HomeMy WebLinkAbout07-09-09~D~
15056041169
REV-1500 EX (OS-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PoBox2soso~ INHERITANCE TAX RETURN
Harrisburg, PA 17128-OS01 RESIDENT DECEDENT ~ ~ ~ g ~ o ~ Z
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
204-01-8886 01052009 07011921
Decedent's Last Name Suffix Decedent's First Name MI
METZGER EDWIN S
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL INAPPROPRIATE BOXES BELOW
1. Original Return
4. Limited Estate
0 s. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ALFRED L WHITCOMB 717-766-9477
Firm Name (If Applicable)
WHITCOMB TAX SERVICE
First line of address
43 WEST MAIN STREET
Second line of address
City or Post Office State
MECHANICSBURG pp,
Correspondent's a-mail address: ALCWHITCOMBTAX . COM
ZIP Code
REGISTER OF WILLS USE ONLY
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unaer penalties or penury, I declare that I have examined this return, including 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 on all information of which preparer has any knowledge.
SIGN RE OF PERSON R SPONSIBLE FOR FILING RETURN DATE
,s wr ~ 7 9- o
ADDRESS
EDWIN B. METZGER, 185 SPRING DRIVE, DILLSBURG, PA 17019
SIG~UR~E PREPARFF~ F12 TI-IDN RGGI?CCCA~reTnic
ADDR
L . WHITCOMB . 4 ~ wF~T MZ1 TRT cT1?~~m ~vr~r^~vTrTnT ~nTTnr
Side 1
L 15056041169 15056041169
15056042160
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: EDWIN S METZGER 2 0 4- 01- 8 8 8 6
RECAPITULATION
1. Real estate (Schedule A) ............................................. 1. 16 8 , 3 0 0 . 0 0
2. Stocks and Bonds (Schedule B) ........................................ 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) ............................. 4.
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ........ 5. 214 , 8 2 7 . 7 8
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1 - 7) ................................... 8. 3 8 3 , 12 7 . 7 8
9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. 5 , 7 8 5 . 5 3
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ............... 10. 1 , 5 9 3 .4 2
11. Total Deductions (total Lines 9 8~ 10) .................................. 11. 7 , 3 7 8 . 9 5
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 3 7 5 , 7 4 8 . 8 3
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ........................ 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 3 7 5 , 7 4 8 . 8 3
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) x .0 15.
16. Amount of Line 14 taxable
at lineal rate x .04 5 3 7 5, 7 4 8. 8 3 16.
17. Amount of Line 14 taxable
at sibling rate x .12 17.
18. Amount of Line 14 taxable
at collateral rate x .15 1 g.
19. TAX DUE .................................................... .... 19.
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
16,908.70
16,908.70
0
Side 2
L 15056042160 15056042160
REV 1500 EJC Page 3
Decedent's Complete Address:
File Number 210 9- 0 0 3 2
DECEDENT'S NAME
EDWIN S METZGER
STREETADDRESS
c/o FOREST PARK HEALTH CENTER,
700 WALNUT BOTTOM ROAD
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 16 , 9 0 8 . 7 0
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 16 , 3 0 6
C. Discount g 5 g
Total Credits (A + B + C) (2) 17 , 16 5 . 0 0
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0 . 0 0
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) 2 5 6 . 3 0
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)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ...................................... . . . ~ 0
b. retain the right to designate who shall use the property transferred or its income : .................... ~ .x~
c. retain a reversionary interest; or .........................................................
d. receive the promise for life of either payments, benefits or care? ....................... . . . . . . .. . ~ 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................
3. Did decedent own an °in trust for" or payable upon death bank account or security at his or her death? .....
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................... . . . . .... . ..........
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is three (3) percent [72 P.S. §9116(a)(1.1.)(i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. §9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax 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.
REV-1502 EX+ (11-08)
s,,,.,;
ht~~ ~ ~~~ Pennsylvania
`h='~ ~`~~~~ SCHEDULE A
~~ DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDWIN S METZGER ESTATE 2109-0032
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 exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
it more space is needed, insert additional sheets of the same size.
