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HomeMy WebLinkAbout06-17-08 (10)J 15056041147 ~~~~ BOO ~ (U6-05) OFFICIAL USE ONLY A epa en o evenue Bureau of Individual Taxes ounty o ear i e um er Po Box.2sosol INHERITANCE TAX RETURN Harrisburg, PA 171213-OSO~ RESIDENT DECEDENT 2 1 0 8 0 6 5 2 So~aal Security Number Date of Death Date of Birth 063280239 03202008 03081933 Decedent's Last Name Suffix Decedent's First Name MI MIISICO DOROTHY M (if Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 113 2 2 5 3 2 6 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Retum p 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) ~ 4. Limned Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (date of death after 12-12$2) ® g, Decedent Died Testate O ~ Decedent Maintained a Living Trust O 8. Total Number of Safe Deposit Boxes (Attach Copy of WSII) (Attach Copy of Trust) 0 9. Litigation Proceeds Received O 1 D, Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 121-91 and 1-1-95) (Attach SCh. O) ame Daytime Telephone Number DALE F SHIIGHART, JR. ESQIIIRE 7172414311 ~, ~: , --~ Firm Name (If Applicable) REGISTEf;~.~VILLS U$,i~ONL~f;' ~. First Ilse of address ~ . 10 o4138T HIGH STREET '; r. ~~, Second line of address 'r' =`~~ ~ ~- ~`-~~ ~~ ` :_~~a ~ , , City or Post Office State Lp Cpde DAT~'FILED ~=~ CARLISLE PA 17013 Correspondent's e-mail address: Under penaH)es of perjury, I declare that I have examined this return, InGudinngg accomparrying schedules and statemerrts, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information aF which preparer has arty knowledge. rcwcrv i n i i v~ DATE Dale F Shughart, Jr. F~quire 6/~~/~~/~ 10 West High Street, Carlisle, PA 17013 Side 1 15056041147 15056041147 J 108 Ramsgate Drive, Phoenixville, PA 19460 J REV-1500 EX 15056042148 Decedents Name: M U S I C O, DOROTHY M. RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 9. Funeral Expenses 8~ 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/Sec 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. 'fAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES '15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (ax1.2) X .00 15. 'I6. Amount of Line 14 taxable at lineal rate X .045 1, 4 0 0, 3 6 4. 4 4 1 g- '17. Amount of Line T- taxable at sibling rate X .12 1 ~_ "18. Amount of Line 14 taxable at collateral rate X .15 , a 119. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedents Social Security Number 063280239 39,435.30 62,351.66 1,317,232.94 1,419,019.90 16,245.10 2,410.36 18,655.46 1,400,364.44 1,400,364.44 63,016.40 63,016.40 Side 2 15056042148 15056042148 J RE:V-1500 EX Page 3 Decedent's Complete Address: File Number 21 Musico, Dorothy M. THE T A R Messiah Village 100 Mt. Allen Drive I'TY Mechanicsburg TAE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 3,150.82 Total Credits (A + B + C) Total InteresT/Penafty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request 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. g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) 63,016.40 (2) 63,016.40 (3) 0.00 (4) (5) 0.00 (5A) (5B) 0.00 :~'~ - - 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 transfen-ed: .................................................................................. ^ O b. retain the right to designate who shall use the property transferred or its income :.................................... ~ a c. retain a reversionary interest: or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ 0 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 fora 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 properly which contains a beneficiary designation? ...................................................................................................................... 