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HomeMy WebLinkAbout06-02-14 1505610140 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 1 3 0 7 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 1 2 3 2 0 1 3 1 2 0 6 1 9 3 3 Decedent's Last Name Suffix Decedent's First Name MI E S L I N G E R E L L E N E (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N o n e Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 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 0 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 SHOPO BE DIRECTED TO: Name Daytime'@ephone Nurdrer m m. E L I Z A B E T H H - F E A T H E R 7 1 7; ET 3 2c 7 rq n" mss z fn REGIS F WILLS USE ONL)rn First Line of Address o c> o --o C A L D W E L L & K E A R N S P C o c �:u . N � m Second Line of Address 0 --1 W r 3 6 3 1 N 0 R T H F R 0 N T S T R E E T N City or Post Office State ZIP Code DATE FILED H A R R I S B U R G P A 1 7 1 1 0 Correspondent's e-mail address: efeather(a�Cklegal.net Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT,R OF PERSON R S ONSIB^LE OR F ING RE RN ATE ADDRESS _3631 North Front Street Harrisburg PA 17110 SIGNA, RE.OF PR PARR 036HER T}iAN REPRESENTATIVE s I� DATE ADDRESS AID ^ 3631 North Front Street Harrisburg PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: ELLEN E • ESLINGER RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 1 0 0 1 • 4 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers& Miscellaneous Nt�n-1-Probate Property (Schedule G) L_I Separate Billing Requested . . . . . . . 7. 3 5 0 2 3 6 • 6 0 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 5 1 2 3 8 , 0 1 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 2 6 2 2 5 . 1 0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 3 3 9 8 . 4 0 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 9 6 2 3 . 5 0 12, Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 3 2 1 6 1 4 . 5 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. 6 4 3 2 2 . 9 0 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 2 5 7 2 9 1 . 6 1 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 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X .0_ 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 • 0 0 18. Amount of Line 14 taxable at collateral rate x.15 2 5 7 2 9 1 . 6 1 16. 3 8 5 9 3 . 7 4 19, TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 3 8 5 9 3 • 7 4 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 1307 DECEDENT'S NAME ELLEN E. ESLINGER STREETADDRESS 4837 EAST TRINDLE ROAD CITY STATE 21P MECHANICSSURG I PA 17050 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 38 593.74 2. CreditstPayr rents A.Prior Payments 8.Discount Total Credits(A+8) (2) 0.00 1 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 38,593.74 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 ..................................................................................................... 171 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ 3. Did decedent own an'in trust foe 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 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)(11)(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 p2 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)j.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. I REV-1508 EX-(08-12) pennsylvania SCHEDULE E DEPARTMENT INHE RITANCE TAX RETURN CASH, BANK DEPOSITS 8r MISC. INHE RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ELLEN E. ESLINGER 21 13 1307 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Country Meadows refund 923.25 2. Clermont Wealth Strategies Ellen E. Eslinger Irrevocable Trust account#41 F810018 78.16 accrued interest income TOTAL(Also enter on Line 5,Recapitulation) E 1,001.41 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX.(0a-00) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER•VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ELLEN E. ESLINGER 21 13 1307 This schedule must he completed and filed it the answer to any of questions 1 through 4 on page three of the REV-15001s yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE.TIER RELATIONSHR TODECEDENT AND DATE OF DEATH % DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A CON'OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST nFAwuuetFm VALUE 1. Ellen E.Eslinger Irrevocable Trust Clermont WS Account 309,767.57 100.00 309,767.57 #41 F810018, Beneficiary-The Estate of Ellen E, Eslinger A copy of the date of death valuation is attached as Exhibit 1. 2. Fulton Bank IRA account#9300083150, 40,469.03 100.00 40,469.03 Beneficiary-The Estate of Ellen E. Eslinger A copy of the 2013 year end valuation is attached as Exhibit 2 TOTAL Also enter on Line 7,Recapitulation) S 350 236.60 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(p8-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DE ED RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ELLEN E. ESLINGER 21 13 1307 Decedents debts must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoover Funeral Homes&Crematory, Inc. 514.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Charles J. DeHart III 12,500.00 Street address 3631 North Front Street city Harrisburg State PA ZIP 17110 Years)Commission Paid: 2014 2, Attorney Fees: Caldwell & Kearns, P.C. 12,500.00 1 Family Exemption:(if decederTs address is not the same as claimants,attach explanation) Claimant Street Address City state ZIP Relationship of Claimant to Decedent 4, Probate Fees: Cumberland County Register of Wills 484.50 5 Accountant Fees: 6, Tax Return Preparer Fees: 7, Trevis A. Nickel, CPA-2013 income tax returns 170.00 8. Fulton Bank date-of-death account evaluation 26.60 9. Fulton Financial Advisors •2013 income tax preparation fee 30.00 I TOTAL(Also enter on Line 9,Recapitulation) $ 26 225.10 if more space is needed,use additional sheets of paper of the same size. REV-1512 EX-(12-12) pennsylvania SCHEDULE ! DEPARTMENT OF REVENUE DEBTS OF DECEDENT, +NNERRANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ELLEN E. ESLINGER 21 13 1307 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. Diamond Pharmacy-medical prescriptions 1,895.72 2. Caldwell&Kearns-Power of Attorney fees 312.95 3. in-Your-Home Care-transportation to medical appointment 52.50 4. PA Department of Revenue- PA41 2013 Ellen E. Eslinger Irrevocable Trust income tax 13.23 5. U.S. Treasury- 1040 2013 income tax 1,054.00 6. PA Department of Revenue-PA-40 2013 income tax 70.00 I I TOTAL(Also enter on Line 10,Recapitulation) $ 3,398.40 If more space is needed,insert additional sheets of the same size. REV-1513 EX-(01 10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ELLEN E. ESLINGER 21 13 1307 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not ListTrustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec.9116(a)(12).) 1, Roy Haglund Collateral 10%of residue 3126 South Glacier Bay Way Meridian, ID 83642 2. Sue Haglund Collateral 10%of residue 3126 South Glacier Bay Way Meridian, ID 83642 I Bethany Haglund Collateral 10% of residue 3126 South Glacier Bay Way Meridian, ID 83642 4, Sarah DeMateo Collateral 10% of residue 3057 South Drake Chicago, IL.60623-4641 5. Mignon G. Singer Collateral 40%of residue 208 Hilltop Road Boiling Springs, PA 17007 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: i. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: IL Mount Laurel Church of God 10%of residue 1295 Piketown Road Harrisburg, PA 17112 2, Trinity Evangelical Free Church 10%of residue 301 Market Street PO BOX 35 Dauphin, PA 17018 TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 If more space is needed,use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF ELLEN E . ESLINGER I, ELLEN E. ESLINGER, of Dauphin, Dauphin County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. ITEM I . I direct that all my just debts and funeral expenses be fully paid and satisfied as soon as conveniently may be after my decease . ITEM II . I give all of the rest, residue and remainder of my estate unto the following: (a) Ten (10%) percent to the Mount Laurel Church of God, Piketown, Pennsylvania . (b) Ten ( 10%) percent to Trinity Evangelical Free Church, Dauphin, Pennsylvania . (c) Ten (10%) percent to Roy Hagland, 3126 South Glacier Bay Way, Meridian, Idaho 83642, provided he survives my death. (d) Ten (10%) percent to Sue Hagland, 3126 South Glacier Bay Way, Meridian, Idaho 83642, provided she survives my death. (e) Ten ( 10%) percent to Bethany Hagland, 3126 South Glacier Bay Way, Meridian, Idaho 83642, provided she survives my death . (f) Ten (10%) percent to Sarah DeMateo, 2702 South Karlov #2, Chicago, Illinois 60673-9926, provided she survives my death. (g) The balance of my residuary estate shall be divided equally between Mignon G. Singer, of Boiling Springs, Pennsylvania, and Kevin E. Singer, of Harrisburg, Pennsylvania, provided they survive my death. ITEM III . In addition to the powers conferred by law, I authorize my Executor, in absolute discretion: A. To retain in the form received, and to sell either at public or private sale any real or personal property. B. To manage real estate. C. To invest and reinvest only in forms of property defined as legal investments according to the laws of the Commonwealth of Pennsylvania . D. To exercise any optional rights arising from ownership of investments . E. To compromise claims without court approval,, and without the consent of any beneficiary. ITEM IV. It is hereby directed that my Executor, hereinafter named, shall pay all inheritance, state, succession and legacy taxes to which my estate or the transfer of any property hereunder may be subject and to charge such tax as part of the administration, payable out of my residuary estate . 2 q' ITEM V. I nominate, constitute and appoint Charles Faust to be and act as my sole Executor of this my Last Will and Testament . In the event of renunciation, death, resignation or inability to act for any reason whatsoever of Charles Faust, I nominate, constitute and appoint Charles J. DeHart, III, as Executor of this my Last Will and Testament . No personal representative or fiduciary appointed herein shall be required to post bond or give any security. IN WITNESS WHEREOF, I have hereunto set my hand and seal this L � day of � 2008 . (v -E - �a (SEAL) ELLEN E . ESLINGE . The preceding instrument, consisting of this, and two other typewritten pages, was on the date thereof signed, published and declared by ELLEN E. ESLINGER, the Testatrix therein named, as and for her Last Will, in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. c� Residing at Charles J. DeHart,III 3631 North Front Street - Ha h 9Pa syl aniA 17110 6' m • Residing at 3 ry COMMONWEALTH OF PENNSYLVANIA SS : COUNTY OF 3)A U NH I PJ The Testatrix and the witnesses whose names are subscribed to the foregoing instrument, being