not check any other 6oxes. � Please sign and date [he back of ihe form when finished. �( �) PART Debts and Deductions 2 Allowable debts and deduc�ions must meel both of�he following cri�eria: A The decedent was legally responsible for payment,and the estate is insuHicient to pay ihe tletluctible items. B. Vou paid the de6is after the death o��he decedent and can fumish proof of payment if requested by the department. Qf additional space is required,you may attach 81/2'x 11"sheets of paper.) Date Paid Payee Description Amount Paid /` . �l �r �/i G� j - � � "t � - �i� s�/ Total (Enter on Line 5 0(Tax Calculaflon) $ �C PART Tax Calculation 3 Ii you are making a correction to ihe establishment date(Line 1)account balance(Line 2), or percent taxable(Line 3), — please o0tain a written comeciion from ih�financial institution and attach it to this form. L Enter the date the account was established or titled as it existed at the tlate of dea[h. 2. Enter the total balance of the account including any interest accrued at ihe tlate of tleath. 3. Enter the percentage of the account that is taxable to you. a. First,determine ihe percentage owned by lhe decedent. '. Accounts Ihal are held"in trusl�or"another ar others were 100%owned by the decedent. ii. For join�accounts established more than one year prior to the da�e o�death,the percentage tauable is 100%divided by the rotal number of owners induding�he decedenL (For example:2 owners=50%,3 owners=33.33%,4 owners =25%,e�c.) b. Neut, divide�he decedenYs percenta9e owned by the number of survivinq owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter Ihe lolal of any deb�s and deductions claimed from Part 2. 6. The amount taxable is de�ermined by sub�racting�he deb�s and deductions irom�he amount subjec�to lax. 7. Enter the appropriate tax rete from Step 1 based on your relationship ro the decedent. If indica[ing a differem tax ra�e, plea sla�e �f1p21 �JSB QfllY�O AAF � your rela�ionship[o[he decedent: '�u ' � . Pj{p�g�mpA[Of flf!4�{i$ 1. Da�e Es�ablished 1 2. Account Balance 2 $ � � 7 3, r� PAD� 3. PerceN Taxable 3 X � .}O � 2 4. AmouniSubjecitoTax 4 $ � `) ��j�o 3 . 5. Debts and DeduCtionS 5 - �3 `! 7 ,�j / Q � - 6. Amount Taxable 6 $ -�-- 5 �. Z 7ax Ra�e 7 X 6 � . 8. Tac Due 8 $ -�— � � $ 9. Wi�h 5% Discoun�(Tax x .95) 9 X Step 2: Sign and date below. ReNrn TWO completed antl siqnetl copies ro the Register of Wilis listetl on the front of this form, alon9 with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent" Do not send paymen�directly to Ihe Department of Revenue. Under penalty oi perjury, I declare ihat the facts I have reported above are tme, correct and complete to ihe best of my knowledge and belief. Work7i7 �.�i i=j�/a ? n �'� CL�4,.. _ G� - � V u�-c�v�� Home 7j� L9i -D4 r � �� - i - /5 Taxpayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 WORKINGER SFIVIMEL &19 EAST MARKEf STREE[YORK, PA 17403•717-854-2315 FUNERAL HOMES JOHNT.SEMMEL,SUPV. ai6C""1°�'°'��'r� LARRY E.KAUFFMAN, FD STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED '��P��tle rt+�or�s wntirig ONun.selecletl a Nat are reqiiretl. I/we are iaqinetl y'lav a by a cametery or vemapry b use arry ttems. b PaY M ertibalmi Vbu do m�hme b YO�selec�d a hneral tl�at mey reµire enmyF�bx�.wch az a fi+erA wilh viexe5.Sa�^aY have miedete burial. If xe PeY br erHwmhg Ya+tlitl not aPpo:e a yw selaYetl arrar5erren�y�h as a tireq ac+r�on w d�8��E+��r9.xe w91 e�la'vi nfy pelpv. Fa the Service of . ' —' .