HomeMy WebLinkAbout12-23-13 � 1505611186
REV-1500 EX(02-11)(FI)
PA Department of Revenue OFFICIAL USE ONLY
County Code Year File Number
Bureau of Individual Taxes
Po eox 2eoso� INHERITANCE TAX RETURN � I ,� o,-���1 '
Harrisburg,PA 17128-0601 RESIDENT DECEDENT (� 7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
151-36-1333 08082012 12271946
DecedenYs Last Name Suffix DecedenYs First Name M I
TREPANIER ANTOINETTE M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS �
FILL IN APPROPRIATE BOXES BELOW
� 1. Original Return � 2. Supplemental Return � 3. Remainder Return(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)
X❑ 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)
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 TO:
Name Daytime Telephone Number
JODI M. BLAIR, CPA 301-733-5020
�._..
REGIST OF WILLS US O LY ,^, `�
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First Line of Address r'� _� n ` � ` ' °
,., _ { '
480 N. POTOMAC STREET '-- ; �;, �; �' ' ;
, , .
Second Line of Address �. � - � � -�� c' � '
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- F...J .. ,;'7
City or Post Office State ZIP Code " qA E FILED r�,> � � r�
HAGERSTOWN MD 21740 �' � `� �'�
'f�
Correspondent'se-mai�address: JBLAIR@SEK.COM
Under penalties of perjury,I declare that have e�mined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,cor c and complete. Decl n of preparer other than the personal representative is based on all information of which preparer has any nowledge.
SIGNA SO SP BLE FOR FILING RETURN DAT
AD SS p
� l✓If' �� .�, � �T� � 7
SIGNA E OF PREPARER OTHER T�REPR�TATIVE DATE
c� �l. ��,a,,n , CPA ����zJ�3
ADDRES
480 N. POTOMAC STREET, HAGERSTOWN, MD 21740
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15�5611186 zwasa�,.000 1505611186 �
� 1505611286
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenYs Name:ANTOINETTE M TREPANIER 151-36-1333
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . �
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . Z.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , g.
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , . 5. �6,976.31
6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , g.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . 7. �1,277.$0
8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , g 2$,254.11
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. 9,268.43
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , , , �p. 27,182•�6
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , ��. 3G,451.19
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , �2. -8,�97.�8
13. Charitable and Governmental 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) , , , , , , , , , , , , , , �q.
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- 1 5.
16. Amount of Line 14 taxable
at lineal rate X.0� �6
17. Amount of Line 14 taxable
at sibling rate X.12 ��
18. Amount of Line 14 taxable
at collateral rate X.15 �g
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0.0�
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 1505611286 1505611286 �
2 W4648 1.000
REV-1500 EX(FI) Page 3 File Number 2112-0954
Decedent's Complete Address:
DECEDENTS NAME
ANTOINETTE M TREPANIER
STREET ADDRESS
10 WHITE OAK DRIVE
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) �.��
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box 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)
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
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 decedenYs 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 decedenYs 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.
2was�> >.000
REV-1508 EX+(pg_12)
pennsylvania SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS � MISC.
RESIDEMDEC ENTTURN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ANTOINETTE M TREPANIER 2112-0954
Include the proceeds of litigation and the date the proceeds were received by the estate.
All ro e 'ointl owned with ri ht of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC BANK — CHECKING ACCOUNT N0. 51-1293-4118 15,758.54
(SEE ATTACHED BANK STATEMENT FROM PNC BANK)
2• PNC BANK — MONEY MARKET ACCOUNT N0.55-0503-8402 545.15
(SEE ATTACHED BANK STATEMENT FROM PNC BANK)
3. PNC BANK — SAVINGS ACCOUNT N0. 50-0581-9421 545.12
(SEE ATTACHED BANK STATEMENT FROM PNC BANK)
4• ACCOMACK COUNTY BOARD OF SUPERVISORS — FINAL PAY CHECK 113.61
5. COMMONWEALTH OF VIRGINIA — REFUND 13.89
TOTAL(Also enter on line 5,Recapitulation) S 16 97 6.31
2w46AD 2.000 If more space is needed,use additional sheets of paper of the same size.
REV-1510EX+(OS-09) SCHEDULE G
pen nsylvan ia
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANTOINETTE M TREPANIER 2112-0954
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIP110N OF PROPERTY o EXCLUSION TAXABLE
ITEM INCLIOEi}f W�MEOFTFETRANSfEREE,ThFJR RELATIONSHP TO DECEDEM AND DATE OF DEATH /o OF DECD�S
NUMBE TFEDATEOFTWVSFEF2.ATfACHACAPY OF TFE DEED FOR RFJ1L ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE
�, CAPITAL ONE SAAREBUILDER, INC. - 11� `Z�J�] .8O ZOOo �-1.�277.8�
INDIVIDUAL RETIREMENT ACCOUNT —
DESIGNATED BENEFICIARY: STEVEN J.
HYVESSON
(SEE ATTACHED CHECK FROM
CAPITAL ONE SHAREBUILDER, INC. )
TOTAL(Also enter on line 7,Recapitulation)$
11 277 .80
If more space is needed,use additional sheets of paper of the same size.
