HomeMy WebLinkAbout06-25-09~ REV-1500 EX (OB-OS)
PA DepaNnent d Revenue
Bureau d IrMNWuaI Taxes
Po Box ztronol
Hertahtm. PA 17125-0801
ENTER DECEDENT INFORMATION BELOW
Socal SacurHy Number Date of Death
578-05-6217 (03/19/2008
Deoedem's Last Name ~ Suffix
,Brechbill ' ~~
(If Applluble) Enter Surviving Spoutro's Information Below
Spouse's last Name Suffix Spouse's First Name MI
........... I ......... ._____. ......._ .._ .. ... ............ _...,
I
Brechbill ~ I~~ Helen R
Spouse's Social Sewrily Number
225-10-1394 - { THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
i REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
S,ltl t. Odginal Rehm O 2. Supplemental Retum O 3. Remainder Retum (date of death
poor to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compremise (date of O 5. Federal Estate Tax Retum Required
deaM after 12-12-82)
t)D 8. Decedent Died Testate O 7. Decedent Malntalned a Living Trust i 8. Total Number d Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceetla Received O 10. Spousal Poverty CredU (date d death O 71. Election a tax under Sec. 9113(A)
belvroen 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUL TA% INFORMATN)N SNOULD BE DIRECTED T0:
Name
' Daytime Tale Number tV
Brechbill Glen I (201)568-
~~~
-~-- --_-~~.~- O
~
Firm Name (If AoolinMel n sa
First line of address ~
_ ,-,
'-~r
59 Oak Avenue <~~ ti
-
-~ z
1
.. ~..
..... .. .. _......_
Second Itne of address
I ~
-"i ~~
{ p'('
i ';
II C
DATE FILED
City or Post Olfice State ZIP Code ---------_..._.__----.._____..._
_. i -_ __..._._~.,~
;Tenafly ~NJ 07670
Correspondent's a-man address: dudeQintergate.com www.pertumerbook.com
Under penePoes d psfjury, I declare that I nave examined thk return, InG Wirg accompanying schedules aM statements, aM W the best d my knowledge and belie},
it is true, coned end CompbM. Dederetion d preperer atlrer than the personal representalive Is based on all In/ormatlon d which praparer nee any knowedge
ATUR F SON RASP ISLE FOR FIUNG RETURN D 7E~ G
ADDRESS I ~ ._ _. _ __ _ ._~~ _O I ..
59 Oak Avenue, Tenafly, New Jersey 07670
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS -- ---- --~ ~ _-~ _ --
PLEASE YBE ORIGINAL FORM ONLY
Side 1
L 15056051058 15056051058
15056051058
OFFICIAL USE ONLY
CaunN Code Year File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~ ~ n s °`ta
Date of Birth
02/09/1910
Decedent's First Name MI
--~ ---,
Ray I ',,
~`~
HISTORIC TAX RATES
EFFECTIVE AS OF DATE OF DEATH SPOUSE LINEAL SIBLING COLLATERAL'
0407-1826 to 04-22-1846 0% 0% 2 1/2% 2 1/2%
0423-1846 to 07-10-1917 0 0 5 5
07-11-1917 to 05-041921 2 2 5 5
OS-O5-1921 to 12-10-1951 2 2 10 10
12-11-1951 to 12-29-1967 @ 4:00 PM 2 2 15 15
12-29-1967 after 4:00 PM to 06-30-1994 6 6 15 15
07-01-1994 to 12-31-1994 6 15 15
01-01-1995 to 06-29-2000 0 6 15 15
07-01-2000 to PRESENT 0 4.5`• 12 15
'~ UNTIL MAY 31,1957, CHARIII'IESTGEI~ONSIDERED COLLATERAL BENEFICIARIES.
