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12-13-13
pennsylvania 1505613110 oEPARnnENr or REVENVE EX(06-13) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 -12-1335 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 12192012 11282014 Decedent's Last Name Suffix Decedent's First Name MI WILSON HELEN V. (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL INAPPROPRIATE BOXES BELOW REGISTER OF WILLS Q 1. Original Return Q 2. Supplemental Return 0 3. Remainder Return(date of death Prior to 12-13-82) Q 4. Agriculture Exemption Q 5. Future Interest Compromise(date of Q 6. Federal Estate Tax Return Required dale of death on or after 7-1-2012) death after 12-12-82) 0 7. Decedent Died Testate Q 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) Q 10. Litigation Proceeds Received Q 11. No Taxable Asset Return Q 12. Election to Tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number STEPHEN D. TILEY 717-243-5838 First Line of Address 5 SOUTH HANOVER STREET Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17013 n REGIS 6f,WILLS UP�PNLY REGISTER OF HALLS USE ONLY i7 t- n --4 C7 DATE FILED IT r1 GJ 1-7 r 7 iJ Ul CJ C..5 TI _D .. -*T O �= :zo C�7) e- Fn M Correspondent's email address: 'D'ATE FILED ST P Ca Under penalfies of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my know life and belief,it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which oreparer has `any knowledge. SIGNATURE OF PERSON R RETUR �ESPONSI@�E FOR FILING N AIAD DDRRESS_Y 1202 CREEK ROAD & 85 OLD MILL ROAD BOTH CARLISLE PA 17015 SI _ E OF RER-OTHER THAN REPRESgNTATIVE pgyE q�i� /CJ] L �i//%i ADDRESS STEPHEN D. TILEY, 5 SOUTH HANOVER STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505613110 1505613110 J J 1505613210 REV-1500 EX Decedent's Social Security Number Decedent's Name: HELEN V. WILSON RECAPITULATION 1. Real Estate(Schedule A). . . .. . . . . .. . .. . . . .. . . . . .. . . . ... . ... . .. . .. . 1. 0. 00 2. Stocks and Bonds(Schedule B)... . . . . . .. . .. . .. ... . ... . ... . .. . ... . .. 2. 350613. 00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). .. 3. 0 . 00 4. Mortgages and Notes Receivable(Schedule D). .. ... . . .. . .. . . ... ... . .. . 4. 0 . 00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ... . 5. 78680 . 00 6. Jointly Owned Property(Schedule F) =Separate Billing Requested.. . .. . . 6. 0 .130 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) =Separate Billing Requested.. . .. . . 7. 73688. 00 8. Total Gross Assets(total Lines 1 through 7). .. . . . . . .. . .. . . .. . .. . .. . ... 8. 502981. 00 9. Funeral Expenses and Administrative Costs(Schedule H). . ... . ... . .. . .. . . 9. 29234 . 00 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)... . . .. ... . ..10. 45581.00 11. Total Deductions(total Lines 9 and 10). . ... . .. . .. . . . . ... . .. . ... . .. . . 11. 74815. 00 12. Net Value of Estate(Line 8 minus Line 11). . .. . .. . ... . ... . .. . ... ... . .. 12. 428166. 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J). . ... ... ... .... . .. . .. . .13. 0100 14. Net Value Subject to Tax(Line 12 minus Line 13). ... . . . . .. . .... ... . .. . 14. 428166.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 0 15. 0. 00 16. Amount of Line 14 taxable atlinealratex.o 45 428166.00 16. 19267. 47 17. Amount of Line 14 taxable at sibling rate X . 12 17. 0. 00 18. Amount of Line 14 taxable at collateral rate X . 15 18. 11 . 00 19. TAX DUE... . . . .. . . . . . . . . . . . . . . .. .. . . . ... .. . .. . .. . .... . .. . .. . . . . . 19. 19267. 