HomeMy WebLinkAbout11-29-07
--.J
15056041114
REV -1500 EX (06-05)
OFFICIAL USE ONLY
County Code Year
File Numbel
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg. PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
SOCIal Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~\
D\J)
\ \llJJ
Date of Birth
188-32-4701
11302006
12141942
Decedent's Last Name
Suffix
Decedent's First Name
MI
ZENTZ
DIANE
W
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
Ml
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
W 1 Onglnal Return
D
D
2. Supplemental Return
D
D
3. Remainder Return (date of deall;
prior to 12-13-82)
5 Federal Estate Tax Return Reqwed
D 4. limited Estate
D 6 Decedent Died Testate
(Attach Copy of Will)
D 9. litigation Proceeds Received
D
D
4a Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
8. Total Number of Safe Deposit Boxes
D
11. Election to tax under Sec. 9113(A)
(Attach Sch 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRLZ\N D. WILSON
Firm Name (If Applicable)
(703)8516584
First line of address
REGISTER OF WILLS USE ONL Y
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679 BELMONT BAY DRIVE
City or Post Office
State
ZIP Code
f'Ti
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Second line of address
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WOODBRIDGE
VA
22191
~.-1"
SI
WOODBRIDGE, VA 22191
DATE
11/16/07
ADDRESS
H&R BLOCK,
12357 DILLINGHAM SQ., WOODBRIDGE, VA 22192
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041114
15056041114
--.J
\
CArl
~
15056042115
REV-1500 EX
Decedent's Name DIANE W Z ENT Z
RECAPITULATION
1.
Real estate (Schedule A) . .
2.
Stocks and Bonds (Schedule B) .
3 Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .
4.
Mortgages & Notes Receivable (Schedule D) .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . .
6. Jointly Owned Property (Schedule F) DSeparate Billing Requested. .
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) DSeparate Billing Requested.
8 Total Gross Assets (total Lines 1-7). .
Decedent's Social Security Numller
188-32-4701
1. NONE
2. NONE
3. NONE
4. NONE
5.
6. NONE
7.
8.
9.
10.
11.
. . 12.
13.
14.
9703.00
34996.00
44699.00
11642.00
9. Funeral Expenses & Administrative Costs (Schedule H) . .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .
11 Total Deductions (total Lines 9 & 10).
12 Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . .
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) .
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . .
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
4793.00
16435.00
2826ci.00
0.00
28264.00
15. 0.00
28264.00 16. 1272.00
17. 0.00
18. 0.00
........... . 19. 1272.00
19 TAX DUE
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042115
D
15056042115
~
bUle "A F'oge 3 188-32-4701
Decedent's Complete Address:
DECEDENT'S NAME
DIANE W ZENTZ
STREET ADDRESS
File Number
21-06-1116
DECEDENT'S SOCIAL SECURITY NUMBER
188-32-4701
679 BELMONT BAY DRIVE
CITY
WOODBRIDGE
I STATE
VA
I ZIP
22191
Tax Payments and Credits:
1 Tax Due (Page 2 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B Prior Payments
C Discount
(1 )
1272.00
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty If applicable
D. Interest
E. Penalty
000
Total Interest/Penalty ( D + 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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
1272.00
A. Enter the Interest on the tax due.
(5A)
1272.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and:
a letaln the use or Income of the property transferred; .
Yes
D
D
D
D
D
D
b. retain the right to designate who shall use the property transferred or its income; , , .
c. retain a reversionary interest; or .
d receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .
4
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .........
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
D
No
~
o
o
o
o
o
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. S9116 (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. S9116 (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 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. s9116(a)(12)].
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
(...5) percent, except as noted In 72 PS. S9116(1.2) [72 P.S. s9116(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. S9116(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,
217
REV-1508 EX+ (6-98)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
DIANE W ZENTZ
FILE NUMBER
21-06-1116
Include the proceeds of litigation and the date the proceeds were received by the estate.
