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HomeMy WebLinkAbout06-18-10 1~C PA Dep~nenCd Rsventae Burasu of Ntdividttsi Taxes ' PC) BoX 28i1t30t , PA 1712i3.0~01 15056051058 oFF~cIAL usE oNLY Courtly Code l~r FNe Number IN RL D~ITEDEC DENT 21 09 1148 ENTER FN<O~ ~lrORiIISATiON SEL.OW Social Security Nta+nber Dote of Death Date ~ Birth 481-64-54fi2 ~ 11!19/2009 10/22/1948 Decedent's Last Name ~ Suffix Decedent's First Name MI Roelke [~ Viola (if Applicable) Entsr SurvivinS Spouse's information Below Spouse's Last Name Suffix Spouse's First Name MI Roelke III George Spouse's Soaal Security Number THIS RETURN MUST BE FILED IN DUPiiCATE WITH THE REGISTER O!F WtLLS FILL iN APPROPRIATE OVALS BELOW d!D 1. Original Rethm O 2. Supplemental Retum O 3. Remainder Retum (data of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) t~ 6. Decedent lied Testate O 7. Decedent Maintained a Uving Trust 0 8. Total Number of Safe Deposit Boxes (Attach Caipy of 1fVill) (Attach Copy of Trust) O 9. Litigation F~r+ooeeds 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 - THI8 SECTION MUBT BE COLLETED. ALL CORRESPONDENCE AND CONFlDENTUL TAX tNFORMATI0f1 SHOUlO BE DIRECTED T0: Name Daytime Telephone Number George Roelk~ IV, Admin (571) 256-OZ Firm Name (If Applicable) "t REGISTER~;i*' S USE Y ~~ ~ •.... w First line of address Cn ~ Ob ! 7204 Caulking Piece a... Second line of address ~ - "'" : ~ ~ .. . . . . r i; 7 City or Post Office State ZIP Code DATE FfLED ~" Burke VA 22015 ----- Correspondents email address: Under penalties of pee~uy, I dedsro thst 1 have eacrdnMned its ream, Indudin9 acoomWnyl^9 schedules and stsbsmeras, and b d,e best of my knowledgQ and bslbt, it is true. oared end Compb6e. Der~atlat o(p other than the personal representative is based on aN lnfomratfor- of which preparer has arty knowledge. SIGNATURE OF PE SON RESPONSIBLE FOR FI~.ING RE DATE ~ D ADDRESS 7204 CauNdng Piece, Burke, VA 22015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS ~q~, ~~ ! r ~,. '~ ~.~, PLEASE IJSE ORIti1NAL FORM ONLY 31de 1 15!056051058 15056051058 J 1505i~052059 REV 1500 EX Decedent's Social Secxarity Number oecsdent~s Name: Viola R Roelke 481-6~4-5462 __ RECAPITULATiO1r1 1. Real estala (Schedule A) ......................................'....... 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 483.42 3. Closely Held Corporation, Partrtersltip or Sole-Pnoprietorstwp (Schedt~e C) ..... 3. 4. Mortgages b Notes Receivable (Schedule D) . ............................ 4. 5. Cash, Bank Deposits b MisceNaneous Personal Property (schedule E) ........ 5. 10,966.19 6. Jointly Owned Property (Schedule F) :.-° - Separate BiBng Requested ....... 6. 3,473.61 7. Inter Vivos Transfers b MisceNarteous Non-Pnobsis Property (sc~tedt~a G) .. Separate BlSrtg Requested........ 7. 154,439.66 8. Total Goss Assab (torsi lanes 1-7) .................................... 8. 189,362.88 9. Funeral Expos b AdmiMstratMe Costs (Schedule H) ..................... 9. 3, 711.70 10. Debra of Decederrt, Mortgage LiabiNles, b Liens (Schedule 1) ................ 10. 286.71 11. Tool Deductlons (>~ Lies 9 b 10) ................................ . 11. 3,998.41 12. Net 1Arue of Estatr (Line 8 n~rttas Line 11) .............................. 12. 165,364.47 13. Charitable and GoMeKr>ntertted BequesteJSec 9113 Tna~s for which an election do tent has not been made (Schedule J) ........................ 13. 1a. Nat value $ub~JeCt ~ Tax (Line 12 minas Line 13) ........................ 14. 188,364.47 TAX COt~UTATION - 8EE MISTRUCTIONS FOR APPLICABLE RATE8 15. An~totxtt of Une 14 taxable at the spot~al tax rsls, or trar>sfers tinder Sec. 9116 (ax1.2) X .0_ 15. 16. Amount' of Line 14 taxable at I~teal rate X .0 4~ 165,364.47 1s. 7,441.40 17. Amount of Line 14 taxable at sibl~g rate X .12 17. 18. Amount of Line 14 taxable at odlaterai rate X .15 18, 19. TAX DUE ......................................................... 19. 20. FILL. IN THE OVAL tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 7,441.40 15056052A59 REV 1500 EX Page 3 Decedent's Complete Address: ~~ 21 ~ 1148 DECEDENTS SOCIAL SECURITY NUMBER Viola R Roeike 481-64-5462 STREET ADDRESS 105 Cavalry Road , CITY Carlisle STATE PA ZIP 17013-1604 TaX Payments and Credits: 1. Tax pue (Page 2 Line 19) 2. CreditslRayments 0.00 A. Spousal Poverty Credit B. prior. payments 0.00 C. Discount 0.00 3. InterestlPenalty if appNcaale D. Interest E. Penalty 0.00 0.00 (1) 7,441,.40 Total Credits (A + 13 + C) (2) 0.00 Total InterestlPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. t`lll in oval on Page 2, Une 20 to request a refund. 5. ff 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 tl~e BALANCE DUE. (3) 0'.00 {4) 0.00 (5) 7,441.40 (5A) 0.00 (5B) 7,4411.40 Make Check Payable to: REGISTER QP WLS, 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 shah use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefds or care? ...................................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer pn~erty within one year of death without receiving adequate consideration? .............................................................................................................. ~ ^ 3. Did decedent own an "in trust 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 pn~perty which contains a beneficiary designation? ........................................................................................................................ ~ © ^ IF THE A~fSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ANO FILE IT AS PA~tT OF THE For dates ~ 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) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for 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 surviv~g spouse from tax, and the statutory requirements for disclosure of assets' and filing a tax r~etum are still applicable even if the surviving spouse is the only benefiaary. 