HomeMy WebLinkAbout12-01-05
REV-1500 EX (6-00)
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.
OFFICIAl USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~L
COIJIITY CODE
......QL 00281_ __
YEAR NUMBER
DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
~ ers Rose
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 3/2/2005 2/15/1906
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
Q
SOCIAL SECURITY NUMBER
172-01-3610
THIS RETUFI'I MUST BE FILED IN DUPLICATE WITH THE
A
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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[i] 1. Original Return
D 4. Limited Estate
[i] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death alter 12-12-82) 0 5. Federal Estate Tax Return Required
[i] 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
o 10. Spousal Poverty Credit (date 01 death between 12.31-91 a'" 1-1-95) 0 11. Election to tax under Sec. 9113(A) (AllachSch0)
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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1013 Mumma Road, Suite 100
Lowell R. Gates, Esquire
FIRM NAME (If Applicable)
Gates, Halbruner & Hatch, P.C.
TELEPHONE NUMBER
Lemoyne, PA 17043
7J. 7-731-9600
1. Real Estate (Schedule A)
(1)
$0.00
$0.00
$0.00
$0.00
$44,107.46
$7,540.89
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OFFICIAL USE ON~
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2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
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4, Mortgages & Notes Receivable (Schedule 0) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Properly
(Schedule E) (5)
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6. J~ Owned Property (Schedule F)
U Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7)
(Schedule G or L)
(6)
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$120,150.00
8. Total Gross Assets (total Lines 1-7)
(8)
$29,081.18
$7,070.35
$171,798.35
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
(11)
$36,151.53
$135,646.82
$0.00
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(12)
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
$135,646.82
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax $0.00 x .0 ~(15)
Z rate, or transfers under Sec. 9116 (a)(1 .2)
0
i= 16. Amount of Line 14 taxable at lineal rate $135,646.82 x .0 45 (16)
<
~
;:) $0.00 x .12 (17)
0.. 17. Amount of Line 14laxableatsibling rate
:;;
0 $0.00
0 18. Amount of Line 14 taxable at collateral rate x .15 (18)
><
Cl: 19. Tax Due (19)
~
$0.00
$6,104.11
$0.00
$0.00
$6,104.11
20. ~
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1,000
Yes
[X]
D
D
D
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [X] D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury. I declare that I have examined this retum. including accompanying schedules and statements. and to the best of my knowledge and belief, it is true. correct and compiete.
Declaration of preparer other than the personal representative is based on all in'ormation 01 which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN/.
Decedent's Com lete Address:
STREET ADDRESS
205 West Marble Street
Cumberland
CI1Y
Mechanicsbur
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
$0.00
$7.000.00
$305.21
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
$0.00
$0.00
Total Interest/Penalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is
Make
(5B)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
Jean A. Adams. Co-Executor
ADDRESS
700 West Keller Street
SIGNATURE OF PREPARER 011-lER 11-lAN REPRESENTATIVE
Gates. Halbruner & Hatch. P.C.
ADDRESS
ZIP
17055-
$6.104.11
$7.305.21
$0.00
$1.201.10
$0.00
$0.00
$0.00
No
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DATE
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17055
DATE
II-~--os
For dates of death on or after July 1. 1994 and before January 1, 199 . the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. S 9916 (a) (1.1) (i)J.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 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 twenty.one 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% [72 P.S. 99116(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%, except as noted in 72 P.S. S 9116(1.2) [72 P.S. 99116(a)(1 )J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. 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.
3W4646 1.000
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Rose A. Myers
FILE NUMBER
21 05 00281
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Citizens Bank
Checking Acct. #610070-192-1
$41,774.69
2
Citizens Bank
Savings Acct. #6140-168147
$2,008.77
3
Internal Revenue Service
2004 income tax refund
$324.00
3W46AD 1.000
TOTAL (Also enter on line 5 Recaoitulationl $
(If more space is needed, insert additional sheets of the same size)
$44,107.46
REV.1509 EX + (6.98)
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rose A. ~ers
e
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21 05 00281
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A.
Adams, Jean A
B.
c.
JOINTL V-OWNED PROPERTY:
ADDRESS
700 West Keller Street,
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Daughter
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INClUDE NAME OF FINANCIAL tNSTlrlITlON Af'V BAr-.I< ACCOUNT DATE OF DEATH DECO'S VALUE OF
N..M3ER OR SIMIlAR IDENTIFYING NUMBER. ATTACH DEED FOR
NUMBER TENANT JOINT J01NTLY.ffiDREAl ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A.
1 A 1/1/1998 Wachovia, N.A.
Savings Acct.
#3083365463047 $15,081. 77 50.0000 $7,540.89
TOTAL (Also enter on line 6 Recaoitulation\ $ $7,540.89
3W46AE 1.000
(If more space is needed, insert additional sheets of the same size)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
REV-1510 EX + (6-98)
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rose A. Myers
FILE NUMBER
21 05 00281
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERlY
ITEM Ir-nLOETfiONAMEOF_TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT A'"
NUMBEF _DATE OF_EA. ATTACHAOOPY OF THE DEED FOR REAL ESTATE
1. One-story, single-family
dwelling located at 205 West
Marble Street, Mechanicsburg,
Cumberland County,
Pennsylvania; being Tax Parcel
No. 20-24-0785-416; transferred
to The Myers Family Irrevocable
Trust by deed dated April 8,
2002, and recorded on April 10,
2002, in the Office of the
Recorder of Deeds in and for
Cumberland County,
Pennsylvania, at Deed Book 251,
Page 916.
Value per county assessment.
2 Vacant land situate on
Kennedy's Valley Road,
Landisburg, Perry County,
Pennsylvania; being Tax Parcel
No. 270,178.02-024.000;
transferred to The Myers Family
Irrevocable Trust by Deed dated
April 8, 2002, and recorded on
April 22, 2002, in the Office
of the Recorder of Deeds in and
for Cumberland County,
Pennsylvania, at Deed Book
1497, Page 214.
Value is sales price.
DATE OF DEATH
VALUE OF ASSET
% OF DECO'S
INTEREST
$103,250.00 100.0000
$16,900.00 100.0000
3W46AF 1.000
(If more space is needed, insert additional sheets of the same size)
TOTAL (Also enter on line 7, Recapitulation) $
EXCLUSION
IIF APPUCABLE\
$0.00
$0.00
TAXABLE
VALUE
$103,250.00
$16,900.00
S120.150.00
REV.1511 EX+(12'99)
e SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rose A. MYers
ITEM
NUMBER
A.
1.
B.
1.
2.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
American Legion Post #109
post-funeral luncheon
Total from continuation schedules . . . . . . . . .
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Jean A. Adams, et al
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 700 West Keller Street
City Mechanicsburg
Year(s) Commission Paid: 2005
State PA
Zip 17055
Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
3W46AG 1.000
Street Address
City
State
Zip
Relationship of Claimant to Decedent
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Acoria Northeast, Inc.
homeowner's insurance premium
Total from continuation schedules . . . . . . . . .
FILE NUMBER
21 05 00281
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
$279.65
$8,169.61
$8,500.00
$8,500.00
$132.00
$668.85
$2,831.07
$29,081.18
e
Estate of: Rose A. MYers
Item
No.
2
3
Schedule H Part 1 (Page 2)
Description
James R. Gingrich Memorials
cemetery inscription
MYers Funeral Home, Inc.
funeral goods & services
Total (Carry forward to main schedule)
e
172-01-3610
Amount
$100.00
$8,069.61
$8,169.61
e
Estate of: Rose A. MYers
Schedule H Part 7 (Page 2)
2
Barry L. Heckard, Sr., Tax
Collector
personal tax
3
Barry L. Heckard, Sr., Tax
Collector
2005 school real estate tax
4
Borough of Mechanicsburg
sewer and refuse charges
5
Citizens Bank
checks for estate account
6
Cumberland Law Journal
publication of estate notice
7
Jeffrey A. Wilbur Plumbing &
Heating, Inc.
furnace repairs at 205 W. Marble
Street, Mechanicsburg, property
8
Lester W. Erb, Inc.
fuel oil service
9
Mark K. Keller, Auctioneer
appraisal of Perry County land
10
Patriot-News
publication of estate notice
11
PPL
electric utility service
12
Terminix
pest control at 205 West Marble
Street, Mechanicsburg, property
13
United Water Co.
water service
Total (Carry forward to main schedule)
e
172-01-3610
$9.80
$1,298.21
$109.22
$28.96
$75.00
$350.77
$248.96
$75.00
$231.72
$59.05
$310.58
$33.80
$2,831. 07
REV-1512 EX + (12-03)
e
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rose A. MYers
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 05 00281
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Barry L. Heckard, Sr., Tax
Collector
personal tax
$9.80
2
Barry L. Heckard, Sr., Tax
Collector
2005 county real estate taxes
$446.84
3
Borough of Mechanicsburg
sewer and refuse charges
$109.22
4
Central Penn Medical Group
Emergency
hospital bill
$29.20
5
Claremont Nursing & Rehabilitation
Center
nursing home care
$5,917.42
6 Holy Spirit Hospital
medical bill
$15.90
7 Lester W. Erb, Inc.
fuel oil service
$459.68
8 Mechanicsburg Volunteer Fire
Departments
pledge to charity made by decedent
$25.00
9 Mobile X-Ray Imaging, Inc.
medical bill
$25.53
10 PPL
electric utility service
$25.00
11 united Water Co.
water service
$6.76
3W46AH 2.000
TOTAL (Also enter on line 10. Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
$7,070.35
REV-1513 EX+ (9-00)
e
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rose A. Mvers
NUMBER
I
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Jean A. Adams
700 West Keller Street
Mechanicsburg, PA 17055
FILE NUMBER
21 05 00281
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Daughter
$135.646.82
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1.000
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
$
$0.00
.
.
DEATH CERTIFICATE
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J: th> On:nnal
L(:'rt!il.!~:dii",:' C\r
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it ,"-' :i.~ tc
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
TYPE/PRINT
IN
PERMANENT
BLACK INK
CERTIFICATE OF DEATH
STATE filE UUMBI::.R
'.
NAME OF DECEDENT (FiISI, MithJIl!, last)
, Rose
AGE (Lasl Bilthduy)
SEX
female
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COUNTY OF DEAHl
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AS DECEDENT EVER IN
US AHMEO FORCES?
YesD NOl:Xl
12
17a. Stal~ P A
MARITAL STATUS. Married,
Never Manitld. Widowed,
OivorCt!d ISpedfyl
,. Widowed
H...ldllnuD ~~~t'l D
RACE - American Indian, Black, Whitt:!. el
(SpedfYJ
10. W hit e
SURVIVING SPOUSE
IIt.."te.~".m..idbnn"",fl)
'b, C 1I m b e r 1 and
DECEDErH'S USUAL OCCUPAl ION
11.
OECE
. 205
I1b. Counl, Climb e r 1 and
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live in a
towm;.hijJ?
17e. 0 Yes, decedenllivad in
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Mechanicsburg
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MOTHER'S NAMt. (J-irs!, Middle. Maiden Surnan'ltEl)
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INFORMANTS MAiliNG ADDRESS (5lr861, Cily{fown, Slate, IIp Code)
20b.700 West Keller Street Mechanicsbur PA 1705
PLACE OF DISPOSITION. Name of Cemeltuy, Cremalory LOCATION - CityfTown. Slale. Zip Code
or Ulher Place
1705
1705
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: inlerval belw~un
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COMPtETlor~ OF CAUSE
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INJUHY AI WUHK" OI::SCRII3~ HOW INJURY OCCURRED
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LAST WILL AND TESTAMENT
OF
ROSE A. MYERS
.
.
LAST WILL AND TESTAMENT
(-::::"-
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( "'-) ) /~.'1
-/ &0 )7
I, ROSE A. MYERS, now of205 West Marble Street, Mechanicsburg, Cumberland County,
Pennsylvania, 17055, do publish and declare this to be my Last Will and Testament, hereby revoking
all other prior wills and codicils made by me.
OF
ROSE A. MYERS
FIRST: Family Background and Appointment of Executor.
(A) Family and Back~round Information. I am not currently married. My child is JEAN
A. ADAMS. Throughout this Will, JEAN A. ADAMS, will be referred to as "my child" or "my
daughter". The word "issue" will include my child as well as my other descendants.
(B) Appointment of Executor. I appoint as my Executors (all hereinafter referred to as
Executor throughout this Will), the following named persons without being required to account to
any Court:
Executors: My daughter, JEAN A. ADAMS, my grandaughter,
ANNETTE E. HACKENBERG, and my grandaughter,
DAWN A. PATRICK, to act jointly or individually_
(C) Inter Vivos Trust. The inter vivos trust agreement referred to in this Will is entitled
"THE MYERS FAMILY IRREVOCABLE TRUST", by and between ROSE A. MYERS, as
Settlor and ROSE A. MYERS and JEAN A. ADAMS, as Trustees, as now in effect or as may
hereafter be amended.
SECOND: Funeral and Last Urness Expenses: Taxes.
(A) Expenses of Funeral and Last lllness. I direct my Executor to pay my funeral
expenses and the expenses of my last illness from my estate.
(B) Taxes. I direct my Executor to pay any and all estate, inheritance, succession, legacy,
transfer and other death taxes or duties, by whatever name called, including any and all interest and
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penalties thereon, imposed under the laws of any jurisdiction by reason of my death upon or with
respect to any and all property included in my gross estate for the purpose of such taxes, whether
such property passes under or outside of this Will. Without any apportionment otherwise required
by law and without being prorated or apportioned among or charged against the respective devises,
legatees, beneficiaries, transferees, or other recipients of any such property or charged against any
property passing or which may have passed to any of them, I direct that any taxes so paid shall be
charged against my residuary estate. My Executor shall not be entitled to reimbursement for any
portion of any such taxes from any such person. The foregoing provisions of this Article SECOND
shall not apply to such portion or portions of said taxes, interest and penalties which may be required
to be paid, or are actually paid or reimbursed, by the Trustee of the Trust described in Paragraph
FIRST (C), above.
TIDRD: Tangible Personal Property. Except for those items excluded below and those
items enumerated in the Letter of Instruction, I bequeath all my tangible personal property, including
but not limited to clothing, jewelry, heirlooms, furniture, household furnishings, personal effects,
motor vehicles, and all other similar articles, which I own, and the insurance thereon, to my daughter,
JEAN A. ADAMS, living at the time of my death.
Notwithstanding any other provisions in this Article THIRD, I may leave a separate, dated
and unsigned Letter of Instruction, which I shall place with my Will, containing directions as to the
ultimate disposition of certain of the property bequeathed under this ..A~rticle THIRD, and such Letter
of Instruction shall determine the distribution of such items.
FOURTH: Residuary Estate. I devise and bequeath all of the rest, residue and remainder
of my estate, real, personal and mixed, of whatever nature and wherever situated to which I am
legally or equitably entitled, to the then-acting Trustee of the Trust described in Paragraph FIRST
(C) of this Will, to be held, administered and distributed pursuant to the terms thereof, as the same
may be amended from time to time. By this devise and bequest of my residuary estate I hereby
exercise all Powers of Appointment I possess at the time of my death except any power of
appointment which I possess under the Trust described in Paragraph FIRST (C) of this Will.
