HomeMy WebLinkAbout08-25-14 (2) 1505611186
REV-1500 EX 112-11)(FI)
PA Department of Revenue •Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes Dep.nment or aewoue County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN n I / ) ���
Harrisburg,PA 17128-0601 RESIDENT DECEDENT o/ 1 I q
ENTER DECEDENT INFORMATION BELOW -
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04162014 01071921
Decedent's Last Name Suffix Decedent's First Name MI
WILLIARD MARIAN R
(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
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(dale of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82) +
® 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 SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
NANCY J CROWN 717-254-6653
a
REGISTER OF WILLS dSRONLY
First Line of Address trn M t� .
5 CROWN VW :I, 1 c�
�- M N r'i t?7 77
Cn ;X) (. G X
Second Line of Address
;'? G Q .�
-DATE FILEOp = n f
City or Post Office State ZIP Code _
CARLISLE PA 17013 — rr\ W t
— � a
Correspondent's e-mail address: NJWCROWN @COMCAST.NET
Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowedge 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.
SIGNATU E OF P RSON RESPON TURN DATE-
ADDRESS d-
5 CROWN VW RLISLE, PA 17013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611186 3W46475,000 1505611186
1 1505611286
-1 REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: MARIAN R WILLIARD
RECAPITULATION
1. Real Estate(Schedule A) . . . . 1 0 00
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . 2. 0 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. 853 86
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , , . 6. 1980 38
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . 7. 0 00
8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8. 2834 24
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. 1824 95
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , . , , , , , , , 10. 453 21
11. Total Deductions(total Lines 9 and 10), , , , , ; , , , , , , , , , , , , , , 11. 2278 16
12, Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , 12. 556 08
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13. 0 00
14. Net Value Subject to Tax(Line 12 minus Line 13) , - , 14, 556 08
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 00 15. 0 00
16. Amount of Line 14 taxable
at lineal rate X.045. 556 08 16 25 02
17. Amount of Line 14 taxable
at sibling rate X.12 0 00 17. 0 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 00 18. 0 00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 25 02
20.- FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT - ❑
Side 2
150.5611286 1505611286 ,
3W4548 5.000
REV-1500 EX(FI) Page 3 File Number 2114-0532
Decedent's Complete Address:
DECEDENTS NAME _
MARIAN R WILLIARD
STREET ADDRESS
801 N HANOVER ST
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1). 25
2. Credits/Payments
A. Prior Payments 0
B. Discount 0
Total Credits(A+B) (2) 0
3. Interest
(3) 0
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
5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 25
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 . . . . . ❑❑ ZI
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . ZI
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)(1)).
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. §)116(a)(1)j.
• 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. �0116(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.
3W4671 3.000
REV-1508E%+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
RESIDENTD DECEDENT PERSONAL PROPERTY
ESTATE OF: - FILE NUMBER:
MARIAN R WILLIARD 2114-0532
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
UNITED HEALTHCARE INSURANCE REFUND 61.40
2 PNC BANK, NA—SERVICE FEE REFUND 15.00
3 DISCOVER CARD CASH REFUND 257.46
4 2014 IRS REFUND DUE 520.00
TOTAL(Also enter on line 5,Recapitulation) E 853.86
3w46AD 1.000 If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX*(01-10) -
pennsylvania SCHEDULE F
DEPAUMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: - FILE NUMBER:
MARIAN R WILLIARD - 2114-0532
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. NANCY J CROWN 5 CROWN VW DAUGHTER
CARLISLE, PA 17013
B. JOSEPH R WILLIARD 6132 CHARING CROSS SON
MECHANICSBURG, PA 17050
C
JOINTLY OWNED PROPERTY:
U r DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FORJOIW MADE INCLUDE NWE OF FINANCIAL w ITUTONANDe ADLOUW NUMBER OR SMEAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING .ATTACH DEED FOR JOINTLY IiELD REAL ESrAT1 VALUE OF ASSET INTEREST DECEDENTS INTEREST
t. A. 10082004 PNC BANK, NA #5140069301 5,941.14 16. 67 990.19
2 B 10082004 PNC BANK, NA #5140069301 5,941.14 16.67 990.19
TOTAL(Also enter on Line 6,Recapitulation) $ 1,980.38
3W46AE 1.000 If more space is needed, use additional sheets of paper of the same size.
