HomeMy WebLinkAbout04-08-15 (2) �yy pennsylvania 1505614105
{�1�....,�a.a.�... ex fo3-i<)frp
REV-1500 OFFICIA�USE ONLY
Bureau of Indivitlual Taxes County Cotle Year File Number
Po BOx zaa60i INHERITANCE TAX RETURN /� � � � �
Harrisburg, Pqll128-o6oi RESIDENTUECEDENT !�f I�j O�LJZ-'
ENTER DECEDENT INFORMATION 9ELOW
Social Secunly Nvm�er �ate of Dea[h MMD�YYVY �a�e ol Birth MMDDYVVY
201-24-1430 01092015 05271932
Name Soffix pecetlenfs First Name MI
CARTER PATRICIA ry�
(If Appllcable)Enter Survlving Spouse's In/o�mation Below
Spouse s Last Name SURix Spouse's Firs�Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIHTE OVALS BELOW
� 1.Onginal ReWrn O �� Supplemenlal ReWm p 3. Remainder ReWm(tlate o�dealh
priorta 12-13-82)
p 4. AgnculWre Exemption(tlale of p 5. FuWre Interes�Compromise(tlate of p 6. Federal Estate Tax ReWrn Requiretl
deelh on or aFler]4-2012) dea1M1 aXer 12�12-82)
�p ]. Dewtlent Oietl Testate p B. DeceGent Mainlained a Living Tmst _ 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (A�taah copy o(ImsL)
p 10. Lltlgation PmceeOs Receivetl p 11. NomPro�ate Trans(eree Retum p 12. De(erraVElection o�Spousal Tmsts
(SCM1eDula F antl G Hssels Only)
O 13. Business Asse�s O �q, Spouse is Sole Benefidary
. (No�mstlnvalvea>
CORRESPONpENT- TMIS SECTION MUST BE COMPLETE�.ALL CORRESPON�ENGE pN�CONFIDENTIAL TAX INFORMATION SHOVLD BE DIRECTE�T0:
Name pay�ime Telephone Numbe�
Daniel R. Carter (717)6673872
First Line of Adtlress
633 Naginey Road
Secontl Line of Atltlress
Ciry or Pos�O(fice S�a�e ZIP Cotle
Milroy PA 17063
corresponaenPsemailaaaress: djcarter1960@verizon.net
REGIS�i OF WILLS ,v ON�' 3]
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aEcisreRorwi��susEON�r � O � m n
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PLEASE USE ORIGINAL FORM ONLY �
Side 1
L Illlllllllllllllll�l�l�ll��lllll4l�l��lllllllllllllllllll 1505614105 J �
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J Lsas61v2as
REV-1500 EX(Fl)
Decetlenl's Social Security Number
oe�eaa�rs rvame�. PATRICIA MAE CARTER
REGAPITULATION
1. Real Es1a[e(Schedule A). . . . . . .. ... . .. . . ... . .. . .. . .... ... . . . . ... . ... . 1.
2. Stocks and Bontls�Schedule B) . ... ... ... . .._ ... . .. . ._ .._ . . . . ... ... 2.
3. Clasely HeIG Coryora�ion, Partnership or Sole-Pmpriebrship(Schetlule C) . .... 3.
4. Mortgages and No�es Receivable(Schetlule D). . . ... ... . . . . . .. . ... . . .. . .. 4.
5. Wsh, Bank Deposits and Miscellaneous Personal PmpetlY(Schedule E). . . .. . . 5. 74,320.�9
6. Jointly Ownetl Propetly(Schedule F) O Separa�e 6illing Reques�etl . .. . . . . 6.
]. Inler-Vivos Transfers&Miscellaneous Noo-Proba�e Pmpetly
(Schetlule G) O Separete Billing Requested.. . ... . . z 124,616.48
8. Total GrossAssets Qo[al Lines 1 through]).. . .. . . .. . ... . ... ... . ... . .. . . 8. 19$�J$6.57
& WneralExpensesantlAtlminishativeCos�s�SchetluleH). .... ... . . .. . .. . ... 9. 4,169.49
10. Debts ot Deceden�,Motlgage Liabillties antl Liens(Schedule I).. . ... . .. . ... . . 1�.
11. Total Detludions(lotal Lines 9 and 10). .. . . . . . ... . ... . .. .... . ... . .. . .. . 11. 4�169.49
12. Net Value of Esia�e(Line 8 minus Line 11) . . . .. . . .. . ... . .. . ... . ... . .. . . . 12. 194,76Z�8
13. Chanlable and Governmen�al BequestslSec.9113 Tmsis for whic�
an election ro[ax has not been made(Schedule J) . . ... . .. . .. . . ... . .. . . .. . 13.
14. Net Value Subjec�[o Tex(Line 12 minos Line 13) ... .... ... . . . . ... . ... . .. i4. �94�767.08
TA%CALCULP.TION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amovn�o(Cine 191axeble
a�the spousaltax rate, or
Iransters unde�Sec.9116 �
(e)IL2)%.0- 15_
i6. Amoun�otLinel4taxable ������� � � ��� � � � �
allinealra�e %.p_ �6.
11. Amount of Line 14 taxable
atsiblingrate X .t2 �z 194,767.08
18. Amounl of Line 14 taxable
al rollaleral rate X .15 �g,
19. TA%DUE . .... . . .. . .. . . . . ... ... . . .. . ... ... . . . ... . . .. .. . . 19. .. ... . . 23�$72.�5
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUNO OF AN OVERPAVMENT p
Untler penal�ies ot psrfury,I tleclare I have examinetl tM1is retum,Nclutling accompanying%cM1etlules antl slalemenis,antl to IM1e�es�ol my knowledge antl belie(
il is Vue, correcl antl complele_�edarelion o�prepareroNertM1an tM1e person responsiblelor filing IM1a relum Is beaed on alllnbrma�ion ofwM1ic� preparer M1as
any knowlepge.
