HomeMy WebLinkAbout02-09-12 (2)J 1505610101
REV-1500 Ex(oi-io) J!'~ OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes ~"'°~"`"'°` aE"E"°` County Code Year File Number
Po Box 28otioi INHERITANCE TAX RETURN
Harrisbur , PA 1'7128-0601 RESIDENT DECEDENT ~~' ~ ~~ 1 ^ '~_ -~,
ENTER DECEDENT INFORMATION BELOW -
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
216-14-8645 11 /27/2011 01 /02/1923
Decedent's Last Name Suffix Decedent's First Name MI
Glover Claudia B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
N/A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Gld 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
QD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
Daytime Telephone Number
Andrew H. Shaw (717) 243-7135
!'~,}
First line of address
200 S. Spring Garden St
Second line of address
Suite 11
City or Post Office State ZIP Code
Carlisle PA 17013
Correspondent's a-mail address: 8ndreW C(1~',BShaW18W.COnI
REGISTEF~{~R~p)rILLSUS~~NLY
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DATE FILED --
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.
SIGNATURE OF PERSON RESPO,J*N``//BIBLE FOR FILING RETURN DATE
ADDRESS /~ /~ ~
18 Ab ey Court, Carli le, PA 17015
SIGNA RE OF'RR RE HER THAN REPRESENTATIVE DATE
200 S. Spring Garden Street, Suite 11, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101 J
J
REV-1500 EX
Decedent's Name: C18Ud18 B. GIOV@I'
Decedent's Social Security Number
216-14-8645
KtGAF'I 1 ULATION
1. Real Estate (Schedule A) .......................................... ... 1. 0.00
2. Stocks and Bonds (Schedule B) .................................... ... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00
4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 663.00
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 48,910.47
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... ... 7. 3,424.55
8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 52,998.02
9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 4,234.87
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 0.00
11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 4,234.87
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 48,763.15
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... .. 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 48,763.15
TAX CALCULATION -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 .0 0 0.00 15.
0.00
16. Amount of Line 14 taxable
at lineal rate x .0 45 48,763.15 16. 2,194.34
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18. 0.00
19. TAX DUE ....................................................... .. 19. 2,194.34
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610105 1505610105
1505610105
O
REV-1500 EX Page 3
Decedent's Complete Address:
0.00
DECEDENT'S NAME
Claudia B. Glover
STREET ADDRESS
18 Abbey Court
CITY
Carlisle STATE
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
109.72
4. 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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
File Number
Total Credits (A + B) (2)
(3)
(4)
(5)
Make check payable to: REGISTER OF WILLS, AGENT.
2,194.34
109.72
0.00
2, 084.62
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 :.................................................................................... ...... ^ 0
b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ 0
c. retain a reversionary interest; or .................................................................................................................... ...... ^ Q
tl. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^ 0
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.
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)].
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.
BOO p~'(
LAST WILL AND TESTAMENT
OF
CLAUDIA B. GLOVER
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I, CLAUDIA B. GLOVER, presently residing at 18 Abbey Court, Carlisle,
Pennsylvania, being of a sound and disposing mind, over the age of eighteen (18) years, and
under no legal disability, and mindful of the brevity of this life, having placed my faith and
confidence in Jesus Christ, my Saviour and Lord, Who redeemed my soul through His shed
blood and death upon Calvary's Cross for my sins and Who, by His resurrection, thus assures me
of eternal life, and knowing that the life which I now live in this world is by faith in the Son of
God Who gave Himself for me, do hereby make, publish and declare this to be my Last Will and
Testament, hereby revoking all other Wills and Codicils heretofore made by me at any other
time.
Article I: I direct that my Personal Representative, hereinafter named, pay all my
just debts and funeral expenses as soon after my death as practicable, including all property, state
and federal death taxes assessed against me, my estate, or my beneficiaries, without proration
among my beneficiaries. However, all property bequeathed or devised hereunder, either outright
or in trust, is bequeathed or devised subject to existing mortgages, liens or encumbrances
thereon. I further direct my Personal Representative to have the appropriate marking placed on
the monument in Druid Ridge Cemetery, Baltimore, Maryland.
t ~' .~L, 't~ `' i
1 Claudia B. Glover
Article II: I confer on my Personal Representative and/or any Trustee(s) appointed
herein and their successors the right to sell or otherwise convert any real or personal property at
public or private sale, at such time or times, in such manner, and for such price or prices, and on
such terms and conditions as my Personal Representative shall determine, and to execute and
deliver good and sufficient conveyances, assignments, and transfers of the property, without
liability of any purchaser for the application of any consideration; to borrow money and to secure
its payment by mortgage of real or personal property, pledge of investments, or otherwise,
without liability on the part of the lenders to see to the application thereof; to retain any
investments at discretion; to invest and reinvest at discretion, as permitted under Act 28 of 1999,
the "Prudent Investor Act"; to make distribution in cash or in kind; to allocate and distribute
different kinds or disproportionate shares of property or undivided interests in property among
beneficiaries, in cash or in kind, or partly in each; and all other powers given under the statutory
and common law of Pennsylvania available at the time of my death and the power to do all acts
and things necessary or appropriate in the management, administration and distribution of my
estate.
Article III: At the time of execution of this Last Will and Testament I am a widow.
Article IV: At the time of execution of my Last Will and Testament I have the
following children:
A. BEVERLY A. GLOVER;
B. HARRY L. GLOVER, SR. (deceased).
E
2 Claudia B. Glover
Article V: I hereby nominate and appoint my daughter, BEVERLY A. GLOVER, as
Personal Representative of this my Last Will and Testament. In the event she predeceases me or
is unable to serve as Personal Representative, then I nominate, AMY COOK, as Personal
Representative of this my Last Will and Testament. My individual Personal Representatives
shall not be required to furnish bond or surety.
Article VI: I give, devise and bequeath all the rest and residue of my estate of
whatever kind and description, wherever situate, absolutely and in fee simple, as follows:
A. 5% to the CHURCH WHERE I HOLD MEMBERSHIP AT THE
TIME OF MY DEATH for use at its sole discretion;
B. 2% to the GLOBAL MINISTRIES DEPARTMENT OF THE
UNITED BRETHREN IN CHRIST CHURCH, for use at its sole discretion,
C. 3% to the RHODES GROVE UNITED BRETHREN
CAMPMEETING ASSN., located in Chambersburg, Pennsylvania, for use at its sole discretion,
D. The remaining 90% to be divided into two shares, the first '/2 to my
daughter, BEVERLY A. GLOVER and the remaining '/2 to the CHILDREN OF MY
DECEASED SON HARRY L. GLOVER, to be divided equally, per stirpes.
