HomeMy WebLinkAbout08-13-14 ' - - - ----
J 1505607121
REV-1500 � (�'05) OFFICIAL USE ONLY
PA Depa�tment of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 1NHERITANCE TAX RETURN 2 1 1 4 0 4 3 3
Harrisburo PA 17t2e-osol RESIDENT DECEDENT
. ENTER DECEDENT INFORMATION BELOW '
Social Securiry Number Date of Death Date of Birth
0 2 2 5 2 0 1 4 1 1 1 7 1 9 � 3
' DecedenYs Last Name Suffix DecedenYs First Name MI
S H U G H A R T B E T T Y J
(It Aqplicable)Enter Surviving Spouse's�lnformation Below �� � ,
Spo�se's Last Name • Suffix � Spouse's First Name � MI ,
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
' FILL iN APPROPRIATE OVALS BELOW ' �
O 1.Original Retum � 2.Supplemental Retum � 3.Remainder Retum(date of death �
prior to 12-13-82)
� � 4.Limited Estate � 4a. Future Interest Compromise(date of � 5.Federal Estate Tax Retum Required
, death after 12-12-82) ,
Q 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 Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
H. A R 0 L D S - I R W I N , I I 1 7 1 7 3 1 9 7 5 6 0 .
Firm Name(If Applicable)
REGISTER OF WILLS US�(�NLY
I R W I N L A W 0 F F I C E c7 `�' °�
r—� = � ���
C.
First line of address �'�a' �::'�' �'�_i
p ti�;_, i.� � �:�
6 4 S 0 U T H P I T T S T R E E T r� _..-
� :
, , F;-,
Second line of address j t�
, � rn� : C.J
--�\_ ' i` c !. -`;7
� C ��� . 9 -�-ii
. , . c_;a
City or Post Office State ZIP Code ���LED _ �` � r�i
-r� � � ���p,
� A R L I S L E P A , 1 7 0 1 3 �y �' � ,
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CdrrespondenYs e-mail address:ifWI111aWOffICe�Q1'T1aII.COF1'1 ' � '
Under penalties of perjury,l dedare that I have examined this retum,including accomparrying schedules and statements,and to the best of my Imowledge and belief,
it is Vue,correct and complete.Declaration of preparer other than the personal representatNe is based on all information of which preparer has arry Iv�owledge. ,
SIGNATURE OF PE�ON R�`31B FI�ETURN DATE
�i��
ADDRESS
934 G BIN DRIVE CARLISLE PA 17013
SIG OF PREPA R HA REPRESENl`ATIVE DATE
� ADDRESS I
64 SOUTH PIT STREET CARLISLE PA 17013 •
PLEASE USE ORIGINAL FORM ONLY
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i - � 1505607121 1505607121 �
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� 1505607221
REV-1,500 EX DecedenYs Social Security Number „
oeceder�t's►vame: $E T T Y J • S H U G H A R T ' � �
RECAPITULATION
1. Real estate(Schedule A) ... ... .. ............. . .... .............. 1. 1 � 2 0 0 0 . 0 0
2. Stocks and Bonds(Schedule B) ..... ......... . . .... ........ ...... 2. � • � �
3. Closely Held Corporation,Partnership or Sole-Prpprietorship(Schedule C) . . . .. 3. � •" � �
. � , �
4. Mortgages&Notes Receivable(Schedule D) ' . . . ..... .........,...... 4. �'• � �
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E) ....... 5. 6 8 9 . 7 5
6. Jointly Ovmed Property(Schedule� ❑ Separate Billing Requested ....... 6. � • � �
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property Q • a O
(Schedule G) ' � Separate Billing Requested ....... 7. `
8.Total Gross Assets(total Lines 1-� .......... ................. 8. 1 0 2 6 8 9 . 7 5
9. ;Funeral Expenses&Administrative Costs(Schedule H) 2 4 6 1 � . 9 7
..........:..... 9.
10. Debts of Decedent,Mort a e Liabilities,&Liens Schedule 1 1 p. $ $ 2 7 3 . d ?
9 9 � ) .... .. ......
