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J 1505610105
REV-1500°`�°2-il,��,��
en lvania OFFICIAL USE ONLY
PA Department of Revenue P �Y
Bureau of Individual Taxes ��'"`�`�"�`"�E County Code Year File Number
Po Box Z8o6oi INHERITANCE TAX RETURN �` � � �_ Q'O��
Harrisburg,PA 1�128-0601 RESIDENT DECEDENT �
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
09222012 09221920
Decedent's Last Name Suffix Decedent's First Name MI
Antonicelli Angelo A
(If Applicable)Enter Survlving 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
C�j 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
Q 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
death after 12-12-82)
O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 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 Telephor��Alumber �
,�.;.
David AAntonicelli 7�-�8-481�-' � �
� � � . � �
� B�G�ER(�F'�IUILL� '� NLY
.� �a #'"` �} F•F..� �"F'I
A .r� � F--' ::� �
First Line of Address � V? � � C�
5805 Stephens Crossing � � �? � � "�
Second Line of Address � � � �`"" n'7
r�"
� � � � �
c.n
City or Post Office State ZIP Code DATE FILED
Mechanicsburg PA 17050
Correspondent's e-mail address:
Under penalGes of perjury,I declare that I have examined this retum,inGuding accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,coRect and complete.Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
N RE O PE ON RESP NSI F R FIL RETURN DATE
. • ���
A ESS
5805 Stephens Crossing, Mechanixburg, PA 17050
S N TU��j PREPARER OT HAN PRESE TATI DATE ^ -
�� ` �. �c,�-2�^ L�I�
A�o� ��- �- �� � ( � o c �
PLEASE US ORIGINAL FORM ONLY
Side 1
L 1505610105 15�561�105 J
� 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate(Schedule A). . ....... .. . ..... .. ... . . .. ...... .. . .. . ... .. .. 1. 135,000.00
2. Stocks and Bonds(Schedule B) . ..... . . ..... . . . .... .. . . ....... . . . . . . .. 2. �
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. .. 3. 0
4. Mortgages and Notes Receivable(Schedule D). .. ....... . .. . . . .. . ... . . . . . 4. 0
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)... . .. . 5. 27,386.11
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . .... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... ... 7.
8. Total Gross Assets(total Lines 1 through 7). ... . . . . ... .. ... .. . . .. .. ..... 8. 162,386.11
9. Funeral Expenses and Administrative Costs(Schedule H).... . . . . . . . . . . . . . . . 9. 19,799.26
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). ..... . . . .. .. .. 10. 1,422.97
11. Total Deductions(total Lines 9 and 10). .. ...... . . .... ... .. . . .... .. . . . . . 11. 21,222.23
12. Net Value of Estate(Line 8 minus Line 11) .. .. ....... ...... ...... . . . . .. . 12. 141,163.88
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . ... . .. .. ... ...... ... .. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) .. ..... ...... .. . . . .. . . . . 14. 141,163.88
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- 15.
16. Amount of Line 14 taxable
at�inea�rate x.0 45 141,163.88 �6. 6,352.37
17. Amount of Line 14 taxable
at sibling rate X.12 �7
18. Amount of Line 14 taxable
at collateral rate X.15 �$
19. TAX DUE .. . ............. .. . . .... . ... .. ... ..... . .. .... . . . ... .. .. . . 19. 6,352.37
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15�56],�205 150561�205
�
e
REV 1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Angelo AAntoniceili
STREET ADDRESS
5 Evergreen Lane
CITY STATE ZIP
Mechanixburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 6,352.37
2. Credits/Payments
A.Prior Payments 4,000
B.Discount 211
Total Credits(A+B) (2) 4,211
3. Interest
(3)
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. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,141.37
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ �
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 tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent(72 P.S. §9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
,
REV-1502 EX+ (1Z-12)
. . pennsylvan�a SCHEDULE A
DEPARTMENT OF REVENUE
INHERITAtVCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Angelo AAntonicelli 2012-01060
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a wiliing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1.
single family ranch house located at 5 Evergreen Lane, Mechanixburg, PA. 135,000
Cumber�and County 38-19-1612-024
TOTAL(Afso enter on Line 1, Recapitulation.) $ 135,000
If more space is needed,use additional sheets of paper of the same size.
REV-15o8 EX+(08-12)
� pennsylvan�a SCI�IEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Angelo A Antonicelli 2012-01060
Include the proceeds of litigation and the date the proceeds were received by the estate.
All praperty jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
� Members 1st Federal Credit Union -checking 2,705.24
2 Members 1st Federal Credit Union -regular savings 5,014.93
3 Members 1st Federal Credit Union -life savings 2,000.00
4 Members 1st Federal Credit Union -money management 10,688.89
5 cash in wallet
2.00
6 2003 chevrolet malibu sedan 3,000.00
7 household goods 690.00
8 verizon credit 49.36
9 verizon credit 32.41
10. erie insurance credit 212.00
11. Id�ler energy credit 19.71
�2 irs tax refund-2012 year 2,384.00
13. adjustment for school taxes on settlement sheet 410.69
14. erie insurance refund 100.00
15. PPI electric 76 88
TOTAL(Also enter on Line 5, Recapitulation) $ 27,386.11
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
� : pennsytvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
AngeloAAntonicelli 2012 01060
Decedent's debts must be reported on Schedule I.
TtEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
�' Malpezzi funeral home 234.65
St Katherine Drexel Church 150.00
Diocese of Harrisburg 32.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
6,488.00
Name(s)of Personal Representative(s) DaVld A At1tOt11Ce111
Street Address 5805 Stephens Crossing
city Mechanixburg state PA ZIP 174050
Year(s)Commission Paid: 2013
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: 265.50
5• Accountant Fees:
6• Tax Return Preparer Fees:
�� continuation schedule 12,505.73
8. the patriot and evening news-advertising of letters 123.38
TOTAL(Also enter on Line 9, Recapitulation) $ �9,799.26
If more space is needed,use additional sheets of paper of the same size.
___ _. _ __ __ _ _ _ __ _
Angelo A Antonicelli . fi le n u m ber�- 2012-01060
_ _ _
check date transaction amount
_ _ _ _ _ _ _ _ __
50 10/7/2012 joy danieis realty 695.00
_ _ _ __ . .
xfer 10/8/2012 Dave-stamps, key copies 61.16
_ . _ _ �__ � ._ _ _ _ _ __ _
_ _ . _
_
55 10/18/2012 yingst-inspection of basement wall 475.00
56 10/12/2012 Deb-cleaning . 500.00
_ _ __ __ . __ _
202 10/22I2012 pa amer h2o 9/24 10/11 55.88
203 10/27/2012 Dave-brass and . 100.00
_. ___ . .__ _ . __
204 11/4/2012 Dave-flooring at home depot 67.02
_ _
205 11/12/2012 ppl-9-24 to 10-24 37.30
_. _. _ _ _ _ _ _ _
206 void
_ . __ _ _ _ __
207 11/12I2012 lesia goldstein . 224.00
209 11/23/2012 lowes-paint 199.58
210 11/24/2012 pa basement-wall remediation 2,159.00
_ . __ ._ . __ _
211 12/1/2012 Blair painting 238.26
_ _ _ _ __ _ _
_ _ __
212 12/2/2012 lowes-basement paint 241.35
213 12/2/2012 walmart-mulch . 15.57
_ __ _ _ . ..._._.. _� _._ _ _ __ _
_ _ _ ._,. _
214 12/3/2012 ppl- 10/24 to 11/26 62.72
_ _ _ _ _ __
215 12/3/2012 st joseph church-memorial 20.00
_ _ _ . _ _ _ _ __ _
216 12/3/2012 kennedy appraisal-home evaluation 300.00
_ _ _ . _ _ _. .