~~
3 Claudia B. Glover
IN WITNESS WHEREOF, I have hereunto set my hand and seal this / t ~ `day of
~~~ ~- ~ ~,-a_~-~, , 2008.
J
- L',~~` ~~-~c~~~; f%a :;t~-c, (SEAL)
Claudia B. Glover
Signed, sealed, published and declared
by the foregoing Testatrix as and
for her Last Will and Testament,
consisting of four (4) pages, in the
presence of us, who at her request,
and in her presence, and in the
presence of each other, have hereunto
set our hands as witnesses thereto.
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4
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, CLAUDIA B. GLOVER, Testatrix, whose name is signed to the attached or foregoing
instrument, being duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I signed it willingly; and that I
signed it as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by CLAUDIA B. GLOVER, the
Testatrix, this t~f `~'~ day of ~ ~, ~,.~ k~..:; r .,, 2008.
Claudia B. Glover
Notary Public
My Commission expires: -- __
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, %~Ct.GY~c~`i~t `"~`l~~'~E~f~LF and~r ?/'.1 1 r ' ' i ~:,
1. /l l~ y ~ , ~ f---~ _ ,
the witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw Testatrix sign and
execute the instrument as her free and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the Testatrix was at the time 18 or more years of age, of sound
mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed before me by ~G~-Gf2cYl~t ~/~'1G~~Gi(.~f;~ and
~~
~' ~ S~_ (~ 1~~'1.~--~ , witnesses, this ~ day of ~-~~-~~ s~,.2 t .; , 2008.
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Notary Public
My Commission Expires: _:
5
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
to IAi t ur FILE NUMBER
Claudia B. Glover 21-11-1323
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Cash
284.64
2. Refunds on accounts
278.36
3. Personal Effects
100.00
TOTAL (Also enter on line 5, Recapitulation) $ I 663.00
(If more space is needed, insert additional sheets of the same size)
REV->sog EX+ (oi->o)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
Claudia B. Glover 21-11-1323
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Beverly A. Glover
18 Abbey Court, Carlisle, PA 17015
daughter
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBE LETTER
FOR JOINT DATE
MADE DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
DATE OF DEATH % OF
DECEDENT'S DATE OF DEATH
VALUE OF
R TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
i. A. Members 1st FCU, Account # 157628-0011
1,172.57
50
586.29
2. A. Members 1st FCU, Account # 157628-0000 123.86 50 61.93
3. A. Members 1st FCU, Account # 157628-0002 60.01 50 30.01
4. A. Members 1st FCU, Account # 157628-0005 2,852.68 50 1,426.34
5. A. Members 1st FCU, Account # 157628-0044 1,006.20 50 503.10
6. A. Members 1st FCU, Account # 157628-0059 509.60 50 254.80
7• A. Members 1st FCU, Account # 157628-0061 20,049.30 50 10,024.65
8. A. Members 1st FCU, Account # 157628-0063 1,005.38 50 552.69
9. A. Members 1st FCU, Account # 157628-0064 20,000.68 50 10,000.34
10 A. Members 1st FCU, Account # 157628-0065 500.00 50 250.00
11 A. Members 1st FCU, Account # 105690-0011 820.81 50 410.41
12 A. Members 1st FCU, Account # 105690-0000 906.71 50 453.36
13 A. Members 1st FCU, Account # 105690-0005 141.84 50 70.92
14 A. Members 1st FCU, Account # 105690-0017 10,637.67 50 5,318.84
15 A. Members 1st FCU, Account # 105690-0021 10,662.14 50 5,331.07
16 A. Members 1st FCU, Account# 105690-0022 10,042.56 50 5,021.28
TOTAL (Also enter on Line 6, Recapitulation) I $ 40,296.03
If more space is needed, use additional sheets of paper of the same size.
tem
Number
Letter for
Joint
Tenant
ate Made
Joint SCHEDULE F continued
escription of Property
ate of Death
Value of Asset
% of
Decedent's
Interest
Date of Death
Value of
Decedent's
Interest
17 A. Members 1st FCU, Account # 105690-0025 10,596.23 50 5
298.12
18 A. Members 1st FCU, Account# 105690-0040 533.92 50 ,
266.96
19 A. Members 1st FCU, Account # 105690-0041 5,082.89 50 2,541.45
20 A. Members 1st FCU, Account# 105690-0060 1,015.83 50 507.92
Total 8,614.44
~ PENNSYLVANIA INHERITANCE TAX
INF012MATION NOTICE FILE No. 21
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 Pennsylvania
HARRISBURG PA l~lzB-o6o1 TAXPAYERNRESPONSE ACN 11181554
DEPARTMENT OF REVENUE
DATE 12-15-2011
REV-1543 E% AFP (OS-11)
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, .you were a joint owner/beneficiary of this account. If yoU are the SpOUSe of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Plea=_e call 717-787-8327 with questions.
COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
,account no. 15/6Cts-11 Date 03-25-1996
7o ensure
proper credit to the account, two
Establ ished copies of this notice must accompany
Account Balance $ 1 ~ 172.57 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 586.29 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( .045 deduct a 5 percent discount on the tax due.
Potential Tax Due
2 6 • 3 8 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPON SE
0
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit Dayment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E
~ an official assessment will be issued by the PA Department of Revenue.
B L 0 C K
0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
file d by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid
Complete PART 2~and/or PART 3^ below. .
