The URL can be used to link to this page

Home My WebLink About04-25-13 � 1505610140 REV-1500 �` �°'_,°, OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau of Individuai Taxes �NHERITANCE TAX RETURN � PO BOX 280601 2 1 1 2 0 1 2 6 2 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW ' Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 1 0 1 2 0 1 2 � 3 1 4 1 9 2 9 Decedent's Last Name Suffix Decedent's First Name MI C A L A M A N E D W A R D S (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 � 1.Original Return � 2.Supplemental Return � 3.Remainder Retum(date of death prior to 12-13-82) � 4.Limited Estate � � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Return Required death after 12-12-82) QX 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) � 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(date of death � 11.Election to tax under Sec.9113(A) befinreen 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone�rrmber R 0 G E R B • I R W I N , E S Q U I R E 7�� 2 �'9 � � 5 3 � � � � � �IS�ER OF-W1LLS� LY �a �,. r rv ;�; r°�� r-- � rn � ;,�; �s First line of address �'" Ctj � � � ` '� —� ,� '"�.i I R W I N & M c K N I G H T , P . C • � � �` � .�� ^� � ...,.i Second line of address `n�' � rv �"�" �t . � ��.. 6 0 W E S T P 0 M F R E T S T R E E T �';� � � � City or Post Office State ZIP Code DAT�FILED C A R L I S L E P A 1 ? 0 13 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. - SIGNATURE OF PERSON RE NSIBIE F R FILING RETURN DATE VIR, e� ADDRESS 19],4 DOUGLAS DRIVE CARLISLE PA 17013 SIGNATURE REPARER OTHF�THAN PRESENTATIVE �E /3 i�� ADDRES 60 WEST P ET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 � 150561�140 1505610140 � ,�) �U � 1505610240 REV-'!500 EX Decedent's Social Security Number oecedenrs Name: E D W A R D S - C A L A Ir1 A N RECAPITULATIC}N 1. Real Es#ate{Schedule A) . .. .. . . .. ... . . . . . . . 1. ' . .. .. . .. .. . .. . . . . . . . . . .. 2. Stocks and Bonds(5chedu(e B) 9 7 � � 9 . 5 D . ..... .. . . . . . . . . . . . . . . . . ... . .. . . . . . .. . 2. 3. Claseiy Held Carparation,Partnership or Sale-Praprietorship{Schedule C) . . . . . 3. • 4. Mortgages and Nates Receivabie(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. • 5. Cash,Bank Deposits and Misceilaneous Personal Property(Schedule E). . .. . . . 5. • 6. Jaintly Owned Praperty(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. � � 8 6 5 4 . 2 7 7. Inter-Vivos Transfers 8�Miscellaneaus Non-Probate Property {Schedule G) � Separate Biliing Requested . . . . . . . 7. 8 4 ? 2 � . 1 � 8. Total Gross Asse#s(totai Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 � 1 1 5 3 . 9 �{ 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . �• 1 � 4 1 5 . 8 6 10. Debts of Decedent,Martgage L.iabilities,and Liens(Schedule I) . . . .. . . . .. . . . 10. 9 . 8 2 11. Total Deduction�(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . 11. 1 � 4 �C 5 * 6 8 12. Net Value of Estate(Line 8 minus Line 11) . ... .. . . . . . . . . .. . . .. . . . . . . . . 12- 3 2 � 7 2 8 . 2 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election ta tax has nat been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. . 14. Net Value 5ubject to Tax(Line 12 minus Line 13} .. . . .. . . . . . . . . . . . . . . . . 14. � 2 0 7 Z 8 . 2 6 TAX GALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amour�t of�ine 14 taxable at the spousal tax rate,or transfers under Sec.9116 t�)t�.�>x.0 3 0 5 � 6 8 . 5 2 �s. p . p p 16. Amount af�ine 14 taxable at lineal rate x.oa� 1, 5 3 5 9 . ? 4 ��. 6 9 7, . 1, 9 17. Amourtt of�ine 14 taxable at sibling rate X.12 0 • � 0 �7. 0 • � � 18. Amount of�ine 14 taxable at collateral rate X.15 � • � � 18. � • � � 19. TAX DUE . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . �9. 6 9 1 • 1, 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 3,50561,OC4� 1,50561024D J Continuation of REV-1500 Inheritance Tax Return Resident Decedent EDWARD S. CALAMAN 21 12 01262 Decedent's Name Page 1 � File Number Correspondents Name Daytime Telephone Number R O G E R B . I R W I N , E S Q U I R E 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & M c K N I G H T , P . C . Second line of address 6 0 W E S T P O M F R E T S T R E E T City or Post Office State ZIP Code C A R L I S L E P A 1 7 0 1 3 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,coRect and oomplete.Declaration of preparer other than the personal representat�ve is based on all information of which preparer has any knowledge. SIGNATUR OF PERSON RESPONSIBL OR FILING RETURN TE DRESS � � � '� 268 STUART ROAD CARLISLE PA 17015 REV-1500 Ex Page 3 File Number Decedent's Campiete Address: 2� �2 o�2s2 DECEDENTS NAME EDWARD S. CA�AMAN STREET ADDRESS 9 STRAWBERRY DRIVE CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Ta�c Due(Page 2,Line 19) (1) 691.19 2. Credi#slPayments A.Prior Payments B.Dist�unt Total Credits(A+B j (2� O.QO _ 3. Interest (3} �. If Line 2 is greater than�ine 1+Gne 3,enter the difference.This is the OVERPAYMENT. " Fill in aval an Page Z,Line 20 to request a refund. (4) Q,pQ 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5} 691.19 Make check payable to: REGISTER OF WILLS, AGENT �.