REV 1511 EX-(08-13)
pe SCHEDULE H
nnsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARIAN R WILLIARD 2114-0532
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1. MICHAELS—FRAMES AND SUPPLIES FOR PICTURE DISPLAY 43.82
2 MUSSELMANS FUNERAL HOME—FUNERAL COSTS 306.00
3 BAIRS FLOWER—FUNERAL FLOWERS 375.08
4 LEWISTOWN MONUMENT—ENGRAVING 125.00
5 JOSEPH R WILLIARD—FUNERAL REFRESHMENTS 591.20
6 NANCY J CROWN—FUNERAL REFRESHMENTS 275.35
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 108.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 1,824.95
3W46AG 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARIAN R WILLIARD 2114-0532
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. CHURCH OF GOD HOIdE—FINAL BILL _ 453.21
TOTAL(Also enter on Line 10,Recapitulation) $ 453:21
swasAH 1.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX+( SCHEDULE J
Pennnsns ylvania
DEPA EMOFREVENUE BENEFICIARIES -
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARIAN R WILLIARD 2114-0532
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1 TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec. 9116(a)(1.2).]
NANCY J CROWN DAUGHTER 278.04
5 CROWN VW
CARLISLE, 'PA 17013
2 JOSEPH R WILLIARD SON 278.04 '
- 6132 CHARING CROSS -
MECHANICSBURG, PA 17050
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: -
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
3W46AI 1.000. If more space is needed, use additional sheets of paper of the same size.
WILL
I, MARIAN R. WILLIARD, currently of 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 ONE: I direct all my debts which may be legally
collectible, and funeral expenses, be paid by my Executors
hereinafter named.
ITEM TWO: All federal, state and other death taxes payable
because of my death, with respect to the property forming my
ti gross estate for tax purposes, whether or not passing under this
=; Will, including any interest or penalty imposed in connection
with such tax, shall be considered a part of the expense of the
administration of m estate and shall be
.� y paid from my residuary
` estate under ITEM THREE without apportionment or right of
reimbursement. All such taxes on present or future interests
shall be paid at such time or times as my Executors may think
proper regardless of whether such taxes are then due.
ITEM THREE: All the rest, residue and remainder of my
estate, real, personal and mixed, of which I shall die seized and
possessed, or to which I shall be entitled at my decease of every
nature and wherever situate, I give, devise and bequeath equally
LAW OFFICES to my son, JOSEPH R. WILLIARD, and my daughter, NANCY CROWN. In
HOUCK&GINGRICH
z3:-WAYNESTREET the event a said child of mine is not living on the thirty-first
P.O.SOX 430
LEWISTOWN,PA.17044 day following my death, said deceased child's share shall go to
his/her issue per stirpes living on the thirty-first day
following my death.
ITEM FOUR: In the event a beneficiary of mine is less than
twenty-two (22) years of age and shares in my estate, I give,
j devise and bequeath said beneficiary's share to the trustees
hereinafter named In Trust upon the following trusts, terms and
conditions:
A. Said share thereof to the trustees hereinafter named In
Trust for said beneficiary with the powers and duties
and under the terms and conditions set forth in
subparagraph B.
B. To hold, invest, reinvest and manage, collect the income
and use the income, and so much of the principal of the
trust estate, as in the sole and absolute discretion of
said trustees, may be necessary or proper for the sup-
port, care, maintenance, medical, surgical and hospital
needs and education of said beneficiary.
C. The payments for the aforesaid purposes may be made by
the trustees directly, without the intervention of a
guardian. The trustees may pay to said beneficiary as
much of the current income, accumulated income, or
principal as the trustees in their sole and absolute
discretion, deem advisable for the support, education
j and well-being of said beneficiary. When said
beneficiary reaches twenty-two (22) years of age, said
trustees are directed to pay over to said beneficiary
the remainder of said trust together with all
accumulated income and said trust shall be terminated.
