HomeMy WebLinkAbout05-14-07
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15056041147
REV.1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes ~
PO BOX.280601 ~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONL V
County Code Year
INHERITANCE TAX RETURN 2 1 0 6
RESIDENT DECEDENT
File Number
1051
195324551
09282006
Date of Birth
07231930
Decedent's Last Name
Suffix
Decedent's First Name
CECELIA
MI
E
JACOBS
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
JACOBS
Suffix
Spouse's First Name
MELVIN
MI
L
Spouse's Social Security Number
204308737
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of death
prior to 12-13-82)
0 4. limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required
(date of delth after 12-12-82)
0 6. Decedent Died Testate 0 7. Decedent Maintained a living Trust 0 6. Total Number of Safe Deposit Boxes
(Attach Copy of wal) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal povr,% Credit (date of death 0 11. Election to tax under Sec. 9113(A)
. betwaen 12-31- 1100 1-1-95) (Attach Sch. 0)
~ORRESPONDENT. THIS SECTION MUST BE COMPLETED. AU CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
EDMUND G. MYERS 7177614540
Firm Name (If Applicable)
JOHNSON DUFFIE
'"
(-"') .('~,::.>
REGISTER OF'~S USE Q8J.V
- "
Second line of address
CJ
--n
',J
- .--
~,...
First line of address --<:
301 MARKET STREET
City or Post OffIce
LEMOYNE
DAlE:FILED
State
PA
ZIP Code
17043
-..J
. /; S;f'~
Correspondenes e-mail address:
Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowled~ and belief,
it is true, correct ana complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knoWledge.
SIGNATURE OF PERSON RESP. IBLE FOR FILING TURN DATE
Melvin L Jacobs r - '? - 0 7
17011
EDMUND G. MYERS
DATE
0-4-,
301 MARKET STREET, LEMOYNE, PA 17043
Side 1
L
15056041147
15056041147
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15056042148
REV-1500 EX
Decedenl',Neme: Cecella E Jacobs
RECAPITULATION
Decedent's Social Security Number
195324551
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
9,364.58
3. Closely Held Corporation. Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D).......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
5,948.28
6. Jointly Owned Property (Schedule F) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested............. 7.
48,685.99
8. Total Gross Assets (total Lines 1-7)....................................................................... 8.
63,998.85
12,057.00
1,040.41
13,097.41
50,901.44
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.
12. Net Value of Estate (Line 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
50,901.44
50,901.44
o . 00
15. 0.00
16. o . 00
17. 0.00
18. o . 00
19. 0.00
o . 00
0.00
19. Tax Du.... ............................................... ................... ................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
D
L
Side 2
15056042148
150560421415
-.J
REV-1.500 EX Page 3
Decedent's Complete Address:
File Number 21-06-1051
DECEDENrs NAME
Cecella E Jacobs
STREET ADDRESS
116 Conodogulnet Avenue
CITY I STATE IZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
6. Prior Payments
C. Discount
(1 )
0.00
0.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 6 + C)
(2)
0.00
TotallnterestlPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAVMENT.
Check box on Page 2 Line 20 to reque.t a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
6. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(5A)
(56) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "~" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..................................................................................
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, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................. ..................................... 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?...... ..... ....... ...................................................... ............................................. [!] 0
IF THE ANSWER TO ANV OF THE ABOVE QUESTIONS IS VES, VOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Ves No
~ ;
[!]
[!]
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. 59116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. 59116 (a) (1.1) (Ii)]. The statute does not exemDt 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 deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 59116 (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 four and one-half (4.5) percent,
except as noted in 72 P.S. 59116 1.2) [72 P.S. 59116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 59116 (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 blood or adoption.
""-1103 EX. (....)
.
SCHEDULE.
STOCKS & BONDS
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIlENT DECEDENT
Jacobs, Caeella E
FILE NUMBER
21-06-1051
ESTATE OF
All property jolntly-oWMll wltIl rlght of survivorship must be dlHloHd on Sohsdul. 1'.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 5111 S6R1 oa 165 shares 0' Metll'. Inc - Com 56.755 9.364.58
TOTAL (Also enter on Line 2, Recapitulation) 9.364.58
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev.1101 EX. (....)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RE8lOENT DECEDENT
ESTATE OF
Jacobs, Cecella E
FILE NUMBER
21-06-1051
Inc:ludlIthe proceeda of IitIgatlon and the d81e the proceed. were rac:elved by the eatale.
All ,,",petty JoIntIy-owneel with the right of aurvlvo...hlp muat lie dl..loHCI on ..hedule F.
ITEM
NUMBER DESCRIPTION
1 MBNA Procurements Services, Inc. - Refund Check
VALUE AT DATE
OF DEATH
88.00
2 The Vanguard Group - Redemption Check
220.41
3 Fulton Bank Checking Account No. 1068-34260
5.639.87
TOTAL (Alao enter on Line 5, Recapitulation)
5,948.28
(If more IPllce Is needed, additional pagel of the same IIze)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
".".,.,0 EX+ eWI)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSY\.VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Cecella E
FILE NUMBER
21-06-1051
Thil IChedule mult be completed and filed If the answer to any of queationl 1 through 4 on the r8V8I'Ie IkIe of the REV.1500 COVER SHEET II yel.
