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HomeMy WebLinkAbout12-18-09 (2) 1505607121 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number POBOx28osof INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 8 2 0 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 8 3 0 2 1 4 9 0 8 2 4 2 0 0 9 1 0 1 4 1 9 3 8 Decedent's Last Name Suffix Decedent's First Name MI B U R G E R R O B E R T E (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 O 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) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 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 T0: Name Daytime Telephone Number C H R I S T O P H E R E R I C E 7 1 7 ~ 4 3 ~3 4 1_.. Firm Name (if Applicable) ^, C © - s~ r -~ r REGISTj 111LLS UNLY~ ~= M A R T S O N L A W O F F I C E S ~~~~m ~ ~ ~.~ First line of address ,:, ~ -- , r_~ ~ ; P r,; h ~ ~ - ' _? ~?'~ - r 1 0 E A S T H I G H S T R E E T ° ~ ^ Second line of address ~' ~r-i ~ -~- i D C.,Tt ~ , : s~ ~ '~ GD , City or Post Office State ZIP Code ..DATE FILED C A R L I S L E P A 1 7 0 1 3 Correspondent's a-mail address: C R I C E a M A R T S O N L A W• C O M Under penalties of perjury, l declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, ff 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 PERSON RESPONSIBLE FOR FILING RETURN DAT j2~~1o9 ADDRESS 39 CHELSEA LANE CARLISLE PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIV ~/f DATE 10 EAST HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J 1505607221 REV-1500 EX Decedents Name: ROBERT E• BURGER Decedent's Social Security Number 1 9 8 3 0 2 1 4 9 RECAPITULATION 1. ........................................ Real estate (Schedule A) 1' • 5 1 2 9 5 1. 8 7 2. Stocks and Bonds (Schedule B) .................................. 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 2 0 9 8 0 8.7 7 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... . 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• • 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ^ Separate Billing Requested ....... 7. 8 7 2 2 7 6 0. 6 4 8. Total Gross Assets (total Lines 1-7) ........................... . 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9• 10. Debts of Decedent, Mortgage Liabilities, & Liens (Scheduled) ............ 10. 11. Total Deductions (totalLines9&10) .....•.•••••••••••••••••••.11. 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ... • . • • • • • • • • • • • • • 13. ~ 4. Net Value Subtect to Tax (Line 12 minus Line 13) .................. 14. 4 2 1 9 5. 8 8 6 0 3. 0 2 4 2 7 9 8. 9 0 6 7 9 9 6 1. 7 4 6 7 9 9 6 1. 7 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15. (a)(1.2) X •0 16. Amount of Line 14 taxable 0 . 0 0 16 at lineal rate X •0 ,_ . 17. Amount of Line 14 taxable 0 0 0 17. at sibling rate X .12 18. Amount of Line 14 taxable 6 6 9 9 6 1 7 4 1 g at collateral rate X .15 , 19. Tax Due ............ ............................. ..... 19. .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505607221 Side 2 0. 0 0 0. 0 0 0. 0 0 1 0 0 4 9 4. 2 6 1 0 0 4 9 4. 2 6 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0820 DECEDENTS NAME ROBERT E. BURGER STREETADDRESS 126 SOUTH HANOVER STREET GTY !, STATE ZIP CARLISLE ' PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 100,494.26 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 95,000.00 C. Discount 4,999.85 Total Credits (A+B+C) (2) 99,999.8> 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 b request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 494.41 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 494.41 Make Check Payable fo: 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; ............................. .. ^ X ^ c. retain a reversionary interest; or .............................................................................................. .. ^ d. receive the promise for life of either payments, benefits or care? ..................................................... .. If death occurred after December 12, 1982, did decedent transfer property within one year of death 2 . without receiving adequate consideration? ..................................................................................... th? h d " .. ^ ^ ....... er ea or payable upon death bank account or security at his or 3. Did decedent own an "in trust for .. 