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 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)]. The taut rate imposed on the net value of transfers to or for the use of the decedents lineal benefrdaries 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 decadent s siblings is twelve (12) percent 172 P.S. §9116(a)(1.3)]. 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. TOTAL (Also enter on line 5, Recapitulation) S 10,966.19 _ ~_ _ _. (If more space is needed, insert additional sheets of the same size) REV 1509 EX+ (8-98) ~. ! ~ ~ ii COMMONWEALTH OF PENNSYLVANIA Jp~~,Y-QINNED P ROP"ERTY INHERITANCE TAX RETURN RESIDENT OEGEDENT ESTATE OF FILE NUII~ER R4ELKE, Viola R. 21-09-1148 tt an asset vws joint wit tlln one yeu of the decedent's date of dea~~ it must be nporbd on Sc hedule t3. SURVMNG JOINT TENANT(S) NAME ADDRESS REtATiONSHIP TO DECEDENT ......_........_ ..............................n.. ...... .....__..,............._...........,............. A ;James Dale Roelke ........_.........._.._..._...._.._..........._..................,.........._._n........._..........._............,...._. ':~ 105 Cavalry Road ..............................., ... -Son Carlisle, PA 17013-1604 8.,. _.. Christopher Andrew Roelke :102 Sycamore Dr ;Son Mount Holly Springs, PA 17065 ,. ~ C ..... ....:.... ,.........._,.: ....... ,_ . ~...:... .......... ~Geor+ge Richard Roelke IV a _..._ _ ..... __ _. . .. o.., ,r:: ._.._.:. .......w,.... ........ ;7204 Caulking Ptaoe ..............._ .. ............................................n......................__........._........ _. ...._.._...................,..._............_....._...................._..................... Son . ;; Burke, VA 22015 JOINTLY-C~IMFIEG PROPERTY: LEITER DATE DESCRIPTION OF PROPERTY ~ x OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE. NAME OF FINANCIAL INSTRUTION AND BANIk ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUM~R T Jk>MiT NUMBER. ATTACH DEED FOR JOINTLYaiEI. REAL ESTATE. VALUE OF ASSET DE S EREST t. A ~.. ...~...., 0$p4/92 3 _.. r_ __-... _._ ...... ......... ...._....._ ... _... _ ..... ...___ ;Savings Acxount, Members 1st FCU (Acct Num.127930-00) 158 81 50 9s~ 79.41 '. _...... `; 5000 Louise Drive, PO Box 40, Mechanicsburg, PA 17055 __. __ _ 2 A 12!26/96 3 _ ..,...._ ........................._ ....... _ ..... ;Checking Acxount, Members 1 st FCU (Acct Num:1297930-11) ~ v .~ . ~ 64 g6 :, 50 .:. 32.48 ' 5000 Louise Drive, PO Box 40, Mechanicsburg, PA 17055 3 ~ ~ q : ; 05~~ ~ : ~ s Certie of Deposit, PNC Bank (Acct Num: 31300293109) 3,167.79 ~ 50: ., ~~ 1, 583.90 PNC Bank, PO Box 609, Pittsburgh, PA 15230-9738 4. A 105119108 :Certificate of Deposit, PNC Bank (Acct Num: 31600241749) 1,292.67. 50 ~; 646.34 PNC Bank, PO Box 609, Pittsburgh, PA 15230-9738 . ,..._ ,_ 5~ A =06/09100 ° ;Checking Account, PNC Bank (Acct Num: 5003197358) 2,19919 ` 50 1,099.60 PNC Bank, PO Box 609, Pittsburgh, PA 15230-9738 ,. , 6 A !08101102 US Savings Bond, Series EE, $100 face value (issued 8/02) 63.76: 50 31.88 !F! _... ................ .: E Y j ...... -, : -., .:.. .., .~ .... 9 ~ _._.. ...___ _ . .. .. ............ ..._._.._..... ... _.. ...... .. ...,..._... .__._.... F P3 .3 d Ems. ... L.E.: :~, ..... .. !~~ i!p $i: TOTAL (Also enter on line 6, Recapitulation) i 3,473.61 (If more space is needed, insert addiitol-al sheets of the same size) REV-1510 EX+ (08-09) pennsy~Varria SCH E @l~~.E G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIIiENT DECEDENT ESTATE OF FILE NUMBER RdELKE, Viola R. 21-09-1148 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF TtIE TRANSFEREE, THEIR RELATIDNSHiP TD DECEDENT AND DATE OF DEATH °k OF DECD'S EXCLUSION TAXABLE TIR: DATE OF TRANSR:R. ATTACH A coat of THE OffD POR REAL ESTATE. . ............. VALUE OF ASSET INTEREST IF APPLI VALUE 1. ~ US Savings Bond, Series I, #100 face value (issued 4199) ~ 190 36 E ° 100 190 36 ~Pay~~ on Death: James D. Roelke (son). Transferred June 2010 ~~ . 2 :IRA (Conventional), PNC Invesbnents (Account Num: 80287067) 2,764 07 ~ 100: 2 764 07 Beneticci ary: G~eoi+ge R. RoeNce IV (son, address C ). Transferred May 10. , . 3 BeneTrt, P ~ 11,361.47'. ; 100 11 361 47 ' e R oelke V ary (son, see. address, C on Schedule F) , . 4 Pension Benefit, PNC Pension Plan 11,36147 100 11 361 47 Beneficiary: Christopher A. Roelke (son, see address B on Schedule F) ~_ ~mew............__...._..m.....~....._......._...~..........._......._._ ............._._..._................,.._.......................,...... ........ ~ 5....,.,.,kKSSY:<51katt'OC'SH5:.9tle.^,kSYev:!€: .. , . ;. - - 5 Pension Benefd, PNC Pension Plan ~ 22,722 95 ~ 100 722 22 95 Beneficiary: James D. Roelke (son, see address A on Schedule F) 3 , . 6 ry ( le ) .4Beneficia ~: James Dk Roelke son see address A on Schedu F 103,039 34 ' 100: __ 103,039.34 -Mutual Fund: BlackRock LifePath Target 2015 Date of Death balance: #16,119.44 --Mutual Fund: BlackRock E.puidity Temp Date of Death balance: #17,656.89 - Mutual Fund: WVells Fargo Adv Total Retum I E Date of Death balance: #19,913.27 '-PNC Common Stock `Date of D~ad~ balance: 549,349.74 ~~ 7 ;Proceeds from sale of US Savings Bonds, given to James D. Roelke (son, 6,000 00 ~ .. . , 100 3 000 00 ' 3 000 00 aee address A on Schedule F). Date of Transfer. 