ITEM .~ try DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Vanguard IRA Account; High Yield Corporate 48.685.99 48.685.99
Fund Inv. - Beneficiary: Melvin L. Jacobs
TOTAL (A180 enter on Line 7, Recapitulation) 48.685.99
(If more space il needed, additional pagel of the lame size)
Copyright (c) 2002 form software only The Lackner Group, Inc,
Form PA.1500 Schedule G (Rev. 6-98)
REV.11.1 EX. (12-"1
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Cecella E
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-1051
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 10,421.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Johnson Duffle 1,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 87.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 49.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 12,057.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1HZ EX+ (I-H)
.
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Caeella E
FILE NUMBER
21-06-1051
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
My.,. - Harner Funeral Home
7.407.00
2
Obituary
259.00
3
Reception at West Shore
1.560.00
4
Roiling Green Cemetery - Plot opening and closing
1.195.00
Subtotal
10.421.00
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
ltev.1H2 EX+ (....I
.
SCHEDULE H.B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEAlTH Of PENNSYlVANIA
~HERrrANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Cecella E
FILE NUMBER
21-06-1051
ITEM
NUMBER
1
DESCRIPTION
Cumberland County Register of Wills - Filing Fees
AMOUNT
30.00
2
Cumberland County Register of Wills - Additional Short Certificate
4.00
3
Cumberland County Register of Wills - Additional Probate Fees
15.00
Subtotal
49.00
Copyright (c) 2002 tonn software only The Lackner Group, Inc.
Fonn PA-1500 Schedule H-B7 (Rev. 6-98)
Rev.U12 EX+ (....)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jacobs, Cecella E
FILE NUMBER
21-08.1051
Inolucl. unrwlmburHCI mecllosl .xpen....
ITEM
NUMBER DESCRIPTION
1 Holy Spirit Hospital
VALUE AT DATE
OF DEATH
807.50
2 Johnson Duffle Stewart & Weidner
200.00
3 Otmoor House
32.91
TOTAL (Also enter on Line 10, Recapitulation)
1,040.41
(If more space Is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1S00 Schedule I (Rev. 6-98)
REV.un EX+ (MO)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Jacobs, Cecella E
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS Onclude outright spousal
Ctistributions,{ and transfers
under Sec. ~116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
00 Not UatTru.-.1
FILE NUMBER
21-06-1051
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
Melvin L Jacobs
116 Conodogulnet Avenue
Camp Hili, PA 17011
Spouse
Total
Enter dollar amounts for distributions shown above on lines 5 throuah 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule J (Rev. 6-98)
ESTATE OF CECELIA E. JACOBS
EXHIBIT A Last Will and Testament ofCECELIA E. JACOBS
signed and dated September 17, 2006
EXHIBIT B Estate Val Valuation for Metlife Stock
EXHIBIT C Fulton Bank Date of Death Valuation of Accounts
(2)
EXHIBIT D Vanguard Valuation of IRA
:297310
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EXHIBIT A
~"...' ,'-...--..... ,............. ............. -,'. '-. ----~_..--..__._..._-~._~----_.. -_.~._._._-_._. _....-----_..~---_.-
"-,
LAST WILL AND TESTAMENT OF
CECELIA E. JACOBS
I, CeceIia E. Jacobs, of Hampden Township, Cumberland County, Pennsylvania,
declare this to be my Last Will and testament and revoke all Wills and Codicils previously
made by me.
ITEM I: I direct that all my legally enforceable debts and funeral expenses, .
including all expenses of my last illness, shall be paid from my residuary estate as soon as
practicable after my decease as a part of the expense of the administration of my estate.
ITEM II: I bequeath any automobiles or motor vehicles I may own at my death,
my personal effects, such household goods if any as may be my individual property and
not the property of my husband or owned jointly by me with him, and other tangible
personal property of like nature (not including cash or securities), together with any
existing insurance thereon, to my husband, Melvin L. Jacobs, Jr., providing he survives me
by thirty (30) days. Should my said husband predecease me or die on or before the
thirtieth day following my death, I bequeath such tangible personal property and insurance
thereon to my sister-in-law, Sylvia Y. Gore. I direct that any of the foregoing articles not
selected by my said sister-in-law shall be sold at public or private sale by my personal
representative(s), and I further direct that the net proceeds thereof shall be administered
and distributed as a part of the residue ofmy estate.
ITEM ill: I devise and bequeath the residue of my estate of every nature and
wherever situate to my said husband, providing he survives me by thirty (30) days.
ITEM IV: Should my said husband pred~ me or die on or before the thirtieth
day following my death, I devise and bequeath the residue of my estate of every nature
and wherever situate to my sister-in-law, Sylvia Y. Gore and brother-in-law, King W.