2W46AF 1.000
REV-1511 EX+(0&13) SCHEDULE H
pennsylvania
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANTOINETTE M TREPANIER 2112-0954
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOLLINGER FUNERAL HOME — FUNERAL SERVICES 1, 965.00
2• WAL—MART — FUNERAL LUNCHEON 429.18
3. JOHN GROSS & COMPANY — FUNERAL LUNCHEON 48. 95
4. HOLLINGER FUNERAL HOME — OBITUARIES 636.80
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 3, 8 0 0.0 0
Name(s)of Personal Representative(s�TEVEN J. HYVESSON
StreetAddress 10 WHITE OAK DRIVE
City CARLISLE State PA ZIP 17015
Year(s)Commission Paid: 2 012
2. Attorney Fees:
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach e�lanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 10 8.5 0
5. Accountant Fees: 2, 2 5 0.0 0
6. Tax Return Preparer Fees:
7. MEMBERS 1ST FEDERAL CREDIT UNION — WIRE TRANSFER FEE 30.00
TOTAL(Also enter on Line 9,Recapitulation) $ 9 2 68.4 3
2wasAC 2.00o If more space is needed, use additional sheets of paper of the same size.
REV-1512EX+(�2_�p) SCHEDULE I
pennsylvania
DEPARTMENTOF REVENUE DEBTS OF DECEDENT,
INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS
RESIDEPIT'DECEDENT
ESTATE OF FILE NUMBER
ANTOINETTE M TREPANIER 2112-0954
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. RIVERSIDE HOSPITAL — FINAL HOSPITAL SERVICES 19, 552.61
z• BLOXOM VOLUNTEER FIRE DEPARTMENT — AMBULANCE SERVICE 576.38
3. VERIZON WIRELESS — PHONE SERVICE 295.77
4• ONCOLOGY ASSOCIATION OF VIRGINIA — MEDICAL BILLS 773.91
5. CREDIT CONTROL CORP — MEDICAL BILLS 1, 044.00
6. APPALACHIAN ORTHOPEDIC CENTER — MEDICAL COPAY 13.89
�• PA DEPARTMENT OF REVENUE — 2012 INCOME TAX DUE 61.00
$• CITIBANK, N.A. — CREDIT CARD BILL 4, 865.20
TOTAL(Also enter on Line 10,Recapitulation) a 2 7 18 2.7 6
zwasAH z.000 If more space is needed, insert additional sheets of the same size.
REV-1513EX+(01-10) SCHEDULE J
pennsylvania
DEPARTMENTOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANTOINETTE M TREPANIER —
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[Include outright spousal distributions and transfers under
Sec. 9116(a)(1.2).]
� STEVEN JAMES ITYVESSON SON 95o RESIDUE
10 WHITE OAK DRIVE
CARLISLE, PA 17015
Z• KRISTIN HYVESSON MCCRORIE DAUGHTER 5% RESIDUE
8530 E. INDEPENDENCE BLVD, SUITE 329
CHARLOTTE, NC 28227
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 S OF REV-1500 COVER SHEET,AS APPROPRIATE.
�� NON-TAXABLE DISTRIBUTIONS
A.SPOUSAL DISIRIBUTIONS UNDER SECTION 9113 FOR WHICH AN EIECTION 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. $
2W46AI 1.000 If more space is needed, use additional sheets of paper of the same size.
� / �S/�"� �S/� ��/ !��J �S/��S�S J��/� ��/�S4 �/�������S�,J���j
SOQAL SECURITY NLJMBER 151-36-1333
DATE OF DEA`I'�L• August 8, 2012
ATTACHMENT TABLE OF CONTENTS
LIST OF ATTACHMENTS (IN ORDER)
Copy of probated L,ast Will and Testament of Antoinette M. Trepanier
Copyof Death Certificate
Copy of the Short Certif icate
APPRAISALS
Bank Statement from PNC Bank for checking account no. 51-1293-4118
Bank Statement from PNC Bank for money market account no. 55-0503-8402
Bank Statement from PNC Bank for savings account no. 50-0581-9421
Check from Capital One ShareBuilder, Inc. for individual retirement account
�CL�.� �Ill c�.111� �P�.�ct.112L1��,� ��=; _1,
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I, Antoinette Ellam-Trepanier,residing and domiciled in Hallwood, Accomack County,
Virginia,declare this to be my last will and testament and revoke all former wills and testamentary
dispositions.
FIRST: I direct that all of my just debts to be paid as soon after my decease as
practicable.
SECVND: I give, devise and bequeath all of my estate,real and personal,tangible and
intangible, or every kind, character and description and wherever situate and however held as
follows: Ninety-five percent (95%) to my son, Steven James Hyvesson, and the remaining Five
percent(5°/o)to my daughter,Kristin Hyvesson McCrorie, in fee simple and absolute property. It
is my desire that my daughter, Kristin Hyvesson McCrorie, be ailowed to live in my residence,
28377 Grotontown Road, Hallwood, Virginia, until it is sold or ownership of the property has
changed with the stipulation that she will pay the utilities.
THIRD: I nominate and appoint my son, Steven James Hyvesson, as Executor of tliis
my last will and testament and knowing that he cannot qualify as such without the joint qualification
of a resident, then I direct that he obtain the services of my attorney, Thomas B. Dix, Jr., for that
punmose. I furrher direc?tha+_no cL*Pty be:equired of tt-,e;n upon their qualificatioa.
FOURTH: In addition to and not in limitation of all power, authority and discretion
granted under applicable law,every fiduciary serving hereunder for the purpose of carrying out the
terms of this will_shzll have all o.`the pcwers set iortn in Code of Virginia, §64.1-57,as amended,
and in effect as of the execution of this will, which section is hereby incorporated in this will by
reference,specifically including the power to sell all or any part of my estate.
IN WITNESS WHEREOF, I have set my hand and seal, this �� �r day of
��L-t,f.� ,2012,to this my last will,consisting of three(3)typewritten pages.
