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Home My WebLink About09-22-15 � �i pennsylvania 15 0 5 61410 5 OEPANIM[NTOfREVENU! EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOx 28060� INHERITANCE TAX RETURN i n/ ,r� ' �3 �� Harrisburg, PA 17128-0601 RESIDENT DECEDENT O< < ' , ENTER DECEDENT INFORMATION BELOW Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _—__.�.—_..�.�_�..... ___.___— �__ _..__— _.._.__ _---, �__ ----- ---; '� 194- ' � 12072013 ` � 10041955 � �� _ ___ --_�.. ___. _ _..._� �_ ._�_. _.__ _____�--- ___ ; _ _,_�_ ....._ _._. � DecedenYs Last Name Suffix DecedenYs First Name �-. MI �--...._. —_ ______ __ __ _.__ _..___� _._. —� _ .. _— _� —. _ — _.___� _._.----� , _ i HELLER , , CLAIR ; R ; _.__-. _ __ _. __ _. � �—_-----w ,,�_u._ __— __ ___; �_.� (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name __ p MI _�_.__� �___ ,_ _ .___ T_ __ __—_ ___. —_, Suffix � S ouse's First Name _.� ' � �CHERI i `HELLER ; � �� _.._.� �_�_.� �_�_�.. �__e � __._e__ _____ _.._._. , _� THIS RETURN MUST BE FIIED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2. Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) p 4.Agriculture Exemption(date of p 5. Future Interest Compromise(date of p 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets � 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ___ __—.. �_��_._.—_, �Andrew H. Shaw, Esquire � �� , �(717) 243-7135 1 __ - -- __ -- — .._ ._. -- -- —__ _� r _ __ —_ ----n _.�._ _ _ --� First Line of Address __. _ _ _ ._ i 200 S. Spring Garden St ; . _..___ ._ _ _ _.__ __ — ____ _ _�_ . .._ __ 1 Second Line of Address _ __ _ _ _ , � ;Suite 11 � � __.._ __._--� ��-- , _____�.__ _... _ ..._ __—_ _—_._ .� City or Post Office State ZIP Code - � --__ _.��. ___....__ _W_...n — _. � I ;Carlisle � PA � �17013 j ....... ..._ ._ _.T ..____ � ' —__ . _ , _ _ andrew@ashawlaw.com �� -: �� CorrespondenYs email address: -_' ,�� REGf�CE �F WILL E ONL�! �-> , . �� `::7 � � '.:'. � REGISTER OF WILLS USE ONLY � , � �DA7��tL�Q��VIMDClYY�YIf i (� ��,,. � a � +, z , . = 4 P � ' , . - I 4 - , � "'`"� � �k ° � . , , e��. ?,� , .�, _ � � _. ._ . 'i � . .. , :: �.,.,�:> t_..+ ._._ �.,�.� DATE FILED STAMP -- �� C!� _ _�� . �G PLEASE USE ORIGINAL FORM ONLY Side 1 i iiiiii iiiii iiiii i�i��ii�iii�iiii�i�ii iiiii iiiii iiii iiii J � � 6 4 5 1505614105 \N � J 1505614205 REV-1500 EX(FI) DecedenYs Socia�Security Number ' 194-42-9810 pecedent's Name: _------, RECAPiTuu►TIOM � O.00 j . 1.�_.._.._.... ; ................ , 1. Real Estate(Schedule A�. ........................... ; 4,063.18 � ......... 2.; , 2. Stocks and Bonds(Schedule B) .............................. t----------`" 0.00 ! 3. Y ' 3. Closefy Hetd Cor�ration.Partn��ship or Sote-Proprietorship(Scheduie C) .•••� ' ' ......... a.; 0.00 ; � 4. Mortgages and Notes Receivable(Schedule D).................. : 760.35 I Schedule E)....... 5.I _______.-------.----� 5. Cash,Bank Deposits and Miscellaneous Personai PrapertY� 1�`��y� o.00 i 6. i� 6. JoinUy Owned Property(ScFiedule F) O Separate Biiiin9 Re4uested .•..••• � i 0.00 i 7. Inter-Vivos Transfers&Misce�laneous NO S P��te B�,u n�g Requested........ 7.` ------s-,----j (Schedu�e G) 4,$Z3.53 � ; , ............. s. 4 8. Totai Gross Assets(tota�Lines 1 through 7)................ ' ......... s.f 11,032.61 � 9. Funerai Expenses and Administrative Costs(Schedule H).......... � __________-.--, ' 8,281.51 ; 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10.� 19,314.12 ; 11. Totel Deductions(totai Lines 9 and 10)................................. 