SIGNAT OF PERS9N R�POys�BLE FOR FlLING RETUFN ONTE
_rv�2✓r.u�C YL Cr aar'-...�. 0'4 - o c. - �o �S
nooaEss
633 Naginey Road Milroy, PA 17063
SIGNATl1RE OF PREPqRER OTHER THNN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
A�DRE55
� iiiiiiiiiiiuiiin�i��ii��i�i4ii�i�i�iiiiuiiiiiiiiiiii Side2
1505614205 J
REV-1500 EX (Fp Page 3 File Number
DecedenYs Complete Address:
�ECEDENT'SNAME
PATRICIA MAE CARTER
srREETnooaess � - � � � �
27 Robin Court
..___- _. . . . ._ ... ___- . . ._ . .____—_
CIN. .. --- STATE �ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2.�Ine 19) (1) 23,372.05
2. Credits/Payments
A.Prior Paymenis .. .
B.Diswun� 1,168.60
(See'mstmc�lons) Ta�elCredi�s(A+B) (2) 1,168.60
3. Interes�
(3)
4. If Line 2 is greater Ihan Line 1 +Line 3,enler ihe Oifference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 m request a refund. (4)
5. If Line 1 +Line 3 is grea�er�han Line 2,enter�he difference.This is�he TAX UUE. (5) 22,203 45
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Ditl decedent make a trans�er and: Yes No
a. re�ain Ihe use or income of Ihe pmperty transferred .._,..., .............. .................. ........... ❑ � �
b. relain Ihe righl lo designa�e who shall use�he propeM trans�ened or its income .._.........._.._..__.._..._....__ ❑ �
c. re�ainareversionarymlerest ......_. .......... ............. _.__. ._.... ❑ �
d. receive�he promise for life of ei��er paymen�s,benefi�s or care� ............... ......_... __..._ ❑ � . �
2. I�dealh ocarred afler�ec. 12, 1982,dia decedent Irans�er pmpetly wilhin one year o(death
wilhoW receiving adequale consideration? ............ ..._....... ............ ............. ❑ �
3. Did Oetedent o�vn an"in trust for"or paya6le-uporoaeath bank account or searity at his or her death?._,_._.,._ ❑ �
4. Ditl deceden�own an individual retiremen�accoun�,annuiry or o�her non-probale property,which �
con�ains a beneficiary Oesignalion? ..._.... ,..,,..,,.., .....,..... ............... _._..... � ❑
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 da�es of death on or afler July 1, 1994,and before Jan. i, 1995,ihe tax rate imposed on Ihe net value of Vansfers to or for ihe use o/the surviving spouse
Is 3 percenl[72 P.S. §9116(a)(1.1)(I)].
For dates of dea�h on or after Jan. 1, 1995, �he tax rele imposed on �he ne� value of Vansfers to or for the use of Ihe surviving spouse is 0 perwnt
[72 P.S.§8116(a)(Li)Qi�J.The staW�e does not exempt a iransfer�o a surviving spouse�mm tex,and ihe statutory requirements Por disclosure of assets antl
filing a tax reNm are still applicable even if ihe surviving spouse is the only benefciary
Por dates of death on or afler July 1,2000:
• The tax rate imposed on�he ne�value of Iransfers 4om a deceased child 21 years of age or younger at death to or for�he use of a naWral parent, an
adoptive parent or a step-parent of ihe chiltl is 0 percent PZ P.S.§911fi(a)(12)].
• The�axrateimposedon[henelvalueoftransfers�oorforlheuseoflhetlecedenCslinealbeneficiariesi54.5percenl,exceptasnotedin[72P5.§9116(a��i�].
• The tax rate imposed on�he net value of iransfers to or for Ihe use oi Ihe decedenfs siblings is 12 percent�72 PS.§9116(a)�1.3)].A sibling is defined,
under Section 9102, as an individual who has al least one parent in common wilh Ihe decedent,whether by blood ar adoption.
PEV-�SoB E%i(o&u)
�pennsylvania SCNEDULE E
���1 ocPnAmen.orneven�e CASH� BANK DEPOSITS & MISC.
�""E""""°E*"""�'°PN PERSONALPROPERTY
eesmervr oeceoeen
ESTATE OF: FI�E NUMBER:
PATRICIA MAE CARTER 2015-00152
Inoude Me pmceeds of Iltiga[ion and Me da[e[M1e pmceeds were received by the es[a[e.
All property la���ly owned wlth rlght of survivorship must be dlulosed on Schedule F.
