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HomeMy WebLinkAbout09-17-09 (2)1505607120 -~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.zsoso~ 2 1 0 9 0 17 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 174 05 1471 02 03 2009 03 28 1921 Decedent's Last Name Suffix Decedent's First Name MI COULSON EARL L (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 jX~ 1. Original Retum ~ 2. Supplemental Return n 3. Remainder Return (date of death - prior to 12-13-82) -J 4. Limited Estate ~ 4a. Future Interest Compromise '-i 5. Federal Estate Tax Return Required (date of death after 12-12-82) X 8 Decedent Died Testate ~~ ~ Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes - (Attach Copy of Wilq (Attach Copy of Trust) __ ~ 9. Litigation Proceeds Received ~ 1p, 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 C. SAIDIS ESQ. 717 243 6222 Firm Name (If Applicable) SAIDIS, FLOWER & LINDSAY First line of address 26 WEST HIGH STREET Second line of address City or Post Office CARLISLE Correspondent's a-mail address: State ZIP Code PA 17013 r.s REGISTER~6f WILLS US~NLY c.~ ~ .sa _ -~ . ~ ~ ~, y ~ rrs ~ (.., i-1~ :. r ~ f , ~ -~;__, - D C-~iILED C.~ ~} ~:~ rt 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 beliet, 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. TURE OF RSO ES LE FOR ING RET RN DATE ~ Michael L. Coulson `~-- /~_;~~~[ A 104 Oak l SIGNATURE OF Carlisle, PA 17015 2 THAN REPRESENTATIVE Robert C. Saidis Esq. 26 West High Street, Carlisle, PA 17013 Side 1 1505607120 1505607120 J~ .J 1505607220 REV-1500 EX Decedent's Social Security Number Decedent's Name: E a r i L. C O U i S O n 17 4 0 5 14 71 -- __ - _ _ __ - RECAPITULATION 1. Real Estate (Schedule A) ...................................................................................... 1. 2. Stocks and Bonds (Schedule B) ..............................._........................................... 2. 1 1 4, 4 4 2. 5 3 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................._....................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 12 , 7 1 5 . 8 3 6. Jointly Owned Property (Schedule F) L ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7, 2 5 , 5 4 6 . 9 9 8. Total Gross Assets (total Lines 1-7) .............................~.................................. 8. 1 5 2, 7 0 5. 3 5 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9. 1 0, 4 6 2 5 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 1 , 7 4 2 6 4 11. Total Deductions (total Lines 9 & 10) ............................._._................................. 11 • 1 2 , 2 0 5 . 2 1 12• Net Value of Estate (Line 8 minus Line 11) ..............................._.......................... 12. 1 4 O , 5 0 0 . 1 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. 1 4 0 , 5 0 0 . 1 4 _ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES _ _ _- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .o0 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 14 0 , 5 0 0.14 16. 6 , 3 2 2.51 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17• 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18• 0. 0 0 19. Tax Due ..........................................................................................._................... 19. 6 . 3 2 2.51 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0179 DECEDENT'S NAME Earl L. Coulson STREET ADDRESS One Longsdorf Way CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 4,300.00 226.32 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable p. Interest E. Penalty Total Interest/Penalty (D + E} (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (4) Check box 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 theTAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) Make Check Payable to: REGISTER OF WILLS, AGENT (1) 6,322.51 4,526.32 1,796.19 1,796.19 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 :............................................................................. [~ C! b. retain the right to designate who shall use the property transferred or its income :................................ ~ C c. retain a reversionary interest; or ..............................__............................_.............................__................ ~_ d. receive the promise for life of either payments, benefits or care? .............. ' ~ x' ............................................ I -~ ~ ~ 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?......... Lei x ~, 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............................. x - 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, 1554 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 statutedoes not exemota 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1503 FJ(+ (8.98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Coulson, Earl L. 21-09-0179 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 1,360 shares of ABA AMRO CAP 6.08% PFD 7.156 9,732.16 2 816 shares of Bank of America 6% 11.27 9.196.32 3 Berks Cty 5.375 5/15/2009 .99 4,950.00 4 500 shares of Boston CAP TAX CR II 14 .50 250.00 5 5,000 shares of Chester PA 5.25% 5/15/2022 .98 4,900.00 6 5,000 shares of Chester PA 6% 11/1/2029 1.03 5,150.00 7 724 shares of Citigroup CAP IX 6% PFD 9.47 6.856.28 $ 12669FRK1 8,229.18 shares of Countrywide 04-4 A8 - Multiclass .7116992 5,856.70 CMO 9 FHR 3120 DD 5.75% 7115/35 .998258 4,991.29 10 10,000 shares of FNMA 5-3 CD 5.5% 7125/34 .9920032 9,920.03 11 390 shares of GMAC 7.375% Pines PFD 10.09 3,935.10 12 600 shares of ING Group N.V. 6.125% 10.52 6,312.00 13 19 shares of Met Life, Inc. 29.13 553.47 14 860 shares of Morgan Stanley 6.25% TR 15.99 13,751.40 15 10,000 shares of Penn HSG 5.25% 4/01/2021 .9740 9,740.00 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 2, Recapitulation) 114,442.53 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1503 EX+ (6-96) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Coulson, Earl L. 21-09-0179 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 16 800 shares of Putnam Mngd Muni Incm Tr 5.35 4,280.00 17 5,000 shares of Somerset Cnty PA Hosp 518% .80339 4,016.95 11 /15/2029 18 $2,500,000 Ford Motor Credit Company NTS 6.2% .300625 7,515.63 12/15/18 i 19 $800,000 GMAC 6.5% 12/15/18 .3169 2,535.20 TOTAL (Also enter on Line 2, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. 114,442.53 Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (8.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Coulson, Earl L. 21-09-0179 Include the proceeds of litigation and the date the proceeds were received by the estate. All propeRy jointlyowned with the right of survlvorshlp must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Cumberland Crossings RFMS Petty Cash -Reimbursement for cash in account 20.99 2 Cornerstone Federal Credit Union Checking Account -Account 11246-07 3,978.37 3 Cornerstone Federal Credit Union Savings Account -Account 11246-01 36.17 4 Wachovia Securities Money Market Account 7,393.40 5 Avalon Insurance Company -Refund for insurance premium 86.90 6 U S Treasury -Refund on the 2008 US Individual Income Tax Return 1,200.00 TOTAL (Also enter on Line 5, Recapitulation) I 12,715.83 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Coulson, Earl L. 21-09-0179 This schedule must be completed and filed it the answer to any of questions 1 through 4 on the reverse side of the REV-1500 ~~OVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Genworth Life 8 Annuity Insurance - 25,546.99 100.000 0.00 25,546.99 Beneficiaries: Peggy S. Coulson Whitcomb--Daughter 3540 Jonathans Harbour Drive Jupiter, FL 33477 Cathy A. Coulson Adams--Daughter RR1 Box 511 Windsor, IL 61957 Wendy