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HomeMy WebLinkAbout09-13-07 --I 15056041125 REV-1500 EX (06-05) PA Department of Revenue .. BUl98uoflndividualTaxes INHERITANCE TAX RETURN PO BOX 280601 Harrisbuta, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 6 File Number 110 8 Date of Birth 195 - 3 8 - 7 9 1 1 1 7 2 0 0 6 o 3 1 0 1 9 4 8 Decedent's Last Name Suffix Decedent's First Name L U S H TIM 0 THY MI o (If Applicable) Enter Surviving Spouse's Infonnation Below Spouse's Last Name Suffix L U S H J A NET MI K Spouse's First Name Spouse's Social Security Number 187 - 4 4 - 7 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 00 1. Original Retum o 4. Limited Estate o o o 2. Supplemental Return 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 SHOULq ~ DIRECTED TO: Name Daytime Tel~l)one Numbet' .,; .,--- ....-.1 7172;='49 QJ780 :' 1 I \J . o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes S USA N J . HARTMAN Firm Name (If Applicable) -r; DUNCAN & HARTMAN, P . C . REGISTER oF WILLS URONL Y ",' .:-: --_:} c....) (._' ,--,,'- First line of address "-..-' . I-I 1 I R V I N E ROW , =.:':j f....:) Second line of address l") <:..n City or Post Office State ZIP Code DATE FILED CARLISLE P A 17013 Correspondent's e-mail address:susanhartman@planetcable.net Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and statemenls, 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. SIGNATURE F PERSON RESPONSIBLE FOR FILING RETU N DATE CARLISLE PA 17013 DATE (1LuJJ.J~~O. tJA. 110/3 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 --.J c; --.J 15056042126 REV-1500 EX DecedenfsName: TIMOTHY D. LUSH 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) ........................... 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. -44998.55 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 .0 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 -44998.55 15. o . 0 0 16. o . 0 0 17. o . 0 0 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 195 -3 8-79 3831.12 3 8 3 1 . 1 2 4 0 5 9. 0 0 4 4 7 7 O. 6 7 4 8 8 2 9. 6 7 - 4 4 9 9 8. 5 5 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 21 06 1108 DECEDENrs NAME TIMOTHY D. LUSH STREET ADDRESS 75 RUSSELL DRIVE CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Une 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. InterestIPenalty it applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E) (3) 4. If Une 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Une 20 to request a refund. (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) A. Enter the interest on the tax due. 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT 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 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for lite of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 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. ~9116 (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. ~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 retum are still applicable even it 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~ 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. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1 )]. 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. ~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. REV-1508 EX + (6-98) 'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TIMOTHY D. LUSH SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 06 1108 Include the proceeds of litigation and the date the proceeds were received by the estate, AR property jolnIIy-owned with right of survlvOl'Ship must be disc:losed on Sc:hedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PROCEEDS OF CITIZENS BANK ACCOUNT 871.51 2. PROCEEDS OF BENEFICIAL ACCOUNT 648.00 3. PROCEEDS OF M&T ACCOUNT 1,561.61 4. SALE OF 1979 CHEVROLET TRUCK 250.00 5. SALE OF 1989 FORD TRUCK 500.