HomeMy WebLinkAbout01-15-10T
.~ ~ 1505607121
REV-1500 EX {06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau oflrxiiuidualTaxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 0 9 1 0 0 0
_ Harrisbu-g PA 17128.0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 9 1 4 ~# 5 1 5 1 0 2 0 2 0 0 9 0 7 0 9 1 9 2 2
Decedents Last Name Suffix Decedent's First Name MI
S M A L L E Y E L I N O R L
(tf Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
® 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
pnor to 12-13-82)
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 [] 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
R O G E R B I R W I N E S Q U IRE 7 1 7 2 4 9 2 3 5 3
Firm Name (if Applicable)
I R W I N & M c K N I G H T P C
First line of address
6 0 W E S T
Second line of address
City or Post Office
C A R L I S L E
P O M F R E T S T R E E T
State ZIP Code
REGISTEIj QF WILLS US LY
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Correspondent's e-mail address:
Under penatiies of perjury, I declare that I have examined this return, including aocompany'mg schedules and statements, and to the best of my knowledge and belief,
it is true, corre<:t and complete. Declaration of preparer other than the personal representative is based on afl infonnafion of which preparer has any knowledge.
T OF PERSON PONSIBLE R FILING RETURN DATE
~ ~ ~ ~
ADDRESS
908 ST• PAUL STREET LEWISBURG PA 17837
SIGNA OF PREPARER OTHER THAC~NTATIVE A
t ~ ~' ~~
ADDRESS
6D WES PO FRET STREET CARLISLE PA 17013
~.... PLEASE USE ORIGINAL FORM ONLY
1505607121
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'[22L09S05'C
• ~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent
•ELINOR L. SMALLEY 21 09 1000
Decedents Name Page 1 File Number
Correspondents
Name
R O G E R B
Finn Name (If Applicable)
I R W I N &
First line of address
Second line of address
6 0 W E S T
City or Post Office
C A R L I S L E
Correspondents e-mail address:
Daytime Telephone Number
I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3
Mc K N I G H T P C.
P O M F R E T S T R E E T
State ZIP Code
P A 1 7 0 1 3
Under penalties of perJury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it ~s true, correct and complete. Declaration of rer other than the personal representative is based on ali Information of which preparer has any knowle~e.
SIGNATURE OF P~RS~N RESPONSIBLE R FY.IN~yRE'~}1AN DATE
ADDRESS
REV-150ie EX Page 3
Decedent's Complete Address:
File Number
21 09 1000
DECEDENTS NAME
ELINOR L. SMALLEY
STREET ADDRESS
46 BULLOCK CIRCLE
CITY
CARLISLE STATE
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 159.27
3. InterestlPenalty if applicable
D. Interest
E. Penalty
(1) 3,185.34
Total Credits (A + g + C) (2) 159.27
Total InterestlPenalty (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.
(3) 0.00
(4) 0.00
(5} 3,026.07
(5A)
B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (5B) 3,026.07
Make Check Payable fo: 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 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 orfor the use of the surviving spouse
is three (3) percent p2 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 orfor the use of the surviving spouse is zero (0) percent
(72 P.S. §9116 (a) (1.1) (ii)j. 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 orfor the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent p2 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)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
SCHEDULE E
CASH
BANK DEPOSITS
~ MISC
COMMONWEALTH OF PENNSYLV
N
,
,
.
A
IA
IN
R" PERSONAL PROPERTY
SI
RE
DENT DECEDENT
ESTATE OF FILE NUMBER
ELINOR L. SMALLEY 21 09 1000
Indude the proceeds of IidgaUon and the date ffie proceeds were received by the estate.