* * EFFECTIVE July 1, 2000 TRANSFERS FROM A CHILD, AGE 21 OR YOUNGER TO NATURAL OR ADOPTIVE
HISTORIC INTEREST RATES
DATE OF DELINQUENCY ANNUAL RATE DAII.Y FACTOR DATB OF DELINQUENCY ANNUAL RATE DAII.Y FACTOR
Before 05-29-1943 12 .000329 05-29-1943 to 12-31-1981 6 .000164
01-01-1982 to 12-31-1982 20 .000548 01-01-1983 to 12-31-1983 16 .000438
01-01-1984 to 12-31-1984 11 .000301 01-01-1985 to 12-31-1985 13 .000356
01-01-1986 to 12-31-1986 10 .000274 01-01-1987 to 12-31-1987 9 .000247
01-01-1988 to 12-31-1991 11 .000301 01-01-1992 to 12-31-1992 9 .000247
1-01-2001 to 12-31- 001 9 .00 47 01-01-2002 to 12- 1- 2 6 .000164
1- 1- t 12- 1- 1-01-2 4 t 12- 1- 4 11
HI STORIC DELIN QUENCY PERIODS
I. ON ORIGINAL INHERITANCE TAX RETURNS:
a. BEFORE 12-21-1965 ...................................... 12 MONTHS AFTER DEATH
b. FROM 12-22-1965 to 06-16-1971 ............................ 15 MONTHS AFTER DEATH
c. FROM 06-t7-1971 to DATE . .............................:.. 9 MONTHS AFTER DEATH
2. INHERITANCE TAX REMAINDER RETURNS: (for D.O.D. "• prior to December 13, 1982)
a. ORIGINAL DECEDENT'S D.O.D. BEFORE 01-01-1962 ...... ..... IMMEDIATELY UPON ACTUAL
DISTRIBUTION TO REMAINDERMEN
b. ORIGINAL DECEDENT'S D.O.D. AFTER 12-31-1961 ....... ..... 3 MONTHS AFTER DEATH OF LIFE
TENANT OR ELECTION TO PREPAY
3. ESTATE TAX BASED ON ORIGINAL FEDERAL 7!706 or PA-706:
a. FROM 01-01-1962 to 10-02-1991 ....................... ..... 18 MONTHS AFTER DECEDENT'S D.O.D.
b. FROM 10-03-1991 to Present '•" ...................... . ...... 9 MONTHS AFTER DECEDENT'S D.O.D.
••'• For dates of death on or after July 1, 2002, the return is due i 0 months alter D.O.D. of decedent
4. ESTATE TAX BASED ON FINAL FEDERAL CLOSING LETTER:
a. FROM 01-01-1962 to PRESENT ............................. 30 DAYS AFTER DATE ON FCL••'••
FAMILY EXEMPTION ALLOWANCE
EFFECTIVE DATES OF DEATH AVAILABLE ALLOWANCE
ACT OF 1851, AMENDED BY 1913 $300.00
ACT OF 1917 $500.00
ACT OF 1949 750.00
FROM 11-10-1 59 to 05-04-1970 1 000.00
FROM OS-OS-1970 to 06-26-1974 1 500.00
FROM 06-27-1974 to 01-29-1995 $2 000.00
FROM 01-30-1995 to PRESENT 3 500.00
~~~ D.O.D.= DATE OF DEATH Revlaed
FCL =FEDERAL CLOSING LETTER p1/5pg
A TRUE COPY FROM RECORD
InTee~tmYnltyen ~~~ c~oqq
~ t! Qcu~at CerIW~.20S1.J_
Thi
i
~ CauR
Cum ~ ~~
LAST WILL AND TESTAMENT
of
RAY BRECHBILL
-„ ~=
20J8 NAY 12 AM 10~ 04
CLER'rC OF
ORPFiP,h'S Ci,IJRT
I, RAY BRECHBILL, presently of Bergen County, New Jersey, do make this my last
Will, hereby revoking all prior Wills and Codicils.
FIRST: Funeral Expenses.
I duect the payment out of my estate of the expenses of my last illness and
funeral.
SECOND: Tangible Personal Property.
Z~ Ofr
I give all of my tangible personal property, together with any insurance thereon, to
my Wife, Helen R. Brechbill (hereinafter referred to as my "Wife"), if she shall survive me; or.
if she does not so survive me, to such of my children as so survive me, to be divided among them
in such manner as they may agree, or if they aze unable to agree, then in as nearly equal shares as
may be practicable, as determined in the sole discretion of my Executors.
THIRD: Residue.
All of the residue of my estate, real and personal, I give and devise to my Wife,
Helen R. Brechbill. If my Wife does not survive me, then I give all the residue of my estate to
my children, Alan L. Brechbill and Glen Brechbill, in equal shares, per stirpes.
