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Home My WebLink About01-20-10 (2)'-'-~ REV-1500 1505607120 PA Departrnent of Revenue ~ (06-U5) OFFICIAL USE ONLY Bureau of Individual Taxes ca,nb code veer Fle ~,,,,,~, Po Box.2soso~ INHERITANCE TAX RETURN Harrisburg, PA 1712s-osol RESIDENT DECEDENT 2 1 0 9 10 0 2 ENTER DECEDENT INFORMATION BELOW Soaal Security Number Date of Death Date of Birth 188 32 4893 10 20 2009 11 30 1917 Decedent's Last Name Suffix Decedent's First Name MI RLLSO MARY M (If Applicable) Enter Surviving Spouse's Irdormation Below Spouse's last Name Suffix Spouse's First Name MI Spouse's Soaal Security Number THIS RETURN MUST BE FlLED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW X^ 1. Original Retum ^ 2. Supplemerrtal Retum ^ 3. Remainder Ratum (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise F ^ 5 . (date o(death after t2-t2~2) ederal Estate Tax Retum Required ^ B (Attach Copy of Wlll~a ^ 7. ordained a Livin® Trust (Attach Copy of Tn,aq 0 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. 5~1 Poverty Credit (date ~ r death ^ 11. Election to tax under Sea 9113(A) between 12~?1-81 and 1-1-85 (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INF ATKMI SHOULD BE DIRECTED TO: Name RICHARD L. W 8 B B S R, J R. E S Q II I R$ Daytime Telephone Number 717 532 7388 Firm Name (If Applicable) W S I G L E & A S S O C I A T L S, P. C, REGISTER O~yVILLS USE t~Y _- C1 ~=' ~ - First line of address - _1, c._, r . , ~ ~_ r ~ ~ ~ r1 `.^+ 126 $AST RING STRF$T r r_c7 "'" ' ... ~ - , ~ --: 7 ' C7 i Second line of address , ~ 1 , ~~ ~? - _r , 1 _° } City or Post Office DA~~ItfD State DP Cods . f -- SHIPPLNSBURG PA 17257 ~~ ~ , ~ .il CorrespondanYse-mailaddress: rwebber~weigleassociates.com ~ ~ ~Pe ~peri~ ' I declare that I have examined this rotum, irtcluding accompanying schedubs and statements, and to the best of plate. Declaration of proparer other than the personal representative Is based on all information of whi belief, 9e h SI ~ ~ d ~ c pMparer t any kn avl e g GNATURE OF PERSON RESPONSIBLE FOR FWNG RETURN e, h r~~ Patricia Pittenger ~~ ADDRESS .t-~~ /P .~~ ~~ 44 Liberty Court, Carlisle, PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~lf~-- ~ ` / Richard L. Webber, Jr. Esquire ~~ mss 1 f l~/ry 126 East King Street, Shippensburg, PA 17257 Side 1 L,~. 1505607120 1505607120 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Kelso, Mary M. 21-09-1002 Under penalties of perjury, I dedare that I have examined this return, induding acxompanying schedules and statements, and to the best of my knowledge and belief, it is true, corned and complete. Declaration of preparer other than the personal representative is based on ail information of which preparer has any knowledge. Signature #2 Name Addressl Address2 City, State, Zip Date 260 Centsrvilk Road Newville, PA 17241 f`/d/-/4 4 f 1505607220 REV 1500 EX Decedent's Social Security Number '_~~ Mary M. Kelso 188 32 4893 RECAPITULATION 1. Real Estate (Schedule A) .................. ........................................................................ 1. 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. 5• Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ................ 5. 2 3 9 , 8 9 3 . 7 5 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 2 7 , 5 7 6 5 0 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ~ Separate Billing Requested ............. 7, 4 8 6 , 9 13.8 9 8. Total Gross Assots (total Lines 1-7) ........... ...................... 8, 7 5 4 , 3 8 4.14 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......................................... 9. 3 9 , 5 9 8 . 7 4 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 6 , 5 3 7 . 1 0 11. Total Deductions (total Lines 9 & 10) .............................................. 11. ........................ 4 6 , 13 5 . 8 4 12. Net Value of Estate (Line 8 minus Line 11.) ............................................................. 12. 13. Charitable and Governmental BequesLs/Sec 9113 Trusts for which 7 0 8 , 2 4 8 . 3 0 an election in tax has not been made (Schedule J) ...... ........................ ................... 13. 4 8 , 4 3 9 . 4 8 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................................ 14. 6 5 9 , 8 0 8 . 8 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sea 9116 (ax12) X .00 0. 0 0 15• 0 0 0 16. Amount of Line 14 taxable . at lineal rate X .045 0. 0 0 16• 0 0 0 17. Amount of Line 14 taxable . at sibling rate X .12 11, 4 0 6. 5 8 17• 1 3 6 8 7 9 18. Amount of Line 14 taxable , . at collateral rate X .15 6 4 8, 4 0 2. 2 4 18• 9 7, 2 6 0. 