All properly jointly~owned vvttll fight of survivorship must be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PERSONAL PROPERTY -APPRAISAL ATTACHED 11,396.00
2. MISSION INVESTMENT FUND #20000003609 22,628.60
3. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT ACCOUNT #2895546139 10,421.32
4. SOVEREIGN BANK -MONEY MARKET ACCOUNT #2891023684 9,130.35
5. SOVEREIGN BANK -CHECKING ACCOUNT #2891029704 1,267.72
6. SOVEREIGN BANK -CLUB ACCOUNT #2894017116 1,240.75
TOTAL (Also enter on line 5, Recapitulation) ~ S
{If more space is needed, insert additlonal sheets of the same size)
REV-1540 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
ELINOR L. SMALLEY 21 09 1000
This schedule must be completed and filed 'rf 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
~NCLUOETHENAME~FTHETRANBFEREE,Tf1EIRREUTI0N8HIPTODECEDENTAND
~~~~~~ ATTACHACOPYOFTHEDEEDFORREALE8TATE.
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
~FAPPLJCABLEJ
TAXABLE
VALUE
1. VANGUARD 21,886.68 100. 21,886.68
SHORT-TERM BOND INDEX FUND INVESTOR SHARES
BENEFICIARIES:
ELAINE S. WALL
KEITH E. SMALLEY
TOTAL (Also enter on line 7 Recapitulation) ~ ~ 21 886 68
(If more space is needed, Insert addfional sheets of the same size)
REV-1571 EX + (10-06)
, , SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ELINOR L. SMALLEY 21 09 1000
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 777.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
2, Attorney Fees IRWIN & McKNIGHT, P.C. 3,700.00
3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees REGISTER OF WILLS 177.00
5 Accountants Fees
6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 350.00
7. REGISTER OF WILLS -FILING FEE 30.00
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
9. THE SENTINEL -ESTATE NOTICE 198.16
10. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 64.00
TOTAL (Also enter on line 9, Recapitulation) I S ~ ,.,,, ~~
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
. ~ SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT s
ESTATE OF FILE NUMBER
ELINOR L. SMALLEY 21 09 1000
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. FIRST ENERGY -ELECTRIC 84.00
2. CENTURYLINK -TELEPHONE 134.56
3. DISCOVER CARD -CREDIT CARD 62.06
4. UGI -UTILITIES 132.64
5. CUMBERLAND CROSSINGS -NURSING 955.00
6. METLIFE PENSIONS -REIMBURSEMENT OF PENSION PAYMENT 416.81
7. UNITED REFINING COMPANY OF PENNSYLVANIA -CREDIT CARD 29.38
TOTAL (Also enter on line 10, Recapitulation) I S
(If more space is needed, insert addfional sheets of the same size)
REY-1513 ~EX + (g-p0)
SCHEDULE J
• COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
ELINOR L. SMALLEY 21 09 1000
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 pndude ouhi~ ~ spousal distributbns, and transfers under
Sec.9116 a 1.
1. KEITH E. SMALLEY Lineal 70,785.31
908 ST. PAUL ST.
LEWISBURG, PA 17837
2. ELAINE S. WALL Lineal
RR1 BOX 166A
NOXEN PA 18636
3. JANET L. SMALLEY Lineal
303 7TH ST., N.E.
WASHINGTON DC 20002-6103
4. ANNETTE R. BUTERA Lineal
1601 MELROSE AVENUE
HAVERTOWN, PA 19083
5. KATHLEEN E. PALMER Lineal
3117 PHEASANT RUN
IJAMSOILLE, MD 21754
6. KAREN S. JOHNSON Lineal
4460 RICHMOND ROAD
KESWICK, VA 22947
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(It more space Is neeoeo, Insert aoaltlonal sneers of the same size)
LAST WILL AND TESTAMENT
I, ELINOR L. SMALLEY, of South Middleton Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my Executors to pay all of my debts, funeral and administrative expenses as
soon as maybe done conveniently after my decease.
2. I authorize and empower my Executors to sell any realty owned by me at my death,
and not specifically devised herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if living.
3. I devise and bequeath all of my estate of every nature and wherever situate to my six
(6) children, share and share alike, the child or children of any deceased child taking the share
their parent would have taken if living.
4. I nominate and appoint KEITH E. SMALLEY and ELAINE S. WALL to be the
Executors of this my Last Will and Testament; they are to serve as such without bond.
