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HomeMy WebLinkAbout11-04-101505610142 EX (oi-io) ~ REV- ~ SOO ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania OERARTMENT Of REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ``11 1 PO Box 280601 RESIDENT DECEDENT ~ I ~ U ~ ~ C I Harrisburg, PA 17128-0601 _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 184-12-5268 08162010 04251919 Decedent's Last Name Suffix Decedent's First Name MI SHELLENBERGER KATHRYN G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return (~ 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Q 2. Supplemental Return Q 4a. Future Interest Compromise (date of death after 12-12-82) Q 7. Decedent Maintained a Living Trust (Attach Copy of Trust) Q 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) Q 3. Remainder Return (date of death prior to 12-13-82) Q 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes Q 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - TNIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number CAROL BEERY 717-243-8161 First line of address 2142 DOUGLAS DRIVE Second line of address City or Post Office CARLISLE Correspondent's a-mail address: State PA REGISTER OF WILLS USE ONLY ts7 t7 r: ~ <„ ;~ r;'.~`~ ~ j t~ ~7 ~ =. r-- i~- _~;~ r-n ~I.+. +.~ R........ ~~ ~M kLI ~_,~ ~~ ~~~ 'w1 ~~ D~l; 4~tED -°~` s+ .~:,: _i -- ~ e-- s: r i __~ ~_ ZIP Code ~- 17013-1023 ~f 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 belief, it is tru~orrect and complete. Declaration of pr~arer other than the personal representative is based on all information of which preparer has any knowledge. SI P~JRE OF PERS ~ RESP SIBLE ILING RETURN DATE ~" AD ESS 2142 DOUG AS DRIVE CARL LE, PA 17013-1023 SIGNATURE OF PREPARER OT ER THAN REPRESENTATIVE DATE ,.JCL- (/',%1- / `~ ~ ~ ~ ~ ADDRESS 815 E ARCM/ TREET PALMYRA, PA 17078 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610142 1505610142 J 1,50561,D242 REV-1500 EX Decedent's Name: KATHRYN G SHELLENBERGER Decedent's Social Security Number 18 4 -12 - 5 2 6 8 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 and Notes Receivable (Schedule D) ................... . ... .... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 5 , 8 6 7 . 0 0 6. Jointly Owned Property (Schedule F) O Separate Billing Requested . , . .... 6. 11 , 924 .5 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. 410 , 2 5 7.0 0 8. Total Gross Assets (total Lines 1 through 7) ......................... .... 8. 4 2 8 , 04 8 . 5 0 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . . . . 9. 4 , 513 .0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... . . ... 10. 9 , 6 0 5.0 0 11. Total Deductions (total Lines 9 and 10) ............................. . ... 11. 14 , 118.0 0 12. Net Value of Estate (Line 8 minus Line 11) ......... . .......... . ...... ... 12. 413 , 930.50 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. 413 , 93 0.5 0 TAX CALCULATION -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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 4 5 413 , 9 3 0. 5 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 . 1 g, 19. TAX DUE ...................................................... ... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 18,626.87 18,626.87 O Side 2 1505610242 1505610242 J t2EV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER KATHRYN G SHELLENBERGER 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 GENWORTH FINANCIAL - LONG TERM CARE POLICY PAYOUT 3,990 MONTHLY PAYMENT - POLICY ## PFN7704810 2 DEPARTMENT OF HEALTH & HUMAN SERVICES 250 REFUND FOR PRESCRIPTION DRUGS 3 PSERS - AUGUST MONTHLY RETIREMENT CHECK 841 4 DIVIDEND INCOME - AMERICAN ELECTRIC POWER CO 570 5 DIVIDEND INCOME - JOHNSON & JOHNSON COM 216 TOTAL (Also enter on line 5, Recapitulation) $ 5 , 8 6 7 . 0 0 (If more space is needed, insert additional sheets of the same size) f~EV-1509 EX+ (01-10) ~ pennsytvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEF JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER KATHRYN G SHELLENBERGER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. CAROL BEERY 2142 DOUGLAS DRIVE DAUGHTER CARLISLE, PA 17013 B C JOINTLY-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 °h OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST ~. A. 05012000 M & T BANK - CARLISLE PA CHECKING ACCOUNT - 8030 22,923 50 11,461.50 2 A 05012000 M & T BANK - CARLISLE PA PERSONAL SAVING ACCT - 0934 926 50 463.00 TOTAL (Also enter on line 6, Recapitulation) I $ 11, 9 2 4 . 5 0 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) ~ enns lvania SCHEDULE G ~PARTMENT OF REVENUE INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER KATHRYN G SHELLENBERGER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OFASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. THE FOLLOWING INVESTMENTS WERE TRANSFER ON DEATH OF DECEDENT TO HER DAUGHTER ALCATEL-LUCENT - 75 SHARES - COMMON ALU @$2.685 201 100 201 2 AMERICAN ELECTRIC POWER CO INC AEP 1,357 SHARES - COMMON @ $35.419 48,064 100 48,064 3 AMERICAN FUNDS CAPITAL INCOME BUILDER CAIBX 1,484.03 SH - MUTUAL FUND A @$47.01 69,764 100 69,764 4 AMERICAN FUNDS INCOME FUND OF AMERICA AMECX 3,738.69 SH - MUTUAL FUND A @$15.43 57,688 100 57,688 5 AMERICAN FUNDS INVESTMENT CO OF AMERICA AIVSX 231.84 SH - MUTUAL FUND A @24.70 5,726 100 5,726 6 A T& T INC COM - T 362 SHARES - COMMON @$26.595 9,627 100 9,627 7 BROKERAGE MONEY MARKET FUND - @$1 5,721 100 5,721 8 COMCAST CORP NEW CL A CMCSA 217 SHARES - COMMON @$17.78 3,858 100 3,858 9 DELL INC COM DELL 320 SHARES - COMMON @$11.94 3,821 100 3,821 10 GLATFELTER COM GLT 320 SHARES - COMMON @$11.71 3,747 100 3,747 11 JOHNSON & JOHNSON COM JNJ 400 SHARES - COMMON @$57.79 23,116 100 23,116 12 LSI CORPORATION COM LSI 21 SHARES - COMMON @$4.22 89 100 89 13 MEDCO HEALTH SOLUTIONS INC MHS 114 SHARES - COMMON @$46.235 5,271 100 5,271 CONTINUATION - PAGE 2 173,564 100 173,564 TOTAL (Also enter on line 7, Recapitulation) ~ $ 410 , 2 5 7 . 0 0 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) SCHEDULE G ~ Pennsylvania INTER-VIVOS TRANSFERS & DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF KATHRYN G SHELLENBERGER FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND 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 ~. PAGE 2 - CONTINUATION 14 MERCK & CO INC NEW COM MRK 480 SHARES - COMMON @$34.795 16,702 100 16,702 15 NCR CORP NEW COM NCR 264 SHARES - COMMON @$12.40 3,274 100 3,274 16 OCCIDENTAL PETROLEUM CORP OXY 400 SHARES - COMMON @$74.96 29,984 100 29,984 17 SELIGMAN COMMUNICATIONS & INFORMATION SLMCX 421.72 SH - MUTUAL FUND A @$36.11 15,228 100 15,228 18 TERADATA CORP DEL COM TDC 264 SHARES - COMMON @$29.795 7,866 100 7,866 19 AMERICAN FUNDS INCOME FUND OF AMERICA IFABX 1,544.24 SH - MUTUAL FUND B @$15.31 23,642 100 23,642 20 VODAFONE GROUP PLC NEW SPONS ADR NEW VOD 818 SHARES - COMMON @$24.05 19,673 100 19,673 PRUDENTIAL VARIABLE ANNUITY BENEFICARY IS DECEDENTS DAUGHTER 21 AST AM CENTURY INCOME & GROWTH 1,339.50 SH - MUTUAL FUND @$12.04 16,128 100 16,128 22 AST INTERNATIONAL VALUE 140 713.15 SH - MUTUAL FUND @$15.54 11,085 100 11,085 23 AST LARGE CAP VALUE 140 1,006.90 SH - MUTUAL FUND @$16.76 16,879 100 16,879 24 AST NEUBER SMALL CAP GROWTH 140 1,146.68 SH - MUTUAL FUND @$7.51 8,610 100 8,610 25 INVESTCO VI TECHNOLOGY FUND 140 957.08 SH - MUTUAL FUND @$4.69 4,493 100 4,493 TOTAL (Also enter on line 7, Recapitulation) $ 17 3 , 5 6 4 (tf more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) ~ pennsylvania DEPARTMENT Of REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: ESTATE OF FILE NUMBER KATHRYN G SHELLENBERGER Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ HOFFMAN-ROTH FUNERAL HOME- FUNERAL EXPENSES 2,685 2 ERIC MACLAREN INTERNMENT FEE 50 3 LYNN SHULTZ - MINISTER MEMORIAL SERVICE FEE 100 4 WENGER MEATS - FUNERAL LUNCHEON 453 5 SYMPOSIUM - FUNERAL LUNCHEON 275 B. 1 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant State ZIP Street Address City State Relationship of Claimant to Decedent ZIP 4. 5. 6. 7. Probate Fees Accountant's Fees Tax Return Preparer's Fees 200 750 TOTAL (Also enter on line 9, Recapitulation) I $ 4 , 513.0 0 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) r pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER KATHRYN G SHELLENBERGER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PSERS - REIMBURSEMENT OF PARTIAL MONTH OF RETIREMENT 216 2 HOME INSTEAD SENIOR CARE - MEDICAL EXPENSE 718 3 SARAH A TODD MEMORIAL HOME - MEDICAL EXPENSE 3,987 4 MILLENNIUM PHARMACY SYSTEMS - MEDICAL EXPENSE 579 5 RUTH GRAVER - MEDICAL EXPENSE 3,000 6 SPRING ROAD FAMILY PRACTICE - MEDICAL EXPENSE 20 7 MILLENNIUM PHARMACY SYSTEMS - MEDICAL EXPENSE 482 8 SARAH A TODD MEMORIAL HOME - MEDICAL EXPENSE 93 9 PHILHAVEN - MEDICAL EXPENSE 10 10 CHECK # 4712 - WRITTEN BEFORE DEATH 500 TOTAL (Also enter on Line 10, Recapitulation) I $ 9 , 6 0 5 . 0 0 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) ~ Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF KATHRYN G SHELLENBERGER FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. CAROL BEERY DAUGHTER 1000 2142 DOUGLAS DRIVE CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1, B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, insert additional sheets of the same size. 08/03/2010 07/30/2010 07/29/2010 07!29/2010 * 07/22/2010 * 07/21 /2010 * 07/20/2010 * 07!20/2010 * 07/09/2010 * 07/02/2010 * 06!30/2010 * 06130/2010 " 06/25/2010 * 06114/2010 * 06110/2010 * 06110/2010 * 06110/2010 * 06109/2010 * 06103/2010 * 05128/2010 * 05128/2010 US TREASURY 303 SOC SEC PA TREASURY DEPT ANNUITANT CHECK NUMBER 4711 GLIC CLAIM PYMT CHECK NUMBER 4708 CHECK NUMBER 4707 CHECK NUMBER 4710 CHECK NUMBER 4709 CHECK NUMBER 4706 US TREASURY 303 SOC SEC PA TREASURY DEPT ANNUITANT GLIC CLAIM PYMT CHECK NUMBER 4795 CHECK NUMBER 4792 CHECK NUMBER 4791 CHECK NUMBER 4794 CHECK NUMBER 4793 DEPOSIT US TREASURY 303 SOC SEC PA TREASURY DEPT ANNUITANT GLIC CLAIM PYMT $1,320.00 $22,922.85 $841.08 $21,602.85 $7,924.00 $20,761.77 $5,700.00 $28,685.77 $612.76 $22,985.77 $10.00 $23,598.53 $10.00 $23,608.53 $319.20 $23,618.53 $718.20 $23,937.73 $1,320.00 $24,655.93 $841.08 $23,335.93 $5,890.00 $22,494.85 $7,646.30 $16,604.85 $509.10 $24,251.15 $20.00 $24,760.25 $35.00 $24,780.25 $638.40 $24,815.25 $3,739.19 $25,453.65 $1,320.00 $21,714.46 $841.08 $20,394.46 $5,700.00 $19,553.38 This is not an official statement 08/18/2010 02:41 PM 1 Welcome to M&T Online Banking Page 1 of 1 ~~r ~ ~r ~~ Accounts Transfers Bill Pay Customer Service ,, ., - _, ~ _' ' > CHECKING DETAIL I " I Classic Checking t- ~ ~ ~ .t., : ~~ ~~ -~ ~ ~~• Related Links _ - ~ _ ~'"` - „ ~ ;.-, - - - ~.. ~= Account Classic Checkin 8030 ~ Tota1 Balance $15,013.95 g Available Balance $14,739.23 ~, l; resin: /'~I,~nri~r '.;ioini !'~I~nrt~- Show Select Range - _ ~ _ View From 08/16/2010 To 9/20/2010 GO Date Transaction Description Credits/Debits Total Balance 09/20/2010 SYMPOSIUM -$274.72 09/17/2010 _ " "~~'~',~~ -- - -$~i00.OG $15,013.95 09/16/2010 ~ N~G~: t~lUf±/l~~?_~Y7?2 -$500.00 $15,113.95 09/15/2010 WENGER MEATS AND ICE CARLISLE -$452.y8 $15,613.95 09/14/2010 G R-! E ~? _I~,s t.~ f~l{ ~ F ~ ~z?_21 -$482.09 $16,066.93 09/13/2010 - - - = -$215.5u $16,549.02 Cl~ ~!3~~~3~M~ '. r 14+ f ±1=. 09/10/2010 C -$20.00 $16,764.52 _ _ _ 09/08/2010 ~:_;;~'~~~< <~su~;~'~-: ~ ~` ~ -$3,u0u.00R.. $16,784.52 09/01/2010 ~E~~~~?_i $3,990.00 ~ $19,784.52 08/31/2010 - - _ ~~ ~. - u ' " , " $841.08~~ ~ $15,794.52 08/26/2010 Cr~E~:1r h~UiU?~` c = r ?5 -$579.09 $14,953.44 _ 08/25/2010 ~~~~~~ "- - ,~i=:o ' ; - -$2,684.8G $15,532.53 08/25/2010 CS ~~uw'._f~~L;l+/izaE~ 4%i4 -$3,987.32 $18,217.33 08/23/2010 C~-{~4:,°r~; i~?llf~f~._~--__~'; v ~'?~, -$718.20 $22,204.65 Depending on when your statement generates, you may not see a full 90 days of history. If your statement has just been generated, you may get a message indicating that no transactions are available from 61 - 90 days. ~~T' B~-,.~~r~s. ® 2010 Manufacturers and Traders Trust Company. Users of this web site agree to be bound by the provisions of the M&T Web Banking Terms and Conditions. View the Terms anc! Conditi;~ns, Pri~facv Folic~~ or S~c~.~rity f~iformatici.,. https://onlinebanking.mandtbank.com/history/HistoryChecking.aspx?Id=1 9/20/2010 `JVelcome to M&T Online Banking rage ~ el ! '~' Accounts Transfers Bill Pay Customer Service . ,.. - . - > SAVINGS DETAIL Relationship Savings - •_ ~ ~' •r •' • Related Links: ~ :: _... , ........ + .,.. ..... ,. .. , ., , ' ~ .. s,~r . ,. .: , . _ .~ L ~; Account Persona( Savings 0934 - Total Balance $926.20 Available Balance $92ti.20 show Select Range ~ _ or - View From OS/'! fi/2010 To 10/17/201 ~ GO t~Post Date Transaction Descriution Credits/Debits Total Balance 10/12/2010 INTEREST PAYMENT $0.04 $928.20 09/10/2010 INTEREST PAYMENT $0.04 $926.16 Depending on when your statement generates, you may not see a full SO days of history. tf your statement has just been generated, you may get a message indicating that no transactions are available from 61 - 90 days. ...~ ~~T BMA. ®2010 Manufacturers and Traders Trust Company. Users of this web site ague to be bound by the provisions of the M&T Web Banking Terms and Conditions. Vlew the ~ ar~rr,s arrr": i ;nn; iitirm~->~ ! •rr~~a;,v s'~^,ii:•,, Of `~..;~u°in% 1ri~r;rrrrrrn• , hops://onlinebanking.mandtbank.com/history/HistorySavings.aspx?Id=2 10/17/2010 .