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HomeMy WebLinkAbout12-14-091 15056041125 -' REV-1500 ~ c~5) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County. Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 9 0 0 5 7 2 Hanisburg, PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 9 2 4 5 4 8 0 0 6 0 9 2 0 0 9 1 0 0 4 1 9 2 7 Decedent's Last Name Suffix Decedent's First Name MI H E R M A N BET T Y ~ 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 OVALS BELOW 1.Original Return ^ 2. Supplemental Return ^ 3. Remainder Returln (date of death pnor to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tex Return Required death after 12-12-82) ^ 8. 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. LRigation Proceeds Received ^ 10: Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHQULD BE DIRECTED T0: Name Daytime Telephone Number H A R D L D S I R W I N I I I 7 1 7 2 4 3 6 0 9 0 Flrm Name (If Applicable) I RW I N LA W O F F I C E First line of address 6 4 S O U T H P I T T S T R E E T Second line of address. City or Post Office C A R L I S L E THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS State ZIP Code P A 1 7 0 1 3 REGISTER OF~VIULS USE 0 0 (;" _ q ~ F:. ~.- ~~- ~ n-;. ... ._ M ., D1~E" LED C. S ~,.J P`r'q F ... ~ C~~. ~~ PLEASE NOTE: DUF, TO N ~. ~.~ ELECTRONIC MALFUNCTION WITH TIMECLOCK -THE CLOCK DATE ON THIS DOCUMENT IS 12 HOURS BEHIND THE ACTUAL, TIMF,. Correspondent's e-mail address:IRYYINLAWOFFICfI~GMAIfLCOM Under penalties of perjury, I declare that I haife examined this return, including accompanying schedules and statements, it is tl~ie oo)pc~and complete. Declaration 9f prepafer ofh~an the personal represer>tatnre Is based on all information c SIG F,QEttSQ-J ONSI (LING RETURN 570 OL R ROAD OTHER THAI LEWISBERRY 64 SOUTH PITT STREET 15056041125 CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 --RF.GI,S7'I;R OF WILL/CLERIC OF ORPHANS' PA 17339 o D~~ 2 /~ PA 17013 15056041125 J 15056042126 REV-1500 EX Decedent's Name: BETTY S. HERMAN Decedent's Social Security 1 6 9 2 4 5 Number 4 8 0 RECAPITULATION 1. Real estate (Schedule A) .................. ...................... 1. 1 5 2 0 0 0 0 0 2. Stocks and Bonds Schedule B) 2. 4 2 4 5 0 2 0 3. Closely Held Corporation, Partnership or Soie-Proprietorship (Schedule C) ..... 3. 0 0 0 4. Mortgages & Notes Receivable (Schedule D) .............. .......... 4. 0 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 3 5 8 6 6 1 8 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 0 0 7. Inter-Vivos Transfers & Miscellaneous No -Probate Property (Schedule G) ~ S Billi t R 0 0 0 epara e ng equested ....... 7. 8. Total Grass Asseffi (total Lines 1-7) ........................... 8. 5 5 3 1 1 2 0 4 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ........ ........ 9. 4 3 3 9 0 0 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) .... ........ 10. 1 . 7 2 7 8 11. Total Deductions (total Lines 9& 10) ................... ........ 11. 4 3 5 6 2 8 4 12. Net Value of Estate (Line 8 minus Line 11) ................. ........ 12. 5 0 9 5 4 9 2 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .......... ........ 13. 0 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14. 