0 ^ IF'THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. §9116 (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. §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 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. §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 four and one-half (4.5) percent, excerpt as noted in 72 P.S. §9116 1.2) [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 twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibliing is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. J 15056042148 REV-1500 EX oecedent's Name: M U S I C O, DOROTHY M. Decedent's Social Security Number 0 6 3 2 8 0 2 3 9 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank De sits ~ Miscellaneous Personal Pro e Po P rtY (Schedule E) ................ 5. 3 9 4 3 5 . 3 0 ~ 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ............. 6. 6 2 , 3 51.6 6 7. Inter-vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested ............. 7. 1, 3 1 7, 2 3 2. 9 4 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 1 , 419 , 019.9 0 9. Funeral Expenses ~ Administrative Costs (Schedule H) ......................................... 9. 1 6 , 2 4 5.10 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 , 4 10.3 6 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 1 8 , 6 5 5 . 4 6 12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12, 1 , 4 0 0 , 3 6 4 . 4 4 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. t4. Net Value Subject to Tax (Line 12 minus Line 13) ................................................. 14. 1 , 4 0 0 , 3 6 4 . 4 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES '15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (ax1.2) X .00 15. '16. Amount of Line 14 taxable at lineal rate X .045 1, 4 0 0, 3 6 4. 4 4 1 ti. '17. Amount of Line 'f- taxable at sibling rate X .12 17 118. Amount of Line 14 taxable at ~Ilateral rate X .15 18 19. Tax Due ..................................................................................................................... 19. 2:0. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 63,016.40 63,016.40 Side 2 15056042148 15056042148 SCHEDULE E CASH, BANK DEPOSITS, & MISC. coMMONwE.n~n+oRPENNSV~vaNla PERSONAL PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MUSICO, DOfOtI1)/ M. FILE NUMBER 21 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Furniture at nursing home. 2 Members 1st FCU Regular Savings Account #104781-00 Principal 50.63 Accrued interest .03 3 ~ Commonwealth of Pennsylvania, final state retirement 4 Genwroth Financial, nursing care insurance (1,591.20 + 632.40) 5 ~ Country Meadows, refund prepaid nursing home fees 6 IOne-quarter interest in Hartford Annuity Contract #711044200 distributed to estate due to named one-quarter beneficiary, Joan Stoner, predeceasing her mother (total 65,270.41) VALUE AT DATE OF DEATH 500.00 50.66 1,472.71 2, 723.60 18,370.73 16,317.60 TOTAL (Also enter on Line 5, Recapitulation) ~ 39,435.30 SCHEDULE F COMMONVSEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE IMF I FILE NUMBER Musico, Dorothy M. 21 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Carol A. Esing A' 108 Ramsgate Drive Phoenixville, PA 19460 Daughter JVIN 1 LT VWIVtU t'KUF'tK I Y: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT Include name o nanclal ins on an bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 10/04/2006 Members 1st FCU 63,162.12 50% 31,581.06 Certificate of Deposit #104781-40 2 A 09/15/1978 PSECU Account #8503 12,111.17 50% 6,055.59 S01 regular shares 3 A 09/15/1978 PSECU Account #8503 