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HomeMy WebLinkAbout07-13-10J 1505607121 06 05 REV-1500 EX ( - ) PA Departmento/Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Poeox2eosof INHERITANCE TAX RETURN Hartisbure. PA 1712i3.Ofi01 RESIDENT DECEDENT 2 1 0 9 0 9 8 9 ENTER DECEDENT INFORMATION BELOW Social Severity Number Date of Death Date of Birth 1 6 5 2 6 5 3 5 8 1 0 1 3 2 0 0 9 1 1 2 1 1 9 3 3 Decedent's Last Name Suffix Decedent's First Name MI M I L L E R M A R I A N E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI 6pouse's Socal Severity Number FILL IN APPROPRIATE OVALS BELOW Q 1. Original Retum 4. Limited Estate ^X 6. Decedent Died Testate (Attach Copy of Will) 9. Lifigadon Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a giving 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 Retum Required 8. Total Number of Safe Deposit Boxes ? 1. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL Name Firm Name (If Applicable) M A R T S O N L A W O F F I C E S First line of address 1 0 E A S T H I G H S T R E E T Second line of address CONRDENTIAL TAX INFORMATION SHOULD BE DIRECTED 70: Daytime Telephone Number 7 1 7 2 4 3 3 3 4 1 City or Post Office State ZIP Code C A R L I S L E P A 1 7 0 1_ -._ -_ REGISTER OF WILL3 ~ ONLY ° i ~ c 7 .J ~~ , ,~ `~` ~ c ~ ~ ~~ ~.~ 77 ~ cry ~ W ~r, c.7 7 ~:.:3 C O _ '~~ ~~ C G ~ ~ N = "= --- :T AI~FILED --. --"- r :.:n t~ v 1;17 ` -- ~ correspondents a-mail address: I O T T O a M A R T S O N L A W- C O M Under pen~fres of perjury, l declare that I have examined dtis return, including accompanying schedules and statements, and to the best of my knowledge and belie/, it is true, correct and complete. Dedar~on of preparer other than the personal representadve is based on all information of whkh preparer has any knowledge. SIG RE P SON R PON FOR FILING RETURN ITNER HIGHWAY OF PREPARER OTHER THAN REPRESENTATIVE 3 10 EAST HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 1505607121 J ; J 1505607221 REV-1500 EX Decedent's Social Security Number oecedenrs Name: MARIAN E• MILLER 1 6 5 2 6 5 3 5 8 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2. stocks and Bonds (Schedule B) .................................. 2, 5 2 7 0 3. 4 9 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. 7 7 6 1 • 7 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 0 6 O O . 8 0 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property (s~nedule G) ~ Separate Billing Requested ....... 7. 4 3 4 4 2 , 7 8 8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 1 4 5 0 8, 8 4 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......... ..... .. 9. 9 4 O 3 , 4 5 10. Debts of Decedent, Mort a e Liabilities, 8 Liens Schedule I 9 9 ( ) ..... ..... 10, .. 1 2 3 7 3 4, 1 2 11. Total Deductions (total Lines 9& 10) .................... ..... .. 11. 1 3 3 1 3 7, 5 7 12. Net Value of Estate (Line 8 minus Line 11) .................. ..... . . 12. ~ 1 8 6 2 8 , 7 3 13. Charitable and Govemmenfal 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. ~ 1 8 6 2 8 , 7 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 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .o _ 0. 0 0 18. 0. 0 O 17. Amount of Line 14 taxable at sibling rate X .12 O. O O 17. O. O O 18. Amount of Line 14 taxable at collateral rate X .15 0 O O 1 g. O. O O 19. Tax Due ......................................... ..... ..19. O . O O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 09 0989 DECEDENTS NAME MARIAN E. MILLER -- - - EETADDRESS 210 BIG SPRING ROAD _ _ ---_- CITY STATE ZIP NEWVILLE PA 17241 Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.00 3. InferesUPenalty if applicable Total Credits (A + B + C J (2) D. Interest E. Penalty Total Interest/Penalty (D+ EJ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII 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 + 5A. This is the BALANCE DUE. 0.00 (3) 0.00 (4) 0.00 (5) 0.00 (5A) (58J 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT ~~~Y'f~i (PA',~ a ~.d A~ . ~i -" 1d€~ &~LN49~Pa'~'a f ~' A yr ( i 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; ...................................................................... ^ Q b. retain the right to designate who shall use the property trensfened or its income : ............................... ^ X^ c. retain a reversionary interest; or ................................................ ^ ................................................ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ ^X 3. Did decedent own an "in trust for or payable upon death bank account or security at his or her death? ......... ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................... ^X ^ ................................... 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) (iJ]. For dates of death on or affer January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (O) percent (12 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax refum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or affer 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 (O) percent (72 P.S. §9116(a)(1.2)J. The tax rate imposed on the net value of transfers fo 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)J. 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(aJ(1.3)J. 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-1503 EX + (8-88) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & B©NDS INHERITANCE TAX RETURN RESIDENT DECEDENT MARIAN E. MILLER 21 09 0989 Ad pmpeRy jointlyowned veldt rldht o-survhrorshlp must he disclosed on Scheduh F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Edward Jones Account # 377-10278-1-4 52,703.49 TOTAL (Also enter on line 2, Recapitulation) ~ S 703.49 (I(more space is needed, insert eddBanal sheets of the same size) REV-1508 EX + (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN R SIDENT DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER MARIAN E. MILLER 21 09 0989 Indude the proceeds of Irtigation and the date the proceeds were received by the estate. AN property jofnNy-owned wldh right of survlvorshtp must be dtselosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Crozer-Keystone Health System, pension benefit paid after date of death 2,252.49 2. 2 Series E. $50 Savings Bonds 77.50 (See attached) 3. Green Ridge Village, refund 5,141.02 4. Banker's Life, refund of health care premium 201.76 5. US Treasury, 2009 1040 income tax refund 89.00 TOTAL (Also enter on line 5, Recapitulation) I s 7 761 (If more space is needed, insert additional sheets of the same she) REV-1509 EX + (8-98) COMMONWEALTH OP PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF RLE MARIAN E. MILLER 21 09 0989 Han asset was made joint wHhln one year of the decedent's date of death, if must De reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Paul E. Miller JOINTLY-OWNED PROPERTY: SCHEDULE F JOINTLY-OWNED PROPERTY ADDRESS Ritner Highw Ile, PA 17015 RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. A17ACH LIED FORJOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET 46 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERES' 1, A. 04/04 M&T checking account # 9835623944 21,201.59 50. 10,600.80 TOTAL (Also enter on line 6, Recapitulation) I ~ 10 600 80 (If more space is needed, insert additional sheets of the same sae) REV-1510 EX + (g_98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY NUMBER MARIAN E. MILLER 21 09 0989 This schedule must be completed and fled Hthe ansxrer to any of questions i through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY M'CLUDEiHENAAIE°FTNEIRiWSFEREE,TNEWREUipNSHWT°°ECE°ENTAND '"E°"rE°Frn""sFER. "rr"°""o°°v°FT"E°EE°FORREUESr^rE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION pFaaai.~cnstF~ TAXABLE VALUE 1. Midland National Annuity 8500208979 (See Attached) 24,659.13 100. 24,659.13 Beneficiaries: Paul E. Miller, brother, 50.5%; James E. Miller, brother, 49.5% 2. North American Company Annuity 8000028347 (See Attached) 18,783.65 100. 