1
This document���°^prepared by: �
Thomas B.Dir,:r.,who is a member of
the Virginia State Bar—VSB 23899
Accomac,Virginia 23301-0577 �.
i
,/�I ^ ('�9, ,���J���''���`�.�
A t inette Ellam-Trepanier � �
Signed, sealed, acknowledged and declared by the said Antoinette Ellam-Trepanier,
Testatrix, as and for her last will and testament, in the presence of us, two competent witnesses,
present at the same time,who at her request,in her presence and in the presence of each other,have
hereunto subscribed our names this �I��day of __�l,�c� ,2012.
�:s-,�'%_���n�� /��.��"�%-� ��i ���/�����
Wit::c-::s Address /iG%�
�� � �,. C ���1
;�:z -�..�..+ ��.)ce�~�-.�, ?�v �,t�`����,:n • ��cti�- �«;� i�"1 .
Witness Y Address 'IC. :->
�,.
State of �� ,
City/County of ��-n2��.�f���1"�U,to-wit:
Before me, the undersigned authority, on this day personally appeared Antoinette Ellam-
Trepanier,Testatrix,_ 1��'�� 1�" �� -P�-�- and �ci�-lo� ���G��-��, known
��
to me to be the Testatrix and Witnesses, respectively, whose names are signed to the attached or
foregoing instrument and, all of these persons being by me first duly sworn, Antoinette EIIam-
Trepanier,Testatrix,declared to me and to the Witnesses in my presence that said instrument is her
last will and testament and that she had willingly signed or directed another to sign the same for
her,and executed it in the presence of said witnesses as her free and voluntary act for the purposes
therein expressed, that said witnesses stated before me that the foregoing will was executed and
acknowledged by the Testatrix as her]ast will and testament in the presence of said witnesses who,
in her presence and at her request and in the presence of each other did subscribe their names
thereto as attesting witnesses on the day of the date of said will and that the Testatrix,at the time of I
the execution of said will,was over the age of e;ghteen(i8j years and of sound and disposing mind '
and memory.
2
This documen[was prepared by:
Thomas B.Dix,Jr.,who is a member of
the Virginia State Baz—VSB 23899
Accomac,Virginia 23301-0577
i
"� lr_ U
��,�� I�?,,��'/Jtit�-'�—
Antoinette Ellam-Trepanier,Testatrix
� ' .
'�,_%�' �'��`�L.(;
�t
Witness
Witness
Subscribed,sworn and acknowledged before me by Antoinette Ellam-Trepanier, Testatrix,
snbscribed and swom before me by 'IdL7�� �i' l�%�t-�.. and ���2�� ��%G"�1� ,
Witnesses,this ��57day of �/^,�.�� ,2012. •
��jc����i� }'Zc.� %.�y (SEALj
Notary Public
COfAir6�WEAL7H QF PEC2NS1't:dkDllin
Ir---''-" p-j�tadal Seal Public �
My Commission expires: �jl��/�� I Krthfeen tdissleY,Nctary
-�� Sou!h Middleton TwD•,Cumberland C.ounty
MY�ommission Fxpire`-Sepc 7.0,2013
�� r i A r�datio.^.�`lotarir�
1d��,r,tPr.vee�.fh.�?,i
3
This document was preparod by:
Thomas B.Dix,Jr.,who is a member of
the Virginia State Bar-VSB 23899
Accomac,Virginia 23301-0577
U�.30�RE�'(9/I I�
�OCAL R�C��TF���'� ����°��'����°��� �� �����
W/�RNING: It is illegal to du�iicat� €hc� ���� E�}r pE��t����� ar ������r���a.
,,,����� 'Fh:s is to cer�ify t?�at the informatiotl he�-e given i
ee for this certificate, �6.00 � �"""""� �
,�"���.�`����E,��;� corr°cti��copied�rom an oriRinal Certificate of Deat
�,�`'o����'�`���, du15� filed ti��ith me as Local Reoistrar. The origin�
,����' �� �i��� cert:ficate �,��ill be forw�a��ded to ihe State Vit�
��I 4�'; ,i�;� Recards O:fice ?c�r p°rn�anent filin6.
* �, �e �-_� *�,
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CeTt1f1C3tlOri NULT1�18r """"'������ LOC11 ��a1S�i;ur �'dte iSSUeC�
6
Type/Prini In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH�VITAI RECORDS
Pef�^a^e^t CERTIFICATE OF �EATH
Bleck Ink State File Number:
1-Decedent's Legal Name(First,Middle,LasL Sufftx) 2.Sex 3.Saclal SecurlSy Number 4.Date of Death(MO/Day/Y�)(Spell Mo)
Antoinette M_ Trepanier F. 'I 51 -36-'i Au ust 8 20"1 2
Sa.Age-LasC Birthday(Yrs) Sb.Under 1 Vear Sc.Untler 1 Da 6.pate of BirtFi(MO/Day/Vear)(Spell MonYh) 7a.Birthplac (City and SYate or Foreign Country�
� I Months Days Hours Mfnut¢s RO S E�1 E N.J.
6 5 DeC� 2 7� 'I 9 4 6 �b.B�rtnoiace(counM n•
8a.Resldence(5[afe or Foreign Country) Sb.Residence(Str�et and Numb�r-Include Apt No.) 8c.Did D�ced��C Live In a TownshipT
pA 'I O WY1ite Oalc Drive ves,ae«a�.,cu�edn, D=ekin_son mw�_ c.,�a.
ad.wez�ae.,�e�co�.,sv> Car 1 i s 1 e, PA
Cumb er 1 and 8e.Residence(Zfp Code) � 7 p� 5 O No,decedent lived within r�.,�cs or �ih•/bo�o.
