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HomeMy WebLinkAbout04-25-11 REV-1500 ~O1.1°' ~ enns lvania OFFICIAL USE ONLY PA Department of Revenue PE .A.ME Y Bureau of Individual Taxes ~ County Code Year File Number PO BOX ~ pINHERITANCE TAX RETURN Harrisburg, PA 1128-o6oi RESIDENT DECEDENT I ~ D ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth ^ar?DD'r,'~Y /S3 3a ~3i ~~U~ d a~,28 Decedents Last Name Suffix Decedents First Name MI (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 i Original Return O Supplemental Return O Remainder Return (date of death prior to O Limited Estate O 4a. Future Interest Compromise (date of O Federal Estate Tax Return Required death after ~ Decedent Died Testate O Decedent Maintained a Living Trust Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O Litigation Proceeds Received O Spousal Poverty Credit (date of death O Election to tax under Sec. 9113(A) between and (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Nl A R i ~ C~ ~ nl U U G ~~w r T T E S~ ~ S~ G r- - ' REGI F WILLSLi~'~E ONLYi t~ ~i~n s~ ~ - First line of address ' a - Second line of address ~ ~ _ - t ' ` .n i ~ J~~~4'M I~17 City or Post Office State ZIP Code DATE FILEDa M~~~~~icsv~~~~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ATURE OF PERSON RE PON IBLE FOR ILING RETURN DATE e - ~ y- eZe - AD ~ S%~ o? a ~ ~~°~f~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 J REV-1500 EX Q Deced~ejnt's SociZal Securitpy Nf~um/ber Decedent's Name: J a S r~ S ~ l 0 ~ / U - ! ( ' RECAPITULATION Real Estate (Schedule A) L O U • Stocks and Bonds (Schedule B) d ~ Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ~ 0 Mortgages and Notes Receivable (Schedule D) ~%p~ Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... ' ~ ~ ~ ~ : O ' `_t .c: Jointly Owned Property (Schedule F) p Separate Billing Requested . O ~ - ....,Y,.,~ Inter-Vivos Transfers & Miscellaneous Non-Probate Property " (Schedule G) p Separate Billing Requested........ ~ C'~i - - Total Gross Assets (total Lines 1 through ~ 7 ~ ~ Funeral Expenses and Administrative Costs (Schedule H) ~ ~ ~ * ~ ax~~v:=~~,~ . Debts of Decedent, Mort a e Liabilities, and Liens Schedule I - * O 9 9 ( ) ~ Total Deductions (total Lines 9 and ~ ~`p y ~~y~: Net Value of Estate (Line 8 minus Line - * Q Charitable and Governmental Bequests/Sec Trusts for which an election to tax has not been made (Schedule J) ~~'Q . L't. ,F Net Value Subject to Tax (Line minus Line * © U TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES Amount of Line taxable at the spousal tax rate, or transfers under Sec. (a)(1.2) X Amount of Line taxable ~ ~ ~ ~ ' ~'~~'~''r` ` at lineal rate X _ _ Amount of Line taxable ~ ~ at sibling rate X + Amount of Line taxable ~ ' f ~ ~ ;ck~~ at collateral rate X + ` ~ ~ ~ .r y is TAX DUE U e. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 REV-1500 EX Page 3 File Number Decedent's- Complete Address: DECEDENT'S NAME STREET ADDRESS e ~ ~ ~O ~O /l6 / ~.//~Dffi~Y! /TY CITY i(/JF CCT (v (G S /;J K G' l7 6,f 5 - ~ ~oZ.- ~ STATE n~ l ~D SS~' .S~o2.~ Tax Payments and Credits: Tax Due (Page Line • v0 Credits/Payments • OQ A. Prior Payments B. Discount . 0 0 Total Credits (A + B) . U D interest If Line 2 is greater than Line 1 + Line enter the difference. This is the OVERPAYMENT. Fill in oval on Page Line to request a refund. If Line 1 + Line 3 is greater than Line enter the difference. This is the TAX DUE. ~ ~ Make check payable to: REGISTER OF WILLS, AGENT. ' Y:.... ~~:'~i7~'~~` ~~.~_+-w-~~xr~~~'+'~,`.4?U*i~~:~~iT~ ''.'~h-k} ~3igr .,k'~r ~r k -h*'x"~ we ~ ~~K'~'.. ~ . _ _ '"s'. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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? ? If death occurred after Dec. did decedent transfer property within one year of death without receiving adequate consideration? ? Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ? Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. r~d~~:F'S:'~Ao.e~`'t., ;+.,i"-' ~I..-3-n~`~':~' a~ °`~,t`-c:~ ~ ~?i ...1P-, ~~a ~ v _ For dates of death on or after July and before Jan. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent P.S. (a) (i)]. For dates of death on or after Jan. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent P.S. (a) (ii)]. The statute does not exempt 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 if the surviving spouse is the only beneficiary. For dates of death on or after July The tax rate imposed on the net value of transfers from a deceased child 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 0 percent P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is percent, except as noted in P.S. P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is percent P.S. §9116(a)(1.3)]. Asibling is defined, under Section as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ SCi~lED1~LE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line Recapitulation) $ ~ 0 d (If more space is needed, insert additional sheets of the same size) REV-1503.EX+ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH N~~~ TOTAL (Also enter on line Recapitulation) $ ~ DO (If more space is needed, insert additional sheets of the same size) a JOSEPH F RUSH Account # Balances Beginning B~tanc~ ~ ~ ~ Current Balance'. ~ -$64Q8.85 Deposits/Credits + Average Daily Balance Withdrawals/Debits - .$1516.t6 Interest Paid this Period * $ OsRS, Annual Percentage Yield Eamed _ Earned this Period $ Paid Last Year Paid Year-To-.Date $ *The interest earned and the interest paid may differ depending on when interest is credited to your account. Service Fees -Itemized Date # Transactions Fee Total MONTHLY MAINTENANCE FEE _ _ 03118h0 _ 1 X10:00 DIRECT DEPOSIT DISCOUNT 1 - Total Checks Posted Check # Date Paid Amount Reference Check # Date Paid Amount Reference _ 4 Check(s) Posted =x888.86 An asterisk indicates a skip in sequential check numbers. An (E) indicates check was converted to an electronic item. Account Activity Date Description Additions Subtractions Balance Beginning Balance .CHECK CHK CARD PUR KARNSOUA KARNSQUALIT ~ MECHANICSBURGPA CHK CARDpUR ©ELLSALE DELLSALES&S TX PUR W/CSH BK310713 WEISMARK 5140SIMPSON MECHANICSBUR PA COMM OF PA UCD UCBENEFITS FEB-10 ' CHK CARD PUR MECHANICS MECHANICSB MECHANICSBURGPA US TREASURY SOC SEC A SSA POS PURCHASE KARNSOUA 4870CARLISL MECHANICSBUR PA CHK CARD PUR CLASSICD CLASSICDRYC MECHANICSBURGPA T. ~ - - PUR W/ CSH BK069283 KARNSOUA 4870CARLISL MECHANICSBUR PA EDS RETIREMENT P PN PMTS/CC MAR F64098MJG/10060 PUR W/ CSH BK401170 WEISMARK 5140SIMPSON MECHANICSBUR PA CHK CARD PUR INFOFREE INFOFREECRE INFOFCR.COM CA pn~e 2 of 4 1 G6 / Sovereign . - Account Activity (Cont. for Acct# Date Description Additions Subtractions Balance UNITED WATER ONLINE PMT CKF419732955POS COMM OF PA UCD UCBENEFITS MAR-10 ~ PUR W/ CSH BK746162 WEISMARK 5140SIMPSON MECHANICSBUR PA CHK`CARD PUR"341363 INFOFREE IN(=OFREECRE '"INFOFCR'.COM CA CHECK COMM OF PA UCD UCBENEFITS MAR-10 CHK CARD PUR EQUIFAXC EQUIFAXCONS GA CHK CARD PUR THESENTf THESENTINEL ' PA CHECK UGI UTILITIES ONLINE PMT100318 CKF419732955POS CHECK INTEREST CREDIT Ending Balance IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS CALL YOUR CUSTOMER SERVICE CENTER AT THE NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRITE TO THE BANK FOR DEBIT CARD ISSUES: FOR ALL OTHER ISSUES: Sovereign Bank Sovereign Bank Attn: Debit Card Services Attn: Client Relations MAI MB 10-421-CR1 P.O. BOX P.O. BOX Boston, MA READING, PA 1 1 Please contact us if you think your statement or receipt is wrong or if you need additional information about a.transfer on the statement or receipt. We must hear from you no later than days after we sent you the FIRST statement on which the error appeared. • Tell us your name and account number. • Describe the error or the transfer that you are unsure about and explain as clearly as you can why • Tell us the dollar amount of the suspected error. you believe there is an error or why you need further infonnation. [f you tell us orally, we may require you to send your complaint or question in writing within business days. We will promptly investigate the matter and call or write to you with an answer within business days calendar days in Massachusetts). IF we need more time, we may take up to days to investigate your complaint or question. If we do, we will credit Your account within This II)-day period for the amount you think is in error, so you will have the use of the money during the time rt takes us to complete our investigation. If we ask you to put your complaint or question in writing and we do not receive it within business days, we may choose not to credit your account. For errors involvingg new accounts, point of sale purchases or foreign transactions, we may take up to days to investigate your complaint or question. For new accounts, we may take up to business days to credit your account for the amount you think is in error We will tell you the results of our investigation within 3 business days after completing our investigation. If we decide there was no error, we will send you a written explanation. You may ask for copies of tre documents we used in our investigation. Important information about your Sovereign