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HomeMy WebLinkAbout09-07-10 (2)J 15D56D712D REV-15Q4 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 File Number ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 235 30 2682 06 12 2010 Decedent's Last Name Suffix D~TSGN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth 02 02 ? 923 Decedent's First Name M4 EFFIE L Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X '; 1. Original Return ' l 2. Supplemental Return '~, 3. Remainder Return (date of death _- ' `~ -~ - prior to 12-13-82) X 4. Limited Estate 1, ' ' 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required ~ ' - ~- - (date of death after 12-12-82) ~Xl; g Decedent Died Testate ~ T Decedent Maintained a Loving Test / 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) L _ i_ 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 Dayttme Telephone Number DAVID J LENQX 717 432 9666 Firm Name (If Applicable) DAVID J LEN~X, ESQ. First line of address 1 3 0 Inl . CHURCH STREET Second tine of address City or Post Office ,DILLSBURG Correspondent's a-mail address: State ZtP Code PA 17019 REGISTER`~#r9gtLLS US>_=-ONLY :~~) t~ i : ,.. ~ n'T.' it '' '~ 'i ~~ i ~ ._, ~, .. DATE FILED • - -- Under pe Ities of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is t ect and complete. Declaration f preparer other than the persona! representative Is based on all information of which preparer has any knowledge. GN TU OF P SON SPON I LE LING TURN DATE ~;,,~~ ,~~,,~~„ Richard L. Eyler ~~ ~ Ir ~ 1 York Road, Dillsburg, PA 170 S NATU O PREP ROT THAN REPRESENTA E DATE David J. Lenox ~ ~ ~ (~ , ADDRESS / 1 ( [ 130 W. Church Street, Dillsburg, PA 17019 Side 1 15056D7120 1505607120 J J 15056D?220 REV-1500 EX Decedent's Social Securtihy Number Decedents Name Effie L. Dotson 2 3 5 3 0 2 6 8 2 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 8 Miscellaneous Personal Property (Schedule E) ................ 5. ~` ~ ~ 1 ~ 8 $ 6. Jointly Owned Property (Schedule F) i Separate Billing Requested ............. 6. 1 1 8 4 9 9 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G} Separate Billing Requested ............. 7- 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 1 6 5? 6 8 4 9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ 9. 5 7 `_3 8 7 5 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ............................... 10. 11. Total Deductions (total Lines 9 & 10)._,._ ........................................... .................. 11. 5 7 ~~ 8 7 5 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12- 1 0 ? c: 8 0 9 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 0 7 2 8 0 9 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 .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 0 0 0 17. 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 1 0 7 2 8 0 9 18- 1 6 0 9 2 1 19. Tax Due .................................................................................................................... 19. 