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HomeMy WebLinkAbout09-05-12 1505610105 REV-1500 ~` {02-1'' `F~' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of I»dividua! Taxes c""p""`~' °` "```°°` Po Box z8o5o1 INHE RITANCE TAX RETURN County Code Year ~ i File Nu Harrisburg, PA l~iz8-o6o1 RESIDENT DECEDENT / / ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 160-16-1992 12/31 /2011 08/10/1917 Decedent's Last Name Suffix Decedent's First Name MI Piccolo Dorothy P (If Applicable) Enter Surviving Spouse's Information Etelow 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 EtELOW m 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82} O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death ages 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A} Between 12-31-91 and 1-1-95) {Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Michael P. Piccolo First Line of Address 1206 Mitchell Drive Second Line of Address City or Post Office Mechanicsburg State ZIP Code PA 17050 REGISTER OF WILLS USE LY ~~ LX7 "Cj r'*-1 T ; L. ., ~`:,: G C1 ~~ ~'_ C~ ~ ~' [^1_, DATE FILED ~j ~ ~Y` Correspondent's e-mail address: Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, con-ect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Sj>r,~t/ T~,1RE OF~(/~~~,;'~NSIBL~FOR FILING RETURN ~ A~~ SIGNATURE OF PREPARER OTHER THAN REPRESEN7A~IVE DATE ADDRESS P4EASE USE ORIt31NAL RORM ONLY Side 1 1505610105 1505610105 J ~_. . ~~ -r- ~ ~ ~ ti''? -~ ~...> --~ t _ /1 _. \..l 1 _ .1 :___ ~. ~.-_ !' c.n c~ N --n C..''~ " '~(,, J 1505610205 REV-1500 EX jFl) Decedent's Social Security Number Decedent's Name: Dorothy P, Piccolo 160-16-1992 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B} ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 0.00 6. Jointly Owned Property (Schedule F} O Separate Billing Requested ....... 6. 2,098.86 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Q Separate Billing Requested........ 7. Q•~ 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 2,098.86 9. Funera{ Expenses and Administrative Costs (Schedule H) ................... 9. 5,348.16 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 3,482.10 11. Total Deductions (total Lines 9 and 10) ................................. 11. 8,830.26 12. Net Value of Estate (line 8 minus Line 11) .............................. 12. -6,731,40 13. Charitable and Govemmenta) Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. -6,731.40 TAX CALCULATION - 5EE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 00 (a)(1.2) X .0_ . 15. 16. Amount of Line 14 taxable at {meal rate X .0 . 0,00 16. 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 18. Amount of Line 14 taxable 0 00 at collateral race X .15 , 18. 19. TAX DUE ............................................... .......... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 0.00 0.00 0.00 0.00 0.00 O J REV 1500 EX (FI) Pape 3 Decedent's Complete Address: File Number DEC DENTS NAME Dorothy P, Piccolo _ STREET ADDRESS 120fi Mitchell Drive CITY ~ T' STATE ZIP Mechanicsburg PA ~ 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _~ _ B. Discount 0.