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Home My WebLink About06-20-12 (2)1505610105 REV-1500 I:x t°'-'„ t"'' PA Department of Revenue pennsylvanta OFFIOIAL USE ONLY Bureau of Individual Taxes °`""""`"~ "`""` County Code Year File Number PO BOX z8o6oi ~ INHERITANCE TAX RETURN ` F Hamsburrl PA 172z8-o6ot RESIDENT DECEDENT l ~ ~ I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11/26/2011 04/06/1925 Decedent's Last Name Suffx Decedent's First Name MI WALLETT JR VICTOR L (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 OVALS BELOW OID 1. Original Return O 2. Supplemental Retum O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limitetl Estate O 4a. Future Interest Compromise (date of O 5. Fetleral Estate Tax Return Required death after 12-12-82) m 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Co of Will 0 S. Total Number of Safe Deposit Boxes py ) (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 Schedule O) CORRESPONDENT- THIS SECTION MUST SE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD 8E DIRECTED T0: Name Daytime Telephone Number DAVID H WALLETT (717) 731-9872 N REGISTER OF USE ONL - ~~ rV ~ rrT I~ c7 First Line of Address ~~ rC`~ ~ r;,0 35 ARGALI LANE ~~ `z± N r~-~' ~ ~' ` - .n ca Second Line of Atldress ~~ c ~ ~ ~C) City or Post Office Slate ZIP Code Or~TE FILED ~-- r'rl i~ ~ MECHANICSBURG PA 17055 "~ T Correspondent's e-mail address: JfIB@BOLCOr1T Under penalties of perjury, I tleclare 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 re resentativ i b d p e s ase on a ll information of which preparer has any knowledge. SIGNA RSON RESPONSIBLE FOR FILING RETURN DATE 4DDRESS_~ -~ ~ - (4°r~ J 0 6/ 2 O / lr Z 3~ A2GRC.-3 L.Ft,V~- v"-t~cc-(r:..f5cs a.2G Pr1 17oS~ aIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: VICTOR L WALLETT JR RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bontls (Schedule B) ....................................... 2. 19,864.50 3. Closely Held Corporation, Partnership or SolaPropdetorship (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. 86,771.17 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 69,392,64 8. Total Gross Assets (total Lines 1 through 7) ...... ....... .. 8 176,028.31 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11. Total Daductlons (total Lines 9 and 10) ................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value SubjeM to Tax (Line 12 minus Line 13) ...................... .. 14. 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_ 0.00 15. 16. Amount of Line l4 taxable - - - at lineal rate X .0 45 156,841.81 ig 17. Amount of Line 14 taxable at sibling rate X .12 0.00 t7, 18. Amount of Line l4 taxable -- at II t I t X 0 00 ce a era ra a .15 18 19. TAX DUE .......................:................................. 19. '. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610205 15D5610205 9,192.50 9,994.00 19,186.50 156,841.81 0.00 156,841.81 0.00 7,057.88 0.00 0.00 7,057.86 O J REV-1600 E% (FI) Page 3 Flle Number Decedent's Complete Address: DECEDENT'S NAME VICTOR L WALLETT JR - - _ STREET ADDRESS ~ -- -- - "-- -- - -- - 35 ARGALI LANE CITY -_ ---_ ---_. _ MECHANICSBURG since ;ZIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _.. _ _ B. Discount 3. Interest 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. Total Credits (A+ B) (2) (3) (4) (5) 7,057.88 0.00 0.00 7,057.88 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 trans(erred .......................................................................................... ^ 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, benefts 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 fol" orpayable-upon-death bank account or security at his dr 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 lax, and the statutory requirements for disclosure of assets and fling a tax return are still applicable even ii the surviving spouse is the only benefciary. 