CITY OF CHARLESTON

SSN Patricia A Earninss and

1

31
AR 72933 Marriedlvvithhold Pay Period: a1I1Il2O14 - 01!2412014 Pay Date: 0112412014

884

29 1 6

Anna Bell Rd.,

ffio:oo @ ffi
T.voc

Hours Gross

!qu,r! Eajg 7.2s 362.50

Currenl

Qurrell

vrD ry!99.t
725.00 YTD Aqgll.lrJ

Deductions From

-18.13 -2.00
47
'27

's626

Current

YTD Amount -4.00

Social Security Medicare AR - Withholdinq

Emproyee
ltems otyEaeral

Employee

-44'95 _13.3i

-35.04 30s.33

-ZZZ
YTD

Net Pay

618.64

Nonlaxable Company
Retuemeni -

Current

53'94

Alllgtlt
107.88

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

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Intuit PaYroll

CITY OF CHAHLESTON
PatriciaARogers,

31854
----------_ezzz
Allowances/Extra

tzgtoffi

tuarieomrl
Pay Date: 0111012014

Pay Period: 1212812013 - 01l1Ot2O14

Taxes
Employee AR - Wlthholding
Medicare Net Pay Non-taxable Retirement - city

Current

yTDAmount

sociarsecurib/

Emptoyee

-i.lrl
-35.06 309.31

-5.26 _5.32

-;lirZ
-5.26
_5.32

-35.00
309.31

Compa Genera-ffi

Current

yTD Amouni

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

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PATRICIA ROGERS Whirlpool Retirees

No.1100046016

Date: 11712014
0f
$50.00 $50.00 Amt This

Glaime lncluded ln this PaYment

Date
11112014

Part D HRA Med HRA Without RHSA

a112014

1ruzv$
2NDAM

$0.00 Total:

$50.00

$85.00

Gurrent Year Account Balances

aid
.oo .00 .00

Plan Year

$0.00 $0.00

.00

Part D HRA Without RHSA

$420.00

$35.00

$3s,00

$s85.00

B ROGERS Whirlpool Retirees

Ns:1100045743

Date: 1l7tZAfi
Date Of Claim Amt This

Claims lncluded ln this PaYment

Ptan HRA Without
211t2014

Amount

Med HRAWithout RHSA

U|DAM

$50.00

$50.00

211t2014

$o.oo $o.oo $50.00 Total: $85.00

Plan Year F9!qn99 $550-oo

Current Year Account Balanees

pran
Part D HRA Without RHSA

Etigible Submitted
nnpqlt
.

gEiqrg , =?1r9 Pe$ilq D9!ti99 0.oo $o.oo

$0.00

$420,00 $3s.00 $35.00 $0.00

$38s.00

Page 1 of

Ozark: (4791662-2415 219W Main Street Ozark AR 72949

2013 P ersonal Property Assessment

Franklin County, Arkansas

PPAN Name !\ame School District

Hff i"J Charleston AR

Between January 1 and Mav 3i
r

3[:

: g7 e) s65'7 r s7
72933

24-7100339

En/aEE6 h ROGERS pATRtCtA ANh

A1

PLEASE READ CAREFULLY

r*r: jt#r,r#niii

nl{,l

ffi ,r.xfiFffi

;',;1p,',.

#ttt#*i*,Tff rjI{h,fft

:i"#;xri,"1i",1,H,,1*?;:::,_,1'

ifinsHrji$IJ
Comments:

1IgIzAfi
1

IN OFFICE JKB

Vehicle
A,utomobiles

Value
IMPALA

Pen:

2011

CHEVROLET

Motorcycles

2c1wA5EK7B1 112454
KAF300-C5 Mute 5S0 JK1AFBC1O1852916,1

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

2,860

2001

Kawasaki

ATV 286cc lcyl 4-Stroke 2+R

Farm Equipment

308

2009

Utility Traiter FORD

1989

Flaibed, Light Duty 4R78U10159TA96279

TRACTOR--1OO DIESEL NON DFA
1,

10'Standard
140 50

Assessed Value
rne vatues rFh.tarad

Ilqls
list for taxation, and that

NOT A B|LL - DO ,v-oT PA\

Penatty

: :r'.g:,i: ffi the varues,eno"i,o i," .-..^rig-qred to -.^ ii;;

,H33ff H:i: l;

rrffi ffi ;;",# ililTilli

'

Total Assessment
gertirv thar the 11i1 1s- 1o, assessed for the current year.

