HomeMy WebLinkAbout03-06-1215D5611180
REV-1500 ~ 10z-„> IF°
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
OEPFRTMENTOf REVENUE County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN --
PO BOX 280601 `, t ~ C~`~~ ~
Harrisburg, PA 17128-0601 RESIDENT DECEDENT - I
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
163-38-8049 04202011 02231944
Decedent's Last Name Suffix Decedent's First Name MI
HARDING MARI E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
Q 1. Original Return 0 2. Supplemental Return ~ 3. Remainder Return (Date of Death
Prior to 12-13-82)
0 4. Limited Estate 0 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax. Retum Required
death after 12-12-82)
Q 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust D 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (Date of Death ~ 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ROBERT G FREY 7172435838
First Line of Address
5 SOUTH HANOVER ST
Second Line of Address
City or Post Office
CARLISLE
State ZIP Code
PA 17013
Correspondent's a-mail address: R F R E Y a F R E Y T I L E Y. C O M
REGISTERILLS USE ONLY
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Dq~ FILED _..
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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 com lete. Declaration of re arer other than the ersonal re resentative is based on all information of which re arer has an knowled e.
SIGNAT E PERSON ESPO LE FOR F ING RETURN DATE
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SIGN RE OF PREPARER OTHER THAN REPRESENTATIVE ~ DATE
ADDRESS
5 SOUTH HANOVER STREET, CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505611180 1505611180
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1505611280
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: f1ARI E HARDING 163-38-8049
RECAPITULATION
1. Real Estate (Schedule A) .......................... ............ .. 1. 9 3 5 0 0 . 0 0
2. Stocks and Bonds (Schedule B) .................................. .. 2. 3 8 O 6 O . 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .. 3. NON E
4. Mortgages and Notes Receivable (Schedule D) ...................... .. 4: N 0 N E
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .. .. 5. 7 7 O 9 D . D O
6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. N 0 N E
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested ..... .. 7. 17 2 8 O 5 . 0 0
8. Total Gross Assets (total Lines 1 through 7) ........................ .. 8. 3 814 5 5 . 0 O
9. Funeral Expenses and Administrative Costs (Schedule H) .............. .. 9. 4 O 2 4 2 . 0 D
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .......... .. 10. 3 9 2 2 . 0 0
11. Total Deductions (total Lines 9 and 10) ........................... .. 11. 4 416 4 . D D
12. Net Value of Estate (Line 8 minus Line 11) ......................... .. 12. 3 3 7 2 91.0 O
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................... .. 13. 8 4 ~ 2 2 . 7 5
14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 2 5 2 9 6 8 . 2 5
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 O 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x .0 4 5 16. O.0 0
17. Amount of Line 14
taxable at sibling rate X . 12 17. O . O O
18. Amount of Line 14 taxable
at collateralratex .15 252968.25 1s. 37945.24
19. TAX DUE ...... .............................................. .. 19. 37945.24
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0
Side 2
L 1505611280 1505611280
REV-1500 EX (FI) Page 3
Decedent's Comn{ete Address:
File Number
21-11-0531
163-38-8049
DECEDENT'S NAME
MART E HARDING
STREET ADDRESS
578 "F" STREET
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount
3. Interest
39500.00
1975.00
(1)
37945.24
Total Credits (A + B) (2) 41475.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4)
3529.76
(5) _ 0.00
Make check payable to: REGISTER OF WILLS, AGENT
,:
.. ,,,~, ..,a ~ : ,~:
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 .................................................................................................................... ...... ^
d. 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? .................................................................................................... ...... ^
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? .............................................................................................................. ...... ^X ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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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 Juty 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(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.
REV-1502 EX+ (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Mari E Harding 21-11-0531
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
If more space is needed, use additional sheets of paper of the same size.
REV-,5°$~+~""'°' SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, 8~ MISC.
