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HomeMy WebLinkAbout12-30-0815056051058 REV-1500 Excos-o5) oFFI~,AL t,:3E oNL,- PA Deperhrtent d Revtxltle Buleeu d Individual Taxes County Cade Year Ftle Number Po Box 280801 INHERITANCE TAX RETURN liartieburg, PA 17128.0801 RESIDENT DECEDENT 21 07 01162 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 173-12-9626 11/28/2007 06/17/1917 Decedent's Last Name SuRlx Decedent's First Name MI FtY James yy (K Applicable) Enter Survivlnq Spoup's IMottrtadon Beltrllr Spouse's Last Name Suflix Spouse's First Name MI Spouse's Sodal Security Number THIS RETURN MUST BE FILED IN DUPLICATE tM'TH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW • 1. Original Relum 2. Suppbmsntal Return 3. Remainder Return (dabs of death prior to 12-13-82) 4. Lfmked Estab 4a. Futuro IrHereat Compromlae (dab of 5. Federal Eetab Tax Return Required death afbr 12-12-82) • 8. Dsosder-t Died Testab 7. Dscerbnt Meinbined a Living Trust 8. Total Number of Sete Deposit Boxes (Attach Copy of WiN) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (dab of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST SE COMPLETED. ALL CORRESPONDENCE MID CONFlDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime TebpFlorre Number Charles J. Long (717) 845-9641 Finn Name (If Applcable) Smith, Anderson et al First line d address 25 North Duke Street second line of address Second Floor City or Post Office York Corresportdenrs e-mail address: sabl. REGISTER Of''NILLS USE ONLY _._ -~ , _; State ZIP Code PA 17401 pAi>r FILEQ ~ '~~ -~ t.i ~~ n+m por~osa rF perjury. I Oedare that t have examined Ihie return. intludlnp aocompanyinp schedules and giat~n fs. ar-d to >ha best pf m k K a true, coned and complete. Declaration of preparer other than the tx>rrsonal representetlve is Desed on all irdorrnetion which y nowlerfge ~. SiGNA7~E OF PER$pN,RESPONSIBLE FOR FluNC: RFn IRN Pr'eParer has any krxiwledpe. DATE ADDRESS - --- ----~~.~[ UC.~ b ~ OCi(]C)__~ David M. Rothert, 925 Some t Lane, York PA 17403 SIGNATURE OF 'P O REPRESENTATIVE - --- DATE ADORES - - ---~~" 9 v ~ _- Charles J. Long, N Duke Street, 2nd Floor, York PA 17401 PLEASE usE oRtoiNAL IFORM oNLY 1 505605 1 058 Side 1 L 15056051058 ~,. -~ -- `-_- ~_.... ~ '_ i ~~ 15056052059 REV-1500 EX Decedent's Social Security Number Decedents Name: 173-12-9626 RECAPITULATION 1. Real estate (Schedule A) ........................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 1,422,912.83 3. Cbsely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages $ Notes Receivable (Schedule D) ........................... .. 4. 0.00 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. 1,077,277.61 6. Jointly Ctivned Property (Schedule F) Separate BilNng Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (Schedule G) Separate Billing Requested...... .. 7. 235,618.49 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 2,735,808.93 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 96,715.06 10. Debts of Decedent, Mortgage Liabilities, 8 liens (Schedule I) .............. .. 10. 2,479.37 11. Total Deductions (total Lines 9 8 10) ................................. .. 11. 99,194.43 12. Net Value of Estate (Line S minus Line 11) ............................ .. 12. 2,636,614.50 13. Charitabk; and Governmental Bequests/Sec 9113 Tnrsts for which an eleccti~on to tax has not been made (Schedule J) ...................... .. 13. 2,551,614.50 14. Net Value Subject to Tax (Line 12 rrrnus Line 13) ....................... . 14. 85,000.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X .0_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 0.00 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 85, 000.00 1 g 12, 750.00 19. TAX DUE ........................................................ . 19. 12,750.