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HomeMy WebLinkAbout10-14-111505610140 1500 EX `°'"'°' REV - OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN PO BOX 280601 2 1 0 9 0 7 6 9 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 1 9 4 6 8 0 7 0 6 0 7 1 1 2 0 0 9 1 2 1 8 1 9 7 6 Decedent's Last Name Suffix Decedent's First Name MI B U C H Y P E T E R A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI P A R I S- B U C H Y R E N E E Spouse's Social Security Number 2 5 7 3 9 6 4 4 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1. Original Return ^ ^ 4. Limited Estate ^ © 6. Decedent Died Testate ^ (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) __ ___ CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime TelepCh~one Number:~;:_: X17 I V O V O T T O I I I 7 1 7 ~d+ 3 ~5 3 ~; REGISTER LS USE ONLY` - - _~~~ fi- -- First line of address "" ~~~~ -*.~ =',' _ j ~-} -i-t ._~... _.y., M A R T S O N L A W O F F I C E S ~~ rv `~~ Second line of address f`..) --~ -...: 1 0 E H I G H S T City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 1 7 0 1 3 Correspondent's a-mail address: !a ~ Q ~nn/~,~s ~-...~n,..~J . cfy-~~ 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. SIGNATUR [~~~ER~jON ONSIBL/~-FOR FILING RETURN DATE r/e / E'r-~fJ 1' - ciC C i1•-/ ~e~ .:fL~ f f~'r L e- ---- Side 1 1505610140 1505610140 10 EAST HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 9 0 7 6 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 4 6 8 0 7 0 6 0 7 1 1 2 0 0 9 1 2 1 8 1 9 7 6 Decedent's Last Name Suffix Decedent's First Name MI B U C H Y P E T E R A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI P A R I S- B U C H Y R E N E E Spouse's Social Security Number 2 5 7 3 9 6 4 4 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1. Original Return 4. Limited Estate Q 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number I V O V- O T T O I I I 7 1 7 2 4 3 3 3 4 1 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY M A R T S O N L A W O F F I C E S First line of address 1 0 E A S T H I G H S T R E E T Second line of address City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 17 0 1 3 Correspondent's a-mail address: I O T T O a9 M A R T S O N L A W- C O M 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, rf is true, correct and complete. Declaration of preparer other than th personal representative is based on all information of which preparer has any knowledge. SIGNAT~ RE O~pER$(1C1 RjZS}jONSI$}~ FOAR ~ ING ~tET , ~ , - SATE `, ADDRESS ' - r " C/0 3 10 OLD URCH ROAD AUGUSTA GA 30907 SIGNATURE P~2EP FR H R TH~RESENTATIVE ~b ~~E_(/ 10 EAST HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 1505610240 REV-1500 EX Decedent's Social Security Number decedent's Name PETER A• B U C H Y 1 9 4 6 8 0? 0 6 RECAPITULATION 0 0 0 1. ........................................... Real Estate (Schedule A) 1 . 1 4 2 6. 8 6 2. Stocks and Bonds (Schedule B) ...................................... 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 6 1 1 2 . ~ 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 . 0 0 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property ~ 0 0 0 Separate Billing Requested ....... (Schedule G) 7. ~ 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 7 5 3 9 . 5 6 9. ......... Funeral Expenses and Administrative Costs (Schedule H) ....... 9. .. 9 8 8 6 . 4 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ....... .. 10. 2 3 2 7 2 . 8 7 11. Total Deductions (total Lines 9 and 10) ...................... ....... .. 11. 3 3 1 5 9 . 3 6 12. Net Value of Estate (Line 8 minus Line 11) ................... ....... .. 12• - 2 5 6 1 9 . 8 0 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. - 2 5 6 1 9 . 8 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15 0. 0 0 (a)(1.2) x.o _ . 16. Amount of Line 14 taxable 0 0 0 0. 0 0 . at lineal rate X .o _ 16. 17. Amount of Line 14 taxable 0 0 0 17 p . 0 0 . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 . 0 0 18 0 • 0 0 at collateral rate X .15 . 19. ............................................ TAX DUE ........ ..19. 0 • O O 20. FILL IN THE OVAL IF YOU ARE RE4UESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0769 DECEDENT'S NAME PETER A. BUCHY STREET ADDRESS 258 NORTH ENOLA DRIVE CITY ENOLA STATE PA ZIP 17025 Tax Payments and Credits: 1 • Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount Interest If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (1) 0.00 Total Credits (A + g) (2) 0.00 (3) (4) 0.00 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 • Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who 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? ....................................................................................... ^ ^X 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ X^ 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 For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan.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)J. • 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER PETER A. BUCHY 21 09 0769 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 171.498sh, State Farm International Index Legacy B Account No. 455/72018233 1,426.86 (see attached) TOTAL (Also enter on line 2, Recapitulation) I $ 1,426.86 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENTEDECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER PETER A. BUCHY 21 09 0769 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Navy Federal Credit Union savings 3009820287 40.55 (See attached) 2. Navy Federal Credit Union checking 7007152270 772.80 (See attached) 3. 1992 Volkswagen Jetta TDI 3,000.00 4. 1992 Volkswagen Corrado, actual sale value 2,000.00 5. Wachovia checking 2745 299.35 (See attached) TOTAL (Also enter on line 5, Recapitulation) I S 6,112.70 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER PETER A. BUCHY 21 09 0769 Decedent's debts must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, Auer Cremation Services 2,656.88 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2 Attorney Fees: MARTSON LAW OFFICES 3,500.00 3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation,) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: Cumberland County Register of Wills 81.00 5 Accountant Fees: 6, Tax Return Preparer Fees: 7, Filing fee, Inheritance Tax return 15.00 8. Cumberland County Register of Wills, additional probate fee 25.00 9. EVP stock valuation 1.55 10. Short Certificates 12.00 11. UPS mailings 14.06 TOTAL (Also enter on Line 9, Recapitulation) I $ 9,886.49 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER PETER A. BUCHY 21 09 0769 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Best Buy Reward Zone, Account # 5268-3500-4219-8401 77.89 2. Capital One, Account # 4862-3625-8952-8432 4,335.37 3. Chase, Account # 4185-8668-2965-9849 3,629.51 4. HSBC, Account # 5491-0986-7888-8099 2,669.06 5. HSBC, Account #702-127-034-315-9694 2,045.46 6. Lowes Account, #819-4205-737596-6 519.98 7. Nary Federal Credit Union, Loan 43000931051601 4,443.37 8. Navy Federal Credit Union, Account # 4060-9555-5404-0604 4,473.79 9 Home Depot, Account # 6035-3204-9256-8967 495.15 10. GE Money Bank/Amazon, Account # 6045-7810-0324-1568 583.29 TOTAL (Also enter on Line 10, Recapitulation) I $ 23 272 87 If more space is needed, insert additional sheets of the same size. c~c~:i~~ LAST WILL AND TESTAMENT OF PETER A BUCHY I, Peter A Buchy, of Hephzibah, Georgia, 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 DISPOSITION OF PROPERTY Residuary Estate. I direct that my residuary estate be distributed to Renee Dhyana Zahmoul (Paris), Hephzibah, Georgia. If such beneficiary does not survive me, my residuary estate shall be distributed to the following beneficiaries in the percentages as shown: 20.00% to Congregation Children of Israel, Augusta, GA. If this person does not survive me, this shaze shall be distributed proportionately to the other distributee(s) listed under this provision. 40.00% to David Barwood Andrews, Minneapolis, MN. If this person does not survive me, this share shall be distributed proportionately to the other distributee(s) listed under this provision. 40.00% to Steven James Buchy, Martin, SD. 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 David Barwood Andrews, of Minneapolis, Minnesota, as the Executor, without bond or security. If such person or entity does not serve for any reason, I nominate Matthew Rippey, of Seattle, Washington, and Jeffrey Detweiler, of Long Island City, New York, as Co-Executors (the "Executor"), without bond or security. Page 1 of 5 Testator's Initials ~/~_ 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 equivalent legislation designed to operate without unnecessary intervention by the probate court. ARTICLE V MISCELLANEOUS PROVISIONS A. Paragraph ~'itles and Gender. 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 singulaz 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. Liabilit,~of Fiduciary. 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's good faith actions or nonactions as the fiduciary, except for such actions or nonactions which constitute fraudulent conduct or bad faith. C. No Spouse. I am not currently married to anyone. D. No Children. I do not have any children at the time of the signing of this Will. E. Bneficiarv Disputes. 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 WITNESS WHEREOF, I have subscribed my name below, this 2~ day of M ?.