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10-17-08 (3)
J 15056(]41169 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO Box 280601 INHERITANCE TAX RETURN ~I /K% O 7~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT 1 ~,1 ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 084202577 06222008 09211925 Decedent's Last Name Suffix Decedent's First Name MI BILOUS EVELYN C (If Applicable) Enter Surviving Spouse's Information 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 INAPPROPRIATE BOXES BELOW ® 1. Original Return ~ 2. Supplemental Retum ~ 3. Remainder Return (date of death prior to 12-13-t32) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 1 O. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0~ Name Daytime Tele~ne Number O FRANK H KELLY 71777476 ° c-~ Firm Name (If Applicable) REGISTER f~F~WILLS ~ ONLY ` KELLY FINANCIAL SER VICES INC "' ` First line of address ~_~ ~ ~' ~~ ~~ ~ -''°' 400 BRIDGE STREET ~ -"I a Second line of address ~ DATE FILED City Or POSt Office State ZIP Code NEW CUMBERLAND PA 17070 correspondent's a-mail address: FRANKKELLY@KELLYTAX . COM Under penalties of perjury, I declare that 1 have examined this return, inGuding 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 o all information of which preparer has any knowledge. SIGNATU E OF PERSON RE O SIBLE FOR FILING RET N ,/ DATE ~~~~ 10.13.08 i' ~~BRIDGE ST, STE #4, NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041169 15056041169 ~_ ~``" 15056042160 REV-1500 EX Decedent's Social Security Number Decedent's Name: EVELYN C BILOUS 084202577 RECAPITULATION 1. Real estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) ..................................... ... 2. 19 , 6 7 0 . 0 0 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. 2 7 , 15 7 . 0 0 6. Jointly Qwned Property (Schedule F) ~ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 9 6 0 0 5 3 9 (Schedule G) ~ Separate Billing Requested .... ... 7. . , 8. Total Gross Assets (total Lines 1 - 7) ................................ ... 8. 5 8 5 , 9 2 3 . 0 0 9. P ( ) .................. Funeral Ex enses 8 Administrative Costs Schedule H g. ... 21 , 8 5 7 . 0 0 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............. .. 10. 5 , 4 8 7 . 0 0 11. . Total Deductions (total Lines 9 & 10) ................................ 11. . . 27, 344.00 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 5 5 8 , 5 7 9. 0 0 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) 1a. 5 5 8 , 5 7 9. 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 5 5 8, 5 7 9. 0 0 (a)(1.2) x .04 5 15. 16. Amount of Line 14 taxable at lineal rate x .0 16. 17. Amount of Line 14 taxable at sibling rate x .12 17. 1 S. Amount of Line 14 taxable at collateral rate x .15 18. 19. TAX DUE ...................................................... .. 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 25,136.06 25,136.06 Side 2 15056042160 15056042160 REV-1500 EX Page 3 Decedent's Complete Address: File Number 2008-00725 DECEDENT'S NAME Evel n C Bilous STREETADDRESS 100 Mt. Allen Drive CITY Mechancisburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty 'd applicable D. Interest E. Penalty Total InterestiPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box 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. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 25,136.06 25,136.06 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 : ....................... . ................ .. ^ 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 "intrust 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? ........................................................ .. ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 1T 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 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. §9116(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. §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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1) 25, 136.06 0.00 0.00 ' REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 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 exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) ' REV-1503 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS 8 BONDS ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) • REV-1504 EX+ (6-98) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN SOLE-PROPR{ETORSHIP RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 Schedule C-1 or C-2 (including all supporting information) must be attached for each closety-held corporationlpartnershipinterest ofthe decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV 1505 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 1. Name of Corporation None State of Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year 3. Type of Business Product/Service 4. 6. Was the Corporation indebted to the decedent? .........................................QYes [~No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ............QYes ~No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-821 Yes ~No If yes, Transfer Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? .......QYes ~No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ......................................................QYes ~No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ......................QYes ~No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ....................QYes ~No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. ~ ~ •' • ~ ~ A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? ........................................QYes ~No If yes, Poskion Annual Salary $ Time Devoted to Business ' REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF Evelyn C. Bilous 1. Name of Partnership None FILE NUMBER 2008-00725 Oate Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business ProductlService 4. Decedent was a ~ Genera{ ~ Limited partner. If decedent was a limited partner, provide initial investment $ 5. A. • • • • • • B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ......................................... QYes ~No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ............ Yes ~No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? []Yes ~No If yes, Transfer ]Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ......... ~ Yes ~ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .......................................... Q Yes ~ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ...................... Q Yes ~ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ........................................ Q Yes ~ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .................... QYes ~No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • ~ ~- • ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. ' REV-1507 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelvn C. Bilous 2008-00725 Atl properly jointly-owned with right of survivorship must be disclosed on Schedule F. SCHEDULE D MORTGAGES ~ NOTES RECEIVABLE (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 Include 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. ({f more space is needed, insert additional sheets of the same s¢e) • REV 1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEF JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G SURVIVING JOINT TENANT(S) NAME I ADDRESS ~ RELATIONSHIPTO DECEDENT A. None B. C. JOINTLY-0WNED PROPERTY: ITEM NUMBER LETTER FOR JDINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FORJDINTLY-HELD REALESTATE. DATE OF DEATH VALUE OFASSET X OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulations I S (If more space is needed, insert additional sheets of the same size) ' REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF _ FILE NUMBER Evelyn C. Bilous 2008-00725 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR REIATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OFASSET °k OF DECD'S INTEREST EXCLUSION (IF APPIICABIE) TAXABLE VALUE 1. Linclon Choice Annuity 92.9812515 539,096 100 539 ,096.00 TOTAL (Also enter on line 7, Recapitulation) I S 5 3 9, 0 9 6. 0 0 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS _ ~_- ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Parthemore Funeral Home, New Cumberland, PA 10,180 B. t ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) StreetAddress City Year(s) Commission Paid: State ZIP 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress City State ZIP Relationship of Claimant to Decedent 4. Probate Fees 517 5. Accountant's Fees 10 , 2 5 3 6. Tax Return Preparer's Fees 5 8 4 ~, Death Advertising 323 TOTAL (Also enter on line 9, Recapitulation) I S 21, 8 5 7 . 0 0 (If more space is needed, insert addNional sheets of the same size) ' REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF ~ ~ FILE NUMBER Evelyn C. Bilous 2008-00725 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (1f more space is needed, insert additional sheets of the same size) ' REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Evelyn C. Bilous FILE NUMBER ~nna_nn~~~ NUMBER NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIPTODECEDENT Do Not ListTrustee(s) AMOUNTORSHARE OF ESTATE 1 TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1. Kathyrn Hackenberg Daughter 500 Spring Grove, PA 2. Robert Bilous Son 500 Camp Hill, PA ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 1 8, AS APPROPRIATE, ON REV 1500 C OVER SHEET 11 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICHAN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLEANDGOVERNMENTALDISTRIBUTIONS TOTAL OF PART tl! -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 5 (Ir more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12.03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY ~ TERM CERTAIN ;heck Box 4 on REV-1500 Cover Shee FILE NUMBER Evelyn C. Bilous 2008-00725 This schedule is to be used for all single life, joint or successive IHe estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other None ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Lffe or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable .............................................. $ 2. Actuarial factor per appropriate table ..................................................... . Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Llne 2) .......................................... . ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ................................................ $ 2. Check appropriate block below and enter corresponding (number) ............................. . Frequency of payout- ^Weekly (52) ^Bi-weekly (26) ^Monthly (12) ^Quarterly (4) ^Semi-annually (2) ^Annually (1) ^Other ( ) 3. Amount of payout per period ............................................................ $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ...................................... . 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^6% ^ 10% ^Variable Rate 6. Adjustment Factor (see instructions) ..................................................... . 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ............................ . If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Lineti) + Line 3 ..................................................... $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX+ (3-04) INHERITANCE TAX SCHEDULE L COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT IN RESI DAENTEDECEDENTRN OR INVASION OF TRUST PRINCIPAL FILE NUMBER 2 ~ ~ 8 - ~ 0 ~ 2 5 I. ESTATE OF - BILOUS EVELYN C (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable None C. Assets: Complete Schedule L-1 1. Real Estate .............................. $ 2. Stocks and Bonds ........................ $ 3. Closely Held Stock/Partnership .............. $ 4. Mortgages and Notes ...................... $ 5. Cash/Misc. Personal Property ............... $ 6. Total from Schedule L-1 .................................................... $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ......................... $ 2. Unpaid Bequests ......................... $ 3. Value of Unincludable Assets ................ $ 4. Total from Schedule L-2 .................................................... $ E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $ F. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . G. Taxable Remainder value (Line E x Line F) ...................................... $ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed .......................................................... $ D. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . E. Taxable value of corpus consumed (Line C x Line D) .............................. $ (Also enter on Line 7, Recapitulation) ' REV-1647 EX+ (9-00) SCHEDULE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. n Will n Trucf I-I n•hor I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. None 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal Ill. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest ...................................................... $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) .. $ 3. Value of Line 1 passing to s ouse at appropriate tax rate Check One ^ 6% J 3% 0% , [ , ^ .................. $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ........................ $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) .. $ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) .. $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .................. $ (If more space is needed, insert additional sheets of the same size) ' REV-1648 EX (11-99)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION ESTATE OF FILE NUMBER Evelvn C. Bilous _ _.2008-00725 SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DATES OF DEATH 01101192 T01213119d) This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1 Taxable Assets total from line 8 {cover sheet) ............................... ................ 1. . 2 Insurance Proceeds on Life of Decedent ................................... ................ 2. . 3 Retirement Benefits ................................................... ................ 3. . 4 JointAssets with Spouse ............................................... ................ 4. . 5. PA Lottery Winnings ................................................... ................ 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary) ... 6a. 6b. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................................................... 6. 7. Total Gross Assets (Add lines 1 thru 6) .................................................... 7. 8. Total Actual Liabilities .................................................................. a. 9. Net Value of Estate (Subtract line 8 from line 7) ............................................. 9. If line 9 is greater than 5200, 000 -STOP. The estate is not eligible to claim the credit. !f nof, continue to Part 1/. Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse ............ 1a. 2a. 3a. b. Decedent .......... 1b. 2b. 3b. c. Joint .............. 1c. 2c. 3c. d. Tax Exempt Income .. 1d. 2d. 3d. e. Other Income not listed above ........ 1e. 2e. 3e. f. Total .............. 1f. 2f. 3f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1f) + (2~ + (3fl - (r3) 4b. Average Joint Exemption Income .................................................... ....... _ If line 4(b) is greater than $40, 000 -STOP. The estate is not eligible to claim the credit. If not continue to Part II/. 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less .................. ..... 1. 2. Multiply by credit percentage (see instructions) ......................................... ..... 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on fine 18 of the cover sheet .............................. ..... 3. 4. Far Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ........................................................... ..... 4. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet... ..... 5. • REV-1649 EX+ (6-98) SCHEDULE O ELECTION UNDER SEC. 9113(A) COM NNERW TANCE TAX RETURNVANiA (SPOUSAL DISTRIBUTIONS) RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn C. Bilous 2008-00725 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. It the election applies to more than one trust or similar arrangement, a separate form muss be filed for each trust. This election applies to the Trust (marital, residual A, 8, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the crust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specificalty identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be wnsidered to have made the election onty as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of khe trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedents surviving spouse P U T N ~, M 2008 YEAR-TO-DATE STATEMENT • I N V~ S T M E N T S Dealer Copy oi/oi/2oo8 - 06/30/200F MR. FRANK H. KELLY H D VEST INVESTMENT SERVICES INC 400 BRIDGE ST STE 4 NEW CUMBERLAN PA 17070-1936 Founded in 1937, Putnam Investments began with the principle that a balance between risk and reward is the mark of e well-rounded financial program. Today, we manage money with a focus on consistent results, and this prudent approach remains the foundation of our investment philosoph}•. Total value as of 06/30/2008: $16,048.24 Client address: EVELYN C BILOUS C/O KATHY HACKENBERG 5041 WALTERSDORFF RD SPRING GROVE PA 17362-7568 For help with your account, contact: Putnam Investments 1-800-354-2228 www.putnam.com ACCOUNT SUMMARY This quarter Year to data Beginning balance 615,862.13 618,467.77 Additions 0.00 0.00 Withdrawals 0.00 0.00 Change in value 186.11 -2,419.53 Ending Balance (06!30/2008) 616,048.24 616,048.24 Are your investments properly diversified? Choosing a mix of diffierent types of investments is a time-tested strategy for pursuing your finanaal goals. Putnam offers a range of funds in many uwestment styles, Talk to your financial representative about opportunities to diversify your portfolio. In the enclosed issue of Putnam Investor, Senior Economist Jonathan Francis discusses challenges and opportunities in a U-oubled economy, and how recessions and presidential elections have affected the stock market historically, PAGE 1 OF ~ 00065 3899849 019156 032577 0002200365 EVELYN C BILOUS 2008 YEAR-TO-DATE STATEMENT 01/01/2008 - 06/30/2008 Summary of your Putnam accounts Fund name Beginning balance (as of 01/0112008) Additions Exchanges in/out PUTNAM INVESTORS FUND-A $10,247.64 $0.00 $0.00 PUTNAM VOYAGER FUND-A 5,812.21 - 0.00 0.00 PUTNAM OTC &EMERG GROWTH-A 2,407_92___ __ 0.00 0.00 Allocation by investment style Total year to date $18 467.77 $0.00 $0.00 _ $0.00 -$2,419.53 $16,048.24 Total this quarter $15,862.13 $0.00 $0.00 $0.00 $186.11 $16,048.24 Summary allocation of your Putnam accounts Allocation by Putnam fund 54% BLEND (8,650.6 54% PUTNAM INVESTORS FUND ~ _ s~cJi® 46% GROWTH 17,397.6 ~~` 32% PUTNAM VOYAGER FUND ~I 0% WCOME 50.0 0% ASSET ALLOCATION 50.0 14%PUTNAM OTC &EMERG GROWTH 0% VALUE SO.O 0% of pottfaGo invastrd i nt a rn a tion a l ly/globally PUTNAM INVESTORS FUND-A Account number: 0001.0316983793 Account open date: 04/03/2000 EVELYN C BILOUS Withdrawals Change in value Ending balance (as of 06/30/2008) $0.00 -$1,597.03 $8,650.61 0.00 -624.03 5.188.18 0.00 -198.47 2.209.45 Account income Thla quarter Year to date Dividends (reinvest) $0.00 $0.00 Capital gains (reinvest) $0.00 $0.00 Average cost basis $14,339.35 Share Number Share Total Date Account activity detai{ Amount price of shares balance value 01!01!2008 Beginning Baiance 14.630 700.454 $10,247.64 06/3012008 Ending Balance 12.350 700.454 $8,650.61 f~,GE ? OF + • 2008 YEAR-TO-DATE STATEMENT 01/01/2008 - 06/30/2008 PUTNAM INVESTORS FUND-A {continued) Account number: 0001-0316983793 Account open date: 04/03/2000 EVELYN C BILOUS Account income This quarter Year to date Dividends (reinvest) $0.00 $0.00 Capital gains (reinvest) $0.00 $0.00 Average cost basis $14,339.35 HISTORY OF YOUR INVESTMENT IN THIS ACCOUNT Initial amount + Additions + Exchanges - Withdrawals = Net amount + Change invested on invested in value 04/03/2000 514,000.00 $0.00 $0.00 $0.00 $14,000.00 -$5,349.39 Capital gains and dividends distributed in cash since initial investment $0.00 = Ending Balance as of 06/30/2008 $8,650.61 PUTNAM VOYAGER FUND-A Account number: 0006-0316983691 Account open date: 04/03!2000 EVELYN C BILOUS Account income This quarter Year to date Dividends {reinvest) $0.00 $0.00 Capital gains {reinvest) $0.00 $0.00 Average cost basis $9,935.96 Share Number Share Total Date Account activity detail Amount price of shares balance value 01/01/2008 Beginning Balance 19.280 301.463 $5 812 21 06/30/2008 Ending Balance 17.210 301.463 $5,188.18 HISTORY OF YOUR INVESTMENT IN THIS ACCOUNT Initial amount + Additions + Exchanges - Withdrawals = Net amount + Change = Ending Balance invested on invested in value as of 04/03/2000 06/30/2008 $9,000.00 $0.00 $0.00 $0.00 $9,000.00 -$3,811.82 $5,188.18 Capital gains and dividends distributed in cash since initial investment $0.00 IIIII~IIIIIIIIIIIII~III~III~II E=(~E 3 OF } 00065 3899849 019157 032579 00023!00365 EVELYN C BILOUS 2008 YEAR-TO-DATE STATEMEN 01/01/2008 - 06/30/200 PUTNAM OTC &EMERG GROWTH-A Account number: 0014-0316950204 Account open date: 04/03/2000 EVELYN C BILOUS Account inconx Dividends (reinvest) Capital gains (reinvest} Average cost basis This quarter Year to date $0.00 $0.00 $0.00 $0.00 $7,846.90 share Number Share Total Oate Account activity detail Amount price of shares balance value 01/01/2008 Beginning Balance 10.070 239.118 $2,407.92 06130!2008 Ending Balance 9.240 239.118 $2,209.45 HISTORY Of YOUR INVESTMENT IN THIS ACCOUNT Initial amount + Additions + Exchanges - Withdrawals = Net amount + Change = Ending Balance invested on invested in value as of 04/03/2000 06/30/2008 $7,000.00 $0.00 $0.00 $0.00 $7,000.00 -$4,790.SS $2,209.45 Capita{ gains and dividends distributed in cash since initial investment $0.00 This quarter Year to date Dividends $0.00 $0.00 Capital gains $0.00 $0.00 Total Income $0.00 $0.00 ~ • Fund 5 years 30 yParsllife inception 1 year annualized annualized Fund name date NAV POP NAV _ ~ ~ POP NAV _ ~ POP PUTNAM INVESTORS FUND-A 12/01/1925 -23.91% -28.28% 5.22% 3.99% -0.43% -1.02% PUTNAM VOYAGER FUND-A 04/01/1969 -9.75% 14.93% 4.23% 3.00% 0.70% 0.10% PUTNAM OTC &EMERG GROWTH-A 11!01!1982 -10.90°~ -16.00% 9.35% 8.06% -3.53% -4.10% If "N/A" appears in any box, performance was either not available or not reported at the time this statement vvas produced, or the fund has not been in operation long enough for performance to be reported. See reverse for information on performance. s" ,r } ;i a ' Historical prices for MET (MetLife, Inc.) -Google Finance Web Images Maps News Shopping Gmail more Portfolios ~ Sign In I Get quotes I Stock. screener u .._ .. Historical prices « Bac_k_to_overview MetLife, Inc.(NYSE:ME'17 - Daily ~ Weekly Jun 20, 2008 -Jun 23, 2008 ~ Update ~ Download to spreadsheet Date Open Hlgh Low Close Volume 23-Jun-OS 57.04 57.40 55.55 55.72 5,156,200 20-Jun-08 57.93 58.56 56.81 56.90 5,206,800 19-Jun-08 56.59 58.57 55.89 58.37 5,800,600 International Google Finance: Canada - U.K, - ~_f~Y,~t_~China~ ,! . ;'...Ci( ~~~:::J .E;.?l ,.> t., >, 2;i li. L F:?r~ J.fic.t'il<"".t'."+"1e7~ .':il.if:,c, ;(,:; 1 E,r f0." Crili~tl'r,~ ~i.1~~s.,. t.w i)f <Ii,~,d~:L; <,3~1£, ~7te y ~h i;fs~~3s,'.L7. ~; :>~r~ w kt.:Ci£#'~C;!. ;.~@' dY '.'l('c',~;@ U=fs I C~v~.~1GY ©2008 Google Google_Home -Help - Prvacy_P_ olicy -Terms of Service ,~ S . '1 Z ~^.~.__ ~ 36,21. 3G~2 Page 1 of 1 http://finance.google.corn/financelhistorical?cid=6643? 8&startdate=Jun+20%2C+2008&... 10/ 13!2008 Please Note: Your Sale Proceeds Check is Attached ~:)MB No 145-0715 AcJdress ZIP Cnde B FOR KK' B R'S N 2008 Proceeds From Broker and Barter Exchange Transactions , arne, , Federal Idenufication Plumber and Form 1099_B Instructions for Recipient Telephone Ntnnber: Brokers and barter exchanges must report proceeds from transactions to Substitute COPY g FCR RECIPIENT you and to the Internal Re~:enue Ser~lce. This form is Jsed to report Melton Investor Services "`IMPORTANT TAX !NFORMAT!CN"' these proceeds. 480 Washmylon Blvd. hrs ~s ~mponant 'ax rnRim .nron uw s .tr'+ny Jersey City, NJ 07310 punished to the internal R venue r race. If '~ _ -hie or a:e n ,n' ,:-, :;er you are reauirecf to the a r.-aum. a nry6gence 0722!2008 ':9156810 22-3367522 penalty or other sanction u,ay be Imposed on --- -------------------- ~ %to rks Binds arc a ~ AL rv r. E ~ ax .v~ rFiPEr G Telephone: t-800-649-3593 rou d this uuome is taxable .end thr. iRS _ !etermmes that it has riot t,e~en rc'pn,ted. $1.674 02 60.00 TO WHOM PAID REPORTED ~ ~:oss ~~-•c~-eas TO IRS U oss:'~o.ePds es~ ,m•~:ssonand :1='~,anr. oiAr~, c,ns . :7escnpnun KATHY NACKENBERG METLIFE. iNC. 5041 WALTERSDORFF RD SPRING GROVE PA 17362-7568 -sector ~D „u.ent= '^errirc ~rcn f~uinber an F ie 124914711370 "9380373 Box 1a. -Shows the trade date of the transactnn Fnr eggreyate lepod~ng, no ~.n'ry mill be present. Box 1b. -For broker transactions, may show the CUSIP (Committee on Uullnrm Security Identification Procedures) number of the item repored. Boz 2. -Shows the proceeds from transactions invoh•h1q stocks, bonds, uth,~r dcrbt ubligalions, commodities, or forward contracts. Cusses on forward cadrar.ts are shown ir: parentheses. This box does not include proceeds irom regulated futures ~.,entracts. RepoA this amount on Schedule D (Form 1040). Capdal Gains and Losses. Sox 4. • Shows backup vJdhholdiny_ ^:anerally, apayer must backup r.ilhhold at 28°~o rate d you did not furnish your taxpayer identifcation number to the payer. See Form W-9, Requast for Taxpayer Identification Number and Cartifir-anon, for Information on backup vnthheldmg. ,nclude this amount on your income tax return as tax withheld. Box 7- - Shows a brief description of the item or service ror ~~hlch the proceeds or b~rteriny income is heing reported. or -rqulated futures contracts and forward ;rntracts. "RFC" or ether appropriate dasuiption may he shn+,vn- For inquiries about your account, contact BNY Mellon Shareowner Services, MetLife's Transfer Agent: Telephone: ' -80Q-649-3593 U.S. Mail: E-Mail: metliferGJbnymellon.coin MetLlfe Internet: wvvw bnymellon cam/sh~reovmer.iisd c/o BNY Mellon Shareowner Services PO Box 358447 Pittsburgh, PA 15252-8447 YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. ^ IMPORTANT TAX RETURN DOCUMENT ATTACHED ^ RETAIN FOR YOUR RECORDS TRANSACTIOAE DETAIL SHAREHOLDER OF -R:',Id ACT~CV DATE '~~ '.r-:"v METLIFE, INC. 07`2212008 ~•HARES SCLC CUSIP :NVIESTCR!G ~ :. ~'-.1 '~.