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 F.X Pegs 3 Flb Number Decedent's Complete Address: 21 07 01162 DECEDENTS SOCW. SECURRY NUI~ER James _ W Fry 173-12-96.26 REET ADDRESS -------- ---- -- ------ ------- ------------- --- 1700 Market Street Camp Hill ~ ~~"" PA ~ --- ~ 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 1 2. CreditslPeymenfa ( ) A. Spousal Poverty Credk _ 0.00 B. Prior Payments 12,750.00 C. Discount - --------0.00 ------ 3. ----- - -- Total Credits (A + g + C) InteresUPenaHy if applicable (2) 12,750.00 D. In~rest 0.00 E. Penally ----- __-----0.00 -- 4. Total InterestlPenalty (D + E) N Lme 2 is greeter than Line 1 + Line 3, enter the differerx:e. This is the OVERPAYMENT (3) 0.00 . FNI In oval on Pape 2, Llrre 20 to nqueet a rMund. (4) 0.00 5. K Line 1 + Line 3 is greater than Line 2, enter the dilferenoe. This is the TAX DUE . (5) 0.00 A. Enter the interest on the tax due. (~) B. Enter the total 0/ Llne 5 + 5A. This is the BALANCE DUE , (~) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Drd decedent make a transfer and: Yes No a. retain the use or income of the property transterted :........................... ... b. retain the right b designate who shat use the property transferred or its income :................................. ..... ^ ....... c. re m a reversionary interest; or....... .. ~ d. receive the promise for life of either ts, benefits a care? .......................... 2. M death oa,urred aPoer December 12,1982, did deoederd trar>,sfer property withn one year of death receiving adequate oonsideration? ........................................................................ ............................... ...... ^ 3. Did deoedeM own an ~n trust for" or payable upon death bank account or security at his or her death7 ........ . ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, ar other non-probate property which contains a beneficiary designation? ...................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 ar for the use of the surviving spouse is three (3) percent j72 P.S. §9116 (a) (1.1) (i)j. Far dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to ar for the use of the survi ' j72 P.S. §9116 (a) (1.1) (n)]. The statute does not oxen ~ a transfer to a survivin `~9 spouse is zero (0) percent fifing a tax return are sfNl applicable evenrf the su 9 spouse from tax, and the statutory requirements for disclosure of assets and rviving spouse is the only beneficiary. For dates of death an or after July 1,2000; The tax rate imposed one of theechild~is zero 0 m a ~ ~~ ~nty~ ~rs of age or younger at death to or for the use of a natural parent, an adoptive parent, or a s ()percent (72 P.S. §9116(a)(1.2)j. The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is four and one-half (4.5) percent, except 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 decedents siblings is twelve (12) percent (72 P.S. §9116(a)(1.3)j. Asibling is defined, under Section 9102, as an indnridual who has at least one parent in common with the decedent, whether by blood or adoption. REV 1503 EX~ (8-9e scN~ouu s coMMONwEAITri of PENNSYWANIA STOCKS de BADS INHERRANCE TAX RETURN RESIDENT DECEDENT EBTATE OF FllE NUMOER Fry, James W. 2107-01162 ~ vmv«tr l~h~~ wwr ~ a wrwrrorshl~ nrurrt bs dlscloNd on aen.aW. F. .. I1FM - ----__-_-- VAUIEAT DATi= t• 100 eharoe oomrrton alodc, Can Produc4 kd'I ka;Ctaip8219023108, i39.33/share 3,933.00 2. 4898 shares Daman abck, General Elecilc, Culp 8388804103, i38.29/ahare 187,467.84 3. 744 shares corrnan aiodc, Flareoo Corporalon, Cusip 8415884107, i80.07/ehars 44.692.08 4. 1200 shares oonrran clock, Hershey Canperty, Cueip 8427888108, i39.911shais 47,892.00 5. 3112 share: Dorman siodc. PNC Financial Servtoes, Cusip 889©475105, i73.21/ehars 227,829.52 8. 7&1 shares oonmon slodc, Royal Dutch SheA ADR, Cueip 8780259208, =81.43/ehsro 63,841.12 7. 5414 shares connan ebck, Sovereign Baraorp Mrc, Cueip 8845906108, i11.77/ahare 64,075.88 8. 180 shares oonsran stDCk, VYsyerhasuser Conparry, Cueip 8982188104, i73.181ahars 13,172.40 9. 547 shares common clock, Corrseco Inc, Cusip 8208484883, i13.111alare 7,171.17 M~riidpal Bonds: 10. 