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)j. 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 (O) 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 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)J. The tax rate imposed on the net value of transfers fo 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. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8 MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT E. BURGER 21 09 0820 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 1, Orrstown Bank checking 108002291 x,444.47 ($2,444.46 + $.O1 accrued interest) 2. Orrstown Bank savings 708000178 47,657.57 ($47,635.06 + $22.51 accrued interest) 3. Orrstown Bank CD 4000031571 102.097.99 ($102,016.29 + $81.70 accrued interest) 4. Orrstown Bank CD 4000032307 42,987.80 ($42,940.88 + $46.92 accrued interest) 5. Cash found in house 61 1.40 6. 2001 Jeep (vehicle), actual sale value 7. Penn National Insurance, refund of premium 8. Rowe's Auction Services, proceeds from sale of personal property 9. Embarq, refund 10. Capital Blue Cross, refund of premium 11. Comcast, refund 12. Sale of personal property to Alan B. Cline TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 7,250.00 50.00 5,925.75 ;.65 214.30 4o.s4 525.00 2o9,so8.77 REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ROBERT E. BURGER 21 09 0820 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1 2 1 Year(s) Commission Paid: 2009/2010 State PA Zip 17015 2. Attorney Fees Martson Law Offices 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant FUNERAL EXPENSES: Hoffman-Roth Funeral Home, Carlisle, PA Romberger Memorials, grave marker ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Alan B. Cline StreetAddress 39 Chelsea Lane Cry Carlisle Street Address City State Relationship of Claimant to Decedent 4. ~ Probate Fees Cumberland County Register of Wills 5 I Accountant's Fees 6. ~ Tax Return Preparer's Fees 1>,500.00 18.00 7. Cumberland County Register of Wills, filing fee, Inheritance Tax return 1.>.00 8. Certified Mailing -Department of Public Welfare >.>4 9. The Sentinel, advertising Letters Testamentary 198.16 10. Cumberland Law Journal, advertising Letters Testamentary 75.00 11. Victor Traini, rent pending dispostion of personal property 400.00 12. Mountz Jewelers, appraisal fee 80.00 13. Cumberland County Register of Wills, additional probate fee X00.00 TOTAL (Also enter on line 9, Recapitulation) S 42.19 ~ . 8 8 654.18 650.00 24.000.00 Zip (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, 8i LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT E. BURGER 21 09 0820 Report debts incuned by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Outstanding checks on Orrstown Bank account 108002291 34.71 2. Quest Diagnostics, Inc. 3. I State Employees Retirement System, reimbursement 1 10.30 14.01 TOTAL (Also enter on line 10, Recapitulation) I $ 603.02 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ROBERT E. BURGER 21 09 0820 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS Cnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Alan B. Cline Collateral 133,992.34 39 Chelsea Lane Carlisle, PA 17015 2. Joseph R. & Dorothy Hribal Collateral ] 33,992.35 1860 Spring Road Carlisle, PA 17013 3. Jody WertAngline Collateral ]33.992.35 .513 Park Drive Boiling Springs, PA 17007 4. Donald E. Wert, Jr. Collateral 133,992.35 9 Azela Drive Mt. Holly Springs, PA 17065 5. Richard L. & Kathy Steigleman Collateral 133.992.35 2842 Oregon Road East Concord, VT 05906 6. The Bellaire Acres Rod & Gun Club Col lateral 10.000.00 c!o 548 Hillcrest Drive Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEE i NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~..