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheels of the same size) 3831.12 REV-1511 EX + (12-99) 'w SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TIMOTHY D. LUSH FILE NUMBER 21 06 1108 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 2,199.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of PeISOnal Representative (s) Social Security Numbe!(s)/EIN Number of PeISOnal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AtlDmeyFees DUNCAN & HARTMAN, P.C. 1,500.00 3. Family Exemption: (If decedenfs address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. ProbateFees REGISTER OF WILLS FILING FEE 63.00 5. Accountants Fees 6. Tax Return Preparel's Fees 7. CUMBERLAND LAW JOURNAL LEGAL AD 75.00 8. THE NEWS-CHRONICLE CO. LEGAL AD 77.00 9. FILING FEES ORPHANS COURT 145.00 TOTAL (Also enter on line 9, Recapitulation) $ 4 059.00 (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 TIMOTHY D. LUSH FILE NUMBER 21 06 1108 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. CITIZENS BANK - COMMERCIAL LOAN 32,491.29 2. CITIZENS BANK - LINE OF CREDIT 3,685.39 3. CITIZENS BANK - LINE OF CREDIT 3,952.55 4. SPRINT TELEPHONE BILL 276.11 5. RBS CREDIT CARD SERVICE 3,865.33 6. HOLY SPIRIT HOSPITAL BILL 500.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 44 770.67 "'-'~,,<X.* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TIMOTHY D. LUSH SCHEDULE J BENEFICIARIES 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 spousal distributions, and transfers under See. 9116 (a) (1.2)] 1. JANET K. LUSH Spousal 75 RUSSELL ROAD 100% SHARE CARLISLE, PA 17013 ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ FILE NUMBER 21 06 1108 (If more space is needed, insert additional sheets of the same size) 00 0 04319H NH 017 14120 TIMOTHY D LUSH 75 RUSSELL RD CARLISLE PA 17013-9534 INTEREST PA~D YEAR TO DATE 0.63 HIGH STREET-CARLISLE ...... . BEGINNING... .. ..... ....... DEPOSITS.,.,...,. ../......&~LAllleE<>....... .. ..............:'oTHERADDITIONS. NO. AMOUNT 2 IJ486.75 473.89 ACCOUNT SUMMARY ...:,..,..'ITHDRAWALS,.....OTHfR.... . .............CURRENr>.. .......... . ....,..... .....,...<suatltACTIONS,.,: .:.....,<IJiitEREsT....PAm:....<.'. NO . AI10UNT 2 400.00 0.29 ACCOUNT ACTIVITY ... POST. ... ..... . ..... .. .. .............. .......................:.........,.. .......... ..:........::.,...........:.........: DEPOSIT$~'INTEResT. '..)DAtE> .......: .......:.,.,.........'..<fR.N:SActION1)E:StRlpHOif ,.:.<.:::<":COTHEil:ADnnloNS 09-30-06 BEGINNING BALANCE 10-02-06 DEPOSIT 10-02-06 I1&T ATH CASH WITHDRAWAL ON 09/29 SPRING GARDJI00 S SPRING GARDEN STJCARLISLEJPA 10-10-06 DEPOSIT 10-10-06 I1&T ATH CASH WITHDRAWAL ON 10/06 SPRING GARDJI00 S SPRING GARDEN ST,CARLISLE,PA 10-30-06 INTEREST PAYI1ENT 917.54 200.00 569.21 200.00 0.29 ENDING BALANCE ANNUAL PERCENTAGE YI~LD EARNED = 0.24 % ENJOY THE FLEXIBILITY OF LOCKING IN FIXED-RATE LOANS WITHIN A LINE OF . WITH I1&T CHOICEQUITYJ YOU GET THE ABILITY TO LOCK IN A LOAN WITH A G~E RATEJ AS WELL AS A LINE OF CREDIT - ALL IN ONE ACCOUNT. HOW'S THAT FLEXIBILITY? BEST OF ALLJ YOU DECIDE THE REPAYI1ENT SCHEDULE THAT F BUDGET. SO WHY WAIT? START ENJOYING THE FLEXIBILITY OF H&T CHOICE TO APPLYJ STOP BY ANY H&T BRANCHJ VISIT WWW.I1ANDTBANK.COI1J OR CAL~ TELEPHONE BANKING CENTER AT 1-866-236-1219. L008A (1/03) IIHi8 28 ~ 2... b? ~1I11:0 2 ~OO ~0881: 11100 ~8 L. b ~ ~ bill (;----------------.-----.------------.------___-c.________________,..___.._________.___________________._-'___...;..,..__________ I , I 9038 000331 549062 '\ I ^ Beneficiar P.O. Box 8639 I I _1ISBC~&ooup Elmhurst,lL 60126 I I I I I I I I I I I I I I I I I I I I I I j r I I I I I I ESTATE OF TIMOTHY D LUSH ), " I 711715-20-508733 I I REFUND I I TAW ! I I ( , ! I I \ I i \ .. I . I , I I I I I I I I I I I I I I I I I I I I I I ! i I I I I I ! i I I I I I I I I I I I I J I I I I I I -..