J. Coulson Guise--Daughter 140 Forest Road Bluffton, SC 29910 Michael L. Coulson--Son 104 Oak Ridge Road Carlisle, PA 17015 Peter J. Coulson--Son 140 Cold Springs Road Carlisle, PA 17015-9111 TOTAL (Also enter on Line 7, Recapitulation) 25,546.99 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleG (Rev. 6-98) REV-1151 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Coulson, Earl L. 21-09-0179 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Saidis, Flower ~ Lindsay 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 3,609.93 6,000.00 4. Probate Fees 260.00 5. Accountant's Fees 265.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 327.64 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 10,462.57 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Coulson, Earl L. 21-09-0179 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Carlisle Memorial Service, Inc. -Monument lettering 215.00 2 First United Church of Christ - Choir at Funeral Services 75.00 3 First United Church of Christ -Use of the Social Hall for Luncheon after Funeral 100.00 4 Hoffman-Roth Funeral Home and Creamatory, Inc. -Traditional Funeral Service 1,329.93 Package $4,150.00; Lincoln Casket $5,400.00; Monticello Interment Receptacle $1,320.00; Opening Grave, Newpaper Obitiuaries, Organist, Clergy, Death Certificates, Flowers, Sextant $2,357.41; Additional Flowers=$13,324.93 Less prepayment $11,895.00 Less $100.00=$1,329.93 Balance Due 5 L 8 D Catering, Inc. -Invoice #3365--Funeral Luncheon 1,590.00 6 Michael Coulson -Reimbursement for food and beverages for family dinner after 150.00 funeral services. 7 Michael Coulson - Reinbursement for sexton and secretary regarding church use 150.00 for funeral H-A subtotal 3,609.93 Other Administrative Costs 8 Cumberland Law Journal -Advertise Estate Notice 75.00 9 Register of Wills -Short Certificates 12.00 10 The Sentinel -Advertise Estate Notice 240.64 H-137 Subtotal 327.64 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Coulson, Earl L. 21-09-0179 Include unrelmbursed medlcalexpenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Alexander Springs Emer Phys -Account No. CLL94122561 9.84 2 Capital Blue Cross Insurance Payment 86.90 3 Continuing Care RX -Accounting #100022110 84.45 4 Continuing Care RX -Accounting #100022110 9.26 5 Cumberland Crossings -Account No. S0000106 1,174.20 6 ~ Cumberland Crossings -Account No. S0000106 7 Draft #8000 8 National Recovery Agency -Account #CGT0804012 Cumberland Goodwill Fire 8~ Rescue Ambulance Service 911 212 0 0 8 9 West Shore EMS -Carlisle -Patient Number 16928 Call Number 185034W 12.44 165.82 83.50 116.23 TOTAL (Also enter on Line 10, Recapitulation) I 1,742.64 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV•1513 EX+(9.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Coulson, Earl L. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] See attached schedule FILE NUMBER 21-09-0179 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) Do Not List Trusteelsl ($$$) Total 140,500.14 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 0 00 Copynght (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98) SCHEDULE J The BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Earl L. Coulson 02/03/2009 174-05-1471 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) ~~yyy .