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03-25-11 (3)
J 1505610101 REV-150 °`t°'-'°' ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania oewx.xex~ or xevExue C°Un Bureau of Individual Taxes ~ e Yea F~ Numtx3~ PO BOxzl3o6oi INHERITANCE TAX RETURN Harrisburg, PA iylz&0601 RESIDENT DECEDENT 1 1 0 0 0 7 1 8 ENTER DECEDENT INFORMATION BELOW Social Security Number TT Date of Death MMDDYYYY Draterof Birth MMDDYYYY Decedent's Last Name Suffix Decedent's First Name MI ® J A E S= (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number ~~~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (date of death O 4. Limited Estate prior to 12-13-32) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 8. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 6. Total Number of Safe Deposit Boxes (Attach Copy of Will) (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 BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number First line of address Second line of address REGISTEI~QF WILLS US~NLY ~~ X7 m :U ~-. rn N r ~ C.t~ ~~O r. '~' i_ ~~pp-y DATE FILED -_' r.~ Correspondent's a-mall address: Under penakies of perjury, I dedare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Dedaretion of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATURE Oj~PEj2SO~SP SIBLE FOR FILING RETURN DATA I~~~,,!!,,wwjj`~~ Executor ~/•2~~// Side 1 L, 1505610101 1505610101 J~ _219 F.aat Main Strppt A~pnh=nicRhtno PA 17(IR~, PLEwae uae vRrQi1NAL FORM ONLY J REV-1500 EX DecedenrsName: James D. Wood 1505610105 1. Real Estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely HekJ Corptxation, Partnership or Sole-Propriekxship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 6. Jointly Owned Property (Schedule F) O Separate Bklling Requested .... ... 6 7. Inter-Vivos Transfers 8 Miscellaneous Nan-Probate Property 7 (Schedule O) O Separate Billing Requested..... ... 8. Total Gross Atssts (total Lines 1 through 7) .......................... ... 8 9. Funeral Expenses and Administrative Costs (Schedule H) . • • • - • • ~ ~ ~ - • - • • • • • • 9 10. Debts of Decedent, Mortgage Llabitlties, and Liens (Schedule 1) ........... ... 10 11. Total Deductions (total Lines 9 and 10) .............................. ... 11 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 1 e 13 Charitable and Governmental BequestslSec 9113 Trusts for which . an election to tax has not been made (Schedule J) ..................... ... 1E 14. Net Value Sttbjstt to Tax (Line 12 minus Line 13) ..................... ... 1 ~ TAX CALCULATION -SEE lNSTRUCTIONS 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unde~Sec. 9116 (ax1.2) x .o_ 16. Amount of Line 14 taxable at lineal rate X .0 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 Decedent's Social Security Number 0 0 0 0 0 A 0 0 0 4- 9 7 8 3 8 1 3 5 6 2 4 1 9 2 6 5 8 1 9 8, T 2 1 4 6 4 1 5 1 0 6 9 4 7 2 3 0 2 2 2 3 4 T 6 2 4 9 5 15. 16. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OYERRAYMENT Side 2 1505610105 150561010.5 1 REV-150~C p~ 3 File Number Decedent's Complete Address: DECEDENTS NAME James D. Wood STREETADDRESS 2903 Societ Hill Dr. A t. 305 cm~ sra~ Camp Hill PA ZIP 17011 Tax Payments and Ct~edlts: 1. Tax Llue (Pegs 2, Line 19) 2. CredttslPayments A. Prior Payments B. Discount 3. Infwest 500.00 4. ff Line 2 is granter ttran Line 1 + Line 3, enter the difference. This is the OYERPAYMENi; FYI in oval on Papa 2, Ww ZO to regwst a shard, (t) 10,519.30 Toil CredHs (A + B) (2) 2,631.58 (3> 0.00 (4) 0.00 5. H Line 1 + Line 3 is greater than Line 2, enter the diHererloe. This is the TAX DUE. (5) 7,887.72 Make check payable #o: REGISTER QF WILLS, AGENT. PLEASE ANSYItER THE FOLLONANG QUESTIONS BY PLACING AN °X" fN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: y~ ~ a. retain the use w irrcxxne of the property transferred :......................................................... ^ ................................. b. retain the right to designate who shaA use the property transferred w its income : ............................................ ^ ~] c. retain a reversionary interest; o- ......................................................................... d. receive the promise fw life of either paymants, benefds or care? ........................................ 2. 8 death occurred after Dec. 12, 1982, did decedent transfer Property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an 'Sri trust for' wpayable-upon-death bank account w security at his w t>er death? .............. ^ ~] 4. Did decedent own an individual retirement account, annuity w other non-proba~ property, which contains a benefxtiary designation? ................................................. ........................................................ E THE ANSNIER TO ANY t~ THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SGI~QULE G ANA Fq.E Cf AS PART OF THE RETURN. For dates of death on or attar July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the rret vaure ~ transfers to or fru the tree of the surviving spouse ~ 3 percent [12 P.S. §9116 (a) (1.1) (i)j. For dates ~ death on or after Jan. 1, 1995, the tax rate imposed on the rret value of transfers ~ or for the use of the surviving spouse ~ 0 percent [72 P.S. §9116 (a) (f.1) (K)). The stadr6e does not exempt a transfer th a surviving spouse from tax, and ttte statutory requKernents for d~dostxe of assets and Bing a thx retlxn are stiN applicable even if the su-vivirrg spouse is the only belre~ary. For dates of death on or attar July 1, 2000: The tax rate unposed on the rret value ~ transfers from a deceased child 21 y~rs of age or younger at,death.to or thr the .use of a natural adoptive parent w a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)j. fit' ~ • Tire tax rate imposed on the rret value of transfers to or for the use of the decedent's lineal benefirs is 4.5 percent, exo~t as rioted ul 72 P.S. §9116(1.2) [72 P.S. §9111i(a)(1)j. • The tax-rate unposed on the net value of transfers to w for the use of the decedent's sibYrrgs Ls 12 percent [/2 P.S. §9116(a)(1.3)j. A sibling is defined, under Section 9102, as an individual who Iles at least one parent in comrran with the decedent, whether by blood or adoption. r ~ REV-1508 EX ~ (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIDENT DECE E TRN PERSONAL PROPERTY ESTATE OF FILE NUMBER James D. Wood SS~~ 467-13-4768 06/30/2010 21 10 00718 Include the roceeds of litigation and the date tha proceeds were received by the estate. All property jointly-owned with the right of survivorship must be diseh»ed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash in Decedent's possession. 187.00 2 New Cumberland Federal Credit Union, - Account No. 068147, 5 09 S1-Savings; principal balance as of D.O.D. (including June . dividend): 3 New Cumberland Federal Credit Union, - Account No. 068147, 48,927.56 S3-Money Market; principal balance as of D.O.D. (including June dividend): 4 New Cumberland Federal Credit Union, - Account No. 06817 S4 4,946.19 Checking; principal balance as of D.O.D. (including June dividend: 5 Velocity Credit Union, - Account ~p170760, principal balance as o 4,738.00 D.O.D. 6 2003 Ford F-150 XLT Supercab, - 4wd, 59409 miles. 10,325.00 7 Chevron U.S.A., Inc., - claim for royalties on mineral rights. 265.53 8 Citibank Government Card Service, - refund of credit balance. 343.01 9 DAFS, - salary earned before D.O.D.. 1,711.29 10 DFAS, - salary earned before D.O.D.. 500.00 11 Household goods, contents, furniture, furnishings, books and 5,692.25 videos. 12 Madison Apartment Group, LLP - refund of security deposit. 152.85 13 Spirit Physician Services, Inc., - refund of overpayment. 15.00 14 U. S. Treasury, - 2010 federal income tax refund. 3,880.93 15 USAA, - refund of auto and renters insurance premiums. 2 352.24 16 Verizon, - refund of deposit for equipment. 535.58 17 Yoakum County (Texas) Tax Assessor, - refund check in Decedent's 20 36 possession. . TOTAL (Also enter on line 5, Recapitula (tf more space is needed, insert additional sheets of the same size) Copyright(c)1996 form aoftwere only CPSystems,Ine. 1 84,597.88 Form REV-508 E7t (Rev.1-97) r "~ REV-1570 Ex~(7-97) SCHEDULE G COMMONWEALTH pF PENNSYLVANIA INTER-VIVOS TRANSFERS ~ INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY AF3IflFYT nFf!FnruT r.~c nVIpOpR ernes D. Wood SS~~ 467-13-4768 06/30/2010 21 10 00718 This schedule must be completed and filed ff the answer to any of questions 1 through 4 on page 2 is yes. ITEM N ~~ LI~pDEETS RIPTION OF PR PgE~~RgqTYEE TT RELATIONSHIPTO~ c~~rFi~~iiPr~~DATEOt=TRANSFER DATE OF DEATH % OF DECD'S EXCLUSION UMBE 1 . R ATTACH ACOPYOFTHE DEED O REAL ESTATE. VALUE OF ASSET INTEREST QF APPLICABLE) TAXABLE VALUE Thrift Savings an, - 43, 13.56 3 81 .56 Acct. ~~6503931022191, , payable to Starr E. Akens as designated beneficiary. Decedent, at 53 years of age, had the right to borrow against his account, limited to the lesser of: (1) $50,000.00; or (2) the total of his contributions, plus their earnings ($43,813.56). TOTAL (Also enter on line 7 Recapitulation) I = 43 , 813 56 (If more space Is needed, insert addl4onal sheets of the same srze) Copyright (c) 1996 form mftware onyCPSystema, Inc, form REV-f 510 EX (Rev. 1-97) r REV-s„Ex.(,-g~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECED NT ESTATE OF James D. Wood 55~~ 467-13-4768 06/30/2010 FILE NUMBER 21 10 00718 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1 Malpezzi Funeral Home, - funeral expense (reimbursed to Joan 9 508 94 Wood). , . B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Rick Boldosser 4, 230.00 Social Security Number(s) / EIN Number of Personal Representative(s) 27-6722791 Street Address 912 Derbyshire Ave. City Mechanicsburg state PA Zip 17055 Year(s) Commission Paid: 2. Attomey'sFees Law Offices-Marlin R. McCaleb 4 500 00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) , . Claimant Street Address CAy State Zip Refauonship of Claimant to Decedent 4. Probate Fees Register of Wi11s 349.50 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 1 Malpezzi Funeral Home, - death certificates . 60.00 2 Marlin R. McCaleb, Esq., - reimbursement for costs advanced to 75 00 advertise Letters in Cumberland Law Journal. . 3 Register of Wills, - reserve for filing First and Final Account 300 00 , Releases, etc.. . 