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HomeMy WebLinkAbout10-06-14 e , 1505610105 C. EX(a2-11)(FI) REV-1500 r OFFICIAL USE ONLY PA Department of Revenue pen^sytvanfa County Code Year File Nu Bureau PO 28o6vduatTaxes INHERITANCE TAX RETURN 91 r// �� PO BOX z8o6o1 ` /7 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date Of Death MMDDYYYY Date of Birth MMDDYYYY 148-26-5690 04/03/2014 02/1911932 Decedent's Last Name Suffix Decedent's First Name MI TAYLOR JR ALBERT E (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 OVALS BELOW COD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required s death after 12-12-82) Ob 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Twst) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 JANE E MURASKY (352) 205-7446 ti REGISTER OFF SLS USE 6aY �7 Pr1 r O First Line of Address .a =C n ti x- 592 SHERWOOD STREET Second Line of Address • ,-� .� r� p �i -~ n City or Post Office _ State ZIP Code DA T#FILED THE VILLAGES FL 32162 r c "' Correspondent's e-mall address: ENAJ007 tLDAOL-COM Under penalties b4Wqury,I declare that I have examined this return,inducing accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and niplete.Declaration of ampamr other than the personal representative is based on all information of which pteparer has any knowledge. F P RS N RESPONSIB FOR FILING TURN • DATE 09/22/2014 WOOD STREET, Till VILLAGES, FL 32162 J13NkATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: ALBERT E TAYLOR, JR :148-26-5690 RECAPITULATION 1. Real Estate(Schedule A). .............. ... .. ... .. ... ... . . ... ......... 1. ! _. .._ 0.00 j 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. 14,663.10 i 6. Jointly Owned Properly(Schedule F) O Separate Billing Requested .... ... 6. . 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. : 8. Total Gross Assets(total Lines 1 through 7)..... ...... .. ................ 8. 14,663.10 J 9. Funeral Expenses and Administrative Costs(Schedule H).. . .. ... ... ........ 9. 2,584.54 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule p..... ...... .... 10. 10,658.56 11. Total Deductions(total Lines 9 and 10)......... ........ ..... ..... ... .... 11. i 13,243.10 i 12. Net Value of Estate(Line 8 minus Line 11) . ... .. . .. .. ... ... ......... .... 12. 1,420.00 13. Charitable and Govemmental Bequeslsl5ec9113 Trusts for which an election to tax has not been made(Schedule J) .... ... .. ... .. ... ... .... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) .... ..... ... ....... ..... 14. ! 1,420.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 1 (a)(1.2)X.0_ 15.1 16. Amount of Line 14 taxable (- --' at lineal rate X.0 45 - u`- " 1-,420.00 + 16,1 63.90 17. Amount of Line 14 taxable at sibling rate X.12 17.i 18. Amount of Line 14 taxableat collateral rate X,15 ; 19. TAX DUE ........ .............. ................................... 19. 63.90 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1511 EX+(08-13) + �pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ALBERT E TAYLOR JR Decedent's debts must be reported an Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ROCAP SHANNON MEMORIAL FUNERAL HOME 1,840.00 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: S. Accountant Fees:. 500.00 6. Tax Return Preparer Fees: 200.00 7. COPIES, POSTAGE-MAILINGS OF INHERITANCE TAX RETURN(ESTIMATED) 44.54 TOTAL(Also enter on Line 9, Recapitulation) $ 2,584.54 If more space is needed,use additional sheets of paper of the same size. .. F . .. . REV-1512 EX+(12-12; IV pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENTr INHERITANCE TAY RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ALBERT E TAYLOR, JR 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. DARYLE GUITWITE,DO 124.02 NURSING HOME PHYSICIAN INVOICE 2. DAIKON LUTHERAN-CUMBERLAND CROSSINGS FACILITY 10,000.00 3. METLIFE INSURANCE COMPANY-MONTHLY DEBIT(APRIL THROUGH SEPTEMBER) 165.00 4. QUANTUM IMAGING&THERAPEUTIC ASSOCIATION 17,70 5. HOSPITALISTS OF CENTRAL PENNSYLVANIA 41.25 6. VETERANS AFFAIRS-MEDICAL BILL 1.87 7. HEALTH DRIVE PODIATRY GROUP-MEDICAL BILL 8,72 8. DCM SERVICES LLC-MEDIAL BILL 300.00. TOTAL(Also enter on Line 10, Recapitulation) $ 10,658.56 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: ALBERT E TAYLOR,JR RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(5)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I - TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under _ Sec. 9116(a)(1.2).1 I. JOHN TAYLOR SON 2/1 0TH 2 LOUISEAWALKER DAUGHTER 2/1 0TH 3 JANE E MURASKY DAUGHTER 2/10TH 4 DANYELLE SLOBODA GRANDDAUGHTER 2/1 0TH 5 JOHN DELLAQUILLA,JR GRANDSON 1/10TH 6 JODY DELLAQUILLA GRANDDAUGHTER 1/1 0TH ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHE; 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $ If more space is needed,use additional sheets of paper of the same size. CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 5.6(a) REGISTER OF WILLS CUMBERLAND COUNTY,PENNSYLVANIA Name of Decedent: ALBERT E TAYLOR JR Date of Death: APRIL 