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 benef curies 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 tllood or adoption. REV-x503 EX+ (~-n) ~ Pennsylvania OEPAPTMENT OF PEVENOE INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER VICTOR L WALLETT JR 21-11-1318 All property jointly owned wlth right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH I' FORD MOTOR CO COMMON STOCK 1,000 SHARES 9,950.00 CUSIP 345370860 DOD VALUATION CALC : DOD SATURDAY, NOV 26, 2011 VALUATION FRI, NOV 25 Hi $9.95, Lo $9.75 Mean $9.85 VALUATION MON, NOV 28 Hi $10.19, Lo $9.90 Mean $10.05 AVERAGE =$9.95 2 COLUMBIA MONEY MARKET FUND CLASS A (IDSXX) AMERIPRISE FINANCIAL ACCT 0011 3446 8553 9 002 2,556.19 SHARES 3 COLUMBIA DIVERSIFIED EQUITY INCOME FUND CLASS A (INDZX) AMERIPRISE FINANCIAL ACCT 0014 3446 8553 3 002 847.374 SHARES TOTAL (Also enter on Line 2, Recapitulation) If mare space is needed, insert additional sheetr of the same size 2,556.19 7,358.46 19,864.65 REV-1508 EX+(1i-3o) TOTAL (Also enter on Line 5, Recapitulation) $ 86,771.17 ~ Pennsylvania SCHEDULE E DEAPTMENT0F1EpENUE INHERITANCE TA%RETURN RESIDENT DECEDENT CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: VICTOR L WALLETT JR 21 11 1318 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. SUNCOAST SCHOOLS FEDERAL CREDIT UNION 58,915.57 ACCT 4039377-50 CHECKING $30,960.34 ACCT 4039377-00 SAVINGS $27,955.23 2 PNC BANK 3,527.60 ACCT 51-1392-2514 PERFORMANCE CHECKING $3,512.60 ACCT 51-1267-8791 MONEY MARKET $15.00 3 AUTOMOBILE :2009 LINCOLN MKS VERY GOOD CONDITION 22,400.00 KELLEY BLUE BOOK PRIVATE PARTY VALUE q CASH ON HAND 128.00 5 WEARING APPAREL 650.00 6 JEWELRY (WATCH) 50.00 7 FURNISHINGS 1,100.00 (Lived in retirement community rental - most furnishings provided) If mare space is needed, use additional sheets of paper of the same size. REV-151.0 Ex+ (OS-09) `; ~ Pennsylvania SCHEDULE G DEPARTmENr DE REVENUE INTER-VIVOS TRANSFERS AND '"xER(T"NDETAf(RETU"" MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER VICTOR L WALLETT JR ~~ ~ ~ ~z"a: ~ ins scneome must pe compietetl and Flletl if the answer to any of questions 1 through 4 on page three of the REV4500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER Lxnuof THE xnxf of rHf TRAxsfERff, THEIR RfunoxsmP TO OfceoEm Axp DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INE OAIE OF itUNSFER, AIIACHACOPY OF THE pEEa FO0. REAL ESTATE. VALUE DF ASSET INTERE57 hf APPDCAaIf) VALUE 1 RIVERSOURCE LIFE INSURANCE CO 69,392.64 100 69,392.6 RIVERSOURCE RETIREMENT ADVISOR 4 ACCESS VA (ANNUITY) AMERIPRISE FINANCIAL ACCT 0930 0808 7233 4 004 BENEFICIARY : AMY S WALLETT (GRANDAUGHTER) TOTAL (Also enter on Line 7, Recapitulation) 69,392.64 If mare space is needed, use additional sheets of paper of the same size. aev-1511 ex+ po-o9) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER VICTOR L WALLETT JR 21-11-1318 Decedent's debts must be reported on Schedule I. ITEM N~ junco A. FUNERAL EXPENSES: I' ROBERT D HEATH FUNERAL HOME 11/27/11 INVOICE B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address.__ -_ _ City _____. _ _.._ _ State ZIP_ _ _. _~. Year(s) Commission Paid: 2. Attorney Fees: 3~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City ___.. State ZIP _ _ Relationship of Claimant to Decedent 4. Probate Fees: S. Accountant Fees: S. Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) ; If more space is needed, use additional sheets of paper of the same size. 8,857.00 335.50 9,192.50 REV-151.2 E%+ (12-OH) .' ` pennsylvania DEPARTMENT OF REVFNDE INHERTfANCE TAX RENRN RESIDENT DECEDEM SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER VICTOR L WALLETT JR 21-11-1318 ~~ ,nme apace is neeaeo, mser[ aamnonai seeets of the same size. REV-1513 EX+ (01-30J ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TA% RETURN RESIDEM DECEDENT SCHEDULE 7 BENEFICIARIES ESTATE OF: FILE NUMBER: VICTOR L WALLETT JR 21-11-1318 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY REDoTNOtSList Ti ustee(s)N7 AMOOF ESTATE ARE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] I DAVID H WALLETT 35 ARGALI LANE, MECHANICSBURG, PA 17055 (100% share of estate excluding annuity beneficiary amount) 2 AMY S WALLETT 35 ARGALI LANE, MECHANICSBURG, PA 17055 (Beneficiary of annuity) SON GRANDAUGHI'ER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS 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. 