4 Register of Wills, - filing Inventory and Appraisement. 30.00 5 Rowe's Auction Service, - appraisal of household contents. 75.00 Total of Continuation Schedule(s) 137.24 r v r qL (Also enter on line (If more space is needed, insert additional sheets of the same s Copyright(c),996 form software only CPSystems, IrK. 19,265.68 Form REV-1511 EX (Rav. t-s7) Estate of: James D. Wood 5oc Sec ~~: 467-13-4768 Date of Death: 06/30/2010 Continuation of Schedule H-B4 (Probate Fees) Item Description Amount ~~ 1 Register of Wills, - Additional Probate Fee. 120.00 2 Rick Boldosser, - reimbursement for funds advanced for probate 229.50 expenses ($169.50) and death certificates ($60.00). -------------- 349.50 Estate of: James D. Wood Soc Sec ~~: 467-13-4768 Date of Death: 06/30/2010 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description Amount ~~ 6 The Patriot-News, - advertising Letters. 137.24 -------------- 137.24 REV-1512 EX ~ (1-9~ SCHEDULE( DEBTS OF DECEDENT, :AGE_LIABILITIES, AND co~NlC Vr James D. Wood SS~p 467-13-4768 06/30/2010 FILE NUMBER 21 10 00718 Include unreimburaed medical ezpensea. ITEM 1 (Bonnie K. Miller, Treasurer, - account payable, Tax. 2 Giant Food Stores, - account payable, groceries purchased by charge 06/29/2010. 3 PA Retina Specialists - account payable, medical. 4 Pennsylvania Department of Revenue, - account payable, 2010 Pennsylvania income tax. 5 PP&L, - account payable, electricity. 6 USAA, - account payable, credit card charges (05/24/2010-06/21/2010). 7 USAA, - account payable, credit card charges (06/23/2010-06/28/2010). 8 Verizon, - account payable, telephone. 93.50 95.07 35.00 6.56 112.50 1,077.68 613.95 164.21 TOTAL (Also enter on Iine 10, Reca itulation) S 2 ,198.47 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, InG Farm REV-1512 EX (Rev. 1-97) REV-1513 EX +(9-00) SCHEDULE) BENEFICIARIES rrLG I~VMCCM James D. Wood SSA 467-13-4768 06 30 2010 21-10-00718 NUMBER NAME ANO ADDRESS OF PERSON(S) RECEIVING PROPERTY R Do Not List TntsteCe(s) MOOF ESTATE I. TAXABLE DISTRIBUTIONS p~lude outright spousal distrlbutlons, and transfers wider See. 9116(aX12>) 1 Starr E. Akens Friend 43 813.56 602 Charles Street , Mechanicaburg, PA 17055 2 Joan Davis Wood Mother 9 423.30 905 Grace Street , Aspermont, TX 79502 3 Judith Solensky Friend 4,756.60 75 West Vine Street Shiremanstown, PA 17011 4 Rick and Debra Boldosser Friends 16 375.72 912 Derbyshire Avenue , Mechanicsburg, PA 17055 5 Michael Ortega Friend 2 355.77 104 Medley Drive , Leesburg, GA 31763 INTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN 15 THRU 18 AS APPROPRIATE ON I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH. AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Food For the Poor, Inc., - 6401 Lyons Road, Coconut Creek, FL 33073; charitable bequest per Article II.B. of Will (509: of residue). 2 St. Theresa of the Infant Jesus Church, - 1300 Bridge Street, Ne Cumberland, PA 17070; charitable bequest per Article II.B. of Will (lOX of residue). 3 U. S. Army War Colle e - 950 Soldi D V 1500 23,558.24 4,711.65 g ~ ers rive, Carlisle, PA 17013; 1 952 45 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1'_ (H more space is needed, insert additional sheets of the same Copyright (c) 200D form software ony The Lackner Group, Inc. 1 . 0.00 r S 30,222.34 Form REV-1513 EX (Rev, g_oc) Estate of: James D. Wood Soc Sec ~~: 467-13-4768 Date of Death: 06/30/2010 Continuation of Schedule J, Part II-B (Charitable and Governmental Bequests) Item Description ~~ charitable bequest per Article II.A.1 of Will. Amount or Share of Estate -------------- 0.00 LAST WILL AND TESTAMENT OF JAMES D. WOOD I, James D. Wood, of Camp Hill, Pennsylvania, revoke my former Wills and Codicils and declare this to be my Last Will and Testament. ARTICLE I PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, funeral expenses and expenses of last illness be first paid from my estate. ARTICLE II DISPOSTl'ION OF PROPERTY A. Sil~ciflc Beaue~atc I direct that the following specific bequests be made from my estate. 1. All my non-fiction books on military history and military simulations shall be offered for distribution to tbe US Army War College, Carlisle. Any remaining materials shall be distributed to Rick Boldosser. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. 2. All my religious books, videos and property shall be offered first for distribution to Judith Solensky. Any remaining materials shall then be offered for distribution to Mr. Rick Boldosser. Any remaining materials after this shall be offered to St. Theresa of the Infant Jesus Church, New Cumberland, PA. Any remaining materials shat] be distribute to Rick Boldosser. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. 3. My remaining tangible personal property shall be distributed to Rick Boldosser. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. B. Residuary E to I direct that my residuary estate be distributed to the following beneficiaries in the percentages as shown: 50.00% to Food for the Poor, INC., 550 SW 12th Ave, Deerfield Beach, Florida. If this person does not survive me, this share shall be distributed proportionately to the other distributee(s) listed under this provision. 