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HomeMy WebLinkAbout04-21-09q 15056041046 REV- ^ 5OO EX (05-04) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Dept. 280801 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ ~ ~ ~ ~ ~ :2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~o~ ~o ~oo~ r~ ~~~.oo~' o~-io~ q~v Decedents Last Name Suffix Decedent's First Name MI ~,~ ~ r z s ,~ R >4 ~ (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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required ' death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number La~R~ ~ ~~ ! Tz 7~ ~ ~6~ ~~~'3 Firm Name (If Applicable) First line of address l3oa' L-A~-?~s ~A F Roy D Second line of address City or Post Offce State M~CH,gN I cSBUR~ ~A ZIP Code REGISTER OF WILLS US~NLY C~ ~~ C ~ ter., _ n I 'fit :~t7 f. , - r~ c:,; ~• _ _ 1 =.~ _... - ~7 TLS FILED ; C] ~ CJ1 l~obol ~2~ ~' Correspondent's a-mail address: ~~ b ~ 0 ~. tLflTwi-tt, I , C,p~ . ~~ z ~._ t.. -_t Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, 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 of which preparer has any knowledge. SIGNATURE OF ERSON RESPONS LE FO FILING RETURN DATE 30~ L~+.l~s ~ra~- Koa 1 _ ,Nl.,ru.~a•>`., G.s 6~~ r.~, . /~f! / ~06`~ ; / 9' %~ SIGNATURE OF PREPARER OTHER AN REPRESE TATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 J 15056042047 REV-1500 EX /^Ln/ y/~, Decedent's Social Security Num/beer Decedent's Name: ~~ lZ. / , / ~ r" l~i~ ~Z- __ ~ ~ `~ `? ' O " '' ~ y RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. +. ~~ ~~~ .(~ 2. Stocks and Bonds (Schedule B) ....................................... 2. * `1 I 3. Closely Held Corporation, Partnership or Sple-Proprietorship (Schedule. C) ..., , , ' ~ 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. + 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ...... .. 5. I Q ~ J ~ ~ -T , .. . 6. Jointly Owned Property (Schedule F) C Separate Billing Requested ..... .. 6. / _ b 6 7 ~ ~ `j 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested...... .. 7. ~r 8 6 ~ b y ~ ~ - 8. Total Gross Assets (total Lines 1-7) .................................. .. . . 1 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. I ~ ~ b `7 . ~~ . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. n Q ~ ~ 1 v ~ ~ 11. Total Deductions (total Lines 9 ~ 10) ................................. .. 11. ~ 2 n / / O y i` ~ . b C~ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. r ~ ~ /~ y / , ~ ~ /~ . 4 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. c7 ~' ~ Q ~ . 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 t x le j ~ I ~ 7 ~ ~ 1 16 n / n ~y / ~ ~ -I b at lineal rate X .0 • . ~ - 17. Amount of Line 14 taxable at sibling rate X .12 17• • 18. Amount of Line 14 taxable .? ~ O /1 ~ ..7 •h 18 f r ~ Q / ,~ ~1 • (/ O • at collateral rate X .15 • ~ '1'~ ~ ~ 7 19. TAX DUE ....................................................... ..19. . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT \~ ~~ 15056042047 Side 2 O 15056042047 J REV-1500 EX Page 3 Decedent's Complete Address: File Number - - --- s`~~,- _~__~~ z STREET ADDRESS STATE ZIP 17o~s`a Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ _ B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty ~~300 00 --- /~1.Q c1) ~ 2y~, yq Total Credits (A+ B + C) (2) 2 y2r. Q Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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. (3) (4) (5) 3 3 .uy A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ ~/ ~, (,~ Make Check Payable to: REGISTER OF WILLS, AGENT 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 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? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" 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 .property which contains a beneficiary designation? .................................................................................................................. ...... ^ 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, 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 decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. • REVr1503 EX+ (6-98) SCI~IEDULE B COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF Sl'L ~1 / ~ l ~ f't/ ~ ~Z FILE NUMBER ~ ~ Q Q - (~ (~ A~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ,. .~ ~ 3, ~ y ~~ ~~~~. ,4-~,~~ Q~,i~.~ I ~~,..~ c~~ss c ~~ q~. 3 Y ~, ~ o~, ~~~ sties. C~,+,~~ s~,C ~~d~ ~l Cass C ~z~l, 3~ ~d. (03, oyy s~+~s, .L ~.,,d Df;l~~~~-;~, CCU C ~,~s'o, r - 3" Sac . y3~ s-~rs. /~~ ~~~~~~ ~~ ~ s~ C ~, 7~'3. ~' ~ ~. ~iq3 ~.~"~ ~ti~. T..~,~~, tom. ~d ~'~~ c 16~, y~ R. ~~ TOTAL (Also enter on line 2, Recapitulation) I $ `~, 17(~j y iff rtare space is needed, insert addfional sheets of the same size) REV-1508 EX+ (g-98) SCHEDVLE E COMMONWEALTH O~ PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~~ /y/• 1~r~ T"Z ~ I t7q~- OO~~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 3, Clo~/-~,t,~ , J~ ~.~-n, 00 ~` ~. ooh ~~. d.~ .~~ ~. ~ x l~ ~. ~l 3~'~3. ~ 9' ~~~ `~v ~ ~- Q~~d z~~~ TOTAL (Also enter on line 5, Recapitulation) S ~~Q 3 Q (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDVLE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER 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 B. ~ ~m . j~/'i '~' Z s~~vy,.t, Gt S ~b01~. DG~ w~~- ~+~ - /Z~,U- c. JDINTLY-0WNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT GATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND 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 ,. A. ~ ~- PN C ~,.,,~ NAB C~k ~ ~ ~l Rg2.12 1/~3 I ~C~l o y #~ a o ©oo~'-~ yvO~,I~.~ ~~ lt, t- ~- 1i TOTAL (Also enter on fine 6, Recapitulation) I S / 6 6 ~ ~ ~ '1 (If more space is needed, insert additional sheets of the same size) ~L I'tEV-1511 EX+ (12-99) ' ' " ~~ SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF .-, FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. ' FUNERAL EXPENSES: A /~/'~ /~~Q ® ~ / ~ ~©~ / ,~~,H,~s~~ ~~t~;~ / /oo~ p~ 7 /Qa~.e v `s Flo w~ev-S l ~ 9. D O ~N ~.-~~ P~ ~ 33 ~, Z~ , o ~w fe+- ~ ~-~~ ~ I ~3~-~/~` p/~0 ! ~ i~ifi~ /~ c7 yb rV~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2 Attorney Fees 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 r~b~ O 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. N~~-sP~,r ~~f~~~ ~af~ ~, qy. ~~ TOTAL (Also enter on line 9, Recapitulation) $ ~ ~ ~ ~6 [{ ~~~ (If more space is needed, insert additional sheets of the same size) ' REV;1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER -~~ vac. ~ . ~r~ =~ z :~ l D 9'-- 0 0 ~ 9 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) 'REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER /I lr,r ~.nn NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~ ~' T Vi~2 ~~"Y ~ ~ ~ /305 ~~s ~ ~~ad ,/~1.