__---~ Holdings by Investor Kathryn G Shellenberger 2142 Douglas Drive Carlisle, PA 17013 Frank H Dogger CFP ®, ChFC Lancaster Financial Services 1525 Oregon Pike Suite 1902 Lancaster, PA 17601 (717) 393-5700 Combined Account Portfolio Date; 08/16/2010 Created: 09/20/2010 Kathryn G Shellenberger Acct Name:KATHRYN G SHELLENBERGER TOD DTD 10/11/00 CUMBERLAND CROSSINGS RETIREMENT 2142 DOUGLAS DRIVE CARLISLE PA 17013-1023 Acct No:43C243839 AcctType:Transfer On Death (Individual) Rep. No: BJ3 ~~ ~ k ~ ,,~ ~' pS~N(a Asset Name Ticker ;Asset Type- Mgt. Name Quantity Price($) Value($) ALCATEL-LUCENT SPONSORED ALU EQUITY ~~7 3 a ~ y 75.00 2.69 ~, ~dS 201.75 a o/, .3~ ADR AMERICAN ELEC PWR INC COM AEP EQUITY 3S, 7 ~~ 3S ~ ~~ 1,357.00 35.73 3s: ~/! 9 48,485.61 yb''06 3. S~' AMERICAN FUNDS CAP INC BUILDR CAIBX BLEND ~ o~ 1 ~~ AMERICAN 1,484.03 47.01 ~ 69,764.39 ~ A FUNDS AMERICAN FUNDS INC FND OF AMECX BLEND /5 43 AMERICAN 3,738.69 15.43 ~` 57,687.94-~ AMR A FUNDS AMERICAN FUNDS INV CO OF AIVSX EQUITY ~ ~, ~ o AMERICAN 231.84 24.70 `~ 5,726.27 Y' AMER A FUNDS AT&T INC COM ' T EQUITY a ~, 7~ d (o . y8 362.00 26.65 o7G• 5 9S 9,647.30 ~ fo.~ ?..~ 9 BROKERAGE MONEY MARKET CASH OR BROKERAGE 5,721.20 1.OO,r~ 5,721.20 EQUIVALENTS MONEY MARKET COMCAST CORP NEW CL A CMCSA '' EQUITY ~ 7 9S ~ ~, r~ i 217.00 17.75 / ~~~ 3,851.75 3~~~ ~~ DELL INC COM DELL EQUITY ~ ra• 8 / ~• ~ 320.00 11.96 11, Q H 3,827.20 ,~ ~~ ~• >~~ GLATFELTER COM GLT EQUITY ~j , ~~ ~' J, y ~ 320.00 11.58 jf ,7~ 3,705.60 3 7`1 '7.3A JOHNSON & JOHNSON COM JNJ EQUITY ~~. I l ~7.`l ~ 400.00 58.01 ~~, ~9 23,204.00 ~ 3, // ~• LSI CORPORATION COM LSI EQUITY y 31 y, ~? 21.00 4.29 ~, ,~~ 90.09 8"~'. In a. CO HEALTH SOLUTIONS INC MHS EQUITY yco, ~y `S, ~ 3 114.00 45.81 y(o•.135 5,222.34 sa?D, 7~ COM f - MERCK & CO INC NEW COM ' MRK EQUITY ~s ~- ~ ~,S ~ 480.00 ' 34.97'.~y, ~gS16,785.60 ~~, 7~~- 60 NCR CORP NEW COM NCR EQUITY. ~a. ~ l ~ • °? ~ 264.00 12.39 / a, ~ ° 3,270.96 ~d ~3~ 6 ~ OCCIDENTAL PETE CORP DEL COM OXY EQUITY -~ (~, a~ ~~ g.o 400.00 75.90 7~1.q~ 30,360.00 ~ ~~~~ ~ SELIGMAN COMMUNICATIONS/INFO SLMCX EQUITY (~ 3/O RIVERSOURCE 421.72 36.11 X 15,228.24'` A . FUNDS TERADATA CORP DEL COM TDC EQUITY ,~'~ l (o' d 9• y~ 264.00 29.93 ~9, ~9S 7,901.52 7~6 S THE INCOME FUND OF AMERICA-B IFABX BLEND ~~'.3 J AMERICAN 1,544.24 15.31" 23,642.25 X .FUNDS VODAFONE GROUP PLC NEW VOD EQUITY ~ ~,:~~ d ~~ ~. ~ 818.00 24.13 ~ y; aS 19,738.34 j 9, 67a. 9~ SPONS ADR NEW ~--~ Account Total: $354,062.36 35,3 0 ~~• ~ ~ Incomplete if presented without accompanying disclosure page Page 1 of 3 Holdings b~lnvestor Kathryn G Shellenberger 2142 Douglas Drive Carlisle, PA 17013 Frank H Dogger CFP ®, ChFC Lancaster Financial Services 1525 Oregon Pike Suite 1902 Lancaster, PA 17601 (717) 393-5700 Combined Account Portfolio Date: 08/16/2010 Created: 09/20/2010 Acct Name:KATHRYN G. SHELLENBERGER 2142 DOUGLAS DR CARLISLE PA 17013 USA Acct No:000428981 AcctType:Non-Qualified `Asset Name Ticker Asset Type 'Mgt. Name Quantity Price($) Value($) AST AM CENTURY INCOME 8~ EQUITY PRUDENTIAL 1,339.50 12.04 16,127.61 GROWTH VA AST INTERNATIONAL VALUE 140 EQUITY PRUDENTIAL 713.15 15.54 11,085.45 VA AST LARGE-CAP VALUE 140 EQUITY PRUDENTIAL 1,006.90 16.76 16,879.25 VA AST NEUBER SMALL-CAP EQUITY PRUDENTIAL 1,146.68 7.51 8 609.91 GROWTH 140 VA , INVESCO