9_Ever In l��Armetl ForcesT 1 Marltai Status at Timc of D¢ath 0 Marriad 0 H/�dowetl 11.S�rviving Spouse's Nam�(If wife,givc name priar to first marriega7
Q Ves �j No �Unknown �Divorced �Neve�Ma�ried 0 Unknow
12.Father's Name(Flrst,Middle,Lasi,Su£fix) 13.Mother's Name Prfor to First Marriaga(First,Middle,Last)
James W. E11am
� 14a.Informani's Name 16b.Ralatfonsliip to Decedent 14c.Informant's Mailing Adtlress(Street and N�mber,Clty,State,Zip Cotle)
� o Steven J_ H v Son 1 O Wh'
� """'"""'""'...... 15a.P ace o Deat C only aneZ...._..."""""""""'""'"'"" ' ... ......... ...'" ""'"' "..."" ""'
"...""'"""'"""......."'"'""......'""""'......"""'""" """"..... ...""'�"""""'"'._.......""""'""'........"'eC""""' , ........""
.. w.. ....."' ". .._ .. ._. .. "'
If Death Occurred In a Hosplial: � Inpatient � :If Death Occurred Samewhere Other Then a Hospltal: u Hospice Faclliiy Decedent's Home
° �Emergen�y Room/OUtpaHent O Dead on Arrival Q Nursing Home/LOng-Term Care Facility Othar(Specify)
15b.Facllity Name(If not instltution,give sireet and number', 15c.City or Town,Stafe,and Zip Code 15d.Counry of DeaTh
� o wn�t k
16a.MeChod of Disposltlon � B�rial Crema[ion 16b.Date of Disposltion 16c.Place of Dfspositlon(Name of cemetery,crematory,or other plac�)
m p 0.emoval From Staie p�o�a��o� 8�� p�2�� 2 Ho 11 inger FH/Crematory .
� o Other(Specify)
� 16d.Location of Disposition(City or Town,Sta[e,and 21p) 17a.Slg of Funerel Service L_icense on�n C a�ge Interment 17b.License Number
� Mt_HOl1y Springs,PA 97065 ��� - -
� �
0 17c.Name antl Complete Address of Funeral Facility a imo AVe�
Ho11in er FH Cremator n Mt_Ho11 S rin s PA 'I
m 18.Decedent's EducaSion-Check the box thaY besC desc�ibes the 19.Uecedent of Hfspanic O�Igin-Check the 20.DecedenC'S Raa-Check ONE OR MORE races to Intlfcale what
� hlghast degrce or level of sciiool completad a[Che Hme of death. box Yliat best dascribes wh�iherlhe tl�cedant the tl�c�dent consitlervd hlmsNf or herselF to ba.
0 Sth grade or less Is Spanish/Hispanfc/la�ino. Chack the••NO" hite 0 Korean
� No diploma,9th-12th grade box If tleced�n¢Is not SpaMSh/Hispanfc/Latino. 0 Black or African Amarican 0 Vietnamase
�'N{gh school graduate ar GED completed No,no[Spanish/Hispanic/latino �American Indian o�Alaska Native 0 Oth�r Aslan
Q Some collage credlC,b�i no tlegree O�'es,Mezice�,Mexican American,Chfcana O Asian Indian � NatNe Hawallan
� Assoclafe degree(e.g.AA,AS) O wes.P�arto Rican �Chinese O Guamanien or Chamorro
� Bachelor's degrce�¢.g.6A,AB,BS) ��'as,Cuban 0 Fllipino � Samoan
� Mastar's dagree(e.g.MA,M5,ME�g,MEd,MSW,MBA) �Yes,other Spanish/Hispanic/Latino 0 lapaneze � OYher Paclfic Islander
� Doctora[e(c.g.PhD,EdD)or Professlonal degree (Speclfy) �Other(Speclfy)
(e. .MD,D�S,DVM LLB,JD
21.Decedent's Single Race Self-Designatio�-Clieck ONLY ONE to indicate what the deceden�considered himself or herself to be. 22a.DecetlenYS Us�al Occupacion-Indicate type of work
�WM1ite Q Japanese �Samoan done dvring most of working Ilfe. DO NOT USE RETIRED.
0 Black or African Amerfcan �Korean � O�her Padflc Islander .
p Q Ame�lcen Indian or Alaska Native �Vietnamese � Don't Know/NOi Sure Rea 1 tor
•.. Q Asian Intlian �OSher Asian 0 Refusetl Z2b.Kintl of Business/Intl�stry
�Chlnese 0 NaHve Hawallan � Othar(Speclfy)
� pFii�P�„o �GUamanianorChamorro Realestate/Bro]cer
� ITEMS 23a-23d MUST BE COMPLETEO 23a.Da[e Prono�ncetl Dead(MO/Day/Vr) 23b.Signa[ure of Person PronouncYng Death(Only when appiicable) 23c.License Numbar
BV PERSON WMO PRONOUNCES OR g vy"7O�Z
CERTIFIES OEATH �'N'l'L��
23tl.Date Si n d(M /Day/Yrj 24.Time f ath
a�jl� 25.Was Me ical Examiner or Corone�Contacted7 Q Yes � No
CAUSE OF�EATH Approximate
26.Part 1. En[er the cha{n of eve�ts-diseases,in)urles,or complicailons-that direc[ly causetl the tleath. DO NOT en�er terminal¢vents such as cardiac arcest. Intarval:
raspiratory arrast,or veniricularfibrlllation wi[houc sFiowin/g theJe[iology. DO NOT ABBREVIATE. EnCer only one cause on a line. A/dd addltional lines if necessary Onset to Death
IMMEDIATECAUSE -------> ��t'��s7i�� � s �{ � �� ��-. C L���
(Final dlsease or Condltlon a Oue to(or as a consequen/c�e oT):
resulting In deaTh) �_ � .� ,�� //r,�.t f f
b. �' /�GtO. �)i
S�quentially list condlHons, Due to(or as a consequence a�:
If any,laatling eo the ceuse
listed on Ilne a. Enier the
UNDERLYING CAUSE Due fo Ior as a consequence o�:
(disease or injury that
FInitlated the events resulting tl.