}��.�.4 3 �� .� .� � � -� _:� �,�'� ;�k<.�� , ��' � �:-a -�'�..�°..��_� ��' ��`�"� � �;:;�u..�`� PLEASE ANSWER THE FOL�QWING QUESTI{�NS BY P�A�ING AN"X" IN THE APPROPRIATE BLQCKS 1. Did decedent make a transfer and: Yes Na a. retain the use or income of the praperty transferred: ...................................................................... ❑ Q b. retain the right to designate who shall use the propert�r#ransferred or its int�me; ............................... ❑ X�, c. retain a reversionary interest;or ................................................................................................ ❑ 0 d. rec�ive the promise for life af ei#her payments,�enefits or care? ....................................................... ❑ �X 2. If death occurred acfter December 12,1982,did decedent transfer property within one year of death withaut receiving adequa#e consideration? ....................................................................................... ❑ � 3. Did decedent awn an"in t�ust for"or payable-uport-death bank accaunt�r seeurity at his or her death? ......... ❑ � 4. Did decedent own an individual retirement account,annuity or ather nan-probate property,which contains a beneficiary designation?.................................................................................................. .X�. � IF THE AN5INER TO ANY OF THE AB4VE QUESTIt3NS IS YES,YOU MUST C�JMPLETE SCHEDULE G AND FIL.E IT AS PART OF THE RETURN. �::?''�+S*;&+ ,..°�� .'. :.. ..,.� . . ,. ,�X -....s-�'-� {. ,�r :r .�� _�, ��.,��r�x� ;�g��...�°^' --; �.:. , ?a. v,�,=s � Y�- ��i�+�°�'�..:..� �,„ �y,�.;"��-'�" '�t f��^2'�`4:,; .-,��.e..`....�....��-- .�.�a.i.-�.,su�...�,.�..�� .s�,,....�� ..�. �w�.•� Far 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 ta}{1.1}(i}]. For dates of death on or after Jan.1,1995,the tau rate im�sed an the net value�f transfers to ar for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)J.The statute does not exempt a transfer to a surviving spouse from tax,and the statutary requirements for disclosure of assets and �iling a tax ret�m are s#ill applicable even if the surviving spause is the only E�neficiary. For dates of death on or after July 1,2Q00: • The tax rate imposed an the net value of transfers from a deceased child 21 years of age or younger at death to or far the use of a naturai parent,an adaptive parent or a stepparent af the child is�perc�nt[72 P.S.§9116(a}(1.2}], • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(9.2)[72 P.S.�9116(a}(1}], • The tax rate impased on the ne#value of transfe�s to or for the use of the decedent's siblings is 92 percent[72 P.S.§9196{a�{1.3)].A sibling is defined,under Section 9102,as an individual wha has at least one parent in camman with the decedent,whether by blood or adoption. REV-1503 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD S. CALAMAN 21 12 01262 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2 SHARES OF FROG, SWITCH &MANUFACTURING COMPANY STOCK 300.00 $150.00 X 2 SHARES=$300.00 2. 144 SHARES OF PRUDENTIAL FINANCIAL, INC. STOCK 7,984.80 $55.45 X 144 SHARES=$7,984.80 3 EQUITY SERVICES INCORPORATED 89,494.70 ACCOUNT NUMBER: F20-001627 TOTAL(Also enter on line 2,Recapitulation) a g7 77g.50 (If more space is needed,insert additional sheets of the same size) ��v-��os Ex+{o�-�a� pennsylvania �CHEDULE F DEPRRTMENT OF REVENUE ,��'NTLY-t�V11NED PROPERTY INHERITANCE TAX RETURN RESlDENT QECEDENT ESTATE OF: FlLE NUMBER: EDWARD S. CALAMAN 21 12 �1262 [f an asset was made joir�y awned within one year af#he deceden�"s date af deatty,�musE be reparted on Schedule G. SURViVWG JC11NT TENANT(S}NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. EDWINA C. HORICK 1914 DOUGLAS DRIVE DAUGHTER CARLIS�E, PA 17013 �.MYRTLE H. CALAMAN 9 STRAWBERRY DRIVE SPOUSE CARL(S�E, PA 17013 C. J8INTLY-BWNED RROPERTY: LETTER �ATE DESCRIPTION OF PROPERTY %OF DATE OF DEATFi ITEM FOR JOINT MADE INCLUpE NAME OF FINANCIAL iNSTITUTION AND BANK ACCQl1NT NUMBER OR SIMIIAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT lDENTIFYING NUMBER.ATTACN DEED FOR JOINTlY-HELQ REAL ESTATE. VALUE QF ASSET INTEREST DECEDENT'S lNTEREST 1. A. WELLS FARGC? 