~ , ?r~z~ . Testator Signature: ~~~ eter A Buchy Page 2 of 5 Testator's Initials / ~~ 3+2 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 Peter A Buchy (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 names as witnesses on the date shown above. Witness Signature: Name: City: State: Witness Signature: Name: City: State: ~C- Witness Signature: ~-- Name: ~tS~ 1/~ l ~ 1~i ~ S City: h State: Page 3 of 5 Testator's Initials _ ~~~___ AFFIDAVIT STATE OF GEO GIA COUNTY OF ~ Ch mon 1 Before me, the undersigned, on this day personally peared Peter A Buch~Y,. ~,U 1 Z ~'~' lJ~ and ~Ct_ ~ ~C -~Gc ~~ n and ~'~ri ~5-~i ~ lJU ~\ ~ `~ cl .nn S known to me to be the Testator and the witnesses, respectively, whose names are signed to the foregoing instrument. All of these persons were first duly sworn by me. Peter A Buchy, the Testator, declared to me and to the witnesses, in my presence, that the foregoing instrument is the Testator's Will and that the Testator willingly signed and executed such instrument in the presence of the witnesses, as the Testator's free and voluntary act for the purposes expressed in the instrument. Each of the witnesses declared in the presence and hearing of the Testator that the foregoing instrument was executed and acknowledged by the Testator as the Testator's Will in their presence and that they, in the Testator's presence, hearing and sight and at the Testator's request, and in the presence of each other, did subscribe their names to the instrument as attesting witnesses on the date of the instrument, and that to the best of the witness' knowledge, the Testator was eighteen years of age or older, of sound mind, under no constraint or undue influence, and the witnesses were of adult age and otherwise competent to be witnesses. ~~___~~ Peter A Buchy, Testator Witness Signature: ~((~i c~ Name: City: State: Witness Signature: C.~`~~,.nr~ ~.(X r-_ Name: r~ ~ ~~ ~ ~ City: ~ State: ,~ S 0 Page 4 of 5 Testator's Initials ~~ Witness Signature: Name: rG' lI ~ S City: Gl~ State: ~~Pr Subscribed, sworn to and acknowledged before me by Peter A Buchy, the Testator; and su ~ ribed and sworn to before me by L D `-% , 5~y ~ and (~~ 6~1 C ~Gt C~ r n and ~ b ~ ~ Q v-z5 , witnesses, this ,~ ~ r~ day of ~ , Irris~in ivicCze Notary Public, Ricirsionil County, Georgia My Commission P.gpires July 31, 2t~19 Notary Public, or other officer authorized to take and certify acknowledgements and administer oaths Page 5 of 5 Testator's Initials Estate Valuation Date of Death: 07/11/2009 valuation Date: 07/11/2009 Processing Date: 04/07/2010 Shares Security or Par Description 1) 171.498 STATE FARM MUT FD TR (SIIBX) INTL IDX LGC B NASDAQ 07/10/2009 Total Value: Total Accrual: Total: $1,926.86 High/Ask Low/Bid Estate of: Peter ~_. Account: :_ __.: Report Type: Date cf ~~ea_'. Number of Securities: File ID: 13521.~.buch- Mean and/or Div and Int Securit Adjustments Accruals Vague 8.32000 Bid 8.320000 $1, .6. $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.4.1) Cam` ~~ C~.~,t~- ~ ~~ Fax Transmission 8/21/2009 4:21:24 PM PAGE ~~ Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 August 21, 2009 MARTSON DEARDORFF WII.LIAMS OTTO GILROY & FALLER ATTN: VICTORIA L OTTO ** Reference ID: 2774144 SUBJECT: Verification /Confirmation of Aooount and Balance Information provided for: Customer: PETER A BUCHY (SSN# XXlC-XX-0706) Date of Death: July 11, 2009 Delwsit Account Information Account Aooount Date of Death Average Date Maturity Ldeaest Accrued YTD Date Type Number Balance Balenoe* Opened Date Rate Interest Interest Paid Closod CHECKING }2'745 5299.35 LEGAL TITLE: PETER BUCHY 6/7/2007 NA No Safe Deposit Box found for a~tomer. * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. ~~~~~~ Amy Crraybill Servicenter Assoaate Phone: (540)563-7323 ag; ag 1/001 Fax Server h ~ a~~ 5~ ~~ Uri/ly/LUUy 11: G1 NAb iU3:,~~ryti3 llh(:LllY;;~l' Al;l:'1' ~UUS/UU4 ' ~~ i ., v Date of death value for the accounts held by Peter A Buchy. Account Tvpes: Account Numbers: Account Balances: Share Saviags 3009820287 Account(s) Held: Individual ~ ~' Esc. Account opened: 03/12/2007 ~, G~ ~~ ~i ,~. 1 Current rate of interest: 0.4 % ~,c~t'~" Year to date interest raid: $0.11 Checking 7007152270 Account(s) Held: Individual ~ ~~- ~ Account o erred: 03/12/2007 ~ ~ ~ .~ Current rate of interest: 0.15 Year to date interest paid: $1.58 Consumer Loan 43000931051601 Account(s) Held: Individual Account opened: 10/24/2008 Collateral: Used Vehicle, 92 Volkswagen 4D 4 arrant rate o interest: 7.000 % ~~ ~e.~"' 14 Dav payoff amount: $4, 443.37 ~ ~~ Insurance/Loan protection: No NRewards Visa 4060955554040604 Account(aLHeld: Individual; with Renee D Paris as authorized user Account o erred: 12/O1/200~ Current rate of interest being paid: 16.9% Collateral: None ~ ~ 14 Dav payoff amount: $4,383.79 'r~ Insurance/Loan protection: No d