~.. .... ~.nTTT r\ITI'-I"f T/1TA1 ~~nni rnvnoi c nicroiQ~ ~T~nn~C r1AI 1 IAIG ~~ r1F RFV_15M C(1VFR .SHEET I ~ (If more space is needed, insert additional sheets of the same G~~~! LAST WILL AND TESTAMENT OF ROBERT E. BURGER I, ROBERT E. BURGER, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as apart of the expense of administration of my estate. BEQUESTS THIRD: I give the indicated amounts to the organizations as follows: A. The Bellaire Acres Rod & Gun Club, Ten Thousand and no/100 ($10,000.00) Dollars. DISTRIBUTION OF RESIDUE FOURTH: I give the rest of my estate in equal shares, per stirpes, to the following persons who survive me for a period of thirty (30) days: A. Alan B. Cline, or his issue; B. Joseph R. and Dorothy Hribal, or their issue; C. Jody Wert Angline, or her issue; D. Donald E. Wert, Jr., or his issue; and ~', ~ . ~~~ initials E. Kathy Steigleman and Larry Steigleman, or their issue. PROTECTION OF BENEFICIARIES (Spendthrift Provision) FIFTH: No interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. Provided, however, any beneficiary may assign any part or all of the beneficiary's interest in my estate to any one or more of my descendants or to any one or more of the beneficiary's descendants. MINORS AND INCAPACITATED BFNEFICIARIES SIXTH: If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority or incapacity without the appointment of any guardian or committee or any authority of court. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the termination of minority or incapacity. My executor as trustee shall have the same powers as my executor. POWERS OF EXECUTOR SEVENTH: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers of the property, without liability of any purchaser for the application of any conciderati«n; to borrotiv money and tc~ secure its payment by mortgage of real or personal property, pledge of investments, or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments"; to make distribution in cash or in kind; to allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in cash or in kind, or partly in each; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. . ~ ~ ~~ initials APPOINTMENT OF GUARDIAN OF ESTATES OF MINORS EIGHTH: I appoint my executor as guazdian of the estates of minors with power to hold all property payable by law to a guardian appointed by my will and to use it for the minor's health, maintenance, support and education, either directly or by payment to any person selected by my executor to disburse it whose receipt shall be a complete acquittance. Guazdian may, in dischazge of all the guardian's duties, pay any minor's share deemed impractical of administration to the pazent or other person in chazge of the minor or to his or her guardian or to a custodian for the minor under the Uniform Transfers to Minors Act. My executor as guardian shall have the same powers as my executor. APPOINTMENT OF EXECiITOR/RIX NINTH: I appoint Alan B. Cline, Executor of my will. WAIVER OF BOND TENTH: I direct that no fiduciary hereunder shall be required to furnish bond in any jurisdiction, and if any bond is necessary, no surety shall be required. INTERCHANGEABILITY OF LANGUAGE ELEVENTH: Words used in the singulaz may be read to include the plural or the plural may be read as the singular. Similazly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS TWELFTH: The headings used on the various paragraphs of this will aze included for convenience only and shall have no legal significance. I have signed this will this ~ day of _ ~u L~ , 2009. 