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE I. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6 $
7 X
e $
PAD
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMn-iNT' pern
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C
WORK C ~
TAXPAYER SIGNATURE TELEPHONE NUMBER nn,rr
~~ ~~~~ ., ~, ~+nr ~ or iax l.OmpULaLlOn) $
°~ PENNSYLVANIA INHERITANCE TAX
BUREAU DF INDIVIDUAL TAXES INFORMATION NOTICE FILE No. 21
PD BDx 266681 Pennsylvania
HARRISBURG PA 17128-0601 DEPARTMENTOFREVENUE TAXPAYERNRESPONSE ACN 11181555
REV-1543 EX AFP (05-11) DATE 12-15-2011
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above named decedent, you were a joint owner/beneficiary of this account. If you are the spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
i*_ to the above address. Please call ?1?-787-8327 with Questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 157628-05 Date 04-04-1996
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 2,$52.6$ payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 1,426.34 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 64.19 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1^
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
BLOCK ~
0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax
t
filed by the estate representative. re
urn
C. ~ The above informs ion is incorr
e-
ct and/or debts and deductions were paid
1
~
Complete PART 2~ and/or PART ~a ~ below. .
PART lr indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4 +fi
5
6
7 X
8 $
PAD
1
2
3
4
5
6
7
8
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMnii~ir Darn
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C )
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER naTF
•~ ..-~~«1 ~1~ L111C n yr iax compucation~ s
~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 Pennsylvania
HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE TAXPAYERNRESPONSE ACN 11181556
DATE 12-15-2011
REV-1543 EX qFP (D5-I1)
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the SpoUSe Of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to *_he above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 157628-44 Date 10-06-2010 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 1 ~ 006.20 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 503.10 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due Any inheritance tax due will become delinquent
'~ 2 2 ' 6 4 nine months after the date of death.
PART TAXPAYER RESPONSE
1^
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A5SESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
B L 0 C K ~ g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3^ below.
PART
^2
Lr lntlicating a tlifferent tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5 -
6 $
7 X
8 $
PAD
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT DF REVENUE
1
2
3
4
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOl1NT Pern
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C ~
WORK ( ~
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
~.,~ .~n~er un a ne s or iax Computation) 8
•-~ PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE NO. 21
PD BDx 266661 Pennsylvania
HARRISBURG PA 1712$-0601 DEPARTMENT OF REVENUE TAXPAYERNRESPONSE ACN 11181557
REV-1543 EX AFP X05-„> DATE 12- 15-2011
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1 ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If y0U are the SpOUSe Of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to f.he above address. please call 71.7-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 157628-59 Date 06-29-2009
To ensure proper credit to the account. two
Establ ished copies of this notice must accompany
Account Balance $ 509.60 payment to the Register of Wills. Make check
Percent Taxable
X
50.000 payable to "Register of Wills, Agent".
Amount Subject to Tax
$
2 5 4 . $ ~ NOTE: If tax payments are made within three
Tax Rate
X months of the decedent's date of death,
.045 deduct a 5 percent discount on the tax due.
Potential Tax DUe $ 11 .47 Any inheritance tax due will become delinquent
nine months after the date of death.
PART
0 TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
B L 0 C K ~ g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax r
0 N L Y filed by the estate representative. eturn
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART If indicating a different tax rate, -
relationship to decedent: please state ~ AAF
OFFICIAL USE ONLY
PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 I
2. Account Balance 2 $ 2
3. Percent Taxable 3 X ~
4. Amount Subject to Tax 4 $ ~
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due g $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMl~11\IT n.r..
•- -•• w. iax computacaonl g
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C )
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
~~ PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL TAxes I N F O R M AT I O N N O T I C E F I L E
PD BDx 2BB6B1 Pennsylvania
HARRISBURG PA 171za-o6o1 TAXPAY E R N R E S P O N S E AC N
OE PARTMENT On REVENUE
REV-1543 EX AFP (05-11) DAT E
N0. 21
11181558
12-15-2011
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1 ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If y0U are the SpOUSe of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 157628-b1 Date 03-08-2010
To ensure proper credit to the account, two
Establ ished copies of this notice must accompany
Account Balance $ 20,049.30 payment to the Register of Wills. Make check
Percent Taxable payable to "Register of Wills, Agent".
X 50.000
Amount Subject to Tax $ 10 , 024.65 NOTE: If tax payments are made within three
Tax Rate
X months of the decedent's date of death,
.045 deduct a 5 percent discount on the tax due.
Potential Tax Due g 451.11 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
BLOC K ~
0 N L Y g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance t
t
filed by the estate representative. ax re
urn
C. ~ The above informs ion is incorrect and/or debts and deductions were paid
Complete PART 2~ and/or PART ~ below. .
riAK i
.~ iiiuica ung a airrerent tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
2
3 X
4
5
6
7 X
8 $
1
2
z
4
5
6
7
8
PART
^3
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION ~A..,,,.,r .,. r,.
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
PAD
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME ( ~
WORK
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.membersl st.org
Main Switchboard: (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312
TeleBranch: (800)237-7288
Statement of Accounts
Nov 25, 2011 thru Dec 24, 2011
Account Number: 157628
Balances at a Glance:
2920 1 AV 0.340 10320-2920
Irr~lll~~rlllrr~r~~tl~lrlr~l~~lr~llrlr~lr~l~l„~rlll~~l~l~~rll
CLAUDIA B GLOVER
BEVERLY A GLOVER
C/O BEVERLY A GLOVER
18 ABBEY CT
CARLISLE PA 17015
Checking : 3.50
Savings: 5.00
Certificates : 0.00
Loans: 0.00
Money Management: 0.00
Swipe 5 YTD Reward: 0.00
Page : 1 of 4
Your aggregate balance as of December 1st is $118,924.85.
An aggregate balance of $2,500 and having 3 products
will place you in the Silver MLR level.
1099-INTs are not included in this statement. If you earned at least $10
in dividends on your account for 2011, you will receive your 1099-INT in
a separate mailing in early January 20.12. 1099-INT information will also
be available on Members 1st Online early in January.
CHECKING ACCOUNTS
0011 -CHECKING
Date __ _ Transaction Description Additions Subtractions Balance
Nov 25 Ba/ance Forward 1,172.57
Nov 30 Check 002964 Tracer 0001101401 7.79- 1,164.78
Nov 30 Deposit Transfer From Share 0016 125.00 1
289.78
Dec 05 Withdrawal ,
1,286.28- 3.50
Dec 24 Ending Ba/ance 3.50
CHECK SUMMARY
Check # Amount Date Check # Amount Date
002964 7.79 Nov 30
SAVINGS ACCOUNTS
0000 -REGULAR SAVINGS
Date Transaction Description Additions Subtractions Balance
Nov 25 Ba/ance Forward 123.86
Nov 30 Deposit Dividend 0.250% 0.07 123
93
Annua/ Percentage Yield Eamed 0.25~~ from 11/01/20» through > 1/30/2011 - .