18,783.65 Beneficiaries: Paul E. Miller, brother, 50.5%; James E. Miller, brother, 49.5% TOTAL (Also enter on line 7 Recapitulation) ~ 3 43 442 78 (If more space Is needed, insert additional sheets of the same size) REV-1511 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS MARIAN E. MILLER 21 09 0989 Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home, Carlisle, PA 17013 2,772 37 2. Cazlisle Memorial Service, grave marker 185.00 3. Green Ridge Village, funeral reception 200.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name o/Personal Representative (s) Street Address City Year(s) Commission Paid: State Zip 2, AttomeyFees MARTSON LAW OFFICES (estimated) 3, Family Exemption: (If decedents address is not the same as daimants, attach explanation) Gaimant 5,600.00 4• Probate Fees Cumberland County Register of Wills 132.00 5 Accountants Fees 6. Tax Retum Preparer's Fees H&R Block, preparation of 2009 personal income tax returns 332.00 1. Filing Fee, Inheritance Tax return 15.00 8. Edwazd Jones, estate services 100.00 9. Death Certificates 52.00 10. Certified mailings, Department of Public Welfaze & US Treasury 11.08 11. Short Certificate 4.00 TOTAL (Also enter on line 9, Recapdulation) I S u Street Address COY State Zip Relationship of Gaimant to Decedent (If more space is needed, insert adddronal sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS MARIAN E. MILLER 21 09 0989 Report debts Incurred by the decedent prior to death which remained unpa/d as of the date of death, including unrelmbuned medical expanses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Millennium Pharmacy Systems East, account payable 93.66 2. Chase Loan #8441210542, balance due 84,647.57 (see attached) 3. Bank of America account # 001199672, balance due 38,992.89 (see attached) TOTAL (Also enter on line 10, Recapffulation) I S 123 734 (If more space is needed, insert additional sheets of the same size) F:IPILES\DATAFILE1Estue Planning\I??e1 Lwill ORI'~r,~ ii ,- - ~. ,.:-_-. - Larv o,; , ~Es <a~a¢Eson 1~. ecaz~o2 f~~Wr.~'~Ccz~;zs ~'r C~t~o A PRCFESSICNAL CCi2PORATION TEN EAST HIGH STREET CARLISLE, PA 17013 LAST WILL AND TESTAMENT (7~7j 143-3341 I, MARIAN E. MILLER, of West Pennsboro Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils made by me. 1. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all death taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give, devise and bequeath all of my estate, both real and personal property, in equal shares, absolutely into my brothers, GLENN E. MILLER, JAMES E. MILLER and PAUL E. MILLER 3. I nominate, constitute and appoint my brother, PAUL E. MILLER as Executor of my estate. 4. I direct that my Executor shall not be required to file a bond to secure the faithful performance of his duties in any jurisdiction. 5. I authorize and empower my Executor, in his sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regazd to any or all property of any kind forming a part of my estate for such terms and such prices as he may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any [Initials) Page 1 of 3 Pages shaze to be composed of cash, property or undivided fractional shazes in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my Executor considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my Executor shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this ~J~i'~L day of LG ' ' ~~.<<~ ,% arian E. Miller SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, Marian E. Miller, No V. Otto III, and _~~~~,a.~~i a ~ ~ W~, 'rw~ ,the Testatrix and the 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 instnunent as her last W i l l and that the Testatrix has signed willingly, and that the Testatrix executed it as her free and voluntary act for the purposes therein 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 ofhis/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. M ian ter, estatrix -vL Witness ~ ~-r-- ~~ ~2,[,t.._o~ Csw Wi ess Subscribed, sworn to and acknowledged before me by Marian E. Miller, the Testatrix, and subscribed and sworn to before me by No V. Otto III and ~'tr ~u a, 4'. ~ U ~-~. ~;t~,.