loise chastain 2014

8/13/2019 Loise Chastain 2014

1/11

31 884CITY OF CHARLESTONEarninss and Hours qu,r Eajg Qurrell vrD ry 99.tffio:oo 7.2s 362.50 725.00Deductions From Gross Currenl YTD Aqgll.lrJ@ -18.13 's626

Patricia A 1 29 1 6 Anna Bell Rd., AR 72933

Net Pay

City of Charleston, P O Box 426, Charleston, AR 72933-0426

SSN MarriedlvvithholdPay Period: a1I1Il2O14 - 01 2412014 Pay Date: 0112412014

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T.voc Current YTD Amountffi -2.00 -4.00Social Security Employee '27 47 -44'95Medicare Emproyee -ZZZ _13.3iAR - Withholdinq -35.0430s.33

Nonlaxable Company ltems Current YTD AlllgtltRetuemeni - otyEaeral 53'94 107.88618.64

CITY OF CHAHLESTON 3185Allowances/ExtraPatriciaARogers, tzgtoffi ----------- _ezzz tuarieomrlPay Period: 1212812013 - 01l1Ot2O14 Pay Date: 0111012014

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Taxes Current yTDAmountsociarsecurib/ Emptoyee -i.lrl -;lirZMedicare Employee -5.26 -5.26AR - Wlthholding _5.32 _5.32

-35.00309.31

Non-taxable Compa Current yTD AmouniRetirement - city Genera-ffiNet Pay

-35.06309.31

City of Charleston, P O Box 426, Charleston, AR 72933-0426


2/11

PATRICIA ROGERSWhirlpool RetireesGlaime lncluded ln this PaYment

Part D HRAMed HRA Without RHSA

Gurrent Year Account Balances

Part D HRA Without RHSA

$50.00 $50.00

.oo .00aid.00

$420.00 $35.00 $3s,00

No.1100046016Date: 11712014Amt This

$0.00 $50.00Total: $85.00

Plan Year$0.00$0.00

.00$s85.00

Date 0f11112014 -a1120141ruzv$ -2NDAM


3/11

B ROGERSWhirlpool RetireesClaims lncluded ln this PaYment

PtanDate Of

Ns:1100045743Date: 1l7tZAfiAmt ThislaimAmount

HRA WithoutMed HRAWithout RHSA 211t2014U|DAM - $50.00 $50.00211t2014 $o.oo $o.oo $50.00Total: $85.00

Current Year Account Balanees Etigible Submitted Plan Yearpran nnpqlt . = gEiqrg , =?1r9 Pe$ilq D9 ti99 F9 qn990.oo $o.oo $550-ooPart D HRA Without RHSA $420,00 $3s.00 $35.00 $0.00 $0.00 $38s.00


4/11

Page 1 of 1 2013 POzark: (4791662-2415219W Main StreetOzark AR 72949 3[: Hff i"J : g7 e) s65'7 r s7Charleston AR 72933ersonal Property AssessmentFranklin County, Arkansas

ifinsHrji$IJComments: 1IgIzAfi IN OFFICE JKB

1

VehicleA,utomobiles2011 CHEVROLETMotorcycles2001 KawasakiFarm Equipment2009 Utility Traiter1989 FORD

IMPALA2c1wA5EK7B1 112454KAF300-C5 Mute 5S0JK1AFBC1O1852916,1Flaibed, Light Duty4R78U10159TA96279TRACTOR--1OO DIESEL 1,NON DFA

4dr 1LS FFV 4DRHT 3.SL 6Cyt_t

ATV 286cc lcyl 4-Stroke 2+R10'Standard

Value P2,860

308

14050

Assessed Value Ilqls NOT A B|LL - DO ,v-oT PA\Penatty,H33ff H:i: l; ffi :r'.g:,i: : rrffine vatues rFh.tarad -.^ .-..^rig-qred to list for taxation, and that 11i1 1s- 1o, gertirv thar the "offissessed for the current year.Total Assessmentthe varues,eno"i,o i," ii;; ffi ';;",# ililTilli ;i 1,,1,.lil*,"0n"Owner/Agent X CountyAssessor: Gathy Bennett