Dec 05 Deposit 500.21 - ~~~ ~ ~ 624.14
Dec 05 Deposit 20,023.78 T' '~ `~ 20
647
92
Dec 05 Deposit 1, 006.41 ~ i~ `~`~ ,
.
21,654.33
Dec 05 Deposit 20,025.91 " ~~E-!` 41,680.24
Dec 05 Deposit 509.70 ~~~'~? ~"~ ~ 42,189.94
Dec 05 Deposit 1,006.41 - , ~ ~> 43,196.35
Dec 05 Deposit 1,286.28 i-/r t'- ~~ 44,482.63
Dec 05 De osit
p r~l
~
Dec 05 De
osit 60.02 .--a
z--~ '~ 44,630.35
Dec 05 Withdrawal 44,625.35- 5
00
Dec 24 Ending Ba/ance - .
5.00
--- Continued on following page ---
St Send Inquires to:
~• Main Switchboard:
5000 Louise Drive (800) 283-2328
Po sox ao EZ Call: (717) 697-4372 or (800) 283-4372 Nov 25, 2011 thru Dec 24, 2011
M~EMBE~RS~1° Mechanicsburg, PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 io3si-.ezo Account Number: 157628
www.memberslst.org TeleBranch: (800) 237-7288
Page : 2 of 4
0002 -HOLIDAY CLUB
Date
Nov 25 Transaction Descri tion Additions Subtractions
Ba/ance Forward Balance ,_
Nov 30
Deposit Dividend 0.300% 0
01 60.01 _
.
Annua/ Percentage Yie/d Earned 0.220"/0 from 11/01/20» through »/30/201 > 60.02
Dec 05
Withdrawal _
60.02-
HOLIDAY CLUB C/osed 0.00
* * *This is the final statement presenting information on this product * *
* * * P/ease retain this final statement for tax reporting purposes * *
uuu5 -MONEY MANAGEMENI
Date Transaction Descri tion Additions Subtractions Balance
Nov 25 Ba/ance Forward
Nov 28
Withdrawal 2852 07
Nov 30 2,765.00-
Deposit Dividend Tiered Rate 0
63 87.07
.
Annual Percentage Yieid Earned 0..3009n from 11/01/2011 through i 1/30/2011 87.70
Dec 05 Withdrawal
87.70-
MONEY MANAGEMENT C/osed 0.00
*"*This is the final statement presenting information on this product***
* * * P/ease retain this final statement for tax reporting purposes *
CERTIFICATE ACCOUNTS
0016 - 19 MONTH IRA CERT
Date
Nov 25 Transaction Description Additions Subtractions
Ba/ance Forward Balance
Nov 30
Deposit Dividend 1.590% 4
59 3,511.67
.
Annual Percentage Yie/d Earned 1.60090 from 11/01/2011 through 11/30/2011 3,516.26
Nov 30 Withdrawal Transfer To Share 0011 Normal Distribut 125.00- 3
391
26
Dec 21 Deposit Dividend .2.95 ,
.
3
394
21
Annua/ Percentage Yie/d Earned 1.60U~ from 12/01/2011 through 12/20/2011 ,
.
Dec 21 Withdrawal Transfer To Share 0020 Transfer within 3
394
21
,
.
-
>9 MONTH /RA CERT C/osed 0.00
* *'7his is the Tina/ statement presenting information on this product*
* * * P/ease retain this final statement for tax reporting purposes * * *
0044 - 6 MONTH CERT
Date Transaction Descri tion Additions Subtractions
Nov 25 Ba/ance Forward Balance
Nov 30 Deposit Dividend 1.100% 0
91 1, 005.41
.
Annua/ Percentage Yie/d Earned >. 1 fU~ from 11/01/2011 through 11/30/2011 1,006.32
Dec 04 Deposit Dividend 1.100% 0
09
.
Annua/ Percentage Yie/d Earned 1.090' horn 12/01/2011 through 12/03/2011 1, 006.41
Renewed at 0.300%to mature 06/03/12
Dec 05 Withdrawal 1,006.41- 0
00
6 MONTH CERT C/osed .
* * *7his is the Tina/ statement presenting information on this product* * *
* * * P/ease retain this fins/ statement for tax reporting purposes * * *
0059 - 19 MONTH CERT
Date Transaction Description Additions Subtractions Balance
Nov 25 Ba/ance Forward 509.01
Nov 30 Deposit Dividend 1.640% 0.69 509.70
Annua/ Percentage Yield Earned 1.66090 from 11/01/2011 through 11/30/2011
Dec 05 Withdrawal 509.70- 0.00
19 MONTH CERT C/osed
* * *7his is the bna/ statement presenting information on this product* *'
* * * P/ease retain this Tina/ statement for tax reporting purposes * * *
- - - Continued on reverse side - - -
St Send Inquires to:
~~
5000 Louise Drive Main Switchboard: (800) 283-2328
Po Box ao EZ Call: (717) 697-4372 or (800) 283-4372
MEMBF~RS~1" Mechanicsburg, PA 17055
(717) 697 5312 or (800) 283-2328 ext
5312
e Nov 25, 2011 thru
1 Dec 24
2011
.
Tel
Branch;
wwvv.memberslst.org (800) 237-7288 0322-2920 Account Number ,
157628
Page : 3 of 4
0061 - 19 MONTH CERT
Date Transaction Descri tion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.640% 20,025.91
Annua/ Percentage Yie/d Earned 1.650 from 11/01/2011 through 11/30/2011 26 ~ 99 20 , 052.90
Nov 30 Withdrawal by Check
Dec 01 CHK# 663770 DIVIDEND W/D 11/30/11 26.99- 20,025.91
Dec 05 Withdrawal
19 MONTH CERT C/osed 20 , 025.91- 0.00
* * *This is the fina/ statement presenting information on this product *
* * *
P/ease retain this fina/ statement for tax reporting purposes * *
0063 - 6 MONTH CERT
Date Transaction Descri tion
Nov 25 Ba/ance Forward Additions Subtractions Balance .