3, 2014 File Number: Date Letters Granted: To the Register: I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a)of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on SEPTEMBER 15 2014 Name: Address: JANE E MURASKY 592 SHERWOOD ST., THE VILLAGES, FL 32162 JOHN TAYLOR 115 B WEST CLINTON ST., CLAYTON,NJ 08312 DANYELLE L SLOBODA 639 N PEARL ST.,BRIDGETON,NJ 08302 LOUISE A WALKER 102 WHARTON ST.,MILLVILLE,NJ 08332 JOHN DELLAQUILLA JR 10410 N CONNECHUSETT RD.,TAMPA, FL 33617 JODY DELLAQUILLA 91. YORK ST.,BRIDGETON,NJ 08302 (]fmore space is needed attach separate sheet.) Notice has now been given to all persons entitled thereto under Pa. O.C. Rule 5.6(a)except: CYNTHIA L DELLAQUILLA,PREDECEASED DECEDENT Dare SEPTEMBER 15, 2014 7 apaCure a ersm Filing this Form city: 171 Personal Representative M Counsel JANE E MURASKY Name of Person Filing this Form 592 SHERWOOD STREET Address THE VILLAGES, FL 32162 352-205-7446 Telephone Form RVV-08 rev. 10.13.06 ti fa t i 'OOH . :-rlJ ,rate 3i,i.' .., 1' ..r o� a � t ,r x ' . 'tiS`.. i l'>3",_. .;W.1...... 2:: .. ,r. i' it i"�(i+`:°7 �i'•.',Sl� ;���34ark-,.,G t�..�i . ::�; ' . . ^t`• t.�.3 �!':" rS 't i f:" .f !'�J : ,1 i�j(�.e 1 fit, r �?,. .. '..,.�i' I Y '- 'i 1 ✓Ai,.;i.; Via. .., ', � ., ' _ is--'•; - _ .. H105.805 REV(9/11) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 Ili„or"° This is to certify that the information here given is �p�1H OF pfyy�! an duly filed with me asLo al Registrar. Certificate The ooriginal certificate will be forwarded to the State Vital v , � a Records Office for permanent filing. P 20550650 ~x''11 "g9lMENT OF�``P 'E" A'iZ�*r•`4p'r APA 5/2014 Certification Number ad rl Local Registrar Date Issued type/PCrnt In COMMONWEALTH OF PENNSVLVANiA•DEPARTMENT OF HEALTH•VITAL RECORDS x°pk` CERTIFICATE OF DEATH smte File Nlmher: 1.Q1 °Alber t Name Eh.t,Mltlme,Lan[.sunl.l 3465 0 Aprf ian IMO/oar/rO Stuff Mo) U. Taylor Jr_ 1 -26569 , 14 d ay(Vrzr Sb.U 6.Date o+BIrtM1(MO/Day/Vearr(Spell Month) a elrtM1Place rClty nne State nr Fnrelgn Count-I o a' .$Zan` rt� entb, t Davn Hn�r In„t February 19 , 1932 NewarX NJ U. Tb.6IrtnPlace gocnq) Fssex o a e I.....or...el6.....M ab.R .men=,(sve ane bar-me app[No.l ere at Live in .wnnmp/ PAe < 1 ,Long sdor£m Wary 1 yen,demtlentlmeama SOUth Middleton <-P Rd.R ¢County, Cumberland e(zro<ade) 013 ONO,aeedenl u�ca wimin rlmi<.m =Itv/hero. mere I c M ar 51,11,x Time of Drum F M ¢a Wmowee survrvmg spouse z Name(Ir wire,,roe name prior ra final manage) §Q. Uo r o U 1OO o tee o N lee rNO U -ame..Name IFI-r.M1ema.Lan[ 5.111.) o nga'11UL Mleme,Lan) - z Albert Eturre M. Tay1Or Sr_ aalanche ,Bari! n.nlptoD .....t nmrenls[ r.slate,zlP Cean) AaJane =E_MUrask 1zDaughtera 1592 mSherwood St- neTtn ae Villages, FL C _ n oa red Ina He.vmal: d _ _ _ _ _ _ _ _ _ _ ere--,where Other Tn-a H_ _ _ - - -tn„ _ c adnn _ _ _ ti oe<eae� z1m6.2_ f paame.R ohm/OCtpaeeof non I f De W D.D.I.,Home/L. R-Term Ca facility I'o Omer(speeifvle .Ezauty h'n me nr nnl lnnn[1eon.e” tan nunmegli rss<.Oty or Town.s e.old Zip Code¢ cse.County nr D¢am _ emea err DI.P.cm.. o E e 1em,1w. 266.Date of Di.nenmaion <.PIa<e of .Pea<m ame.r<eme Cumberland AS I ` 6 o a m val r.em state =o P.-Po R c _ 1E DI n w mrv,<.emamrv.o.ocher plate) R eo ome.ISPearvl 4/5/2014 Hollinger Funeral Home S Crematory Ge.Location of Dizcla<nn(cry oc Town,state,and ZIP) irr-1-1 It F-1 se,or Penon In C e,-of I-th-r- nt vb.Llcense Numb r E 1Mt_ Ho17.y Springs, PA 17065 1J�1 J-.- - 011589Le ane temple,Aaare.of Flneal Fa=niw - o nger user, ame rem, ory, 17 5 m v Mt Holl S rin s PA 17065 x[be,be"hen<.roen me origin-c k me Decedent'. check ONE OR M.PC race.m lridi-be, m Mghes[eeeTe Eor I eyeioa1n hba¢a<ik<omamt¢a a1 me Pm¢or road, been Delete-best,,vibes iwhe De,,team[c-dreoea bimnevn,netaeifto be M Rm e.aae or let, Izb/HI m/w enee`x the Wbire o K o No mebute,em-2zm F-de, of spare./Hi.Panrc/Letno. o R o V bilf H of.,ad..,.or G ED completed �Na sn/Hi r</La o A Indian n 11 Aiazka Native o O<hepaIdm M s donee¢<.emq For net dogs, o let.Meis[llon.M nn Amelcan,Chicano o n Indian o plan- o A edegrae(e. As) o v <a. o C o c or CM1amn.rn M R ¢(peg 9p,AR.RS) o y Cubes R D F o 5 M M degree(I.E.M pn) o v ,error 1Panbh/HISPamdLa6no o m an¢a o .,be,avaan=I.ianaer o D 1¢(c g.PhD,E.C'or Fr 1-fr n^r,ergs,¢ M ,(Speedy) o Ome(sped,) IN smRle R O71t9 Ir-D¢nlRna DEC m Irritate a tle<eaen!<ennaece elmnetrerr nerneir m be. a npe a+work 21Oedbprz nnO-Ch ens net during mazr of working fe^DO NOT USE RETIRED. O Rack or AfNCa.AmaNC p K O OtheaPa=Iflc I.I¢nde 9 pA anm nor Am-k,Dart- ovetnam... oD -/Net SCre nMO<ld Maker M n :,mantl1 IM erne Anh- o R n n „d-h-1. 1a o CJnece o N wa ban o Oth,,(Spe=iro) o mmine o Co. Manu£ac turf ng sae MUST BE COMPLETED e.e(M1/Dav/vr) .`1A s ,.re 11 Pe.nn r =Ind Death(only-ben appe<amel _. me �m err OR CERTIFIES R pea lMe/DO/r.)Ea D netu2j un ruN E+3'�39 --2©/ /FT/t 25-W zMemcal Examiner or Coroner Coon«,,) U Sea }a!Go CAUSE OF DEATH oxima<e 26.P rt I. Enter the chain or ev.n![-tll.eezes,In)une.,o.campllca[lonz--mar elrectly taus¢,[M1e eeatM1. p0 NOT enter!ermine!events such as caralac arrest, rval: renpi-t-, rr,,t.or vencrlcular fibrillation without the ellolo6V. DO P..EIIATE. Enter only one neon tl net....... D.