-:,. F.'f -'r!?!'K hll!tvir FR ,. _'- -.-CK~=MGU^JT 001 928 59156810 X249 1 4 71 1 3 70 ^~ACKENBE RKATH 0000 581763 - _52008 $1,674.02 OPENING TRUST INTEREST 3ALANCE f r ai?FS SOL.G ~R!CE ?ER SNARF !;1 _.:~ F ~~ : c~:DS 32.5000 I 325000 51508200 _ $t,674A2 TAX WITHHELD 'r.- =2'?CEEGS i 7LJsSriG TRr;ST N =RE °_ ~ _~ ~;; 50.00 31 67a 02 ^O 6000 PLEASE DETACH BELOW CHECK NUMBER: 56118; __ ~ - -, r'~~...- T ~-'4'Y'-.-,n -._._,,r,.1 ''tom"Yta,.. _.~~"~ ~1 ~' ~ - +'7^' ~' ~'*""^„" ~ ~,~ '~" "~'~. i "`_~ '`'.."__^ 60-160 Met~ife ~~ 5/ Q08 CHEC81N6~f3ER 433 P O BOX 4410 souTH HACI<ENSACK, NJ c~ea~-zot° PAYABLE AT THE BANK OF NEW YORK MEILCN 1N U.S. DOLLARS ~Ci0697801 rA80'69 ^AUTO ~806?48 !~'^e2-7SU8 ai0 DOMOOOOOtO't ~11 ~~~~111~11 ~~1 r~~ll ll~t~~lll~l~l~11~~11 ~1I~Il~ll~lll~~~~llr~ PAY TO THE oRDEROF: KATHY NACKENBERG 5041 WALTERSDORFF RD SPRING GROVE PA 17362-7568 --- ----~ PAY'"«««««,..«,««51,074 02~ t~. ~ t---~ ~ ----- 4UTt,OR!ZF_D 31GNATI,RE It•00 58 L 76 311' t:0 4 3 30 160 :t: 0 L 1~~r0 10 311' Please Note: Your Sale Proceeds Check Is Attached c~nnB No 1x45-o71s BROKER'S Name, Address, 21P Code, 2008 Proceeds From Broker and Barter Exchange Transactions Federal Idenhlicahon Numner ,and p FOri'rt ~ 099-8 Instructions for Recipient Telephone Number. 3rokers and barter exchanges .'must eport proceeds from transactions to Substitute CGPY '3 FGR REC!p!ENT "' 7ou and to the !eternal Revenue 3ernce r~^is form a used to repoR Mellon Investor Services 'MPORTANT TAX INFCRMA r!ON"' 'hese proceeds 480 Washington Bivd. Ths i, anportant t.,x ~nlorn~ahcn ~nrt : ce;ng . Jersey City, NJ 07310 run.ishr:d to the lnien!a~ I:~:~~~nuc :;r~l,ic~ If ' r - ,te ; ',le ~c~ ~,,.., ;ar you are rec;cared to !ife ~:, ratan ,, ~~~ yl,yence 07/221^008 ~'9t5£iR10 22-3367522 I>r~nalty or other sanction n,,,y ~,e n,;;,isad on -------------------__-_-._--------------_-_--- Telephone: 1-800-649-3593 you a !his Income is laxanle un1 the !PS = -exxs Goods. ztc ,_RAt- , tip,„_ -a x',viT~HELD Jeler,nules mat it ;.as n t keen repr;rt~o 31.674 02 ?0 00 TO WHOM P.41D REPORTED 1~ ' :,<s r,,~c ~.,Cs TO IRS ~ _..oss v.^r~~a, IPSS c „nr,issior and ;escnnta~n ROBERT BILOUS 'JIETLIFE, INC. 212 DEERFIELD ROAD --- _______-_.__ .. __ _ f CAMP HILL PA 17011-8434 .. stor iD ?~ n ; de ~ h cn :umuer on Fde 124914715063 179380372 fio,l 1a. - Shovrs the Trade date of the Transaction. For aggregate reporting, ro sorry v~ill cox 4 -Shows backup r:ithholdlnq. GAneratly, a gayer ;nest backup withheld at he Present. a 28°/o rate d you did not rurnish your taxpayer ide~frficahon ,umber to the payer. Box 1b. -For broker transactions, may show the CUSIP (Committee on uniform Secunfy See Form W-9. Request for Taxpayer IdennficaUon Number and Certification, for Identification Procedures) number of the item reported. information on backup withholding. Include this amount on your income tax return as tax withheld. Box 2. -Shows the proceeds from Transactions involving stocks, bonds, other debt obligations, commodities, or forward contracts. Losses on forward rontracts are Shown Box 7. - Shows a brief description of the 11em ur servrre for arhich the proceeds or In Parentheses. This box does not include proceeds from regulated futures contracts. bartering income is being reported. For reyulated futures contracts and forward RepoA this amount on Schedule D (Form 1040), Capital Gains and Lossrls. ,contracts, 'RFC" or other appropnate description Inay be shown. For inquiries about your account, contact BNY Mellon Shareowner Services, MetLife's Transfer Agent: Telephone: 1-800-649-3593 U.S. Mail: E-Mail: metlife~bnymellon com MetLlfe Internet: www.bnymellon comishareowner/isd c/o BNY Mellon Shareowner Services PO Box 358447 Pittsburgh, PA 15252-8447 YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. ^ IMPORTANT TAX RETURN DOCUMENT ATTACHED ^ --- . TRANSACTION DETAfL SHAREHOLDER OF 'RAM3ACTICN CATE .._. R.P-. ~:d METLIFE. INC. 07122!2008 ~HA.RES SOLD CUSIP '~NVEST~R '~D A i..C•:'., 1T ~:EY .-ECK NI iMBER :_. :.--E : -~FCK rMOUN7 00192859156810 ?24914715063 GILOVS--ROBE-0000 581516 0 %52008 $1674.02 OPENING TRUST INTEREST BALANCE r~ARES ~GLD PRICE ?ER SHARE -,81 '=.RvSS PP.OCEEDS 32.5000 32 5000 51.5082000 $1,674.02 TAX WITHHELD rlF T PRO~;~EEGS JLOSMG 'RUST '~.NT R.=ST GAL~? rvCE $0.00 31.674.02 ]0 0000 _ L ETACH B ry T~ _ ~~ 1 ..581! _,., _ ... ~::~-1~'"~.yT~',w."1~-~--'~s+ ~:?r~;n-,-- -~.r-~-f,~ ' to `~ -+rf -~ SE D - E SOW - ~ ~ - ~ :'e ~`' -~ - .~ y't --- 16 Sa 160 MetLife CHECK DATE CHECK NUMBER 433 0?.2512008 ;$1516 P O BOX 4410 SOUTH HACKENSACK, NJ vi505-2010 PAYABLE AT THE BANK OF NEW YORK MELLON tN U.S. DOLLARS ' 0051309 Ot MB 0 n5 "4!JTO n 0 b" Afl 1'^,11 34?4 ~ ,A :?OM+00!)00101 I111"I111'I'111111"111" II II11'11~11 I111~11~111'~11'1~'l ill' PAY TO THE ORDER OF: ROBERT BILOUS 212 DEERFIELD ROAD CAMP HILL PA 17011-$434 PAY"'#*####.####*#$1,674 02 ~'~ ' -' - ~--~' ~t---._ { iU7~iCRi7'-=G SICGPtril•!.iRE il'00 SIB L 5 1611' +:0 4 3 30 i 60 L+: 0 1 i1rr0 LO 3i1' • Inicrest Chcck:ing Accou><it Staicmcnt ,- PNCBANK 1'NC \1'r.dth \4:ut.r~cuu•t)t -7 j~ "~ ~:p.~.r ~ .~"~JY~~ Primary account number. 51-4000-4575 Page 1 of 2 For the period 07/10/2008 to 08/08/2008 Number of enclosures: 0 t EVELYN C BI LOUS LJ' For 24-hour banking, and transaction or 50G1 WALTERSDORFF RD `-'interest rate information, sign on to 'Q t'NC Bank Online Banking at pnc.com. SPRING GROVE PA 17362-7568 For customer service call 1-888-762-6126 between tl,e I,otJrs of 6 AM and Midnight ET. Movingi• Please contact tts at 1 888-762-6226 ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit tts at pnc.com TDD terminal: 1-800-531-1648 r Pbr hrar u~~ mrP-au rd rhenrc Drily (}~'ERDIZV'"I' 1'ltO'I'TX'"LION foryonr I'N(' Bank checking account l l'you haven't already done so, stop into your local YN(' Bank branch today to open and enroll your PNC Bank Selecl Kewards ~~isa 1'lalinum C ud. 11~hat could be better Ihan the salcty and cmntoti of kno,vin~ vou'-r I,rotected') - S~tting a sound inveshnent course myuires expet1ise, empathy and experience. I'N(' [nvesltnents guides theirclienls toward real-world srrhtlions designed to help Ihan meet their goals. l~or mom intonnatiun stop by a PN(' Branch or visit pnc.com \ot TDIC' Insnt•ed * 1I:+} Lose ~'alae * ~0 13•rnk Guar»nlec I-uporlunt L~~~eslor Inli-rn+ation: Securities and brokerage services are provided by YNC Im~estnrents I_I_(', member FIN1Z~ and SIYC. :lnnuilics and other insurance products are ollct~:d by I'tiC' h}surance Sets ires, LL(' a licensed insurance agency. Interest Checking Account Summary Evelyn C Bilotts Account number: 51-4000-4575 Balance Summary Please see tl,e Activity Detail section For additional information. E3eginninq Deposits and Cher><s and other Ending balance other addifions deductions balance Average monthly Charges balance and fees (,~i?