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HomeMy WebLinkAbout06-08-1015056051047 R~"" ~~ ~ ~~O EX (06-05) PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harristwra, PA 17128-~01 RESIDENT DECEDENT (If Applicable) Enter Surviving Spouse's information Below OFFICIAL USE ONLY Code Year File Number 3, Spouse's Last Name Suffix Spouse's First Name MI ~' ~ ~.µ. ~ iv; _ Spouse's Social Securit Number THIS RETURN MUST BE FiLEf~ IN DUPLICATE WITH THE REGISTER C~-F V'~-1L~S FILL IN APPROPRiA-TE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (dale of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate- O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of tNill) ` (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST $E COMPLETED. ALL CORRESPONDENCE AND CONFIDENfiAL TAX INFORMATION SFIOIrILD $IE DIRECTED T0: Name Daytime Telephone Number Firm Name (If Applicable) w -~ ~ ~ ~: ~ 6 ~ ., - . r REGISTE WILLS u _. S q~ .~ M1 First line of address i`'f , v is s, .,id r.. "L'I 'r'~' •;. w#t t. ,'. t- 2 ~..• 3Y [I4 '...; .t, o- ;.. v ' ~. Second line of address .~ :. f ~ ~ ., ~ ~: ~ .,..~;.... ~ , . ;p r~. ~~ ~x. w r, ~~~; .~ , . ,, .,.. ~; ' City or Post Office State ZIP Code FILED r _ `~ ~ ! IS ~ rC.k G-~ !-~ ` ~ ~ ~ ~1 ~ ~ ~ 5 v , Correspondent's a-mail address: V ~ ~. N @ V rn R+2^~~ u C IPA . Co i~ Under penalties of perjury, I declare that l have examined tetum, including accompanying schedules and sti~temen#s, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FO RETURN DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ~~~E ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505605104? 15056051047 J~ J 15056052048 REV 1500 EX Decedent's Name: Decedent's Social Security Number ';~ $~~ 30 ~ ~%3 ~ l RECAPITULATION 1. Real estate {Schedule A) ............................................. 1. 2 Stocks and Bonds{Schedule B) 2 . ....................................... .~ r ~ . 3. Closely Held Corporation, Partnership or Soie-Proprietorship (Schedule C) ..... 3 r"' <_ ~°°~ r. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4 ~;: _' ~ ~ :'~ 5 ll P l P S h d l E rt k D it 8 Mi C h B ~ 5 Sz ~~ ' ~ `P'° ( ~ ~ 3 . y { ) ........ ro e u e po pa an sce aneous ersona c as , e s s : - , .~ , '' k~ '. ` ~ Y:.~ . 6. Jointly Owned Property (Schedule F) O Separa#e Billing Requested ....... 6 7. Inter-Vivos Transfers 8~ Miscet{aneous Non-Probate Property ~ ~ (Schedule G) O Separate Billing Requested........ 7. ^ ~"~ .. 8. Total Gross Assets (total Lines 1-7) .................................... 8. ~ ;'~ ~~ F ~ t ,.~. " 9 hed l H al E i i t ti C t S F ~ Ad 9 t VD ~P ~~ ° . ) ..................... ve c u n ra os s ( e uner xpenses m s . • ~ , 10. 11. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule 1) ................ Total Deductions (total Lines 9 8~ 10) ................................... ~.. f 10 '~ ' / r 11 • ^ ~'`~ v l to b 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 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. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable a#, 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 _ 16. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 15056U52U48 J REV 1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME 1-. Rtr3R K ~., ~~fE2s STREET ADDRESS f "l~~ ~S S t 6~ N l ~ c- /~ G- "~ 'O ~ ~1/~f~' C.~.E ~s. i CITY STAT ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) ~ v , 2. CreditsJPayments A. Spousal Poverty Credit 8. Prior Payments C. Discxaunt Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. if Line 2 is grea#er than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Fll! in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of tine 5 + 5A. This is the BALANCE DUE. r {56) - ~- Make Check ~ayable,~ to. REGISTER OF IA~LitS, AGENT ~ a ~' .e7 '. f i ~,~~. `~ ~ Z.,.4 ~,2YG~t,~ zc far ~ 7j. ~y fir. * ; ~' <~ . ;,:sa ''w _ 1 ~, _ ~t' .. ;~ PLEASE ANSW£R THE FOLLOWING QUESTIONS BY PLACING AN "~(" IN THE APPROPRI~ITE 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 "in trust for" or payable upon death bank acxount or security at his br her death? .............. ^ 4. Did decedent own an Individual Retiremen# Account, annuity, or other non-probate property which contains a beneficiary designation? ..................................................................................... 1F THE ASR TO ANY OF THE. ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SC##EDULE G AND FILE IT AS PART OF THE .RETURN. .:. "~.~"yy ~. ::3P~ t _ .~> E 7p ,.,"fi 5,. k :.:':}L s'} r.:._ i c:: Y'# ~ * ~ 4T t'tS i b t`1 ~ t x :':v ; »"~~ ` ..`-~ ~ ~f.' _.. .. .. 'i' ~ ~~~_.. ~'-?""<~" :_ _ ? ~ a. ~~"3 t. .f~"`•- ii;. _. _.. ~ an, -~ ~ ~~i~Y.t: ~." m3.5: M fist= _... '!.;k ~'.~~..... 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 survivir~ spouse is three (3) percent [72 P.S. §9116 Via) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to pr for the use of the surviving spouse is zero (0) percent (72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exemQt 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 i# the surviving spouse is the only beneficiary. For da#es 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 or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116{x)(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(x)(1)]. The tax rate imposed on the r~et value of transfers to or for ~ use of the decedent's siblings is twelve (12) percent j72 P.S. §9116(x)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bioad or adoption. REV ~so3 Ex+ ce-~) COMMONWEALTH Oir PENNSYLVANIA tNHERRAhICE TAX RETURN RESIDENT t')ECEDEN7 ESTATE OF ~~ B STOCKS & BO1~DS FItE wUlY~ER ,~.1- / O - ~o ~ 313 AN prosy lointiy-orrr+sd with eight of amrhrorship must be disdos~d on Stdse#~Is F. - - f