1 of6 20.00% to Mrs. Joan Davis Wood, 2507 38th Street, Lubbock, TX. Lf this person does not survive me, this share shall be distributed proportionately to the other distributee(s) listed under this provision. 10.00% to Judith Salensky, 81 West Vine Street, Shiremanstown, PA. ff this person does not survive me, this share shall be distributed proportionately to the other distributee(s) listed under this provision. 10.00% to St. Theresa of the Infant Jesus Church, 1300 Bridge Street, New Cumberland, PA If this person does not survive me, this share shall be distributed proportionately to the other distributee(s) listed under this provision. 5.00% to Mr. and Mrs. Rick Boldosser, PO Box 242, Loysville, PA. If this person does not survive me, this share shall be distributed proportionately to the other distributee(s) listed under this provision. 5.00% to Mr.lVfichael Ortega, 123 Mossy Dale Lane, Albany, GA If this person does not survive me, this share shall be distributed proportionately to the other distributee(s) listed under this provision. 100.00 -Percent Total ARTICLE III NOMINATION OF EXECUTOR I nominate Rick Boldosser, of PO Box 242, Loysville, PA, as the Executor, without bond or security. If such person or entity does not serve for any reason, I nominate Mrs. Edyth Moran, 1075 Lancaster Blvd, #5, ofMechanicsburg, PA, to be the Executor, without bond or security. ARTICLE IV EXECUTOR POWERS My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that may be included in my estate, without order of court and without notice to anyone. My Executor shall have the right to administer my estate using "informal", "unsupervised", or "independent" probate or equivaleirt legislation designed to operate without unnecessary intervention by the probate court. 2 of6 ARTICLE V MISCELLANEOIIS PROVISIONS A Paraaranh Titl a n C*Ander The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all genders, and any singular words shall include the plural expression, and vice versa, when the context or facts so require, and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number. B. Thirty Day Surn_ 'y_a1 Reuuirement For the purposes of determining the appropriate distributions under this Will, no person or organization shall be deemed to have survived me unless such person or entity is also surviving on the thirtieth day after the date of my death. C. Liabilit of Fiduci No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary'sgood faith actions or nonactions as the fiduciary, except for such actions or nonactions which constitute fraudulent conduct or bad faith. D• No S use I am not currently married to anyone. E. No Children I do not have any children at the time of the signing of this Will F. Beneficiary Dishes If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. IN TNE$S WHEREOF, I have subscribed my name below, this f~day of OVd-n /~ ~,~,~ Testator Signature: es D. Wood We, the undersigned, hereby certify that the above instrument, which consists of pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by James D. Wood (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our 3 of 6 names as witnesses on the date shown above. Witness Signature: Name: City: State: Witness Signature: ~ ~~~ Name: ~ ~ City: A/J e'~xl-A//~spdp.~ State: ~~- 4 of 6 PENNSYLVANIA Self-Proving Clause COMMONWEALTH OF PEl`1NSYLVAIVIA COUNTY OF CUMBERLAND I, James D. Wood, the Testator whose name is signed to the attached or foregoing instrumem, having been duly qus~ified according to law, do hereb signed and executed the instrument as m Y acknowledge that I free and vohmtary act for the Y bast Will; that I signed it willingly and ~ my Purposes expressed in the instrument. S. wojp to or affirms and ack,,,,wledged before me b lames D, Wo ~7~1~ day of ~~~ ~~/ y od, the Testator, this Testator Signature ~iT/ es D. Wood S~ ofofficer NOTARL4L SEAL Official capacity of o c Public scamp Hln, Cumberland county Commlaelon Iree Jens 6, 2005 (Seal) 5 of 6 AFFIDAVIT COMMONWEALTH OF PENNSYLVAI~TIA COUNTY OF CUMBERLAND We and attacd~ed or fo o' the witnesses whose names are signed to the !eg >ng instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator ~gn and execute the instrument as the Testator's Last Will; that the Testator signed willingly and executed it as the Testator's free and voluntary act for the purposes expressed in it; that each of us in the hearing and sight of the Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind aad under no constraint or undue influence. SwQ~ to or affirmed and subscribed to before me by /L!c 5 5 cL~ /C'~Q~,~ sild ~ ~ witnesses, this _~l-day of __..tlo y~rn~-~. a/ . Witness Signature: Name: ~ ss~w /~ ~~~ City: _L(~~Gf~/~.C't~ ~le?l~ State: ~ Witness Signature: ~~_ Name: ~~ ~ r ~ !t~ D ~ R rJ City: _~ ~ tl/lc~s,8d,~ State: JAMES E. t3REEN, Notary Pr1bIlC Camp Hiil, Cumberland Courriv Seal and 6 of 6 New Cumberland Federal Credit Union Your Community Credit Union P.O. Box 658, New Cumberland, PA 17070-0658 Phone: (717) 774-7706. 