All orooertv iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1 MEMBERS FIRST FCU ACCT NO. 201189--CHECKING ACCOUNT
2 MEMBERS FIRST FCU ACCT NO. 201189--SAVINGS ACCOUNT
3 1999 CHEVROLET CAVALIER
VALUE AT DATE
OF DEATH
799
5,054
3,850
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9,703
217
REV~1510 EX+ (6~98)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
DIANE W ZENTZ
2006-01116
DESCRIPTION OF PROPERTY
ITEM iNCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST ;F APPLiCABd:', VALUE
1. AMERICAN UNITED LIFE INSURANCE CO PENSION (401 K) 34,996 100.00% 0 34,99(3
0
0
0
0
()
0
()
()
()
()
()
()
()
()
()
()
0
()
()
0
0
()
()
()
()
()
0
()
()
()
0
()
0
0
0
0
0
0
0
()
()
0
0
0
0
TOTAL (Also enter on line 7 Recaoitulation) $ 34,996
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.
(If more space is needed, insert additional sheets of the same size)
217
REV-1511 EX + (12-99)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
DIANE W ZENTZ
21-06-1116
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 MALPEZZI FUNERAL HOME 3,814
2. IVY HILL CEMETERY CO. OF ALEXANDRIA 2,746
3. GARDEN BOUQUET, MECHANICSBURG, PA 17055 298
4. FUNERAL REFRESHMENTS, VISAGGIO'S RISTORANTE 1,20U
5 7 COPIES OF DEATH CERTIFICATE VITALCHEK V99-0662968-1 84
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid
2. Attorney Fees
3 Family Exemption (If decedent's address is not the same as claimant's. attach explanation)
Claimant BRIAN D. WILSON
Street Address 679 BELMONT BAY DRIVE
City WOODBRIDGE State VA Zip 22191
Relationship of Claimant to Decedent SON 3,500
4. Probate Fees
5 Accountant's Fees
6. Tax Return Preparer's Fees
7
TOTAL (Also enter on line 9 Recapitulation $ 11 642
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX. (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DIANE W ZENTZ
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-06-111 6
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
FREYSINGER PONTIAC, GMC, BUICK, INC REPAIRS ON CHEVROLET CAVALIER
1,783
2.
FINAL VERIZON PHONE BILL
27
3.
COMCAST COMMUNICATIONS FINAL BILL
48
4
NATIONAL WATER AND POWER FINAL BILL
49
5.
AXA EQUITABLE LOAN AND INTEREST
2,886
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,793
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.members1st.org
b\ f\ N E \tJ :2-EN Tz3tatement of Accounts
'\ '8 <3 -"3 a - 4-tD l Nov 25, 2006 thru Dec 24, 2006
Main Switchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283-2328 ex!. 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
Account Number:
Account Balances at a
Checking:
Savings:
Certificates:
Loans:
Money Management:
MEMBERS 1st
FEDERAL CREDIT UNION
35869 1 ME 0.326 71737-35869
1..1.1'11.1"1111.1.....11.1.1..1111.1..11.1..1"111.1..1...11
DIANE W ZENTZ
c/o BRIAN WILSON
679 BELMONT BAY DRIVE
WOODBRIDGE VA 22191
*-
iiiiiiOii
.....=
-
N_
-
""-
.;.-
-
.....=
-
*
Page:
Reminder - 10991NT's are not included with your December statement. Please
read the enclosed insert for additional information.
S"~ -[ =!J
+ #. d--
201189
Glance:
0.00
0.00
0.00
0.00
0.00
1 of 2
CHECKING ACCOUNTS
11 - CHECKING
Transaction Description
Balance Forward
Check 001154 Tracer 1128012137
Check 001153 Tracer 1129001762
Check 001152 Tracer 1201014023
Che.ck 001149 Tracer 1201014022
he 1155 Tracer 1204005064
Deposit Transfer rom are
Withdrawal Transfer To Share 00
CHECKlNGC/osed
*"""Thisisthe final statement pf'eSenting1riformation on this pr()cjpct~"""f
""*" Please retain this final statement fl;rtaxreporting purposes~ ~;....:
t".. .. ~t ',' ;
~ECK SUMMARY ~
4bYL ~Check'#
p [:001.154
.E ~. · 001155
Additions
Subtractions
I
100.00-
56. 14-
19.91-
97.80-
2-
1,467.20-
668.42
Check # Amount Date
001149 97.80 Dec 01 ~
001152* 19.91 Dec 01 "
o
001153 56.14 Nov 29 j' .
