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Home My WebLink About06-01-09 15056051058 REV-1500 EX O6 OS PA Department of Revenue ( - ) OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN Po sox 2sosol Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 00953 ENTER DECEDENT INFORMATION BELOW 09/16/2008 08/11 /1913 Decedent's Last Name Suffix Decedent's First Name MI HAAS 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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW • 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~: 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) r:~ 6. Decedent Died Testate :""'m 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date 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 BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name. Daytime Telephone Number ROBERT W MORRIS II, CPA ~_, (717) 582-8135 ..__ ~1 r. Firm Name (If Applicable) [•; ,`~ REGISTER OF 1~1t:~ USE ONt Y ~ ^ ~ i ROBERT W MORRIS & CO PC c=. -; -. , First line of address - .. - ~ ~..~~ I ' PO BOX 68 ..__ Second line of address_ _ -r _3: _ -~ C~ ' City or Post Office DATE FILED C,J ~ State ZIP Code -,..,; NEW BLOOMFIELD PA 17068 Correspondent's a-mail address: BOB@ROBERTMORRISCPA.COM Under penalties of perjury, I declare that I have examined this return, includi 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 onal representative is based on all information of which preparer has any knowledge. SIGNATURE IB FOR ILIN DATE ~r~ O X 6 ADDRESS 36 GOLFVIEW RD, CAMPHILL PA 17011 SIGNATI~FfOy P$,E^PfyRER OTHER THAN REPRESENTATIVE /l1a PO ~OX 68, NEW BLOOMFIELD PA 17068 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX __. ..._... ~_ ...~r__.~.... __._., ~ ._ _~ m RECAPITULATION ._ _ . _ . 1. Real estate (Schedule A) . .......................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 211,107.64 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. ! 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 9,067.51 6. Jointly Owned Property (Schedule F) °~~~~,r Separate Billing Requested ..... .. 6. 24,907.81 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) <"".:'? Separate Billing Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 245,082.96 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 24,798.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 0.00 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 24,798.00 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 220,284.96 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. ' 0.00 14. , Net Value Subject to Tax (Line 12 minus Line 13) ...................... . _ .. 14. ', 220,284.96 ~ _..w ..e~......, _~ e., . ~. .. ~._,_ ..~,,.a~._ .......,.. _w_~P....~..., ... ~~,_ n.~...~_s... _~~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ~~ m~._. ~ ,~A„. ~ . _ ., 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 220,284.96 16. 9,912.82 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line l4 taxable at collateral rate X .15 1g, 19. TAX DUE ....................................................... ..19. 9,912.82 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Fle_Number 21 08 00953 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER DOROTHY M HAAS 195-07-3300 STREET ADDRESS 5225 WILSON LANE CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 9,912.82 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 9,500.00 C. Discount 475.00 Total Credits (A+ B + C) (2) 9,975.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 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. (4) 62.18 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 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 :...................................................................................... .... ^ ^X 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? .......... .... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................... .... ^ ^K 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. LAST WILL AND 'f ~STAMENT OF DOROTHY M. I-I:AAS I, DOROTHY M. I-IAAS, of New Cumberland, Cumberland County, }'ennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my 1'.ast Wiil and Testament hereby revoking and malcang void any and all other wills Uy me at any time heretofore made. 1 direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. All the rest, residue and remainder of my estate, whether real, persona} or mixed, and wheresoever situate, I hereby give, devise and bequeath as follows; A. One-ha}f (%) unto my son, ROBERT M. i•}.AAS, per stirpes, B. One-half (%) unto my daughter, DONNA LEW1S, per stirpes. If either child does not survive me, but leaves descendants who so survive me, such descendants shall receive, per stYrpes, the share such child would have received had he or she so survived me. III. 1 hereby nominate, constitute and appoint my son, ROBERT M. HAAS, as Executor of this, my Last Will and Testament. If the said Robert M. Haas should predecease me, fail to qualify or cease to act as such, then l nominate, constitute and appoint my daughter, DONNA LEWIS, as Executrix. U00/200 ~d 80E9 Z69 ZlZ(7(dH) ~1Nn8S~TNHNI~W ~nnn~l ~HISf,HI 14 ;a1 rn~m~~nn~-in-uur 1V. Na fiduciazy acting under this Will shall be required to post bond in this jut•isdietion or in any jurisdiction in which he may act. IN WITNESS WHEREOF, I, DOROTHY M. 1-IAAS, the Testatrix, have unto this, my Fast Will and 'T'estament, consisting of two (2) type-written pages, set my hand and seal this .., ice' ~~ / day of ~~J ~,c ~~"" A.D., 2000. ) ,f SEAL) Testatrix SIGNED, SEALED, PUi3LlSHED and DECLARLll by DOROTT-IY M. HAAS, the above- named Testatrix, as and for her Last Will and Testa~r~ent, in the presence of us who have hereunto subscribed our names as witness at her request, in the presence oi~thc said Testatrix, and of each other, and we certify that at the time of the execution thereof, the said Testatrix wa,S of sound mind and disposing mind and memory. ~ ~~ ~~"~~ Residing at: -~ Residing at: 2 D00/E00 ~d 80E9 Z69 ZtZfXEj9) 9a(185]INdH]3W S100d ]dlSfia] ZD~2l fa3m)6nna-an-rtHr COM:MON~VEA,LTH Oi+ t'ENNSYLVANIiA 55.. COUNTY OT CUIVII3TRLANn We, DOROTHY M- HAAS, the Tcsta.trix, and ~,u~J! . ~+.~4 ,and .~G~.l.~.~...~t° ~?~.~/,~, ,the witnesses, respectively, whose names arc signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned auti~ority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary a.ct for the purposes therein expressed, and that each oi'the witnesses, in the presence and hearing of the Testatrix, signed the WiII as witness and that to the best oFhis/her knowledge the Testatrix waS at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Wetness Subscribed, sworn to and acknowledged before (•ne by the "l"estatrix, DOROTI-lY l•IAAS, atl(a subscribed and sworn to before i~te by :(;,~ ~. ~ l,t-, ~, 4__ ,___; -,_ and ~`',~'~_ _~~ ~ 1,~.' tT';r. ti. witnesses, this ,';~'"'t ~ day of i~ l , 2000. Note ~l uUlic SE~i~ Notarial Seal ~ ) Leann fVi. t3ensch, Notary Public FlarrEsburg, Dauphin County My Commiaelon Explrea Oct. 24, 2002 t+nnlbOn'd 806=9 Z69 ZlZ(7(H9) 9~n859INHFI73W ~~nn~l 9HIS6N~ JI?~~I cnam~~nna-In-tiur IOSBOS R[V 101/0%I LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ~P 14544134 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly tiled with me as Local Registrar. The original certificate will he forwarded to the State Vital Records Office for permanent filing. L~~ ~ ~EP t 8~1008.1~ Local Registrar Date Issued 3EV itlzlwfi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN ;ANENT CERTIFICATE OF DEATH ,K INK (See instructions and examples on reverse) 1. Name of Decedent (First. middle, last suffix) 2. Sex 3. Social Security Number 4. of D alh (Month, day, year) female 195 -07 '- 3300 ~~/~~ 5. Age (Last Birthday) rider 1 year Under 1 day 6. Dale of Birth (Month, tlay, year) 7. Birthplace (City aM stale or foreign country) 6a. Place of Death (Check only one) , Months Deys Hours Mlnuln HOSpllal: Diner'. 