1 6 0 9 2 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 ],505607220 J REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21-10 - DECEDENT'S NAME Effie L. Dotson STREET ADDRESS 700 Walnut Bottom Road _-- --- CIn Carlisle _-STATE _ 'ZiF PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 1, 6 09.21 2 Credits/Payments A. Spousal Poverty Credit B. Prior Payments -- -- - _ - C. Discount 8 0.4 6 Tota- Credits (A + B + C) (2) 80.46 3 InteresUPenalty 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 the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request arefund - ------ - - - - 5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1 , 5 2 8.7 5 A. Enter the interest on the tax due. (5A} B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ ~ S 2 8.7 5 Make Check Payable to: REGISTER OF WILLS, AGENT ,.; rr y;?.,.' .. a~. ~. '1"'~ .. , .°s'•~. ,.~.....:, ~ rttR.r..s ~..."si, h. .:, ..~.~.~~, ., ; , ... ~ ~ ;,,. ,: ,,.' ;>.....,, ;>... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................. [~ x b. retain the right to designate who shall use the property transferred or its income :.................................... [~ ~x c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ~_~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................. `!~ ..................................................................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ~ _~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _ contains a beneficiary designation? ........................................ ~ ~}} .............................................................................. ~_~1 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS P~1RT OF THE RETURN. ,.. ~ n. ~,.,.. , 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)J. 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 stilt 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 adaptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) {1.2)]. The tax rate impaled 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)j. 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-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE ~l1RN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dotson, Effie L, 21-10- Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right o! ~lrvivor~htp m~~st be disclosed on schedut~ F. (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-1505 EX+ {6.98) ., COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Dotson, Effie L. 21-10- If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP 1-O DECEDENT A. Richard L. Eyler (1010 York Road Nephew Dillsburg, PA 17019 B. C. .jO1NTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET o /o OIF DECL-'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 7/19/2000 M&T Bank Checking Account 18,546.31 0.500% 9,273.16 3740861590: 2 A pril, 1989 PPG Stock (80 shares) 5.153.60 0.500% 2.576.80 TOTAL (Also enter on Line 6, Recapitulation) ~ 11.849.96 (If more space is needed, additional pages of the same size} Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150() Schedule F (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 NUMI3ER Dotson, Effie L. 21-10- Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached ~ 400.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representatives}: Street Address City State Zip Year(s) Commission paid 2, Attorney's Fees David J. Lenox, Esq. 1,383.75 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 4,015.