FOURTH: Disclaimer.
In the event that my wife, Iielen R. Brechbill, shall disclaim any or all of my
estate devised to her under this will pursuant to applicable state and federal laws, then and in that
cCsz2
event, all such disclaimed property shall be held IN TRUST by my Trustees to be hereafter
named, subject to the following conditions:
To invest and reinvest the sums and to pay or apply the entire net income to or for
the benefit of my wife, Helen R. Brechbill, in at least quarterly installments, for her life. My
Trustees aze also authorized to pay or apply to or to the use of my said wife at any time and from
time to time such part or all of the principal as my Trustees, other than my said wife, in their
absolute discretion, deem necessary or advisable for the health, support and maintenance of my
said wife. It is my hope and. wish that my wife be able to maintain, as neaz as reasonably
possible, the standard of living and quality of economic life to which she had been accustomed
during our life together. The judgment of my Trustees, other than my said wife, as to the amount
of such payments or applications and as to the necessity or advisability thereof shall be final and
conclusive upon ail persons interested in the trust and upon making such payments or
applications, my Trustees shall be fully released and dischazged from all furtlter liability or
accountability thereof. My Trustees, other than my said wife, shall take into consideration any
other income or resources of my wife in determining what amounts, if any, of principal aze to be
paid to her pursuant thereto. Upon the death of my wife, the Trustees shall pay over the
remainder of the trust in accordance with the provisions of Article Three herein.
FFFTH: Death Taxes.
All federal, state and other death taxes, except generation-skipping transfer taxes,
payable because of my death on the property forming my gross estate for tax purposes, whether
or not such property passes under this Will, shall be paid out of the principal of my residuary
estate as though they were debts, and none of those taxes shall be chazged against any beneficiary
or any outside fund. Death taxes on future interests shall be paid whenever my Fiduciary deems
best. No property which would be exempt from federal or state death taxes if not payable to my
Executors shall be used to make any payments under this paragraph.
SIXTH: Beneficiaries Under Twenty-One or Disabled.
If any beneficiary is either under twenty-one (21) years of age, or, in my
Fiduciary's opinion, disabled by advanced age, illness or other cause, and such beneficiary
becomes entitled to any income or principal hereunder, then my Fidnciary may hold and invest
such income or principal IN TRUST far such beneficiary,. in accordance with all powers granted
to my Fiduciary under this Will as follows:
(a) As much of the income or principal as my Fiduciary deems desirable may
be paid to or applied for that beneficiary;
(b) The balance of such income and principal shall be paid to such beneficiary
when he or she attains twenty-one (21) years of age or becomes, in my Fiduciary's opinion, free
of disability;
(c) Any funds to be applied under this paragraph either shall be applied
directly by my Fiduciary, or shall be paid to a pazent or guazdian of the beneficiary or to any
person or organization taking Gaze of the beneficiary, and my Fiduciary shall have no further
responsibility for any funds so paid or applied.
SEVENTH: Protective Provisions.
The interests of the beneficiaries under this Will shall be free from anticipation,
assignment, pledge or obligation of the beneficiaries, and shall not be subject to any execution,
attachment, levy or sequestration or other claims of the creditors of the said beneficiaries.
3
EIGHTH: Powers of Fiduciaries.
Any Executors and Trustees acting hereunder, in addition to the powers given by
law and other provisions hereof, shall have the following powers, exercisable without leave of
court, both as to,priacipal and income.
(a) To retain and to invest in all forms of real and personal property whether
or not it is yielding income, regardless of (1) any limitations imposed by law on investments by
fiduciaries; (2) any principle of law concerning delegation of investment responsibility by
fiduciaries, or (3) any principle of law concerning investment diversification;
(b} To keep reasonable amounts of cash in bank uninvested, if deemed
advisable;
(c) To compromise claims and to abandon any property which, in my
Fiduciary's opinion, is of little or no value;
(d) To borrow from anyone, even if the lender is a fiduciary hereunder,
without liability on the part of the lender to see to the application of the proceeds thereof, and to
mortgage or pledge real and personal property as security for repayment of the funds borrowed;
(e) To sell at public or private sale, for cash or credit, to exchange or to lease
for any period of time, any real or personal property, and to give options for sales or leases;
(f) To make loans to, to borrow from, to sell to, and to buy property from, my
or my Wife's Executor or Administrator or the Trustee of any generation-skipping trust of
which I am a deemed transferor;
(g) To join in any merger, reorganization, voting-trust plan or other concerted
action of security holders, and to delegate discretionary duties with respect thereto;
4
(h) To register securities and other property in bearer farm or in the name of a
nominee;
(i) To give proxies, both ministerial and discretionary;
(j) To allocate any property received or chazge incurred to principal or income
or partly to each, without regatd to any law defining principal and income;
NINTH: De£mitions.