In death)LAST. Duc to(or as a consequence of):
S 26.PaK 11. Enter other i iF t ditf ontribuGlna to death but not r�sulting fn the underlying ca�sa given In Part 1 27.Was an autopsy p�rformetl7
- � Y¢5 No
� 28.Werc autopsy flndings evailable
- To compleCe the cause of tleethi
� � Vas 0 No
29.If Female: 30.Did Tobacco Use Contribute to Death7 31.Manner of Death
o � Not pregnanc withln pas2 year ��'es O Probably [�'j Natural � Homicide
Q P�egnani d�tlme Of dCaYh � No � Unknown 0 Accideni 0 Pending Investigation
°m' � Not pregnant,bui pregnant wlthin 42 days of deatt 0 Suicide � Could not be determfned
� Q Not p�egnant,but pregnant 43 days[0 1 year betore deatF 32.Date of Inj�ry(MO/Oay/Yr)(Spell Month)
0 Unknown if pregnant wlthln the past year 33.Time of Injury
34.Place of Injury(e.g.home;con5trucHOn site;farm;school) 35.Location of InJury(Street and Number,Clty,Siate,Zip Cotle}
36.In}�ry at Work 37.IfTranspoKation InJ�ry,Specify: 36.Describe How Injury Occurretl:
0 Ves �Driver/Operator � Pedestrian
0 No �Passenger � Othar(SpeclTy)
39a.Gertifier(Chvck only one):
�Certlfying physician-To the best of my knowiedge,tleaih occurred due to H�e c use�s)and mannar siacetl
Q Pronouncing 8.CeKiN�'+6 Physician-To th¢best of my knowledge,daath occurred at the Hme,date,antl place,and due to She cause(s)and mannar r[ated
� Medlcel Examiner/COroner-On the basis of aminarion,and/or Investigation,In my apinion,deafh occ rred e(ihe Yime,tlate,and place,antl d�e to the ca�se(s)antl mann r tated
Signature of certifie�' «�� Title of certifle�: ���u License Number: '17�y2-��SL/
39b.Name,Address and Zip Code of Per o PleLng Cause of Death(Item 26) 39c DaLe Signed(MO/Day/Vr)
� 10 �u �P-a P�, l tz e� . t��� s..pr`c rc� . �'l ob
� 40.Reglstra�'s OlsSricl Number 41.R�gist�ar's na�ts iu�e � 42.Reglstrar Fllc Date(MO/Day/Yr)
a'��-oZ�O [.�at�IL�. 'r0a�c�-��� O la
43.Amendments -" '
0
f
z
�n �� � ���� H105-143
COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
� ,�
_ , , ;
,�
.. R I
I, GLENDA FARNER STRASBAUGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 4th day of September, Two Thousand and
Twel ve,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of ANTO/NETTEM TREPAN/ER , late of D/CK/NSON TOWNSH/P
(FirsL Middle,Lastl
a/k/a ANTOINETTE ELLAM ANTOINETTE HYVESSON
in said county, deceased, to STEVEN JAMES ITYVESSON
(First,Middle,Lastl
and that same has not since been revoked.
IN TESTIMONY WHEREDF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 4th day of September
Two Thousand and Twel ve.
Fi 1 e No. 2012- 00954
PA Fi 1 e No. 21- 12- 0954
Da te of Dea th 8/08/2012
S. S. # 151-36-1333
�,
� f � , �..
� �
'� ; � � �
/ Register f ills
� -i - ,
! �
-�,�� � ) �- ���c�
eputy �
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
Free Checking Account Statement `�s` PNCBANK
PNC Sank �
Primary account number:51-1293-4118
Page 1 of 4
For the period 07/24/2072 to 08/20/2012 Number of enclosures:0
000580 p For 24-hour banking,and transaction or
� ANTOI NETTE M TREPANI ER �interest rate information,sign on to
10 WHITE OAK DR PNC B2nkOnline Banking at pnc.com.
CARLISLE PA 17015-9169 'a Forcustomerservicecall1-888-PNC-BANK
Monday-Frid�y: 7 AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espaRol, 1-866-HOLA-PNC
Moving7 Please contact us at 1-888-PNC-BANK
� Write to:Customer Service
PO Box 609
Pittsburgh PA 15230-9738
�Visit us at pnc.com
� TDD terminal:1-800-531-1648
For l�earing impaired�lients only
IMPORTANT NOTICE ABOUT PNC POINTS�:Tlie PNC points Program is Ueing discontinned for customers wit.h PNC Bank
Visa� Check Cards. However,the PNC Purchase Payback Re�vards Program wi(1 be enhanced to offer cash rewards to eligible debit and
credit customers for quatifying purchases at participating merchants.PNC points�and PNC Flex�Visa credit card customers will continue to
enjoy the benefits of PNC points.
For PNC Bank Visa Check Card customers:
>You�vill no longer be able to enroll or link your Consumer or Business Check Card(s)in PNC points on or after November 1,2012.
>Any Check Cards enrolled or linked in PNC points before November 1,2012 will continue to earn points through January 31,2013.
>If your Check Card isn't linked to a PNC points participating credit card in your name,the points in your account must be redeemed before
December 1,2013 or they will be forfeited.
Look for exciting,new information about the PNC Purchase Payback Rewards Program later this fal(.