""AsterisknexUo numberindicates skip in numtJrr sequen~
'..5Checks Cleared for 392.57 ~. l
o
Amount
100.00
118.72
d
G
~
1"
SAVINGS.. ACCOUNTS
~~
"l;l:"
"~r:l."r"~'1i~:~' 4k,+'if
!1>r''7~ . Wl'''''& ~'"f't:r' ii~' a
~~\:~,!yjt~,~__.t7~, J;1
00 -REGULAR SAVINGS
(,.'I~tF;I)ri' t> ;;_'f-_~\:"iJ::
Date Transaction Description Additions
Nov25 Balance Forward
Nov e osit Dividend 1.000010 4. 13
Annualpercentage Yield Eamed 1. l) 'Om 11/01/2006/hrough 11/30/2006
Dec 08 Deposit ACH FREYSINGER PONTI ,,693.42
TYPE: PAYROLL 10: 1231491072 DATA: PAYROLL DIRECT DEPOS
Dee 08 Withdrawal Transfer To Share 11
Dec 15 Deposit Transfer From Share 11 1,467.20
Balance
1,191.35
1,091.35
1,035.21
1,015.30
917.50
798.78
1,467.
0.00
Date
Nov 28
Dee 04
668.42-
- - - Continued on following page - - -
5,747.88
5,079.46
6,546.66
~1.st
MEMBERS 1"
fEDElI."LCR.FDrrUNlO~
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.members1st.org
Main Switchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283-2328 ex!. 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
71738-35869
Nov 25, 2006 thru Dee 24 2006
Account Number: 201189
Page: 2 of 2
>l-
N_
N
-
0>_
-1:0-
......-
-
>I-
Date Transaction Descri tion
Dec 15 Withdrawal by Check
Dee 15 Deposit Dividend
Annual Percentage Yield Eamed 1.()()(J% from 12/01/2006 through 12/14/2006
Dec 15 Withdrawal by Check
REGULAR SA V/NGS Closed
H"This is the final statement presenting information on this productH"
H" Please retain this final statement for tax reporting purposes H"
b I AN 'E. \jJ . l.-t: N l2..
\<68- sa - L\ 1-0
Additions
Subtractions
3,814.20-
Balance
2,732.46
2,734.40
1.94
2,734.40_
0.00
YTD SUMMARIES
TOTAL DIVIDENDS PAID
00 REGULAR SAVINGS
11 CHECKING
18.09
0.00
Total Year To Date Dividends Paid
NOTE: Total includes closed shares
18.09
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Kelley Blue Book - Private Party Pricing Report - Chevrolet, Cavalier
SeJ-, t, -#3
Kelley Blue Book
THE TRUSTED IU:SOUlCE..
~.. ........._..._...~ ~C'III
Page 1 of 4
D lANf Z f:rJTZ
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Home> Used Cars> 1999> Chevrolet> Cavalier> Z24 Convertible 2D > Equipment
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1999 Chevrolet Cavalier Z24 Convertible 20
Trade-In Value
Private Party Value
Suggested Retail Value
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BLUE BOOKs, PRIVATE PARTY VALUE,
Condition Value
Excellent $4,735
Good $4,285
L ....."....,"~.,_....,..-" ...~",. 1
Fair $3,700
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Average Consumer Rating (275 Reviews)
Read Reviews
4.1 out of 5
Review This Vehicle
Vehicle Highlights
Mileage:
Engine:
103,000
4-Cyl. 2.4 Liter
http:/ /www,kbb,com/KBB/U sedCars/PricingReport.aspx?trid=20&ManufacturerId=9&Ds.,. 11/16/2007
~f
Kelley Blue Book - Private Party Pricing Report - Chevrolet, Cavalier
DIANE
ZENTz..
mID THE RIGHT (AR
Compare Used vs. New
.it
lUnder' $5,000
jConvertible
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Transmission:
Drivetrain:
Automatic
FWD
Selected Equipment
Change Equipment
Standard
Air Conditioning
Power Steering
Power Windows
Power Door Locks
Tilt Wheel
Cruise Control
AM/FM Stereo
Cassette
Dual Front Air Bags
ABS (4-Wheel)
Alloy Wheels
Blue Book Private Party Value
Private Party Value is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumes the vehicle is sold
"As Is" and carries no warranty (other than the continuing factory warranty),
The final sale price may vary depending on the vehicle's actual condition and
local market conditions, This value may also be used to derive Fair Market
Value for insurance and vehicle donation purposes.
