HomeMy WebLinkAbout97-00854
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ESTATE SETTLEMENT AGREEMENT 'ro INDm~IFY,
~mC~IPT AND ~E~rn~SE
THIS AGREEMENT by and between ROBERT O,LIVINGSTON
individually and as Executor of the Estate ofB:DWARD P. SALSICH,
Dec8ued, and MAAGARETLIVINGS'l'ON, both of, 308 North Dickinson
Sohool Road, C1'\rlisle, Cumberland County, Pennsylvania, 17013,
WHEREAS, Edward P. Snlsich, who resided at The Claremont
Nursing and Rehabilitation Center of cumberland County, carlisle,
Middlesex Township, pennsylvania 17013, and died, there on October
11, 1997, leaving a Last Will and Testament dated May 20, 1996, a
petition for Letters Testamentary was filed on October 24, 1997,
with .the Register of Wills of Cumberland County, Pennsylvania,
WHEREAS, Robert o. Livingston was duly appointed as
Executor of the Estate of Edward P. Salsia\1 Decease'd, on October
24, ,1997, with such grant of letters first! being oompletely
advertised on November 21, 1997, and, filed to Estate No. 2197-
0854, said Letters Testamentary remain in .full force andeffe9tl
WHEREAS, all parties in interest under the will of Edward P.
Salsioh, Deceased, arel
(1) Robert O. Livingston, and,
(2)' Margaret Livingstonl
WHEREAS, the ,above .identified parties in interest, being
husband and wife, are entitled to the net residl.\ary estate by the
entiretYI
VlHEREI\S, each of l:he partieu to this I\greement haa heen
furnished with a complete presuntation of the estate assets,
receipt a and disbursement.s as set forth in th~ pennaylvania
inheritance Tax Return acoepted by the Department of Revenue as
filed, the receipt for which showing no.further tax due is
attaohed hereto and marked as Exhibit "A"I and in the informal
,final account summarization attached hereto and marked as, Exhibit
"a/"
WHEREAS, the parties to thill Agreement each aoknowledge to
having received a schedule of Distribution included within
Exhibit liB," attaohed hereto I
WHEREAS, each of the partiea to. this Agreement doea '
aoknowledge having received from the Executor thediutributive
gifts eet forth in. said Exhibit "B/" and
WHEREAS, it is the desire of the parties to this Agreement
that final" distribution of thill eetate be aocompliehed without a
formal aoco\.mting to the orphans' Court Division of the Court of
common pleaa of cumberland County, it being the deeire of the
parties to avoid the expenSe, delay and publicity of a formal
aocounting.
NOW THEREFORE WITNESSETH, in consideration of the mutual
promieee, covenants and agreemente recited herein the parties do
agree as follows I
1. Eaoh benefioiary. party does hereby acknowledge
receipt of the gifts described as distributions of principai and
interest shown in said Exhibit "B" hereto.
2
, ,
2, Each party does hel-eby waiVE!! the HUng Of a formal
First and Final Aocount and SchedUle of Distribution,
3, Iilaoh party to this Agl"eemant does hereby releaee
and forever disoharge Robert o. Livingston from any and all
liability which may from time to, time arise in connection with
his servioes as Ekaoutor of the Estate of Edward P. 8alsioh,
Deoea~ed, and the parties do further agree to indemnify and hold
harmless said Robert o. Livingston, Executor, from any and all
liability Which may arise against the estate from,oreditors or
other claimants,
4. Each Party does hereby agree to be jointly and
sevetally liable ~or any proper liabilities of the estate Which
should hereafter oome to the attention of the Executor or any of
the other partiias hereto, and to .reitllbut'se on a prorata basis
payment for su(':h Obligations of the Est:.,t:a, if any.
S. ,Iilaoh party to thia Agreement acknowledges that this,
"
Agreement may be exec~\ted in multiI?le counterparts' and one shall
be indexed i',nd recorc;iecl in the estate proceedings, and that the
,termS hereof shall be binding upon all partieS, their re~peotive
heirs, sucoessOrll, administrators and aIIsigns.
6, Thill agreement shall be governed by the lawlI of the
Commonwealth of Pennllylvania.
