HomeMy WebLinkAbout05-07-12 (3) 1505607122
REV-1500
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Vear File Numher
Bureau of Individual Taxes
PO BOX 280801 INHERITANCE TAX RETURN
~ ~
Harrisburg, PA 17128-0801
RESIDENT DECEDENT - 0 0 2 6 5
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
0 2/ 1 7/ 1 2 0 5/ 1 8/ 2 1
Decedent's Last Name Suffix Decedent's First Name MI
B E N E D U M HELE N H
(If Applluble) Entsr Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Nan1e MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
11 1. Ortginal Retum o 2. Supplemental Retum o 3. Remainder Retum (date of death
prior to 12-13-82)
0 4. Limited Estate o 4a. Future Interest Compromise (date o 5. Federal Estate Tax Return Required
of death after 12-12-82)
0 6. Decedent Died Testate o 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Bozes
(Attach Copy of Will) (Attach Copy of Trust)
c~ 9. Litigation Proceeds Received c~ 10. Spousal Poverty Credit (date of death c~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTN)N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T~n
Name Daytime Telepho~Number M1+Y ,
~O
HARRY L B' R I' C K E R J R 7 1 7 23 2-s 5 ~'
I
Firm Name (If Applicable) n1 ~ n ~' r"':~ G
'%.
HARRY L B R I C K E R J R ESQ USE'BIt1LV
REGISTER ~ilY"~° 't r
,
~
~
i
First line of address ~_ ~
"-'~
~
_ - -
921 BR A DF O R D R OAD
-
~~'" '- ~'~'
y r-
`~
Sewnd line of address } ~ ;.~ } ~
DATE KILED
City or Post Office
H A R R I S B U R G
State ZIP Code
P A 1 7 1 1 2 1 6 1 1
Comespontlent's a-mail address: HLBLAW2~VERIZON.NET
Under penakies of perjury, 1 tleGare that I have examined this return, inGuding accompanying achadules and atetemenb, and to the beat of my knowledge antl belief,
it is Mre, correct and complete. Dedaretion of preperer other than the personal representative is based on all iMOrmalion of which preparor has any knowledge.
SIG ATURE OF PERSON RESPONSIBLE FOR F ING RETURN /~ DDATE
-~~r -N~C1~C-'I-t fin e-d at,.-~ J _ ~- / 2
ADDRESS
318 W. MEADOW DRIVE, MECHANICSBURG, PA 17055
ATURE OF PREPfjBEE;_OTHER TH 0 PRESENTATIVE DATE
921 BRA D ROAD, HARRISBURG, PA 17112
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607122 1505607122
1 1505607222
REV-1500 EX Decedent's Social Security Number
Decedent's Name: HELEN BENEDUM 2 3 6 4 2 0 4 5 4
RECAPITULATION
1. Real estate (Schedule A) 1. O D D
2. Stocks and Bonds (Schedule B) z. 2 9 8 1 4 4
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. D D D
4. Mortgages & Notes Receivable (Schedule D) 4. 0 D D
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) 5. 4 3 9 3 D 6 0
6. Jointly Owned Property (Schedule F) c~ Separate Billing Requested 6. 0 D D
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Propeny
1 0
4
4
3
7
1 5
3
(Schedule G) o Separate Billing Requested z
8. Total Gross Assets (total Lines 1-7) e. 1 0 9 1 2 8 3. 5 7
9. Funeral Expenses 8 Administrative Costs (Schedule H) 9. 2 9 3 7 5 1 6
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) 10. D D 0
11. Total Deductlons (total Lines 9& 10) 11. 2 9 3 7 5 1 6
12. Net Value of Estate (Line 8 minus Line 11) ,2. 1 0 6 1 9 0 8 4 1
1g. Charitable and Governmental BequestalSec 9113 Trusts for which
1
Jr
D
O D
D
an election to tax has not been made (Schedule J) 13.
14. Net Valus SubJeet to Tax (Line 12 minus Line 13) 14. 1 0 6 0 4 0 8 • 4 1
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
of the spousal tax rate, or
transfers under Sec. 9116
D 0
D
(a)(L2) X 0. 15.
16. Amount of Line 14 taxable
1 0 6 0 4 0 8. 4 1
4
7
7
1
B• 3
8
at lineal rate x o.o4s 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17. D D O
18. Amount of Line 14 taxable
at collateral rate X .15 18. 0 0 D
19. TAX DUE 19. 4 7 7 1 8 3 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c~
Side 2
1505607222 1505607222
REV-1500 EX Page 3 Flle Number
Decedents Complete Address: ??
DECEDENT'S NAME
HELEN BENEDUM DECEDENT'S SOCIAL SECURITY NUMBER
i
STREET ADDRESS
MESSIAH VILLAGE LIFEWAYS
100 MOUNT ALLEN DRIVE
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) $47,718.38
2. Credits/Payments
A. Spousal Poverty Credit _
B. Prior Payments
C. Discount $2,385.92
Total Credits (A + B + C) (2) $2,385.92
3. InteresUPenalty if applicable
D. Interest
E. Penalty
_
Total InteresUPenalty (D + E)
(3)
$0.00
4. H Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FIII In oval on Page 2, Llne 20 to request a refund. (4) $0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $45,332.46
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 r 5A. This is the BALANCE DUE. (56) $45,332.46
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ^
b. retain the right to designate who shall use the property transferred or its income; ^
c. retain a reversionary interest; or ^
d. receive the promise for life of either payments, benefits or care? ^
2. If death occurred after December 12, 1982, did decedent transfer property within one
year of death without receiving adequate consideration? ^
3. Did decedent own an "in tmst fof or payable upon death bankaccount or severity 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
Far dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (I)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (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 twenty-one 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 zero (0) percent [72 P.S. §9116(a)(1.2)].
The taz rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (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 twelve (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.
REV45~]EX ~ (&BE)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF HELEN BENEDUM
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All orooaM1V lolntryowned wHh A9M of ~uMvorahlp mart bs dl~elosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 77 SHARES OF METROPOLITAN LIFE INSURANCE COMPANY STOCK AT $38.72 A SHARE $2,981.44
TOTAL (Also enter on line
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX ~ (&9B)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, St MISC..
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF HELEN BENEDUM
FILE NUMBER 00265
Include the proceeds of litigation and the date the proceeds were received by tfle estate.
All property Jolntly.wvnsd whh the RpM of survlvonhip mwt ha d4cloaad on SchMule F.
NUMBER
1.
2.
3.
4.
DESCRIPTION
NO. - 6100627705
TAX REFUND
/ANIA TAX REFUND
2S CHECKS
TOTAL (Also enter on line 5,
(If more space is needed, insert additional sheets of the same size)
VALUE AT DA
OF DEATH
$1,370.00
$303.00
$100.00
REV-1510 EX • I&881
SCHEDULE G
INTER-VIVOS TRAN8FERS d.
COMMONWEALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY
INHERITANCE TAX RETURN
ESTATE OF HELEN BENEDUM
FILE NUMBER
This schedule must be completed and filed if the ensurer to any of questions 1 through 4 on the reverse side of the REV-1:00 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INOWOE THE NAME OF THE TRANSFEREE. THEIR REIATONSHIP TO DECEDENT AND THE DATE OF TRANSFER
ATTACH gCOPY OF THE DEED FOR REALEBTATE. GATE OF OEATH
VALUE OF ASSf:T % OF DECD'S
INTEREST EXCN SIO
(IF TAXABLE
VALUE
1. 30 SERIES EE SAVINGS 80NDS $46,532.00 100.0°!° NONE $46,532.00
DATES: 6/1989. 4/1989, 2/1989
2. 27 SERIES EE SAVINGS BONDS $47,33[1.80 100.0°/ NONE $47,330.80
DATES: 10/1987, 3/1987, 12/1985, 4/1985, 10/1984, 4/1984
3. 37 SERIES EE SAVINGS BONDS $52,304.80 100.0% NONE $52,304.80
DATES'. 6/1992, 2!1992, 11!1991, 7!1991, 111990
4. 8 SERIES EE AND I SAVINGS BONDS $74,698.00 100.0% NONE $74,698.00
DATES: 4/1985, 12/2001, 10/2003
5. 32 SERIES EE SAVINGS BONDS $61,838.80 100.0% NONE $61,838.80
DATES: 10/1986, 8/1986, 7/1986, 3/1986, 1/1986
6. 25 SERIES EE SAVINGS BONDS $39,764.00 100.0% NONE $39,764.00
DATES: 9/1988, 7/1988, 4/1988
7. 37 SERIES EE SAVINGS BONDS $47,620.80 100.0% NONE $47,620.80
DATES: 9/1993, 1111992, 9/1992, 7/1990, 1/1990
B. 8 SERIES EE AND I SAVINGS BONDS $69,138.00 100.0°!o NONE $69,138.00
DATES: 12/2001, 10/2003, 2/1991
9. WELLS FARGO ADVISORS ACCOUNT NO. - 1189-7741 -INVESTMENTS $605,144.33 100.0% NONE $605,144.33
(If more space is needed, inser
TOTAL (Also enter on line 7, Recapitulation) $1,044,371.53
of the same size)
REV-1511 EX ~ (160
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAx RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8
ADMINISTRATIVE COSTS
ESTATE OF HELEN BENEDUM FILE NUMBER
Debts of decedent must be roported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MALPEZZI FUNERAL HOME -FUNERAL SERVICES $6,369.84
2. ST. JAMES PRESBYTERIAN CHURCH -FUNERAL EXPENSES $262.02
3. REV. DR. JAMES A. REITZ -FUNERAL SERVICES $100.110
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) _
Sheet _
Cit State Zi
Year(s) Commission Paid:
2. Attorney Fees HARRY L. BRICKER, JR., ESQ.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street
CR State Zi
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS, CUMBERLAND COUNTY
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. MESSIAH VILLAGE -NURSING CARE FOR JANUARY AND FEBRUARY, 2012
8. ALERT PHARMACY -MEDICATION FOR JANUARY AND FEBRUARY, 2012
9. PA SERS - REIMBURSEMENT OF OVERPAID PENSION
10. THE SENTINEL -ADVERTISING ESTATE
11. CUMBERLAND LAW JOURNAL-ADVERTISING ESTATE
12. 2012 INCOME TAX
13. REGISTER OF WILLS, CUMBERLAND COUNTY -RECORDING OF RELEASES
more space
TOTAL (Also enter on line 9,
els of the same size)
REV-1513 EX+(9-W)
SCHEDULE J
CDMM
ANIA
TA
N BE
EFI
IA
E
NHERI
NCE TTAX RE
URN N
C
RI
S
RESIDENT DECEDENT
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Oe xa WtTnuM(.) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distrihutions, and
transfers under Sec. 9116 (a) (1.2)]
1. JUDITH 5. BRODOVICZ DAUGHTER $525,204.21
31a W. MEADOW DRIVE, MECHANICSBURG, PA 17055
2. BARBARA B. ROWS DAUGHTER $525,204.20
4 KELLY COURT, ENOLA, PA 17025
3. BRANDON C. ROWE GRANDSON $5,000.00
32 NATHAN DRIVE, ENOLA, PA 17025
4. ALLISON E. ROWE GRANDDAUGHTER $5,000.00
704 N. OAKLAND STREET, ARLINGTON, VA 22203
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH ifl, AS APPROPRIATE, ON REV- 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS N07 BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. SAINT JAMES PRESBYTERIAN CHURCH - 1425 ORR'S BRIDGE ROAD, MECHANICSBURG, PA 17050 $1,000.00
2. KEARNEVSVILLE PRESBYTERIAN CHURCH - 48 CAMERON LANE, MARTINSBURG, WV 25405 $500.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF RE\I-1500 COVER SHEET $1,500.00
(If more space is needed, insert additional sheets of the same size)
_ °----_
'~:
March 27, 2012
Harry L Bricker 7r
921 Bradford Rd
Harrisburg PA 17112
Estate of Helen H Benedum
Date of Death: Feb 17, 2012
SSN: 236-42-0454
Deaz Sir/Madam:
One Citizens Drive
ROP112
Riverside, RI 02915
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his/her date of death.
For Installment Loans or Line of Credit accounts, contact our Loan Department at 1.800-708-6680. For
all other inquiries, please call 1-877-579-2667
REF#: 538001
+~ Cftizens ~~&-
Account Nurnber 6100627705
Account Title Helen H Benedum
Date erred 3/5/1999
Account T e Checkin
Princi al Balance as of DOD $42157.60
Interest from Last Postin to DOD $1.46
Account Balance as of DOD $42159.06
YTD Interest to DOD $1.56
Calculated Value of Your Paper Savings Bond(s)
Calculated Value of Your~Paper SavingsBond(s)
Calculator Results for Redemption Date 02/21Di2
Page 1 of 1
' Total Price Total Value Total Interest YTD Interest
$15 000 00 $46 532.00 531,532.00 8308.00
Bonds: 1-30 of 30
Issue. Next. Final Interest
Serial # Series Denom Date Acttual Maturity Issue Price .Interest Rate Value Note
m76921926 EE $1,000 06/1989
m76921925 . EE $1,000 06/1989
m76931881 , EE $1,000 06/1989
m76921880' EE $1,000 06/1989
m76921879 --EE $1,000 06/1989
m76921878 EE $1,000 06/1989
m76921877 EE $1,000 06/1989
m76921876 -EE $1,000 06/1989
m76921875' EE $1,000 06/1989
m76921873 EE $1,000 06%1989 06/2012:
m76921874 'EE $1,000 04/1489 04/2D12;
m76921897- EE $1,000 04/1989.04/2012'
m76921896 -EE $1,000 04/1989'04!2012;
m76921895 EE $1,000 04/1989 04/2013:
m76921894 EE $1,000 04(1989 04/2013'
m7692189& EE $1,000 04/1989 04/2012-
m76921842 _EE $1,000 04/1989.04/20121
m76921891 EE $1,000 04/1989 04/20121
m76921890', EE $1,000 04/1989.04/2012.,
m76921889 EE $1,000 04/1989 04/2012:,
m76921888 EE $1 000 02{1989 08/2012`
$500.00 $1,040.80 4.00%; ;1,540.80'
$500,00 $1,040.80 4.00% #1,540.80'
$500.00 $1,040.80• 4.00% ;1,540.80',.