This is to certify the "oFtaxes due, as recorded *,:Hff'0"'o Tl;;"ilt'*t-wom before and subscribed to before methis 19 of December,2013 1:40 pMJKB

on date lOlO4lZOlgin the amount of _ 1g2.6g for the yearSylvia Knot"" --.__--

PPAN 24-7100339Name En/aEE6 h\ame ROGERS pATRtCtA ANhSchool District A1PLEASE READ CAREFULLYBetween January 1 and Mav 3ir*r: r jt#r,r#niii nl{,l ffi ,r.xfiFffi , ;',;1p,',.#ttt#*i*,Tff rjI{h,fft :i"#;xri,"1i",1,H,,1*?;:::,_

Assessor, Dei@ETotaE2A12


5/11

Sylvia KnolesCollectorPO Box 1267OzarkAR 72949(479\ 667-4124

2012 Tax Receipt 6767Franklin County, Arkansas Page 1 ofREPRINT ott24t2o14 oPosted 1oto4t2o13 o2

lf payment is made by check and same is nothonored on presentation, receipt is null and void.Payment Received JLW rclo4t2A1310t04t13 IN OFFICE

PAID RECEIPT14404324ROGERS PATRICIA ANN12S16 ANNA BELL RDCHARLESTON AR 72933

01

Year Owner and Legal Description2012 ROGERS BOBBY & ANN

04-A7-28 4.21 Acres PT SE SEReal EstateHomestead CreditTotal Due

Payment Received

Valuation Millage

13,14A 45.50

Amt Due

$597 87($350.00)

247.87$

ROGERS BOBBY & ANN01c CITY OF BRANCH A4-A7-2e 1.05 Acres pT SW SE SEReal Estate

Payment Received 1,200 50.50 $60.60

71 00339 ROGERS BOBBY & ANN01

Personal PropertyPersonal PropertyPayment Received 4,015 45.50 $182.68 $Total Payment Applied $

Distribution of Tax DollarsDistrict 1 $38492Branch City $6.00Branch City Roads $1.80Couniy General $46.92County Road (Fuli) $28.38County Library $21.33County Road (Split) $1.S0Total Tax $491.15 Total Parcels PaidAecount Balance: $ 0.00


6/11

a Employee's SSNs3L-1 8-81 27

'I Wages, trps, olner comp.4729 .13 z reoelal lncome Ex 33.003 Soclal securtty wages434L .25 4 Social secunty tax wlthneld269.L6b Emplsyer ID no. (ElN)

71 -60169495 MediEre wages and tlps434L.25 62 .95@cooeCITY OE CHARLESTON

P O BOX 426CHARTESTON AR 72933-0425ETontrol mber

e Employee's name, address, and ZIP code Suff'PATRICIA A ROGERS12916 ANNA BEI,], RD.CHARLESTON AR 129337 Social securi, tips SAllocated tips ,, : .. ",1::.':: | , -:' -0 Deoendent care benefrls 1 Nonqualitred Plans zauooe >ee lllst. lul uu^ l.E 2L2.L2i3;talutory employee

ieiirement Plan X-hird-oartv sick oav

4Other I Zh L;odel2cCodeI 2d Code

AR I71-5076909II

15 State Emolover's siate lD flumber4129.73

6 State waqes, tips, etc.60.89

I7 State income tax8 Local wages, tips, etc. 9 Local income tax l0 Locality name

Treasury.intoimTtibirl3 -neiiiriluinlihed-io ihe [ntsnal Revmue ssvice.

coov 2 To Be Filed with Employee s slare,Ciwlor Local lncome Tax Returh. ZUISOMB No. 1545-0008a Employee's SSN43L-1 B-8121

1 Wages, t ps, otner comp.a12q 1? 2 Federal income iax wltnheld33.003 Social secuilty wages4341.25 4 Social securitY tax withhetd269.16b Emolover ID no. (ElN)

7 1- 60 1 69095 Medrcare wages ano ups4341.2 52 .95?EEii6-veis:mie,mployer3me, addmi, and ZIP codeClTY OF CHARLESTON

P O BOX 426cHART,EsroN AR '12933-0426

d Control numbere Employee's name, address, and ZIP code Suff'PATRICIA A ROGERS129].6 ANNA BELL RD.CHARLESTON AR 129337 Social securdy trps SAllMted tips 9110 Dependent mre benellts 'I I Nonqualrf red plans l2aCode See inst. for box 12E )1) 12t3;tatutory employeletilement Plan X:hrd'oartY sick paY