10Q.01 50. 50.Q1 ACCC3UNT#5561749044 2. B. WEL�S FARGO 12,992.13 50. 6,496.07 ACCC}UNT#1010C}08383831 3. B. WE��S FARG{� '15,125.89 50. 7,562.95 ACC4UNT#1 f11026387719 4. A. VIIEL�S FARGC} 25,C85.41 54. 12,842.71 ACCOUNT#6301054703 5. B. WELLS FARGO 3,878.11 50. 1,939.06 ACC4UNT#3t�a0186708122 f. B. WELLS FARGQ 2'1,788.86 50. 1Q,894.43 AGGC}UNT#247442053822422 7. B. WEL.�S FARGt� 47,946.�Q 5Ct. 23,973.20 ACCCIUNT#247402302760943 8. B. WE�I.S FARGQ 169,791.fi$ 50. 84,895.84 ACCOUNT#19671101 TOTAL(Also enter an Line 6,Recapitulation) � 148 654.27 If more space is needed,use additional sheets of paper af the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD S. CALAMAN 21 12 01262 This schedule must be completed and filed if the answer to any of ques6ons 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFaPPUCAe�Ery VALUE 1. NATIONAL LIFE GROUP 30,658.20 100.00 30,658.20 VARIABLE ANNUITY#NL9011238 BENEFICIARY: MYRTLE CALAMAN 2. WELLS FARGO 54,061.97 100.00 54,061.97 IRA ACCOUNT#19671102 BENEFICIARY: MYRTLE H. CALAMAN TOTAL (Also enter on Line 7,Recapitulation) $ 84 720.17 If more space is needed,use addi6onal sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD S. CALAMAN 21 12 01262 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOLLINGER-FUNERAL HOME&CREMATORY, INC. 939.20 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State PA zIP 17013 Year(s)Commission Paid: 2, Attomey Fees: IRWIN &M�KNIGHT, P.C. 5,000.00 3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) 3,500.00 Claimant MYRTLE H. CALAMAN � StreetAddress 9 STRAWBERRY DRIVE Ciiy CARLISLE State PA Z�p 17013 Relationship of Claimant to Decedent SPOUSE 4, Probate Fees: REGISTER OF WILLS 266.50 5 Acxountant Fees: 6. Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 375.00 FINAL FIDUCIARY TAX RETURN 7. THE SENTINEL-ESTATE NOTICE 200.16 8. CUMBERLAND LAW JOURNAL-ESTATE NOTICE 75.00 9. NOTARY FEES 50.00 10. REGISTER OF WILLS-SHORT CERTIFICATES 10.00 TOTAL(Also enter on Line 9,Recapitulation) $ 10 415.86 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES, &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD S. CALAMAN 21 12 01262 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. QUANTUM IMAGING&THERAPEUTIC ASSOC-MEDICAL 9.82 TOTAL(Also enter on Line 10,Recapitulation) $ 9 82 If more space is needed,insert additional sheets of the same size. Ktv-isis tx+�o�-�o) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: EDWARD S. CALAMAN 21 12 01262 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I_ TAXABLE DISTRIBUTIONS [Indude outright spousal distribu6ons and transfers under � Sec.9116(a)(1.2).J 1. MYRTLE H. CALAMAN Spousal 305,368.52 9 STRAWBERRY DRIVE REMAINDER CARLISLE, PA 17013 2. EDWINA C. HORICK Lineal 15,359.74 1914 DOUGLAS DRIVE JOINT ACCOUNTS CARUSLE, PA 17013 LESS DEDUCTIONS ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 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. � � , �- ' ` LAST WILL AND TESTAMENT I, EDWARD S. CALAMAN, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executrix to sell any realty owned by me at my death,and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor,in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate to my wife, Myrtle H. Calaman,providing she shall survive me by sixty days. 4. Should the gift in Paragraph No. 3 not take effect, I devise and bequeath all of my estate of every nature and wherever situate to my two children, Edwina C. Horick and John W. Calaman, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 5. I nominate and appoint Myrtle H. Calaman to be the executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my esta.te unadministered, I nominate and F • � � 1 �A I appoint Edwina C. Horick and John W. Calaman, as substitute executors, also to serve as such without bond,with the same powers as are given herein to my executrix. 6. I hereby suggest that my personal representative reta.in the services of Irwin,McKnight &Hughes, as attorneys in the settlement of my estate.