DEPARTMENT OF REVENUE PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Mari E Harding 21-11-0531 _
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 Orrstown Bank, account no. 35756 1,960
2 2003 Dodge Neon. Actual sales price 2,000
3 Merrill Lynch Bank Deposit Program 35,701
4 Merrill Lynch Bank Deposit Program, CMA account 1,808
5 ROYALTY MINERAL RIGHTS, .00260039 INTEREST (CAPITALIZED @ 10% OF ROYALTY PM' 19,209
6 REAL ESTATE TAX PRORATION FROM HUD-1 SETTLEMENT STATEMENT 588
7 DOWN PAYMENT RETAINED FROM CANCELLED TRANSACTION 9,700
8 LIFE INSURANCE RECEIVABLE PAYABLE ON THE LIFE OF JUVENELIA HARDING 1,000
9 PERSONAL PROPERTY IN RESIDENCE 2,500
10 NURSING HOME REFUND 2,016
11 COMCAST REFUND 13
12 NATIONWIDE INSURANCE REFUND 302
13 REAL ESTATE TAX REFUND 250
14 AMBULANGE MEMBERSHIP REFUND 43
TOTAL (Also enter on line 5, Recapitulation) $ I 77,090
If more space is needed, use additional sheets of paper of the same size.
REV-1503 EX+(6-98)
COMMONWEALTH OF PENNSYLVANIA
fNHERITANCE TAX RETURN
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
Mari E Harding 21-11-0531 _
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH _
1. Danville Area School District, 10,000 units 9,619
2. Alliance Bernstein Global Bond Fund, ANAGX, 680 shares, $8.35 share price 5,678
3. Danville Area School District, 10,000 units, CMA account 9,619
4. Duff & Phelps Util & Corp Bond Fund, DUC, 1263 shares, 9.35 ave. share price 11,809
5. Prudential Financial, 22 shares, 60.675 ave. share price 1,335
6.
TOTAL (Also enter on line 2, Recapitulation)~$ 38 060
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (OB-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PR08ATE PROPERTY
ESTATE OF
FILE NUMBER
Mari E Harding 21-11-0531 _
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.ATTACHACOPYOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
UFhPPLICABLE)
TAXABLE:
VALUE
1. Merrill Lynch IRA 172,805 100.00% 172,805
TOTAL (Also enter on Line 7 Recapitulation) $I 172 805
If more space is needed, use additional sheets of paper 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
Mari E Harding 21-11-0531
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EXPENSES IN CONNECTION WITH MEMORIAL SERVICE 288
2. COSTS FOR SPREADING ASHES
3. HONORARIUM TO OLD BELLAIRE #375
4. HOFFMAN ROTH FUNERAL HOME
5. HONORARIUM TO MINISTER
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) John S. Koczella
Street Address
City WASHINGTON State DC ZIP
Year(s) Commission Paid: 2012
2
3
4
5
6
7
Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
EXPENSES OF REAL ESTATE SOLD
8. Advertising costs
9. Title transfer charges
10. Death Certificates
11. EXECUTOR TRAVEL & TELEPHONE EXPENSES
12. POSTAGE
500
200
2,173
300
16,840
12,000
413
6, 081
254
219
36
894
44
TOTAL (Also enter on Line 9, Recapitulation
If more space is needed, use additional sheets of paper of the same size.
ZIP
40
REV-1512 EX+ (12-OB)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Mari E Harding 21-11-0531
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE NUMBER:
NAari F I-larrlinn 71-11_n5'~1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
Ronald and Hazel Kunkelman
1 ~
1355 Centerville Road, Newville, PA 17241 Friends 50% of residue
Robert S. Koczella
2~
1932 Gear Avenue, Lot #4, Fairfield, IA 52556 Cousin 25% of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SH EET, 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. First United Church of Christ of Carlisle 25% of residue
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
mod. OMB Approval No. 2502-0265
~~~)~~~~-'= A. Settlement Statement (HUD-1)
06)IU
^Conv. Unins.