217 12/3/2013 DeAnna _painting 160.00
_ _ �._ _ __ . .
_ _.._ . ._ _
218 12/5/2012 pa basement waterproofing 4,317.00
219 12/16/2012 penn waste 1/1 to 3/31 38.20
_ _ ___ _ _ ,_ _ _.
__ _ _ . _
: register of wills-preliminary estate tax ,
220 12/17/2012 due
_ _ _ __. __. __ _ _
221 12/15/2012 DeAnna-cleaning8-3 70.00
__ __ _
222 12/27/2012 DeAnna-sno removal trash cleanup 1-3 20.00
223 12/30/2012 DeAnna-sno shovel 2-4 20.00
. _ __� _ _. ___ _.. _ _ _
224 1/9/2013 mumma appliance-stove replacement 932.80
__. _
_.
225 1/12/2013 home depot-door 59.74
__ _ _ ___ _ .
226 1/14/2013 Dave-supplies on 1-12 and 1-14 151.40
227 2/1/2013 pa amer h2o12-21 to 1/23 . 52.49
_ _ _ _ ___ _. __ _._ _ _ _ _ _
228 2/1/2013 Dave-sump pump n parts 198.72
_ _ . _ __ _ _ _ _ __
__. . _ _
229 2/20/2012 ppl 11-28 to 1-28 235.15
_ _. __ �
_. __ . _._..
230 3/1/2013 Blair Powell-paint, labor, dvd 289.00
_ ._ , _
231 2/17/2013 mumma appliance-labor on oven 75.00
_ _ 233 _ 2/17/2013 leffler energy_ __ _ . 279.90
. _ _ _ _ __ _ ____ __ ._
_ ___. ___ _
235 void
_ _ . _ _. _
236 3/11/2013 pa amer h2o 1-23 to 2-1 fi 31.11
_ _ _ _ . ____. _
237 3/28/2013 patriot news-testamentary notice 123.38
_ _ __ _ __ 12,505.73.
� SCHEDULE I
.
� � _„ pennsylvan�a
' DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCE TAX REfURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Angelo AAntonicelli 2012-01060
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medicai expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• Faye grant-caregiver 1 000.00
,
2. verizon-telepone and cable 136.48
3. ppl electric 8*23 to 9-24 135.86
4. PA American water 8-24 to 9-24 38.64
5. silver spring twp-sewer 106.00
6. cumberland county office of aging-shared cost of construction at 5 evergreen lane 5.99
TOTAL(Also enter on Line 10, Recapitulation) $ 1,422.97
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10)
� i ��pennsylvania SC H E D U LE ]
� DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BE N E FICIARI ES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Angelo AAntonicelli 2012-01060
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECENING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
�. Stephen M Antonicelli, 118 southend ave,wamer robbins,GA 31098 son 22,119.24
2. Brian AAntonicelli,720 gary st,augusta,GA 30904 son 22,119.24
3. Matthew E Antonicelli,4136 arjay circle,ellicott city,MD 21042 son 22,119.24
4. Debra A Howell,58 amanda blvd,new bloomfield,PA 17068 daughter 22,119.26
5. David AAntonicelli,5805 stephens crossing,mechanixburg,PA 17050 son 22,119.24
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.
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N�ec��a�icsbutg, Pe�€�sytvania, declare�t�s�be rny�as�VIfi11 and
hene�y�ke a1�prior v�ar�d codia#s.
1. 1 d�ect t�a!!my just�a�ci funeral exper�ses,
g�ra�e t�ar�c�r�d admini�s#ra�ive e�q�er�s+es sh�1 be paid� r�ty
r�������..��as�as�€��ab�e 2�'m�dea#h_
2. � dic�ct t�a#a!1 int�er�an�e, es�te, transfer,
success�n a�ttl d�ea��ax�es c�f�ny k�d w���soever vvhich rn�be
payable by reasan af my death sha�#be pa�d ou�of rny re�dwa�ry estar�e_
3. i di�+ect t�nny e�be dis#ribu�eci�s fvt�ws:
�
� A. 1 �eave�►ery#hirtg#� H�e�en L. A�t�ic�l��.
� ~ Sh�uld she p�ned���ase me, t direct my entire
es�a#e#�e d'nr�det�ir��qua��a�es and
dis�ribu�ed#o rny c�ik#r+en L3avid A. Ar�#a�ir�U�,
St�ephen M.A�niceiti, �bra A. Hershey���-�c��.:¢��`�
` - s�ian,4.Ar��ir�a�, and Nta�f�+►E.An�onic�li�.
- � �hou�i any pnedece�ase rne,�eir share shall
� k�as�arnd t���a tt�es�te t�f the
� de+ceased�hik�_
4. 1 a�o►irrt Helen L.A�xtonia�li�s E�cer,u�ri�c. 1�she
shc�uld predevea�me c�r ceas�e tv ac�in suc�t ca�, t appoi�rt flavid
A. A�rti+c�i as a�rrtate.
5. The Ex�ccrtrix o#this i��s�tsa�te the prnnrer fio
�dis�t�te m�y estafie in k�d or in r�fi, oc par#!y�n�#l�ter.
C. t ��r�et�tha�nr� E.xet�tor ac�ng under th�V�l'dt shall
be nequired�o errter bo�d in�tny furisd�[t�t't.
iN irViTNESS VY�iEREQF, l,Ange�o i4rt�oni�efti, i�ve
her+et�mto set my l�and this_��day af � �
2002.
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77 7-790-224� Second Flaor
_ , _..:
_�_: _.:.. -::: . _._._:� =-;= : Mechanicsburg, Pa.77D55
IN RE: Persanal Property Appraisal September 22, 2012
(�t�'NER Angelo Anthony ��ntonicelli
# 5 Evergreen.
IVlechanicsburg, Pa. 17055
This appraisal is �campleted as per request to determine a fair market for the followin�list
of personal praperty.
Shap V ac �1 Q
Bed �y,
Pet cage 5
Camera, saw, shears, recards & snake 5
D-humiciifier 10
Metal Wardrobe, chifferobe & wardrobe poor 10
�'asher motor and dryer 6p
Metal shelf& cantents 1p
GE S/S refrigerator 1�p
lUlicrowave oven and stand �
Table and chau s 15
Contents of attic �
TV 8� Upholstered furniture, ald stereo NV
Various lamps 5
VCR �-V
Mirror 15
2 Book shelves particle board 5
360 day clock 1�
B entley clock 3�
Bed and lamp in b�droom �p
TV �,T
Brass Bed 14
Lamps and shelf �
Bedroam furniture &lamps �a
Plaque and clt�ck �
E/rr��r l��lur Au�cti�rr�s /�c.
�'Y �
License No.�►U-fi49-L 14 North Wainut S#.