5 0 9 5 4 9 2 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o _ 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable 5 0 9 5 4 9 2 at lineal rate X .045 0 1s 2 2 9 2 9 7 1 17. Amount of Line 14 taxable 0 0 0 0 0 0 at sibling rate X .12• 17 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 18 19. Tax Due _ 1 g. 2 2 9 2 9 7 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Y r a s Side 2 L 15056042126 15056042126' J REV-1500 EX Page 3 Decedeht's Complete Address: Ffle Number 00572 DECEDENTS NAME BETTtt 8. HERMAN STREET ADDRESS 855 WEBT NORTH STREET CITY CARLI8LE STATE PA ZIP (7013 Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 22,929 71 22,850.00 1,204.62 Total Credits (A + B + C) (2) 24,054.62 Total InterestlPenalry (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX. DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (3) 0.00 (4) 1,124.91 (5) 0.00 (5A) (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIAITE BLOCKS L 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. ff 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 acxount or security at his or her death? ... ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefiaary designation? .........................................................:.................................. ...... ^ ^X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND fILE IT AS 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 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 stahrtory requirements for disdosure 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 tra'hsfers from a deceased child twenty-qne 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 benefiaaries 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 [/2 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 + (8-98) SCHEDiJLE A CONgNONWEALTH OF PENNSYLVANIA REAL ES~~II`E INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE BETTY SL HERMAN 00572 All real property owned solely or as a tenarrt in common must be reported at lair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wHling seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real nrooerty whk:h is birdlv~ownad with right of sunivon:hio must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NOOSE AND LOT AT 855 WEST NORTH STREET, CARLISLE, PA 17013 152,000.00 Va1ae Based on Sales Price See Exhlblt "A° 70TAL (Also enter on line 1 .~ ~.e s__~ .:~.~ REV-1504 IX + tg-~) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scHE~ v~~ c CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER BE ITl/ S HERMAN OOS72 Schedule C-1 or C-2 (induding all supporting information) must be attached for each dosely-held oorporationlpartnershipinterest ofthe decedent, other than a sole-proprietorship. See instructions for tl-e supporting information to be submitted forsole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 8 enter on line 3, Recapitulation) ~ s ,.,e e~~, r - - REV 1507 E~ + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDU4E D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER BETT1/S. HERMAN OOS7Z All properly jointly-oMmed with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE p,00 Y y TOTAL Also enter on line 4, 'tulation S ' O.t>b (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (8-98) • SCHED~JLE E COMMONWEALTH OF PENNSYLVANIA CASH, BpANK DEPOpSITS,p&~MISC. INHERITANCE TAX RETURN PERSONAL PROPER 1 1 RESIDENT DECEDENT ESTATE OF .FILE NUMBER BETTY S HERMAN OOS7Z Indude the proceeds of litigation and the date the proceeds were received by the estate. All propeRy jointly-owned with right of eurvivorahip must be diecbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MEMBERS 1ST FEDERAL CREDIT UN/0N 22,709,29 - - Accoant No. 34479 (Check/ng) See Exh/blt ^C^ 2. MEMBERS 1ST FEDERAL CREDIT UNION 3,27057 Account No. 34479 (Savings) See Exh/bK ^C" 3, MEMBERS 1ST FEDERAL CREDIT UNION 3,364.42 Account No. 34479 (Money Management) See Exh/blt ^C 4. MEMBERS 1ST FEDERAL CREDIT UNION 200,224.20 Account No. 34479 (CertMcate of Deposit) See Exhibit ^C" S. MEMBERS 1ST FEDERAL CREDIT UNION 121,180 1 S Account No. 34479 (Cart/sate o/ Deposit) See Exhibit ^C" 6. 