7 May 2009 f , . , . ~d~ TOTAL (Also enter on Line 7, Recapitulation) # ~ 154,439.66 5.. i~~ ~ ~k H5 5:55k5~e .ktl:555~:5k,,g _, .,, -, If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) p~ennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS E~1'ATE 0~ ~~ p ROEI.KE, Vivia R. 24-09-1148 Det~dNtt': d~bb meat br r~port+ad on 8thedua I. If more space is needed, use additional sheets of paper of the same size REV-1512 EX+ (12-08) pennS~-lvania SCt~EDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIASILMES & LIENS RESIDENT DECEDENT TOTAL (Also enter on Une 10, Recapitulation) ; ' 286.71 ,____ , If more space is needed, insert additional sfieets of the same size. REV-1513 EX+ (11-08) pen-tvan~a ~CHEDtJLE ~ DEPAflTMENT OF REVENUE INH~tITANCE TAX RETURN BENEFICIARIES RESIDENT D~DENr ESTATir OF ROELKE, Viola R. NUMBER I 1. 2i 3' 1. 1. .................... LATIONSNIP TO Do Niot Lirt Tn FILE NUMBER 21-Q9-1148 AMOUNT OR SHARE OF ESTATE 1/3 1/3 1/3 TOTAL ~ PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ ~ ___ If more space is needed, insert additional sheets of the same size. ~ ~ ~ ~~ ~ ~~~~ ~~ ~~~ ~~~ , ~ ~~p~. ~ ~/f~o~ Please Note: Your Sale Proceeds Check is Attached OMB NO. 1545-0715 20 1 ~ ~'oceeds From Brakar and Barter Exchange Transactions BROKERS Name, Address, ZIP Code, Instructions for Recipient Federal Identification Number and ~~~ 1 ~~9_B Brokers and barter exchanges must report proceeds from transactions to Telephone Number: COPY B FOR RECIPIENT you and to the Irttemal Revenue Service. This form is used to report Mellon Investor Services ""IMPORTANT TAX INFORMATION""' these proceeds. This is important tax information and is being 480 Washington Blvd. Jersey City, NJ 07310 furnished to the Internal Revenue. Service. If 1a. Date of Sale 1b. CUSIP Number you are required to ills a i*®tum, a negligence 03/18/2010 59156R10 d 22-3367522 on penalty or other sanction may be impoe;e you if this income is taxable and the IRS 2.5'tocks, Bo^ds, etc. 4. FEDERAL INCOME TAX WITHHELD Telephone: 1-800-649-3593 determines that ft has not been reported. $595.24 $0.00 To wHOM PAID REPORTED Q Gross Proceeds TO IRS ~ Gross Proceeds less commission and options premiums GEORGE RICHARD ROELKE ADM 7. Description EST VIOLA R ROELKE METLIFE, INC. 7204 CAULKING PLACE Irrvestor ID Recipients Identification Number on File BURKE VA 22015-4408 124872836860 276376362 Box 1a. -Shows the trade date of the transaction. For aggregate reporting, no entry will be present. Box 1 b. -For broker transactions, may show the CUSIP (Committee on Uniform Security Ident~cation Procedures) number of the item reported. Box 2. -Shows the proceeds from transactions involving stocks, bonds, other debt obligations, commodities, or forward contracts. Losses on forward contrails are shown in parentheses. This box does not include proceeds from regulated futures contracts. Report this amount on Schedule D (Form 1040), Capital Gains and Losses. Box 4. -Shows backup withholding. Generally, a payer must backup withhold at a 28% rate if you did not famish your taxpayer identification number to the payer. See Form W-9, Request for Taxpayer Ident~cation Number and Certification, for information on backup withholding. Include this amount on your income tax return as tax withheld. Box 7. - Shows a brief description of the item or service for which the proceeds or bartering income is being reported. For regulated futures contracts and fonnrard contracts, "RFC" or other appropriate description may be shown. For inquiries about your account,- contact BNY Mellon Shareowner Services, MetLife's Transfer Agent: Telephone: 1-80049-3593 U.S. Mail: E-Mail: metlife~bnymellon.com MetLife Internet: www.bnymellon.com/shareowner/isd c/o BI~Y Mellon Shareowner Services PO Box 358447 Pittsburgh, PA 15252-8447 YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. ^ IMPORTANT TAX RETURN DOCUMENT ATTACWED ^ RETAIN FOR YOUR RECORDS ,;:.;•,. ..~ . SHAREHOLDER OF TRANSAC110N DATE DESCRIPTION METUFE, INC. 03/18/2010 SHARES SOLD CUSIP INVESTOR 10 ACCOUNT KEY CHECK NUMBER CHECK DATE CHECK AMOUNT 001 928 59156R10 124872836860 ROELKE---VIOLROCDO 789250 03/23/2010 $595.24 OPENING TRUST INTEREST BALANCE SHARES SOLD PRICE PER SHARE ($) GROSS PROCEEDS 14.0000 ~ 14.0000 42.5168000 $595.24 TAX WITHHELD NET PROCEEDS CLOSING TRUST tNTERES'C BALANCE $0.00 $595.24 00.0000 PLEASE DETACH BELOW CHECK NUMBER: 789250 MET: Historical Prices for MetLife, Inc. Common Stock -Yahoo! Finance http://finance.yahoo.com/q/hp?s=MET&a=10&b=18&c=2009&d=10... New Usar? Sign Up ~ Sign In ~ Help Preview Mail w/ Toolbar Yahoo! Mail ~~~~~,~ ~'~,,,,,,r"~s ~" ~ ~-~ Search Ceb Search Dow • 0.3SaY~s Nasdaq • 0.71% Sun, Mar 21, 2010, 7:59AM ET - U$. Marlaets dDNd ` till' Finance Search M@tLife, ~11C. ~~T~ On Mar 19:41.83 • 0.62 (1.46°IG) ,~,, His~OiriCill Pf iCQa Get ~tori~ does for: W 3 GO . ~....~ w SET DATE RANGE ADVERTiSEbENT ~.~..~ .. ...........................: ..............................._ O ai Start Dato: = NOV ' 18 !2009 ~ Eg. Tan i, 2003 yyee~y End Date :Nov 20 2009 ~; Monthly Dividends Ony Get Prides First ~ Prev ~ Next ~ Last PRICES Date Open Hgh Low Close Volume * Close 20-Nov-09 34.01 34.09 33.62 . 