__ Da4 of DesM PurMeser: - Wme AAdm Ciry Stere � A CHAqGE Poq SEMICES SELECTED: Opi¢r clopiing___ 1. PROFESSIONqL SEflVICES -- — Besic Servicgs N Fwieral Direcla. $— StaH arM Over�eatl....._..._..__.._...._... $ _ —$—.— Embalmin Crematiwum...__..............__..__.....__. S__ g_......__..._...._......_.........__.. E (DescriVtion)_ OMer preP�tian W botly —_ _ _ —_— OUier . --$_ ___..._.._.....__........_....... _...__..._..... S _.� _—E— SUB-TOTAL OF PpOFES510NAL SERVICES......_A1 § _ II1TAL MEBCMAN�ISE SELECTED_.........$.._....__B 5 2. FACILRIES ANO EOUIPMENT C. SPECIpL CMpqGES: Use of 1atllNes antl spry�p v��y Forwsrdrg of remains ro ariotlier funerdl horne (VivlaGaWJake)._.....__.......__.......... g __ _. __5_ Use of facifiUes yM yTyry br hx�ery �Funeral Home) cererrwrry._._................._......_........ S __"_ Receiving ol remans iran arwiher funeral�ome Use d IaalNes antl gaH br _ _$_ rnenonal service_...._........._._......._._. S __ (Funeral Hame) Use o/equipzy„aM staif M gravestle Imrre6ate Burial....__.................._......_.. S service.....__....._...................._.._.__.... S _ DireclCrematim_..._........_......._......_...S _ SU&TOTAL OF SPECIAL CNMGES.._. _s..._....._.0$ _....._.__.....__. ._........_................_ S _ D. CASHADVANCEREMS SUB-TOTAL OF FAqLR1ESIEQUIPMENT....._.......A2 S__ We chargq you(prWr servic¢s f�apgining Rems rriark¢d� 3. AUTOMOTIVEEIXIIPMENT OPeningGrave.._......__......_.._..._._...... S ___ Trdnyier remains to Fune�al Home ��rery Equiqnent._......_....._...._.._ 5 __ �o�a................._......_......__.......__...._ a --- �a�e o�a........._... _..... s —. .._._..._....... Hearse NewsPaVer Nolices-Locel_......__._._. E _ ,. Newspaper NoGces-O�[-of-Town........ $ _ lOral.__......__......._._....._......_........._. 5 __ ._ TeIeOMn¢BTelefax._.. ._. _ R ,� q ? ( j �1�� v,� �,<, � e yp��s� s�Jcr i � '�y I��IIG . �OA''^ S C�N Y/�° l CGr� ��Y�. 06 ��-�� 6�,�� fG� - Limousine Local........_........._..._...._..........._....__ $ — Airtare......._........_............_...._......_..... $ — FbwarUrwibreltlisposiean - qe�gy/MassOlfemg...._...__....._...__. $ _ Local._....._..... Certifietl copies of tlre Death � _....._.._.........__...._...__ 5 --_ Cernficeta_..._......._...._................._.. E Leatl car/dergy�ar _ Local... Hairtlresser._...........___.._.._........_.._._ § _.�. .._..._......._...._......_.........._.._... $ _ Outottoxnbanspurtytlon.__.....__..._... S _ Fbwers..._.........._....._.........._.............. E _'— $ Vaun Servse Charge...__.._...._....._.... S -'._ � — OrqarnsL.___.._...... S __ $ _ __...._.........__.......... SUB-TOTALOFAUTpMOTNEE0UIPMENT...._..A3y__ -'---' E TOTAL OF PRpFES510NAL SERy�CES, —a—'— �� FAqLITIES AND AUTp1ApTVE �'—a—�—' EQUIVMENT....._.............__...................................A1 S_—' � B. CHARGE FOq YEflCHRNDISE SELECTED: TOTAL COST OF ApqANGEMEHI$ CaskeL......_.._................_....__..__...._ S __ PAID RTT NE OP OA PR�OHTOCE ITEMS......._..D$__ (Descriptim) MNANGEMENTS.............._....._..... S --$ -- BAUINCE WE...._.........._._..........._.. $ _ Other........._..._....._......_......_....__..._ $ _ (��P��— REASON FOR EMBALMING Othe�burial mntainer...._......_..... _ $ -- .. . ...... $ _ _— (Descnption�_ — If ary legal,cem¢(ery.a aqny�qy requirement has requiretl Me — W�ase ol any o�Ihe i�ens liste�apo�q.Ng�Y qxplyn tlie Ackiwwl $ -- requiremeM bebw. eUgenient cartls..........._......._. $ _ Registerbook(s)._...._......_....._..._._.... 8 _ —_ —._ MemorybMers.._._.._....._.....