to more spice ~ needed, tnse~t add~a~t she$ts of the sense size) aEV-isoe ac, (~•en SC~~DUtE E COMMONNfEALFN OF PEI~ISYLVAN{A CASH, BANK DER4'~~TS~ $ Mi~C. ~ fAAI(~ r~-x PER~At PRC}PERTY ESTATE OF t~R ~--~~P~~ 2, ~~E2s ~.1_ r~ _ 0~3~3 inclt~e the proceeds of ~ligetlon ~d tFie date the protaeecla wane teoelved by the ests~. AN PAYowned wilt ti» of sunrir~hip e,b~ dlscio~ad on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ , ~' j`(~ (.~ ~ ~ ~ ~ 4~ E c ~c. ~ +~ f~ ~ c C, o ~•. ~s ~"~5~~ -~3 da ~-- ~~ S2~ / /~ ~ ! ~ . S~O /~-~ ~-~ Irv` Q~c 2 ~-s `~ (Z ~ ~M C- c >~A u t c S a t,. 2~ ~ ¢1 (`7 ~ ~5"~ ~ . ~, ~ ,~ c~ a K ~ --~. R.. ~.~. ~P2~ Pa-~ ~.~.~~-s ~ ~sa~ . ~ ~ ~. ~ \ 5 cJ ~ +,-~ ~- Pd ,~ ~ ~ u4.t" ~ E "F v.t~ ~ S ~, +r~~ ~ t S-t'~~ ~Q v-^< < v -t-t -~ ''23 ~ , ~ ~ ~, ~/zL~~ TOTAL (Also error on line 5, Rscepitutation) , ~ ~~, ~ g S~ . ~ 3 ,~ (If more space is needed, insert addltiiar~ sheets of the same size) r Y REV•,e~o Ex • c~•sn COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESmENT DECEDENT SCHEDULE G INTER-~IUOS TRA~N~FERS MISC. NON-Pi~OBATE PROPERTY ~~ ESTATE OF _ _ FILE t~tt~ER This schedule must be completed and tied if the answer to any of questions 1 thnxrgh 4 on the reverse side of the'REV-1500 COVER SHEET is yes. DESCRt!'~T}t'3N Of ~tOPERTY R6 0~ ~~ ~,,~ ~ t~+E ~, TNEIR RElAT10HerMir to oECEaEMS Ara THE DATE of tiuuroRER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ITEM ATTACH A Cow CF THE DEED FOfI REAL. ESTATE . V I ~ T " / ~9,~~ ~ ~fl'7~ 3~ g~ q~~8 1. ~'1~ lti L~-c ~ ~ ( ty f~~ c.~ ~.- ~~ c wti. k~~ +~ S ~ ~ r2-P ~ ~P ~ _ ~ -- ~~~, ran `~:J is s~ w f~ 5 ~. rv~C. t-"'-.. ~,,~-- ~; [s'p t! ~ `:.~ ~-'P ._.. a -r- ~ ~ ~ ~~ O '~ 00'0.0 I~~~e r-... ~~~/~ , AL Aiso erg on iine 7, ~1 i "~' 1P, g ~ ~ , TOT (tf mare spate is needed, insert addMianat sheets ~ tfie same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~~~~~~~ N FUNERAL EXPENSES & ADMtNiSTRATtV'E COSTS ESTATE OF ~ ~ t3 ~ ~ ,2 FiL~ NUIIr~$ER r3~E21 ~,~ j~--Do ~r3 Deb#s of ~cedant must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. _ ~C Kt- I i~t '~" v- tit E 1E. P t.. ~ ~ vM. ~ ~ ~ ~.c C . ~"'~ , C 1~ Eyz:~ }.t w'C"' S ~--,) ~ I L L t Q v. 2 G- ~ ~ ~ (~ `o (~ ~ ~ ~ ~ , ~ ~ ~4-+~ w~ G ~ ~~. M C- A~- - ~ its ~ A t~+- Uti ~, ~. ~ 6 ~ 01 $ ~", SO B. 1 2. 3. 4. 5. 6. 7. ~' , ~. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representatives} Street Address City Years} Commission Paid: ______ Attorney Fees Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address ____ _ City State Zip ___ Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees ~~ V E 2~` I s l µ G- yn Gas r R w ll t t... ~ c• E ~~ ~ ~~.