IIEM VAI�E AT DATE
NIIMBER DESCRIMIDN OF DEATH
1. Santander Bank,401 N.Enola Road, Enola,PA 17025 Checking 10151069858 21,158.48
Santan0er Bank C�0925263071 16,38976
Santander Bank Checking 921725876 3,258.03
M87 eanh,423 N.Enola Roatl,Enola, PA 17025 CD 310 03 91 3 9 38 840 p,g�p,7g
M&T eank Checking 9843208654 25,803.06
1989 Honda Civic(selling price) 800.00
Peroonal DroDe`�Y in 2 Uedroom apartment 4,000.00
TOTAL(Also enter on Line 5, Recapitulation) S �4�320.09
It more space Is needeQ use adGltional shee[s of paper of[he same size.
aev-�sm ex. rus-oe)
'�'� pennsylvania SCHEDULE G
ry� oeanArwcmrarAevemue INTER-VIVOS TRANSFERS AND
0.x�exi„r�cE.axae.uan MISC. NON-PROBATE PROPERTY
es�oen.oeceoErvr
ESTATE OF FILE NUMBER
PATRICIA MAE CARTER 2015-00152
ihis s[�eaule must be mmple[ed and filetl If IM1e answer to anY of Questions 1 IhmugM1 9 on page IM1ree oflhe RER15�O Is yei
ITFM �ESCRIPTION OF PROPERTY
nneor*xcrv.xs�eaEe�xaeuunoxsxirrooeaeoexiuuo �ATEOFDEFTH %OF�E[�'S E%CLOSION TA%AOLE
NIlM9ER �exeuen.�e VAWEOFASSET IMERFST ev�uaui=i VPLOE
�� Athene Annuity&life Insurance Company P.0.Box 1555, Des Moines,IA �p4,616Ae 100 0.0a 124,616A8
i
TOTAL(AISo enter on Line 7, RecaOiNlation) f 124.616 48
It more space is neeEetl, use aGOitional shee[s of paper ol Ne same nze.
' REV�1S11 E%� (09-13)
� pennsylvania
SCHEDULE H
ocaanlnErvr oFaEverv��E FUNERAL EXPENSES AND
irvnea�.nrvce*nxaeruar+ ADMINISTRATIVE CO5T5
aEsmenr oeceoe�+*
FILE NUMBER
ESTATE OF
PATRICIA MAE CARTER 2015-00152
DecedenPs tlebGs must be reporteC on Schetlule 1.
NUME ER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1� Bohn Funeral Home 2,611.32
g. ADMMISTRATIVE COSTS',
1. Personal Representative Commissions'
Namels)o�aersonalReoresentative(s) __ . ___. ___. . .— - -� —� —� -
SlreetAGdress _ .. - —. . _ . —_. __.. ._. - .—.. —_ .—
CiN ._. .—..� � . . . __ . Stak __ ZIP_ __. —
Year(5)Commission Paitl: _.__. _.__ ._ _. _— ---- -- --- —
2. Attomey FPes'.
3. Famlly Exemp6on: (If decedent's atlOress Is not the same as clalmanPs,attach explana6on.)
Claimant --� � --- -- � -- --- -
StreetAGdress .._ _ —. ._. . --_ .._ —_. .—_. .._.
�� � 5[ate_. ._ZIP . _. —-
CitV . — .—. ___. ._. _ _ __
Rela[ionsFp ofClaimant!o�ecetlent ___ .. __ ___ . ._ . . .___ . _ - —
4. Probate Feu:
5. Accountant Fees.
6. Tar ReNrn PreDare�Fees'.
�. Cumberlantl Coun�y Cour�House 395.50
Wesley Park Townhomes(apadment reN for Febmary for removal of personal belongings) 930.00
Utilities 314.80
Patriot News Es�ate No�ice 17378
Erie Auto Insurance Refundlcancellation upon sale of 1989 Honda Civic -346.00
Batteries Plus @adery for car�o sell iQ 90�09
TOTAL (Also en[er on Line 9, Recapitula!ion) S 4,169.49
Ifmore spaceis needed,use additional sheels ofpaperofthe same sixe.
nEv-�s:s Ex, (m-io�
�� pennsylvania SCHEDULE ]
°""a'"`"�°`p`°`"°` BENEFICIARIES
�xxeai,nn�E rnx ae�uxH
PESI�ENi DECE�ENi
ESTRTE OF: FILE NUMBER:
PATRICIA MAE CARTER 2�15-0�152
RElATI0N5HIC TO DECEDENT RMOUNT OR SHHAE
NOM9ER NAME AN�A�DRE55 OF PERSON(5)RECEIVING PROPERIV Uo Not LinTms[x(s) OF ESTFTE
] TA%ABLE�ISTR18lITI�NS�Intlutle ouMght sp�usal tlis[nbutions and hansfPrs unQer
Sec 9t16(a)(Ld).�
�. Daniel R.CaRer Brother 100%
ENTER�OLLA0.PMJUNTS FOR DISTRIBUTIONS SMOWN A60VE OIJ LINES 15 TNROUGH 18 OF REV45�Q COVER SHER,NS AD4ROPRIATE
II NONTAXABLEDISiRiBUT10N5
A. SPOUSAL�ISTYI6UTIONS UNDER SEC710N 9113 FOR WMICH AN ELEQION TO TN%IS NOTTNKEN',
1.
B. CHARRABIE AND GOVERNMENTAL DISTRIBUilONS',
1.
TOTAL OF VART II - ENTER TOTAL NON-TA%ABLE DISTRIBUTIONS ON LINE 13 OF REW1500 COVER SHEET. S
II more space is neede0;use aGElfional sheets al paper of[M1e same size.
�0l�-�0N°�
Last Will and Testament
I�i�[21,C�� /�fn� ��w��-' of rhe Ciry of l" �-^- —
County of� ��.�'-�-�>-�- , Siate of %�� ..��-t i
being of sound mind, and not acting under duress, enace, fraud, or undue
influence of any person do hereby make, publish and declare this instrument my
last Will and Testament and do hereby revoke any and all other Wills and Codicils
heretofore made by me.
FIRST: I order and direct that my just deb[s and funeral expenses, expenses for
administration of my estate and any inheritance, State or Federal taxes upon said
estate, except those, if any, which are secured by mortgage or deed of trust, shall
be paid as soon after my death as may be practical.