The following definitions and rules of construction aze applicable to this Will and
the trusts created herein, unless in the particulaz case, the context cleazly requires otherwise:
"Fiduciary" shall mean the Executor or Trustee serving hereunder.
"Executor" or "Trustee" shall mean not only the person or persons designated
as such in this Will, but shall, for all gurposes of this Will and the trusts created herein, also
mean any person or persons acting at any time as my Executor, Administrator or Trustee under
this Will and any trust created herein, and shall be construed in the plural or the singulaz, and as
the masculine, feminine or neuter, as the context and circumstances may require.
References herein to "child," "children" or "issue" shall be deemed to include
legally adopted persons, and persons bom or legally adopted hereafter. Pronouns shall be
construed as feminine, masculine or neuter, and as the singular or plural as the context and
circumstances may require.
TENTH: Fiduciaries.
I appoint Helen R. Brechbill, Alan L. Brechbill and Glen Brechbill, as Co-
Executors and Co-Trustees under this Will.
I direct that no fiduciary acting hereunder shad be required to enter any security or
bond in any jurisdiction in which such fiduciary may act.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this'~gday of
~~~ , 20~
ILL
SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testator as
and for his Last Will and Testament, in the presence of us, who at his request, is his presence,
and in the presence of each other, all being present at the same time, have hereunto subscribed
our names as witnesses.
~ 0 3,~.~~K ~~
Name
~s~~ ~~
Address
~,~ V )6 )~
Name Address
6
State of
County of
Acknowledgment
I, Ray Brechbill, the testator whose name is signed to the attached or foregoing instrument,
having been duly.qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for
the purposes therein expressed.
Sworn to or
day c
RAY
/ 11
Notary Public
State of
County of
:d before me by '~~I ~OY-C'G~1 ~i ({ ,the testator, this
200.
NOTARY PUBLIC Ur NE4Y JERSEY
My Commission Expires May 25, 2004
Affidavit
We, ~ L a„ (_/ • ~ i, ~ ~, ~,L~ and Ni~irti ~ % .~. ~~1~; the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified according to law,
do depose and say that we were present and saw the testator sign and execute the instrument as
his Last Will; that the testator signed willingly and executed it as his free and voluntary act for
the purposes therein expressed; that each subscribing witness in the hearing and sight of the
testator signed the will as a witness; and that to the best of our knowledge the testator was at the
time 18 or more yeazs of age, of sound mind and under no constraint or undue influence.
Witness ` Witness
Sworn to or aff ed and subscribed to before me by ~p~ C,~r'2C (~ hi I I and
>'~2-~Q, n ~ .~f C C h ~ ; (~ ,witnesses, this ti day of ~c~~ ~e,r
20~~.
CAROL M, JAr_CER
m ( F_e , NOTARY PUBLIC OF NEW JERSEY
Notary Public My ~~~~ Expires May 25, 2004
,. ~ ~ BRECRBILL~ NELEN R
N nMe_ ®BYSS4 No.
