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Home My WebLink About01-29-08 -.J 15056051058 REV-1500 EX (0&-05) 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 OFFICIAL USE ONLY County Code Year 21 07 File Number 0078 Date of Birth 178-32-0652 12/24/2006 02/10/1909 Decedent's Last Name Suffix Decedent's First Name MI Curran Rose Alice (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 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 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 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Hugh C. Weaver Firm Name (If Applicable) (717) 691-1678 City or Post Office Mechanicsburg State ZIP Code 33 Bourbon Red Drive r-..> \.0 First line of address Second line of address :r:..... :1; c.) 0"1 PA 17050 Correspondent's e-mail address: DATE / pr/o'/ / /vJe> DDRE ~ u1/J ~ 3 a 00 '" f' b 0 V\ f\:-e'd r . f fie c a41 {c S b vg.. 1> /l SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE . , DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 --I d.~ ....J 15056052059 REV-1500 EX Decedenfs Name: RECAPITULATION Rose Alice Curran 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) Separate Billing Requested . . . . . ., 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 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 Governmental Bequests/Sec 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 .0_ 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 8,197.87 15. 16. 17. 18. 19. TAX DUE......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number 178-32-0652 27,022.87 27,022.87 12,573.69 5,051.31 17,625.00 9,397.87 1,200.00 8,197.87 1,229.68 15056052059 --I REV-1500 EX Page 3 .Decedent's Complete Address: File Number 21 07 0078 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Rose Alice Curran 178-32-0652 STREET ADDRESS 33 Bourbon Red Drive CITY I STATE I ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 1,229.68 Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon Page 2, Line 20 to request a refund. (4) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 1,229.68 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 1,229.68 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D fi] c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D fi] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ 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 exemDt 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)]. 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)]. 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) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Rose Alice Curran FILE NUMBER 21-07-0078 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. First Commonwealth Bank DESCRIPTION VALUE AT DATE OF DEATH 7. Conseco Reimbursement check number 0001389475 1/16/07 399.48 1,048.31 2,585.35 4,440.81 8,168.09 1,620.48 2,520.00 2. Commerce Bank 3. Integrity Bank 4. Ameriserv 5. Federated 6. Federated 8. Conseco Reimbursement check number 1388128 1/11/07 3,577.35 9. Reimbursement from Country Meadows Resident Refund 2,663.00 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 27,022.87 REV.'511 EX+ ('2...* COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETIJRN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Rose Alice Curran FILE NUMBER 21-07-0078 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Moskal Kennedy Funeral Home Johnstown, PA Malpezzi Funeral Home Mechanicsburg, PA Hotel Expenses Meal Expenses in Mechanicsburg and Johnstown Mileage Church Donation 3,849.25 7,150.40 208.22 823.82 207.00 200.00 2. 3. 4. 5. 6. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/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 Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 135.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 12,573.69 REV-1512 EX- (12-03) .. COMMONWEALnt OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABIUTlES, & UENS ESTATE OF Rose Alice Curran FILE NUMBER 21-07 -0078 Report debts Incurred by the dec:edent 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. Choice Nursing 3,870.76 22.50 2. Comcast 3. Verizon 128.12 4. Alert Pharmacy 367.41 5. PSERS 247.52 6. US Department of Treasury Internal Revenue Service 103.00 7. Stop Payment fee at Integrity Bank 12.00 8. Reimbursement to JoAnne Weaver for Chrisbnas Gifts Purchased for Country Meadows 3rd Floor Staff 300.