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Home My WebLink About09-14-111505610143 EX (01-10 ~' REV-1500 ) ~ OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEFIIRTMENT OF REVENUE PO BOx.2sosof INHERITANCE TAX RETURN 21 11 ~~ r~~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 194 42 8914 O1 02 2011 09 30 1951 Decedent's Last Name Suffix Decedent's First Name HOCKENBERRY J,pgRy (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number MI V MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ~ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ^ qa Future Interest Compromise 5. Federal Estate Tax Return Re uired (date of death after 12-12-82) ^ 4 g Decedent Died Testate (Attach Copy of Will) ^ 7 Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p. Sppousal Poverty Creditl(date of death 11. Election to tax under Sec. 9113(A) bEtween 12-31-Jt and -1-95) ^ (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GEORGE F DOUGLAS III ESQ 717 249 6333 First line of address 354 ALEXANDER SPRING RO Second line of address City or Post Office State ZIP Code CARLISLE PA 17268 Correspondent's a-mail address: 9douglas@Salzmannhughes.com ~~ ~_ a O -- REGISTER OF`.1Ma.S USE ONLY _"r ~;_ C7 ,~- -~~ ; = .~ ~ ~"- ~~ ~ t~_1 ,' -,_ _:; 7 - - -1 , - _ , DATE FILED ~ r a, ~~t unaer penaiues or peryury, I Declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, ct; s~tr Te, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Ella I. Hocke /~ /! / 227 Bobcat Rd. Carlisle PA 17015 SIGNATURE OF PREPARER OTHER THAN REPR SENTATIVE DATE George F Douglas, III Esq. II ADDRE S 354 Alexander Spring Road, Suite 1, Carlisle, PA Side 1 1505610143 1505610143 --.~., ', , REV-1500 EX 1505610243 Decedent's Name: HOC~(ellberry, Larry V. RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 2. Stocks and Bonds (Schedule B) ............................................................................. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ 4. Mortgages & Notes Receivable (Schedule D) ...................................................... 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 7. Inter-Vivos Transfers & Miscellaneous coq Probate Property (Schedule G) u Separate Billing Requested............ 8. Total Gross Assets (total Lines 1-7) ..................................................................... 1. 2. 3. 4. Decedent's Social Security Number 194 42 8914 5. 6,385.00 6. 7~ 112,468.60 $~ 118,853.60 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a>(1.2)x.oo 103, 196.36 15. 16. Amount of line 14 taxable at lineal rate X .045 0.00 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due .................................................................................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 5,015.00 10,642.24 15,657.24 103,196.36 103,196.36 0.00 0.00 0.00 0.00 0.00 Side 2 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11 DECEDENT'S NAME Hockenberry, Larry V. STREET ADDRESS 227 Bobcat Rd. CITY Carlisle STATE ZIP PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 0.00 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 0.00 Total Credits (A + g) (2) 0.00 (3) (4) (5) 0.~~ _ Make Check Payable to REGISTER OF WILLS, AGENT ^'~ ~~~5., ',~"i1x~~4~~'a2~+.~'~K~er~+i''~~'~R~ i""~~-. ±'i, ~y{ ~ , ~ ai r, ~~::- a. ti , PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... ^ b. retain the right to designate who 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? ................... x ............... . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ [~ 4. 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. .,~.. ~ fir. v.~bi.~i_ ~~ .