FIFTH: Powers of Executor. In addition to the powers and duties as may have been
granted elsewhere in this Will, but subject to any limitations stated elsewhere in this Will, the
Executor shall have and exercise exclusive management and control of the Estate and shall be vested
with the following specific powers and discretion, in addition to the powers as may be generally
conferred from time to time upon the Executor by law:
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(A) In the management, care and disposition of the Estate, the Executor shall have the
power to do all things and to execute such instruments, deeds, or other documents as may be deemed
necessary or proper, including the following powers, all of which may be exercised without order
of or report to any Court:
(1) To sell, exchange or otherwise dispose of any property at any time held or
acquired hereunder, at public or private sale, for cash or on tenns, without advertisement,
including the right to lease for any term notwithstanding the period of the Estate, and to grant
options, including any option for a period beyond the duration of the Estate.
(2) To invest all monies in such stocks, bonds, securities, mortgages, notes, choses
in action, real estate or improvements thereon, and any other property as the Executor may
deem best, without regard to any law now or hereafter enforced limiting investments of
fiduciaries.
(3) To retain for investment any property deposited with the Executor hereunder.
(4) To vote in person or by proxy any corporate stock or other security and to agree
to or take any other action in regard to any reorganization, merger, consolidation, liquidation,
bankruptcy or other procedure or proceedings affecting any stock, bond, note or other
security .
(5) To use attorneys, real estate brokers, accountants and other agents, if such
employment is deemed necessary or desirable, and to pay reasonable compensation for their
servIces.
(6) To compromise, settle or adjust any claim or demand by or against the Estate and
to agree to any rescission or modification of any contract or agreement affecting the Estate.
(7) To renew any indebtedness, as well as to borrow money, and to secure the same
by mortgaging, pledging or conveying any property of the Estate.
(8) To retain and carry on any business in which the Estate may acquire an interest,
to acquire additional interest in any such business, to agree to the liquidation in kind of any
corporation in which the Estate may have an interest and to carry on the business thereof, to
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join with other owners in adopting any form of management for any business or property in
which the Estate may have an interest, to become or remain a partner, general or limited, in
regard to any such business or property and to hold the stock or other securities as an
investment, and to employ agents and confer on them authority to manage and operate the
business, property or corporation, without liability for the acts of such agent or for any loss,
liability or indebtedness of such business if the management is selected or retained with
reasonable care.
(9) To register any stock, bond or other security in the name of a nominee, without
the addition of words indicating that such security is held in a fiduciary capacity, but accurate
records shall be maintained showing that such security is a Estate asset and the Executor
shall be responsible for the acts of such nominee.
(B) Whenever the Executor is directed to distribute any Estate assets in fee simple to a
person who is then under twenty-one (21) years of age, the Executor shall be authorized to hold such
property in Trust for such person until he/she becomes twenty-one (21) years of age, and in the
meantime shall use such part of the income and the principal of the Estate as the Executor may deem
necessary to provide for the proper support and education of such person. If such person should die
before becoming twenty-one (21) years of age, the property then remaining in trust shall be
distributed to the personal representative of such person's estate.
(C) In making distributions from the Estate to or for the benefit of any minor or other
person under a legal disability, the Executor need not require the appointment of a guardian, but shall
be authorized to payor deliver the same to the custodian of such person, to payor deliver the same
to such person without the intervention of a guardian, to payor deliver the same to a legal guardian
of such person if one has already been appointed, or to use the same for the benefit of such person.
(D) In the disbursement of the Estate and any division into separate trusts or shares, the
Executor shall be authorized to make the distribution and division in money or in kind, or both,
regardless of the basis for income tax purposes of any property distributed or divided in kind, and
the distribution and division made and the values established by the Executor shall be binding and
conclusive on all persons taking hereunder. The Executor may in making such distribution or
division allot undivided interests in the same property to several trusts or shares.
(E) The Executor shall be authorized to lend or borrow, including the right to lend to or
borrow from any trusts which I may have established during life or by will at an adequate rate of
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interest and with adequate security, and upon such terms and conditions as the Executor shall deem
fair and equitable.
(F) The Executor shall be authorized to sell or purchase at the fair market value as
determined by the Executor, any property to or from any trust created by me during life or by Will,
even though the same person or corporation may be acting as Executor of my estate or as Trustee
of any of my other trusts.
(G) The Executor shall have discretion to determine whether items should be charged or
credited to income or principal or allocated between income and principal as the Executor may deem
equitable and fair under all the circumstances, including the power to amortize or fail to amortiz.e
any part or all of any premium or discount, to treat any part or all of the profit resulting from the
maturity or sale of any asset, whether purchased at a premium or at a discount, as income or principal
or apportion the same between income and principal, to apportion the sales price of any asset
between income and principal, to treat any dividend or other distribution of any investment as
income or principal, or apportion the same between income and principal, to charge any expense
against income or principal or apportion the same, and to provide or fail to provide a reasonable
reserve against depreciation or obsolescence on any assets subject to depreciation or obsolescence,
all as the Executor may reasonably deem equitable and just under all the circumstances. If the
Executor does not exercise the above discretionary power, the cash or accrual allocation shall be in
accordance with Chapter 81 of Title 20 of the Pennsylvania Consolidated Statutes, or the
corresponding provisions of subsequent state law.
(H) If at any time the total fair market value of the assets of any trust established or to be
established hereunder is so small that the corporate Trustee's annual fee for administering the trust
would be the minimum annual fee set forth in the Trustee's regularly published fee schedule then,
in effect, the Trustee in its discretion shall be authorized to terminate such trust or to decide not to
establish such trust, and in such event the property then held in or to be distributed to such trust shall
be distributed to the persons who are then or would be entitled to the income of such trust. If the
amount of income to be received by such persons is to be determined in the discretion of the Trustee,
then the Trustee shall distribute the property among such of the persons to whom the Trustee is
authorized to distribute income, and in such proportions, as the Trustee in its discretion shall
determine.
(I) Except as otherwise provided in this Will, when the authority and power under this
Will is vested in two (2) or more Executors or Trustees, the authority and powers are to be held
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jointly by the Executors or Trustees, respectively. A majority of the Executors or Trustees may
exercise any authority or power granted under this Will or granted by law, and may act under this
Will. Any attempt by one such Executor or Trustee to act under this Will on other than ministerial
acts shall be void. The action of one such Executor or Trustee under this Will may be validated by
a subsequent ratification of the act by a majority of the Executors or Trustees.
SIXTH: Rights and Liabilities of Executor and Trustee.
(A) No bond or other security shall be required of any Executor.
(B) This instrument always shall be construed in favor of the validity of any act or
omission by any Executor, and any Executor shall not be liable for any act or omission except in the
case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any
investment, the overall performance of the entire Estate shall be taken into account.
(C) Each Executor shall be entitled to receive reasonable compensation for services
actually rendered to my estate, in an amount the Executor normally and customarily charges for
performing similar services during the time which he/she performs the services.
SEVENTH: Tax Elections.
(A) In determining the estate, inheritance and income tax liability relating to my Estate,
the Executor's decision as to all available tax elections shall be conclusive on all concerned. In
accordance with IRe Section 2632(a) and without regard to whether a Federal estate tax return is
actually filed, my Executor shall allocate so much of the Federal Generation Skipping Transfer
(GST) exemption amount as will fully exempt any generation skipping transfer which may occur
under this Will.
(B) The Executor may, in its discretion, determine the date as of which my gross estate
shall be valued for the purpose of determining the applicable tax payable by reason of my death.
(C) The Executor may, in its discretion, decide whether all or any part of certain
deductions shall be taken as income tax deductions (even though they may equal or exceed the
taxable income of my estate and whether or not claimed or of benefit on my estate's income tax
return) or as estate tax deductions when a choice is available; and in the event that all or any part of
such deductions are taken as income tax deductions, no adjustment of income and principal accounts
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in my estate shall be made as a result of such decisions.
EIGHTH: Spendthrift Provision. No beneficiary shall have the power to anticipate,
encumber or transfer his or her interest in the estate in any manner other than by the valid exercise
of a power of appointment. No part of the estate shall be liable for or charged with any debts,
contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of
a beneficiary.
NINTH: Defmitions and General Provisions.
(A) Survival. Any beneficiary who dies within sixty (60) days after my death shall be
considered not to have survived me.
(B) Captions. The captions set forth in this Will at the beginning of the various articles
hereof are for convenience of reference only and shall not be deemed to define or limit the provisions
hereof or to affect in any way their construction and application.
(C) Children. As used in this Will, the words "child" and "children" shall include
persons who are legally adopted and the issue of said persons, whether born in or out of wedlock,
so long as any person born out of wedlock is acknowledged in a written instrument executed by the
one of their natural parents who is a descendant of mine to be the child of said descendant. The word
"issue" shall include descendants of all generations including adopted persons. A posthumous child
shall be considered as living at the death of his parent. The birth to me or the adoption by me of a
child or children subsequent to the execution of this Will shall not operate to revoke this Will.
(D) Code. Unless otherwise stated, all references in my Will to section and chapter
numbers are to those of the Internal Revenue Code of 1986, as amended, or the corresponding
provisions of any subsequent federal tax laws applicable to my estate.
(E) Other terms. The use of any gender includes the other genders, and the use of either
the singular or the plural includes the other.
(F) Powers of Appointment are Exercised. By this Will I exercise any and all Powers
of Appointment which I possess at the time of my death except any power of appointment which I
possess under the Trust described in Paragraph FIRST (C), above.
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IN WITNESS WHEREOF, I, ROSE A. MYERS, the Testatrix, have to this my Last Will
and Testament, typewritten on nine (9) pages, including the Acknowledgment and Affidavit, set my
hand and seal this 'f\-fh day of April, 2002.
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ROSE A. MYERS
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and
Testament, in the presence of us, who have hereunto subscribed our names at her request, as
witnesses hereto, in the presence of the said Testatrix, and in the presence of each other. Each ofus
further declares that he or she believes the Testatrix to be of sound mind and memory. The
preceding instrument consists of this and eight (8) other consecutively numbered typewritten pages
including the Acknowledgment and Affidavit.
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ACKNOWLEDGMENT AND AFFIDAVIT
C0l\1lv10NWEAL TH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
The Testatrix and the witnesses whose names are signed and subscribed to the attached or
foregoing instrument, being fIrst du1y sworn and qualified according to law, do hereby acknowledge,
depose and say to the undersigned authority, that the Testatrix signed and executed the instrument
as her Last Will in the presence of the witnesses; that she signed it willingly or willingly directed
another to sign it for her; that she executed it as her free and voluntary act for the purposes therein
expressed; that each of the witnesses were present and saw the Testatrix sign and execute the
instrument as her Last Will; that each subscribing witness in the hearing and sight of the Testatrix
signed the will as witnesses; and that to the best of their knowledge the Testatrix was at that time
eighteen years of age or older, of sound mind and under no constraint or undue influence.
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WItness
Sworn to or affirmed, subscribed to, and acknowledged, before me by the above-named
Testatrix and witnesses, this "6 i~ day of April, 2002.
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Notary Public
My Commission Expires:
Notarial Seal --
Teri L. Walker, Notary Public
Lemoyne Bora, Cumberland County
My Commission expires Jan. 20, 2003
Member. Pennsylvania Association ot Notaries
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THE ROSE A. MYERS FAMILY
IRREVOCABLE TRUST
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THE
MYERS FAMILY
IRREVOCABLE TRUST
TillS TRUST AGREEMENT is executed in triplicate on this ~ day of April, 2002, by
and between ROSE A. MYERS, now of 205 West Marble Street, Mechanicsburg, Cumberland
County, Pennsylvania 17055 (hereinafter called "Settlor") and ROSE A. MYERS, now of205 West
Marble Street, Mechanicsburg, Cumberland County, Pennsylvania 17055, and JEAN A. ADAMS,
now of 700 West Keller Street, Mechanicsburg, Cumberland County, Pennsylvania 17055
(hereinafter called "Trustees" or "Co-Trustees").
ARTICLE I. TRUST ESTATE
1.01. Initial Principal. Settlor, desiring to establish an irrevocable trust, does hereby
irrevocably transfer, assign and deliver to the Trustees and their successors, and assigns the assets
listed on Schedule A, attached hereto and made a part hereof. As further evidence of such
assignment, the Settlor has executed or will execute or cause to be executed such other instruments
as may be required for the purposes of completing the assignment or transfer of title to such property
to the Trustees. The Trustees accept such transfer and assignment to themselves as Trustees, and
undertake to hold, manage, invest and reinvest the assets of this Trust, and to distribute the income
and principal of the Trust in accordance with the provisions of this Agreement.
1.02. Additional Principal. The Settlor and any other person or persons, with the consent
of the Trustees, shall have the right at any time to make additions to the corpus of this Trust or any
share thereof hereby established. All such additions shall be held, governed, and distributed by the
Trustees in accordance with the terms and conditions of this Agreement. The Trustee, in its sole
discretion, may require, as a prerequisite to accepting property, that the transferring party provide
evidence satisfactory to the Trustee that (i) the property is not contaminated by any hazardous or
toxic materials or substances; and (ii) the property is not being used and has never been used for any
activities directly or indirectly involving the generation, use, treatment, storage, disposal, release or
discharge of any hazardous or toxic materials or substances.
1.03. Disclaimer. The Trustee shall have the right to disclaim, in whole or in part, prior
to its acceptance by the Trustee, any interests in property for any reason, including but not limited
to a concern that such property could cause potential liability under any federal, state, or local
environmental law .
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ARTICLE II. IRREVOCABILITY OF TRUST
2.01. Irrevocability. Settlor has been advised of the consequences of an irrevocable trust
and hereby declares that this Trust shall be irrevocable and shall not be altered, amended, revoked,
or terminated by Settlor or any other person or persons.
ARTICLE III. LIFE INSURANCE POLICIES
3.01. General Provisions. If any insurance policies are transferred into this Trust, the
Trustees shall be vested with all right, title, and interest in and to the transferred policies of insurance,
and are authorized and empowered to exercise and enjoy, for the purposes of the Trust herein created
and as absolute owners of such policies of insurance, all the options, benefits, rights and privileges
under such policies, including the right to borrow upon and to pledge them for a loan or loans. The
Trustees take all rights, title, and interest in and to the above-stated insurance policies subject to any
prior split-dollar life insurance agreement and assignments, which may be in effect at the time of
transfer. The insurance companies which have issued policies are hereby authorized and directed to
recognize the Trustees as absolute owners of such policies of insurance and as fully entitled to all
options, rights, privileges, and interests under such policies, and any receipts, releases, and other
instruments executed by the Trustees in connection with such policies shall be binding upon all
persons interested in this Trust. The Settlor hereby relinquishes all rights, title, interest and powers
in such policies of insurance which Settlor may own and which rights, title, interest and powers are
not assignable, and will, at the request of the Trustees, execute all other instruments reasonably
required to effectuate this relinquishment.