33.90 6,393,400 33.90 19-Nav-09 34.73 35.06 34.00 34.20 6,608,700 34.20 18-Nov-09 35.57 35.65 34.61 34.93 5,242,900 34.93 ' Cbse price adjusted for dividends and spits. First ~ Prev ~ Next ~ Last Down load To Spreadsheet Add to PorHolio ~ ~ Email to a Friend ........................... • 6M~l~0 1~airioas for Another Symbol: ~~.w _~ . C-,O' ' s~,~ t.nokuo 1 of 2 3/21/2010 7:5~ AM ~~~~'` December 30, 2009 George R Roeike IV 7204 Caulking Pl Burke,. VAS 22015 RE: Name: Viola R Roeike SSN~: 481-64-5462 DOD: 11-19-2009 Dear Mr. Roeike: In response to your request for Date of Death (DOD} balances for the customer noted above, our records show the following: . Certificate of Deposit Account # 31300293109 . VIOLA R ROELKE JAMES D ROELKE DOD balance: $3,157.67 + 10.12 accrued interest Account # 31600241749 VIOLA R ROELKE JAMES D ROELKE DOD balance: $1,286.97 + 5.70 accrued interest Chec~i~g Account Account # 5003197358 JAMES D ROELKE VIOLA R ROELKE DOD balance: $2,199.19 non interest bearing Account # 5003606318 VIOLA R ROELKE DOD balance: $2,138.58 non interest bearing Account # 5003 923 997 GEORGE R ROELKE VIOLA R ROELKE DOD balance: $292.42 non interest bearing Established: OS-26-2006 Established: OS-19-2008 Established: 06-09-2000. Established: 04- 3 0-2001 Established: 03 -24-2003 Page 1 of 2 Account ~# 5140299246 VIOLA R ROELKE DOD balance:. $3,450.67 non interest bearing Established: 12-17-1992 investment Account The .decedent maintained Investment Account # 80287067. For further information, you may call the Brokerage Department at 1-800-762-6111. Please note that this off ce provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do aot process any Fnancial transactions or prnvide st~temeets. If you need .assistance with . any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 2 of 2 2000 Honda Civic -Private Party Pricing Report -Kelley Bl~ Book http://www.kbb.com/kbb/UsedCars/PricingReport.aspx?ModelId=l2... ~~'~. t'i~us'rl~- ~~ Send to Prhter advertisement 2aQ4 Honda Ci~ric EX Sedan 4D 6~UE $4~~ Pitl~~~'E '~-TY YJllt~ Condition Excellent Good Value $4,980 $4,555 °~ Fair $4,Ofl5 (Selected) 100,000 4-Cyl. 1.6L VTEC Automatk Equipment Conditbnhg Cruise Control Dual Front Air Bags ver Steering AM/FM Stereo ABS (4-Wheep Wheel Shale Compact Disc Blue Book Private Party Value KeNey Bkie Book prNate Party Value is the amount a buyer can expect to pay when buyhg a used car from a private party. The Private Party Vakie assumes the vehicle is Mli'LJRCN~i sob "As Is" and carries no warranty (other than any remahhg factory warranty). The Thal sale prke may vary depending on the vehicle's actual conditbn and bcal market >t r'•wt~w, . . conditions. This value may also be used to derive Fak Market Value for hsurance and _ .. ._.....w ,_. vehicle donatbn purposes. iec.p~c • --~---.--•••--.-.- Vehicie Condition Ratings ~,~ Excellent ~"~~ $4,980 ~ , • Looks new, fs h excelent mechankal conditbn and needs no recond~ionhg. ~~~ • Never had any paht or body work and is free of rust. Cbse Window • Clean title history and wi pass a smog and safety hspectbn. • Engine compartment is dean, with no fluid leaks and is free of any wear or visible detects. • Complete and verifiable servke records. Less than 5°rb of aA used vehkies faN hto this category. , Good $4,555 1 of 2 3/21/2010 8:1Q AM ~~ ~~~ Arrtisric~e's Bret lillirrarrtlr: `~ t1 ~ ~r~ imiies. Sedgwick Claims Management Services, Inc P.O. Box 14566 Lexington, KY 40512-4566 ~l~ ~ i N1 ~ p ~ 902 18178 0001 OF 00001f0PM 091123 1445 X000 DATE CHECK AMT CHECK NO. 11/30/2009 1,193.75 0000018178 PAYEE TAX Ip VIOLA ROELKE SCMS UNIT F-AGE 210 Sedgwick Claims Management Services b01 ~uri~~rrr~~~anur~~u~~mr~~r~~n~~un~u~~~snr~r~nr~r~~ VIOLA R. ROELKE 105 CALVALRY ROAD CARLISLE PA 17013 STATEMENT OF BEI~IEFITS THIS PERIOD Y AR TO DATE THIS PE IOD YEAR TO DI4TE EARNING/OFFSET DETAIL LTD1 ti/OS/2C09-ii/30i~Gv8 2,157.75 .:rd Benefits For From Date: 11/01/2008 Offset:SOCIAI SECURITY DISAB 964.00- .00 Through Date: 11/30/2009 TOTAL DETAIL 1,193.75 .00 PSP PayGroupp: PN1 EARNING SUMIAARV Employ•a ID: X0370000713 LT01 1,193.75 13,131.25 Clsim Number: A82101113700p101 CROSS EARNINGS 1,193.75 13,131.25 Date of Disability: 02/25/2008 STATUTORY DEDUCTIONS Estimated RTW Otte: Federal Tax .00 210.84 TOTAL STATUTORY DEDUCTIONS .00 210.84 Marital Status Fed: M State: M NET PAY 1,193.75 12,920.41 Exemptions Fad: O Stets: O v v D C Sedgwick Claims Management Services, Inc P.O. Box 14566 Lexington, KY 40512-4566 *001313 0000't018367 00001 OF 00001 OPM 100128 1446 ~sss~~~sss~~~ssrssr~~s~~rsrr~l~~~ss~~asss~ss~~~ssss~s~sss~s~~ VIDLA R. RCIELKE 105 CALVALRY READ CARLISLE PA 1701:3 GATE CHECK AMT CHECK N . 01/29/2010 172.83 00000183$7 PAYE TA;X ID IOLA ROELKE SCNIS UNtT !PAGE 210 S®dgwick Claims Management Services 001 STATENNIT OF BEFITS THIS PERIOD YEAR TO DA THiS RIOD YEA TO Ai'E EARNING/OFFSET DETAIL LTD1 11/01/2009-11/19/2009 172.B3 .QO Benefits For From Data:. 11/0:/2009 TOTAL DETAIL f72.83 .00 Through Date: 11/19/2009 EARNING SUMIARY LTD1 172.83 172.83 PSP PayGroupp: PN1 EmP#or~• ID; 20370000713 GROSS EARNINGS 172.83 172..83 Claim Number; A821011137000101 NET PAY 172.83 172.83 Date of Disability: 02/25/200$ Estimated RTW Date: Marital Status Fed: M State: M Exemptions Fed: 0 State: 0 `` f' o~s~ j ~~ ~,~f '~ i VIOLA R ROELKE ~~ ~Q $(~j 4T4! 