^4C ~e',~r~ ;~ ~, ` ~ ," +~','a .,,... For dates of death on or after Jul 1, 1994 and before Jan~1,~1, the tax ra ^ posed on the net value of transfers to or for the use y of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (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 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 [72 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 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 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 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1508 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Hockenbern V. FILE NUMBER 21-11 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 1997 Mazda B 4000 pickup truck 2 2004 Saturn VUE Sport Utility 4D VALUE AT DATE OF DEATH 1,775.00 4,610.00 TOTAL (Also enter on Line 5, Recapitulation) I 6,385.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+(6-98) SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hockenbe V. FILE NUMBER 21-11 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST IFEXCLUSION ( APPLICABLE ~ TAXABLE VALUE 1 Members 1st Federal Credit Union, IRA Certificate No . 12,877.02 100.000% 12 877 02 23226-16 -Beneficiary -Ella I. Hockenberry, Spouse , . 2 Thrift Savings Retirement Plan -Beneficiary -Ella I. 99,591.58 100.000% 99 591 58 Hockenberry, Spouse , . TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 112,468.60 Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+~10-06) IN E ITAN E R T RN COMMOHRESIDENT D CEDEN~YLVANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hockenberry, Larry V. 21-11 N I MB R DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s1 Commission paid 2. Attorney's Fees Salzmann Hughes, P.C. 1,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3 500.00 Claimant Ella I. Hockenberry Street Address 227 Bobcat Rd. City Carlisle State PA Zip 17015 Relationship of Claimant to Decedent SpOUSe 4. I Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 5,015.00 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Hockenberry, Larry V. 21 11 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Register of Wills -filing fee 15.00 H-67 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Hockenbern V. FILE NUMBER 21-11 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Members 1st Federal Credit Union, Credit Card Account No. 4672090000058339 8,769.82 2 I Members 1st Federal Credit Union, Loan Account No. 23226-09 1,872.42 TOTAL (Also enter on Line 10, Recapitulation) I 10,642.24 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-08) COMMONWEALTH OF PENNgYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hockenber , Lar V. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(aN1.2N 1 Ella I. Hockenberry 227 Bobcat Rd. Carlisle, PA 17015 FILE NUMBER 21-11 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Spouse I Entire Estate I 103,196.36 ~ ~ Total I 103,196.36 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet, as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS SCHEDULE J BENEFICIARIES 1 OTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) l~i~l .~~~ ;! 'S ~C:`..'.S .~`__ ~ ~?., -~ 1~diC t'~:i'.V ~ .,_C; ..t~C)1L ...... ._.. ~, i~}!C3 ~~~ THE7RU5TEL7 RES~tJRtE }i ,' ~` ~~l •,r, - ----. - . .~ J`~~,.. ._ _ b __ aro7~' F it a Send r., ~-;nr,~. < ~ I ~~ _ _ ___ 1997 Mazda B-Series Regular Cab B4(3OO 4W® Short Bed BLUE BOOKfl PRIVATE PARTY VALUE Condition Value ~~e~lent $2, a~C~ '+'~ Eair $1,775 (Selected; Vehicle Highlights Mileage: 130,000 Engine: V6, 4.0 liter Transmission: Manual, 5-Spd Drivetrain: 4wD Selected Equipment Standard Powe; Steering AP9/FM Si2reo Steel :'d'neels Blue Book Private Party Value Kelley Blue Beck Private Party Value is the amount a buyer can expect to pay when buying a used car from a private party. The Privato Party Value assumes the vehicle is sold "AS Is" and carries no v,•arranty (other than any remaining factory warranty). The final sale price may vary depending on the vehicle's actual conditicn and local market conditions. This value may also be used to derive Fair Market Value fcr insurance and vehicle donation purposes. Vehicle Condition Ratings Ex~el]~~at ~ sSCB • t ;c.:ks rr ~, ,.. _:aent '. _r -1a-'~..._,.,I:' ~Cr ac'. ~ .. _. -~d ~;`,Il~g, s der; N1 i~.e ~,^, l ,17i~•^.; _. . i I L -,: ~ c,.,Gg 3" 1'-: `.--,- I' . ~. • t- ~-~~.._ t ~~ ;.. .i I- rl _? ~'~. J `Ui(' t-:7 i ,:, I _.._ ""/ .,,_.