V.I. TECHNOLOGY FUND EQUITY PRUDENTIAL 957.08 4.69 4 493.00 140 VA , Account Total: $57,195.22 I nvestor Total : $411,257.59 Incomplete if presented without accompanying disclosure page Page 2 of 3 F \F[LES\DATAFILE\W-LLS\7642. WIL ORI©INAL RkTAlNED S'y-: LAW OFFICES d~(attson. ~tatd~=ff. ~tiv~['cra,ns ~ ~,~Ef~• A PROFESSIONAL CORPORATION TEN FAST NIGH STREET' CARLISLE. PA 1701 (7171 243-3341 LAST WILL AND TESTAMENT I, KATHRYN G. SHELLENBERGER, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My personal representative shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. n 2. ® If she shall survive me by thirty (30) days, then I give, devise and bequeath all of my estate, bath real and personal property, unto my daughter, CAROL S. BEERY, absolutely. 3. In the event my said daughter shall predecease or fail to survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, unto my son-in-law, DOUGLAS W. BEERY. 4. In the event neither my daughter nor my son-in-law survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, unto my Trustee, in trust, for the following purposes: a. I direct that my Trustee shall hold, invest and reinvest the same, collect the income arising therefrom, and after paying all expenses incident to the management of the trust, to use and apply as much of the income and principal as may be necessary, in the sole discretion of my Trustee, '- .G.S. Page 1 of 5 Pages for the support, well-being and education of my granddaughter, ANGELA K. BEERY. b. I direct that my said granddaughter shall have the right of withdrawal of the principal and any accumulated income of said trust as she attains the age of thirty (30) years. c. To the extent that the same is permitted by law, none of the beneficiaries hereunder shall have any power to dispose of or to charge by way of anticipation any interest given to such beneficiary; and all sums payable to such beneficiaries hereunder shall be free and clear of the debts, contracts, alienations and anticipations of the beneficiaries, and all liabilities for levies and attachments and proceedings of whatsoever kind, at law or in equity. 5. I nominate, constitute and appoint my daughter, CAROL S. BEERY, as Executrix of my estate. In the event she shall be unable or unwilling to serve in such capacity, then I appoint my son- in-law, DOUGLAS W. BEERY, to act in such capacity. In the event neither shall be able or willing to serve in such capacity, then I appoint KEYSTONE FINANCIAL BANK, N.A., of Carlisle, Pennsylvania, as Executor of my estate. 6. I nominate, constitute and appoint KEYSTONE FINANCIAL BANK, N.A. as Trustee under the terms of this Last Will and Testament. 7. I direct that neither my personal representative no~~ my Trustee shall be required to file a bond to secure the faithful performance of their duties in any jurisdiction. 8. I authorize and empower my personal represent,~.tive and Trustee, in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any K.G.S. Page 2 of 5 Pages claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative and Trustee consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as maybe necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. A majority of all income beneficiaries of the trust or trusts created under this Will may from time to time remove any corporate trustee then acting for