~,~.~h,~~~-d~~ , P.~ I~a~~ ~ . ~ C . ~~--~ .t ~ .~a ~u- - .~ - ~ ~3~ • d 2 l3 O6 ~~s~ /~~.~ M ~?~r~ ics.~vl x~ ~ /~f-~ l ~pb~0 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) .~-----° REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA -. ,- - . -~ g _ _- - --. , -'!~ CERTIFICATE OF GRANT Of LETTERS No . 2009- 00029 PA No . 21- 09- 0029 Estate Of : SARA M FRITZ (Fast h~u~ ~; Late Of: HAMPi)EN TOWNSHIP CUMBERLAND COUNTY Deceased Socz a1 Security No : 203-10-300G WHEREAS, on the 12th day of January 2009 an ans trurren t dated y~ ~..-,, - - -- - - ~ - - - - - av~~rerrer l.7tF~ .~.y~.Z .saS ..: -..-.._ ~_~. -, .., .-.-,-,-r--._.~~ .`~., _..^..~.- ._.-.. ,.._ SARA M FRt TZ ~:~ 1a to of HAMPDfN TQ t~VNSH/P, C1JM.BEt4L.~ ~~3 L:~;,:~ *, who died on the 15th day ~f ~eo~:j.~~ ~.: ~~ WHEREAS, a true copy of the :~~~1 zs ~r° __ ~e~ed ~et THEREFORE, I, GLFNDA EARNER STRASBAtJGf-f ~<ey.~sLer of ..~~~~s ~. and for CUMBERLAND County, in the Cotr¢rronweay. ~~ -_ ~ e:~~sylvanaa, hereby certify that I have this day granted Letters TESTAMENTARY.to: LARRY E FR/TZ who has duly qualified as EXECUTORtRIXJ and has agreed tc~ ad.~.aaaister ~..he es~a a~:ror~~.g ~::y ~:aw, aly of ~:~~^ . fully appears of re~~rd a L~~ offy~~ at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PFNNSYL VANIA. IN TESTIMQNY WHEREOF, I have hereunto set my hand and affixed the _seal of my office on the 12th day of January 2009. -, - _. ~ -~ - _, ~ .-~__ y •~" ~ ~~! * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) < < I , SARA ''~3. FR TTZ , re s i c~ i n ~ a t :~a~ c~s^~z~ ~~~-~c~ i ~s - _ Czi~hr~r~.nnr~ Cc~~inty, ?'ennsylvania, being of sound and ~3is?,asins mind and t~t~~:ox~;-, clo tierel~;r ~ieClare t'~is to he LASt ~-~iil and.` ~ostarte~tt, here~F~y xevo~:fnQ any rind all *rills s.nr~ testArgents, or ~rrtings in t1~e natt.ire thereof, ~2y rye it any time heretc~farP na~le, thus c~isrnsinr~ of aII r!v estate; ITEM I,: i give, devis+~ and he~ucat~- ~-I1 ~y ~sstate, ghat- saever and whersstieYer, hc~th rea3 and p@'~$4it3~x, tt~ ~'hic}t I a~Ry die entztlec: ar +~~ich I nRy have ~~o~er to {~sr+ose of at ^~v c':eat~~, ~~nta saa, Larry i~, l~rita, c-f IS(35 L~-s Gel ~taad, hanicsMur~, Aa,~ iTI?'d III In the event t1~at ~y son should ~treciecease r~e~, then I ~ give, devf 4e r~nci bequeath sc21 of. ,~y estate, whatsaevsr anc~ ~rheres~ever., ~r~t~~ r~:al and ~ersQ~taZ~ to rah crandc'~~.~.dxon, C,ar~y _I:, pr~.tw ant Kristen ,~~ Fxi.tx~ px~ov%ct+ad hnwever,-if' either df_ tale a€Qre snzct cl~~.~.dren ~~RS nat reaC~aed the ss*e of tt~enLy-nne X21) years, then _ _. T give, devise and bequeath such share, to ~ Trustee hsrei.na~'ter narteEt, in trtfst, to collect and receive the rents, r~rnfits' Anci in- corae of such share. I"~~{'i TI;. I autl~orixe ~y trustee, to ttse I~ivv ~iundred C~5t3f~.Ac~~ Dollars tier runt}~ from the co~hiziec~ zriist £t~rad, fot tiro maintenssce of ray Grandchildren antil they reach the aye of L~te:1t~ - v~e~ (~1) years. In adriitian, ~ authorize ~Y Trtistce to use a~'ciztzona2 .mss ~~s~ ~ ~~ .f~ ~a+~ tk~e ~a¢'-' ,~~' ~~:~ ~~u=~.zr~ {~:: ~ r s:~:~ -- chfld bey~zcd xhe haig~.schoa~t level, px`mvicted however, that ~hezx sueh child ~ea~ches they nee of t~rea~ty-ona (~1) years:, h~ o~ shy ~~,~,1 se- dive eue~hal~' of the L~alance rem~in~n~; ~n the trust fund, less the a~ec~nt e~~enz~od fctr hf4 Qr der higher eciucati+4n, ~ra~vd+~d farther, t#~at if efther of Gr€~dchii~rea~ s~auld dio before he attains the a.ge of twenty»a-ne ~~i~ years., any i+alax~ce rs~ainin in said fund mill go t+a the surviing +ch~.ld, IT~``t IV. I nominate, ca~nstit~~te Vinci a.nn~int Janet F. Frig, the ~'otleer of my Granet+~hi3ciren, as '~'ru~t~*e ~~eren. ITr'~ V, I hereby nominate, constitute and aPPaint ~y son, Lar~Y F,„ Fritz, as Executor, of this, nay Last Fill and Testament, grovid+r~ hc~arerres, if ay saw, Larry E. Fritz should Predecease ~-e, .. .. t~~,- ~~ina~t~, c~~sLituta and a~P~aint Janet ~', Fritz, as Executrix, of t'rS, ~~~ Last •'z? i an<t Testament. IH MITNFSS NFHP.R~OF, I, Saga !d. Prig, Nava heretmta set hand and seal tv this, ~ Last ~-f I1 and '~+estaaent, consisting of t~+a (~'; t~?~e~rittert ~-ages, this 9th duty o~ ~lflv~ber, I978. ~. `1jj,~,~ f 53?AL~ ~~""ara ~. ~' Sz~;ned, seal~c3, ~t~~,la.shr~ci and declared })ti' the saki Sara '(. Frtx, t~~o a~~ov~ named testatrix, as and for her Last W321. and Testa~- ment fn the Presence of :is, wtio at last rPC~ttest an~i in her ~~resencc~ and in the ~rt~sence c~~ Pac}i other, all bein~* Present at the same tire, ~€~ve }~.~rexi~t+a ~txhs~ri~~ed oiix names. ~:s ~ritnesses. ~`~~ ~, residing sit R.l~, #Y ~;tters , Pa. ,,,..~~;~~,~r ~.~.~ resi~iin~ at 2731,A Green Street,. ~?~ Sia.rYist~urg, Pa. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280607 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX171-96? NO. CD 010993 FRITZ LARRY E 1305 LAMBS GAP ROAD MECHANICSBURG, PA 17050 eoa ESTATE INFORMATION: ssN: 2oa-io-soos FILE NUMBER: 2109-0029 DECEDENT NAME: FRITZ SARA M DATE OF PAYMENT: 03/13/2009 POSTMARK DATE: 03/13/2009 couNTY: CUMBERLAND DATE OF DEATH: 12/15/2008 REMARKS: CHECK# 4249 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ( 52,300.00 1 TOTAL AMOUNT PAID: INITIALS: AJW RECEIVED BY: 52, 300.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER Sara M Fritz Date of Death Values 12/15/2008 Cash in the Money Market Amer Balanced Fund Class C 573.647 shrs Price Per Share $13.42 Capital Income Builder Class C 203.336 shrs Price Per Share $40.58 Franklin Income Fund Class C 8656.137 shrs Price Per Share $1.52 $156.43 BALCX $7,698.34 CIBCX $8,251.37 FCISX $13,157.33 Income Fund of America Class C IFACX 603.044 shrs Price Per Share $12.52 $7,550.11 New Perspective Fund Class C NPFCX 396.438 shrs Price Per Share $19.66 $7,793.97 Templeton Income Fund Class C TCINX 8193.657 shrs Price Per Share $2.01 $16,469.25 Total Value of Account on date of death 12/15/2008 $61,076.80 SARA M FRITZ account lMarket vafl~ Stock Price as of 11 10 2008 Total Market Value 533.110 51,191.96 The aggregate amount paid to all Trust Berte(ic:ierfes in this distribution is $180304.989.34. Irnl68tOir ID 8062 5379 7981 2008 Wvidsnd Summary Record Date _ ~ ti!IMdn~la= Dividend per Trust Interest t;urrent Distritwtiorl 11/10/2008 36.09t1C $0.74 526.64 P able Date ~ Tax Withheld ~ DistfibutiolR Prior Year Distribution 12/15/2008 50.00 :2664 528.64 For Inquiries about