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Home My WebLink About05-12-06 (2) \"",~,":;fl~~,.:',.' n ~ ,~t ~'~ '~1!~(;Ct'I~:~;t)': , Decedent's Com lete Address: S1REET ADDRESS 2167 Merrmac Avenue Cumberland em Mechanicsbur STAlE PA ZIP 17055- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) $0.00 $0.00 $0.00 0.00 Total Credits (A + 8 + C) (2) $0.00 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnteresUPenalty (D + E) (3) $0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the differen . This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 8. Enter the total of Line 5 + 5A. This is the BALANCE DU . Make Check Pa able to: REGISTER OF WILLS AGENT (4) $0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the differen . This is the TAX DUE. (5) $0.00 A. Enter the interest on the tax due. (5A) $0.00 (58) $0.00 PLEASE ANSWER THE FOLLOWING QUES IONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes D D D D without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable u on death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement A ount, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Ii] D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YE . YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penaltie. of perjury. I declare that I have examined this rBlum. including accompany" g .chedule. and statements, and to the best of my knowledge and belief. n i. true. corred and complete. Decleration of preparer other thl," tha personal representative is based on all information which preparer has any knowledge. SIGNA 11JRE OF PERSON RESP NSIBLE FOR FILING RETURN 1 . Did decedent make a transfer and: a. retain the use or income of the property trans b. retain the right to designate who shail use th property transferred or its income; . c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments benefits or care? . . . . . . . . . 2. If death occurred after December 12,1982, di decedent transfer property within one year of death No ~ []l []l [j OQ [Jg DATE ~tvl 5 8 O~ Avenue ,s N REPRESENTATIVE Mechanicsburg, PA 17055 DATE S~ f 0 <.. 0;::/'/' St., Strawberry Square "'-~",,~~__r~lll1t 'l-'.,~ For dates of death on or after July 1, 1994 and before January 1, 1995, the t [72 P.S. 99916 (a) (1.1)(Q]. For dates of death on or after January 1, 1995, the tax rate imposed on the n The statute does not exempt a transfer to a surviVing spouse from tax, and th the surviving spouse is the only beneficiary. Harrisburg, PA 17108 ,.""W~;,,",~ -~~~~~~;~::>Jiilj~~~m.~~~:r...j,' rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)), value of transfers to or for the use of the surviving statutory requirements for disclosure of assets an UJJ f 61-; cI -~~ ?J ~fT ? V \)vQ . ~ "q \4 ~ <i\ ,( ty-one years of age or younger at death to or for thl The tax rate imposed on the net value of transfers to or for the use of the dece nt's lineal beneficiaries is 4.5%, except as noted in The tax rate imposed on the net value of transfers to or for the use of the deced nt's siblings is 12% (72 P .5. 9 9116(a)(1.3)). A sil individual who has at least one parent in common with the decedent, whether y blood or adoption, 3W4646 1.000 :EV.1500 EX (6-00) COMMCOOP OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 RE INHERIT AN RESIDEN -1500 E TAX RETURN DECEDENT FILE NUMBER ~L COUNlY CODE -9~ 0862 ___ YEAR NUMBER .... Z W Q W hi Q DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Kalar Timoth DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD YEAR) 9/18/2005 9/1/19 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE IN M SOC~SECURITYNUMBER 187-60-6325 THIS REl\JRH MUST BE FILED IN DUPLICATE WITH THE W I- :.: :!ill) uD::lII:: W ll.U :z: ~9 u ll.ll3 ll. 4( [X] 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Allach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retu 0 3. Remainder Return (date of death prior to 12.13-82) D 4a. Future Interest C mpromise (dete of death after 12.12-82) D 5. Federal Estate Tax Return Required D 7. Decedent Maintain d a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes o 10. Spousal Poverty redit (doto of d..th botwun 12-31.g10"" 1-1-g5) 0 11. Election to tax under Sec. 9113(A)(AllllchSchO) REGISTER OF WILLS SOC~ SECURITY NUMBER THIS SECTION MUST BE COMPLETED; ALL CORRESPONDENCE NDCONFIDENTIALTAXINFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z W Q Z o lL II) iii! u: 8 John DeLorenzo Es ire FIRM NAME (If Applicable) Goldber Katzman, P.C. TELEPHONE NUMBER 320 Market Street Strawberry Square ,....." ':"J ~ ~) , 2. Stocks and Bonds (Schedule B) (2) _."