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Home My WebLink About03-16-07 :...:J ) 15056041125 REV-1500 EX (06-05) PA Department of Revenue. Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128.{)601 ~- -- RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 6 File Number o 8 0 8 Date of Birth 18742 998 0 0910200 6 oC:. 6 3. 19~ Decedent's Last Name Suffix Decedent's First Name B A I LEY J U N E MI G (If Applicable) Enter Surviving Spouse's InformatIon Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach Copy of Trust) o 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number FILL IN APPROPRIATE OVALS BELOW I2Q 1. Original Retum o 4. Limited Estate I2Q o THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes H A R 0 L D SIR WIN I I I Firm Name (If Applicable) 717 243 6 0 9 0 I R WIN LAW 0 F F ICE REGIST~F WILLS U~NLY ~;;O ....... ...~ :JM: ::u ).- ! ::r: P ;;0 ~> rn I2 0"\ f-.'.' c.~-, ..", .-;1 ~ First line of address 6 4 SOU T H PIT T S T R E E T Second line of address CAR LIS L E PA 17013 :~.:J N ~:~AiI: FILED .. W City or Post Office State ZIP Code Correspondent's e-mail address:irwinlaw@earthlink.net Under penalties of pe~ury, 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 complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN E PERSON ESPONS FOR ILlNG RETURN DATE o E PA 17013 s CA LISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 --' .:...J ' 15056042126 REV-1500 EX DecedenfsName: JUNE G. BAILEY RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) Decedent's Social Security Number 187 4 2 9 9 8 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 9 0 9 6 8 0 0 0 0 0 0 1 0 9 0 9 6 8 6 4 2 2 8 0 8 9 5 4 8 0 1 5 3 7 7 6 0 - 4 4 6 7 9 2 0 0 0 - 4 4 6 7 9 2 ........................... 8. 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. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value SUbject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X. 12 18. Amount of Line 14 taxable at collateral rate X .15 o o 0 15. o o 0 16. o o 0 17. o o 0 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L Side 2 15056042126 o 0 0 o 0 0 o 0 0 o 0 0 o 0 0 o 15056042126 .....J REV-1500 EX Page 3 Decedent's Complete Address: File Number 0808 DECEDE~rs t1AME, JUNE G. BAILEY STREET ADDRESS 168 AMY DRIVE CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 0.00 Total Credits ( A + 8 + C) (2) 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In oval on Page 2, 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. 0.00 0.00 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) III Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ...................................................................... 0 IXl b. retain the right to designate who shall use the property transferred or its income; ............................... 0 IXl c. retain a reversionary interest; or ................................................................................................ 0 IXl d. receive the promise for life of either payments, benefits or care? ....................................................... 0 IXl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 IXl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 IXl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 IXl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. 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 zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot 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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. 99116(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 twelve (12) percent [72 P.S. 99116(a)(1.3)J. 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. 