3.02. Payment of Premiums. The Trustees shall be under no obligation to pay the
premiums which may become due and payable under the provisions of any policy of insurance which
may be transferred or assigned to this Trust, or to make certain that such premiums are paid by the
transferor of such policy, or to notify any persons of the nonpayment of such premiums, and the
Trustees shall be under no responsibility or liability of any kind in case such premiums are not paid,
except the Trustees shall apply any dividends received on such policies to the payment of premiums
thereon. Upon notice at any time during the continuance of this Trust that the premiums due upon
such policies are in default, or that premiums which will become due will not be paid, either by the
transferor or by any other person, the Trustees, within their sole discretion, may apply any cash values
attributable to such policy to the purchase of paid-up insurance or of extended insurance, or may
borrow upon such policy for the payment of premiums due thereon, or may accept the cash values
of such policy upon the policy's forfeiture. In the event that the Trustees receive the cash value of
such policy upon its forfeiture for nonpayment of premiums, the amount received shall be added to
the corpus of this Trust, and shall be administered according to the terms ofthis Agreement. If the
insured under such policies of insurance, becomes totally and permanently disabled within the
meaning of any policies and because thereof the payment of premiums, or any of them, shall during
the pendency of such disability, be waived, the Trustees, upon receipt of such knowledge, shall
promptly notify the insurance company which has issued such policies, and shall take any and all steps
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necessary to make such waiver of premium provision effective.
3.03. Duties of Trustees With Regard to Life Insurance Policies. The Trustees shall be
under no obligation or duty whatever except with respect to the safekeeping of such policies of
insurance and the duty to receive such sums as may be paid to them, in accordance with the
requirements of this Trust, by the companies issuing such policies, and to hold, manage and disburse
such proceeds subject to the terms of this Agreement. Upon the death of the insured, the Trustees
shall make reasonable efforts to carry out the provisions of this Agreement, including the maintenance
or defense of any suit, provided, however, the Trustees shall be under no duty to maintain or enter
into any litigation unless its expenses, including counsel fees and costs, have been advanced or
guaranteed in an amount and in a manner reasonably satisfactory to the Trustees. The Trustees may
repay any advances made by them or reimburse themselves for any such fees and costs from any
corpus or income of this Trust.
ARTICLE IV. TRUST DISTRIBUTIONS
4.01. Trust Principal. The entire corpus of this Trust, including the assets initially
transferred to this Trust, subsequent additions to this Trust, and the proceeds of any sale, exchange
or investment of such Trust assets, shall be used for the purposes herein contained.
4.02. Income Distribution. During the Settlor's lifetime, the Trustees shall distribute all
ofthe net income of the trust to, or for the benefit of, ROSE A. MYERS. The Trustees shall make
no distributions of principal to ROSE A. MYERS. Upon the admission of ROSE A. MYERS to
a long term care facility for a period oftime in excess of thirty (30) days, the Trustee shall cease the
distribution of income and shall accumulate the income to the principal of the Trust. If and in the
event that ROSE A. MYERS is discharged from a long term care facility for a period in excess of
thirty (30) days, then the Trustee may resume the distribution of income, provided that any income
accumulated to that point shall remain the principal of the Trust.
4.03. General Power of Appointment. Settlor's grandchildren, DAWN A. PATRICK,
NATALIE J. KEYSER, BRIAN A. ADAMS, CHRISTINE M. KINGSBOROUGH, ANNETTE
E. HACKENBERG, and KAREN L. ADAMS, are hereby granted the general power to appoint
some or all of the principal of this Trust to themselves, their estates, their creditors, the creditors of
their estates, in such proportions and upon such terms (in trust, outright gifts, or in any other manner)
as they jointly or individually deem advisable. This power shall not be exercisable under their Wills.
If Settlor' s grandchildren fail, either in whole or in part, to exercise this general power of appointment
herein granted, the unappointed principal shall continue in trust and shall be administered according
to the terms of this Trust. Upon the death, resignation, removal or incapacity of any of Settlor's
grandchildren, DAWN A. PATRICK, NATALIE J. KEYSER, BRIAN A. ADAMS,
CHRISTINE M. KINGS BOROUGH, ANNETTE E. HACKENBERG, and KAREN L.
ADAMS, the survivor(s) of them shall exercise the general power of appointment under this
provision. Prior to the exercise of the General Power of Appointment by the Settlor's grandchildren,
or any of them, the grandchildren shall provide a written notice of the intent to exercise this power
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to the then-current Trustees. The Trustees shall inform the Settlor of the intent to exercise this
General Power of Appointment. For a period often (10) days, the Settlor may veto the proposed
exercise of the General Power of Appointment. After the ten (10) day period expires, the proposed
exercise of the General Power of Appointment shall take effect unless the Trustees have received
written veto from the Settlor or have reason to believe that the Settlor needs a greater period oftime
to evaluate the notice of intent.
4.04. Principal Distributions. Upon the death of the Settlor, the Trust shall terminate.
Upon termination, the remaining trust estate shall be distributed to the Trustees herein named for the
use and benefit of the Settlor's daughter, JEAN A. ADAMS, (hereunder "the Beneficiary")
according to the following terms and conditions:
(A) Intent of the Settlor. This Trust is established for the benefit of JEAN A.
ADAMS as well as to preserve assets for distribution to the remaindermen
hereunder. It is not the purpose of this Trust that it serve as a primary or
main source of income, support or maintenance for JEAN A. ADAMS.
Anything to the contrary herein notwithstanding, no trust income or principal
shall be paid to or expended for the benefit of JEAN A. ADAMS so long as
there are sufficient monies available to her for care, comfort, and welfare from
federal, state, and local government agencies and departments. The Trustees
shall consider such governmental funds in determining whether there are funds
available to the Beneficiaries from sources other than the Trust estate and
shall use Trust assets only to supplement and never to substitute for such
funds. In no event may Trust income or principal be paid to or for the benefit
of a governmental agency or department, and the Trust estate shall at all times
be free of the claims of such governmental bodies.
(B) Conditions of Use and Benefit of Trust. Upon the funding of this Trust,
JEAN A. ADAMS shall not be permitted to serve as Trustee. Subject to the
termination of this Trust, the trust estate shall be held for the benefit of the
Beneficiary, JEAN A. ADAMS, for her lifetime, together with any other
assets received by the Trustees, for the following uses and purposes:
(1) This Trust is established for the purpose of improving the
quality oflife of the Beneficiary, JEAN A. ADAMS, for and
during all the term of her natural life. As the result of current
or future physical and mental deteriorations of her age and
infirmities, the Beneficiary, JEAN A. ADAMS, suffers or may
suffer from substantial mental and physical disabilities and may
require additional medical care. She may be entitled to benefit
from various governmental programs which provides for her
basic or supplemental care. It is the purpose of this Trust to
provide the Beneficiary, JEAN A. ADAMS, with a higher
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quality of life beyond that which would be provided by these
public entitlement programs and to provide her each with a
proper funeral and burial.
(2) Settlor's intent in creating this Trust is that the Trustees use
the Trust created herein to promote the happiness, welfare and
benefit of the Beneficiary, JEAN A. ADAMS, through
income and principal distributions, without in any way
reducing the services or financial assistance and basic
maintenance, support, medical or dental care which the
Beneficiary may receive without charge from any local, state
or federal government agency or department thereof, and
without using any portion of the Trust income or principal to
reimburse any local, state or federal government agency or
department thereof for basic maintenance, support, medical or
dental care received by the Beneficiary. Settlor's intent is that
the Trust income and principal is not to be considered income,
assets, nor resources of the Beneficiary, for any purpose,
including but not limited to, the determination of income,
assets or resources as stated in any rules or regulations set
forth in any local, state or federal government agency or
department thereof. In the event the Trustees are requested
by any department or agency to release principal or income of
the Trust to or on behalf of the Beneficiary to pay for
equipment, medication or service which other organizations or
agencies are authorized to provide, or in the event the
Trustees are requested by any department or agency
administering such benefits to petition the Court or any other
administrative agency for the release of Trust principal or
income for this purpose, the Trustees shall deny such request
and are directed to defend at the expense of the Trust estate,
any contest or other attack of any nature.
(3) The Trustees shall distribute to the Beneficiary, JEAN A.
ADAMS, or expend and apply for her benefit, so much of or
all of the income and principal of this Trust, as the Trustees,
in their sole and absolute discretion, determine to be advisable
for the Beneficiary's special needs for happiness and comfort
to achieve the purpose of the Trust herein set forth. The
"special needs" which the Trustees may provide to the
Beneficiary, JEAN A. ADAMS, include but are not limited to
spending money, additional food, clothing, gifts on their
birthdays and major holidays, small appliances that would
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provide the Beneficiary with entertainment or amusement,
computer equipment, vacations, athletic contests, movies,
trips, money to purchase appropriate gifts for relatives and
friends, any recreational items that would be of use to them
and other monetary requirements to enhance their self-esteem
or situation. "Special needs" shall also include medical and
dental expenses, annual independent check-ups, rehabilitation
and physical therapy equipment, programs of training,
education, treatment, physical therapy and rehabilitation,
private residential care, eye glasses, transportation (including
vehicle purchase), maintenance, and insurance (including
payment of premiums of insurance on the life of the
beneficiary) and other requisites for maintaining the good
health, safety, and welfare of the Beneficiary when, in the
discretion of the Trustees, such requisites are not being
provided by any public agency, office, or department of any
state or of the United States. Nothing herein shall preclude
the Trustees from purchasing those services and items which
promote the Beneficiary's happiness, comfort and welfare.
The Trustees shall also have authority in their absolute and
sole discretion to make gifts to any community residence in
which the Beneficiary may be residing.
(4) Any net income not expended for or applied to the special
needs of the Beneficiary, JEAN A. ADAMS, shall be
accumulated and added to the Trust principal.
(5) The Trustees shall have no obligation to expend Trust assets
for the Beneficiary's special needs, but ifthe Trustees, in their
sole discretion, decide to expend Trust assets, under no
circumstances should any amounts be paid to, or reimbursed
to, the federal government, any state, or any governmental
agency for any purpose, including for the care, support, and
maintenance of the Beneficiary. This Trust is created
expressly for the Beneficiary's extra and supplemental care,
maintenance, support and education in addition to, and over
and above the benefits they otherwise receive or may receive
as a result of handicap or disability, from any local, state or
federal government, or from any other private agency, any of
which provides service or benefits to persons with disabilities.
It is Settlors' express purpose that this Trust be used only to
supplement other benefits that the Beneficiary may receive.
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(6) Because the Beneficiary may be dependent on the support and
aid of others, the Trustees shall, in the exercise of its best
judgement and fiduciary duty, seek support and maintenance
for her, or request her or her guardian or agent(s) to seek
support and maintenance for her, from all available public
resources, including, but not limited to, Social Security
Administration benefits, the Supplemental Security Income
Program (SSI), any such supplemental income program
offered by or through the Commonwealth of Pennsylvania, the
Old Age Survivors and Disability Insurance or successor
programs, U.S. Civil Service Commission benefits, Medicaid,
and Federal Social Security Disability Insurance (SSDI), and
any other comparable programs, state, federal, or local. The
Trustees shall take into consideration applicable resource and
income limitations of any public assistance programs for which
the Beneficiary is eligible when determining whether or not to
make any discretionary distributions. In carrying out the
provisions ofthis Article, the Trustees shall be mindful of the
probable future needs of the remaindermen of this Trust. If
necessary, the Trustees may seek appropriate authority to
collect, expend, and account for separately all such
governmental assistance benefits, but shall not commingle
them with these Trust assets. In addition, in making
distributions for the special needs of the Beneficiary, the
Trustees shall take into consideration the applicable resource
limitations of the public assistance programs for which they
are or may become eligible.
(7) The Trustees shall regard this Trust as existing for the welfare
and benefit of the Beneficiary, JEAN A. ADAMS.
Accordingly, the Trustees shall exercise their discretion as to
disbursements and investments with this standard in mind.
Consistent with the purpose of this Trust, the Settlors may
establish a life plan to be periodically updated, signed and
dated. It is intended that the Trustees read the life plan and
use it as guidance in administering this Trust according to the
terms set forth herein. In no event shall the life plan be
binding upon the Trustees or otherwise diminish the Trustees'
discretion as described herein.
(8) The Trustees shall exercise reasonable diligence. However,
the Trustees shall not be liable for any acts or omissions done
or performed in good faith.
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(9) The Trustees shall not be required to make an accounting to
any public official except to the extent otherwise required by
law. The Trustees shall, however, keep and maintain
complete and open accounts of the Trust principal and income
and any expenditures from the Trust. Anyone having an
interest in the Trust shall have a right to inspect the accounts
at reasonable times and with reasonable notice to the Trustees.
All discretion conferred on the Trustees shall be absolute and
unlimited, and its exercise by the Trustees shall be conclusive
and binding on all persons.
(10) The Trustees shall pay reasonable burial expenses including a
suitable and proper grave marker for the Beneficiary, JEAN
A. ADAMS.
(C) General Power of Appointment. Until such Termination of this Trust as
described in Paragraph 4.04(D), DAWN A. PATRICK, NATALIE J.
KEYSER, BRIAN A. ADAMS, CHRISTINE M. KINGSBOROUGH,
ANNETTE E. HACKENBERG, and KAREN L. ADAMS, are jointly
hereby granted the general power to appoint some or all of the principal of
this Trust to themselves, jointly or individually, or any other individual, in
such proportions and upon such terms (in trust, outright gifts, or in any other
manner) as they jointly deem advisable. This power shall not be exercisable
under their respective final Wills. Prior to fulfilling the exercise of this
General Power of Appointment, Trustees shall inform the Beneficiary of the
intended exercise and the Beneficiary shall, for a period of seven (7) days,
have the right to veto the pending exercise by writing delivered to the
Trustees within the seven (7) day period. If and in the event that the
Beneficiary does not exercise her veto power, the exercise of the General
Power of Appointment shall be granted. The Beneficiary shall have no
authority to veto this provision ifthe Beneficiary is receiving a public benefit
that would be reduced or terminated by the exercise ofthis General Power of
Appointment.
(D) Distributions Upon Termination of Trust. The Trust shall terminate upon
the death ofthe Beneficiary, JEAN A. ADAMS. Upon termination, the then-
remaining trust estate shall distributed to DA WN A. PATRICK, NATALIE
J. KEYSER, BRIAN A. ADAMS, CHRISTINE M. KINGSBOROUGH,
ANNETTE E. HACKENBERG, and KAREN L. ADAMS, in equal shares,
per stirpes. If and in the event that any of these individuals predeceases their
distribution without surviving issue, then their share shall be distributed,
equally, among the remaining named individuals, per stirpes.