;i 1,,1,.lil*,"0n"

"offi Tl;;"ilt'*t2A12

Owner/Agent

CountyAssessor: Gathy Bennett

This is to certify the on

Swom before and subscribed to before me this 19 of December,2013 1:40 pM

taxes due, as recorded

date lOlO4lZOlg

"oF *,:Hff'0"'o

JKB

in the amount of

Assessor,

Dei@ETotaE

Sylvia Knot""

1g2.6g _ --.__--

for the year

Sylvia Knoles Collector

PO Box 1267

2012 Tax Receipt 6767 Franklin County, Arkansas

Page 1 of 1 REPRINT ott24t2o14 o2:a2

Posted

1oto4t2o13 o2:4e

OzarkAR 72949 (479\ 667-4124

PAID RECEIPT
lf payment is made by check and same is not honored on presentation, receipt is null and void. Payment Received JLW rclo4t2A13 10t04t13 IN OFFICE

14404324
ROGERS PATRICIA ANN 12S16 ANNA BELL RD CHARLESTON AR 72933

Year
2012
01

Owner and Legal Description

ROGERS BOBBY & ANN 04-A7-28 4.21 Acres PT SE SE Real Estate

Valuation

Millage

Amt Due

13,14A

45.50

Homestead Credit Total Due Payment Received

ROGERS BOBBY & ANN

$597 87 ($350.00) 247.87 $24

01c

CITY OF BRANCH A4-A7-2e 1.05 Acres pT SW SE SE Real Estate 1,200 Payment Received
ROGERS BOBBY & ANN

50.50

$60.60

71

00339
01

Personal Property Personal Property Payment Received

4,015

45.50

$182.68
$1 82

Total Payment Applied

$1

82

1 City Branch City Roads Couniy General County Road (Fuli) County Library County Road (Split)
District
Branch

Distribution of Tax Dollars

$38492
$6.00

$1.80
$46.92 $28.38 $21.33 $1.S0

Total

Tax

$491.15

Total Parcels Paid Aecount Balance:

0.00

Ciwlor Local lncome Tax Returh.

a Employee's SSN 'I Wages, trps, olner comp.

coov 2 To Be Filed with Employee s slare,

a Employee's SSN
1

ZUIS
OMB No. 1545-0008 2 Federal income iax wltnheld

z reoelal lncome Ex

Wages, t!ps, otner comp.

4729 .13
3 Soclal securtty wages

33.00
4 Social secunty tax wlthneld

a12q
3

1?

33.00
4 Social securitY tax withhetd

s3L-1 8-81 27
b
Emplsyer ID no. (ElN)

43L-1 B-8121
b
7
Emolover ID no. (ElN)

Social secuilty wages

434L .25
5 MediEre wages and tlps

269.L6
62 .95

4341.25
5 Medrcare wages ano ups and ZIP code

269.16
52 .95

71

@cooe

-6016949
CHARLESTON

434L.25

mme, addmi, ?EEii6-veis

r:mie,mployer3

1- 60 1 6909

4341.2

CITY OE

ClTY OF CHARLESTON P O BOX 426

P O BOX 426

CHARTESTON
ETontrol

AR 72933-0425
code AR
12933
Suff'

cHART,EsroN
d Control number
e Employee's name, address, and ZIP

AR '12933-0426
code AR
911 Suff'

mber

e Employee's name, address, and ZIP PATRICIA A ROGERS

12916 ANNA BEI,], CHARLESTON

RD.

129].6 CHARLESTON
7

PATRICIA A

ROGERS ANNA BELL RD.

12933

Social securi, tips Deoendent care benefrls

SAllocated tips Nonqualitred Plans

Social securdy trps Dependent mre benellts

'I

SAllMted tips I
Nonqualrf red plans

,, : .. ,!-:' ::: |

",1::.' 0

zauooe >ee lllst. lul uu^ l.

l2aCode See inst. for box 12

E
4Other
I Zh

2L2.L2
t3
;tatutory employe

E
'l4Other

)1)

12

i3
;talutory employee

L;ode

'lZ!
1

Code

l2cCode
ieiirement -hird-oartv

2c Code

Plan
sick oav

X
I 2d Code

letilement

Plan
paY

X
'12d Code

:hrd'oartY sick

AR I71-5076909
I I

4129.73
6 State waqes, tips, etc.