-tn°eat mout NO' e. Aetl,eel e 1 Inter au ells sal line.if , O h ,rMMEDIATE CAUSE --------------- E .a D1e<e(err ane lnnneacn <e nn: .eneleng 1.tleaa;i n is...nzt ceneiann., Due-o'as a<nnneGpan<e of): u any. .ern l e Co.1e her I.a cen.ea.er...f): <e�ea Re o.�m�pVn,r le ereace)`us.en[n reambng Dce m for on n<oncewen<¢rd': S26.Part If Enter other siemeca x enm t em thin,bat m,to roam hot not r¢nwtlne In the uneenving tale,Rben In Part i. a tl2 No uto a "on v o octopi mz male: .le Tobacco e Cen<rfaut.[o D °e5 cause No S IfOPe Do,p-,m-1-It M1ln P.O'a..' O O.O Pro a ea[M1i 1.Mac lees! earn M H miciee of,sera Unknown Q A P ntlingoin .)Radon m p N z rays o;aeaote<de o eII Mc o sm<me` o cobra t be ape-freer. o N b . aa, n.1i.ry(M./Davr.usP !w o U.1 Pewp n wean..!-Rhle the Fall ve.1 1A, 1Im¢.1-1.1 34.place o+miury(ere.name:=o,,t...do,cite farm:s=noop lo-bo.of I.h.,(Street and Number,City,county,state.alp Code) injury of Work e -0......d: O v O et O N o O Ut a.(.m Dsrb u eym err(a<eck only one): se(z)and m E! P mly se$T of my k_ o!mvek�ow�eage,eesm occuvee m me bma,data,sad piece and Cue to me=acne(.)and m 6+ o Maracee.m�.�•/termer-on< inatmn ane/o.In-ItSpibon.In my opinin,Beam /�.rred 11 me Ice,ear¢,and place,,a doe m the tame(,)and mane ame. 1 Signature of comfier: Ca TRIe of c-1111.1. 0 Number: r ��+jc r- L Address and Z4p Cede a+ Death pamyl Guistewite s IMe/DaV'd e 56m Ashton St_ Carlisle¢ f PA 17015 'f/ .R .our.,,TOI umh¢r .RngNrrar a 5� t�w `U Amendment, .ap—d—Pe.mlt No f.(93hOa\ RE./'o�16 nau TO: Whom It May Concern FROM: John W. Sloboda DATE: 5-11-2014 RE: Relinquish Executor Dear Sir, My name is John W. Sloboda. I currently live at 639 N. Pearl St. of Bridgeton, NJ 08302. On 11-2-2008, 1 was made the primary POA/ Executor and the person identified as the agent for Albert E. Taylor Jr. I appointed my sister, lane E. Murasky, as my alternate. This was recorded with the Salzmann Hughes, P.C. Law Firm at 354 Alexander Spring Rd. Suite #1 of Carlisle, PA 17015. I am currently not able to serve as Executor for Albert E. Taylor Jr. so I am relinquishing all my responsibilities of this title as Executor to my alternate, Jane E. Murasky. John W. Sloboda r 124-h � 2e /�Ay OFFICIAL SEAL igwes �� NOTARY PUBLIC STATE OF WEST VIRGINIA TROY DUNN R, •C )i CITY NATIONAL DANK 39 RAYMOND PEAK WAY HURRICANE,WV 25526 "°` U "MMI on o� UeB AUpust 7B,2916 LAST WILL AND TESTAMENT I, ALBERT E. TAYLOR JR., of South Middleton Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ONE. I direct my Executor or Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executor or Executrix of my estate. Further, to the extent that sufficient assets exist in my D estate, any and all inheritance or other estate taxes, whether to non-charitable or charitable beneficiaries, shall be paid by my Executor or Executrix from the residuary of my estate. --� TWO. My Executor or Executrix may, at his or her discretion, compromise claims, borrow money, retain property for such length of time as he or she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he or she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically 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 I could do if living. My Executor or Executrix 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 Executor or Executrix. L. � . ,. , . �. . � , 'i "' � � _ ... _. I . . t� .i THREE. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my spouse, JEAN H. TAYLOR. FOUR. If my spouse, JEAN H. TAYLOR, does not survive me by a period of at least sixty (60) days,then I give, devise and bequeath the rest, residue and remainder of my estate equally to my children and stepchildren, JOHN W. SLOBODA, JANE E. MURASKY, LOUISE WALKER, CYNTHIA DELAQUILLA and JOHN TAYLOR, per stirpes, which provides that the child or children of any deceased beneficiary shall take the share their parent would have taken if living. Provided, however, if any heir or beneficiary is under the age of twenty-five (25) years at the date of my death, then his or her share my estate I give, devise and bequeath, to be held IN TRUST in accordance with the terms and provisions of Paragraph Five hereunder. FIVE. If any heir or beneficiary is under the age of twenty-five (25) years at the date of my death, then his or her share of my estate I give, devise and bequeath to be held IN TRUST by the hereinafter mentioned Trustee according to the following terms and conditions: C� Upon the creation of this Trust, the Trustees shall divide this trust principal into individual shares in the name of each heir or beneficiary in the amount equal to the amount that said heir or beneficiary inherited hereunder. The Trustee, as well as my Executor or Executrix, as the case may be, is hereby authorized to retain, unconverted, any property, real or personal, that I may own at my death and shall be under no duty to convert it into