(i.t i (J(1 Interest Summary As of 08108, a total of $36.92 in interest was paid this year. Annual ?ercentage Number of days Average r.ollected Interest Paid Yield Earned (APYE) m interest period balance for AP YE this period Activity Detail Online and Electronic Banking Deductions Tl,ere was 1 Online or Electronic Banking Date Amount Description Deduction totaling 527,156.78. I)"7.'t~i ~~l,l?(i.(~ "t~1:111~{CI "t~rr:~tCl/11tH OO1)1)1)USJ}O{Ji5)I)75).j Other Deductions There was 1 Other Deduction totaling Da•e Amount Description 5.00. UZ' Iii (N) UttJstantling item (:Irrx' FORM953R-1005 Reviewing Your Statement ~~~~ PNCBANK 1'leasr t~rie-- this stalrnuttt c;u~rfitlly and rrconcilr it -- ith your rccr,rtls. ('al{ the lclrphone number i,n the upper right side of the lirsl page r~Cthis slatrtnenl il`. • you have any questions n_gartlins votu• acconnl(s): • vour name or addtrss is i:ncun~ect: • you havr any yuesliuns t,~gardins inlrresl paid to an intrrrsl-hearing account. E3alancing Your Account lJpdate Your Account Register Compare: the arti- ily drlail section oCyour stalemenl to your accotuil trgistrr. Check Off: :VI items in your account trsislrr that also appear on yrntr statement. Remember to begin ~~ ith the ending bate of•~ our last slatenteni. (\n asterisk ; * } -vill appear in the ('becks section iClhere is a sap in the Ilstit-g of consrcutive check numhrrs.) Add to Your Account Register \ny deposits or adclitirn-s including intemst payntrnls and ;\"I~i\3 or electronic deposits Balance: listed on the stalemenl that an; not ahrady entered in your register. Subtract From Your Account :\ny account deductions includins lees and :\1'Z{ or electronic deductions listed on the Register Balance: stulrntcnl that arc not already enlrtrd in your register. pdate Your Statement Information Step 1: :1dd losethrr d~ posits and other additions li~trd in vow• account rceistcr but not on vour st.dcntrnt. Step 2: :\dd losclher chicks and other drductiats listed in vour amount resister but not on ~-our statement. Ckock Namber or Dedactioa Description Amount Total B Date of Dapoait I Amount Total A Stop 3: Enter the coding balarnr rrcordcd on your stalrmcnt _\,.Id drposils and other additions not recorded Total :\ + Subtotal- Subtract checks and olhrr deductions not recorded "Dotal 13 - g '17-e rrsuh should equal your amount trgisirr balance = g Verification of Direct Deposits 'I'o verily whether a dimct deposit or olhrc Iranster to yonr arrotutl b.,, ~,rcun~rd. call us 7 days a -vrek from C a)(l .\.;t1. to \lidnight (l."l') at the customer service number listed nn the upper right side oCthe 17rst page ol~lhis slalentent. Electronic Funds Transfers In c:rs0 of errors or questions about your electr•aric h;msletx or if 1'c~u necxl more intro maliou about a hander, call us 7 days a week from fi:0(1 :1 \t. to \lidnight t1^ 1) at the cnstomzr sen~rce tmmbCl' IlSielt OII 1110 Ilhpel' nkhl slue OI 1hC fitxt page of tbic slatenrent. t h. if yon prefer. please write ns at: Customer Sen•icz. I'.t r. Roc 6t19. 1'i0.cbnrgh, P:~ 15230-(1609. If you believe there is a prohlzn,, you nnut coutacl us no later than fi0 ,Lrys al)er the ending rL•rte of the lira st:rtement on ,vhich Ihz error or problem appc:u~ed. ti'ou will need to pro,•ide the li,llo,ving inlla•nudion: `r'oar name and account numberts): • .~ dzsetiptirnr of the ennr or the hhnslzr you are questirnrine. Please explain as clearly as you can -~~hy you need more information or o~h1' yon lretlCCO an 21T01' 1-'aS made: 'I Le dullar;nnonul aflhe cuspeckd error. tl'z ,vill invzsrigatc yonr congrlaint and will correct anV en~or promptly If the in,•estirs;rtion takes looser than 10 Inrsinecc days, wz -vill credit your account 1br the auumnt you thick is iu ztrur. so Ural yon will have nae of the lauds awing the tiwe i1 takes us to complete our iut estigaliou. FORM953R-1005 Member FDIC Q Equal Housing Lender C~ Lincoln 5M Financial Groups L~nco/n Cho~cePlus 1'c> l;„x';48 annuity Quarterly tifatement ~^~ j/ P,nt Wayne. Iti [6xol -2; tx 2nd Quarter 2008 Ylwr .lcclwN Lforuat}w Your .~®oaU Contact taformalioH ('oatrxl Owner: IiVI{LY'Y ('. l;ll;OCS LiupdeC'hoiceYlusllB: 42-9x135(5 Kepreseutative: frank H. Kelly .lotouitaet: 1iV1'.I.Yti l'. 1;11,(1liS Plato'fype: Van-(luaGli~xi ltrokerllhraler: ill) V}iST ltiV}?S7~MEN{' C'outract Naieclive Uale: 1.27 3(N)3 If you have any yuastions r •garding this statement. plwse call l inculn Financial (;ruup at xlN)-x26-6x4x ur visit ,wr websita at +v+aw.lfg.axn Your uarterl .lccoutot Value ~ stye 3/31108 \et .+lclhi ty l:aia /boss ~'atue 6!311!1!8 8559,193 9x tS16,50(1.(N)) (53,59x.1x) 6519,095.x0 Ralar a, your contract li,r surrender charge inlittntatiun. Surrender Value: 6513,64x.x2 Yoaf .~9(iet :1111-catll-Y I''YCd dame .1SSet ('lass" Perceul;~! .1l'WUYt Value .~F Gn>vvth l,S Large Growth 3.x °% s14,912.07 Fid Gn,wth IiS Large growth ~.4 °% S tx,?67.25 I.VIP .tan ('a .1p lS Larga (;rowth 2.(1 °% 6((1,696.60 1'ut Health Sc US Large Growth +.4'40 `51x,179.97 :1F (;rwth-Inc GS Larga Hland ..4 "., s IR,ax4.32 LV}P T>rl So Aw US Larga Hleud 6. I °%o ~33,07Q.35 :1H GrwlhXclnc US Large Value 3.9 °'o S2b,91436 Fid liy-Inc IJS }.urge Value 7.3 °/u 639,213.63 V1Fti l;tilitias liS Large Value 4.7 qo 625,437.05 1'ut GrwthXc}nc l!S Large Value ~ 4 "~0 615,606.7x VH Regency L;S slid Value 5.0 =i. 526,979?3 Del Ctrnd t'S Smal] growth ;.5 "% S I x.x63.7x Fid (h~erseas International F.yty x.7 ~'0 646,769.Ix LV[P Vion It Va Internuuuoal Fyty 6.0 °'o 532,199.06 .1H<ilbt }'ach (iloballiyuity 3J% 520,12Lxx .1C [nl]tn Prot Hund SA "% S29?50.37 Dal HivJt 1'iald Hond L9 °% .610,0x9.27 I.V[P lhl Hond 43+md 33.6"fo 6127.197.57 LN Vtuy ~lrkt Money :Market 3.4 "0 512,74_;.Ox Pen:antages lass than I"., may not be rcprrsented in the pia chutt. lhre to nrunding, the percrnlag.-s shown may not ba ~yual to I (Ili°~o. `Asset ('lass is detemtined by Lincoln ~lational Life Insurance Company and is n,x considered investment advice. Ytwr Performance Summ .