~,r Cr Gt3{3d - -- advertisement - ~'"•l ~ iJ iJ f ~, , ~ • ..., _. .. ~ i _ .. ~ 1t I,-lay. _. _ ... ... 'Ill ... ~ ~.,... ,., ., ., .. ., ,.._ c I., ....:I '.. FdlC (Selected; $1,775 • some mechanical or cosmetic defects ar:d needs servicing but is still in reasonable running condition. • Clean tide history, the paint, body andJor interior need vdork per`ormed by a prcfessicnal. • Tires may need to be replaced. • There may be some repairable rust damage. r° 0 X31' ~' /~ ~~ ~ ,.,_,erC 1, Cha-^._o al di., ~ ~C _;'IEL.C d_°°_ru ..a~ I~ wvGr rl 1 r ~:_ir;~L - -~_ • :'-ia: h,3,~ ,,.,,.. .I ~ _~ ?t ~_.?nl";1 :, r_ d!i,. f, ...1 .._ n ... z. ,. ;rx! :~r a rssta~;-tbr I:cdy. u.e!I r~.~,n °r. ,r r~ t ...~r~,pt to r , . ._. _ , n Nacr" . _ir~ b~ _ ;:~~, * Pennsylvania O1J18J2011 C; 2011 Kelley Blue Book Co., Inc. All rights reserved. Sj1a;2011-1/ZC!,/2p11 Editirn. The specific infcrrnaGOn regwred to determine the value for this particular vehicle was supplied b, the person generating this repent. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or of?rer particular cirrumsfances pertinent to this particular vehrde or the transaction or the parties to the transaction. phis report is intended for the individual use of the person generating this report cnl, and shall not be sold or' transmitted to ancti?er party. Kelley Blue Book assumes no responsibility for errors or omissions. (v.1.1013) Close Windeyv ~~~ ~~ ~~~~ ~~~ THETRUaTEC~ RF,~OUP.CE _~ _ tC ?rlntar 7 ' o" ;: 2004 Saturn VUE Spurt Utility 4D BLUE 800K® pRiVATE PARTY VALUE . ~._. ~-,~ Condition .~~t~~. l ,...~ ~` ~t~od ~ ~ ~~ (Selected) ~3T' Vehicle Highlights Mileage: 128,OOr~ Engine: 4 Cyl, ?.2 ^ter Transmission: Automatic Drivetrain: AVJD Selected Equipment Standard Air Conditionin * \rJ^e~l Cua A:r Bags Povaer Steering A6'/Fht Stereo Steel b'~/heels Blue Book Private Party Value Kelley Blue Beok Private Party Va:ue is the amount a buyer can expect to pay when buying a used car from a privatz party. The Private Party Value assurnes the vehicle is sold "As Is" and Carr ies no 4'Yafranty (other- [i~an any remaining factory warranty). The final sale price may vary depending on the vehicle's actual condition ar,d local market conditions. This value may also be used to derve Fair P~larket Value for insurance and vehicle dor3ation purposes. y~pi~d:~ $4,53.0 ~~~~~~ Vehicle Condition Ratings Exce93*~n~ _ , $~C33~ • t ,. ~ . , _ouci_ _, ~:ul _.. ,, ...~ :.fi way. s f -i 5 :, ~~ rust. s I _ ,.': '~ s a ~ o ; and sa`ety r _,!or. ., a; ~u .. ~ ._ `t . _;. Les;tr ~.~., r ._.~;, _> .iii±,_ ..,.a' ,_r. "ci~ir,£I rn ~'s=;~3 ytigt°iF' ~ _rtr-: ~,7u~ 'i~as: 4a' ~4n ,.~~.1:._ _ i ii Winn, . Close l'~Jlr o,;~ -.')t~-~ SP.tI. t_ - - ,.ill:.' .. l I ~:i': , _ - .~ - - 1" _ GOOC~ (se!ectedi $4,610 • Free of any major defects. • Clean trtie history, the paints, body, and intoner have or,iy minor (if any) blemishes, and there are no major mechanical problems. • Little cr no rust on this vehicie. • Tires match and have substantial tread wear lef*,. • A "good" vehicle will reed some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. Fair {{~~ y.y^^~~ • ~p:ra n ~_ .. ,."l~ ... w_ '.C dp:..r;g :.^.~i F,_.i5 SP :`.,_ b .. c, ,.... r~9-~Ci~l I + rUt?n y ri Ci 0.3 _. __ v • Cleu^ tl ~ '~i_.~r;, -Po- t, .^_od'~. a:~''r.^, irtc;'Irr rce ; ,tint _i , • TI-.~s may n=e-i to h._ ,a~inra,d. • T^e e rr~; t ..^r ~F;,: :r 7=.~ ru_.,. as n.~ ~rJOr ~'^~ ;~ • 52vere r _,. ~ ::,a~ a~~ ~,'cr ~_ . ret:c''r°s'ct, end is it ., _ i rt. G rr Ir n • i%1, t'., ,I ,..;,i .', i3 r.. 1,Jt ,_ r..,G. i'v fn'1 .,., . ..~.. ... ,_,.~ .: d • E .. _3a (`.~< 7 ~ f.!~'. 1, :',:C.) ri' J^Sl ..-3 L.:I..i .. ~(: :: ~7%'. ,_ . , Kefle; clue Bt h ra,e r t __._. „t to . _ rt a a i':,: _ n a ~c: ° _L +.e ,~ ..,.t_ ,. ; ltj'ue r;f t.t;;; v rlr~r, { < a ,<r A ~ t. Ir p,. .~cr „Its.,:. r- Indep : c,en a ~ ~ _.... ^.~__.. :ra ;ti> v .e. .