__.......... $ . Prayer wrtls..._..........................._......_ $ -- .— TemW�Y92vemvker_..._.......__..._ S &ir�dotliirg...................._...._..__.__ $ _._ I heraby agree tliat I faes a.aR:red me aeo.� srarea �m� e.m a�,�a mem ro ea ��,,y e„d acc«arg ro me ar�a�ya,�n� �ea�ea °�re^�r� �P^ce aritl hetrepY��ard ar.enart' �a9�eemen[ I hereb�'IgVreserit tlgt I ha�e sulfipen[asse�IegeRy arWlatle br Ia�Y antl sevBrelly b meke payrtien(of S_._. 4 late charge d 1-12% per monM artqunM1rg b 18% P�Y�is applietl tri I�e ury�aie Galance beprmirg ihirlYare tlays han�he tlate M tltls 3greemeiri. MY a7dtioral servi�s n rrertiwqise orderetl a repuesle�afler�he tlate d Ms a9�een�ent wiN be conti0eretl part d IhR agreemg�� intl�he cmY tlureof vnq be reflecle�m tlie NW'+�etement. (WE),iME BUYEH(S), HEREBY AGqEE THAT IN CONSIDERATION OF TryE Ca00D5 ANWpq SEqVICES TO BE DELIyERED, TNAT 3UYEP(5) INdVIWALLY qND JOINRY 5 (ApE) HEREBY OBIJGATED TO PAY A�L AMOUNTS OWNING ANO SHpULD BUVEH(S) )EFAULT IN THE AC�qEEMENT WffH$E�LEq, IN A�pRDANCE W�TH TME TEHMS OF THE CpN}ppCT BETWEEN BUYER(S)ANU :ELLEF,BUYEq(S)HEREBY AGpEE(S)TO PpY ALL COLLECTON COSTS,REI150NABLE q7TpRNEY FEES AND COURT COST$UPON :OMMENCEMENT OH INITIATION OF ANy CpLLECTION EFFOHTS ON LEGp�pqOCEEDING3, ieal) (Purcheser) — — , - ieal)_ (Date) (Purchys¢r) - - . � (Licereetl Funeral Direclor) b;una.mCaerin¢6 �'•nb " ••�• 19H��y.�Prmpett Rwd 1 nr4�'� ��b= ��+bINF1515 v,, I ��. w.� , .�i m��r�•rn �� .�. .i II �� ,��irvnia� ltarf�qd �� .� �. �J,�,r i Invoice � ,,,,,,,,,,,,,,, ,,,,,,,,,,, ,,,,, ,,, ,,,,; I�� qn� I�ti 1� d lrycl 16n Yaw�x Narvun Yaan nJ 111ee6. I v�l Lur+ l� � In� Irn��.r�aJ41u e I u a Ynmllurn IWIXi 4lvay �rl .`IY. Scnipy. �Ill.iw p Lm �� I.W �•!I V. YaJ 1lalan< 1N1�11 14r�sM'trlXirrl4r• IIy�I�rur�eui�Jbir�a y.1si..�r.a x...i..�w�mrr ye....r.+u�.r s,b Nra.....� Iw r+h n:qr+^�.A'm....,ir �h� Ntyw�B�O��[MI'�w p�� a�-J napa'.��Vn��q,p - 1 pIqQ66151 p'p�6n E�.r��v ti / U/1['/C� I �� C��JYic°� � r �oit'nC � � � � /_ a � 7 / . % � ��-/m�r�se� l/i�n,� o � � � HOLY SPIRIT EMS - BLS !�ewn ....,,n � � 205 GRANDVIEW AVE SUITE 2N � ��_:� �' CAMP HILL, PA17011-1708 ONREVERSESIUE 0� - � - Phone#: (800) 367-0512 FederalTaxID: 23-2463002 A (.l'ISNGFR 9FPILLATF PAnENT NnME FLORENCE SPO7T5 INSUHANCE NOVITAS SOLUTIONS, INC. WCS BANKERSLIFE-CARMEL NONE CALL NUMBER 25337933W onre oF cnu.: °°25nois FROM: HOLY SPIRIT HOSPffAL Tp; ACUTE REHAB HOSPITAL ACCOUNT SUMMARV FLORENCESPOTTS 147 SALEM CHURCH RD TOTAI CMARGES: 155.04 MECHANICSBURG, PA 77050 ppp,�ENTynpA�5ndp,Rg: �5.67 aiEasE rnr n�is nreouNr. 129•37 _ DElACHALONG GERFOFATi(IN AND RENRN SNB WITH PAYMENT DESCNIP'f10NOFCHMOE q1�MRY �.UNRPitICE AMWNT Stretcher One Way Trans Member TT005 1.0 128.33 128.33 StretcherVanMileage T2049 5.6 477 26.71 �� V Total Charges 155.04 DESGNIPTION OF PAYMEHf pECE1PT PAYMEM DATE AMOUNT SUBSCRIBER WRITE-OFFADJ OS/0420t5 2567 _ __ _ . _ .- . .__'._---. . Total Cretlits 25.67 � F, . . ..- . , � ..^.!)NT- INVOICE U� i ."'(%M RECEIPT ----"� E129.37 kETI �h!': . '-. .,,, PATIENT NqME SPOTTS,FLORENCE V cnu Nurnsea: 25337933W �ourrr cao: / � �' � _,� OS/052015 _� �,,P� � �.i PJ�_�. � , : This service is not covered by y ur insurence. Please remit payment to our office.� ��1 ��u�.� ��, ��,� ��6D%N �dr, `f � $`.�/� 3� HOLY SPIRIT EMS-BLS 205 GRANDVIEW AVE SUITE 271 CAMP HILL,PA 17011-1708 aEccr,,.,-,, -.-,-�cE oF �� KEGitiitit : r ��::i�LS >mrn ��o- 2�15 POG 13 °f� 3 22 �� >' � or�F, cu�eer_ g'z 4 ! ) ' � � O `� � C` V` ` � a � o 0 � ^ `�'� a� � v � ,r � q �, r �