- ~~, ~ c Q~~i ~ ~. ~-~--s State Zip ~ 23~ ~~ ~-3 OO. CJD t~~~~'~' T©TAL (Also ertter on line 9, Recapttutatian) ~ ~ ~- ~, etc ~. ~ `~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF NENNSYLYANIA INHERITANCE TAX RETURN RESIDENT DECEDENT BENEFICIARIES ESTATE OF FILE NUMBER RELATfOMSI~lIP TO DECEDENT Atu~tN1T OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Oo Not Clst'[(a) OF ESTATE I TAXABLE DISTRIBUTIONS (include outrlgM spausat ~stt~utions, atxl transfers under Sec. 9116 (a) (1.2)j 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTION8 SHOWN ABOVE ON LINES 15 TH ROUr3~H 18, AS APPROPRGTE, ON REV 15QU COVER SHEET II NON-TAXABLE DtSTR18UTtONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 8113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 1 ~ TOTAL Of BART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE i 3 01=: REV 1 Sfl4 COVER SKEET ~ ~., ~~,~ ~' 3 ~ ~ g {N more spe~ce ig needed, Msert additkmsi sheets of the rime size) _ ... .,. _,.: _ . r xlvs.eos ~v ~o~xm - LOCAL REGISTRAR'S CERTIFICATIQN OF :~~~I~TM WARNING: 1# is Illegal to duplicate this copy by .photostat or photograph. Fee for this certificate, $6.00 ~~~"p'-'----. This is to certif that the information here iven is ~~"p~~H OF p fA, correctly copied from .an original Certificate: of Death ~~ -. ~ -~> ~-~~~ duly filed with xiie ~as Local. ~tegs#rar. The original certificate will ~ tie forwarded to ~ the State Vital iE : '- '~ = ~~: °w a Records Office for permanent filing. .:- .. P 1620447 9 ~. 9EM'i 0~;~~' su d Cert,~ficatlon Number ocal Re Date Is e ~~ • mac c~~oKwen~.rN a~ raiw+snv~a-•x~cerenr ors w~-uM REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No . 2010- 00313 PA No . 21- 10- 03 ~ 3 Estate Of : LABAN Z BYERS (First Middle, Lestl i Late Of : UPPER ALLEN TOWNSHIP '~ CUMBERLAND COUNTY ' Deceased Social Security No: 188-30-9391 WHEREAS, on the 26th day of March 2010 an instrument dated Tune 9th 2009 was admitted to probate as the last will I,of LABAN Z BYERS (first, Midtlye, Lsstl 1a to of UPPER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 14th day of March 2 010 and, WHEREAS, a true copy of the wi 11 as probated i s annlexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH Regi s t~r of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsyl va.~ii a, hereby certify that I have this day granted Letters TESTAMENTARY to: VERNON M MART/N JR who has duly qualified as EXECUTOR~R/X1 and has agreed to administer the estate according to 1aty, all of which fully appears of record in my office a t CUMBERLAND CDUIVrTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand aid affixed the seal of my office on the 26th day of March 2010. * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) WILL _____~. (1F __._ LABANZ. BYE.R~S I, LABAN Z. BUYERS, currently of Cumberland County, Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose again to redeem me and give me eternal life, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and .funeral expenses be paid from the assets of my estate as soon as practicable. after my demise. II. I direct that all .estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my .taxable estate whether or not passing under this Will shall be free and clear thereof. III. I intend to keep with this my Will a separate memorandum concerning disposition of certain items of tangible personal property. I bequeath the items on said memorandum to the persons designated. IV. All the rest, residue and~remainder of my estate I devise and bequeath unto Brethren In Christ Foundation, Grantham, Pennsylvania, for the charitable purposes I intend to outline to it by separate instructions. V. I appoint Vernon M. Martin, Jr., Executor of this my Will. In the event that he fails to qualify or ceases to act as Executor, I appoint my sister, Eva Martin, Executrix, of this my 'Will. VI. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITl'+~i~SS ~#~REI~F, I, LABAN Z. BYERS, herewith set my hand to this my Last Will, typewritten on two (2) sheets of spar including the attestation clause and signatures of witnesses, this "` day of ~t.~.. , 2009. n `~" {SEAL) LABAN Z. B RS Signed by LABAl'~T Z. BYERS, by him declared to be his Will in our presence, who have hereunto subscribed our names as witnesses in his pretence and at his request, this 9~ day~~of ~~`~°1~-~-r , 2409. . ~ .;~ ~..~.~ .. ~. ...~ ~- residing at ~' ~- ,~r ~" ~ c y....._ --~--~ i-- '~ .~ residing at C~.-~'' -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF WE, LABAN Z. BYER.S, GERALD J. BRINSER and ~s~"ity J~ . P~~'~5 the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being fast duly affirmed, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he signed willingly (or willingly directed another to sign for hirn), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as witnesses and that to the best of our knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ,~ -'~ ~~~ LABAN Z. BYERS TNESS . -, C Y~,;, ., ~. WI SS ..~ Subscribed, sworn or affirmed and acknowledged before me by LABAN Z. BYERS, the testator, GERALD J. BRINSER and ~`iA`~T tfy A . ~'~'~:y~s ,witnesses, this ~~ day of , 2009. (SEAL) Notary Pub ' COMMO~'HWEAI-TH CF ~'~NNSYLVANIA NOTARfAL SEAL VYENDY L. CRA1NFCyRa, Notary Pt~c Palmyra Boro.. Lebanar- County M Commission Ex ~ s en~aet 14, 2t~9 -3- .. ~ ~- eti~q AN .AFFIIUI'E C~FTIIF. RAN{; OF NCW Yl'-R): MGLION C>n. Penhing Plaza, leney City, N107399 Pershing llC, member fINRA, NYSE, SIPC ESTATE OF LAEA1i Z BY~RS _~_~____ VERWOE M~TIR F~BCUT~R 12 SUMMIT D-RIVBC DILLSBURGi PA 17019-9589 MULTI-FINANCIAL SECURITIES CORD 1290. BROADWAY DENVER CO 80203-2122 2108 084'] Page: Accowtt MuNber: AeaHatt raids Issuing BaAk Acct: 1 of 1 KZ-745785.1 ~170,Y97.48 0300956497 PA~'~4zEN2' SL1~I~IARY f-~'~` . .~ CHECK NUR: 4pp82 g~ 88,E 1 CHECK DA 04 / 1312010 DATE ©ESCRtPTi©N AIYtOUNT 04/13/2014 AS PER Y~ RE(KIEST ~IfiO,t97.48 NET AN~tlNT 170,297.48 ~E ~- .~[~ O C ~c L 1 S '~ ~-~--~--R ~..