100% 69,392.64 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. victor L Wallett (Pile 21-11-03318) InfieNtance Tax Return t3st of Oetai! Support for Schedules c:u euu rax nungsura e~uee rax r7llng.~dsxxl5uppen7ng oeuu 1 Key Accounts & Cornett Info Decedent Dkd Testate 2 Copy of Will Schedule B :Stocks & Bonds 3 Ford Motor Co Stock 1,000 Shares (Edward Jones Statement) 4 Mutual Funds Ameriprise Financial Columbia Funds DOD Vaulation = $9,914.65 Statement to be used to show holdings only. DOD valuation provided by Ameriprrse separately. Schedule E : Cash, Hank Deposit, ~ Mise Personal property 5 Suncaast Schools Federal Cred{t Union Checking & Regular Savings 6 PNC Bank Interest Checking & Premium Money Market Account 7 2009 Lincoln MKS Purchase Info + Kelley Slue Book Valuatlan Schedule! G : Mist Non-Pr~-ate Property 4 Annuity Ameriprise Financial RiverSource Retirement Advisor 4 DOD Valuation =$69,392.64 Statemern to be used to show holdings only. DOD valuation provided by Ameriprise sepanttety, i:24 PM AmeNpr6e Ftnanelal 70100Amarlprtsa FlnanWl Center Minnespolb, MN 55474 3-866-X65.3297 GktrtNumber 151+1 2238 3 001 tout tontad tlu 90.° Ntn 1-80957.3886 Annuky RiverSourte Retirement Advaor 4 Access VA Contract OJ30 080$ 7233 4004 Muwai Funds Columbia Money Market fund Class A (it>SXX) Acct 0011 3446 8553 9 002 Coknnbia t3hrersif(ed Equity income fund Class A (iN82X) Aox 0014 3446 8553 3 002 Edawrd 10~ 201 ProBreas Parkway Maryland Nalghts, MQ X043 i-80041-2357 Acd #306-1.4229-1-5 tool CoMUt Jim KsMy 38425L1Da ROOd 67i wlta 103 Sun Cky tee, FL 33573 Stock Ford Motor Co (F) CUSiP 34537Q860 wrKOast sdwWs Federal padk uniwf P.Q. Boa 1190+1 Tampa, FL 3~-1904 1-800-999-5887 Member B 4039377 ~n8 ( ~) PNC BaMc 1480 Camp t1i8 Ma8 32rM Street and Roux is tamp N81, PA 17011 717-7b1-0359 Aort 51-1392514 ~~s~ ~ ~n~ ~~st~xnen~ of VICTOR L. 1H17 LETT I, VICTOR L. IHILLER'P, residing in Hillsborough County, Florida, by this instrument revoke my former wills and codicils to them and declare this to be my Last Will and Testament. ARTICLE I w I direct my Personal Representative hereinafter named, to pay all of my just debts, if any, including the expenses incident to my last illness, death and burial, and administration expenses, in the 3 order and manner provided by law; however, this direction shall not authorize the payment o£ any debt or obligation prior to its ' + maturity in due course, nor, unless otherwise provided herein, shall this direction authorize the payment of any debt or obligation by the sale o£ property exempt by law from the claims of creditors. ARTICLE II A. All the rest, residue and remainder of my estate, of whatsoever the same may consist, real, personal and mixed, tangible i and intangible, and wheresoever located, including any property over which I own or may possess a power of appointment, I give, devise and bequeath to my companion, BETTY H. LDCITO, in the event she survives me by thirty (30) days. B. In the event my companion, BETTY H. LIICITO, does not ( survive me by thirty (30) days, then, in that event, I give, devise and bequeath my entire residuary estate to my son, DAVID H. vsrr_eT~ ~ ~ VICTOR L. ysrr.e~+r i PAGE ONE OF THREE j O C. In the event my son, DAVID H. EALLETT, shall have predeceased me, then, in that event, I give, devise and bequeath my entire residuary estate to my granddaughter, A1R SARA 1WLLETT. D. In the event my granddaughter, AIQ HARA 1GLLETT, shall have predeceased me, then, in that event, I give, devise and bequeath my entire residuary estate to my son, ROBERT ![, lU1LLE1•P. ARTICLE III I hereby nominate and appoint my companion, HETTZ H. LIICITO, as Personal Representative of this, my Last Will and Testament, without bond. In the event she has predeceased me or in the event she fails to qualify or refuses to serve as such Personal Representative, then, in that event, I nominate and