47 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505613210 1505613210 J REV-1500 EX Page 3 File Number 172-32-1699 Decedent's Complete Address: 21-12-1335 DECEDENT'S NAME HELEN V WILSON STREETADDRESS 1196 CREEK ROAD CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 19267.47 2. Credits/Payments A.Prior Payments 17100.00 B.Discount 899.97 Total Credits(A+B) (2) 17999.97 3. Interest (3) 8.83 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1276.33 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?..............................................................-........................................................ ❑X ❑ 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-1503 EX.(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen V.Wilson 21-12-1335 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. $7,000 GMAC Smart Notes 7.30 12-15-17 7,056 See Exhibit"A" 2. 1344 Shares American High Income TR Class A 15,295 See Exhibit"A" 3. Cash Balance in Boston Global Capital brokerage account 105 See Exhibit"B" 4. Wells Fargo Advisors-100,000 Goldman Sachs CD CUSIP 38143AKC8 100,883 Accrued Interest to DOD(Actually 12/31/12) 1,059 See Exhibit"C'-Page 5 5. Wells Fargo Advisors-75,000 Goldman Sachs CD CUSIP 38143AJE6 75,177 Accrued Interest to DOD(Actually 12131/12) 234 See Exhibit"C'-Page 4 6. Wells Fargo Advisors-75,000 Goldman Sachs CD CUSIP 38143AJA4 75,020 Accrued Interest to DOD(Actually 12/31/12) 275 See Exhibit"C"-Page 4 7. Wells Fargo Advisors-75,000 Bank of China CD CUSIP 06425HYWO 75,244 Accrued Interest to DOD (Actually 12/31/12) 265 See Exhibit"C'-Page 4 TOTAL(Also enter on Line 2, Recapitulation) $ 350,613 If more space is needed,insert additional sheets of the same size REV-1508 EX-(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT TA REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Helen V Wilson 21-12-1335 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Wells Fargo Bank-Savings Account No.: 3548507080-Exhibit"D" 35,064 Accrued Interest to DOD (Actually to 12/28/13) 4 2 Wells Fargo Bank-Checking Account No.: 8431262230-Exhibit"E" 100 Accrued Interest to DOD (Actually to 12/28/13) 0 3 Wells Fargo Bank-Crown Checking Account No.: 10114206324986-Exhibit"F" 32,213 Accrued Interest to DOD(Actually to 12/28/13) 0 4 Sovereign Bank Checking Account No.: 1721809317-Exhibit"G" 160 Accrued Interest to DOD(Actually to 12/28/13) 5 Sale of 1991 Plymouth Acclaim 1,000 6 Sale of 1971 Dodge Dart Swinger 3,000 7 Sovereign Bank Checking Account No.: 1721809317-Exhibit"G" Reversal of Service Charges 90 8 Auction of Household Personal Property-See Exhibit"H" 7,049 TOTAL(Also enter on line 5, Recapitulation) $ 78,680 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE DE TAX RETURN -RESIDENT MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Helen V Wilson 21-12-1335 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENTAND DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACHACOPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLaDLC VALUE 1. Wells Fargo Advisors-See Exhibit"C"- Page 5 0 Al Western National Life Annuity No.: 11BX204996 0 Original Premium: $10,000 0 Value on December 31, 2012 13,852 100.00% 13,852 0 2. Wells Fargo Advisors-See Exhibit"C"- Page 5 0 Al Western National Life Annuity No.: 11BX205486 0 Original Premium: $10,000 0 Value on December 31, 2012 10,047 100.00% 10,047 0 3. Wells Fargo Advisors-See Exhibit"C"-Page 6 0 Al Western National Life Annuity No.: 11T001564260 0 (American General Life Companies) 0 Original Premium: $30,000 0 Value on December 31, 2012 49,789 100.00% 49,789 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL Also enter on Line 7, Recapitulation) $ 73,688 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX•(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT R ADMINISTRATIVE COSTS INHERITANCE TAX DECEDENT ESTATE OF FILE NUMBER Helen V.Wilson 21-12-1335 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: - 