your aocourrt, you may visk www.brlyrrlelbn.com/shareoiarterJisd, Or call 1~00~849,~i93. Trust 8arreAciary Nrlbraratlon You may purchase a salt shares of Metlife Inc. Corrurron stock through the MstLde Policyholder Trust (the `Trust'), free of any cormmiasioris ar other fees. under the Metlife Purchase and Sale Program. as amended. A copy of the brochure describing drs program is available an the Internet ~ www.rtredife.cam by selecting Investor Relations and then the Shareholder Services InfamrMion page, or by caging the number listed above. You are pemtdted to transfer your Trust Interests ordy in the circumstances described in the brochure. You may also irretnxt drat all (but not Isss Bran aR) of yow shares of Matlifs, Inc. otarnmorr stock held by dte Trust be witlrdrawn from dre Trust. Information regarding your withdrawal rights may be found in the Purchase and Sale Brochure or by caRirrg dre number Rated above. An annual shareholders' meeting to elect members of the Board ~ Drectors of MetLife, Inc. and for the transaction of other business is expected to be held on April 28, 2009. The deadlare for submitting shareholdm proposals for txxrsideration at this meeting is November 18, 2008. A copy of Metlife Inc.': annual report aril proxy st~errrent will be available bee of charge on or before March 3t, 2009, along with other MetLHe Inc, and Trust fiNr-gs under federal securities laws. G) on the Internet at www.mediFe.com by selecting About Us, Corporate Governance. under Related l.irrka, (a7 by writing to MetUM, Irrc., c% BNY Mellon Shareownar Services,-PO Box 358447. Pidsburgh, PA 15252-8447 or (ia) by calling the number Rated shave. These arrd other SEC filings by MetLife and the Trust are also available on dre Internet at www.sec.gov. ~+r~r~}~ ~'u- ~.,' .~ ~x ~~~, . , ~ +' 'fir ,,~ 9 r .~ ` , ., ~ .~ ~. ~~ +~ ~~ t~ v ~F k~a h~ ~t ~` ~- :r ~~,t k 4i R~ ~' ~ r, ~' ~~~ . a ,., ti~~. ~ ?~ ~. ~ ; 8 . . ~ .fi , , ;: , t . . . .r~. _ 4 ~ - - D ~ .^Y _f ~ 1 .ice A_; oD19aB0 f><$ 60~~iT/£ ~y~~~~~~~~'t~-~~BiGt IZt=a~t~~'xiuao~d/tuoa•a~aLU•ioasan~ti/% ~~ Investor Relations @~~'s ±~~' („)~~ ~~~®,~ ES Company Overview Executive Officers Board of Directors MET (Corrxrton Stock) Stock Information Select Data stock Quote - -__-.-.... .. _ __ -- --- ____-- Deceynber - 15 - ZOOS - took Up Price Stock Chart Historkal Price lookup Rawlts investment CalaWror Financial Information C~iaallaDe~~t1~ ' News & Events Volume 8,448,800 Conferences & Split AA)rNtmeat Factor 1:1 Presentations ~n ;30.94 Analyst Coverage Day's Nigh ;31.36 Shareholder Services Information Day's Low ;29.12 E-mail Alerts Copyright ®2006 MarketWatch, Inc. All rights reserved. fNease see our Terms of_Use. Information Requests Desigfled and powered by Dow_)o_nes Client Solu_kions Contact Information Irrbaday data provided by Interactive Data Real Time. Services and sub)ect to the Termer of_Use. Intraday data is at least 20-minutes delayed. Ail times are ET. H~torkal and current end-of-day data provided by Interactive Data_ Pricing and Reference_Deta. Senior Checking Plan. Account Statement ~~ ~ PIVCBANK YNC Bank For tha period. 