appoint my son, DAVID H. 1H1LLEIT, as Alternate Personal Representative of this, my Last Will and Testament, without bond. In the event he has predeceased me or in the event he fails to qualify or refuses to serve as such Personal Representative, then, in that event, I nominate and appoint my son, R.OHSRT K. EALLEI'P, as Alternate Personal Representative of this, my Last Will and Testament, without bond. ARTICLE N I hereby authorize and empower the Personal Representative named herein, if and whenever, in the settlement of my estate, as he deems it advisable, at his discretion, to sell the whole or part of my property, real, personal or mixed, at public or private sale, and to execute and deliver deeds, instruments of transfer or any other writings necessary to pass the proper title thereto. This power shall be deemed discretionary and not mandatory. IH HITlII6HB EHBREOF, I, VICTOR L. EALLETT, have hereunto set my hand and seal to this my Last Will and Testament contained ,in three (3) sheets of paper, at Brandon, Florida, on this the aS~"day of March, 2008. ~ICTOR~.~ PAGE TWO OF THREE Signed by the Testator, VICTOR L. 1~1LLETT, as his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of f~e~~,ch other, have subscribed our names as witnesses on this the S'"~ day of March, 2008. WITNESS `~ of Brandon F~ ~++-' ~ of Brandon. Florida WI S STATE OF FLORIDA COUNTY OF HILLSBOROUGH I, VICTOR L. ~T-T~~+'" declare to the officer taking my acknowledgment of this instrument, and to the subscribing witnesses, that I signed this instrument as my Last Will and Testament. ~_ ~. Q T /', Testator We, }~1Q~ l!-~QW~~S and JdDI A. PORiLL, have been sworn by the officer signing below, and declare to that officer on our oaths that the Testator declared the instrument to be the Testator's Will and signed it in our presence and that we each signed the instrument as a witness in the presence of the Testator and o£ each other. tness Acknowledged and subscribed before me by the Testator, VICTOR L. RALLEIR, who has produced Florida Driver License as identificat_i~D and sworn to and subscribed before me by the witnesses, ~WQ~ ~gyy~ ,fir a witness who is personally known to me and JOpI A. PORiLL a witness who is personally known to me, and subscribed by me in the presence of he Testator and the subscribing witnesses, all on this the ~~day of March, 200(3. c My commission expires: This instrument prepared by: ~i~~Wlliam R. Mumbauer William R. Mumbauer, Esquire -y~CommissionS DD4fi4170 William R. Mumbauer, P.A. 4 Ypres October29. 2009 misera,.,,.~n,,.K,..' ^~sio,e 205 N. Parsons Avenue Brandon, Florida 33510 813/685-3133 I PAGE THREE OF THREE nmoum nonmrt.r vimm ~ vvaueu Amount Number 306-14229-1-5 p AocouM Type Single \~e Flnsndal Advisor 1im Kelly, 813-633-00 3842 State Road 674, SuKe 103, Sun Cit Statement Dsta Oct 1-Dec 31, 2011 00075033 01 SP 0.440 Ot TR 00320 EJADD064 100000 . VICTOR L WALLETT 1118 NEW WINSOR LP _E SUN CITY CENTER FL 33573-8026 $10,660.00 1 Month Ago 1 Year Ago ;9,670.00 E 36, 790.00 Edward Jonos Tax Stahsents Ali Forms 1099-R and 1099-Q will be issued to clients by Jan. 31, 2012. Consolidated 1099 tax statements will be issued to clients no later than Feb. 15, 2012. Visit us at www.edwardjones.com/taxcenter to learn more about your 2011 Edward Jones tax forms and the new IRS cost basis tracking and reporting requirements for financial services providers. Ending Value $10860,00 Thb Period Thk Year Beginning value 59,670.00 ;16,790.00 Assets added to account 0.00 0.00 Income 0.00 0.00 Assets withdrawn from account 0.00 0.00 Change in value 990.00 -6,130.00 Ending Cash 8 Mansy Markst Balance Cash X300.00 Amount Amemrt Imrestsd WHIWraam Stocks price Quantlgr Singe Inwptlon Sina Inapflon Vdue Ford Motor Co 10.76 1,000 5,201.12 - 1p,7OO,OO Total Amounn Yalue $~ ~.~ r c u e c u r c e 4 T- U ~ ill Y i mooo' ~ ~ N y Y A m~ p Y r N W ~ e a~~ s '' `~ Y U 0~D c'~ ~y O O ~ (~ ~ In ~ ~ M ~ N ~p N a i~j O ~ ` ci N .a d E Z E ~ 7 ~ Z C j ~ O ~ 3 U U' O ~ N •7 d ~ ~ ~ O U •~ e~ ~a 0 N U t" ~ V d ~ a j ~, W J ~ Q J N ~ 'a O L d J Q ~ a a ~ e i ~ S a M N a y N 7 YI ei „ ~ ~ d N ~ r + a O O ~ N a d !