� IN WITNESS WHEREOF, I have hereunto set my hand and seal this 24th day of � March, 2000. �. •�, ,�� , (SEAL) EDWAR.D S.CALAMAN . Signed, sealed, published and declared by EDWARD S. CAI,AMAN, the above-named testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. � �W � 6 � � � � ACKNOWLEDGMENT AND AFFIDAVIT - WE, EDWARD S. CALAMAN, CHERYL L. CLELAND and SHARON L. SCHWALM, the testator and witnesses respectively, whose names are signed to the foregoing instrument,being first duly sworn,do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. � . EDWARD S.CAL RYL L.CLELAND . SHARON I,.SCHWALM COMMONWEALTH OF PENNSYLVANIA : � : SS: COUNTY OF CUMBERLAND • . Subscribed, swom to and acknowledged before me by EDWARD S. CALAMAN, the testator herein, and subscribed and sworn to before me by CHERYL L. CLE�.AND and SHARON L. SCHWALM,witnesses,this 24th day of March,2000. . f. `�. . N t y Public Notarial Seal �w��~r�_�..�` Roger B.Irwin,Notary Public � Carlisle Boro.Cumberland County � My Commission Expires Oct.3.2000 ' ! Member Pennsyivan�a AsSoc;r,tiur cf P,�,,;;�;i�� — - - _-- ---- ------------- ---------- -- i��IIIIIIIIIIIIUIIIi�1��IIIiIIIIIIIIIIHI��J��;IIIIIIIIIIIIIIIIC��j��IIIIIIIIIIIIIIIiI�1��IIIIIIINIIINIII��IIII�INIIfl III,��IIIIIIIIIIIIIIIII�J��IIIIIIIIIIINIIIC��1`��iIIUIIiiliiliui JJI��i , �' , - - �— _ ��= , . . . . . • -��'� �� _ � � I;�, �'I � �, �� '� I_-= \ \\ . =I i� �� \ . =I' i�� . . ��I � � � �� ;1� � �rl � —� '� . =�1 _ � _ I�= � = �_ _ � � � �`I 'l � . �I _ ` \ � � - �I-- � \ =I ij�, � * \ • �`I �' � �� 1_ � �r I� . _ _ � � =I \ ` ►• _� �� _ �� _ � J, \ � � ��' �-. �` �—r • ` — � i,J \ � ��- . �• � �� a �i � ��'�.C� 54. � . �i `� _ _ �..�_ - _ �: � ' ,�,� � �' \ T'� � > ^'� . _ � � � • I I�� \ � U,�l��•"� �� _ � . �, �,.,_,�� >� ,,'�, � _ � '► � � ��,i!` ; �� =I = i • � `r ! _ �� —� I��` � ,� s�� r� • • �� 1� � `� \\ \ � _ �I _ � _ � _ � ��\ � � .� � �� _'i II�— � _ — � r� � � �_ � � �� ! �t II + � _ I� �� t' r \ \ � � • �i i� • � � � IJ� • � � � � �� i 1�i�� ` • �r I — � , _ :�� — �i� ♦ \ =i � ,� ; � _� i�� ` � • �i :► �1� � � � �r �� _ _ ; � � =�� _ � �� _� _ �_ — J, r�I� i� �li Is =� �� . � � � Ii - � ,_ _ �J, =�', ,� .►-i �;��IInIIIINnII1C�1I�r..if111111111111111 a11��:IIIINHIl�1111C�111r.�I1111nIIIIItIIIC�11��,IIIIIIIIIIIIIIIIC�1��lIInIIIIIIn11;�11��JIINl1lIUIIIfiC�11/��IIiIIIIIIIIftII�C�11�rJllllllllllllllll;�11�' . m utershare "�" Prudent�al -- � p � Computershare � PO Box 43033 � Providence,RI 02940-3033 - Within USA,US territories&Canada 800 305 9404 � IMPORTANT TAX RETURN DOCUMENT ENCLOSED Outside USA,US territories�Canada 732 512 3782 � •**••'*•"'AUTO"5-DIGIT 17013 000421/0141962 1419 6 2 www.computershare.com�nvestor � ': I�II � �I� I� ul�i n� �I��I I n �I I 11� �n� I � i I il I il ilu Iliil I li il il I n li _ ,� Recipient �' EDWARD S CALAMAN � 9 STRAWBERRY DR Holder Account Number — CARLISLE PA 17013-4418 C0006649091 I N D _ — � _ — Record Date Nov 20 2012 — Check Number 0014314123 SSNITIN Certifisd Yes 001 CSO l 07.Doml.ng..PG 1.PRU.191043_23/141962/14196y 1 � _ . � _ { Prudential;Financial,�:lnc.=-�Combined Dividend�P�ayment 1.20.12�Tax Form 1'099-DIV � - � � C0�'ieCted(If CheCked) Account Number C0006609091 ' Form 1099-DIV-Dividends and Distributions 2012 Copy B-For Recipient Recipient's ID No.ending in `"'-*"-02ZS Payer's Federal ID No. 22-3703799 Thls b Important tax Mfonnallon and la being tuml�ed to the Intemal Revemie SeMce.If you are requlred to 81e a relum,a negllgence OMB No. 1545-0110 penalty or other sancdon may be Imposed on you ff thls lncome Is taxable and the IRS debennlnes dmt lt has not been reported. pepa�nt oi fhe Treasury-Intemal Revenue Servlce ReclpleM EDWARD S CALAMAN 9 STRAWBERRY DR CARLISLE PA 17013-4418 �e Total Ordinary �b Qualified 3 Nondrvidend 4 FEDERAL INCOME 6 Foreign Tax � Foteign Cow�ry e Cash Liq�ddafion Dividends($) Dividends($) Distributions($) TAX WITHHELD(S) Paid($) a U.S.P�session Dishi.($)I Payer's Details 230.40 230.40 0.00 0.00 0.00 PRUDENTIAL FINANCIAL INC CIO COMPUTERSHARE P.O.BOX 43010 ' PROVIDENCE RI 02940-3010 V. Form 1099-DIV � (Keep far your records), Dividend Confirmation Payment Date Class Description Participating Dividend Gross Deduction Deduction Net I I ShareslUnits I Rate I Dividend($) I Amount($) I Type I Dividend($) 14 Dec 2012 COMMON 144 $1.60000 230.40 0.00 NIA 230.40 Year-To•Date Paid 230.40 0.00 230.40 i � 46UTX PRU '}' 001CD70008/R OORX6A-PP•(F2) PRU Historical Prices�Prudential Financial,Inc.Comm Stock-Yahoo... http://finance.yahoo.com/q/hp?s=PRU&a=10&b=1&c=2012&d=10&... '� , �Hi,Karen HeIP Get new Yshoo!Mail apps Maii AAyr Y! Yahool SearCh i ;Search�Web_J I HOME INVESIING NEWS PERSONAL FlNANCE AAY PORTFOLJ0.S IXCWSNES _- -- - - --- � GetQuotesr.,:; Finance Search _ __I ,_ ------—�- - — ---_ -- --__. . _._ __ _____ ___..._ - _ .._ _. ._ _ . _ _ _ Dow?0.2T°�Nasdaq?0.15% �1�' - t;.�:�, s 0.23, �7�T�� .��!.tl!'!f rr±1/1�' 1 PRU� � ._ . ----_., COPEN}AN�ACCOfUNT� ��O .cw�r��c sccwemcs uo �T��' � Prudential Financial,lnc.(PRU) -NYSE aad eo Porcroi�o; � __u�e�92! 5V.95 ��.