for questions call: 717-783-6806 po box 3265...

Pennsylvania Public Utility CommissionBureau of AdministrationPO Box 3265Harrisburg, PA 17105-32S5

For questions call: 717-783-6806

Address:

UNCONVENTIONAL GAS WELL FUND USAGE REPORT

Calendar Year Reporting: ~ 0 I a.. SAP Vendor NO.: I if 3 S- r :;zCounty: L!UfJ Rf I'~ L D Name of Municipality: GR E. EN W (J 0 P NWI'{.5f/IPcounty I Municipal Website: \/\l W ,Vi.- !1DYf/1-Llfi COG"*> eO f\1

!1tJ R:[7J tV J () H N S' Title:.s G C i l - TR£11.5',fa i III C 1<6'1 t,8NE EmailAddress: iV/II

Telephone No.: 8'1 J,1r '~.I1ext: __

/,£,[51

Contact Name:

Address 2:

City: 1jftHIl F FEY - State: PA Zip Code:

TOTAL AMOUNT OF FUNDS RECEIVED: $' I J...j

J;2.1: d. IUSE OF UNCONVENTIONAL GAS WELL FUNDS AMOUNT

.-_ .._-- ~-...- ..--. -_. ,._ ..-._-

1. Construction, reconstruction, maintenance and repair of roadways, bridges and 1ftI ~ 30C),Odpublic infrastructure. ,2. Water, storm water and sewer systems, including construction, reconstruction,

maintenance and repair

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

4. Environmental programs, including trails, parks and recreation, open space, floodplain management, conservation districts and agricultural preservation

5. Preservation and reclamation of surface and subsurface waters and watersupplies

6. Tax reductions, including homestead exclusions-'~.~

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

8. Records management, geographic information systems and informationtechnology

9. The delivery of social services

10. Judicial services

11. Deposit into the municipality's capital reserve fund if the funds are used solely fora purpose set forth in Act 13 of 2012

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

13. Local or regional planning initiatives under the act of July 31,1968 (P.L.805, No.247), known as the Pennsylvania Municipalities Planning Code

rOTALFUND USAGE t>~{ 2_ 3DO 00--I

Rev. 11-8-2012

Calendar Year Reporting:

County: CJ, E t3 R [/ i L f?2 (J I ;;.. SAP Vendor No.: / 'f :3J 1J..

Name of Municipality: Gg E f.N W(!) 01> MwNSH if

VERIFICATION STATEMENT

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 that Iexpect to be able to prove the same at a

hearing, if one is deemed necessary by the Public Utility Commission, in this matter. Iunderstand that

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

falsification to authorities).

..?J2~9JJW0V ¥tt-3-ateSignature of Individual or O~er

Name of person to be contacted for additional information: /'10 1Z..'li AI J 0 HA/SPhone Number: ffIi :l77...(, ~ 12 Email: /VLII

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