legal investments. The Trustee shall have the power and authority to sell, transfer, convey, invest and reinvest and to pay over the net income of the trust property, to or for the use of said heir or beneficiary, or to accumulate it in the sole discretion of the Trustee. The Trustee is also authorized and empowered to pay over to, or for the use and benefit of my heir or beneficiary such portion of or all of the principal of the trust estate 2 a'. r . _ ... �,. _. �i� - 1 ' ... .... . .. .tf.: . . . , 'nor. . . ,., ,. c, � . as in the Trustee's sole discretion seems proper for their continued support, maintenance, education, medical care or general welfare. My primary objective is to ensure the continued support, maintenance, education and medical care of said heir or beneficiary until he or she reaches the age of twenty-five (25) years. Notwithstanding the above purpose of this trust, the Trustee, in the Trustee's sole discretion, may distribute any portion of the income or principal of the trust estate over to any said heir or beneficiary who has attained the age of twenty-five (25)years prior to the ultimate distribution hereof as the Trustee deems proper for the health, maintenance, education or setting up of said heir or beneficiary in a business or in a profession or for similar purposes. The Trustee shall be under no duty to distribute or use the principal equally for each of the said heir or beneficiaries, but may distribute or use principal unequally in its discretion. When each heir or beneficiary reaches the age of twenty-five (25) years, then whatever remains of A Rincome and principal of his or her trust estate shall be distributed to said heir or beneficiary, per stirpes, which provides that the child or children of any deceased child shall take the share their parent would have taken if living. SIX. I hereby nominate and appoint JOHN W. SLOBODA to be the Executor of this my Last Will and Testament. In the event he has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint JANE E. WRASKY to be the substitute Executrix of this my Last Will and Testament, whereby the said substitute personal representatives shall have the same powers as are given to the original Executor hereunder. SEVEN. I hereby nominate and appoint ORRSTOWN BANK, or its successor to serve as Trustee of the trust created in Paragraph Five hereof. 3 . � f . ���� ��. ,. �:. ,� . .. .., . ,: . t:_ , . . .. , �; _ , . :� . . 'r . ... . �:; ,� � .,. � ., � �. _ . ,� , r � . .. �•. .. i .. 1'. i f _ . ..1.. r ... N" � . e EIGHT. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty(60)days. NINE. No Executrix, Executor or Trustee acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. TEN. No beneficiary may assign, anticipate or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. ELEVEN. If any person or institution entitled to share in any distribution under the terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its entire interest inherited hereunder and all provisions in favor of such person or institution shall be declared void and of no effect. The share of such person or institution so forfeited shall be distributed as part of the residue hereof except that if such person or institution is entitled to share in the said residue, that interest shall be distributed proportionately to the other residuary distributees. TWELVE. It is hereby my intent to specifically exclude my son, Robert Taylor, and his issue, from any inheritance whatsoever under this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this �, day of October, 2008. W r (SEAL) ALBERT E. TAYLOR". 4 . t� 1' � �� � '�. � � fi -Y . Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our n as subs sses. 5 ACKNOWLEDGMENT AND AFFIDAVIT WE, ALBERT E. TAYLOR JR., JAMES D. HUGHES and SUZANNE M. KREIDER, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will, and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. w�'a '�".�L L, E. TAYLOR 4ANNE HES " (]SU KREIDER COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by ALBERT E. TAYLOR JR., the testator herein, and subscribed and sworn o before me by JAME D. HUGHES and SUZANNE M. KREIDER,witnesses,this day of October, 2008. f jN`�✓ ry Public � �, yt F, a{� 1. . .. . � i JEAN G. SHANNON,C.E.O. ROBERT J. SHANNON, President/Licensed Manager, NJ#3163 JAMES T.SHANNON,Sec'yrrreas., NJ#3913 E.TINA SHANNON, Director, NJ#3912 �aca� J�taszi2art ���e�rea�ca���i,�rfe�a���e A New Jersey Corporation 24 NORTH SECOND STREET MILLVILLE„NEW JERSEY 08332 Phone: (856) 825-0781 FAX: (856) 825-8275 21 APRIL 2014 DEAR MRS. MURASRY, THANK YOU FOR YOUR RECENT PAYMENT, THE ORIGINAL FUNERAL BILL FOR MR. ALBERT E. TAYLOR, JR., IS PAID IN FULL. IF YOU NEED ANYTHING FURTHER, PLEASE CALL OUR OFFICE. $ CERELY ROB SHANNON •FIVE GENERATIONS SERVING THE MILLVILLE AREA RoCAP SMA-1s,"CINT, MEMORIAL Fl.-N'ERAL HOME OPTIONAL PACKAGE SERVICES(it an optional package service is selected,categories 1-111 are not applicable.) AN'Ev, JER.5EY COKPO�ATIQN 23 NORnt Sr, M; %!