Vehicle Condition Ratings
Check Vehicle Title History
Excellent
$4,735
"Excel:enC! condiUon rneans that the vehicle looks new: is in excellent
r-nechanical ce;nd\tion and needs no rec.onditioning. This vehic\c has never
;,ad any paint or' body work and is fr'ee of rust, The vehicle has a clean title
history and wi!! oass a smog and safety inspection, The engine
c.ornpartment is clean,- ',-"Jith no flu;d leaks and is free of any WC:2F' or v~sib!e
defects. The vehicle aLso has cornpletc: and verifabte sefVlce rec.orDS, 1...f:;SS
than 5cy) of aU used vehic.ies fal! lnto tills cateqory,
Good
$4,285
':GGod~' condit\on rr)eans that the veh~cle IS free of any 111ajor (jefects. Tr"!is
vehicle h2)S 2 clean title history, the paint, body and interior have only
innor (if any) blemishes, 2nd there are no mellor mechanical Droblems
There should t)e nUle (jr no rust on this vehicle, The tires match and have
sut)stantla~ tread \:'Jeaf left. P. l'goodll vehicie wfJj need sorne rec$ndltlor';Jr:9
to tie sold at retaiL f'.-1o~;t consurner owned ver)\cles fa\! Into trllS category,
Fair
1:100, $3,700
"Farr" condition means that the vehicie has some mechanical or cosmetic
defects and needs servicing but is still in reasonable running conditron. This
vehicle has a clean title history, the paint, body and/or interior need work
http://www.kbb.com/KBB/U sedCars/PricingReoort.asox?tricl=70& M::1nl ,f'Olf't,w",vT rl-O 9. - ~
Page 2 of 4
/g 8 . 3 d. .tf 70 J
Get a Pre
6 65% M
Your Cree
Get a Fre<
a
1"1/1.,-1......;-..,..-
Kelley Blue Book - Private Party Pricing Report - Chevrolet, Cavalier
D'ANE; 4::AfT?-
I ff- 3J."' Y70J
Page 3 of 4
performed by a professional. The tires may need to be replaced. There may
be some repairable rust damage.
Poor
N/A
cond!['ion fTicans that tr-iC vehic~e has sr:;~vere rnechan!caf ~1nd/or
cosmetic defect.s and is in poor running condition, The vehicle may have
prcb!erns that cannot: be readHy fixed such a::. ~:i darnaged rran'1E: or a
rusteci-thr'Gugh bod\!. /j.. vehicle v-Jith a branded title (sF.l!vagcr food, etc.) or
unsubstant.iaretJ nlt!c3gc IS cons~de(ed '\poor." (l, vehicle in poor c.ondition
Tay require an independent appraisal to deterrnine its value. Keliey Biue
Book does not attempt to report a value on a "poorll vehic~f:: because the
vaiue of cars in thiS category varies greatly.
'" Pennsylvania 11/16/2007
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Condition Quiz Results
Calculated Rating: Fair
Change Condition
Exterior Condition
Paint and body
Dents, dings or chips
Paint or body work
Less than $3000
frame or unibody
Unaltered
Glass, lights, lenses
No defects
Rust
None
Interior Condition
Upholstery and carpet
Stained/faded/worn
Odor (smoke/mold...)
Some
Locks/radio/NAV...
Repairs needed
Mechanical Condition
Engine/transmission
No noises, no leaks
http://www.kbb.com/KB B/U sed Cars/Pri cingReport. aspx?trid=2 O&Manufacturer I d=9& ns_
11 /l hnnn7
Kelley Blue Book - Private Party Pricing Report - Chevrolet, Cavalier
] fANt ZENTZ
Page 4 of 4
j~8" -3~- Y70J
Steeri n9 / suspension
Trouble-free/stock
AC/heater
Fully functional
Brakes
Need replacing
Tires
Newer, all matching
Miscellaneous
Title - "Pink Slip"
Clean title
Emissions test
Passed
Maintenance records
None available
@ 2007 Kelley Blue Book Co., lne. All rigilts reserved. Sep-Dec 2007 Edition. The
specific information required to determine the vaiue for this particular vehicle was
supplied Loy the person generating this report. Vehicle valuations are opinions and may
vary from vehicie to vehicle. Actual valuations will vary based upon market conditions,
specifications, vehicle condition or other particular circumstances pertinent to this
particuiar vehicie or the transaction or ti7e parties to the transaction. This report is
intended for the individual use of the person generating this report only and shal! not
be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for
errors or omissions. (v.07114)
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Copyright & Trademarks
(C) 1995"2007 Kelley Blue Book Co., Inc.