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,051.31 REV-1513 EX' (""") .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS pndude oubight spousal disbibutions, and transfers under Sec. 9116 (a) (1.2}) FILE NUMBER ell - 6 7 - () (;) 76' RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE ESTATE OF J I<05t tklLLL U~ t 11-# 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 2. Seraphic Mass Association 1200 TOTAL OF PART 11- ENTER TOTAl NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) 1200 ~ &I FIRST rrr Commonwealth Banking Insurance Trust Financial Management Investments First Commonwealth Bank P.O. Box 400 Indiana, PA 15701-0400 17050 10000000360403 0303-001542 01 2 Items Enclosed Statement Period 12/11/2006 through 01/09/2007 Page 1 of 3 I.. .111.. .111... .1.1.11...1...11.1.. .1.111I1.1. .11.. .11.1..1.1 ROSE ALICE CURRAN 33 BOURBON RED DR MECHANICSBURG PA 17050-7952 EFFECTIVE FEBRUARY 15, 2007, ACCOUNTS HAVING PREVIOUSLY REQUESTED AUTOMATIC TRANSFER OF FUNDS FOR OVERDRAFT PROTECTION WILL BE ASSESSED A $10 FEE TO THE CHECKING ACCOUNT FOR EACH TRANSFER. FINANCIAL PROFILE CHECKING AND SAVINGS 0303-001542 LOANS 399.48 TOTAL 399.48 TOTAL .00 FIFTY N'BETTER CHECKING+ Account Number 0303-001542 ROSE ALICE CURRAN 2 Items Enclosed Balance Summary Balance Last Statement Add: 2 Deposits & Interest Less: 3 Withdrawals & Fees Balance This Statement 2,709.63 Total YTD Interest Paid 1,202.05 Average Daily Balance 3,512.20 Avg. Collected Balance 399.48 .05 1,316.73 1,316.73 Account Transactions 12/21 01/02 01/03 Description Balance Last Statement Check 1741 Check 1742 Deposit US TREASURY 303 sac SEC Debits/ Withdrawals(-) Credits/ Deposits(+) Posting Date 1,202.00 Balance 2,709.63 567.18 399.43 1,601.43 2,142.45 167.75 Commerce .Bank Commerce Bank/Harrisburg N.A. 3801 Paxton Street Harrisburg PA 17111 888-937 -0004 ROSE ALICE CURRAN 4833 E TRINDLE RD MECHANICSBURG PA 17050 Page 1 of 1 STATEMENT DATE ACCOUNT NO. CYCLE-011 *** CHECKING *** 50 PLUS CHECKING ACCOUNT NUMBER 0536043516 PREVIOUS STATEMENT BALANCE AS OF 12/20/06 .. ................... ... PLUS 2 DEPOSITS AND OTHER CREDITS .. ........... ...... LESS 1 CHECKS AND OTHER DEBITS '" ............ ....... CURRENT STATEMENT BALANCE AS OF 01/22/07 . ....... ..... ............ NUMBER OF DAYS IN THIS STATEMENT PERIOD 33 1,048.16 149.80 149.65 1,048.31 DEBITS ----------------------------------------------------------------------------------- *** CHECKING ACCOUNT TRANSACTIONS *** DATE DESCRIPTION 01/02 AC-MET LIFE -ANNUITYPAY 01/18 AC-MET LIFE -RECLAIM 01/22 INTEREST PAYMENT 149.65 CREDITS 149.65 .15 1,197.81 01/18 ----------------------------------------------------------------------------------- 1,048.31 *** BALANCE BY DATE *** 12/20 1,048.16 01/02 1,048.16 01/22 23-2324730 .15 PAYER FEDERAL ID NUMBER INTEREST PAID YEAR TO DATE ---------------------------------------------------- *** INTEREST EARNED THIS STATEMENT PERIOD DAY S IN PERIOD ......................... INTEREST EARNED ... ..................... ANNUAL PERCENTAGE YIELD EARNED (APY).... *** 33 .15 0.15% ---------------------------------------------------- MANAGING YOUR ACCOUNT IS ABOUT TO GET EASIER. . . LOOK FOR OUR NEW STATEMENT DESIGN COMING SOON! t..1f"\TC. ~el:' n~"~"~~ ~."',.. ..".--, .....,............ ..... .. ..."..... .............. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE * REVISED NOTICE * * * FILE NO. 21 07-0078 ACN 07104400 DATE 02-16-2007 * 1lEV-1543 EX AFP C09-00> EST. OF ROSE A CURRAN S.S. NO. 178-32-0652 DATE OF DEATH 12-24-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS (i] CHECKING D TRUST o CERTIF. ** HUGH WEAVER 33 BOURBON RED DR MECHANICSBURG PA 17055 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 INTEGRITY BANK has provided the Depart.ent with the infor.ation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If YOU feel this infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co..onwealth of Pennsylvania. Questions .ay be answered b>> calling (717) 787-8321. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 206000166 Date 05-26-2006 EstablIshed To insure proper credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Allent". Account Balance Percent Taxable AMount Subject to Tax Tax Rate Potential Tax Due 2,585.35 X 100.00 2,585.35 X .15 387.80 TAXPAYER RESPONSE NOTE: If tax pay.ents are .ade within three (3) .onths of the decedent's date of death, you .ay deduct a 5X discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. PART [!] [CHECK ] ONE BLOCK ONLY A. D The above infor.ation and tax due is correct. 1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue. B. E:J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [J The above inforaation is incorrect andlor debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. PART [!J TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount SUbject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x If you indicate a different tax rate, please state your relationship to decedent: x PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) . Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TFtEPHONE NUMBER DATE TAXPAVFR ~T~NATIIRF **.= AMERISERV FIN A N C I A l- Page: 1 of 2 EIGHTH WARD OFFICE 1059 FRANKUN STREET JOHNSTOWN PA 15905-4303 TELEPHONE 814-533-5300 PO Box 520 . Johnstown, PA 15907 ()."". .:,'.. ROSE AUCE CURRAN 33 BOURBON RED DR MECHANICSBURG PA 17050-7952 111.111'11111111.111.111..1...11.111.1.1...1, I , , II. , , II , I , .1.1 *** CHECKING *** PREFERRED MM ACCOUNT Account Number 6560148229 Previous statement balance on December 17, 2006 Total Deposits and Credits: 2 Total Checks and Debits: 2 Cycle Service Charge Ending balance on January 16, 2007 Number of days in this statement period: 31 01/16/2007 6560148229 CYCLE-020 Enclosures 2 Beginning Rate 0.75000 $ 6,112.30 + 1,780.14 3,451.63 o $ 4,440.81 o . Checkinp Account Transactions Date Description 12/29 AC-PA TREASURY DEPT-ANNUITANT 12/31 INTEREST PAYMENT . Check Transactions Serial Date 509 12/20 Amount 1. 000 . 00 . Balance Bv Date Date Balance Date 12/16 6.112.30 12/20 12/31 4.440.81 Balance Date 5.112.30 12/27 PAYER FEDERAL ID NUMBER................. INTEREST PAID YEAR TO DATE.............. THIS STATEMENT OVERDRAFT CHARGES........ THIS STATEMENT RETURNED ITEM CHARGES.... YEAR TO DATE OVERDRAFT CHARGES.......... YEAR TO DATE RETURNED ITEM CHARGES...... PREVIOUS YEAR OVERDRAFT CHARGES......... PREVIOUS YEAR RETURNED ITEM CHARGES..... DEBITS CREDITS 1. 776.63 3.51 Serial 510 Date 12/27 Amount 2.451. 63 Balance Date 2.660.67 12/29 Balance 4.437.30 25-0851535 .00 .00 .00 .00 .00 .00 .00 ....................... -................ --........ -................................................ *** INTEREST EARNED THIS STATEMENT PERIOD *** DAYS IN PERIOD ......................... 31 I NTEREST EARNED ........................ 2. 96 ANNUAL PERCENTAGE YIELD EARNED (APY).... 0.75% .......................... --...................... --................................................ ~:.) SEE REVERSE SIDE FOR IMPORTANT INFORMATION Novemher 2006 ~ Pa.ge 2 ()f 2 For the period ending November 30, 2006 Investor reference number: RET-68156 T RAN SAC II 0 N continued PERSONAL ACCOUNTS continued ROSE ALICE CURRAN UBERTY U.S. GOVERNMENT MONEY MARKET A Fund/Account Number: 2188/16908 Account Opened 08/24/1982 NASDAQ. ticker symbol: lUGXX You have checkwriting privileges to this fund. You have debit card access to this fund. Confirm Trade date date Transaction description '"$ The fund's tht'rty-day yield as of 11/30/06 is 4.4196. Dividends: Reinvest Cap Gains: Reinvest Price Dollar amount per share Shares this transaction Tota/shares owned 11/30 11/30 PREVIOUS BAlANCE as of 11/01/2006 $8,138.60 1.00 8,138.6000 INCOME REINVEST $29.49 1.00 29.4900 8,168.0900 Ending balance as of 11/30/2006 $8, 168.09 1.00 8, 168.0900 For those accounts With a VISA Check Card, the annual fee Will be deducted on December 11, 2006. If the account balance is less than the fee, the account Will be closed and the money applied to the annual fee. The maximum fee of $40 may be reduced or eltminated for certain investors (for example, Federated employees). Federated WORLD-ClASS INVESTMENT MANAGER @ November 2006 ROSE ALICE CURRAN 33 BOURBON RED DR MECHANICS BURG PA 17050-7952 gL Page 1 of 2 For the period ending November 30, 2006 Investor reference number: RET-68156 005921 ./ ~()O - d l(,)./ ((77u ; 11111111111111111111111111111111111111111111111111111111111111 l'O u r Po r t:fO li'o Federated Securitie, Corp, Distrih"tl lbe rundS' SeWor Officer, who~tbe process by wlaid1 tI:te~..