77 7-79�}-2241 Second Floor
������������,����;�,��,����°��������.N���� Mechanicsburg, Pa.17055
Toro GTS mower 40
Aluminum ladder 5
Small roto tiller 44
Honda lawn mower 75
Snow blower 30
Homelite chain saw 30
Hedge trimmer 1 Q
Weed eater/blower 15
String trunmer 40
Long handled toaLs 5
Craftsman leaf blower 20
Balance of contents of shed 15
Wheel barrow 5
Upon observation of the afarementioned items it is to the best c�f my knawledge
and belief that Six Hundred and ninety{$690)Dallars would represent a fair
market value.
_---
Sub b F
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� � Print
Take The ��t�sst�cark C��t t�f T'r��1ng Yc�ur�ir
Black Book� Pre-Inspection Trade-In Estimate
Biii Fenwick
2003 CHEVROLET MALIBU
$1,175 - $3,173
7une 30, 2013
Lower Your Tax Bill By $71 ��-
State sales tax could save you an additionai $71 when you trade your used vehicle with
the dealer. Ask your dealer for more details. Market conditions may allow your dealer to
offer more.
Your Trade-In Vehicle Detaiis
Year: Vehicle You Plan to Purchase
Make:
Model:
Style:
Mileage:
Equipment:
Interior:
Exterior:
Your Trade-In Appraisal
OMB Ppproval No_2502-0265
A SETTLEMENT STATEMENT(HUD-1) B• 7YPE OF L�AN
.F"`"E"``�� Colonial Valley Abstract Co. '• �F"A 2•CX1 RHS 3. CONV.UNINS.
=o*�I)�m*� 4. ❑VA 5.�CONV.INS.
�qe Ii �1 2'IB E.MBfIC@t St. 6. ESCROW FILE NUMBER: 7. LOAN NUMBER:
NINo� 01329390-OQ1 MAH 0000362072
wo�� York,PA 17403
(717)848-2871 8.MORTGAGE INSURANCE CASE NUMBER:
F1NAL 1006269-0000362072-4
C.NOTE: This form is fumished fo give yDU a statement of actual s�ttlement costs. Amounts paid to and by the sett/ement agent are s��rown.
ltems marked"(P.O.C.)"were paid outside the dosing,•they ara shown here fnrinformationa!puiposes and are not included in fhe tota/s
o.►vanne oF soRROweR: Bouchra Badaoui and Benaissa Bahadda
AooRess oF aoRROw�R: 4232 Wagon Wheel#D
Harrisburg,PA 17109 �
e. ►�ann�oF s���ER. Estate of Angelo A.Antonicelli and By David AntoniceNi Executor
ADDRESS OF SELLER:
F. NAME OF LENDER: Acre Mortgage&Finanical,�f1C.
ADDRESS OF LENDER: 7O E.M81f1$tf2@t
Marlton,NJ 08053
c.PROPE�n�oc.�TioN: 5 Evergreen Lane
Mechanicsburg,PA 17050
Cumberland County 38-19-1612-024
__ 5 Ever reen Lane,Mechanicsbur ,PA
H.sErr�EMervracer,r: Colonial Valley Abstract Co. (717)848-2871
Pv�ce oF s�r�nnEr,r: 216 E.Market St.,York,PA 17403
I. SETTLEMENT DATE:2/�5/2013 PRORATION DATE: 2/�5/2013 DISBURSEMENT DATE: 2/15/2013
J• SUMMARY OF BORROWER'S TRANSACTION K SUMMARY OF SELL�R'S TRANSACTION
;., _ . _
, _
^100'".GROSS�kMOUNT.DUE.`FR�If[:BORROWER�.;�° ' ..,_400.�G.RO'SS�AMOUNT.'DUE T,O:SELLER:�:' . �:� � :�;� ..;' .,
� �
� �-;,:�
101. Contract Sales Price • 135,000.00 401. Contract Sales Price 135,00�.00
102. Personaf Property 402. Personal Property
103. Settlement charges to Borrower(line 1400) 11,389.31 403.
104. 4p4.
, 105. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
106. City/Town Taxes 406. Ci /Town Taxes
1 Q7. County Taxes �407. Coun Taues
108. Assessments 408. Assessments
109. School taxe Q2/15l13 ta 06/30/13 410.69 409. Schoo!taxe 02/15/13 to 06/30/13 410.69
110. 410.
111. 411.
112.. 412.
113. 413.
114. 414.
915. 415.
120. GROSS AMOUNT DUE FROM BORROWER: 146,800.00 420. GROSS AMOUNT DUE TO SELLER: 135,410.69
: ;;�?�,00.'AMOUNTS PAID BY:�j 11'4 BEHAL�:OF¢ORROVY�R� '.., . ;_ . �.,;i: S00�itEDU,C17�t�fS;lN AMOUNTDUE xO SE�.LER .;; �
201. peposit or earnest money 1,000.00 501. Excess deposit(see instructions)
202. Principal amount of new loan(s) 137,755.00 502. Settlement charges to Seller(line 1400) 10,408.48
203. Existing loan(s)taken subjed to 503. Existing(oan(s)taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 6%Selter Pa+d Closing Costs 8,1Q0.00 50&. 6%Seller Aaid Closing Costs 8,100.00
207. 507.
208. 508.
209. 509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. Cityrfown Taxes 01/01/13 tn 02/15/13 15.97 510. Cit/Town Taxes 01/01/13 to 02/15/13 15.97
211. CountyTaxes 01/01/13 t� 021i5ii3 3�•�� 5ii. Co�nty�aaces C1:0�/13 tr �?,'�5:'.3 32_05
212. Assessments 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYJFOR BORROVYER: 146,903.02 520. TOTAL REDUC'170NS IN AMOUNT DUE SEILER: 18,556.50
.300 GA$HATSEITLEMENTFRO.MITO"BORROMI,ER ' _.600 CASHATSETTLEMEIqTTO1FROMSELL�R. � ,;,,�,`
301. Gross amount due from Borrower(line 120) 146,800.00 601. Gross amount due to Seller(line 4201 135,410.69-
302. Less amou�t paid by/for BoROwer(line 220) 146,903.02 602. Less reduction in amount due Seller(line 520) 18,556.50
303. CASH(�FROM) ( � TO)BORROWER: 103.02 603. CASH(❑ FROM) (� TO)SELLER: 116,854.19
The PubGc Reporting Burden for this colledion of information is estimated at 35 minutes per response for wI(eding,reviewing,and reporting the data.
This agency may nof collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.
No conf�ientiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPA oovered transaction with information
during the settlement process.
� - � -� ue tn.