2003 BUICK LaSABRE S,S00.00 Value Based on Sales PrJce 7. M/SCELLANEOUS HOUSEHOLD CONTENTS 1,000 00 8. VA DEATH BENEF/T 100.00 9 TAX PRORATION FROM REAL ESTATE SETTLEMENT 1,308.21 See Exh/b/t ^A^ Y tl ` ~ ~ TOTAL (Also enter on line 5, Recapitulation) S 358 661.84 (If more space is needed, irrsert additional sheets of the same size) REV-1509 EX + (8-98) • , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BETTI~ S. HERMAN NONE ff an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT B C JOINTLY-0WNED PROPERTY: __ _ _ _ __ FILE NUI 00572 ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANGAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % DE S INTE ST. DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. i A. NONE i i 0.00 0.00 i TOTAL (Also enter on line 6, Recapitulation) I s C ~ SCHEDULE F JOINTLY-OWNED PROPERTY moos space 's needed, insert additional sheets of the same size) REV-1510 EX + (B-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHED~lLE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY OF FILE NUMBER BETTIES NERMAIII OpgM This schedule must be completed and filed 'rf the answer to any of quesfions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY n~ru~oFn~,n+enrsaAna~Proo~EO~rANO ~oAh~TRA~ ATTACHACOPYOFTIEDE®PoRRFALEBTA7E DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLWSION CAI TAXABLE VALUE 1. NONE • s 0.00 ~ 0.00 TOTAL Also enter on line 7 Reca ' lotion ; p 00 (H more space is needed, insert additlonal sheets of the same size) REV-1511 EX + (12-99) ' ~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY ~ HERMAN 00572 Debts of decedent must be reported on Schedule L ITEM NUMBER bESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EW/NG BROTHERS FB/NERAL HOME, INC. 9,654.32 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s~EIN Number of Personal RepresentatNe(s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees IRW/N LAW OFFICE 20,343.36 3, Family Exemption: (If deoedertYs address b not the same as daimanYs, attach explanation) Claimant Street Address ' City State Zip Relationship of Claimant to Decedent 4. proba~ Fees CUMBERLAND COUNTY REGISTER OF WILLS 504.00 5 Accountants Fees 6. Tax Return Pteparer's Fees 7. CUMBERLAND COUNTY REGISTER OF WILLS - Flle Inventory and Apps/sement 30.00 8. CARL/SLE BOROUGH TAX ACCOUNT = 20091!0 School Rea/ Estate Taxes 2,077.!3 9. PPaL - E/ectr/c Bill 5617 !O. MARL/SLE BOROUGH - F/nal Water B1II 75.08 !1. B-NAOENCI~! CENTIlRl~2! -Real Estate Comm-sslons 9,!20.00 12. Notary Fees on Rea/ Estate Sale 10.00 13. hansfer Taxes on Real Estate Sale s 1,520.00 TOTAL (Also enter on line 9 Recapitulation) s , 43.380.06 (If more space is needed, insert additlonal sheets of the same size) REV-1512 EX + (1203) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER BETTI~ S NERAIAN 00572 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed~ medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. OMNI CARE PHARMACY sERVICES 172.78 Medlca/ BIII TOTAL (Also enter on line 10, Recapituiaation) I .S 172.78 (if more space (s needed, insert addfional sheets of the same sae) REV-1513 EX + (9-00) SCHEDULE J COAIMAONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTI/ S HERMAN 00572 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 [ndude outright spousal distributions, and transfers under 1 S 9116 . ec. a 1. MAR]/ ~ OETZ Llneal 570 Old Quaker Road 5095 Res/due Lewsberry, PA 17339 2. PATRICIA J. MACE L/neal 700 Walnut Bottom Road 5095 Res/due CarlIsle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. NONE p 00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. NONE a 0,00 y y , TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET E 0.00 (If more space is needed, insert additional sheets of the same size) EXHIBIT ••A" _ ___ __ OMB NO. 2502-0265 1r A. B. TYPE OF LOAN: S DEPARTMENT OF HOUSING b URBAN DEVELOPMENT U 1.QFHA 2.OFmHA 3. ~X CONV. UNINS. 