SECOND: I am a,-uM�-c��-� - person. My spouse is ��— and
� A �
aze al my children, either natural or adopted.
THIRD: I nominate my spouse as Guardian of my minor children. In the event that
my spouse shall predecease me or fails to serve as such Guardian, then I nominate
and appoint
,-�;�r Gua�dian of the person and pxoperty of my
minor childr�n. I further direct that no bond shall be required.
FOURTH: I hereby make the following specific bequests� „ ,
,�. �c-,z<./� �C �u�c��
���//% �" _ <?�/ C�;,�'� � ,-r� �� z/
� T2� /1/r�-c,-�l /.i1.:2'2r_c�r��w/��.L.�u'o-v .�Llc�'�- .X//`� �":�
% /
_�,�� ���r�.
� �� ���_ �� _ �«� r
�
FIFTH: I hereby give, devise and bequeath all of the rest and residue of my esta[e,
all property /;
over which I have power to dispose to �7-R^%�� � �l'��'
� �
SIXTH: I nominate and appoinY �G��-��- �� � Cz�`�
as Executor of this will. In the event that the Execu[or named above shall
predecease me or fails to serve as such Executor of this will, I nominate and
appoint
7
J�� ,- � �c7` as Execucor. I further direct tha[ no appointee hereum
�er shal e required to give any bond for the faithful performance of their duties.
SEVHNTH: I hereby authorize my Execumr to exercise all power, rights, discretion
and duties deemed necessary for the proper adminis[ration and disposi[ion of my
es[ate.
I s�cribe my name to this Will this .,1� Day of�l�d C�at
l
/J�h�Gt _ 1�/ry�'n�.G?�
z -
City State
..�_-�
/,L/�/C-c.ic� 9//(.� C lL��CrL
S ature
On the day written below, �� c�. �-�_ �i . �"'��
declared to us, the undersigned that this instrument, consisting of 2 pages, was
�,
the Will of �i Zi� � ��- �� � �
andH�requesred us to act as witnesses to it. ��� thereupon signed this
Will in our presence, all of us being present at the same time. We now in /�' �pres-
ence and in the presence of each other subscribe our names as witnesses.
� �– �+
It is our belief that�� .v�..� js of sound mind and under
no cons[raint or undue influence whatsoever.
We dedare under penalty of perjury that the foregoing is true and correct and that
this
declar�ion was executed onj � iz�af-, ��% , .� 'd� �
a[_ � : .��� _ � -. ��
/ c � „r. -� /, �–m.
.;l � � - \����� ������^`� t .e��ri�i�l
�C( �2��i ;_ `�.�'z<<n� ���t�t ��c����ai �h i 7/l
Wlmess ,9 ddress
�4C-� s-ic� ,Eo,,�.Z�L �O
�rr�-,� �`-�- e- � AP� 7 e K,�� P.ea.�, ��T
Witness Address o�'� s 0
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Wimess� � Addres's�—
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SWtement Veriod 111tC/la t0 Ol/13R5
THE SANTANDEP ONE ACCOUNT
For your mnvenence our G�stomer Contact Center
is avallable trom)am-e pm EST. ]days a week.
Call us at 1-BJJ-J5&22fi5
uSBGI 1u01011nOBJt3B9000lusBm}���p I leanng impalred may Call l-$OOd28 9121 (ITV/!DD).
www sanUnAerf�ank com
PATRIaA CAPTER
D ROBIN CT 1000
MECHANI68URG PA 1]055-43)i �� 13
_ _ �
YA1A/C/ACAN1Ep
Deposit AccoUnts Acmunt Numher Average Daily Balance Cunent Balance
_ THESSt�T&NbYRONEACCOtmN' 39273258?A '� S�d5800 F325ff213`
SANTANDEAINTEREACHECKING 1051069858 $2150258 E2t 15848
Total Deposits tza,ne.si
� • • • �
g va ralaA cawreq Account M 921775876
g Balances
g Beginrnn9��M� 53 Z57 93 �.:: Cu2mi k3bnr S,��5g� >���
a Depmi6/Gedi6 aS0A6 AverageDadyBalance g3,258D0
W�Endrawakloehas o oU i.
Interest
� paidlhRp@rbd���.� 5�06 �: Anquai4tsenfa Y��dFar ed��: n41%
Eamed[hisPerad q003 VadLas[Vear E035
Fa� YearToQS@ 5003 :
'l he mrems(eamed and tl e n�erest paid may d�Her depending on when merest a cred t d m your a¢ount
Acmunt AdiviTy
Date Descrip[ion Addi[ions Subbaitions ealm¢
12-�4 Be innin Balance f3,15)9)
�' 1Y�15 �.INFFRESf€AEflikPflOR1 �791?72M4 � 12171YT614 Sb03 5��25&U0�
01-13 IIJTERF4CREDIiPROM12/�2ROtCT0�1/1120t5 $003 $3Z5803
� Oi-73 ntlingBalame .. .. .. .. .. .. f3.258:03�.�:
� �
PATRKU CqRTER AttqlOt M 1051069858
��
" Balances
r��.Begmning BalaMe 4�iA6212 .�'. CuaPntBdWxe 52i 15&d8:.:
Depos6/Gedits �f1.2019] Avera DaJ Balance f21,50258
.W thdrawatsNetiiS -5 .045.6f`1.