7?!OS/2008 to 01/06/ZOAB SARA M FRITZ LARRY E FRITZ JANET C FRITZ 4905 E TRINDLE RD STE 47 MECHANICSBURG PA 17050-3643 Primary account number: 51-4002-1834 Page 1 of 3 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to 'a' PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espaRol, 1-866-HOLA-PNC Morringl' Please contact us at 1-888-PNC-BANK ® Write to Customer Service PO Box 609 Pittsburgh. PA 15230-9738 Vish us at pnacom ® TDDterminal:1-800-531-1648 For heating imparted clients only s9fNfN ChAC~U11g ~81n Sara M Fritz Larry E Fritz R@~11~ar ~@6b~ ACCOlR1t SlA111111/'y Janet C Frttz Account number. 5t-4002-1:834 Balance Sgmmairy Please see the Activity Detail `section for Beginning Deposits and Checks and other Ending additlOnal InfOrmatlOn. balance other additions deductions balance 7,OOi.12 2,365.37 2,015.W 7,357.49 Average monthly Charges balance and fees 6,264.14 00 Transaction Sammary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN Yransactions 1 0 0 Total ATM. PNC Bank.... Other Bank transactions ATM transactions ATM transactions U 0 0 Deposlt8 and Other Addtions There were 2 Deposits and Other Additions Date Amount l~scription totaling $Z,385.3Z. 12/23 1,000.00 Direct Deposit -Credit First Clearing XYXXXX.~YX0411 01/02 1,365.37 Direct Deposit -Civil Serv L?S Trea.4wv 312 A 25392 71 0 CSA Checks and Substitueta Checks Check Date Reference number Amount paid number 4243 2,015.00 12/15 084301651 There is 1 check listed totaling $2,015.00. Dam Balance Detl!a~ ---- Date Balance Date Balance Date Balance Date Batance 12/05 7,007.12 12/15 .4,992.12 12/23 5,992.12 01,'02 7,357.49 f~ORM953R-1005 BUREAU OF INDIYIDUAL TAXES PO BOX 280601 WIRRISBURG PA 17128-0601 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 09-0029 TAXPAYER RESPONSE ACN 09108396 DATE 02-16-2009 REV-1543 E% AFP (OB-0e) TYPE OF ACCOUNT EST. OF SARA M-F~R'i-PFTi- {-f~' IT2 ^ SAVINGS S$N 203-10-3006 ® CHECKING DATE OF DEATH 12-15-2008 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: LARRY E FRITZ 1305 LAMBS GAP RD MECHANICSBURG PA 17050-1926 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK NA provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000005140021834 Date 08-01-1974 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 4,992.12 payable to "Register of Wills, Agent". ~_____~ r_.._~,,. Y 16-667 C. ^ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3^ below. PART If indicating a different tax rate, Please state relationship to decedent: TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due a . PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are tr/ue, c~JorQr'ect and comp to to the best of my knowledge and belief. HOME C ) b ~ /Y/ ~/ ' WORK C ) -~, -D TAXPAYER IGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax ComputasionJ $ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 09-0029 Po BOX 280601 TAXPAYER RESPONSE ACN 09108397 HARRISBURG PA 17128-0601 DATE 02-16-2009 REV-1543 IX AFP COB-OB) TYPE OF ACCOUNT EST. OF SARA M f'it'l1Qh'~ ~P,IT~- ^ SAVINGS $$N 203-10-3006 ® CHECKING DATE OF DEATH 12-15-2008 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: JANET C FRITZ REGISTER OF WILLS 1305 LAMBS GAP RD CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17050-1926 CARLISLE, PA 17013 PNC BANK NA provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the inforoation is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. !'lease call C717) 787-6327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000005140021834 Date 08-01-1974 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 4,992.12 payable to "Register of Wills, Agent". o .. ........