IN WITNESS WHEREOF, the, parties have hereunto set their
hands and eeals with intent to be legU~y bound, dated at
"
3
OOMMONWBALTH' OP PBNNSYLVANIA
DIPARTMINT OP RIVINUI
WXlIIIlt'l' "11"
'*)
SUHEAU Of INaIVIUUAL TAXUS
INIIE"lIAN(;\' W IiIYI",""
UliIIl, ~806(l1'
IlAkRIU,nJRO, IIA 17Ha"OMl
NOTICa Of' INllaHITANCV TAX
AI'I'RAIUUMP.tH 1 AI.LUHANCU OH UIU^LLO\lANcr:
01' auaUCTlONS ^NU AsaUSBMVNT OF TAX
UY-IIU .. m "'.Hi
11'16-1998
SALSICH
10-11-1997
21 97-06'4
CUMPERLAND
101
f~:~=~^m~~Ynnl.1 HI~- _ ~~I
MAKI OHIOK PAVABLI AND RBMXT PAVMINT TOI
REGISTER OF WILLS
CUMbERLAND CO COURT HOUSE
CARLISL~, PA 17013
OUT ALONa THIS LINB ..... RITAIN LOWBR PORTION POR YOUR RI00RD8 ~
RW;UW.i'l/"AF'ji-niFm..NOTiiii'.o~.i:NHilfffAN-oli'TAX. iipPRA.fiiiifi-r,-.ALt"OWANOii-cili..,........_......
. . DISALLOWANOE OP DEDUCTION8 AND A88E88~INT OP TAX
ISTATE op. SALsICH EDWARD 'I' PXLI NO. 21 97-0851, AON 101 DATE 11-16-1998
W S DANIELS ESq.
HUMER 8 DANIELS
1 W HIGH ST STE
CARLtSLll
DATI
ISTATB OF
DATI OF DIATH
FILl NUMBBR
COUNTY
AON
EDWARD
I'
206
PA 17013
TAX HSTUHN W^S, I X I ^ccnrreo AU FILUU
RISERVATION OONCERNING FUTURE INTIREST . 81~ RIVER8E
APPRAISED VALUE OF RITURN BA81D ONI ORIGINAL RETURN
I, Hul htato (Uohldull A I III
2. atook. and Oondl (Oohldull B I Iii I
5, Clo..ly Hlld StookJPadnl".hlp Inte"..t (Sohodulo C I 131
4. Ho"tUlua.INot., Rlo.ly_bl. (Soh.dul. al Iql
. p, Cuh/Bank UlPOU to/tlllo, P."oonll rl'OplI'ty I Boh'dul. f: I In!
6. Jolhtly O.wnld P"oPIl'ty (Boh.dull 1'1 161
7. T"anI1l". (Sohldull 0) 171
8. Totol A...to
I clMNOaO
.00
,'DO
.00
,00
164 I B8 9 11(,
,00
,DO
(8)
NOTa I To In.u". p"op."
'.".dlt to yoU" aaaaunt,
lub.lt thl upp.r'po"tlon
of thh fo"m Hltll you"
hx p.ym.nt,
154,889.14
APPROVID CEDUCTICN8 AND IXIMPTIONSl
9, Fun."d nxp.n.../Ad", Caito/Mho, expo"... (So"odulo II I 191
10. DlbtlJHodulU' LlIbl1IH.,/LI.n. (Sol,.tjuh XI Illil 16,450,45
U, Total Dlduotlon. (11) :OR. 4QU Q4
lB, N.{ Vllu. of TlX R.tu"n (12) 129,398.20
13. Cha"Habll/OQII"'n~'ntal.ll.qua.h) Non-.hotod 9113 t"u.tt ISoh.duh JI (151 ,00
14. N.t Valu. of hhto Subjoot to Tlx (14) 129 ,398,20
NOTII I1.n ......m.nt w.. i..u.d previouIly, lineR 14; IS end/or 16. 17,.nd 18 will
r.1l'otfigur.. th.t inolud. the total D1~ rlturn. .......d to d.t..
ASSIISSMINT of TAX I '
IS. Amount of Lln. 14 .t Spou..1 I"to llSI ,00 X' 00.
h, AmoUnt of Lln. 14 hxabh It Llnul/Cl... A ".te ll61 ,00 X, 06.