Notwithstanding, in the event said beneficiary fails to
reach twenty-two (22) years of age, said deceased
beneficiary's share shall be distributed to his/her
issue per stirpes and in default of any such issue
equally to said deceased beneficiary's siblings then
living and said trust shall be terminated. In the event
the proceeds of any insurance policies are paid over to
LAW OFFICES the trustees hereinafter named such proceeds shall be
HOUCK&GINGRICH held by the trustees under the same trusts, terms and
28 N.WAYNE STREET conditions as are provided in this Will; and as respect
P.O.BOX 430 to any payment made by the insurance company to said
LEWISTOWN,PA.17044 trustees, the company shall be under no liability to see
to or be responsible for the proper discharge of the
trust or any part thereof, and any such payment to said
trustees shall fully discharge the company for the
amount so, paid; and the company shall not be charged
with notice of a separate trust instrument, the death of
such beneficiary or issue or the termination of a trust
until written evidence thereof is received at its home
office.
D. My trustees shall be compensated in accordance with the
normal rates charged by trustees in the county in which
my estate is probated.
E. Should the principal of this trust be or become too
small in the trustees, discretion so as to make
continuance of the trust inadvisable, my trustees may
make immediate distribution of the then-remaining
principal and any accumulated or undistributed income
outright to the persons or entities in the proportions
they are then entitled. Upon the termination, the
rights of all persons who might otherwise have an
interest as succeeding income beneficiary or as
remainderman shall cease.
ITEM FIVE: I nominate, constitute and appoint my daughter,
NANCY CROWN, and her husband, LARRY CROWN, or the survivor of
�J either, as trustees under this my Last Will and Testament.
ITEM SIX: Notwithstanding anything herein to the contrary,
J issue of mine or my children shall not include stepchildren or
'V
..S
step-grandchildren.
�j
ITEM SEVEN: I nominate, constitute and appoint my son,
JOSEPH R. WILLIARD, and my daughter, NANCY CROWN, or the survivor
of either, as Executors of this my Last Will and Testament.
ITEM EIGHT: I direct that my Executors, Trustees, or their
successors, shall not be required to give bond for the faithful
LAW OFFICES performance of their duties in any jurisdiction.
HOLICK 8 GINGRICH
23 N.WAYNE STREET ITEM NINE: No interest (including, but not limited to all
P.O.BOX 430
LEWISTOWN,PA.17044 shares of principal and income) of any beneficiary under this
Will or any Codicil hereto or any trust herein created shall be
subject to anticipation or voluntary or involuntary alienation.
IN WITNESS WHEREOF, I, MARIAN R. WILLIARD, the Testatrix,
have to this my Last Will and Testament, set my hand and seal (to
this instrument only) this `;4 day of May, 1993 .
� r� .� �1: li� <•�i SEAL
Signed, sealed, published and declared by the above-named
MARIAN R. WILLIARD, Testatrix, as and for her Last Will and
Testament, in the presence of us who have hereunto subscribed our
names at her request thereto in the presence of the said
Testatrix and of each other.