Debit Card The nehvorks through which some of your Sovereign Debit Card purchases are processed have begun allowing merchants to process }•our purchases without either a signature or a PIN. If you are not required to enter your PIN when you make a purchase, your purchase may be processed either through the Visa network or through the STAR or NYCE networks. If our purchase is processed through STAR or NYCE, different terms apply and you will not be eligible for the rights and protections available through Visa. Please see your Personal Deposit Account Agreement for more infonnahon. page 3 of ~ Statement Period TO ArasinE- 37p130010 rm ms .r r9..arcunn.,... JOSEPH F. RUSH So-3tannt - m2Aa l la 1p103MM cr.. APE. 10e i3MLM11 I ~ a M a..Nau .wrma MECIWIMSBUp13, PA 1]06651x1 n r~t?1d MOVnwoeu,G elrr3.3n1 Q0M a9 Pn)m„x ham,4q tv«v n /I _ r / /IJ^ aC wa•.u cr ..a _ _ sw. F~Orum 2M0 1 9116e _ i ~ $ W " ~ a Tarr Ax6 rnr 0ouue5 - ~1E'~'~"'•~-'~'~`^"~~- --UOLIAas a s PPl ELECTPoC u)AmES 9p PO 80525tH W10 AOV ~r MV3. ~~~re1EfnB~~- \ O'tlu tE«WHVYLEr.M~MlOx31A 5/9niWreOnFile C/J/IL _ a L„Ip.,1.II..,N.,,J.1.1.4.1A«11.66.JIJJ..61J rti. w~e,me~a;:,e ~ rrr _ E:2 3 1E. 16Si2 LOGS --rgg500 L.•-1:23Y3'?~269'P:-16'fii22~916•• -I0000005200V- # # I ~9991M11: opsazxroo4l"°ro..n......o,.ra~,.«n,,,..~., r<.r..o.rr«,........ 91up _-~L~661.1e,.,3~am3ax .r w.11.,..,~,,,9.v , ern Dhsl A,y OuepM, ASVnn I A,y on.wra r~~„fSxAB j a.rl P« P ul" cr ur w ~~6LJ1PM,rN r.«.w,a c.nl. +aev« Awl r an3r e~r,P,w,l hnc..,w9 crti 3 u~,«~aeu3y Pa lr635a.1• - :iRHr~n'yw`ac, P~3r°®3s9+ Marts I S9vE9e6n an«« 6.,,t Marth i I ~PA9 OME NU88«ifD IWEMIY FOU6 Ally SSIIM DO)l ft5 rY r3RV A60 041N DOl1A »....•124.M = ~ . Ta Ca805r GBLE ~ Ta PM Ei[CIPA: ui2rt(9 TM PO ena Vab AAtl wv5. 'lM Pon0F VW Mer Ir WYS. O.O,r 50UT«FAS` E««. $Ipn9Wra On Flla Oa lE«9N v.'1EY. PA 18002-)il9 S/ynMwB On Fl/e d I.JII.4..IIJJ.J..I.JI,N,,.p.,,J.1.0..J.IJ,.d 31w a,~erworn Awn9«2r w MJp,dJI...I1.....LI.I.I.JJ„N.IJ..J41.I..I..IJ Tnd a~ca E~~w6,~n,e M Ywr a.pmiur av - i Hr r --~-~~~s"~' r•995009r i1; 1 2 269L. 166122491,6~r # # page 4 of4 /66122~9d6 REV-1509 EX + SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. ~ JI~D J1I~ B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed forjointly-held real estate. , / VALUE OF ASSET INTEREST DECEDENT'S INTEREST A. ~ /D N TOTAL (Also enter on line Recapitulation) $ ~ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ SCI~IEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1 FUNERAL EXPENSES: ~ 7 ` s,T E LL o f~'G ff a/yi~C T ,cv/VE/L,¢L effsKe'~ s~i~,~{-~ / ~s9 vd B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees /QO` sd Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line Recapitulation) $ p p - ~,Z (If more space is needed, insert additional sheets of the same size) JOHN A. MORELLO F.D., SUPVR. NICHOLAS ST. EASTON, PA TEL.:610-253-4941 FAX: F u n e r a f H o m e I n C. WWWMORELLOFUNERALHOME.COM Mrs. Marjorie Joseph April Lewis Circle Easton, PA The Funeral Service for Joseph F. Rush, II We sincerely appreciate the confidence you have placed in us and will 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. PROFESSIONAL SERVICES Services of Funeral Director and Staff $ Embalming $ Dressing, Cosmetology, Personal Grooming $ OTHER STAFF AND RELATED FACILITIES Services & Facilities for Viewing $ Services & Facilities for Funeral Ceremony $ Services & Equipment for Graveside Service $ Inc. TRANSPORTATION Transfer of Decedent to Funeral Home $ Hearse $ Flower Car $ Lead Car !Clergy Car $ ~c• MERCHANDISE Saturn Blue, 20ga Steel $ Concrete Grave Liner $ Register Book $ Prayer Cards $ Temporary Gravemarker $ Interior Cross $ CASH ADVANCES Out-of--town Transportation -Harrisburg $ Clergy /Mass Offering $ Certified Copies of the Death Certificate $ Newspaper Notices -Harrisburg Paper $ Joseph F. Rush, II Page 1 TOTAL CHARGES $ Payments $ April Payment - CK#101 $ April Payment - CK#1026 $ BALANCE DUE: $ The statement is net and payable in full on or before April The unpaid balance over days is subjected to a service chazge per month per annum). Joseph F. Rush, II Page 2 OCT-01-10 02:08PM FRO1~-Keystone Naiareth Bank & Trust T-611 P.006/006 F-lld O ~ ~ ~ ~o ~ ~ ~~m ~ ~ ~ ~ O D ~ o ~ ~ Q ~ ~ ~ ~ ~ ~ ~ .w~ ~ ~ • r AI rLl r F~ is 1Cti O m > a~ o l ~ i ~ ~ o l ~ N ID .men N t a\{1U, ~ C u i B~ W OCT-07-2010 97i P.OO6 4 ~ ~ ~ ? _ i.. J ..i F T ~ 1 § , \ ~ ~ --~M..J... ~ ~ F ` v' ~ v ~1.t ~ ~ ~ - ~ v ~ ~ ~ ~ - f „~~'F g:. ~ f x v ,"ten` 42e~ ~s ~.d $ 'v ~ ~ - _''+..r ^~3n~ 8 ~ "'i, ~ t 6k^.! ~ a'r°,..' ~ € _ _ A i,.