4~ Rob E. Burger, Testator Witness ~~ ~'J is~G~'~-.- Witness ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, Robert E. Burger, the Testator in and the undersigned witnesses to the will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the Testator, do hereby acknowledge that I signed the instrument as my will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testator sign and execute the instrument as his will, that he signed it willingly and 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 a witness and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. t 1 ~ ~ /~ Robert E. Burger, Testator Witness Witne ~-(~ Notary Public CUMMUNWEALTH OF PENNSYLVANIA Notarial Seal Robert R. Black, Notary Publk; Carlisle eoro, Cumberland County My Commission Expires Sept. 28, 2409 5EP 2Q 2009(THU) 14;55 ORRST04lN BANK Holdings by Investor Robert E Burger Robert Russoli 126 S Manov9r Strest Carfislo, PA 17013 ., Fi4 717-791-3909 (FRX)7172498010 P. 002/002 Combined Acxount Portfollb Date: 08/2412009 Crested: 09/2412009 Robert E Burger Acct Name:ROBERT ~ BURGER 126 S HANOVI:R ST CARLISLE PA 17013-3420 Acd No:4N2283345 Acct Type:lndlvldual Rep. No:26V .... As9et•.Namo :.....::.: ...:..:. .; .. ;.:;...•.,:; TIcIi6r:.. ASSae.'Cype .. IIAgRNdma~~ ::'.Qua'ntity', `' ~Prfeo(S}.:~: ~~i.~,...;."::~;;:.vatu~(:I`: ALCATEL-LUCENT SPONSORED ALU EQUITY 221.D0 3.45 762.45 ADR ATB,T INC COM 7 EQUITY 4,704.00 26.14 122,962.56 ATLANTIC SOUTHN BK MACON FIXED INCOME 100.000.00 1.00 100,120.56 CaA CTF DEP ACT1363 3.45096 09/11109 B/EDTD 09/12108 BANK FAYETTEVlLLE NATL ASSN FIXF~ INCOM7= 100.000.00 1.00 too,064.92 ARK CTF DEP ACT/365 3.a5o96 os117ros 9/EDTD o9/irroe BROKERAGE MONEY MARKET CASH OR BROKERAGE 586.07 1.00 568.07 EQUIVALENTS MONEY MARKET COMCAST CORP NEW CL A CMCSA EQUITY 837.00 15.10 9,618.70 FAIRPOINT COMMUNICATIONS INC FRP EDUITY 73.00 0.45 10.35 GOM FOOT LOCKER INC COM Fi. EQUITY 312.Op 9.93 3,098.16 IDEARC INC COM IDAR~ EQUITY 6t.00 0.04 2.28 1.51 CORPORATION GOM LSI EQUITY 64.00 5.08 325.12 TOMATOSANK NA DIAMOND BAR FIXED INCOME 10o,oa0.oo 1.00 103,244.93 CALIF CTF DEP ACT/366 3.tI0D°/n 09/29/09 BIEDTD 09/29108 COMMON COMMUNICATIONS INC VZ EQUITY 1,238.00 31.41 38,885.se ACCqurd Toial: $479,681.86 Imresipr7otaL 5479,681.68 Incomplete if prasentcd wltlwul nxompanyinp disclosum pugs Pago 1 Of t ~rrstown Financial Services Inc (ORRF) - Stock chart, Index chart - MSN Money Page 2 of 4 10/30/2009 34.4100 31.4500 33.8500 31.9500 20,500 10/29/2009 35.4800 33.6700 35.4600 34.0700 24,300 To 10 Stocks for 10/28/2009 10/27/2009 36.0400 36.5800 35.0000 35.6100 36.0400 36.3900 35.2000 35.6300 20,500 6,800 p 2009 America's SO Leading 10/26/2009 36.6700 36.1700 36.5400 36.1900 9,200 Experts Share Their Top 10/23/2009 37.5000 36.2200 37.5000 36.7000 12,400 Stock Picks. 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Policyholder's saved. 10/6/2009 37.8000 37.0000 37.3300 37.2800 6,800 ppRP.TheHartford.com 10/5/2009 37.9650 37.1700 37.8000 37.3900 7,700 10/2/2009 37.9600 36.9500 37.2700 37.6500 13,300 Hot Stock Alert - EHSI 10/1/2009 37.7500 37.0000 37.5200 37.3800 15,400 profit From Healthcare 9/30/2009 9/29/2009 38.6650 37.6500 37.2600 37.3000 37.4700 37.3100 38.6400 37.4600 28,700 5,600 Explosion. New Millionaires Created 9/28/2009 37.9700 37.4000 37.8000 37.6300 3,900 Today. Emerg any HealthcareSo~~tlo . 9/25/2009 9/24/2009 37.9100 38.7200 37.3500 37.2350 37.3500 37.6200 37.8100 38.3200 10,600 21,600 . 9/23/2009 37.7500 37.0430 37.1500 37.4100 9,900 $79/Hr Job - 433 enin s O 9/22/2009 37.8700 36.8700 37.6500 37.8700 4,400 g p Make $79/hr workiny 9/21/2009 37.9900 36.7600 37.9900 37.7500 12,100 From Home. As Seen On 9/18(2009 39.0000 36.7800 36.9200 38.4900 44,800 CNN,NBC,& Fox News 9/17/2009 37.0950 36.7500 36.9100 36.7500 10,200 ww w,newstribweekly.cor^%... 