A9
J
DATE MEMO INTER EIT WIT XORAWAL DEP081T8 IALAMOE pYM
1
z 03-30-07 14.74 34.956.24
3 04-13-07 1078 100.00 34.856.24
a
5 04-20-07 1078 34.736.24
6 '
~ 04-27-07 1078 34.616.24
°°~ ~L's ~ ~~;~
g 04-x-07 14.32 34,630.56
9 OS-10-07 1019 100.00 34,530.56
to
05-24-D7 1078 118.08 34.420.56
11
12 ry[_yn_{t7 ?n+~ xt ann nr, r ern cr,
13 05-31-07 21.60 6,432.16
to 06-08-07 1019 68.00 6.372.16
t5
Ob-15-07 1878 60.00
b,312.16
16
06-21-01 1018 6,252.16
17 ~ ~ O7 1078 ~~ ~~:
is 60
19 07-95-D7 1078 "~' 6,124.76
t~~
2u 07-T7-0T ~' 1819 -"'"~'°~ "`"
"6'000 6,064.76
21 07-31-07 "'~! 2.60 6,067.36
22 08-03-07 6613 1,905.24 7,972.60
23 OS-31-07 3.31 7.795.91
za 39-07-07 .. 3019 60.00 7.735.91
THE SAFETY OF YOUR SAVINGS IN THIS BANK IS INSURED
UP TO THE MAXIMUM PERMITTED BY THE FEDERAL GOVERNMENT
~ AND IS BACKED BY THE FULL FAITH AND CREDIT OF THE
` UNITED STATES OF AMERICA. i
NAME ACCOUNT NO. '
~f ,~ YvOJ J~~ DATC MCMO INTERCBT WITHOR
v~^ /.WAL 06P061TB BALANOB BYM
1
z 12-21-47 1078 611. b7 7,742.00
3
a i2-21-D7 107B 611.67 7,180.33
5 12-21-D7 1078 211.67 7.342. DD
5 12-31-D1 14 ?,345,14
~ 01-31-08 13 ?,398,23
g 02-24-4B _
-"t'**"' :~1, :;~ 7, 4D1.18
9 03-31-48 3.14 7,4D4.34
to ~-~" ~ 3.09 7,407.34
r li OS-30-08 3.14 7,410.48
' iz 05-17-OB 1078 75.OD 7.335.48
t3 3.02 7.338.50
'' is '355 15.00 7;Z63.BD':
15 " 07-31-08 3.OB 7,266.58
°tb 08-01-08 7ZZ7 75.00 4,191.58
17 08-04-OB 1078 1.D49.30 9.290.88
is OB-18-OB 6232 75.00 9.165.E
19 OB-29-08 7227 .DD 9,090.88
08-29-08 °'--~+
~6ii~`+'
"~ 9
094
69
zo .
_ ,
.
zi 09-O5-OB 7227 100.00 8,494.69
2z 09-12-~ 7169 100.E 8,894.69
23 D9-19-OB 7ZT7 75
D0
. ~ _ c
8,8.9 6~
za
THE SAFETY OF VOUR SAVINGS IN THIS BANK IS INSURED
UP TO THE MAXI MUM PERMITTED BY THE FEDERAL GOVERNMENT
AND IS BACKED BV THE FU LL FAITH AND CREDIT OF THE
UNITED STATES OF AMERICA.
NAME 9rechbYii, Neien B. ACCOUNT No. 6001896
GATE MHMO INTHREeT WITNORAWAL OHPOHIT9 BALANCE l1VM.
~ OS-19-08 (~~-~ 1D51 70.00 9.363.97
2 CS-'_9-08 lOSi 70.00 9.293.97
3 u5-3D-D8 3.72 9.297.89
4 06-n2-D8 1025 6DO.OC 9.897.69
s 06-30-00
• "" 9 901~i74`
6 0'1=31-00 I9 trg 905 %3 • `-
I ~ 08-29-08 a , 20 " , ` ".B; '~" ~*r`a~'~LO' T3~t•"' ,:
. ...
i $ 09-30-OB '.;, '~.:°"' Y;U6 ~. ,a, ~ a ~ .fi,.. 9,:914.19
~ 9 21~3I'~IB ~ ~ ' .. _ 4.20 ~, ~. ,"""9,910.39"
Flo ~ '11~?8-0~ _ 4.07 '> ~~,"~ " "-' 9,922.46 ''
111 12-05-08 7227 140.00 9,702.46
12 12-19-D8 7227 120. D0 9.662. a5
13 12-31-08 4.i3 5,886.59
la C1-92-U9 SSZZ 120.00 4.546.59
11s 01-09-09 ...22<_ 120. ~ 9, 426.59
16 1t-23-49 2483 13D.00 9,246.59
18 01-30-09 9,3D0.59
ly 02-09-09 1051 00 9,170.59
02-20-04 2483 ~ '' ~~~_ YD: 00 4,050.59
20
;21 03-06-09 7227 12(1.00 0,934.11
22 D3-13-04 2403 i24.D0 8,814.11,
23 03_27-D4 2483 LDO.DD 8,714, i1
za
i THE SAFETY OF YOUR SAVINGS IN THIS BANK IS INSURED
' UP TO THE MAXIMUM PERMITTED BY THE FEDERAL GOVERNMENT
AND IS BACKED BV THE FULL FAITH AND CREDIT OF THE
UNITED STATES OF AMERICA.
