Pennsylvania Public Utility CommissionBureau of AdministrationPO Box 3265Harrisburg, PA 17105-3265

For questions call: 717-783-6806e-mail Reports to: RA-Act13-Fiscal@pa.gov

Address:

UNCONVENTIONAL GAS WELL RUND USAGE REPORT

Calendar Year Reporting: .;( 0/3 SAP Vendor No.: /S'l398county:::Ban.(:;7e,. Name of MuniCiPalityb/f.-A D8 -r;w AJ...s./I.c:;,e

Coun~/MunicipaIWebsHe: ~b~r~~~~~~4~&~~~·+f~~~~~s~·~~~~~~~~~~~~~~~~~~// ~ IY (\. i (V I~-:"

Contact Name: LfttJ.uAC£ LIl')'y<...ttku. itle: ~c-c..U TA-~ /1CJ;:"l.3u..e.-lSP-..

br"'--ol~-C(NI,1@ v 7/'-1/ 4./c.s I Lrt3;;; .<Cre) -Ko/\1> mail Ad~ss:(J z.V~·iK.:CN n,.'C.NEI. Ne;F

~elePhone No.: 7:1/- 738 -/,J[I~ext: __

ftate: PA Zip Code: 14 {)-!; 7

41.35{!,t7

Address 2:

City:

TOTAL AMOUNT OF FUNDS RECEIVED'

USE OF UNCONVENTIONAL GAS WELL FUNDS AMOUNT

1. Construction, reconstruction, maintenance and repair of rladways, bridges andpublic infrastructure.

2. Water, storm water and sewer systems, including construe ion, reconstruction,maintenance and repair

3. Emergency preparedness and public safety, including law enforcement and fireservices, hazardous material response, 911, equipment ace uisition and otherservices

4. Environmental programs, including trails, parks and recrea lion, open space, floodplain management, conservation districts and agricultural ~Ireservation

5. Preservation and reclamation of surface and subsurface We ters and watersupplies

6. Tax reductions, including homestead exclusions

7. Projects to increase the availability of safe and affordable hpusing to residents

8. Records management. geographic information systems an~ informationtechnology

9. The delivery of social services I10. Judicial services

11. Deposit into the municipality's capital reserve fund if the f nds are used solely for# 135';' 6; 1a purpose set forth in Act 13 of 2012 ~

12. Career and technical centers for training of workers in the Jil and gas industry

13. Local or regional planning initiatives under the act of July 3J: 1968 (P.L. 80S, No.247), known as the Pennsylvania Municipalities Planning Ca,de

14. TOTAL FUND USAGE (This amount must equal the amount entered in the "TotalAmount of Funds Received" space above)

Calendar Year Reporting:

County: ~ lA..ll-{;[.e.

dO/3 SAP Vendor No.: /S~ 3' 78Name of Municipalit: '13.e.~'p'O '10 W•.•J..5 H r f

VERIFICATION ST TEMENT

I, the undersigned, hereby state that the facts above set forth are true and correct (or are true and correct

to the best of my knowledge, information and belief) and tlat I expect to be able to prove the same at a

hearing, if one is deemed necessary by the Public Utility CEmmisSion, in this matter. I understand that

the statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 (relating to unsworn

falsification to authorities).

Name of person to be contacted for additional information: -,dl....-::A'f-'! .:.:.;J:...s~=-. .!-/I.....,C£=I :::...-"'_G"--''-'-'-'m-T-(J..z::.,(J'''''c ••••'--Z.=..::;L'-- _- . 7J

Email: b ·("t.i.d~);Lv)":} @ z-oot1lLJ-J 1a~A1L-r./\/'Phone Number: -7,;(V' 1.38 - /.j----g8

Revised 4/5/13 Page 2