12,197.42 50% 6,098.71 S04 Checking 4 A 07/17/2006 PSECU Account #8503 37,232.59 50% 18,616.30 S07 Money Market TOTAL (Also enter on line 6, Recapitulation ) 62.351.66 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS ~ INHERITANCE TAX RETURN F2ESIDENTDECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Musico, Dorothy M. FILE NUMBER 21 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of Vansfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Edward Jones Brokerage Account valued in 210,428.63 100% 210,428.63 accordance with attached Statement from Edward Jones, distributed by beneficiary designation 3/20/08 Total value 841,714.52 Carol A. Esing, daughter, 1 /4 interest 2 Edward Jones Brokerage Account valued in 210,428.63 100% 210,428.63 accordance with attached Statement from Edward Jones distributed by beneficiary designation 3/20/08 Total value 841,714.52 Laurie A. Musico, daughter, 1/4 interest 3 Edward Jones Brokerage Account valued in 210,428.63 100% 210,428.63 accordance with attached Statement from Edward Jones distributed by beneficiary designation 3/20/08 William J. Musico, son, 1/4 interest 4 Edward Jones Brokerage Account valued in 105,214.31 100% 105,214.31 accordance with attached Statement from Edward Jones distributed by beneficiary designation 3/20/08 Jennifer L. Stoner, granddaughter, 1/8 interest 5 Edward Jones Brokerage Account valued in 105,214.31 100% 105,214.31 accordance with attached Statement from Edward Jones, distributed by beneficiary designation 3/20/08 Sarah C. Stoner, granddaughter, 1 /8 interest 6 Lincoln National Life Ins. Co. annuity contract 53,352.66 100% 53,352.66 #95-9363029, distributed on death by beneficiary designation 3/20/08 Total value, $160,057.98 per attached statement. Carol A. Esing, daughter, 1/3 interest TOTAL (Also enter on line 7, Recapitulation) 1,317,232.94 SCHEDULE G COMMONWFJU..TH OF PENNSYLVANIA INTER-VIVOS TRANSFERS ~ INiHERITANCETAxRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF Musico, Dorothy M. I FILE NUMBER 21 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of Vansfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 7 Lincoln National Life Ins. Co. annuity contract 53,352.66 100% 53,352.66 #95-9363029, distributed on death by beneficiary designation 3/20/08. Total value $160,057.98 per attached statement. Laurie A. Musico, daughter, 1/3 interest 8 Lincoln National Life Ins. Co. annuity contract 53,352.66 100% 53,352.66 #95-9363029, distributed on death by beneficiary designation 3/20/08. Total value $160,057.98 per attached statement. William J. Musico, son, 1/3 interest 9 Hartford Annuity Contract #711044200 distributed on 16,317.60 100% 16,317.60 death by beneficiary designation 3/20/08,. Total value $65,270.41 per attached statement. Carol A. Esing, daughter, 1/4 interest 10 Hartford Annuity Contract #711044200 distributed on 16,317.60 100% 16,317.60 death by beneficiary designation 3/20/08. Total value $65,270.41 per attached sheet Laurie A. Musico, daughter, 1/4 interest 11 Hartford Annuity Contract #711044200 distributed on 16,317.60 100% 16,317.60 death by beneficiary designation 3/20108. Total value $65,270.41 per attached statement. William J. Musico, son, 1/4 interest 12 Members 1st FCU IRA Certificate of Deposit 61,988.50 100% 61,988.50 #104781-15 distributed on death by beneficiary designation 3/20/08. Valued in accordance with attached Statement: Total value $123,977.01 Carol A. Esing, daughter 1/2 interest I Page 2 of Schedule G SCHEDULE G COMMOtJWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF Musico, Dorothy M. FILE NUMBER 21 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 13 Members 1st FCU II~A Certificate of Deposit 61,988.51 100% 61,988.51 #104781-15 distributed on death by beneficiary designation 3/20/08. Valued in accordance with attached Statement: Total value $123,977.01 Laurie A. Musico, daughter 1 /2 interest 14 Cash gifts to Carol A. Esing, daughter 8/01/07 $5,000; 25,000.00 100% 3,000.00 22,000.00 11/27/07 $10,000; 01/22/08 $10,000. 