~ ~~~ l ~~ ~-~s r - a-~ ~ ~ ~~° o,.. ............................................................................................................... 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Box 2828 Norcross, GA 30091-2828 L.aben 2 Byers 12 Summa Dr ~ DiUsburg PA 17019-9589 ~i~~~1~tx~~~~~~~~~~~~~~~i~~t~~r~~~~r~~i~~~~~~f~~~~~~~`t~~~~~~~ E3i~i~dend C#~r~nation Divid~tnd h~orrnat~on Dividerul paid on 03115/10 $100.80 Less Federal W/H $0 00 Net dividend $100.80 Check sent directly to: Laban Z Byers The dividend for the quarter was $.3150 -per share ~iii1!"i[~ Vis~Ye -Ali Piedmont Classes Number of shares owned 03115/10 320.0000 Share value on 03/15/10 $17,85 Account value n 03/15/1x`-~' ~-$5,712.00 Detail in~r+or ~~ceas ff Y~ haw any gw:tions or n~e1 !o rnsics ch~rg~s to Mawr accaurit, Please cotKact Peti~nt ~nwstor Ssrvices: ToN-free: 800-557-4830 E-mail: ~ investor.services~piedmontr~t.com Enroll for E-mail alerts at: www.piedmantreit.com To discuss your financial strategy contact: Piedmonrt Office Realty Tnmt Ctass A CUSIP 720190206 Shares Owned Market Vsius 12/16/09 Quarter Beginning Balance 0,0000 ~ ~ ~ 01 /22/10 Recapitalization Shares issued 80,0000 03/15/10 Quarter Ending Balance 80.0000 $1,428.00 Piedmont Offfoe Realty Trust Class B1 CUSIP 720190305 Shams Owned Market Vales 12/16/09 Quarter Beginning Balance 00000 $0 ~ 01 /22/10 Recapitalization Shares Issued 80 0000 03/15/10 Quarter Ending Balance . 80.0000 $1,428.00 Piedmont Offfoe Rsaity Trust Class B2 CUSIP 720190404 Shares Owned Market Value 12/16/09 Quarter Beginning Balance 0,0000 $0 00 01 /22/10 Recapitalizat~n Shares Issued 80 0000 ,,,_,_ 03/15/10 Quarter Endmg Balance , 80.0000 $1,428.00 '~ Piedmont Office Rssity Trust Class B3 CUSIP 720190503 Shares Owned Market Vsiue 12/16/09 Quarter Beginning Balance 0.0000 $0 00 01 /22/10 Recapitalization Shares .Issued "'-' .80 0000 , 03/15/10 Quarter Ending Balance """ . 80.0000 $1,428.00 Page 1 of 2 Statement Date: Mar 09, 2010 Brethren in Christ Foundation P4 Box 290 Grantham PA 17027 Mr. Laban Z. Byers 12 Summit Dr Diltsburg PA 17019-9589 Account Type: TAP -Special Maturity Date: NiA Interest Rate: 2.47°!° Date Check # Type Amount 1/2/2010 Beginning Balance 7,002.43 1!19!2010 3617 Deposit 3,000.00 1!31/2010 Interest 17.33 2/18/2010 3619 Deposit 3,000.00 2/28/2010 Interest 21.22 3/9/2010 3621 Deposit 5,000.00 ~ l 3/ 9 - CJs. ~~ ~ o v ~..____,.w.._.~.~..~.~_ ...~. ~Y'1"'~ ~ r E yam. 4~~~"" ~ ~. "~Q ~ Pk~L ~' ~-s~- ~,~_ ~ - Total Deposits: $11,000.00 ~ Total Interest: $38.55..-'y'7 •gt ~ ~ ~" ' 3 Unpo~s#ed Interest: $0.00 Total Withdrawal: $0.00 Ending Balance: $18,040.93 g,z Q ~ ~~ ~ ~~~~ ~/ ~ a ~ Statement Date: Mar 09. 2010 1n~Anti~n C3at~~ .tun ~7 1gg7 Account Number: 1'038 Account Narrte: Mr. Laban Z. Byers JUtJ~t~S-~©1C~ 0~:4t3 From: 3''7~3~"~19 To:'1 r76~1U95 F. 1 '~ Priority 54 Pius ~0.ccoc~nt St~t~ment PNC ~srrk far the porbd 03l'061T0~ 0 to l~ylnl~010 prirtra'y aOCOwII nun~twr: !tA->ft~?a ~;.r;;, r'x3fl ± nt Nisrti~r cf 4rukr~uu+ar. i1 ~A>s~ z u x>wvi~ ~lL~ 1~'tFtNUi; t-;AI:TIN 22 :;t7MMTT 1')R DZI`~7.