http://www.kbb.comJKBB/UsedCars/PricingReport.aspx?trid=20&ManufacturerId=9&os... 11 II f)/)007
American United Life Insurance Company'"
One American Square, P.O. Box 368
Indianapolis, IN 46206-0368
S'chQ-#(
D \ A Nt. \N. L6t-JT2-
(' ('" '. Check Number
~i:) N. ,~g -~~- ...1-0\
2376417
a OneAmericlf financial partner
2376417 OM36310577 WILSON
01102107
CDW AUl 1301 PCJ OMN MA
12/2912006
SSN I ***-**-4122
2510000001 30,096.15
AMOUNT WITHDRAWN
FEDERAL INCOME TAX WITHHELD
STATE INCOME TAX WITHHELD
THE STATE TAX WITHHELD WILL
G34292
34,995.52
3,499.55
1,399.82
GRP PENS O/S DISBURS
iI
@
1
CHECK>AMT
****30,096.15
Please Detach Before Depositing
Sch I -# (
153
374601
Di ANt \N, 2_tNTL
5$ N'# I 83 - 3-1 - L.\- -q.-O 1
FREYSINGER PONTIAC, GMC, BUICK, INC
6251 CARLISLE PIKE
MECHANICSBURG, PA 17050
(717) 766-8422 * DIAL P-O-N-T-I-A-C
INVOICE
17050
BUS:717-766-8422
PAGE 1
.......AG
CHG 04DE 06
O-DED. $30-RENTAL
TOTAL
****************************************************
II.
Goodwrench
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T A TEMEN 0 ISCLAIMER
The factory warranty constitutes all
of the warranties with respect to
the sale of this item/items. The
Seller hereby expressly disclaims all
warranties either express or
implied, including any implied
warranty of merchantability or
fitness for a particular purpose.
Seller neither assumes nor
authorizes any other person to
assume for it any liability in
connection with the sale of this
itemrltems.
444.00
1744.88
0.00
0.00
0.00
2188.88
0.00
CUSTOMER SIGNATURE
PLEASE PAY
THIS AMOUNT
f"'TTC!",t"\......~- - - - -
I
C;~ L #.~
~'
. ven7Ol1
We never stop working for you.
DIANE ZENTZ
Account Summary
Previous Charges
Payment Received Nov 16. Thank You.
Balance
New Charges
Verizon (page 3)
Verizon Long Distance (page 5)
Total New Charges Due Dec 19
Total Due: (past Due + New)
Questions about your bill? Call 1 800 660-2215
See page 2 for all other Verizon contact information.
Change of billing address?
Go to verizon.com/billingaddress or see page 2.
$ 30.75
- 30.75
$ .00
$ 26.30
.48
$ 26.78
$ 26.78
Billing Date: 11/22/06 Page 1 of 6
Telephone Number: 717795-0688
Account Number: 717795-0688513 92Y
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.... Detach & return payment slip with your check, payable to Verizon
---------------------------------------~~-~~~--~~~---~--~------------~--~------------------------,-
,
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TOTAL
AMOUNT DUE
$47.82
Dt A~E. W. 2.E f\JT2-
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ACCOUNT
NUMBER
DATE
DUE
09547411345-01-4
12/25/06
.'~'-\:C.;.';--;__;-"
. hus...
reach us:
rlisle Pike, Suite 0-14
anrcsburg, Pa 17055
540-8900
News from Com east
,
S~I
-#If
(6491-740906772-D01 )
D iAN"E. W. 2.ENT2-
SSN: \<og-3~1.-t.t1-o'
~ NW&P
740906772-001
DIANE ZENTZ
1400 BENT CREEK BLVD APT 124
-
NATIONAL WATER & POWER
10/01/2006-10/30/2006
National Water and Power
PO BOX 790275
51. Louis, MO 63179-0275
Readina
Hot/Cold
10/0112006
5467
10/30/2006
5684
Usaae
217
217 x 10 GAL units
'4~,-.sJ 01-
f> c.l ' :. I., l'
NWP S~ 11
. _'"' JU)~
'lU^ e,I Jl
NO M -e .
Submelered Waler Service
Service Fee
Meier Fee
Sewer Base Fee
Residenl account and payment information available at:
www.nwpco.com
To ensure prompt and accurate processing, please write your
account number on your check or money order.