~HUDSONCITY
VV~~VV BAVINCfl aAN[
e*.t m ems vane
IRA WITHDRAWAL STATEMENT
D
.tA'. H:OLDER
'S NA
M
E AND A
DDRE
SS IRA CUSTODIANrS NAME AND~ADDRESS
]I
n
I
1
y
~
'I'C I-Qi
R/ 1~1'eR-~ b ti ~' ` f
~
~
C( d G,~ ~}.rq ~Iudson City Savings Bank
JOHN G. D'ARIENZO
~~,
~~ N _-S., cT7 b"}'e
•re ~
NOTARY PUBLIC OF NEW JERSEY
nt7
Y I Paynm~,= ntr mrs~ 'NN7
NFJCanndtasion Exohes Run. 30 .
SocielSecurily Number •; Date olBii•t6 H'omrEhono '. „.: 1RA ,:.
Account IdentlHcutlon eoe IRA
~ Cwtodim's
PAone Number
~.`a,5-W 13~j4 I ?. 2 ! ..~6 S.~ ''~„ (6 ~ Tmdidond B2A (20l)
SIMPLE IRA
' HENEFiCIARY (orFbrmer 3pouee)INFORMATION~
Thk
h
ld ~.. DLSTRIBUTION.IINFORMKTION~
nestmrs s
ou
be compkred~8ya b[neftcfory takiiigadaatk
dkMbutton or a}o' rnler spowetakbrg;a dlstrlStiNon w s Rrult ~¢ property; Until /give the Cwlodian wriaen butructiow to the commry I dfrcct the Cwtodian to
aealement. DO NOT we this-.tecNort to wme orchange yourbeneJ}Clnry(ker): distribute the amount rcqueaed w follows.
BeneEciary's-(or Former 3 onse'u)Nemeand'Addreas. Dtiifriliution Reas
n
o
I dircet Hudson Ciry Savings to ntaYe a distribution from my II2A far the following reason
^ Transfer ^ Normal Distribution for Tax Year_
^ Revocation ^ Excess Contibudon Removal*
^ Eazly Diatibudon (IRS Penalty App]iea) ^ Duct Rollover to Employer Plan
$oddSecur(ty Number Date oCBlrth ^ Early Distribution (IRS Penalty Exception) ^ Same Year Recharacterization
^ Disability ^ PNa Year Recharacterization
~ Death ^ Eazly SIMPLE IRA Distribution
Phom.. ~ Rdatfoaetiip..' ^ Prohibited Transaction (IRS Penalty Applies)
*Ia the excess contribution being removed before October IS of the year following the yeaz
for which [he contribution was made?"*
WTfHHOLDING ELEC'LTON (Form W-4P/OMB+No. 1545.0415) ^ No
See Page 2 of tkk fdrm for the withholding notice ikfdrmcNon.
Complete foxanY dutnbuNan, except a danrfex. .
^ Yes. Wes the excess contdbutlon made during the prim year? ^ Yes ^ No
!f you are a ronrcsidekt alien, do wt edmplete thk:sectiort. Was the IRA holder under age 59Y. at the urns excess was withdrawn? ^ Yes ^ No
Select One:
^ Withhold Feder
l i
[
t
t
f % ++Aaeumes [he IRA holder timely filed his m her federal income tax return. )f the remm was not
a
ncome
ax a
a ra
e o
(not timely filed, replace the October 15 date with the due date of the remm (including extensions).
less than /0 percent) firm the amount withdrawn.
Withhold additional Federal income tax of Commeucemmt Date Distribution Amomf
(complete only if appficable)
~ Entlre Account
Withhold smte tax m a rate of % from the amount
i 07/14/2008 ^ Specify Amount $
w
thdrawn (ca nplete only if applicable).