30,000 urrb PhAs G0, 5.000%, meWrily 3M588, Cueip 87178138Y4. i1.0145378hN1 30,436.13 11. 30,000 urtb Phis SID-A2, 4.75%, rtwYirily 4A1/27, Custip 8Y17880ZI6, i1.0117Slhinit 30,352.62 12. 5,000 unit PA Inlerpovtl, 5.25%, makdly 8/'15118, Culp 8~~08840GE7, i1.018008hxiil 5,090.04 13. 10,000 units Pore Aud Au, 5.000%. maArrtiy 2101/17, Cueip 812M787AN8, i1.02~08VYNt 10,269.09 14. 30.000 units Ptita Aud Au, 5.000%, maikuthr ?A189, Cusip 872478PAP1 i1.0180818hstt , 30, 542.45 15. 25,000 un8e PA Tpk Caml, 4.75%, makxily 12A187, Cusip 8709221.IY2, i1.0018644hrrR 25,041.36 18. 5,000 units PA Tpk Caren, 4.75%, maturity 12A187, Cueip 8709221KS3, i1.00110~0/ulit 5,005.52 17. 30,000 units Lef~iglt Co pure, 5.000%, metaily 710188, Cusip 8624806868, i1.010578Jb18 30,317.34 18. 30,000 urtl~s Detawere HNh, 4.875%, rtnkxtly 1 f /15/'18, Cueip 8245913FS2, i1.003TAmR 30,111.00 Caporals Bonds: 19. 30,000 units Fad tiAolor Credt, 7.000%. makrUy 10A1N3, Cusip 8345397728, i0.841700/urs~ 20. 30,000 units GMAC, 7.000%, maltrihr 11/1584, Cusip 83704AOTV4, i0.857800hmit 25,251.00 19,728.00 21. U. S. Goremnrent Bonds, Total from pages 2-8 altadred 499, 303.91 22- Unit Irn. Trusts, tiAudiai Funds, Total tom pegs 7 altadred 21, 389.36 TOTAL (Abo erller on ins 2, RecapifWslon) : 1,422, 912.83 (K mare ~ b rid, iirasrt addrpMl Mob or are sranrs stare) PAGE 2 SCHEDULE B ESTATE OF ~AME3 W. FRY STOCKS 8 BONDS U.S. GOVERNMENT BONDS FILE NUMBER 107-01162 VALUE AT BOND NUMBER DATE OF DEATH #62219281E #90768447E 420.36 #95764699E 435.00 #C100065950E 441.88 #C 100065951 E 441,88 #C 103341039E 441.88 #C 113929279E 44 l .88 #C114687308E 453.32 #C114806637E 453.32 453.32 #C12806779E 389.80 #C 16365699E 389.80 #C17991555E 389 80 #C18840557E 389.80 #C19015128E 389.80 #C22466127E 393.60 #C23600384E 399.80 #C25183224E 399.80 #C275583IOE 399.80 #C29226017E 399.80 #C29226018E 399.80 #C29226034E 399.80 #C31079450E 399.80 #C31142033E 399.80 #C35404162E 399.80 #C36697401E 403.64 #C39668524E 409.92 #C4001481168E 769.44 #C4001481169E 770.76 #C4001481170E 78712 #C4001481171E 78716 #C41581708E 409.92 #C43141003E 409.92 #C46282672E 409.92 #C46282673E 409.92 #C47056279E 413 92 #C47471950E 409 92 SUBTOTAL $16,315.20 PAGE 3 SCHEDULE B STOCKS 8 BONDS ESTATE OF JAMES W. FRY FILE NUMBER 2107_ -01162 U.S. GOVERNMENT BONDS VALUE AT BOND NUMBER DATE OF DEATH #C47471951E 409.92 #C53299941E 409.92 #C54491627E 413.92 #C58125742E 420.36 #C58743062E 420.36 #C58743063E 420.36 #C66197562E 430.80 #C72863762E 420.36 #C73615014E 420.36 #C75658248E 424.44 #C84775292E 430.80 #C84775301E 430.80 #C85459182E 430.80 #C85459187E 430.80 #C87053305E 430.80 #C87053306E 430.80 #C88435978E 430.80 #C94287945E 441.88 #C99110700E 441.88 #C99110701E 441..88 #D 10283561 E 2,154.00 #D10359633E 2,154.00 #D 13454047E 2,209.40 #D13458241 E 2,230.80 #D 14280458E 2,266.60 #D3656010HH 500.00 #D3656011 HH 500.00 #D3656012HH 500.00 #D6042245HH 500.00 #D6045217HH 500.00 #D6196875HH 500.00 #L4002030306E 394.36 #L4008423743E 234.56 #L4008423744E 234.56 #L4008423745E 234.56 #L74163103E 210.18 SUBTOTAL $23,855.06 PAGE 4 SCHEDULE B STOCKS 8 BONDS ESTATE OF JAMES W. FRY FILE NUMBER 2107-01162 U.S. GOVERNMENT BONDS VALUE AT BOND NUMBER DATE OF DEATH #L76443811E 21018 #L85508177E 217.50 #M 11609727E 4,577.20 #M 12006272E 4,691.20 #M36404231 EE 1,264.00 #M36404232EE 1,264.00 #M36404233EE 1,264.00 #M36404234EE 1,264.00 #M36404235EE I ,264.00 #M36404236EE 1,264.00 #M36404237EE 1,264.00 #M36404238EE 1,264.00 #M36404239EE 1,264.00 #M36404240EE 1,264.00 #M41572316EE 1,239.20 #M41572317EE 1,239.20 #M41572318EE 1,239.20 #M41572319EE 1,239.20 #M41572320EE 1,239.20 #M41828817EE 1,214.80 #M41828818EE 1,214.80 #M41828819EE 1,214.80 #M4 1828820EE 1,214.80 #M4182882 (EE I ,214.80 #M8613321HH 1,000.00 #M8617037HH I ,000.00 #M8617038HH I ,000.00 #M8617039HH 1,000.00 #M87482852E 5,124.80 #M8829779HH l ,000.00 #M8829780HH 1,000.00 #Q 126096067E 99.95 #Q 154597303E 99.95 #Q23978201E 97.45 #Q4014069489E 1 17 28 #Q434759951E 107.70 SUBTOTAL $46,253.21 PAGE 