_E.NJ 08332 1 Direct Cremation.................................................... $ pHo,N, F.A>:: ,S56)825-8275 2.Immediate Burial.... ............... .................. 3.Other.................................... ...... .................... Lu:EN�ElS J. S9A',NON,NJ#3913 Jr cN G.SHAN\,,N.NJ-1 Fo;A SHANNON,NJ 43912 SUBTOTAL:Optional Package Services................ TCLCup5j',ajm0n+Paoi.cora IV.MERCHANDISE File 17 Casket or Alternative Container: Arrangerti Manufacturer I.. Quote Only F2(At Need L1 Pre-Need Model namesnumber INFORMATION ON DECEASED Kind of woodimetal— wi./gauge Name: W>1JIM�' %,� Interior Address: Vault/Outer Burial Enclosure. City: Zip:State: Deceased's DOB: 11 - Sex: F Manufacturer l*, F Model name/number Material Place of Death: Um Date of Death: _q :3 - 7 Clothing.................... ........ ...... STATEMENT OF FUNERA L GOODS AND SERVICES SELCTED Prayer Caurds..< —7TL,C_ Changes are only for those items that you lected or that are required. Acknowte ........... ----- It we are required by law or by a cemetery or crematory to use any lienne, Register Book we will explain the reason in writing below. Miscellaneous items of Merchandise(specify) 1. PROFESSIONAL SERVICES I. TEMPORARY MARKER Basic Services of funeral director and staff............ Special Services of funeral director and staff(specify) 2. 3. 2. CA 7z 6— SUBTOTAL:Merchandise....................................... $ Embalming(Chemical Preparation)..................................... If you selected a funeral that may require embalming,such as i TOTAL FUNERAL CHARGES(I-IV&Packaged Services)... $ limenil with viewing,you may have to pay fee embalming.You SH D SBURSMEHIS4Estimated) do not have to pay viewing, embalming you did not approve if you selected arrangements such as a direct cremation at immediate $ burial.if we chirged fur embalming,we will explain why brow. e;F.F:�ty-'6otl(or Church....... .............................. ams, Other Preparation of the Body I -an at andlor Soloist........... ................. Sanitary Care,without embalming.......................................... Other(specify) Certified Copies of Death Certificates and PemM Fee...... 1. Dressing,CaskeHng Cosmotology......................._.._. . Newspaper Notices 2. t. 3. s� C' SUBTOTAL:Processional Services....._.......................... I$ Gratuities(specify) It.OTHER STAFF AND RELATED FACILITIES Use of Facilities,Staff and Equipment for. Ocher(specify) Visitation(viewing).......................................................... $ 1. MARKER (R) (VA) Funeral Ceremony...................................,............ 2. Memorial Service.......... .................................... } 3. Graveside Service(including accompaniment of remains !^� to place off _.. final dispostfon.)..................................... _.,. SUBTOTAL:Cash Disbursements... ................ Sheltering of Remains........................................................ Other(specify) TOTAL ESTIMATE(I-V&Package Services)... 1. NIGHT BEFORE 12 HOURS IFANYLA W, eamerery or cremarery regui have required the amItass of 2 any of the Bens listed above,ilia law or r nts is described belovt.•�. _ [ ] Crematory requires container t mound the remains. 3, [ Your CetauthoNzed. s an o burial container.e��;Other: SUBTOTAL:Oilier Stall and Related Facilitlea...._..._...... .r REASON FOG: ) [ ] Family III.TRANSPORTATION 1 ( J Other: Transfer of remains to funeral home................................... F I ha Pared the above Statement otFuneral Goods and Sm Jces Selected: Use of: Hearse.............. ................................................................ ;Print ame of Pratiy .ran ense# —1-P"— Limousine(s).................................................................... Flower Cents)............................_.......__........................... n 're of clitioner Family Car(S).............. ..................... the ;eceivW Py of the Stalemem of Funeral Goods amf Smiees Selected: Other(specify) LEAD &CLERGY r --------- � .�YYr•� at a of Pars king rangements Date —f— eI i Ip to Deceased /I t SUBTOTAL:Transportation.................................................I$ � � /- 1 145 4th q- 4-G.IN;)7lZLj St tAtl ress y �•� (White)Funeral Home (Yellow)Purchaser I State Zip , ggq DARRYL GUISTWITE,DO (717)609-2639 56 ASHTON STREET CARLISLE,PA 17015-6914 i i Albert E.Taylor 11360 02/19/14 1 MED C/o Jane Murasky 592 Sherwood Street The Villages,FL 32162 i i CPT4 12/27/13 99308 Nursing Home Est.Patient Level 2 DG 1 80.00 13.15 Patient:Taylor,Albert E- 11360 Servicing Provider:Darryl K Guistwite DO. 01/29/2014 Medicare 51.55 15.30 01/03/14 99307 Nursing Home Est.Patient Level 1 DG 1 68.00 43.58 Patient:Taylor,Albert E- 11360 Servicing Provider:Darryl K Guistwite Dd 01/28/2014 Medicare 0.00 24.42 Applied towards deductible 01/06/14 99308 Nursing Home Est.Patient Level 2 !DG 1 80.00 67.29 Patient:Taylor,Albert E- 11360 Servicing Provider: Darryl K Guistwite DO: 01/28/2014 Medicare 0.00 12.71 Applied towards deductible 124.02 Please pay within 30 days...thank you Albert E.Taylor 