~ C ~ $ C ~ 0 , O ~ o a , o a ° a 8 0 8 0 8 0 8 0 8 0 8 0 8 0 N O N YI p N O I(1 N q ( p N Q N N N y m S ~ a-~1 .O LO C .-~ O c'if r ~ ~ II ~ p a ~ ~ ~ ~ n !~ a 1 (b ~ ~ tsi E o 3 da @ ~ t v ~ 3 r O ~ ~g" .-r haw ` t III a oov ~ w N N ~' ~ o ~m ~ ~ W a 0 ~ ~ ~ (~ c0 N N rl . 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C 0 ~ ~, Q a~,. ~. o: W ~ V; ~ N O a c ~ N ~ yy01 ~ N C ~ ~ p m C O C ~ ~: V~ d y ~.I y N C pp q ~ N, ~J N C ~ 1 pp > a N C C ar C V V 0 C O ar C1 O a JU£2Y OdOiIW 6GOZOOM 4-£OSL9 OI ZS£0 de 2R 34 3e de 8e de a2 de a2 2e de oooo$°o$$~go~~°n ~..C)C) t0 V' O If1 In O O O O tl) 1('1 C7 CV C~) I~ ~ Oi C 0 !. 1 1 ~g~ Y~88 ~~ a ~~ ~~ O O N 1k ~ 00 00 W ~ r N H ~ N g~ ~g$ v U d Z w v N L > fn j ~ c ~ C O~ ~y C p C V Q) oC0010 ~~ GO pCm ~ bmpU ONE O LO Nm-'-r O o N ~ y~ g t 0 0 0> D 0 0 j CU3N C [7(:70 ~U~ c°7a°°>3»»»aa U> CO) 000 UU» 3e p8e 2e dpe dpe 2e de de dpe 2pe 2e 2pe 1100 100 tO0 t~OOO1~O N.ti In tiln ti fO In fD ~N .r .a .-i .-r .ti .--i O .+ O .+ ~ ~ ~ ~ ~ ~ U E ct~~7 ?°~~L ~~ o ~ m }p' ~ !~ ~ V ~ G'3 ~ Y E ~ d ~ _r_ ~ ~op C7 ~ m a ~ ~n N~ U E E N !? >~ O N C w¢ £°_° c e'en ~ > C ~oad.c~~~~~zoa >~»;»°»> O a m ~g M i Q N I ~ ~ O ~ < O ~ C M ~ O p __ =- e N O N ^\ ~ Q N o O ~ N ~ N ~ V C Q a~ ~ O N ~ N V C '~ Q ~ N ~ ~ W ~ C J G.' N J N 3 ` ~ ` J ~ O j ~~g a ~v~ c ~ o ~ c 7 ~ v 0 f 1 n I 1 ~ r y .~ ~ E 7 E a E O W1 m o N ~ m t U LL U d > N 5 ~ 'p E ~o j c d ~ I ~ ~~"' ¢ 3 L c U > > C O o E `o $oog _o_ cov°u~im m:+ ~O'+O ~ j ~° ._ ~g qc a~ t w 0 °~ ~~ ~~ ~ N ci ~ N ~ M N .\I O n o & m Q v ~ m a m ~ ~ O ~ U wE~m mt N c U H ~~~A a~ L~- 3 ~ m c c a m p c 3 E ~ a >c ~ o VV ~ ~ Z U O N S~~> a~ {Q M M 0 •' o°Di m Q m crn y 1(~ I!1 C N N 0 0 Q Y C Q~ N ZW ` W W Z Z W c~ W Z V U O m a Statement 4039377 I1 18 11~~,r 12-16-y{1 6 - 6114 ~ VICTOR L WALLETT ~ 35 ARGALI LN ~ MECHANICSBURG PA 17055-4859 .hilphi•.Ih1111rdihll~lh.fq.Hl,iN~~riulP•,hq~ifq ~s> r-eaer~i Crean union www.suncosstfcu.org IRS FORM 1099INT WILL BE MAILED BY ]ANUARY 31, 2012 REFLECTING OMDEND(DTTEREST) EARNED IN EXCESS OF f10.00 ON EACH SOCIAL SECURITY NUMBER FOR TAX YEAR 2011. D' DUPLICATE COPIES OF TAX FORMS ARE REQUESTED, A f1.00 FEE WILL BE ASSESSED. SUFFIX: 50 CHOICE SS CH[CKING PREVIOUS BALANCE 30510.34 DEPOSITS 2340.21 CHECKS .00 MISC DEBITS 1799.82 FEES/SERVICE CHGS .00 ENDING BALANCE 31050.73 POST EFF DATE DATE TRANSACTION DESCRIPTION 11/18 ACH DIRECT DEPOSIT AMERIPRISE FINC 11/30 ACH DIRECT DEPOSIT PA TREASURY DEPT 12/02 ACH DIRECT DEPOSIT US TREASURY 303 12/02 ACH WITHDRAWAL 21STCENTURY 12/05 12/02 US TREASURY REVERSAL 12/05 ACH WITHDRAWAL MET LIFE INS. CO 12/05 ACH WITHDRAWAL UnitedHealthcare AMP PAYOUT ANNUITANT XXSOC SEC PNOT.DED. METLTC DEC PREMIUM 0 NEW AMOUNT BALANCE 450.00 30960.34 639.01 31599.35 1251.20 32850.55 -102.28 32748.27 -1251.20 31497.07 -205.59 31291.48 -240.75 31050.73 : • : t e • w x • • • • x • e e : • x • x ~ • • r • • x • • • • • • : • • a • : : x t CONTINUED ON NEXT PAGE TOTAL NUMBER CHECKS CLEARED Direct Inquiries to: PO Box 11904 -Tampa, FL 33680-1904, (813) 621-7511 or (80(I) 999-5887 Statement f ~- ~_'•~ 4039377 I1-18-11 12-16-11 2 of 2 . Member Number ~ ...From' .. ~ , lieu : r ,.i~.. r, VICTOR L WALLETT TRUTH IN SAVINGS: ANNUAL PERCENTAGE YIELD 0.00% Y-T-D DIVIDENDS: .00 StJI1C0>~ $CIl00~S Federal Credit Union wanv.suncoaatfcu.org lff flfifRfffR11ff111f1 Rff1f1ff11 tf11f1f yffffffff lff1f11t1fffflf RtffRlRfffllffffltfRtRtf Rf TAOTAL FOR THIS TOTAL fffff rAfllffRlflffafflwefffffffe:l fffflfiTffeEMENf1S1PERfIODf t111tffi RfllfEAReip ISDAeEff1f11f~ f 1ffO:tLI ROVERDRA*TRf EESf1f1f1fffff:ffflffffff1f111ffO4~Rtflf Rf 1f f111f f1f:ff111fi~OR:11fR1f f TOTAL RETURNED ITEM FEES 5.00 s,00 t 1f Rf 1ff111f1f11f Rf tfff111Rtf1f1ff1f1ff R11ffRffffflflRffffff1tR111f f11ff1ffffffff11f 1ff! POST EFF NEW DATE DATE TRANSACTION DESCRIPTION AMOUNT BALANCE PREVIOUS BALANCE 27955.23 11/30 DIVIDEND 3.45 27958.68 TRUTH IN SAVINGS: ANNUAL PERCENTAGE YIELD 0.15% ANNUAL PERCENTAGE YIELD EARNED 0.15% ON 3.45 FOR THE PERIOD 11/01/11 