11,i � . ' -14,490.59 ! 12. Net Vatue of Estate(Line 8 minus Line 11) ...•••••••••.•••��• ........... 12.j 13. Charitabte and Covemmental Bequests/Sec.9113 Trusts for which � ..... 13.' 0.00 ; an elecNon to tax has not been made(Schedule J) ................... � 14. Net Vaiue Subject to Tax(Line 12 minus Line 13) .............. 14 -14,490.58 ; TAX CALCULATION-SEE lNSTRUCTtONS FQR APPI.ICABLE RATES 15. Amount of Line 14 taxable � at the spousal ta�c rate,or __ _ ,_---- - transfers under Sec.9116 ��"�- �' p.p� � 15 � 0.00 j (a)(12)X.OQQ - , 16. Amount ot lfne 14 taxable Q.00 �6. 0.04 � at lineal rate X.0 45 � __ 17. Amount of line 1d ta�cable � 0.00 � 17. 0.00 j at sibling rate X.12 � . ----E 18. Amount of Une 14 iaxabie ��d j �S � 0.00 � at coltateral raie X.15 � �, 1 19. TAX pUE ........................................................ . 19.j 0.00 ! 20. PtLL IN THE OVAI IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Under penaities of perjury,�declare 1 have examined this retum,inGuding accomP�Y�9 sChedules and statements,and to the best of my knowledge and beuef, it is true,cortect and complete.Declaration of preparer othet than the persat responsible for filing the retum is based an alf information of which preparer has � any knowted9e. SIGNAT E OF PERSON R SPO �-E FOR FiUNG RETURN DATE �.ha� �. ��.�a,� .5� � � - /.� ADDRESS 319 Chestnut Street, M oi Springs, PA 17065 SIGNATU F P PERSON RESPONSfBI.E FOR FILING 7HE RETURN DATE�„ J� ADDR SS 200 S. S rin Garden Street, Cariisie, PA 17013 I f�lNN I��i��1 I��I S�de z J ! 15Q56142�5 L�. REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Clair Heller STREET ADDRESS 319 Chestnut Street —- -- ------ -— _.._..._ _.....--—-----. ----- ---------- —. __ __..__ _____------ -__ ----_ CITY STATE ZIP Mt. Holly Springs PA 17065 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments __ 0.00 ---._.....----........ _------ --- B.Discount 0.00 (See instructions.) Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. - W = co �; F k r 1 ti�aa" �€.,a n,ti _ - y(a.u� i a� -s,,.' P .,. :nac�` F�. f .�.. : .. r... . � <m.-r€..� i.�`'u�.� .. �, .. . " , .;,� . . . - . , n�� v'°��t�.sAb"i..� . �'"�_-a..��_. . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .......................................................................................... ❑ � b. retain the right to designate who shall use the prope�ty transferred or its income ............................................ ❑ � c. retain a reversionary interest .............................................................................................................................. ❑ � 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 containsa 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. d� '�°'� �'�' 'u� : a = s��+ � a i � � 4, �� ^"i ' �' i '��+„ap-t�,�[,: . 4��-��im�, ..�`�,`-r:�.,�;,.�;"�,:, x -�.-�`» f'��. 4 ..,..��;a�Hs��ti+:_ ,k.w�.. e"�'"�-�. ..:�t,-s._ .�..�,4 �.,-a. , . .7_.�mw.`�aw., a,.,.,xmP „ �,�?�3., . r�` . , 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)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(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 deceasetl child 21 years of age or younger at death to or for the use of a natural parent, an atloptive parent or a step-parent of the chiltl 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.