'l4Other 'lZ Code1 2c Code'12d Code

AR li 1-601 6eoe5 State Emolover's slate lD number

Al aa 136 State waoes. iios, etc

60.897 State income tax

8 Local wages. tips, etc- 9 Local itrcome tax l0 Locality name

and Tax reasury

Form 1099-R Form 109$R2At3 2At3MB o. 1545-01'19 ZUIJf)istributions fromPensions,Annuities'Retirement orProfit-SharingPlans, [RAsInsurance1 Gr6s DistnbutEn$ 8206-80 2a Tilable Am@nt$ 8206.802b Tdable amount Totrnot determinedrAYER'S Federal idenlification number38-6223426 BECIPIENT'S identitication number43't-78-8727

PAYER'S name, slret address, city, state and ZIP cdeWhirlpool Retirement Trust2000 NORTH M-63BENTON HARBOB MI 49022-2692

3 Capital gain {ircludedin box 2a)$

4 Federal incme tax wthhelr$

sEmploye conlributionsor tnsurane premlums$i Net unrealized apPreiaiionin employer's ssurities 7 Dislribuiion code

7IHA/SEP/iIMPLE

8 Otherq o/o

Ja Your percentage ol total distribulion 9b Total employe contributionsFIECIPIENT'S name, stree address, city, slate and ZIP code

Patricia A Bogers.12916 Anna Bell FlD.Charleston AR 72S33-9802

l0 Am@nt allog.atie to IHHwithin 5 vears S J 1 1st year ot degg. Roth:6trib- 12 State tax withhld$ 72.24Accent numbrq2rlqRg7g7 1 3 SlalelPave/s stata no.A E , aa-AiranrA 1 4 Stale distribul$nt arna anl5 L@al tax withheldc

16 Name of l@ality 17 L@al distnbutrmcSndT:-Frlr feeinient'c Flct:rrrdq DtrurtmenloliheT*asrre

CORFIECTED (if qh4ked) OMB No. 1545-0l 19 ion\nnremt-SanIns

1 GrN Distributiqs 8206.B0 2a Taxable Amount$ 8206.80 DrstrrDulPensions,,RetiProfPInol detemined [l o,"tnorr,on TlPAYEF'S Fedral idenlilicaiion number?8-6223026 RECIPIENl-S identiticalion number431-78-8727

PAYEB'S name, street addres, city, state and ZIP codeWhirlpool Betirement Trust2000 NoRTH M-63BENTON HARBOR MI 49022.2692

Capital gain (includedin box 2a)$4 Federal income tax wthhel

s5 Employe contributionsor Insurance prmlumss

i Net unrealized appr*iaiionin employe/s ssurities 7 Dislribution code7

IBAISEP/iIMPLE8 Other

q]a Your percentage of total distributim 9b Total employee cmtribution

bRECIPIENT S name, street address, cjty. atalq

Patricia A Bogers1 29 16 Anna Bell RD,Charleston AR 72933-9802

1 0 Amomt atloqgble to I RBsilhin 5 vea6 $ I t I st year ot dsig. Roth.mlrihAccount numbero2n6eq7q7 1 3 Slate/Paver's stale noLa l.ta-A6cenr1 distributim15 L@al tax withhelda 16 Name ol l@ality disldbuti@n6^.&-.t ^t tb Tra^er 'ru


7/11

;iE=;l;il-ffi ==ffi- iEfrEE;-ffi=Eil" f- Distributions Fromcou4rry and ztpor foreign postat code I ""- :-"'""'- I I Pensions' Annuitie-s'D fif s/o0oo0q5p90Distribrrtipns Fron"Pensions. Annuides,Relirbrnent orProfit-SharingPlans, lFlAs,lnsqranceContracts, etc-fra.fgC'S name, street addres, cily or town' province or state,corrntru. an(, ZtP or forciqn poslal codcHOURLY PENSION

ELM HTLt PIKETN 372T0

-l Gross dist.ik)ution55s2.84 2@1 3OMEi No- 1 545 Ol 1 9.rsm 1O99-R

2a -raxa|>le amountcZU -raxaUte amount Totalnot detelmined Fl distritrution E CoPY EFleport tttisancome ort yourfederal taxreturrr- lf thisforrn strowsfederal ineorne

tax vnitlrheld inbox 4, attachthis copy toyour return-This information isbeing lumished tothe lntemaFlevenu Service-

PAYER'S federal idenlificationnumtler FlECI PIENT'S identificationnumtrer430692987

3 Capital gain (includedin box 2a) 4 FedeEl incotne taxwithhelda

RECIPIENT'S nameROGERSSlreet address (including apt- no')L29L5 AHNA BELL ROADCity or toM, Province s stEte, @untry, and ZIP or foreign postal codeAR 72933

5 Employe conlrit utions,/Designated Rothcontritlulions orinsurace premiumss6 Net unrealizedapprrciation inemployer's seurities

7 Distributioncode(s)7

IRA/SEPISIMPLET-tI Other

q9a Yourpercentageoftotaldi$ribuion "/o

9b Totd.errdqleffiMl:rcA1O Asount allocatfle to IRFlwathin 5 YaF

Q, i -l st year of desig - Roth contrib.