60.89
I7 State income tax

AR

1-601 6eoe

Al aa

13

60.89
7 State income tax

li
5
State

15

State

Emolover's siate lD flumber

Emolover's slate lD number

6 State waoes. iios, etc

8 Local wages, tips, etc.

9 Local income tax

l0 Locality name

8 Local wages. tips, etc-

9 Local itrcome tax

l0 Locality name

intoimTtibirl3

-neiiiriluinlihed-io

Treasury.
ihe [ntsnal Revmue ssvice.

and Tax

reasury

Form 1099-R
1

OMB !o. 1545-01'19

2a

2At3 ZUIJ

Form 109$R
1

Gr6s DistnbutEn

8206-80

Tilable Am@nt

f)istributions from Profit-Sharing Plans, [RAs

Insurance

8206.80

Pensions,Annuities' Retirement or

GrN Distributiq
8206.B0

CORFIECTED (if qh4ked) OMB No. 1545-0l 19 2a Taxable Amount

2At3

DrstrrDul ions

8206.80

Pensions,,

\nnuit

fr

2b

Tdable

amount

Reti remenl Prof t-Shar

PI ans, IR

Totr

not determined

nol

detemined

o,"tnorr,on

[l
PAYEF'S Fedral idenlilicaiion number

Tl
RECIPIENl-S identiticalion number

Insural 431-78-8727

rAYER'S Federal idenlification number

BECIPIENT'S identitication number

38-6223426
PAYER'S name,

43't-78-8727 slret
address, city, state and ZIP

?8-6223026 Whirlpool Betirement Trust

cde

PAYEB'S name, street addres, city, state and ZIP code

Whirlpool Retirement Trust 2000 NORTH M-63

BENTON

HARBOB MI 49022-2692
4 Federal incme tax wthhelr

2000 NoRTH M-63 BENTON HARBOR MI 49022.2692

3 Capital gain

{ircluded

sEmploye conlributions
or tnsurane premlums

in box 2a)

Capital gain (included in box 2a)

4 Federal income tax wthhel

5 Employe contributions
or Insurance prmlums

$
i
Net unrealized apPreiaiion in employer's ssurities

$
7 Dislribuiion code
IHA/

$
8 Other

s
7 Dislribution code

s
IBAI SEP/
iIMPLE 8 Other

i
o/o

SEP/
iIMPLE

Net unrealized appr*iaiion in employe/s ssurities

7
Ja Your percentage

7
]a Your percentage of total distributim

ol total distribulion

9b Total employe contribution

9b Total employee cmtribution

s
FIECIPIENT'S name, stree! address, city, slate and ZIP code

b
RECIPIENT S name, street address, cjty. atalq

Patricia A Bogers
.12916

Patricia A Bogers AR 72S33-9802

12
1

Charleston
l0 Am@nt allog.atie to IHH within 5 vears S Accent numbr
J

Anna Bell FlD.

Charleston
1 0 Amomt atloqgble to I RB silhin 5 vea6 $

29 16 Anna Bell RD,

AR 72933-9802

:6trib1

1 1st year ot degg. Roth

tax withhld $State72.24 4 Stale distribul$n

.mlrih
1

st year ot dsig. Roth

q2rlqRg7g7 c

E , aa-AiranrA

3 SlalelPave/s stata no.

arna an

Account number

o2n6eq7q7
15

La l.ta-A6cenr1
16 Name ol l@ality

3 Slate/Paver's stale no

distributim disldbuti@ n6^.&-.t ^t tb Tra^er 'ru

l5 L@al tax withheld

16 Name of l@ality

17 L@al distnbutrm

L@al tax withheld

SndT:-Frlr

feeinient'c

Flct:rrrdq

DtrurtmenloliheT*asrre

ffi cou4rry
I

and ztpor foreign postat code

;iE=;l;il-ffi

I
-l

""-

:-"'""'==ffi-

fiEfrEE;-ffi=Eil" I I
OMEi No- 1 545 Ol 1 9.

Pensions' Annuitie-s'

Distributions From

D fif
TRANE-MERGERED HOURLY PENSION
PLAN
fra.fgC'S name, street addres, cily or town' province or state, corrntru. an(, ZtP or forciqn poslal codc Gross dist.ik)ution

55s2.84
2a -raxa|>le amount c ZU -raxaUte amount not detelmined Fl

Z1O5 ELM HTLt PIKE IIASHVILLE TN 372T0

PAYER'S federal idenlification numtler
FlECI PIENT'S identification numtrer

Capital gain (included in box 2a)

r3-5209551
RECIPIENT'S name

430692987
5 Employe conlrit utions ,/Designated Roth contritlulions or insurace premiums

BOBBT ROGERS

s
Slreet address (including apt- no')

s/o0oo0q5p90 Distribrrtipns Fron"l Pensions. Annuides, Relirbrnent or Profit-Sharingl 2@1 Plans, lFlAs, lnsqrance Contracts, etcrsm 1O99-R Total CoPY El distritrution E Fleport tttis ancome ort your incotne tax 4 FedeEl withheld federal tax returrr- lf this forrn strows a federal ineorne 6 Net unrealized tax vnitlrheld in apprrciation in box 4, attach employer's seurities this copy to your return-