5 SCHEDULE B STOCKS & BONDS ESTATE OF JAMES W. FRY FILE NUMBER 2107-01162 U.S. GOVERNMENT BONDS VALUE AT BOND NUMBER DATE OF DEATH #Q434759980E 107.70 #Q434759981 E 107.70 #Q434759982E 107.70 #Q434760719E 107.70 #Q441365967E 107.70 #Q441365968E 107.70 #Q441365992E 107.70 #Q454747139E 107.70 #Q53926331 E 97.45 #Q92524296E 99.95 #R 1782096E 915.44 #V002248863I 5,000.00 #V002248864I 5,000.00 #V 1663274HH 5,000.00 #V 1663275HH 5,000.00 #V 1663276HH 5,000.00 #V 1663277HH 5,000.00 #V 1663278HH 5,000.00 #V 1663279HH 5,000.00 #V 1663280HH 5,000.00 #V 1664043HH 5,000.00 #V 1664044HH 5,000.00 #V 1664045HH 5,000.00 #V 1664046HH 5,000.00 #V 1664047HH 5,000.00 #V 1664048HH 5,000.00 #V 1897701 EE 6,320.00 #V 1897702EE 6,320.00 #V 1966169EE 6,196.00 #V 1966170EE 6,196.00 #V 196617 I EE 6,196.00 #V21 l 3885EE 6,074.00 #V2113886EE 6,074.00 #V21 13887EE 6,074.00 #V5886637EE 3,050.00 #V5886638EE 3,050.00 SUBTOTAL $132,.524.44 PAGE 6 SCHEDULE B STOCKS 8 BONDS ESTATE OF JAMES W. FRY FILE NUMBER 2107-01162 U.S. GOVERNMENT BONDS VALUE AT BOND NUMBER DATE OF DEATH #X001422469I 10,000.00 #X001422470I 10,000.00 #X0016792201 10,000.00 #X001679221 I 10,000.00 #X001679222[ 10,000.00 #X 1831175EE 12,640.00 #X 1890129EE 12,392.00 #X2085018EE 12,148.00 #X2393372EE 11,224.00 #X2393373EE 1 1,224.00 #X2393374EE 11,224.00 #X5770498EE 6, 100.00 #X5770499EE 6,100.00 #X6005965EE 5,768.00 #X6005966EE 5,768.00 #X6005967EE 5,768.00 #X693282HH (0,000.00 #X693283HH 10,000.00 #X693284HH 10,000.00 #X693285HH 1 O,000.UO #X693286HH 10,000.00 #X693287HH 10,000.00 #X693288HH 10,000.00 #X693289HH 10,000.00 #X693290HH 1.0,000.00 #X693291 HH 10,000.00 #X693292HH 10,000.00 #X693293HH 10,000.00 #X693294HH l 0,000.00 SUBTOTAL $280,356.00 GRAND TOTAL U.S. GOVT. BONDS $499,303.91 PAGE 7 SCHEDULE B STOCKS & BONDS ESTATE OF JAMES W. FRY FILE NUMBER 2107-01162 UNIT INVESTMENT TRUST, MUTUAL FUNDS ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 22A 3952 UNITS UNIT MIT MUNI AMT INT SR 409S , CUSIP #626225254, $0.37/CJNIT $ 1,460.94 22B 1058.892 UNITS AIM INVEST SEC FUND HIGH , CUSIP #001420706, $4.26/LJNIT 4.510.88 220 50.839 UNITS MS TAX-EXEMPT SECURITIES TRT A, CUSIP #616977104, $11.53010/iJNIT 586.18 22D 1432.982 UNITS EVERGREEN CORE BOND FUND C CUSIP #299909580, $10.34999/UNIT , 14,831.36 TOTAL $21,389.36 REV-~soe ex+ ce-eel ~~++~~~~ scN~ou~~ ~ COMMONWEALTH OF PENNSYLVANIA ~Jy.7H~ ~NK DEPOSRS~ & M~.~. INHERITANCE TAx RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry, James W. 2107-01162 Indude the proceeds d Ndyadon and the dae the proceeds wen roceived by the setae. AN Property Joingy~owkked rrkh rbht M survivorship must be dlaclaed on Sehedule F. ~~ I,~M n ,-~---•___-• VALUE AT DATE 1. Cash in hand 10.00 2. Integrity Bank Savings Acct. No. 0401001800 105,032.60 3. Janney Montgomery Money Market Acct. No. 3474501 142,9132.43 4. Janney Montgomery Money Market Acct. No. 3474513 0.24 5. M 8 T Bank Checking Acct. No. 98190018 52,075.71 8. Members 1st Credit Union Savkiga Aod No. 37503-00 33.36 7. Morgan Stanley Aod. No. 410 051636 003, Caen Aod 37.35 8• ,Liquid At>;eet Ftrnd 3,121.68 9• ,Trust Bank Acd 24,263.00 10. PSECU Aril. No. 0173129828, Checking 9,087.47 11 'Savings 33,027.46 12. PSECU Aod. No. 1173129628, Savings 4,602.11 13. Sterling Finartca Checking Acct. Wo. 26015685 74,945.47 14. Wak~tovia Bank Checing Aoil. No. 1010071424167 699.85 15. MetLife Annuity, Contrail #1932767, named berteficary Evelyn Fry preder decedent 42, 309.10 16. Bank Hapoalim CD, 6.000'x, Maturity 10/20/21, Ctrsip #0625124X3 29,872.77 17. Commerce Bank CD, #701219, 3.9296, Maturity 9/2/'09 111,606.62 18. Lehman Bros. CD, 6.12596, Maturity 3130/27, Ctrsip#52521EFB1 26,670.82 19. Members 1st CD, #37503-45, 4.17096, Maturity 6f!