$500.00 $1,040.80' 4:00% ;1,540.80
$500.00 $1,040.80 4:00% $1r540.80'
$500,00 $1,040.80 , --4.00% $1,540.80
$500.00 ¢1,040,80 4.00% ¢1,540.80
$500.00 $1,040.80 4.00% ;1,540.80'
$500;00 $1,040.80 4,00% 31.540.80. _
$500.00 $1,040.80 4.00% ;1,540.80
$SOOAO. $1,040,80 4.00% #1,540.80
$500.00 $1,040.80 4:00% 31,540.80
$500.00 $1,040.80 4.00% ;1,540.80;
$500..00 $1,040.80 4.00% ;1,540.80'
$500.00 ¢1,040.80 4.00% ¢1,440.80_
$500.00 $1,040,80 4:004/0 _ #1,540.80'
$500.00 $1,040.80: 4.OD% 31,540.80
$500.00 $1,040.80' 4,00% #1,540.80
$500.00 $1,040.80 4.00% #1,540.80 _,
$500_.00 $1,040.80 4'.00% #1,¢40.80
.,..,-...~ $500.00 $1,071.60 4:00% $1,571.60 _
m76921887 EE $1,000 02/1989 06/2012102/2019_ $500:00 $1,071.60, 4:00% 31,571.60'
m76921886__EE $1,000 02/19$9 08/20121
m76921885 EE $1,000 02/1989 OS/2012I
m~b921884: EE $1,000 02/198908/2012'
m76921883' EE $1,000 02/1989 08/2012.
m76921882 EE $1,000 02/1989 08/2012'.,
m76921912 EE $1,000 02/1989'OS/2012j
m76921911 EE $1,000 02/1989 08/2013'
m76921910 . EE $1,000 02/1989 08(2012
?019 $500.00 $1,07Y.60 4:00% 31,571.60
>.019i
- $500.00 $1,071.60 4.00% $1,571.60._
?019_' $500.00 $1,071.60 4.00% #1,571.60'..
?019' $500.00 $1,071.60 4,00% $1,571.60'.
?019' $500:00 $1,071.60 4.00% ;1,571.60
?019; $500:00 $1,071.6,0 4.00°fo _ $1,571.60.
>D19' $500.00 $1,071.60 4c00% $1,571.60
Q2/2019 $500,00 $1,071.60'. 4.00% $1,571.60
Notes
NI Not Issued
NE Not eligible for payment
PS Indpdes 3 month interest penalty
MA 'Matured an n ea i erect
~~ ~'~ ~ l
https//www.treasurydirect.govBC/SBCPrfce 2/26/2012
t,aicuia>:ea vame ox your raper ~avmgs bond(s) Pagel of 1
Calculated Value. of Your Paper. Sarings~ Bo~rd~s)
Caicutator Resuitsfor Redemption Date 02/2p12
Total Price Total Value .Total Interest yTD Interest
$43 500 00 $47 330.80 $33,830.80 $0.,00
Bonds: 1-27 of 27
Serial # Series
Denom Issue Next Final
Date Accrual Maturity
Issue Price interest
Interest Rate
Value Note
n76921909' !
EE $1,000 10/1987 04/2012 10/2017, ,.$500.00;, .,$1,135.204, 4.00%._ ;1,835.20
n76921908 ,
EE _ $1,000 10/1987 04/2012 10/2017 $500.00 . :,$1,135.20,: 4.00%; $1,635,20
n76921907 EE : $1,000% 10/1987,04/2012,1U/2017 ;;$500.00 $1,135.20_:, 4.00%: #1,835.2Q
n76921906 EE
, $1,000: 30/1987.04(2D12 14!,2017 :$500.00 .$1,135.20: 4.00% #1,835.20
n76921905 ,
EE $1,000 10(1987 04.f.Z012 10/Z017 :_$SOD.00 ,_:$1,135.201 4.00°h $1,835.30,
n76921904 EE ; $1,000 ,
10/1487'04/2012I:1Q/2017' ,$500.00 . ,.$1,135.20: 4.00% ;1,695.20
n76921903 EE ; $1,000. 10/19$7 04/2012 1012011 .._$500.00 . ,:$1,135.20;. 4.00% ;1,635.20 __
n76921902, EE $1,000 SD/1987 04/2012 10/2017 ,$500.00 . ...$1,135.20: 4.00%. ;1,535.20
n76921901 EE ' ..$1,000 10/1987 04/2012;.10/2017 $500.00,_ _ $1,135.20;, 4.0040:. ;1,635.20
n76921400 EE `.$1,000 10/1987;04/2012,30/2017 ;$500.00 ;$1,135.20; 4.OD% ;1,835:20
n76921899 EE .$1,000' D3/1987 03/2012.03!2017 .,$500.00 _$1,168.00 4.00% ;1,868.00
n76921898 EE $1,000 03/1987 03/2012,03/2017 .,$500.00 , - $1,168.00' 4.00%;_ ;1,68$.00!
n76921923' EE j$1,000` 03/1987 03/2012 03/2017 :.,.$500.00 -.$1,168.00;, 4A0% ;1,888.00
n769?1924 EE $1,000 03/1987,03/2D12 03/2017 $500.00. >;$1,168.00 4.00%7 ;1,68800 _
n76921927 EE $1,000; 03/1987,03/2012•.03/2017 _.$500.00 -,$i,lb&.f)0; 4.OD96. ¢1,888,00
776921928 EE, ,$1,000 03/1987 03/2012,03(2017 $500.00 $1,168.00; 4.OD% ;1,88$.00 _
m76921929 .EE $1,000 03/1987 03f2012 03J2017 ,$SDO;DO $1,168.00; 4.00%; ;1,888,00 ,
m76921930 _
EE '$1,000 03/198~,03/2012'03J2017 ;$500.00 . :;$1,168.00;;, 4.00%: ;1,888.00,_.:_,.
m76921931 EE :$1,000 03(1987 03(2012 03/2017 ,$500.00', _ $1,168.00. 4.00%, ¢1,868.00 _
m76921932 EE $1,000 ,
03!1987 A3/2412 03/2017 $SOO.DO . _,$1,168.00', 4.00%, ;1,888.00
m76921922 EE '$1,000 12/1985
06!2012 12/2015 $500.00 . ,..$1,468.40; 4.00%;_ ;1,988.40
m76921921 EE :$1,000 ,
,04/1985:0412012 04/?Oi5 ,$500.40: ,$1,500.40) 4.00%'. $2,008.00
m76921920. EE ..$1,000 04/1985.04/2012 04/2015 ,_$500.00 ; :$1,508.QOt. 4.00°h. ;2,008.00
m76921919 EE
' $1,000 1.0/1984 04/2D12,10/2014: $500.00 $1,548t0i7± 4.00°h' $2,048.00
m76921918 ,
EE $1,000, .
04/1984,04/Z012 04/2014 _ .$500.00 _ _$1588.80: 4.00%`_ 32,088:80
m76921917 EE $1,000 04/1984 04/2012 04/2014 .,_$500.00 _ ;$1,588.80y, 4.00%' ;2,088.80.
m76921916 _
EE $1,000 04/1984 04/2012.04/2014 ,,$SOQ,00:_ $1,588.80 t,_ 4.00%: ;2,088.80'
Notes
NI ,Not Issued_,_
_.