~uuuallzed Perfurmaece ('arrest (jaarler fear to Uate t Year 3 Year ~ Year 10 fear _- --- _. (1) 65 "i,) I x.24 °'o) 17.74 "o) 1.79 "u 5.6(1 °o Vla1 Your Perti>nnance Sununary is rha personal rate of rctutn that represents the individual perlbrntance of the investment(s) you have selected !br your IxiAfolio. lha calculation includes activity in yexlr account (such as conlri]wlions, exchanges among mvestment options, etc.) using daily share pricy in et]ect when the activity ,xcutxd. Hal:ausa the timing of your investments and withdrawals will vary. your personal investment results will generally not be the same as the investment returns yuotad tar the individual tirnds y,x< have chosen. Pertiumance data represents past parliirntance. Past performance does m,t guarantee future results. Your lac tiu~-`I'o-Uate Salome ('rwlriUutious V1`ithJrawals (:ai W Lens ___ 5-1717;9(1 ~6 '449.351.06 5164,556.30 Gain Lass may be understated ifyour contract is subject to administrative fees. I-incoln Pinancinl Group i.+ the mark~:un~ name kx I inudn \uh,,nal C.aporation and its ,initiates. ~ 37708 7~ha Lincoln A'auonal Life Insurance (~ompany. 9? 4x12515 tiV}?l.y"ti (. fflL(~l S Page I of nn0ri(7(N) SY~116'1:7 't ;6647 Kall}'. Prank 11 ~~(tV 33(1 ia~a ,z sn ~ 4UC I'Udd `iUIU IUa vs I lr 3~ z l 1118 ~, of 6fitlnltl Sun-6er ~ umber Mudd lame I nil Value of Lnils Value \rl .\clivily laiNl.uss l'uil Valve of I nits \'alur V Gurwth +)"rr)315 1.~44.6I68 515.136.19 15457.83 J 57.33.71 +).!)39322 LSU0.3106 514.91'.u7 Iid(innvth 711xx512 3.5x1.6302 ~lK,xx)92 (555Z'S) 5624.58 ".:1247(11 _'.507.1771 51x.367_'5 1 V1l'Jnnt'a.\p It.o~K4=17 83x_'.111 ?ilu,+)46.16 1'631 .(16) yR;.~O 1;.1;7578 N14.1+)K7 lO.(r96.60 IhulL+althtic lu.3x4977 1.795J771 518,649.10 ('353',.871 56x.'4 111.4227(1{ t.744.2t>Er5 51x.179.!>7 V Grwth Inc 1 3.113737 L392.13U3 519,567.4(1 155x3.65 1 15499.43 1 1'_.753710 1.4-19.3?+)I 518.-184.32 tVll'I)eltiu.Aw 11.1564704 ?.277.8+)'N) ~33.xtd1.22 151,019Z4J 52_'9.37 11.946684 '_'12.5~d4 5+3.070.35 \I3GrwthBclnc I L630410 1.!)24.0416 522.377.39 15667.33) 15785.70) 11.191(!23 Lx68.K516 520,5)14.36 I~idlSllnc ~ t?.566344 ;.~113U540 54''.x89.61 1'11.:'73'91 152.4(12.691 I1-82x608 3.315.1519 539_'1;.63 \lFti l'0lities 15.'55168 1.~-12.1+)50 5?-1?U'.j4 ib7{5.~b) 11.K95.27 16.981152 1,4y7.95H11 S'5.~13705 I'm (;Huth&Inc I I_'334(r3 1.51 ;.8674 517,UA7.49 15503.98) 15896. Ti) 10.613650 I.-170.1.138 515.(~t)6."'K \13R~gency 17.132553 1.561.'685 526.75208 15835.40) 51,057.55 17.784946 L516.9700 526,979.'_'3 Ik•I fund ".41;888 3.579.1536 519,121.56 15575.xx 1 5318.10 '.529913 2.505.1723 51 x.)ibl.?8 I id OVertiea% I I. 120631 4._'91.`)869 5.18,6'6.63 151.45LN8) t'f~305.~[7) I L218661 -1.168.8738 5-16.769.IK L\'IP Vk>n It Va X2.512762 I.`1-1.6156 534.77356 1$L016.15 1 ($1.?58.35 J '1.-161615 I.."(HLi09l 532.199.1)6 \B Glbl Tech 3.26 3801 4,757.8363 520.2tte~.47 1562:1.75) 5459.16 4.354104 4.62 L.3586 520,121.88 \(~ Intltn Prot 11.5'01177 '.631.6213 530.316.48 15857.73) (520x.38) I I.-93204 '.556.1 348 M?9._'S0_37 UrlViiehS"field 13.010707 "`94.3x51) 510,335.51 ($304..31) 558.07 13.075812 771.598(1 SIt).Ox4?7 I VIP Del Bond I-3.510662 y.142_'-779 562.843.35 ly3.ib4.4O 1 (51.8'76.18) 14.323')91 K.880.f)369 5127.197.57 I.V1P ~1ny'vtrkt Iu.y72588 1.194.0954 .513,10'.32 15376.14) 516.90 10.986905 LI59.x424 512.743.08 Yuar darted :~ccudut Activi Date \ctivity Fudd tisme \muudt Call Value \uleber u[ twits 3 I ~ 118 \utomaNc withdrawal 1555(10.110 ) \F Gn~wth Fid Growth LVIP Jan ('a Ap \P Gn~ih-Inc I. VIP fkl So :\w :Ui Gn+~haclnc l=id F.y-1n1; W'S Utilities 1'111 GnvrhXzlnc l3 Regency I)el Trend Fid (herseas LVIP Muo It Va \N Glbl f~•ch ~(' [ntltn Pmt Del high 5'ield LVIP Del Bund i.ti Vlny 41rkt 5 15 OK \ututnatic withdrawal \F Gruwgh fid Gruw~h LVIP lan Ca Ap 1'ut Health Sc .~ Grwth-Inc I.VlP I7e1 So :1w '~ GnvthNr.(nc fid Iiy-Inc ~11'S Utilities V13 Regency Dal 1'reod Fid Overseas I.4'IY Ylon h Va \B Gibl Jech \l Inllln Prot lle) Hieh Yield L VI(' Uel Bond 155500.00 ) I in.,~ln I~inancral Ganrp is th~• murk~•tin~ narn<• ti+r Lln~+~In Vati,~nsl ('~+rix+ratiun and its .+Ililiates. kJ:uOK I'heLin.~dn\a4unalLilalnsuran~e('+unpany. +)~ +Jxf 2515 I:V)~LY~ ('. 1310 JI S !~utiu1~00 5!llVli7 x3669 K.•Ily. frank tl "'1~ti 131) 1$150.10 ) 151x3.63 ) 151()9.36 1 15180?7 ) 15192.35 ) (5332.62 ) 15?~0.84 1 15422.71 ) 1$247.38 ) (5167.10 1 35271.27 ) t51x4.x8 ) 15481.91 1 15342.16 ) 15198.'3 ) I $294.60 ) 151102.15 ) ISI?90.71 ) t5127J1 ) (5151.59 ) 151x5.12 ) (5111.50 ) 15175.37 1 151!)6.41 ) 15;341.13 ) 15226.42 ) 15432.49 J i S_'SLl)4 ) 15171 l)2 1 1'3'80.59 ) 15192.65 ) l 539(L27 1 i 5344,40 J 15211.35 ) i 5279.93 ) 15100.01 ) 151.'32.57 1 +).973738 '.3(10(125 13.3896118 10.11),2603 13?3(1346 I.3.986594 11."80(174 i 2.710956 16.462756 1 1. 328xx2 17.K262b3 3>~iJ(x 11.5_4174 22.73497(1 ~ ?75974 1 1.489318 13.196876 14.389612 11).976294 UL677769 7.7001 36 14 '83825 10.487249 14.13657x 16.1 JK 1776 12.637094 13.6(17359 1.4x0355 12.131407 19?929Fi5 8.021 107 12?66633 2 3 5 43-157 4.2315 3.30 11.429811 13. ~ I ~>5'6 11.37-1348 115.0.395 ) (25.1547 ) 18.1675 ) 1 17.4975 ) 11-3.53x5 ) 1'_2.1945 ) 118.''469 1 133?556 ) (15.0266 1 1 14.7494 1 l15?l~4 ) 125.1-'9'? ) 141.x15N1 ) t { 5.0444 ) t 4(1_35 y0 1 (25.6412 ) 17.'-1(15 ) 189.0"'83 ) 1 l L6351 ) 114.3841 ) (24 (141 I ) 17.x/160 ) (16.73'2 1 113.8952 ) 121'122 ) 11?.4171 ) (31.'x35 ) ! 1=1.1613 i I I -3.1197 3 ) 1 1454 36 1 1'4.0174 ) 139 U(.7K 1 1 I-3.1x39 ) (-34.31164 ) 1245059 ) 1'. 3974 1 185.1349 ) Uale ~clivitV Punt \aroe I 1 ~lny ~1rkt ~rnunnl 1'nit Value 'umber of 1'uils 1S12Z.12) I(Lc)t41928 111.1?01 1 6 I 1 118 .lutomalic withdrawal 155,1111.11(1 ) 1P Growth I~id Growth 1'5154.14 1 15188..0 1 I O. ~64t) iS ~ ,8;275 (14.87?G ) 1'4.8573 1 1 V1P Jan Cn :gyp t ~ 112?0) 13.cN11 SUB 1 8.071 1 ) lhtt Ilealth tic: (5(82.23) 10.5;9075 117._'9(N) ) :1FGrwth-Inc 1X194.87) 11.563239 114.3675 ) LVIP (kl Su .1w 15345.49) 15.7521 33 (21.9.;29 ) 113 (irwthAc' Inc 15220.07 1 11.878984 118.52(,0 ) Fid t-:y-Inc ('5418.09) 12.7221U2 132.86;0 ) ~1FS l;hlities 15257.34) 17.330327 114.8491 ) I'ut GnvthXdnc ! $165.86) 1 1.378646 (14.5764 ) ~ti Regency (5283.54) 18.855483 t 1.0375 ) Dcl l~rend 1$198. i5) 7.9871'_8 1'4.8 i 37 1 Fid (h~erseas 15479.78) I I-6(,0563 t41. 1261 ) LVIP Ion It Va 15329.59) '~.l(><)773 ~ 114.8727 ) lA(ilbll'ech ($212.17 1 4-631289 (458123 ) U' fntltn Prot 152832(1 1 I L176262 (25.3;94 ) Ikl High Yield 1$102.15) 13.354558 17.6491 ) LV[P Ihl Bond tSl.r-16.12) 13.155988 188.0278 1 LN'~Iny ~Irk1 15126.31) 10.985592 l l 1.4978 ) Ywr Frtnre . Wocatioss .1s of 6. +O.08, ycwr contract instructions show that additional contributions will be alhx:ated acco rding to thew panentages: 10"•;, Put Health tic: 10°%!~1Fti [.`tilities 10°~o Af3 (1161 Tech IU°~ .