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by biood or adoption. REV-i5o3 EX+(8-iz) �pennsylvania SCNEDULE B ��iT DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Clair Heller 21-13-1349 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' 46 shares of Prudential Financial, Inc. 4,063.18 TOTAL(Also enter on Line 2, Recapitulation) $ ; 4,063.18 If more space is needed, insert additional sheets of the same size IIII IIII IIIII ill Iflllll illll IIIII IIIII IIIII IIIII III Illlllfl I � Prudential (omputershare Computershare PO Box 43033 Providence,RI 02940-3033 Within USA,US territories£r Canada 800 305 9404 Outside USA,US territories b Canada 732 512 3782 D�0 6 31 www.computershare.com/investor I�"��""'ll��'I��'��II�I��"I�'�'ll'�'I�III��I�I��""'I'll� CLAIR R HELLER 319 CHESTNUT ST MT HOLLY SPGS PA 17065-1213 Date 12 Der,2013 Re: CLAIR R HELLER Company Name: Prudential Financial, Inc. Account Number:0023199131 "DRS book-entry shares:46 ""*Closing Price per Share as of 12 Dec 2013: $88.33 **Certificated Shares:0 Dear Sir or Madam: Thank you for notifying us that the owner of the Prudential Financial stock account noted above has passed away.On behalf of Prudential and myself, I would like to express my sincerest condolences for your loss. I understand that this is a difficult time and the process of transferring the assets of a loved one who has passed away can seem overwhelming at times.We want to help in any way possible and have enclosed the forms you will need to transfer the Prudential shares to a new owner.We have also included detailed instructions,as well as a set of Fre�auently Asked Questions,to guide you through the process. I hope this information will be helpful as you make decisions regarding this account. Most of Prudential's registered shareholders received their shares as a result of Prudential's demutualization in December 2001.Although some individuals were given shares as a result of their policy ownership,the shares are completely separate from the policy and they must be transferred to a new owner,even if you have already claimed the policy benefits. We understand that,in some situations,the new owner may wish to sell the shares as soon as the transfer is completed. If the new owner wishes to sell through Computershare,it offers a voluntary sales facility for eligible shareholders to conveniently liquidate their shares.A copy of the terms of this sales facility will be enclosed with the new account statement that will be mailed once the transfer is completed.Once the transfer is complete and the new account materials are received,shareholders wishing to sell their shares may do so by contacting Computershare directly at the number contained within those materials. Please do not hesitate to contact us if we can be of any help to you during this difficult time. If you have any questions regarding the transfer process,please call 800-305-9404 and select menu option 4.After the automated message,you may then press 2 to reach a Computershare representative for assistance. Again, please accept our sincere condolences. Sincerely, ��. r�, � �� Margaret M. Foran Chief Governance Officer, Vice President and Corporate Secretary 'DRS book-entry shares-a recordkeeping option for you to record your ownership electronically on the books of the company. "Shares for which a physical stock certificate has been issued. '*'Account value subjecl lo market 8uctuation. OtDAVA OOICS0003.d.f.mix.0.i1422 4394/0006iIl003li1 REV-15o8 EX+(o8-iz) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Clair Heller 21-13-1349 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 1. PSECU,Account#8684 