first duly sworn and qualified according to law, do hereby acknowledge and declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will in the presence of the witnesses, that she signed willingly or willingly directed another to sign for her, that she executed it as her free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses, and that to the best of their knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix tness Wi n ss Sworn to, subscribed and acknowledged before me by the above named Testatrix and witnesses this )q }1, day of FE-gRury(Ztl 2008 . -)U41 N -- (SEAL) otary Public 08026-001/128470 CC)k'f "31 ti i..4V°! OF r1-'tA;N8YL%ffAW1A NOT/,'HAL SChL 194N 'Y L B9ESMI. MYtal; Public l!'Sl.IL�'it�:tYl5c21bv,-isNrj, DG1'i1j Wri Comity saran P008 4 Estate Valuation Date of Death: 11/23/2013 Estate of: Ellen E. Eslinger Irrev Trust Valuation Date: 11/23/2013 Account: 41F810018 Processing Date: 01/27/2014 Report Type: Date of Death Number of Securities: 15 File ID: EslingerEllen TrustASSets Shares Security Mean and/or Div and Int Security or Par Description - High/Ask Low/Bid Adjustments Accruals Value 1) 578.58 ADVISORS INNER CIRCLE FD (0075W0759) EDGWD GRW INST Mutual Fund (as quoted by NASDAQ) 11/22/2013 18.06000 Mkt 18.060000 10,449.15 2) 324.173 ADVISORS INNER CIRCLE FD (00758M162) ACADIAN EMRGN Mutual Fund (as quoted by NASDAQ) 11/22/2013 18.68000 Mkt 18.680000 6,055.55 3) 379.398 ADVISERS INVT TR (00770G847) JOHCM INTL SL I Mutual Fund values reported to NASDAQ 11/22/2013 17.71090 Mkt 17.710000 6,719.14 4) 1520.853 FEDERATED EQUITY FDS (314172560) STRG VAL DV INST Mutual Fund (as quoted by NASDAQ) 11/22/2013 5.87000 Mkt 5.870000 8,927.41 5) 11996.713 FEDERATED TOTAL RETURN SERS (31428Q101) TOIL PET INSTL Mutual Fund (as quoted by NASDAQ) 11/22/2013 11.01000 Mkt 11.010000 132,083.81 Daily Div. Accrual as of 11/23/2013 314.71 6) 104.144 HARBOR FD (411511306) INTL FD INSTL Mutual Fund (as quoted by NASDAQ) 11/22/2013 70.81000 Mkt 70..810000 7,374.44 7) 140.882 MANAGERS AMG FDS (561709593) GW&K SCEQ INST Mutual Fund (as quoted by NASDAQ) 11/22/2013 24.76000 Mkt 24.760000 3,488.24 8) 312.002 NATIXIS FDS TR II (63872T828) VN VL OPP FD Y Mutual Fund (as quoted by NASDAQ) 11/22/2013 21.11000 Mkt 21.110000 6,586.36 9) 6079.317 PIMCO FEB PAC INVT MGMT SER (693390700) TOTAL REIRN PT Mutual Fund (as quoted by NASDAQ) 11/22/2013 10.89000 Mkt 10.890000 66,203.76 Daily Div,. Accrual as of 11/23/2013 92.48 10) 16.569 PERRITT FDS INC (714402203) MICROCAP OPPTY Mutual Fund values reported to NASDAQ 11/22/2013 34.86000 Mkt 34.860000 577.60 11) 1476.013 PROFESSIONALLY MANAGED PTFL (742935489) OSTER SIR INCM Mutual Fund (as quoted by NASDAQ) 11/22/2013 11.91000 Mkt 11.910000 17,579.31 This report was produced with Estateval, a: I I icing Systems, Inc. If you have questions, please contact EVP Syst s.com. (Revision 7.3.1) Date of Death: 11/23/2013 Estate of: Ellen E. Eslinger Irrev Trust Valuation Date: 11/23/2013 Account: 41F810018 Processing Date: 01/27/2014 Report Type: Date of Death Number of Securities: 15 File ID: EslingerEllen TrustAssets Shares Security Mean and/or Div and Int Security or Par ., Description High/Ask Low/Bid Adjustments Accruals Value 12) 354.536 RIVERPARK FDS TR (76882K306) WEDGEWD INSTL Mutual Fund (as quoted by NASDAQ) 11/22/2013 17.27000 Mkt 17.270000 6,122.84 13) 218 VANGUARD BD INDEX FD INC (921937827) SHORT IBM BOND NYSE Area Equities Exchange 11/22/2013 80.59000 80.53000 H/L 11/25/2013 80.61000 80.54000 H/L 80.567500 17,563.72 14) 217.307 VANGUARD INDEX PUS (922908462) VALU IDX SIGNL Mutual Fund (as quoted by NASDAQ) 