~~1R pA ~7QIa-589 Fnr !!4 ~~ Iwr'li~~, ar~rl trs*A1~tiCn ~x Inrnrt-Rr rOt4 inta+~»t~tct, siy-: us ks PN~', 8~nk f>MiMnc: !~u?lti•iy a~~ ~C.C~3tri. Fqr CNftlift'~Yr 4Nva'w q,~ ' ~8ti-FN~-BAi~i+C M=Htii::y - F rid>iy : 7 A1A ~ 7 S; ?M F T' wuNrclrlh a ".3uf1My A I!M - 4 pM K T r'ara arrrvlcl0 on !1lt~1lN1Ai, 1-~IQ6.!iC~.A•AlwC YoWng? h'~u~rsv uvrrttct i» ti ; •EiAB-PNc;: t~Al~r; Wr~tu t=~ Custr,r~rr SisvK~C~ Ftt f!:» 609 Fmoou,~~iaa !5230-~r3e Vi3it uY ~ti pnc C"JfT~ 'ff)l'I tC~ilai~al. I.80G.!S'1~.tC;gg r~- n~rq irnwr~, trl~sa:~ rn~ Rribrily fit! ptus L.a>M, z ~lyo~c Int~res# Clteckelt~ ~c+~QUnt Summary Auucwr4 rwtntser. 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Checka artd Substitute Chocks r;Reer~k O~K~ rSwNwwee~u• RW'~iCNr f~~+l~and p11<A t'yYl!7<K ~'TeM'e1 ~r~.,y ^.e"ebti "i/tltba~s ,1ifWi"A' ~hifl ..U~NUNe 382^v A :~ 43;/$ r:++;r.:u::•tI 3t~'.~' ~~q.Ji;: U:+/iR :>F17?;•tif,: '2f.,?. 3 ~ GlitJ.{!L' ~ Yi±f1V fiU 3? c 6~3s Gpsttr, Ct!gf:~ t~At1+~f,rn,r; ,. h~w•c• w4i:.~ :~ ~:rerV%' lis'+k: trn~~rru; p!'lttAg aftd ~,1~t`#~rt~fl4iC ~t'1k11"!Q pef~Wt~1l011S 'ihara ware, ;14nhncr ~c tart:.a~aMe: 3ard+i~•wj OieW A~~~ur,t Oe,Rnnnt~nn ~~+i~il:itiW>; +•:fTAlsry #?',~Sx.e3 U3~'1 I f i tf~ f~irs'Ct P~y~-tcttt lr~tytti~r:tr~c \~Qtiiciill XXXXX?iXXXt',A~IFi C13r'18 :'.N:lt.7n t~irAM Frtyrnehi $tatCrrle~tS 1'leJ.9:+ih f iiKt~ 1~~312 :~:V?4 2t)tS.S9' L'~~v~t Pary.r,~tll • At',H for Abort PhBrtte~tti;' ist•~ytrf t/Rt~ t.~O~~t;~tG ~•~tt 'r'r"'wrrr ^r~~~..n ~.1-t! ~+Irllfi<i 03tn4 t'~,ai 4 r+2 ti Belk! ' ~ ~ i ~ ntM 11 19&7.;it tli,,lt,. li~'24 tlAli/`::+~ "ti:l !'~ 3 J3~Gt! ~ r.,,~t .I :+~ U.3, i V~rt1Z . 5.Q2~t .~iCl l.13Into , ~ , i~ t a.3;; ~~I1 A .~ 9~3U.:s .• OdrCS r, ,,tr~-.od ii'yat~ hn~~i-n'i alrcc~r~ly, take a hook at the new prri»t~ '~'i~ Crec~iit S'ard. N~~i r~n':~ ..an ye~tt take ad~•antaga +!~ tr1~At I~ctra, trot yuu :wit .11;5tiJ tJVtiCl~CbtC ~ c~u~ t°h-C pcatnts(5,'~1; e:;~ r~~u~, ta'wt t by 1~ttktn~; iht~ ~><;~~ t.:t•t:di1 t;atd ,~s sattr yr»+•til~-1 t'h hce•~: t:~ii. ' t~ l~•' vuue lex:~! hr~+nrit t~x1a • ttt tn• uitr, Arhiev! taut' awvilt~ gwri t,y crpttnin~ a t`Ni:. 3ttti>,-$x aCCtxt~t witit ~1ut+tr ~Savin~c, QrtCC yvu+ :+u-•ict~;,^t ac~etu•tt i~t~cta}+tishcel, ;ink it Iii t'-,ur curt~:n~ t•h~'t;htr;.ktit~:tf.~rueti. Act••,.ra.~ thc• AuE~ ~av~nk:> ;r.'11.ue~ .r~~,~ ~.~hc~>,4e~ eh~ xrt+urnt ynrl rrr;tnt ti- tt"itlltiior ~r,t7 ile3w+Ili~:n. (i'4 .+. tttl'.~M wxy is ~tert o ~r~r~+nil!>r•t 4r+~ :.t~~ rautirtt. ~~ !: c:t:r w:ts.:r(irlr. Ail ~c.u htty~ .~: J+; is watr•h 'VUt'it~t`rtc.; i•;stv:. Pay b~ls tM +easy woy stud brim points...,wtttt yot.~ NNC Viso Ch~1Ck Card. 11`tc >, eartvsnient, secure end rev-~isdtrty wt~y eft pay a~ k+n~a 4f biiM w+th yGi~r Wi.