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 5,798.75 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES ANn ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Dotson, Effie L. 21-10- ITEM NUMBER DESCRIPTION AMOUNT Funeral Exuenses 1 Church Memorial Service: 300.00 2 Ministers Honorarium: 100.00 H-A Subtotal 400.00 Other Administrative Costs 3 PA Department of Public Welfare: 4,000.00 4 Register of Wills {filing fee): 15.00 H-B7 subtotal 4,015.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUI6ABER Dotson, Effie L. 21-10- NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) ~ TAXABLE DISTRIBUTIONS [include outright spousal ° dfstrldutions, and transfers under Sec. 9116(a)(1.2)] Richard L. Eyler Nephew 10,728.09 1010 York Road Dillsburg, PA 17019 Total 10,728.09 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r ;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 I{ -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) LAST WILL AND TESTAMENT OF ~FFIE L. DOTSON 1, EFFiE L. DO T SON, of Franklin - ~::~~.-...,.,.,a make, publish and declare this to be my Last Will and Testa Wills and Codicils- at any time. heretofore made by rn.e. burial costs and administration expenses from my Estate, as an expense of my estate, as soon after my death as conveniently may be done. All Federal, State and other death taxes payable because of my death with respect to the property forming my gross Estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the administration of my Estate and shall be paid from my residuary Estate without apportionment or right to reimbursement. E Ic my property of every RICHARD L. FYLER. live, devise and bequeath all the rest, residue and remainder of - -r . z: __ ...... _ . .... :_ - _. nature and wherever situate to my betoved~ nephew-~n=Eaw, T I In the event that RICHARD L. FYLER predeceases rn~e, then I give, devise and bequeath all the rest, residue and remainder of my estate to his wife, JOANN C. FYLER. In the event that both JOANN C. FYLER predeceases me and LZ & WALZ To~SAT~,w RICHARD L. FYLER predeceases me, then all the rest, residue and remainder of my EWPORT, PA. . _ _, . _ :. r _ ,.r estate 1 give to BRADLEY R. FYLER and KATHY JO WILSON. FQURTH. {appoint my nephew-in-law, RICHARD L. FYLER, as. Executor of this my last will. In the event ~he is unable to serve as Executor, l r~~n~RADLEY R. FYLER and KATHY JO WILSON as co-Executors. of~~his~~-#r~-i~le All Warned persons are to serve as such without bond. {N WITNESS WHEREOF, I ..have hereunto set my hand and seal this ~~~ - ~ - ,(~~-~ (SEAL} ~e L. Dotson ~~c ~ - ~ ~~ .LZ & WALZ -roture~s nr taw EWPORT, PA. COMMONWEALTH OF PENNSYLVANIA COUNTY OF PERRY SS: WE, EFFIE L. DOTSON, SHAUBUT C. WALZ, III ANQ BARBARA D. FLURIE, ~~ WALZ &WALZ arroxrrEYS nT tAw NEWPORT, PA. instrument, being first duty sworn according to law, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes.therein expressed, :and hat each of the Witnesses, in the presence and hearing of the Testatrix, signed the Wifl as Witness and that to the best of their knowledge, the Testatrix was at that time eighteen (18} years of age or older, of sound mind, and under no constraint or undue influence. WITNESS: ~7 ~11~ 1~~n ~ct~ -1- Cx ~ ~ (SEAL) BARBARA D. FLURIE :~. Subscribed, sworn to and acknowledged before me by EFFIE L. DOTS~N, the Testatrix, and subscribed and sworn to before me by SHAUBUT C. VUALZ, IIl and BARBARA D. FL UR1F, the L~~itnesses, this ~~ uay of ~ ~° _ , 1993. ~L 'C . % ~ , ~ .