HomeMy WebLinkAbout05-17-10s
. ~ 15056051058
~~ REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 28oso1 INHERITANCE TAX RETURN
!!\\ !\
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ I V D c~ ~ V
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
080-05-3193 ' 10/01 /2009 ' 10/28/1908
Decedent's Last Name Suffix Decedent's First Name MI
LAYTON ' FLORENCE B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
__
Spouse's Sociat Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return .... 2. Supplemental Return 3. Remainder Return (date of death
prior 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 ~M~~:b 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
JOHN LAYTON (717) 763-8930
Firm Name (If Applicable)
REGISTER O~ilI~S USE '
O~ ..~„
~, ~ ~ •:~
First line of address a r :.~t:~
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141 SOUTH LOCUST STREET ,_ ;,
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City or Post Office
State .........ZIP Code _ DA, ILED
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CAMP HILL
_ _ PA ' 17011
__
Correspondent's a-mail address:
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 is true, correct and omplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA P RSON RES ON BLE OR FILING RETURN D T
.~... ~' ~y ~a
ADD SS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
15056051058
Side 1
15056051058
~_~.. l
,~ ~~~,
`~ J
15056052059
REV-1500 EX
Decedent's Social Security Number
FLORENCE B LAYTON 080-05-3193
Decedent's Name:
RECAPITULATION .. _.
1. Real estate (Schedule A) . ............................................ 1.
2. Stocks and Bonds (Schedule B) ....................................... 2. 12,299.80
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ............................. 4.
___
__
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5.
_ _ _
_ _.
6. Jointly Owned Property (Schedule F) _:~°~~::'~ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 'Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .................................... 8. 12,299.80
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ..................... 9. 3,620.00
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. 495.57
__ _ ___
11. Total Deductions (total Lines 9 8 10) ................................... 11. 4,115.57
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 8,184.23
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. 8,184.23
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 .0 4 8,184.23 ' 16. 327.37
17. Amount of Line 14 taxable
at sibling rate X .12 17. ',
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ......................................................... 19. ' 327.37
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052059
1 REV-1503 EX; {6-98)
' SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
ESTATE OF FILE NUMBER
FLORENCE B LAYTON
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~~ U.S. SAVINGS BOND SERIES EE - M25089120-EE 684.00
2. U.S. SAVINGS BOND SERIES EE - M25089116-EE 697.80
3. U.S. SAVINGS BOND SERIES EE - M25089109-EE 711.80
4. U.S. SAVINGS BOND SERIES EE - D19173526-EE 355.90
5. U.S. SAVINGS BOND SERIES EE - D19173525-EE 363.00
6. U.S. SAVINGS BOND SERIES EE - D15930443-EE 370.20
7. U.S. SAVINGS BOND SERIES EE - D15604733-EE 385.20
8. U.S. SAVINGS BOND SERIES E - D89296096-E 1,258.60
9. U.S. SAVINGS BOND SERIES E - 839219933-E 503.44
10. U.S. SAVINGS BOND SERIES E - 839219934-E 503.44
11. U.S. SAVINGS BOND SERIES E - 839219935-E 503.44
12. U.S. SAVINGS BOND SERIES E - L2162778566-E 108.28
13. U.S. SAVINGS BOND SERIES E - L2162770229-E 108.27
14. U.S. SAVINGS BOND SERIES E - L2147361192-E 106.97
15. U.S. SAVINGS BOND SERIES E - L2121222271-E 106.97