�s��.27%� 2:11PM EDT-Nasdaq Real Time Price Historical Prices Get Historical Prices for:�p};,��g k•'; Set Date Range � f�)Daily Start Date: Nov�� 012 I Eg.Jan 1,2010 4 Weekly End Date: Nov I� 012 �J Monthly C�Dividends Only �`;�:Get�P First�Previous�Next�Last � Prices , Date Open High Low Close Vblume Adj Close• Nov 1,2012 57.05 58.17 56.33 57.69 4,001,800 55.45 'Cbse price�usted for di�dends and splits. First�Previous�Next�Last t�IDownload to Spreadsheet Currency in USD. CopyrigM�2013 Yahoo!Inc.AA rights reserved.Privacy Policy-About Our Ads-Tertns of Service-CopyrighUlP Po6cyr-Send Feedback-Yah00�-ABC N@WS N@t1NO�k Quotes are real-time for NASDAQ,NYSE,arxl NYSE MKT.Sae al�delay Gmes for dher e�xchanges.All information provided"as is"for i�ormational purposes only,not intended for treding purposes or advice.Neither Yahoo!nor any of independent providers is liable for any informational errors,incampleteness,or delays,or for arn actions taken in reGance on information contained herein.8y accessing the Yahool site,you agree not�redisVibute the ir�formation found therein.Real-Time con6nuous sfreaming quotes are available through our premium service.You may tum streaming quotes on or off. Fundamental company data provided by C�ital IQ.Historical chart data and daily updates provided by Commodity Systems,Inc.(CSI).Interna6onal historical chart data,daily updates,fund summary, fund performance,dividend data and Morningstar Inde�c data provided by Nbmingstar,Inc. �: . c � `� � O � � '-' � � "C °oO � n n � n � � 7�0 � ��-1� -. �om O�t�f' � N � �, z � W Oz � .� �� , a v o ozAz.; ` ' .,� � � � D� � zO � � � H�� ., �y�# l, � � � � � �Z 70 0 � cnav �' ��,� � � � _ � . r � � x � ° � zM � z x � � o p � � � CJ `� '� d mr^N �zSW __ w �� z �' z �� ' �� n�a �� ° Sy �� ~ a � --'' � ��a °�,zy � m w �y :� � � � � O O =i �� o�D �°,tiddn�W z C o p � S • y n Z �� z A � '� Z ►-3 � � z � M y� w H � � ,��. o � z ~� °z � d � � � x N �, • z zM , d � � �, � � � � � � i - � � N � � � � �p � � � .� u° �o � m � N �O � � �a � � � :'J � owo � N H G� � t�l bd '� � W � N � � � N � � x � � �. �� n hy.. � � * z � � `n �' M . � � � `Cz � �� ;� �� - � r ° � � � � � � � �` ��. - � y o r �i y y ( o�p � Vf � !'C V1 � O � ��'J' �/f C ,� +� �y � o �� O � � Z � � � � � � W� �� '� t� C �, � nO,� �.C�., d � C � F bd � °z � d o� d � . dyz z � � � � " o " �, yo � � � � � � � � � � . a a � �S O n � "� � � o � o � ,o � z a . � D m � �`' o °o °o °o °o °o �m . C� ?. � m � zo � fD a � � a ° C C �. � -"'�Tt o � � m c� � � J � � N � °� � m \ O N � m � � � y ° O �O� � z � n� o �t C ° , m �, o � � � � � �� p_ � ` Q '� N Q � � �. � c O v <' � . � � � �o '' � � o- � � C /� 7 � � O� � + � l � � o• $� � 7�D r- _ � , o � � + o �� s � �' � � � � N � o p � �' � � � ;� � o O � � ° � � 'n �. � � � m F"� N n J x T� � n � r � ? � � m c-i- " � � � w �D � � q x N O � x� � � �� . � 3 i � � J ° N � N � � n � Q �. � � � � � . � s� N 'p � �A� � O f �+ � � O� � N � •'f O � O PMA account 5561749044 ■ October 1,2012-October 31,2012 ■ Page 2 of 22 . - Overview of our PMA account � Y Assets Percent 8alance/ast Ba/ance this Increase/ Percent ACCOU►1t (account�vwnber) of tota/ month($) month($) decrease($) change PMA�Prime Checking Ac�courrt �sssnasoaa� <1�0 1�.01 1 OO:Q1 0.00 0.00% Crown Ciassic Banking'��oi000eae3es�� 4% 12,260.95 1�992:13 731.18 5.96°� Crown Ciassic Ba�king�io�o��ar»s� 4% 14,145.18 1��5:89�' 980J1 6.93� Welis FargoO High Yield Savings�s3oiosa�o3� 7% 25,681.40 25,68�4+1`"':�� 4.01 0.02% _ Welis Fargo Way2Save�Savings(�000�ss�osi22) 1°�6 3,7�6.08 3;87�'11-' 112.03 2.97°� Certficate of Depasit (2a�4o2os3a22�) 6°� 21,784.39 2i�;788`86 4.47 0.02% _ Certificate of Deposit �Za�4o2ao2�sosa3) 14°� 47,936.55 47,946.40 9.85 0.02% Standard Brokerage* ��ss��o�� 48°k 169,545.40 169,791.68 246.28 0.15% Individual Retirement Acxount ��k �iss�i�o2) 15% 54,344.49 5�4;ACs1a9"7�' (28252) (0.52)% Total assets $349,564.45 s351,370.46 �1,806.01 0.52% �k Investment and Insuran Products: , >Are NOT insured by the FD ot any otFter federal govemment agency >Are NOT deposits of or guar ed by die Bank or any Bank a�iliate >MAY Lose Value Total asset allocation(by account type) Total asset allocation(by RetiremeM and Non-Retirement) cn�c��:a% Savings:8% Retirement:15% Cerdficates e. of Deposit: 20% �Retirement Acxount-An InvesUnent: acxount that Wells Fargo class�ies �� as a retUement acoount ....