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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 ~C ~ . : '~.. } ~ ~..~ •~ is ~, ..; ~~r fil -` - ..-- r r'~ ~ CJl ti > ~.'~ ':~ ~: c~ ~ F° _ TILED ~"~ ., , P A 1 7 0 1 3 L~ ^.`3 -- _~,{7 _~ -i a ~.~ i= ~ i c.:.u) -ra 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 Side 1 1505607121 (fir r 'I22L09SOS'[ 'C22L09S05'[ Z aplS h E 'S 9 2 E 1N3WAtld3i3A0 Ntl dO aNfld321 tl ~JNLLS3f1b32i 3?!tl f3OA dl '1tlAO 3H1 NI l~ld 'OZ 61 ................................................ anQ ~1'6l 0 0' 0 "86 0 0. 0 9l' X ales le~alepoo le • algexel ql aun;o lunowtl gl 0 0 •0 •1 ~ 0 0 0 • f g s L L alq~l tiL u!1 ~o lu n o uro h E' S Q 2 E .g ~ '[ E' S S L O L 5tio• x ale, leaull le algexel ql aul~;o;unou~y •gl 9 L l6 .oaS ~apun SJa;sueA ~o'ale~ xel lesnods ayl le algexel til aui~;o;unowy "gl S31tl21318tlO1'lddtl liOd SNOI1~n3d1SN133S - NOI1tl1f1dW0~ Xtll 2 E • S Q L O L •bl .................. 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(1_l saul~ lelol) slasstl ssa0 Ielol '8 Q 9 ' 9 Q Q 2 2 ~1 ~ ' ' ~ ' ' ' palsanbaa 6u11118 a3e~edaS (] (O alnpa4oS) • ~adad alegad- snoauepaoslw +g SJa;sued sonl/~-~alui 1 • .g ....... palsanbeb Bu1018 alt?wedeS ~ (~ alnPa4oS) ~adad paunnO ~(gulor 'g h L ' fi 9 0 9 S .5 ~ ~ ~ ~ ~ ~ ~ (3 al~pa4oS) ~adad IeuosJad snoauepa~slw +g sllsodaq ~lueg 'yseO 'g .b ........................ (d aI~Pa4oS) algenlaoaa se3oN S sa6eB~ow •b .£ ..... (O alnPa4oS) dlUsaWaudad-aloS ~o dlysJeu~ed 'uo~eJOd~o~ plaH ~(lesol~ '£ 0 0 • O .z .................................. (e alnPa4oS) spuo8 pus s~o3S 'Z . l ........................................ (b aI~Pa4oS) slelsa lean • l NOlltl~f111dtl~321 S '[ S h h 2 6 L `[ A 3 9 ~ 11 W S ' l 210 N I l3 ~®waN swepe~ea ~agwnN i(lunoag lelooS s,luapaoaa X3 0091-A3a '[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 3 ~~ ~~l~~V ~~~~e `' ~ / _ i~~ r ~.i1.d~• ~/~J1/J'j ~~2G7 ~ ~- C~~~~~ G~ ~~ ` r~,...2~ , r t ~ -^~ i ~~ /G ~7 ~~ /~ ~~ ~~ 4 ~~ ~ ~~ ~ ~'~. ,~? G ~4 l.~ /~ ~`• ~/ /~ ~z ~~~ ~ ~ i. ~~ a~ ,. ~~~~~ ` r F y.. ' ~.-wis~i~ C h • ' L/ ~ // ~ A 7TH/AAA/~4 ,f~/. ~~ ~~ ~~ ~d ~Z7 y ~ ~ ~' ~ ~ ~ 1 / ~/1 /~~~ v~~~ ~~1 ~`-~ a° ~ ~ ~~ ~~;~' ~'it,39~ ~°~~~`~~~~~i~ ~ , o•~ 1 /D ~~y_r° p' ~~..~----to7 •oo + ~ff~-~~g~2•p0 ~~:396°* 0• ~ ~~~~ ~~ ~~ ~. •~ ~.~ ~ ~ 9' ~ ~~~~f .,' ,~, Qa ~ ~~' ,`~ ~~ ~ . R 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 a I v W O .~~ N .~ U 0 t 0 c ~y P CMO Cb_o r N d C `y y J •~ ~ Y ^~ m O ~ ~ U Wpm v r' ` ;7. '."~ (t,. ,_ -~k ;~l trs rt,E .rl ../c ' ~ ~, u ~' ~;'-., .. ,-., ~A : ~ ~- a ~., ~; ~a ,~ _~. }~ •:~ ~ ~ ~ 4~ r' .r^~ iv '"a? 'w _a i+ .i. ::+k ~., s3? :J ~ ~" +s ~:a ~ ~' ~~~o ~+ 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 ~. a: :...~. .,. . - ~~....-.. _ .1 ~~y ? ~ _ ~ .,.j ~ i~~.. ~ c `St+rr~-+;i~~~i`':£5~~ 2~~'~G -~~~ . ~ t; z!t' ~}:.. yM ,'w i r ~a R~ `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 _.... _ ,. xxy}y( ~y~, _ ~.. ... _ i 1'~lttl ~4~ ;l~fotr, t ~Y. c. ~~ ~~7,- ~ y' - ~, 'i2: Total $80.00 Checks Posted Check # Date Pakl Amount Refenmce # -~ arp „,, 4! :: ~ :., - „~. ~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 {a~ .µ .~~;;.: .. ~wN.f~ ;}~ r{ 1 • HIJSv'~. w~i.l~. Catii~M e^"• W ,} *f ~S ~~. ~ .~, 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 -n .n m ~ a o rn ~o 0 N Z G) N b m m c z f N ~ ~ Z r ~ ~ ~ g ~ Zv 9 rnm z "~ a 9 Z O v O ~_o Z T 71 9 9 A O O w o -' S C T O W ~ . `~' ~: n Z ~ G ~ ~' ~ C ~ ~' g~° ~~ O ~ = d- ~ tQ t~ tf- ~ w o ° $ ~ ~ ° a m ~ ~ c ca