3 4 19: Tax Due ......................................... ............................................................................ 19. 9 8 , 6 2 9.13 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. a Side 2 1505607220 150560722D J f REV-1500 EX Page 3 Decedent's Complete Address: File Number 21.Og.1002 B. Prior Payments 0.00 C. Discount 5,19 0.8 5 3. tnterest/penalty ifapplicable Total Credits (A + g + C) (2) 5,190.85 D. Interest E. Penalty Total InteresUPenalry (D + E) (3) 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 5. If Line 1 + Line 3 is greater than Line2 enteathe difffference ~Thisris the TAX DUE. (4) A. Enter the interest on the tax due. (5) 93,438.28 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. ($A) (5s) 93,438.28 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: a. retain the use or income of the props trap Yes No ........................................................ z b. retain the right th designate who shallruse the ro d~ .......................... r~ retain a reversiona inte P ~~ transfeRed or its income : .......................... rY resk or ................... .......... d. receive the promise for life of either paym ts, benefits or ............ x 2. If death oocurr ~ care? ................... •• x ed after December 12, 1982, did decedent transfer ......................................... receiving adequate consideration? ............... Property within one year of death Mrithout 3. Did decedent own an "in trust for" or ~~~~~~~~~~~~~~" x 4. Did decedent own an Individual RetlremenblAcoount, anu nor o~er nton-s ~~ aro ~s or her death?........, ~ O contains a beneficiary designation? ..................... ... p........... p... P~! which................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS' YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PAROT OF TO 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 beneficary. 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 beneficlaries 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 taz 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. Tax Payments and Credits: 1. Tax Due (Page 1 L'me 19) 2. CrediLs/Payments (1) 98,629.13 A. Spousal Poverty Credit Rev-1508 EX+ (698) ~~ ~~~ ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, ~ MiSC. PERSONAL PROPERTY Kelso, M. LE NUMBER 21-09.~ oe~ ~ hrclude the proceeds of kOpstion and the date the proceeds wwe reeaiNvad by the estate. pfOp°rh jointlY~rled rrlM tM right of survivorship nwst pe disGosed on schedule F. ITEM NUMBER DESCRIPTION 1 Adams County National Bank - Paymnt of RMD on IRA 2 Adams County National Bank Certificate of Deposit #158230 Accnied income on Item 2 through date of death 3 Adams County National Bank Certificate of Deposit #160302 Accrued income on Item 3 through date of death 4 Adams County National Bank Certificate of Deposit #160464 Accrued income on Item 4 through date of death 5 Adams County National Bank Certificate of Deposit #180694 Accrued income on Item 5 through date of death 6 Adams County National Bank Certificate of Deposit #455080300002-004 Accrued income on Item 6 through date of death 7 Adams County National Bank Checking Account 121665 Accrued income on Item 7 through date of death 8 Ameriprice Financial Services Certificate #063047104193001 9 FPM Trust #35-22911 -Checking Total of Continuation Scheele TOTAL (Also enter on Line 5, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Ina Sse attached page 239,893.75 Form PA-1500 Schedule E (Rev. 6-98) VALUE AT DATE OF DEATH 476.32 40,000.00 13.48 61,800.00 911.22 12,000.00 34.80 20,000.00 9.78 2,558.29 14.70 26,520.02 0.48 8,165.65 22,811.69 r ` Rev-1508 p(+ (8.88) SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY coMUONwFUni of ~nwwU o~~ continued ESTATE OF Kelso, Mary M. FILE NUMBER 21-09-1002 ITEM NUMBER DESCRIPTION Accrued interest on Item 9 through date of death 10 F&M Trust #70-85206 -Checking Accrued Interest on Item 10 through date of death 11 Millenium Pharmacy Systems -Refund 12 Orrstown Bank Checking Acct. #1060000869 13 PSERS -Refund 14 Refunds - HARP, Readens Digest, and Nationwide 15 Refunds -Miscellaneous magazines 16 River Source Life Insurance Company -Refund of portion of premium VALUE AT DATE OF DEATH 2.17 42.427.34 32.98 216.87 917.91 527.19 241.24 83.22 128.40 TOTAL (Also enter on Line 5, Recapitulation) 239,893 75 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) 4 Rev-'ISD9 EX+ (6-98) c~MaNweA~n, of PENNSnvaNu INF{E(ZRAPY'E TAX RETURN RESIDENT DECEDENT _ __ _ _ SCHEDULE F JOINTLY OWNED PROPERTY ~.,,nrlr= yr Kelso, Mary M. Man asst was made SURVIVING JOINT