^ FHA 2
^ RHS 3
1 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
.
.
. IARK2-12
4. ^ VA 5. ^Conv. Ins.
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid tc and by the settlement agents are shown Items marketl
"(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals-
D. Name 8 Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender:
IARK PROPERTIES MART E. HARDING ESTATE RICHARD L. CLITES
50 HICKORY ROAD, CARLISLE, PA 17013 578 F STREET, CARLISLE, PA 17013 P 0 BOX 37, ELLIOTTSBURG, PA 17024
G. Property Location: H. Settlement Agent: I. Settlement Date: 02/13/2012
578 F STREET IirM REAL ESTATE SERVICES, LLC Disbursement Date: 02/13/2012
Carlisle, PA 17013 West Pomfret Pmfessional Bldg, 60 West Pomfret Street,
Carlisle Borough Carlisle, PA 17013
Telephone: 717-249-2353 Fax: 717-249-6354
Place of Settlement: TitleExpress
West Pomfret Pmfessional Bldg, 60 West Pomfret Slreet, Printed 02/13/2012 at 9:10 am
Carlisle, PA 17013 by JMR
100. Gros Amourrt Due from Borrower 400. Grose Amount Due to Seller
101. Contract sales price 93,500.00 401. Contract sales price 93,500.00
102. Personal pr ert 402. Personal propert
103, Settlement charges to borrower (line 14001 1,700.00 403.
104. 404.
105. 405.
Ad'ustments for terns aid b seller in advance Ad ustments for items aid b seller in advance
10fi. Cityltown taxes to 406. CityAowrt taxes to
107. County taxes to 407. County taxes to
108. Scnool Taxes 02/13f2012 to 06(3012012 587.78 408. School Taxes 02/13!2012 to 06/30/2012 587.78
109. 409.
110. 410.
111. 411.
112. 412.
120• Gross Amount Due from Borrower 95,787.78 420. Gross Amount Due to Seller 94,087.78
200. Amounts Psid or in Behalf of Borrower 500. Reduefbrts in Amount Due to Seller
201. Deposit or earnest money 501. Excess deposit (see instructions)
202. Prindpal amount of new loan(s) 105,000.00 502. Settlement charges tc seller (line 1400) 1.002.23
203. Existin loarrsl taken subject to 503. Ezistin IoaMs) taken sub'ect fo
204. 504. Payoff of first mort age loan
205. 505. Pa off of second mortga a loan
206. 506.
207. 507.
208. 508.
209. 509.
Ad'ustments for items unpaid b seller Ad'ustments for items unpaid b seller
210. Cityltown taxes to 510. Cityltown taxes to
211. County taxes 01/0112012 to 02113!2012 81.84 511. County taxes 0110112012 to 02/13!2012 81.84
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220• Total Paid b Ifor Borrower 105,081.84 520. Total Reduction Amount Due Seller 1,084.07
300. Cash at Seltlematt Momho Bortoxler 600. Cash at SeHlemertt tolfrom Shier
301. Gross amount due from bonower (line 120) 95,787.78 gp1, Gross amount due to seller (line 420) 94,087.78
302. Less amounts paid by/for borrower (line 220) 105,1)81.84 602. Less reductions in amount due seller (line 520) 1,084.07
303. Cash ^ From ^X To Borrower 9,294.06 603. Cash ^X To ^ From Seller 93,003.71
selpemen~ nkss p E,spleys • uxrenny vela OMB foMnN nwn0er. No runfiEe,plNgy,e °...,rM. iVls tlutlpxre n manJNary. TI„. ,s Eeapnetl ra pmv,ae V,e penes io a RE'.GA ruvereU Ve,uattan xVm InbrmNOn Oun,q me
Previous editions are obsolete Page 1 of 4 HUD-1
:Total Real Estate Broker Fess ~ Paid From Paid From
Division of commission Iine70D as follows: Borrower's Seller's
/01. $0.00 to Funds at Funds at
702. $O.DO to Settlement Settlement
703. Commission paid at settlement