1. Hoffman-Roth Funeral Home&Crematory, Inc. 9,729 2. Westminster Cemetary 305 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Names)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 15,000 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: 412 5. Accountant Fees: 0 6. Tax Return Preparer Fees: 0 7. Register of Wills-Short Certificates 10 8. Kevin M.Wickard,Auctioneer-Sale of Household Personal Property 1,095 9. Wells Fargo Advisors-Estate Valuation Fee 25 10. Advertising (The Sentinel$200.16 and Cumberland Law Journal$75.00) 275 11. Miscellaneous Administrative Costs from Schedule H-1 2,383 TOTAL(Also enter on Line 9, Recapitulation) $ 29,234 If more space is needed, use additional sheets of paper of the same size. ESTATE OF: FILE NO. HELEN V.WILSON,DECEASED 21-12-1335 SCHEDULE H-1 ADDITIONAL ADMINISTRATIVE COSTS LINE B(11) ITEM NO. DESCRIPTION AMOUNT 2013 23-Jan RT Carey Trucking,LLC 30 Yard Trash Container 170.80 25-Feb PP&L 3257 4-Mar Kough's Oil Service (Bill of 2/4/13) 761.25 4-Mar Kough's Oil Service (Bill of 2/25/13) 491.34 11-Mar RT Carey Trucking,LLC Disposal Fee 160.16 12-Mar CenturyLink 31.31 12-Mar Kough's Oil Service 759.98 5-Apr PP&L(Two Bills) 64.56 5-Apr CenturyLink 22.40 8-Apr Refund -Westfield Insurance (139.00) 15-Apr Wells Fargo Advisors - Estate Valuation Fee 25.00 9-Jun Refund - PP&L (31.95) 11-Dec Register of Wills - Filing fee for Inheritance Tax Return 15.00 ??. Reserve: Register of Wills - File Family Settlement Agreement 20.00 Total: 2,383.42 Schedule H-I Page 1 REV-1512 EX4(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE LIABILITIES &LIENS ESTATE OF FILE NUMBER Helen V Wilson 21-12-1335 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. Miscellaneous Debts, Mortgage Liabilities&Liens from Schedule 1-1 45,581 TOTAL(Also enter on Line 10, Recapitulation) $ 45,581 If more space is needed,insert additional sheets of the same size. ESTATE OF: FILE NO. HELEN V.WILSON,DECEASED 21-12-1335 SCHEDULE I-1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS LINE A(1) ITEM NO. DESCRIPTION AMOUNT 2012 19-Dec Checks cleared after death Wells Fargo Crown Classic Checking No.: 1014206324986 12/24/12 - Check# 1813 for 1,635.14 (Note: 12/28/13 $25,000 Transferred to Estate Savings) 12/28/12 - Check# 1815 for 305.00 1/4/13 - Check# 1814 for Westminster Cemetery 1,826.00 1/4/13 - Check# 1810 for Rosa's Team 120.87 1/7/13 -Automatic Pmt Unitedhealthcare Premium 172.25 2/5/13 -Automatic Pmt Unitedhealthcare Premium 172.25 3/5/13 -Automatic Pmt Unitedhealthcare Premium 172.25 4/5/13 -Automatic Pmt Unitedhealthcare Premium 181.00 31-Dec Rebecca Hoover- Severence Pay for Caregiver 800.00 31-Dec Juliet Hodges - Severence Pay for Caregiver 800.00 31-Dec Elisa Delp - Severence Pay for Caregiver 800.00 31-Dec Rosa Bowie - Severence Pay for Caregiver 750.00 31-Dec Rosa's Team - In-home care (Full Week plus 2 days) 4,041.00 2013 10-Jan CenturyLink-Telephone Bill 105.61 10-Jan Southampton Township -Trash Collection 46.74 10-Jan Kough's Oil Serice 563.93 29-Jan PP&L 125.75 Schedule 1-1 Page 1 ESTATE OF: FILE NO. HELEN V.WILSON,DECEASED 21-12.1335 15-Feb Westfield Insurance 155.00 15-Apr Reimburse Donna H. Clever for One Week of Care for Rosa's Team 3,024.00 15-Apr Reimburse Donna H. Clever for Christmas Bonus - Rosa's Team 50.00 15-Apr US Treasury -Year 2012 Form 1040 24,505.00 15-Apr PA Dept.of Revenue -Year 2012 Form PA-40 6,355.00 9-Jun Refund -United Healthcare Insurance Co. (697.75) 31-Oct Refund - PA Department of Revenue - Personal Income Tax (42854) Total: 45,58050 Schedule 1-1 Page 2 REV-1513 EX+(0140) pennsylvania v SCHEE}11�E J DEPARTMENT OF REVENUE - INHERITANCETAXRETURN ` .BENEFICIARIES RESIDENT DECEDENT - ESTATE OF: , h i ;. .. - ." FILE NUMBER: t Helen V. Wilson 1 21-12-1335 -r 3!REIATIONSHIPTO DECEDENT AMOUNT OR SHARE AM NUMBER ' " ' NE AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outrightspousai distributions and transfers under -Sec.9116(a)`(1.2).] .,- e _ Ronald E.Wilson .. 