- _~ Not= - Pubic _ _ M 'Commission Expires: -~~.- __ ~. SEAL) t~T~1 JUDITH ~ W~kt,2~lotuy Publk Ntwport~8,oro.'enY Go+,-+-ilt; P~ ~1ft Co~tniMion ~ ~~• ti,ltp7 tc~r tl1i~ cert~~~~L°_ItE, ~(;.O(? ~%~{;;,l!,,j,~- ;[, % "~'hi~ i~ t~~ certify tI!.:~ ~ht info~7l~ation ~i~ere ~~~~en ~F'f ~,1 ~1 Ui ~ ~ - ts`'~~R= fii~!~ = ct~i-rectly icr~ied i{{ {~~ a{~ o{-i~inalCertificate of Dea ;,, ~, ~- l~ ~li~iy tiled ~~ith -ne .~~~ I~E~ca~l Re~ititrar. The ~~i-it~~n ~, ~. ~ `,. ;~ ~~ \~~~ certificate will tic i~~)--~~~arded to the: State Vit ~~~ ~ Y ~ , ~: ~ E~ecords Office 1i>{ E~errt~~inent filn~_ ~~ _ -,-, ~ ,~ :.~ ~-~ ~ :~ ~ JU~I 1 5 ~~~~ ,~ ,~ ~_:~eal fZe~isti Date I~s~~~cc~ t+res~<;Fw~~rnl, COMtMONWFALTN OF PENNSYLVAN?A' DEPARTMENT OF HEALTH • V!1AL RECORDS n~=~': CEFtTIF'1CATE OF DEATH FF.°.YiN.TtA aF~~ xt< (Sw htstrnetions >„d ~xsnFplos on rHrWaj . --- - -- ---- - --- - - ---- --- - --- -- - _. Oir )tFRt MlMEtFlt ~ '. ~ tb. wow.l.d{F>nt ni7a•. nl ?lik) 2 Sea S Dada Seca,W 1-~•FS ~. UAMOedI,(-4ll fbr. llO) F ffie L. 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Fta.re.a!~eeF 7x. owMbYrOda^rtar.r ) -- -- _ re. oeaa~--w.p}.row..~f -. .--------- -- ,wn ~ ,4Matl~ 'tA'O~ik.ewas~r NV.+~3~~~' aca.waw.ao ~wwi Lj Flnauw . ~ ^Ya ~ ~,~ ~" [] .Mde„ ~ A,dn,b...F,d.. - T1t Twrd4{sr sat,y.ry ytwatn ^ ^ ~Da .~)genr ~Palaairr Ui,><,n.dxt~n{sy+e-dtrlbaR att/r~ 3 L1 arsd. ^ rn.tb n.c -. tT.r.F..d u. ra w. ^ p,« - ~Y ~ ; - .M~M~wfAb~PMridaowMtiTesebdi.Y.Aie. rwWr~Phlaisnlrospow.w.N b~a.dwq/aMbw YA l 1 a Ra a i Y N / ---- t~ ~~//J _ 7 ~ q 4»r W s...{a}.w n, aia, r oa~w saws rsla/d- - - - - - - - - - - - - - - - - - - - - - - - - - - A b d P ~ ~d ~'•~' ••~ ' - / ~-~- .~~ s Poo„aua an a~hl pYr , u wA~pba,w JltaR~ ~ ~dx~...,,~~d.•.,>M...~>~ra..~,,.,.~...._..,~--------------- ~ :a ~ "`os~~ ~ ~ ~7n d+lt}w} ism ~~ . ( T Ow,MbMada[1lM1ODI1lM1O/O+N/~irOM1 It wf R/w arLMa~RM/Af.QMAr1,A/a~il wfd»b MCMe(s)wMnw~.a Malet_yJ _ ~~a ; » ia.a.+ y ~+ ~ ~.r*rtrbt:«eedoesFp o w.~rn.r x s~axr-tws f FswPb+war.r~f J / / J - /-~ d 1f'` /C</ ST r/~ ~, ~P,,,.tt~ Od0127'l ---- - -- - - - ~ .~ ~_`.: $ _~'_: { p M~~ 499 Mitche4l Road,',vlillsboro. DE ]9966 Adjustment Services Phone 88~ 50? =+349 July 16, 2010 "I'he Wiley Group Attorneys At Law 1.30 W Church Street, Suite 101 Dillsburg, PA 17019 Re: Estate of ~:ffie I_ Dotson Social Securit :235-30-2682 Date of Death: June l2. 2010 Dear Sir or Madam: Per y~»,r inquiry on July 2, 2010, please be advised that at the time of death, the above-named decedent had nn deposit with this bank the following: 1. Type ofAccount Checking Account Account Number 3740861590 Ownership (Names o~ Ef~re L Dotson Opening Date Balance on Date of Death .Accrued Interest Total 2. Type of Account Box NumberlL,ocation Ownership (Names of} Openink Date Richard L Fyler 07/19/00 $18,_546.31 $ 0.00 __ __ __ __ $18,54b.31 Safe Deposit Box 022/1~7illsburg Gfc Effte L Dotson 03/Z9/01 For further account information, closures and/or reimbursement of funds please call the Dillsburg Office at #717-432-28_`+0. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Ihriform 'Transfers, Representative Payee, or Trustee under a Written Agreement Sinc ly, S panne M Kimble Adjustment Services Li - ~'1'li 111i1lltifl~lE;~ . ~1~(<)riCdl I)atki $ ~''~ .