9 5 Aug . l l , 1913 A 1 t o o n a , P A Yre Lyympatienl ^ ER / Outpalienl ^ DOA ^ Nursm Home q ^ Resltlence ^Other- Bpeaty: Bb. County of Death ec. City, Boro, Twp. of Death Sd. Facility Name (If not institution, give street and number) 9. Was Del~dent of Hispanic Origin? No ^Ves 10. Race: American Indian. Black, White, etc. (If yes, specify Cuban, Dauphin Co. Harrisburg Harrisburg Hospital Mexican,PUertoRican.etc) (Spenty) white 11. Decedent's Usual Lion Kind of work done darts most of worki INe. Do rat stale retired 12. Was Decedent ever in the 13. Decedents Education (Specify only highest grade completed) 14. Marital Status: Married. Never Married, 75. Surviving Spouse (II wife give maiden name) KiM at Work Klntl of Busirress I Indust U.s. Armed Forces? Widowed, Divorced Specil)7 7 Elementary /Secondary (0-12) College (1-4 or 5.) ( , su ervisor vital r ^Yes ` Np widow 16. Decedent's Mailing Address (Street, coy I town, slate, zip code) Decedent's Did Decedent 5 2 2 5 W i l s o n Lane Actual Residence 17a. Stale P o n n .G 1 V a n i a Live in a 17c ~~py(L Ves, Decedent Lived in y - T. n w~ r A 1 1 2 n Twp M2chanicsbur PA 17055 Township? 17b. County Cumberland 17tl. ^ No, Decedent Lived wit . hin ACWaiomllspl cltyle~rp 18. Famer's Neme (First, mkltlls, last, sudixl 19. Mother's Name (First. middle, maiden surname) Herbert 5. Mark Sarah jape Lupton 20a. Informant's Name (Type! Print) Robert M. Haas 20b. Informant's Mailing Address (Street, city! town, state, zip code) 36 Golfview Rd., Camp Hill, PA 17011 21 a. Method of Disposition ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) lid. Location (Chy I town, slate. zip cotlel ~r Basset ^ Removal from State 'Was Cremation or Donadon Authorized peciyy: j by Medical Examiner /Coroner? ^ Yes ^ No S 2 p t. 2 0 2 0 0 8 ~ R o 11 i n g G r 2 2 n C a m e t a r y amp H i 11 P A 17 01 1 r cure of Funeral rvbe Licensee (or person aclirg as such) 22b. License Number 22c. Name and Address of Facility ,e. ~ FD-013163-L Musselman FH&CS 324 Hummel Ave. Lemo n2 PA 17043 eta Items 23a~c only when certifying 23a. To ate best of my knowledge, dea rted at the lime, date an0 place staled. (Sgnature and title) 23b. License Number 23c Dale Signed (Monts da ear) pnyskian is rat available at time el deem l0 . , y, y Cedlfy cause of death. Items 24-26 must ba completed by person 2d. Tme of Death 25. Date P D (Month, ay, year) 26. Was Case Referted to Medical Examiner I Coroner for a Reason Other than Cremation or Donation? who Dronounces death. M. ~1 ' ~ 4 ^ Yes ^ No G 4 CAUSE OF DEA7H (See Instructions arid a am les) r Approximate interval: Item 27. Pan I: Enter me ghats of events - diseases, Injuries, or complkaaons - that directly caused Ne death. DO NOT enter terminal events such as camiac artesl, r Onset to Deam i t l t i l fib ill i i Pad II: Enter other sion ficenl contli6ons coninbuY g to_d~ath, but not resulting in me undedying cause given In Part I. 26. Did Tobacco Use Conlribule to Death? ^ Yes ^ Probably resp ra ory artas , or ven r cu ar r at on w thout showing the etblogy. List onty one cause on each line. r r ~ Na ^ Unknown IMMEDIATE CAUSE (Final tleease or ff A /~ r 6 1 I 1"I C ter 1 6 I . , corMkion resulting in death) ~ a G ~ T E S T I V b 1" I t ~ ~ r {- /`1 t (. ~/ R [ ~ 1 ~ G ~ L ~ n .l Q -Cfy /I Gl 29. II Femzl ~ Due to (or as a consequence oft: nn Fr~~. x-~~v ss'~11 ~ sequentially list conditans, If any, b, C~RO ~Q (~ V M r~T u=1\ / p I S t c r S ~ '~e~,YS leading to the cause listed on line a. p'7 21 A L ~ 1 ~i(L1 L.LR IZ t7 d`( ~ot pregnanl within past year ^ Pregnant al bme of death Enter he UNDERLYING CAUSE Due to (or as a consequerce oQ: r No nanL bN pregnant wrists 42 days ^ (disease or injury that initiated the c events resuttirg In death) LAST. r o ~a,Ig Due to (or as a consequence op. r Nol ^ pregnant, bm pregnant 43 days to t year d r ^ Unkno waif pregnant within the past year 30a. Was an Autopsy Penormed? 30b. Were Autopsy Findings Available Prior to Completion 31. Manner of Deam 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurted 32c. Place of Injury: Home, Farts. Street Factory, of Cause of Death? ,,--,, // L~nvatural ^ Homicide OKCe Buildin etc. (Specif q' Yl ^ Ves NJ"N0 ^ Yes ~.