P. Amount.f Lln.14 tlxobllat Collah"alJClo.. o."oto 1171 129,398,20 x,15.
18. Prlnolp'l .Tax OUo (18)
TAX~J)nSI
PAYMENT
O^TS
01-06' 9 8
09-11-1998
9,040,49
,00
,00
19,409,73
19,409,n
MnCEtPT
NUMseR
2 2 ~
AA296640
OISCOUNT l+)
INTaRESTJrF.N PAlO (_I AMOVNT PAID
.IT'"-r'---~--------
n.,ou 17,500,00
15,14- 1,003.82
EXHIBIT "11"
------------..'---mAL TAX ORIDn-
llALANOIl OF TAX" DUE
INTEREST AND PIN.
TOTAL DUE
19,'109,73
,00
,00
..00
H Ir PAlp AFteR DATa INPICATnb,sss REvnRSE
FOR CALCULATION OF AIlOITIONAL INTERnST,
IF TOTAL OUS IS LESS THAN .1, NO PAVHSNT IS RnQUIRED,
IF TOTAh DUE IS RefLeCTEO AS II "CReOIT" ICM) 1 YOU HAV OE DUE
I ",....",," ".... ...."........ ..,..... ... ..,._. _._., ~,_
,I
REFERENCE.! INIIERI'I'ANCJ<) TAX RWI'IJR,N II'IL,EDNOVEMIJEI\ II, 1998
4, Loss Taxes Paid
2
3
INH, TAX ADJUSTBD
ImIl1ltN
$154,8119,14 $154,1189.14
J~4.1!1l2,l1. .- ~AJlJiiU1
25,490,94 25,307,94
16,450,45. 16,450,45
115,00 115,00
980,49 797.49
7,945,00 7,945,00
18,488,68 18,488,68
1J,2J.9.Ji~ <J1.72Q,YZ
$11 O,909,5~ $111,092,52
$ 91,000,00 $ 91,000,00
15,000,00 15,000,00
-0. 5,092,52
.0.
I, Prlnci)la.1 Recolpts .
2, l:o.tJ\l.A.Bu.QJj
3, Less Dlsbursemonts (Total) .
. A. Dobts
n. Funlll'al Bxponslls
C, Administration
D, Fllcs
5, 'rotal L1nbllltlQJI
6,Prlncipal Distributable
7, Principal Distributions Madll
A, 1/20198
13. 4/9198
C,51J7/99 4 & 5
,
8, Balllnc\l. 011 Hllnd
EQQtnm~
I Unuscd l'OSCIVO crcdltcd to nccount ($200 . $ 17 lbl' tlllitg Agreclllent).
2 Intercst paid not attrlbutnble to Estnte ($17,500 + $988,68),
3 SUm ot'dlsbursements and Inherltntlcc tnx pnld,
4 Balance distributed to close account nnd setUc Bstlltc,
5 Interest eatneddurlngadmlnlstl'atlon plIss\ld to bCl1\ltlclarles with Income being
Rccpuntcd for by Ih\lm,
Iti.V,'~'X'IH11 ~
COMMQ~8YLV~1.\
OEPAATMeNT Of' ReveNue
11lIPT.l1OlO1
\05- t},O ((.. '7
6
\i\t'\i!lil'
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
12, Ntt Vllut of SIIIII (Line 8 mlnUI Lint 11)
13, Chlrtlab~ end Govemmenlal Seques\llBeo 9113 TI\IIII fOl whiQl1tn ,leotIon 10 \&lI hDl nol been
mede (Behldule J) . .
14, NIl Vllut 8ubjtol to Tu (Line 12 mlnul Line 13)
18, Amounlo line 1 taxeble
elll10 lPOUlI1 \&lI rate ,', . ,.(
Bile InalNctiQnl on rave,.. Ilde fOleppllQe* PfI96~laIle
16, Amount 01 IIn,14 \&lIlble
et6% rete . I I
17, Amnunt 011lnll,4 ta~eble 1 2 9 3 9 8 ,2 0
It 18% ral' 1..1
11M I
187-09-6406
J
1 0 Ii
[kl, Orlglnel R.lum
o Ulmlled Blltle
~6, Deoe(lenl DItdTMlate IAllChlClyol\\\lJ
o UI ellon Proceedl Reoelved
l e
43~3831
& Dan els
!