16. U.S. SAVINGS BOND SERIES E - L2121213088-E 108.54
17. U.S. SAVINGS BOND SERIES E - L2111543856-E 128.45
18. U.S. SAVINGS BOND SERIES E - L2099823352-E 139.67
19. U.S. SAVINGS BOND SERIES E - L2088743523-E 139.67
20. U.S. SAVINGS BOND SERIES E - L2078958233-E 139.94
21. U.S. SAVINGS BOND SERIES E- L2078948337-E 138.04
22. U.S. SAVINGS BOND SERIES E. L2058948251-E 137.65
23. U.S. SAVINGS BOND SERIES E - L2058838267-E 136.32
24. U.S. SAVINGS BOND SERIES E - L2036570968-E 136.34
25. U.S. SAVINGS BOND SERIES E - L2010465112-E 134.76
TOTAL (Also enter on line 2, Recapitulation) I $ _ 8,106.69
(If more space is needed, insert additional sheets of the same size)
REV,1503 EX+ (6-98)
' SC1~1EDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FLORENCE B LAYTON -PAGE 2
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
26. U.S. SAVINGS BOND SERIES E - L2010454442-E 134.75
27. U.S. SAVINGS BOND SERIES E - L2010443580-E 133.15
28. U.S. SAVINGS BOND SERIES E - L697532841-E
125.86
29. U.S. SAVINGS BOND SERIES E - Q6024825409-E
66.58
30. U.S. SAVINGS BOND SERIES E - Q5249960002-E
66.57
31. U.S. SAVINGS BOND SERIES E - Q5249950013-E 66.42
32. U.S. SAVINGS BOND SERIES E - Q5244710618-E 65.79
33. U.S. SAVINGS BOND SERIES E - Q5244701123-E
65.79
34. U.S. SAVINGS BOND SERIES E - Q5224486266-E
65.79
35. U.S. SAVINGS BOND SERIES E - Q5224476576-E
65.80
36. U.S. SAVINGS BOND SERIES E - Q5210941714-E
65.01
37. U.S. SAVINGS BOND SERIES E - Q5210931836-E 65.01
38. U.S. SAVINGS BOND SERIES E - Q5197916688-E
65.01
39. U.S. SAVINGS BOND SERIES E - Q5182759858-E
65.01
40. U.S. SAVINGS BOND SERIES E - Q5167677904-E
64.86
41. U.S. SAVINGS BOND SERIES E - Q5167667722-E
64.24
42. U.S. SAVINGS BOND SERIES E - Q5152012507-E
64.24
43. U.S. SAVINGS BOND SERIES E - Q5152002055-E
64.24
44. U.S. SAVINGS BOND SERIES E - Q5138531377-E
65.88
45. U.S. SAVINGS BOND SERIES E - Q5124780705-E
65.88
46. U.S. SAVINGS BOND SERIES E - Q5111029761-E
65.88
47. U.S. SAVINGS BOND SERIES E - Q5111018597-E
65.73
48. U.S. SAVINGS BOND SERIES E - Q5089102130-E
65.10
49. U.S. SAVINGS BOND SERIES E - Q5089090715-E
64.95
TOTAL (Also enter on line 2, Recapitulation) $ 1,767.54
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX+ (6-98)
' ~ SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
ESTATE OF FILE NUMBER
FLORENCE B LAYTON -PAGE 3
Ali property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
50. U.S. SAVINGS BOND SERIES E - Q5076224240-E 64.95
51. U.S. SAVINGS BOND SERIES E - Q5064082500-E 64.95
52. U.S. SAVINGS BOND SERIES E - Q5064070374-E 64.17
53. U.S. SAVINGS BOND SERIES E - Q5057523085-E 64.03
54. U.S. SAVINGS BOND SERIES E - Q5048680754-E 64.03
55. U.S. SAVINGS BOND SERIES E - Q5029523478-E 64.03
56. U.S. SAVINGS BOND SERIES E - Q5020943612-E 63.89
57. U.S. SAVINGS BOND SERIES E - Q5020930971-E 63.10
58. U.S. SAVINGS BOND SERIES E - Q5005283440-E 63.10
59. U.S. SAVINGS BOND SERIES E - Q2636350605-E 63.10
60. U.S. SAVINGS BOND SERIES E - Q2617012942-E 62.94
61. U.S. SAVINGS BOND SERIES E - Q2610579932-E 63.33
62. U.S. SAVINGS BOND SERIES E - Q2610567029-E 63.18
63. U.S. SAVINGS BOND SERIES E - Q2605233926-E 63.18
64. U.S. SAVINGS BOND SERIES E - Q2586650715-E 63.18
65. U.S. SAVINGS BOND SERIES E - Q2579062609-E 63.48
66. U.S. SAVINGS BOND SERIES E - Q2571334686-E 63.30
67. U.S. SAVINGS BOND SERIES E - Q2558921971-E 63.30
68. U.S. SAVINGS BOND SERIES E - Q2547889085-E 63.30
69. U.S. SAVINGS BOND SERIES E - Q2547876174-E 63.30
70. U.S. SAVINGS BOND SERIES E - Q2534328299-E 69.85
71. U.S. SAVINGS BOND SERIES E -Q2526582568-E 69.85
72. U.S. SAVINGS BOND SERIES E - Q2508569432-E 69.85
73. U.S. SAVINGS BOND SERIES E - Q2508556028-E 69.68
TOTAL (Also enter on line 2, Recapitulation) $ 1, 551.07
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX+ (6-98)
.