~ ,the witnesses, this~sy~ day of ~.,utu,,_y ,,~"d 7' . r~" G~-Lelc (~E'lL Notary Public con~o ~q ~~sYtvwu Victoria [,.~ acorn ~ ~ is Carlisle Barou M commauon ex ita Daxmba2Q 1p p Page 3 of 3 Pages 7 O T ~ N ®y ~, ~ ~ Z ~~ F i o .O W "m0 > O 2 7 R ~, ~ ~ ~ ao c W p ~ to O C 2 p~ W L ~_ H .-~ O Z ~ T L 3 O 3 ~ ~ m 3 L O 7 T ~ ~ y a-r ~ ~ ~ t 3 `m~~ ~'W~ 6. p ML (gyp my;N ~3C~ d ~° y ~ [U' ~ r, N f ~ 1r .T. l~ T `~ ti w ~~ W 0 oU o$a O C q m Y m y E~ y fA L > .. 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INw Dab: EE Bands 50 - NI Not Issued N[ Not eligihle for payment PS tnclutles 3 month - MOW TO SAVE YOUR INVENTORY Interest penalty j MA Matured antl not earning ,,, interact Calculator Results for Redemption Data 10/2009 _......._......____________._ Tebl Prlp Tool Valw Total IMafrt VTD Inbrast (50.00 f77.50 ;27.50 ;1.24 Bonds: 1-2 of 2 Uwe Next rind Irw ' Serlsl a SaHr '. Denem ' Inbram ~ lnbreat ' ' Value Nate ' ,, [Nh , Aarual NaturNy ". OHU !; ~ Rate Lfi77fi43013EE EE ! f50-, 12/1996' 11/2009; 12/2028„ f25.00;~ 512.66 1.64%~ {77d{ Lffi4339779EE EE f60; 12/19961 12/2009; IZ/2D2fi ~' f2f.00' (14.64' 1.fif%i sta.{4'~ ~ CALCULATE ANOTHER BOND Survey ~NOw would you rah !hb ho1T ~P> Ex[ellent Gootl Fair (' ~~~ Poor FfeetlOm Of;nfprmatlon Apt I tow d Gu WeDSS ~ Prw4cr a 4eflal Notipe# I WeDSlte Termi { C40tllSipnS I A[eefsipllity ~ Data Qusp[y U.S...OepaRDle0t.4f. Shs.Tfee$Yfy,. eDreaY 4(6le W pll[ Dept http://www.treasurydirect. govBC/SBCPrice 11/13/2009 ' ~ IVI~rTBank 499 Mitchell Street, Millsboro. DE 19966 November 3, 2009 M:artson Law Offices 10 East High Street Carlisle, PA 17013 RE: Estate of Marlaa Miller Date of Death: October 13. 2009 3oda18ecurlty Number: 16-26-358 Dear Ms. Otto: In response to your request, please be advised that at the t[me of death, the abave- named decedent had on deposit with this bank the following accounts. 1. Aocautt T ape ........................... Checking Account Aocaivtt Number ....................... 9835623944 Ourtership (Names o,~ .............. Marian Miller.. Paul Miller Opening Date ...........................04/22/04 (account closed 10/23/09) Balance on Date of Death..........$21,201.16 Accnred Interest S 0.43 Total ...................................... $21.201.59 'lYie above named decedent did not have a safe deposit box. ' If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including erahip and arty changes, closures and/or reimbursement of funds, please contact our High Strcet Carlisle branch at 1 West High Strcet, Carlisle, PA 17013, or # 717-240- 4536. Sincerely, c----` Charlene Warrington, Adju t Services 1-888-502-4349 Nov 17 09 05:36p Gabbys For The Birdl Printer Frieadly Inforce Contract ' Print Contrast # 8500208979 Flexible Premium Deferred Owner Mame= Product: Annuity -Legacy Bonus 11 Owner Address: Contract Type: Npn~ualifled issue pate: 02/01/2005 Annuitant: Agant Name: CHERYL L CARR Agent Phone: 856-90+1-9040 ~ Contract Value as oT 10/13/2009 $22,2oo.o0 Total Premium:°' W tthdrawals:'°' 50.00 Interest and Indm: Credits: $2,4Sg.13 Outstanding Loan Balance: $0.00 Acwmdation Velue: `~ $2a,659.13 (A) Ail premfurn bonus amounts are Included in the Premiums amount a (B) WlthGrawals include any surrender charges incurred. t[1 Amount Rayabk upon surrender may be less. MARIAN M[LLER 2830 RITNER HIGHWAY CARLISLE PA 17013 MARIAN MILLER 2 Page 1 of I n ~ wn.r •~n rnr ~ n~• •... .._.. /Y~l.. _.~_l1~_~___n_!