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ARTICLE V. POWERS OF TRUSTEES
5.01. General Powers. In addition to such other powers and duties as may have been
granted elsewhere in this Trust, but subject to any limitations contained elsewhere in this Trust, the
Trustees shall have the following powers and duties:
A. In the management, care and disposition of this Trust, the Trustees shall have the power
to do all things and to execute such deeds, instruments, and other documents as may be deemed
necessary and proper, including the following powers, all of which may be exercised without order
of or report to any court:
(1) To sell, exchange, or otherwise dispose of any property, real, personal or
mixed, wheresoever located, at any time held or acquired hereunder, at public or
private sale, for cash or on terms as may be determined by the Trustees, without
advertisement, including the right to lease for any term notwithstanding the period of
the Trust, and to grant options, including an option for a period beyond the duration
of the Trust.
(2) To invest all monies in such stocks, bonds, securities, investment
companies or trust shares, mortgages, notes, choses in action, real estate,
improvements thereon, and other property as the Trustees may deem best, without
regard to any law now or hereafter in force limiting investments offiduciaries.
(3) To retain for investment any property deposited with the Trustees
hereunder.
(4) To vote in person or by proxy any corporate stock or other security and
to agree to or take any other action in regard to any reorganization, merger,
consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any
stock, bond, note or other security held by this Trust.
(5) To use lawyers, real estate brokers, accountants and any other agents, if
such employment is deemed necessary or desirable, and to pay reasonable
compensation for their services.
(6) To compromise, settle or adjust any claim or demand by or against the
Trust and to agree to any rescission or modification of any contact or agreement
affecting the Trust.
(7) To renew any indebtedness, as well as to borrow money, and to secure
the same by mortgaging, pledging or conveying any property of the Trust, including
the power to borrow from the Trustees (in the Trustees' individual capacity) at a
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reasonable rate of interest.
(8) To retain any business interest transferred to the trustee, as shareholder,
security holder, creditor, partner or otherwise, for any period of time whatsoever,
even though the interest may constitute all or a large portion of the trust principal; to
comply with the provisions of any agreement restricting transfer of the interest; to
participate in the conduct of the related business or rely upon others to do so, and to
take or delegate to others discretionary power to take any action with respect to its
management and affairs which an individual could take as outright owner of the
business or the business interest, including the voting of stock (by separate trust or
otherwise regardless of whether that separate trust will extend for a term within or
beyond the term of the trust) and the determination of all questions of policy; to
execute and amend partnership agreements; to participate in any incorporation,
reorganization, merger, consolidation, sale of assets, recapitalization, liquidation or
dissolution of the business, or any change in its nature, or in any buy-sell, stock
restriction, or stock redemption agreements; to invest in additional stock or securities
of, or make secured, unsecured, or subordinated loans to, the business with trust
funds; to take all appropriate actions to prevent identify, or respond to actual or
threatened violations of any environmental law or regulation thereunder; to elect or
employ with compensation, as directors, officers, employees, or agents of the
business, any persons, including a trustee of any trust held under this instrument, or
any director, officer, employee, or agent of a corporate trustee of any trust held
under this instrument, without adversely affecting the compensation to which that
trustee would otherwise be entitled; to rely upon reports of certified public
accountants as to the operations and financial condition of the business, without
independent investigation; to deal with and act for the business in any capacity
(including in the case of a corporate trustee any banking or trust capacity and the
loaning of money out of the trustee's own funds) and to be compensated therefor; and
to sell or liquidate the business or any interest in the business.
(9) To register any stock, bond or other security in the name of a nominee,
without the addition of words indicating that such security is held in a fiduciary
capacity, but accurate records shall be maintained showing that the stock, bond or
other security is a trust asset and the Trustees shall be responsible for the acts of the
nommee.
(l0) To set aside as a separate trust, to be held and administered upon the
same terms as those governing the remaining trust property, any interests in property,
for any reason, including but not limited to a concern that such property could cause
potential liability under any federal, state, or local environmental law.
B. Whenever the Trustees are directed to distribute any trust principal in fee simple to a
person who is then under twenty-one (21) years of age, the Trustees shall be authorized to hold such
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property in trust for such person until he becomes twenty-one (21) years of age, and in the meantime
shall use such part of the income and the principal of the trust as the Trustees may deem necessary
to provide for the proper support and education of such person in the standard of living to which he
has become accustomed. If such person should die before becoming twenty-one (21) years of age,
the property then remaining in trust shall be distributed to the personal representative of such person's
estate.
C. In making distributions from the Trust to or for the benefit of any minor or other person
under a legal disability, the Trustees need not require the appointment of a guardian, but shall be
authorized to payor deliver the distribution to the custodian of such person, to payor deliver the
distribution to such person without the intervention of a guardian, to payor deliver the distribution
to the legal guardian of such person if a guardian has already been appointed, or to use the
distribution for the benefit of such person.
D. In the distribution of the Trust and any division into separate trusts and shares, the
Trustees shall be authorized to make the distribution and division in money or in kind or in both,
regardless of the basis for income tax purposes of any property distributed or divided in kind, and the
distribution and division made and the values established by the Trustees shall be binding and
conclusive on all persons taking hereunder. The Trustees may in making such distribution or division
allot undivided interests in the same property to several trusts or shares.
E. If at any time after Settlor's death the total fair market value of the assets of any trust
established or to be established hereunder is so small that the corporate Trustee's annual fee for
administering the trust would be equal to or less than the minimum annual fee set forth in the
Trustee's regularly published fee schedule, then the Trustees in their discretion shall be authorized to
terminate such trust or to decide not to establish such trust, and in such event the property then held
in or to be distributed to such trust shall be distributed to the persons who are then or would be
entitled to the income of such trust. If the amount of income to be received by such persons is to be
determined in the discretion of the Trustees, then the Trustees shall distribute the property among
such of the persons to whom the Trustees are authorized to distribute income, and in such
proportions, as the Trustees in their discretion shall determine.
F. The Trustees shall be authorized to lend or borrow, including the right to lend to or
borrow from the Settlor's estate, at an adequate rate of interest and with adequate security and upon
such terms and conditions as the Trustees shall deem fair and equitable.
G. The Trustees shall be authorized to sell or purchase, at the fair market value as determined
by the Trustees, any property to or from Settlor's estate, the estate of Settlor's spouse, or any trust
created by Settlor or Settlor's spouse during life or by will, even though the same person or
corporation may be acting as executor of Settlor's estate or the estate of Settlor's spouse or as trustee
of any other such trusts and as the Trustee of this Trust.
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H. The Trustees shall have discretion to determine whether items should be charged or
credited to income or principal or allocated between income and principal as the Trustees may deem
equitable and fair under all the circumstances, including the power to amortize or fail to amortize any
part or all of any premium or discount, to treat any part or all of the profit resulting from the maturity
or sale of any asset, whether purchased at a premium or at a discount, as income or principal or
apportion the same between income and principal, to apportion the sales price of any asset between
income and principal, to treat any dividend or other distribution on any investment as income or
principal or to apportion the same between income or principal, to charge any expense against income
or principal or apportion the same, and to provide or fail to provide a reasonable reserve against
depreciation or obsolescence on any asset subject to depreciation or obsolescence, all as the Trustees
may reasonably deem equitable and just under all ofthe circumstances.
1. The Trustees are hereby authorized and empowered to purchase such insurance policies
as they deem appropriate.
5.02. Actions and Voting by Trustees. When the authority and power under this Trust
is vested in two (2) or more Trustees or Co-Trustees, the authority and power under this Trust or
granted by law shall be vested in, and exercised by, each of the Trustees individually or all of the
Trustees jointly, such that each Trustee may act independently, or the trustees may act jointly, in the
administration or under the terms of the Trust agreement.
5.03. Trustees Power to Deal with Environmental Hazards. The Trustee shall have the
power to use and expend the trust income and principal to (i) conduct environmental assessments,
audits, and site monitoring to determine compliance with any environmental law or regulation
thereunder; (ii) take all appropriate remedial action to contain, clean up or remove any environmental
hazard including a spill, release, discharge or contamination, either on its own accord or in response
to an actual or threatened violation of any environmental law or regulation thereunder; (iii) institute
legal proceedings concerning environmental hazards or contest or settle legal proceedings brought
by any local, state, or federal agency concerned with environmental compliance, or by a private
litigant; (iv) comply with any local, state or federal agency order or court order directing an
assessment, abatement or cleanup of any environmental hazards; and (v) employ agents, consultants
and legal counsel to assist or perform the above undertakings or actions. Any expenses incurred by
the trustee under this paragraph may be charged against income or principal as the trustee shall
determine.
ARTICLE VI. SPENDTHRIFT PROVISION
6.01. General Provision. No beneficiary shall have the power to anticipate, encumber or
transfer his interest in the Trust Estate in any manner other than by the valid exercise of a Power of
Appointment. No part of the Trust Estate shall be liable for or charged with any debts, contracts,
liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a
beneficiary.
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ARTICLE VII. CONSTRUCTION OF TRUST
7.01. Choice of Law. This Trust shall be administered and interpreted in accordance with
the laws ofthe Commonwealth of Pennsylvania.
7.02. Code. Unless otherwise stated, all references in this Trust to section and chapter
numbers are to those of the Internal Revenue Code of 1986, as amended, or corresponding provisions
of any subsequent federal tax laws applicable to this Trust.
7.03. Other Terms. Unless the context otherwise requires, the use of one or more genders
in the text includes all other genders, and the use of either the singular or the plural in the text
includes both the singular and the plural.
7.04. Captions. The captions set forth in this Agreement at the beginning of the various
divisions hereof are for convenience of reference only and shall not be deemed to define or limit the
provisions hereof or to affect in any way their construction and application.
7.05. Situs of Trust. The Trust shall have its legal situs in Cumberland County,
Pennsylvania.
ARTICLE VIII.
COMPENSATION OF TRUSTEES AND
APPOINTMENT OF SUCCESSOR TRUSTEES
8.01. Compensation. The Trustees shall receive as their compensation for the services
performed hereunder that sum of money, based on an hourly charge or percentage rate, which the
Trustees normally and customarily charge for performing similar services during the time which they
perform these services.
8.02. Removal of Trustees. Settlor may remove the Trustees, or any ofthem, at any time
or times, with or without cause, upon thirty (30) days written notice given to the current Trustees.
Upon the death of the Settlor, a majority of the current income beneficiaries may remove the
Trustees, or any of them, at any time or times, with or without cause, upon thirty (30) days written
notice given to the current Trustees. Upon the removal of the Trustees, or any of them, a successor
Trustee(s) shall be appointed in accordance with the terms set forth in Paragraph 8.03.
8.03. Appointment of Successor Trustees. The Trustees, or any of them, may resign at
any time upon thirty (30) days written notice given to the Settlor if Settlor is living, or in the event
of Settlor's death, upon thirty (30) days written notice given to the current income beneficiary or
beneficiaries (including a beneficiary's natural or legal guardian or legal representative), hereunder.
Upon the death, resignation, removal or incapacity of the Trustees, or any of them, a successor
trustee(s) may be appointed by the Settlor during Settlor's lifetime, or, after Settlor's death, by a
majority of the current income beneficiaries. Notwithstanding the foregoing provisions respecting
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the appointment of a successor trustee(s), if and in the event that one Trustee shall die, resign, be
removed, or be adjudicated incompetent, the remaining Trustee shall exercise the powers, and carry
out the duties, of Trustee individually until such time as a successor trustee is appointed. Any
successor trustee( s) shall be a financially sound and competent corporate trustee or issue of the
Settlor. Unless otherwise designated, the Successor Trustees shall be DAWN A. PATRICK and
ANNETTE E. HACKENBERG, or the survivor of them, to act jointly only. Any successor
trustee(s) thus appointed, or, ifthe corporate trustee shall merge with or be consolidated with another
corporate fiduciary, then such corporate fiduciary, shall succeed to all the duties and to all the
powers, including discretionary powers, herein granted to the Trustees.
8.04. Exoneration of Trustee. No Trustee shall be liable for any loss or depreciation in
value sustained by the Trust as a result of the Trustee retaining any property upon which there is later
discovered to by hazardous materials or substances requiring remedial action pursuant to any federal,
state, or local environmental law, unless the Trustee contributed to the loss or depreciation in value
through willful default, willful misconduct, or gross negligence.
8.05. Indemnification of Trustee Upon Distribution. Notwithstanding any contrary
provision in this Trust Agreement, the Trustee may withhold a distribution to a beneficiary until
receiving from the beneficiary an indemnification an agreement in which the beneficiary agrees to
indemnify the Trustee against any claims filed against the Trustee as an "owner" or "operator" under
the Comprehensive Environmental Response, Compensation and Liability Act of 1980, as from time
to time amended, or any regulation thereunder.
ARTICLE IX. PERPETUITIES CLAUSE
9.01. General Provision. Notwithstanding anything to the contrary in this Trust, each
disposition the Settlor has made here, legal or equitable, to the extent it can be referred in its
postponement of becoming a vested interest to a duration measured by some life or lives in being at
the time of Settlor's death is definitely to vest in interest, although not necessarily in possession, not
later that twenty-one (21) years after such lives (and any period of gestation involved); or, to the
extent it cannot be referred in any such postponement to such lives, is to so vest not later than
twenty-one (21) years from the time of Settlor's death.
ARTICLE X.
ACQUISITION OF UNITED STATES TREASURY BONDS
ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL
EXPENSES, AND EXPENSES OF ADMINISTRATION
10.01. Acquisition of Bonds. The Trustees may, at anytime, without the prior approval or
direction of the Settlor and whether or not the Settlor is able to manage Settlor's own affairs, acquire
United States Treasury Bonds selling at a discount, which bonds are redeemable at their par value
plus accrued interest thereon for the purposes of applying the proceeds to the payment of the United
States estate tax on the Settlor's estate; and the Trustees may borrow from any lender, including
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themselves, with or without security, to so acquire these bonds.
10.02. Payment of United States Estate Tax by Bond Redemption. The Settlor directs
that any United States Treasury Bonds which may be redeemed at their par value plus accrued
interest thereon for the purpose of applying the proceeds to the payment of the United States estate
tax imposed on the Settlor's estate, and which are held by the Trustees, shall, to the extent of the
amount determined to be required for payment of the estate tax, be distributed to the legal
representative of the Settlor's estate to be used by the legal representative ahead of any other assets
and to the fullest extent possible to pay the estate tax.
10.03. Payment of Death Taxes and Other Estate Settlement Costs. After the Trustees
have complied with paragraph 10.02, above, and ascertained from the legal representative that all
such bonds have been redeemed in payment of the United States estate tax, the Trustees shall also
ascertain from the legal representative whether the legal representative has sufficient assets to pay the
remaining legacy, succession, inheritance, transfer, estate and other death taxes or duties (except the
additional estate tax imposed by Section 2032( c), or corresponding provisions of the Internal
Revenue Code of 1986 applicable to the Settlor's estate and imposing the tax) levied or assessed
against the Settlor's estate (including all interest and penalties thereon), all of which taxes, interest
and penalties are hereafter referred to as the death taxes, interest and penalties. If the legal
representative advises the Trustees that insufficient funds exist to pay all the death taxes, interest and
penalties, the Trustees shall then pay to the legal representative from the trust property, an amount
equal to all the death taxes, interest and penalties in excess of the funds available to the legal
representative for these purposes, which payments are to be made without apportionment.