1 85 Old Mill Road,Gar isle, PA 17015 _ Son - 114 Per Prop&112 Reslduan Donna H Clever,�� • - 2' 1202 Creek Road;Carllsle,,PA 17015 Daughter 1/4 Per Prop&1/2 Residual, Ronald J.Wilson,}I 3' 7 Watson Drive, Carlisle, PA 17015 Grandson 1/4 Personal Property Toye J.Walker 4. 2609 South Market Street,,Mechanicsburg,PA:17055 Granddaughter' 1/4 Personal Property ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500-COVER SHEET,AS APPROPRIATE. it NON-TAXABLE DISTRIBUTIONS A. "SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FORWHICH AN ELECTION TOTAXIS NOT TAKEN: B. 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Financial Consultancy February 26, 2013 Frey & Tiley Attorneys at Law 5 South Hanover Street Carlisle, PA 17013 Re: Estate of Helen V. Wilson Account # 39K-221222 Date of Death Values as of 12-19-2012 $7,000 GNIAC Smart Notes 7.30% 12-15-17 Value $7,056.00 1344 Shares American High Income TR CL. A Value $15,294.72 Values are assumed to be accurate but cannot be guaranteed. Richard B. Pursell 205 York Road•Carlisle,PA 17013 • (717)2430619•1-866-443-0619 •Fax(717)243-3216 SettlnoHerad mm6h 00'.6win h--C." 59 M.in S.. -N MA$)M•PWdINM3 l Memlen'.N•.Sn,SIPC.MSRB J ♦ . s Financial Consultants April 12, 2013 To: Steve Tilley Re: Estate of Helen V. Wilson Acct# 39K-218079 Bolton Global Capital Cash Balance as of 12/19/2012 is $105.17 Pursell Associates, Inc. Richard B. Pursell 205 York Road •Carlisle,PA 17013• (717)243-0619 • 1-866-443-0619•Fax(717)243-3216 9.�nllea o1kM hnuRh Rlta F'yully 9mm Gory. SA Mtm A.•BnnN A .Sim•R00.6f9-9xR.l Mtmbem ry�5D. 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Om m \/ 0m . ! c § *� ZC3 )\ � (\ ( \m. . `( }§ m { K / § |§ ~ 0 \ \ k hem. © \ { § Account number:3548507080 g Decer, 1,2012-December 31,2012 a Page 2 of ,�} e• 0{ Transaction history Deposits/ withdrawals/ Endingdally �f_ �� Date Desorption Additions Subtractions balance �•4f{7//,j-1213 _ e Recurring Transfer Ref#0pec5Zf43W to Checkingxxxxx xxxx4986 1500000 35063.68 f f�—� nter�ment 'T�'j•�' 7288 withdrawaf MadeinAamnch/5tore _ 35,067.69 0.00 Ending balanct on 12/31 0,00 Totols $4.01 $50,067.69 The Ending DoliyaatancedoesnorreBectanypendng withdrawals orhoids on deposited funds thatmay hove been outstanding an youraccount when your transactions pasted Ifyou had insuBkient available funds when a transaction posted fees may have been assessed. e Indicates transactions duncounttowardFederal Reserve Boardkeguladon Dlimim Please refer myourAccountAgreemenr forcomplete detalls ofthe fedemlf y-mandatedtrmesochmiunitsforsavingsa=o m ® IMPORTANT ACCOUNT INFORMATION We want to letyou know of important upcoming changes. Effective April 1,2013,the Legal Process Fee which includes levy,writ,garnishment,and any other legal document that requires funds to be attached will be$125 each, If you have questions about these changes,or would like a complimentary financial review to ensure that you have the right accounts to meet your financial goals,please contact your local banker or call the phone number listed at the top of your statement. We want to let you know of important upcoming changes. Effective April 1,2013,the Domestic Collections Fee will be$25 per item. o b m If you have questions about these changes,or would like a complimentary financial review to ensure that you have the right accounts to meet your financial goals,please contact your local banker or call the phone number listed at the top of your statement. Effective February 7,2013,a new federal regulation requires us to disclose all of