148.31 2. Members 1st FCU,Account#xxx232 612.04 TOTAL(Also enter on Line 5, Recapitulation) $ 760.35 If more space is needed, use additional sheets of paper of the same size. ,�R� Pennsylvania State Employees Credit Union � � P.O. Box 67013 Harrisburg, PA 1 71 06-701 3 800.237J328 Member Number: 8684"'*" psecu.com Statement Period: 12/01/13 to 12/31/13 Direct inquiries regarding preauthorized electronic page Number: Regular 1 of 1 transfer or account errors to the above address. Account Balances at a Glance Total Shares: $148.31 Total Certificates: $0.00 . 16286 1 AT 0.384 00.301 00.031 T39 P1 322 Total Loans: $0.00 MR CLAIR HELLER 319 CH ESTN UT ST -------------- ------------ MOUNT HOLLY SPRINGS, PA 17065-1213 ��I��IJI1��1�1�1�1��1��111��'��I��I'�II�'��' 001021 09 016360 001 D S1 SAP: 1,2 ShareYour Credit UnionWithYour Family and Friends. »psecu.com/join . • . • • • • • • • • • • . . . . • • . . • • • • • �I�F'�'�`1�`��IP��`��1��`�I�"�'�F�`�`�'�`��`��I� YEAR TO DATE INFORMATION Description Amount Total Dividends Year to Date $0.30 SHARES Posting Effective Transaction New Date Date Transaction Description Amount Balance REGULAR SHARE ID 01 12/01 Beginning Balance 5.00 12/31 Encling Balance 5.00 Dividend YTD: Year to Date 0.00 CHECKING ID 04 12/01 Beginning Balance 243.30 12/U2 VJithqrawal at ATM#0�00123GiSRS232 -100.OQ 443 30 12/02 ATM M&T Bank M&T 420 NORTH BALT MT HOLLY 12/02 SPR PA 12/31 Payment: Dividend 0.100% 0.01 143.31 Annual Percentage Yield Earned 0.080%from 12/01/13 through 12/31/13 Based on Average Daily Balance of 146.53 12/31 Ending Balance 143.31 Dividend YTD: Year to Date 0.30 � .. 6 E � ` � F [ • 6 ! � :1 �� Members tst Pederai Credit Union 11/01/2013 11/30/2013 1 of 3 XXXXXXX232 5000 Louise Drive -- — --- - P.O.I3ox�0 MectutnicsUurg YA 17055-0040 � (800)237-7288 MEMBERS 15� ��17)697-5312(Hearing Imp�ired) FLDERAL CREDi'C UMON V`'«'�'�me111�e1'S I Sf.OI'�T I•LI'i rF � �o G� ��r�s CLAIR HELLER Are Perfect For Any Occasion� 319 CHESTNUT ST '=''� • • • MOUNT HOLLY SPRINGS PA 17065 � Cl�ck here or vis�ti 39517 www.members1 st.org/products-services/ card-servicesivisa-gift-cardsl "' '' � i '' I i i "' i • I � Signature ��, �� •Terms up to 60-months. I 0 aPR�t + OPfer availabte until �anuary 15, 2014 � CEick here or visit memberslst.org/signature-lonn. 'Q � _ __.__ _.----_ ___ =a ___..._... ___.__-- ______ � ._I � � � � � + � � Your aggregate balance as of November 1 st is$562.71. An aggregate balance of$2,500 and having 3 products wil! place you in the Silver MLR IeveL CHECKING 35$.68 SAVINGS 248.14 CERTI FICATES 0.00 LOANS 0.00 SWIPE 5 YTD REWARD 525 ! � BEGINNING BALANC�: $363.29 Eff. Post Date Date Description Deposits Withdrawals Balance 11/01 11/01 Check 002498 Tracer 00�0249781 80.00 283.29 11/02 11/02 Withdrawal Debit Card CHECK CARp 24.25 259.04 11/01 NEW GREAT WALL BUFFET CARLISLE PA 11/03 11/04 Withdrawal Debit Card CHECK CARD 7.78 251.26 11/02 HOLLY PHARMACY MOUNT HOLLY S PA 11l04 11l04 Recurring Withdrawal Debit Card CHECK CARD 7.99 24327 11/03 HLU*HuluPlus 1593223 HULU.COM/BILL CA 11/04 11J04 Withdrawal POS#778700 15.16 228.11 WAL Wal-Mart Super 052475 5358 WAL-SAMS SHIPPENSBURG PA 11/04 11/04 Withdrawal Debit Card CHECK CARD 5.Q0 223.11 11/03 RUTTER'S FARM 5TORE#3 SHIPPENSBURG PA 11/04 11/04 Withdrawal ACH BEST BUY 50.00 173.11 TYPE: PAYMENT ID: CITICTP CO: BEST BUY 11/05 11/05 Withdrawal POS#123013 30.Q0 143.11 KMART 7746 CAR�ISLE PA 11/06 11/06 Withdrawal Debit Card CHECK CARD 6.00 137.11 11/05 717-2432611 THE SENTINEL PAUS12514952 11/08 11/08 Deposit Members 1st Online Transfer From Share OOOQ 900.00 1,037.11 REV-1511 EX+ (08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Clair Heller 21-13-1349 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1� Holiinger Funeral Home&Crematory, Inc. 9,708.96 z. Pamela's Flowers 180.15 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 1,000.00 2. Attorney Fees 3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.) Clalmant __. _..._.