___.11__n_ .. Current New Money Rate: 3.55 96 Nov 17 09 05:36p Gabby's For The Bii Printer Friendly Contract Print Contract # 8000028347 Pr~~ Fleotlble Premium Deferred Owner Name: Annudy- eonua 10 Contract rypr. IRA OwnerAddrnes: Issue Date: 021D4JZ003 Mnultant: Agent Name; CHERYL L CARR Agent Phone: 868.904-8040 Contract Value ss of 10/1312009 Totai Promium:~> ;71,811.28 1Nkhdrarrals:~ 565,758.85 Inbnat and Index Crodib: 53,781,22 Outsbrtding Loan Belartce: 10.00 Aecumulatlon Value. ~l ;18,789,63 (A) AO promium bonus amourMs are InGuded in the Promlums amount. (B) MlittMrewab include any sunander charges ineurrea. IC) Amount payable upon surrender may be bss. MARIAN MILLER MARIAN MILLER Porlfdio Descri on Value ElA Fixed AtcouM S8P 500 $7,34,2.79 Dow Jones 30 p 52,281.20 S8P 400 52'242'44 Rusaoll 2000 52.304.14 Nasdaq 10D 52,311.80 sz.291s6 Inuwwlmwnl 014vslMnc Fund Allocation EIA Fixed Aeogtnt 58P 500 ~'~ ~' Dow Jones 30 1D.00 % rip 400 1 D.00 % Russel 2000 pp 10.00 % Nasde 100 10.00 1a.oa 9< Currant New Monsy Rob; 4.45 °~ QA M Mis... I.,dl,......w... Banaflcie Name T pe 1Regldortshi Percent LENN E 1AILLER SR Owner Prl 3LINC3 33 00 y° JAMES E MILLER Dwner Pri ~ S19LINO . 3$ 00 96 PAUL E MILLER Ownor Pri SI3LIN0 , 34.00 ~ ~~ j p.1 Page 1 of 1 htYnc•1/~xnuw nsranmrity rnm/armlira+innc/rlinnt `lwfo ri.ntnr/Arin+nrFr:on~ilv(`,..,r..,,.* ,.-....7.7=_AOG~G']GI1 71111 AYI/111fl CHASE O Customer Care: Toll free 800-848-9136 Se habla eapafid Hearing Impaired (fDD): 800.582.0542 O For a refinance or purchase loan, call 800-453-0367 O www.chae.com N IIBWNCWN ~ #2984419210954291ff LJJ 2oosozll a a1 1-z MARIAN E MILLER toot71a5 2830 RITNER HWY CARUSLE PA 17015-9434 ~ Itttlllrttliltttrrrllalriririttrlrtltrlitrltrlttlltlltttrtlltl O LZLI Your Next Paymerrt Next Payment Due: December 01, 2009 w Principal end Interest S 646.77 Escrow: S 617.78 Optional Produce: S 8.9~-. Q Curcent Payment S 1,273.50 Total Amount Due :' S 1,273.50 Z Importarrt Mealsatyss • To avdd a late charge of 532.34, we must receive your payment d O prindpd, interest, end any raow depaib and/or part-due paymsnp by 12/16/09 during our bwinar haun. M this date falls on a weakmd or hd(dey, your payment must be received by the next business day. LLI Please sae the reverse side for Recant Aeeount Activity. *"" You are arrantly being billed for an optional product(s) you have O selected. Failure to pay sn optional product fee will not caws your account to ba in default but may rruk in product esneellation. If you haw questioro regarding your product, the fee, or your right to = cancel and potentially rec.hro s refund, piers emtsct w tdl free at 800-848-9136 "' DO NOT rely on the account balance r a payoff quote. Additional amounts maybe due for interest, late charges, raow advance, or other related cosh. You may rsgwat • payoff quote by calling w at 800-848-9136. 77N 847• J6e 881 87 8 !2al11 PaoE 1 of 2 10017185 Page 1 of 2 Home Loan Statement October 2009 Statement Date: October 31, 2009 Activity Since: October 07, 2009 Your Loan Number: 8441210542 Your Property and Loan IniTormatlon Property Address: 16b ASBURY STATION RD PAULSBORO NJ 08085 Pr'mcipal8alance: S 84,647.57 Interest Rate: 7.1250096 Escrow Balance: S 2,427.81 Dld You Know? WaMu is becoming Chase. You'll riow start to rw the Chess name and logo on your statement. You'll continue to rapiw the greet seMa you've come to expect. Condnw to bmk wkh w as you usually do. In the coming months, you'll begin to see the Chaw name In your lool branch, u we bring you the power of Chue. k is not nacewary to send w your regular rvnant real estate tax bill unleu we request k. Inmost wa, the uircent nd eaten tax bill is a copy of the bill the taxing suthor'rty has already supplied to the mortgage company for losre with an naow account. k is generally the ctmomer's resporrdb8ity to pay supplemental, ocwpanry end spedd sacrament bills. For details about your home loan, visk w at www.chre.com. Check recant Vsnsaetioro, order eopir d your loan documents, view your arrant prindpal balance, or we one of the many helpful loan celculston. N you're a first time war, simply dick on 'My Homs Loan" and follow the prompt to regista by selecting a User ID end Pamword. Year to Date Account Actl Principal Paid: S 1,665.14 Interest Paid: S 6,096.10 PropertyTaxan Paid: S 5,049.74 Insurance Paid: S 0.00 Late Charges Paid to Date: S 323.40 l7rre COLD856{ 756.8 lounas 0000000 OOODDDO 0000000 8441210542 0127350 OOD3234 0127350 6 Please write In airy addfNenal /ands that you may M Indud/ng wkh yew payment. N yea inducts sddkfenel lands and de not indicate how to apply them, we wNl apply them Rrst to applkable adwncr, then to arty has dw end then to prlndpsl. Loan Number. 