~
® Effective
, I elect no[ m have Federal
i
i Frequency ~ Spedd Payment Imteactions -
ncome lax w
held. I undersmnd that I am still liable for the
payment of Federal income tax on me amount received. I also ~ One-lime
^ Quarterly
^ To checking account #
understand that f may be subject [o Federal income tax penalties
under the esimated tax payment rata if my payments of the ^ Monthly ^ Annually ^ To savin s ccount #
~
estimated tax and withholding are insufficient ^ Other L'~'
~F]C Othec
FINANCIAI. IIVFORMATION
Irrvestment Number InterwtIn Current Gross Cash. Imtltutlon.mPeoaltka Liquidate Dktribule Distribute
Or CertlOcate Year (Or Oa Extxse) Dk4ibuted Or OfherFeea Immediately At Mamrily. Ia Kind
I. YO I O $ s 137b S ® ^ ^
a. $ $ $ ^ ^ ^
a. S $ $ ^ ^ ^
.Federal Wlthholdiug State. WidtholNng NET D~U~ ON
- 1 d. ~ o
SIGNATURES
I certify that 1 ern Ne proper party to receive payment(s) fium this IRA and that all information provided by me is true and accurate. I have read and underswld the Rules
and Conditions Applicable to Withdrawals on page 2 of this form and agree m abide by those rules and condiions. No tax advice has been given to me by the Custodian. All
decisions regarding this withdrawal aze my own. I expressly assume the responsibility for any adverse wnsequenrsgyvhich may arise from this withdrawal and I agree that
the Custodian shall in no way be held responsible.
7~~
y'~o ~
I
( .a awwe)
~
NOTARY PUBLIC OF NEW J4' ~ g
( a+ry Publir131gvgwro Guueo ~ r~~~~~ ~a rya
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• ® HUDSONCITY PAGE 1 of 1
9 A V I N G 5 B A N K
PO BOX 706, PA&AMI15. NJ 01b53-0]06
80 UNION AVENUE
CRESSKILL NJ 07626-2128
ESTATE CHECKING
0 THE ESATE OF RAY BRECHBILL STATEMENT DATE: 07/24/08
59 OAK AVE
7ENAFLY NJ 07670 ACCOUNT NUMBER: 0301402653
IIIIIII~IIIIIIIIII~IIIIIIIIIIIII BRANCH TEL: 201.568-8777
Need your checking or savings account balance
quickly? Use our Bank by Phone service. A single
call will provide you with all the information you
need. Contact your local branch about using this
convenient system.
All Transactions by Date
Date Description Amount Balance
07/13 Balance Forward •-•--••----- -------•-- -••••--•-•••-•••' 0.00
07/14 Deposit BR: 001404967 38.607.07 38,607.07
07/P4 38.607.07- 0.00
ACCOUNT SUMMARY
Beginning Interest Service Ending..
Balance + Deposits + Paid - Withdrawals - Charge = Balance
0.00 38.607.07 0.00 38.607.07 0.00 0.00
Statement Period from 07/14/08 Thru 07/24/08
Average Balance: 38.607.07 Minimum Balance: 38.607.07
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NOTE: SEE REVERSE FOR IMPORTANT INFORMATION Visii our Website: www.HCBK.com -Telephone Banking: 1-866-448-9498 MEMBER FDIC LENDER
HUDSONGITY
3 A Y I N G 9 B A N K
PAGE. 1 of 3""'
PO BOX 746, PAAAN113. NJ 07653-4]46
80 UNION AVENUE
CRESSKILL,NJ'07626.2728
SUPER. NOW.: CHECKING
6 RAY BRECHBILL OR STATEMENT DATE:. 03/31/08
HELENiR BRECHBILL
59 OAK AVE. ACCOUNT. NUMBER: 0801405423
TENAPLY NJ 07670-2647
BRANCH TEL: 201 -568-8777
IILIJIIIIJI,ILIIIff1111111LiI~11L11Cd11~IJlf'
Consolidation of certain Federal. Reserve. check
pprocessing centers means more items have. now
become local checks. In some cases, faster chect
availability may occur :. For details, please.
request an .updated Funds Availability brochure:..
All Transactions by Date
Date Description.