Ifthe Executor of the Settlor's estate, in such Executor's sole discretion, shall determine that
appropriate assets of Settlor's estate are not available in sufficient amount to pay (1) the Settlor's
funeral expenses, and (2) expenses of administering the Settlor's estate, the Trustees shall, upon the
request of the Executor of the Settlor's estate, contribute from the principal of the trust estate the
amount of such deficiency; and in connection with any such action the Trustees shall rely upon the
written statement of the Executor of the Settlor's estate as to the validity and correctness of the
amounts of any such expenses, and shall furnish funds to such Executor so as to enable such Executor
to discharge the same, or to discharge any part or all thereof itself by making payment directly to the
person entitled or claiming to be entitled to receive payment thereof. No consideration need be
required by the Trustees from the Executor of Settlor's estate for any disbursement made by the
Trustees pursuant hereto, nor shall there be any obligation upon such Executor to repay to the
Trustees any of the funds disbursed by them hereunder, and all amounts disbursed by the Trustees
pursuant to the authority hereby conferred upon them shall be disbursed without any right in or duty
upon the Trustees to seek or obtain contribution or reimbursement from any person or property on
account of such payment. The Trustees shall not be responsible for the application of any funds
delivered by them to the Executor of the Settlor's estate pursuant to the authority herein granted, nor
shall the Trustees be subject to liability to any beneficiary hereunder on
account of any payment made by them pursuant to the provisions hereof.
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IN WITNESS WHEREOF, the Settlor and Trustees have hereunto set their hands and seals
as of the day and year first above written.
WITNESS:
/;;7 1#.
t .
. .
I! :i
7h'~'
RosE 1.1.. /VIYf.RS
ROSE A. MYERS, SETTLOR
(SEAL)
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF (11)~~E~LAI\1~
SS:
On this, the S-th day of April, 2002, before me, a Notary Public, the undersigned officer,
personally appeared ROSE A. MYERS, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within Trust Agreement, and acknowledged that she executed the
same for the purposes therein contained.
IN WITNESS WHEREOF, I have set my hand and official Seal.
c!fiJ~
Notary Public
My Commission Expires:
Notarial Seal
Teri L. Walker, Notary Public
Lemoyne 8oro, Cumbertand County
My CommissIon Expires Jan. 20, 2003
Member, Pennsylvania Association ot Notaries
16
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The foregoing Trust Agreement was delivered, and is hereby accepted, at Lemoyne,
Pennsylvania, on April 15 , 2002.
,~~.,'e #f
WITN S
, 'I
;, 'ljA:;4-1,'
-R~ A "fYl
ROSE A. MYERS, ~EE
(SEAL)
(SEAL)
17
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.
SCHEDULE "A"
SCHEDULE
REFERRED TO IN THE ANNEXED
TRUST AGREEMENT
DATED: APRIL 8', 2002
FROM ROSE A. MYERS,
SETTLOR
TO ROSE A. MYERS AND JEAN A. ADAMS,
TRUSTEES
Property Description:
1. ALL THAT CERTAIN lot of ground situated on West Marble Street, in the Borough of
Mechanicsburg, County of Cumberland and State of Pennsylvania, bounded and described as
follows, to wit:
BEG INNING at an iron pin in the center of Marble Street and comer of lands now or formerly of
the Church in Christ; thence by said Marble Street South sixty-eight and one half degrees West
seventy-five and one half feet to an iron pin at comer of lands now or formerly of William
Westhafer; thence by said lands South twenty-one and one half degrees East three hundred feet to
a stake; thence North sixty-eight and one half degrees East forty-five and one fourth feet to a stake
at comer oflands of said Church in Christ; and thence North fifteen and one-half degrees West three
hundred feet to the place of BEGINNING.
HA VING THEREON ERECTED a frame dwelling house.
2. ALL THAT CERTAIN piece, parcel or tract of land situated in Tyrone Township, Perry County,
Pennsylvania, bounded and described as follows:
BEGINNING at a point in the center of the public road, thence South 330 East 637 feet along the
lands now or formerly of Lulu J. Kallas to the Macabes Run; thence South 74% 0 West 100 feet along
the lands now or formerly of Malcolm Crull to a point in the Macabes Run; thence North 330 West
594 feet along the lands now or formerly of Joseph Craly heirs to a point in the center of the public
road; thence North 50Y, 0 East 100 feet along the said public road to the point of BEGINNING.
CONTAINING 1.4 acres, more or less.
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PA REV-1500
SCHEDULE E
CASH, BANK DEPOSITS &
MISCELLANEOUS PERSONAL
PROPERTY
.
~~ (.a ;.iJ:(~ll<r" I L H ~~{
1-800-773-7373
Call Citizens' PhoneBank anytime for account information,
current rates and answers to your questions.
US059 BR292
ROSE A MYERS
205 W MARBLE Sf
MECHANICSBURG PA
4
17055-6421
1
.
Citizens Circle Gold
Account Statement
o OF 3
Beginning February 09, 2005
through March 08, 2005
Contents
Summary Page 1
Checking Page 2
Savings Page 3
Citizens Circle Gold Summary
Account
Account Number
Balance
This statement
Balance
Last Statement
DEPOSIT BALANCE
Checking
Circle Gold Checking Hi Interest
Savings
Statement Savings
610070-192-1
6140-168147
Monthly combined balance to waive monthly fee is
Your monthly combined balance this statement period is
41,774.69
2,008.77
20,000.00
38,889.00
27,362.42
2,009.16
ROSE A MYERS
Circle Gold Checking Hi Interest
610070-192-1
o
Total Deposit Balance
29,371.58
0.
Total RelationshIp Balance
29,371.58
"-.j
.
.
PA REV-1500
SCHEDULE F
JOINTL Y OWNED PROPERTY
II!
-~~....
~--~
WACHOVIA
.
.
Reference ID: 1256260
Wachovia Bank N.A.
Balance Confirmation Services
POBox 40028
Roanoke, VA 24022-7313
June 13,2005
GATES HALBRUNER & HATCH
LAW OFFICES
1013 MUMMA ROAD SUITE 100
LEMOYNE, P A 17043
SUBJECT: Verification I Confirmation of Account and Balance Information provided for:
Customer: ROSE A MYERS (SSN# 172-01-3610)
Date of Death: March 2, 2005
Deposit Account Information
Account
Type
Account
Number
Date of Death
Balance
Average
Balance*
Date
Opened
Maturity Interest Accrued YTD Date
Date Rate Interest Interest Paid Closed
SAVINGS
LEGAL TITLE: ROSE A MYERS
JEAN A ADAMS
3083365463047
$15,081.77
2/111976
$0.12
$3.66
RECORDS SHOW JOINT AS FAR BACK
AS 1998
* Due to system limitations, we can only provide a twelve month average balance on depository accounts.
No Safe Deposit Box fOlmd for customer.
* Date of death balance does not include accrued interest.
weekend or a holiday, date of death balance does not include any transactions that were
Phone: (540)563-7323
II; at
0000 000614
/
I
.
.
PA REV-1500
SCHEDULE G
INTER-VIVOS TRANSFERS and
MISCELLANEOUS NON-PROBATE
PROPERTY
.
.
TAX PARCEL NO. 20-24-0785-416
BOROUGH OF MECHANICSBURG
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DEED
· 02 APR 10 RAIl 25
TillS DEED is made the 8th day of April, in the year two thousand two (2002).
BETWEEN ROSE A. MYERS, formerly known as ROSE A. SMEIGH, now of 205 West Marble
Street, Mechanicsburg, Cumberland County, Pennsylvania, 17055, party of the first part, GRANTOR,
AND
ROSE A. MYERS and JEAN A. ADAMS, Trustees of THE MYERS FAMILY IRREVOCABLE
TRUST, parties of the second part, GRANTEES.
WITNESSETH, that said party of the first part, for and in consideration of the sum of One ($1. 00) Dollar,
lawful money of the United States of America, well and truly paid by the said parties of the second part
to the said party of the first part, at or before the sealing and delivery of these presents, the receipt whereof
is hereby acknowledged, has hereby granted, bargained, sold, aliened, enfeoffed, released, conveyed and
confmned, and by these presents does grant, bargain, sell, alien, enfeoff, release, convey and confirm unto
the said party of the second part, her heirs, successors and assigns,
ALL THAT CERTAIN lot of ground situated on West Marble Street, in the Borough of Mechanicsburg,
County of Cumberland and State of Pennsylvania, bounded and described as follows, to wit:
BEGINNING at an iron pin in the center of Marble Street and corner of lands now or formerly of the
Church in Christ; thence by said Marble Street South sixty-eight and one half degrees West seventy-five
and one half feet to an iron pin at corner of lands now or formerly of William Westhafer; thence by said
lands South twenty-one and one half degrees East three hundred feet to a stake; thence North sixty-eight
and one haif degrees East forty-five and one fourth feet to a stake at corner of lands of said Church in
Christ; and thence North fifteen and one-half degrees West three hundred feetto the place of BEGINNING .
HAVING THEREON ERECTED a frame dwelling house.
BEING the same premises which D. Wayne Gutshall and Charlotte C. Gutshall, his wife, by their deed
dated December 19, 1941 and recorded in the Recorder of Deeds Office in Deed Book N, Volume 12, Page
600, granted and conveyed unto Rose A. Smeigh, now known as Rose A. Myers, Grantor herein.
TillS IS A TRANSFER FOR NOlVlINAL CONSIDERATION TO TRUSTEES OF A LIVING
TRUST AND IS THEREFORE EXEMPT FROM THE PAYMENT OF REALTY TRANSFER
TAX.
TOGETHER with all and singular the buildings and improvements, ways, streets, alleys, driveways,
passages, waters, watercourses, rights, liberties, privileges, hereditaments and appurtenances, whatsoever
unto the hereby granted premises belonging, or in any wise appertaining, and the reversions and
remainders, rents, issues, and profits thereof; and all the estate, right, title, interest, property, claim, and
demand whatsoever of the said Grantor, as well at law as in equity, of, in, and to the same.
.
.
TO HAVE AND TO HOLD, the said lot or piece of ground above-described, with all and singular the
buildings and improvements thereon erected, hereditaments and premises hereby granted, or mentioned
and intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, to and for
the only proper use and behoof of the said Grantees, their heirs and assigns forever.
AND the said Grantor, for herself, her heirs, executors and administrators, does covenant, promise and
agree, to and with the said Grantees, their heirs and assigns, by these presents, that she, the said Grantor,
and her heirs, all and singular the hereditaments and premises hereby granted or mentioned and intended
so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, against them, the said
Grantor and her heirs, and against all and every person and persons whomsoever lawfully claiming or to
claim the same or any part thereof, by, from or under him, her, them or any of them, shall and will, subject
as aforesaid, SPECIALLY WARRANT AND FOREVER DEFEND.
IN WITNESS WHEREOF, the said party of the first part has hereunto set her hand and seal, the day and
year flIst above-written.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF
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ROSE A. SMEIGH V
71nt.A ~v
ROSE A. l\1YER'
C0Ml'v10NWEAL TH OF PENNSYLVANIA
SS:
COUNTY OF ~Uk BE"I2LAl'fD
On this, the 55th day of April, 2002, before me, aN otary Public for the Commonwealth of
Pennsylvania, the undersigned officer, personally appeared ROSE A. MYERS, formerly known as,
ROSE A. SMEIGH, known to me (or satisfactorily proven) to be the person whose name is subscribed
to the within instrument, and acknowledged that she executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~wJLucJ
Notary Public
My Commission Expires:
Notarlal Seal
Ten L. Walker, Notary Public
Lemoyne Boro, Cumberfand County
My Commission expires Jan. 20, 2003
Member, Pennsylvania Association 01 Notaries
See Reverse for Instructions
RECORDER'S USE ONLY
~EV.l t3 EX (6-96)
'* .
COMMONWEALTH OF PENNSYLVANI
OEPARTMENT OF REVENue
BUREAU OF INDIVIDUAL TAXES
DEPT. 280603
HARRISBURG, PA 17128-0603
REALTY TRANSFER TAX
STATEMENT OF VALUE
Complete each sedion and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) when the deed
is without consideration, or by gift, or (3) a tax exemption is daimed. A Statement of Value is not required if the transfer is wholly exempt from lax
based on: (1) family relationship or (2) public utility easement. If more space is needed, attach additional sheet(s).
A CORRESPONDENT - All inquiries may be directed to the following person:
Name Telephone Number:
Craig A. Hatch, Esquire Area Cade ( 717
Street Address City State
1013 Mumma Road, Suite 100 lemoyne
B TRANSFER DATA Oat.
Gran,or(sl/lessor(s) Gran,..(sJLessee(s)
Rose A. Myers Trustees of The Myers Family Irrevocable Trust
Stree' A ress Street Ad ress
731-9600
Zip Code
17043
,
205 West Marble Street
City State
Mechanicsburg" PA
C PROPERTY LOCATION
Zip Code
17055
205 West Marble Street
City Stale
Mechanicsburg PA
Zip Code
17055
Cumberland
D VALUATION DATA
Mechanicsbur Area Sch Dist
Street Address
205 West Marble Street
County
School District
I. Actual Cash Consideration
2. Other Consideration
+ 0
5. Common Level Ralio factor
3. Tolal Consideration
1.00
4. County Assessed Value
= 1.00.
6. fair Market Value
97010.00
E EXEMPTION DATA
10. Amollnt of Exemption aimed
100%
x 1.00
= 97,010.00
1 b. Pereemage of Interest Conveyed
100%
2. Check Appropriate Box Below for Exemption Claimed
o Will or intestate succession
IName of Oeaodentl
(btate file Numberj
11
LJ Transfer to Industrial Development Agency.
[3 Transfer to a trust. (Anach complete copy of trust agreement identifying all beneficiaries.)
o Transfer belween principal and agent. (Attach complete copy of agency/straw party agreement.)
o Transfers to the Commonwealth, the United States and Instrumentalities by gift, dedication, condemnation or in lieu of condemnation.
(If condemnation or in lieu of condemnation, altach copy of resolution.)
o Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number , Page Number
;
o Corredive or confirmatory deed. (Attach complete copy of the prior deed being corraded or confirmed.)
o Statutory corporate consolidation, merger or division. (Attach copy of articles.)
rn Other (Please explain exemption claimed, if other than listed above.) This is a transfer to a Trustee of a living Trust
and is therefore exempt from the payment of Realty Transfer Tax. [72 P.S. Section 8102-C.3(8.1)]
Date /
!//z?/~ -;2
FAILURE TO COMP~ THIS FORM PROPERLY OR ATTACH APPLICABLE DOCUMENTAnON MAY RESULT IN THE RECORDER'S REFUSAL
TO RECORD THE DEED.
2\
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.........
63-0
.