15 Cash gifts to Laurie A. Musico 7/24/07 $10,000; 20,000.00 100% 3,000.00 17,000.00 01/16/08 $10,000 16 Cash gift to Jennifer L. Stoner, granddaughter 8/02/07 10,000.00 100% 3,000.00 7,000.00 17 Cash gift to Sarah C. Stoner, granddaughter 08/02/07 10,000.00 100% 3,000.00 7,000.00 18 Cash gift to Brian Esing, grandson 8/27/07 10,000.00 100% 3,000.00 7,000.00 19 Cash gift to Melissa Esing, granddaughter, 8/27/07 5,000.00 100% 3,000.00 2,000.00 20 Cash gift to Jacqueline (Musico) Shepp, 5,000.00 100% 3,000.00 2,000.00 granddaughter, 7/24/07 21 Cash gift to Jacob (Musico) Shepp, grandson, 7/24/07 5,000.00 100% 3,000.00 2,000.00 22 Transfer within one year on 1/28/08 a 1/2 survival 38,545.73 100% 38,545.73 interest in a M 8~ I Bank Certificate of Deposit to Laurie A. Musico, daughter. Date of death value: Principal 38,366.00 Interest 179.73 Per attached statement. 23 Transfer within one year on 8/07 a 1/2 survival interest 37,984.91 100% 37,984.91 I' in Citizens Bank Circle checking account #610066-305-1 .Value based on attached bank stmt. Page 3 of Schedule G SCHEDULE H FUNERAL D~ENSES ~ COMMONWEALTH OF PENNSYLVANIA w ^^.'N~~ INHERRANCE TAX RETURN ~Y' RESIDENT DECEDENT FILE NUMBER ESTATE OF Musico, Dorothy M. 21 Debts of decedent must be reported on Schedule I. -- ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A• 1 Parthemore Funeral Home, funeral, (2,617.04 + 1,202.14 + 142) 3,961.10 2' Olive Garden, family get together 400.00 3 Leann Myer, Memorial Service; piano 100.00 4 Country Meadows, service 150.00 5 Robert Lehman, Pastor 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions n/a Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Dale F. Shughart, Jr., (estimated) 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 5. Accountants Fees 6. Tax Return Preparer's Fees (estimated) 7, Other Administrative Costs 1 Parthemore Funeral Home, Death Certificates 10,000.00 140.00 500.00 52.00 TOTAL (Also enter on line 9, Recapitulation) 16,245.10 CGMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE C3F Musico, Dorothy M. Sd~eckde H w~.Fuieral E~er~ses & 2 ~ Register of Wills, Short Ceretificates 3 ~ The Sentinel, advertising Letters 4 ~ The Cumberland Law Journal, advertise Letters 5 ~ Register of Wills, filing Inheritance Tax Return and Inventory 6 ~ UPS, overnight mail 7 ~ Reserve for Accounting. 21 12.00 150.00 75.00 30.00 25.00 500.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN ~ RESIDENT DECEDENT FILE NUMBER ESTATE OF MUSICO, Dorothy M. 21 Include unreimbursed medical expenses. ITEM NUMBER 1 ~ In Your Home Care, pesrsonal care 2 ~ Andrews & Patel Assoc., doctor bill 3 ~ Messiah Village, nursing care DESCRIPTION ~ AMOUNT 200.00 57.33 2,153.03 I TOTAL (Also enter on Line 10, Recapitulation) I 2,410.36 REV-1513 EX+(gA0) ~ ~ - SCHEDULE J COMMONN/EALTH OF PENNSYLVANIA BE N E F I CIARI E S INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Musico, Dorothy M. FILE NUMBER 21 NUMBER. NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) RECEIVING PROPERTY Do Not LJst Trustee(s) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers 11 under Sec. 9116 (a) (1.2)] 2 Carol A. Esing Daughter one-quarter 108 Ramsgate Drive Phoenixville, PA 19460 3 Laurie A. Musico Daughter one-quarter 967 Malcolm Avenue Los Angeles, CA 90024 4~ William J. Musico Son one-quarter 7034 