7 Distribution
code(s)

7 Province s stEte, @untry, and ZIP or foreign postal code 9a Yourpercentageoftotal di$ribuion ^HaPr.E:qToN AR 72933 -l Siate tax withheld 12 year Roth contrib. of desig st , i IRFl to allocatfle Asount 1O wathin 5 YaF $ City or toM,
Q

L29L5 AHNA BELL

ROAD

IRA/ SEPI SIMPLE

Other

T-t

q 9b Totd.errdqleffiMl:rc

This information is being lumished to

Flevenu Serviceno-

the lntemal

"/o

13 State,/Payry's state
16 Name of locality

14 State distribution

$
17 L@al disiribrrtion

0000

Ac@unt numbs

(s iretrustioE)

i5

Local

lax

witt*ld

$
D@aftfitent of the Trsury - lnlernal Revenue Seruice

1()99-R

ww-iE-qov/forml

O99r

wHr(
Name!

Kettree Payro.LIll'rIlEE
92A5e979 1L004

ZUUU

![-OJ

D&]

ZU'lg EeIIgOn HarDor !{I

49tJ22

Cost Center
curreoE
Y?D

Pers No.

Patricia A Rogers

683.90
8, 206 .80

0.00 0-00

6.02 72.24

677 .48 8,134 . 56

683.90
8, 205.80

YI

REMOVE DOCUMENT ALONG THIS PERFORATION

IcF]6T0C

Trane Merged Hrly Pension Plan

2105 Elm Hill Pike Nashville, TN 37210 Bobby Rogers 12916 Ama Bell Road
Charleston AR Employee

Pay

Group:

PFS-Pension Ft.

Busines Unit: RETUS

Check

Pay Begin

Da!e: 12l0ll20l3
TAX DATA

#;

07f0999

ID:

1017712R

Departmeirt: CPENUFISH-FI Smith (6530) Hourly

[-ocation:

Forl Smith

Marital Stanrs: Exempt Allowances: Addl. Pct.:

Single 0

Addl. Amt.:

?.533145

173.33

Fed Mthholdng

Retiree - Dependent

Life

2155

258

411.07
.84

471.07 5.652.84

FORM SSA-1099

SOCIAL SECURITY BENEFIT STATEMENT

rN

201 3
Box 1. Name

Box 5 MAY BE TAXABLE TNC.ME

Box 2. Beneficiary's Social Security Number

: 3tE,,HE'[?Y?S3."fo1'fi3HEHr3il*,T+li-=HowN

PATRIC]AAROGERS
Box 3. Benefits Paid in 2013 Box 4. Benefits Repaid to SSA in 2O13

431-78-8i2i
Box 5. Net Benelfis lot zo13
(Box 3

s15,1?8.80
DESCRIPTION OF AMOUNT IN BOX 3

NONE
s13,s?0.00
$1,258.80 $15,1?8.80 $15,1?8.80

$15,178.80
DESCRIPTION OF AMOUNI IN ts(J,(

Paid by check or direet dePosit &ledicare Part B premiurns deducted foom your benefits

NONE

Total Additions Beneflts for 2013

Box 6. Voluntary Federal lncome Tax Wiihheld

NONE

PATRICIAAROGERS 12916 ANNA BELLE RD CHARLESTON AR 72933.9519

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

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

FORM SSA.1O99

- SOCIAL

SECURITY BENEFIT STATEMENT

sHowN
rN

201 3
Box 1. Name

Box s MAY BE TAXABLE INC.ME

Box 2. Beneficiary's Social Security Number

: EtE rflE'l??ESr"Jf&'fi3HE I'I='"H.=#rs

430-68-298?
Box 4. Benefits Repaid to SSA in 2013 5. Net Benefits for 2013
(Box

BOBBIE G ROGERS
Box 3. Benefits Paid in 2013

minus Bax 4

$14,316.00
DESCRIPTION OF AMOUNT IN BOX 3

NONE

$14,816.00
DESCRIPTION OF AMOUNT IN BOX 4

Paid by check or direct deposit

Benefits for 2013

s14,816.00 s14,316.00

NONE

Box 6. Voluntary Federal lncome Tax Withheld

NONE
uo* r. lroor"rt

BOBBIE G ROGERS 12916 ANNA BtrLL ROAD CHAELESTON AR 7 2933 -951,9

Box 8. Claim Number {t-)se this number if you need to contact SSA.)

430-68-2987A
Form SSA-1 099-SM
(1 -201

4)

DO NOT RETURNTHIS FORMTO SSA OR lHS

2w l'