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FiN 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) (1) o.oo 0.00 t7. DO 0.00 0.00 Make check payable to: ~4EGISTER GF Wr~.ZS, 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 .............................................................................................................................. ^ 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 benefiaary designation? ........................................................................................................................ ^ tF THE ANSWER TO ANY OF THE ABOVE QtlESTIONS tS YES, YOU MUST COMPLETE SCHEDULE G AND FdtE fT 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 (aj (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the gild is 0 percent [72 P.S. §9i16(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(x)(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(x)(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. 0,00 REV-7508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Dorothy P. Piccolo FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-awned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF ©EAT!-! 1. MetLife PO Sox 330 Warwick, RI 02887 Policy No. 12554803A dividends and interest i ,987.69 TOTAL 1 987.69 REV_sosoc.h_9~it~ SCHEDULE F COMMONWEALTH OF PENNSYLVANIAJOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy P. Piccolo 1f an asset was made joint within one year of the decedent's date of death, it must be reported on Sthed>ale G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Michael P. Piccolo 1206 MiicheA Drive, Mechanicsburg, PA son B. C. JOINTLY-OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH % OF DATE OF DEATH NUMBER FOR JOINT MADE fncJude name of financial instilutia, and bank account number a similar VALUE OF ASSET DECD'S VALUE OF TENANT JONVT identifying number. Attach deed forjoinUy-held real estate. INTEREST DECEDENTS INTEREST 1. A. 1/29/1998 Pa State Employees Credit Union PO Box 67013 Harrisburg, PA 17106-7013 Regular Shares (Savings) 2,988.58 50% 1,494.29 Checking Account 1,209.13 50°l0 604.57 TOTAL (Also enter on line 6, Recapitulation} X2,098.86 COMMONWEALTH OF PENNSYLVANIA SCHEDULE H INHERITANCE TAX RETURN FUNERAL EXPENSES & RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Dorothy P. Piccolo ITEM DESCRIPTION NUMBER AMOUNT A. FUNERAL EXPENSES 1. Giant Food Store, 5301 Simpson Ferry Road, Mechanicsburg, PA Meeting at house with family and funeral director $58,70 2. Cash -Funeral Mass /Gift envelopes for clergy, organist, altar servers $320.00 3. L'Koste Villa Cafe, 2151 Fisher Road, Mechanicsburg, PA Memorial Mass Luncheon $831.93 4. Royer's Flowers and Gifts, 6520 Car{isle Pike, Mechanicsburg, PA -Wreath for Urn table $106.00 5. Richardson Funeral Home, Inc., 29 South Enola Drive, Enola, PA Funeral Home partial pay $2,000.00 6. Richardson Funeral Home, Inc., 29 South Enola Drive, Enola, PA Funeral home balance due $807.47 7. Catholic Cemetaries, i 16 S. Oak Grove Road, Harrisburg, PA Opening the ground at grave site $645,00 8. Olive Garden, 5102 Jonestown Road, Harrisburg,PA Post-interment luncheon $299.06 B. ADMINISTRATIVE EXPENSES 1. Personal Representative Commissions - 0 - 2. Attorney Fees: Karen M. Balaban PO Box 821, Harrisburg, PA 17108-0821 250.