� �+4rcWnYNF�n aH�dH�+�sJVImyJNnm4m.Mo,lA B viqn
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Interert
pdd�R'�€�bd� ' F@97 knnl�tfielteAYA�Y�MFAkiikd : ' QDi�:-
EamedthisGerbd f019 PaidlastYear 3�D9
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'The Interesteamed and Ihe mkrest pa d ay differ dependmg on when m[erest rs credited to your acmunt
Checks Ported
Ueck Y Wh Paid Amount Referena Ched�M Date Paid Amount Reterena
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Dah Deurip[ion Addkions Subtractiens Balantt
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Sbhment Period 01/14/15 TO OZ/13/15
THE SANTANOER ONF ACCOUNT
roryour nveorenceourCusmmercontac�Cenmr
�rs avaipble hom )am-e pm E9, J Aays a week
Call us af 1�N�]-]6B 2265
msecnnrozozn�vw3aamasremm��o 0o Hearing ImpaireA may call 1-80�-4285�1]1 (TiV/�DD).
www santanAeibankmm
ppiplOA CARTER
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MECHANICSBUPG PA 1IDSSJ3]T �� ��
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TWO WAYS TO SAVE WITH AN IRA
A SanGndeF IRA CD and a Santander°'IRA Money Market Savings account can help you plan a m«e com(ortable
retirement and may prwide Wx benefits'.
IRA Monry Market Savings Acwu�rt AdvaMages IRA CD Advmtages
•Save for retirement while eaming a great rate •Grow your retirement savings at a mmpetitive rate.
Savings are FDIC insured up m applicable limks` •Get a fixed interest race mmpounded daiy over ihe
•Available as a Traditiowl or Roth Plan I'rfe of Ihe CD
•Contribute up to SS.Soo per indNidual' •Savingz are FDIC insured up to applicable limits'
•Contribure up ro 555�Per individuaP
Whether you choose a SanWMer IRA Money MarkM Savings xcounl or a SaMaMer IRA CD,don't forget to
open an IRA by April g to make your zoi4�orrtribuUon.
A Santander banker will guide you every step of the way.
Open an IRA accoun[today-�isit Santanderbank.com to
locate your nearest branch.
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vVisi[rourloca�boMM1 ❑ veppp66.:a65 � �_^��^�erbank.com
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PATRK/q CAqTER
DepoSiT AccoUnts Ac<ount Number Aveage Daily Balance Current Balance
TMES+SNTJrPi�EHtlNEACCOUNf�: 92Y2,�5$75 ;2��3?66 f(�',
SANTANDERIMEftE4CHEIXMG 1051069858 E1905958 qp��
Total Deposits ���
� • • . � �
PATRKu CqR1EN A[rount N 9I7725876
Your acmunt¢at rem balance.Please deposit funds mro this acmunt quickly ro ensure mntinued use of yourecmun� For your mnvenience
you ran check yow a¢oun�balance using Santande�OnLne Banking at santanrkrbank com,at any Santander ATM or by calling our
Customer Contact Cen�erat 1.8]].I68.2265 It thrs acmm�is not meeting your nreds,please call yoar branch or romz in ro see vs�or a
mmpLmentnryfinanl�alreview Wewlllassrstyoolnmakingsurethatyouhave[herightpmduchandserviesromeetyourbankingnreds.
Balances
���.9euimritYg Fsls`ti[E i3 75$t13 ''� � ' E�HbMce' ' 'jp Ch-:.:
Depos WGedits +30 00 Average D ty Bala gZ g3�bp
�.W�tkidrawak�De�ik -i3.25803 �:: '
Interest
..va�dmmre.�oa-��,. set�o �;��. a�A�,a�ae�cm " xv �a� ed -.. aui��.�.
EamedthsPenod 4003 PaidLastVear f035
«Raid YeervTa-QatC jpa3 .
`The inlerest eametl and ihe mterest paid may ditfer depentl nq on when nterest s credited to your acrount
Account ARiviTy
Date Desaiption AddiHons SubVa�tions Balance
Ol 14 ' n BabMe f325803
.��;02�1 CL4SfiVGT SACfKiW- R �R71 AL � . 5$03 " i0D0..
U2-13 EndingBalana f000
� � 1 1
PiITRK/A CApTER Account R 1051069858
ealances
:'�._9egmrring931ancp„ ;: f37156-09 -� C�tBalan .: , 3RiT'
De ositLGedi6 .$1�,61293 Avera Dai Balance f19p5958
;w�vn�awak+�iti , a.zzt2� : -
Interert
:Paidthaperiod*'� S4t7 ��:AMRUSIPmcertGYIPY' Idfamd �� 40F%�.
EamedihsPerpd� b016 PadL IV 4209
.-PeM Year- o�ate �gg
^ihe inierut eamed and Me mterest pa d may ditler tlepend ng on when mterest s aedited to youra¢ount
Account ARiviTy
Date Descrip[ion Additions Subhactions Balmce
0114 Begimm� Balanae 121.15848
fl138 3tR25R{REA5390X%GQCSEE Pi7bi5'�R•`*'••`ASSA ' 7 ,�23 W SZ?.387A8..
0210 fMOUNTFPOMTERMACCOUNT2313)269109252630]t E16,389]6 538,�)1.24
Q'2-70 BQANCHTRANSAff(£M]AdCqRLI51.E -L}iE KPVftCIV1`f:. . '-- S37,Sq&2A { 57.223,9��
��e��� 9YUY589fi
.�
Account ARivity(Cont.for AcRq 705f069858)
D [ De 'oH Additions SuMnRions Balance
02-13 INiERESTCREDIiFROM01/1 22 01 5TOOUI12015 f0.1] E1,223.1]
213 k LCBRA i qT6 ����:. ..:.