Strathmore Street, #207 Bethesda, MD 20815 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV•t513EX+1g..30) ~ SCHEDULE) COINMONGVEALTHOFPENNSYLVANIA BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I Musico, Dorothy M. FILE NUMBER 21 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) RECEIVING PROPERTY Do Not Llst Trustee(s) I~ TAXABLE DISTRIBUTIONS [nclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 5 Jennifer L. Stoner Granddaughter one-eighth 5041 Woodbox Lane Mechanicsburg, PA 17055 Daughter of Joan M. Stoner, dod 7/17/04 6 Sarah C. Stoner Granddaughter one-eighth 5041 Woodbox Lane Mechanicsburg, PA 17055 -- Daughter of Joan M. Stoner, dod 7/17/04 - -- Page 2 of Schedule J St MEMBERS 1St FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 104781-00 Date Account Established 10/19/1988 Principal Balance at Date of Death $50.63 Accrued Interest to Date of Death $.03 Total Principal and Accrued Interest to Date of Death $50.66 Name of Joint Owner None IRA CERTIFICATES OF DEPOSIT Account Number/Suffix 104781-15 Date Account Established 10/02/2006 Principal Balance at Date of Death $123,625.00 Accrued Interest to Date of Death $352.01 Total Prinapal and Accrued Interest to Date of Death $123,977.01 Name of Beneficiary Carol Esing Laurie Musico CERTIFICATES OF DEPOSIT Account Number/Suffix 104781-40 Date Account Established 10/04/2006* Principal Balance at Date of Death $62,982.78 ,Accrued Interest to Date of Death $179.34 'Total Principal and Accrued Interest to Date of Death $63,162.12 (Name of Joint Owner Carol Esing (Date Joint Ownership Established 10/04/2006 *Purchased by transfer of funds from 104781-00. EM ERS 1sT FEDERAL CREDIT UNION and ~ -~,-~.~ } Danielle A. Kline Insurance Services Specialist May 1, 2008 Estate of: DOROTHY M. MUSICO Date of Death: March 20, 2008 Social Security Number: 063-28-0239 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org May 2, 2008 Account # 8503XXXXXX, 8307XXXXXX DALE F. SHUGHART JR 10 WEST HIGH ST CARLISLE, PA 17013 Dear MR. SHUGHART: The following is the status of DOROTAY M. MUSICO's account (85037s;JiLXXX3~ with P5ECU as of the date of death. Joint Owner's Name CAROL A. ESING-ADDED 12.06.2005 AS JOINT TENANT W/ROS :Date of Death 03.20.2008 :Date of Birth 03.08.1933 ;share Description Open date Balance Accrued Dividend S O1 Regular Shares 09.15.1978 $12,103.35 $ 7.82 S 04 Checking 09.15.1978 12,195.65 1.77 :> 07 Money Market 07.17.2006 37,169.47 63.12 Loan Description Open Date Balance Accrued Interest I.O1 PSL Loan 01.28.1988 $ 0.00 $ 0.00 I, 09 VISA 02.02.1988 0.00 0.00 T'he dividend earned from January 1, 2008 through the date of death was $321.16. We do not have safe deposit boxes for our members. T'he following is the status of GEORGE J. MUSICO's account (8307377021) with PSECU as of the date of death of Dorothy M. Musico on March Z0, 2008. Joint Owner's Name DOROTHY M. MUSICO- JOINT TENANT W/ROS Share Description Open date Balance Accrued Dividend S O1 Regular Shares 04.27.1994 $ 86.38 $0.00 S 04 Checking 04.27.1994 3,102.42 0.00 No dividend -account is a non interest bearing account. If you have any questions, please ca11234-8484 in H~urisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, ~ ~ Meacie Fair x Member Service Representative Finance Support Unit Pennsylvania Stale Employees Credit d9na®n Main Address: 1 Credit Union Place, Harrisburg, PA 171 10-2990 • 717.234.8484 • 800.237.7328 Mailing Address PO; ,Box 67013, Horrisburg, PA 1,71 O6 7013 • 717.777.2100 (TDD) 800.472.1967 (TDD) This credit union is federally insured by the Nationol Credit Union Administration. Equal Opportunity Lender www.pSacU.Cam ~ ~~ Doo ~~ ~ ~, ~ ~ ~~ ~~ II ~ ~ ~ n n CD ~ O ° O ~ ~ ~ (n ~ a, O p j ~-°. °- = ~ ~ o N D ~ ~ ~ ° ~ ~ ~ ~ c o m ~ O c~D ~ N N t~4 N -fl di. ~ ~ ~ ~ ~ C to N A~ _ -- ~ ~ ~ ~' C. (D ~ N . ~ CD ~ C cD U~1 r3'- O 4 ~ ~ N N N ~ ~ O ~ ~ ~ ~ p ~ S~ ~ - N ~-+ ~ 7 ~ N ~N ~ 7 fl 'a C Q ~' to ~ ~ _ ~ cp c !D ~ K ~ d. 