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.} 4. Probate Fees 5. inheritance Tax form and inventory form filing fees 30.00 TOTAL 5 348.16 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA SCHEDULE INHERITANCE TAX RETURN DEBTS OF DECEDENT, ~ESrt~r=NT a~c~or=nr-r MORTGAGE LIABILITIES, & LIENS ESTATE OF Dorothy P. Piccolo FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical e~enses. ITEM NUMBER 1. 2, 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. TOTAL DESCRIPTION December Social Security repayment Giant Food Store 5301 Simpson Ferry Road, Mechanicsburg PA 17050 postage stamps for bil{s/thank you notes, misc. expenses Community Life Team EMS 2222 Paxton Street Rear, Harrisburg, PA 17111 Date of service 11 /28/2011 -Ambulance charge PinnacleHealth ,Hospital PO Box 2353 Harrisburg, PA 17105 Date of Service 12/22/2011 -Harrisburg Hospital bill Pinnacle Health Med Svcs PO Box 1286 Harrisburg, PA 1 71 08-1 286 Date of Service 12/22/2011 -Pinnacle Heath Wound care PharMerica PO Box 644458 Pittsburgh, PA 15264-4458 -prescription drugs Susquehanna Township EMS PO Box 98 Enola, PA 17025-0098 Date of Service 12/28/2011- ambulance PA Dept. of Revenue -Pennsylvania personal income (2011) Orthopedic Institute of PA 3399 Trindle Road Camp Hill, PA 170ii-4413 Dates of service Z 1 /01 /2011 & 11 /08/2011 - steroid shots ter knee Golden Living Nursing Home-- Blue Ridge Mountain PO Box 644407 Pittsburgh, PA 15264-4407 - post-surgical care PinnacleHealth Hospitals PO Box 2353 Harrisburg, f'A i 7f 05-2353 Dates of Service 11 /19/2011 -11 /28/2011 Co-pay Barbara Madigan Preston 18 N Walnut St. Mechanicsburg, PA 17050 Reimbursement for incidentals and serving meats on two occasions AMOUNT $1,787.00 $40.00 $40.00 $12.00 $25.00 $106.25 $75.00 $3.00 $25.45 $846.00 $500.00 22.40 3 482.10 .~t ~ ;~ r MEMBER NUMBER 0160XXXXXX PAYMENT DUE DATE 01/25/12 N.U. fox 6/U 13 (/ I /) Z34-~4~4 (Harrisburg) Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide) website - http://www.psecu.com 0401 000 000 4 10 045269 2206881 PAGE 1 TOTAL gIy1OUNT PAST DUE + CURRENT AMOUNT DUE MINIMUM PAYMENT NEW BALANCE ~ 0.00 0.00 0.00 ~ 0.00 00001306 2 AV 0.465 DOROTHY P PICCOLO 1206 MITCHELL DR MECHANICSBURG PA 17050-3132 AMOUNT OF PAYMENT ENCLOSED • PSECU PO BOX 67010 1000901606002061992 TO REPORT A LOST OR STOLEN CARD: CALL OUR BUSINESS NUMBERS LISTED AT THE TOP OF EACH STATEMENT PAGE FROM 7 AM - 5 PM MONDAY TO FRIDAY AND 8 AM TO 12 PM SATURDAY, OTHERWISE CALL 500-556-5678 MEMBER NUMBER ~ STATEMENT DATE ~ PAYMENT DUE DATE _ ~_ 0160XXXXXX 12/31/11 01/25/12 -SUMMARY OF ACCOUNT ACTIVITY-- CREASE BEFORE A DETACHING HERE CREDIT LIMIT _ T AL VI A N W _ TO L P L N -_ UNU E CREDIT ~ __ BALANCE.. i BALANCE ~ AVAILABLE _.. 