W 13 Ending BalaMe $� ��
What Vou Need to Know about Overdrafts and Overdraft Fees
werview
An overdraft occurs when you do not bave enough money In}rour acmunt ro mver a hansactron,bot we pay i�anyway.We can mveryour
overdalts in N+o dlfferentways�.
t We have sbndard oveMnk pnRices that mme with your acmunt
2 WealsoofferenoverdnkprohRionplanwhKhalbvrsyou�olinkotheraccounpzuchasasavingsacmuntoranEaryAccess
Line of Gedlt ro<over overdraf6 In your checking acmunt Thrs pWn may be less expensWe than our sfnndard overdraft prac&ez.To kam
more,ask us about ihis plan.
Thrs notee explalns our sbndard overdnk practices.
W hat are Ae sGndard overdraft praRices that come wilh my aaounn
� Santandercurrentyamhonzesandpaysoverdrafrsforthefolbwingrypesofhansactans
• Chxksandotherhansactronzmadeusinqyour<hxkinqacmuninumber
• Automati bdl paymen6
• OnlineBankingpaymen6andhansfen
• Rxurring debi�card transactwns
Santander will no�authorire and pay overdraf�on the lolbwing rypez of hansactrons,UNLE55 you auMorire us ro do so.
� . ATMwlthdrawa!sandhansfers
� . One-time debi�card hansactions
� Wepayoverdra�tzatourtliuretpn.whichmeanswedonotguarznteetha[wewillaM1vaysauthorizeantlpayanyrypeofVanuc[ion.ItweJo
not authorae and pay an werdraft,your hansactan will be dedlned.
� What fees vrill I be aharqed it San[ander pays an overdnk oused by my ATM or one-time debk tnnsactiont
Under our standard overdraf�practices�.
� • Wewillchargeyovafeeofupto535eachtimevrepayanovardraftTherersalimltof6feesperdaywzcanchargeyoubr
3 overdrawingyouraccoont.
• An additonal one-[ime fee of S35 will be charged on the 6th mnrecu�rve business day your acmunt¢overdrawn.Ths charge
apples ro chxking accounh(other Ihan any Premer Chxking and Saniander Select Chxking Acmun6),savings and money
market savings a<roun6(other[han any Santdnder Selxt Money Market Savings Acmun6).
What if I want Sa�Mander m authorize and pay overdnks on my ATM and one-time debit ord hansaRions]
If you want us to authorae and pay overdraftz on ATM and one-time debi�card Vanuctans,the easies[way to do w¢to enmll online in
San�ander Acmunt PmMcror by veiting www.santantlerbank.mm/acwun@rotecror.You can alw call us a11-8)]-)68-9>2 t,vrsit your nea�ezt
branch or opL In at any San�nder ATM
fan I change my mind late�?
If you lell us that vre are permltted ro pay any overdraffi cauxd by ATM or one-�ime debrt hansactons,you can aM1vays change your mind and
�ell us you no bnger want us ro do Ih�rs.Vou can vait any branch or call us at 1-8]�-�68-4]21 and MII us you no bnger want us m pay these
typez o�overdratk.
�
Pqqe3ol� 91i1Y5d�6
IN CASE OF EPROIIS ql W ESTIONS ABOUT YOUR EIERRONIC TNANSfENS
CALL VOUP NSTOMER SERVICE CENTEP ATTHE NUMBEP SMOWN ON TNE TOP OF YOUN STATEMENT OP WRITE TO THE BANK
PoR DE6R CARD ISSUES FOR A�L OTHFR EI FCTftOW C TRANSfE0.65UES
Santandereank Santander Bank
Aqn�Card Daputes Team Atirt Client Relations
MAI MB3 02 OS 10-02LCP1
VA Box 831002 P O Box 12646
Boston,MA 02283-1002 qead�ng,PA 19612-�646
Pkase wntact us rf you thlnk Inbnnatron about an eleamnlc nansler on yom statement or receipt�a wrong o�II yov need addrtional
'mtormatpnaboutanelec(mn¢NansferonNesbtementorreceipt Wemusthearfromyoonolalerthan60daysafterwesentyoutheFlRST
s2tement on which Me ertor appeared
•Tellusyournameandaccouninumber � •DesaibeMeekctronlctrans�erermrorMeelxtmnictrans(erihal
• fellusthedollaramoimtofNesuspecledermr youareunsureaboutande�lalnastlearlyasyou�anmmyyov
believe Mere¢an erroror why you need turiher Infomiaaon.
If you�ell us orally,we may reqclre you to send your mmplaml or quesoon in wming wi�hm 10 busmess days
We will pmmptly Investigate the ma�ter and call or wnte ro you with an answer withln 10 business days It we need more�ime,we may hke up
to a5 days ro invesogate your mmplalnt o�quuoon.If we do,we will credTyour acmunt wi�hin p(u 10.day perrod for Me amounTyou Ihmk a in
error,myoa w10 have�he ux d,the money dunng the tlme It qkes oz m mmplete our Invez[igatron If we ask you to put your c mplaint or
qoestion m writing and we tlo nol recerve i�withm 10 business dayz.we may choose not ro«edi�youraccount.