i
~
1, Rill Slltlt (Bohedule A)
2, BloeM end Bond, (Bohedule S)
3, CIoIe~ H.1d COl1lOralJQn,Par1nerehlp or SoIe-Propr1elOrehlp
4, Mor1gIQes & NoteJ Reoelvable'(Bohedule D)
8, Celh, Sank DaJlO'Ite & Mllcellaneou' Pal1Qnel Property
(Bohedule S)
6, JolnUy Oovnld Property (Bohldule F)
7, Inllr.vIvOl Tran"lre & Mllcelleneoul Non.Probtle Property
(~ldule G or L)
6, TOIII GrOll Atlltl (101e1 Llnet 1.7)'
9, Funaral E~pen'" & Admlnlllttllve COlli (Schedule H)
10, Deb" of Decedent, Mor1gaOe LleblllliM, & Llenl (Bohedule I)
11, TolIl DtduOllonl (10111 Linea 0 & 10)
~
. 16, Tax DUI
10,
(1)
(2))'
(3)
(4)
(8) "
(8) 'e
'Y'~'-;"...'"
(7)' ,
(0) '"
(10) i'
'.h.aNllIlNR
21 9700854
7
o 5 I 1
-
.
o 3, RemelndlJRll\lmlllllollll"pI1Or~Il,I"h
Cl &.Fedlr,1 Bllele Tex R8tum Required
_ 6, TOIII Number of B8fl DlpQllI SO~II
o 11,SlecIIonlOlaX UM8ISeo, 0113 A lAllChGc!lO)
I
One West High
Carlisle, PA
st" ate,
17013
205
(;ril('IAUJ\W"ill~
, ~)O
r \1;"
t ~l '
c.
IrJ
en
T1
.oli-i
" l',
T I
""
Ifl
"(1
, ,~4 I 8 8 9 ,
4 '.1
i '~
.',,1
'.
'"
\' 1 5 4 I 8 8 9 ,1 4
9
"
5
2 5 I ~ ~ 0 ..9 4-
, l' 2 9 I 3 9 8 , 2 0
,:~,., 'T-,.' it '~_,.",-,
(6)
9:1', 0 4 0, 4
" ,1 61 4 5 0 ,4
(11)
(12)
(13)
H'
x ,,0
(14)
(16)
11291398.20
I.
x
(16)
(17)
(16)
9409,73
9 I 4 0 9 .7 3
,06
,18
x
OATE
Seh Rd, C~rlisla PA 17013
OATS
Y'r'(/' ~:.r'
Decedent'. Com lete Addre..,
375 Claremont Drive
carlisle
PA
17013
ZIP
1Y
Tax Paymente and Credltll
1, Tax O~e (Page 1 Une 18\
2, Credl18lPayment8
A, 8POUlel Poye~y C,edlt
8, PMOI Peymenll
C, Olecount
(1) 19,409.73
17.fiOO.OO
921.05 _
. TotelCredll8 (A + 8 + C) (2)
18.421.05
3, IntereeVPenelly Ilepplloeble
0, Interelt
e, Penelty
TotellntereeVPenelty ( 0 + e) . (3)
4, II line 211 grel\er \hen line 1 + line 3, enter \he dlfferenQ8, Thllll \he OVBRPA VMINT,
Check box on Pegll Lln.18 \0 reqUt8le r.lund (4)
6. If line 1 + line 311 greeter then line 2, enter the difference, Thllle the TAX DUB, (6) 9 B 8 . 6 B
A, enter the Interelt on the tax due, (6A) 1 5 . 1 4
8, enter the 10181 01 Line 8 + SA, Thllle theSALANCB DUB, (68) 1 , 003 . 82
Make Cheok Pa able to: REGISTeR OF WIt.I.S AGeNT
PAT P 0 QB os
. BY PLAOING AN lX"1N THB APPROPRIATB BLOCKS
1, Old decedenl meke a traneler and: Yee
a,relaln Ihe uee or Inoome ollhe property trenelerredi ..,,,..,,,,,,,,....,,,,,,,,,....,,..,...,,..,....,..,........ ~
b, relaln the right to deelgnalewho ehall uee the property tranelerred pr Itelncomei ..,..,,,,,..,,..
a, retl. In8 reyerelonary lntereltl Of...llllq..'"I1Il'llll"'''....'''"'''''II'''''''llllll'"....II""",''''''.II''''""..,
d, receive the promleelor IIle olellher paymentl, benefltl or oare? ....."",,,,,......,..,,,,,,,..,,..,,,..