8000.00 0.00 0.00 8000.00 ----------------PAYMENT INFORMATION------------- NEW BALANCE 50.00 I MINIMUM PAYMENT DUE 50.00 I PAYMENT DUE DATE 01/25/12 I I LATE PAYMENT WARNING: IF WE DO NOT RECEIVE I YOUR MINIMUM PAYMENT BY THE DATE LISTED ABODE, I YOU MAY HAVE TO PAY A LATE FEE OF UP TO I 520.00. I I PREVIOUS BALANCE 50.00 II I PAYMENTS 50.00 II I OTHER CREDITS 50.00 II I PURCHASE 50.00 II I CASH ADVANCE 50.00 II I PAST DUE AMOUNT 50.00 II I FEES CHARGED 50.00 II I INTEREST CHARGED 50.00 II I------------------ I NEW BALANCE ------------I 50.00 I I I CREDIT LIMIT I 58,000.00 I I AVAILABLE CREDIT 58,000.00 I I STATEMENT CLOSING DATE I I 12/31/11 I ~ DAYS IN BILLING CYCLE 31 I ------------------------------ LOST OR STOLEN CREDIT CARD 800-237-7328 ID 09 VISA LOAN POST TRAN REFERENCE DESCRIPTION AMOUNT FEES TOTAL FEES FOR THIS PERIOD 0.00 INTEREST CHARGED INTEREST CHARGE ON PURCHASES 0.00 INTEREST CHARGE ON CASH ADVANCES 0.00 TOTAL INTEREST FOR THIS PERIOD 0.00 ---------2011 TOTALS YEAR-TO-DATE------------ FEES CHARGED YTD 50.00 I INTEREST CHARGED YTD 50.00 I r.U. fsox 6/U 13 (111) 234-8484 (Harrisburg) ~~ ~ ~ Harrisburg, PA 17106-7013 (800) 231-1328 (Nationwide) .,~..~ ~~ vvebsite - http://www.psecu.com 0402 000 000 4 10 045269 22068 PAGE 2 MEMBER NUMBER ~ PAYMENT DUE DATE NEW BALANCE AMOUNT PAST DUE ~} CURRENT AMOUNT DUE MINIMUM PAYMENT i 0160XXXXXX 01!25/12 0.00 0.00 0.00 0.00 PSECU AMOUNT OF PAYMENT ENCLOSED PO BOX 67010 DOROTHY P PICCOLO 1000901b01002061992 TO REPORT A LOST OR STOLE~CARD: CALL OUR BUSINESS NUMBERS LISTED AT THE TOP OF EACH STATEMENT PAGE CREASE BEFORE FROM 7 AM - 5 PM MONDAY TO FRIDAY AND 8 AM TO 12 PM SATURDAY, OTHERWISE CALL 800-556-5678 DETACHING HERE MEMBER NUMBER j STATEMENT DATE PAYMENT DUE DATE CREDIT LIMIT AL VI N _ ALP N _ NU I ~ BALANCE I. BALANCE I AVAILABLE OI60XXXXXX 12/31/11 01/25/12 INTEREST CHARGE CALCULATION YOUR ANNUAL PERCENTAGE RATE CAPR) IS THE ANNUAL INTEREST RATE ON YOUR ACCOUNT. ANNlJAt PERCENTAGE BAt SuSJECT TQ TYPE OF BALANCE RATE CAPR) INTEREST RATE INTEREST CHARGE PURCHASES 9.9009 0.00 0.00 CASH ADVANCES 9.9009: 0.00 0.00 ,~%% i. ,,. P.O. Box 67013 (111) 234-84$4 (Harri~bur~ Harrisbur , PA 11106-7013 800 231-1328 Nationwide ~ ~~~ 9 ( ) ( } website ' http:~~wWw.psett~.~Om 045269 2206883 IMPORTANT TAX RETURN DOCUMENT ENCLOSED JOINT OWNER MICHAEL P PICCOLO DOROTHY P PICCOLO PAGE 3 .,,: <:: :: F~O~TiNfdi ' : EFFEGTIWE' ~~ FINANCE ~EEBQR.. `f3~At+t:SiAGr1~lN NEY1t `#'~tJ~'11~I t~rClalp'tk31'! ~QR ADDITIONAL JOINT OWNER: ELIZABETH PICCOLO 12lQ1 __ ~D O1`; R~GULAI~ SHARES BEGYl~lYNG ~#ALAN~E '.. ::. ;: T1~3~6 .. . . .: '~~/b~ f'A1~MEtV~'K ~`~Ahi~:~'~E !"RIM., SHA;R~: 04 ~ ~Y~5.4b i ~7$~'., ~~ ; _ _ :.:.:.........~,~....Q~... ..............;:::.P1~Y~#E:NT.t....TR:AN~:~ER. ARUM; ~~lA~~::.:~+~.....::: ........ ..:.....................:.: :: ............,.:....~ ~:Q.t ~Q ... ~987....:$~ . 12/31 PAYMENT: DIVIDEND 0.300% 0.76 2988.58 ANNUAL PERCENTAGE YIELD EARNED 0.30% FROM 12/01/11 THROUGH 12/31/11 BASED, ON AVERAGE .DAILY, BALANCE. OF 2,981 37_ _. ....<.::1 ~~~ ~ . .. ,.. EMD~Mt~ B.ALAt~CE. ...< : ...:. _ .... ' Q 1t11t1~1~I~ Y~`~:: YEAt~ :.