For ermrs InvoHing new acmun6,pomto(sale purrhues or breign hansarnons,we may bke up ro 90 days lo investigate your complalnt or
questron Por new acmunh,we may mkc up�0 20 business tlays ro credl�your accoonl br the amount yw thlnk is In ermr
Wewilltellyoutherervltsofourinvestiganonwlthln36usnessdaysa(�ermmpleongounnvesM1ganon tlwedmdetherewasnoerror,wewill
sendyouawnttenexplanation Youmayasklorcoplesollhedommen6weusedlnourinvesbgatpn
IN CASE OF ERRORS OR QUESTIONS ABOUT OTHER TRANSARIONS ON YOUR STATEMENT
You must conm�t us within thirry(30)days atter you rxerve your statement If you thlnk a tranzac(ron,other(han an electronk hansfer,shown
on yoursmtement�a wmng oi i�you need more in�orma4on about Me hansactron
vou maymnizc�yow nearest banch or om Customer ConUct Centeret BJR]68-2265 Customers wiih hearing impairmen6 may call
800.42&9121 (TT1'/fDD) We will investigate your tl¢pute and tell you the resWB ot Ihat investigation
Poee I nN
92/]IS8J6
0
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FORINOUIHIESCALL: (800�]29-2N0 ACCOIIMTYPE
M8T CLaSSIC CHECKINO W/IMEPEST
00 006121MNM 017
ACCOUM NUMBEN STATEMEHr PERIOD
P g9qyZpg5y1 DEG.O6JAN.0],2015
000004410 F1051509001I01�)1501 02 000000
PATRICIA MAE CAHTER BEGINNING BALANCE SNqN2.n
� DEPOSR58CNEDffS 0.00
27 ROBIN CT
MECHANICSBURG PA 77055 LE55 CHECKS 8 DE&TS a26.19
INI'EAE6Y � 0.R4
���LE85S@.HYICECHA�if1B� 0.00
" '° ��"'°" 526,016.82
INTERESTEARNEDFORSTATEMENTPERIOD $�23 SUMMERDALEPLAZA �
INTERFST PAID YEAR TO�FTE $029
ACCOUNTSUf.AMARY
BEGINNING DEPOSRS 8 OTHEN CHECKS PAID OTHEP DEBRS(-) CUPPEHf ENDING
BALANCE CflED1T5 + INfER TPD LAN E
N . AM Nf N . I1M0 N . AM M
$26A42]] 0 $0.00 6 $32924 2 $96.95 $024 $26,016.82
� ACCOUNT ACTIVITY
POSTING TNANSACTIONDESCXIPTION DEPoSITS60THER WITHDMWAL58 DI11LY
R OATE CHEOR ♦ OTHER DEBITS - BALANCE
12/06/2014 BEGINNING BALANCE $x',a42'P
g 12/09/2014 CHECK NUMBEF 0518 525.00 z6A�Z��
� 12R V2014 CHECK NUMBEA 0520 41 90 26.3]5.8�
- 12A2/2014 CHECKNUMBER0519 12200 26,253.8�
12/22/2014 CHECKNUMBER0.523 10.3G 2624353
12Y23/2014 VEPRON FlNANqA PAVMENTS 0000�0000000522 29.tr8 26R14D5
12/24/2014 COMENINCAFDPAYCHECKPVMTOOW00000000521 6�.4] 2fi,146.58
; 12/29/2014 CHEGKNUMBEfl0524 SO.W 26,096.SB
� Ol/OS/2015 CHECKNUMBER0526 80.00 26,016SB
; O1N]/2015 IMERESTPAVMENT $024 26,016.B2
EN�ING BALANCE 26016.82
CHECKS PAID SUMMARY
CHECKNO. DATE AMOUM CHECKNO. DATE NMOUNr CNECKNO. �ATE AMOUNT
518 12tt19/14 2500 519 12/1P/1< 122.OU 520 12/11A9 41.90
523' 12/22/14 10.34 524 12/29/14 50.00 526' 01/05/15 80.00
FNNUAL PEPCENTAGE VIELD EARNED=0.00%
� �6� � Ib. g�.
��� — /�3. 7� �V�o�7 � atl�St�/�i
��D �cj =0•�0 �5� �
�� ���� PAGElOF1
moeienz
� .
FOHINOUINIESCALL (BOD�1204400 AGCOUMTYPE
M8T C1A551C CHECKING W/INTEREST
00 006121MNM017 �� � �
ACCOUPlrNUMBER STATEMEMPEPo00
P 9843208650 JAN.O&fEB.06,2015
� 000000400Fi�S1599001]020815020.5000p00 .....
PATRICIA MAE CARTER BEGINNING BALaNCE 526,016.82
27ROBINCT DEPOSR58CREDRS ],WS.iB
MECHANICSBURG PA 17055 �ESS CHECKS 8 DEBrts 213.]6
IffTEREST 0.25
LE85§EHYICE CHAR6ES� 0.00
FMpW6BR49}y10E 333�498A9
INTEREST EARNED FOR STATEMENT PERI00 $025 SUMMEFDALE PLAZA
INTEREST PAID VEAR TO DATE $0.49
ACCOUNTSUMMARY
BEGINNING DEPOSRS60TNEN CHECKSPAIU pTHEROEeITS CUHPENr ENOING
BALAN E qEDITS ♦ (-) IMERE TPD BpUWCE
AM NT NO. AM UNr AMOUNT
$26.016.82 1 $1,645.18 2 $213.]6 0 $0.0p $025 $33,448.49
a" ACCOUNT ACTVITY
8 POSTIN6 TNANSACTIONOESCRIPTION DEPOSR580THER WITNDRAWALSB DAILY
DATE CPEDRS + OTHEfl DEBfTS - BALANCE
� 01/OB/2015 BEGINNINGBALANCE $26.Offi.e2
� 01/O9/2015 CHECKNUMBEq052] $63.]6 25,95306
01/16/2015 CHECK Nl1MBER 0525 150.00 25,80�.Ofi
0120/2015 ATHENE ANN 8 LIF ATHENE $],605.18 33,44fl24
02/O6/2015 IMEREST PAVMENT 025 33,448.99
P ENDIN BALANCE
33 048<9
� CHECKS PAID SUMMARY
� CHECKNO. DATE AMOUNT CHECKNO. DATE AMOUNT CHECKNO. DATE AMOONr
525 01/16I15 150.00 52�' 01Po9/15 63)6
ANNUAL PERCENTAGE VIELD EARNED=0.00%
SHOW YOUR STVLE WITH A CUSTOMIZED DEBIT CARD!GET A CUSTOM IMAGE ON VOUR M8T
DEBIT CARD FOR JUST$2.95 VISIT MTB,COM/CUSTOMCARD TO GET STARTED.