F~EV--1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
EDWIN S METZGER ESTATE
FILE NUMBER
2109-0032
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M&T BANK, CHECKING # 2673080699 11,556.00
2 M&T BANK, MONEY MARKET ACCT # 15004202173289 72,706.78
3 JUNIATE VALLEY BANK, CHECKING # 56-333861-3 4,328.08
4 WESTERN-SOUTHERN LIFE - ANNUITY- W0020178796
1/3 TO EDWIN B METZGER - SON 25,771.50
1/3 TO BONNIE LEE LEE - DAUGHTER 25,771.50
1/3 TO BETTY LOU PHILLIPS - DAUGHTER 25,771.50
5 ALLSTATE LIFE INS - ANNUITY- GA17244917
1/3 TO EDWIN B METZGER - SON 15,244.03
1/3 TO BONNIE LEE LEE - DAUGHTER 15,244.03
1/3 TO BETTY LOU PHILLIPS - DAUGHTER 15,244.03
6 1999 FORD F150 PICKUP 1,000.00
7 MISCELLANEOUS TOOL AND PERSONAL ITEMS 500.00
8 HARLEYVILLE INSURANCE REFUND 126.50
9 AFLAC INSURANCE REFUND 305.14
10 JUNIATA INSURANCE CO REFUND 413.00
11 COUNTY AND SCHOOL TAXES REFUNDED AT SETTLEMENT 711.77
12 DIRECT TV REFUND 36.90
13 INTERNET SERVICE REFUND 87.02
TOTAL (Also enter on line 5, Recapitulation) ~ $ 214 , 8 2 7 . 7 8
(If more space is needed, insert additional sheets of the same size)
~tEV 1510 fiX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
EDWIN S METZGER ESTATE
FILE NUMBER
2109-0032
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 RELATIONSHIP TO DECEDENTAND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1. SEE ANUITIES ON SCHEDULE E
TOTAL (Also enter on line 7, Recapitulation) 15
(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 &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
EDWIN S METZGER ESTATE 2109-0032
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~~ GUSS FUNERAL HOME 101.41
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)EDWIN B. METZGER (RENOUNCED
Street Address
City State ZIP
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
5.
s.
7.
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
ZIP
TOTAL (Also enter on line 9, Recapitulation) I a
(If more space is needed, insert additional sheets of the same size)
4,244.12
1,295
145
5,785.53
REV-1512 EX+ (12-08)
`~'"~'~~ SCHEDULE I
~~ ~ '~ pennsylvan~a
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDWIN S METZGER ESTATE 2109-0032
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
it more space is neeaea, insert additional sheets of the same size.
REV-1513 EX+ (11-08)
;~~ • ;: -
::
-~~ ~ ~- pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
EDWIN S METZGER ESTATE
FILE NUMBER
2109-0032
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 2116 (a) (1.2).]
i. EDWIN B METZGER SON 33.333
185 SPRING DRIVE
DILLSBURG, PA 17019
2 BETTY LOU PHILLIPS DAUGHTER 33.333
6 RIDGE ROAD
SOUTHAMPTON, NJ 08088
3 BONNIE LEE LEE DAUGHTER 33.333
439 KERSHAW ST NW
CALABASH, NC 28467
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, insert additional sheets of the same size.
,llstate Life Insurance Company
P.O. Box 94212
Palatine, IL 60094-4212
Telephone: (877) 499-6418
Facsimile: (866) 635-4523
January 8, 2009
Malcom R Park
Financial Network
129 S. Main street Suite 600
Lewistown, PA 17044
Re: Edwin S Metzger
Contract No: GA17244917
Dear Mr. Park:
~~:
You're in good hands.
We received •a request to complete IRS Form 712 for the above referenced contract. The purpose of Form
712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain
date (usually the owner's date of death or date of transfer of the contract).
Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the
following information for estate purposes:
Date of Death: J t~ 009
Annuity Value as of Date of Death: $ 45,732.09*
Cost Basis: $ 39,000.00
Named Beneficiary: Edwin e g ,Bonnie Lee Lee,
Betty Lou Phillips
*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges.
If you have any questions, please contact me at 1-877-499-6418 Ext. 86184.
Sincerely,
Donna Gray
Sr. Claim Examiner
~- ~:-~ettle~rnent Statement U.S. Departrnent of Housing
and Urban Development
OMB Approval No. 2502-0265
(expires 11/30/2009)
B. Type of Loan
6. File Number. 7. Loan Number. 8. Mortgage Insurance Case Number.
1. ^ FHA 2. ^ FmHA 3. ^Conv. Unins.
4. ^ VA 5. ^Conv. Ins.