+ Y Q00041742 Funeral Casket Spray Occasion: Sympathy Rush -Inv. t~ ~ ~ _ _ .1~!.:!..1_ui' f,1I:~P:It'F4 < r!i C r . - - - page 1 of 1 Sales On All Plants Are Final. STATEMENT -Please Check Invoice Numbers To Avoid Duplicate Payments. Thank You. 6 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: Cumberland County - Register Of Wills Receipt Time: One Courthouse S uare Receipt No.: Carlisle, PA RUSH JOSEPH F II Estate File No.: Paid By Remarks: JAMES WITTE WZ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST CUMBERLAND COUNTY GENERAL FUN WILL CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE CUMBERLAND COUNTY GENERAL FUN JCS FEE BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE CUMBERLAND COUNTY GENERAL FUN Check# Total Received......... REV-1512 EX+ SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~/o I~/E TOTAL (Also enter on line Recapitulation) $ ~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. (a) ~o~~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES THROUGH AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE /(/o/~% B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE OF REV-1500 COVER SHEET $ ~ (If more space is needed, insert additional sheets of the same size) REV-1514 EX+(12-03) SCI'IEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4 on REV-1500 Cover Sheet ESTATE OF FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication Actuarial Values, Alpha Volume for dates of death from to and in Aleph Volume for dates of death from and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ? Will ? Intervivos Deed of Trust ? Other • 'NAME(S) OF LIFE TENANT(S) DATE ©F BIRTH NEAREST AGE AT TERM OF YEARS ,.DATE OF DEATH LIFE ESTATE IS RAYABLE ? Life or ? Term of Years ? Life or ? Term of Years ? Life or ? Term of Years ? Life or ? Term of Years ? Life or ? Term of Years Value of fund from which life estate is payable Actuarial factor per appropriate table . Interest table rate - ? 3 ? ? ? Variable Rate Value of life estate (Line 1 multiplied by Line • NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE ? Life or ? Term of Years ? Life or ? Term of Years ? Life or ? Term of Years ? Life or ? Term of Years Value of fund from which annuity is payable Check appropriate block below and enter corresponding (number) . Frequency of payout - ? Weekly ? Bi-weekly ? Monthly ? Quarterly ?Serni-annually ? Annually ? Other ( ) Amount of payout per period Aggregate annual payment, Line 2 multiplied by Line 3 . Annuity Factor (see instructions) Interest table rate - ? 3 ? ? ? Variable Rate Adjustment Factor (see instructions) . Value of annuity - If using or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line + Line 3 ~ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines and through (If more space is needed, insert additional sheets of the same size) REV-isaaEx.ls-oaf INHERITANCE TAX SCHEDULE L COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT INHERITANCE TAX RETURN RESIDENT DECEDENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER I. ESTATE OF (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section of the Inheritance and Estate Tax Act of or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 Real Estate Stocks and Bonds Closely Held Stock/Partnership Mort a es and Notes $ 9 9 Cash/Misc. Personal Property Total from Schedule L-1 D. Credits: Complete Schedule L-2 Unpaid Liabilities Unpaid Bequests Value of Unincludable Assets Total from Schedule L-2 E. Total Value of trust assets (Line - minus Line D-4) F. Remainder factor (see T e I or Table II in Instruction Booklet) . G. Taxable Remainder lue (Line E x Line F) (Also enter on Line Recapitulation) III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed D. Remainder factor (see Table I or Table II in Instruction Booklet) . E. Taxable value of corpus consumed (Line C x Line D) (Also enter on Line Recapitulation) aFV..16e5 EX+ INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -ASSETS- FILE NUMBER I. Estate of (last Name) (First Name) (Middle Initial) I1. Item No. Description Value A. Real Estate (please describe) Total value of real estate (include on Section II, Line C-1 on Schedule L) B. Stocks and Bonds (please list) Total value of ocks and bonds $ (include on ction II, Line C-2 on Schedule L) C. Closely Held Stock/Partnershi attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgage and Notes (please list) Total value of Mortgages and Notes $ (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property $ (include on Section Line C-5 on Schedule L) TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8'/s x sheets.) REV-1646 EX+ INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER I. Estate of (Last Name) (First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ (include on Section II, Line D-1 on Sched L) B. Unpaid Bequests payable from assets reported on Sched L-1 (please list) Total unpaid bequests $ (include on Section II, Line D-2 on Schedule L) C. Value assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part the trust. Computation as follows: Total unincludable assets $ (include on Section II, Line D-3 on Schedule L) III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ (If more space is needed, attach additional 8'/z x 1 1 sheets.) REV-1647 EX+(9-00) SCI~IEDULE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4a on Rev-1500 Cover Sheet ESTATE OF FILE NUMBER This Schedule is appropriate only for estates of decedents dying after December This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ? Will ? Trust ? Other I. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY II. For decedents dying on or after July if a surviving spouse exercised or intends to ex ' e a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the ument in which the surviving spouse exercises such withdrawal right. ? Unlimited right of withdrawal ? Li ' ed right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: Amount of Future Interest Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line of Cover Sheet) Value of Line 1 passing to spouse at appropriate tax rate Check One ? ? ? (also include as part of total shown on Line of Cover Sheet) Value of Line 1 taxable at lineal rate Check One ? ? (also include as part of total shown on Line of Cover Sheet) Value of Line 1 taxable at sibling rate (also include as part of total shown on Line of Cover Sheet) Value of Line 1 taxable at collateral rate (also include as part of total shown on Line of Cover Sheet) Total value of Future Interest (sum of Lines 2 thru 6 must equal Line (If more space is needed, insert additional sheets of the same size) REV-1648 EX SCHEDULE N ~ SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH TO INHERITANCE TAX DIVISION ESTATE OF FILE NUMBER This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. ~ ~ , 1 Taxable Assets total from line 8 (cover sheet) 1 . Insurance Proceeds on Life of Decedent Retirement Benefits Joint Assets with Spouse PA Lottery Winnings 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6b. 6c. 6d. SUBTOTAL (Lines 6a, b, c, d) Total Gross Assets (Add lines 1 thru Total Actual Liabilities Net Value of Estate (Subtract line 8 from line If line 9 is greater than -STOP. The estate is not eligible to cla the credit. If not, c tinue to Part II. Income: TAX YEAR: AX YEAR: TAX YEAR: a. Spouse ia. 2a. 3a. b. Decedent 1 b. 2b. 3b. c. Joint 1c. 2c. 3c. d. Tax Exempt Income id. 2d. 3d. e Other Income not listed above 1e. 2e. 3e. f. Total 1f. 2f. 3f. Average Joint Exemptio ncome Calculation 4a. Add Joint Exemption come from above: f) + (2f) + (3f) - 4b. Av ge Joint Exemption Income _ line 4 6 is rester than -STOP. The estate is not eli ible to claim the credit. If not, continue to Part III. Insert amount of taxable transfers to spouse or whichever is less 1 Multiply by credit percentage (see instructions) 2 This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line of the cover sheet . For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .Include this figure in the calculation of total credits on line of the cover sheet....... REV-1649 EX SCHEDULE 0 COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN SPOUSAL DISTRIBUTIONS RESIDENT DECEDENT ESTATE OF FILE NUMBER Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's survivin souse under a Section A trust or similar arran ement. DESCRIPTION VALUE Part A Total $ ~ Gd PART B: Enter the descri tion and value of all interests in ed in Part A for which the Section A election to tax is bein made. DESCRIPTION VALUE Part B Total $ ` d ~ (If more space is needed, insert additional sheets of the same size) REGISTER OF WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA R No . PA No . Estate Of : JOSEPH F RUSH (first, Middle, Last) Late Of : MECHANICSBURG BOROUGH CUMBERLAND COUNTY Deceased Social Security No: WHEREAS, on the 29th day of March an instrument dated February 2nd was admitted to probate as the last will of JOSEPH F RUSH (First, Middle, Lastl late of MECHAN/CSBURG BOROUGH, CUMBERLAND County, who died on the 11th day of March and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: MARGARET A MCDONOUGH-WITTE and CHARLES J WEINMANN who have duly qualified as EXECUTOR(R/X) and have agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IIV