the fees that will be charged for outgoing international wire transfers initiated by consumers.These fees will be different from the fees that have been previously provided to you and will be disclosed to you at the time you request the transaction. Effective February 7,2013,the subsection titled'Laws governing your account"in the Consumer Account Agreement is modified to add a new second paragraph reading:"Any funds transfer Including a wire transfer)that is a*remittance transfer'as defined in Regulation E,Subpart B,shall be governed by the laws of the United States and,to the extent applicable,the laws of the state of New V-.,, ,,,�,nclu :ng New York'sversinnofArricle4AoftheUniformCommercialCode,withoutregardtoitsconnict'aflawsprinciples.' Revised Agreement for Online Banking We've updated.our Online Access Agreement. To see what has changed,please visit welisfargocom/onlineupdates. Wis"�» Wells Fargo Values =hecking Account number:8431262230 ■ December 1,2012-December 31,2012 ■ Page 1 of 4 DCDPIIDTOV 010083 Questions? -1111 I'll 1dL11'��III'�I�II1II.11111111411111111 rife HELEN VWILSON Available by phone 24 hours a day,7 days aweek DONNA NIPPLE CLEVER PDA 1-800-742-4932 RONALD E WILSON PDA TTY: 1-800-877-4833 1196 CREEK RD - En espanof. 1-877-727-2932 CARLISLE PA 17015-8932 ME 1-800-288-2288(6 am to 7pm PT W) Online.welisfargo.com Write: Wells Fargo Bank,N.A.(345) P.O.Box 6995 Portland,OR 97228-6995 c 0 9 O O You and Wells Fargo Account options s Getting ready for tax season can be a hasslel Creating a checklist,and preparing in A checkmark in theboxindicatesyou have these IS advance will set you up for a successful meeting with your tax preparer. convenient services with your account Go to z Remember tobri n p g prepaid g wells/ar comatcallthenumberaboveIf ouhave z g yourde osit to and account number when re grin gO' y z questions or would like your taxes and you may be able to take advantage of using direct deposit for your q to odd new services. z z tax refund into one of your Wells Fargo checking or savings accounts. Online Banking Direct Deposit z z Online Bill Pay Auto Transfer/Payment z z Online Statements Overdraft Protection z Mobile Banking E] Debit Card z z My Spending Report [:] Overdraft Service z °o 0 0 N Y q Activity summary Account number. 8431262230 �\ i3 Beginning balance on 12/1 S100.00 HELEN V WILSON Deposits/Additions 0.00 DONNA HIPPLE CLEVER POA $o' Withdrawals/Subtractions - - 100,00 RONALD E WILSON PDA Closing balance on 12128 . $0.00 Pennsylvania account terms and condidoni apply For Direct Deposit and Automatic Payments use m Routing Number(RTN):031000503 Overdraft Protection This account Is not currently covered by Overdraft Protection. If you would like more Information regarding Overdraft Protection and eligibility requirements please all the number listed on your statement or visit your Wells Fargo store. are Account number:$431262230 ■ Decen 1,2012-December 31,2012 ■ Page 2 of C e i Interest summary Interest paid this statement $0.00 Average collected balance $100.00 ' Annual percentage yield earned 0.00% Interest earned this statement period $0.00 Interest paid this year $0.00 Transaction history Check Deposits/ Withdrawals/ Ending daily Date Number Description Additions Subtractions balance - 12128 withdrawal Made In A Branch/Store - 100.00 010 Ending balance an 12/31 0.00 Totals $0.00 $100.00 The Ending Daily Balance does not renectany pending withdrawals or holds an deposited funds that may have been outstanding on your occount when your transactionsposted.tfyou badinsufdentavailable fundswhen a transaction pasted feesmayhave been assessed ® IMPORTANT ACCOUNT INFORMATION NOTICE OF EXPIRATION OF THE TEMPORARY FULL FDIC INSURANCE COVERAGE FOR NONINTEREST-REARING TRANSACTION