800. ksms Pa ble in Connaetlon with Loan
801. Our orgination charge Qncludes Odgination Point 0.000 % or $0.00) $ (from GFE #1)
802. Your creditor charge (points) for the specific interest rate chosen $ (from GFE #2)
803. Your adjusted origination charges (from GFE A)
804. A raise/ fee to from GFE #31
805. Credit report to from GFE #3)
806. Tax service to from GFE #3)
807. Flood certification to (from GFE #3
808. to
900. 8srm ufrsd Lendarto be Paid in Advance
901. Daily interest charges from from 02/13!2012 to 03/01!2012 @ $0.00/day (from GFE #10)
902. Mort a e insurance premium months to from GFE #3
903. Homeowner's insurance months to from GFE #11)
904. months to from GFE #11
1000. Reserves De Ited xrNlr Lender
1001. Initial deposit for your escrow account (from GFE #9)
1002. Homeowner's insurance months $ /month
1003. Mort a e insurance months $ Imonth
1004. Prope taxes months $ /month
1005. County taxes months $ 58.051month $ to CLITESIRICHARD L.
1006, Schogl Taxes months $ 128.971mgnth $ to
1007. Aggregate Adjustment $ to
1100. TMk Pha es
1101. TiOe services and lenders title insurance from GFE #41 639.00
1102. Settlement or closing fee to $
1103. Owners title insurance from GFE #5)
1104. Lender's title insurance $
1105. Lenders title policy limit $105,000.00
1106. Owners title policy limit $93,500.00
1107. Agent's portion of the total title insurance premium $
1108. Underwriters portion of the total title insurance premium $
1109.
1200. Government Recordln and Transfer Cha ea
1201. Government recording charges $ (from GF"c #7) 126.00
1202. Deed 562.00 Mortgage $64.00 Release $ to Recorder of Deeds
1203. Transfer taxes $ (from GFE #8) 935.00
1204. City/County tax/stamps Deed $935.00 Mort a e $ to Recorder of Deeds
1205. State Tax/stamps Deed $935.00 Mort a e $ to Recorder of Deeds 935.00
1206. Deed $ Mortga e $ to
1300. AdditlonalSeltJemenYCha es
1301. Required services that you can shop for (from GFE #6)
1302. to
1303. to
1304. 'rINAL WTRlSWR #005446 to BOROUGH OF CARLISLE $ 67.23
1305. to
' r r - r ~ r 1,700.00 1,002.23
`Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. "Credit by lender shown on page 1. "'Credit by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-1
.lack Koczela
From: valuations.us@webuyanycar.com
Sent: Tuesday, May 10, 2011 3:12 PM
To: jack@koczela.net
Subject: Vehicle Valuation
::a .: _-,
Yo~ur~ Online_
Valuat~o~
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Merrill Ly1~1cI?
~nnilities Tj~q AIII1U1t~r~"~~
Statement
Transactions al~d
lialdings for the period
June ~0, 2011 to
September 30, 2011
Mari E Harding
578 F St
Carlisle PA 17013-13.19
0
1 11 11 E 1 0
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P
Contract Information Contract number: N032044368
Contract Date: March 6, 2003
Owner: Mi,FF&S Custodian FBO Mari E Harding
Atu~uitant: ll~tari E Harding
Values as of .Total premiuans since issue: $101.000.00
September 30, 2011 Total w~ithdrawais since issue: $13.410.00
Contract value: $ 106238. ] 3
Surrender value: $106238.13
Death Benefit Values as of Maximum Anniversary Value: $121.336.37
September 30, 2011 Prcnvums Less adjusted withdraw°als: $89,868.02
Tr:msazneriea Ad~-isurs Lifc Insurance
Conepan~~ October 19, 2011 N032044368 Page 1 of 6
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