~. ~.vu~avn vvmicomp uaugnter One fifth (1/5) of the 28 100 02 3540 Jonathans Harbour Dr. residue. , . Jupiter, FL 33477 2 Cathy A. Coulson Adams Daughter One fifth (1/5) of the 28 100.03 RR1 Box 511 residue . Windsor, IL 61957 3 Wendy J Coulson Guise Daughter One fifth (1/5) of the 28 100 03 140 Forest Road residue. , . Bluffton, SC 29910 4 Michael L. Coulson Son One fifth (1/5) of the 28 100 03 104 Oak Ridge Road residue. . . Carlisle, PA 17015 5 Peter J. Coulson Son One fifth (1/5) of the 28 100 03 140 Cold Springs Road residue. . . Carlisle, PA 17015-9111 Tota I 140.500.14 1 ~., ~ 0 ~I l) ? _~i°I LAST WILL ANID TESTAIe/IENT BE IT KNOWN that I, Earl L. Coulson, a resident of 111 Petersburg Road, Carlisle, County of Cumberland, in the State of Pennsylvania, being of sound mind, do make and declare this to be my Last Will and Testament expressly revoking all my prior Wi11s and Codicils at any time made. I. PERSONAL REPRESENTATIVE: I appoint Michael L. Coulson of Carlisle, Pennsylvania, as Personal Representative of this my Last Will and Testament and provide that if this Personal Representative is unable or unwilling to serve than I appoint Cathy A. Adams of Carlisle, Pennsylvania, as alternate Personal Representative. My Personal Representative shall be authorized to carry out; all provisions of this Wi11 and pay my just debts, obligations, and funeral expenses. I further provide my Personal Representative shall not be required to post surety bond in this or any other jurisdiction, and direct that no expert appraisal be made of my estate unless required by law. II. BEQIJES'I'S: I direct that after payment of all my j ust debts, my property ber, r. ti.:a :.., be ueathed in the manner followiti -= ~-' `~~' - - ' Yi J _? r~~ My estate is to be divided evenly between my five children; their=~' ,. ._ names are as follows: - --= ~_-~ _~, -- r .~ Michael L. Coulson of Carlisle, Pennsylvania - .~ ,.. Peter J. Coulson of Carlisle, Pennsylvania ° Cathy A. Coulson Adams of Carlisle, Pennsylvania Wendy J. Coulson Guise of Boiling Springs, Pennsylvania Peggy S. Coulson Whitcomb of Carlisle, Pennsylvania Testor's Initial Page 1 of 3 II. F3EQLTESTS C~~ITINUED: I further direct that if any of my children listed above shall predecease me, that their equal share shall be left to their survivorslesta.te. IN WITNESS W'I~REOF, I have hereinto set my hand this 26`x' day of February, 2002, to this my Last Will and Testament. ICI. 4i'ITI4IESSED: ~, r Testator Signature The testator has signed this will at the end and on each other separate 'f d ~ resence that it is his last will and page, and has declared or signs Ie m our p testament, and in the presence of the testator and each other we have hereinto subscribed our name this 26th day of February, 2002. I Gtr ~~L ~-/ ~ /.~ ~ ~z/ Witness Si ture Address Witness Sigmature ,.~ /jam/ ~tness Signature Address ~ jam' Address jr'~~'s ~~ .T-' Testor's Initials Page 2 of 3 ACKNOWLEDGEI~!IENT State of Pennsylvania County of Cumberland VVe Earl L. Coulson, of Carlisle, Pennsylvania, ~~_ C~.~-r~s F~Pc~ ; ~K 1 9J . To ctim So.n ~ and .~ o~,,n 7 c~ wry s~n.~ the testator and witnesses, respectively, whose names are signed to the attached and forgoing instrument, were sworn and declared t:o the undersigned that the testor signed this instrument as his Last Fill and that each of the witnesses, in the presence of the testor and each other, sign the will as a witness. Tester {~~ -=~~ ~ ~~.> .,~ , Witness ~ ,~ ~c . ,~, ~-`~-,2-.t/ A Witness ~~~~FY-~.~.,~~~ _ ~ ~~ Witnes ~~ ,C ~,~>~1~~~ ' a~ On ~~~,~,,.,,, ~ ~, aao~. before me, ' , appeared C' , z~ I~ n ~ • Cnx-~S, Fre~.ir~ c, t~ Lu - 7awr, s~.r~-c~. mot- ~ or~.r~ dawn se.~ personally known to me (or proved to me on the basis of satisfactory, evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me and that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. Signatu Si nature of Notary NaTA~I~~ s~ LISA ANN MIQMLANL?s, Notary Public Carilalo ®orough, Cumberland County M GAmmlQ~lon Explroa Aug. 20, 7A(?5 Affiant Known Produced ID Type of ID ~^ V~er~ L.i GM~c i Ylt.a,mp ll~~-c (Seal.) Pagc 3 of 3 Wachovia Securities, LLC 919 Russell Drive Lebanon, PA 17042 Tel 717 273-8818 March 18, Zooy Jo Ann Seker Saidis Flower & Lindsay Law Offices Zlo9 Market Street Camp Hill PA 17011 RE: Date of Death for Earl Coulson Dear Ms. Seker: WACHOVIA SF.OL7I~IT7ES