C. Note: This. form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p.o.c.)" were paid outside closing; they are shown here for infomnational purposes and not included in the totals.
0. Name and Address of Borrower. E. Name and Address of Seiler. F. Name and Address of Lender:
SCOTT E. LANDIS EDWIN B. METZGER, BONNIE L. LEE MEMBERS 1ST MORTGAGE SERVICES
JOAN M. LANDIS BETTY L. PHILLIPS, Execs. Edwin S. Real Estate Lending Department
R. R. #5, Box 408, Log House Lane Metzger Estate, late of HC-67 Box 56-C 5000 Louise Drive
Mifflintown PA 17059 Mifflin PA 17058 Mechanicsbur PA 17055
G. Property Location: H. Settlement Agent:
Beale Township, Juniata County ~ JOHNSTON & ZAGURSKIE
1765 Acedemia Road Place of Settlement: I. Settlement Date:
Mifflin PA 17058 117 Main Street 4116/2009
Mifflin PA 17058 Disbursement Date:
Lot: Block: 4/16/2 9
J. Summary of Burrowers Transaction K. Summary of Seller's Transaction
100. Gross Amount Due From Borrower 400_ Gress Amount Due Te Setler
101. contras sales ce 170 000.00 ao1. contras sales 170,000.00
102. Personal 402. Personal '
103. Settlement cha es to borrower Ifne 1400 6 339.90 403. A
104. 404,
105. 405.
Adjustments for items paid by seller in advance _
Adjustments for items paid by seller in advance
106. Ci ftown taxes to
406. C ltovvn taxes to _ _
107. coup taxes 4/16/20090 12/31/2009 448.02 407. Cou taxes 4/16/2009,12/31/2009 448.02
108. Assessments to 408. Assessments to
1os. School taxe>~/16/2009, 6/30/2009 263.75 409. School taxed/16/2009, 6/30/2009 263.75
110. to 410. to
111. to
411. to _
112. to 412. t0
113. to 413. to
114. to 414. to
115. to 415. to
120. Gross Amount Due From Borrower 177,051.67 420. Gross Amount Due To Seller 170,711.77
[vv. AmOUnts Pata By Or In Behalf Of Borrower 500_ Reductions In ~-mnunt rf~m Tr Ce~t1e~
201. De sit or earnest mon 500.00 501. Excess d see instructions 500.00
202. Prins 1 amount of new loans 108 000.00 502. Settlement cha es to seller ine 1400 _
1 ~ 700.00
203. Existi loans taken su 'es to 503. ExisS loans taken su ' to
204. 504. P of first loan
205. ~ 505. Pa of second a e loan
206. 506.
207. 507.
208. 508.
209. r~9
Ad ustments for items un id b seller Adjustments for items un aid b seller
210. C /town taxes to 510. C' /town taxes to +-
211. Coun taxes to 511. coun taxes to
212. Assessments ~ 512. Assessments to
213. to 513. to
214. to 514. ~ to
215. to 515. to ______ . _
216. to 516, to
217. to 517. to ^--
218. to
518. to - ----
219, to 519. to -- - ~-
220. Total Paid By/For Borrower 108,500.00 520. Total Reduction Amount Due Seiler 2,200.00
~uv. ~.asn Az veLUement rromf ro Borrower 600. Cash At Settlement To/From Seller
__»__ -
WESTERN-SOUTHERN LIFE ASSURANCE COMPANY
CINCINNATI OHIO
STATEMENT OF DEATH CLAIM SETTLEMENT
INFORCE DEPT METZGER EDWIN S 2-05-2009 MAIL TO
980 5144 METZGER EDWIN s PAYEE
W0020178796
CHECK HOC 06226746 HAS BEEN ISSUED FOR $25,632.65
THE CLAIM ON THE ANNUITY LISTED ABOVE HAS BEEN APPROVED AND A CHECK FOR
YOUR SETTLEMENT AMOUNT IS ATTACHED BELOW. WESTERN-SOUTHERN LIFE WILL
NOTIFY THE IRS THAT THE TAXABLE AMOUNT OF THIS PAYMENT IS $771.50
FOR THE 2009 TAX YEAR.
IF YOU HAVE ANY QUESTIONS, CALL A WESTERN-SOUTHERN LIFE REPRESENTATIVE
AT (800) 926-1702.