LAW OFFICES
HOUCK 8 GINGRICH
23 N.WAYNE STREET
P.O.BOX 430
LEWISTOWN,PA,17044
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'Nationwide Mutual Insurance Ca - pay ar9 p: 148-Retaement Quai Plan-Fom Advice s: 016627400
One Nationwide Plaza L01.401 Pa ae In Date: 04101/2014
Columbus, CH 43215 Pa End Dete: 0 413 01201 4 Advice Date: 04/01/2414
Marian R Wiiilard Employee)D: 007490 TAX DATA Federal PA State
6 crown Vim CL Pay Type: 000001000 Memel Status: Matted We
Catlis*PA 17013 Location: Pennsylvania Work at Home Allowances: Be 0
Job TOW Belles Addi.Pa.:
Pay Rate: SOOOAnnual Addl,Amt.: 130.00
or
m "- Prior Ped.d -- ............................. Current ...----...----.......... ......................YTD .........-.._-. '
O a e
NRP Brass Taxable A 1,205.99 4,753 0 Fad WXhhatdng 130.00 520.0ff
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Total: 1,205.99 4,753.70 Total; 130.00 520.00
Description Current Year To Date Dasctl;mon Cunent Year To Data Descrption LLCurrent m Year Ta Date
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Mod-AXer Textar Her Medical 62.94 331.76
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1,205.99 1,205.99 O.Otl 1,075.99
Year 7o Daze; 4,753.70 9,75},70 520 A0 0.00 4,233.70
Advice a: Di6e2746e 1,075.99
To:el: 1 075.94
' a.3 ;acDipEGTD pQfl(i;[3787YiiR�t y,�.ati.C&.a` :?ar'h�'
Account Type Account Number �-Deposit Amount
Bank Name
Checking 00000005140069301 11,075.99
Please Retain For Your Records PNCBANK NA
Nationwide Mutual Insurance Cc
One Nationwide Plaza 1 -01 -401 001
Columbus, OH 43215
Total: 1 075.99
i'
ROP PA 000001000 ZZZPA
Account A MARIAN R WILLIARD
Accou
Of 5 CROWN VW
CARLISLE PA 17013-8130
NON-NEGOTIABLE
PNC
LEADINGTHEWAY
July 17, 2014
Nancy J Crown
5 Crown View
Carlisle,PA 17013
RE: Marian R Williard
SSN: 193-14-6285
DOD: 04116/2014
Dear Ms Crown:
In response to your request for Date of Death (DOD)balances for the customer noted above, our
records show the following:
Checking Account
Account#5140069301 Established: 0610111969
MARIAN R WILLIARD
NANCYCROWN — {� t• ICt
JOSEPH WILLIARD
DOD balance: $ 7,141.12+0,02 accrued interest Less•,
�ti. E4C.thLsZ6 7 or7.0
Dt�p VANE 5941. 1
Please note that this office provides date of death balances for deposit accounts IRAs,CDs, C mg and
Savings). We do not process any financial transactions or provide statemen eed assistance with
any of these items, please call 1-888-PNC-13ANK(1-888-762-2265)or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that.is privileged, confidential and exempt from disclosure under applicable law,
If the reader of this message is not the intended recipient or the employee or agent responsible far
delivering this message to the intended recipient, you are hereby notified that any dissemination,
distribution or copying:of this communications is strictly prohibited. If you have received this
communication in error,please notes me immediately by reply or by telephone at 800-762-1775 and
immediately destroy this faxed document.
Page 1 of 1.
rnv- vnunu nanKmg Page 1 of 1
(;y PNC Online Banking
Account Activity - - Monday.May 19,2014
Marian Williard—checking XXXXXX9301 Available Balance: $4,763.06
Pending Transactions
These transactions have been submitted to us since me last business day and are not yet posted to your account.
When they have posted,they will be reflected in your Posted Transactions,Pending items may affect your
Available Balance and are not a statement of your account.
Data Description Withdrawals Deposits
This account has no Pending Transactions
Posted Transactions
Date Descdpdan Withdrawals De
posits eaianpe
05/06/2014 INTEREST PAYMENT $0,05 $4,763.06
05/052014 CHECK 6216084750059 1=(vJC�U_S $375.08 $4,76301
05/022014 CHECK 6215051065927 ;A'iI ct SSt .y $306.00. $5,138.09
0 412 4/2 01 4 CHECK 6214077541514 ``,� S453,21• $5,444.09
04212014 CHECK6 83249249 (T $43.82• $5,697.30
04/172014 CHE 621207 24444 "�
•1 ( 1,20000 1.12
04/112014 ACH CREDITX)0=0908 IRS TREAS 310TAXREF $2,068.00 $7,141.12^
04/07/2014 CHECK 6211 035593559 $468.00 $5,073.12
04/072014 ACH DEBIT XXXXX5M1 UNITEDHCMEDICARE $44,90 $554112
MEDINSPYMT
04/04/2014 CALCULATED SERVICE CHARGE TYPE JD $15.00 $5,585.02
04/04/2014 INTEREST PAYMENT $0.03 $5,601.02
04/032014 ACH CREDIT XXXXX1166D SSA SSA TREAS 310 $1,195.00 $5,600.99
XXSOC SEC
04/012014 ACH CREDIT 007450 NATIONWIDE ROP PAYROLL 30 $1,075,99 $4,405.99
04/012014 ACH CREDIT XXXXX62W 10 10 US TREASURY 310 $1,130.00 $3,330.00
XXVA BENEF
03/172014 CHECK 6210 077044280 $2,918.83 $2,200.M
03/132014 CASHED CHECK 5209055775765 $468.00 $5,118.83
Fi..