11360 228.00 45.30 229.12 124.02 Darryl Guistwite DO 56 Ashton Street•CARLISLE,PA 17015-6914 72 .:� ,� . , . ._, �. � . , ..,.. �,::. �,n. . �,. .. _ _ . . � � , ... . �.. : .. , RESIDENT FUND MANAGEMENT SERVICE STATEMENT DIAKON LUTHERAN SOCIAL MNSTRS ACCOUNT NUMBER: 403401214 1 LONGSDORF WAY CARLISLE, PA 17013 FACILITY RESIDENT IDENT: 3138 ALBERT TAYLOR QUARTERLY STATEMENT FOR THE PERIOD JOHN SLOBODA 04/01/2014 THRU 06/30/2014 639 NORTH PEARL STREET BRIDGETON, NJ 08302 REF BATCH&SEQ TRANSACTION DESCRIPTION DEBITS CREDITS DATE BALANCE BEGINNING BALANCE 04/01/2014 0.00 D-APRILDDI AUTO PMT-M&T BANK 200.00 04/24/2014 200.00 D-APRILDDI CARE COST AUTO WDL 200.00 04/24/2014 0.00 D-APRILDDI AUTO PMT-M&T BANK 2400.00 04/24/2014 2400.00 D-APRILDDI CARE COST AUTO WDL 2400.00 04/24/2014 0.00 D-APRILDDI AUTO PMT-M&T BANK 2400 .00 04/24/2014 2400.00 D-APRILDDI CARE COST AUTO WDL 2400.00 04/24/2014 0.00 D-MAYDDI4 AUTO PMT-M&T BANK 200 .00 05/14/2014 200.00 D-MAYDDI4 CARE COST AUTO WDL 200.00 05/14/2014 0.00 D-MAYDDI4 AUTO PMT-M&T BANK 2400.00 05/14/2014 2400.00 D-MAYDDI4 CARE COST AUTO WDL 2400.00 05/14/2014 0.00 D-MAYDDI4 AUTO PMT-M&T BANK 2400.00 05/14/2014 2400.00 D-MAYDDI4 CARE COST AUTO WDL 2400.00 05/14/2014 0.00 ENDING BALANCE 06/30/2014 0.00 SUMMARY: 6 CREDIT(S) TOTALING. . . . . . . . . . . .10000.00 6 DEBIT(S) TOTALING. . . . . . . . . . . .10000.00 YEAR-TO-DATE INTEREST PAID. . . . . . . .0.00 The Resident Fund Management Service is a service of National Datacare Corporation and Wells Fargo Bank. All accounts are held at Wells Fargo Bank,an FDIC insured financial institution. This statement was prepared by National Datacare using transactions provided by the facility. If you have any questions regarding your account,please contact the business office at the facility. �. t °� . i. .� � �. .. 1. .. . . �. r .. .. Patient:ALBERT E TAYLOR JR Account: 642213 Services Rendered At: CAR Date Code Description Charge Adiu tm nts Balance 12/15/2013 73120 XRAY HAND 2 VIEWS 32.00 1.60 1/24/2014 PMT MEDICARE-NOVITAS SOLUTIONS 6.27 1/2412014 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 24.13 12/15/2013 70450 CT SCAN BRAIN W/O CONTRAST 198.00 6.01 1/24/2014 PMT MEDICARE-NOVITAS SOLUTIONS 23.57 1/24/2014 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 168.42 12/15/2013 72125 CT CERV SPINE WO CONTRAST 238.00 10.09 112412014 PMT MEDICARE-NOVITAS SOLUTIONS 39.53 1/2 412 01 4 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 188.38 ^- G 0 n r. Current 31 -60 91 -120 Over 120 BALANCE DUE $17.70 0.00 17.70 1 0.00 0.00 0.00 PAY BY Due Upon Receipt For billing questions call: (717)932-5955 or: (877)932-5955 Fax: (717)932-4856 Office Hours: 8:00 AM-4:30 PM To pay your bill online and register for eStatemer STATEMENT (VIII III�I IIIIIINII�IIlllilll II I I II II SEE REVERSE SIDE FOR IMPORTANT BILPLING INFORMATION""glta.com I I 19670-373 ................................................................................................................................................................................................................................................................................................ GUARANTOR NAME AND ADDRESS IF PAYING BY VISA.MASTERCMD OR D19COVER.FILL Our BELOW ALBERT E JR TAYLOR 73 MAGAW AVE uqo EIVISA 0Mrzm,,m 0MCOVER® CARLISLE PA 17015-7618 ea uusr:rvcwDESacn SECLggY CCOE FPOM �q DF CAPD Final Notice Date: 3124/2014 Patient Name: ALBERT E TAYLOR JR Re>mt To: Account#: 642213 Balance Due: $17.70 Quantum Imaging and Therapeutic Associates P O Box 62165 Baltimore,MD 21264-2165 I.IIIIIIIII..111111...II.I.II�I���II�II���I�iIIIIII�I�IIII���i IIIIIIIIIIIIIIIIilllllllllll�l�llllllllllllllllllllllllllll 19672-132 AR—ctstnt #: 1403 09 Please Pay: $41 .25 Due gate: 05/01/14 Payments Date Description Amount Adjustments BALANCE FORWARD LAST STATEMENT 0.00 12/16/13 12/17/13 99232 HOSPITAL DAILY VISIT 300.00 01/06/14 DEMP DEMO DENIAL PRACTICE 0.00 01/28/14 MCCK MEDICARE CHECK -107.69 01/28/14 MCDS MEDICARE DISALLOWANCE -164.84 12/18/13 99238 HOSPITAL DISCHARGE T 138.00 01/06/14 DEMP DEMO DENIAL P ICE 0.00 01/28/14 MCCK MEDICARE CK -54.02 01/28/14 MCDS MEDICAR DISALLOWANCE t -70.20 A Word About Your Account Total Now Due 41.25 Make Checks HOSPITALISTS OF CENTRAL PENNSYLVANIA For Bllling QueStlo Gall Payable To: PO BOX 62722 (888) 610-8 322 BALTIMORE, MD 212642722 PAGE 1 OF 1 00,529 � t i � . . . n ... � r t . 1 e — Y �I1 �. . 1 �..} � _ .. �- VA LEBANON VA MEDICAL CENTER (595) LJ.S. Department 1700 S LINCOLN AbE LEBANON PA 17042-7597 Veterans Affairs i STATEMENT QUESTIONS OR ADDRESS CHANGE? 1oz 1091553 00 0069224 0138447 cats 1-866-408-2657 � III III,6dIii III ISO III III1111'1'11i111511'IP11111111[11111111 Methods of payment: ONLINE: www.pay.Qov ALBERT E TAYLOR BY MAIL: t0 the address below 73 MAGAW AVE IN PERSON: at the VA Medical Center CARLISLE PA 17015-7618 PAY BY PHONE: 1-888-827-4817 Statement reflects payments received by 04/10/2014 PATIENT NAME: ALBERT E TAYLOR LOCAL VNS MESSAGE. ACCOUNT NUMBER: 595 0000 0000 98824 TAYLO STATEMENT DATE: 04/14/2014 " ACGpU1�1T PtiEV}�lE BP LANBE- �P YEfVTS;i# CE1VE0 '::: NEtN;�HANGES TO AVOID LATE SIJMAAABY CHARGES PAY BALANCE 72.75 70.88- .00 " BY 05/09/2014 1.87 DESCRIPTION ;AMOUNT... BII L1NG; tFERENCE PAYMENT POSTED ON 03/27/2014 12.75- 595-K4o8L]u PAYMENT POSTED ON 03/27/2014 15.00- 595-K408QYB PAYMENT POSTED ON 03/27/2014 43. 