853i$ A~ooOwlt M~k~t Yilr~+e Stock Pries as of » 2009 Trial Market value x.100 ;1481.40 The apgre~aEe amount paid to all Trust Berlefb~riss in this distribution is $17a,4e6,231~.n. 20Q3 Dhdd~ind Sunll~ntnry Record Date Total Trust Intert~s Dividend per Trust Interest Current Distribution 11/09/2009 14.0000 $0.74 $10.36 Payable Date Tax Withheld Net Dtstribut~rl PD~~ 12/14/2008 ~o.oo $to.36 $to.36 For hq~ri®s bout your ~ccourtt, YOU may visit www.br>fyrnellon.t;'~t~c>wishl~treawrtier/i~d, or t~ 1-800-G4~-3S9~3. Trust 9artsAalary You rill ptuchass or se9 stares of Metlife, Inc. common stock ~+s~ the MetliN Pdiayholdrr Treat 'Tnuat'), Errs of alny cgnrnissio~ns or otther lees. under the= f-Mtl.ils Pvc'flass and SaN Proarlrrt. as anterded. A copy of the brocC'NJte ~ the proylram is a+ali4ble txt the Intsrrtet at www.nlMlflecdn by sNeoting Invrslor aNations and then the 8haw'~ettalder Services Mbrntapprl pads, or by cdiir~ the number listed abotre. You are permitted to traneNr your Trwt Interests only in the oireurtsetaraes described in tale brochure. You may also intttruct that all fmut not less .than ah) of your shares of .iMq.ife, Inc. common stock hNd by the Trust be witlodraw+n from the Tnrat. IrNonrtatiort regalydinp your withdrawal riDhES may be found in the Purchase and Sale Brochure or by caNinp the number ksted above. An annual shareholders' meeting to elect members of the Board d Directors of Msti.ife. Inc. and for ~ trar»action of a~ busilhps is expected to be held on April 27, 2010. The dead6rte for sut~mittinp shareholder 'proposals for consider~brl at this n»etirtp is Decellnber 1, 2009. A copy of MetUfe, Int.'s annual rN~oet and proucy ''wsi be rt+a9abb free of charge on or babes Merril 31, 2010, akxtg widh other llileRlile. Inc. and Trust 8linps under fis0eral sectxbies laws, (i) on the Internet at www.medih.com by seiectutp About MetLife, Colrporate C3o~remance, under Related links, (~) by wnkirt0 to Metlife, Inc.. c/b BNY Mellon 3ltarAOwnsr Services, PO Box ;!68447. Pilxaburbh. PA 1 -8447 or (iii) by calling the nutTtb~sr gstsd abo~w. These and other SLC61~a by IiAetlite and the Trust are also available on the Internet at wwwsecgov. FORAii ~~' U.S. TAX INFORMATION FOR 2008 OMB N0.1545-011q DIVIDEf VOS/DISTRI@UTIONS COPY B FOR RECIPIENT ~''" ` ~~ RECIPIENT'S TOTAL ORDINARY y' IDENTiF1CATION NUN~ER DMAIQS QUALIFIED DMDENDS . MKaOME TAx MATi~FiB.D x 1A x 1 'i"""~'-- d, 481.84-54Q~2 $10.36 ~ $10.36 ~ ,D.00 PAYER'S NAME PA R'S FEDERAL tDENTIFICATKNV N MBER BNY MEU_ON SHAREOWNER SERVICES AS CUSTODIAN OF THE METUFE POLICYHOLDER TRUST 51-6516987 SECURITY DESCRIPTION TO WHOM PAID TRUST NTEI RESTS _~ VIOLA R ROELKE 105 CAVALRY RD CARLISLE PA 1 T013-1804 TAX IN~OI'~MATtON FOR THis b ltnporgtnt tax i~onnetiort and h behtg furnMhed to tits Irtlsrrtal Mvsrtue service. M you are ngttind to rse a rebtnt, a rte~ertos penaky or olive sartctlott may bs Intpoeed on you H thM income b taxable and tM ~S deMrmfrtsa that K Ins not been rsporNd. BOx 1 A -Shows total ordinary dividertde that are taxable. Irtdttde this amount on line 8a of Fonn 1040 or 1040A. Also, report it on Sc~tedule B (Form 1040) or Schedule 1 (Form 1040A), if mired. The amount eitown may be dividends a corporation paid directly to you as a parts- - (or berteiiciary of a participant) in an employee stock ownersidp plan (ESOP). Report it as a dividend on your Fom- 1040/1040A, but treat it as a plan disMtiution, not as investment income for any other purpose. Box 18 -Shows the portion of the amount in box 1 A that may be eligible for the 15% or zero gapRal grins rates. Sea the Form 1040/1040A irnbuctions for how to deterrttkte Otis amount. Rl~xt 1~Rliiellls ~ Mt Nns 8tt. Foam 1410 or 1040A. REPORTED BY THE BANK OF NEW YORK MELLON 480 WASHINGTON BOULEVARD JERSEY CITY, NJ 07310 THE Box 4 -Shows bada~t wtlhlwkiing. For example, a payer must backup withhold on certain pay- ments at a 28% rate H you did not give your taxpayer identification number to the payer. See form W-9, Request for Taxpayer Identific:atlon f~tmtber and Certirication, for information on backup wid~Ftolding. Irrdude this amount on your income tax return as tax withhekt. Nomhtess, If this form indudss amourrts belonging to another person, you are conefdered a nomk-se recipient. You moat file Forrn 1089-DIV with the IRS for each of the otiaer owners to show their share of the income, and you must famish a Form 1099-DIV ~ each. A husband or wife is not regtarsd to file a nominee return to show amounts owned by the Other. See the 2009 General Instructbns for Forms 1089, 1098, 3921, 3922, 5498, and W-2G. ~_Moe.: Imporh~nt 200 Tax tr~omadon M.a.n. MEMBERS 1St PBDERAL CREDIT UNION PF~MARY C?~R: sAVn r-+c~NT: Account NumbeM~uffac Date account E tad Princ~al Balretce at Qate of Death Accxued Interest to Date of Dsath Total Printapai and Accrued Interest Name of Joint Otimer Date Joint Ownership Eatab{fished CHEC James Roelke Georgia Roeike 127930-00 08/04/1992 $158.78 $.os $158.81 Viola Roelke 08/04!1992 Account Nur~er/Suffbc 127930-11 Date Account Established 12/2tiM 996 Principal Balance at Date of Death $64.96 Accrued Interest to Date of Death $.00 Taal Principal and Accrued Interest $64.96 Name of Joint Owner Viola Roelke Date Joint Ownership Established 12/26/1996 IRA SAVIS: Account NumbedSuffa 100626-1 Q Date Account Established ~l1912003 Principal Balance at Date of Death $2,602.99 Accrued Interest to Date of Death $.~ Total P~ncipal and Aca'ued Interest $2,602.99 Name of Beneficiary Viola Roelke EMB S 1~ FE(J E L C IT Danielle A. Kline Lending Insurance Support Specialist February 19, 2010 Estafae of: VIOLA R. ROELKE Date of Death:11M6/21109 Social 3ecurlty Number: 481-64-5462 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 www mernbersl st.org 3~ ~R ~ ~ ~ ~ aR 2R ~ 3e 3~ i~ ~ ~ ~ ~ iR c~ <-) ~f 4"1 M M e+f e+1 pl Q'? M e+U M e$ th M th ch co M M :e~ e+f , c+o trf .- ~ ~ M~~ ~~88588~~~~~8~~8$$ tLi ip to tti iCM ~ tL71 tQ tD t0 fsi 4? QD tt'i ~C tG m tp pp yy~~ ~y ~~pp ~pp pp pp ~~yy pp ~, ~ CM C 'Q; ~ ~O O O~ Q O O © O S ~~ r r t- r r r r r N N M M~ M M M M M C~! C7 C~ C7 M M M M ~I~I~CRIgl~l81$I~Ig 88~ aD t~'! P. ~~~$~~ t~D OrD~ h ~ M ch of ' cif M Pl c~ g8 N ~ h. 1~ ~~~$~~ M M M erf c~ M th M hl C Clef ~ 1'aD d; tD * d~ et !~ ~ N C N M ri ti ~ ao .aki c7~ vs d' et ~c3 ~ ~ ~- .