-1 1. Real Estate (Schedule A) (1) 17108-1268 0.00 0.00 0.00 0.00 39 200.05 1 985.20 OFFICIAl USE ONI::V- f" " 717-234-4161 3. Closely Held Corporation, Partnership or SoIe-Proprietorship (3) (';) 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) \.0 (5) z o t= :3 ::J .... n: <C (J w ex: 6. J~ Owned Property (Schedule F) U Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) (6) 6 545.98 8 . Total Gross Assets (total lines 1-7) (8) 13 480.38 37 362.73 $47,731.23 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) $50,843.11 ($3,111.88) $0.00 12. Net Value of Estate (line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an e1ectio to tax has not been made (Schedule J) (12) (13) 14. Net Value Subject to Tax (line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABlE RATES (14) ($3,111. 88) 15. Amount of Line 14 taxable at the spousal tax Z rate, or transfers under Sec. 9116 (a)(1.2) o ~ 16. Amount of line 14 taxable at lineal rate I- ;:) ~ 17. Amount of line 14 taxable at sibling rate o U 18. Amount of Line 14 taxable at collateral rate ~ I- 19. Tax Due 20. 0 0.00 x .0 L(15} 0.00 x.o 45 (16) 0.00 x .12 (17) 0.00 x.15 (18) (19) $0.00 $0.00 $0.00 $0.00 $0.00 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESnONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 (: I V t,~,,~,~ " '1;' ':'~;,.~i~"i1i~ ';f~V'Z:. , Decedent's Com lete Address: STREET ADDRESS 2167 Merrmac Avenue Cu.:mber1and em Mechanicsbur STAlE PA ZIP 17055- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditsfPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) $0.00 0.00 0.00 0.00 Total Credits (A + B + C) (2) $0.00 3. InterestfPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnterestfPenalty (D + E) (3) $0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the differen . This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) $0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the differen . This is the TAX DUE. (5) $0.00 A. Enter the interest on the tax due. (5A) $0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Pa able 0: REGISTER OF WILLS AGENT (58) $0.00 NS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes D D D D without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 3. Did decedent own an "in trust for" or payable up death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Acco nt, annuity, or other non-probate property which contains a beneficiary designation? . . . . . .. ........................ IiJ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, OU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have Blalmined this ratum, including accampanying chedules and statements, and to the best of my kncwledge end belief, it is true, correct and complete. Declaration of preparer othar thim the personal represenlaliw Is based on all information of ich preparer has any knowledge. SIGNA1\.IRE OF ERSON RESP NSIBLE FOR FILING RElURN 1. Did decedent make a transfer and: a. retain the use or income of the property transfe ed;. . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, neflts or care? . . . . . . . . . 2. If death occurred after December 12, 1982, did ecedent transfer property within one year of death No og og ug [j ~ ~ DATE l)M 5 8 o(P S are Harrisburg, PA 17108 -~~~~':!~iiiI~QE.~~_~"WR~~11&~~S~im.ti.