(If your Check Card is associated with a Free Checking,Foundation or Virtual Wallet checking product and�vas previously enrolled or linked
in PNC points but is no longer earning points,you cannot reopen your PNC points account by changing your checking account type to one
that participates in PNC points effective November 1,2012.)
INIPORTANT ACCOUNT INFORIVIATION
The information below amends the PNC Consumer Funds Availability Policy. Please read this information and retain it with your records.
Effective Augnst 20,2012
Determining Availability of a Deposit:
The cut-off time for a mobile device and a remote deposit scanner is 10:00 p.m.Funds deposited after this time will be considered deposited
the next business day.
All other cut-off times and terms of the Funds Availability Policy remain the same.If you have questions or would like a copy of the complete
Consumer Funds Availability Policy,please visit your local PNC branch or call us at the Customer Service phone number listed above.
.���
PNDMLT01-J0661342-N40-NNN N NN-002-001271
�ree Checking Account Statement
For the period 07/24/2072 to 08/ZO/Z012
�For 24-hour information,sign on to PNC BankOnline Banking ANTOINETTE M TREPANIER
on pnc.com. Primary account number:51-1293-4118
Page 2 of 4
'ree Checking Account Summary Antoinette M Trepanier
Iccount number: 51-1293-4118
�verdraft Protection has not been established for this account.
Please contact us if you would like to set up this service.
talance Summary
Beglnning Deposits and Checks and other Ending
balance other additions deductfons balance
.00 31,576.57 18,243.22 13,333.35
Average monthly Charges
balanee andfees
10,66�.17 .00
'ransaction �urnmary
Checks pald/ Check Card POS Check Card/Bankcard
wlthdrewals slgned transactlons POS PIN transactlons
3 1 4
Total ATM PNC Bank Other Bank
transactions ATM transactlons ATM transactlons
0 0 0
lctivity Detail
leposits and Othe� Additions There were 10 Depositsand OtherAdditions
3te Amount Descrlptlon totaling�r31,576.57.
7/25 4,672.00 Deposit Reference No. 523321013
7/27 1,000.00 Deposit Reference No. 520685245
7/31 12,558.70 Online Transfer From 0000005505044394
'7/31 .15 Direct Deposit-Moneydirct Scottrade 4515621
7/31 .12 Direct Deposit-Moneydirct Scottrade 4515620
B/06 12,717.66 Deposit Reference No. 522795048
B/07 200.00 Refer To Maker Retum Ck 000000000080512
Effective 0&06-12
3/07 85.00 Refer To Maker Return Ck 000000000080512
Effective 0&06-12
9/07 325.00 Deposit Reference No. 521020124
B/15 17.94 Deposit Reference No. 522259363
�hecks and Substitute Checks
ieck Date Referenee Check Date Reference
imber Amount pafd number number Amount paid number
)512 200.00 08/06 os5os7os7 80512 * 85.00 08/06 085096974
Gap in check sequence There were 2 checks listed totaling
$285.00.
�anking/Check Card Withdrawals and Purchases
ate amount Descriptton Therewere4CheckCardBankcardPINPOS
3/10 1,965.00 8408 Check Card Purchase Hollinger Funeral&CR purchases totaling$478.73.
3/15 143.02 POS Purchase Wal-Mart Super Carlisle PA
3/15 48.95 POS Purchase John Gross&C Mechanicsbur PA There was 1 other Banking Machine/�heck
Card deductionstotaling$1,965.00.
3/20 155.37 POS Purchase Wal-Mart Super Onley VA
3/20 130.79 POS Purchase Wal-Mart Super Pocomoke Cit MD
Fo�,r,�:ie�F:-c!ii
Free Checking Account Statement ` :>PNCBANK
For the period 07/24/2012 to 08/20l2072
�For 24-hour information,sign on to PNC Bank Online Banking ANTOINETTE M TREPANIER
on pnc.com. Prim2ry account number:51-1293-4178
Account number:51-1293-4118-continued Page 3 of 4
Online and Electronic Banking Deductions There were 30nline or Electronic Banking
Date Amount oescr�Ptior, Deductionstotaling$2,469.97.
08,/06 1,677.58 Web Pmt Single-Online Pmt
GM Card Sivcs000000859539789
08/06 500.00 Web Pmt Single-E-Payment Discover 7833
OS/08 292.39 Direct Payment-Fe Echeck
Firstenergy Opco 1YYYYXYY0551
Othe� Deductiona There were 3 Other Deductions totaling
Date Amount Description $13,045.1Z.
07/�6 545.12 Withdrawal Reference No.H215840806
Effective 07-25-12
08/02 7,500.00 Witlidrawal Refecer�ce No. 52�O�fi105
OS/02 5,000.00 Withdra�val Tel 0400017155 0033
Daily Balance Detail
Date Balance Date Balance Date Balance Date Balance
07/24 .00 07/27 5,126.88 08/06 15,440.93 OS/10 13,793.54
07/25 4,672.00 07/31 17,685.85 08/07 16,050.93 OS/15 13,619.51
07/26 4,126.88 08/02 5,185.85 08/08 � 08/20 13,333.35
Did you know yoa can send money to familV ancl friends just.by knowzng their cell phone namber?
Try using popmoney today -the easy and convenient tivay to send money to just about anyone using popmoney.
Leam more at pnc.com/alwaysopen
Manage old bills. Make new plans.
See what you can do with your home's equity and see how much you can save with interest rate discounts of up to 0.50%on Home Equity
Loans and Lines of Credit.* You've put a lot into your home,and it has done a lot in return.Whether you're m�king home improvements,
consolidating bills or paying for college expenses,our competitive rates could make it more affordable. To leam more about the Home Equity
solutions available,call 1-877-CALL-PNC(1-877-225-5762)or visit pnc.com/equitydiscount.**
*Credit is subject to approval.Certain terms and conditions apply.