4. QVA 5. ^CONV. INS. . . SETTLEMENT STATEMENT fi. FILE NUMBER: MOLLACK 7. LOAN NUMBER: 1002115 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is famished to give you a statement of aqua! settlement costs. Amounts paid to and bq the settement agent aro shown. Items marked ~POCJ" were paid outside the closing; they are shown here for in/ormaHonal purposes and aro not included in the totals. . 1.0 39B (MOLLACKPFDMpLLACKnS) D. NAME AND ADDRESS OF BORROWER: HENRY C02ZENS MOLLACK E. NAME AND ADDRESS OF SELLER: MARY E. GETZ Administratmc of the Estate of BETTY S. HERMAN F. NAME AND ADDRESS OF LENDER: GMH MORTGAGE SERVICES, LLC 10 CAMPUS BOULEVARD NEWTON SQUARE, PA 19073 G. PROPERTY LOCATION: 855 W. NORTH STREET CARLISLE, PA 17013 H: SETTLEMENT AGENT: 23-2402316 PURITY ABSTRACT COMPANY I. SETTLEMENT DATE: December 1 2009 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT CENTURY 21 A BETTER WAY 398 E. HIGH ST, CARLISLE, PA , J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contrad Saks Price 152,000.00 401. Conlrad Sales Price 152,000.00 702. PersonalP 402. PensonetPro 103. Settlement Cha es to Borrower Line 1400 5,914.23 403. 104. 404. 105. 405. Ad'u nts For Items Paid 8 Ss/br in advance Ad'usfmsnts For /kms Paid B Seller in advance 106. Coun R Taxes 12/01/09 to 01!01110 75.59 406. Coun Taxes 12/01/09 to 01/01/10 75.59 107. C Tax' t0 407. C' Tax to 108. School Tax 12/01/09 to 07/01110 1,232.62 408. School Tax 12/01109 l0 07/01/10 1,232.62 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 159,222.44 420. GROSS AMOUNT DUE TO SELLER 153,308.21 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De' sit oreamestmone 1,000.00 501. Excecs ft SeelnsWdions 202. Prind ai Amount of New Loans 121,800.00 502. Settlement Cha a to Seller Line 1400 10,725.08 203. Existin ban s taken sub' to 503. Exist loan s taken sub'ed to 204• 504. Payoff of firot Mo a 205. 505. Pa second Mo 206. 506, 207. 507. De Daft dkb.as raceeds 208. 508. 209. 509. Ad'ustments For hems Un aid B Seller A 'ustmeMs For hems Urt aid 8 Seller 210. Coun R Taxes to 510. Cou R Taxes to 211. C Tax to 511. C Tax to 212. School Tax to 512. Schod Tax to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID t3Y/FOR BORROWER 300. CASH AT SETTLEMENT FROMRO BORROWER: 122,600.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 600. CASH ATSETTLEMENT TO/FROM SELLER: 10,725.08 301. Gross Amount Due From Bortower Line 120 302. Less Amount Palo 8 /For Borrower Line 220 159 222.44 ( 122,600.00 801. Gross Amount Due To Seiler Line 420 602. Less Reductions Due Seller (Line 520) 153,308.21 ( 10,725.08) 303. CASH(X FROM) ( TO) BORROWER 36,822.44 603. CASH(X TOJ ( FROM) SELLER 142,583.13 The undersigned hereby adtnowledge receipt of a completed copy of pages 18.2 of this statement 8 any attachments referred to herein. - ~ rj Borrower ~ ~ L/L:. ~ •,t„ ~ i~Y`" `o~ Seller PAARY E. GETZ AdministraMx of the Estate of BETTY S. H NRYCO NSM CK HE o ' R`~ j 'y' /~ c ~~_: •J a a ~(-~IIBIT "B - Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results~for Redemption bate 06/2009 Page 1 of 1 Tota! Price Total Value Total Interest YTD Interest 16 250.00 42 450.20 26 200.20 818.80 Bonds: i-6 of 6 Seria! Issue ~ Series Der+drr~ Date Next Firtsi Accrue! Maturity Issue Price Interest Interest Rate Value NA: EE $500p08/1988 ;.08/2009:08/z018, _.. •„ •,$250.00 461.80: 4.00°Yo• 7X1.80 .