NE Not eligible for payment
P5 lnciudes 3 month Interest penalty
MA Matured and not earnin Interest
Mt~s;/lwww.treasurydirect.gov/BC/SBCPrice 2/26/2012
Calculated Value of Your Paper Savings Bonds}
Calculated Value of Your Pap®r~Savings:~ond(s)~ - '
Calculator Results for Redemption Date 02J3012 ,
Pagel of 1
7ota1 Price Total Value Total Interest YTD Interest
$18 500 00 $52 304.80 $33.804.80 - $623,20 i
Bonds: 1-37 of 37
Serial #
Series Denom Issue
Date Next
Accrual Final
Maturky
Issue Price Interest
Interest
Rate
Value Note
m76749347 : EE $1,000 06f1992' 06/20i2 06/2022 $540.00 $868.00 4.OOMa ;1,358.00
76749346 EE ' $1,040' 992
06/1 06%2012, :06{2022„' _ ,$SDO:DO , $868.00, 4;Cb0% ;1,368.00 ., __
m76749345 EE ,
$1,000 _
Ob~1992 06J~01?' :06/2022, $SOOC00 $868.00 4:00% ;1,368.00
m76749344 _
EE ,
$1,000 06/1992 Ob/2012; ,D6f2022; __ $SOOAO _ _$868.00 4.00% #1,368.00 ,,
m76949343 _
EE $1,000_06%1992 06(24IZ .:06/2022: . _ $500.00 _ $868.00, 4.00% $1,368.00
m76749342 ,
' EE $1,000 06/1992 06/2012, .06/2022; _, $500..00 $86800. 4,00% ;3,358.00,__
m76749341 EE $S,000
06%1992 06/2012 ',,06/2022 . $500.00,. $868 00. 4;tl0% $1,358.00 _ .
m76749340 _,
EE T
$1,000~ O6f1992 06f2012 06/2022 _,$500.00 _$86$.00' 4.00% $3,368.00
m76749339: EE $1,000'06/1992 06/2012 1.06%2022` $5D4.00 :$868.00__ 4.QU% $3,388.00.
m76749338 EE $1,000 06/1992 06/2012 :06/2022., _ $500.00 $868.00_ 4.00% #1,368.00;
m76749337 EE $1,000 02/1992 08/2012 .02/2022'. $500.00 .$895.60 4.00% ;1,398.60 __.
m76749336, EE $1,000 02/1992 08/2012 !._02/2022; $500.00 $895 60y, ..4.40%, $1,395.60
m76749335 EE $1,000 02/1992 48/2012 ..02/2022', $500.00 $895 60 4.00% #1,395.60....
m76749330 EE $1,000 02/1992 08/2012 ,02/2027 $50Q.00 $895 60 4,00% $1,395 60,.,_.
m76749329 EE $1,000 0211442 D8/2012 ;02/2022' $500.00 $895.60 :4.00% ;3,395.60
m7674933~3. EE $1,000 02/1992 08/2012 ,02/2022 . ,$500.00 $895,60 4.00% _$1,395.60
m76749333 _ EE $1,000 02/1992 08/2012 '.02/2022'. $540.00 $895.60 . 4.00% _1,395.60
m76749332_ EE $1,000 02/1992 08/2012. ,_02/2022., . $500.00 #895.60- 4,00% ;1,39¢.80
m76749331 EE $1,000 02/1992 08/2012 ;02/2022' $500.00 $695.60 4,OD% ;3,395.60,_
m76749328 EE ,$1,000 02/1992 08/2012 :.02/2022, $500.00 _$895.60: 4.01)% ;1,395.60:
m76749327, EE $1,000 11/1991 05/2012 ;11/2D21 $500.00 $895.60; 4.00% #1,395.60
m76749326 EE $1,000 11/1991 O$/2012 :11/202L $500.00 $895.60 _4.00°/x. $1,395.60
m76749325. EE $1,000 11/1991 05/2012 :11/2021 $500.00 _,$895.60 4.00"/0; .¢1,395.60
m76749324 EE $1,000 11/1991 05/2012 11/2021; $500.00 $895.60 4,00% $1,395.50 _
m76749323' EE $1,D00 11/1991 05/2012 11/2021 $500.00 __$895.60 4,00% $3,395.60
m76749322 EE $1,000 07/1991 07/2012 07/2021, $500.00 $923.60 4.00°/a ;1,423.50
m76749321' EE $1,000 07/1991 07/2012 '07/2021. $500.00 $923.60 4.00% ;1,423.60;
m76749320 EE $1,000 07f1991 07/2012 07/2021 $500.00 $423.60 4.00% $1,423.50.
m76749319 EE $1,000 07/1991 07/2012 '.07/2021; $500.00 $923.60 4.0090 #1,423.60'
m76749318 EE $1,000 07(1991 07(2012 :07/20x1' $500..00 $923.60 4.00% $1,423.50'
m77755620_ _EE _
$1,000 01/1990 07/2012 01/2020! $500.00 $1,010.40 4,00% $1,310.40
m77755619 _ EE $1,000 01/1990 07(2012 01!2020 $500.00 $1,010.40 4.00% ;1,510.40
m77755618' EE $1,000 01/199D .07/2012 01/2020 $500.00 $1,010.40 4.00% $;,510.40.
m77755617 EE .$1,000 01/1990 07/2012 01/2020', _ $500.00 $1,010.40 4,00% S.1.c510.40 .
77755616 EE $1,000 01/1990 07/2012 ;01/2020 $500.00 $1,010.40 4.00% ;1,510.40.
m77755615
EE
$1,000
01/1990
07/2012
'01120201
$500.00
$1,010.40
4.00% ,
$1,510.40
m77755614 EE $1,000 01/1990 07/2012 .,,_01/2020; $5,00.00 $1,010.40 4.00% ;3,510.40
Notes
NI NotISSUed
NE Not eligible for Rayment
P5 Includes 3 month interest penalty
MA :Matured and not earnin Interest
httpc//www.treasurydirect.govBC/SBCPrice 2(26/2012
~,aicwatea v slue or Your raper aavings tsond(s) Page 1 of Y
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date Q2/2012
Total Price Total Value Tatarlnterest YTD Interest
$42 500 00 $74 698.00 - $32,198.00 ~g408.00
Bonds: i-8 of 8
Issue Next Final
Serial # Series Denom
Date Accrual Maturity
Issue Price Interest
Interest
Rate
Value Note
x6006626ee EE $10,OOQi04/1985:04/2012 .04/2015,_ . $5,000.OOi $15,080.00 4,0~%,¢20,080.00,._,,.
~
x5717155ee EE $10,000;12J2001;03/2012 ,12/2031 __.$5,000.00.; $1,780.00, 1.19% $6,780.00
,EE $5,000_12/2001:03/2012,
v5835396ee _12/2031 ,,,$2,500.00.; $840,.(10, 1.19% ;3,390.00__.._
.
I $10,000;12/2001,03/2012,
x0013561051 .12/2031 ,$10,000 00; $5,892.00. 5.09% 515,892.00
,
v002147308f I .$5,000,_12/2001:03/2012 12/2031; ;,.$5~OOQ,00 $2,946.00, 5.09°!0 57,945.00 ___
v002025800i _I _ $5,000 10/2003;03[2012 10/2033. _$§,000.00( $1,870.00 5.73% 56,870.00 _
03/2012,
I $S,000,.lOf2003,
x002025601 30/2033 5,000 00,, $1,870.00 5.73% 56,870.00:__.
,
. _
I $5,000_10/2003'03%2U12;
v002025802i _ _1Of2033 ;, _$5,000 00. $1,$70.00 _SJ3°k 56,870.00 .._.