1-800-716-2328 • Fax: (717) 774-7996 • Web: www.ncfcuonline.org July 21, 2010 Marlin R. McCaleb Frankeberger Place 219 East Main Street P.O. Box 230 Mechanicsburg, PA 17055 RE: Estate of James D. Wood Date of Death June 30, 2010 Deaz Mr. McCaleb, Pursuant to your request in regazds to Estate of James D. Wood the information is as follows: Account Number: Owner(s) on Account: Date acct opened: Date of Death Balances: 68147 James D. Wood 10/4/1991 S1 (Savings) $ 5.09 S3 (Money Mazket) $48,927.56 S4 (Checking) $ 4,946.19 If you need anything additional, pertaining to this matter, please do not hesitate to contact me directly. Sincerely, ,` i Bazbra J. ri Branch Manager Enclosures Schedule E.2,3&4 Velocit CREDIT UNION August 3, 2010 ]tE: James Woods Account # 1.70760 To Whom It May Concern: As of June 30, 2010, the balance on James Woods' account was $4,738.00. This account is now closed. If you have any questions regarding this matter, please contact. me at (512) 469-7114. Schedule E.5 0P,/i0/i010 .07;4 3 7177707.36 DDC TRWvSPORTATIOPJ PAGE ©2/07 Plil~~i~w ''"' ~ is 60111~1~ ~ ~I~ ~B~ Ppli~ To Whom it May concern, The 2003 Ford F-150 XLT Supercab 4wd with 59,409 miles . Vehicle Identification Number 1FTRX18W63NA09519 Registered in the name of James D. Wood has an actual cash value of $10,325. In its current condition as appraised on 07/19/2010. Thank You , Inventory Control Manager Mccafferty Ford of Mechanicsburg ;, ~.~~... ~~ 6320 Carlisle Pike • Mechanicsburg • PA 17050 • (717)-766-4733 • www.mccafferty.corn Schedule E.6 Mark Turner Rowe's Auction Service 2505 Rimer Highway Carlisle, PA 17015 717-249-2677 249-1978 697-4794 To: Marlin McCaleb, Attorney 219 E. Main St. Mechanicsburg, PA From: Rowe's Auction Service 2505. Rimer Highway Carlisle, PA 17015 Re: Appraisal Estate of James D. Wood 2903 Society Hill Dr. Apt, 305 Camp Hill, PA 17011 Living Room Pr. Bookcases Low Entertlainment cabinet 5 pieces newer Southwest Indian pottery Sony 32" Flat screen TV 8c DVD player 2 open bookshelves Appx. 500 Movie DVD's & VHS Matching Sofa, Chair & Ottoman Coffee Table & end stands Southwest hYdian Sand painting Misc. Pictures Portable stereo Pr. Lamps Floor Lamp Misc. Religious items ~~~ ~ Kitchen Microwave cart Table 8c 6 chairs Bakers Rack Bone Handled knife OflYce 6 open bookshelves Computer table August 10, 2010 $ 50.00 25.00 25.00 125.00 40.00 1000.0(1 300.00 25.00 25.00 10.00 10.00 10.00 5.00 20.00 10.00 50.00 25.00 10.00 60.00 10.00 Schedule E.11 Office Chair 15 00 ~ c°mputer . 50.00 ~~' ~~ 100.00 Archive of WWZ military photos ._ ~cn nn 500.00 Be rNm Bedcnom suite Exerciser 2 Bookshelves Approximately l00 music CD's Canon 35mm camera & lenses Gerber military knife Southwest Indian Bolo's & misc. men's items Jewe Smith & Wesson 38 cal. pistol 14K gold ring w/ appx 1/3 center cut diamond flanked by 2 appx. '/. ct. diamonds (4) Pairs 14K post earrings w/ various stones (3)14K gold rings, 2 bands 8c one w/pearl & diamond chips (2) 14K gold crosses, one w/pearl & diamond chips 14K gold pendant 8c earring set w/ amethyst & diamond chips Pearl Necklace LESS• Total 50 Militarq books Q $5.00 V 100.00 10.00 20.00 100.00 100.00 50.00 25.00 30.00 350.00 100.00 120.00 100.00 100.00 35.00 $3990.04 250.00 x,740.00 w W. David Rowe Schedule E.'11 ~~ Brian P. Gottlieb 120 Ashford Way Camp Hill, PA 17011 November 10, 2010 Marlin R Mct.,aleb, Esquire 219 East Main Street Mechanicsburg, PA 17055 Dear Mr. McCateb: tJn behalf of the United States Army Heritage and Education Center ("USAHEC'~, the Army Heritage Center Foundation ("Foundstion'~, and. tbe .military history community, I wish to thank the estate of James D. Wood for its August 23, 2010, gift to the Foundation of nearly 200 books from the late Mr. wood's personal fibrary. The Foundation asked me to inventory the books and arrange for their proper disposition. Some of the books will be integrated into the USAHEC library to supplement its extensive military history collection. Books not required by the library will be sold for the benefit of the Foundation, which is the non-profit organization partnered with tbe Aany to support the development of USAHEC facilities and programs. USAHEC's mission is to educate Soldiers, veterans and the general public about the history and heritage of the Army. Attached for your records is a copy of my detailed inventory. I estimate the fair market value of the donated books to be X1,952.25. For your information, the Foundation is atax-exempt organization incorporated under Pennsylvania law with offices at 950 Soldiers Drive, Carlisle, PA 17013. Gifts to the Foundation receive all of the income tax and estate tax benefits allowable under law. The Foundation is listed in Internal Revenue Service Publication 78 (C~anulative List of Orgcmizutions) under its legal name, Military Heritage Foundation. If you have any questions, please contact me at bgottheb a~rfidinspect.com or 717-991-2823. sincerely, ~ ~.