Nov 30 Deposit Dividend 1.100% 1,005.38
Annua/ Percentage Yie/d Earned 1. 110"/o from 11/01/2011 through »/30/2011 G . 91 1 006 29
Dec 05 Deposit Dividend 1.100%
Annua/ Percentage Yie/d Earned 1.090"/o hom 12/01/2011 through 12/04/2011 0.12 1, 006.41
Renewed at 0.300%to mature 06/04/12
Dec 05 Withdrawal
6 MONTH CERT C/osed 1, 006.41- 0.00
* * *This is the fina/ statement presenting information on this product * * *
* * *
P/ease retain this fina/ statement for tax re
ortin
p
g purposes
0064 - 15 MONTH CERT
Date Transaction Descri tion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.240% 20,000.68
Annua/ Percentage Yie/d Earned 1.250' from 11/01/2011 through 11/30/2011 20.38 20 , 021.06
Dec 05 Deposit Dividend
Annua/ Percentage Yie/d Earned 1.250 from 12/01/2011 through 12/04/2011 2.72 20 , 023.78
Dec 05 Withdrawal
15 MONTH CERT C/osed 20 , 023.78- 0.00
* * *This is the fina/ statement presenting information on this product * * *
* * *
P/ease retain this fina/ statement for tax reportin
* * *
g purposes
0065 -19 MONTH CERT
Date Transaction Descri tion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.240% 500.00
Annua/ Percentage Y/e/d Earned 1.290' hom 11/23/2011 through 11/30/2011 0.14 500.14
Dec 05 Deposit Dividend
Annua/ Percentage Yie/d Earned 1.290' from 12/01/2011 through 12/04/2011 0.07 500.21
Dec 05 Withdrawal
19 MONTH CERT C/osed 500.21- 0.00
* * *This is the Bna/ statement presenting information on this product* *
' * *
P/ease retain this fina/ statement for tax reportin
ur
* * * -
g p
poses
YTD SUMMARIES
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 0.~
0002 HOLIDAY CLUB 0 ~
0005 MONEY MANAGEMENT 9,76
0011 CHECKING 0.00
--- Continued on following page ---
~~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES FILE N0. 21
Po Box zao6ol p@I111S~/~Vd~118 AND ACN 11181560
HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE TAX P AY E R R E S P O N S E
DATE 12-15-2011
REV-1543 EX AFP (05-11)
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the spoUSe of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-7A7-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 105690-11 Date 12-27-1988
To ensure proper credit to the account, two
Established copies of this notice must accompany
AccOUnt Balance $ 820 81 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to TaX
4 1 0 ' 4 1 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due
1 8 •4 7 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1^
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E
~ an official assessment will be issued by the PA Department of Revenue.
BLOC K
0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~J below.
PART if intlicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
2
a X
4
5
6
7 X
8 $
PAD
1
2
3
4
5
6
7
8
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
PART
0
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT Pern
(u(w~ icnter on Line s of iax Computation) $
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C )
WORK ( )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
~ PENNSYLVANIA INHERITANCE TAX
BUREAU DF INDIVIDUAL TAxES INFORMATION NOTICE FILE
PD Box zaB6ol pennsylvanla AND
HARRISBURG PA 171zs-o6o1 TAXP AY E R R E S P O N S E AC N
DEPARTMENT OF REVENUE
REV-1543 E% AFP (05-11) DA T E
N0. 21
11181559
12-15-2011
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA -17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1 ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above named decedent, you were a joint owner/beneficiary of this account. If y0U are the SpOUSe Of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1 05690-00 Date 12-27-1988
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 906.71 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 453.36 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate
X . 0 4 5 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 20 40 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
BLOC K ~
0 N L Y B, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inherit
filed by the estate representative. ante tax return
C. ~ The above informs ion is incorr
ect and/or debts and deductions were paid
~
Complete PART ~ and/or PART u below. .
rAKI it inaicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE I. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6 +fi
7 X
8 $
PAD
1
2
3
4
5
6
7
8
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
PART
^3
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
eunnur .~,. r..
--- --' -' - ~- myuld llOnJ $
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C ~
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
~ PENNSYLVANIA INHERITANCE TAX
INF012MATION NOTICE FILE N0. 21
BUREAU OF INDIVIDUAL TAXES
PD BDX 280601 Pennsylvania ACN
HARRISBURG PA 17128-0601 AND 11181562
DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE
REV-1543 EX AFP (05-11) 12-15-2011
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1 ST F CU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the Spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it tc the above address. Please cal', ?17-?87-8327 with questions.
COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1U56y0-40 Date 06-29-2009
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 533.92 payment to the Register of Wills. Make check
"
payable to
Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax NOTE: If tax payments are made within three
$ 2 6 6 . 9 6
months of the decedent's date of death,
Tax Rate X . 045 deduct a 5 percent discount on the tax due.
Potential Tax Due Any inheritance tax due will become delinquent
$ 1 2 • 0 1
nine months after the date of death.
PART TAXPAYER RESPONSE
0
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K
0 N E a discount or avoid interest, or return this notice to the Register of Wills and
an official assessment will be issued by the PA Department of Revenue.
[ B L 0 C K ~ g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3^ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE I. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 $
s X
4 $
5 -
6 $
7 X
8 $
PAD
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of_my knowledge and belief. HOME C ~
WORK C
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
~(( L1fIC n or ( ax wmputatlon) $
°~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No. 21
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 Pennsylvania
HARRISBURG PA l~lz6-o6o1 TAXPAYERNRESPONSE ACN 11181563
DEPARTMENT OFREVENUE DAT E
REV-1543 EX AFP (05-11) 12 - 15 - 2011
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the spOUSe of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 105690-41 Date 03-22-2009
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 5, 082.89 payment to the Register of Wills. Make check
"
payable to
Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 2,541.45 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( .045 deduct a 5 percent discount on the tax due.
Potential Tax Due 1 1 4. 3 7 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1^
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K
0 N E a discount or avoid interest, or return this notice to the Register of Wills and
an official assessment will be issued by the PA Department of Revenue.