_
Totals for 8 Bonds - 2 500.00; 32 148.00 $74,698.00
Notes
NI Notlssued
NE Not elig1bfe for payment
P5 Includes 3 month Interest penalty
MA ' Natured and not earnin Interest
h
TOT~~ - ago SGS. 6~
http:f/www.treasurydirect.govBC/SBCPrice
2/26/2012
Calculated Value of Your Paper Savings Bond(s)
Calculated Value of Your Paper. Savings:Bond(s)
Calculator Results for Redemption Date 02/2012
Page 1 of l
Total Price Total Value Total Interest YTD^Interest
Bonds: 1-32 of 32
Serial # Series Issue
Denom Next. Final
Issue Price Interest
Interest
Value Nate
Date Accrual Maturity Rate
m76921860ee EE , $1,000 10/1986 04/2012 10/2016, _$540.00 . $1,392.00_ 4.00% #1,892.00;
,
m76921859ee`, EE ;$1,000 10/1986 04/2012 10(2016, $500.00 $1,392.00 4.00% 51,892.00.
m76921858eef EE .$1,000,10/1986 04/2012 10/2016 $500',00 '$1,392.00 4.00% #1,892.00
m76921857ee! EE ' $1,000 10/1986 04/2012 10/2016 $500.00 $1,392.00: 4.00% #1,592.00
m76921856ee: EE .$1;000 10/1986 .04/2012 10/2016 $500.00 $1,392.00 4,00% #1,892.00.-
m76921855ee1 EE .$1,006 08(1986 OS/2D2 08/2016 $500.00 $1,430.00, :4.00% #1,930.00
m76921854ee' EE '$1,000 08/1986 08/20,2 08/2016 $500.00 $1;430.00 4.00%. #1,930.00
m76921853ee EE $1,000 06/1986 08/2012 0812016 $500.00 $1,430.00 4.00% #1,930.00.. ;
m76921852' EE $1,000 0811986 08f2012 08/2016 $500:00 $1,430.00 4.00% #1,930.00.
m76921851eei EE ' 08/2012 08/2016 $900.00 $1,430.00 .4.00% #1,930,00'.
m76921850ee EE 08/2012 08/2016 $500:00 . $1,430.00 4.00% ;1,930.00;
m76921849ee. EE I 08/2012 0812016 $500;00 $1;430.OOt _4.00%. #1,930.00 _
m76921848eei EE 08/2012 .08/2016 $500:00 $1;430.00 4.00%. #1,930.00
m76921847ee EE 08/2012 08/2016, $500:00 $1,430.00 . 4.D0% #1,930.00
m76921846ee EE 08/2012 08/2D16, $500.00 $1,430.00 4.D0% #1,930A0,
m76921845ee, EE ; ,07/2012 07/2016 $500:00 $1,430.00 4.00% #1,930.00:
m76921844ee`, EE 07/2012 07/2016 $500.00 , $1,430.00: 4.00% #1,930.00
m76921843ee: EE ,. 07/2012 07/2016 $500.00 $1,430.00: 4.00% . #1,930.00:. _
m76921842ee. EE 1$1,000107/1986 07/2012 07/2016 $500.00 $1;430.001 4.OD%; #1,930.00:
m76921841ee; EE '$1,000
0711986 .07/2012 '07/2016 $SOO.OD $1,430.00 4.00°/, .;1,930.00,
m76921840ee' EE ,
;$1,000 03/1986 03/2012 03/2016 $500.00 $1,430.00 4.00% #1,930,00'.
m76921839ee1 EE '$1;000 03/1986 03/2012 03/2016 $500.00 _
$1,430.00 4.00% #1,930.00'
m76921838ee: EE ..$1;000 03/1986 03/2012 03/2016 $500.00 $1,43D.00 4,00% #1,930.00.
m76921837ee` EE .$1,000 03/1986 ,03/2012 03/2016 $500.00. , $1,430.00 4.00% #1,930.00:
m76921836ee EE $1,000 03/1986 03/2012 03/2016 $500.00 $1,430.00 4.00% #1,930.00
m76921835ee} EE , ;$1,000_01f1986 07/2012 01/2016, $500.00. ._$1,468.40,, 4.00% #1,968,40..__._
m76921834ee EE $1,000 01/1986 07/2012 01(2016 $500.00 $1,468.40 _ _4.00% #1,968.40..
m76921833ee EE ',$1,000 01/1486 07/2012 01/2016 $500.00 .$1,468.40 4.00%' #1,968.40._
m76921819ee EE .$1,000 01/1986 07(2012 01/2016 $500.00 $1,468.40 _4.00% #1,968.40 _
m76921818ee EE _$1,000 01/1986 07/2012 01/2016 $500.00 $1,468.40 4:00% (1,988,40 .
m76921817 EE $1,00001/1986 07(2012 01/2016 $500.00 $1,468.40 4:00% _ #1,968.40_.
m76921816ee EE_ $1,000 01/1986 07/2012 01/2016 $500.00 $1,468.40 4.00% #1,968.40
Notes
NI Not Issued -~-
NE Not eligible for payment ~ / ~ ~I'~ ~~ b
PS Includes 3 month interest penalty ~ C~~' `•~-
MA .Matured and not eamin Interest "`~~~JJJ _
'~ e~~ ~j
htYp://www.treasurydiurect.gov/BC/SBCPrice 2!2612012
Calculated Value of Your Paper Savings Bond(s) Page-1 oz 1
Calculated Value of Your Paper Savings 3ond~
Calculator Results far Redemption Date 02/2012
Bonds: 1-25 of 25
Issue Next Final Interest
Serial # Series Denom Issue Price Interest Value Note
Date Accrual Maturity. Rate
m76921872ee EE $1,000 09/1988 03/2012 09/2018! $500:00 _ $1,071 60 4.00% ;1,571.60
m76921871eei EE $1,000,04/1988 03(2012 09/2D18; $500:00 $1,071.60 4.00% ;1,57y.60
'm76921870ee; EE ; $1,000 09/1988 03/2012 09/2018; $500:00 $1,071.60, 4.00% ;1,571.60 _,.
m36921869eei EE :$1,000.09/1488 03/2A12 09(2018,, $500.00 $1,071.60 4.00% ;1,571.60.
~m36921868ee: EE :$1,000 09/1988 03/2012 09/2418-: $500:00 $1,071.60;__4.00% #1,$71.60..
m76921867ee: EE $1,000 09(19$8.03J2012 A912018c .$500:00 $1,071.60 4.00% ;1,571.60 _
m76921866ee: EE $1,000 09/1988 03/2012 09/2018; $500.00. $1,031.60 4.00% ;1,571.60
m76921865ee; EE $1,000,0911988 03/2012 09/20181 $500.00 $1,071.60 4.00% ;1,571.60
m76921823eei EE $1,000 09/1988 03/2012 09/2018; $SOOOD $1,071.60 4.00% ;1,571.60 it
m76921821ee~ EE $1,000,09/1988 03)2012 09/2018'. $500:00,. $1,071.60 4.00% $1,571.60 _ i
m36921820eei EE $1,000 07/1988,07/2012 07/2018, $500:00 $1,103.20 4.00% #1,603.20 ._ {
m76921822ee; EE $1,000 07/1988 07/2012 07/2018: $500.00 $1,103.20 4.00% $1,603.20
m36921824; EE .$1,000 07/1988 07/2012 07/2018; $SOU'.00 $1,103.20 _ 4:00% ;1,603.20
m36921825ee'. EE $1,000 07/1988 07/2012 07/2018,1 $500:00, $1,103.20 .4.00% ;1,603.20:,,
m76921826ee' EE :$1,000 07/1988 07/2012 07/2018s $500:00 $1,103.20, 4:00% ;1,b03.20.
m76921827ee_, EE 07/2012 07/2018_. $500.00 $1;103:20 .4.00% ;1,603.20
m76921828eei EE 07/2012 07/2018~i $SOO.AO $1,103.20 4.00%~ _;1,603.20;.._._ J
m36921829ee. EE 07/2012 07/20L8; $500'.00 $]„103.20 4.00% ;1,603.20
m76921830, EE 07/2012 07/2018:, $500:00 $1x103.20 4.00% ;1,603.20
m76921831eec EE ,. 07/2012 07/2018; $500.00 $1;103.20 4.00% ;1,603.20
m76.921832ee: EE 04/2012 04/2018_ $500.00 $1,103.20 ,4.00°k ; ;1,603.20.,
m36921864ee!'EE 04/2012 04/2018; $500.00 $1,103.20. 4.00°k ;1,603.20
m76921863ee EE 04/2A12 04/2018: $500:00 $1,103.20 4.00% ;1,603.20
m76921862ee EE 04/2012 04/2018!, $500..00, $1,103.20 ,_4.00% ;1,603.20
m76921863ee: EE y$1,000 04/1988 04/2012 04/2018, $500.00 , $1,103.20 4.00% ;x,603.20
~_.._._..__-.. ..__~_, ~.. ...-.... nw rww....c. wn. ...on.:mow nn.