Amount
Balance
02/29 Balance Forward`--•------•--•----------- -
US TREASURY 303 SOC SEC
03/03 '--•---- "-'
1,263.00 11,994.85
13,257.85
,
03/05 AARP HEALTH CARE PREMIUM 364,00-
35-
280 12,893.85
613..50
12
03/05 CITICARD PAYMENT CHECK PYMT . ,
Check Number: 1403
03/12 CK 1404 TR: OQOA01718
50.00-
12,563.50
03/14 CK 1405 TR: 000018619 73.45- 12,490...05
03/17 CK 1406: TR: 000009759 221.49-
81-
33 12,268.56
234
75
12
03719 VERIZON ARC CHECK PYMT . .
,
Check Number: 1408
03/20 LIBERTYMUTUALINS INSPAYMENT
300.00-
11,934.75
Check Number: 1409
03/21 CK 1402 TR: 000026535
182..35-
11,752...40
03G24 CK 1411 TR: 000016573 90.08- 11,662.32
03/24 CK 1412 TR: 000016574 97.25-
23
9 11,565.07
574
30
11
03/31 Interest Credited Deposit. . .
,
Checks in Order
Oate Number Amount Date
Number Amount.
-
03/12 1404 50.00 03/21 182.35
1407-
03/14 1405 73.45.. 03/24 1411* 90.08
03/17 140.6 221.49 03/24 1412 97.25
(*) PRECEDING CHECK. NUMBER(S) MISSING
Interest Rate Summary
Rate Paid Based on Balance Level Maintained
DATE 0- 52,499 52,500 and up
03/01 0.64000X 0.89000k
DATE 0- 52,499 52.500 and up
03/21 0.64790X 0.89599X.
ACCOUNT SUMMARY
Beginning Interest
Service
Ending
Balance + Deposits + ^^ Paid - Withdrawals - Charge = Balance
71,994.85 1,263.00 9.23 1,692.78 0.00 11,574.30
Statement Period from 03/01/08 Thru 03/31/08 Average Stmt Balance 12189.72
Interest Earned 9.23 *Annual Percentage Yield Earned 0.90X
Average Balance: 12,189.72 Minimum Balance: 11,565.07
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van~a•
RAY BRECHBILL
59 OAK AVE
TENAFLY NJ 07670-2647
TRANSACTION ACTIVITY
Mazch 31, 2008, yeaz-to-date Page 1 of 1
TRANSACTION DETAIL
800-662-2739 - Client Services
vvww.vanguazd.com
~ ~ (800) 662-6273 - Tele-Account
V
Vanguard New Jersey Long-Term Tax-F~tempt Fund Irnestor Shares Fund / Accourrt no. 0014 / 09893315880
Trade data Transaction desa~tbn Dollar amount Share prk:e Shares Vansactad Total shares owned
Balance on 12/31 /2007 ~ ~ - - - $ 55,393.24 - $ 11.6&- - ~ 4,738.515
1/31 Incomedividertd 202.96 11.78 17.229 4,755.744
2/29 Income dividerd 189.51 11.11 17.058 4,772.802
3/31 Income dividend 199.90 11.43 17.489 4,790.291
Balance on 3/91 /2008 $ 54,753.03 $ 11.43 4,790.291
YeaFto-date Short-term gains / Purchases / Total cost basis / 30-day Share Trade DlsVtkxdbn
T_a_x-_exempt income Lorg-term gains Redemptions Average cost par share yield price date payabb date
$ 592.37 $ 0.00 $ 0.00 N/A 3.90% $11.41 3/28/2006 4/01 /2008
0.00 0.00 N/A
VANGUARD NEW JERSEY LONG-TERM Fund / AcwuM no.
TAX-EXEMPT FUND INVESTOR SHARES 0014 /09893315880
•Do not allot This Invest-By-Mer1 slip. RAY BRECHBILL
"Visit www.vanguard.com or call to change your address.
List each check $ ^r^^^r^^^•^^
separatey. $ ^~^^^t^^^.^^
$ ^r^^^,^^^.^^
TotalamouM $ ^r^^^r^^^.^^
00149 09893315880 307 70
Make cttecks payabb to: Tha Vanguard Group -0014
THE VANGUARD GROUP
PO BOX 13750
PHILADELPHIA PA 19101-9897
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