~~ 0.00 (0.00°l0) Vvlun~tt': 0 Start: End: Date Open High low Close 6/15/10 64J7 65.60 64.56 65.58 6/ 14/ 10 65.32 65.61 64.02 64.07 6/11/10 6?.78 64.93 62.18 64.78 6/ 10/ 10 62.88 63.69 62.66 63.32 6/9/ 10 62.65 63.25 61.58 61.91 6j8/10 6056 62.32 60.28 62.13 6/ 7/ 10 G 1.79 62.4 5 60.46 60.52 6/4/ 10 b2.] 9 63.06 61.60 61.79 6/3/ ] 0 64.80 65.16 63.45 63.96 6/Z/ 10 62.88 64.76 62.82 64.73 6/1/10 63.35 64.19 62_.54 62.54 I~?t(~~:;,'~~-w~v.inv,:~ ~,,r~~ui~)c ~~r~itr'~~i,~~tr~rle~~i,i tr<<rrt~~.f~hp?~Y0e hist~>ri<~~~tc~~_. 4_~t1 E'M rDI Juf 1, 2k~11~ Volume Chg %Chg Adj. Close 1,073,834 151 2.36% 65,_/8 2,047,427 -0.71 -1.10°Io 64.07 ~"~ 2,295,937 1.46 ?. > I °/v 64.~~8 ~-\j't"~~ , 2,379,545 1.41 ~ .78°/n 63.32 2,7?_3,328 -022 0.35% 61.91 2,710,149 1.61 2.66% 62.]_3 2,572,987 -1.27 7.06°,% 60.~~2 1,82.3,180 -2.17 3.39~~0 61.T9~ 1,738,473 -0.77 ] .19% 63.96 1,690,416 2. ] 9 ;5.50% 64.73 1,543,869 -1.53 Z3~3% 62.54 r '/ O T / !' ~./~ ~ ; c~ a--r ~- L . C ~~ 1 ~l'~, ~~~~c,~ ~ 1 ~ ~ ~.l 1 7/2%2010 9.22 ,~~I~ THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT ~~ ~-------- - --_- ~. To inquire about your account, contact ~ ~. ~ BNY Melton Shareovvner Services Toff Free Number 800-648-8160 j Outside the U.S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 ~-~~- ~ ,-----------f': BNYMellon Shareowner Services is dedicated to providing you~rvf~h#he~-~bes-t-sh eowne~r experience! Did you know that you could manage your portfolio online 24 hours a day, seven days a week? ,~11?1~Ily IOC; lyl to Investor ServiceDirectfl (tSD} at www.bnvmeilOn.COm/ShRrAnwr~~arlicrl CUSIP 001 750 69350610 vU i SUfY-EFFIL0100 NUMBER OF SHARES OWNED TAX IDEM1FtCAT10N NUMBER __ ON FILE Please detach and retain this form for your records. ., ..~ ~~,~ r~° o :v ~~-v ~c~. ane ~ . c . ;f ~ ~,:r`~ •«~ - ~~f ,.fti .a_ - _,t .~ fi• +,~ 1t.~ :. ..;: ..: _ ~ - ~ x .f~ ~ - PAY - _ , ~~ A. ~~1M,,~EF~ -;~~ :160 = _ - -. ~ ~ - - - ~. k - 433=- . s !~C}cENSgcNC;~N.~ o~8oa-825 P1~YA~LE:AT , Tt-1~BANlCAF NEVIl~Y4fi`fC y1ELLON- tN UPS DOL!_ARS - - `~ ~~~;~/ ;.~y ~.~-S'" ~~r OdOQ3594 ©1 AB Oz~6II~~01 TR=00016-SOCDBAOa~_. Q(~ - { ~~'R~ ~* ~~ ~ ~ ~ ,, ~ -,~ .~F~1~-~ D,O::`~-~R~.~ ` ~- - ~ i . ~ ~ - - - $43:2!0 ~ ~ -s t ~. .tom s.9s ' ~ ~ - 7- ~. ~ ~ _ ' ~ ~}~- r~~{ ~~,~ ~ -~~~ ti 402 ~z t ,` ;;M ~ _ ,:;,y f„~ z __ ,,.,. ~ f~ ,,. ~ ~ t I~ ~~~;~ t - /~~'~'t-fOR1LI~U, S 1 ~t~A~i~JRE -. >-.~~x. .- _.__. __ _ - - ~ 11' ?~ Z8 7 2 3911' x:04 3 30 ZOO ~'~: 09 ~~~~94041f' Jan M. Wiley ~~~ ~ ~ ~ ~~~ David ). Lenox THE WILEY GROUP Attorneys at Law September 3, 2010 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 In Re: Effie L. Dotson, deceased Dear Register: Enclosed please find an estate information sheet and inheritance tax return in duplicate along with the filing fee of $15.00. A death certificate is attached to the inheritance tax ret~xrn. This estate was not probated, as there were very limited assets, and jointly owned property only. I am also enclosing a check in the amount of $1,528.75 representing the inheritance tax due. Please send a receipt to my attention. I am enclosing an envelope for your use. Si rely, avid J. Lenox, Es ire DJL/sdg `~ encl. -~ `r.~ ~ c~a ~:.~ ~, ~-_-, !' ..: ~ .. cl ~~ 130 W. Church Street, Suite 101 Dillsburg, PA 17019 Phone: (717) 432-9666 • (800) 682-4250 Fax: (717) 432-042b