~~~~. Brian P. Gottlieb Enclosure cc: LTC Mike Perry (USA, Ret.), Foundation Executive Director LTC Martin Andresen (USA, Ret.), USAHEC Schedule E. 11 Schedule J.II.B.3 Schedule J.II.B.3 Schedule J.II.B.3 .8$ 8 8 88 $ A $ ,$8 A $ 8 $ $ ~ $8 5S ~ St $ $$~8 $ $ $ 8 8 $ 8 8 $ 8 $ 88 $ 53 $$ 8 8 $8 ~~ A 8 ti R ~ ~ M $ A Si ~ tt `.k A ~ 8N a i AAA~ t9R ~ ' ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ C ..,: "ie: . > ~ a ~ . , v °' ~ $ aY q ~ 4 ' ~ Y ~ " ' , ~ dq yQ ~ ~~pi ~ ~ ~ ~ ~ IN+ . ~~~ 33pgq Il $J, M aD ~ ~ N ~ ~ ~ ~ ~ ~ ~ 2~ ~ ~ ~ 11'ZZ ad N 1. O v O d 3 a d a a s ~~ ~ ~ d ~. ~: _. ~~ ~, ti ~ ~ ~, ~ ~ ~ ~ 8 ~_' ~~ ~ ~ ~ t 4 K G K 1'. 6 ~~ ~ Schedule J.II.B.3 8 $ m8Q ~8y M tl ~8pJ $ M 8 N 8 $ M 8 N q88 53 M 8 ~ p~p 8 N $ ~ g8 8 8 N NM . O~p M 8 ~ ~8pp $ $ N .~.~ t8~ M ~Ny M ~ C 8 wq p n M 8n MM ~f t~ 8C pp pp G M N^tl'0 0O AS A A M N , N ~ • '.':~.:. "'y Y ~ ~ ~ ~ ~ ja~~ Y x 5 ~ ~ g~ ~i ~ ~ ~ ~ iii C ~ ~ e ° ~ iii ~ S 5 ? w $ T q 4 Nn d ' 3 `~ ~ `~ ~ ~ a ~ ~ ~ ~ d ~ ~ a $ ' d ~~ N grg d ~ ~ ~^~ `~q d b dd $ $ $ $ $ f $ ~' ~' $ $ E $ ~ 2 ~ P ~ 8 ~' $ ~ $ $ ~ ~_ ! ' 4 i i ~ 3; ~ ~ ~ ~ ~ ~ d d_ a _ d 5 S ~' ~ ~# ~ $$ ~ S ~6 S~R .~ ~5 ~ ~ ~ ~S S ~ ~ ~ $ oYGS ~$~~~~S " , ~{ ~' ~ / d~ ~ ~ ~ ~ ° ~ ~ $ n pas ~ 6 ~a(F ~ ~. r~ t~ ~ ~ M ~i U ~ ~ ~ ° ~ g . m ~ ~ .'~ ~ i F = ~ ~ = a ° ~ $ ~ L~ E Ea ~ a ~ ~ ~ w S 8 ~ ° s ~ 8 '~ T` d ~~~ ,~~.Er~ ~i5 ~ ~ ~ y 1 ~ m ~ ~ F LL MF5 a x' x a ~ Z 8 ~ ~ g t E ~ s $ Zo g i s ,e ~ '" 8 ~'~, .,~, LL~ 4s ~ $ iii ~ ~ ~ ~ ~ ~ ~ ~ g ~ ~ ~ ~ g~~ ~ 'S F ~ y i ~ 9i ~ i ,~~ ~ jj ~ 3 ~ ~ E ~ U ~ ao~ ~ ~ ~ ~ L~ ~° ~~ ~ S ~ ~ 8 4 i ~ g g p y ~,' Fd ~~~3 y R ~ ~ ~~ y Fa ~~ p da ~tR FF3 ~ ~ ~ ~ s cR~ W ~+ J aR 8 z ~ a~ ~i m ¢ ~ ~ ~ ~ '~ £ ~ ~ ~ ~ 3 'S w 3 > > s j ~ W R ~ ' ~ i r- ~ F ~ ~ ~3 ~ .-....uua._ J:Y.11 Schedule J.II.B.3 TAXPAYER DIED 06/30/2010 ~ 1040 °~°a°-T~-~~.~. X010 US. Individual Income Tax Retum ~ Hsu..o,~,,_~,,,~,~„~a.~,,,~;,,~~ P FalMyarJnl-0ee.91.20lgvatlenc~yarbepYriry .ZOfgedn0 .20 OAA8No.1546.0074 Nine, A Yar trat rrme andWhal teat „~, rte, ssoudty Address, T J es 467 J 13 ~ 4768 and SSN sPer•.s's ~,,~, ~ c Rick Boldosser Executor ~ ~ $°D °~A to ~ In~1~~ q~ at~eq,, eyou have a P.O. ba4 sae Aar. Apt ro. Mahn euia the SSN~ above a ast Nta1II treat ~ and en Ikre ec era correct t . town or poet e1Ree, state. and 2W coda a yw have a address, see ~trrctione. one a twx below wll not Pr~wdarrwl r Mechanicsburg, PA 17055 ~~~taxwr~und l3ac+lorr caatprYn - Cheek here ff yeu, w yotr spouse if tl6ng 1~N. want S3 to go to this fund . - ^ You ^ 8pouea Fling Stahls t Sktgle 4 ^ tiaad a hormldd Mdh grmlfyYtB p~,rN (s» .) 9 2 ^ Merited OBng ~y (~ iF ~h one had 6>cofrte) ttr wtlhinc Peron m a child but not your deperdrd, err thb Check ~y ate 3 ^ Menial ttNng h• ~r spcwse's SSN above lase rrerrre Here. ~- and tup rrrrre tore. - s ^ ono wkiovr(er) with dePerwer,t ctrld Exemptions b a soe.e ff sanraone can lain you as a aePerderd, do rtm check box 6a . c °spandarRo: ~ tle-aedail'a p) oepeaderd's (A ~ 9 eMd untlerape 17 . (t) fiat aare tartrrarre sari axu~ aurosr reYrlargrp b you ~ ~ ~ °~ ff more then tour ^ deperderKS, sea ^ mstrtxxlorts and ^ d,ecirhere -^ ^ a twat raxnbar of exemptions dairrard Income ~ Wes' , ~. ~. Attach ~(~ W-2 Ba TaaabM Brterest. Attartt ScftedWe B B requred _ b Tax~xempt Merest. Do not kxdrrde on Ilne 8a 8b W ~. Abo 8a Orditary divkierds. Attach Schedule B 8 requ'eed attadb Forma b Que9fiad dividends 9b W-2G and 10 Taxable refiatds, credits, or offsets of swte arxl local krcome taxes 70YY-R If bnt 71 ~y received . Was wNhhsld. . 12 eusir>ass 6rcwne or (bsa). Attach Schedule C or FEZ . t3 Capital gain w (bast. Attach Schedule D if required. H not required. dreclc here - ^ H ~ ~ ~ ~a W Z 74 Olfrer grins or (. Attach Form 4797. _ . see page 20. ltia IRAdish'butlons 75a b Texade amotart 1 i6a Perp,iorrc and arnrrities 78a b Taxabb artrorxrt 1 17 Rental rest estate, royalties, partrterafrips, S cwporatiorrs, trttsrs etc. Attach Schedule E Endoae. but do trot attach. any 18 , Farm trcame or (heel. Attach Schedule F . Also, ~ rrerrt-rpensl el~atonl . I .I b Taxatrle m t Form 7040-V. 21 norm Otltx 6rcorrte. L)st type and amwart 2 22 __ Combine the emards in the far right crohsrsr tar foss 7 tirdrgh 2t. TFis is your iWai irrearrta - S ~~ 23 l~lucatorexperrses ~. . 2.3 p~ Gross 24 ... CfAteRl txraness BKPBIIaB6 of IBSBMb15, P~`^'•°•tl . and 3's: s~ Income ferrbaaa ~ ofhaals. Attach Form 2106 ar2106-EZ 24 Hr ~~- ~+ ff~ith seWngs arx;ount deductiwr. Attach Form 8889 25 ';^~ 26 Moving expert9es. Attach Form 3903 28 r",'x"! 27 tie-half of aelf~mpbyment tax. Attach Schedule SE 27 .. "'' 28 SeM-ernpbyed SEP, SIMPLE, and qua0fied Plans 48 ,,,, 2g Self-employed hearth Ita3urarx~ deduction 28 ~ Fertally ~ early wltidrawal of sevrrgs . 30 rr 31a Afimorrypeid b Redpfent'sSSN - ' f 31a ~' 32 IRA deduction . 32 . :;;' ~ 33 Student ban interest deduction . 33 , 34 Tu@bn and fees. Attach Farrrr 8917. 34 `"""' 35 Domaetic production acdvtties deduction. Aitech Form 8903 35 38 Add foes 23 ttxough 31 a and 32 through 35 3i 37 Subtract line 36 from 9ne 22. Thiss your adjusted gross irtcorrte - 3' Fa Disrioarae, Privacy Act. and PeperWOrk Redtrefion Aar Nofke. sae seyxerats irrstras;tlorrs. Cat nb. Y 13206 Schedule` E.14 a.edm 1 Nil a ehtfdren ea ac whx • Wad eralr you • aid ea rw wrar p."p.'aa" a ,_ ~.e Adid ra.nb.rs onL• 1 itrr.a show - L• 0 ~ 00 Form 7040 (2070) Fam taco lzotq PeeB 2 TeX end 36 Amount from ins 37 (adjusted gross income) 36 39a Chadt { ^ You were bom betas January 2.1948. ^ Blind. ~ Toial ber[as ~?