~~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax e imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. S 9916 (a) (1.1)(i)J. For dates of death on or after January 1, 1995, the tax rate imposed on the net va e of transfers to or for the use of the surviving The statute does not exempt a transfer to a surviving spouse from tax, and the st utOl)' requirements for disclosure of assets an the surviving spouse is the only beneficiary. The tax rate im posed on the net value of transfers to or for the use of the decedent's individual who has at least one parent in common with the decedenf, whether by bl 3W4646 1.000 U;() f (i'l; cI -~~ 11 ~f1 ? V \)vQ' B "q \~e,\ S\ \( F or dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child !went e years of age or younger at death to or for tht or a stepparent of the child is 0% [72 P.S. 9 91 16(a)(1 .2)]. The tax rate imposed on the nef value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE1URN RESIDENT DECEDENT SC HEDULE E CASH, BANK DEPOSITS, & MISC. PERSC NAL PROPERTY ESTATE OF Timothv M. Kalar FILE NUMBER 21 05 0862 Include the proceeds of litigation ant the date the proceeds were received by the estate. All property jolntly-owned with the rlgl t of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 2005 BMC Hooligan Motorcycle VIN #1B9HT28845B565029 - Valuation per attached payment from Foremost Insurance Group - vehicle destroyed in accident 2 2005 Ford Escape, VIN 1FMYU93135KB13691 Vehicle repossed by Bank and sold - value per attached sale documents 3 AMEX Assurance Co - Refund of unused automobile insurance premium 4 Foremost Insurance Co. - Refund of unused motorcycle insurance premium 5 Members 1st Federal Credit Union - Checking Acct. No. 248502-11 valuation per attached bank letter 6 Members 1st Federal Credit Union - Savings Acct. No. 248502-00 Interest accrued to 9/18/2005 valuation per attached bank letter 3W46AD 1.000 TO AL (Also enter on line 5 RecaDitulation) $ (If more space is needed. in ert edditional sheets of the same size) $21,854.90 $16,200.00 $205.81 $474.00 $438.57 $26.69 $0.08 $39,200.05 REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ......; . M Tl'..,..... SC ~EDULE F JOINTLY-OWNED PROPERTY FILE NUMBER ." 01:\ OR':;? If an asset was made joint within one year of the decedent's d te of death. it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Kalar, Stephen G B. c. JOINTLY -OWNED PROPERTY: ITEM NUMBER LErIER FOR JOINT TENANT DATE MADE JOINT 1. A. 1 12/30/1899 A 'W46AE 1.000 ADDRESS 2167 MerJimac Avenue, Mechanic~burq, PA 17055-9318 DESffilPllON OF PROPERTY INCLUDE ~E OF FIJoIANCIAL INSTITUTION A1iJ 'sA ~ ACCOlJolT IUolBER OR SlMIUIR IDENTIFYING NUMBER. ATT AC DEED FOR JOINTLY -l'ELD REAL ESTATE 327.59 Shares Ameriprise Financial Fund Acct No. 0101150 002 DATE OF DEATH VALUE OF ASSET u tual 908 9 $3,970.39 TOTAL IA so enter on line 6 Recaoitulation} $ (If more space is needed, insert additic ",al sheets of the same size) Father %OF DECD'S INTEREST 50.0000 RELA llONSHIP TO DECEDENT DATE OF DEATH VALUE OF DECEDENl'S INlEREST $1,985.20 $1,985.20 REV-1510 EX + (6-98) SC. EDULE G INTER-VlV DS TRANSFERS & MISC. NON-P ~OBA TE PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX REnJRN RESIDENT DECEDENT ESTATEOF Timothv M. Kalar FILE NUMBER 21 05 0862 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY II\ClLOE nE N'\ME OF nE TRANSFEREE, TIiEIR REV. nONSHlP TO DECEDENT AN) nEOAlEOF1R...N9A,R....TTACH...COPY OF nE DEED FOR REAL EST"'TE. %OF DECD'S INTEREST DATI OF DEATH VAW OF ASSET Roth IRA - Ameriprise Financial Acct No. 01297352072 4 002 Beneficaries are Steven G. Kalar and Pataricia A. Kalar the Decedent's parents $6,545.98 100.0000 TOTAL (Also el ter on line 7, Recapitulation) $ (If more space Is needed, insert additi Pnal sheets of the same size) W46AF 1.000 EXCLUSION nF APPUCABLE\ $0.00 TAXABLE VALUE $6,545.98 $6.545.98 REIi-1511 EX + ('2-99) sel iEDULE H FUNERA ... EXPENSES & ADMINIS RATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ti M. V"_,_.... Debts of decedent ust be reported on Schedule I. ITEM NUMBER DESCRIPTlC N A. FUNERAL EXPENSES: 1. Cindy Long - Funeral expense (vocalist) Total from continuation schedules B. ADMINISTRATNE COSTS: Personal Representative's Commissions 1. FILE NUMBER 21 05 OB62 Name of Personal Representative(s} Stenhen G. Kalar & Kimberlv A. Gettv Street Address Social Security Number(s} I EIN Number of Personal Re resentative(s} City Year(s} Commission Paid: 2. AttorneyFees Goldberg Katzman, P.C.. State Zip Claimant 3. Family Exemption: (If decedent's address is not the same c s claimant's, attach explanation) Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Cumberland Law Journal - Legal Publication