+ r~..~tii e Y 16.667 C. ^ The above inforna ion is incorrect and/or debts and deductions were paid. Complete PA RT 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state u, , ~i~ y , d {~ti~ r r r S ^ relationship to decedent: g ~ r,a s, v t ~ y LG ""~ ~ ~r ~ ~ 4 ~~~ + + TAX RE TURN - COMPUTATION OF TAX ~~y D t 3SU ) i 4 y s„`• ~. r d ; ON JOINT/TRUST ACCOUNTS AA ~ ~-- j 3 ~ ~ 'i LINE 1. Date Established 1 ~i3ai a"I~kyq ~. --~ ~ {~~~ ~ ~" P ~~~~ 2. Account Balance 2 $ 2 ` ' ~ " ' 3. Percent Taxable 3 X ~ n, ~ ~~ 1 ink ~ ,+,,,,,~,~~ ~~ i `~ yt°'' g it tti;"~r~ ~` ~ 4. Amount Subjeet to Tax 4 $ -- ~t~9 'V,4 ~? t ~ ~"~„ 5. Debts and Deductions 5 ' ~ ' ' 6. Amount Taxable 6 $ ~} ~:i ~~ { § f Ids„'.,,, ;':~, . , ~ <<I. 3 '~ d , 7. Tax Rate 7 X 5' 4` f/ 7 ' 8 Tax Due 8 :,~ / . PART DEBTS AND DEDUCTIONS CLAIMED S^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and co plate to the best of my knowledge and belief. HOME C ) 't-" ~ . ~ C+ .ZWORK C ) T PAYE SIGNATU TELEPHONE NUMBER DATE. TOTAL CEnter on Line 5 of Tax Computation) e WEST SHORE EMS -BLS ~~°°~~ 205 GRANDVIEW AVE ~~~ SUITE 271 ~~ ~w~~ .~ , , CAMP HILL, PA 17011 _ Phony #: (800) 367-0512 Federal Tax ID: 23-2463002 ~~ ~ ~;;,'~ ~; ; _: ~ ~,L~,~. EMERGENCY MEDICAL SERVICES PATIENT NAME: SARA FRITZ INSURANCE: SHELBY INSURANCE 40208188 MEDICARE B 203103006A FEP 802796589 182947W SARA FRITZ 770 POPLAR CHURCH RD CAMP HILL, PA 17011 PATIENT NUMBER CALL NUMBER: DATE OF CALL: TIME OF CALL:. CALLER: FROM: TO: REASON(S) FOR TRANSPORT INVOICE 31747 WCS 182947W NONE 12/05/2008 06:52 PM HOLY SPIRIT HOSPITAL HOLY SPIRIT HOSPITAL GOLDEN LIVING DEHYDRATION DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT STRETCHER One Way Transport A0999 1.0 108.75 108.75 Transport Van Mileage A0999 1.0 3.74 3.74 INF CONTROL GLOVES (PR) A0382 1.0 3.83 3.83 Total Charges 116.32 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT - _ _ - ~ ~ --- - - -` -- -- _ ^ - - - - Total Credits 0.00 r°LEA~c ~~Y Tt`iIS cvp'~~~l9NT - a~'~VC)ICE ,L~ I.ba't)I~ e~~~~IPT ~=,~-_ $116.32 RET~R.~o::~ C~iECIt F~~ g~;1.00 ~.~-~ E.~ ~ -. ~J~ Billing. Date: 01M9/09 Page 1 of 6 Telephone Number : 717 972-8481 Account Number: 717 972-8481 448 57Y SARA FRITZ Account Summary Previous Charges $ 25.73 No Payment Received .00 Past Due Chagos (please pay now) New Charges $25.73 Verizon (page 3) $ 6.09 Total New charges Due $ s.09 Total Due $ 31.82 MOVi»g? MovingT t-ass-viz-tlro,rEs One call gets you up & running. Count on the Verizon netwrxk to make at least one part of your move easier. Acrr~ss the street or across the nation all you need is one call to Verizon to set up your /ntemet, phone & digital N in your new home in no time. Service availability varies. Pleaso pay upon receipt - FlNAL BIl1- This Final Bill may have already been referred to an outside collection agency. Pay your bill online at verizon.com/payfinalbill Questions about your bill? visit verizon.com or call 1-800-VERIZON (1-SOr1-837-4966) t3hango of billing address? Go to verizon. comlbiliingaddress or call us. ~ Detach 8 return payment slip with your check, payable to Verizon