7":':.,,~:'~~.....'":"~?~'..'.,7.-_,..,_,____,<,;,_~~,.~.~"""_~________ REV-1502 EX + (6-98) 01. r, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JUNE G. BAILEY 0808 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell. both having reasonable knowledge of the relevant facts, Real propertv which is iolntlv-owned with right of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. NONE DESCRIPTION VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed. insert addilional sheets of the same size) 0.00 ~~~=: REV-1503 EX + (6-98) ~!* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF JUNE G. BAilEY ITEM NUMBER 1. FILE NUMBER 0808 All property jolntly-owned with right of survivorship mUlt be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, Insert additional sheets of the same size) 0.00 -:.'>..,.....'...:,--,;.~~ REV-1504 EX + (6-98) ~,. , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSEL Y.HELD CORPORATION, PARTNERSHIP OR SOLE.PROPRIETORSHIP ESTATE OF JUNE G. BAILEY ITEM NUMBER 1. Schedule C-l or C-2 (including all supporting infonnation) must be attached for each closely-held corporation/partnership interest of the decedent other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. FILE NUMBER 0808 NONE DESCRIPTION VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert eddltlonal sheels of the same size) 0.00 ,.".".., ''',''e''"''.''.' REV-1507 EX + (6-98) ... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF JUNE G. BAILEY FILE NUMBER 0808 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH NONE 0.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed. insert additional sheels of the same size) 0.00 ,. ;. ,,,;l:.~, REV-150B EX + (6-9B) .,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JUNE G. BAILEY SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 0808 I nelude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right ofsurvlvol'lhlp must be disclosed on Schedule F. ITEM NUMBER 1, 2. 3. 4. DESCRIPTION COMMERCE BANK Checking Account No. 0513130310 Balance from attached bank receipt at Exhibit "B" 1995 REDMAN MOBILE HOME VIN No. 12226895/ Title No. 47509080901 BA Value based on sale price - see attached documentation at Exhibit "C" 1995 PONTIAC GRAND AM Very Poor Condition / Surrendered to Creditor in Lieu of Payoff Value based on payoff waived by creditor at surrender HOUSEHOLD CONTENTS VALUE AT DATE OF DEATH 1,109.68 8,500.00 800.00 500.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space Is needed, Insert additional sheets of the same size) 10909.68 REV-1509 EX + (6-98) .,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF JUNE G. BAILEY FILE NUMBER 0808 If an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. NONE 8 c JOiNTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERlY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrSINTEREST 1. A. NONE 0.00 0.00 TOTAl (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert additional sheels of the same size) '. . .~~".;rF'-' " ~ REV-1510 EX + (6-98) .,W SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JUNE G. BAILEY FILE NUMBER 0808 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 PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR R8.ATlONSHIP TO OECEOENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE CATE OF TRANSFER ATTACH ACOPV OF THE OEEO FOR REAl ESTATE. VALUE OF ASSET INTEREST OF APPlICABLE) VALUE 1. NONE 0.00 0.00 TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (If more space is needed, Insert additional sheets of the same size) ""'..,,,,,,,, REV-1511 EX + (12-99) ,,. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JUNE G. BAILEY FILE NUMBER 0808 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 4,392.80 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees IRWIN LAW OFFICE 2,000.00 3. Family Exemption: (If decedenfs address is not the same as c1aimanfs. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 5. Accountanfs Fees 6. Tax Retum Prepare~s Fees 7. REGISTER OF WILLS 30.00 TOTAL (Also enter on line 9, Recapitulation) $ 6 422.80 .. (If more space IS needed, Insert additional sheets of the same size) '".'...,~,._.'~, ~ REV-1512 EX + (12-03) ,,*' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JUNE G. BAILEY FILE NUMBER 0808 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. STATE EMPLOYEES RETIREMENT SYSTEM 537.19 Reimbursement of Overpayment 2. PHARMERICA 64.87 Medical Expenses 3. U. S. TREASURY 1,793.85 Unpaid Taxes, Interest and Penalties 4. CAPITAL TAX COLLECTION BUREAU 152.00 Unpaid Personal Taxes 5. STATEWIDE TAX RECOVERY INC 122.00 Unpaid County and Township Taxes 6. CAPITAL ONE 540.04 Unpaid Revolving Credit Account 7. SWISS COLONY 693.00 Unpaid Account 8. DISCOVER 205.00 Unpaid Revolving Credit Account 9. NORTHWEST CONSUMER CREDIT 800.00 Unpaid Car Loan Balance 10. SARAH TODD MEMORIAL HOME 4,046.85 Unpaid Nursing Home Expenses TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8 954.80 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude outright s~usal distributions, and transfers under Sec. 9116 (a)(1. )] 1. JOHN M. BAILEY Lineal 1887 Douglas Drive 1/5th Residue Carlisle PA 17013 2. DONNA E. CIOKOTA Lineal 215 Ciokota Lane 1/5th Residue Portage P A 15946 3. CARRIE L. McCONNELL Lineal 1701 Spring Hill Road 1/5th Residue Portage P A 15946 4. ANDREW M. BAILEY Lineal 407 "A" Street 1/5th Residue Carlisle PA 17013 5. GERALD M. BAILEY Lineal 80 Betty Nelson Court Lot 118 1/5th Residue Carlisle PA 17013 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 1. NONE 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. NONE 0.00 TOTAL OF PART IT - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 .. <<EV.'''' "',' '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JUNE G. BAILEY SCHEDULE J BENEFICIARIES FILE NUMBER 0808 (If more space IS needed, Insert additional sheets of the same size) , ' . , EXHIBIT IIAII WILL OF JUNE G. BAILEY I, June G. Bailey of Cumberland County, Carlisle, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate go to my son, John M. Bailey. Should John M. Bailey predecease me, then I direct that my entire estate go to my daughter, Donna E. Cikota. 4. I appoint John M. Bailey, as Executor of this my last Will. If John M. Bailey should predecease me or cease to act in such capacity, I appoint Donna E. Cikota as alternate. 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN '(TNESS WHE " day of f~~ ~75 i..J -:;':'Q i-n .~ 9-~ r....., '= = 0""\ C/) n, -0 tlj~~ (~ ,-,~ =:':J f~'-'~ ;? _-.J L.J ()(::J . ~~' :Li . . -- ('""' "'1 . -:- 11'1 "" 4) . -.~ ~ Ul ~ LAW OFFICES OF .~::~ 1'0 '0 STEPHEN J. HOGG 19S.HANOVERSTREET SUITE 101 CARLISLE, PA 17013 -.! . .. . , LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by June G. Bailey as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ?!Urlf.JLL f~ A j J.Rtf WITNESS . .: >> ., LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 State of Pennsylvania ss County of Cumberland I, June G. Bailey, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary ael for the purposes therein =sse~ J,- J~e G. Jley Sworn to or affirme/~ acknowl Bailey the Testatrix, this ayof 2006. IlO1'AllW.IEAL IlII'HIH J. HOGG. NOTNlY i"JUUC CMU8l.IIlCIIO, CUMIlIIUNO co. N. W;"I'''qflaN IlCPIIlIlI HI'11IMUi'I s, _ Notary PUbliclAtl.J!;t:- AFFIDAVIT State of Pennsylvania ss County of Cumberland We, L. indo-.. e. -00:, ~and I..l~ to ."fu.e'l the witnesses whose names are sign d to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~im,,:Lo_j~.