8441210542 MARIAN E MILLER f Please check here if change of addrrs or telephone L _~ number is indicated on the rweroe side of this term. ~r~u~~~nus~r~~r~u~~uuu~~ur~~u~s~n~~us~r~u~~nr~~t~ CHASE PO BOX 9001123 LOUISVILLE KY 40290-1123 ~~r~r~u~~~r~~r~~r~~r~r~~r~~~u~~r~r~~~uu~~~~r~t~~t~~t~~t~t~~t~t~~t~t~ Payment Due Dab: December 01, 2009 Current Payment S 1,273.50 Total Amount Plus Late Charges: S 1,305.84 Late Faes may apply ff received after December 16, 2009 Total Amount Due S 1,273.50 Late Charges + Additional Principal + Additional Escrow + Total Amount Enclosed t: 5000050 261: 0008441 2 L054 2 ua CHASE O Making Your Monthly Payments By mail: Mail your check, along with the bottom portion of this statement, in the enclosed envelope. In person: Drop off your payment at any Chase Banking Center. • Automatic payments: Make payments automatically from your checking or savings account with our easy and convenient Auto Pay service -just call us tell free at 800-848-9136 to set up a payment schedule. • Payment by phone: Set up a one-time withdrawal from a checking or savings account on a date specified by you. A fee will be assessed for this type of transfer. Call us toll free at 800-848-9136 to make a payment by phone. • Notice About Electronic Check Conversion: When you provide a check as payment, you authorize us either to use information from your check to make cone-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your. check back from your financial institution. 10/16 Tax Disbursement $1,299.94- $1,299.94- 10/31 Payment $1,273.50 5143.32 $503.45 $617.78 $8.95 10/31 Payment $15.00 10017185 Page 2 of Z Have puestions? Need Mailing Addresses? At Chase, customer service is our top priority. If you have general questions about your loan, please call our Customer Care Department toll free at 800-848-9136; se habla espanol or write to us at the "Customer Service Inquiries' address noted below. Hearing Impaired (TDD): 800-582-0542. (Calls received by our Customer Care Departrnent may be monitored for training purposes.) Please use the addresses below for other payment or correspondence needs. Customer Service Inquiries: Chase Home Finance PO Box 24696 Columbus, ON 43224-0696 Fax: 614-422-7575 Payment without a Coupon: Chase Home Finance PO Box 9001123 Louisville, KY 40290-1123 Real Estate Tax Bills: Chase Home Finance Attn: Tax Department PO Box 961227 Fort Worth, TX 76161-0227 Overnight Payment: Chase Home Finance 6716 Grade Lane Building 9, Suite 910 Louisville, KY 40213 CoNections (Letters Only): Chase Home Finance PO Box 44118 Jacksonville, FL 32231-4118 Fax: 904-462-1925 Overnight Payoffs: Chase Home Finance OH4-7137 3415 Ysion Drive Columbus, OH 43219 Propsrtylnsurance: Chase I-fome Finance PO Box 100564 Florence, SC 29502-0564 Fax: (843) 413-2026 Loss Draft: Chase Home Finance PO Box 100565 Florence, SC 29502 Fax: (843) 673-3923 We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report. Recent Account Activity Optional Unappliad Other Fass/ Data Description Total Amount Principal Interest Escrow Products Funds/Su6sidies Late Charges Has your mailing address or phone number changed? If so, please update your information online at www.chase.com, where you r_an also view your recent account activity. Alternatively, you may check the box on the front of this payment coupon and fill in the correct information below. Street Address: City: Home Phone: E-mail Address: Name (please print): Name (please print): State: Zip: Business Phone: Borrower Signature: Borrower Signature: $15.00 (,orz BankofAmerica ~j Home Loans Customer NerWce Billia~ Cyols YO 13oz b170 10p1/EOOa-10/!1/!009 Simi Valley, CA 9x08&b17U Account Number 001199672 Property address 166 Asbury Station Rcad 0042860 a1ATOm7"AIRO 78 0 7155 17015-%3/ H HF AG ..1..2.......... 