5. I hereby suggest that my personal representatives retain the services of Irwin &
McKnight as attorneys in the settlement of my estate.
.-
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~'~ day of
September, 2003.
(SEAL)
ELINOR L. SMALLEY
Signed, sealed, published and declared by ELINOR L. SMALLEY, the above-named
Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in
her presence and in the presence of each other have subscribed our names as witnesses hereto.
. y~D~l~
2
ACg1VOWLEDGMENT A=D AFFIDAVIT
WE, ELINOR L. SMALLEY, MARTHA L. NOEL and SHARON L. SCHWALM,
the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed
and executed the instrument as her Last Will and Testament, that she had signed willingly, that
she executed it as her free and voluntary act for the purpose herein expressed, and that each of
the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that
to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
ELINOR L. SMALLEY
L. NOEL
~/A~l~ ~X ~Ci~~
SHARD L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by ELINOR L. SMALLEY, the
Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and
SHARON L. SCHWALM, witnesses, this -Zz'= day of September, 2003.
'3. c~-_
Public
Nc}t~rial Seal
R twin, Notary Public
Carlisle Boro, Cumberland County
rvty Commission Expires Oct. 3, 2004
Member, Pennsyhlartia Association of Notaries
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Page: 1 of 1
Account Number: 20000003609
Statement Date: 10-20-2009
ELINOR L SMALLEY
46 BULLOCK CIR i
CARLISLE PA 17015-7617
I
I
Statement Summary
Account Number T~-pe
20000003609 MissionTermSelect 3 Year
Current Maturity Date: 03-05-2010
Balaace
22,628.60
Account Summary for MissionTermSelect 3 Year - 20000003609
Starting Interest Service Ending
Balance + Deposits + Paid - oPithdrawals - Charges Balance
22,628.60 0.00 0.00 0.00 0.00 22,628.60
There is no activity for this account.
The amount of Interest earned between 10-01-2009 and 10-20-2009 is $17.23.
The average daily balance during this period was 22,628.60.
The minimum balance during this period was 22,628.60.
The Annual Percentage Yield Earned for this account is 1.40.
Interest Paid YTD: 222.56 E~EIVED
DEC 0 8 2009
iRWIN & McKNIGH~i
LAW OFFICES
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i~ovrereign Bank
STATEMENT OF ACCOUNTS
1-877-SOV BANK (1-877-768-2265) www.sovereignbank.com
... ~1 ,
ELIl110R L SMALLEY
Account
Your account is currentty at a zero balance. If your account remains at a zero balance for two entire
statement periods with no activity, your account may be closed. Please deposit funds into this account
quickly to prevent it from closing. If this account is not meeting your needs, it would be our pleasure to
discuss other options-with you.
Bareness ... _ .. .. _..........; .. ~~ ._.. ...
,, 1~~,.},~
Deposits/Credits_ + $0.00 Average Daily Balance i" $9,527.61
Interest
~,
~~.~~' '~ „~ ;:
'
ti.0;0o ~ ~
~ 14~+'}~'i:
, t6~~7'ief~'~
OA ~~
~ ., .,
Earned
his Period $ 0.00 Paid Last Year $282.22
t
_.'7M~ tixr~~+a .t ...~ -_., eA~.e.:a..~.anxn -. ... _._.J:aa~ .r~Cr .. .. _.L~....1~.,~1 .~'.~ .~.~ .. _ .- ..._. .,._... v .~... .... _..~~.~
'The interest earned and the interest paid may differ depending on when interest is credited to your account
Checks Posted
Check # Date Paid Amount Reference # Check # Date Paid Amount Reference #
T,n~- ~
1 Check(s) Posted s $975.44
An asterisk (*) indicates a skip in sequential check numbers which maybe caused by one of the following:
. A check not yet received
A check that was converted to an electronic transaction, .which will be listed in the."Electronic Checks Posted"
section below. If no checks were electronically converted, this section will not appear. : .
Account Activity
Date Description Additions 3ubtrections ~ Balance
10-06 Beginning Balance $10,105.79
~y y _
r ~, ~ ~ ~,
..~ _ ~~ .:#~, .. w. _.~.