[ B L 0 C K ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3^ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8 $
PAD
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
IUINL renter on Cane 5 or iax Computation) $
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C )
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER nerF
~~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No. 21
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 pennsylvania
HARRISBURG PA l~lzs-o6ol TAXPAYERNRESPONSE ACN 11181561
DEPARTMENT OF REVENUE
DATE 12-15-2011
REV-1543 E% AFP (OS -11)
EST. OF CLAUDIA B GLOVER
SSN 216-14-8645
DATE OF DEATH 11-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
BEVERLY A GLOVER REGISTER OF WILLS
18 ABBEY CT 1 COURTHOUSE SQUARE
CARLISLE PA 17015-4385 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS IST FCU provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU art the SpOUSe of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this farm and return
i*_ to the above addrecs. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
U• 1U76YU-6U Date 04-09-2009
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 1 ~ O 15.83 Payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 507.92 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( .045 deduct a 5 percent discount on the tax due.
Potential Tax Due
2 2 ' 8 6 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESP ONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
BLOC K ~
O N L Y g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
fil ed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid
Complete PART 2~ and/or PART 3u below. .
PART
tr 1ntl1caLing a tllfferent taX rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8 $
PAD
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMnIINT Pern
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C 1
WORK C
TAXPAYER SIGNATURE TELEPHONE NUMBER nwTr
•-- ~ ~ ..,, ~~,~r n ur iax compucauonl $
~~
MEMBERS 1St
FEDERAL CREDIT UNION
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.membersl st.org
Main Switchboard: (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312
TeleBranch: (800) 237-7288
Statement of Accounts
Nov 25, 2011 thru Dec 24, 2011
Account Number: 105690
Balances at a
Checking
Savings
Certificates
Loans:
Money Manac
Swipe 5 YTD
Glance:
1,527.14
58,673.22
48,633.37
8,667.64
lement : 16.85
Reward : 0.00
2709 1 AV 0.340 9567-2709
I~~rlll~~rlll~~~~~~llrlrlr~lr~lrrll~lrrlrrl~l~~~rlll~~lrlr~~ll
BEVERLY A GLOVER
18 ABBEY COURT
CARLISLE PA 17015
Your current Member Loyalty Rewards level is Titanium.
Page : 1 of 4
1099-INTs are not included in this statement. If you earned at least $10
in dividends on your account for 2011, you will receive your 1099-INT in
a separate mailing in early January 2012. 1099-INT information will also
be available on Members 1st Online early in January.
CHECKING ACCOUNTS
f 0011 -CHECKING
Date Transaction Description Additions Subtractions Balance
Nov 25 Ba/ante Fonva~d 265.81
Nov 25 Deposit by Check 600.00 865.81
Nov 25 Check 006756 Tracer 0001411924 10.00- 855.81
Nov 25 Check 006754 Tracer 0001208461 35.00- 820.81
Nov 28 Deposit 2,765.00 3,585.81
Dec 01 Deposit by Check 225.00 3,810.81
Dec 01 Check 006758 Tracer 0001078254 74.19- 3,736.62
Dec 02 Check 006760 Tracer 0001086152 2,220.00- 1,516.62
Dec 05 Withdrawal ACH AD&D800-860-7182 7.50- 1,509.12
TYPE: INS PREM ID: 1621282786 DATA: MEMBERS 1ST FEDERAL
CO: AD&D800-860-7182
Dec 05 Check 006761 Tracer 0495419481 99.97- 1,409.15
Processed Check - FIA CardSen~ices
TYPE: CHECK PYMT ID: 2200000005 DATA: 18004212110
Dec 05 Check 006763 Tracer 0002805549 125.00- 1,284.15
Dec 06 Check 006762 Tracer 0610933336 67.13- 1,217.02
Processed Check - CenturyLink
TYPE: BILL PYMT ID: 4202975500
Dec 07 Check 006770 Tracer 0001071213 5.54- 1,211.48
Dec 08 Check 006769 Tracer 0001083118 44.00- 1,167.48
Dec 09 Deposit Transfer From Share 0010 500.00 1,667.48
Dec 12 Check 006759 Tracer 0002313836 100.00- 1,567.48
Dec 13 Deposit 125.00 1,692.48
Dec 13 Check 006757 Tracer 0001102371 35.00- 1,657.48
Dec 13 Check 006764 Tracer 0001102372 35.00- 1,622.48
Dec 13 Check 006766 Tracer 0001097485 100.00- 1,522.48
Dec 14 Check 006767 Tracer 0001243759 19.94- 1,502.54
Dec 14 Check 006768 Tracer 0001243161 50.00- 1,452.54
Dec 15 Check 006774 Tracer 1701550604 210.43- 1, 242.11
Processed Check -MET-ED TYPE: BILL PYMT ID: 2258580002
Dec 15 Check 006772 Tracer 0001072358 35.00- 1,207.11
Dec 16 Check 006771 Tracer 0001094207 125.00- 1, 082.11
Dec 19 Check 006778 Tracer 0002329628 25.00- 1, 057.11
--- Continued on following page ---
St
~~ Send Inquires to:
Main Switchboard:
5000 Louise Drive
(800) 283-2328
. PO Box 40 EZ Call: (717) 697-4372 or (800) 283-4372 Nov 25
2011 thrU Dec 24
2011
MEMBERS t°
~~ Mechanicsburg, PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 e
TeleBranch: ,
sea-2~oe gccount Number: ,
105690
www memberstst.org (800) 237-7288
Page : 2 of 4
Date Transaction Description Additions Subtractions Balance
Dec 20 Check 006775 Tracer 0001096527 120.00- 937
11
Dec 21 Deposit Transfer From Share 0001 870.03 .
1
807
14
Dec 21 Check 006662 Tracer 0001252291 10.00- ,
.
1
797
14
Dec 21 Check 006675 Tracer 0001252288 10.00- ,
.
1
787
14
Dec 21 Check 006753 Tracer 0001252287 20.00- ,
.
1
767
14
Dec 21 Check 006776 Tracer 0001252290 85.00- ,
.
1
682
14
Dec 21 Check 006765 Tracer 0001252289 100.00- ,
.
1
582
14
Dec 22
' Deposit Transfer From Share 0005 25.00 ,
.
1
607
14
_ Dec 22 Check 006773 Tracer 0001074432 80.00- ,
.
1
527
14
Dec 24 Ending Balance ,
.