TENMIT(S) NAME A. Patricia A. Pittenger B. C. FILE NUMBER 21-09-1002 unt wkhin one year of kis deadenfs data ~ death, k must be rePortsd on schedule G. ADDRESS RELATIONSHIP TO DECEDENT 44 Liberty Court . Carlisle, PA 17013 ,/vo ~ ~ JOINTLY OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY NUMBER FOR JOINT TENANT MADE ~~ ~~ NAME OF FlNANCUt. gl5n'RJnON,gPp BANCACt;OIMrr ~eER OR SIMILAR IDENT}~~, NUA~ER ATTAC °~ OF DATE OF DEATH D ' DATE OF oEA~ H DEED FOR JOInntY-HEtp r~ ESTATE, ECD S VALUE OF ASSET I~~ vAt.UE OF ~~~ ~~ 1 A 5/31/2002 Orrstown Bank Certificate of De Posit X5060069489 55.153.00 50.000% 27,576.50 TOTAL (Also enter on Line 6, Recapitulation) (If more apex is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. r 27,576.50 Form PA-1500 Schedule F (Rev. 6-98) r~-ts~o oc+ (6-se) corwor+wEALTH of rEHrisnvAwA M ~tITANCE TAX REtURN SCHEDULE G INTER-ViVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF Kelso, Mary M. FILE NUMBER 21-09-1002 The sdbdule must be completed end filed H the answer to any of questions 1 through 4 on the reverse side of the REV-1500 CpyER g~~ ~ ~. ITEM NUMBER tHCLUOE t~ of TRAnLS~EREe, THt:~ REUTtotvsHtP ro oEC~nEtvr AHO THE DATE OF TRAtVSFER ATTACH A COPY OF TI$ DEED r-oR REAL ESTATE DATE OF DEATH VALUE OF ASSET x of oECO•s Extxtr!stoH g~fTEREgT ~ TAXq)3LE 1 Ameriplrise Annuities Post 1985 Acct ~ A~UCABt.E) VALUE . X930072696899004 41,626.35 100.000 41,626.35 2 Ameriprise Annuities post 1985 Acct . #930072748443004 44.610.59 100.000 44,610.59 3 Ameriprise Annuities post 1985 Acct . #930075326817004 69,582.59 100.000 - 69,582.59 4 Ameriprise Annuities Post 1985 Acct . #930075342657004 115,454.41 100.000 115,454.41 5 Ameriplrise Certificate Company -Certificate #008049318481001 34,633.07 100.000 34,633.07 6 Ameeiprise Certificate Company - Certficate X063042714582001 13.585.73 100.000 13,585.73 7 Ameriptlse Certfficate Company -Certificate #063046412860001 22,558.25 100.000 22.558.25 8 Ameriprise Certificate Company -Certificate #063047104193001 32.575.28 100.000 32,575.28 9 Ameriprise Certificate Company -Certificate #063047625288001 9.203.62 100.000 9,203.62 10 Ameriprise Cert~cate Company -Certificate #063048285108001 27,964.50 1 00.000 27,964.50 Total of Continuation Schedule TOTAL (Also enter on Line 7, Recapitulation) (tf moro space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Ina r attached page 486,---.-,_. Form PA-1500 Schedule G (Rev. 6-98) r~-~s~o oc+ Is.sal COLMI ~ E VANIA ~~ ESTATE OF Kelso, Mary M. SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY continued LE NUMBER 21.R~~ nn~ f~M DESCRIPTION OF PROPERTY NUMBER ~NCwoE NAAAE OF ~AHSr-~E~, ~T~~P ro ~~ THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR Re 11 Ameriprise ONE Financial Account Acct. #000514665892021 12 Onatown Bank Certificate of Deposit #5060069489 TOTAL (Also enter on Line T, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. A-~ DATE OF DEATH x of Dears ~p~pr,~ TAXABLE :A~, VALUE OF ASSET iNTERESr (~F APPUCAe~ VALUE 65,006.99 100.000 65,006.99 13,112.51 1100.000 13, 000.00 I 10,112.51 I 486,913..89 Form PA-1500 Schedule G (Rev. 6-98) ~ + ~ Rev-~~s~ EX+i~o-osi CC+M~NOPNHEALTH of PENNSYWANu INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS Kelso, Mary M. ITEM NUMBER A. FUNERAL EXPENSES: 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address City ~~ ~ Relationship of Claimant to Decedent p Debts of decedent must be reported on Schedule I. DESCRIPTION See continuation schedule(s) attached FILE NUMBER 21-09-1002 AMOUNT 5,831.63 B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name(s) of Personal Representative(s) Patricia Pittenger Denny H. McCullough Street Address 44 Liberty Court / 260 Centerville Boad, Neville, City Carlisle state PA ~p 17015 Year(s) Commission paid 2009,2010 2. Attorneys Fees Weigle & Associates, P.C. 4. ~ Probate Fees 17241 15,647.85 17,073.76 630.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs TOTAL (Also enter on Ilne 9, Recapitulation) 415.50 ~y.aya. r a Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) 4 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued --.+ ^ n ^ ~. yr Kelso, Mary M. LE NUMBER 21-09-1 Ong ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Denny H. McCullough -Reimbursement for funeral meat 457.41 2 Egger Funeral Home 5,374.22 Copyright (c) 2002 form software only The Lackner Group, Inc. H-A Subtotal 5,831.63 Form PA-1500 Schedule H (Rev. 6-98) t + Rev-1512 tJ(+ (12-06) cowwonw~ni of Pe~wsv~vAWA TAX RLMURN DECEDENT ESTATE OF Kelso, Mary M. SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS o~ ILE NUMBER 21-09-1002 ITEM NUMBER 1 2 3 4 5 6 7 8 9 - - ---_ .. • •• .