0 Copyilmrt3010. 11 PNc cal, atnl5¢rvicn Graup,Inc NI WpM16 KeserveE,
NreE Melp?GA w at 1-86&PNCBgNK(163-Y265)
https://www.onlinebanking.pne.com/alservlet/DepositActivityServlet?account=//////////403/... 5/19/2014
PNCBANK
July 22, 2014 _
To Whom It May Concern:
Nancy Crown and Joseph Williard were added to account 5140069301 (formerly the account of only Marian
Williard) on 10/8/04. A copy of the signature card showing the handwritten note and date has been provided.
�V
A member of the PNC Financial Services Group
Adam Boyce
w .pncbank.com -
f Page I of 1
( PNCBAM
PNC Hank,.Natioml Association PH90807
ACCOUNT REGISTRATION AND AGREEMENT
Please read the following statement before signing. Under penalties of perjury,I certify(1)that the taxpayer identification
number shown on this form is my correct taxpayer identification number,(2)that I am not subject to backup withholding
either because I have not been notified that i am subject to backup withholding as a result of failam to report all interest or
dividends or because the IRS has notified me that I am no longer subject to backup withholding,and(3)I am a O.S.person
(including a U.S.resident alien).
Certification Instructions: Strike out item k(2)above if you have been contacted by the IRS that you are currently subject to
backup withholding because of under repotting of interest or dividends on your tax return and the IRS has not terminated that
notice. The Internal Revenue Service does not nVuire your consent to any provision ojthis document other than the
cerfi icadon required to avoid backup withholding
❑ Cheek this bex if you are a non-resident alien.
!rmnnf n_,�r�emrnr_py c,,�nUrg n v»n'#IS�L ry u$ineLhiF ACCnI_ top.or_aler iitg oneni»¢dote, agree to be legally bound
by the terms and conditions of PNC Banks Account Agreement for Checking and Savings Accounts and Schedule of Service
Charges and Fees,as well as other terms and conditions that may apply to my PNC Bank account,including thane related to
the Account Features described heroin.I agree that my account is subject to final approval by PNC Bank.If 1 have requested a
PNC Batik Check Card, Gold Check Card, or Banking Card, I agree to be bound by the terms of PNC Banks Customer
Agreement for such cards.If I applied for Overdraft Protection,I agree to be bound by the terms and conditions of the PNC
Bank Overdraft Protection.Agreement.For those customers residing in NI,PA,OH,KY and IN,accounts will deemed to be
opened in.PNC Bank,NA, .Accounts opened in DE are deemed to be opened with PNC Dank.Delaware.
- - - ACCOUNT NUMBER PRODUCT BRANCH DATE OPEN D I APPLI Ant N DATE 1APPMATI ON
I 5140069301 RC1t 106- 06/01/1969
MARIAN R WILLLARD t,r,_t,"---."-_
NANCY -CHOW
aavc
JOSEPH WILLIARD �X�Sign�._."
R
LEGALT Mr T_LN,NUMBER
WARMAN,R WILLIARD 193-14-6265
NANCY CROM 3430
JOSEPH WILLIARD e
53 H VINE STREET
SHIREt9eNSTOWN PA 17011
1645-014 addin3 atdulf d0(t9h+Cr sun
titcourl-} 05 join+ Oulrlef5.
Please forward this form via Red folder or interoffice retail to OF-Mall Stop:P7-PFSC-04-F
eaora.razuw.osrs .
https://www.ect.pnebank.com/eaiws/Eailmage5ervlet?imageType=front 7/22/2014