11. Total Deductions(total Lines 9&10) . .... . . .... . . ...... .. .. . . .. 11. 7 9 8 8 4 . � 4
12.Net Value of Estate(Line 8 minus Line 11) .. . ...... .......... .... ... 12• 2 2 8 0 5 , 7 1
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which O . o Q
an election to tax has not been made(Schedule J) .. ...... .......... 13•
14.Net Value Subject to Tax(Line 12 minus Line 13) .................. 14. 2 2 8 � 5 . 7 1
TAX COMPUTA710N-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.oa5_ 2 2 8 0 5 . 7 1 15. � 1 0 2 6 . 2 6
16. Amount of Line`i 4 taxable
at lineal rate X.0; ' 0 . 0 0 �g. � 0 . 0 0
17. Amount of Line 14 4axable 0 . 0 0 �7, 0 . 0 0
at sibling rate X.12
1 S. Amount of Line 14 taxable
at collateral rate X.15 � 0 . 0 0 1 g. 0 . 0 0
19.Tax Duel � : :......... ................. �s. � 1 0 2 6,. 2 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
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: Side 2
:_, L 1505607221 1505607221 � .
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REV-1500 FX Page 3 _ File Number
Decedent's Complete Address: 2i i4 0433
DECEDENT'S NAME
BETTY J. SHUGHART
STREET ADDRESS
934 GOBIN DRIVE
CITY STATE Z�I'
CARLISLE PA 170t3
Tax Payments and Credits:
1. Tax Due(Page 2 Line 19) (1) 1,026.26
2. Credits/Payments
'A.Spousal Pove�ty Credit ' "
�� B.Prior Payments � '� \ �
� C.Discount � ' `.
Total Credits(A+B+C) (2) 0.00
3. Interest/Penalty if applicable
D.Interest
E.Penalty
Total Interest/Penalty(D+E) (3) 0.00
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 Une 1+Line 3 is greater than Line 2,enter the difference.This i5 the TAX DUE. (5) ` 1,026.26
A.Enter the interest on the tax due. ' (5A)
B.Enter the total of Line 5+5A.This is the BALANCE DUE. (5B) 1,026.26
� Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IPl THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred: ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income; .......:....................... ❑ 0
- c. retain a reversionary interest;or ...........................:...:................................................................ ❑ �
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after December 12,1982,did decedent transfer property within one year of death �.
without receiving adequate'CO�sideration? ....................................................................................::. ❑ ❑X
3. Did decedent own an'in trustfor'or payable upon death bank acxount or security at his or her death? .........' ❑ �
4. Did decedent own an Individual Retirement Acxount,annuity,or other non-probate property which
contains a beneficiary designaiion?.................................................................................................. ❑ ❑
, � � � �
IF THE ANSWER TO ANY OF THE ABOVE�QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE��T AS PART OF THE RETURN.
For dates of death on or after July 1,199�4 and before January 1,1995,the tax rate imposed on the net value of transfers to`.or for the use of the sunriving spouse
is three(3)percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1,1995,the tax rate impased on the net value of transfers to or for the use of the sunriving spouse is zero(0)percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a sunriving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are still applicable even if the sunriving spouse is the only benefiaary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child twenty-one 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 zero(0)percent[72 P.S.§9116(a)(1.2)].
The tax rate impased on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half(4.5)percent,except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)l• - _ �
The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is twelve(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. '
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REV-1502�X+(6-98)
' SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. SHUGHART 21 14 0433 `
All real property owned solely qr as a tenant in common must be reported at fair market value.Fair mark8t value is def�ned as the price at which property would be
exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable leiowledge of the relevant facts.
Real ro whiCh is oin -owned wkh ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. HOUSE AND LOT AT 1822 BASIN HILL BLVD, CARLISLE, PA 17013 102,000.00
Value Based on Appraisal
See Appraisal Attached as Exhibit"B" •
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TOTAL(Also enter on line 1,Recapitulation) a 102 000.00
(If more space is needed,insert additional sheets of the same size)
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REV-1503 EX+(6-98) "
' SCHEDtJLE B
COMMONWEALTH OF PENNSYLVANIA' STOCKS Q BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF , FILE NUMBER ,
BETTY J. SHUGHART � � _ 21 14 0433 .
� ,All P�KY IaMIY-owr�ed with rigM of survhrorship must be discbsed on Schedule 6. ` �
�-�-Ep� VALUE AT DATE
NUMBER OESCRiPTION OF DEATH
1. NONE 0.00
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T
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. . . . - � � - � � . F
i +./ / •/ .
" TOTAL(Nso enter on line 2,Recapitulation) � 0.00
.� � ' : (If more space is needed,insert additional sheets of 1he same size)
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F�' �[ "^°a�! " . : ., ' ' ..� . . 1 +;;;;D'' e'+ ' y�x�' 'va'
�� . ." .. ., * ' ' . . � . . . � � . k ' � �
� �•HEV-t504 EX+(&98)
• , � SCHEDULE C �e_ �
' . . . CLOSELY-HELD CORPORATION,
coMnaor�wen�TM oF PeNNS�vavin PARTNERSHIP OR �
'N RES DENTE E EDE�RN -- SOLE-PROPRIETORSHIP
ESTATE OF fILE NUMBER
BETTY J.SHUGHART 21 14 0433
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Schedule G1 a G2(induding all supporting infortnation)must be attached for each dosely-held corporationlpartnership interest of the decedent,other than a
sole-proprietorship.See insUuctions for the suppo�ing infortnaUon to be submitted for sole-proprieiorships.