/08 120, 573.88 20. PNC Bank CD, #31900213690, 3.0696, Maturity 7/9108 128,144.60 21. Providerkt Bank FID, 5.596, Maturity 10/23/17, Cusip #743838YX6 47 908.16 22. PSECU CD, #1173129626, 5.370%, Maturity 11/5/08 118,946.34 23. Sovereign Bank IRA CD, No. 0358000339, 3.5696, Maturity 4/20108 1,125.59 24. IRS Income Tax refund 25.00 25. IRS Economic Stimulus Payment 196.00 TOTAL (Also enter on line 5, Recapitulation) ti 1,077,277.61 In more space ~ needed, inert additions sheets a the same sae) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE 6 INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Fry, James W. 2107-01162 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 vas. REM NUMBE DESCRIPTION OF PROPERTY iNCwoe n+e ~ of n~ rnMUFer+~. n~x~ ru:uTgrar~ ro oEC~oerrt,vm n~ onrE OF rn~wsFH+. Attu A Coax of Try o®Faa raxx EsrAh. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION pF N TAXABLE VALUE ~ ~ MetLife Annuity, Contrail #1103344, Beneficiary St. Francis Soup Kitchen (Schad. J, Sect. II.B. No. 4) 89,362.46 100 0.00 89,362.46 2. MetLife Annuity, Contract #1421050, Beneficiary Mammals, Passerines, Raptors-Rehabilitation-Research, Inc. d/b/a Otter Habitat and Wildlife Rehallitation Center alkla Otter Habitat and WiIdliUe Habitat Center 71,422,92 100 0.00 71,422.92 3. Protective Life Insurance Company Annuity, Acil. No. PX0358898, Beneficiary Bethesda Mission (Schad. J, Seil.11.B. No. 5) 74,833.11 100 0.00 74,833.11 TOTAL (Also enter on line 7 Reppitulatan) s I 235,618.49 (If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (12-99) SCHEptlLE M COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE CCtSTS RESIDENT DECEDENT ESTATE OF FILE NUIWBER Fry, James W. 2107-01162 DstKs of dscsdsM must bs reported an Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Aver Memorial Funeral Home 1,407.10 z. Funeral luncheon costs reimbursed to David M. Rothert 83.93 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Conunissians 20,000.00 Name of personal Representative(s) David M. Rothert (commission per Art. 7 of will) Social Security Number(s)lEIN Nunber of Personal Representative(s) 173-38-9000 _ street Address 925 Somerset Lane city York State PA zip 17403 Year(s) Commissron Paid: 2009 2. Attorney Fees 68,640.00 3. Faml7y Exemption: (H decedent's address is not the same as deimaM's, attach explanation) Clairtrant Street Address ~Y Sys ~p Relationship of Claimant b Decederd 4. Probate Fees 1,480.00 5. Accountant's Fees s. Tax Return Preparers Fees 1, 800.00 ~. Cumberland Law Journal, legal ad 75.00 e. The Sentinel, legal ad 182.56 9. FuRon Bank, checks 18 85 to_ State Employees Retirement System, reimburse overpayment 2,262.57 t ~ ~ David M. Rothert, reimburse registered mail charge and cash advanced 23.78 t z. Total from Page 2 741.27 TOTAL (Also enter on Nne 9, Recapitulation) ; 96,715.06 (H more space is needed, insert additional sheets of the same size) PAGE 2 SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF JAMES W. FRY FILE NUMBER 6721-01162 ITEM NO. DESCRIPTION AMOUNT 12. Wachovia Bank, service fees $ 70.00 13. VitalChek, Maine death cert for Anne Thompson 27.95 14. Gail Bollinger, Notary 5.00 15. USPS, Certified Mail charge 5.32 16. Register of Wills, short certs & copy 49.00 17. Morgan Stanley, maintenance fee 95.00 18. Morgan Stanley, annual service Fee 150.00 19. Register of Wills, short certs 8.00 20. Vita.lChek, 3 PA death certs 47.00 21. VitalChek, 5 PA death certs 79.00 22. Smith, Anderson, et al, reimb. postage & copies 115.00 23. Register of Wills -file Inheritance Tax Return 15.00 24. Clerk, Orphans Court -file releases 75.00 Total $741.27 REV-1572 EX~ (1203) con~x.+orowEUTH of PENNSV~vANIA INHERRANCE TAX RETURN RESIDENT DECEDENT scN~ou« ~ DEBTS OF DECEDENT, MORTGAGE UABIUTIES, 8 UENS E8TATE OF FILE NUMBER Fry, James W. 2107-01162 Report d~bb Incurred blr do d~11t prior to lath whkh nnnln~d unpdd a of tM dab of dath, Ineludlllp unnimbun~d m~dlcal alp~raa. ~.~ .•....o ~rv..a w .