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N n C n 4~ O n ~ ? ~G ~~ 7 ~' it ,D p w ~ c~3 ~~ O S co ~ ~ v ~ 0 LP ~ ~ CD1 c N rt G? C N ~ N ~° ~ ~ ~ ..~ tp ~ .`~D.r ~ ~ ~ ~ p N ~ ~ f~i < m ~ m ~ ~ ~ ~ ~ a` GL ~ ~ -i C1 N ~ N N N N '~"~ Q ~ a, °~ m ~ ~. a ~ N ~ ~ ~D ~ ~~~ ~ ~ ~ ~ 01 ~ ~ o ~ o~ (~D v ~ ~ A ~; .~ o~ CD Q. ]y ~!1 ~ y N N (D (t? N m N ~~~.~ ~ N ' ~ a ~- N ~G ? ~ ~_ ~ G. ,,.. ~ 0 ~: 0 N ~ W N N IV ~ ~ O O O ~ O ~ "~ N ~ ~ ~ ~ p p ~ ~ ! c ~ N c ~' N N ~ , t~D O a ~ UN ~~ O N ~ ~ tD ~ ~ ~~ v ~ ° ~. QN ~ N ~ ~ ~, v ~~ ~ ~Q 3 ~. 'Q ~ ~~ ~ _ ~ o d ~ F ~~ O h ~ ~ oN m -3 O O_ CQ ~ N ~ ~' N 3 O OD tD O et "O a (D N CAD ~ ~- CD ~ ? N °7 0 Q1 ~ Q. n ~ O tD fl. ~ ~- ~ ~ a ~ Q. CD (D 3 ~ tD N O "` C,,,sD N -, O ~' ~a _~ n~ -„ o .-. ~ G ~ N ~ O L~1. N 7 CL C~1 0 Edward Jones Cris N. Smith 4401 Carlisle Pike Ste E Financial Advisor Camp Hill, PA 17011 (717)763-7669 EdwardJones May 1, 2008 Dale F. Shughart, Jr. Attorney At Law 10 West High Street Carlisle, Pa. 17013 Re: Dorothy M. Musico Account 270-06189-1-7 Date of Death: March 20, 2008 Dear Attorney Shughart: As requested in your letter dated April 23, 2008, I am forwarding to you the Historical Date of Death Valuation Worksheet which includes the value of account assets on the clients date of death, plus any interest and dividends that have accrued. I have also included the date of death values for the two annuities held by Dorothy M. Musico, deceased. The annuity contract numbers are: Hartford - 711044200 Lincoln - 959363029 If you have any questions or need additional information, please direct them to my attention or Call me at 717-763-7669. Sincerely, ~ '~ ~ _jz-~ ~]"ean W. Robertson Sr. Branch Office Administrator Financial ~r~~,pa^ The Liuenltti Nniional l.if~: Insu-~prticq ~'otitpany 1'.U. Box 2~4H l~nri W1yne,1N 4bfi01-?34R Rl~ril 30, 2(?0$ EDW/1R17 Jt~NF.S ANI~ SUN A'1"I'N JEAN RUJ3ER'!'St~N 44~Uf +~'A[tLlSl,b; J'JKt~ ST13 L ~C:AMP 1IiLt. J'A 1701 l Cotitr~tct f>E ~S-43G302t? t~ertr Ms, Rc~bcrtspn; Tl~aiik you for ct~ot~sin~; t]i~+ A.iueriG~Yn J.,c~ttcy 17roduct as part oFyour clients retirement partfolia, We have bccti res7etcstcd to fut~~ish the d~ttu of ctcatl~ ~valuo for T.~orothy Musics As af7V(arch ~0, 2008 the vnlrie an the af~ove Ai~tcrican Lc~acy contract was $160,057.98. rFyou h7vc questions, l~le~~sc call cusio~xtc:r sctvaCe at I-'800-942-5500 IVlanday through 'I'YaurscJay, ~ ~t.m. - 7 ~,tn. EST, Friday, S ;Y.m. -~- 5:30 p.n•t, J3S'I'. Sinect~eJy', ~+hirlcy Stebin8 t~tastoi'ncr Servieo Represcntativc I~incn~n Li.fc anti Annuity C~pcraiiiJi~s Wl7y Ghoosc eD~livcry7 rl)clivrty t:an be n ct>nvrnient, aocncc~, untl timely way to access your annual and santi- annuitl t~:~ot~ts, pruspvetuscs, uncl stactr~~nrnts. `t'his free service allows yott ro view these doctuiu:nts ou-llt-c or print iltcnt for your canvcniyncc, Tcy sign ut~, gt- io ~v~rnv.llt»crieani.c~acy.co~~ and clink "My rlccotrut" to re~istcr For our interitEt service ce,d~r. R~,~lstt•rrr! Rrl'rt,~rnprtir~ pf, ntrr(te~urrfi~ ~ rhvlribrrlchl hpLi«rnln ! r+ar«e~In(!)isi+v~udnt:f, Alcp a brpkrrlt9err/dr. /riSU1'nnce procitrc•Is lerrr<rr(Ay The LUk'o7n Nar(nrrnl Life bru«'uttc•r ~'urx/x~+rt', L«rcnfrt f•'urn«rio(Clr ou/! ia• t(~n nrpr~,lrttrr~ nnmcJur limn/rr N«rr'orrnl CbiF>a,•nr(on n+,rl -te ~ltatcs. Apri130, 2008 Jean Robertson Fax: 888-52?