THROUGH 11/30/11 Y-T-D DIVIDENDS: 29.82 tfllftRttf tRl Rl tfifRRt1 R11f1R1f11tYft1t1 RR111f1tfRfftlflf RRfif11f1R1tf YfflR1f f11ft11 Rfftlf f R TOTAL FOR THIS TOTAL R STATEMENT PERIOD ~ YEAR TO DATE " R1t1 t11 R1ffRffiRtltlf R11 R1t1fttftft1f1f1111f1Rff111ff1ffflf Rff1Rt11fR1t11ft1f 111 tR1111 RfY TOTAL OVERDRAFT FEES 5.00 f s,p0 Yfff1t111f111 Rttfiffitt1ft11 Rff1 Rtt11t1f1f1tR1f111 R11fff118111 Rt1tRf1 fff1f11Rffffflfff Yflf ' TOTAL RETURNED ITEM FEES 5.00 S 00 t 11Rt1Rf1fft1Rf11f t11f111t11f1 tfif RYff}f Yff1f 1f 1tffRffllfftRfftlRf~t1f 1f 1fRRRf 1f•t1 RRffff tY r OTHER YTD TOTAL YTD DIVIDENDS DIVIDENDS ####### 62.52 62.52 TOTAL YTD TOTAL YTD WITHHOLDING FORFEITURES 00 .00 The amount of the INTEREST CHARGE on your open-end credit plan is determined by multiplying the daily balance in each Loan account by the Daily Periodic Rate. The daily balance shall be computed by taking the beginning balance of each day, adding new advances and subtracting any payments or credits. PNC Bank for ttM pr,riod 77/06!2077 to 72/00/2077 000839 VICTOR L WALLETT • 4833 E TRINDLE RD MECHANICSBURG PA 17050-3652 PNCBANK I ~j / r: 51-1392-2514 !!! ) 1, and transaction or - nnnres[ rate information, sign onto FMC Bank Online Banking at pnc.com. 'a For customer service call l-888-PNC-BANK Monday - Friday: 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espaRol, 1-866-HOLA-PNC Rtoarir07 Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsb!rrgh IPA ?5230-9738 Visit us at pnc.com ® TDD terminal: l-800-531-1648 For hearing unpaved clirnu only Online statements aze convenient, safe and environmentally friendly. Sign up through online banking today and enjoy the benefits ~tt~t7St r.~ttlCbn9 ~ttnt .Sf171nn780y Account number: 51-1392-2514 Overdrak Protection has not been established forthis account. Please contact us if you would like [o set up this service. Your account is currently Opted-Out of Overdrak Coverage. To learn more, visit us online a[ pnc.com/overdrattsolutions Victor L Wallett Balance Stum~sary Beginning balance 3,614.911 Deposits and Checks and other Ending other adtlitions deductions balance 540.03 102.36 4,052.63 Average monthly Charges Valance and fees 3,559.85 ,00 Transaction sn7wnary Checks paiN Check Card POS Check Card/Bankcard withdrawals slgnetl transactions POS PIN trznsactions 1 0 p Total ATM PNC Bank Other Bank transactions ATM transactions ATM tansactions 0 0 0 nreerest 7iunueary Annual Percentage Yield Eamed (APYE) 0.01% Number a days gverzge collected Interest Pald in imerest pedod balance for APYE this penod 32 3,522.32 .03 As of 12106, a total of $.70 in interest was paid this year. Performance Checking Account Statement For t>tro period 11/06/207 7 b 12/88!2811 For 24hour information, sign on to PNC Bank Online Banking VICTOR L WALLETT on pnc.com. Priman/ account number: 51-1392-2514 Accosml number: 51.1392$514 -continued Page 2 of 3 Actlritr Detail Deposits and Ollhor Adrilioas Date Amount Description 12/05 540.00 Deposit Reference No. 523078961 12/06 .03 Interest Payment Chocks and Subslitkite Cheeks Check Date Reference number Amount paiE number 103 25.16 11/08 oeaaaooas Online and 6ectronic Banidng Deductions Date Amount lkuriptlon 11/09 - 74.21 Payment,E-Check Checkpymt At&T MobBity 0109 11/25 2.99 Payment,E-Check Paytnents Discover ARC 105 'there were 2 Deposits and Other Add'rtiors ¢otaling $640.88. !there is 7 check listed totaling $26.18. 1"here were 2 Online or Electronic Banking Deductions totaling $7720. uaNy lialancs Dela7 Data Balance Date Balance Date Balance 11/05 3,614.96 11/09 3,515.59 12/05 4,052.60 11/08 3,589.80 11/25 3,512.60 12/06 4,052.63 Performance Checking Account Statement 'NCBANK PNC Bank 67-8791 For tM period 11/06/287 7 to 12/08/2811 000838 rensad'ton or VICTOR L WALLETT ignonto 4833 E TRINDLE RD atpnc.com. NECHANICSBURG PA 17050-3652 'a'Forcustomerservicecalli-888-PNC-BANK Monday - Friday: 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espaRol, 1-666-HOLA-PNC MstrYpi Please tooted us at 1-888-PNC-BANK ® 1M1lrheto:CustomerService PO Box 609 Pittsburgh PA 