,...s....w..~. . .'a n., 's °. ,
10-28 CLOSING TRANSACTION
Statement Period 10106(09 TO 11105!09
MONEY INARKET
va¢e 3 of 3 2891023684
deign Bank
STATEMENT OF ACCOUNTS
' Statement Psrlod 10/08/09 TO 11/05109
68-1143 wwwsovereignbank.com 30VEREIGN PREMIER CHECKING
SMALLEY
Account # 2891029704
7Deposits/Credits + $416.81 Average Daily Balance $1,028.31
, iW ~ Y
illlt@II,98t.. __ .
-`~ I« ly ~y~y~ .
,
~
Eamed this Period $ 0.00
Paid L
a
st Year X1.29
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~ _ ~ .,.j ~ i~~.. ~ c `St+rr~-+;i~~~i`':£5~~ 2~~'~G -~~~ . ~ t; z!t' ~}:.. yM
,'w i r ~a
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`The interest earned and the interest paid may differ depending on when interest is credited to your account.
S@rviC@ Fees Date # Transactions Fee Total
_.... _
,.
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i 1'~lttl ~4~ ;l~fotr, t ~Y. c. ~~ ~~7,- ~ y'
- ~, 'i2:
Total $80.00
Checks Posted
Check # Date Pakl Amount Refenmce #
-~ arp
„,,
4!
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~
:., - „~. ~r~_ , :r _ tee
~
.
5703 10/06 $380.00 991150850
I
5705 10/15 • $85.00 657800680
Check # Date Paid Amount Reference #
.~°
"Nwe - :..'~fIL~R~.f - 'L ,~.1~ ~itT 12~T f~^
5707 10/20 $100 00 658375400
.. _
} ~.
lll~
7 Check(s) Posted = 51,078.17
An aster~k (~ indicates a skip in sequential check numbers which may be caused by one of the following:
• A check not yet received
• A check that was converted to an electronic transaction, which will be listed in the "Electronic Checks Posted"
section below. If no checks were electronically converted, this section will not appear.
Account Activity
Date Description Additions Subtractions Balance
10-06
Beginning Balan
c
e $2,404.89
~,
yW
__+~
~t,
10-06 CHECK 5702 $2.99 $2,021.90
~
10-13 UGI UTILITIES $79.00 $1,492.90
UGI BILL OCT 13
213-772-1435-13
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1 •
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10-16 CHECK
5706 $40`18 $1,367.72
~.
Page 3 of 5 2891029704
8ov+ereign Bank
1-877-SOV-BANK (1-877-76&2265)
EUNOR L SMALLEY
Your account is currently at a zero balance. if your account remains at a zero balance for two entire
statement periods with no activity, your account may be ~ciosed. Please deposit funds into this account
quickly to prevent it from closing. If this account is not meeting your needs, it would be our pleasure to
discuss other options with you.
www.sovereignbank.c~m
Account # 2894097116
" This balance was cak:ulated for the peHod beginning on 11/01/09 and
Interest
~ 1VJ
. ~:, ,: s..F;~~ s i Y.-. ._, -7 'Siii4. e.. ~. ,. r ,~ .,~ .. fl 1~, W.r.~... ~4 ... .._~
Eamed this Period $ 0.05 Paid last Year X0.93
~ -
"The interest earned and the interest paid may differ depending on when interest is credited to your account.
Account Activity
Date Description Additions Subtractions Balance
10-01 Beainnina Balance $1,140.00
~.
page 3 of 3 2894017116
STATEMENT OF ACCOUNTS
Balances
~vereign Bank
Balances
STATEMENT OF ACCOUNTS
Statement Period 11!06109 TO 92106/09
80VEREIGN PREM{ER CHECKING
DapositsliCredits +$417.77 Average Daiiy Balance - $147.77
,:
.{-
Interest ~ .. ..
Earned this,Period $ 0.00 Paid Last Year $1.29 ;
*The interest earned and the interest paid may differ depending on when interest is cred(ted to your account.