Notice 2 Goldberg Katzman, P.C. - reimbursement for costs advanced Total from continuation schedules State Zip 3W46AG 1.000 T )T AL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert add tional sheets of the same size) AMOUNT $50.00 $12,715.84 RESERVED RESERVED $92.00 $75.00 $214.77 $332.77 $13,480.38 Estate of: Timothy M. Kalar Item No. 2 3 4 5 6 7 Schedule Description Dr. Neil Olcott - Funeral expense (service) Gingrich Memorials - Gravestone expense Malpezzi Funeral Home - Funeral Mechanicsburg Cemetery - Burial plot expense Phillip Cackrell - Funeral expens (music) Rothermel's Florist - Funeral expense (flowers) Total (Carry forward to main schedule) 187-60-6325 Part 1 (Page 2) Amount $125.00 $3,290.00 $7,871. 24 $1,210.00 $50.00 $169.60 $12,715.84 Estate of: Timothy M. Kalar Schedule 3 Steve Kalar - reimbursement for costs advanced for postage 4 The Patriot News - advertisement for sale of vehicle 5 The Sentinel - Legal Publication Notice Total (Carry forward to main schedule) 187-60-6325 Part 7 (Page 2) $176.00 $27.00 $129.77 $332.77 REV.1512 EX" (12..Q3) COMMONWEALTH OF PENNSYLVANIA INI-ERITANCE TAX RElURN RESIDENT DECEDENT ESTATE OF M tr"'1"'.... SCliEDULE I DEBTS JF DECEDENT, MORTGAGE lIABILITIES, & LIENS FILE NUMBER ?1 nl:; nRf:;? Report debts incurred by the decedent prior to death which reml ined unpaid as of the date of death, including unrelmbursed medical expenses. ITEM NUMBER 1. DESCRIPTION Bank of Hanover - Loan Acct No. 7040007045 2 Members 1st Federal Credit Union - Vehicle Loan No. 248502-01 3 ~lton S. Hershey Medical Center - medical expenses 4 Pennsylvania Department of Revenue - payment of 2005 Income Tax due 5 Visa Credit Card Acct. No. 4121449992485024 6 West Shore EMS - Medical expense - last illness 3W46AH 2.000 TOT L (Also enter on line 10. Recapitulation) $ (If more space is needed, insert a ditional sheets of the same size) VALUE AT DATE OF DEATH $11,901. 95 $19,915.72 $25.00 $1.00 $4,243.29 $1,275.77 $37,362.73 REV-1513 EX+ (~O) SCH EDULE J BEN I :FICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Timothv M. Kalar NUMBER I 1 NAME AND ADDRESS OF PERSON(S) RECEIVING F ROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distribi tions, and transfers under Sec. 9116 (a) (1.2)) Patricia A. Kalar 2167 Merrimac Avenue Mechanicsburg, PA 17055 2 Stephen G. Kalar 2167 Merrimac Avenue Mechanicsburg, PA 17055-9318 FILE NUMBER 21 05 0862 RElATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Mother Father $0.00 $0.00 \I ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABC VE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS; A. SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHI:::H AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS <W46AI 1.000 TOTAL OF PART 11- ENTER TOTAl NON-TAXABLE DISTRIBUTION ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, in ert additional sheets of the same size) $ $0.00 TIM( THY M. KALAR SS~: 187-60-6325 INDEX EXHIBIT SCHEDULE OF rnTURN DESCRIPTION A E Copy of Foremost Insurance Co.'s check for payment of value of motorcycle B E Copy of Members 1 st Disposition of Proceeds Sale Notice for Ford Escape C E&F Copy of valuation of Members 1st Federal Credit Union D F&G Copy of valuation of Ameriprise Financial 00415523.1 Exhibit A \ 1 ... ." ..' ..-. ., ..~... II'! ARMING' Original doc~ment has an _"'le' wale,mam nn ~."...... '. .. ..- ',' .. ~.,., t,I_..~IF' '.O.R'E.MO'S' T~ \.... . Bank One, Dearborn! N.A"'_..I2~ 'le" INSlJRANCE COMPANY ' · -.. ." "'" "".""'....... ~ ....-1 e 14:345' f' IllI$UllEl' I i~p~~., TIMOTHY 9o\TI! i 5~J~l?_ . 10/28l05 .c_ - -- .... . ".. .._. .. -.. -~. _.....:'"' . -. '. ~ ~1,S.~Clc:VO\l) IF NOT,CASlED, WImaN 60 DAYS FROM ITS DAlE. . $~ii'~5;4!90-.'; TWENTY~ON.~ THOUSAND, SlGHTHQNP~~P ~lFTY-f()tlR OOL~A~S . STEPHEN KALAR, 'KIMBERLY BANK OF HANOVER NO NtNaTt C~NTS ETTY AND ~~ - - - - - - _ _ __v -~, ~,.. ~ - _. - - - ---- l'=~=~==- pAy 10 iRE O~OER QF' .' . Col1i~(Qn tos~on 9/16/20Q5 1I11.8?~ j~ Sill -:O? 2~ I. 2 1. q? ? 