Notes
NI Not Issued
NE Not eligible for payment
P5 , Indudes 3 month interest penalty
MA Matured and not earnin interest
http:/1www.treasurydirect.govBC/SBCPrice 2/2b/2013
Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of.Yaur Paper,~Sa~ings;Bond(s)
Calculator Results for Redemption Date OZ/ 20Y2
Total Price Total Vafue Total Interest VTD Interest
$18,500:00 $47,620.$0 $29,120.80 271.20
Bonds: 1-37 of 37
Serial #
Series
penom Issue Next Final
Issue Price Interest
Interest
Value Note
Date Accrual Maturity Rate
m76749377 : EE .$1,000 09/1993 03/2012, 04/2023, $500,:00 $537.20< 4.00% ;1,037.20
m76749376 : EE $1,000 09/1993 0312012'; :09/2023 $500.00 $537.20' 4aJ0% ;1,037.20
m76749375 !,.EE $1,000 09/1993 03/2012 '_09/2023 $500.00 $537.20' _ 4.00% #1,037.20
m76749374 EE .$1,040 '09/1993 03/2012 09/2023' $500.00 $537.20 4.00°~ ;1,037.20
m76749373 EE $1,000 04/1993 03/2012. .09/2023. $500.00, $537.20 4,.00% ;1,037.20
m76749372 EE $1,000 ,09j1993 03/2012 .:09/2023,, ;: $500.00 $537.20 4:00% ;1,037.20:
m76749371 EE $1,000 ,09/1993 03/Z012 ~09/2023j $500:00 $537.20' 4.00% ;1,037.20,
m76749370 ., EE $1,000 09/1993 ,03/2012- ,,.09/2023' $SOD00, $537.20 4:OOMo $3,037.20'
m76749369 EE $1,000 :09/1993 03/2012 t_09/2023` ' $500.00' $537.20 4A0% ;1,037.20.
m76749368 EE $1,000 09/1993 03/2012 109/2023: $500.00 $537 20 _ . 4:00% #1,037.20
m76749367 , EE $1,000 11/1992 05/2012' ,11/2022; _ $500.0(1 ,$841 20' 4.OOM° X1,341.20 _ _
m76749366, EE $1,000 11/1992 05/2012 11/2022 $500.00 $841 20 4.00% ;1,341.20
m76749365 _EE $1,000 11/1992 05/2012' _11(2022: _ $500.00 $64X.20 , 4,00°!o j1,341.20
m76749364
'_EE
$1,000
11/1992
05/2012:
_11/2022
$500.00
$841.20r
4.00% _
;1,341.20
m76749363 EE $1,000 11/1992 05/2012' .11/2022_ $SOO:Ofl $841.20' 4:00% ;1,341.20
m76749362 EE $1,000 11/1992 05/2012 11/2022 $SOO.OD $841.20 4.00% ;1,341.20
m76749361 EE $1,000 1111992 05/2012; 11/2022 $500.00 $841.20 4.00% ;1,341.20
m76749360 EE $1,000 11/1992 05/2012; _11/2022; , $500.00 $841,20 4.00% ;1,341.20
m76749359 EE $1,000 11/1992 O512012' i1j2022 _ $500.00 $841.20 4.00%, ;1,341.20.
m76749358 EE $1,000 11/1992 05/2012 11/2022 $500.00 $841.20 4.00% _;1,341.20
m76749357' EE $1,000 09/1992 03/2012' 09/2022! $500.00 $841.20. 4.00% ;1,341.20
m76749356' EE $1,000 09/1992 03/2012: .09/2022.. $500.00 $841.20. _4.00% ;1,341.20
m76749355 EE $1,Op0 09/1992. 03/2012; 09/2022, $500.00 $841,20 4.00°k ;1,341.20
m76749354' EE $1,000 09/1992 03/2012., 09/2022; $500;.00 _
$841.20 4.OOMo ;1,341.20Q
m76749353 EE $1,000 09/1992 03/2012 09/2022 $500.00 $841.20 4.00% ;1,341.20
m76749352
EE
$1,000
09/1992
03/2012,
_09/2022.
$500.00
$841.20
4.00% __
X1,341.20
m76749351
EE
$1,000
09/1992
03/2012;
09/2022:
$500.00
$841.20
4.00% .
;1,341.20.
m76749350 EE $1,000 09/1992_ 03/2012 09/2022. _ _$500,00 $841.20 4.00% ;1,341.20
m76749349 EE $1,000 09/1992_ 03/2012„ 09/2022: $500.00 $841.20 4.00°k ;1,341.20'
m76749348 EE $1,000 09/1992, 03/2012'. ,
09/2022.. $500.00 $841.20 4.00%: ;1,341.20.
m77755613 EE $1,000 07/1990 07/2012 07/2020 $500.00 $980.80 4.00% ;1,480.80
m77755612
EE .
$1,000
07!1990
07/2012,
07/2020;
$500.00 .
$980.80 _
4.00% _
;1,480.80
m77755611 EE $S,OOD 07/1990 07/2012, 07/2020 $500.00 $980.80 4.00°k ;1,480.80.
m77755610
EE
$1,000
07/1990
07/2012;
07/2020':.
$500.00
$98p.80
4.00% _
;1,480.80-
m77755609 EE $1,000 07/1990 07/2012. 07/2020. $500.00 $980.80 4.00°h ;1,480.80.
m77755608 EE $1,000 O1/1990. 07/2012' O1/2020 $500.00 $1,010.40 4.00% ;1,510.40:
m77755607 EE $1,000 O1/1990;_ 07/2012! O1/2020: _ $500.00 $1,010.40 4.00% ;1,310.40'
Notes
NI Not Issued
NE Not eligible for payment
PS Includes 3 month interest penalty
MA .Matured and not earnin Interest
http://www.treasurydirect.govBC/SBCPrice 2126Y1012
1.a0.%U12iLGU V a1LG Vl .l V W raiJGa Javausn lJVaiU~J~ - a ,~6~,. ~ „y
Calculated Value of Your Paper Sa~inga<8ond.(s;i~
Calculator Results for Redemption Date OZ/2d12
Total Price Total Value Total Interest YTD Interest
$42,500.00 $69,138.00 $26,638.00 $692.00.