+~ uw wceaent prior>b death that ramalnad unpaid at the deb of death, ineludinp unroimbuned medipl e~enaea DESCRIPTION VALUE AT DATE Adams County National Bank -Reimbursement of RMD on IRA OF DEATH 476.32 Dr. Guistwite 57.78 Dr. Guistwite 10.00 Green Ridge Village 4.007.45 Green Ridge Village 30.00 Howard's Accounting -Income Tax Preparation 600.00 Millennium Pharmacy Systems 141.78 Orthopedic Institute of PA fDrthooedic Institute of PA 10 Outstanding checks at date of death - ACNB 11 PA Department of Revenue -Income Tax payment for personal return 12 U.S. Treasury -Income Tax payment for personal return TOTAL (Also enter on Line 10, Recapitulation) (It moro space is needed, additional papas of the same size) Copyright (c) 2009 form software only 7}1e Lackner Group, Inc. 6,537.10 Form PA-1500 Schedule I (Rev. 12-08) 10.00 10.00 343.77 150.00 700.00 r rev-~s~s oc+ I»-oal ~LTH of aE VANIA ~ RESIDEA t~D ~CEDE~ ESTATE OF Kelso, SCHEDULE J BENEFICIARIES NUMBER I. Mary M. PERSON(S) RECE~ NG PROPERTY under II. 1 2 3 4 5 6 See attached schedule FILE NUMBER 21-09-1002 ATIONSHIP TO SHARE OF ESTATE AMOU DECEDENT HocuurrusWls) (Words) iter dollar artwunts for disMbuBons shown above on Imes 18th h 16 on Rev 1 ~ TOtal >1V-TAXABLE DISTRIBUTIONS; 0D~ ~~ as approl SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN B' CHARITABLE ANp GOVERNMENTAL DISTRIBUTIONS First United P~byterian Church Friendship Hose Company Green Ridge Village Fund Newville Historical Society Newviile Senior Center John Graham Library TOTAL OF PART h -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV_t inn rn~~re ~~~ T OF ESTATE ($ss) GS~~~~~~, ~~ 145,3t~>~ 38,439.48 2,000.00 2,000.00 2,000.00 2,000.00 2,000.00 --~,~•b,..,.., «,~.~ wrm ~mNare onry The Lackner Group, Inc. -- -- .,.,~~•• °"G` ~ 4ts,439.48 Form P/1-1500 Schedule J (Rev, 11-pg) k ~ f SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Mary M. Kelso 10/20/2009 188-32-4893 Item Name and Address of Person(s) Number Receiving Property Relationship Share of Estate Amount of Estate 1 Pamela Brown None (Words) ($$$) 1990 Walnut Bottom Road One Thousand Carlisle, PA 17015 Dollars -Pius $6406.58 ~~7~ UO6, 7S 2 Delmer Comman ~ ~'~"s ~ y~ ~~'0• ~ ~ ~~~~.1.•l~ 11 Meadow Ridge Drive Nephew One Thousand 7,406 58 Shippensburg, PA 17257 Dollars-Plus $6406,58 . 3 Frances Comman Sister 11 Meadow Ridge Lane Five Thousand 11,406 58 Shippensburg, PA 17257 Dollars Plus $6406.58 . 4 Michelle Comman Niece 11 Meadow Ridge Drive One Thousand-Plus 7 4,06 58 Shippensburg, PA 17257 $6406.58 , . 5 Charles Fahnestock None 6253 Bridle Lane One Thousand 7,406 58 Harrisburg, PA 17111 Dollars-Plus $6+106.58 . 6 Diane Hoover None 54 East Main Street One Thousand 7'4'06 58 Newville, PA 17241 Dollars-Plus $6406.58 . 7 Linda Malsbary None 2235 North Pea Ridge Road Five Thousand 11,406 58 Temple, TX 76502 Dollars -Pius . 8 Ryan Malsbary None $6406.58 4500 E. Ohort, #407 One Thousand 7 406 58 Austin, TX 78741 Dollars-Plus $6406,58 , . 9 Travis Malsbary None 1210 N. 13th Street One Thousand 7 406 58 Temple, TX 76501 Dollars-Plus $6406,58 , . 10 Denny H. McCullough 260 Centerville Road Nephew One Thousand r16j 606.9,E 7 Newviile, PA 17241 Dollars-Plus ~4p6.58 PI s4A6.g8 I 11 Donald A. McCullough "s II ~~~W, ~ y ~~Ga / .1~ GJ 143 Route MM Ne hew p „ . One Thousand 7 406 58 Ash Grove, MO 65604 Dollars-Plus $6406.58 , . 1 ` 4 SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) (ESTATE OF: Mary M. Kelso 10/20/2009 188-32-4893 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words 12 Douglas McCullough Grand Ne hew ) ($$$) c/o Donald McCullough p One Thousand 7,406.58 143 Route MM Dollars-Plus $6406.58 Ash Grove, MO 65604 13 Gary McCullough Grand Nephew One Thousand 331 Steelstown Road Dollars-Plus $6406.58 7,406.58 Newville, PA 17241 14 James McCullough Grand Nephew One Thousand 481 Oak Flat Road Dollars-plus $6406.58 7,406.58 Newville, PA 17241 15 Jet~rey McCullough Grand Nephew One Thousand 141 Route MM Dollars-Plus $6406.58 7,406.58 Ash Grove, MO 65604 16 Bradley Pittenger None 25 Acorn Drive One Thousand Boiling Springs, PA 17007 Dollars-Plus $6406.58 ~ 7~ U~ , 7S I V~ 17 Patricia Pittenger None ~ scG. ~(~ 6~ ~ ~ 44 Liberty Court Five Thousand }}58 Carlisle, PA 17015 Dollars-Plus $6406.58 ~~7~ Y~~~ 18 William Quigley None r/~f~ 76 ~' ~~ Ones Thousa 11 Harvard Avenue Dollars-Plus $6406.58 7,406.58 Maplewood, NJ 07040 Total 1„~,b.