2, II death ooourred on or belore December 12, 1082, did deoadent wlthll1 twoyeare
preceding deeth tranller property without reoalvlng adequate conelderetlon'lll death ooourred
al\er Oaoamber 12, 1982, did decedent traneler property within one yeer 01 deathwllhoul
receiving adequate consideration? .", "" '1' I!lUllII' ,I I jj "'111 ""'" II.."" I" "'" I '''' I" I" II" '" """""""""" . 0
3, Old decedent own an 'In truet lor" or peyeble upon death benk aOODunt or eeourlty
4, ~tl~I~:~~~n~:~~:~' 'l~di~i;;~~'I';~';I;~;;;~~;'~~~~i','~~~~ii~:'~;'~ih~;'~~~~f;;~;;~;~';;;~;;~;;Y?:::: 8
i
rD
~
IP THE ANSWER TO ANY OP THE ABOVe QUE8TIONS 18 YES,
'IOU MU8T cOMPLeTB 8CHBDUL.1! G AND PIL.B IT AS PART OP THE RETURN
72 P,S, g01 8 (a (1,1 ( provided ort e reduollon 0 the tex rete Impoeed on the net value 0 trenlerl to or ort e Ule 0
eurvlvlng epouae from 8% to 3% for date. 01 death on or altar July 1, 10114 and belore Jenuary 1, 1006,
72 P,8. g9118 (e) (1,1) (II) provided lor the reduotlon of the rate Impoeed on the net value 01 tranelere to or lor the. uee 01 the eulVlvlng
spouee Irom 3'10 10 0% lor detee of deeth on or efter Jenuary 1, 1996, The etetute doee not exemot a tranlfer to a eurvlvlng epou18
Ironltax, end the eletutory requlrementelor dlloloeura of auete and filing e tll)( return ere ellll applicable even II the eurvl~lng epoule
II the only benefiolary,
POR DATIB OP DEATH ON OR APTER JANUARV 1, 1885. Pleaee enewer the lollowlng queetlon by placing an 'x' In the
epproprlate epace,
Old the deoedent oreate Ilrult or Ilmlllr arrangement whloh II lolely for the lurvl~lng epouee'e benefit for. hi. or. her entire
lifetime? 'lee 0 No lil .
II you answered yea to the ebova queetlon, Iha tax on the truet or elmller arrengement Ie poetponed until the death 01 the lecond
epouse, et which lime It will be lully texable el the rete(e) apPlicable to the remelnder beneflolary(lee), Enter the value 01 the truet on
Sohedulo J, Part II, In orde.r to ramove It Irom the oalculatlon ollhe tll)( due In thle eetete, 'Iou mey wleh to file Sohedule 0 .In order to
make the election available under Seollon 9113, II the eleotlon II made, the trull or elmllar arrengement II taxed In the eltate 01 the
firlt decedent epouee, the portion 01 thatrull or elmller arrengemenl Whloh beneflte the lurvlvlno epoule Ie taxed at Ihe ~ero tax rite,
and the remainder II texed et the rate(e) eppllcable to the remainder baneflOlery(lee), II you ohboee 10 make the eleollon, you mUlt
attaoh Sohedule 0 to a timely. filed tex return, along wllh Sohedule(e) K end/or M In order to Ihow the apportionment 01 the truet or
similar errengement between the eUNlvlng epou.. end the remelnder benefiolary(les),
MAKI, OHIOK PAYAILI AND RIM~T PAYMINT TOI
REBISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
OUT ALONO THXI LXNI ... RITAXN LONIR PORTION P08 YOUR RIOORDI ....
Tl'W: lIW.a'll'.A~1l".r&":f')""tlllYi~a..O..lNHllf!flll6'Ii:YA~. .'A'Il'''R'A.!iIJ.litlt...At1.'lSWA1Jl.l5'I.W.................
.. D%8A~LOWANCI 01' DIJJUCTlON8 ANb All 81HIHT 01' TAlC . .
IITATI ell SALSICH EDWARD P FILl NO. 21 97.08B4 AON 101 DATI 11-16-1998
TAK RBTURN WAB I I X) ACCBPTeD A8 PILBD () CHANGBD
RIIIRYATXON,OONOIRNxNO PUTURI XNTIRIIT . 811 RIYIRII
APPRAXllb YALUI 0" RITURN BAIID ONI ORIBtNALRETURN
1. R..l B.t.t. (Boh.d~l. A)
2. 8took. ~d Bond. (8oh'd~1' I) ,
I, Clo..l~ H'ld Btook/P.rtnlr.hip Int.r..t (8oh.d~1. C)
4, Honta.a"/Not..R.o.iv.bl. (Boh.d~l. 0)
I. C,'h/l.nk D.po.it.JHi.o, P.r.on.l Prop.rty (Soh.d~l. B)
6, Jointly D~n.d Prop.rty (Soh.d~l. P)
7, Tr~.f'r' (Soh.d~l. 0)
8, Tot.1A...t.