.
TAX PARCEL NO. 270,178.02-024.000
TYRONE TOWNSHIP
PerrY CGf~rlti - Document St.~mp
D3Vid I Mdgee~ Recorder
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DEED
TillS DEED is made the 8th day of April, in the year two thousand two (2002).
BETWEEN ROSE A. MYERS, now of 205 West Marble Street, Mechanicsburg, Cumberland
County, Pennsylvania, 17055, party of the first part, GRANTOR,
AND
ROSE A. MYERS and JEAN A. ADAMS, Trustees of THE MYERS FAMILY
IRREVOCABLE TRUST, partie~ of the second part, GRANTEES.
WITNESSETH, that said party of the first part, for and in consideration of the sum of One ($1.00)
Dollar, lawful money of the United States of America, well and truly paid by the said parties of the
second part to the said party of the first part, at or before the sealing and delivery of these presents,
the receipt whereof is hereby acknowledged, has hereby granted, bargained, sold, aliened, enfeoffed,
released, conveyed and confirmed, and by these presents does grant, bargain, sell, alien, enfeoff,
release, convey and confirm unto the said party of the second part, her heirs, successors and assigns,
ALL THAT CERTAIN piece, parcel or tract of land situated in Tyrone Township, Perry County,
Pennsylvania, bounded and described as follows:
BEGINNING at a point in the center of the public road, thence South 330 East 637 feet along the
lands now or formerly ofLuluJ. Kallas to the Macabes Run; thence South 74% 0 West 100 feet along
t.~e lands no'.\' or formerly of Malcohn Crull to a point in the Macabes Run; thence North 330 West
594 feet along the lands now or formerly of Joseph Crall' heirs to a point in the center of the public
road; thence North 501;20 East 100 feet along the said public road to the point of BEGINNING.
CONTAINING 1.4 acres, more or less.
BEING the same premises which Malcolm C. Crull and Ethel M. Crull, his wife, by their deed dated
November 5, 1960, recorded in the recorder of Deeds Office in and for Pery County, Pennsylvania,
in Deed Book 168, Page 92, granted and conveyed unto PaulO. Myers and Rose A. Myers, his wife,
PaulO. Myers departed this life in November of 1974, thereby vesting complete title under operation
of law to Rose A. Myers, his wife, Grantor herein.
TillS IS A TRANSFER FOR NOMINAL CONSIDERATION TO TRUSTEES OF A LIVING
TRUST AND IS THEREFORE EXElVIPT FROM THE PAYMENT OF REALTY
TRANSFER TAX.
TOGETHER with all and singular the buildings and improvements, ways, streets, alleys, driveways,
passages, waters, watercourses, rights, liberties, privileges, hereditaments and appurtenances,
whatsoever unto the hereby granted premises belonging, or in any wise appertaining, and the
reversions and remainders, rents, issues, and profits thereof; and all the estate, right, title, interest,
e
ef'!<O\J-- /,:/11''''''' '''''f'.'''.''1 r..;..'- 11 ~'.1'rt;li""I. '1 -~ '7 r~1"":-
1.j.~4):~ \}"i.! ':...1 i...,:'IJ{,. ~ !.!~~ _.!...j!=::,:,~ ~ U! J r~:
No; 2002-00045822 GEN Book 1497 P.a3e
lit:;
"';".i,....,.
property, claim, and demand whatsoever of the said Grantor, as well at law as in equity, of, in, and
to the same.
TO HAVE AND TO HOLD, the said lot or piece of ground above-described, with all and singular
the buildings and improvements thereon erected, hereditaments and premises hereby granted, or
mentioned and intended so to be, with the appurtenances, unto the said Grantees, their heirs and
assigns, to and for the only proper use and behoof of the said Grantees, their heirs and assigns
forever.
AND the said Grantor, for herself, her heirs, executors and administrators, does covenant, promise
and agree, to and with the said Grantees, their heirs and assigns, by these presents, that she, the said
Grantor, and her heirs, all and singular the hereditaments and premises hereby granted or mentioned
and intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, against
them, the said Grantor and her heirs, and against all and every person and persons whomsoever
lawfully claiming or to claim the same or any part thereof, by, from or under him, her, them or any
of them, shall and will, subject as aforesaid, SPECIALLY WARRANT AND FOREVER
DEFEND.
IN WITNESS WHEREOF, the said party of the fIrst part has hereunto set her hand and seal, the
day and year fIrst above-written.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF
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~ifUA~
ROSE A. MYERS
corvl~1o~rv/EAL TH OF P8'~TNSYL VANIA
SS:
COUNTY OF (lOMiSE12l..A~~
On this, the 't)th day of April, 2002, ~efore me, a Notary Public for the
Commonwealth of Pennsylvania, the undersigned officer, personally appeared ROSE A. MYERS,
known to me (or satisfactorily proven) to be the person whose name is subscribed to the within
instrument, and acknowledged that she executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
!tlJcwfu0
Notary Public
My Commission Expires:
Notarial Seal
Tari L. Walker, Notary Public
Lemayne Boro, Cumberland County
My Commission Expires Jan. 20, 2003
Member, PennsylVania Association at Notaries
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C0MlV10NWEAL TH OF PENNSYLVANIA
SS:
Date 04/22/2002 Time 11:39:24 3 of 3 PSo
COUNTY OF PERRY
No: 2002-QQQ4SS22 SEW Book 1497 P~~e 216
RECORDED in the Office for Recording of Deeds, etc., in and for said County, in Deed
Book No. , Page
WITNESS my hand and official seal this
day of
,2002.
Recorder of Deeds
CERTIFICATE OF RESIDENCE
I hereby certify that the present residence of the Grantee herein is as follows:
The Myers Family Irrevocable Trust
Rose A. Myers and Jean A. Adams, Trustees
205 West Marble Street
Mechanicsburg, PA 17055
RETURN DEED TO:
The Myers Family Irrevocable Trust
Rose A. Myers and Jean A. Adams, Trustees
205 West Marble Street
Mechanicsburg, PA 17055
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PA REV-1500
SCHEDULE H
FUNERAL EXPENSES and
ADMINISTRATIVE COSTS
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ROSE A. MYERS
205 W. MARBLE ST
MECHANICS BURG 'PA ~
' 17055-6421 I
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RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Receipt Date:
Rece~pt Time:
Recelpt No.:
3/28/2005
15:44:44
1040069
MYERS ROSE A
Estate File No. :
Paid By Remarks:
2005-00281
DAWN A PATRICK
RSK
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 2521
Total Received.........
90.00
15.00
12.00
10.00
5.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
$132.00
$132.00
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Acordia, Inc.
4900 Ritter Road
Suite 250
P.O. Box 1220
Mechanicsburg. PA 17055
Telephone: (717) 761-1919
www.acordia.com
July 28, 2005
Jean Adams
700 W Keller Street
Mechanicsburg, P A 17055
Dear Jean,
All of us in the personal insurance department of A cordia 'would like to welcome you
to our important family of clients. We take great pride in offering you the insurance
protection and personal service you deserve. Your new Vacant Fire/Dwelling policy is
enclosed Enclosed also for your retention is a copy of our Acordia 's Privacy Policy brochure.
Please note that an invoice has been attached to the policy. There is a balance due on
the policy of $23.51 which will need to be submitted immediately upon receipt of this letter. All
fees/taxes are generally billed "up front" for this type of policy; however, the initial invoice did
not include the entire amount of the taxes/fees due on the policy. Please submit vour
remittance to our office in the attached envelofJe. Thank vou.
Although you dealt with one representative when you purchased your insurance program,
'we ,;;ant you to lmow that our entire staff is here to sene yuu. Shuulc1 yuu huve u quesiiun
011 this coverage, or any other insurance product, please do not hesitate to call us.
Acordia is a full service agency providing protection for home, cars, boats, health, life and
business. We hope you will think of us when you think of insurance. We represent many
fine companies and will search their products to find the best combination of protection and
price for you.
Once again, welcome to our family! Thank you for allowing us to serve your insurance
needs. We look forward to serving you now and for many years to come.
lfyou have any questions or concerns, pleasefeelfree to contact me at (717) 761-1919 ext. ext
3033 between 8:00 - 4:30.
Sincerely yours,
&n :J. .6'(
. iY- () 10' tf/ I (7
ud .C
uel b"' 3 < D-j
Laura Zody/sp
Personal Lines Representative
/
Acordia Northeast, Inc.
P.O. Box 122U -
4900 Ritter Road: Suite 250
Mechanicsburg. P A 17055
717/761-1919
717/761-1665 Fax
.
G?9kordia.
.
INVOICE
Jean Ann Adams
700 W Keller Street
Mechanicsburg, PA 17055
DETACH THIS PORTION AND RETURN WITH REMITTANCE TO:
Acordia Northeast, Inc. P.O. Box 827796 Phi ladelphia, PA 19182-7796
Pol icy Number- 05SF100201
Pol icy Term- 7/19/05 TO
New Line Po I icy
RET TO LAURA
7/19/06
Company- W.N. Tuscano Agency
Coverage- DP-l Basic Form
TAX
SURPLUS STAMPING FEE
POLICY FEE
INSTALLMENT PREMIUM
31.35
15.00
100.00
261 .25
RE: annual premium to be bi lied
quarterly pay plan
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A)OLLARS 61
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ES A SE
JEAN A ADAMS EXEC
ESTATE OF ANNETTE E HACKENBERG CO-E EC
700 W KELLER ST 1
0. A _ ty'IEYHANICSB~h 17055, -~~.
FOFt-~1t.(! /J - P.. -L!# ? 7-.0
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EXECUTORI
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PERSON^L
REPRESENTATIVE
TRUSTEE
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DETACH THIS PORTION AND RETURN WITH REMITTANCE TO:
Acardia Northeast, Inc. P.O. Box 827796 Philadelphia, PA 19182-7796
Po I icy Numbe r- u5SF i 00201
Pol icy Term- 7/19/05 TO 7/19/06
New Line Pol icy
Comp~~y- W.N. Tuscano Agency
Coverage- DP-3 Special Form
INSTALLMENT PREMIUM
RE: annual premium to be bi lied
quarterly pay plan
"'
f? h38 ,5'
a( f, {}~ . t
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9/01/05 473241
261. 25
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$261.251
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BOROUGH OF MECHANICSBURG
36 WEST ALLEN STREET
MECHANICSBURG. PA 17055-6257.
PHONE; 717-691-3310
HOURS; MONDAY - FRIDAY 8;30 AM - 4:30 PM
'7HE BOROUGH OF MECHANIC$BURG, A GOOD PLACE TO UVP
PRESOR-n;D
FIRST ClASS MAIL
U.S. POSTAGE PAID
PERMIT NO.1 01
MECHANICSBURG, PA 17055
A<'~~" ~:::'ye<srr" ~'9\ Sbeet
Account, N, umber JUl aillln Period i
55-0005852 ' ' 1. - ~0/05
Balance Forward
BY: _____
---...........---
$0.00
Current Charges
. SEWER
. REFUSE ,',
Amo;~ue 110% penalty added after 30 days)
(1) tiP~n Re~ipt 07/01105 - 07/31/05:
(2)4'itWr 07/31/04:
'.-.''-7':r.
Mrs;;paul Myers
205 W. Marble Street
Mec:l1anicsburg, PA 17055
$67.40
$41.82
$109.22
$120.14
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f! uhlll LlulllHi.III!'1 L IllHillllill II illB
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CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, P A 17013
t0~!J
!Q)
June 24, 2005
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
CumberIfuid County and the legal newspaper for publication of legal notices.
TO:
Rose A. Myers, ESQUIRE
RE:
Lowell R. Gates, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
---------------------~---------------------------------------------~-
---------------------------------------------------------------------
Advertisement inserted on following dates:
June 10, 17,24,2005
Second Proof Request
$ 75.00
$ 0.00
$ 0.00
$ 75.00
-------------
Advertising Cost
Proof of Publication
Payment Received
Total Amount Due
$
0.00
---------
---------
Payment received June 7, 2005
by Becky H. Morgenthal/Executive Director
/
/
/
JEFFREY A. WILSlA
Plumbing & Heating, IP
6508 Brandy Lane
MECHANICSBURG, PA 17050
;2; l Zo.ii I '"'~-
!..- O' ?DA,At
I l~
';"""..-..;:
10379
'7 teCc "-L-: 23 .
WORK TEL.
TO: (717) 766-5291
---
....Jl:;1t!J ADAM.5
'100LU. K€.LLE~ S~~r
J\tte-('.-t+AAricsb(,L'~ Pit- 1705'S:
/
5lDAYWORK 0 CONTRACT 0 EXTRA
o OVERTIME 0 OTHER
T
~,;-' i=_::<'! " ... ....,Jiffji,{~1 f. "1';" C.O II f.(/t
- 'J,e 0 q; ,l,-
- .'-~' ,- ~ (y g:
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~.tPLETED ~'i> 00 ~ ~ ;if cf ~~ / DESCRIPTION OF WORK .'
o ~ (y </.'f' </." ti ;s ,J(5 r r t?'tLlIl m 11- 1* 0 a
> .<..<{'~ ~~ ~ ~ ~ ,p ......<<.~ 2e_S'TA.e:-r /Qt'L 't-CL ~YVi (P ;--
NO HEAT
NO WATER ill () 0 dj1 -+0 J\ "~(tA-r ..o<;Ui\_;'O , iLl? I , '0 0,., A <_J,..4-04.P
BURSTPIPE(S) e, ,-L G((V ~T ~.:::( ~ ~f) be ~ "r .2 L..~<-
THAW PIPE(S) ~ r::: c;. ~I'O .~~- '" U.
INSULATE PIPE(S) ~"fC . (IO _..k '- c.L~4.JV lI<-1:::
BLOCKAGE - WASTE SYSTEM LABOR v HRS. 7RATE AMOUNT
KITCHEN l2eCVv,- / IZ'~ 1,'2. IC~
SINK
INSTANT HOT
WATER FILTER
DISPOSAL
DISHWASHEA
BATH (1) (2) (3) TOTAL LABOR -t'Z-
~o
LAVATORY
QTY. MATERIAL UNIT AMOUNT
WATER CLOSET ii~<-
BATHTUB J i'-l"7 '7 &:
SHOWER STALL I HEAD I " f ~l.lT'-
Di:.l ~ Ib'"O.
WHIRLPOOL I SPA I HOT TUB
LAUNDRY ITi)
WASHING MACHINE
FAUCET(S)
SILL COCK ..... I ..
SUPPL V L1NE(S) . . <c::> ./
I> TRAP(S)I DRAIN(5) ^ /
n f}-\J'- .1\ --f:,/'
FIL TER(S)
GATE I BALL VALVE(S) . ~\J -A"'.Jk1 L
/}, b
WATER L1NE(S) (\. J-\/ "-
WELL I WATER PUMP
PRESSURE TANK ,
WATER SOFTENER I CONDo
SUMP I EFFLUENT PUMP
W A TEA HEA TEA i"q
BOILER - STEAM I HOT WATER /'
SAFETY VALVE !(3t ~~:J. 9,Ob
I
CIRCULATOR WORK ORDERED BY i \ Co' TOTAL
ZONE VALVE MATERIALS t'l, ;1-
BASEBOARD(S) I RADIATOR(S) I hereby acknowledge the satisfactory completion of the above TOTAL ,L aU
described work. LABOR
FURNACE ke:. 52-
BURNER ~,CiJ CD
x ,/' TAX
HEAT PUMP SIGNATURE DATE ,. ,.