~~v Credits t K: ^ Spouse was txxn before January 2,1948. ^ BirW. dtacimd - 39a 0 ~ b M your spouse iattizes on a separate rebirn a °~ you were aduel-st~us a6~, c~reclc trere- ~ : r 40 itmmized dedtrcttorts Qrorn Schedule A) a yaa• standard dedrrcttort (see insevctions) 40 :- :, ,. i '` ,: 5,700 . 00 41 Stdttrset title 40 frrxrr 6te 38 at 46 148 71 42 F.xempBats. Multlply 53,650 by the number on Ikte 6d . 42 3, 43 Ta:ebb trtcorne. Subtrad ins 42 from tlne 41. ff Ihte 42 is more than Ifne 41, enter -0- 48 44 Tax (see it>structiats). l;heck ff sty tax is frorte a ^ Farm(s) 8814 b ^ Form 4972. 44 42 498 6 8 0 71 00 45 Altsrtatlvs mfMrmrm tax (see irtstruc8orrs). Attach Form 6251 45 46 Add Ines 44 mid 45 . - 46 6 800 00 47 Foreign tax aedR Attach Form 1 t 1 fi if required . 47 ` ~ 48 CrerEt for ctrid and daperrdart care e• Attach Farm 2441 48 ~ 49 Educatlon credits from Fortm 8863, ins 23 4e 50 Redrerrtard savings c~rrtrfbutlons cxedh. Attach Form 8880 50 51 Chid tax vedt (sae instructlats) . 51 52 Residadial energy credits. Attach Form 5895 52 •'' 53 Olfier aedAs tram Fume a ^ 3800 b ^ 8801 c ^ 53 54 Add Ines 47 thraugtt 53. These are yotwtotal credits 54 0 00 55 Subtractfirte 54 from ins 4& H ins 54 is more than ins 46, enter -0- - 5S ~ Other ~ ~-~PbrmeM tax. Attaan sa,ad<ra se ss '''~~ S7 lJnreported social sewMly and Medicare tax from Form: a ^ 4137 b ^ 8919 57 58 AddiBorral tax on IRAs, other qualiied rNaenertt plans, etc. Attach Form 5329 if required 58 !~ a ^ Form(a) W-2, box 9 6 ^ Sdadule H c ^ Form 5405. ins 16 56 80 Add tines 55 tMougtt 59 This is yatr total tax - BD PeytftefltS 87 Federal ktCOtTre tax withheld from Fame W-2 and 1099 8.1 2010 estimaded tax payrrerrts attd amount applied frem 2009 rehxn ~ ~9 work ~ vedi. Aftarlr Schedule M . K you fleas a ti4a Earned insane credit i~ . t~tl ch b Warttatrahle carrbat pay election ~ 64b I ~ 5ehedUb ~. ~ AddiBanal chBd tats aedlt Attach Farm 8812 !t6 Antedcart opportunity taedlt from Forth 8883. ins 14 67 First-time homebuyer credit from Forth 5405, ins 10 . 88 Amoud paid with recrynst for ez[~sion to fie ~ Fxoees sodel sewr8y and tier 1 FE1TA tax wlthhdd TO Credit for federal tax on fuels Attach Form 4136 71 Cradle flan Fame a ^ 2439 b ^ 8839 c ^ 8801 d [] 8865 72 Add tines 61,62.63.64x, and 85 throttph 71. These are vourttr ReTund 73 M ins 72 fs mac than ins 6D, subtract Nne 80 from line 72. This is the amount you overpaid 74a Amount of ins 73 you watt refunded to you. ff Form 8866 Is eCadted. cheek frets - ^ p:.ct dew? - b Routktg rxar~ar L I i I I ! ! t I I - ~ Type: ^ ^ savings i ~tctiae - d Ac¢atM number ~ ! I I ~ ` ~~~ I I ! ! I ~ I I 10,680 ! 93 • A -.: 75 Amount d tine 73 wart to 2011 est~ed tax - 75 J -`: AnlOUnt 76 AmaaR you owe. Subtract ins 72 Tram Ere 80. FOr details on how to Pay. see Instrttciiorts - .76• You Owe 77 ~ cau...eWY taX see kISfrUCdOna }d•r.~~: ~ 1M<~y:~ Y~ ry ~ ~~ Ti~fd PBKY lb you want to albw artoCter person to discuss this rattan with the IRS (see Ingtrttc8ons)7 gj Yea Complete bektw. ~, Designee pa.laee'8 t~nate 717/691-7770 Pereorrdiderr8icauon ,,,,,,e - Marlin R. MCCaleb „o. - nurrmer - gf1 Under v^alees of perJtny. I a.dam that ~ here ezaaitea this rehxxn .nd eommpenyhy echeares and stmments, ana m me best w my Wpwleuae ant beYst, H@I'e they ae tnts, comet, arxl mngida. pecrrauon or ~drer men tsrtreyer) b based a, M Mdannaeon of wtda, Prepsar tae ary Isx+aAedae• Jorrtretun7 ~ Estate of James 1~W vouretxt~aeon ~~~~ see peas i2. - Executar tceepacopy -~~• (717) 691 7770 for your ~i!]Gtatt~ y~ pale spouse•soccupatia~ •. scads. Rick Boldosser A _ r:. • x,. -~ . + : a. i.',= PSid tmmv i yce anep~er•s ~eme Preperer Marlin R. McCaleb ~~~ ,3 x~ !~ Use Ony Fam'smame - Marlin R.-IylcCaleb Esa TAXPAYER DIED 06/30/2010 Sc:h~:dul~~ E. 14 a Fan's md- 23 2393' Fam 704p (20t0'j ** niwFr BAVINCS PLAN Thrift Savings Plan Death Benefits Processing Unit P.O. Box 4450, Fairfax, VA 22038 Fax: 703-592-0170 Febniary 8, 2011 Law Offices Marlin R. McCaleb P.O. Box 230 Mechanicsburg, PA 17055 Re: Thrift Savings Plan Account of James Wood Acct: 6503931022191 This 'is in response to your request for the Thrift Savings Plan (TSP account balance for the participant named above. TSP accounts. are valued on a daily basis as of the end of each business day. On June 30, 2010, the balance in the participant's TSP account was $43,813.56. If you have questions, contact the TSP Death Benefits Processing Unit at the address on the letterhead or call 1-800-371-2365, (if you are hearing-impaired, call TDD at 1-877-847-4385), Monday through Friday between 8:00 a.m. and 5:00 p.m. Eastern Standard Time. Callers outside the United States and Canada should call (404) 233-4400 (not atoll-free number). Documents pertaining to death benefits may be faxed anytime to (703) 592-0170. Include your daytime telephone number and the participant's Social Security number or account number on all correspondence. In addition, the TSP booklet Death Benefits is available from the TSP website (www.tsn.govl. If you do not have web access, please call or write to receive a printed copy. Note: If you are a member of the uniformed services; do not provide your Defense Switched Network (DSN) telephone number. Schedule G.1 SIWT178/SINT271 /D8150 ~ ra .