Bonds: i-8 of 8
Issue Next Final
Serial # Series Denom Date Accrual Maturity
.ISSUe Price Interest
Interest Rate
Value Note
ro5835397ee.,.EE $S,OOfl 12J2001 03/2012 12/203}, $2,500.00 ;$890.00 1.19°h ;3,390.00;
x0013561061 I $10;000 12/2001 03/2012'12/2031, $10,000,00' $5;692.00' :_5.09% $15,892.00'-
v002147309i, I $S,OOD 12J2001 03/2012 12/2031" , $S~Op0,00, $2,946.00 5.09%., #7,948.00
v002025797i._ .I $5,000 10/2003 03/20.12 10/2033, $5,000.00 $1,870.00 ,5.73% _;6,870.00.
v002025798i I $S,OOD'10/20U3 03/2012,10/2033.. $5,000.00, $1,870.00 5.73% x.6,870.00
v002025799i ;, I $5,000 10/2003 03/212 10/2033._ , $5,000.00, , $1;$70.00 _5,73% ;6,870A0 _
x6006627ee .EE ,$10,000,02/1991 08/2012 02/2021 „ $5000.00, $9,520 OOy .4.00%;14,520.00
x571T156ee EE $10,000 12/2001 03/2012 12/2031. _ $5,000.00 $1,780.00 1.19%, _8,780.00 ,.
Totalsrore Bonds 42 600.00; 28 638.00.: 69 138.00:.
Notes
NI Not Issued _
NE Not eligible for payment
P5 `Includes 3 month interest penalty
.
.
.
MA :Matured and not earnfn interest
ToTR~ - #~1~~3~1. 60
httpa/www.treasurydirect.govBC/SBCPrice 2/2612 0 1 2
:-9ub'£ ^a'; '*', COe+V . '. ~£ `(Coil ~ `~Adevtiid Number=
001 II4 U402 1189-7741
TRANSFER ON DEATH (TOD) APPLICATION
P~1kYARY BENEFICIARY DESIGNATION
When the last surviving exount owner has died and we have received the documents listed in Section 8 of the TOD agreement,
we will transfer assets to the following beneficiaries, H they survive fhe lest account owner. If you ind~ate no percentages below,
we will divide the assets in your account equally among the beneficiaries. If you designate percentages, they must add up to
100%. If no primary or contngent beneficiaries are alive when the last surviving account owner dies, or i sll beneficianes
disclaim their interests in your account, we wi8 distribute the assets to the last surviving account owner's estate.
YOU MUST CHECK ONE BOX BELOW
If any primary beneficary Ia not alive when the lest surviving account owner dies or if that beneficiary disGaims his/her interest,
th n we will distribute that benefidary'a share as follows:
[~ To the remaining primary benaficiary(ies) on a pro rata basis (proportionate to the designated percentages).
To the applicable contingent beneficiary(ies) designated at the bottom of this page.
r` To the last surviving account owner's estate.
rDlaaca nm n mnamia .chew/ if eddlNonwl henaficYaries are desired. The sheet must be Sidned by all etxaunt OWOers. )
Daughter Judith Hrodovicz 195-32-2390 (717} 796-1529
1 PereorNa a Bene/kls Address Street number State and Z7 Code Birth Dab or Trust Data
5o.oa o~ 318 W Meadow Dr Mechaaicaburg, PA 17055 - 01/08/1941
Daughter HarbaraH Rowe 162-48-22(40 (717) 732-8829
2 PeresMe Bsnaflela Addrus Street number State and ZI Code Birth Dote or Trust Date
-so-:ooo~ 4&slly Court Enola, PA 17025 04/09/1954
3 Psre
snta a Banaflela Address Street number G Stare and ZI Code BIM Date or Trust Date
~
L
I,~~Ja/a - 1
_I
~ L . 1'n2rv 4 r . t. r„('.'r;e"o v. ~ , .h ~ _
1(
[~T~.~.-. _ .~I .._.- _ ~_t
y ~ _ _
-
4 ~ Ferrante a Street number, Cft State and ZI Code
Beneflcla Address 'B'~IM Dab o~r Trus~t Date
I
CONTINGENT BENEFICIARY DESIGNATION
rainase ,rse a seoerate sheet if additlonal beneficiaries are desired. The sheet must be signed by all account owners.)
„'. , S ~ q.C,,. p4's T.. .. a", .. e . , i. .. .. ~;? . ~. . ` `r ~ '~ ~D'~`.„ ':; e~`E111`; .... 0 ` if :~
M
a
s t ~
Banalkl
Numb _ ... __..._ l ...
1 Pareamepa of Pdmery Banafielary Address (Sheet number, qty, State end Zlp Coda) BIM Date or Trust Daa
Bansaefe aMn
, .. ~1~:] {''.[NY'[* .YT ~~~u .~~3A. !:W .'laf ar., r.l~, f .. b'. _ 6Y. Ayi i! .. ~.q}' -1I,:? .. ,1 ~ •14d~. ~' dTR.../~:
Com{npaMtO Primary rr''-- r-~-~
Bana8c4 Numbs s L! _.~_._.__.._____.._.,._..___..._~_.~.,___._.._~ I_..______.,.~____._..; ___. ..__....., _._._..;
2 Paroamaaa of Pdmary Beneflclary Address (Street numbei City, State and Zip Code) Birth Dab or Trust Data
BansaWe ah
sn
-
~~--
L.~___~.i°k ._._._,__,._.__._.______,..____......~__..~._____..____.__.~.__.
4...a a,~.:i :,, ~-`Bad'sfl@k--~•N a ~ ~ ~ti .~~ ''Han,i1'6~TatJRf.,•.
" ,_. `:. hallcle'-.:Phdnsi ~.:
Contlnpant t0 Prhnery -
~
C
_~.._~
i .~~_. ..___ ....„.._,. _.._ ~
Bamncla NumM s .._... _.._..._._.._. .. __....:
3 ParearNaa of Pdmary BenNlelery Address (Street number, City, State end Zip Code) B1M Dab or Trust Date
BanaRda SMn
~:_a ~, .,; .. ". ... .; 'Berrsfleie',Name ~. _ ~' oa Sec.>rtAr Tat IDO -
3 :Bsnaflcia .Phone t
.
CoreingarRb Primary 1"-. -
1 ---' (
~
Banetlcia Numb a 1 .. _..
_.... _ 1
4 Parcanteaa of Primary Bensficiuy Address (Street number, City, State and Zip Cotle) BIM Date or Trust Dete
eanahd alien..
~%
^ (-~
I
558142 (Rev t0) Peye 8 of 7
~8uh Irtii:IF:; ;: ER Coda ~ ~' A Code. - ; i - AedooeY Number'
001 II4 U402 1189-7741
ACCOUNT INFORMATION (Check one box below.)
Original TOD application
Change of beneficiaries in TOD application
IMPORTANT: If some securities in your account are not eligible for TOD registration, then we will distribute those
securities to the last surviving account owner's estate. Louisiana residents may not open TOD accounts with us.
Because of the complex legal and tax issues, we cannot advise whether a TOD registration is appropriate for your
tax and estate planning. YOU SHOULD CONSULT WITH YOUR LEGAL AND TAX ADVISORS BEFORE
ELECTING OR REVOKING A TOD ACCOUNT REGISTRATION.
Account Owner Signature
SPOUSAL CONSENT
' 6asr;
Dab
If you live in a community property jurisdiction and your spouse is neither a joint owner nor the sole. beneficiary of
your account, your spouse should complete this section. By signing below, your spouse declares that he/she is
your spouse and consents to any designation of beneficiaries you have made. He/she agrees not to make any
Gaim against us or the beneficiary(tes) as a result of any distribution we make.
,.