' SCHEDI~LE B
COMMONwEA~TH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
ESTATE OF FILE NUMBER
FLORENCE B LAYTON -PAGE 4
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
74. U.S. SAVINGS BOND SERIES E - Q2501077515-E 69.00
75. U.S. SAVINGS BOND SERIES E - Q2487858397-E 68.68
76. U.S. SAVINGS BOND SERIES E - Q2487845695-E 68.68
77. U.S. SAVINGS BOND SERIES E - Q2467048531-E 68.67
78. U.S. SAVINGS BOND SERIES E - Q2432901266-E 67.51
79. U.S. SAVINGS BOND SERIES E- Q2420909643-E 69.30
80. U.S. SAVINGS BOND SERIES E - Q2409520339-E 68.64
81. U.S. SAVINGS BOND SERIES E - Q2381017413-E 68.64
82. U.S. SAVINGS BOND SERIES E - Q231348594-E 65.64
83. U.S. SAVINGS BOND SERIES E - Q2297994989-E 65.64
84. U.S. SAVINGS BOND SERIES E - Q2297981041-E 65.64
85. U.S. SAVINGS BOND SERIES E - Q2289777388-E 64.23
86. U.S. SAVINGS BOND SERIES E - Q2279158414-E 64.23
TOTAL (Also enter on line 2, Recapitulation) $ 874.50
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (iC••Q9j
~ ' pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
FLORENCE B LAYTON
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMDUNT
A. FUNERALEXPENSE5:
1' GREENWOOD UNION CEMETARY 460.00
MYERS FUNERAL HOME 2,480.00
DOMENICK DE NIGRIS -MONUMENT 500.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4.
S.
6.
7.
City _ State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
State ZIP
ZIP
180.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 3,620.00
If more space is needed, use additional sheets of paper of the same size.
REV-1 S 12 EX+ (12-08;
' ~ ~' ennsylvania SCHEDULE I
DEPARTMENT OF REVENUE
p DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FLORENCE B LAYTON
Renert debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
REV-1513 EX+ (01-10)
i pennsylvania SCHEDULE ~
~~ DEPARTMENT OF REVENUE
- - BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
FLORENCE B LAYTON
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. 9116 (a) (1.2).]
1• JOHN C LAYTON SON 12299.80
141 SOUTH LOCUST STREET APT. # 4
CAMP HILL, PA. 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 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. I $
If more space is needed, use additional sheets of paper of the same size.
PENNSYLVANIA INHERITANCE TAX
THE ESTATE OF FLORENCE B LAYTON
NOTES:
The bonds were owned by Florence B. Layton and John Layton. Each had a 50%
ownership. Bonds reported on Schedule B. show the portion owned by Florence B.
Layton.