AIR CONDITIONER /
T! I // OTHER CHARGES I/'
WASTE I SEWER LINE(S) hanK Yr.'"
VENT PIPE(S) vU! :/ TOTAL 13 '1 3~
JEFFREY A. WILBUR-
Plumbing & Heating, Inc.
6508 Brandy Lane
MECHANICSBURG, PA 17050
10586
TO:
(717) 766-5291
-r"'-l~ ....~ ~...
'- j("''Cl H (,{ C{ U p.t.::)
'700 Le), KplLer "STle/c-r
^,LeC~LC1,.'I/Lt (-~~ b \..UL:8 Pt~ I', DS=:;-
?0L-, --&2.-3 '-I
:ci:- '-s'1 - 4-' g Sy
GKlA VWORK 0 CONTRACT 0 EXTRA
o OVERTIME 0 OTHER
INVOICE DATE
,-' ;-~ ::.- ,~
i<'I::H!":'-"_":',_:":J~p&~:!,~~ ~~.~o,F/ 'I'C""g/'C!ode.d
.,",c y,,- D' 8',,:" ~f
~ c, j!&,s #" s "-~ (}' d' DESCRIPTION OF WORK .~
<P~ J? $ $ !'? <'1 #/ r ; ; , ,( , " , J
A:. ~ -:s Q:' Q:' ~ Q:' 4: &-11 VV1 (1 tP iA )0 V'L-Y ,.L;t-R,{ ,~, {I J.t v{ 11 .1..'..1 ,~, 6-L,L
f?l) ()! 0 tv:') i:, I :'-'1--7':'-\-' ,.(:;JP L1 Yr r.: i1 n!l_~ --
I r U
>
NO HEAT
NO WATER
BURST PIPE(S)
THAW PIPE(S)
BATHTUB
-.
LABOR HRS. RATE AMOUNT
\\PO riA ~ i /7 t;S ()O /0'- ,",0
,
",
TOTAL LABOR t02- Ul)
QTV. MATERIAL UNIT AMOUNT
"7 6.:J({~_ V~LV~"j q ~'~ I ~ 70
:;:;.17: 1;, ~:tJ 0- ,
'I -r:L t,.C. ~ "2c.. "l t
'" A..v\.l
I
INSULATE PIPE(S)
BLOCKAGE - WASTE SYSTEM
KITCHEN
SINK
INSTANT HOT
WATER FilTER
DISPOSAL
DISHWASHER
BATH (1) (2) (3)
LAVATORY
WATER CLOSET
SHOWER STALL I HEAD
WHIRLPOOL I SPA I HOT TUB
LAUNDRY
WASHING MACHINE
FAUCET(S)
SILL COCK
SUPPLY L1NE(S)
(
--- .,,-,
L./V7 V~ A
~ ---.../1 .-'
\'"l)~
~I ,1/ ~
\...:.}' \ ~ T ~
\ '-36
> TRAP(S) I DRAIN(S)
FIL TER(S)
GATE I BALL VAlVEIS)
WATER L1NE(S)
WELL I WATER PUMP
PRESSURE TANK
WATER SOFTENER I CONDo
SUMP I EFFLUENT PUMP
WATER HEATER
BOILER - STEAM I HOT WATER
SAFETY VALVE
HEAT PUMP
SIGNATURE
DATE
TOTAL i (p '-If
MATERIALS
TOTAL I 0""2... :>'.:J
LABOR I
4?KY (."e e !oS DD
"TAX
,/ OTHER CHARGES
JI
-rCtT"AL", "I 3 to{ I
-.zl
CIRCULATOR
WORK ORDERED BY
ZONE VALVE
I hereby acknowledge the satistactOlY completion of the abovB
described work.
BASEBOARD(S) I RADIATOR(S)
FURNACE
BURNER
,
x
AIR CONDITIONER
WASTE I SEWER L1NE(S}
-- '~--
c1 i ~
,
UJ
./
~ENT PIPE(S)
'0 --< ,--. ..!::-
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PRICE
UNLESS YOU ARE A BUDGE1 CUSTOMER, THIS IS A BilL PLEASE PAY FROM THIS INVOICE TERMS:
30 DAYS. 1'/'% SERVICE CHARGE ADDED AFTER 30 DAYS, THIS EXPRESSES AN ANNUAL RATE OF 18%
GALLONS
CUSTOMER
SIGN HERE
n ~~R
CHECK 0
CASH 0
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Now you know
Order Con'rmation
Paver
Paver Account Number
11885
Ad Order
Sales
Order Taker
0001323865
Customer
GATES, HALBRUNER & HATCH, P.C
Orderer Account Number
11885
Order Source
rholton
rholton
Fax
Special PricinCl None
GATES, HALBRUNER & HATCH, P.C
ATTN: TRACI L. SEPKOVIC, 1013 MUMMA ROAD,
SUITE 100
LEMOYNE PA 17043 USA
PO Number
ESTATE OF MYERS
TRACI
Ordered Bv
Customer Fax
Customer EMail
Customer Phone 717-731-9600
Paver Phone 717-731-9600
Tear Sheets
o
Proofs
o
Affidavits
1
Blind Box
Promo Type
<NONE>
Invoice Text
Materials
Total Ad Cost
$231.72
Pavment Amount
$0.00
Pavment Method
Amount Due
$231.72
Ad Number Ad Type
0001323865-0' Legal Liners
Ad Size
:1.0X18Li
Color
<NONE>
Production Method Production Notes
Ad Booker
Product Information
Classification
# Inserts
Run Dates
Online: :Full Run
806-Estate Notices
3
6/6/2005, 6/13/2005, 6/20/2005
Run Schedule Invoice Text
LETTERS TESTAMENTARY for the Estate of Rose A. Myers, deceased,
6/20/20059:12:19AM
1
PPL Electric
Utilities
Electric
Service
r- () r:
MRS PAUL MYERS
2ll:, \\AMARHLE ST
MECHANiCSBURli PA 171)55
1\.. .-...;~.......' ...1. .......;
'.(U'-3I..l'V"':' U""'U'
this bIll? Please
contact liS by Oct 20
at 1-800-342-5775 Ill'
484-634-4900
01' \\Tite to:
ClIstolIlH Service
827 Hausman Rd.
Allentown. PA
] 8 Hl4-9392
W\vw.pplclectric.com
Electric
Use
This graph shows
your electric use
oVer the last 13
months.
Tvpes of
Meter Readings:
Acluill _
Estimated 1< Yl
Customer D
.
ppl
.
Page]
14001-24004
YQ\lrB ill Ac~otlJ1IN \lrilheiy>>>
. [ls,," \vh,'nl'aIlirig(}[wrilm T
Sumnlary Page
Balance as of Sep 29, 2005
Chan~es:
TotaiPPL ELECTRIC UTILITIES Charges
Total Charges
Account Balance
, '
I ,A-/......
I . .:-r:'
rei '
1:2 ;;:
.) '-)
" J~ [,r-
li)'- J.-!:)
6
KWH - Average Per Day
5
4
3
2
o
ONDJFMAMJJASO
2004 Months 2005
$ n.oo
$ 14.30
$14.30
'-
Meter Reading Information
Ieter #58544875
Sep 29 Adual
Aug 29 ACtUill
,I ha 'S KWH Bdlcd
Average - Sep
Tell1jJerature
KWH Per Day
Yearly Use:
Oct 2003 - Sep 2004
Oct 2004 - Sep 2005
2004
69F
I
Tolal
llse
505
532
$ 14.30
1216
~
6g
2005
72F
2
A ven'fJe
Month1v
42
44
Other important information 011 back ..
PPL Electric
Utilities
Electric
Service
For:
MRS PAUL MYERS
205 W MARBLE ST
MECHANICSBURG PA 17055
Questions about
this bill? Please
contact us by S~ 19
at 1-800-342-5775 or
484-614-4900
or write to:
Customer Service
827 Hausman Rd.
AIlentown, P A
18104-9392
www.pplelectric.com
Electric
Use
This graph shows
your electric use
over the last 13
months.
Types of
Meter Readings:
Actual _
Estimated IhMWI
Customer 0
.
.
Page 1
........................Yb\iiBiIlMr'O~ltitNl.ImWi'..:......... .
14001-24004
Summary Page
Balance as of Allg 29, 2005
Char~s:
TotarPPL ELECTRIC UTILITIES Charges
Total Charges
$ 0.00
$ 11.35
$ 11.35
Account Balance
$ 11.35
I'
r) "ri ; r '?
.! b - I ,'/.. ._
~--I~ /) !. (J 5
itf \J'~(["
KWH - Average Per Day Meter Reading Information
6
eter
5 Au~29 Actual 1148
Jul :...9 Actual 1112
4 31 Da s KWH Billed ~
Average - Aug 2004 2005
3 TemlIerature 72F 77F
KW Per Day 1 1
2
Yearly Use: Total Avera~e
Use Month y
Sep 2003 - Aug 2004 538 45 !..~.,
0 Sep 2004 - Aug 2005 500 42
[" ..~:\':"
-...
SOND J FMAMJ J AS
2004 Months 2005
Other important information on back -+
L/
PPL Electric
Utilities
Electric
Service
For:
MRS PAUL MYERS
205 W MARBLE ST
MECHANICSBURG PA 17055
Questions about
this bill? Please
contact us by Aug 22
at 1-800-342-5775 or
484-634-4900
or write to:
Cllstomer Service
827 Hausman Rd.
Allentown, PA
18104-9392
www.pplelectIic.com
Electric
Use
This graph shows
your electric use
over the last 13
months.
Types of
Meter Readings:
Actual
-
I777l
~
D
Estimated
Customer
.
.
Page 1
::::.::.::.::':::.':Y~liJi..B.m.Acc\)iirif.Ntimhit....:::.:.:::...
14001-24004
....:.:...:.:...:...:::: .:JS....'Wh<.m::Cia
Summary Page
BaJance as of JuJ 29, 2005
Char~s:
TotafPPL ELBCTRIC UTILITIES Charges
Total Charges
$ 0.00
$ I 1.44
$ 11.44
Account Balance
$ 11.44
. - JI ,-,
RIP ~,,;p;~
KWH - Average Per Day Meter Reading Information
6
eter -
5 Jul29 Actual 1112
Jun 29 Actual 1075
4 30 Da s KWH Billed --yr
Average -Jill 2004 2005
3 TemRerature 72F 78F
KW Per Day 1 1
2 Averaoe !.-
Yearly Use: Total
Use Montb1y "'\:~: \...
Aug 2003 - Jul 2004 582 41) ,. -Io:--L.
0 Aug 2004 - Jul 2005 500 42
ASOND J FMAM J J A
2004 Months 2005
Other important information 011 back ~
l/
PPL Electric
Utilities
Electric
Service
For:
MRS PAUL MYERS
205 W MARBLE ST
MECHANICSBURG PA 17055
Questions about
this bill? Please
contact us by Jun 21
at 1-800-342-5775 or
484-634-4900
or write to:
Customer Service
827 Hausman Rd.
Allentown, P A
18104-9392
wv.,w.ppldectric.com
Electric
Use
This graph shows
your electric USe
oVer the last 13
months.
Tnles of
Meter Readings:
Actual _
Estimakd 1i!%&1l
Customer D
.
.
Page 1
........................yq\liB.IUA~;.cJ;ii.llliNllmWi..............
14001-24004
Summary Page
Balance as of May 31,2005
Charges:
TotafPPL ELECTRIC UTILITIES Charges
"
Total Charges
$ 0.00
$ 10.98
3> 10.98
Account Balance
$ 10.98
_ rl
!)-fr /()Y r
//:/ / - 7-0 J
/ {( (j'/
KWH - Average Per Day Meier Reading Information
6
eler - 8
5 May 31 Actual 1041
A,fr 29 Actual 1009
4 3~ Da 'S KWH BIlled ~
Average - May 2004 2005
3 T em~erature 66F 58F
KW Per Day 1 1
2
Yearl" Use: Total Avera~e ;:<.-.- .'t"" -~.
Use Montb y .-.
Jun 2003 - May 2004 627 -') <,:.:'''-
)~
0 Jun 2004 - May 2005 503 42
.~ -
JJASONDJFMAMJ
2004 Months 2005
Other important information 011 back ~
/'
J
.
5040 LOUISE DRIVE #108
MECHANICSBURG P A 17055-4897
.
Termite Plan Renewallnvoi
Luck in your renewal rate for 2 years and you will realize a 10% discount off of
second year. Please mail your check for $590.10, which reflects this discOl
IReply by 10/31/20051
Choose a conven.ient method of cOn/acting us today.
Service Center: 2241-MECHANICSBURG P
Local Office: (717) 796-1710
Toll Free: 1-800-TERMINIX
E-Mail: tmx2241@terminix.com
RENEWAL SUMMARY
Plan Type:
Customer No:
Plan Period:
Property Serviced:
11111111111111111111111.1..11...1..11.1.1.1.111 1a...III.111111
--rt- ) n /
'}" . .'J If'
f,1 J!~ -j (- /)L~
I L/~ U .~ ~ v- ~ ~
Baiting Protection
2758342
11/01/2005 - 11/30/2006
205 W Marble SI
Mechanicsburg, P A 17055
29.1.62381 MB 0.309 71282S11.xr1
Rose Myers
205 W Marble SI
Mechanicsburg PA 17055-6421
Impol1anl Message: Please relain tbe top portion of tbe renewal invoice for your
records. Your guarantee will be mailed to you within 60 day~ after receipt of payw"nt.
Current Renewal Charges:
Additional Charges/Ct'edits:
Sales Tax: "'
TOTAL DUE:
$
$
$
$
293.00
0.00
17.58
310.58
Dear Ruse Myers,
Piease be aware that if you haven't returned your payment to renew your Terminix Subterranean Termite Baiting Protection Plan,
your home may be at risk. Rush the bottom portion of this renewal notice with your payment to us today, and we'1I continue to
help defend your most valuable investment.
What's the hurry? If you let your Terrninix Subterranean Termite Baiting Program lapse, you could face large, out-af-pocket
expenses. And, your homeowners insurance probably doesn't cover termite-related damage.
By disregarding your Terminix Subterranean Termite Baiting Protection Plan renewal, you may leave yourself responsible for
paying bills related to:
. Re-treatment of subterranean termite infestations (FREE with your paid Terminix renewal!)
. Repairs for new subterranean termite-related damage (FREE with your paid Terminix renewal!)
. Periodic termite re-inspections (FREE with your paid Terminix renewal!)