15230-9738 V iisR us at pnc.com ® TDD terminal: t-800-537-1648 For hearing imliahed climb oNy Pe+rfarmance Checlnng Vidor L Wallett Prenliwn Money Maiitl[et Account Summary Axount number: 51-1267-8791 ~C SUMlnify Beginning Deposits and Checks and other balance other adtlitlons detluctions 15.00 .Op ,00 Average morrthly balance 15.00 Endlnq balance 15.00 Charges and fees .00 ~•, PNnMI TD1-.Ir)R01F7A_INdn_NNNNNN-001~107d1D 2009 Lincoln MKS Sedan 4D Trade In Values -Kelley Blue Book Page t of 3 i Fin7 cm values a' itaa0~e; _ `~~.. home ~'. car values f cars for sate ~ car reviews ~ kbb top picks f research tools Popular at KBa.com 10 Coolest Cars under $18,000 advartkement wt~Y ads? Home > Car Valdes > Lincain > MKS > 2009 > Style > Gptions > Sedan qD Lincoln MKS 2009 go T~~'n/ ~pt~ v~tt ~. Show Used Car Prices 2409 Lincoln MKS Sedan 4D edit options j diange style Mlkage; 35{1!10 change l&e this car Trade-in Value P rtlfdt! ~f~yatUG ExceOent sz3,laa Shop for your Wert car Price a new car Very Good 522r4Q0 Ver!fy condaion Instant Trade-In Offer get the offer Good S21,aaa Fair 519,aaa C ~ V ' . awh ~ ~ LOYC Its review this car Dut of 5 How i5o Getthe Most torYour Car advert5enent SeE Used Cdr PlICeS why atls? New Ce~'S You Might lifts 2012 Lincoln MKS .t view 2012 Acura RL view 2012 BMW 5 Series ~... ~_..~. view Share Print Pfy Recently Viewed My Saved Cars save My KBB ZtP Code: 17055 Sign In http://www.kbb.comllincolnJmkaf2009-lincoln-mks/sedan-4dPlvehicleid=348816&intent-trade-in-sell&m... I2/8/20I ] FLORIDA SIMPLE INTEREST VEHICLE RETAIL INSTALLMENT ~-$QD-7Q7 7000 Buyer (and Co-Buyer}Name and Address (Including Zip Code) • • VICTOR L WALLETi I118 NEW WINSOR LOOP SUN CITY CENTER NILLSBOROUf,N FL 33 WWW.fOrdCfedit.COrrl Month of B~~Irth Co-Buyer 4[:U4C GATOR' LINCOLN MERCURY 11780 TAMPA GATEWAY BLVD SEFFNER, FL 33584 You, the Buyer{and Co-Buyer; if any), may buy the vehicle described below for cash or. on credit. The cash price is. shown below as 'Cash Price.' The credit pdce is shown below as "Total Sale Price.' By signing. thisrrontract; you choose to buy the vehicle on credit under the agreements oK the. front and back of this contract. NEW I 159 I 2003 MKS ~ ILNNM93R89G624232 ^ AgncuRural Year -S td~?~$ r_.:.~~,en..,s..,.e 1: Cash Price..........::.....:.... <'u~ c ~ncz `'`~ => ... ........ ...... . ...wo ~~v. 2: Down Payment (al rnlyd:Party Rebate Assigned to crednor ... ' .:....... $ ~snn na (d) Cash Down Payment [Items 2(a) plus 2(b) :plus. 2(c.)] ,.., $ --4~,.QQ (e) Trade,in (description above) :....:... ..:. . $ ~.Ob34,35 Total Down Payment (Items 2(d) plus 2(e)j , $ f~w(2) S. Unpaid Balance of Cash Price (1 minus 2) ..:............................. .... 5-2~.393,~5(3) 4. ArnouMS paW on your behalf (Seller mey be retainMg a portion of these amounts) To Public Officials (i) for license, title & registration fees$~t (ii) for official fees S N ~A (iii) for documentary stamps $ 80.15 (iv) for taxes (not in Cash Pnce) S 1345.6(1 g t~7~ To Insurance Compenles for: Credit LHeJnsurance.:. ......... .:....... ......: $~~~ .... Credh Disabillly Insurance ......... .,.......: ...:. .::....: $ ~.T io, for. u in $- - ~, r To for. U rn $ r T -r To fdr $~~ To for $~~ To for $ ~n- To for $ N/A To for $ ~T To for $~ To for u tT $ T ~ To for. $_~ e Total ............. ...,..... ,......, ...:.,:.,........_............... ... $ M1--~P~?4Ig) 5. Amount Financed (3 plus 4) ..:...... .............:.::................. ... $ 99uM1~n~ (5) PERCENTAGE CHARGE ftnensed Payments PrFce . RATE The-dollar amount The amount of The amount The total cost The cost of your the cri:dN will credit provided you wili have of your ___... __ __ ..._.,, cost Vou to you or on paid when you purchase on credit, LIABILITY `INSURANCE COVERAGE FOR BODILY IN.IURY AND PROPERTY DAMAGE CAUSED TO OTHERS'IS NOT INCLUDED. CREDIT LIFE CREDIT DISABILITY AND OTHER OPTIbNAL INSURANCE ARE NOT REQUIRED TO'OBTAIN CREDIT AND'WILL NOT BE PROVIDED 'UNLESS YDU SIGN AND AGREE TO PAY THE PREMIUM. #: Bwyer understands that he has the option cf assigning arty other policy