�'�M VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NONE 0.00
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. . � . . . y. I .. � . . . '.1 . � .. � . .
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•l 1
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I I i
TOTAL(Also enter on line 3,Recapitulationj S 0.00
• (If more space is needed,insert addidonal sheets of the same size)
REV-1507 EX+(6-98)
SCHEDULE D .
COMMONWEALTH OF PENNSYLVANIA MORTGAGES aL NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF . FILE NUMBER �
BETTY J. SHUGHART 21 14 0433 '
All propeAy jointly-owned with the right of survivorship must be diaciosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NONE �•�
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TOTAL(Also enter on line 4,Recapitulation) � 0.00
(If more space is needed,insert additiona�sheets of the same size)
F .
REV-1508.EX+(6-98)
� SCHEDU�E E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� a( MISC.
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBfR ,
BETTY J. SHUGHART ° 21 14 0433
Include the proceeds of litigation and the date the proceeds were received by the estate. ' ,
All propeAy jointly-owned with right of survivorship must be disclosed on Schedule F.
��M VAWE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MEMBERS 1 ST FCU 53.46
Checking Account
See statement attached as Exhibit"C"
2. .' MEMBERS 1ST FCU ' 84.19
` Savings Account ., \ i
� See statement attached as Exhibit"C" �
3. MISC. HOUSEHOLD GOODS 500.00
4. ESCROW REFUND FROM CENLAR 52.10
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TOTAL(Also enter on line 5,Recapitulation) S 689.75
(If more space is needed,inseR additional sheets of the same size) � �_
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REV-1509 FJC+(6-98)
' SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. SHUGHART 21 14 0433
If an asset was made joint within one year of the decedenYs date of death,it must be reported on Scbedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
q. NONE
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C
JOINTLY-0WNED PROPERTY: " �
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
fTEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK A(xOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDEN'fIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET IMEREST DECEDENTS INTEREST
1. A. NONE 0.00 � 0.00
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TOTAL(Also enter on line 6,Recapitulation) $ 0.00
(If more space is needed,insert addi6onal sheets of the same size) �
R
REV-151 C.EX+(6-58)
• SCHEDULE G
INTER-VIVOS TRANSFERS &
COMM HER TANCE TAX RETURN ANIA MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. SHUGHART ° 21 14 0433 `
This schedule must be completed and filed'rf the answer to any of questions 1 through 4 on the reverse'side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM ir«xuoen�ru�oFn�rwws�r�e,THEIRRFIATIONSHIPT00ECEDEMANO DATEOFDEATH %OFDECD'S EXCLUSION TAXABLE
NUMBER �TMEDATEOFTRANSFER.ATfApiACOPVOFTHEDEEDFORREALESTATE. VALUEOFASSET INTEREST pF�uc�e� VALUE
1. NONE 0.00 0.00
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TOTAL(Also enter on line 7 Recapitulation) a 0.00
(If more space is needed,insert additional sheets of the same size)
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REV-1511.EX+(10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. SHUGHART 21 14 0433
Debts of decedeM must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME, INC. - Funeral and Burial Expenses 7,999.00
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B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
• Name of Personal Representative(s) '
SVeet Address
City State Zip
� Year(s)Commission Paid: � '
p. AttomeyFees IRWIN LAW OFFICE 5,850.00
3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach e�lanation) 3,500.00
Claimant TINA L.WHITSELL
Street,4ddress 934 GOBIN SRIVE
Ciry CARLISLE - State PA Zip 17013 -
� Relationship of Claimant to Decedent DAUGHTER
4. ProbateFees CUMBERLAND COUNTY REGISTER OF WILLS � 363.50
5 AccountanYs Fees
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6. Tax Retum Preparers Fees
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7. NORTH MIDDLETON MUNICIPAL AUTHORITY-Water Bill 87.23
8. MELANIE STRICKLAND- Real Estate Taxes 437.66
9. MELANIE STRICKLAND - Persojnal Taxes 9.80
10. PP 8�L- Electric Bill 101.46
11. ADVANCED DISPOSAL-Trash Bill 73.10
12. CARLISLE RENT-A-SPACE-Storage Fees 90.00
13. CLOSING COSTS- Real Estate Sale 5,233.22
14. HAZARD INSURANCE ON REAL ESTATE = 866.00
' TOTAL(Also enter on line 9,Recapitulation) E 24 610.97
(If more space is needed,insert additional sheets of the same size)
C . .