9001N 11 P12902 DT001 MARIAN MILLER 2830 Ritner Hwy Carlisle PA 17015-9434 ('I'1"~~I~Illlal~Il~I~u16116~r661Lllrlr~~l~1"111~11~I~~~~ ...................................................................... SPECIAL MESSAGE TO YOU Get the answers you need, any time, day or night! You can call 13AC Home Loans 3orvicing, LY for answers to your questions 2.1 hours a day, 7 days a week. Dy choosing our automated self-service option, you can accuss your information and manage your accoutlt instantly. You can: • Make a payment by phone or report a promise to pay • Hear the payment and mailing address information • Confum your loan information, including receipt of payment, available credit, loan balance, and interest rate • Order a loan history statement • Request payoff information to close your Home Equity Iano of Credit • Ox'der a duplicate monthly statement • Hear details regarding electronic Yay Plans for new enrollment and existing accounts We're here to assist you- please contact us et 1-566-653-6185 with any questions. Our automated system can provide you with immediate access w your loan information at your convenience, 24 hours a day. If you choose to speak with a representative, our friendly, professional staff is here to assist you during normal business hours. Ass a reminder, Yailura [o make your nunimwn payment by the payment due date could result in auapenaiun or Wrmination o[your credit privileges. In [he event or default, we may require that any and ell subsequent payments due ha nwdo in ore of uw.e of the [ollox•ing Ibrma, as we uwy aelecc iaj cash 0•i .:w.iay of dm~, (c) certi0nd check, bank check, treasuror's check or caahiera check, provided ouch check is drawn upon an inatihrtion whose deposits are insured by a federal agency, instrumentality, or entity; or, (dl Electronic Fonda Tranarec ACC 0 U N T Loin Summrry---_-- -----_--- --- --- -_ - S U M M A R Y Credit limit $39,000.00 Available credit $7.11 Average daily balance $38,992.89 Corresponding ANNUAL PERCENTAGE RATE 5.5000°/. Daily periodic rate 0.01507% Historical ANNUAL PERCENTAGE RATE 5.500096 Days in Cycle --- --- - - 31 FINANCE CHARGE -- - -------- 5102.1 PAYMENT W e will credit your account the same day we receive your payment on a banking day (not including Saturday) priorte 3PM Pacrflc Time Payments made on your account by check or other non•cash method will be included in your'Available CrediC 1 G days from receipt of payment. We may assess a late fee as described in your credda0reementiFwe do not receive your paymentwithin IG days of the Daymentdue date. Good creddrelies on the Dmely receipt of your payment. If your acc oun[ is delinquent, we may submit a negative credd report to the credR reporting agencies. Aa • mrirhr, fiilrn >e etak• yow mllrltrwl Irtw•a w the /ryat•rt iw has cerl~ Hach it wyforsies or axmin•asa of your anin pivifipa a ...- ------ ------------- - (Account number 001199672 (5) I Marian Miller 166 Asbury Station Road ' 9EE UlaEO 9mE FOr WPOIITANT mfaaunoal 7155 BAC Home Loans Servicing, LP PO Box 650225 Dallas, TX 75265-0225 Pnymrnt Ostsils Periodic FINANCE CHARGE $102.14 Mlnlmllm payment due:11/2Tr/1009 5102.1 (see next page for transaction details) HOME EQUITY LOAN Payment due Nov 25, 2009 ~ =182.14 A late charge may be assessed 10 days from paymentdue date. Addidonal Principal N/A ~IIIII~~~I~II~IIIII~III'II'f rlll~rlll~lrllrlaall~~~ll~~alallll~l~ ChetkTotal 001199672500000018214000000000 1:58 6 9 900 581:00 i 19967 211^ 2of2 TRANSACTION DETAILS Post date Transaction date Description Loan advances/debits Payments/credit Balance 10/01/1A09 10101/1009 PREVIOUS BALANCE 539,169.1fi 10A72009 10~t17/2009 CASH RECEIPTS 5176.27 538,992.69 10/31(1009 10/31/1009 PERIODIC`FINANCECNARGE" SI82.14 339,175.03 "'New balance as of tOA• t/200a S~,t75.o3 "'NNe: The amowd needed to psy off your loan may bs d8hrant than the New BNmce due to daily accruN aF finmce chrpes and tlm posting N trarsactiorr aaer tlw staromam closing date (the last day in the stateroom psdodl. For pryolf informedon, please cNl Customer Seviee N 1-80U689-5881. CREDIT DISCLOSURE