--1'~g~-.g.9_g.!...Q!...._Q!LQ1...__......._......._.._......._...-....--.....,.........-...-.-....-....-...---....___..____..:.c___...._.._...__..___.__.....__._____.........__....__...._......_....__._.............__________.._.__....._j / ". -,' / 02/28/07 Dear Customer: (~ . ) Attached is your loan proceeds cl,teck. Thank you for choosing HFC. Ifwe can be of further assistance, ple~"se contact us at 1-(800)365-8389. ~p.: l S-S H t20 C/w LJ r Hoffman-Roth Funeral Home & Crematory, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 December 20, 2006 Janet Lush 75 Russell Rd. Carlisle, P A 17015 The Funeral Service for Timothy Dale Lush 14899-218 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. (A) OUR SERVICE: CREMATION PACKAGE #5. . . . . . . . FUNERAL HOME SERVICE CHARGES $1490.00 $1490.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . $1490.00 Cash Advances Newpaper Obituary Notice-Patriot News. Newspaper Obituary Notice-Sentinel . Certified Copies of Death Certificates. . Coroner Authorization Cremation Fee. . TOTAL CASH ADVANCES AND SPECIAL CHARGES. $383.80 $240.20 $60.00 $25.00 $709.00 ~... Total Total Cost . $2199.00 TOTAL AMOUNT DUE $2199.00 ) 1>" AJ I 0 1 is statement is net and payable in full within 30 days of receipt. ~- - - - -. ... _........ - _.. - - _.... -.".i"':- _",,,,,,, ___ - -....- - - -....,,,,,,,,, -", - - II""' - -. ~~ Citizens Bank PO BOX 18204 BRIDGEPORT, CT 06601-3204 111'11I.1.11.1...1..111...1.1...11...11'111.1.11...11...1.1..1 Account Number Payment Due Date 4798153251028655 DEe 17,2006 $73.71 $3,685.39 Amount Due It PO BOX 9665 PROVIDENCE, RI 02940-9665 New Balance Amount Enclosed 1$ 111.111"1111""1111.1.1.1.111.1.111111..1..1111.1.1.1...11.1 TIMOTHY D LUSH LIBERTY MILLWORKS 75 RUSSELL RD CARLISLE PA 17015-9534 For proper credil, please mail payments to address at Jeft. Payments received at any other location may delay crediting your account up to five days. P000181 4798153251028655 000007371 000368539 -...---...---....--....-....--.-.-.--..-....--..--..-...--...--.-....--.-.............-...-.......--....-------....-....----..-...---.. Please detach and return with your payment ~~ Citizens Bank Account Summary For: TIMOTHY D LUSH LIBERTY MILLWORKS 75 RUSSELL RD CARLISLE PA 17015-9534 Account Information: Account Number: 4798153251028655 Total Credit Line: $5,000 Available Credit: $1,315 Days In Billing Cycle: 31 Billing Information: Statement Date: Payment Due date: Amount Due: Past Due Amount: Disputed amount: NOV 22, 2006 DEC 17, 2006 $73.71 $0.00 $0.00 To report card lost or stolen, call 1-877 -593-3878 For 24-hour customer service, call 1-800-862-6200 Send billing inquiries to: COMMERCIAL CARD PO BOX 18290 BRIDGEPORT, CT 06601-8290 Average Daily Monthly Corresponding Annual Periodic Balance Periodic Rate Percentage Rate Finance Charge PURCHASES $3,837.23 0.9583% 1 1.50% $36.77 CASH $0.00 0.9583% 1 1.50% $0.00 FEES $0.00 0.0000% 0.00% $0.00 PERIODIC RATE MAY VARY PLEASE REFER TO YOUR CARDHOLDER AGREEMENT Post Tran Date Date Reference Number Transaction Description Amount 11-08 11-06 74864646312000369470029 Payment Received Thankyou 500.00 CR 11-16 11-15 24692166319000072970476 TWX'AOL SERVICE 1106 800-827-6364 NY 25.90 11-22 11-22 PURCHASE 'FINANCE CHARGE' 36.77 Member FDIC Page 1 of 2 419 VILLAGE DRIVE CARLISLE PA 17013 ft Beneficiar Member HSBC ID Group Statement of Your Account Payment Coupon 711715-20-508733-4 1;3,818;41 09/20/06 10/14/06 649.00 1.111111111111111111111.1.1.111.1.11..11111111..11111.1.111.11 TI MOTHY D LUSH 75 RUSSELL RD CARLISLE PA 17015-9534 Mail Payment To: 111.1.111..11111111.1.11.11.1.1111111111.11111.111111111111111 BENEFICIAL FINANCE POST OFFICE BOX 4153-K CAROL STREAM IL 60197-4153 1.1111111.1111111.111111111111111.1111.1...111111111 0920011632 o 3000649007117152050873340013818412 For Assistance: 419 VILLAGE DRIVE