REV-1512 EX+(12-03)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT�
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BETTY J. SHUGHART ' 21 14.0433 �
Report debts incurred by the dec�ent prior to death which remained unpaid as of the date of d�th,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CENLAR MORTGAGE 45,836.64
, Payoff Balance , .
�' ^ �' � l
, 2. KOH�'S , � , 1,461.60
Revovling credit balance
3. WALMART 2,164.93
Revolving credit balance
4. VISA � � 5,809.90
Revolving credit balance
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� TOTAL(Also enter on line 10,Recapitulation) S � 55 273.07
(If more space is needed,insert addiGonal sheets of the same size)
a
REV-1513 EX+(9-00)
� SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER ,
BETTY J. SHUGHART 21 14 0433
� RElATIONSHIP TO DECEDENT ' AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustce(sj OF ESTATE
I TAXABLE DISTRIBUTIONS [include ouVight spousal distributions,and transfers under
Sec.9116(a)(1.2)]
1. TINA L.WHITSELL Lineal
934 Gobind Drive 100% Residue
Carlisle PA 17013 . •
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE,ON REV-1500 COVER SHEET
II. NON-TAXABtE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1, NONE 0.00
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B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. NONE _ . 0.00
. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S '0:00
(If more space is needed,insert additional sheets of the same size) � .
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EXHIBIT "A" -
`� LAST WILL AND TESTAMENT
1, BETTY J. SHUGHART, of Carlisle, Cumberland County, Pennsylvania�17013, do hereby . A
� make, pubiish and declare��his to be my last will and testament, hereby revoking all,wiiis
heretofore made by me. _
1. i direct my personal represerrtative to pay all of my debts, funerai a�d administrative
expenses as soon as convenient after my decease. I direct that all inhe�itance taxes imposed -
or payable by reason of my death and intgrest and penaities thereon with respect to a0_property, ;`
whether or not such property passes under this Will, shall be paid by my personal �
representative out of my estate. ,
2. I authorize and empower my personal representative to sell any realty and/ot personalty
owned by me at my death and npt spec�cally devised or bequeathed herein, at public or.private
sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as
� 1 could�do�f living. My representative is authorized and empowered to engage in any business
� � in which I may be engaged at my death,for such period of time after my death as seems
expedient to said representative.
- 3. I give, devise�nd bequeath all of my estate of whatever nature and wherever situate ta
�.'.�
my daughter Tina L.Whitsell, or if she is deceased then to her children, share and share alik� �
_ . � the child or children of any deceased child taking the share their parer�t would hav�'#�en if 3 rn o
�
- living. , _ � A � ."� � �
t"' � R'1 N �] c7
D � �7
4. I nominate and appoint my daughter, Tina L.Whitsell,to be the capersona� � � -o � �
3
. representative of my estate, to serve without bond. o � �" s � rn
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5. I su�gest that my personal representative retain the services of Harold S. Irwin, III, C°
° Carlisle, Pennsylvania in the settlement of my estate. �
�
IN WITNESS WHEREOF, 1 have hereunto set my hand and seal this 3� day of January,
2013. :
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- t� t " : (SEAL)
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� � ETTY J.SHUGHART , , � �
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Signed, sealed, published and declared by the above-named person as and for a lasf will and
- testament, in our presence, who at said person's requesf, in said person's presence and in the
� presence of each other have hereunto set our�ames as subscribing witnesses. . �_
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� ACKNO'WLEDGMENT AND AFFIDAVIT
._
WE, BETTY J. SHUGHART, AMY J. MAZUTIS, and RACHfL I. SHAW,the testatrix and ,
' witnesses�respectively,whose names are signed to the foregoing instrument, being first duly _ �
swom, do hereby declare to the undersigned authority that the testatrix signed and executed the
instrument as her last will and that she had signed willingly, and that she executed it as his free
and voluntary act for the purpose herein expressed, and that each of the witnesses, in the •
prese.nce and hearing of the testator, signed the will as a witness and that to the best of their
knbv(rledge the testatri�c was, at that time, eighteen years of afge or older, of sound mind and
_ _ ;
• 'under no constraint or undue influence. . � •
— � ' BE �. HUG ART , _
' � A �UT
RACHEL 1. SHAW
COMMONWEALTH OF PENNSYLVANIA
:ss: _
COUNTY OF CUMBERLAND •
Subscribed,.sworn to and acknowledged before me by BETTY J.SHUGHART,the testatrix
herein, and subscribed and swom to before me by Y J. MAZUTI3 and RACHEL L SHAW,
__ witnesses,#his �'�'day of January, 2013.
- NOTARIAL SENL
HAROLD&1R1MN III Notary Public
� Notary Public
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EXHIBIT ••C•• .