__ _____— Street Address City ___.._.._State__ ZIP Relationship of Claimant to Decedent _ __ __._ _._._.___ -- 4. Probate Fees: 143.50 5. Accountant Fees 6. Tax Retum Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) $ 11,032.61 If more space is needed, use additionai sheets of paper of the same size. -- . �.. riciiir��r ��i��i�i �ic�� b� �.::��r��c��, i�'�:. F.ric_ �. Ho1ii,7s�e�. �.�.�}�er�i�o� D�c�rr�f�3�r�, ?!�a 3 ,.�__ ,� _ �,ri��i �euer ;�1.9 Gh:�StnU�t 5t, iYli. 1 fVii� JNili�t ya� �Y'� 11 3V� The F�xi�Er�i Seivic.es far Glair R, I;�ller: We sinc�rely appr�eciate th� confidence you have placed in us and wiil continue to assist you in every way we can. Please feel fr�e to c.antact us if you have any questinns in regar� t�this statement. THF FOLLQWING iS AN ITEMIZEU STATEM�N�f'OF THE SFf2VICES, �ACfI_I�'fES, AU�`OMQTIVE EQUIi�MENT, AN[3 IVICRC�i/�NC�ISE Ti-iAT YQU SELECTf=D VVNEN M�K![VG TI-IE FUNER/al.ARRANGE��ENTS. Prs�fe��inr�a! Ser�9�e Traciitiona! Scr��ic�s 57SC?.00 Merc�ar�ise C�asket- �c��,;�lk�ll Haven Rairree�- 1895,Of� � `y�.V��t'r� ... 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BankofAmerica $78•$7 3. Citi Cards 6,556.67 TOTAL(Also enter on Line 10, Recapitulation) $ 8,281.51 If more space is needed,insert additional sheets of the same size. r�vvvaa� �� v�u«�� Send Naice of Billing Errors and Cuatomer Service Inquiries to: p � Customer Service: BEST BUY CREDIT SERVICES �� peS� Buy� besibuy.acoountonlinacam PO Box 790441,St.Louis,MO63179 Account Inquiries: Account Number: 7001 0621 3564 280� Cred it Ca rd � 1-88&574-1301 Summar of Account Activit Pa menf Information Previous Balance $89�•97 New Balance $845.97 Payments -$50.00 Other Credits -$0.00 Minimum Payment Due $25.00 Purchases +$0.00 Payment Due Date January 5, 2014 Cash Advances +$0.00 Late Payment Warning: If we do not receive your minimum payment by the Fees Charged +$0.00 date listed above,you may have to pay a late fee up to$35. Interest Char ed + 0.00 Minimum Payment Warning: If you make only the minimum payment each New Balance $845.97 period,you will pay more in interest and it will take you longer to pay off your balance. For example: Past Due Amount $0.00 �}you make no additional You will pay off the And you will charges using this card balance shown on this end up paying an and each month you pay... statement in about... estimated total of... Only the minimum payment 11 years $3,830 Credit Limit $3,600.00 $56 3 ears $2,03� Available Credit $2,754.00 y (Savings=�l,7ss) Statement Closing Date 12/11/2013 If you would like information about credit counseling services,call 1-877-337-8187. Next Statement Closing Date 01/10/2014 v Days in Billing Cycle 31 p � � You must pay your promotional balance of$845.97 in full by 06/08/15 to avoid paying deferred interest charges. � J TRANSACTI t�NS Trans Date Description Amount 12/04 ONLINE PAYMENT DEERFIELD IL $ 50.00- FEES TOTAL FEES FOR THIS PERIOD $ 0.00 INTEREST CHARGED TOTAL INTEREST FOR THIS PERIOD $ 0.00 PLEASF SEE IMPORTANT I�iFORMATION(7N PAGES 2 