`~fl ~A`t`~;.. '. ... ::: :......;. .... X 1.. ~b #FF~F#i+~ii~`r~i~Fx"F~i+'#F~:iii"r+.4~~'F'i~i~i`rii'r'i~Fr'i'i#{~gs~zi'r~rr~Fw~«#r`F~kFw#R~F~iir##q#RFR:~"i~.r'S~'r'SF3F.#it~F,r'fi#ii~#F#iF~#.+nr"xi r`R'#p?FF~F.r'i'ir`Ffr`~#Fi~~'-:+`i'ixr~C:~#i~~#:#~i#Cr~Gi7?#FF~Fi'~#i~i:~'ir'?rx"x:xie~F~~i'+. 12/01 ID 04 CHECKING BEGINNING BALANCE 1228.65 12/01 WITHDRAWAL TRANSFER TO SHARE O1 /216.46- 1012.19 12/01 CHECK .0.02120 _ t~45.00- 767.19 ;X2.~~~. .:. ::..:,.~'A~fM~MT. #~:REC~`~ DEF'OSI'€ #~~::' ~'l3EA~Ut~Y.~4.3.. ..:..:. .... .....::... ::~~'~5~~ 49 : ~ 2:~92,19~ TYPE ~ XXS~C SEC Ia s ~03~,iQ3fs03ii~ .., 12/02 WITHDRAWAL TRANSFER TO SHARE O1 r~200.00- 2292.19 12/14 PAYMENT: AT ATM #00001183/00005F v°! 54.84 2347.03 ,..ATM AMERICHOICE FC 20 SPORTING GREEN .. .. . .: ;: ... :::: M~CMANICSB~J.RI3: PA :: > .: . ' 1~/~~~ I*R~~K~ .~,Q2~22 ' ..:' .: ,,: ~''"~~. 0~~» ; 2Z8~ . ~S ' .. . 12/29 CHECK 002123 V1120.00- 992.49 12/30 PAYMENT: DIRECT DEPOSIT PA TREASURY DEPT ,.216.46 1208.95 TYPE: ANNUITANT ID: 1236003133 : > :.., DATA. A7Q1.21411:1TEl~5Et18 , ~:.' ::. .... ...! ~El~ a , Pl~ ;~F~EA~I.tRlf` DEPT` .....::....: ~,~~3.~ .. .....:..........i'I~YM~.~T.:....~liU~~J-~N~ ::Q...~4:~~ ......... .....................:. :.......::.... .. ...... `:.Q~+~$.: ~:~Q~.~ ~;'~ ANNUAL PERCENTAGE YIELD EARNED 0.10% FROM 12/01/11 THROUGH 12/31/11 BASED ON AVERAGE DAILY BALANCE OF 2,082.06 12/3,1 __ ENDING BALANCE >. > 1209.13 :; :: ;; ;,A~~tIAENB YTD. YEAR Tp~ DATE > :. ~; 1. ~0 ,..: ;- , ...:.:.. i~UM~ER. __ - ..! ......:... kM4~1NT . NUM~~R AhI0E1NT .:1~~1M~lK.R: AMO~.RT .. N~1N~~R: Al~Ot~l~T . 002120 245.00 002121 173.54 002122 61.00 002123 1120.00 0160XXXXXX ~- 1201111123111 ~*~ ANNUAL PERCENTAGE. RATE 12.900% *~~ ,: ;1~/'4J~ I~ 01:.; PSL LQAN .~tfPEl~ El~D) BEGINt~I~1~; BALgt!~CE ~ .. ~;4R PSEC -~~~~~~~~~~~~~~~~~~~~~~~ P.O. Boz 67013 (717) 234-8484 (Harrisburg) Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide) website - http://www.psecu.com 0403 000 000 4 10 045269 2206884 IMPORTANT TAX RETURN DOCUMENT ENCLOSED JOINT OWNER DOROTHY P PICCOLO MICHAEL P PICCOLO POS'T]N4 EFFEGTIItE T [)ASE gA`I'E '1'FiAtQ~IM~'~'f~ I~CRIP'rkN~l FINANCE F~EE$ _ _ _ __ _ _ t~Bl~: CHARDE ~tApy 12/31 ENDING BALANCE~WW ~ _.__._.~.~.__~. ...W --~- -______-__ ._... CREDIT LIMIT 8,000.00 CREDIT AVAILABLE 8,000.00 _ _ NuMaea 0160XXXXXX 87~tTEM~i'f P~Efi[OD ~rotn 'trti 120111123111 I PAGE 4 NEW ~~• ._~..~_. _._..0 . 0 0 ,. INTEREST €HARQE GALGULATIQN: .......... _. >:. ;THE; EAE;ANCE; US:~D T.4 COEIPU~'~ INTEREST ~~. 1';HE I~NPA~~ Ba~AF~~~ E~~H . I~~~.. AFT~~ PAY.MEF~T~ :. '~ .: _ AND CREDITS TO THAT BALANCE HAVE BEEN SUBTRACTED AND ANY ADDITIONS TO THE BALANCE HAVE BEEN MADE. 2011, TO1'AL.S YEAR.-T~~I3ATE .. ~. FEE~.::GHARGE~:. ~ITD :. :< . _ ~~... oa i ~ INTEREST CHARGED YTD 50.00 ~ FEES ' . p0S'~ DES~RI;PT~Q~f AMOUNT .. ,., T©TA1. ~~~~' FOtt:!,TH.~~...PER.14~: ' ... 0, Q0 INTEREST CHARGED INTEREST CHARGE ON LOAN O1 - PSL LOAN 0.00 _ ,: _ T~QTAL 2~ETERES~''' FQR 'HIS PER20D 0'.'00: CO~,~. 'TOT~tL~ YEAAR:-TQ-DkT~! ; . .; ~ FEES CHARGED YTD 50.00 ~ ~ INTEREST CHARGED YTD 50.00 ~ TOT;/~~. D;~1tL~EN~:`Y~I~:.:: YEAR ~D. 1#ATE