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� Members 1 st Federal Credit Union 02/01/2014 02/28l2014 1 of 2 XXXXXXX636
5000 Louise Drive
P.O.Box 40
Mechanicsburg PA 17055-0040
� (800)237-7288 _.,,.
M����� (717)697-5312(Hearing impaired)
��L��,�� www.memberslst.org.
�
BETTY J SHUGHART
TINA L WHITSELL
C/0 TINA WHITSEL ' "
' 934 GOBIN DR I � � �
� CARL.ISLE PA 17013 , • , '
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. , ., ,:w;. . . . , 53.46.. _
' CHECKING � 5.20
SAVINGS
CERTiFICATES 0.00
LOANS 0.00
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Eff. Post 5
Date Date Description Deposits Withdrawals Balance
02/03 02/03 Deposit Transfer From Share 0000 1,121.00 1,274.04
02/03 02/03 Check 003528 Tracer 0000274762 83.07 1,190.97
02/07 02/07 Check 003529 Tracer 0010109811 50.00 1,140.97
Processed Check-KOHLS DEPT STORE TYPE:8005645740
ID:30015440W2 DATA: CARLISLE .
`02/10 02/10 Check 003531 Tracer 5130561209 =, 80.00 1,060.97
� ' Point of Purchase Check-SAMSCLUB-WALMART Terminal,City
&State-CARL PA TYPE:GE CARD ID:9037112574 DATA:
02/10 02/10 Check 003524 Tracer 0000344033 20.00 1,040.97
02/11 02/11 Check 003530 Tracer 5130047093 162.28 878.69
Point of Purchase Check-BB'S GROCERY OUT Terminal City& ,
, State-NEWB PA TYPE: PURCHASE ID:9009010261 DATA:
02/14 02/14 Check 003532 Tracer 5136064094 , , 21.31 857.38
Point of Purchase Check-GIANT CARUSLE Terminal Ciry&
State-CARL PA TYPE: PURCHASE ID:9036396112 DATA:
-- ---- 117.00 740.38
02/18 0?J18 VVthdrawal ACH Visa:
TYPE: PAYMENT ID: 1465106539 CO:Visa
02/19 02/19 Withdrawal ACH PP 101.46 638.92
TYPE:ELEC BILL ID: 1230959590 DATA:21 CO: PP
02120 02/20 Withdrawal ACH CENLAR LOAN ADM 585.46 53.46
TYPE: 1 TIME DFT ID:21-0534340 DATA:
000000000000000000 C0:CENLAR LOAN ADM ,
ENDING BALANCE: 553.46
Check# Date Amount Check# Date -i�mount Check# Date Amount
3524 02/10 20.00 3528' b2/03 83.07 3529 02/07 50.00 -
3530 02/a 1 162.28 3531 02/10 80.00 3532 02/14 21.31
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���EMBERS iN 02/01/2014 02/28/2014 2 of 2 X;�O{XXXX636
*Indicates check out of sequence 6 Checks Cleared for 416.66
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Eff. Post
Date Date Description Deposits° Withdrawals Balance
02/03 02/03 DepositACH XXSOC SEC 1,121.00 1,233.19
ID:9031736026 CO:XXSOC SEC
02/03 02/03 Withdrawal Transfer To Share 0011 1,121.00 , 112.19
02/10 02/10 Withdrawal Members 1st Onlin�Transfer . 30.00 ,' 82.19
. To WHITSELL,TINA L XXXXXXXXXX Share 0011 • .
02/19 02l20 Withdrawal Members 1st Online Transfer 68.00 14.19
To WHITSELL,TINA L XXXX)UCXXXX Share 0011
02/22 02/22 Deposit by Check 70.00 84.19
02/27 02/27 Withdrawal Members 1st Online Transfer 79.00 5.19
To WHITSELL,TINA L XXX�CXXXXX Share 0011
02/28 02/28 Deposit Dividend 0.100% 0.01 , 5.20
Annual Percentage Yield Earned 0.160%from 02/01/14 through -
02/28/14
' ENDING BALANCE: 55.20
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, TOTAL DIVIDENDS PAID , ,
0000 REGULAR SAVINGS 0.03
0011 CHECKING 0.00
Total Year to Date Dividends Paid Qncludes Closed Shares) 0.03
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