Gore, or to the survivor. Should both of them predecease me, I devise and bequeath the
residue of my estate of every nature and wherever situate equally to their sons, Michael
King Gore and Brian Jacobs Gore.
.-_._---_.-.+.._._.~.........-.-~.
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ITEM]II: All Federal, State and other death taxes payable because of death,
with respect to the property forming my gross estate for tax purposes, whether passing
under this Will or otherwise, including any interest or penalty imposed in connection with
such taxes, shall be considered a part of the expense of the administration ofmy estate and
sball be paid out of the principal ofmy residuary estate without apportionment or right of
reimbursement.
Ja-
ITEM:BE: I appoint my said husband Executor of this my last will. Should my
said husband filiI to qualifY or cease to act as Executor, I appoint my brother-in-law, King
W. Gore, Executor of this my last Will. Should my said brother-in-law filiI to qualifY or
cease to act as Executor, I appoint my sister-in-law, Sylvia Y. Gore, Executrix oftbis my
last Will. Should my said sister-in-law mil to qualify or cease to act as Executrix, I
appoint Michael King Gore, Executor of this my last Will.
ITEM iYB: I direct that all fiduciaries acting under this Will, whether or not
named herein, shall not be required to give bond for the fiUtbful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this 3rd day of
September, 2002.
& fj~(Seol)
The pte('~ing instrument, consisting of this and the two other typewritten pages,
each identified by the signature oftbe Testatrix, was on the date thereot: signed, published
and declared by Cecelia E. Jacobs, the Testatrix therein named, as and for her last Will, in
the presence ofllS, who, at her request, in her presence and in the presence of each other,
have subscribed our names as witnesses hereto.
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EXHIBIT B
,.~.......,~...,.. "~....", .,.cu.,"._..,.'-...................
Estate Valuation
Date of Death: 09/28/2006
Valuation Date: 09/28/2006
Processing Date: 04/30/2007
Estate of: Jacobs, Estate of Cecilia
Report Type: Date of Death
Number of Securities: 1
File ID: Jacobs
Shares
or Par
Security
Description
High/Ask
Low/Bid
Mean and/or Div and Int Security
Adjustments Accruals Value
1)
165 METLIFE INC (59156R108)
COM
New York Stock Exchange
09/28/2006
57.01000
56.50000 H/L
56.755000
9,364.58
Total Value
Total Accrual
Total $9,364.58
$9,364.58
$0.00
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4)
EXHIBIT C
.....:.'.:>,.",...'1:
FultmBank
LISTENING.
December 28, 2006
Johnson Duffie
301 Market Street
P.O. Box 109
Lemoyne, Pennsylvania 17043
Dear Ms. Wieseman:
RE: Cecilia E. Jacobs, deceased September 28,2006
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
Checking # 1068-34260, open 3/12/1968, balance $5,639.87, in her
name only.
CD # 022-0233624, open 7/15/2005, matures 1/15/2008, balance
$10,396.94 and accrued interest $85.16; paying 3.97%, joint with
Melvin L. Jacobs, Jr.
~ The decedent also has an account through our trust affiliate, Fulton
Financial Advisors, for information please contact Gregory Malin
at (717) 763-2098. '""N6l1LUO U'\.., hJ.-r /1.tJ.m..L .
If you should have any further questions, please do not hesitate to contact me at (717)
291-2437.
CONFIDENTIAL
Very truly yours,
\1ln.,--~ ~
Karen D. Hillegas
Credit Inquiry Processor
This information is furnished as a matter of business courtesy
in answer to your inquiry, and is tor your confidential use only.
No responsibility is assumed by this bank or any of its officers.
Any opinion herein expressed is subject to change without notice.
POBox 4887
Lancaster, PA 17604
fultonbank.com
1-800-FULTON-4
EXHIBIT D
.
. Vanguard'
January 2, 2007
P.O. Box 2600
Valley Forge. PA 19482-2600
www.vanguard.com
ESTATE OF CECELlA E JACOBS
116 CONODOGUINET AVE
CAMP HILL PA 17011-4112
RECE,'VED
JAN 0 9 2007
STE~\SOANN'DDWUFF'E
EIDNEh
High-Yield Corporate Fund Inv
09788606691-Traditiona11RA
Dear Executor:
We are responding to a letter notifying us of the death of Cecelia E. Jacobs, and
requesting that we provide you with a valuation of her above-referenced traditional
individual retirement account (IRA). First, please accept our condolences for your
loss.
As of September 28, 2006, the number of shares, the price per share, the value of
the fund, and the accrued dividends (if applicable) were as follows:
Fund Shares Price Value Accrued
Dividends
High-Yield Corporate Fund Inv 7,955.227 $6.12 $48,685.99 $266.26
If you have any questions or need further assistance, please contact a member
of our Transition Specialist Team at 1-888-237-9045. We are available Monday
through Friday from 8 a.m. to 8 p.m., Eastern time.
Sincerely,
Client Services Department
ksc
50783042
Vanguard Marketing Corporation. Distributor.