Not to mention, you won't have the comfort of working with the nation's leading termite control company, or a Subterranean
Termite Baiting Protection Plan supported by Terminix.
Don't let down your guard! Subterranean termites never stop in their search for food, and without Terminix, the damage they cause
can go undetected until it's not just a nuisance... it's a severe problem.
Please take this opportunity to continue to help defend your home and protect your finances. Your Terminix Subterranean
Termite Baiting Protection Plan renewal fee is minimal compared to the original installation price you may have paid. Plus, you'll
avoid potential repair and re-treatment costs associated with new subterranean termite infestations.
Fill out the bottom portion of this renewal notice and return it along with your choice of payment today. If you have any questions
regarding your Terminix Subterranean Termite Baiting Protection Plan, call us anytime at 717-796-1710.
Caution · Your Terminix Termite Plan
is scheduled to Expire!
Sincerely,
C~.h &A4&.h
Emerson Corson
Your Terminix Manager
1-800-TERMINIX
No Bugs. No Hassles.
fe,mlnlx.com
This invoice reflects payments received by 10/02/2005. If you have not paid your renewal charge, please mail your payment today.
Please detach and :retUm bottom portion along with YOll!.Payment in the enclosed envelope. Thank Yon!
\~I
.
.
'''~
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8laremont NUrsTng~~
1000 Claremont Drive
Carlisle PA 17013
(717) 243-2031
PATIENT NAME
Myers,
TOn
ODE
39
CODE
Rose A Myers
Jean Adams
700 W. Keller St.
Mechanicsburg, Pa 17055
a
b
c
d
45 SERVo DATE 46 SERVo UNITS
Z REV. CO. 43 DESCRIPTION
TOTAL CHARGES
o PAYER
l TREATMENT AUTHORIZATION CODES
64 ESe 65 EMPLOYER NAME
I REMARKS
-92 HCFA-1450
APPROVED OMB NO. 093lHl279
@ Printed on Recycled Paper OCR/ORIGINAL
VALUE CODES
AMOUNT
2
6417~62
.- 6-lJOj ) c
5"1 n j~"
54 PRIOR PAYMENTS
55 EST. AMOUNT DUE
61 GROUP NAME
66 EMPLOYER LOCATION
OTHER PHVS. 10
x
31
VALUE CODES
AMOUNT
46 NON-COVERED CHARGES 49
- eeL \-
56
62 INSURANCE GROUP NO.
78
66 DATE '
03/10/2
I CERTIFY THE CER11FtcATlONS ON THE REVERSE APPlY TO THIS BtLl AND ARE MADE A PART HEREOf.
.
.
REGISTER ANY QUESTIONS OR
COMPLAINTS ABOUT THIS BILL
PRIOR TO THE DUE DATE TO:
UNITED WATER PENNSYLVANIA
8189 ADAMS DRIVE
HUMMELSTOWN, PA 17036
PHONE: 717-564-3662
T U L L F R E E: 1 -- 8 a B -- 2 9 9 -. U 9 72
-----------BILLING SUMMARY-----------
PRIOR BILL AMOUNT $6.76
PAYMENTS THRU 05/09/05 $6.76CR
BALANCE FORWARD $0.00
CURRENT BILL CHARGES:
METER READINGS
04/07/05 0128
05/06/05 0128
CONSUMPTION 0 MGL
SERVICE CHARGE
W-DSICSRCH
TOTAL CURRENT CHARGES
W-STASSRCH
TOTAL AMOUNT DUE
$6.50
$0.33
$6.83
$0.07CR
$6.76
r J ? I t ()() -
I) d ._j{ - I :J - {) S
7
~f
UWPA WILL BE CONDUCTING THEIR SPRING FLUSHING PROGRAM EFFECTIVE
4/4/05 THROUGH MID JUNE 2005.
APPROXIMATE STATE TAX INCLUDED IN THIS BILL
$0.31
Amollnt due
05/09/05 205 W MARBLE ST
00200999555101
6.76
BOROUGH OF MECHANICSBURG
36 WEST ALLEN STREET
MECHANICSBURG. PA 17055--6257
PHONE: 717~91-3310 . ,
HOURS: MONDAY - FRIDAY 8:30 AM - ~:3O PM
fHE BOROUGH OF MECNANICSBURG. A Gooo FtAce: TO live-
PRESORTED
FIRST CLASS MAIL
U.S. POSTAGE PAID
PERMIT NO. tOI
MECHANICSBURG, PA 1705$
Account Name
Mrs. Paul MyerS
Account Number
55-0005852
Service Location
. . 205 W. Marble Street
Bllllnll Period
04/01/05 - 06/30/05
Balance Forward
$0.00
Current C:S!arlles
SEWER
REtl,!SE . ._ ...'
Amoont-Ilue 110% penalty added after 30 daysl
(1) Upon Receipt 04/01/05 - 04/30/05:
(2) After 04130/05:
$67.40
$41 .82
~
$120.14
Mrs. Paul Myers
205 W. Marble Str~' .E\ ~ c---'"
Mechanicsburg, p 17 ~ I, J" \
..._~PR 1 9 2
-t\
----...
C-\c-Y Oqqlo
BY: __
, I " I, I , , I, " , I. " I " .. I I.. I, I 1.1.. i '"111"" " . I ,,~
j
J
(~HOLY
SI:~I
The S/Jirit of Caring
Holy Sp.t Hospital
.
503 N 21ST STREET
CAMP HILL PA 17011
#
717.763.2141
:'Nix~~~9~Q$Jt~i
$6t<vi~e))aten<:.
........................... -, .........................
. . . . . . . . . . . . . . . . . . . . . . . . .... . . . - . . . . . . - . . . . . . . . . . . .
>s6t<viliKErid:<}:<
........-..-.................. .........................
:.H##-t@*#*#I11#~~p###l
:A.&61ffifNM/2411()()853
.... ..-.-......-........................_-...-.........
. . . . . . . . . . . . . . - . . . . . . . . . . . .
...........................
. . . . . . . . . . . . . . . . . . . . . . . . . . .
...........................
. . . . . . . . . . . . . . . . . . . . . . - . . . .
...........................
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .. . . . . . - . . . .
...........................
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<09127}04<....
For Account Intilrmaticm, Plcase Call 717-763-2141
Statement of Account
02/25/05
Transaction Date
09/17/04
09/17104
09/17/04
09/17/04
09/17/04
09/17/04
09/17/04
09/17/04
09/18/04
09/18/04
09/18/04
09/18/04
09/27/04
09/28/04
10/12/04
10/12/04
10/13/04
10/13/04
10/13/04
10/13/04
Dcscription
PREVIOUS BALANCE
VENIPUNCTURE
VENIPUNCTURE
VENIPUNCTURE
VENIPUNCTURE
OXYGEN PER HOUR
LEVEL IV FC
ED LEVEL IV PC
NON-EVA EAR/PUL OX FOR 02SATUR
ANES CHARGE
BASE UNITS
CRNA TIME UNITS
SPINAL I
MED CIA HOSP-IP M90 MEDICARE lIP
OTHER PATIENT NON CO M90 MEDICARE lIP
MEDI LATE CHRG ADJ I M90 MEDICARE lIP
MEDI LATE CHRG ADJ I M90 MEDICARE lIP
MEDI PVMT-HOSP IP M90 MEDICARE lIP
MEDI PART B PVMT-IP M90 MEDICARE lIP
MEDI CIA HOSP-IP M90 MEDICARE lIP
MEDI PARTB C/A-IP M90 MEDICARE lIP
Amount
16,563.89
13.00
13.00
13.00
13.00
39.00
541. 00
285.00
39.00
135.00
552.00
720.00
471 . 00
8,179.74-
16.60-
671.00-
606.00-
7,498.65-
.00
8,167.34-
.00
Estimated Insurancc Due:
.00
Total Patient Credits:
Account IJalance:
15.90
M90 MEDICARE liP
.00 Z55 TRICARE FOR L
.00
PLEASE DISREGARD THIS STATEMENT IF YOU HAVE PAID.
- - - - - - __ _ __ - ____ _____ _____ _______u__ __u____ _____________________~~_a.!!_d..e~'!"_h_'!~!!'!!."!~_"!I!'l.y~~~ J?'!Y.'!'!!!!._______n_n_ ____________n ____ ____________ __ n___ ___ ______.._
For Hospital Use Only Account Number:
24000853
1I0LY SPIIUT HOSPITAL
5113 N 21 ST STREI~T
CAMI) HILL PA 17011
#
ADDRESS SERVICE REQUESTED
ADM DT: 091704
DSH DT: 092204
S8: 21022
717-766-6234
Patient Name:
MYERS ,ROSE A
0.0
03/12/05
C!C
o
Card Number:
HR: HSG
820.21
Signature:
Amount Paid:
Make Check Payable To HOLY SPIRIT HOSPITAL
. The CVV] Number Is the last] digits on tho back of your credit curd, by your signature
1...111...111'1111111.111111111111111111.1'1.11111111'11111.11
00019053 1 AT 0.292 02
24000853
1...111,11111,1,1,111...11..111..1.111"1.1..111,,,1.11.1.1'11
HOlV SPIRIT HOSPITAL
503 N 21ST STREET
CAMP HIll, PA 17011
ROSE A MVERS
700 W KELLER 5T
MECHANICSBURG PA 17055-3737
I
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.
REGISTER ANY QUESTIONS OR
COMPLAINTS ABOUT THIS BILL
PRIOR TO THE DUE DATE TO:
UNITED WATER PENNSYLVANIA
8189 ADAMS DRIVE
HUMMELSTOWN, PA 17036
PHONE: 717-564-3662
TOLL FREE: 1-888-299-8972
-----------BILLING SUMMARY-----------
PRIOR BILL AMOUNT $6.76
PAYMENTS THRU 04/08/05 $6.76CR
BALANCE FORWARD $0.00
CURRENT BILL CHARGES:
METER READINGS
03/07/05 0128
04/07/05 0128
CONSUMPTION 0 MGL
SERVICE CHARGE
W-DSICSRCH
TOTAL CURRENT CHARGES
W-STASSRCH
TOTAL AMOUNT DUE
$6.50
$0.33
${,.83
$0.07CR
$6.76
--'
0-:11- 0 9 9,~
I d ij -I f, ()S-
j
UWPA WILL BE CONDUCTING THEIR SPRING FLUSHING PROGRAM EFFECTIVE
4/4/05 THROUGH MID JUNE 2005.
APPROXIMATE STATE TAX INCLUDED IN THIS BILL
$0.31
Amount clue
04/08/05 205 W MARBLE ST
00200999555101
6.76
PPL Electric
Utilities
, , ,
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'".\...~::../.", ~
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Page 1
.. """,",'iYi:!\ii'B.ill'Accoi.iri.t,Ncirilbi:i,,"'"',.,'
14001-24004
'iWeriliii "'w
Electric
Service
For:
MRS PAUL MYERS
205 W MARBLE ST
MECHAN1CSBURG PA 17055
Summary Page
Balance as of Apr 29,2005
Char~s:
TotafPPL ELECTRIC UTILITIES Charges
Total Charges
$ 0.00
$ 10.98
Questions about
this bill? Please
contact us by May 23
at 1-800-342-5775 or
484-634-4900
fJ1b~'111
5-t?oC
or write to:
Customer Senice
827 Hausman Rd.
Allentown, P A
18104-9392
www.pplweb.com
J
-,_._-~-,.,-.",;,~-----"....".,
.
PPL Electric
Utilities
.
Page I
..:..:.:::'::YOW Bill :Accoulll:Numb<ir.::::::>> :
14001-24004
For:
MRS PAUL MYERS
205 W MARBLE ST
MECHANICSBURG PA 17055
Summary Page
Balance as of Mar 1,2005
Char~s:
TotafrPL ELECTRIC UTILITIES Charges
Total Charges
$ 0.00
Electric
Service
$ 12.82
$ 12.82
Account Balance
$ 12.82
Questions about
this bill? Please
contact us by Mar 22
at 1-800-342-5775 or
484-634-4900
or write to:
Customer Service
827 Hausman Rd.
Allentown, P A
18104-9392
www.pplweb.com
Electric
Use
Types of
Meter Readings:
Actual _
Estimated !'t5'W?!
Customer D
KWH - Average Per Day Meter Reading Information
6
eter
5 Mar 1 Actual 932
Jan 28 Actual 880
4 32 Da s KWH Billed ~
Average - Mar 2004 2005
3 T em~erature 28F 33F
KW Per Day 2 2
2
Yearly Use: Total Avera~e
Use Month ~
Apr 2003 - Mar 2004 702 5
0 Apr 2004 - Mar 2005 504 42
MAMJ J ASOND J FM
2004 Months 2005
This graph shows
your electric use
over the last 13
months.
Other important information on back -+
------------------------------------------------------------------------------------------------------------------------------------------------
Return this palt to address below with a check payable to PPL Electric Utilities Corporation
14001-24004
Mar 22, 2005
$ 12.82
AC 01 002757 67501B 23 A"C002
MRS PAUL MYERS
205 W MARBLE ST
MECHANICSBURG PA 17055-6421
Amount Enclosed
DDD,DDD.DD
PPL ELECTRIC UTILITIES
2 NORTH 9TH STREET RPC-GENNl
ALLENTOWN PA 18101-1175
1"11111..111'1..1111.1.1..11...1..1..1.111.1111'1'11.1..1..11
1 5000000128200000012822 1400124004
.
.
REGISTER ANY QUESTIONS OR
COMPLAINTS ABOUT THIS BILL
PRIOR TO THE DUE DATE TO:
UNITED WATER PENNSYLVANIA
8189 ADAMS DRIVE
HUMMELSTOWN, PA 17036
PHONE: 717-564-3662
TOLL FREE: 1-888-299-8972
METER READINGS
02/07/05 0128
03/07/05 0128
CONSUMPTION 0 MGL
-----------BILLING SUMMARY-----------
PRIOR BILL AMOUNT $6.76
PAYMENTS THRU 03/09/05 $6.76CR
BALANCE FORWARD $0.00
CURRENT BILL CHARGES:
SERVICE CHARGE
W-DSICSRCH
TOTAL CURRENT CHARGES
W-STASSRCH
TOTAL AMOUNT DUE
$6.50
$0.33
$6.83
$0.07CR
$6.76
APPROXIMATE STATE TAX INCLUDED IN THIS BILL
$0.31
03/09/05 205 W MARBLE ST
00200999555101
6.76
0020099955510100000000676000000009
03/09/05 03/29/2005
x
I
1...11.1.1...1.1.1.1.11...1...1..11.1..1..1.1.1111..1.1..11111
UNITED WATER PENNSYLVANIA
PO BOX 371385
PITTSBURGH, PA 15250-7385
)::"i
6.76
MRS PAUL MYERS
205 W MARBLE ST
MECHANICSBURG PA 17055-6421
111.111...111....1.1..1.1..11...1..1..1.1...1111....1.1..1..11
205 W MARBLE ST
00200999555101
6.76
.
.
*** END OF ATTACHMENTS ***
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