~~, nixn GWrUg181 Sf16@LS O! UIB 58111@ SR@) REV-151J EX~ 1~) scNEOU~s ~ CaMMON4VEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry, James W. 2107-01162 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not Lbr Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [induds auMpht spousal disbibutlons, end transfers under Sec. 9118 (a) (1.2)] 1 • Catherine Powers, 1540 Washingtat Street, Bath ME 04530 Friend $50000 2• Donna SmNh, 20 Shady Lane, York Harem PA Friend $5000 3• Patricia E. Grove,15 CantpbeN Place, Camp Hill PA 17011 Friend $5000 4• Stephen, aikla Steve, Rothert, 2616 Bowling Green, Vienna VA 22180 Second Cousin $25000 5• L. Evelyn Fry was given 6150,000 in the wiN conditioned on Ex-Wile 0 surviving Decedent by 30 days: she predeceased Decedent so her gift lapsed. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON UNES t5 THROUGlr 18, AS APPROPRIATE, ON REV 1500 COVER SHEET R NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 • Helen 0. Krause Animal Foundation, Inc., PO Box 311, Mechanicsburg PA 17055 1 /10 of Residue 2• Lebanon Humane Society, 150 North Ramona Road, Myerstown PA 17067 1/10 of Residue 3• Rehabitat, Inc. aAda Rehabit, Inc., 1815 Pennsylvania Avenue, DiNsburg, PA 17019 1/10 of Residue q• St. Francis Soup Kitdten of St. Francs of Assisi parish, 1459 Zarker Street, Harrisburg PA 17104 1 /10 of Residue Continued on attadted Page 2. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET = (If more space is needed. insert addi6orral sheep of Ure same soe) PAGE 2 SCHEDULE) BENEFICIARIES ESTATE OF JAMES W. FRY FILE NUMBER 2107-01162 AMOUNT OR NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE II. B. CHARITABLE & GOVERNMENTAL DISTRIBUTIONS 5. Bethesda Mission P.O. Box 3041, Harrisburg, PA 17105 6. Salvation Army, P.O. Bvx 2771, Harrisburg PA 17105 7. Campaign for Human Develoment of the Roman Catholic Diocese of Harrisburg PA 4800 Union Deposit Road, Harrisburg PA 17111 8. The Nature Conservancy, National Office, 4245 North Fairfax Drive, Suite 100, Arlington VA 22203-1606 9. Castaway Critters, successor to Stray Cat Alliance of Harrisburg PA, 1266, Locust Grove Road, Middle- Town, PA 17057 1 / 10 of Residue 1/10 of Residue 1 / 10 of Residue 1/10 of Residue 1 / 10 of Residue 10. PAWS, P.O. Box 855, Camp Hill PA 17011 1/10 of Residue COO p}7 ~~ ~~~ ~~ I, ,iAMLS ~'. l~hY, of C:a~iip Ilill, Cumbcrl~~n~t CouYtt~,~, 1'emisy•lvar~i~l, t,~i~~~, of soui~,i and disposing mind, memory, and understanding, do hereby make, publish, and declare this to be my Last Will and Testament and hereby revoke all other Wills and Codicils that I have made, including the Will dated August 1, 2003. FIRST: It is my wish, and I direct, that after my death, my body be cremated and I direct my Executor to scatter my ashes on the Appalachian Trail or wherever he may deem appropriate. SECOND: I give and bequeath the following: ~\ \ A. One Hundred Fifty Thousand ($150,000.00) dollars to my ex-wife, L. EVELYN FRY, of Camp Hill, Pennsylvania, so long as she shall survive me by thirty (30) days. Should she fail to survive me by thirty (30) days, this sum shall become a part of my residuary estate. B. Fifty Thousand ($50,000) dollars to my friend, CATHERINE POWERS, of Bath, Maine, so long as she shall survive me by thirty (30) days. Should she fail to survive me by thirty (30) days, this sum shall become a part of my residuary estate. C. Five Thousand ($5,000) dollars to my friend, DONNA SMITH, of Etters, Pennsylvania, so long as she shall survive me by thirty (30) days. Should she fail to survive me by thirty (30) days, this sum shall become a part of my residuary estate. D. Five Thousand ($5,000) dollars to my friend, PATRICIA E. GROVE, of Camp Hill, Pennsylvania. Should she fail to survive me by thirty (3C-) days, this sum shall become a part of m}~ residuary estate. E. Twenty-Five Thousand ($25,000) dollars to my second cousin, STEVE ROTHERT, of Vienna, Virginia, so long as he shall survive me by thirty (30) days. Should he fail t~~ survive nle Icy thirty (30) days, this sung shall heco~n~; a p:ut of my resicluar~ estate.. THIRD: All the rest, residue, and remainder of my Estate, of whatever nature and wherever situate, I give, devise, and bequeath in equal shares to the following: A. HELEN