1, 527.14
' CHECK SUMMARY
Check # Amount Date Check # Amount Date
006662
* 10.00 Dec 21 006765 100.00 Dec 21
006675 10.00 Dec 21 006766 100.00 Dec 13
006753* 20.00 Dec 21 006767 19.94 Dec 14
006754 35.00 Nov 25 006768 50.00 Dec 14
006756* 10.00 Nov 25 006769 44.00 Dec 08
006757 35.00 Dec 13 006770 5.54 Dec 07
006758 74.19 Dec 01 006771 125.00 Dec 16
006759 100.00 Dec 12 006772 35.00 Dec 15
006760 2,220.00 Dec 02 006773 80.00 Dec 22
006761 99.97 Dec 05 006774 210.43 Dec 15
006762 67.13 Dec 06 006775 120.00 Dec 20
006763 125.00 Dec 05 006776 85.00 Dec 21
006764
' 35.00 Dec 13 006778* 25.00 Dec 19
Asterisk next to number indicates skip in number sequence
26 Checks C/eared for 3, 841.20
SAVINGS ACCOUNTS
0000 -REGULAR SAVINGS
Date Transaction Description Additions Subtractions Balance
Nov 25 Ba/ance Forward 706 58
Nov 25 Deposit by Check 200.00 906
58
Nov 30 Deposit Dividend 0.250% 0.16 .
906
74
Annua/ Percentage Yie/d Earned 0.260 from »/01/2011 through »/30/2019 ,
Dec 01 Withdrawal Transfer To Loan 0003 391.46- 515
28
Dec 21 Deposit by Check 6,037.85 .
6
553
13
Dec 24 Ending Ba/ance ,
.
6 , 553.13
0001 -SUPPLEMENTAL SAVINGS
Date Transaction Description Additions Subtractions Balance
Dec 05 Ba/ance Forward 0
00
Dec 05 Deposit 44,625.35 .
44
625.35
Dec 05 Deposit by Check 26 99 ,
44 652 34
Dec 21 Deposit by Check 39.05 44
691
39
Dec 21 Withdrawal Transfer To Share 0011 870.03- ,
.
43
821
36
Dec 21 Deposit by Check 220 42 ,
.
44 041 78
Dec 24 Ending Ba/ance 44 041 78
0002 -HOLIDAY CLUB
Date Transaction Description Additions Subtractions Balance
Nov 25 Ba/ance Forward 0.00
Dec 24 Ending Balance 0.00
0005 -MONEY MANAGEMENT
Date __ Transaction Description Additions Subtractions Balance
Nov 25 Ba/ance Forward 141.84
Nov 30 Deposit Dividend Tiered Rate 0.01 141.85
Annua/ Percentage Yie/d Earned 0.090"/o from 91/01/2019 through 19/30/2099
Dec 22 Withdrawal Transfer To Share 0011 25.00- 116.85
--- Continued on reverse side ---
St Send Inquires to:
~~ 5000 Louise Drive Main Switchboard: (800) 283-2328
•
MEMBERS 1~ PO Box 40
Mechanicsburg
PA 17055 EZ Call: (717) 697-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 NOV 25, 2011 thru Dec 24, 2011
9sa9-s,o~
P~~ ~ ,
www.membersist.org TeleBranch: (800) 237-7288 Account Number: 105690
Page : 3 of 4
Date
Dec 22 Transaction Descri lion
Withdrawal Additions Subtractions Balance
Dec 24
Ending Balance 100.00- 16.85
16.85
0010 -IRA SAVINGS
Date Transaction Descri lion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend Tiered Rate
2
13 8,631.74
Annua/ Percentage Yie/d Earned 0.30U~ from > 1/01/201 > through > 1/30/20» . 8,633.87
Dec 09 Withdrawal Transfer To Share 0011 Normal Distribut 555.56- 8
078
31
Federal Withholding 55.56 ,
.
Dec 24 Ending Ba/ance
/RS Withho/ding Year to Date 8 , 078.31
61.97
CERTIFICATE ACCOUNTS
0017 - 19 MONTH IRA CERT Maturity Date -May 11, 2012
Date Transaction Descri lion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.640%
14
34 10,637.67
Annua/ Percentage Yie/d Earned 1.650' from 11/01/2011 through 11/30/2011 . 10,652.01
Dec 24 Ending Ba/ance
10 ,652.01
0021 - 19 MONTH IRA CERT Maturity Date -Jun 13, 2012
Date Transaction Descri lion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.590%
13
93 10,662.14
Annua/ Percentage Yie/d Earned 1.600"/o from 11/01/2011 through 11/30/2011 . 10,676.07
Dec 24 Ending Ba/ance
10 , 676.07
0022 - 11 MONTH IRA CERT Maturity Date -May 12, 2012
Date Transaction Descri lion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.100%
9
08 10,042.56
Annua/ Percentage Yie/d Earned 1. > 10~ from 11/01/2011 through 11/30/2011 . 10,051.64
Dec 24 Ending Ba/ance
10 , 051.64
uu~a - eu MONTH IRA CERT Maturity Date -Sep 13, 2014
Date Transaction Descri lion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 2.720%
23
69 10,596.23
Annua/ Percentage Yie/d Earned 2.750 from 11/01/2011 through 11/30/2011 . 10,619.92
Dec 24 Ending Ba/ance
10 , 619.92
0040 - 19 MONTH CERT Maturity Date -Apr 28, 2012
Date Transaction Descri lion
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.640%
0
72 533.30
Annua/ Percentage Yie/d Earned 1.66U~ from 11/01/2011 thraugh > 1/30/2011 . 534.02
Dec 24 Ending Ba/ance
534 02
0041 - 15 MONTH CERT Maturity Date -Jan 20, 2012
Date Transaction Descri lion -
Nov 25 Ba/ance Forward Additions Subtractions Balance
Nov 30 Deposit Dividend 1.490%
6
22 5,077.50
Annua/ Percentage Yie/d Earned 1.500 from 11/01/2011 through 11/30/2011 . 5,083.72
Dec 24 Ending Ba/ance
5 , 083.72
--- Continued on following page ---
St Send Inquires to:
Main Switchboard:
5000 Louise Drive (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
~~
Po Box ao
• Nov 25 , 2011 thru Dec 24
2011
MEMBERS t~ Mechanicsburg, PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 ys,o-s~o? gccount Number: ,
105690
www.memberslst.org TeleBranch: (800) 237-7288
Page : 4 of 4
0060 - 15 MONTH CERT Maturity Date -Feb 07, 2012
Date Transaction Description Additions Subtractions Balance
Nov 25 Ba/ante Forward 1
014.75
Nov 30 Deposit Dividend 1.490% 1.24 ,
1
015.99
Annua/ Percentage Yie/d Earned 1.500' from 11/01/2011 through 11/30/2011 ,
Dec 24 Ending Ba/ante 1
015
99
,
.