'. SEiTLEMENT CHARGES ESCROW FILE NUMBER: 01329390 001 MAH
L
;7D0:'TOTALREAL ESTATE>BROKER;F�ES: �.d': ' ;:, ,;:;:., . , : ;_P o c :
DIVISION OF COMMISSION(LINE 700)AS FOLLOWS: 1' r PAID FROM PA1D FROM
701. $3,807.00 to Joy Danieis Real Estate Group BORROWER'S FUNDS SELLER'S
AT SETTLEMENT FUNDS AT
702. $3,807.00 to Keller Wiiliams Keystone Reaity SETTLE MENT
703. Commission paid at settlement 7,614.00
704. Broker Fee to Joy Daniels Real Estate Group (695.00)S
705. Transaction Fee to Keiler Williams Keystone 395.00
;800:�ITEMS,PAYABLEIN CONNECTION.WITN LOAN: , P.O.c. = : ,
801. Our origination charge $3,555.71 �from GFE#�)
$p2. Your credit or charge(points)for the specific interest rate chosen $0.00 (from GFE#2)
803. Your adjusted origination charges to Acre Mortgage E�Finanical,Inc. (from GFE,4) 3,555.71
804. Appraisal fee to Appraisal Links �from GFE#3) (450.00)B
805. Credit report to Universal (from GFE#3) 87.34
806. Tax seroice (from GFE#3)
807. Flood certification to Corelogic (from GFE#a) 18.0�
808.
809.
810.
., `ADVANGE: , , . �
. :.;. P qC ;°
900.ITEMS'�. QUIRED BY,L'ENDER TO BE;PAID IN_ , : ;
' _: ;
901. Daily interest charges �from�Fe#10� 184.93
from 2/15/2013 to 3/1/2013 @$13.2094/day 3.5000% ( days)
902. Mortgage fnsu2�ce premium for 0 month(s) (from GFE�3)
903. Homeowner's insurance for 0 year(s)to Nationwide (rrom GFE#��) 569.98
904. Rural Development Gua2ntee Fe to USDA 2,755.10
905.
�,r1000.:RESERVESDEPOSITED WITH:LENDER. ` " ' '
, -:, ,:
, ,
1001. iniUal deposit for your escrow account �trom�FE#s) 348.76
1002. Homeowner's insurance 2 months @$ a7.5o per month $95,00
1003• Mortgage insurance months�$ per month
1004. City properly taxes 1 months @$ 21.67 per month $2'1.67
1005• County property taxes 1 months�$ 10.79 per month $10.79
1006. Annual assessments months @$ per month
1007� School taxes 7 months @ 5 94.42 per month $660.94
1008� USDA Annual Fee 2 months @$ 45.52 per month $91.04
1009. Aggregate Acct Adj. months @$ per month -$530.68
1100�,T1TLE CHARGESr � P.O.C.
_ j 1,544.00
'!101. Title services and lender's title insurance to Colonial Valley Abstract Co. (from GFE tt4
9102. Settlement or ciosing fee
1103. Owners title insurance (from GFE#5)
1104. Lenders title insurance•to Colonial Valley Abstract Co. $1,090.00
1105. Lender's tide policy limit 5137,755.00 Old Republic National Title
1 106. Owner's titie policy limit 5135,000.00 Old Republic National Title
1107. AgenYs portion of the total title insurance premium 31,146.65 to Coloniai Valley AbsVact Co.
1108. Underwriters portion of the total title insurance premium 5202.35 to Old Repu6lic National Title
1109. Ends.100,300,8.1,1030•to Colonial Valley A6sttact Co. 5259.00
1110. Insured Closing Letter•to Old Republic National Title $75.00
1111. Notary Fees•to Martha A.Horn $50.00 24.00
1112. "See attached for breakdown $70.00 110.00
'�i1200.'GOVERNMENT REGORDINGANb TRANSFER CHARGES: `: P.O.c. : -
1201. Government recording charges (from GFE#7) 152.00
�2p2. Deed$62.00 Mortgage$90.00 Release$0.00
1203. Transfer ta�ces (from GFE:8)
1,350.00
1204. City/County tax/stamps Deed$1,350.�0 Mortgage$0.00
1205. State tax/stamps Deed$1,350.00 MoRgage$Q.00 1,350.00
1206.
1207.
1300.ADDITIQNALSETTLEMENTCHARGES`. '' ,;'I ;� . :,:; . - ' ;P.O.C. _
__ __ _ - _.
1301. Required services thatyou can shop for (from GFE#6)
1302.
1303. 2013 county Twp.tax Escrow to Colonial Valley Abstract Co. 428.49
1304. Home Warranty 10360672101 to FirstAmerican Home Buyers Protection 365.00
1305. Radon Reduction System to American Radon Solutions 825.00
1306. Fir,al Sevrer 1 pin�_�?�ng r�Silver Sprine Township Authori�
120.48
14�0. TOTAL SETTLEMENT CHARGES(Enter on line 103,Section J-and-line 502,Section iQ 11 389.31 10 408 48
I have carefully reviewed the H UD-1 Settlement Stateme nt and�the best of my knowledge and belief,it is a true and accurate state ment of all receip�and d isbursements made on my
accfluntor by mein this transaction. I further certify that I have receiveda copy ofthe HUa1 Settlement Statement.
� !-�_-�
� a " _ . ��
1 ''
4� � I
{-;- w��� /i k�c ,.�; ,<< �� � �� ,. �`.:
Bouchra Badaoui Estate of Angelo A.Antonicelli `" ,;
r
c��u-� �_-�- -� - .
- :,_ ;
¢�,�-�"_ �_.�- '� Fi.��,�,c L l�{i I�l'/l.�`C�r�,�(. e` ��•°�(�i; r��\
Benaissa Bahadda -�' eorrowers By David Antonicelli Executor } Seliers
The HUQ1 SetUement Statement wh ich I have prepared is a fiue and accura�account of this transadion. I have rau sed or will cause the fund s to 6e disbursed in accordance with this
statement �
r� � °�;' l-• J`-
� f _ y/ .�
� /
> `� . < <��<- i '"_ SettlementAgent - � - Date
Colonial Val ey-� Abstract Co.
WARNING: Itis a crimeto knowingiy make false siatements to the United States on this orany similarform.Penalties upom m�viction can include afine and imprisonment Fordetails
see: Title 18 U.S.Code Section 1001 and Sedion 1010.
� • Escrow Number. 01329390-001 MAH
Coritipar�son�of Gaod Faith;Esfimate(GFE):and•HUD 1 Charges '�� Good Faith"E"sEimate HUD-1
�harges That Cannot increase HUD-1 Line Number
Our origination charge #801 3,555.71 3,555.71
Your credit or charge(points)for the specific interest rate chosen #802 0.00 0.00
Your adjusted origination charges #803 3,555.71 3,555.71
Transfertaxes #1203 1,350.00 1,350.00
. ,- - -.. .. ,
Chal,tg�s That,in Total Cannot Increase Mcre Than�'!0%„ _> , '� ": „ ,. Good Faith,Estimate.. ' ` HUD=1
Govemment recording fees #1201 158.00 152.00
Appraisal fee #804 450.00 450.00
Credit report #805 50_00 87.34
Flood certification #807 18.00 18.00
Rural Development Guarantee Fe #904 2,755.10 2,755.10
Title services and lenders title insurance #1101 1,817.50 1,544.00
#
#
Total 5,248.60 5,006.44
Increase between GFE and HUD-1 Charges $ -242.16 or -4.6138%
Charges�'rfiiat Can Cfiahge.: : -Good Faith.Estimate HUD:-1
Initial deposit for your escrow account #1001 779.00 348.76
Daily interest charges #901 $13.2094/day 0.00 184.93
Homeowners insurance #903 576.00 559.98
#
#
#
Loan Terms
Your initial loan amount is $137,755.00
Your loan term is 30 years
Your initial interest rate is 3.5000%
Your initial monthly amount owed for principal,interest,and any $618.58 includes
mortgage insurance is QX Principal
❑X Interest
�Mortgage Insurance
Can your interest rate rise? �No.� Yes,it can rise to a maximum of 0.0000%.The first change will
be on and can change again every after.Every change date,your interest
rate can incxease or decrease by 0.0000%.Overthe life ofthe loan,your
interest rate is guaranfeed to never be lower than 0.0000%or higher than
: 0.0000%.