ACCOUNTS By operation of federal law,beginning January 1,2013,funds deposited in a noninterest-bearing transaction account(including an Interest on Lawyer Trust Account)no longer will receive unlimited deposit insurance coverage by the Federal Deposit Insurance Corporation(FDIC).Beginning January 1,2013,all of a depositor's accounts at an insured depository institution,including all noninterest-bearing transaction accounts,will be insured by the FDIC up to the standard maximum deposit insurance amount °> ($250,000),for each deposit insurance ownership category. m N We want to let you know of important upcoming changes. Effective April 1,2013,the Legal Process Fee which includes levy,writ,garnishment,and any other legal document that requires funds to be attached will be$125 each. If you have questions about these changes,or would like a complimentary financial review to ensure that you have the right accounts to meet your financial goals,please contact your local banker or call the phone number listed at the top of your statement. We want to let you know of important upcoming changes. Effective April 1,2013,the Domestic Collections Fee will be$25 per Item. 1? If you have questions about these changes,or would like a complimentary financial review to ensure that you have the right accounts to meet your financial goals,please contact your local banker or call the phone number listed at the top of your statement. Account number, 10142063224986 or December 1,2012-December 31,2012 ■ Page 2 of 4 Interest summary Interest paid this statemam 30.26 Average collected balance $30.556.65 Annual percentage yield earned 0.01% Interest earned this statement period $026 interest paid this year '$2.41 Transaction history Check Deposflsr Wimdmwalsl Ending daffy Date Number Description Addi7Joxs Subtractions balance 1213 Remrnng Transfer Rot#Opec5Zt43W From Savings�7080 15.000.00 1213 US Treasury 303 Xxsoc Sec 120312 Helen V Wilson 511.00 41,367.04 1215 Unitedheslthcare Premium 0296549791 Wilson H 172.25 41,19419 1216 1809 Check .. .. . .. 2.934.00 38,26019 12114 1812 Check 3,024.00 12114 1011 Check 3,024.00 32,212.79 I 1224 1813 "�1, b.14 335T935 1228 Withdrawal Made In A amnchfStore 25.000.00 1228 1815 Check 305.00 5272.65 12131 Interest Payment 0.26 5,272.91 Ending balance on 12131 5,272.91 Totals $15,51126 336,09419 The Ending Daffy Balance does not tared any pending wfhdrswals or holds on deposited funds that may have been outstanding on your account when your lransadlons posted. If you had 1nsuRfdent ovallable funds when a transaction posted,fees may hem been assessed. Summary of checks written (checks listed are also displayed in the preceding Transaction history) Number Data Amount Number Date Amount Number Date Amount 1809 12f6 2.934.00 1812 12114 3,024.60 1615- 1228 305.00 1811- 12114 3,024.00 1813 1224 1,635.14 Gap In check sequence. IMPORTANT ACCOUNT INFORMATION We want to let you know of Important upcoming changes, Effective April 1,2013,the Legal Process Fee which includes Eeiry,writ;garnishment,and any other legal document that requires funds to be allached will be$125 each. If you have questions about these changes,or would Ike a complimentary financial review to ensure that you have the dghl accounts to meet yaw financial goats,please contact your local banker or can the phone number listed at the top of your statement. We want to tot you know of Important upcoming changes. Effective April 1,2013,the domestic Colleaons Fee will be$25 per Item. VOW ssc x i Interest !Pa j,t-hlg PWOTWUM-T717, „� t ;. $0, 0 .. nlivab etcen 9erel rEarned: . 6.00°..:_ Earned this Period $0.00 Paid Last Year $0.00 The interest earned and the interest paid may differ depending on when interest is credited to your account. Account Activity Date Description Beginning n do Balance Additions Subtractions Balance $190.02 12-30*ZEnd TtitI Ait TENANCEAFEE'F,OR P,.RIOR.PERIOD 4$�ir.