~dVo ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury al Work? 321. If Transportation Injury (Spedryi 32g. Location of Inlury iSlreel. city /town, state) ^ Suicide ^ Could Nol be Delerminad ^ Yes ^ No ^ Driver I Operator ^ Passenger ^Pedesinan M ^ Other - Spedly 33a. Certifier (check only one) 336. Signature and Title of CartHler • Gasifying physician (Physician certifying cause of deem when another pnysk;ian has pronounced death arM completed Item 23) T b f I ~ ~ ~,wx ~ ~r , IN ly) n o me eet o my krowledge, death occurred due to the cause(s) and manner as statod_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pronouraing and certifying physician (Physcian bolo prorauraing death and cenitying to cause of death) To the best of m knowled e death occurred et the time date and la e d d t th d ^ 33c License Number 330 Date signed (Month, tlay, year) t y g , , , p , an c ue o e cause(s) en manrrer as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medical Examiner! Coroner ~ YV1 ~ ~{ 2I ~ ~ F 7 ~'[_p ~'C rem la{ r 1 (~ 2 ICJ On the basis of examination and / or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as steted_ ^ 34, Name and Address of Person Who Complete0 Cause of Death (Ite m 271 Type i Print 35. Registrar's Signature and D' ~ ~ ~~~ ~ 36. Date Fil (Mon d ay, year) ~~ ~~ ~ l'F-zzn I ~~° ~ Y cr v7 3u5(s Teri /'>c(le I 01 ~ ~ i ~ ~ / ' / ~ %F vtv~~ . , Disposillon Permit No. __w~` Y_~._LJ._9L.~- REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M HAAS 2008-00953 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) Portfolio Detail Dorothy M Haas Mr Robert Morris 36 Golf View Road RWM Asset Management, LLC Camp Hill, PA 17011 PO Box 68 17 E Main St New Bloomfield, PA 17068 717-582-8135 Value() Beginning Value 209,539.68 Net Contribution p.00 Change In Value -772.04 Ending Value 208,787.64 Irnestment Return -0.37 % Incomplete if presented without accompanying disclosure page Combined Account Portfolio Period: 09/16/2008-09/16/2008 Created: 09/26/2008 (thousands) $ 209.61 - 209.30 zaa.99 -' 2oa.e9 c JQ ~~ ,av'~ Js~ ~ r Page 1 of 2 Portfolio Detail Dorothy M Haas Mr Robert Morris Combined Account Portfolio 36 Golf View Road RWM Asset Management, LLC Period: 09/16/2008-09/16/2008 Camp Hill, PA 17011 PO Box 68 Created: 09/26/2008 17 E Main St New Bloomfield, PA 17068 717-582-8135 Disclosure: Advisory services offered through RWM Asset Management, LLC. Shareholders Service Group, Inc. and RWM Asset Management, LLC are non- affiliated companies. Values are as of 09/16/2008 unless otherwise noted. The Information contained in these reports is collected from sources believed to be reliable, however the accuracy and completeness of the information is not guaranteed, as it is a compilation of information from various financial sources (mutual funds, direct participation programs, correspondent brokers, etc.). In the event of any discrepancy, the sponsor's valuation shall prevail. If you have any questions regarding your report, please call your Registered Investment Advisor. For fee-based accounts only: The figures may or may not reflect the deduction of investment advisory fees. If the investment is being managed through afee-based account or agreement, the returns may be reduced by those applicable advisory fees. Refer to your Advisor's Form ADV, Part II. This report contains performance information calculated using Modified Dietz formula and may differ from other performance reporting systems. Page 2 of 2 Holdings by Portfolio Dorothy M Haas 36 Golf View Road Camp Hill, PA 17011 Mr Robert Morris RWM Asset Management, LLC PO Box 68 17 E Main St New Bloomfield, PA 17068 717-582-8135 Combined Account Portfolio Date: 09/16/2008 Created: 09/26/2008 Account Number Asset Name Ticker Asset Type Mgt. Name Quantity Price($) Value($) 47Y006696 ALLIANCEBERNSTEIN ANAGX FIXED INCOME ALLIANGEBE 1,335.79 7.63 10,192.06 GLO GOVT INC TRST A RNSTEIN 3 VESTMENT 47Y006696 AMERICAN CENTURY BULIX EQUITY AMERICAN 746.04 14.88 11,101.02 UTILITIES INV CENTURY INVESTMENT S 47Y006696 BROKERAGE MONEY CASH BROKERAGE 14,972.32 1.00 14,972.32 MARKET MONEY MARKET 47Y006696 MANAGERS INTERMED. MGIDX FIXED INCOME MANAGERS 763.02 10.53 8,034.60 DURATION FUNDS GOVERNMENT FUND 47Y006696 OPPENHEIMER STRAT OPSIX FIXED INCOME OPPENHEIM 2,861.30 4.12 11,788.56 INCOME A ER FUNDS 47Y006696 PIMCO EMERGING PAEMX FIXED INCOME ALLIANZ 909.29 9.79 8,901.99 MARKETS BOND FUND FUNDS CLASS A 47Y006696 PIMCO FOREIGN BND PFOAX FIXED INCOME ALLIANZ 943.13 9.92 9,355.83 (US DOLLAR-HEDGED) A FUNDS 47Y006696 PIMCO TOTAL RETURN PTTAX FIXED INCOME ALLIANZ 757.32 10.60 8,027.59 CLASS A FUNDS 47Y006696 PIONEER GLOBAL HIGH PGHYX FIXED INCOME PIONEER 830.36 10.37 8,610.78 YIELD FUND A FUNDS - DOMESTIC 47Y006696 ROYCE TOTAL RETURN RYTRX EQUITY ROYCE 972.82 11.92 11,596.03 FUND INVESTMENT CL FUNDS, THE 47Y006696 VANGUARD TARGET VTINX