Even if you make your payments on time,can your loan balance rise? Q No.❑ Yes,it can rise to a maximum of$0.00.
Even if you make your payments on fime,can your monthly amount X❑No.� Yes,the first increase can be on and the monthly amount owed
owed for principal,interest,and mortgage insurance rise? can rise to$0_00.
' The maximum R pn ever rise to is$0.00.
Does your loan have a prepayment penalry? xQ No.� Yes,your ma�amum prepayment penalty is$0.00.
Does your loan have a balloon payment? Q No.❑ Yes,you have a balloon payment of$0.00 due in 0 years on.
Total monthly amount owed induding escrow account payments �You do not have a monthly escrow payment for items,such as property
±axes and homeowner's i�surance.You must pay thes°it°ms directly
yourself_
�X You have an additional monthly escrow payment of$219_90 that resufts
in a total initial monthly amount owed of$838.48.This includes prindpal,
interest,any mo�tgage insurance and any items checked below:
�x Property taxes �Homeowners insurance
❑Flood insurance �USDA Annual Fee
❑ ❑
Note:(f you have any questions about the Settlement Charges and Loan Terms listed on this form,ptease contad your Iender.
_r_..i..�., oe..e'2 nf e HI If1_�
Escrow�'umber. 01329390-001 MAH
HUD 1112 DETAILED BREAKDOWN OF ADDITIONAL TITLE CHARGES
Dera� Sel ler
• Description Amount Amount
1113.Wire/EDD•to Co�onial Valley Abstract Co. �50.00
1114. Overnights•to Colonial Valiey Abstract Co. $20.00
1115.Tax Cert.Fee to Debra Basehore Wiest 10.00
1116. Deed Prep to Colonial Valley Abstract Co. 100_00
Totai as shown on HUD page 2 Line#1112 110.00
HUD'1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES
Buyer Seller
Amount Amount
City 8�County Tax/Stamps
CityTax/Stamps: Deed $1,350.00
Total as shown on HUD page 2 Line#1204 1,350.00
Buyer Seller
Amount Amount
State Tax/Stamps ,
State Tax/Stamps: Deed $1,350.00
Total as shown on HUD page 2 Line#1205 1,350.00
�_.............a:.:.........,..,ti..,.i,,... o�..o n„F� u�m_�
• . Send Inquires to:
St 5000�ouise Drive Statement of Accounts
PO Box 40
Mechanicsburg,PA 17055 Aug 25, 2012 thru Sep 24, 2012
www.membersi st.org
Main Switchboard: (800)283-2328
EZ Call: (717)697-4372 or(800)283-4372 Account Number: 15332 �
� TDD: (717)697-5312 or(800)283-2328 ext.5312
TeleBranch: (800)237-7288
MEMBERS lst Balances at a Glance: _
FEDERALCREDIT UNION CI1@Ckltlg: 2,705.24 -
5114 1 AV 0.350 17706-5114 Savings. 7,014.93 �
*= I���III���III����I�I�II�����I�I�II��II�����II�II����I�I����III Certificates: 0.00
�- ANGELO A ANTONICELLI Loans: O.00 _
N= DAVID ANTONICELLI Money Management: 10,688.89
= 5 EVERGREEN LN $WI e 5 YTD Reward: 2.95
"� MECHANICSBURG PA 17050-2603 p
W-
o= Page: 1 of 3
�_
Your current Member Loyalty Rewards level is Gold.
Your aggregate balance as of September 1 st is $20,799.06.
An aggregate balance of$35,000 and having 3 products
will move you to the Platinum level.
Go mobile with our mobile banking apps�
See the enclosed insert for more details.
CHECKING ACCOUNTS
0011 -CHECKING
Date Transacfion Description Additions Subtractions Balance
Aug 25 Ba/ance Forward 7,237.62
Aug 27 Check 006616 Tracer 00026136 3 0 52,99- 7,184.63
Aug 30 Check 006617 Tracer 0001270923 500:00- 6,684.63 .
Aug 31 Deposit Transfer From Share 0000 678.00 7,362•63
Aug 31 Withdrawal Debit Card CHECK CARD 9.32- 7,353.31
08/30 33502fi805887 KFC/LJS 048 MECHANIGSBURG PA
Aug 31 Deposit:ACH XXVA BENEF � 741.00 8,094.31
ID: 3111036196 CO: XXVA BENEF
Aug 31 Deposit Dividend 0.100% 0.68 8,094.99 .
Annua/ Perceritage f'`ie/d Eame�d 0. 100'�from 08/0�/2012 through 08/3>/2012
Based on Average Daily�/ance of 7,9T3.66 f '
Aug 31 Deposit; Swipe 5 Rebate 0.25 8,095.24
S e p 0 4 - V i l i t h d r a w a l D e b i t C a r d C H E C K C A R D-F : = - . 5�.2a- - 8,U41...p�
' 09/03 172179000187955 GI�1T 60Q5 MECHANICSBURG P
Sep 04 Deposit Transfer From Share 00� '� � 2,476.89 10,517.93
Sep 04 Check 006648 Tracer 0003040573 36.00= 10,481.93
' Sep 05 Check 0�621 Tracer 6012344352 � - 5.25- 10,476.68
Processed Check - VETERANS AFFAfRS '
TYPE: PAYMENT 1D: 3600920001 DATA: ACH TRAf��ACT10N
Sep 05 Check 006619 Tracer Q429680679,y
` 276.03- 10,200.65
Processed Check - VERIZO`N ARC =
TYPE: CHECK PYM� J� 20f�Z2221 ���1� DATA z
Sep`05 Check 0�620 Tracer 0001'��'fl�8���� ��� : � �� � 'x � � 10.04- 10,190.65
Sep`;05 Check 006623 Tracer 00014'240�� . " T, ° ° 500.00- 9,6�.65
�.�_ -. _ ;
' Sep:06 Withdrawal Debit Card CF�€��4:��R�). =�,_�_.K�W m _ . � .�_.d 29.88- 9,660.77
09f06 �56636000153307 GIANT 6005 MECHANICSBURG P •
Sep 07 Withdrawal Debit Card CHECK CAaD 30.48- 9,630.29
TRANSACTLON' DATE - 09/06/2012
09/06 1721790�167955 GIANT 6005 MECHANICSBURG P
Sep 07 Withdrawal Debit Card CHECK CARD 43.00- 9,587.29
09/06 1566360�153307 GIANT 6005 MECHANICSBURG P
Sep 10 Check 006624 Tracer 0001330037 ` 59.41- 9,527.88