Following is in response to your letter dated February 23, Zoog, for date of death values for Earl Coulson. Death values are as follows: Rarl C'nnl.cnn #zino-oRdfi QUANTITY DESCRIPTION 2/3/09 Value/share Accrued Interest in s 1 bo ABN AMRO CAP 6.o8%PFD .1 6 N/A 816 BANK OF AMERICA 6% 11.27 N/A z CITIGROUP CAP IX 6%PFD .47 N/A 86o MORGAN STANLEY 6.z5% TR 15.99 N/A o GMAC 7 % PINES PFD 10.09 N,/A 60o ING GROUP N.V. 6.12 % lo. 2 N,/A 80o PUTNAM MNGD MUNI INCM TR 5.35 N,~A 0o BOSTON CAP TAX CR II 1 * ~} N,~A 5000 BERKS CTYS•375%5/15/zoo9 9 6ci•47 00o CHESTER PA •2 % /15/zo22 8 .06 5000 CHESTER PA 6% 11/1/ZO29 103 7 .17 27000 CWHL 04-4 A8 5.5%5/25/34 71.16992 2.51 000 FHR l2o DD •75%7/15/ .82 8 1.60 10000 FNMA 05-3 CD 5.5%7/25/34 99.20032 3.a6 25000 FMCC NTS 6.2% t}/21/14 o.o6z 44 •4 8000 GMAC 6.5% 12/15/18 1.69 6 •33 10000 PENN HSG .2 % 4/ol/zozl 97.40 182.2 000 SOMERSET PA .8%111 zoz 80. 6 .2 24584.1 GENWORTH LIFE&ANN INS ** N/A *Boston Capital is a Limited Partnership. A value can be found on the secondary market. List attached. **Genworth Life & Annuity is an annuity product. Death value is calculated by the annuity company upon receipt of a completed death packet. The money market portion of this account as of the date of death was $7,393.40• If you have any questions, please call me or one of my assistants at 1-866-344-3882 or 717-zz8-5824• Sincerely, ~. ~ ~~David Pleet Managing Director -Investment Officer The above summary of prices/quotes/statistics contained herein have been obtained from sources believed to tie reliable but are not necessarily complete and cannot be guaranteed. ]n some instances the prices may not reflect the value at which securities could be sold. nistoricai prices for ivlr,i (ivletl,ite, 1nc.) - Boogie t'inance Yage 1 of 1 Web Images Videps Maps News Shopping Gmail more Get quotes Example: "CSCO" or "Google" ____.___M___.____ _._.___.___._._._..._.___.__....._,,.._.___~__.__._.~.~_____..___...__~_,...____......_.._.._..._.__._._..__ MetLife, Inc. historical prices Watch this stock Show: Daily ~ Weekly Feb 3, 2009 _ Feb 3, 2009 Update Date Open High Low Close Volume Feb 3, 2009 29.56 29.91 28.35 :?8.52 8,801,623 Show rows: 30 1 - 1 of 1 rows Google Finance Beta available in: U.S. -Canada - UK. - ~ _~ ~ _ (Chinal - Information is provided 'as is' and solely for informational purposes, not for trading purposes To see al! exchange delays, please sse disciaimer. ©2009 Google Google Home - Helms -Privacy Polite -Terms of .1 http://www. google.com/finance/historical?cid=664378&startdate=02%2F03 %2F2009&en... 9/14/2009 MAR ~ 3 200' CORNERSTONE F e d e r a l C r e d i t U n i o n P.O. Box 1181, 5 East Gate Drive, Carlisle, PA 17015 Telephone (717) ~ 49- 166 I FAX (717) 249-8208 Member founded -- Service based www.cornerstonefcu.coop March 2, 2009 Saidis, Flower & Lindsay Attn: Jo Ann Seker 2109 Market Street ramp viii, rA i70~i i RE: The Estate of Earl L. Coulson. Jo Ann: At the time of his death Earl L. Coulson was a single owner of a savings (account # 11246- 01)and achecking account (account # 11246-07). The date of death balance of the savings account was $36.17 and the checking account balance was $3,978.37. The checking account balance includes Mr. Coulson's social security direct deposit of $1,130.00 which was deposited on February 3, 2009. This direct deposit may need to be returned. Mr. Coulson did not have certificates of deposit, safe deposit box, bank stock, mortgages or any debts with Cornerstone FCU at the time of his death. There were no accounts transferred by Mr. Coulson within one year of the date of death. If you require any further information, please call me at 717-249-1661 ext 240. Sincerely, y Donna J. Mlckey Financial Service Administrator YOUR SAVINGS FEDERALLY INSURED TO AT LEAST $ I OO,000 BY THE NATIONAL CR=DIT UNION ADMINISTRATION