�:.:�.:•:::::.. Non-Retiremer�t: 85% Interest, dividends and other income The information below should not be used for tax planning purposes. Account This month This year PMA°Prime Checking Aocount (sssnasoaa) 0.00 0.01 Crown Classic Banking� ��oi000esese3i� 0.12� 0.95 Crown Classic Banking �ioio�2s3ems> 0.13 1.46 Welis Fargo�High Yield Savings (ssoiosa�) 4.01 48.15 Weils Fargo WayLSave'Savings�3000�ss�os��z> 0.03 5.97 Certificate of Deposit �2a�ao2os3s22�� 4.47 45.47 Certificate of Deposit (2a�4o��sosns) 9.85 100.06 Standard Brokerage (iss��o�� 82.37 1,274.00 Individual Retirement Acoourrt (�ss�i�o2� 0.00 83.87 Totai interest,dividends and other income $100.98 ;1,559.94 86837 PMA account 5561749044 ■ October 1,2012-October 31,2012 ■ Page 4 of 7� . � . � . P MA P r�me C heck�n Accou nt g ACtivity Summary A000urrt number: 5561749044 Balance on 10/1 100.01 EDWARD S CALAMAN DepositslAdditions p.pp EDWINA C HORICK Withdrawals/Subtractions -0.00 Weils Fargo Bank,N.A,.Pennsylvania (Member FDIC) Balance on 10/31 �100.01 Queshons about your account: 1-800-742-4932 Worksheet to balance your account and General Statemerrt Policies can be found towards the _ end of this statement Interest you've eamed Irrterest paid on 10/31 $0.00 Average collected balance this month $100.01 Mnual peroerrtage yieid eamed 0.00°k Irrterest paid this year $0.01 86839 PMA account 5561749044 ■ October 1,2012-October 31,2012 ■ Page 5 of 22 . ■ . � Crown Classic Bank�n � g Activity summary Aocount number: 1010008383831 Balance on 10/1 12,260.95 EDWARD S CALAMAN Deposits/Additions 1,731.18 MYRTLE H CALAMAN WithdrawalslSubtracdons -1,000.00 We1lsFargo Bank,N.A,.Pennsy/vania (MemberFDIC) Balance on 10/31 $12,99213 Questions about your account: 1-800-742-4932 Worksheet to balance your accourrt and General ' : Statemerrt Policies can be found towards the _ end of this statement Interest you've eamed Irrterest earned this morrth $0.12 Average collected balance this month $13,528.91 Annual percentage yield eamed 0.01% IrKerest paid this year $0.95 Transaation history Deposits/ �thdrawals✓ Endir�g Daily Date Description Check No. Additions Subtracfions Ba�ance Beginning balance on 1 Q/1 12,26p,95 10/1 Bank of America,Pension X�000c0000676606 Calaman,Edward 1,053.06 13,314.01 S 10/3 US Treasury 303 Xxsoc Sec 100312 M eman 678.00 13,992.01 10/19 Withdrawal Made In A Branch/Sbor 1,000.00 12,992.01 10r31 Irrterest Payment 0.12 12,992.13 Ending balance on 10131 12,992.13 . Totals a1,731.18 51,000-00 ' ,� 86840 PMA account 5561749044 ■ October 1,2012-October 31,2012 ■ Page 6 of 22 • �rown Classic Bankin ° g Activity summary Accourrt number: 1010126387719 Balance on 10h 14,145.18 EDWARD S CALAMAN DepOsits/Additions 3,�gg.pg MYRTLE H CALAMAN Withdr�wals/Subtraations -2,212.37 Wells Fargo Bank,N./�Pennsylvania (Member FDICJ Balance on 10/31 a75,125.89 Questions about your acxount: 1-800-742-4932 Worksheet to balance your ar.count and General Statemerrt Policies can be found towards the - end of this statement Interest you've eanled Irrterest eamed this month $0.13 Average collected balance this month $15,209.09 Annual percerrtage yield eamed 0.01°� , Irrterest paid this year $1.46 Transaction history Deposits/ Withdrewals/ Endirtg Daity � Date Description Check No. Addidons Subtractions Balancg Beginning balance on 1Q/1 14,145.18 10/1 The Hartford Rps 00 Ltf GA203840141 Calaman Edward 1,198.95 15,344.13 10/3 Bill Pay Church Recumng52 On 10-03 ��p.pp 10r3 Save As You Go Transfer Debit 1.00 15,233.13 10/4 Bill Pay Cerrturylink On-Line)Gooc03676 On 10-04 �5.gg 10/4 Save As You Go Transfer Debit 1.00 15,206.24 10/10 Bill Pay Ppl On-Line X�000c22010 On 10-10 63.29 10/10 Biil Pay AAA CeMral Pertn On-Line X�a77772 On 10-10 7g.pp 10/10 Bill Pay South Mdltn Twp'On-Line X�oc17053 On 10-10 119.82 10/10 Save As You Go Transfer bebit 3.00 14,941.13 10/12 Idprtctoct 877-816-82121011 6724912 Edward Calaman 12.gg 10/12 Save As You Go Transfer Debit 1.00 14,927.14 10/15 Recurring Transfer Ref�Ope86Kqmys to WayLSave Savings 100.00 14,827.14 X�0000000t6122 10/17 SSA Treas 310 Xxsoc Sec 101712 X�000t0225A SSA N1'Tt* 1,994.00 W1*Be* 10/17 Bill Pay Condominium Asso RecUrrinc�0000c-Xx-X00009 On 135.00 �a» 10/17 Save As You Go Transfer Debit 1.00 16,685.14 10/19 Bill Pay Cable Comparry On-Line Xf0000000�30027 On 10-19 80.46 10/19 Bill Pay Highmark Biue Rx Recurring�000c82416 On 10-19 114.40 10/19 Bill Pay Highmark Biuerx Recurring�000c82271 On 10-19 114.40 10/19 Bill Pay Messiahlifewaysc On-Line X71205 On 10-19 605.00 10/19 Bili Pay Mastercard On-Line X�000000000c84338 On 10-19 640.12 10/19 Save As You Go Transfer Debit 5.00 15,125.76 10�31 Interest Paymerrt 0.13 15,125.89 Ending balance on 1Q/31 15,125.89 Totals $3,193.08 $2,212.37 aseai PMA account 5561749044 ■ October 1,2012-October 31,2012 ■ Page 7 of 22 . � � . . . Welis Fargo