13- 595-K4o8SE2 LA``*llllll9 PAYING BY MAIL OR IN PERSON? DETACH THE COUPON BELOW. DO NOT INCLUDE ANY CORRESPONDENCE WITH PAYMENT. ; . _, f � t � � a' i a r 7 � � t 1 -- v.. � .. --- - --- ---------------- ----------------------- -- ----------------- Service Dx Procedure Date Provider Name Code Code Description Charge Payments/Adj. Balance 03!03!2014 Marques 735.4 99307 Level 1 Exam- New 64.00 64.UU MEDICARE PA Payment ($34.16) $29.84 MEDICARE PA Adjustment ($21.12) $8.72 To the best of HealthDrive Podiatry Group's knowledge, this patient has no other available insurance coverage or other liable third party coverage for the service(s) being billed. CURRENT 1 25 DAYS 1 50 DAYS 75 DAYS $ 8.72 1 $ 0.00 $ 0.00 0 Balance Due Insurance Information on File: q e Date 0611 8/2 0 1 4 MEDICARE PA 148265690A I 4se� 7 6t)I PENN AVE.S,r �JUITE A6�MINNEAPOUS, MINNESOTA 55423-5004 Y August 27, 2014 Re: the Estate of Dear Sir or Madam: C ALBERT TAYLOR On behalf of our client Omnicare King of Prussia, we offer condolences for the loss of ALBERT Our Client: TAYLOR. Omnicare King of Prussia We are contacting you only in your capacity as Personal Representative or attorney for the Estate of ALBERT TAYLOR. We are attempting to collect a balance due from the assets of Account #: the Estate and any information obtained will be used for that purpose. As of the date of this ***********-304 letter, the Estate owes an unpaid balance of$804.49. Please note that the unpaid balance may change based on Insurance payments or adjustments or other invoices not yet billed. Reference #: We will inform you of any.balance adjustments. 10324834 Please understand that itis DCM Services'/Omnicare King of Prussia's policy to inform you that only the Estate is responsible for any outstanding balance on this account. Please accept F this letter as a Notice of Claim on behalf of our client. Please contact us. On behalf of the Estate, you may: 1. Complete the payment slip below and mail it and a check made payable to DCM Services LLC in the envelope provided. DO NOT SEND CASH. 2. Cali us toil-free at 1-877-326-5674. We have a number of payment options available. 3. Call us with a probate case number and/or trust information, if applicable. Calls may be monitored or recorded for quality assurance purposes. i You have the right to dispute the validity of this debt or any portion of it. We will assume this debt to be valid unless you do so within 30 days after receipt of this letter. If you do so in writing within that time frame, we will obtain verification and mail it to you, If you send a written request within the same time frame, we will provide you with the name and address of the original creditor, If,different from the current creditor. We invite you to check out www.MyWayForward.com. This non-collection-related web site offers great information for those handling the final affairs of a person who has died. Topics range from requirements to well-being and remembering the deceased. If you are not the one handling decisions about the outstanding bills of the Estate, fill in the 7 am-7 pm CT M-TH form at the bottom of the reverse side of this letter and return it to us in the envelope 7 am- 5 pm CT F provided. Respectfully, Telephone; 612-243-8640 DCM Services, LLC Toll-Free: 877-326-5674 Fax: 877-326-8784 NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2- *-Detach Lower Portion and Return with Payment"' DCM SERVICES, LLC 7602 PENN AVE S, SUITE A600 Reference #: 10324834 Client ID: QOMN31 p MINNEAPOLIS, MN 55423-5004 ADDRESS SERVICE REQUESTED Checks Payable to: DCM Services LLC II� � 11 ��,n 1Vf1�lIV�I Amount Enclosed: $ August 27, 2014 �t � '�, f f}� Ull M55-$25 The Estate of ALBERT TAYLOR pO DCM f3oxr9317s payment Processing Attn:JANE MURASKY 592 SHERWOOD ST Minneapolis MN 55440-9317 THE VILLAGES FL 32162-1602 1,6I„Id,d„Irlr,Illy„Idr,,,I6t„111r,rhrrlll,rd,Irrll 10324834 -304 25 ALBERT E TAYLOR JR 592 SHERWOOD ST STATEMENT PERIOD: MAR.28-, PR.25,2014 THE VILLAGES FL 32162 INTEREST EARNED FOR STATEMENT PERIOD 0.00 ACCOUNTSUMMARY BEGINNING DEPOSITS& CHECKS PAID OTHER CURRENT ENDING BALANCE OTHER ADDITIONS SUBTRACTIONS INTERESTPD BALANCE NO. AMOUNT NO. AMOUNT NO. AMOUNT 13,239.9 5 3,853.98 7 4,856.85 5 5,098.38 0,01) 7,138.74 ACCOUNT ACTIVITY POSTING TRANSACTION DESCRIPTION DEPOSITS INTEREST CHECKS 8 OTHER DAILY DATE I&OTHER ADDITIONS SUBTRACTIONS BALANCE 03-28-14 I BEGINNING BALANCE I 1 1 $13,239.991 03-28-14 I VETERANS AFFAIRS PAYMENT 000000000002234 I 1 $70.881 1 03-28-14 1 CHECK NUMBER 2240 ( ( $1,191.551 $11,977.561 03-31-14 1 IRS TREAS 310 TAX REF 1 $1,522.001 1 1 03-31-14 1 CHECK NUMBER 2235 1 1 $949,781 1 03.31-14 1 CHECK NUMBER 2241 04-01-14 1 FIDELITY INVESTM PENSION 1 1 $200.001 $12,349.781 0401-14 1 CHECK NUMBER 2238 1 $342 321 1 1 04-03-14 1 SSA TREAS 310 XXSOC SEC 1 1 $51.501 $12,640.601 I j $1,315.001 i 1 I Welcome to M&T Online Banking Page 2 of 2 04-03-14 1 WEB PMT METLIFE INSURANCE CO D4�` $27,501 $13,928.101 04-11-14 1 CHECK NUMBER 2237 11. 