-7385 Re: Hartford Annuity Contract # 711044200 Decedent: Dorothy Musico :©ear Ms. Robertson: 'Thank you for your correspondence regarding the above annuity oontraot. Y The death benefit payable under this contract is not considered "life insurance" reportable on IRS korm 7X2, (life insurasce statement). Please fund the below infomnation in response to your request. ~oxtract Number Chvner Decedent S'ocial' Security Nu»:ber Date of Dea~`h 711044200 Dorothy Mulrico Dorothy Mulrico ~~X--0239 03/20/2008 bate of l)~ath Value ~' ~~5,2'70.41 The Date of Death Value displayed shave may include a Death Benefit Adjustment as outlined in the Annuity Contxsot. This figurb is being provided for illustration purpose» end is net equivalent to the final death benefit. The death benefit will be calculated on all contrasts associated with this client the day we receive the oestifxed death oeztificate. Onrs the death benefit is calculated, the benefit amount remains invested and is subject to market fluotuetion until complete settlement instructions era received, If you have any questions or concerns, please feel free to contact your investment professional, or one of our annuity specialists by walling 1.800-$~2.66+a8, Monday through Thursday from 8 a,m. to 7 p.m. and Friday from 9;15 ern. to b p.m., Eastern Standard Time. We will be happy to assist you. Thank you for the opportunity to help provide for your financial needs. Sincerely, A. Taylor Investment Product Services ICS-Death Benefit Contract Ghange Team ~iaxttford Life Insurance Company Hartford fife Insurance CompanNs 20+0 tlopmeadow Street Simsbury, CT DB089 Toll Free 1 80d 882 6688 Investment Product Services Melling Address: P.O. Box 5085 Hartford, ~T 06102.5065 www.hertfordinvestor.c om Edwaxd Jones Cris N. Smith 4dOl Carlisle P'Ace: CtP .F. Financial Advi6ox Camp Hill. PA 17011 (717) 763-7~9 May 27, 2008 Dale k'. Shughart, Jr. Attorney At Law 10 West High Straat Carlisle, Pa. 1707.3 &e~ Ao``n~rnf' Number: 270-13684 joint account for Dorothy M. Mus1C0 & Laurie Musico Dear Attorney Shughart: EdwardJones Laurie Musico has requested that Z fax to you the date of death value far the M ~ Z Mazahall & i.l.sley Sank - Certificate of Deposit that is held in the above xisted jvixi4 ac4aunt. Date of death value: $38,366.00 Accrued Interest 179.73 xf you have any qu®pt]-ons or need aAtlir.ional information.. please da.rect them to my attention or call the at 717-763-7669. S ~ erely, ~ Jea~ W . Robert ~n Sr. Branch Oi<fice Administrator ~~ C~t~~'~'~S B ~~ Circle A'c~ount Statement '' ~~ : s 1-888-910-4;10 ': O of 3. CalrCitizenS PhoneBapk arrytime for account information, ypur,quesNoris. current rates and answers to , Beginnigg F$bi•uary 26, 2008 through 'March.~S4, 2008 ,,. _. C#~eck~ng sil ~ M~r~sY DORO'~NY M MU$ICQ ` - -. CAROL ESING ~ 1 Balanice ~a~i:ulation cl i Prevf¢iis Balance. J38,~5`7 '18 e Check l~g Cir 610066-305- j `.. Checks' ;472 27 - Withdhaweis . :00 - Depasts ~g Additions > b0 Current balance 37,984.9.1 = a ;~Wou; patance - ... TRAN,~AYi['DN 'pETAIIS '' $8,457.18 Che4k5'.71t~re is o: break in check sequence ` Xhedc; Amount Data. '. 'thedc It Amount pate ' ;578 348..47 b22f28 ,.. 5...~1, . 1~4.:A.~ Q311 580' 9:80 03/06 Daily BaianTe Date Balance Date 02/28 38,108.71 43/06 n TotalLhecks 472.27 (- 1 Current Balance 37,984.91 Balance Date .Balance 38,098.91 03J11 37,984.91 ~ MEMU -Invest in yaurfuture with a Citizens Bank IRA! Are you shopping for a Traditional or Roth IRA and need help deciding which is right for you? Whether you need to make a new contribution or are Looking to rollover or transfer an existing account, ask us about.our IRA Certificates of Deposit (CDs) and our new Citizens IRA Savings Plan. Whether you're just starting to save fur retirement