AND 4: Pege 1 of 6 This pccount is Issued by Citibank,N.A. ___ _ _ __ __y Please detach and return lower portion with your payment to insure proper credit__Retain upperportion tor your records_ y ---------------------------------------------------- ------------------- o� Your Account Number is 7001 0621 3564 2803 IIIII I II II'I II I�II IIII I II IIIII II I'll�I I I�I'I � � • � Payment Due Date January 5,2014 Po eox�soaaa . - New Balance $845.97 ST.LDUIS,MO 63179 : � � � � Past Due Amount $0.00 Minimum Payment Due $25.00 Statement Enclosed Pay your credit card bill online at BestBuy.com/CreditCard ar at any Amount Ehclosed: �' Best Buymstore. � Please print address changes on ihe reverse side. 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"' �i, , t _ . � � �� t� r _ , , t�w;„-r {..,� � . . ,� a ' � c.' . y. c, _ CG.AIR .*'2 liELi�ER t-1L>v�#D reaC{'�s.J°a Member Since 1980 Account number entling in:7573 www.citicards.corn Billing Period:1i127(13-�2f26113 1-500-983-6453 PO BOX 6500 SIOUX FALLS,SD 57117-6500 Account Summary Minimum payment due: �157.32 Previous balance 56,594.66 New baiance: $6�c��i6.,6� Payments -$165.00 Credits -$0.00 Payment due date: �f/��/�� Purchases +$44.69 Cash advances +$0.00 late Payment Warninq: If we do not receive your minimum payment by the Fees +$0.00 date listed above,you may have to pay a late fee of up to$35 and your APRs Interest +$92.32 may be increased up to the variable Penalty APR of 29.99%. Minimum Payment Warninq: If you make only the minimum payment each New balance $6,566.67 period,you will pay more in interest and it will take you longer to pay off your Credit Limit balance.For example: Credit limit $21,40C� If you make no additional You will pay off the And you will end up Includes$12,200 cash advance limit � charges using this card balance shown on this payfng an estimated ....................................................................................y.. � and each month you pay... statement in about... total of... Available credit ��4�83�� Includes$12,200 available for cash advances i Only the minimum payment 23 year(s) $15,080 1 — --- � $234 3 year(s) $8'427 (Savings=$6,653) For information about credit counseling services,call 1-877-337-8187. �"' �Citi �. �� '' Learn how customers have received an average refund of $80 on �`"'�� ' eligible purchases.* *BasedonrefundshetweenJanuaryantlAugust2013 F�Ecoa4�ia Poir�t Salanc� �s of 1�IOif2Q13 �rV�� Please make sure we have your preferred email address on file so we can >} �� P�9� � far more inform�tiart contact you about your account and other products&services. about y�t�r rewa�'ds. � .. � : �. . . . . . . .. ' . . � �� fGEN016013 �.�� Please print Address Changes on the reverse side �� r � Pay online www.citicards.com P.Q.BoX 6004 t�+�€m�ir» payrr�?�i du� �3�7,�� Sioux Falls,SD 57117-6004 � Pay by phone 1-800-983-6453 ��h ��,� �� 4`t'x:.l3``�:��;�?f'i�1�'n�i�Pil�+(C�P � Pay by mail Use this coupon �`'�;�� f�� • Enclose a valid check or money order payable to CITI CARDS.No cash or foreign currency. �"��`�r�� `'��r'��` � , • Write the last four digits of your account number on your check. Account number ending in 7873 IK00323030 2 AT 0.384 XJ022006 TMN 003994 1819 ��il�i�l�il��i�lil�l��ll��i�l�lln�lillilli�n�l�il��l�i��lll CLAIR R HELIER CITI CARDS 319 CHESTNUT ST PO Box 183113 Columbus OH 43218-3113 MOUNT HOLLY SPRINGS PA 17065-1213 ��'II�II�I��III�III'I�II�III��I�I�I�I�I��II�I�I�I��'��I�II �b'" , � 150�8 0015732 065666? 0016500 05491492011267873 1810