>3~ Grwth-lnc I1Wio I'ut GnvthXclnc 30°%LVIP Del Hond 10°~ I~id I:y-Inc 10"-o Dal l~rend Ywr Nutitkatiois atd IJNisch-snres •7~his confimtation is przparad by the Lincoln tiational Lite Insurance Company or one of its t_ite Insurance company at7iliates pursuant to its agr eement with the principal underwriter of the insurance sectrritias describe(! herein, lix the benefit of the selling tm>ker dealer. •tiotity Lincoln promptly if infixmation contained in this dcxument is not accurate. Please feel free to re-confirm any oral communication in writi ng to further protect your tights. • Intarest rotas and crctliting methcxlology will be provided to you upon reyuest and tae of charge. l +nculn Financial Gawp i. the rnarkating name fix I inu+ln \ational Curporttion aml its aftiliatas. ~ ?008 fha I.incolo ~atiunal Lita Insurance ('ompany. ~t2 ~,812515 f•VELY\ ('. LiILOGti nO1Nd)t)0 `iYHVli7 ((46697 Kclly, frank H '70'S~ 33(1 oiazs a w fake 3 .,f 3 ``~r/ / `` // ~ ~ A Family Tradition Of Caring' ~'` ~-~ PA RTH E MOR E Funeral Ho & Cremation Services, Inc. Mrs. Katherine E. Hack , 6/25/2008 5041 Waltersdorff Road ~, ~ S rin Grove, PA 17362 P g For the service of Evelyn C. Bilous 1 2113 Bri~1~c ~n'cet P.O. 8~~~ -13 ~e~° C~u~ihcrl,uxl. PA I?U7(l l?I~I ~,~-7?~I f i <tx) ?~-1-~3~4fi ~~~~~~c.harthci~wrc.curn Gilbert 1'V'. P;irthcnun~c 1=~wndcr (;filbert J. Parthcrnurc. SuPer~ i;ur Steti~hcn K. Pur~hemure l'FSP Bruce K. Parthemore. Pre-Need Co~~rdinatur, CPC Prolc.~unuil 19embcrshiPs; NI~[)A • PFDA [)CFDr~ ~ CY~FDA ,,, ~,,,,,.,u,,,, ,,w. G(`'~ D~N ~~. r;,~~~ ~,.~~ ~,~,,,,. ~~,~ i~~„~,i,~ >,,,~ fir,,,, 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 regazd 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. Terms ' Due Date Account # Net 30 7/25/2Q08 2008064.0 ~ Description ~ Amount ~ SERVICES 8r. MERCHANDISE Memorialization Funeral Service Grouping Stainless Steel Casket Total Services and Merchandise CASH ADVANCE ITEMS Death Notice, Harrisburg Patriot Death Notice, Beacon, NY 15 Certified Copies of Death Certificate Hairdresser Clergy Honorarium Organist Honorarium Soloist Honorarium Altaz Servers Flowers, Casket Spray Total Cash Advances ,~ ~ ~~ i~ Total Payments/Credits 4 ~ Balance Due ~,.. ~~ i ~ _~. :1~~' gab 5,910.00 3,395.00 9,305.00 133.67 71.53 90.00 40.00 150.00 100.00 75.00 15.00 200.00 875.20 $10,180.20 s-lo,lao.2o $o.oo RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S uare Carlisle, PA 1713 Receipt Date: Receipt Time: Receipt No.: 7/09/2008 15:17:25 105331'7 BILOUS EVELYN C Estate File No.: 2008-00725 Paid By Remarks: KATHY HACKENBERG AKK Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 460.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D CERT COPIES 15.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 4559 $517.00 Total Received......... $517.00 'i <; •+1 ~>~'L: ha , •~ ~%L. Luz ~c_ /`~rC '., ~{ ~ b~ ~ ~ .n~, _; ~- ~,-rt~n.es~e~..m~ ,raR~l., r ._ ~~ -, ~ i v, ~.- ~ -,-,,. ,~ ,.d ~ ~, ,, ~, „~ ~_ ~i ~. , r ,- b, e _ .i , ~ ~I <_~~'?'~s'~w~`Z~~".r=l c~~c~_ __ -enpeu:~- N0..3 B PN CBAT~K I'NC Bank, N.A. 040 ~ h' 60-1273/313 ~~ Ccnlral PA ; DATE 7 ~2 0 ~G ~ -------- ~. PAY TO THE ~' ~ ~' ORDER OF / „ ,~ f"_i ~.~ x ~J~~~ ~ ru ~cc c. cYc; ~~rl ~c 5 .9,~~1 i c~ - -- DOLLARS 8 - ~ , a( '~ ~J • .~; ESTATE OF /",iC ~r•v ~ /~~ ~U~ ~~ l .. ., .. \ P ~ 11V ~ EXECUTOFL ADMINISTRATOR `, J _ /~ZO `jI•I K , CCS. r>N :z Lea (s FOR . . M' PERSONAL . _ REPRESENTATIVE ~ I~ -- - i' ------ --- ~ M' TRUSTEE , x:03 L312738~: 5004690793ii' ( Kelly Financial Services Inc 400 Bridge St. Suite 4 New Cumberland PA 17070 Tel: (717) 774-7536 Fax: (717) 774-4802 October 13, 2008 Estate of Evelyn C. Bilous c/oKathy Hackenberg, Co-Executrix 5041 Waltersdorf Road Spiting Grove, PA 17362 For Professional Services Rendered: Preparation of REV1500 - PA Inheritance Taxa Ret. 10,250.00 Preparation fo final 1040 -Evelyn C. Bilous 289.00 Preparation of Fidicuary Income Tax Return 295.00 Total Fee ................................................... $ 10,834.00 Prior Balance ............................................. $ 0.00 Received on Account ................................ $ 0.00 Amount Due .............................................. $ 10,834.00 .'he Patriot-News Co. 812 Market St. Harrisburg, PA 17101 Inquiries - 717-255-8292 E3ILOUS 221 DEERFIELD ROAD CAMP NILL c~he ~lahiot Neu-s NOw you know PA 17011 INVOICE ALL CHARGES ARE NE' AG4j Jj NAME AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT 190064 1311 OUS 0001889864 08/20/08 REGULAR BASIC AD CHARGE $2.50 190064 t31LOUS 0001889864 08/21/08 REGULAR BASIC AD CHARGE $80.19 190064 BILOUS 0001889864 08!28/08 REGULAR BASIC AD CHARGE $80.19 190064 BILOUS 0001889864 09/04/08 REGULAR BASIC AD CHARGE $80.19 AFFIDAVIT CHARGE $5.00 TOTAL: 5248.07 REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL Chicago, IL 60673-1237 Please include the Account # or Ad Order # (above} with your remittance--Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication '._I J -' CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Yele: (717) 2493188 Fax: (717) 249-2889 September 5, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Robert Bilous RE: Evelyn Bilous Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: August 22, August 29, and September 5, 2008 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director i h .~ ess a ~, ~~~~~ 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 KATHERINE E. HACKENBERG 5041 WALTERSDORFF ROAD SPRING GROVE, PA 17362 Form PB-01 QUESTIONS? CALL: 717 697-4666 RESIDENT # UNIT STMT. DATE 10612 258 W 06/30/2008 RESIDENT S Mrs. EVELYN C. BILOUS TOTAL AMOUN~~ DUE $5,399.85 DATE DUE 07!31!2008 DATE DESCRIPTION RATE Daysl ~ CHARGES Units CREDITS BALANCE Balance Forward 7,978.2 06/19/08 PAYMENT RECEIVED -THANK YOU'.!! 7,978.25 0.00 *** Nursing Care *** 06/05/08 BARBER/BEAUTY SHOP 13.00 1.00 13.00 13.00 SHAMPOO/SET 06/12/08 BARBER/BEAUTY SHOP 21.00 1.00 21.00 34.00 SHAMPOO/SET/CUT 06/21/08 RM/ BRD -NURSING -SEMI-PVT 247.00 21.00 5,187.00 5,221.00 06/01-06/21 06/21/08 FRUIT BEVERAGE 1.85 21.00 38.85 5,259.85 - _ y -- °---~• ~ • Tt uuTFF Xi. 1.25 12.00 140.00 5,399.85 ~~ -- - - , i f NC Rank, N. q. U4U Central Yq . NO. Z ~I PAY TO THE ORDER OF /~7css.,~~( , ~~~~ DATE +11~~~u Sf 60-1273/313 ;~ Mq' I ~ u;~sAti J J ~ .vd~t~y~s,C~ ~.vt _ ; C ~~~ ~ X Z ~ , Js uC CJh / A jZ /J,ud ,~cc, ESTAT ~ --_-_-_,-_--- A R S 8 ., ~~ ~ FOR ~/J___ C~__`'S~: j 'l. U. ~f . a ~s' /'ACS /VG ~~ ~' ~Z ~ -~ Y ~~ ~ ~ EXECUTOW ~ ti ~~ _ G1/~US( G ~??f(~S~ - _ ._... _ _ ADMINISTRATOR M' ` I . - ~ / PERSONAL { REPRESENTATIVE , _. ---.:_ _-___ __ ~:03131273B~: 500469079311 ~ TRUSTEE 1 RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 10612 5,399.85 0.00 0.00 0.00 O.UO $5,399.85 RESIDENT NAME Mrs. EVELYN C. BILOU5 roan ro-~~i N!A A 1% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. 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