May it 10 06:15p
4 s
p.1
LT.S. Savings Bond Redemption Receipt
Branch ID: 1 Transaction Number: 102-2315411017991
John laytcn 226-42-3907 Redemption Date: 02/23/2010
141 S Locust St
Camp Hill, PA 17011 Teller ID: honafiee
Serial Number
Series
Denom Issue
Date
rssue Price Interest
Earned Redemption
Value
25089120-EE EE ~ $1,000. 03/1990 ~ $500.00 $868.00 $1,368.00
25089116-EE EE 1,000. 02/1990 500.00 895.60 1,395.60
25089109-EE EE 1,000; 04/1989 500.0.0 923.60 1,423.60
19173526-EE ~ EE 500' 06/1989 250.00: 461.80 711.80
19173525-EE EE 500 02/1989 250.00 ~ 476.00 725.00
15930443-EE EE 500 04/1988 250.00, 490.40. 740.40
D15604733-EE EE ~ 500 03/1987 250.00 ~ 520.40 770.40
D89296096-E E 500: 04/1967 375.00 2,142.20 2,517.20
839219933-E E 200; 04/1967 150.00 ~ 856.88 1,006.88
839219934-E E 2001 04/1967 150.00 856.88 1,006.88
839219935-E E 200 04/1967 150.00 856.8~B 1,006.88
L2162778566-E E 50~ 03/1979 37.50 179.Oi'a 216.56
L2162770229-E E 50 12/1978 37.50 179.04 216.54
L2147361192-E E 50 09/1978 37.50 176.44 213.94
L2121222271-E E 50 07/1978 37.50 176.44 213.94
L2121213088-E E 50 04/1978 37.50 179.58 217.081
L2111543856-E E 50 01/1978 37.50 219.4{) 256.90
L2099823352-E E 50 10/1977 37.50 241.84 279.34
L2088743523-E E 50~ 07/1977 37.50 241.84 279.34
,L2078958233-E E 50 05/1977 37.50 24]..30 278.80
Metro Bank
3801 Paxton Street
Harrisburg , PA 1 "I 111
888-937-0004
Page 1 Of 5
May 11 10 06:15p p.2
U.S. Savings Bond Redemption Receipt
Redemption Date: 02/23/2010
John Layton 226-42-3907
Transaction Number: 102-2315411()7991
Issue Interest Redemption
Serial Number Series Denom Date Issue Przce Earned Value
L2078948337-E E $50 02/1977 $37,50 238.58 276.08
L2058948251-E E 50 11/1976 37.50 237.E30 275.30
L2058838267-E! E 50 08/1976 ~ 37.50 - 235.:L4 272.64
L2036570968-E E 50~ 06/1976 37.50 235.18 272.68
L2010465112-E E 50 03/1976 ~ 37.50 ~ 232.02. 269.52
L2010454442-E E 50 12/1975 37.50 232.(}0' 269.50
L2010443580-E E 50 09/1975 37.50 228.80 266.30
L697532841-E E 50 04/196? 37.50 ; 214.22 251.72
Q6024825409-E E 25 08/1975 18.75 ' 114.40 133.15
Q5249960002-E E 25 07/1975 ~ 18.75 114.40 133.15
Q5249950013-E E 25 05/1975 ~ 18.75 114.08 132.83
Q5244710618-E E 25 04/1975 18.75 112.82 131.57
Q5244701123-E
E
25.
03/1975 i
18.75
1.12.82
231.57
Q5224486266-E E 25 01/1975 18.75 112.82 131.57
Q5224476576--E E 25 12/1974 18.75 ~ 112 . F34 131.59
Q5210941714-E E 25 10/1974 18.75 111.27 130.02
Q5210931836-E E 25. 09/1974 18.75 111.?7 130.02
Q5197916688-E E 25 08/1974 18.75 111.27 130.02
Q5182759858-E E 25 07/1974 18.75 111.27 130.02
Q5167677904-E E ~ 25 05/1.974 18.75 110.96 129.71
Metro Bank
3801 Paxton Street
~Iarrisburg, PA 17111
888-937-0004
Page 2 Of 5
Mai 11 10 06:16p
• t.
U.S. Savings Band Redemption Receipt
p.3
Redemption Date: 02/23/2010
John layton 226-42-3907
Transaction Number: 102-2315411017991
Issue Interest Redemption .