STATEMENT Finance Charges Periodic finance Charges for each billing cycle are computed by muhiptying the Average Daily Balance of your account (including current transactional by the Deity Periodic Rate, then this product is applied to the number of days in the billing cycle. The Deity Periodic Rate on your account may vary. Refer to your credit agreements for further details. To getthe Average Daily Balance, we take the beginning principal balance of your account each day, add any new debit and subtract any principal payments or credits. This gives us the Daily Belence. Then we add up all the Deity Balances for the billing cycle and divide by the number of days in the billing cycle. This gives us the Average Daily Balance. Billing Rights Stlalmary In Case of Errors or Questions About Your Bill. If you think your bill is wrong, or if you need more information about a transaction on your bill, please write us ]on a separate sheet] at the Customer Service address below as soon as possible. We moat hear from you no later than 60 days after we sent you the first bill on which the error or problem appeared. TO CONTACT US You can telephone us, but doing so will not preserve your rights. In your letter, give us the following information: • Your name and account number. • The dollar amount of the suspected error. • Describe the error and explain, if you can, why you believe there is an error. If you need more information, describe the item you are unsure about You do not have to pay any amount in question while we are investigating, but you are atiU obligated to pay the parts of your bill that are not in quasdon. While we investigate your question, we cannot reportyou as delinquent or take any action to collectthe amount in queston. CREDIT REPORTINg NOTICE We may report information about your accountto credit bureaus. Late payments, missed payments or other detauhs on your account may be reflected in your credit report. For up-to-the-minute iaformMlon about your account, or to reorder checks, please call 1-t66-~9-6116, Monday-Friday, Sam to 9pm Eastern Time. Se habla espalfol. Please have yew acoauM number available whsa you call. Send notice of bUling error or address corrsMlon to: Custtunor Senios CA6-919-Ot-41. PO Box 5170. Simi Vallev, CA 9306 -5170 Send your payments to: PO Box 650225, Dallas, TX 75265-0225 Ovenigbt Nlhrsries 5401 N Beach Street, 7X2-977-01-M, Fort Worth, TX 76131-2733 Our wsbsits www.bankofamerica.com/cwcustomers Calls may be monitored or recorded to ensure quality service. We rN cargo you a he tr any papaam retunae or reiechd eyyau anancir uarwon, auepot b aPlauaaN lent Bank NAmsdea, NA. Member FDIC. Bank NAmerica, NA. and BAC Home lomis Servicing, LP, o subsidiary N Benk NAmarica, N.A., xs EquN Housing lenders. m 2009 Bank NAmarica Corparaton. Trademarks re tM property N Bank N America Corporation. All dpms reserved. Account Number 10111gi72 E-mail use: Providing your e-maN address(es) bekrvy will albw us to send you information on your account Marian Miller E-mail address E-mail address Avoid IeYpayteaes. Make your prymem on r hNra the due dre specified in your loan documems. II you don't hwe a paymem coupon, wnh your eccoum manbr on your check r many order aM zuhlldt k promptly to arare VN neeNa yor paymam bNore a late chrpe Decomn dw. The payment address is loeahd under To Comact Ua. ArlaaaaN aaaaaaee. Even p you imruct ue ro apply addltlonal ' amolxas a -AddlDonN PrincipN- vw w01 apply arty adatlonN amouma racawed to any lag chrgaa arayr arratendnp has prior to reducing lM UnpNd ptinciDN DNanee. ' Papael. We will credit your sccoum tM same dry wa receive ' your paymam en a barddng day (not including Sadrdry) Ddor ro 3PM PecficTime. Good credh rNiaa on lM timely recaiptNyor payment If yor accorad is dalirrgrrrr, we may srrbma a nsgadve '. credd report to the cradd npaning epencia. Postdated checks will De Drocessed m the den received unless a loan crwnsefor aryees to horror the date written on the check as a condition of a repaymem glen