•.•,NA,•„•.EE•,, ,,,$10~000~12~1991 1Z%2009~12%202].,, ........... ~,,,$5,000.00. $7,640.00; 4.OO~o,$X2,640.00 , NA EE $].4,000 ].Z/1991 12/2009: 12/2021.: $5,000.00: $7,640.00: ~ 4.00%0;$12,640.00 _• „• •, NA : EE $10,000' 1211991 ' :12/2009 = 12%2021 . , X5,000.00•.•• .. . ••_•$7,640.00 4.00°Yo ~ $12,640.00 NA • EE 03/ 1985 ; $1,000 ; • ~ ......... i .. .. 03/2015 „092009 $500.00 ; $1,318.80 . , 4 ;00%0 • ••;1,81.8.80 EE NA ~ , ,• •„ . 07~1983 ~1,000 ,• 07~Z013: 07/2009 ~ _$500.00 _ ~ $1,499.60+ y2.93°Yo $1,999.60 ~ ~ ~ •~ ~~ , ,~ .,_ , •,•, • , ,,, ~•• ~~ ~-~ ~ •~ ~ ~ ~~ ~~ ~ • ~ Totals for 6 Bonds ~ 516,~50.00 $Z6,2o0.20 : X542,450.20 Notes NI Not issued •• , NE `Not eligible•for payment •, „ „ , P5 •:Includesy3 month interest penalty , ,. MA ~ Matured and not earnin Interest . httn•//www trPacnrvAimrt anv/R['!/CRf :Prirps ~G/~dl'fnn~ JUI\-LY-LUU74WLU! ~~~ ~u unn~iuwn unnn ~i ui~~~ sui,~ ., ~~.,~ ~ ~ ~ ~... ...,.~ ,... _. _._ OOQ 006 JUIY-ca-cuuytwcul ~~~ » . . i i I r :' 1 t URR] l uwn unnn u~ ~nri ~ a ~i~~ ~~ ~~.,, ~ ~ ... ~ _.. __ _ - To Helen M. 5~~~~. ..z -- .8~848(~ _~~~~'" __ xH ~, Box. 8b1~' ~- ' ~~w,r ~ ~j Duncannou, E~;, i~1.7 "I ~; • ~:_.,. Bert J. Herm~.n '~'rr?~,~ `• cFR~ ~c FF ^~. _.~"°:~~P.. ;~'~~~ -"r''~ (H 9 0 9 2 9 8 4 E E ~~ `~' "~~ CY r\~J . 'JET ~ rwn+n~ ~T nuaw w~u.-nT . - v ti.;ir rr - - ~. ~ •.; '•" I' • ~„~ 155UE DATE . ...... wipcn is niG rinsT oar or ~ '~='Y~" 7a Helel', i~t }~vely :~O July •~9:'~'3 r .•' .~~ .'k~cl ''~'`. L ir'1 •. ~ ,~ . ~s ~SllAltp' 0~~~~'-: ~ e .a' a ... 'U.Y1Ct1'T3111S~~,~~ a'• :~,... .. ~p,~~urn.•'. ~ I ~ ~ 1. IOGtnM3 AGCMYO ~i' - ~ r .OY' Grr~~own.:Banti. ... '1, i rw~ ,`i:~ ~ . ' ,Betty . ~ I'Ie. i~riari'• _ - •, ~ '*'~~'.,• ~, `~.''.:.~,; : ~ _ '~~~~~~.rr~:PA~. •:17.244:• ~ .... • •.~ ~ . _~•. ~ ~ ~= .t•.~..~~:;:~;~ ._ .. •~.~;~ ,w ~, ~ ~~„~,.,.::...:~.j ~~M2.'06.3°:892 EE-' A -_ ~. .. - ... EXHIBIT "C" ve • PO Box 40 Mechanicsburg, Pq 17055 www.memberst st.org Main Switchboard: EZ Catl: (717) 697-4372 or (800) 283,4372 ® TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (800) 237-7288 St EMBERS 1 FEDERAL CREDIT UNION 23468 1 AV 0.335 _ ...~~ ~~n~~linlnl~~n~~~l~~u~~~u~~~rl~~n~nILI46IIIm~in~l8 ~._ BETTY S HERMAN -" C/O MARY GETZ,EXECUTOR __ 570 OLD QUAKER ROAD "'- LEWISBERRY PA 17339 ~~ Statement of Accounts Jun 01, 2009 thru Jun 24, 2009 Account Number: 84.4.79 Balances at a Glance: Checking : 0 ~ Savings : 3, 275.57 Certificates : 321,404.35 __. Loans: 0 ~ _- Money Management: 3,364.42 _ Swipe 5 YTD Reward: 0.00 Your current Member Loyalty Rewards level is Titanium. St Send Inquires to 5000 Louise. Dri Page:. 1 of 2 Would you like to receive a full calendar month statement? Sign up for eStatements today! See the enclosed insert for more details. ~y- ~ Send Inquires to: Main Switchboard: (800) 283-2328 ~~ 5000 Louise Drive ~ Call: (717) 697-4372 or (800) 283-4372 JUn O1, 2009 thru Jun 24 , 2009 PO eoz 40 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 ses3s-33ass Mechanicsburg, PA 17055 Account Number: 34479 ~~ www.memberslstorg TeleBranch: (800) 237-7288 Page; 2 Of 2 Date Transaction Des ' tion Additions Subtractions Balance ID: 3121736156 CO: CIVIL SERV Jun 01 Withdrawal Transfer To Share 11 1,409.94- 3,275.57 Jun 24 Ending Balance 3,275.57 05 -MONEY MANAGEMENT Date Transaction DesciiDtion Additions Subtractions __ Balance -- Jun O> Ba/anoe Foiwab 3 ,364.42 364.42 3 Jun 24 Ending Balance , CERTIFICATE ACCOUNTS 41 - 9 MONTH NO PENALTY CERT Maturity-Date -Jan 77, 2010 Date Transaction Description Additions Subtractions Balanie .Jun tit Balance-Fo~dnl - 2a0,~4 ~©:. 200...224<~0 Jtm 24 End~g~8a/anae