~;,g,~ 6~~~~ ~~ 2 } 4 4 i BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF MARY M. KELSO, DECEASED NO 21-09-1002 DECREE OF THE REGISTER OF WII,LS --- -~- ___._-- ------_--_-. AND NOW, this 23rd day of October, 2009, upon review of the original Will of Mary M. Kelso, submitted for probate on October 23, 2009, which original Will contained interlineations, the Register of Wills finds the following with regard to the Estate of Mary M. Kelso and renders the following decision: IT IS DECREED the handwritten words appearing on the third page of the document in the - Sixth Item are not admitted to probate. IT IS FURTHER DECREED that Letters Testamentary shall be issued to Patricia Pittenger and Denny McCullough. Patricia Pittenger and Denny McCullough shall have all the rights and duties of the fiduciaries under the laws of Pennsylvania and shall proceed with the administration of this estate according to law. ~, . r~ ..: ~:. ~y ~` - I ~ ~ ,~ .t ~„~ .~,.;, -= Glenda Fanner Strasbau Register of i s ~ . C_ J C~C~ r ~ .~Y~ = - V C ~ !~. i i.., r , ~~ CL ~•. b ~ b ht c~o~~ LAST WILL AND TESTAMENT I, Mary M. Kelso, presently residing at 12 Ridge Lane, Newville, West Pennsboro Township, Cumberland County, Pennsylvania 17241, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I desire to be interred in my cemetery lot at Westminster Cemetery. SECOND. I hereby make the following pecuniary bequests: A. I give and bequeath the amount of Five Thousand Dollars ($5,000.00) to Patricia Pittenger, presently residing at 44 Liberty Court, Carlisle, Pennsylvania 17015; and B. I give and bequeath the amount of Five Thousand Dollars ($5,000.00) to Linda Malsbary, presently residing at 2235 North Pea Ridge Road, Temple, Texas 76502. C. I give and bequeath the amount of Five Thousand Dollars ($5 000.00) to m , y sister, Frances Cornman, presently residing at 11 Meadow Ridge Lane , Shippensburg, Pennsylvania 17257. TURD. I hereby make the following pecuniary bequests: A. I give the sum of One Thousand Dollars ($1,000.00) to my niece, Michelle Cornman, presently residin at 11 M g eadow Ridge Drive, Shippensburg, Pennsylvania 17257; ~ B. I give the sum of One Thousand Dollars ($1,000.00) to my nephew, Donald A. McCullough presently residin t 143 ~ '" , g a Route MM, Ash Grove, MO . , -.~~. C. ~ I give the sum of One Thousand Dollars ($1,000.00) to my nephew, Denny li. McCullou h l , g , present y residing at 260 Centerville Road, Newville, Pennsylvania 17241; ~' •. D. .., I give the sum of One Thousand Dollars ($1,000.00) to my nephew, Delmer Cornman, presently residin at 11 M •,, . g eadow Ridge Drive, Shippensburg, Pennsylvania 17257; WEIGLE & ASSOCIATES . P.G. -ATTORNEYS AT LAW - 126 EAST KfNG STREET - 51-IIPPENSBURG, PA 17257_397 E. I give the sum of One Thousand Dollars ($1,000.00) to my grandnephew, Gary McCullough, presently residing at 17 Parsonage Street, Nevwille, Pennsylvania 17241; F. I give the sum of One Thousand Dollars ($1,000.00) to my grandnephew, James McCullough, presently residing at 481 Oak Flat Road, Nevwille,. Pennsylvania 17241; G. I give the sum of One Thousand Dollars ($1,000.00) to my grandnephew, Douglas McCullough, presently residing in care of Donald A. McCullough, 143 Route MM, Ash Grove, MO; H. I give the sum of One Thousand Dollars ($1,000.00) to my grandnephew, Jeffrey McCullough, presently residing at 141 Route MM, Ash Grove, MO; I. I give the sum of One Thousand Dollazs ($1,000.00) to my granddaughter Pamela Brown, presently residing at 1990 Walnut Bottom Road, Carlisle, Pennsylvania 17015; J. I give the sum of One Thousand Dollars ($1,000.00) to my grandso Bradley Pittenger, presently residing in caze of Patricia Pittenger, 25 Acorn Drive, Boiling Springs, PA 17007; K. I give the sum of One Thousand Dollars ($1,000.00} to my grandson, Ryan 1Vlalsbary, presently residing at 2235 North Pea Ridge Road, Temple, Texas 76502; L. I give the sum of One Thousand Dollars ($1,000.00} to my grandson, Travis Malsbary, presently residing at 2235 North Pea Ridge Road, Temple, Texas 76502; ~~ M. I give the sum of One Thousand Dollazs ($1,000.00) to my former son-in- law, Charles Fahnestock, presently residing at 6253 Bridle Lane, Harrisburg, Pennsylvania 17111; N. I give the sum of One Thousand Dollars ($1,000.00) to my foster son, William Quigley, presently residing at 11 Harvard Avenue, Maplewood, New Jersey 07040; O. I give the sum of One Thousand Dollars ($1,000.00) to my foster daughter, Diane Hoover, presently residing at 54 East Main Street, Nevwille, Pennsylvania 17241; WEIGLE & ASSOCIATES. P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257_1397 P• I give the sum of One Thousand Dollars ($1,000.00) to the John Graham Library of Newville, Pennsylvania; Q• I give the sum of One Thousand Dollars ($1,000.00) to