�l%'t'E -. 30;9 36o ga_ 9 $160.02 IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS CALL YOUR CUSTOMER SERVICE CENTER AT THE NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRITE TO THE BANK FOR DEBIT CARD ISSUES: FOR ALL OTHER ELECTRONIC TRANSFER ISSUES: Sovereign Bank Sovereign Bank Attn:Card Disputes Team Attn:Client Relations MAI M133 02 05 10-421-CRI P.O.Box 831002 P.O.Box 12646 Boston,MA 02283-1002 Reading,PA 19612-2646 Please contact us if you think information about an electronic transfer on your statement or receipt is wrong or if you need additional information about an electronic transfer on the statement or receipt. We must hew from you no later than 60 days after we sent you the FIRST statement on which the error appeared. • Tell us your time and account number. •Describe the electronic transfer error or the electronic transfer that you are unsure about and • Tell us the dollar amount of the suspected error. explain m clearly as you can why you believe there is an error or why you need further information. If you tell us orally,we may require you to send your complaint or question in writing within 10 business days. We will promptly investigate the matter and call or write to you with an answer within 10 business days.If we need more time,we ma take up to 45 days m investgato your complaint or question.If we do,we will credit your account within this 10-day period for the amount youth is in error,so you will have the use of the money during the time it takes us to complete our investigation.If we ask you to put your complaint or question in writing and we do not receive it within 10 business days,we may choose not to credit your account. For errors involving new accounts,point of sale ppurchases or foreign transactions,we may take up to 90 days to investigate your complaint or question.For new accounts,we may take up to 20 business days to credit your account for the amount you think is in error. We will tell you the results of our investigation within 3 business days after completing our investigation.If we decide there was no error,we will send you a written explanation.You may ask for copies of the documents we used in our investigation. IN CASE OF ERRORS OR QUESTIONS ABOUT OTHER TRANSACTIONS ON YOUR STATEMENT You must contact us within thirty(30)days after you receive your statement if you think a transaction,other than an electronic transfer,shown on your statement is wrong or if you need more information about the transaction. You ma-conta(t yyour nearest branch or our gCus Omer Contact Centert 877-SOV-BANK. Customers with hearing impairments may call TTY/TDD. We will investigate our dispute and tell you the results of that investigation. I�I'�i-i�ri1 G r•�•r nnoa 3 of 3 1727Rn9377 SELLER NAIVE DATE OF SALE �i !` ADDRESS p �( � °1 PHONE ZIP LOCATION OF'S/ALE SCLYYI e Q S d bo-,Ie. AUCTIONEER K E U � 1't�� 3 c n Q I� PHONE SELLER'S EXPENSES RECEIPTS �y ry PROFESSIONAL FEES AUCTIONEER $ / 01 R9 CASH $ ')16010 CLERK $ CHECKS $ CASHIER $ OTHER RECEIPTS OTHER EXPENSES $ I���l✓��ISi�I $ .3 ��< .3� $ $ $ $ $ $ $ $ $ $ TOTAL RECEIPTS $ /7 $ LESS TOTAL EXPENSES $ �• D 9S, rO Cj TOTAL EXPENSES $ 1S NET PROCEEDS PAYABLE TO SELLER $�� lS9 A 17 I (or we), the seller, acce t this settlement and acknowledge receipt of the above specified net proceeds from the auction of my goods and property sold on the above date. I accept all responsibility for providing merchantable title to all goods, and property sold, and for delivery of title to the purchaser. Date Auctioneer or Cashier's Signature (Seller's Signature) Date Date (Seller's Signature)