5 bUI MAILING ADDRESS: p.o. X 2739. GAANO RAPIDS. MI ~9601.27~9 'r::(,r, ;- :;7'1",: J ;!""';/,' l=\tcvCI..'EO Exhibit 8 January 23, 2006 1m EMBERS 1st DlSPOS.r;;;;;;;;~OCEEDS SXfE NOTICE Timothy M Kalar c/o John Delorenzo 320 Market St., Po Box 1268 Harrisburg, Pa 17108-1268 RE: Accoullt # 248502-01 VEHICLE: 2005 Ford Escape VIN #: IFMYU93135KB13691 \ Dear Timothy M Kalar, J This letter is to notify you of the dispositi n of the proceeds from the sale of the above referenced rep~sseSSed vehicle. I Outstanding Loan Balan1e (+) Interest \ (+) Late Fees I (+) Repossession Fees (+) Auction Fee (-) Proceeds of Sale (=) Deficiency Balance Due $19,915.72 $ 420.20 $ 3.85 $ 162.50 $ 224.00 $16,200.00 $ 4,526.27 TillS LETTER IS FOR INFORMATIO AL PURPOSES ONLY. THIS IS NOT AN ATTEMPT TO COLLECT. Sincerely, #~4~-1Z..-~ Arlanda H. Dintaman Lead Collector copy: file 5000 Louise Drive · Po. Box 40 · Mechanicsburg, rennsylvania 17055 · (717) 697-1161 · www;me~bers1st.org -I - Exhibit C ~lm MEMBERS 1st fEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 248502 -00 07/24/2004 $26.69 $.08 $26.77 None CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 248502 -11 07/24/2004 $438.57 $.00 $438.57 None VEHICLE LOAN ACCOUNT: Account Number/Suffix Date Loan Established Principal Balance at Date of Death Daily Per Diem Date of Last Payment Due Date Payment Amount/Frequency Collateral 248502 -01 1 0/23/2004 $20,531.57 $3.3976 09/16/2005 1 % 1/2005 $192.42/semi-monthly 2005 Ford Escape, 1FMYU93135KB13691 VISA CREDIT CARD ACCOUNT: Account Number Date Account Established Balance at Date of Death Name of Joint Cardholder 4121449992485024 12/19/1996 $4,243.29 None ;QB:RS 1ST FEDERAL CREDIT UNION ~4X t??at: enise A. Wolfe Insurance Services upervisor October 11, 2005 Estate of: TIMOTHY M. KALAR Date of Death: 09/18/2005 Social Security Number: 187-60-6325 5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www.members1st.org . I The Personal Advisors of 4 Ameriprise ~ Financial Alan R. Malkoff, CFP" , CPA Advanced Financial Advisor Ameriprise Financial Services, Inc. Suite A 15 North Rosanna Street Hummelstown, PA 17036 Bus: 717.566.1073 Fax: 717.566.1076 alan .r.malkoff@ampf.com Advanced Advisor Group An Ameriprise associated franchise April 27 , 2006 Ms. Sharon H. Simcizen Estate Paralegal Goldberg Katzman 320 Market Street Strawbeny Square P.O. Box 1268 Harrisburg, PA 17108-1268 Dear Ms. Simcizen: Attached please find the date of death values for the two accounts owned by Mr. Timothy M. Kalar at his date of death. Note the jointly held account is account number 010115069089002 and the Roth IRA account is account number 01297352072 4 002. Sincerely, 9..~:!~F~ Advanced Advisor Group - Senior Financial Advisor Certified Financial Planner@ Enclosures: Date of death account values for Timothy M. Kalar Brokerage, investment and financial advisory services are made available through Ameriprise Financial Services, Inc. Member NASD and SIPC. Life insurance, disability income insurance and annuities are issued by IDS Life Insurance Company, an Ameriprise Financial company. Products marketed under the RiverSourceSM brand are provided by affiliates of Ameriprise Financial. H...H.... t......"" Kathleen E Doherty ~.. ..~ G)~ 0412612006 03:28 PM To: Alan R MalkofflFieldIWHlAEFA@AMEX cc: Subject: Date of Death Values for Timothy Kalar 169664455 001 April 26, 2006 ALAN RICHARD MALKOFF STEA IS N ROSANNA ST HUMMELSTOWN, PA 17036-1520 Dear ALAN RICHARD MALKOFF: Thank you for your recent inquiry regarding TIMOTHY M KALAR's accounts. These are the values of the accounts as of 09/1812005. Mutual Funds Account Number 01011 506908 9 002 01297352072 4 002 Total Value $3970.39 $6545.98 # of shares 327.590 3224.620 Asset Value Per Share 12.120 2.030 The date of death values provided are for estate tax pwposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance product(s) reflect the gross death benefit at date of death. not the cash value. Values for any proprietary mutual funds include accrued dividends as applicable. Values provided for brokerage products are manually calculated, and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprlse Financial does not guarantee the values. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. Sincerely, Kate Doherty Death Settlements Processing Team 70100 Ameriprise Financial Center Minneapolis, MN 55474 1-800-862-7919, Option 5,1