**Rate Discount Eligibility:(1)Application must be received between July 16-August 31 and must close no later than Octoher 12,2012,(2)a draw or loan
disbursement of$25,000-$49,999 is required at closing ro qualify for a 0.25%discount off the approved rate, (3)a draw or disbursement�f$50,000 or more
is required at closing to qualify for the 0.50%discotmt off the approved rate,(4)the eligible amount drawn at closing excludes any fimds used to pay PNC
debt,(5)the mortgage lien must be in a first-lien position and(6)discount offer may be modified or discontimied at anytime.
Equai rio::sing Lender.
�
PN DM LT01-J 0661342-N40-N N N N N N-002-00127 2
Reviewing Your Statement
Please review this statement carefully and reconcile it with your records. Call the telephone number on the upper right side of the first page
of this statement if:
• you have any questions regarding your account(s);
• your name or address is incorrect;
• you have any questions regarding interest paid to an interest-bearing account.
Balancing Your Account
Update Your Account Register
Compare: The activity detail section of your statement to your account register.
Check Off: All items in your account register that also appear on your statement. Remember to begin
with the ending date of your last statement. (An asterisk{*}will appear in the Checks
section if there is a gap in the listing of consecutive check numbers.)
Add to Your Account Register Any deposits or additions including interest payments and ATM or electronic deposits
Balance: listed on the statement that are not already entered in your register.
Subtract From Your Account Any account deductions including fees and ATM or electronic deductions listed on the
Register Balance: statement that are not already entered in your register.
Update Your Statement Information
Step 1: Step 2: ci�ck 1II�mb�r or
Add together Dats of Dsposk Amount Add together D�d�etiow D�seriptiow Amou�
deposits and checks and other
other additions deductions listed
(isted in your in your account
account register register but not on
but not on your your statement.
statement.
Tolal A
Step 3:
Enter the ending balance recorded on your statement $
Add deposits and other additions not recorded Total A+ $
Subtotal= $
5ubtract checks and other deductions not recorded Total B- $
I'he result should equal your account register balance = $
Tolal B
Verification of Direct Deposits
To verify whether a direct deposit or other transfer to your account has occurred,call us Monday-Friday:7 AM -10 PM ET and Saturday
4�Sunday: 8 AM-5 PM ET at the customer service number listed on the upper right side of the first page of this statement.
In Case of Errors or Questions About Your Electronic Transfers
Celephone us at the customer service number listed on the upper right side of the first page of this statement or write us at PNC Bank Check
�ard Services,500 First Avenue,4th Floor,Mailstop P7-PFSC-04-M,Pittsburgh,PA 15219 as soon as you can,if you think your statement
�r receipt is wrong or if you need more information about a transfer on the statement or receipt.We must hear from you no later than 60
iays after we sent you the FIRST statement on which the error or problem appeared.
(1)Tell us your name and account number(if any).
(2)Describe the error or the transfer you are unsure about,and explain as clearly as you can why you believe it is an error or why you
need more information.
(3)Tell us the dollar amount of the suspected error.
rVe will investigate your complaint and will correct any error promptly. If we take more than 10 business days to do this,we will
�rovisionally credit your account for the amount you think is in error,so that you will have use of the money during the time it
akes us to complete our investigation.
Vlember FDIC L=J Equal Housing Lender
FORM766R-Otit
Money Market Direct Account Statement PNCBANK
PNC Bank
Primary acxount number:55-0503-8402
Page 1 of 3
For the pariod 07/31/201Z to 08/30/Z012 Numberofenclosures:0
000226 For 24hour banking,and transaction or
� ANTOI NETTE M TREPANI ER �interest rate information,sign on to
10 WHITE OAK DR PNC BankOnline Banking at pnc.com.
CARLISLE PA 17015-9169 a Forcustomerservicecali 1-888-PNC-BANK
Monday-Friday: 7 AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espaPiol,1-866-HOLA-PNC
Morinp� Please contact us at 1-888-PNC-BANK
�Write to:Customer Service
PO Box 609
Pittsburgh PA 15230-9738
�Visit us at pnc.com
� TDDterminal:1-800-531-1648
For hearing impaued clients only
IMPORTANT ACCOUNT INFORMATION
The information below amends the PNC Consumer Funds Availability Policy. Please read this information and retain it with your records.
Effective August 20,2012
Determining Availability of a Deposit:
The cut-off time for a mobile device and a remote deposit scanner is 10:00 p.m.Funds deposited after this time will be considered deposited
the next business day.
All other cut-off times and terms of the Funds Availability Policy remain the same.If you have questions or would like a copy of the complete
Consumer Funds Availability Policy,please visit your local PNC branch or call us at the Customer Service phone number listed above.
Money Market Direct Account Summary Antoinette M Trepanier
Account numbor: 55-0503-8402
Balance Summary
Beginning Deposits and Ghecks and other Ending
balance other additions dedudions balance
2,310.51 1,765.37 1,765.56 2,310.52
Average monthly Charges
balance and fees
1,456.30 .00
Interest Summary As of 08/30,a total of$3.24 in interest was
Annual Percentage Number of days Ave2ge collected Interest Paid paid this year.
Yield Earned(APYE) in interest period balance tor APYE this period
0.01% 31 1,456.30 .Ol
Activity Detail
Deposits and Othe� Additions There were 2 Deposits and Other Additions
Date Amount Description totaling$1,765.37.