9/16/2009 37.8000 36.5400 36.7300 37.8000 11,200 9/15/2009 37.5700 36.5700 36.5700 37.5700 6,500 9/14/2009 37.2000 36.5250 36.5700 37.2000 5,300 9/11/2009 9/10/2009 36.9500 37.7500 36.5000 36.7500 36.5500 37.7300 36.7800 37.7500 6,300 3,600 919/2009 37.8000 37.0000 37.1800 37.7400 11,800 9/8/2009 37.4900 36.3100 37.4900 36.5700 2,aou 9/4/2009 37.6000 36.5300 36.8900 37.6000 4,000 9/3/2009 37.0200 35.6300 36.2500 37.0200 6,900 9/2/2009 36.5300 35.6600 36.0000 36.2800 4,100 9/1/2009 37.8490 35.3100 37.5000 35.9100 12,800 8/31/2009 37.2000 36.2475 37.2000 36.5300 13,300 8/288009 37.4800 36.2900 37.1400 37.4600 11,100 8/27/2009 37.3000 36.0000 36.0000 36.9400 7,000 8/26/2009 37.6000 36.9000 37.1800 -""37:6008 _ 3,200 8/25/2009 37.2450 36:~9BG-. 36.2500 36.1900 2,000 8/24/2009 37.0100 36.0501 36.0501 36.4200 5,700 8/218009 37.5500 35.1500 37.5500 37.0300 17,000 8/20/2009 37.2000 36.5000 37.2000 37.0000 9,300 8/19/2009 37.7100 36.5000 37.4500 -"7.2000 10,600 8/18/2009 37.7500 37.2500 37.5000 37.5500 10,200 8/17/2009 37.7400 36.9100 36.9100 37.5300 10,400 8/14/2009 37.6500 36.7700 37.6500 37.1400 16,600 8/13/2009 37.7500 36.7450 37.7500 37.7400 18,400 g/12800y 0.220 Ex-dividend 8/12/2009 38.0500 36.9000 36.9400 38.0000 23,800 8!11/2009 37.1100 36.3200 36.3500 37.1100 5,900 8/10/2009 37.1700 35.7800 37.1100 36.6000 36,900 8/7/2009 37.2000 36.5300 36.9900 37.2000 11,700 8/6/2009 37.2000 35.9700 37.1700 36.5400 8,900 8/5/2009 37.5000 36.3900 37.2900 37.2500 12,200 8/4/2009 37.2847 35.8200 36.5100 37.0500 6,900 8/38009 37.0900 36.5000 36.5000 37.0900 9,000 7/31/2009 37.5000 36.8600 37.2700 36.9300 16,200 7/308009 37.4900 36.4000 36.9900 37.4900 7,800 7/29/2009 37.2500 36.8600 36.9150 36.6/UU o,ow 7/28/2009 36.9800 36.1200 36.5000 36.9800 15,300 787/2009 37.4300 36.6000 37.2900 37.0500 7,100 784/2009 37.4300 36.3100 37.0000 37.1100 11,200 7/23/2009 37.4500 35.6700 35.8500 37.4500 12,700 http://moneycentral.msn.com/investor/chars ch .aspx?PT=6&compsyms=&D4=1&DS... 12/2/2009 REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER ROBERT E. BURGER 21 09 0820 All property jofntlyowned with right of survivorship must he disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DAT E OF DEATH 1. Financial Network Brokerage Account No. 4N2-283345 479.68 I.66 See attached 2. Orrstowns Financial Services, Inc. Account No. 000181006 31,826.97 871.2556 sh ORRF @ 36.53/sh 2a. Dividend on Item 2 declared 8/12/09; payable 8/26/09 193.24 3. Bellaire Acres Rod & Gun Club, Inc., Certificate No. 28 1,250.00 TOTAL (Also enter on line 2, Recapitulation) I $ 12.951.87 (If more space is needed, insert additional sheets of the same size) SEP-14-2009(MON) 09.34 ORRSTOWN . Fnvalvcrai, sERVir~s, nvc. A Tradition of Excellenc+s Manson Law Offices 10 East Nigh Street Caxiisle, PA 17013 Fay 243-1850 September 14, 2009 Re: Estate of Robert E. Burger Date of death Au.~ust 24, 2009 IT IS HE1:L~RBY CERTIF~D THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNTS W1TF1 ORRST04VN BANK: CFIECKING ACCOUNT Account - Title of Account - Date opened - Joint Account (name/date) - Balance Accrued Interest - SAVINGS ACCOUNT Account - Title of Account - Date opened - Joint Account (name/date) - Balance - Accrued Interest - 108002291 Relation Int Check 12/21/98 None $2,444.46 $.01 708000178 Prime Statement Sav 2/22/05 None $47,635.06 $22.51 77 Fast King Street, Shippenaburg, Pennsylvania 17257 P. 001 /002 S' 4 ~ D~ t' ~~ ~_~ SEP-14-2009(NON) 09;34 CERTIF'I'CATE OF' DEFOSTI(S) Account - Title of Account - Date opened - Joint Account (name/date) - Balance - Accrued Interest - Account - Title of Account - Date opened - Joint Account (name/date) - Balance - Accrued Interest - 4000031571 Personal Jumbo CD 3/4/09 None $102,016.29 $$1.70 4000032307 3-5 Month Growth 4/1/09 Nane $42,940.88 $46.92 Be "t°Rega~ds, ~ , Vicki L. Gullixan Customer Sexvice Specialist 77 Exist King Streex, Shippenxburg, Pennsylvania 17257 P. 002/002 r ~ n ~ ~`~ / / I i