Sep 12 Check 006626 Tracer 0001307333 500.00- 9,027.88
_ --- Continued on following page ---
s� Send Inquires to: Main Switchboard: '
5000 Louise Drive (800)283-2328
PO Box 40 EZ Call: (717)697-4372 or(800)283-4372 /qUg ZrJ, 2012 thru Sep 24, 2��2
Mechanicsburg,PA 17055 TDD: (717)697-5312 or(800)283-2328 ext.5312 �»o7-s��4 Account Number: 15332
MEMBE�RSoN� WW�y.memberslst.org TeleBranch: (800)237-7288
Page: 2 of 3
Date Transaction Description Additions Subtractions Balance -
Sep 13 Check 006625 Tracer 0001238403 175.83- 8,852.05
Sep 14 Withdrawal Debit Card CHECK CARD 33.00- 8,819.05
09/13 156636000153307 GIANT 6005 MECHANICSBURG P -
Sep 14 Withdrawal Debit Card CHECK CARD 14.97- 8,804.08
09/13 08515951886WSP1 WAL-MART #1886 MECHANICSBU
,,_ Sep 14 Withdrawal Members 1st Online Transfer To Share 00 5,000.00- 3,804.08 -
- Mobile Banking Transaction
�__ Sep 16 Withdrawal Debit Card CHECK CARD 62.83- 3,741.25
�.= 09/15 172179000167955 GIANT 6005 MECHANICSBURG P
'= Sep 17 Withdrawal ACH PPL EU 81.84- 3,659.41
'- TYPE: ELEC SVC ID: 1230959590 CO: PPL EU
�= Sep 17 Check 006fi27 Tracer 0002393222 116.63- 3,542.78
-- Sep 18 Withdrawal ACH LEFFLER ENERGY 309.00- 3,233.78
TYPE: EPAYMENT ID: 9085958001
DATA: 63783 CO: LEFFLER ENERGY
Sep 19 Withdrawal ACH PAWC 28.54- 3,205.24
T`�'PE: PA`�MENT ID: 10080966a0 CO: Pr1WC
Sep 19 Check 006629 Tracer 0001335283 500.00- 2,705.24
Sep 24 Ending Ba/ance 2,705.24
CHECK SUMMARY
Check # Amount Date Check # Amount Date
006616 52.99 Aug 27 006623* 500.00 Sep 05
006617 500.00 Aug 30 006624 59.41 Sep 10
006618 36.00 Sep 04 006625 175.83 Sep 13
006619 276.03 Sep �5 006626 500.00 Sep 12
006620 10.00 Sep 05 006627 116.63 Sep 17
006621 5.25 Sep 05 _QQ6629i_ 500.00 Sep 19
'' Aste�isk next to numbe�indicates skip in number sequence - .
12 Checks Cleared fo�2,732. 14
SAVINGS ACCDUNTS
0000 -REGULAR SAVINGS
Date Transaction Description Additions Subtractions Balance
Aug 25 Ba/ance Forward 14.51
Aug 31 Deposit ACH XXSOC SEC 266.00 280.51
ID: 3101036216 CO: XXSOC SEC
Aug 31 Withdrawal Transfer To Share 0005 266.00- 14.51
Aug 31 Deposit ACH XXVA BENEF ' 678.00 692.51
ID: 3111036002 CO: XXVA BENEF
Aug 31 �Nithdrawal Transfe� To �h�re 00�1 678.OQ- 14.��
Aug 31 Deposit Transfer From Share 0004 0.42 14.93
Sep 04 Deposit ACH XXCIV SERV 2,476.89 2,4g�,g2
ID: 3121736156 CO: XXCIV SERV
Sep 04 Withdrawal Transfer To Share 0011 2,476.89- 14.93
Sep 14 Deposit Members 1st Online Transfer From Share 001 5,000.00 5,014.93
Mobi(e Banking Transaction
Sep 24 Ending Balance 5,014.93
0004 - LIFE SAVINGS _`..�, �'�� 2�=
. �� ��
_�� �
;
Date Transaction Description Additions Subtractions Balance
Aug 25 Ba/ance Forward 2,000.00
Aug 31 Deposit Dividend 0.250% � �� �� -� � �� � � � � �� 0 42 2,000.42
Annua/ Percentage Yie/d Eamed 0.250'�from 08/01/20�2 fh�ough 08/3>/2012
Aug 31 Withdrawal Transfer To Share 0000 0.42- 2,000.00
Sep 24 Ending Ba/ance 2,000_00
--- Continued on reverse side ---
� ! Send Inquires to: � �
�L 5000 Louise Drive Main Switchboard: (800�253-2328
PO Box 40 EZ Call: (717)697-4372 or(800)283-4372 Aug 25, 2012 thfU Sep 24, 2012
TDD: (717)697-5312 or(800)283-2328 ext.5312 �»oa-s��a
Mechanicsburg,PA 17055 Account Number: 15332
MEMBERS 1"� TeleBranch: (800)237-7288
��°•,�,,,,,,�„ www.memberstst.org Page: 3 of 3
0005 —MONEY MANAGEMENT
Date Transaction Description Additions Subtractions Balance
Aug 25 Ba/ance Fon�vard 10,420.24
Aug 31 Deposit Transfer From Share 0000 266.00 10,686.24
Aug 31 Deposit Dividend Tiered Rate 2.65 10,688.89
Annua/ Percentage Yie/d Eamed 0.34U�from 08/01/2012 through 08/31/2012
Sep 24 Ending Ba/ance 10,688.89
YTD SUMMARIES
70TAL DIVIDENDS PAID
0000 REGULAR SAVINGS 0.00
0004 UFE SAVINGS 3.32
�05 MONEY MANAGEMENT 18.89
0011 CHECKING 6.85
Total Year To Date Dividends Paid 29.06
NOTE:`Total includes closed shares `
Add Your Phato For Se�urity -
Your persanal safety and finar�cial security are top priorities at Members 1 st. As a result of
irrcr�ased sca-ms and fraudutent activiiy throughout the entire Country, we are strongly
errcauraging'm�mbecs to hrave tM�ir photc�s added to their�ccount recortls. When visiting our
brart+ch affices, yo.0 may be asked by ane of aur Assa�ia��s to atlow us to take your photo. This
mernber id�n#ifrcation'progr~am wilt assist m our fraud deterrence=initiatives and will take our
ictenti#y theit pre�ent�on �rogram to the:next level. We are experiencing an increasin� number of
atternpted fi�audulent arct�v�tres:ar�d'as a r��ult, we need to be able to ver�fy yaur ider�tity
imm�diately upan re�eving your arccoun�inforr�nation.
ln addition to haviRg your phota in our frles, you may 1ae rec�uired to show additional forms of
id�ntificati�n la�s�d on the fype of transact`ran you are seekin This is for yaur protection and
•
security and we appr�ciate your angoing cooperation and un erstanding.