or policies Buyer owns or may .procure for'the purpose of covering this retaN instalment sale and the policy need hot be purchased from- the Creditor m order So obtain credit. Buyer Signs.. _ Co-BuyePSigns 2,.BUyer: understandsthat the-.credit- life coveragge may be deferred 'If, at the time of application, Buye[ is unable to engage in erclployment or unable. to pedonrc normal actrolbes of a person of like age and sex, if he proposed credit life. insurance policy . contains this restdction: - Buyer Signs Co-Buyer Sgns 3. t3uyeY understands that the benefits under the policy will terminate when Buyerreaches a cenafn .age .and- that Buyer's.. age is aa;urately represented on the application or policy. Buyer Signs Co-Buyer Signs ~75dtt DL"ife urartce Company ...._... ,.__.__,_, a, You want Ctetlit Lffe Msttr^ance. BUyef $IARS Your Payment Schedule will be: Number ofPayments Amoum WPevments When Pa enta'are Due - ^MOMhIy.. p3eml-Annually OAnnually . stanin 8 06 2009 A ,. , Prepayment: If you pay off your debt early, you will not have to pay apenalty. Security Interest: You are giving a security interest in the vehicle being purchased: _ Late Payment: You must pay a late charge on each payment received more than t0days late. The charge is 5 percent of the scheduled payment. Contract: Please see this contract for additional information on secudty interest, nonpayment, default, the right to require repayment of your debt in full before the scheduled date, and prepayment penalty. ^ Your last installment payment under this contract is a balloon payment. EXCESS WEAR. USE AND MILEAGE CHARGES If the box directly above is checked, this section, Paragraph B, and Paragraph C of this contract apply.. You may be charged for excessive wear based upon our standards for normal use. It you exercise the option to sell tre vehicle back to Creditor under Paragraph ).you must pay the Creditor $0. N`A per mile for each mile in excess of if /S miles shown on the odometer. " ~Yrisuralice Company $ N/A Premium Insl,ued(s) You want Credit Disatriliry Insurance. <, Buyer Signs -OTHER OPTIONAL II~SUififii4NCE '' Coverage, and Premium-and Insurance Company - Terrain Month: $ v/~_ By - ~; ~~. By- - r wle i ~.rv= ,~~,! ey By ey You want the optional insurance for whicFt- premiums ate included above. Buyer Signs I Co-Buyer Suns - I Credit Life and Credit Disability insurance are for the term of the contract. The amount and coverages are shown in a notice or agreement given to you today. Any changein this~cont[act must be\iln (((w;;~`riting~,ainnrd signed by you-and the Credttor. - Buyer Signs X ~~~,}-pile i tt l~ Co-Buyer Signs X The Annual-Percentage Rate may be negotiated with the Seller. The Seller may assign this contract and may retain its right to receive a portion of the Finance Charge. YOU ACKNOWLEDGE THAT YOU HAVE READ AND AGREE TO BE BOUND. BY THE ARBITRATION PROVISION ON THE REVERSE SIDE OF THIS CONTRACT. ~Ig~ida documentary stamp tax required by law in the amount of 11 has been paid or will be paid directly to the Department of Revenue. Certificate of Registration 39-8000747171-3 Debt Cancellation Waiver Addendum (Optional) If this box is checked you havepurchased a debt can- cellation waiver. Purchase of this coverage is optional and is not required to obtain credit. The terms and corn ditions of the debt cancellation waiver are set fonhin the affached Addendum which is incorporated into this contract. The price for the debt cancellation waiver is set forth on this contract in the Itemization of Amount financed under section 4. a) Do not sign this contract before you read it or if it contains any blank spaces. b) You are entitled to an exact copy of the contract you sign. Keep it to protect your legal rights. Buyer (and Co-Buyer) acknowledge that (i) before signing this contract, Buyer (and Co-Buyer) received and reviewed a true and completely filled in copy of this contract and (ij) at She time of signing this contract, Buyer. (and Co-Buyer) received a true and completely filled in copy of this contract. ; f ~r-f , ~ r .:~