~itr t;ht3CK Card phrsrte ;'„g!"Jt(.'M, I~iurar,Cl. cdbte, U?~liti+r2t; at:uf trutra. You can Chtt4sC 110'1" two ways ice ~y• ~ time payrr,trt car 5r~h~selutvd MitrtOrl~tiC p~nert~ Arrv '~r~h, PNC points, cant 1 pr~in~ tnc• every duYat p~t:a• visit ptnc.cctm'pc~ints for s:ttm~lC!C TeMt>1~ attct <<~rnitiaf•-5. I:~et ~;atted rinw t:y uurng .,n4inC ai, Nrlc.oort','payhycar~ is, verily Oiliers cnrvilment c:r 3nti~tl>r• c:unc~;t [hem ~Irc•,:ii~'. ~~~ ~~~a ~ ~ ~~,~ ~~ 3~~•~ ~',~-9 ~,~~.~~ Cocklin Funeral Home, Inc. 30 N. Cl~estnut St. Di!lsburg, AA 17019 (717)432-5312 April 20, 2010 Mrs. Eva Martin 635 Messiah Village Mechanicsburg, PA 17055 The Funeral Service for Laban Z. Byers We sincerely appreciate the confidertce you have placed in us and wt!l continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. 'CHE FOLLOWING iS AN ITCMIZED STATCMENT OF Tt-1E SERVI = ,FACILITIES,. AU'fOMOTiVE EQUIPMENT, AND MERCHANDISC THAT YOU SELECTED Wi-IEN MAKTNG Ti-iE FUNERAL ARRANGGEMFNTS. Protessionai Services Funeral Director 8t Staff Total Professional Services Merchandise P68 Churehhill Blue Monarch 3,725.00 ______~~..~.w 2,370.00 990.00 Tote! Merchandise Sclee#ed ---_~~_.._.._~__ AT THE T1ME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. T'HE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Cemetery Charges 500.00 Newspaper Notice Harrisburg 220.12 Newspaper Notice Lancaster 266.80 Clergy Honorarium 75.00 Flowers l 62.18 Death Certificates b0.00 Tent Rental 150.00 Cutting Date on stone 150.00 O:banist 50.00 Total Cash Advances "~ ' ~,.~fl~ SALCS TAX 0.00 SU OTAL ,? 19.10 ,y ~NITIAL PAYMENT DISCOUNT / CRETflIT5 8 2'77.18 ~ ~ TOTAL AMOUNT DUC 441.92 ~ ~ ~'` ~~- Q O ~l ~J f~\ The unpaid balance over -35 days is subjected to a U "/o service charge per month - 0'/e per annum. f'ase ,_._n ~. ,. ' ~~~ A N AFFl11A'!E C1lT71E MNK OP NEiG YC-RK MELWN one Pershing Plata lasey CiAy, W 07399 Pershing LK, member HNRA, NYSE, S>PC MULTI-FI1tANCIAL SECURITIIS3 CORP 12 9 0 aROADitAY DENVER CO 80203-2122 .-.~.~ I llfllll~lill`I~111I~~!!//Illilt"Ih111111~1111t111111i11ii11111~1111~111 VSYlPC~ Mi1R'~'Il1 505 0868 12 St~T DRI'C18 DILI~S'8 PA 17019-9589 ~111~''III~~~IHI•i~~~1~fi~i'f11~i~1'11~1~/~Ilill'~11~1~~11'1' ~110.00851„T, Page: Acco+aelt r: Awowtt *i~f s I asei ~ ds~c Acct PAY~VtE~'T` S 1A~t Y cttECic r~~~f~: c~cK DATE 19ESCRIPTION D4/22/2010 I?EATH ~M ~ACCQIINT OF E~J4 IT.A~BAN Z BYEitS ~ ESTATE ~S) 'T/(E, / ~ ~ f ~ c S ~ R t ~ v~ ~ o ati ~ ~~ a ~ ~ , ~ :~ ~~ ~O ~. ~~ ~~t~ c> tv C- ~ o 1PF2 ~(34v~ 3`~~-~`~ aoos3a~s39 oa122/2010 20.00 1 of 1 ~xZ-705801-i 36.843.48 0300956497 AMOUNT X38 959.48 6.84 .48 ~ ` ~ r \~ ~, \ _.r-- CC D•~ ~~_ ........................................................................ .. lntw~i+ Wnn.~ S r ~. ~~ ~~ ~~~~~ ,~ ~ ~j* ~y N ~MM ~ '}~ O o 1 ~ ~ ~~ ~ ~ ' ~8 • t,1 ~~ ~ ~ `~ ~ z -~, ~` ~ ,. 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