O. KRAUSE ANIMAL FOUNDATION, INC. of Dillsburg, Pennsylvania; B. LEBANON HUMANE SOCIETY, of Lebanon, Pennsylvania; C. REHABIT, INC., of Dillsburg, Pennsylvania; D. ST. FRANCIS SOUP KITCHEN, of Harrisburg, Pennsylvania; E. BETHESDA MISSION, of Harrisburg, Pennsylvania; F. SALVATION ARMY, of Harrisburg, Pennsylvania; G. CAMPAIGN FOR HUMAN DEVELOPMENT of the Roman Catholic Diocese of. Harrisburg, Pennsylvania; H. NATURE CONSERVANCY NATIONAI. OFFICE, Arlington, Virginia; I. STRAY CAT ALLIANCE, of Harrisburg, Pennsylvania; and J. PAWS, of Harrisburg, Pennsylvania. FOURTH: All interests of any beneficiary in the income or principal of this Estate, while undistributed and in the possession of my Executor, even though vested and distributable, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to pledge, assignment, conveyance, or anticipation. FIFTH: All inheritance, estate, and succession taxes (including interest and any penalties thereon) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate, without apportionment or right reimbursement from any person. In the event that a substantial portion, as determined in the sole and absolute judgment and discretion of my Executor, of the non-probate assets such as an annuity or mutual funds are directed to be paid to a benefit. iary or beneficiaries, so that the taxes referred to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of this will (whether or not the same as the beneficiary or beneficiaries under the non-probate \_~ assets), my Executor, in his sole and absolute judgment and discretion, shall have the right to 3 ~` allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of the non- .- probate assets. SIXTH: In addition to all rights and powers conferred by law, I authorize and empower my Executor and his successors, in his absolute discretion and without necessity of obtaining co~irt approval: A. '1'o buy investments at a prerniurn or discount. B. To hold property unregistered or in the name of a nominee. C. To give proxies, both ministerial and discretionary. D. To compromise claims. E. To join any merger, consolidation, reorganization, voting trust plan, or any other concerted action of security holders and to delegate discretionary duties with respect thereto. F. To lend to, and buy from, my estate. G. To borrow and to pledge real and personal property as security therefor. H. To sell at public or private sale for cash or credit or partly for each, to exchange, or to lease for any period of time, any real or personal property, and to give options for sales, exchanges, or leases. I. To exercise any option permitted by law which he believes to be advantageous from the viewpoint of overall tax reductions, including, without limitation of the .~ foregoing, power and authority to claim administration or other expenses either as income tax .~ ~•. ~' deductions or inheritance or estate tax deductions, without regard to whether they were paid r from principal or income and without requiring adjustments between principal and income for any resulting effect on income or estate taxes, and a deduction of such expenses for income tax purposes shall be given effect in computing the respective shares of all persons interested in my estate set forth herein, even though the effect is to increase the share of one beneficiary or class of beneficiaries hereunder at the expense of another; and to make such adjustments, if .any, between beneficiaries with respect thereto as he shall deem appropriate in view of the nature of the tran~actioii and Tic amounts involved. J. To distribute in cash or in kind or partly in each. The powers granted hereunder shall be exercisable with respect to all real and personal property, including, but not limited to, income and principal held for minors or disabled. beneficiaries at any time, until the actual distribution of all property. All powers, authorities and discretion granted here shall be in addition to those granted by law and shall be exercisable