AMOUNT OF CONTRACT $77,314.51
TOTAL PAYABLE THIS CONTRACT
OTHER CHECKS ISSUED FOR
$51,543.00
$77,314.51
FEDERAL INCOME TAX WITHHELD
STATE INCOME TAX WITHHELD
AMOUNT OF THIS CHECK
$115.72
$23.14
$25,632.65
~^
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Detach the check below. .,~Z~. ~
YOUR BANK OF CHOICE
~NI P.O. Box 66
o Mifflintown, PA 17059
Temp-Return Service Requested
~ I~~~111~~~111~~~~1~1~1~~1~1~1~~1~~~1l1~~~1~1~~~1~1~~11„~~11.1
~ 002355 0.4804 AT 0.346 TR00011
~~ EDWIN S MBTZGER
~ SC 67 BOR 56C
.~ MIFFLIN, PA 17058-9709
56-333861-3
PAGE 1 OF 1
STATEi~N'P PERIOD
FROM. 02/01/09
THRU 02/28/09
ENCLOSURES 1
**************EFFECTIVE FEBRUARY 1, 2009**************
FEE CHANGES: ALL CHECKING AND SAVINGS ACCOUNTS
NON-SUFFICIENT FUNDS PAID ITEM FEE $35.00
NON-SUFFICIENT FUNDS RETURN ITEM FEE $35.00
DEPOSITED RETURN ITEM FEE $8.00
EARLY HOLIDAY CLUB j ACCOUNT CLOSE-OUT FE8 $10.00
CHECKS CASHED OR DEPOSITED FROM ANOTHER BANK MAY RESULT IN
WITHHELD AVAILABILITY OF FUNDS ON ANY OF YOUR JVB DEPOSIT
ACCOIINTS. FUNDS AVAILABILITY IS DETERMINED BY REGULATION.
REFER TO JVB CHECK CLEARING POLICY. JVB WILL NOTIFY
_ _~!. YOU_OF DELAYED FUNDS AVAILABILITY.
FINANCIAL SUMMARY
ACCT DESCRIPTION ACCT NITMSER
DEMAND 56-333861-3
TOTAL DEPOSITS
M
0
N
N
0
0
N
0
ch
rn
0
0
0
0
0
0
N
O tD
o u~
.~
~ o
o ~
o ~
~n
z o
~~
BALANCE
$.00
$.00
------------------------------ INTEREST CHECRING -------------------------------
ACCOUNT NBR DD 56-333861-3 BEGINNING BALANCE $4,328.08
INTEREST RATE .200$ DEPOSITS/CREDITS $.00
AVG LOLL BAL $4,328.08 INTEREST PAID $.00
YTD INTEREST $.89 CHECKS/DEBITS $4,328.08-
YTD WITHHOLDING $.00 SERVICE CHARGES $.00'
ENDING SALANCB $.00
# DEPOSITS/CREDITS 0
# CHECKS/DEBITS 1
2008 INTEREST $12.80
2008 WITHHOLDING $.00
DATE DESCRIPTION AMOUNT BALANCE
02/01 BEGINNING BALANCE $4,328.08
02/25 WITHDRAWAL-CLOSING-CHECK 4,328.08- .00
** ACCOUNT CLOSED ** $.00
-------------------------------- - FE8 SUMMARY ----------------------- -----------
CYCLE TO DATE YEAR TO RATS
NSF RETURN ITEM FEES $.00 NSF RETURN ITEM FEES $.00
NSF PAID ITEM FEES $.00 NSF PAID ITEM FEES $.00
PLEASE EXAMINE AT ONCE; if no error is reported within ten days, the account will be considered correct.
Please notdy bank in writing of change of address.. usE REVERSE s(oE FoR
MEMBER F D.I.C. RECONCILING YOUR ACCOUNT .
I~ M&I'~aail~
ACGAlJM'~ N~1 r :. ~::..
:/I~CGQtIMT- TYP~::: .
15004202173289 M8T MARKET ADVANTAGE
00 0 04309M NM 017
ED S METtGER
HC 67 BOX 56 C
MIFFLIN PA 17058-9709
16810
NO!V.13-FEB.12,2009 1 OF 1
INTEREST EARNED FOR STATEMENT PERIOD 154.44 DILLSBURG
INTEREST PAID YEAR TO DATE 80.33
Or[_[1lINT ~IIMMARV
.. ... ;,BALAM~E :.