11/22/2013 30.66000 Mkt 30.660000 6,662.63 15) 12966.42 Federated Govt Obligation MMF#395 (CASH) 12,966.42 Total Value: $309,360.38 Total Accrual: $407.19 Total: $309,767.57 Page 2 This report was produced with EstateVal, a product of Estate Valuations a Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1) N N O� iP r �D W O Ol r r r O O O [ IP D7 N r W N �P W OJ lD r r IP IP J J H lO D lW D CN D w W J In N r W H i 0 w 0 w O 0 w z rb M x n N 0 H 4 r b N L1 X o m H I I I I I ♦✓ 0 W 0 w W r VI m r J O R7 m N o m o o N o �D 0 o m a m ui 113 i I i i I i I i I I I i i i i W o 7J O J yC yCC H (n d m H y b7 "7 m x 0 Y b7 z z C H 7J 3 C 0 R+ z d b 0 w tom" r W n m z n 0 x x m n l7 m n r v C C :V x7 H O 13 13 x1 O H rom 3 H E C z 'C] t7 d ;v H H O m H y y z 0 1H1 x 3 H z t7 C z N H H vi k H L. m t)i T� On Pd Oz H ro Y� c n C) z n z 0 H H C H z Czx Z G) x S 0 lH] ro ni p t' C7 C t7 H H w 14 H o C�C L] K '*7 d U] xx z 7O 11 O 0 z ;d z O 'a l7 H w th H m d z z 3 CCZH C7 a 10 11 CZ C7 H n] h] O N H C+7 to b] H z ro A7 [D H H H !n u w I r w Z O 0 � � m H k N z m C7 H H r W H W k] v m z � d •N.. 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OO O IP W J r r O W O r J m In O N W l0 N J lfl J W O W O q b] r r H r r r r r r r r r r r r Po r r r r r r r r r r r r r r r ,ro N N N N N N N N N N N N N N N n NW NW Nr NH NW Nr NN W NN NJ Nr N Nr Nr Nrb] N• N• N• N• N• N• N• N• N• N• N• N• N• N• N• wo W� W� rr wo W� rr W0 rm rr rr ro rr Wm wnmm \ WO WO WO WO WO WO WO WO WO WO WO WO WO WO WOL�7 D7 N J r 3 a Y r H O r W r x PO Ol J O\ J Ol Dl N W J N OJ O1 Ol O y O1 VI r VI Ui N V1 lD m O1 Ol N J J O OJ N m J W N r ltl IP C b N IP N l0 J W T Ol OJ IP W J �D Ut lD C' 47 O1 N W W J W �P N iP W IP r m r C� [T7 W IP r O Ol N iP r r �P VI mm r n z c m m r ro H i p • ro ro z m y r o H m o b [s7 r N X7 i O m J ED M M [ r r v m z ro H G y t1 C K H L-3 O Cl m z co r 0 H W pa Q ro z y z H H f zz H C y H H H H y O O O O HHy yHy yyH yyy t t C C N n z z o � o z o o v m z b n s o s x m y °� m •• H z r G7 r cn N W W W O O K r m m H W z N N N O O 'W [ r o o r C ro z H n m ro b H O yn � to m N a w w ro 0 o X H w w m m C ro w o o w C [] N O O N h] N pA�,l 1 8 L'f4 532-NoBr-NoMc I d111tl E P.O. Box 4887 Page 1 of 3 RdtonB� Lancaster, PA 17604 Statement Date: 12/31/12 through 12131/13 LISTENING IS JUST THE BEGINNING.' fultonbank.com Retirement ID Number: XXXX3018 Temp-Return Service Requested For information regarding your account please call customer service at 800.FULTONA. Retirement Account Statement TRADITIONAL IRA IIIIIrI'I'1'���I'I�IIIII�'I��'��III�IIIII'�'ll�"�I'll'lll'��I1�� 008752 0.6500 AT 0.384 TR00035 J_ ELLEN E ESLINGER 3631 N FRONT ST HARRISBURG PA 17110-1533 I-Summary of Your Investment Account Number Rate Matures Value 9300083150 0.080% 40,468.95 Retirement Plan Totals 40,469.03 • Balance as of 12/31/2012 40,437.91 • Deposits/Contributions 0.00 • Interest Credited 31.04 - Withdrawals/Distributions 0.00 - Service Charges 0.00 Ending Plan Balance 40,468.95 Earnings Not Yet Credited to Your Account 0.08 o Total Account Value - 40,469.03 0 Fair Market Value 12/31/2013 40,469.03"' Taxes Withheld 0.00 Contributions made in 2013 for tax year 2012 0.00 o Contributions made in 2013 for tax year 2013 0.00 This information is being provided to Internal Revenue Service m o.. on gN Activity on Your Account(s) J° Date Account Number Type of Activity Amount Balance 12/31/2012 Beginning Balance 40,437.91 06/30/2013 9300083150 Interest Added _ 15.04 40,452.95 12/31/2013 9300083150 Interest Added .16.00 40,466.95 12/31/2013 Ending Balance 40,468.95 This information is be -rvice Member FDIC. M c•+ ,