~.COIlSldenitl1eftm.!.~ fees. ptqtare5 ao~" assist the Boa:nI in this regard, wbJCb'u ~ In the "Eftl~c..>_4Appro_ of~ CoattaCt"for eadtfund that Is~ at F~VCSlol'5.com. FOR (f For account questiOns, balances, yte/d$, etc. call 1-800-245-4770. For automated phone acce:ssctiJl anytime 1-800-245-2999. 17Y- SertJicefortbe deaf and bearing impaited aua1Jab1lJ at 1-8oo-358-693o-11Y phone ~ "IfJ. Acces3' to fund tnformation ts avail4bllJ on the Internet at Federated1nvestors.com. Early preparation for tax season isk.~. Now is the perfect time to review your account information andtn~e sure it's up-to-date for the 2006 tax season. It's important to .~ain year-end statements for your records. Tired of getting statements via ~1 Experience the convenience of recei~ statements, fund prospectuses, reports, and proxy materlalsvia email with E-De1ivery. To leam more and sign up, call or viSit us online today! TR AN S A C;r.J9~..&'iW' ..:~~!___,:{,::!:~*' '11t-;:~~:~ :.t~:ifi!~.~~f..it. i:.. For fund performanc~.llndrj;llrr;entyieJds log on to Federar.dltJvf1sttN's,com. You may be e/tgf1;J1IJjOr breakpoint discoun.f$ b~fJ!1:!besize ofyourpurcbt1se/iCUrrt!nl boldings or future purchases. Tbesa1lJs cbargeyou P4k1ffI!IY~VftJf! $ltgbtlyfromtbq~U8fJ~ rate due to roundingcalculatkms. Please refertfrt~~us, StaternentofAdlJiIJondllnformatkm or wiita.,,'"t you, ft;iiM".cit:;ladt/i.;v, fo, f";'i'1berinf(7)'/"f;'"atf,$'n. PERSONAL ROSE ALICE CURRAN FEDERATED. FD FOR U.S. GOVT SEeS A Fund/Account Number: 337/8806!108 Account Opened 02/12/1988 NASDAQ ticker symbol: FUSGX Confirm Trade date date Transaction descrfption ACCOUNTS r$ ~.fU;nd'stbirly-day yield as>of1113.QIf)6 ts: 4.6896. ~: Reinvest cap Gains: Reinvest Price Dollar amolJnt pefs(1~fe Shares this transaction Tota/shares otMlBd 12101 11130 PREVIOUS BAlANCE a$of 11/01/2006 INCOME REINVEST 0.03 CHANGE IN INVESTMENT VAlUE Ending balance as of 1.1/30/Z006 $1 ,601 .67 $6.27 $12,54 $1 ,620.48 7.66 7.72 o . 8120 209 .0960 209.0010 209 .9078 7.72 520979 . CHECK NUMBER: OOUlj~~4/~ LH~LK UAI~: POLICY-CERT. NO. PATIENT NAME 130529A CURRAN ROSE A UI/lb/U/ PAT.NO. AIL PYMT NO. 357312-1 /ljLt't'A/ljt'H / DATE PAID 01/16/07 **2,520.00 THE FOLLOWING SERVICES WERE CONSIDERED FOR PAYMENT: AMOUNT AMOUNT MEDICARE AMOUNT SERVICES BY DATES OF SERVICE BILLED APPROVED PAID COUNTRY MEADOWS 12-1 TO 24-2006 3142.45 2520.00 NURSING HOME CUSTODIAL CARE 24 X 105.00 2520.00 TOT A L 2520.00 TOTAL POLICY BENEFITS CHECK TO YOU 2520.00 2520.00 POLICY-CERT. NO. 130529A PATIENT NAME CURRAN ROSE A PAT.NO. P Y M T NO. D ATE ___..g.A--!-O.-.-..___ 561200-1 01/11/07 ~// THE FOLLOWING SERVICES WERE CONSIDERED FOR PAYMENT: AMOUNT PAYMENT AMOUNT MEDICARE BASED ON SERVICES BY DATES OF SERVICE BILLED APPROVED THIS AMT. HOSPITAL HOSPITAL COUNTRY MEADOWS HOSPITAL COUNTRY MEADOWS COUNTRY MEADOWS 9-1 TO 9-2006 9-9 TO 10-2-2006 10-2 TO 10-18-2006 10-18 TO 23-2006 10-23 TO 31-2006 11-1 TO 30-2006 831.33 999.99 1519.63 9999.99 715.12 -- 3105.63 17g~oc> ~/?~ CJ cf fA ~ - cr V S'- NURSING HOME CUSTODIAL CARE CUSTODIAL CARE INTEREST PREVIOUSLY PAID TOT A L TOTAL POLICY BENEFITS CHECK TO YOU 26 X 105.00 2730.00 3150.00 65.95 2368.60 3577.35 3577.35 3577.35 --------- \D~l~ c>oOi:t '#,-W.W U'ltt:iH -...'=' It .~...~~ 5 (1""", ~.~ nrr.1 ti -00 fJ@ ~~ :r:3:. c(\l QQ) :t:% ~~ ~~ ~g ?J-' ~ (0. (/) ~ N - N - -1 ~ - N 0 g ~ 0'\ g ""'" % ~ ~ ~ i ~. I tv 0'\. 0\ VJ o o z ~ ~ c: ~ N 0'\ 0'\ VJ o o o ~ ~ o ->- (;i o t3 o o -..I o ~ (") (;) c ~ ~ I o c ~ ~. ~ {;f} r-.:> ~~ .<.>> ->- bt';.) 0-..1 ,.,0 "'....... r-.:> -------------