0411-14 1 CHECK NUMBER 2243 7.50$2i $500.001 $13,304.081 04-15-14 1 WEB PMT REFUND 4P3 METLIFE INSURANCE CO i ir�l 04-15.14 1 RIO TINTO ALCAN PN PMTSICC 1 $$27.161 1 $13,978.741 04-18-14 1 CHECK NUMBER 2242 (f i 1 04-25-14 1 DIAKON LUTHERAN DBT#3X0424 $1,840.001, $12,138.741 i 1 $200.001 1 04-25-14 1 DIAKON LUTHERAN DBT#3X0424 1 (�/ k //$2,400.001 1 04-25-14 ( DIAKON LUTHERAN DBT#3X0424 1 FJj� Y `\ $2,400.001 $7,138.741 ENDING BALANCE 1 I I $7,138.741 CHECKS PAID SUMMARY 72240* DATE AMOUNT CHECK N7!7 AMOUNT CHECK NO. DATE AMOUNT 03-31.14 949.78 2237' 124.02 2238 04-01-14 51.50 03-28-14 1,191.55 2241 200.00 2242 04-18-14 1,840.00 04-11-14 500.00 v 0 592 SHERWOOD ST STATEMENT PERIOD: APH.28-MAY.2/,2074 THE VILLAGES FL 32162 INTEREST EARNED FOR STATEMENT PERIOD$0.00 ACCOUNTSUMMARY BEGINNING DEPOSITS& CHECKS PAID OTHER CURRENT ENDING BALANCE OTHERADDITIONS SUBTRACTIONS INTERESTPD BALANCE NO, AMOUNT NO. AMOUNT NO. AMOUNT $7,138.74 0 $0.00 0 $0.00 4 $5,027.50 $0.0 $2,111.24 ACCOUNT ACTIVITY P�ATEG TRANSACTION DESCRIPTION IgO SERADDI noNs SUBTRACTI NSR I DAILY BALANCE 04/2612014 1 BEGINNING BALANCE I I 1 $7,138.741 05/05/2014 I WEB PMT METLIFE INSURANCE CO 1 I $27,501 $7,111241 05/15/2014 1 DIAKON LUTHERAN DBT#3X0514 I 1 $200.00 0511512014 1 DIAKON LUTHERAN DBT#3X0514 1 $ 00.00I J 1 05/15t2014 I DIAKON LUTHERAN DBT#3X0514 1 V�� $2,400.001 $2,111.241 ENDING BALANCE I I $2,111.241 ALBERT E TAYLOR JR 592 SHERWOOD ST STATEMENT PERIOD: MAY.28-JUN.27,2014 THE VILLAGES FL 32162 INTEREST EARNED FOR STATEMENT PERIOD$0.00 ACCOUNTSUMMARY BEGINNING DEPOSITS 8 CHECKS PAID OTHER CURRENT ENDING BALANCE OTHER ADDITIONS SUBTRACTIONS INTERESTPD BALANCE NO. I AMOUNT NO. AMOUNT I NO. I AMOUNT $2,111.2 1 1 $67.67 2 1 $29.37 $0.0 $2,041.70 ACCOUNT ACTIVITY P O- TRANSACTION DESCRIPTION I!!,OTHER ADDITIONS SUBTRACT NSR BALANCE 05/28r2014 1 BEGINNING BALANCE 1 1 1 $2,111241 06/0312014 1 WEB PMT REFUND 515 METLIFE INSURANCE CO 1 $27.501 1 $2,138.741 06/0512014 1 WEB PMT METLIFE INSURANCE CO 1 1 $27.501 $2,111.241 06/10/2014 1 CHECK NUMBER 2244 1 1 $17.701/ 1 06/10/2014 1 CHECK NUMBER 2245 1 1 $41,25 06110/2014 1 VETERANS AFFAIRS PAYMENT 000000000002248 1 1 $1.87)✓ $2,050.421 06/20/2014 1 CHECK NUMBER 2247 1 1 $8.721 V/ $2,041.701 ENDING BALANCE 1 1 1 $2,041.701 https://onlinebanking.mandtbank.com/eDelivery/eDeliveryMain.aspx?Id=l 8/27/2014 . - � `' ?,i Weleome to M&T Online Banking Rage t of I Account MyChaics Checking 7725 v; Total BaWn $1,741.70 Available Balance$1,741.70 `,. -*' 4d View Ca_I_e_ndar View Calender Learn More Show Last 10 Transactions v 1 ( ' -or- View From; To ,..,_.T.,...,„ ;GOl vDaw TmgsacBOn DescHatton Creditst0ebtts Total Balance 0911012014 CHECK NUMBER 2248 ""3lIaoo $1,741,70 09/05/2014 WEB PMT REFUND 8/5 METLIFE $27.50 $2,041.70 INSURANCE CO 09/04/2014 VVEB PMT METLIFE INSURANCE CO -•1127.yel $2,01420 0 810 512014 VVES PMT METLIFE INSURANCE CO 1;2714b $2,04110 Depending on when your statement generates,you may not see a full 90 days of history.If your statement has just been generated,you may get a message indicating that no transactions are available from 61-90 days. f.....................„.....� . .__^i Available Balance se,u4v.ry -. ✓l.Afl View Calendar View Calendar Learn More Show Last 10 Transactions vJ -or. yew From{ _ TO t vDqk Tran;ige ion Description CredwDeMts Total Balance 08105/2014 WEB PMT METLIFE INSURANCE CO , 'ZJ.5b $2,041.70 WEB PMT REFUND 7/2 METLIFE 07/15/2014 INSURANCE CO $27.50 $2,069.20 07/15/2014 WEB PMT REFUND 615 METLIFE $27.50 $2,041.70 INSURANCE CO 07/02/2014 WEB PMT METLIFE INSURANCE CO -<cZ-7. d $2,014.20 Depending on when your statement generates,you may not we a full 90 days of history.If your statement has just been generated,you may get a message tndcating that no transactions are available from 61-90 days. . - ALB ERT E_.—TAYLOR Jft ACCOUNT NUMBER: 9832877725 592 SHERWOOD ST STATEMENT PERIOD: JUN.28JUL.25,2014 THE VILLAGES FL 32162 INTEREST EARNED FOR STATEMENT PERIOD$0,00 ACCOUNTSUMMARY BEGINNING DEPOSITS& CHECKS PAID OTHER CURRENT ENDING BALANCE OTHER ADDITIONS SUBTRACTIONS INTEREST PD BALANCE NO. AMOUNT NO. AMOUNT NO. AMOUNT $2,041.701 2 L.. $55.00 0 1 $0.00 1 $27.50 $0.0 $2,089.20 ACCOUNT ACTIVITY IMNSAC710N DESCRIPTION DEPOSITS INTEREST CHECKS&OTHER DAILY P DATEG ,B�nTHER ADO!' pN3 SUBIRAC�ONN BALANCE 05128/2014 1 BEGINNING BALANCE �_ 1 $2,041.701 07/02/2014 WEB PMT METLIFE INSURANCE CO + $27,501 $2,014.201 0 7/1 51201 4 ( WEB PMT REFUND 615 METLIFE INSURANCE CO 1 $27.501 1 1 07115/2014 1 WEB PMT REFUND 712 METLIFE INSURANCE CO i $27.501 t $2,069.201 ENDING BALANCE I1j $2,069.201 YOU CAN PAY WITH YOUR M&T DEBIT CARD AT MORE PLACES THAN YOU MIGHT THINK. https:H onlinebanking.mandtba&com/eDelivery/eDeliveryMain.aspx?Id=l 8/27/2014