H�gh Yield Sav�ngs Activity summary Accourrt number: 6301054703 Balance on 10/1 25,681.40 EDWARD S CALAMAN Deposits/Additions 4_01 EDWINA C HORICK Withdr�twals/Subtractions -0.00 Wells Fargo Bank,N.Ay.Pennsylvania (Member FDIC) Balance oh 10/31 525,685.41 puestions about your aocount: 1-800-742-4932 . Worksheet to balance your account and General Statemerrt Policies can be found towards the � - end of this statement Interest you've earned Interest eamed this month $4.01 Average collected balance this month $25,681.40 Annual percentage yield eamed 0.18% interest paid this year $48.15 Transaction history Deposits/ Wititdrawals/ Ending Deily Date Descripdon Additions Subtracctions Balence Beginning balance on 1Q/1 25,681.40 10�31 Interest PaymeM 4.01 25,685.41 Ending balance on 1 N31 25�685.41 Totals s4.01 s0.00 86842 PMA account 5561749044 ■ October 1,2012-October 31,2012 ■ Page 8 of 22 • ' • � . We�i ls Fargo Way2Save �av�n s g Activi�y stl.mmary Accourrt number: 3000166706122 Balance on 10/1 3,766.08 EDWARD S CALAMAN Deposits/Additions 112,08 MYRTLE H CALAMAN WithdraWals/Subtractions -0.00 Wells Fargo Bank,N.A,.Pennsy/vania (Member FDIC) ealance on 10r31 �3,878.11 Questions about you�acxount: 1-800-742-4932 Worksheet to balance your accourrt and General Statement Policies can be found towards the _ end of this statemen� Interest you've eamed Interest eamed this month $0.03 Average collected balance this mor�th $3,828.11 Annual percerrtage yieid eamed 0.01% Interest paid this year $5.97 Transaction history DepositsJ wthdrawals/ Ending Daity Date Description Additions Subtractions Balence Beginning balance on 10✓1 3�766.08 10/4 Save As You Go Transfer Credit 1.00 3,767.08 10/5 Save As You Go Transfer Credit 1.00 3,768.08 10/11 Save As You Go Transfer Credit 3.00 3,771.08 10/15 Save As You Go Transfer Credit 1.00 10h 5 Recurring TransFer Ref#Ope88Kqmys From Checking X�0000000c7719 100.00 3,872.08 10/18 Save As You Go Trar�sfer Credit 1.00 3,873.08 10/22 Save As You Go Transfer Credit 5.00 3,878.Q8 10131 Irrterest Payment 0.03 3,878.11 Ending balance on 1Q131 3,878.11 Totals $112.03 $0.00 86843 PMA accourrt 5561749044 ■ October 1,2012-October 31,2012 ■ Page 9 of 22 Certificates of De osit p ■ C�rtificate of Deposit , ACCOUnt Su1t11118ry Account number: 247402053822433 Original vaiue $20,000.00 EDWARD S CALAMAN Current value $21,788,gg MYRTLE H CALAMAN Origirtal issue date 10/2/08 Wells Fargo Bank,N.A,.Pennsylvania(Member FDIC) Current iss�ie date 12I2111 Questions about your account: 1-800-742-4932 Maturity date 1 yy�3 Term 24 morrths Interest you'Ve earned Irrterest rate 0.25% Annuai percentage yield 025°� Interest accrued but not paid $4.48 Interest paid this year $45.47 Activity detail IMerest Paid 4.47 Current balance $21,788.86 ■ Certificate of Deposit ACCOUM summary Acxount number. 247402302760943 Original value $40,000.00 EDWARD S CALAMAN Current value $47,946.40 MYRTLE H CALAMAN Original issue date 10/2/06 Wells Fargo Bank,N.A,.Pennsyhrania(Member FD/C) Current issue date 1?J2/1'1 questions about your account: 1-800-742-4932 Maturiry date 12/2/13 , Term 24 months Interest you've earned Interest rate 0.25% Annual percentage yield 025�0 Irtterest accrued but not paid $9.85 Irrterest paid this year $100.06 Activity detail Interest Paid 9.85 Current balance �47,946.40 86844 PMA accourrt 5561749044 ■ October 1,2012-October 31,2012 ■ Page 10 of 22 . � B ro kera e acco u nt statem n g et Accou nt profi le EDWARD S CALAMAN AND MYRTLE H CALAMAN JTWROS Acxourrt type: Standard Brokerage 9 STRAWBERRY DR Brokerage account number. . 1gg711p� CARUSLE PA 1 701 3-441 8 , Tax status: Taxable Invesiment products and services are offered through Wells Fargo Investment objective/ Advisors,LLC,brokerage acxount(s)camed by Frst Clearing,LLC. Welis Risk tolerance:' Moderate Growth&income Fargo Advisors,LLC and Frst Clearing,LLC,Members FINRA/SIPC are Time horizon:' Please Provide �i�ate registered broker-dealers and non-bank affiliates of Wells Fargo Liquidity needs:" Piease Provide &Company. - Cost basis election: Frst in,First out To view you�account informa6on online,visit: wetisfargoadvisors.com *For more ir�fomiation,go to www.wellsfargoadvisors.com/disclosures. Customer Service or 24 hour service: 1-800-359-9297 Brokeraae document deliverv status: Paoer ElectroMc : StatemeMs X , Your Fnancial Advisor: Trade confirmations X JAY BAVLISH Tax documenis X �-243-1422 600 PENN STREET,2ND FLOOR Shareholder communications X ° READING,PA 19602 Portfolio summary Current asset allocation Esdmated ann. Desr,riphon Previous value!�1 Current value f$) income!