Service Fees Date # Transactions Fee Total
SERVICE FEES PENDING DEBIT 12/04/09 1 30 00 $30 00
Total
_ $0.00
Account Activity
~a 1 y~
~~~~
page3 of3 ,on~n,n~n.
EuNOR t snwccEr ~ ~ Account # 2891029704
.Vanguard'
ELINOR L SMALLEY
46 BULLOCK CIR
CARLISLE PA 17015-7617
TRANSACTION ACTIVITY
December 31, 2009, yeaz-to-date Page 1 of 1
TRANSACTION DETAIL
800-662-2739 - Client Services
vrww.vanguazd.com
~ ~ (800) 662-6273 - Tele-Account
~~ ~
Vanguard Short-Term Bond Index Fund Investor Shares Fund / Account no. 0132 /09934295270
Trade date Transaction descr~tlon Dollar amount Share price Shares transacted Total shares owned
Balance on 12/31 /2008 $ 21,00.45 $10.28 2,046.736
1 /30 Income dividend 58.97 10.27 5.742 2,052.478
2/27 Income dividend 53.42 10.21 5.232 2,057.710
3/31 Income dividend 56.41 10.25 5.503 2,063.213
4/30 Income dividend 53.15 10.28 5.170 2,068.383
5/29 Income dividend 52.93 10.33 5.124 2,073.507
6/30 Income dividend 49.77 10.32 4.823 2,078.330
7/31 Income dividend 50.69 10.37 4.888 2,083.218
11 /30 Income dividend 44.13 10.56 4.179 2,101.075
12/23 LT cap gain .001 2.10 10.46 .201 2,101.276
12/31 Income dividend 44.84 10.42 4.303 2,105.579
Balance on 12/31 /2009 $ 21,940.13 S 10.42 2,105.579
Year-to-date Short-term gains / Purchases / Total cost basis /
Income dividends Long-term gains Redemptions Average cost per share
$ 607.28 $ 0.00 $ 0.00 $ 21,465.20
2.10 0.00 10.19
$ 609.38 Total Income year-to-date
000000012233980 2 1_ 1
047041 7049 1048 M1 5
IN~NN~a~N~NN~~~NN~N~~Nnl
. ~-
219 North Hanover Street
Carlisle, Pennsylvania 17013
717.243.4511
1~ ~ .toll free 1.866.451.4511
~ ~ fax 717.243.3723
www.hoffmanroth.com
FUNERAL HOME ~ CREMATORY, INC. info~hoffmanroth.can
~~IV~ED
• NOV~ 1 ~ ?dOg November. 12, 2009
Keith Smalley ~ ' •
908 St. Paul Street ~ ~~WIN & McKNIGHT
Lewisburg, PA 17837 l.AW OFFICES •
Statement of Funeral Expenses for: Elinor Smalley
Date of Death: October 20, 2009 Acxount Id: 15763-240
FACILITIES AND PROFESSIONAL SE VICES:
Services of Director and Staff $ 3,630.00
. Sub Total: S 3,530.00
MERCHANDISE:
Casket: Hearthside $ 2,930.00
Sub Total: $ 2,830.00
TOTAL FUNERAL HOME CHARGES: S 6,460.00
CASH ADVANCES:
12 Certified Death Cert~cates at $ 6.00 each $ 72.00
Newspaper Notice -Sentinel $ 160.68
Newspaper Notice -Patriot $ 274.72
Flowers $ 159.00
Hairdresser $ 40.00
Newspaper Notice -Bradford Era $ 71.10
Sub Total: ; 777.50
Total Funeral Expense: $ 7,237.50
Total. Payments Mads: S 6,460.00
Payments made:
PreAr Disount .Discount PreAr Nov 12, 2008 780.85
SecurChoice Check 59537 Nov 12, 2009 5,678.05
• Total Balance Due: t 777.50
Please return this portion with your Remittance
S Amount Enclosed
Elinor Smalley
Service ID #: 15763-240
SERVING OUR COMMUNITY SINCE 1 9~7
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