' LOAN ACCOUNTS
' 0003 -INDIRECT NEW AUTOS
Date Transaction Description Amount Interest Fees Principal Balance
Nov 25 Ba/ante Forward 9
001.10
Dec 01 Payments Transfer From Share 0000 391.46- 58.00 0.00 333.46- ,
8
667.64
Dec 24 Ending Ba/ante ,
8
667.64
Annual Percentage Rate 7.840% Daily Rate .021479% ,
2010 /merest Paid 1,134.50
YTD SUMMARIES
TOTAL DIVIDENDS PAID TOTAL LOAN INTEREST PAID
0000 REGULAR SAVINGS 1.80 0003 INDIRECT NEW AUTOS 844,90
0001 SUPPLEMENTAL SAVINGS 0.00
0002 HOLIDAY CLUB 0.05
0005 MONEY MANAGEMENT 1.93
0010 IRA SAVINGS 26.67
0011 CHECKING 0.00
0017 19 MONTH IRA CERT 158.57
0021 19 MONTH IRA CERT 154.10
0022 11 MONTH IRA CERT 51.64
0025 60 MONTH IRA CERT 260.78
0040 19 MONTH CERT 7.g4
0041 15 MONTH CERT 68.80
0060 15 MONTH CERT 13.74
Total Current Year IRA Contributions 0.00
Total Year To Date Dividends Paid gg.57
NOTE: Total includes closed shares
Total Year To Date Nontaxable Dividends 701.06
Total Year To Date tRS Withholding 61.97
Add Your Photo For Security
Your personal safety and financial security are top priorities at Members 1st. As a result of
increased scams and fraudulent activity throughout the entire country, we are strongly
encouraging members to have their photos added to their account records. When visiting our
branch offices, you may be asked by one of our Associates to allow us to take your photo. This
member identification program will assist in our fraud deterrence initiatives and will take our
identity theft prevention program to the next level. We are experiencing an increasing number of
attempted fraudulent activities anal as a result, we need to be able to verify your identity
immediately upon retrieving your account information.
In addition to having your photo in our files, you may be required to show additional forms of
identification based on the type of transaction you are seeking. This is for your protection and
security and we appreciate your ongoing cooperation and understanding.
REV-1510 EX+ (OS-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Claudia B. Glover 21-11-1323
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE 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
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1~ U.S. Savings Bond
30.34 100 0.00 30,3
2 IRA, Members 1st FCU, 157628-0020
3,394.21 100 0.00 3,394.2.
TOTAL (Also enter on Line 7, Recapitulation) $ ~ 3,424.55
If more space is needed, use additional sheets of paper of the same size.
~7~
MEMBERS 1St
FEDERAL CREDIT UNION
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.membersl st.org
Mafn Switchboard: (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312
TeleBranch: (800)237-7288
4552 1 AV 0.340 4552-4552
In~l~ln~~llnnnll~l~lnlnlu~~~lnlnl~lnullln~~ln~~l
BEVERLY A GLOVER
18 ABBEY COURT
CARLISLE PA 17015-4385
Statement of Accounts
Dec 21, 2011 thru Dec 24, 2011
Balances at a Glance:
Account Number: 157628
Checking : 0.00
Savings : 0.00
Certificates : 3 , 394.21
Loans: 0.00
Money Management: 0.00
Swipe 5 YTD Reward : 0.00
Page : 1 of 1
1099-INTs are not included in this statement. If you earned at least $10
in dividends on your account for 2011, you will receive your 1099-INT in
a separate mailing in early January 2012. 1099-INT information will also
be available on Members 1st Online early in January.
CERTIFICATE ACCOUNTS
0020 -19 MONTH IRA CERT Maturity Date -Jun 29, 2012
Date Transaction Description Additions Subtractions Balance
Dec 27 Ba/ante Forwaro~ 0.00
Dec 21 Deposit Transfer From Share 0016 Transfer from wit 3,394.21 3,394.21
Dec 24 Ending Ba/ante 3 , 394.21
YTD SUMMARIES
TOTAL DIVIDENDS PAID
0020 19 MONTH IRA CERT
0.00
Total Current Year IRA Contributions 0.00
Total Year To Da#e Dividends Paid B'~~.75
NOTE: Total includes closed shares
Total Year To Date Nontaxable Dividends 62.71
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REV-i.511 EX+ (1J-49)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Claudia B. Glover 21-11-1323
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I' Vaugh Green Funeral Home, Baltimore, Maryland 2,220.00
2. Hoffman-Roth Funeral Home, Carlisle, Pennsylvania 870.03
3. Flowers 74.19
a. Pastor Stewart Johns 125.00
5. Musician 25.00
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions;
Name(s) of Personal Representative(s)
Street Address
0.00
City
Year(s) Commission Paid:
State ZIP
z• Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
4.
5.
6.
7.
s.
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Postage
Copies
ZIP
700.00
209.50
10.30
0.85
TOTAL (Also enter on Line 9, Recapitulation) I $
If mare space is needed, use additional sheets of paper of the same size.
4,234.87
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
Claudia B. Glover
SCHEDULE ~
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1 • Beverly A. Glover, 18 Abbey Court, Carlisle, PA 17015
2. Lamar Glover, Jr., 2880 N. 700 South, North Judson, IN 46366
3. Amy Cook, 770 College Ave., Adrian, MI 49221
4. Lori Kroupa, 50 Alamance St., Cameron, NC 28326
5. Sarah Glover, 50 Alamance St., Cameron, NC 28326
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Daughter
Grandchild
Grandchild
Grandchild
Grandchild
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
FILE NUMBER:
21-11-1323
AMOUNT OR SHARE
OF ESTATE
46,678.53
0.00
0.00
0.00
0.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
If more space is needed, use additional sheets of paper of the same size.