SEE REVERSE FOR CERTAIN DISCLOSURE AND CUSTOMER SERVICE
CONTACT INFORMATION
PLEASE NOTE - Your payment by check may clear the bank electronically. This electronic payment occurs each time we
receive a check from you. If you have any questions about this process please call us at 800-845-6767.
l' PLEASE DETACH HERE AND RETURN BOTTOM PORTION WITH YOUR PAYMENT l'
D CHANGE OF ADDRESS ON BACK
National Water and Power
PO BOX 790275
51. Louis, MO 63179-D275
740906772-001
~ NW&P
-
NATIONAL WATER & POWER
$48.68
11/15/2006
12/11/2006
LATE FEE APPLIED IF PAYMENT RECEIVED AFTER DUE DATE
MAKE CHECK PAYABLE 'TO:
~
1::
T55/P109 ***AUTO**MIXED AADC 852
DIANE ZENTZ
1400 BENT CREEK BLVD APT 124
MECHANICSBURG, P A 17050
1",111,,, III" "1,1,11"""111,,1,,11,,,,1,1,1,,11,1,,1,,, II
NATIONAL WATER & POWER
CHECK NUMBER
740906772001670000649100486800416812112006102
POLICY/UNIT INSURED
084023465 MS DIANE WILSON ZENTZ
DCO
AGENT NAME
048429, AH SCHALL
s~ 7. 1i.~
b i A ~ E \N. 2.t N T2. \ % g - :5;z. - 4 1-0 \
DEATH eLM NO REGISTER DATE CHECK DATE
620694 FEB 22,1984 JAN 18,2007
ASU
PPA
FEDERAL I
183-62-4122
TRANSACTION TYPE
DEATH CLAIM
SIP 20070108 POUCYTYPE INSURANCE
BASIC DEATH BENEFIT 1 0,332.00
ACCRUED LOAN INTEREST FROM FEB 22,2006 IS 1 66.02
TERMINATION DIVIDEND 21 8.42
LOAN BALANCE 2,71 9.79
VOLUNTARY INTEREST 60.32
DIVIDEND ADDITIONS 6,91 9.00
POST MORTEM DIVIDEND 395.58
C:HECK AMOUNt 1 51039.~
~
111111111!.!ilillj~II!II'I;,:il /iillilllllll'/illlllllilljl./llliiili//III'jjliI11Iil1~llli'I.I~/lilli' l'ill!.III'II!II!III!illl:III~II.I'~IIII!I!I~'I~I~I:I'iil
AGENT: ANDREW SCHALL @ PPA
PH: (717) 560-2000
CHECK TYPE: ELAS~M
DETACH THIS STATEMENT BEFORE DEPOSIT1NG
CHECK NO.
0200771362
....
r- .. . uu u --
National Operations Center S 4 '1 :if- ~ tn f\ ~ E. \lJ ,1- Eo N T 2.-- .
PO Box 1047. \ 0'3 ~"""\ Li. -:L .
Charlotte NC 28201-1047 . 0 -;::> oc. - , TO I
01008333
111111111111111111111111
Insured: Diane Wilson Zentz
Policy Number: 84 023 465
Associate: Andrew Schall
Associate Phone:(717) 560-2000
Service Center: (888) 855-5100
Date: November 25, 2006
MS DIANE WILSON ZENTZ
1400 BENT CRK BLVD 124
MECHANICSBURG PA 17050-1862
Your payment of $50.00 has been applied to reduce the loan on this policy effective November 20, 2006, as
follows:
Beginning Loan Balance
Loan Payment Applied to Interest
Loan Payment Applied to Principal
Ending Loan Balance
$2,767.01
$2.78
$47.22
$2,719.79
You may wish to consider repaying your loan in full since it will reduce any benefits payable under the policy.
For additional information, contact our Service Center at the number shown above.
000005000
Please detach and return this form with your payment to the address below.
Apply I $ 'I to reduce the loan on policy 84 023 465 OZ.
MS DIANE WILSON ZENTZ
1400 BENT CRK BLVD 124
MECHANICSBURG PA 17050-1862
111111.1.11111.1.1.1.1111111111.111111111.1.1.1111.11.11111111
AXA Equitable Payment Center
Box 371405
Pittsburgh P A 15250-7405
1200000000000000000000840234650200611200410047019000005000900