EQUITY VANGUARD 10,055.57 10.56 106,186.86 RETIREMENT INCOME FUNDS FUND Portfolio Total: $208,767.64 Incomplete if presented without accompanying disclosure page Page 1 of 2 Holdings by Portfolio Dorothy M Haas Mr Robert Morris Combined Account Portfolio 36 Golf View Road RWM Asset Management, LLC Date: 09/16/2008 Camp Hill, PA 17011 PO Box 68 Created: 09/26/2008 17 E Main St New Bloomfield, PA 17068 717-582-8135 Disclosure: Advisory services offered through RWM Asset Management, LLC. Shareholders Service Group, Inc. and RWM Asset Management, LLC are non- affiliated companies. Values are as of 09/16/2008 unless otherwise noted. The Information contained in these reports is collected from sources believed to be reliable, however the accuracy and completeness of the information is not guaranteed, as it is a compilation of information from various financial sources (mutual funds, direct participation programs, correspondent brokers, etc.). In the event of any discrepancy, the sponsor's valuation shall prevail. If you have any questions regarding your report, please call your Registered Investment Advisor. For fee-based accounts only: The figures may or may not reflect the deduction of investment advisory fees. If the investment is being managed through afee-based account or agreement, the returns may be reduced by those applicable advisory fees. Refer to your Advisor's Form ADV, Part 11. ___ Page 2 of 2 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER DOROTHY M HAAS 2008-00953 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. (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 SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER DOROTHY M HAAS 2008-00953 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 A. ROBERT HAAS 36 GOLFVIEW RD, CAMP HILL PA 17011 SON B. C. JOINTLY•OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT 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 DECEDENT'S INTEREST t. A. 09122104 M & T BANK #15004211211202 49,815.61 50 24,907.81 TOTAL (Also enter on line 6, Recapitulation) $ 24,907.81 (If more space is needed, insert additional sheets of the same size) ~ M&T Banlc 5528 Carlisle Pike, Mechanicsburg, PA 17050 717 766 0507 Fnx 717 766 1793 October 3, 2008 Estate of Dorothy Haas Robert Haas, Exec. 36 Golfview Rd Camp Hill, PA 17011 Dear Bob, Per your request, please find the information needed for the accounts housed at M&T Bank for Dorothy Haas. I have included the account title, opening date, account number, balance, accrued interest and total as of September 16, 2008. Dorothy Mark Haas Individual Account Account # 40020568 Account Opening Date 7/28/1971 Balance $7,792.19 + Accrued Interest $0.32 =Total Balance $7,792.51 Dorothy Mark Haas Robert M Haas Joint Account Account # 15004211211202 Account Opening Date 9/22/2004 Balance $49,773.32 + Accrued Interest $42.29 =Total Balance $49,815.61 Should you have any questions, please do not hesitate to contact me at 717 766 0507. As always, thank you for banking with M&T Bank. Sincerely, ~G7'!G~ ~'~o7`Z~~~+ Cindy Rotolo Branch Manager EV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DOROTHY M HAAS 2008-00953 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' MUSSELMAN FUNERAL HOME 6,147.00 2 MEMORIAL STONE 2,039.00 3 LUNCHEON 265.00 a MINISTER 200.00 5 FLOWERS 691.00 s PATRIOT NEWS 318.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ROBERT HAAS Social Security Number(s)IEIN Number of Personal Representative(s) _ Street Address 36 GOLFVIEW RD City CAMP HILL .State PA Zip 17011 Year(s) Commission Paid: 2009 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 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. CONTINUING CARE RX s WEST SHORE EMS s DIAGNOSTIC FEES 1o BETHANY VILLAGE 11 STORAGE 12 PA RETIREMENT OVERPAYMENT 10,000.00 364.00 675.00 372.00 1,867.00 71.00 1,439.00 169.00 181.00 rnrs~ ini .... ........ .... r__ n n.. _.-..:,..i...:,-_~ I A 7d 79R (1(1 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (11-08) Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M HAAS 2008-00953 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1. ROBERT HAAS SON 1 /2 2 DONNA LEWIS DAUGHTER 1/2 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, insert additional sheets of the same size,