Serial Number Series Denom Date Issue Price Earned Value
~~
Q5167667722-E E $25 03/1974 $18.75 109.73 128.48
Q515201250?-E E 25: 02/1974 18.75 ~ 109..'3 128.48
Q5152002055-E; E 25 01/1974 18.75 109.73 128.48
Q5138531377-E E 25 11/1973 18.75 ~ 113.011 131.76
Q5124780705-E E 25 10/1973 18.75 113.01 131.76
Q5111029761-E E 25 09/1973 ~ 18.75 113.0}1 131.76
Q5111018597-E E ~ 25 07/1973 18.75 112.71 131.46
Q5089102130-E E 25 06/1973 18.75 211.9:5 130.20
Q5089090715-E E 25 04/1973 18.75 ~ 111.1.4 129.89
Q5076224240-E E 25 03/1973 18.75 111.1.4 129.89
Q5064082500-E E 25 02/1973 18.75 ~ 111.1.4 129.89
Q5064070374-E E 25 12/1972 18.75 109.58 128.33
Q5057523085-E E 25 11/1972 18.75 109.?,0 128.05
Q5048680754-E E 25 09/1972 18.75 ~ 109.30 128.05
Q5029523478-E E 25 09/1972 18.75 109.?~0 128.05
Q5020943612-E E 25 07/1972 18.75 ~ 109.G2 127.77
Q5020930971-E E 25 05/1972 18.75 107.9.4 126.19
Q5005283440-E E 25 04/1972 18.75 107.4:4 126.19
Q2636350605-E E 25 03/1972 18.75 107.4:4 126.19
Q2617012942-E E 25 01/1972 18.75 107.1.3 125.88
Metro Bank
3801 Paxton Street
Harrisburg, PA 171.11
888-937-6004
Paae 3 Of 5
U.S. Savings Bond Redemption Receipt
May 11 10 06:16p
f' ~ +',
•
~t
p.4
Redemption Date: 02/23/2010
John layton 226-42-3907
Transaction Number: 102-231541107991
Issue Interest ~ Redemption
Serial Number Series Denom Date Issue Price Earned Value
Q2610579932-E E ~ $25 12/1971 $18.75 107.91 126.66
Q2610567029-E~ E 25 10/1971 18.75 107.61 126.36
Q2605233926-E E ~ 25 09/1971 18.75 ~ 107.61 126.3E
Q2586650715-E E 25 08/1971 ~ 18.75 ~ 107.61 126.36
Q2579062609-E E 25 06/1971 18.75 ~ 108.20 126.95
Q2571334686-E E 25 05/1971 18.75 107.85 126.60
Q2558921971-E E 25 04/1971 18.75 107.85 126.60
Q2547889085-E~ E 25 02/1971 18.75 107.85- 126.60
Q2547876174-E E 25 01/1971 18.75 107.55 126.30
2534328299-E E 25 11/19?0 18.75 1.20.94 139.69
2526582568-E E 25 10/1970 18.75 ~ 120.94 139.69
Q2508569432-E E 25 09/1970 18.75 120.94 139.69
Q2508556028-E E 25 07/1970 18.75 120.51 139.36
Q2501077515-E E 25 06/1970 18.75 119.25 138.00
Q2487858397-E E 25 05/1970 18.75 118.61 137.36
Q2487845695-E E 25 03/1970 1$.75 118.61 137.36
Q2467048531-E E 25 02/1970 18.75 118.59 137.34
Q2432901266-E E 25 08/1969 18.75 116.26 135.01
Q2420909643-E E 25 05/1969 18.75 119.85 138.50
Q2409520339-E E 25 04/1969 18.75 118.52 137.27
Metro Bank
3841 Paxton Street
:-Harrisburg, FA 17111
888-93?--4004
Page 4 ~f 5
May 11 10 06:16p
~ ~' ~
U.S. Savings Bond Redemption Receipt
p.5
Redemption Date: 02/23/2010
John layton 226-42--3907
Transaction Number: 102-231541107991
Issue Interest Redemption
Serial Number;Series Denom Date Issue Price Earned Value
IQ2381017413-E E $25: 12/1968 $18.75 118.53 137.28
~Q2313478594-E E 25 02/1968 18.75 112.53 131.28
Q2297994989-E E 25 01/1958 18.75 112.53 131.28
Q2297981041-E E 25' 12/1967 ~ 18.75 3.12.53 131.28
Q2289777388-E E 25' 10/1967 18.75 109.70 128.45
Q2279158414-E E 25 09/1967 18.75 109. i'0 128.45
Total number of bonds redeemed: 86
Customer Signature
Total
Price Total
Interest Total
Value
$5,050.00 $19,547.97 24,597.97
Customer YD: 19317946
:,
1 . ~.,~
vietro Bank
3801 Paxtcn Street
Harrisburg, PA 17111
888-937-0004
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