or are Looking for ways to add to your retirement portfolio, we have options that will fit your savings strategy. Great rates are available just in time for tax season. Ask a Banker for details. NEWS FROM CITIZENS --Already in Rewards? As of February 2, .the Citizens Bank Rewards program will help you redeem your Everyday Points even faster with lower redemption amountr, Alt customers enrolled in Rewards before February 2, 2008 will receive a letter with details on how to confirm their enrollment. Make sure to confirm your enrollment in the Rewards program to take advantage of this great benefit. For more information visit citizensbank.com/rewards. Member FDIC Q Equal Housing Lender 9 i ' i= 7 L.[~ l •Y lLL Lll`I Y 1 J4J l l]lY1P.lY 1 ~~ ~ ~ of DOROTHY M. MUSICO I, DO~tO'~EiY M. MUSICO, of the Township of pairview, 'County of York, and Commonwealth of Pennsylvania, being of sound and disposing mind, memAry and undet:rtandin~g, do make, publish and declare this as' and for my Last Will and Testament, .~ hereby revok~.ng and makimg void akl former w~ls and codicils by me ai anytime heretofore made. ~ ~ . 1. ~ I order and direct that all my debts and i'ttrieral expenses be paid 'by my Executrix,Y~xeinafter Warned, as soon as ~GOnveniently may be done after my demise. 2. `' t nominate, constitute and appoint my daughez, JO,A~N lVl. S~'ONk~ to be the Executrix of his, my Last Will and Testament. ~~ 3. : I give all my property, real, pezsonal and mixed, in equal shares per stirpes, to my cluZdr'~n, JORN ~ STONER, C~eiRt?L ANN ESING, LAURIE ANN MUSICO, amd VIIII.I~4M JOL~EPH "MLISICO. ' ,- 4. i ~ give to my Executrix and Trustees all those powers granted bylaw pursuant i t4 the Penns~lv~ania Probate, Estates, and Fiduciaries Code. I direct that their authority be :~ construed' irl the broadest manner consistent with validity aztd wYth their duties as .f fxducianies hereunder in carrying out and executing'my will. :; ! i,. ~~ L L s AGICNOWI.F,.DGMENT Cl~MMONWE,P-LTH OF PENNSYL'V'ANIA ) . •~ JI ) . ss. COUNTY OF '' li~~~'~C~ •) .i . 1, DOR~TE•iY M. MUSICO, Testatrix, whose came is signed to the attached or foregoing inst~tutient, having been duly qualified accoxding to law, do hexeby acknowledge that I signed aad executed this instrument as my Last Will; that I signed•>r willingly; and that I signed ii as my free and voluntary act for the purposes therein expressed. • ~. ~, I A . DORGITHY MUSICO • ~ ~ Sworn br ed to and acl owledged before me, by DOROTHY M. MUSLCO; the Testatrix, this day of 1997. Notary Public -~-~-~ • i~f31~!i;§i 3Li;yi i~~?'h=;Fn t).'a'I:r„hI, iVG+?~N Ptlt~is0 AFFIDAVTI" Fic-~isi.~>.s, C~:~.~i~i~t t;;:!mty P.ty Ccr.~r~i~;;;:~r~ ~xrrras Yaay?,19y~ W4~r~er, r'r-r~,~ssociatictt ci 1 cozv.~oriv~wF.~LT'H of PFN~vsY~.vANrA ~ ~ ~ ) ss. COUN'T'Y OF ; dQL~t ~ ) ~~~ ' . We; ' Y~lr,~.rul~_ _ ~~S~hGI _ and ~ ~ s.•~ti ~E`(~t~ ~~ ~ witnesses whose names are signed to the attached and foregoing instrument, being duly qualified aceo$~duig to law, do depose and say that we were present and'saw the Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as~ her free and voluntary aet for the purpose therein expressed; that each of us iu the hea~ng and sight :of .the Testatrix signed the Will as witnesses; and that to the best.of our lcdowledge, •the Testatrrix was at that time 18 of more years of age,, of 'sound ruind and under no constraint or undue influence. . Swo ~x afFirmed to and. subscribed to before me by these witnesses, this ~~ day of 199?. ~j ''1.~/1 _ . ~ ~ // // r • i t ~ i, . Notary Public ~~ Notarial Seal 1Ca±4ttee» C_'A'right. N:,taty Pubec Harrisburg, La~~phin Cvut!,y A+ty Cv+nnli55ion ~Xplr!3S Msy 2, 1998 -~ 3 -