the Newville _ Historical Society of IVewville, Pennsylvania; and . I give the sum of One Thousand Dollars ($1,000.00) to the Newville Senior Center of Newville, Pennsylvania 17241; S• I give the sum of One Thousand Dollars ($1,000.00) to the Green Ridge Village Fund ofNewville, Pennsylvania 17241; and T• I give the sum of One Thousand Dollars ($1,000.00) to the Friendship Hose Company of Newville, Pennsylvania 17241. FOURTH I direct that all of the rest, residue, remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, be liquidated and the proceeds distri~iuted as follows: A• Twenty_five percent (25%) to the First United Presbyterian Church of Nevwille, Pennsylvania; B• One Thousand Dollars ($1,000.00) to each of the organizations listed in Paragraphs THIRD (p) thru (~ above; and . C• 'The remainder to be divided equally among the persons listed in Paragraph SECOND, subparagraphs A, B and C, and Paragraph THIRD subparagraphs (A) through (O) above, with each of those 18 persons receiving an equal share, on a per capita distribution basis. FB'TH• I direct that any and all inheritance, estate and transfer taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residuary estate. S~H• In addition to the powers conferred by law, I authorize my Executors in their absolute discretion: ~ A• To retain in the form received, and to sell either at public or private sale any real or personal pro ~::~~=C /f~: , P~ • -'1 ~7c.-:' •~n;s: r•S .+l i<;...Y,' •~,/: f•,! ~f f'fr, ..;,iC ~'~'(~3' '~~ l i B• To invest and reinvest in all forms of ro ~ f r LR.:r %~ ~ .• ti•: • / I s ~~~."~ !f. s !~ ~ ~ P Ply without being confined to ~ ~•~ ~, ' legal investments, and without regard to the principle of diversification; v C• To exercise any option or rights arising from ownership of investments; and -;: r-y '' WEIGLE & ASSOCIATES, P. C. -ATTORNEYS AT LAW - 126 EAST KIN G STREET - SHIPPENSB UR6, PA 7?257-~qQ7 D. To compromise claims without court approval, and without the consent of any beneficiary. SEVENTH. I nominate, constitute and appoint Denny McCullough and Patricia Pittenger, or the survivor thereof, to be the Co-Executors of this my Last Will and Testament. In the event that neither person can serve as Executor, I then appoint my sister, Frances Cornman as Executor. EIGHTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. NINTH. I direct my Executors to retain the services of Richard L. Webber, Jr., Esquire, presently located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. TENTH. I hereby direct that all federal, state and other death takes payable because of my death, with respect to the property forming my gross estate for tax purpioses, whether or not passing under this Will, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of adnministration of my estate and that such be paid out of the rest and residue of my estate. IN WITNESS WHEREOF, I, Mary M. Kelso, have hereunto set my hand and seal to this my Last Will and Testament, written on four (4) pages, the first three (3) pages signed for identification only, this IY t~ day of ~<~~2..,~ ~~- 2007. ` , ,l' C~ ,egg. /~9~ ~ '~(~.{~'~ -(SEAL) Mary Mf' elso p II WEIGLE & ASSOCIATES, P. C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. ... .J ~_ , ., ~-~ ~ - ~ ~' r J COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS I, Mary M. Kelso, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Mary M ~' elso Sworn or affirmed to and acknowledged before me by Mazy M. Kelso the Testatrix, this l y;~` day of SE,a~.-~ l n,•- , 2007. =1 ~~`t-~~ ~(- ~Z1:y~` Notary Public ' II ~~'~T4RIAL SEAL RICHARD ~. ~`: " "~R J9., t~QTR.I~Y ?f38LIC SHIPPENSE3't!s,t '. ^11sVISE!;L~-~,`:.~ fCJt~TY MY C0~1~1~;:;:ti:r ; ."lr~ES JUI.`# [" 2Q10 WEIGLE & ASSOCIATES. P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND ._ ---, We, I ~ r ~ < < c. ~ i.-1" -1~' !~_ and _ ,1~'~ •~:.r.~ ', i'.' ~) ~ '~P`~~2.' ~:,__ the witnesses whose names aze signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Mary M. Kelso, the Testatrix, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix, signed the will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me ~,. by 5~~. ~.~ ~. ~ ~ ~ ~ ~~ <~ ~-/ ~~ r , t and ~~ GwF ;3c.~t-jti~ .I = (`~~P `1-~.~ I tZ witnesses, this 1 y day of _ SE~-~ ~~~~ ~~.~- , 2007. Notary Public °. r;r~a;~t,~' l,. ~'dE:~: `~ ' , ~f07r~RY PU$UO ~~~P1~Cil~,R;l~;ti RG~;".:.:.. ~:3~RLAI~D COUNTY -- F'1' ;C~~i(~ra~5t~t~ i;'~:` _._.