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" �� Send Inquires to: Stat@m@nt of Accounts
5000 Louise Drive
PO Box 40
Mechanicsburg,PA 17055 Sep 25, 2012 thru Oct 24, 2012
www.membersl st.org
Main Switchboard: (800)283-2328
Ez cs��: (717)697-4372 or(800)283-4372 Account Number: 15332 _
� TDD: (717)697-5312 or(800)283-2328 ext.5312
TeleBranch: (S00)237-7288
MEMBERS 1St Balances at a Glance:
-
' FEDERALCREDIT U1�1ION Crl@CkIC1C�' : 0.��
Savings: 0.00 —
6527 1 AV 0.350 13053-6527 �
I���III���III����I�I�II����II��I��i��il���l��lll����l�l�l��l�l Certificates: 0.00 —
�= Loans: 0.00
� ANGELO A ANTONICELLI -
N_ DAVIDANTONICELLI Money Management: �.��
C/O DAVID ANTONICELLI Swi e 5 YTD Reward: 2.95
°'- 5805 STEPHENS CROSSING p
^'= MECHANICSBURG PA 17050
o_ Page: 1 of 2
�_
Your aggregate balance as of October 1 st is $2,005.00.
An aggregate balance of$2,500 and having 3 products
l��l� ��a�� ;�ou in �he �3lver "v�LR lev�i.
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Get a free pet insurance quote! See the enclosed insert for more details. ; � � �'� - ` '
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CHECKING ACCOUNTS ��
�..�-�-°�-�
0011 -�HECKING ,..-�°
' Date Transaction Descri tion Additions Subtractions Balance
Sep 25 Ba/ance Fo�wam� 2,705.24
m ��/
Sep`25 -- Check 006630 Tracer 0001410245 �/ 1.000.00- 1.705.24
p Deposit Dividend �t� 1,705.67
An�ua/Percentage Y"ie/d Eamed 0.10U3o fcom 09/01/2012 �inugh 09/30/20�2
Based on Average Dai/y Ba/ance of 5,25�.80 : '"
Sep 27 Withdrawaf 2s5.50- 1,440.17�"?�''�'
Sep 27 Withdrawal Transfer . 1�,440.17 ��0..00`
To ESTATE OF ANGEL 3�CXX)CXX)CXX Share �11 ��o'���-"�
CHECK/NG C/osed
**:*This is ihe.fma/stafement presenfi� infnm�a�on on fhis p uc�*�',
�"' P/ease �etam fhis fma/statement� �tar re�aofing pur,vos , ,' �
� �,f -
_--- _
� � �WECK��SUItAMARY � `� � � �� � �� . :. � �
Check # Amount Date � Check # Amount Date
006630 1,000.00 Sep 25� � `
. �
SAVINGS AGCOUNTS
0000-REGULAR SAVINGS �
Da#e 7ransaction Descri tion ` " - . - � ' =' Add'ttions � 5ubtractions Balance
Sep:25 Balance Foiwar�d ,� �' S,014.93
� � Sep�27 Qeposit�C7iv�dend � � � �,�: � _�� � � 0.45 � 5,015.38� �
��� � �����Annua/Percenfage Y'�/d Eamerd 0.2��m�������°t►;im[�i���?2� � � � �
� � Sep-2T Withdrawal 7ransfer ; � � �� � � � � � ��� � � ���� 5,010.38- � ��� . �
To ESTATE OF ANGEL X�fX70CXX)CX Share OOQO � "°`��
Oct 01 Deposif Transfer Fram Share 0004` 0.41 41 -
Oct 06 Withdrawal Transfer =`. - - ` ' 0.41- 5.00
To ESTATE OF ANGEL XX3�CX�WC?C: Share 0000
, .,.
Oct 19 Deposit; 515�36�,_ 520.36
� �� � ���� LIFE S/�VIN:G� F'"RC?CEEB�; ;�� ��� � ���� '� �� � �
Oct 19 Deposit Transfer From Share 0004 - �� � � � 2,520.36
� �
_ --- Continued on following page ---
- S� Send Inquires to: Main Switchboard:
5000 Louise Drive (800)283-2328
PO Box 40 EZ Call: (717)697-4372 or(800)283-4372 Sep 25, 2012 thru �Ct 24, 2�12
Mechanicsburg,PA 17055 TDD: (717)697-5312 or(800)283-2328 ext.5312 13054-6527 Account Number: 15332
MEMBERS 1�'Q www.memberslst.org TeleBranch: (800)237-7288 /
FEDER�LCREDITIiN10N Page: 2 OI �
Date Transaction Description Additions Subtractions Balance -
Oct 19 Deposit Transfer From Share 0004 0.25�� 2,520.61
Oct 22 Deposit Dividend 0.05 � ,520.66
Annua/ Percentage Yie/d Ea�ned 0.24p�from 09/27/20>2 through �0/3�/20>2 ��, -
Oct 22 Withdrawal Transfer ; 2,520.66- 0.00
To ANTONICELLI,DAV Share 0000 -
F REGULAR SA V/NGS C/osed
-
,,- ***This is the fina/ statement p�esenting info�mation on this product'*'` -
�= ''*'' P/ease retain this fina/ statement for tax repo�ing pu�poses "�'* -
-
-
�= 0004-LIFE SAVINGS
J
� 1
'- Date Transaction Description �
Additions S�btractions Balance
F= Sep 25 Ba/ance Forwa�d 2,000.00
Oct 01 Deposit Dividend �--0.41- 2,000.41
Annua/ Percentage Yie/d Eamed 0.25U�from 09/0�/20�Z through 09/30/20>2 •�
Oct 01 lNithdrawal Tr�nsf�r ?'o Shat-e �Q00 � . 2,000.�0
Oct,fi9, Withdrawal Transfer To Share 0000 i , 00:00 0.00
Oct `�9 Deposit Dividend 0.25 p 2�
Annua/Percentage Yie/d Eamed 0.25U�from 10/01/20�2 through �0/3>/20>2
Oct 19 Withdrawal Transfer To Share 0000 � 0.25- 0.00
L/FE SA I//NGS C/osed
'''"'This is the fina/ statement p�esenting information on this product**'`
''`* P/ease retain this fina/statement fo� tax reporting puiposes *"
0005 -MONEY MANAGEMENT
Date Transaction Description Additions Subtractions Balance
Sep 25 Ba/ance Forward 10,688.89
Sep 27 Deposit Dividend 2.28 Q,691.17 "�-�
Annua/ Pe�centage Yie/d Eamed 0.30U�from 09/0�/20�2 th�ough 09/26/20>2 ,
Sep 27 Withdrawal Transfer � 10,691.17- 0.00
To ESTATE OF ANGEL �C�CXX)OOCX Share 0005
MONEY MA/VAGEMENT C/osed
'**This is the fina/statement p�esenting information on this product'''"'
*" P/ease retain this fina/ statement for tax�eporfrng purposes '''"'
YTD SUMMARIES
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 0.5p
0004 LlFE SAVINGS 3,gg
��u5 h�iON``t PJiaNA^EMEf J i �2'i.�7
0011 CHECKING 7_28
Total Year To Date Dividends Paid 32.93
NOTE: Totaf includes closed'shares
Add Your Photo For Security
Your personal safety and financial security are top priorities�at Members 1st. As a result of
increased scams and fraudulent �ctivity thro�ghou�the entire cauntry, we are strongly
encouraging members to have their photQS�.a�ddec!#Q_tf�t�ir�account records. When visiting our
branch offices, you may be asked by one;of�our Assoc�ates_to allow us to take your photo. This
member identification program will ass�s�in'ourfraud detei�rence initiatives and will take our
identity theft prevention program to the next level. We are experiencing an increasing number of
attempted fraudulent activities and as a result, we need to be able to verify your identity
immediatety upon retrieving your account information.