~ * Pennsylvania O1/18/2D11 2011 Kelley Slue Book Co., Inc..7/I;ight5 reserved. Ij11,12011-1;20,/2p11 Edit;cn. The;/;ec;ric information required to determine the value for this particular vehicle was supplied by the person generating this report. Ve.hide valuatons are opinions and may vary from vehicle to vehicle. flctual valuations will vary based upon rnarket conditions, specifications, vehicle condition or eiher particular circumstances pertinent to thrs particular vehicle or the transaction cr the parties to the transactia7. This report is intended for the individual use of the person generatin_q this report onl, and shall not he sold or transmitted to another party. Kelley Slue Book assumes no responsibility for errors ur omissions. (v.11013) $~ I~IEMBERS 1St FEDERAL CREDIT L'NION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 23226-00 Date Account Established .12/27/1979 Principal Balance at Date of Death $223.63 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest ~ $223.63 Name of Joint Owner EIIa Hockenberry Date Joint Ownership Established .09/24/1983 CHECKING ACCOUNT: Account Number/Suffix 23226-11 Date Account Established 09/24/1983 Principal Balance at Date of Death $827.22 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $627,22 Name of Joint Owner Ella Hockenberry Date Joint Ownership Established 09/24/1983 HOLIDAY CLUB ACCOUNT: Account Number/Suffix 23226-02 Date Account Estabiished 09/03/1992 Principal Balance at Date of Death $570.24 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest $570.24 Name of Joint Owner Ella Hockenberry Date Joint Ownership Established 09/03/1992 IRA CERTIFICATE OF DEPOSIT: Account Number/Suffix 23226-16 Date Account Established 02/12/2010' Principal Balance at Date of Death $12,826.76 Accrued Interest to Date of Death $,26 Total Principal and Accrued Interest $12,827.02 Name of Beneficiary Ella Hockenberry 'Rollover from IRA certificate 23226-15, originally established 02/15/2000. LOAN ACCOUNT: Account Number/Suffix Date Opened Principal Balance at Date of Death Loan Type Interest Rate Name of Co-Borrciwer VISA CREDIT CARD ACCOUNT: Account Number Date Account Established Balance at Date of Death Name of Joint Cardholder 23226-09 05/07/2008 $1, 872.42 Unsecured 10.39% None 4672090000058339 09/24/1986 $8,769.82 None M ERS 1ST FEDERAL REDIT UNION ~~.~~ Danielle A. Kline Lending Insurance Support Specialist January 2~, 2011 Estate of: Larry V. Hockenberry Date of Death: 01/02/2011 Social Security Number: 194-42-8914 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org Th~-1ft S~YIngS Plan -Retirement Account for Larry V. Hockenberry . Beneficiary: Ella I. Hockenberry -spouse Your account balance below is based on share prices as of close of business 01/10/2011. Account balance information is updated by 6 a.m., Eastern time; each business day. On occasion; hea~~y volume during the nightly processing cycle may delay the update by a fe~v hours. View balance as of: rnmldd%v~,~,w Investment Funds Shares Share Price Balance distribution Contribution Lifecycle Funds of Account Allocation L 2040 0.0000 $17.8543 $0.00 0.00°~0 ~ ° 0 /° ~ L 2030 0.0000 $17.4326 $0.00 0 00°i . ° L 2020 . o 0.0 io 0.0000 $16.9757 $0.00 G.00% 0 0° /0 L Income 0.0000 $14.6980 $0.00 0 00° ~ . . ° Individual Funds . , 0 0.0 ,~° G Fund overnment Securities 1.420.9717 $13 4983 . $19,180.70 19.26% °, 20 0 ,° F Fund Fixed Income Index 1.065.5399 $14.2465 $15 180 21 F ° . , . _2 1 ~ 4 /° 20 0° ~0 C Fund Common Stock Index 1,371.2887 $15.3635 $21 067 79 ° . . . . 21.15 ~b 30.0'/° S Fund Small Cap S±ock Index 1,043.8029 $21.5110 $22 453 24 ° . . 2 2.55 /0 15 0% I Fund International Stock Index _ 1 102.7006 818.6877 $21 709 64 . _ _ __. _ ... _ ._. . 21.80% 15.0% Total _. .. _ . . _. .. _ _ _. _ _. _ _ $99,591.58 100.00% 100.E°%_ 4~ie~sr your 12-Month personal rate of return >4`CCOt.lt'it C~tstt'ihsi#6naro ~4f~'kt'll]Lr:tic~n ,4`Ilnr~tgr~.~~ i I I i Fund = Fund _ ~~ y F Fund j = 15.24": IIII 5 F u n d = ~2.55~' ~ , F~md _ ?1.15"6 i I fund = -- - -- -- es 1:,. ~~ Fund { _~ up' ' I 5 Fund _ - = 15': --. _ F fund = Z n'6 ~ Fund _;~~ https://www.tsp.gov/tsp/accountBalance.do?subaction=view& name=nfclo in - cJ 1%11/2011