~'~~ THRIFT SAVINGS PLAN Page,nf2 PARTICIPANT STATEMENT For the period: oa/ov2olo-06/30/2010 Please review this statement for accuracy, as the information in it is considered correct unless you notify us. To correct errors in contribution allocations and interfund transfers, contact the TSP at the ThriftLine number below. For all other corrections, contact your agency or service. 53328652311 N DD 074018 97380500 07/10 JAMES D. WOOD YOUR QUARTERLY ACCOUNT SUMMARY Account Number: Date of Birth. Retirement Coverage: CSRS Employment Status: Active Beneficiary Designation: Yes, dated 01/07/1998 Beginning Balance Contributions and Withdrawals Change in Endin TSP FUNDS (04/01/10) Additions and Deductions Interfund Transfers Value from Balan g Individual Funds Previous uarter Q (06/30/10) C Fund I Fund $39,147.06 9 3 $1,044.75 $0.00 $0.00 -$4,575.45 $35 616 36 Total , 42 72 $48,489.78 261 17 $1 305 92 0.00 0.00 - 1,406.69 , . 8,197.20 , . $0.00 $0.00 - $5,982.14 $43,813.56 How your future contrjbutions and loan payments were allocated as of (16/30/10: Individual Fund(s) . C Fund 80'y~ I' Fund • ,~~y;, How your ending balance is distributed among the funds .. ~ ~ C Fund 1 Fund ~' How your ending balance was distributed as of 06/30/10 (see pie charU: Individual Fund(sj C Fund t;I~~, Fund ~' 19'i„ TSP website: www.tsp.gov THRIFTLINE: 1-TSP-YOU•FRST (1-877-968-3778) Outside the U.S. and Canada, call 404-233-4400 TDD: 1-TSP-THRIFT~> (~-fi7;-847-4"t8;) Schedule G.1 >' ~ Page 2 of 2 Account Number: for the period: 04/01/2010 - 06/30/2010 TRANSACTION DETAIL BY~SOURCE Payroll - Posting Office Date TratwMion Type Employee Total Beginning Balance $48,489.78 $48,489.78 97380500 04/01/10 Contribution 186.56 186.56 97380500 04/15/10 Contribution 186 56 97380500 04/29/10 Contribution . 186 56 186.56 97380500 05/13/10 Contribution . 186 56 186.56 97380500 05/27/10 Contribution . 186 56 186.56 9-3liU50U 1161 1(1,'10 Cunlrihulinn . IYP~ ib 186.56 975 t1U500 06/2x/'10 Cuntribulion . Iit6 :iG 186.:6 . 186.56 Increase/Decrease in Value - 5,9ti2. l4 - 5,982.14 Ending Balance $43 813.56 $43,813.56 I TRANSACTION DETAIL BY FUND Common Stock Index Investment (C) Fund Posting Transaction Share Number of Dollar Date Transaction Type Amount Price Shares Balance Beginning Balance $13.9317 2,809.927? $39 147.06 04/01/10 Contribution $149.25 14.0354 10.6338 , 04/15/10 Contribution 149.25 14.4442 10.3329 04/29/10 Contribution 149.25 14.3910 10.3711 05/13/10 Contribution 149.25 13.8176 10.8014 05/27/10 Contribution 149.25 13.1834 11.3211 06/10/10 Contribution 149.25 12.9967 11.4837 06/24/10 Contribution ~ 149.25 12.8490 11.6157 Ending Balance $12.3390 2,886.4868 $35,616.36 International Stock Index Investment p) Fund Posting Date Transaction Type Transaction Share Number of Dollar Amount Price Shares Balance Beginning Balance $18.6945 499.7576 $9 342 72 04/01/1(1 Contribution 5.37.31 IF1.9196 1.9720 , . 04/15/1(1 ('nntrihution - 17.31 I~~.i311v I,~itlll (I-!:?'L'I(1 (-~r,t~riliuliu;~ ' ~ - ,-. I1 , , I;, ~ ~ „ ' .~.fl . i6 US/I,f/10 (uniriltulirm 17.31 I: ?5I '~ '.16!7 OS/2i/10 Cuntributiun 37.31 1b.451U ?,x(;79 06/10/10 Contribution 37.31 16.3444 2.2827 06/24/10 Contribution 37.31 16.5941 2.2484 Ending Balance $15.9275 514.6570 $8,197.20 Schedule G. 1 Fnrm TSP-8 (10/200h1 THRIFT SAVINGS PLAN Page, ofz . PARTICIPANT STATEMENT Far the period:oaiov2olo-06/3o/ZOIo Please review this statement for accuracy, as the information in it is considered correct unless you notify us. To correct errors in contribution allocations and interfund transfers, contact the TSP at the ThriftLine number below. For all other corrections, contact your agency or service. 53328652311 N DD 074018 97380500 07/10 JAMES D. WOOD Account Number: Date of Birth. Retirement Coverage: C'SKS Employment Status: Active Beneficiary Designation: Yes, dated 01/07/1998 YOUR QUARTERLY ACCOUNT SUMMARY TSP FUNDS Individual Funds C Fund I fund Total Beginning Balance Contributions and Withdrawals d Change in Endin (04/01/10) Additions an Deductions Interfund Value from Transfers Balance Previous uarter Q (06/30/10) $39,147.06 9 342 72 $1,044.75 $D.00 $0.00 - $4,575.45 $35 616 36 , . $48,489.78 261.17 $1,305.92 0.00 $0 00 0.00 -1,406.69 , . 8,197.20 . $0.00 - $5,982.14 $43,813.56 How your'future contrjbutions and loan payments were allocated as of Q6/30/10: IndividualFund(sj . C Fund 80'y~ • ' •I' Fund . ?O~y;, How your ending balance is distributed among the funds ~ C Fund . ' 1 Fund ~' How your ending balance was distributed. •as of 06/30/10 (see pie chart): Individual Fund(sj C Fund g 1 ~~~ I Fund . 1 ~)'y TSP website: www.tsp.gov THRIFTUNE: 1-TSP-YOU-FRST (1-877-968-3778) Outside the U.S. and Canada, call 404-233-4400 1"D D: 1-1~P-~fH{LIFT; (I-1377-fi47-a~{g;) Schedule G.1 v ~~~' ~~ ~ ~ ~~~ ~ ~~- ~~, ~ ~~