.Atltltdaitvt taca;..~,
~,.
: ~'°stite ~ ~.. .;tl.,
r_
Signature
Dab
REQUIREp NOTARIZATION OF SPOUSE'S SIGNATURE
State Subscribed and sworn to before me
County
This Day of
the Year
(Signature of Notary Public)
My Commission Expires _
ACCEPTED BY
Branch Manager Signature Date
Not IMUrod b FDIC or an Fedsnl Oovemmant A ene Ma Lwa Value nor a wpoan or or uuaromwa oy a Hens a wny eons
Y Y a Y Y emn.~.
558442 (Rev 10) Page 7 of 7 Wella Fargo Advisors, LLC
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~ rNd~~3v _ m3
LAST WILL AND TESTAMENT
OF
HELEN H. BENEDUM
I, HELEN H. BENEDUM, an adult individual of the County of Cumberland, and
Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my Last Will and Testament,
hereby revoking and making void any and atl Wills or testamentary writings by me at any
time heretofore made.
FIRST: I direct that all my debts, funeral expenses and inheritance
taxes be paid by my personal representative, hereinafter named, as soon after my death
as may be practicable.
l SECOND: I give and bequeath the sum of one thousand dollars
~ry ($1,000.00) to SAINT JAMES PRESBYTERIAN CHURCH, presently situate at 1425 Orr's
Bridge Road, Mechanicsburg, Pennsylvania 17050,
)~ THIRD; I give and bequeath the sum of five hundred dollars ($500.00)
to the KEARNEYSVILLE PRESBYTERIAN CHURCH, presently situate in Kearneysville,
West Virginia 25430.
FOURTH: I give and bequeath all of myjewelry and personal ornaments
to my daughters, JUDITH S. BRODOVICZ, who presently resides at 318 W. Meadow
Drive, Mechanicsburg, Pennsylvania 17055, and BARBARA B. ROWE, who presently
resides at 4 Kelly Court, Enola, Pennsylvania 17025 in equal shares, per capita, which
jewelry and personal ornaments shall be divided between them by my Co-Executors with
due regard for their personal preferences in as nearly equal shares as practical.
FIFTH: I give, devise, and bequeath all of the rest, residue, and
remainder of my estate, be it real, personal, and mixed, of whatever nature and
wheresoever the same may be situate, as follows:
A. Five thousand dollars ($5,000.00) to each of my grandchildren who
are living at my death, which gift is to be received as a token of my
affection for them.
6. The balance thereof in equal shares to my daughters, JUDITH S.
BRODOVICZ and BARBARA B. ROWE. Should my daughter
JUDITH S. BRODOVICZ predecease me or not be living at my death,
I then direct that the assets herein referred to be distributed to my
daughter, BARBARA B. ROWE. Should my daughter BARBARA B.
ROWE predecease me or not be living at my death, I give, devise and
bequeath her share to her childrem in equal shares per capita.
SIXTH: I hereby nominate, constitute, and appoint JUDITH S.
BRODOVICZ, BARBARA B. ROWE, and HARRY L. BRICKER, JR., of Harrisburg,
Pennsylvania, to serve as Co-Executors of this, my Last Will and Testament, Should one
or more of these individuals fail to qualify or cease to act as Executor, I hereby, nominate,
constitute and appoint the other or others as Co-Executors or sole Executor. I further
direct that my personal representatives shall serve without bond. Said personal
representatives shall have the power to discharge all the debts, liens and encumbrances
upon my Estate, as well as any taxes thereon, to pay'for the cost of the final disposition of
~ my remains and final illness, if any, to receive arty and all commissions and other
-~ compensation for services rendered by me during my lifetime and to perform any and all
fiduciary duties authorized by statute. Further, I direct my personal representatives to
~ preserve my Estate and any instructions pertaining to the distribution of the same from any
. attachment or anticipation while in the hands of my personal representatives, it being my
-,
-~ express intent that all legacies shall be free from amy attachment or anticipation while in
~ the hands of the accountant for my Estate.
1 SEVENTH: I hereby direct that all taxes attributable to the passing of any
assets by means of this Will or otherwise, or that maybe assessed inconsequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid from the
residuary of my estate as a part of the expense of the administration of my estate.
IN WITNESS WHEREOF, I, HELEN H. BENEDUM, have signed, sealed,
published and declared this to be my Last Will and Testament, consisting of this and three
(3) additional pages in the margin of each of which I have also set my hand for greater
_---
security and better identification this ;! •~ day of _ d ~.. ~o b ._ J , 2007.
`~1-=-t~..~ 1 ~~ _ '~~,.. _Z...~~ (SEAL)
Helen H. Benedum
2
The preceding instrument, consisting of this and three {3) other typewritten
pages, was on the day and date hereof signed, sealed, published and declared by HELEN
H. BENEDUM, Testatrix herein named as and for her Last Will, in the presence of us, who
at her request, and in her presence have hereunto subscribed our names as witnesses
hereto. We further certify that at the time of the execution hereof, the said HELEN H.
BENEDUM was of sound and disposing mind, memory and understanding.
`~a.Y~~_ 1 ~C~tQ~ of yO7 ~•~j'M'f s'~'•
~rvi_ sl~; fit- /~/a>'
l,~.r, r~~r.t;cr~' of ~1-y~~~~i.~~::;.,.1L..~~
~l
~.I
r
1
f~ COMMONWEALTH~OF PENNSY VANIA )
COUNTY OF
~.
I, HELEN H. BENEDUM, Testatrix whose name is signed to the attached or
foregoing instrument, having been dulyqualified 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 or affirmed to and acknowledged before me by HELEN H. BENEDUM, the
Testatrix, this 11th day of 2007.
1 /
~~,~ v.~ 1 ~-_
Not Pub1'Ic
My ~ mission expires: L- - ;~ ~ -<<_
(Seal)
COMMONWEALTH OF PENNSYLVANIA
Nolnlel3eal
Agcy O. Nkhid, Ngery pygp
Ctty OFHar~rg, py~ryn ~,
My Cummhelm EgYrte,pyie D, 2J10
Member, Panneylvenle Aewga~bn of Netetles
COMMONWEALTHgqOF P~p7NNSYLVANlA ) SS:
.' L'~l~-'}vLi $. ~,t~L~
COUNTY OF -- )
the witnesseswhese~a~as are signed to`N~attached orforegoing mstrument, demg aury
qualified cording to law, do depose and say that we were present and saw HELEN H.
BENEDUM, Testatrix, sign and execute the instrument as her Last Will and Testament;
that HELEN H. BENEDUM signed willingly, and that she executed it as her free and
voluntary act for the purposes therein expressed; that we, in the hearing and sight of the
Testatrix, signed the Will as witnesses; and that to the best of our knowledge, the Testatrix
was at that time 18 or more years of age, of sound mind, and under no constraint or undue
influence.
-~ ~-~ O-~
~~a ~~
Sworn to and subscribed before me
i ~t-ttw.
1, this day of _ ~ , 2007
A
~. ~
~~, ~l;~.u . , i ~ , J ,r:
N ry Pub6c
-~r M~ ommission expires: [... - ,Z•~ _ ~~,
'~ (SEAL)
COMMONWEAL7N OF PENNSyLVANIq
_-- A9Pas O. NI ~N PiAlb
CHy Of ~~fvdMiuu; Ot14F~ir!Cgmry
iHy tsr'nr ub:;;~; ~y;,;uc JUw 2I, 9910
Member, Panneylvenia AesadeNon M NotaHea