TESTIMOIJY WHEREGF, I have hereunto set my hand and affixed the seal of my office on the 29th day of March Regrste f ills De tv * * NnTF. * * AT,T. NAMF,.S ABOVE APPEAR (FIRST , MIDDLE, LAST _ .J i LAST WILL AND TESTAMENT OF ~f~~~ u~il= JOSEPH F. RIISH .r~ ~ t., :1L~ i I, JOSEPH F. RIISH, a resident of Lint~li'~m Cou`r't; Apartment Mechanicsburg, Dauphin County, Pennsylvania being of sound mind and understanding, declare this to be my last Will and Testament and hereby revoke any Will I may have previously made. FIRST: I direct that all my legal debts and funeral expenses shall be paid from my estate as soon as practicable after my decease as part of the administration of my estate. SECOND: I direct that ail taxes which may be assessed in consequence of any property passing through or under this, my Last Will and Testament, shall be paid from my estate as part of the expense of the administration of my estate. THIRD: I give, devise, and bequeath all of the rest, residue and remainder of my estate, of whatever kind and wherever situate, in equal shares, to my children, Marjorie L. Rush and Joseph F. Rush III. In the event that eith€r of my children shall predecease me, then I give, devise, and bequeath his or her share to his or her issue, per stirpes, and in default of any such living issue, I give, devise, and bequeath such child's share to my surviving child, or his or her issue, per stirpes. FOIIRTH: I appoint my hereinafter named Executor as Trustee of the estate of any children under the age of twenty-one years, until such children reach that age, with respect to all property passing to or vesting in such children by reason of my death, whether such property passes under the terms of this will or otherwise. The Trustee may, in his/her/its discretion, accumulate for such children the whole or any part of the income and/or principal from my estate, or may pay, distribute, or apply the whole or any part of the income and/or principal at any time held for such children, including accumulated income, to or for the maintenance, support, education, and general welfare of such children, either directly or by making payment or distribution thereof to any guardian or legal representative, wherever appointed, of such children, with the right to make such payments without the intervention of a guardian. In addition to the foregoing, I also give specific authority to the Trustee to make distributions for the higher education of any beneficiary, including expenditures from either income or principal for tuition, books, supplies, room and board, or transportation to and from school, which may, in the Trustee's discretion, include the purchase of an automobile. I direct that neither the income from said trust estate, nor the principal fund, shall be liable for the debts of the beneficiary, present or future, nor shall it be subject to the right on the part of any creditor to seize or reach the same under any writ or by any proceeding at law or in equity. The beneficiary shall not have any power to give, grant, sell, convey, mortgage, pledge, or otherwise dispose of, incumber, or anticipate the income, or any installment thereof, or any share in the principal thereof, it being my will that no right of 2 disposition of any such property shall vest in the beneficiary until the same shall have been actually transferred or paid over to the beneficiary. FIFTH: I appoint my sister, Margaret (Madge) Anne Witte, of zz Durham Road, P. O. Box-3.4, Mechanicsville, Pennsylvania and my brother, Charles Weinmann, of North Line Road, Lansdale, Pennsylvania as Co-Executors of this, my Last Will and Testament. In the event that either one should fail to qualify or cease to act as said Co-Executor, I then appoint the remaining individual as sole Executor. My Co-Executors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREQF, I, JOSEPH F. RIISH, have to this, my Last Will and Testament, typewritten on three sheets of paper, set my hand and seal, this Z day of r~ WITNESSES: ~ l ~ir. ~ ( SEAL ) ~/r ~ Jf~S RUSH t/ ' 3 COMMONWEALTH OF FENNSYLVANIA . ss. COUNTY OF YORK I, JOSEPH F. RUSH, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed this instrument as my Last Will and Testament, willingly, as my free and voluntary act, for the purpose therein expressed. Sworn to and acknowledged before me by JOSEPH F. RUSH, this day of . U COMMOI~JWEALTH OF PENNSYLVANIA , i Notarial Seal Deborah Ann I.a: Notary Publio City ofY<,ri. ~.,,-t~ Cn,,,,ty. dry Pub My Commission 1-:xnirtr i)ac. ~ COMMONWEALTH OF PENNSYLVANIA . ss. COUNTY OF YORK We, Marc Roberts and tt,Gtr~_ N~ the witnesses whose names are signed to the attached instrument, being duly qualified according to law, do affirm that we were present and saw JOSEPH F. RUSH sign and execute the attached instrument as his Last Will and Testament, willingly, as a free and voluntary act, for the purposes therein expressed; that in the hearing and sight of JOSEPH F. RUSH we have signed this Will as witnesses; and that to the best of our knowledge, JOSEPH F. RUSH was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn to and subscribed to before me by the above named witnesses, this ~ day of ( v ~ L_ ~ Wi ess G~- Witn s COIbUdONWE~,~ OF PENNSYLVANIA Ot ry Pu 1 Deborah Ann arial Seal Lau, Nat,~y public City of York, York County awry Commission Expires Dpc. i ~ . ui a r_ c. ~ a: w r•.y~ E ~ ~ v. i a¢ c o _ =i = U LLl E ~ . i N d ' ~ O - O ~ o ti C J ,t+ ~ _ a. r ~ a r - r I~ - ' :r~ C ~ _ ~w~a ~ H YK fit ~r ~ . iA I~ ~ I H k1 ~ i ~ ~ ~ ~ ~a, ~ i _ a.r f a+ f ~ 4 ry, ~ yr s Y ~ i~ r~ ~ ~ . - ~~+V ~ N ~ ~Y N U - ,.r I%f. iLl 'C > r REV-1504 EX+(1-97) SCNEDI~LE C - CLOSELY HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~/o~l~ TOTAL (Also enter on line Recapitulation) $ ~ Oll (If more space is needed, insert additional sheets of the same size} REV-1505 EX+ SCHEDULE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSELY HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Name of Corporation State on Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders Federal Employer I.D. Number Business Reporting Year Type of Business ProductlService TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK PAR VALUE YotingtNon-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all rights and restrictions pretaining to each class of stock. Was the decedent employed by the Corporation? ? Yes ? No If yes, Position Annual Salary $ Time Devoted to Business Was the Corporation indebted to the decedent? ? Yes ? No If yes, provide amount of indebtedness $ Was there life insurance payable to the corporation upon the death of the decedent? ? Yes ? No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to ? Yes ? No If yes, ? Transfer ? Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and(or sales. Was there a written shareholder's agreement in effect at the time of the decedent's death? Yes ? No If yes, provide a copy of the agreement. Was the decedent's stock sold? ? Yes ? No If yes, provide a copy of the agreement of sale, etc. Was the corporation dissolved or liquidated after the decedent's death? ? Yes ? No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. Did the corporation have an interest in other corporations or partnerships? ? Yes ? No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • • ~ ~ A. Detailed calculations used in the valuation of the decedent's stock. Complete copies of financial statements or Federal Corporate Income Tax returns (Form for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market valuels. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ SCHEDULE C-Z PARTNERSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Name of Partnership Date Business Commenced Address Business Reporting Year City State Zip Code Federal Employer I.D. N er Type of Busine ProducUService Decedent was a ? General ? Limited partner. If decedent was a limited partner, provide initial investment $ PARTNER NAME PERCENT PERCENT BALANCE OF _ _ OF INCOME ~F OWF1ERSfitP CAPITAL ACCOUNT A. B. C. D. Value of the decedent's interest $ Was the Partnership indebted to the decedent? ? Yes ? No If yes, provide amount of indebtedness $ Was there life insurance payable to the partnership upon the death of the decedent? ? Yes ? No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to ? Yes ? No If yes, ? Transfer ? Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. Was there a written partnership agreement in effect at the time of the decedent's death? ? Yes ? No If yes, provide a copy of the agreement. Was the decedent's partnership interest sold? ? Yes ? No If yes, provide a copy of the agreement of sale, etc. Was the partnership dissolved or liquidated after the decedent's death? . ? Yes ? No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. Was the decedent related to any of the partners? ? Yes ? No If yes, explain Did the partnership have an interest in other corporations or partnerships? ? Yes ? No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • • ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market valuefs. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX+ SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line Recapitulation) $ ~ DO (If more space is needed, insert additional sheets of the same size) rtw iwaex, hs>> SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ . So V E'/~E' ~G N ~V K ~ ~o ~ ~S r 99cf L./~?~'oG n! ~~cl i ~,vcN i,4-L... d3o . vo So c. D 1 ~~-.S ~ S',3 . o 0 ~O U SE ~4G. l> ~oo ~S ~d~/~/Sffill~C~ S ~ (715~9-R~cD U~~ED Eit1 ~ Lv r¢ g r~ ~ / srr d KC2 iN ~ o~clE t3~0 ~o~~I TOTAL (Also enter on line Recapitulation) $ ~O ! ll • (If more space is needed, insert additional sheets of the same size) Santander Strong--- ` \ Sovereign Sovereign is part of Santander, "Global Bank of the Year."* r Statement Period TO SOVEREIGN INTEREST CHECKING For your convenience our Customer Contact Center is available from 7 am - 8 pm EST, 7 days a week. Call us at 1-877-SOV-BANK Hearing impaired may call (TTY/TDD). JOSEPH F RUSH www.sovereignbank.com LINDHAM CT APT MECHANICSBURG PA n o 0 0 ~olso 16onn3z6s8 PROTECTION AND CONVENfENCE Do you want peace of mind by avoiding paten#ially embarrassing situations where your transaction is denied".due to insufficient or unavailable funds? If you wish to continue to allow the Bank to pay ATM and one-time debit purchases that overdraw your accotant, which. may result in overdraft fees,' please read the=notice below` and either call or visit a branch to give] your consent. IMPORTANT INFORMATION Overdraft Opt-In Notice: What You Need to Know about Overdrafts and Overdraft Fees and the changes coming on August OVERVIEW An overdraft occurs when you do not have enough money in your account to cover a transaction, but we pay it anyway. We can cover your overdrafts in tvvo different ways: We have standard overdraft practices that come with your account. We also offer an overdraft protection plan which allows you to link other accounts, such as a savings account or an overdraft line of credit, to cover overdrafts in your checking account. This plan may be less expel ~sive than our standard overdraft practices. To learn more, ask us about this plan. This notice explains our standard overdraft practices. STANDARD OVERDRAFT PRACTICES What are the standard overdraft practices that come with my account? Sovereign may currently authorize anti pay overdrafts for the following types of transactions: ¦ Checks and other transactions made using your checking account number s ATM withdrawals and transfers ¦ Automatic bill payments ¦ One-time debit card transactions ¦ Online Banking payrents and transfers ¦ Recurring debit card transactions We pay overdrafts at our discretion, which means we do not guarantee that eve will always authorize and pay any type of transaction. If we do not authorize and pay an overdraft, your transaction will be declined. OVERDRAFT PRACTICES EFFECTIVE AUGUST As of August Sovereign will no longer authorize and pay overdrafts on the following types of transactions, UNLESS you authorize us to do so by visiting a branch or calling us at 1-877-SOV-BANK. ¦ ATM withdrawals and transfers ¦ One-tune debit card transactions ¦ What if f want Sovereign to authorize and pay overdrafts on my ATM and one-time debit card transactions as of August If you want us to authorize and pay overdrafts on ATM and one-time debit card transactions, the easiest way to do so is to call us at 1-877-SOV--BANK or visit a branch to fill out a form. What fees will I be charged if Sovereign pays an overdraft caused by my ATM or one-time debit transaction? Under our standard overdraft practices: •We will charge you a fee of up to S35 each time we pay an overdraft. •Also, if your account is overdrawn for 5 or more consecutive business days, we will charge an additional per day. •There is a limit of 9 fees per day vve can charge you for overdrawing your account. What happens if I don't authorize Sovereign to charge overdraft fees on these transactions? UVithout authorization from you, we generally won't processATM or one-time debit card purchases that would overdraw your account. ¦ Can I change my mind later? If you tell us that vve are permitted to pay any overdrafts caused by ATM or one-time debit transactions, you can always change your mind and tell us you no longer want us to do this. You can visit any branch or call us at 1-877-SOV-BANK and tell us you no longer want us to pay these types of overdrafts. woacva Sovereign Bank is a Member FDIC and a wholly owned subsidiary of Banco Santander, S.A. ~ Sovereign and its logo and Santander and ~ / page / of 4 ~ logo are registered trademarks of Soveregn Bank antl SantarWer, respecfively, or [heir affiliates or subsidiaries In [he UnRed States and other counMes. 'According to The Banker, December,