......... _ : L1E ... . ~ ... 5::: $:::.: , .:: > :
........OTN~R=<1itB1~TY: :; ::~~..
. ; : - -.; . R11M11R:S . ;~ :..:. HEt#:;.
....::: >::4B~"r .. _~ . .. ...,:.. ::; <...., .: ~t
., ..: ,.: ~N'i'E~tEST'. - ~AYb ....,; ..
:....:......... BALAt~E ..:::.... <.._.
N0. AMOtN~IT N0. AMOUI~IT
72,577.84 0 0.00 1 , .18 154.34 0.00
L1CC~ilNT ~-CTTVTTY
:
. .. ... .......,.::. 1#..:: ...... ~ ,... R ..
~ :: R~:. ~T~ .. N/DR11N . I,.S B Q_ TNT
........SUB*itAC~I ~ 1~I~Y
:.
i1-13- BEGII~MIIIiG BALANCE S72,577.84
12-12- INTEREST PAYMENT 74.01 72,651.85
01-12-0 INTEREST PAYMENT 54.93 72,786.78
01-30-0 INTEREST PAYMENT 25.40
01-30-0 CLOSEOUT 72,732.18 0.00
ENDING BALANCE $0.00
ANNUAL PERCENTAGE YIELD EARNED = 0.99
LOOK FORMARD KITH MST. HELPING YOU FACE TODAY'S FINANCIAL CHALLENGES BY
PUTT~IG A PLAN IN PLACE FOR TOMORROM. JUST VISIT ANY MiT BRANCH, OR CALL
1-800-724-3222. MERE HERE TO HELP. SO LET'S TALK.
MEMBER FDIC.
L008A (fi!0'n
I~ M&TBank
:~cT pct. TY~~
2673080699 CLASSIC CHECKING
00 0 04342M NM 017
ED S METZGER
HC 67 BOX 56 C
MIFFLIN PA 17058-9709
15561
.. .
.:.........
JAN.10-FEB.09,2009 1 OF 1
___._ _ ___ _ -____-- ---- - .- - CARLISLE PIKE
ACCOUNT SUMMARY
::` :' :::~O1tLAiiCE :.,, ...... ::~TH~R~~~~'C~d~iS_ ~"; , ........ >:~i~C~dC-S <t~ATD : . ::...>SU8'Y'I~A~~ItlN.S ...:.> .... .::iN~`~RFS7` . ~D .....:~ .:~i-lait~IC~ .:....
N0. AMOUNT N0. AMOUNT N0. AM01JliT
11,556.40 0 0.00 0 0.00 11, 56.40 0.00 0.00
ACCOUNT ACTIVITY
:: ~ ~ . Q P._ . ~~~ ~MT~R,~ST , ....:CiOCKB..~:'Q~H~R ..............
.. .. .~:.........TRi1NS11CT~ON-;DESCR ~P"fIOM::.....,... :: ....&~:=0~'f1. R::_, ....... ....... ..::SUB~......,J`IONS:; ......::<:::::BA .:...,..
T ~ ~ .....: ..:;:
01-10-0 BEG~MIIN6 BALANCE 511,556.40
01-30-0 CLOSEOUT 11,556.40 0.00
ENDING BALANCE 50.00
MiT PARTICIPATES IN THE FDIC'S TRANSACTION ACCOUNT GUARANTEE PROGRAM tTA6),
UNDER NHICH ALL BALANCES IN NON-INTEREST-BEARIN6 TRANSACTION ACCtMN~ITS ARE FULLY
GUARANTEED BY THE FDIC THROUGH 12/31/09. TAG COVERAGE IS IN ADDITION TO AND
SEPERATE FROM THE COVERAGE AVAILABLE UNDER THE GENERAL FDIC DEPOSIT INSURANCE
RULES. MiT MILL ALSO MAKE ALL CONSUMER NON ACCOUNTS (OTHER THAN PDMER CHECKING)
ELIGffiLE FOR COVERAGE UNDER TA6 8UT TO 00 SO, THE FDIC REQUIRES MtT TO COMMIT TO
PAY NO MORE THAN .50% L~iTTEREST THROUGH 12!31/09. THUS, MET MILL PAY NO MORE THAN
.50% INTEREST ON SUCH ACCOUNTS (OTHER THAN POMER CHECKING) THROUGH 12/31/09.
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