~ULY 15, ~OiO WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 1Z6 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 1 ~I.JJ~~~~1'1lJ COI;~~'TY ~o~~ October 28, 2009 Richard L. Webber Jr, Esquire WEIGLE & ASSOCIATES, P.C. 126 East King Street Shippensburg, PA 17257 RE: Estate of Mary M. Kelso Dear Mr. Webber: OCT 2 ~ 1009 Mrs. Kelso had the following accounts with this bank, all of which were in her name alone: Checking account #121665 opened January 22, 1985 with a balance as of October 20, 2009 of $26,520.02 plus .48~ accrued interest; Certificate of deposit X158230 for $40,000.00 opened 1/14/2002 renewed 7/15/09 plus 13.48 accrued interest; Certificate of deposit X160302 for $b1,800.00 opened 4/1/2002 renewed 5/2/2008 plus 911.22 accrued interest; Certificate of deposit #160464 for $12,OOO.OAOopened 9/23/2002 renewed 9/23/07 plus 34.80 accrued interest; Certificate of deposit X180694 for $20,000.00 opened 2/13/2009 plus 9.78 accrued interest; and Certificate of deposit X455080300002-004 for $2,558.29 opened 7/22/2004 renewed 1/23/2009 plus 14.70 accrued interest. Inquiries concerning ACftB Corporation stock may be directed to Registrar & Transfer Co. at 1-800-368-598. Sincerely you Carolyn H. Kough PO Box 3129, GFI1YSBVRG, PA 17325 ~ nro~ 717.334.3161 ~ rai t~ 888334.2262 ~ wwwacnb.com t~ov i o Zoo9 November 6, 2009 Weigle & Associates, P.C. Attorney's-at-Law 126 East King St Shippensburg, PA 17257-1397 To Whom It May Concern: RE: Marv M. Kelso In reference to the above customer, our records show the enclosed information to be accurate of today's date. If I may be of any further assistance, please contact me. Sincerely, r~ ~.,°~ Tricia Ganoe Deposit Operations Manager 717-261-3624 717-264-6116 888-264-6116 P.0. Box 6010 Chambersburg, PA 17201-6010 FINA.NCtAL`SO.LUfiIONS... FROM PEOPLE Y.OU KNOW N C O .~ 7 l0 1 L lyQ O w O d N O M Y$ ~ N W N O w l0 W Z O .C..~+ N W U~ ORxsz~owrrBar~ A Tradition of Excellence 77 East King Street Shippensburg, PA 17257 November 3, 2009 Weigle & Associates, P.C. Attorneys-at-Law 126 East King Street Shippensburg PA 17257 Attention: Richard L Webber, Jr., Esquire From: Shirley Wescott Orrstown Bank PO BOX 250 Shippensburg, Pa 17257 Re: Estate of Mary M. Kelso Date of death: October 20, 2009 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNT Account # Title of Account 106000869 Mary M Kelso CERTIFICATE OF DEPOSIT Account # Title of Account 4000033105 Mary M Kelso Patricia A Pittenger Account # Title of Account 5060069489 Mary M Kelso Patricia A Pittenger Best re , C.// ~~ " ' ley Wescott Receptionist Date opened Principal Accrued Interest DOD Bal 9/24/99 917.91 .00 $917.91 Date Opened Principal Accrued Interest DOD Bal 5/18/09 13110.57 1.94 $13112.51 Date Opened Principal Accrued Interest DOD Bal 5/31/02 55020.35 132.65 $55153.00 The Personal Advisors of Ameriprise Financial Ronald P. Leuschen, CFP•, CFS Ameriprise Fnancial Services, Inc. Fnancial Advisor 25 South 35th Street CeRnREOFIwwcIA~PtaNNER*~+ Camp Hill, PA 17011 practitioner Tel: 717.525.9481 Fax: 717.525.9484 ronaid. p.leuschen@ampf.com E~i1Y - ~~ 2009 NOVEMBER 3, 2009 RICHARD L. WEBBER, JR, ESQUIRE 126 EAST KING STREET SHIPPENSBURG, PA 17257-1397 DEAR MR. WEBBER: ENCLOSED IS THE COPY OF BENEFICIARY AND DATE OF DEATH VALUES. I WILL PROVIDE SETTLEMENT FORMS TO BENEFICIARIES. THE ONE ACCOUNT HAS NO BENEFICIARY (6304702890-5-001) AND WILL NEED TO GO TO THE ESTATE. NO SHORT CERTIFICATE WAS IN YOUR LETTER. I WILL GET ONE FROM PAT OR DENNY. SINCERELY, fe,f/e.:.~ ~~ RONALD P. LEUSCHEN, CFP, CFS An Ameriprise Fnancial franchise. Ameriprise Fnancial Services, Inc. offers financial advisory services, investments, insurance and annuity products. RiverSource~ products are offered by afFliates of Ameriprise Fnancial Services, Inc., Member FlNRA and SIPC. .« ~,~_~: ;, ~~ ~_~~ 4 1 ~ ~ C /m it z ~at H r. a ~~~~' To Ronald PLeuschen/Field/AMPF@AMPF CC bcc Subject 15527991 2 001 MARY M KELSO PATE OF DEATH VALUES Please do not reply to this email. This database does not support incoming mail. Please call the phone # within the letter if you require assistance. Thank you. Life Events Team RlverSource Life Insurance Company RlverSource Funds Ameriprise Certiflcate Company Ameriprise Brokerage 70100 AmeNprise Financial Center Minneapolis, MN 55474 October 30, 2009 RONALD PATRICK LEUSCHEN 25 S 35TH ST CAMP HILL, PA 1701 I-4409 Dear RONALD PATRICK LEUSCHEN: Thank you for your recent inquiry regarding MARY M KELSO's accounts. These are the values of the accounts as of 10/20/2009. • ~ G~ Account Information n ~ ~P~ Certificates ~ Q I ~ 4 r /,~l ~l y~ ~ / Account Number l U 00804931848 1 001 06304271458 2 001 06304641286.0 001 06304702890 5 001 06304710419 3 001 06304762528 8 001 06304828510 8 001 e shi Individual - TOD Individual - TOD Individual - TOD Individual n wi ual - TOD Individual - TOD Individual - TOD Annuities -Post 1985 Account Number 93007269689 9 004 93007274844 3 004 9300753268] 7 004 93007534265 7 004 LTC Premium Return Account Number Ownership Individual Individual Individual Individual Ownership ~~-~~" ~~~lN ~ ~ ~~ n ~ ~/ /'1 ~~l I 91002954839 3 004 Individual Ameriprise ONE Financial Account Account Number pwn_ ershin 00051466589 2 021 Individual - TOD Certificates Account Number Total Value # of shares Asset Value Per Share 008049318481001 $34633.07 06304271458 2 001 $13585.73 06304641286 0 001 $22558.25 06304702890 5 001 $8165.65 06304710419 3 001 $32575.28 06304762528 8 001 $9203.62 06304828510 8 001 $27964.5 Annuities -Post 1985 Account Number Total Value # of shazes Asset Value Per Shaze 93007269689 9 004 $41626.35 93007274844 3 004 $44610.59 93007532681 7 004 $69582.59 93007534265 7 004 $115454.41 LTC Premium Return Account Number Total Value # of shares A_ sset Value Pgr Share 91002954839 3 004 $0.00 Ameriprise ONE Financial Account Account Number Total Value # of shares Asset Value Per Shaze 00051466589 2 021 $65006.99 Acct Naenn:Mteriprise C>1VE Fmk Account, MARY M KE1.S0 TOD Acct No:000514865891)21 • ^^ ..~. . ~Ap~Ntnw . ; ~~ ;<~~ ~~ ? `~ _ ~ Acct - .... ~ L 1~ ~ ACNE CORP s ACS ~ ~ ~ ~' ~,~; ` .~ ,. "' , ,~~ . , Value~~ STOCK 3.37300 13.35 45.029.55 ~~ 19,977 4d 100 19,977.44 Accant Total: 365,006.99 The date of death values provided are for estate tax purposes and aze not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance product(s) with the insured deceased reflect the gross death benefit at date of death and npt the cash value. Values indicated for Life Insurance Products with only the owner deceased reflect the cash value as Hof the date of death. Values for any proprietary mutual funds include accrued dividends as applicable. Values pro~+ided for brokerage products aze manually calculated, and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be verified by your legal and accounting advisors. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. Sincerely, Christine Meath Death Settlements Processing Team 70100 Ameriprise Financial Center Minneapolis, MN 55474 1-800-862-7919, Option 2, ask for Estate Settlements Beneficiary Information We have the following beneficiazies on record for the deceased's accounts. Account Number: 00804931848 1 001 Designation: PRIMARY BENEFICIARY PAT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% THE SURVIVORS, OR THE SURVIVOR PROPORTIONATELY Account Number: 06304271458 2 001 Designation: PRIMARY BENEFICIARY I'AT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% "fl-iE SURVIVORS, OR THE SURVIVOR PROPORTIONATELY Account Number: 06304641286 0 001 Designation: PRIMARY BENEFICIARY PAT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% "fHE SURVIVORS, OR THE SURVIVOR PROPORTIONATELY Account Number: 06304702890 5 001 Designation: Not applicable for this ownership type. Account Number: 06304710419 3 001 Designation: PRIMARY BENEFICIARY PAT P[TTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% THE SURVIVORS, OR THE SURVIVOR PROPORTIONATELY Account Number: 06304762528 8 001 Designation: PRIMARY BENEFICIARY PAT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTMGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% THE SURVIVORS, OR THE SURVIVOR PROPORTIONATELY Account Number: 06304828510 8 001 Designation: PRIMARY BENEFICIARY PAT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% THE SURVIVORS, OR THE SURVIVOR PROPORTION ATELY Account Number: 91002954839 3 004 Designation: No record on file. Account Number: 93007269689 9 004 Designation: PRIMARY BENEFICIARY I~A'I' PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% T}-[E SURVIVORS, OR THE SURVIVOR PROPORTIONATELY Account Number: 93007274844 3 004 Designation: PRIMARY BENEFICIARY I'AT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% "fHE SURVIVORS, OR THE SURVIVOR PROPORTIONATELY Account Number: 93007532681 7 004 Designation: PRIMARY BENEFICIARY PAT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% THE SURVIVORS, OR THE SURVIVOR PROPORTION ATELY Account Number: 93007534265 7 004 Designation: PRIMARY BENEFICIARY PAT PITTENGER DAUGHTER 50.00% DENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTINGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% THE SURVIVORS, OR THE S URVIVOR PROPORTIONATELY Account Number: 0005 1466589 2 021 Designation: PRIMARY BENEFICIARY PAT PITTENGER DAUGHTER 50.00% UENNY MC CULLOUGH NEPHEW 25.00% BRAD PITTENGER GRANDSON 12.50% PAM BROWN GRANDDAUGHTER 12.50% THF, SURVIVORS, OR THE SURVIVOR PROPORTION ATELY