CARLISLE PA 17013 717-249-1515 Your Credit Line is $ 14,750.00 Your Available Credit is $ 931.00 \ r f~' ; '! ~ I t;q/~ :"y'~ \, !,t;;', Account Summary v') ! Life Insurance ,00 Tolal'lnsurance .00 If HN/AH appears, N/A means not applicable Account Detail Since Last Statement Transaction Date 09/20/06 09/20/06 09/20/06 Posting Date 09/20/06 09/20/06 09/20/06 Transaction Description LIFE INSURANCE CHARGE A & H INSURANCE CHARGE ANNUAL FEE Transaction Amount 9.68 21.75 50.00 To evaluate and maintain the quality of our service to you, you permit us to listen to and/or record telephone calls between you and our representative. You may request a credit line reduction or cancellation at any time during the life of this loan. Contact us at 1-800-564-779"1 or visit our website at www.Beneficial.com/creditline for additional information. YOUR MINIMUM PAYMENT INCLUDES A $321.00 PAST DUE AMOUNT WHICH WE REQUEST YOU PAY PROMPTLY. IF YOU ARE UNABLE TO MAKE YOUR PAYMENT, PLEASE CONTACT A SERVICE REPRESENTATIVE AT THE NUMBER LISTED ON YOUR STATEMENT. Want a convenient way to make your payment? Just call 1-866-PAY-2DAY (1-866-729-2329) or pay online at Average Daily Balance $ 13.175,10 Monthly Periodic Rate 2,000% ANNUAL PERCENTAGE RATE 24000% CURRENT FINANCE CHARGE $ 263,50 Page 1 of 2 'New Balance mayor may not include interest accrued since the billing date, If you have questions on this billing, please call Customer Service at 717-249.1515, Written inquiries about billing errors or questions a~d any nonpayment correspondence, including instructions on how to request a credit line reduclion, cancellation. or reinstatement, should be addressed to Beneficial Cuslomer Service, 419 VILLAGE DRIVE. CARLISLE PA 17013, Please include your name, address. and aCClJur t number on all correspondence, Mail payment to: BENEFICIAL FINANCE, POST OFFICE BOX 41 53-K, CAROL STREAM IL 60197, NOTE: PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION DATE "",. ~ LOAN STATEMENT 11-17-06 Page 1 $256.41 TOTAL AMOUNT DUE Int Charged To Acct $256.41 $256.41 9.25000 BALANCE FORWARD 32,491.29 2001 HARKEr ST PHILAnELPHIA PA 19103 COMMERCIAL LOAN Account 060-0001-8146225-0101 TIMOTHY LUSH DBA LIBERTY MILL WORKS t5RUSSELL RD CARLISLE PA 17015 Interest $0.00 DUE DATE 11-28-~6 MATURITY DATE -DEMAND- Balance TOTAL AMOUNT DUE $32,491. 29 $256.41 Re~ittance Amount RATE 11-28-06 Account Nunber 6100086577 Will Be Charged $256.41 On 11-28-06 PAYMENTS AND ADVAN~ES MADE AFTER YOUR STATEMENT DATE WILL APPEAR ON NEXT I1ONTH'SSTATEHENT. IF YOU HAVE ANY QUESTIONS PLEASE CALL YOUR RELATIONSHIP MANAGER, OR 1-800-403-2736 WEEKDAYS FROM 8 AM TO 5 PM AND A CUSTOMER SERVICE REPRESENTATIVE WILL BE HAPPY TO ASSIST YOU. COMMERCIAL LOAN Account 060-0001-8146225-0101 Payment Address: P.O. Box 9799 Providence RI 02940-9799 Amount Due Late Charge TOTAL AMOUNT DUE TIMOTHY LUSH DBA LIBERTY MILL WORKS 75 RUSSELL RD CARLISLE PA 17015 Additional Principal $ Additional Escrow $ Late Charges $ Other Amount Enclosed $ TOTAL AMOUNT ENCLOSED $ 24 001060 0001 8146225 0101 0000000 0000000000 0000000000 0000 DUE DATE 11-28-06 $256.41 $0.00 $256.41 LINE OF CREDIT STATEMENT Page 1 Closing Date NOVEMBER 27, 2006 060-00006007408675 5,000.00 1 , 047 .45 30 3,974.76 .03493150% 12.75% 41.65 3,952.55 79.88 0.00 0.00 79.88 Finance + Insurance + Charge 41.65 0.00 Other Charges 0.00 New Total Balance 3,994.20 Check No. Amount 100.00 Principal Balance 3,952.55 IF YOVHAVE ANY QUESTIONS ABOUT YOUR STATEMENT, PLEASE CALL OUR 24-HOUR PHONEBANK AT 1-800-708-6680. THANK YOU FOR BANKING WITH CITIZENS. NOT YOUR TYPICAL BANK. ::; > Q. u o ;::; o LINE OF CREDIT Payment Address: PO Box 42008 Providence RI 02940-2008 Account Number Payment Due Date Minimum Payment 060-00006007408675 12/17 /06 79.88 TIMOTHY D LUSH 75 RUSSELL ROAD CARLISLE, PA 17013 Amount Enclosed 1$ 01 060 00006007408675 000000000007988