In addition to having your photo in our files, you may be rec�uired to show additional forms of
identification based on the type of transact�on you are seeking. This is for your protection and
security and we appreciate your ongoing cooperation and understanding.
� , .
.
�t y �� Send Inquiresto: Stat@m@►�t of Accounts
5000 Louise Drive
PO Box 40
Mechanicsburg,PA 17055 Sep 27, 2012 thru �Ct 24, 20�2
www.membersl st.org
Main Switchboard: (800)283-2328
EZ Call: (717)697-4372 or(800)283-4372 Account Number: 479213 _
� TDD: (�17)697-5312 or(800)283-2328 ext.5312
TeleBranch: (800)237-7288
MEMBERS 1St Balances at a Glance:
Checkin 1 ,959.20
FEDERAL CREDIT UNION 9•
Savin s: 13,914.39 —
7787 1 AV 0.350 15573-7787 � �
�_
I���III���III����I�I�II����II��I��I��II���I��III����I�I�I��I�I Certificates: 0.00 —
ESTATE OF ANGELO ANTONICELLI Loans: O.00
N= C/O DAVID ANTONICELLI EXECUTOR Money Management: 0.��
- 5805 STEPHEN'S CROSSING
°'- MECHANICSBURG PA 17050 Swipe 5 YTD Reward: 0.0�
N
o= Page: 1 of 2
�—
Get a free pet insurance quote! See the enclosed insert for more details.
CHECKING ACCOUNTS
0011 -CHECKING
Date Transaction Descriptian Additions Subtractions Balance
Sep 27 Ba/ance Forwa�d 0.00
Sep 27 Deposit Transfer T�-i� --�j. 1-,440.17 1.,440.17
From ANTONIGELLI,ANG Share 0011 -��"�����
Sep 27 Withdrawal -k�:a�� � 197.00- 1,243.17
Oct 02 Withdrawal ACH DELUXE CHECK � ` 13.55- 1,229.22
TYPE: CHECK/ACC. 1D: 1410216800 CO: DELUXE CHECK
Oct O6 Withdrawal Transfer = ✓ 50.00- 1`,179.22
+ To ANTONICELLI,DAV X)E)QUUUUCXX Share 0011
Oct 09 Deposit Members 1st Online Transfer From Share 000 �;968-00-'� ' 3,179.22
Oct 09 Withdrawal �� � �`.; � , ,f 61.16- 3,118.06
Oct 15 Check 000053 Tracer 0000243757 �, � �135.86- 2,982.20
. �. � �.
Oct 15 Check 000051 Tracer Q000265109 �� - � �' _::- _____� s�-!��--�--�_-��- _�z=74�-5`
Oct 1.6 ' Check (k'�Q52`1`i-acer"0027�1282 � , ` : �f136.48- �' 2,611.OT
Processed Check - VERIZ N A
TYPE: CHECK PYMT I D: 0050 2 2�'11 DA : Q A T A :
Oct 17 Deposit AGH VERIZON z � � 49.36 2,660.43
TYPE: VERtZON Re ID: 9�83397101'��C : VERIZON
Oct 17 Check 000050 Tracer 9130Q$7876 � � ' ✓G9`.00- 1,965.43
Processed Check = JOY D�NIELS I�AL
TYPE: CHECK PMTS ID �717695317 DATA: 717-695=3.�77
Oct 17 Check 000054 Tracer 0000235358 �� � r/38.64- 'l,9Z6.79
Oct 23 Deposit ACH YERIZON �� �� , �/'32.41 1,959.20
TYrE: VERIZ�N Re' � fJ �
Oct 24 Ending Ba/ance .�.�°� . 1,959.20
�--� � � � .� � �
.�.�::��:��.�����,.�;���'�:_����
A� ' CHECK SUMMARY '
Gheck # Amount Da#e Gheck # Amount Da#e
000050 fi95.00 Oct 17 < .'000053 135.86 Oct 15
000051 234.65 Qct 15 '000054 ` 38.64 Oct 17
000052 136.48 C�ct 16
' ' 5 Checks C/eared for 1,240.63
--- Continued on following page ---
st Send Inquires to: Main Switchboard: 800 283-2328
5000 Louise Drive � �
EZ Call: 717 697-4372 or 800 283-4372
Po eox 40 � > � > Sep 27, 2012 thru Oct 24, 2012
Mechanicsbur ,PA 17055 TDD: (717)697-5312 or(800)283-2328 ext.5312 �ss�a-��s�
e Account Number: 479213
MEMBERSI°� www.memberslst.org TeleBranch: (800)237-7288 Pagg: 2 Of 2
FEDEAAL CIIEDR UYION
�
AVINGS ACCOUNTS
0000 - REGULAR SAVINGS -
Date Transaction Description Additions Subtractions Balance
,� Sep 27 Ba/ance Forwa�d 0.00
�- Sep 27 Deposit Transfer _, : �, 5,010.38 5,010.38 -
- From ANTONICELLI,ANG XJCXXXXX)CXX Share 0000 � � -
�'— Sep 27 Deposit Transfer From Share 0005 10,691.17 15,701.55
"— Sep 30 Deposit Dividend 0.250% 0.43 15,701.98
_ �
"_ Annua/ Pe�centage Yie/d Ea�ned 0.25d�from 09/27/20>2 through 09/30/20�2
�— Oc 06 Deposit Transfer 0.41 15,702.39
*— From ANTONICELLI,ANG X�vUC�OUCX Share 0000
Oct 09 Withdrawal Members 1st Online Transfer To Share 00 �,-089-80� 13,702.39
Oc t 1 2 Deposi t by C hec k 212.00 13,914.39
Oct 24 Ending Ba/ance 13,914.39
0005 -MONEY MANAGEMENT
Date Transaction Descri tion Additions SWbtractions Balance
Sep 27 Ba/ance Fon�vard 0.00
Sep 27 Deposit Transfer 'j`�-� �'� 10,691.17 10,691.17
From ANTONICELLI,ANG X�UCXX)WCX Share 0005
Sep 27 Withdrawal Transfer To Share 0000 10,691.17- 0.00
MONEY MANAGEMENT C/osed
'**This is the fina/ statement presenting information on this product'`�*
'''"' P/ease retain this fina/statement fo� tax reporfing purposes ''*'
YTD SUMMARIES
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 0.43
0005 MONEY MANAGEMENT 0.00
0011 CHECKING 0.00
Total Year To Date Dividends Paid 0.43
NOTE: Total includes closed shares
Add Your Photo For Security _
Your personal safety and financial security are top priorities at Members 1 st. As a result of
inc�-�a�e� �ca��� df�d ��audui�nt aciivifiy ti�roughout the entire country, we are strongly
encouraging members to have their photos added to their account records. When visiting our
branch offices, you may be asked by one of our Associates to allow us to take your photo. This
member identification program will assist in our fraud deterrence initiatives and will take our
identity theft prevention program to the next level. We are experiencing an increasin� number of
attempted fraudulent activities and as a result, we need to be able to verify your identity
immediately upon retrieving your accaunt infarmation.
In addition to having your photo in our files, you may be required to show additional forms of
identification based on the type of tcansaction you are seeking. This is for your protection and
security and we appreciate your ongaing cooperation and understanding.
� `�
� �
,
_. �