- ~:..: ~- r e~ ,M.. ~.. ~ ~- r !f+ '1"' ,r e- r e.. ~" r !'~ r er. -w ,r. !~"' r r; K- ~- r r aW- r r 'r ~ :+~ Q d®c~oc>m,-~~- "" +~ o u~i~"+6~C a$~~5`~'a~r~. oa^a"~d'~`i~r4~$~~cw .e~',`~~',°~i~+~ a'~',~s,$8 ~- r r r r r e- r t'V N N N N C~0 M c+~ ,c~r~~ ~ry C~ v .t ~rr~~tt ~t Ott t~ tt~~ ~y {~} ~r ~~pp ~~pp M M M M M M M M !rf M M M M M M M M c~ M M~~ cr7 ch ~ ~! ~ M MMi cr! c+1 M~~ c+1 M W ~ d! W ~~ g" ~ ~ N N t'+1 Cif 4 d N OC W tY! W M ~ ~~ ~ i~ ~ ~ ~ ~ ~ ~ ry ~ ~ ~ ~ ~ ~ a l co cci m ~ci ~i am so ~ci ~c ici vi cc c c w wy 7~~y M ~~ ~~~ +m ~ ~ Op CE1 t- e- e~ *' r v+~ e- e- M ~ ~ I~6; C O Ci ~ ~' ~ $ S ~ Q Cy O ~ .CD 0p OQ aD vr+ r e- t- p ~~ ~ C(! ~ N r r pp N O~ to 14! Cyf Of W D! ~- ~ C~di D! Grf - OS C» C~ p ~ ~ ~ ~ ~ GCS i3 ~ 0 8 C7 ~ RD tCf ED Qp M Cp t0 N N r +~ ~ ~r a- a+ r r ~-- ~- rr r r r r MIS V` ~ g c~ ~b ~t~ ~IC~a~ ~ a~ ~~c ~ , , C? C4 - .~ r ~r- ~^- Q3 ~ ' ~7f Gs ~f En ~ ~ ~ ~ , e- ilr~• ~C ~ f ~ ~pj V C A O r r r+ r r .~ ~ ~ ~ ~ ~" ~~5~~~~~~~~~3 ~~~~ a a~'~a~a~a~~~~~~r~~i ~i~i~i~ i r r r ~^ r ~ r e- r a~ w r r r r i ~ . ~ Q C "~ ` 7 "! ~ "`! h !~ ~ A 1 ~ 1+ cr3 M h~ ,.. ~~yy +yy~~ ~C~y pp GG N ~, ~ t'9 ~i ap 00 g? ~ 00 qD CD ~! a ~-- r ~ - r ~~pp ~~pp 0 CD N N r r ~y ~j (-~ ~y ~y { ~ Cb d! ~ ~ I~f Cs ~i ~ ~ 01 ~ app ~p ~ ~ Q~ 0 1 W ~ ~ ~ ~ ~ ~ ~ ~ ~ a ~ ~ ~ N ~ ~ ti t W w ~ ~~ Z W Z 0 ~"' W a° m N~ C9 Z 4 ,,~ ,Y,,~, W F~NC INVESTMENTS Mem~r FINRA and SIPC February 3, 2010 George Roelke N, Executor 7204 Cam Place Burke, VA 22015-4408 RE: Estate of Viola R Roelke Date of Death Valuation Date of Death: November 19, 2009 SS# 481-64-5462 Dear Sir: The date of death value for securities held by Viola R Roelke in her PNC Investment IRA Account Number 8028-7067 is as follows: 174.945 shares Blackrock FDS Small Cap Value Equity Fund Class A @ $ 6.35 per share 97.763 shares Blackrock Small Cap Growth Equity Fund Class A @ $ 16.91 per share PNCI Account Number 8028-7067 is an Individual Retirement Account owned solely by Viola R Roelke. Account was opened April 7, 1995. The benef ciary for this account is George R Roelke IV. Please feel free to contact me if I can be of further service. Sincerely, Charles E Little, CFP, SVP Financial Advisor CEL/djp The inform~!on cont~tnut herein has been obtar~ned from sources ive belicve to be rel~abte but do not gaarantee it io be accuri~tc, correct, comfplete or:inety, and shat! not be responsible for the results obtained from it's use PNC Investments t.lC Member of The PNC Financial Services Group Two East Main Street Mechanicsburg Pennsylvania 17055 www.pnc.com ~~I'0~~ lmpor'gwrtNsr~IMornalloar. Securities and brokerage services are provided by PNC Investments LLC, member FINRA and SIPC. ~N° 13ankGuaruucc Annuities and other insurance products are offered by PNC Insurance Services LLC, a licensed insurance agency. ~ PNC GEORGE R. R4ELKE N 7204 CAULKING PL BURKE VA 22015 Payment Information The P~TC Pension Pian Starting Your Beneficiary Pension Benefit Statement Date 12-23-2009 As the beneficiary of Viala R. Roelke, you're entitled to a one-time payment of $11,361.47 from the PNC Pension Plan as of February 1, 2010. Additional Payment Information Starting your benefit requires several decisions on your part. The enclosed materials will help you through those decisions. Please keep this material for your records. What You Need to Do ^ Review all the enclosed information: - Beneficiary Pension Elections Worksheet - Beneficiary Notice of Rights - Special Tax Notice Regarding Plan Payments ^ Use the Beneficiary Pension Elections Worksheet as a guide in making your decisions. ^ If all the information in the statement is correct, no action is needed. A benefit will automatically be paid to you. If any information is not correct, please contact Your PNC Service Center. For More Information If you need additional information, call the Your PNC Service Center toll-free at 1--PNC-PLAN (1-800-762-7526}, option 2. Service Center Representatives are available between 9 a.m. and 5 p.m., Eastern time, Monday through Friday. 45550049 (?4269 B PNC v0000Q1 VIOLA R. ROELKE 105 CAVALRY ROAD CP,RLISLE PA 1?013 Account Summary Activity from October 1, 2009 through November 20, 2009. PNC ISP Plan On Demand Account Statement Opening Balance 596,456.27 Gaina/Losses 6,583.07 Closing Bslance $103,039.34 Vested Balance $103,039.34 Your Rate of Return for the Period 6.8% Total value of your account: $103,039.34 Total Account Balance by Source The charts below show what portion of your total account balance comes from each source. 30% 70% Amount Percent Vested'I [~ Employee $71,832.86 100°10 Employer 31,206.48 100% Totsl $103,039.34 For more information about your account, to change your contribution rate, to change how your account is invested, or to learn more about the plan, visit Your PNC at http://www.yourpnc.com from any computer with Internet access. delivered by 1 _lE'~ ~'~ 302300058 04269-V000001 • `• On Demand Account Statement Contribution Rates >;mployce Pre-tsx Page 2 Elected Rate 0% You may change your contribution rate at any time. Investment Fund Choices for Future Contributions This chart shows how you have chosen to invest future contributions by fund. You may change your investment fund choices at any time. Future investment elections for Employer Match contributions may be changed at the age of S0. Fund Future Contrlbutfons Employee Employer B1kRk LifePath Target Dt 2015 25% 0% BlackRock Liquidity Temp 25% 0% BlackRock Total Return II 25% 0% PNC Common Stock. 