reasonable cause and substitute another corporate trustee; provided, however, that such successor corporate trustee shall not be a related or subordinate to any one or more of the beneficiaries hereunder within the meaning of Internal Revenue Code §672(c) or successor provisions. When the removed corporate trustee has received written notice of its removal and has been notified in writing by its successor corporate trustee of the latter's acceptance, the removed corporate trustee shall surrender all books, records, and assets in its possession comprising any portion of the trust or relating to the trust. In no event shall the removed corporate trustee charge a "termination fee" based on a percentage of trust assets as a result of such removal but shall be entitled only to charge such fee as fairly represents the cost of any accounting required by the beneficiaries or successor corporate trustee as part of such removal and substitution. The removed corporate trustee shall not be relieved of liability until its successor has qualified and the removed trustee's accounting, if applicable, has been settled or the beneficiaries and successor corporate trustee have otherwise accepted an account stated in lieu of a formal accounting. As used in this paragraph, the term "reasonable cause" includes, but is not limited to: (1) poor investment performance, (2) the removal of all current income beneficiaries from the state in which the corporate trustee is licensed to conduct business as a corporate trustee, (3) inattention to the reasonable needs of the beneficiaries, (4) lack of communication between trustee and beneficiaries, (5) inaccurate or unclear transaction statements or statements of account, (6) conflicts between the corporate trustee and the beneficiaries, (7) merger, acquisition or deteriorating financial K-'- Page 3 of 5 Pages condition of the corporate trustee, or (8) high turnover of account officers assigned to any trust under this Will. IN WITNESS WHEREOF I have hereunto set my hand and seal this 9~'' day of ,~~~~ . 1 enbe er Kathryn . S c 1 r~ SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. J l Page 4 of 5 Pages COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I, Kathryn G. Shellenberger, Testatrix, whose name is signed to the attached or 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. Kat hellenberger Sworn o firmed to and acknowledged before me by Kathryn G. Shellenberger, the Tcstatnx, this ~ day of u..J , !~ /~ Notary Public i (~ NOTARIAL SEAL CORRINE L. MYERS, Noterryy Pubic COMMONWEALTH OF PENNSYLVANIA } Carlisle Bono, Cumbert~u~dCounly SS. -~C°~~ssion Ez 'res Ma 27, 2003 COUNTY OF CUMBERLAND ) We, ~VJ ~ Q77a .~ and {~~}RCiH y C~BmPTDN the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Kathryn G. Shellenberger, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix 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 that time 18 or more years of age, of sound mind and under no constraint or undue influence. Address /D ~. ~ .Si • ~-rsL C l "70 ~ i;C... -t.,~£~--- ' L-~-~'~1~ _~ lames y-- , ,1 ~5 vim-.- e `:~ ~ ~-S;,~) ~ rj~ 1 (~G' C' ~' Sworn or affirmed to and subscnbcd bcfirc me this day •f , ~~j.~'rj , y Notary Public NOTARIAL SEAL CORRINE L. MYERS, Notary Public Carlisle Boro, CumberlandCounry Page 5 of 5 Pages My Commission Ex ' es M 27, 2003