APPROVID DIDUOTXON8 AND IXIMPTXON81
9, PU/1.r.l BMp'n.../Adl, Co.h/Hho. BMP.n... (8oh.d~1. H) 191 9,040,49
1O,D.bt./Horto.o. L'i.bUitiu/LI..n' (Boh.d~lI I) (lOI 16,460,48
11, Tot.1 D.dllotion' (11) I'B ,don. Od
lB. N.t V.l~. of T.~ R.t~rn 11a1 129 j 598.20
18, Ch.rit.bl./Gov.rn..nt.l l.q~..t'J Non,.l.ot.d 9118 Tr~.t. (8oh.d~1' J) 11Bl .00
14. 'H.t V.l~. of e.ht. 8~b.i'ot to T'M (141. 129 ,598,20
NOTII If '.n ......m.nt W'.' :I.IIU'ct pr.V:l.ou.1y,1:Ln.. 14, 18 .nel/or 16, 17.'nd 18W:I.11
r.f1,ot f:l.gur.. th.t :l.no1uct. the totl1 of ~ r.~urn. .......d to dltt.
ABBIBBHINT Op TAXI
11, A.ount af Lin. 14 .t Bpo~..l r.t. (111
16, A.o~nt of Lin. 14 t.~.bl. .t Lin..l/CI'e' A r.t. (16)
17, A.o~i\fof Lin. 14 b~.bl. .t Coll.t.rd/Clu. I r.t. (171
18, Prinoip.l T'M D~.
TAX ORIDITII
PAVMtiNT
DATB
/5'-.1 (J!/ - , '1
BURBAU OF INDIVIDUAL TAxeB
IHtIf."II^HCE TA~ nlVIIIOH
IlEPl, 110601
IIA""lBlutlO. I'^ 11111'0601
QOMMONNIALTH OF PIN~8YLVANXA
PIPARTHINT OF RIVINUI
NDTICB OF INHBRITANCB TAX
APPRAI8BHBNT, ALLOWANce OR OI8ALLOWANce
OP OBDUCTIONS AND A88fi08HBHT OF TAX
Ii
,
PATI
leTATa OP
DATI OP DIATH
PILI NUM"R
..3d i : IOOUNTY
AON
11-16-~998
BAL SI CH
10-11-1997
21 97.0884
CUMBERLAND
101
AMount "..iH.d
,
'(X ~
W S DANIELS UQ
HUMaR 8DANIELB
1 W HIBH ST aTa 20B
CARLISLE PA
(';1, ,
170d~lll"
(1)
CB)
II)
(41
III
(61
C71
.00
.00
.00
.00
lBtL889 i 14
.00
.00
(81
.00 H .00.
,00x.06.
129 ,598,20 X .18.
USl
RBCUPT
NUHBBR
DI8CDUNT (+ 1
INTSRBBT/PSN PAID 1-)
,0
18,14-
AHOUNT PAID
, ,
1,003,82
09-11.1998
AA296640.
TOTAL TAX OR.DXT
BALANOI OP TAX DUI
INTIRIST AND PIN.
TOTAL DUI
" IP PAID APTti" DATB INDICATBD, 8BB RBVBRBS
FOR'CALCULATIOHOP ADDITIONAL INT8"BBT.
-l
C..
,..
.U-IWUI1.Ufot"
EDWARD
p
NOTBI. To in'~r. prop.r
or.dit to Yo~r .ooount,
.~b.it th. ~pp.r portion
of th~' for" with Yo~r
t.~ pllYM'nt.
1B4,809 .14
,00
,PO
19,409,73
19,409,75
19,409,73
,00
,00
,00
( IP TOTAL DUB IS LeS8 THAN *1, NO PAVHBNT IS RE~UIRBO.
IP TOTAL DUE I8 RBFLECTeO AS A "CRBon" (CRl, VOU NAV BE DUE
A RBFUNO, SBB REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS,)