25% 100% 302300058 04269-V000001 On Demand Account Statement Page 3 Current Balance by Asset Class The plan's investment funds fall into major asset classes. These asset classes range from conservative to aggressive types of investments. The chart to the right shows your asset allocation, or how your money is divided among asset classes. It is important that you periodically review your asset allocation to maintain swell-balanced and diversified portfolio that fits your personal situation. Asset Class Current Allocation on November Z0, 2009 Money Market 17% GIC/Stable Value 0% Bond 19% Lifestyle/Pre-mix 16% Large U.S. Equity 0% Mid U.S. Equity 0% Small U.S. Equity 0% International 0% Stock 48% Account Activity by Fund For the period October 1, 2009 through November 20, 2009. Asset CUua Lifestyleflre-mlac Moeey Muket Band Lif -- - ~c ` ~ ~217.56~ Earnings -52.00 2.90 _~ 251.24 6.57 Fasit-'I`~ru Div C~:40 0.00 0:40 4.00= Transfers 16,171.44 0.00 0.00 -224 13 C~g:B~~ ~-16,1194~4 $~7,6~6.89 ~~49~13~? S41~18' Rate of Return -0.3 % 0.0% 1.3 Closing Units 1,733.273 i :7,656.89(}' 2y ~ 73.938 Price (NAV) Per Unit $9.300000 $1.000000 $9.160000 Slo~k P'~ice She Stock Cost ~;,~: 302300058 04269-V000001 On Demand Account Statement Page 5 For More Information Your PNC at http://www.yourp©c.corn is your best source for detailed, personalized information about your account. The site puts everything right at your fingertips whenever you need to check your balance, make a change, or learn how the plan works. Use the site to: • Check your account balance. • Change your contribution rate, investment fund choices, or transfer balances. • Monitor your investrnent performance. • Learn more about the available funds using fund detail information. • Request a withdrawal. • Request a R ollover Form. • Change your beneficiaries. • Learn about the plan. Additionally, you can call the Your PNC Service Center toll free at 1-877-Your-PNC (1-877-968-7762), option 2. Service Center Representatives are available between 9 a.m. and 5 p.m., Eastern time, Monday through Friday. The Web site and automated telephone system are available 24 hours a day Monday through Saturday and after 1 p.m., Eastern time on Sunday. ~; ., 302300058 04269-V000001 Free Checking Account Statement PNC Bank ~ tla period OS/07/Z000 !o O!i/28/Z000 JAMES D ROELKE 105 CAVALRY RD CARLISLE PA 17013-1604 Important Account Information Effective Apri117, 20119 PN C BANK Primary account number:-9837 Page 1 of 2 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign onto a PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espanol, 1-866-HOLA-PNC MoriwVt Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaired climb only Due to consolidation within the Federal Reserve Proc~saing Centers, the following routing numbers will be considered local for funds avaiLtbility: 0215, 0216, 0260, 0280, 0510, 0514, 0520, 0521, 0522, 0540, 0550, 0560, 057Q, 2215, 2216, 2260, 2280, 2510, 2514, 2520, 2521, 2522, 2540, 2550, 2560, 2570. This means that funds from these checks will be available sooner in most cases. The complete listing of local routing numbers appears below. Amendment to the Consumer, Business and Analysis Business Funds Availability Policies for the PNC Bank Philadelphia, Northeast PA (Scranton, Wilkes Barre), Central PA (State College & Harrisburg), Delaware, and New Jersey markets. The information stated below amends certain information in our Consumer and Business Funds Availability Policies ('Policies. All other information in our Policies continues to apply to your account. Please review the following information and retain it with your records. Identification of Market Philadelphia, PA: (Philadelphia) PA Counties of Bucks, Chester, Delaware, Montgomery, Philadelphia Northeast, PA: (Scranton, Wilkes Barre) PA Counties of: Carbon, Columbia, Lackawanna, Lehigh, Luzeme, Monroe, Northampton, Pike, Schuylkill, Susquehanna, Wayne Central PA /Northern Region (State College): PA Counties of Lycoming, Center, Huntingdon Central PA Southern & Eastern Regions (Harrisburg) PA Counties of: Adams, Berks, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Perry, York Delaware: All Branches • FORM953R-1005 'ree Checking Accouzit Statement For ttw period OS/07/2008 to OS/Z6/2000 ~; For 24-hour information, sign on to PNC Bank Online Banking JAMES D ROELKE on pnc.com. Primary account number~837 Page 2 of 2 ew Jersey: Att tsrancnes ocnl Ro-ltitig Nu><nl~ers for Above Markets 110, 0111, 0112, 0113, 01140115, 0116, 0 l 17, O 118, 0119, 0210, 0211, 0212, 0213, 0214, 0215, 0216, 0219, 0200, 280, 0310, 0311, 03.12, 0313, 0319, 0360, 0510, 0514, 0520, 052.1, 0522, 0540, 0550, 0560, 0570, 2110, 2111, 2112, 113, 2114, 2115, 2116, 2117, 2118, 2119, 2210, 2211, 2212, 2213, 2214, 2215, 2216, 2219, 2260, 2280, 2310, 231 1, 312, 2313, 2319, 2360, 2510, 2514, 2520, 2521, 2522, 2540, 2550, 2560, 2570 'you have any further questions about our Funds Availability Policies, please contact your local branch office or Gall ur toll-free customer service line for Consumer Customers at 1-888-1'NC-Batik and for Business Customers at -877-13CTS-13NKG between the -hours of 6 am - 12 midnight Eastern Time, 7 days a week. 'ollege is ai: adveatar~, gelling a loan ~ pay for it shoiuldn't b~ b lean: nro»e...vrsit ptsconcanipt~s.com or call 1-804-762-1001 affective April 17, 2Q()9, authorized/approved restaurant check card transactions will no longer be considered in determining the balance vailable in your account to pay checks ;tnd other ~vithdthwals until the merchant has submittecl a fn>:al trnnsaction amount. ;rte C ~QQOtMilt Sitl~tn~slryy James D Roelke account number: 50-0585-9837 overdraft Protection Provided By: Contsot PNC to sstsbHsh Ov~rdrsh Probotion 3aance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance .(30 fi,000.W .UO 6,Ot~.UO Average monthly Charges balance and fees E;,000.f1U .00 Please see the Activity Detail section for additional information. ~C~~~ Dita~~ ?epotsitts and 4Eheir Ad~ons )ate Amount DescHption 15/07 6,000.00 Deposit Reference No 023608911 There was 1 Deposit or Other Addition totaling $1,000.00. wily Balance Deter gate Balance -5/07 6,000.00 Cra.veling Chttside the Clnited States itop by your local PNC, branch to order foreign currency Uefore you go. Convenience -carry currency with you for immediate expenses such as taxi fares, tips and meals. Avoid delays and save time when you travel. 1-Iaving local currency for your destination will give you added peace of mind. Competitive rates and no transaction fees. When you t~ehtrn with excess currency, PNC can. ln.iy it back for U._ S. dollars. Jisit any PNC branch for more information. ~.,.. PNCBANK Reviewing Your Statement Please review this statement carefully and reconcile it with your records. Call the telephone number on the upper right side of the first page of this statement if: you have any questions regarding your account(s); • your name or address is incorrect; • you have any questions regarding interest paid to an interest bearing account. Balancing Your Account Update Your At~aount Register Compare; The activity detail section of your statement to your account, register. Check Otf: All items in your account regidsr that also appear on your statement. Remember to begin with the ending. date of your.last statement. (An asterisk {* } will appear im the Checks seotcm if there is a gap in tln± listing of con~cutive check munbers.) R /4tdd to Your 14t~+ount Reyis~sr Any deposits or additions including interest payments and ATM or electronic deposits Balance: listed on the statesrnent that-are not already entered in your register. Subtract Fran Youf' Accoemt Arty account deductions inehiding fees and ATM or electronic deductions listed on the R~;sty' Bat: statement that are not already entered in your register. Update Your Statement information Stop 1: Add together deposits and other additions listed in your account register but not on your statement. Stop 3: Enter the ending balttnee recorded on your statement $ Add deposits acrd other additions not recorded Total A + $ Step Z: Add together checks and other deductions listed in your account register but not on your statement. Subtotal= $ Subtract ehecdcs .and other deductions not recorded Total B - $ The result should equal your account register balance = $ Yetlficatl+on of Direct Deposits OtMok N^wiee+a .~ Tested s To verify whether a direct deposit or other transfer to your account has occurred, call us 7 days a week from 6:00 A.M. to Midnight (ET') at the auatorner service number listed on the upper right side of the first page of this statement. Electronic ;Funds Transfers Tn case of etmra or epeetions about ywer electronic tr>,asfets ae if yon need moc+e information abelut a transfex, callus 7 days a week from 6.'00 A.M. to Mielnight (E'I) at the customer eervioe n®ber ~d at tla~ upper tight aide of fhe Su>:t page of his aEatemext. Or, itf you prefer, please write ~ at; Cnatomtr Setvux, P.O. Box b09, Pit~barr~gh, PA 15230-0609. If you believe Thet+e ~ s problem, you mast contact ua no later than 60 days after the encliag date of the fhst statement oa which ~e error or problem appeare:ti. Yoe will aced to pt+ovide the feilexwing information: Your name and acoowt mrmber+(s); • A description of the eavr ex the hansfer yom are questioning. Please explain as clearly as you can why yon need more iafc~rmation or why you believe an error was made; The dollar amount of the aerspected error. We will investigate your e:aenphwrt and will correct any error promptly. If the investigation ratan longer' than 10 basineas days, we will cr>xlit your account far' the amamt yaA think is in error, so Seat you will have use of the fends daring the time it blces as to cromple:te oar investigation. Member FQIC Ho Lender FORMedi3R-1006 ~,,.~.i i waraaruava vaaarca>.vuaai~+-.t~aillWl~''~ LEFFLER ENERGY PO BOX 302 MOUNT JOY PA 17552 800-984-1411 ------------ BILL TO ------------- GEORGE ROELKE 105 CAVALRY RD CARLISLE,PA 17013 ----------- DELIVER TO ----------- GEORGE ROELKE 105 CAVALRI' RD CARLISLE,pA 170130000 DATE 11/10/09 START C~JUNT 0,D GALLONS END NET COUNT 98,9 GALLONS NET DELIVERY 98,9 GALLONS 2C DISTILLATI GALLONS CORRECTED TO 60,0°F SALE NUMBER 19033 METER NUMBER 367265 UNIT ID 1948 * MULTIPLE DELIVERIES AT ONE SITE Check if not full [ x __ Signature INVOICE Invoice No 927872 Account No 10-4226664-1 Date Delivered 12:07 11/10/09 Gallons Delivered 98.9 Driver No 728 Truck No -1948 <Dyed Unmarked Heating Qil:Nat> <for use in highway, nonroad,> <locomotive or marine engines,> #2 HEATING OIL 286.71 <98,9 Gallons ~ $2,899> TOTAL $ THIS DELIVERY $286.71 If paid in 15 days, deduct $1,98, this is a $0.02/Gallon discount. PLEASE PAY THIS AMOUNT 286,71 lc Vi1111Ar Lill 1 4~ ~ wiWaiill w'iiw/V~1~a ..n.i..~~q, Pay Bills Pigment Cm~irnowtt~on p~ .-~...... ~.._... -----r-~...~__-____._---zrr---•----- - •• - - -. .. r- You've paid the follopwing bills. If you wain to keep any additia®al uoa~ an file with the bill, click the Note link. Bier Nye Accost Autos T'sy Drate Goa~taio® leffier mdargy JNTERIST CHECKING X063 i 8 5,286.71 11/23/2009 9KWS3-QS~V4M X40927 " Wells Fad Hcyme Mvrlgsge INTEREST CHECKING X0631$ 5254.56 11 / 19/2009 9K-Q7QKS X28467 Total: 5541.27 I6ed 1 of 1 11/17/2409 6:56 PM