�) Cash and sweep balances 2,981.55 2,981.55 0 �'��"'�p�"0�� Foced ir�come securities:3% Stocks,options&ETFs 0.00 0.00 0 Fixed income securities 5,169.35 5,159.50 195 Mutual funds 161,394.50 161,650.63 2,045 Asset value $169�545.40 $169,791.68 $2,240 Mutual tunds:95% Investment and Insurance Products: IMPORTANT PLEASE READ > Are NOT insured by the FDIC or any other federal govemment agency �mportant Information about Your Brokerage Acxount and Statement > Are NOT deposits of or guaranteed by the Bank or any Bank affiliate �n be found at the end of the brokerage section.Please read this page > May Lose Value to better understand information in your statement and leam about other items relating to your brokerage acxount 020 L4 L45S 86845 PMA accourrt 5561749044 ■ October 1,2012-October 31,2012 ■ Page 16 of 22 Retirement Brokera e account statement g ` Account profile W B�►��ODIANTRAD IRA Acxount type: individual Reqremerrt Aaount 9 STRAWBERRY DR Brokerage account number: 19671102 CARLISLE PA 17013 Tax status: Re�rement Irnestmerrt products and services are offered through Wells Fargo Irnestrnent objeativve/ Advisors,LLC,brokerage acoouM(s)carried by Frst Clearing,LLC. Wells Risk tolerance:' Moderate Growth Fargo Advisors,LLC and Frst Clearing,LLC,Members FINRAISIPC are Time horizon:" Please Provide �Parate registered broker-dealers and non-bank affiliates of Wells Fargo - Uquidig►needs:' Please P�ovide &Company. Cost basis election: First in,First out To view your account information online,visit: welisfargoadvisors.com . *For more i�onnation,go to www.welisfargoadviso�s.wm/disdosures. Retiremerrt inquiries: 1-800-669-2136 Brokerage documeM delivery status: Paaer Electronic Sta�meMs X Your Fnanaal Advisor: Trade cor�irmatlons X JAY BAVLISH 886-243-1422 Tax documertts X 600 PENN STREET.2ND FLOOR Shareholder communications X READING,PA 19602 Portfolio summary Current asset allocation Esnn�ared ann. Descri�don Prev�ous value f$1 Cument value($) income f$) Cash and sweep balanoes 0.00 0.00 0 Stocks,options&ETFs 0.00 0.00 0 Fixed income securibes 0.00 0.00 0 Mutual funds 54;344.49 54,061.97 951 Asset value 554,344.49 554,061.97 $951 •�=:�> -:r:: .{1•l Mutual tunds:100% Investment and Insurance Products: IMPORTANT PLEASE READ > Are NOT insured by the FDIC or any other federal govemment agency Important Information about Your Brokerage Account and Statement > Are NOT deposits of or guaranteed by the Bank or any Bank affiliate �n be found at the end of the brokerage section.Please read this page to better understand ir�formation in your statemeM and leam about > May Lose Value other items relafing to your brokerage account 020_L4_L45S 86851 o.. � . / �� - - National Life Insurance Company� : :.. National Life � r:�:��Grou � P . December 6,2012 #BW1�ICDPH JEFFREY BOUDER 19 S HIGH ST NEWVILLE PA 17241-1413 Re: NL9011238-Edward S Calaman �Dear Mr.Bouder: Thank you for furnishing the necessary requirements for settlement of the above claim. Enclosed,please find the following: 1. Statemerit of Proceeds � � 2. Check for$30,658.20 drawn to the order of Myrtle Calaman representing settlement as shown on the Statement of Proceeds. If you have any questions or if we can be of assistance,please call 1-800-232-5246. Sincerely, ` c. . � .� . � . _ . Kimberly M.Hart Claims Accounting Technician II,Claims Depart�nent P: 800-232-5246 ext 3878�F: 802-229-7353 �kimberlyhart@NationalLifeGroup.com Enclosure cc: 015-LELA�r�'A� S/A: J�F'FI'�Y i�.BOUD�h' 9 National Life Group�is a t�ade name of National Life Insurance Company(NLIC)and its affiliates. National Life Variable Contracts distributed by Equity Services,Inc.,Member FINRA/SIPC,Broker/Dealer A�liate of NLIC. Centralized Mailing Address:One National Life Drive,Montpelier,VT 05604�www.NationalLifeGroup.com C x p e r i e n ce L i fe�� IQ� mP' 0� � � LA Hollinger Funer�l Home &Crematory, Inc. Eric L.Hollinger,Supervisor November 1,2012 . Edwina C. Horick 9 Strawberry Dr. Carlisle, PA 17015 _ �'he Funeral Service for Edward S.Calaman: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES,AUTOMOTIVE EQ.UIPMENT, ` AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional Service-Cremation Package $ PREPAID Merchandise-Memorials, Register Book AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Extras for services � Death Certificates(SX 6.00) 30.00 Patriot 357.52 Sentinel 338.78 Chambersburg Paper 212.90 Total Charges $ 939.20 Current Balance: . • _ $939.20 501 NORTH BALTIMORE AnENllE • M011NT HOLLY SPRINGS, PENNSYLnANIA 17065 • (717)486-3433 • FAX(717)486-3215 wvvvv.hollingerfuneralhome.com ,