-g~ (S'j'Iorn to or affir, ed and subsc ibe 0 before me by witnesses, this (; day of , 2006. NC'INIW. Sa.>oL lITII'HeN J. HOOG. HOI'AIIV il'\IIIUC . CNllJIlIZ _0. CUMBER........, co. PA " MV ~ Il<l'IAES seI'TfMel!II" . I · · ~ EXHIBIT ..B.. Commerce ..Bank Convnerce Bank/Harrisburg N.A. 3801 Paxton Street Harrisburg PA 17111 888-937-0004 Page 1 of 1 STATEMENT DATE JUNE G BAILEY 1887 DOUGLAS DR CARLISLE PA 17013-4612 I,Q~P13Q~lQ I . ACCOUNT NO. . ......... CHECKING *** :JU PLUS CLUB ACCOUNT NUMBER 0513130310 PREVIOUS STATEMENT BALANCE AS OF 09/26/06 ..... ................... PLUS 2 DEPOSITS AND OTHER CREDITS... ..... ... ........ LESS 0 CHECKS AND OTHER DEBITS .... ... ..... .......... CURRENT STATEMENT BALANCE AS OF 10/26/06 .. ..... ..... .... ...... ... NUMBER OF DAYS IN THIS STATEMENT PERIOD 30 CYCLE-016 .10 805.87 .00 805.97 ----------------------------------------------------------------------------------- *** CHECKING ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 09/29 AC-PA TREASURY DEPT-ANNUITANT 10/26 INTEREST PAYMENT DEBITS CREDITS 805.78 .09 ----------------------------------------------------------------------------------- *** BALANCE BY DATE *** 09/26 .10 09/29 805.88 10/26 805.97 23-2324730 .83 PAYER FEDERAL ID NUMBER INTEREST PAID YEAR TO DATE ---------------------------------------------------- *** INTEREST EARNED THIS STATEMENT PERIOD DAYS IN PERIOD ......................... INTEREST EARNED ......... ...... ......... ANNUAL PERCENTAGE YIELD EARNED (APY).... *** 30 .09 0.15% ---------------------------------------------------- ..."""'..... --- --..---- -.-- --- ...------ ....- ....---.... --_.. . .. , - .... CD q- N:! N! 0* cO .,.- o !. > o! ~ >~ .. .a; I J~; ~ . ;: I ~~ A.~ ,., * ~ ~ ~ ""'"' .. - "* en " :s ..J o o W ...J m cC - ""<>".. .... o (!) W .2 Iz ._..~-..i CJ3AOtll8aO YO N3"IO.LS 'CIlIOV1d8ft '.LS01 81 .u lHlII\lI lIHJ. Nt lBaNn:Sl:I YO ~ . T1lM >mHO 8IHJ. 3YO:BlI ~. T1W\ 0N08 AJ.NBJNlIN:IO ~ lIHJ. s~allO.1sno 0.1 a:H.LON )l03HO 1VIOI:YO ..,~. ".: .~lidV'~ t. ca r1'I o o o o rr ... e.n .. - .z ca ... o Ii ... n.I o U'1 .. - " t:JJ .z "" N o ra ... I. ~ (') .~ <"). N' 'J-" ~:z .::> o ~ <( ~ ~. ~. . ':::.5 .~. ~ ~ .~' \..~.~ I ....__..' v~' ..~': oti. Z .~.~. c( '.~ 1D;;1 WI. On. a:~ w< ~o ~ o o ~ ~ . ".w '/~' "/ J~. 1"" ~ .~ .. z o (;f) LS II: .w is 0::. It /~ ~",./ ..t....- j. ',~ ~ '/'1 '0 z 52 o W .::E: .(J -~-_._----:------.--:-;:--.:- .~;f ru . ~.. r:. ~i' m .r u") 'e .\ . _ iu k(.. ,m , '.~ . .' .' . ("r) , , ''8.f:; ,W ...0'0.:: . jg ',),0 "a\ .~~. d.:::.~ '~-~,; :';~.,~m E') .. J. '.;~;A 5~'=4 'AdO:) .Y3wciLsno ,,~,..J ...... ,......<1 "" 5 < ~ '-. , \...../ ' '." ,/t -:.J' ....~---. ...) ".~.. ,.'.'8 .. - J ca ... , ...~~_.J , '.;../ ,~I o - - :t'- ru. o U1 .. - \ ' ""j ,J.. ,';1 ../' .J .;.""'......-,.; I ." . ,L:....:.. aW[]J-.~ ----,-~~~,--~-~...:..:....:.~,.-.......;...-~-- '(j \_---' '.. ,. 1 <.-J . "'~~-.'.'.).'.:. .... ' ",. : , \ . .- "..,,'" 'I . 1,;) --f;: ,/1 ' ~ -~, .l) ".- f.. . EXHIBIT "C" --...., The Estate of June G. Bailey John M. Bailey, Executor DATE October 31.2006 PAID BY Preatie Rankin AMOUNT J7000.00 SEVEN THOUSAND DOLLARS FOR Final Davment on 95 Redman Mobile home /--1.1/ ~/' Slgnaure 7fP4< A1. 1k7'~ I' I f ..oil \ PAID BY The Estate of June G. Bailey John M. Bailey, Executor DATE October 12. 2006 Preatie Rankin AMOUNT J1500.00 ONE THOUSAND FIVE HUNDRED DOLLARS FOR Down Davment on 95 Redman Mobile home Slgnaure ~~ I/f. ~5 J ~ L\s.oV ~~.~ t{~J) vs · U\J ~\~\Al) r' .. .. .