000012 Siate tax withheld$ 13 State,/Payry's state no- 14 State distribution$

Ac@unt numbs (s iretrustioE) i5 Local lax witt*ld$ 16 Name of locality 17 L@al disiribrrtion$1()99-R ww-iE-qov/forml O99r D@aftfitent of the Trsury - lnlernal Revenue Seruice


8/11

wHr( Kettree Payro.LIll'rIlEE ZUUU [-OJ D&] ZU'lg EeIIgOn HarDor 49tJ22Name Patricia A RogersPers No. 92A5e979Cost Center 1L004

curreoEY?D 683.908, 206 .80 0.000-00 6.0272.24677 .488,134 . 56 683.908, 205.80

REMOVE DOCUMENT ALONG THIS PERFORATION

IcF]6T0C


9/11

Trane Merged Hrly Pension Plan2105 Elm Hill PikeNashville, TN 37210

Pay Group: PFS-Pension Ft.Pay Begin Da e: 12l0ll20l3 Busines Unit: RETUSCheck #; 07f0999

TAX DATAMarital Stanrs: ExemptAllowances:Addl. Pct.:Addl. Amt.:

Single0Employee ID: 1017712RDepartmeirt: CPENUFISH-FI Smith (6530) Hourly[-ocation: Forl Smith

Bobby Rogers12916 Ama Bell RoadCharleston AR

?.533145 173.33

Retiree - Dependent Life 2155 258

Fed Mthholdng

411.07.84

471.075.652.84


10/11

FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT201 3 : 3tE,,HE'[?Y?S3."fo1'fi3HEHr3il*,T+li-=HowN rN Box 5 MAY BE TAXABLE TNC.ME

Box 1. NamePATRIC]AAROGERS

Box 2. Beneficiary's Social Security Numb431-78-8i2i

Box 3. Benefits Paid in 2013s15,1?8.80

Box 4. Benefits Repaid to SSA in 2O13NONE

Box 5. Net Benelfis lot zo13 (Box 3$15,178.80

DESCRIPTION OF AMOUNT IN BOX 3Paid by check or direet dePosit&ledicare Part B premiurns deductedfoom your benefitsTotal AdditionsBeneflts for 2013

s13,s?0.00$1,258.80$15,1?8.80$15,1?8.80

DESCRIPTION OF AMOUNI IN ts(J,(NONE

Box 6. Voluntary Federal lncome Tax Wiihheld

NONE

PATRICIAAROGERS12916 ANNA BELLE RDCHARLESTON AR 72933.9519

Box 8. Claim Number {l}se this number if you need to contact SS

437-78'-87274Form SSA-lO99-SM (1-2014)


11/11

FORM SSA.1O99 - SOCIAL SECURITY BENEFIT STATEMENT201 3 : EtE rflE'l??ESr"Jf&'fi3HE I'I='"H.=#rs sHowN rN Box s MAY BE TAXABLE INC.ME

Box 1. NameBOBBIE G ROGERS

Box 2. Beneficiary's Social Security Numb430-68-298?

Box 3. Benefits Paid in 2013$14,316.00

Box 4. Benefits Repaid to SSA in 2013NONE

5. Net Benefits for 2013 (Box 3 minus B$14,816.00

DESCRIPTION OF AMOUNT IN BOX 3Paid by check or direct depositBenefits for 2013 s14,816.00s14,316.00

DESCRIPTION OF AMOUNT IN BOX 4NONE

Box 6. Voluntary Federal lncome Tax Withheld

NONEuo* r. lroor"rtBOBBIE G ROGERS12916 ANNA BtrLL ROADCHAELESTON AR 7 2933 -951,9

Box 8. Claim Number {t-)se this number if you need to contact SS430-68-2987A

Form SSA-1 099-SM (1 -201 4) DO NOT RETURNTHIS FORMTO SSA OR lHS

2w l'

loise chastain 2014

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