USE OF THE M8T CUSTOM CARD DESIGN SERVICE IS SUBJECT TO PROGRqM TERMS AND
CONDITIDNS AND IMAGE GUIDELWES.A$2.951MAGE SET-UP FEE FOR EACH NEWLV
APPROVE�CUSTOM CARD DESIGN MAY APPLV.ONE FEE WILL BE CHARGEO PER APPROVED
CUSTOM DESIGN.REPLACEMENT CARDS WILL NOT INCUR THIS FEE IF THE CUSTOM DESIGN
REMAINS UNCHANGED.
PAGE 1 OF 1
I➢�BUIPI
. ��WS na�,�.. . ,, _
� .
FORINQUINIESCALL: (800�]29-2G<0 FCCOUNTTVPE
REGULAH TIME OEPOSIT
00 006127MNM 017
ACCOUNT NUMBER STAtEMENT PERIOD
P 310039139388i0 JUL01-DEC.31,2014 _
000000352 FID51549D01]123H012 0300W00
� PATPICIA MAE CAHTER BEGINNING BALANCE _ 32,90].a9 _
27 ROBIN CT DEPOSITS b CREDITS 0.00
LESSCHECKSb�EeITS 0.00
MECHANICSBURG PA 17055 '—-- ��
INTEREST 3.6]
1E55SEHVICECHAHOES � ���
�ENRRi(i�BA4ANCE �� 52.910.]6 �
MAIURITYDATE 02�0945 Cl/RPENTINT[R[STFATE 0250��a
IMEHEST PAID VF.AF TO�ATE E]2] SUMMERDALE PLAZA
ACCOUNT AC7IVITY
POSTING 7qprySACTIONUESCRIPTION �EPOSITS80THEF WITH�RAWALSd DAILY
�ATE GPEDITS + OTHENDEBITS - BALANCE
W/012014 BEGINNINGBALANCE $2,90"l.09
OB/OB/2014 WTEflESTPAVMENTGENERATE� $1B3 2,90892
11/0]/2014 INTEREST PAVMENt GENERATED 1.84 2910J6
ENDING BAIANCE 2 91016
�One M�uttalo,� � �
Summerdalc Plaza
Fcbruary 13, 2DI5
W W00'20C FTDA10NM090214150203 01 OOOOOD
� 204
PATRICIA MAE CARTER
27 ROBIN CT
MECHANICSBURG PA 17055
Re: CD Account Closing Notice
Account # 31003913938840
Dcar Pavicia Mae Carter,
We are writing to confirm that on 02/ID/I5, your CD account was closed or ?ransferred.
At that time, thc balance was 52,912.59.
We'd like to remind you that M&T Bank is commiited to providing yuu wiih solutions to
all your financial needs. To find out more about the many ways we can help you wiih
a those needs, simply stop by any M&T Bank office ur call the M&T Telephoac 13anking
"s Center at 716-526-1400 or 1-800-724-3222. Or if yuu'd like, visit thc M&"I website nt
www.mandtbank.com.
R
g Thank you for banking with M&T Bank.
a
SMqCCL PZR41
,�c/3oo�,�z
�l)ATH EN E A.he�eA���„Ya�d�,�e�amPa�Y
Afhcnc Lifc Insumna Company of NewYork
��Aal mrtespondunce lo�. PD_Nox 1555, Des Moines,IA iU30fi-0Si5
Cusmmer Contact Center Tel:800 800 9802 Fax�R00 531 0038
January 15, 2015
W63990P10'J1 Wp398
PATRICIA M CARTER Contract Numbec 305B560512
27 ROBIN COURT
MECHANICSBURG PA 17055
RE: Fair Market Value
Thank you for choosing Athene to help strengthen yourfinancial security.
We are writing to provide you information regarding the Fair Market Value of your contract as of December 31,
2014. This information is also 6eing furnished to the Internal Revenue Service. You do not need to�le this
document with yourtax retum.
Yaur fair market controct value as of December 31,2014 is$124,616.45.
This value is used [o help calculate your Required Minumum Distribution (RMD). Please call our Customer
Contact Center if you would like assistance in calculating your RMD.
Generally,[o comply with IRS requirements, all policy owners must start taking[heir RMD by April 1,following
the year they reach 70'�'. RMD amounts mus[then be[aken each subsequent year by December 31. So, if you
will be older than 70'�' by Ihe end of 2014, you may need ro take action. If you do not take your RMD the IRS
may penalize you half of the calalated RMD amount.
We appreciare your business and are committed to providing you with prompt and accurate service. If you
have any questions or need additional assistance, please mntact your insurance professional or our Cusromer
Contact Center at 500-800-9582.
Sincerely,
Customer Service
Endosure�s)
(Please see revene side for Frequently 0.sked Questions)
n0U Mills Ci�lc P�rk�vay,ANea Des Momes,IA 5026fi-3B62 20012A0$14
www.athene.mm
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