OS/21 1,765.36 Telephone Transfer From 0000005112934118
08/30 .Ol Interest Payment
�
PN DMLT01-JOB 78123-N40-N N NNNN-002-0005 77
►�oney Market Direct Account Statement
For the period 07/31l2012 to 08/30/2072
�For 24-hour information,sign on to PNC Bank Online Banking ANTOINETTE M TREPANIER
on pnc.com. Primary account number:55-0503-8402
Account number:55-0503$402-continued Page 2 of 3
�nline and Electronic Banking Deductions There was 1�nline or Electronic Banking
�te Amount Description Deduction totaling 57,765.36.
3/06 1,765.36 Direct Payment-PNC Pymt
PNC Mortgage Y.YX.YXX2400
�aily Balance Detail
�te Balance Date Balance Date Balance Date Balance
�/31 2,310.51 08/06 � 08/21 2,310.51 08/30 2,310.52
id yon know you can send money to family and friends just by knowing their cell pLone n um6er?
ry using popmoney today -the easy and convenient way to send money to jusf about anyone using popmoney.
°ar�moi�e at pnc.c�iri/ah��ays:;pe.li
[anage old bills. Make new plans.
�e what you can do with your home's equiry and see how much you can save with interest rate discounts of up to 0.50%on Home Equiry
�ans and Lines of Credit.* You've put a lot into your home,and it has done a lot in return.Whether you're making home improvements,
msolidating bilis or paying for college expenses,our competitive rates could make it more affordable. To leam more about the Home Equity
�lutions available,call 1-877-CALL-PNC(1-877-225-5762)orvisit pnc.com/equitydiscount.**
:redit is subject to approval.Certain terms and conditions apply.
`Rate Discount Eligibility:(1)Application must be received between July 16-August 31 and must close no later than October 12,2012, (2)a draw or loan
sbursement of$25,000-$49,999 is required at closing to qualify for a 0.25%discount off the approved rate,(3)a draw or disbursement of$50,000 or more
required at closing to qualify for the 0.50%discount off the approved rate,(4)the eligible amount drawn at closing excludes any funds used to pay PNC
:bt,(5)the mortgage lien must be in a first-lien position and(6)discount offer may be modified or discontinued at anytime.
�ual Housing Lender.
FORhf'66R-Gt'?
Savings Account Statement ` PNCBANK
PNC Bank
Primary account number:50-0581-9421
Page 1 of 3
For the period 07/24/2012 to 09/30/2012 Number of enclosures:0
003357 � For 24-hour banking,and transaction or
�'`�� �� ANTOINETTE M TREPANIER DECD
' interest rate information,sign on to
r'� "'. 10 WHITE OAK DR PNC BankOnline Banking at pnc.com.
CARLISLE PA 17015-9169 'a' Forcustomerservicecall1-888-PNC-BANK
Monday-Friday: 7 AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espanol, 1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
� Write to:Customer Service
PO Box 609
Pitts6urgh PA 15230-9738
�Visit us at pnacom
� TDDterminal: 1-800-531-7648
For l�earing unpaired cliena only
IMPORT_aIYT ACCOUNT INFORl��LaTION �
The information below amends the paragraph in the Account Agreement for Personal Checl:ing, Savings and Money Market Accounts,
"Withdrawals"section regarding the order of withdrawal. Please read this information and retain it with your records.
Effective December 7,2012
If there are sufficient funds to cover some but not all of your withdrawal orders,we will exercise our discretion(i)in paying some but not all of
the items,and(ii)to pay the items in any order.
Our general practice is to first add deposits(credits)to your account,and then subtract�vithdrawals(debits)from your account.Transactions
are ordered according to the date and time the bank receives notice of the transaction. We receive notice of transactions at various times
throughout the day,and not necessarily in the order in which they occur. If multiple transactions are received at the same time,or are grouped
together and contain no time,then the items will be processed in order of sequence number or,if no sequence number is available,
largest-to-smallest dollar amount. If�ve do not have information that allows us to determine the exact time notice of a transaction was
received,we may assign an approximated time to that transaction.
Debit card purchases will be posted according to the date and time provided by the merchant. Because processing times vary,the time we
receive notice of a transaction may dilfer f'rom the time shown on a receipt.
The order in which we process these withdrawals may affect the total amount oi'overdrai't fees charged to your Account.We will not be
responsible for damages or�.rrongful dishonor if any item is not paid as a result of the order in which we process withdrawals.We reserve the
right to refuse to cash a check or to impose a charge on anyone who asks us to cash a check that you have written.Even if your check is
otherwise properly payable,we will not be liable to you for dishonor of your check,or�therwise,as a result of such refusal.
Sa�ings Account Summary Antoinette M Trepanier Decd
Account number: 50-0581-9421
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
.00 545.1� 545.1? .00
Deposits and Other Additions There was 1 Deposit or Other Addition
Date Amount Description totaling$545.1Z.
07j�5 5451� Deposit Reference No. 5?33�1011
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PN DM LT01-J O B30754-N40-N N N N N N-002-006651
�avings Account Statement
For the period 07/24/2012 to 09/30/2072
pl For 24-hour information,sign on to PNC BankOnline Banking ANTOINETTE M TREPANIER DECD
�on pnc.com. Primary account number:50-0581-9421
Account number:50-05$1-94�1-continued Page 2 of 3
)the� DeduCtions There were 2 Other Deductions totaling
+ate Amount Description 5545.12.
�9/1S .00 Outstanding Item Close
�9/13 54512 Debit Memo Refe►-ence No. 523U?0456
)aily Balance Detail
�ate Balance Date Balance Date Balance
�7j?� .OU 07j25 � 09/13 .00
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