without leave of court. However, nothing herein shall be interpreted or construed to encourage, authorize, empower, or permit the Executor to act or cause anyone to act in a manner contrary to or inconsistent with accepted standards of portfolio diversification and risk management. SEVENTH: I nominate, constitute, and appoint my cousin, DAVID M. ROTHERT, of York, Pennsylvania, as Executor of this, my Last Will and Testament. In the event of the renunciation, death, resignation, or inability of my cousin to act for whatever reason in this capacity, then I nominate, constitute, and appoint my friend and broker, CRAIG WATSON, of Camp Hill, Pennsylvania, as Executor of this, my Last Will and Testament. I direct that my Executor be paid the sum of twenty thousand ($20,000) dollars for serving as Executor. No representative named above shall be required to post security for the faithful performance of his duties in any jurisdiction it sofar as I am able by law to relieve him of such obligation. IN WITNESS WHEREOF, I have hereunto set my hand and seal this (o~`' day of '~'Vt1~ , 2005, on this, the fifth of five typewritten pages. I have also signed the left-hand margin of the first four of these pages for purposes of identification only. JAMES W.~FRY SIGNED, PUBLISHED, and DECLARED by the Testator, JAMES W. FRY, as his Last V~'ill and Testament, in the presence of us, who at his request, in his presence, and in the presence of each other, have hereunto subscribed our names ~s witnesses. 1~.P.~, u . ~.~r ,~. ~_ d?~,~~ Ksv Aa~,~~~ ~ ~t . _ i ~ ~ '1 . ;._ . ACKNOWLEDGMENT Commonwealth of Pennsylvania County of Cumberland I, JAMES W. FRY, Testator, whose name is signed to the attached instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~l ~s' JAMES W fFRY Sworn or affirmed to and subscribed before me by JAMES W. FRY, the Testator, this ,' 4 : F., day ofi l I : ~`: ~ t , 2005. Notary Publig _.. .... _.._ i'It~flrl i~I Peary M. Lr>prr,lVat~~y Public Camp Hill Baro, Cumberland County My Commission Expire, Oct 27, 2007 Member, Penn;~;l~.sn~a Pssccaation Of Notaries AFFIDAVIT Commonwealth of Penns}'lvania County of Cumberland We, Debra K. Wallet and ~~ „~ ~~ f~,~;, ~,, _, the witnesses whose names are signed to the attached instrument, being duly qualified according to law, depose and say that we were present and saw the Testator, JAMES W. FRY, sign and execute the instrument as his Last Will and Testament; that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that, to the best of our knowledge, the Testator was at that time 18 years of age or older, of sound mind, and under no constraint or undue influence. ~„Q,~w IG t~,,~- ~ C ,~ ~~~ J ~ -. , ~. r Sworn or affirmed to and subscribed to before me by ;::: ~,-,, k._. ~. ~t ,, ~ ;~ f- and ~. ~~_~, ;_,~ ~~ , ~ ~, ~ _-r ~ ~~-~~--~-~ witnesses, this _ (, ~ ~~` ~ _- day of _ i i r :_. ~ , 2005. -- _f-..--_ -_ -- Notary Public !Nary tai. Lo,;,er, ~~•lo+.ary Public Camp Hil{ f9oro. Cu; ntv~:-iza^d County i I,!y Co; nmis:si,r? E- x;;ir _~. Ch f. ~7, i107 i Law Offices SMITH, ANDERSON, BAKER do LONG 2S North Duke Street, Second Floor York, Pennsylvania 17401 David P. Baker* Charles J. Long *LL.M., Taxation Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, Pa 17013 Re Dear Ms. Farner-Strasbaugh: Tel: (717)845-9641 Fax: (717)854-1565 email~u;S,9BL-LAW com Horace E. Smith Website: www.SABL-LAW.com (1913-1991) December 29, 2008 Estate of James W. Fry No. 2007-01162 W. William Anderson Retired Enclosed for filing are two original Inheritance Tax Returns on the above captioned estate, as well as an estate check payable to you in the amount of $15.00 representing the filing fee. Please clock in the enclosed Return marked "copy", and return it to me along with the filing fee receipt for my files and records in the envelope provided. If you have any questions, please don't hesitate to give me a call. Thank you for your help in this matter. 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