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HomeMy WebLinkAbout12-01-10J 1505610143 REV-1500 EX (01-10)l i~ 5.it OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 10 0239 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 514 12 1814 03 05 2010 Decedent's Last Name FOUST (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Date of Birth Suffix Decedent's First Name MI NADINE R Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS a 1. Original Return ~ 2. Supplemental Return L_~ 4. Limited Estate ~ 4a, Future Interest Compromise (date of death after 12-12-82) ~) ~ n ~ t3 Decedent Died Testate (Attach Copy of Will) ~ Decedent Maintained a Living Trust (Attach Copy of Trust) -I 9. Litigation Proceeds Received ^ 10 betvveenQ2v31 y91 nd~tT-dlatge5~f death 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes C~ 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD W STEWART (717) 761 4540 First line of address 301 MARKET ST Second line of address PO BOX 109 City ar Post Office State ZIP Code LEMOYNE PA D6E ONLY . :. REGISTER OF WIL " ' _ _ ~ ' ' ' { ;r - -.I --r~ C'7 ~= : f 1 =~ . .... .c . ., j l~~ rµ ~ t ~.m.-: t. ~ I~ - _... ~._~` ' -;. y t.l ~ .'. DATE F'~ED f'•.: t~ ~~ !-. t~ 7 -; ~ ~` -~=~ ..., "T" 1 _~.`~ Correspondent's a-mail address: RWS@JDSW.COM 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 true, correct and complete. Declaration of preparer other than the personal representative is based on ali information of which preparer has any knowledge. SIGNATUI`.<'V1PER~ RESPONSE F0~2 FiLING~RET RN r~ iDrA~TE~, ti ,,~. '/ ~1 ,~ ~ Barbara F Kriebel _ I I IdO(ot~.~l o ADDRESS 5903 Stephens Crossing, Mechanicsburg,__PA 17050 SIGNATURE OF P EPARER OTHER THAN REPRESENTATIVE DATE - i~~ ~ RICHARD W. STEWART (l j ADDRESS 301 Market St., Lemoyne, PA 1505610143 Side 1 1505610143 ~~ J 15D5610243 REV-1500 EX Decedent's Social Security Number Decedents Name: FOU$T, Nadine R 514 12 1814 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 248,474.53 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. 20,973.47 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 5 , 0 3 0.16 7. Inter-Vivos Transfers & Miscellaneous I~oq Probate Property Requested rate Billin Se 7 3 0 8 , 011.0 2 ............ g pa (Schedule G) ^j . 5 82 , 4 8 9.18 g. .......................... Total Gross Assets (total Lines 1-7) ......................... .,................ g, 8,634.66 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 12,793.78 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 21 , 4 2 8 . 4 4 11. ............................................... Total Deductions (total Lines 9 & 10) .................... 11. 561,060.74 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. . 561,060.74 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. 0 - ~ ~ (a)(1.2) X .00 16. Amount of Line 14 taxable 5 51, 0 6 0. 7 4 16. 2 4 x 7 9 7. 7 3 at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17. 0 . ~ ~ - at sibling rate X .12 18. Amount of Line 14 taxable ~- ~ 0 0 0• ~ ~ 18. 1,r 0 ~ - 0 0 r r at collateral rate X .15 19. Tax Due ......................................... ............................................. ............................ 19. 2 6 , 2 97.7 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 REV-1500 EX Page 3 Ilnrnrlcant'c (~mm~lpta Dr1r1rPSS' File Number 21-10-0239 DECEDENT'S NAME FOUST, Nadine R _ _________,____ STREET ADDRESS 5225 Wilson Lane _ Apt. 3126 ___ CITY i STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 26,297.73 2. Credits/Payments A. Prior Payments 24,225.00 B. Discount 1,275.00 Total Credits (A + B) (2) 25,500.00 3. Interest (3} 4. ff 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 a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 797.73 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: 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 :.................................. ^ 0 c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... [x] ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ~ 1 ~~11 contains a beneficiary designation? .................................................................................................................. U u IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 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 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 21 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 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 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 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER F('1UST_ Nadine R _ 21-10-0239 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Janney Montgomery Scott Brokerage Account -Date of 51,255.01 Death Valuation from EstateVal is Attached to this Return 2 MFS Pennsylvania Muni Bond Fund -A Account No. 10.08 74,246.31 8189603102 -Date of Death Letter from MFS is Attached to this Return 3 MTB Pennsylvania Muni Bond Fund -A Account No. 10.16 122,973.21 8189603102 -Date of Death Value from MTB is Attached to Return TOTAL (Also enter on Line 2, Recapitulation) 248,474.53 (1t more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, lnc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FOUST, Nadine R 21-10-0239 Include the proceeds of litigation and the date the proceeds were received by the estate. Afl property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash and Coins in Wallet 75.60 2 2010 Distribution to Decedent under Tilman H. Foust Trust Under Will 1,403.00 3 2005 Lexus -- -Agreed upon distribution price. 12,000.00 4 Cordier Antiques and Fine Art -Sale of Antiques 2,032.56 5 Horst Coin Auctions -Proceeds from Sale of Decedent's Coins 1,376.00 6 Sale of Electric Scooter and Seated Walker -Proceeds from Sale 275.00 7 Various Items of Antique Jewelry 2,610.00 8 Refund from Capital Blue Cross -Major Medical Fee for April and May 343.97 9 Refund from Internal Revenue Service -Tax Return for 2009 668.47 10 Refund from Travelers Insurance -Jewelry Floater Policy 150.00 11 Refund from Verizon 16.87 12 Refund from Westfield Insurance -Auto Insurance 22.00 TOTAL (Also enter on Line 5, Recapitulation) I 20,973.47 (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-1509 EX+ (6-98) SCHEDULE F COMMONWEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE 7AX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FOUST. Nadine R 21-10-0239 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. Barbara F Kriebel B. C. 5903 Stephens Crossing Daughter Mechanicsburg, PA 17050 IntruT~ v nwNFn PRC)PFRTY~ ITEM NUMBER LETTER FOR JOINT TENANT DATE MARE 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 AS5E % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 12/19/2006 M8~T Bank Account No. 33884854 10,060.31 50.000% 5,030.16 TOTAL (Also enter on Line 6, Recapitulation) f 5,030.16 (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 F (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-V{VOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FOUST, Nadine R 21-10-0239 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 HE DADTE OFnTRANSFERSATTACl1 A COPY OF TIE DEED ~OR REAL ESTAT~ . DATE OF DEATH VALUE OF ASSET °i° OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Allianz Annuity Policy Number 30755031 -Date ofi 24,943.16 24,943.16 Death Letter is Attached to Return Beneficiaries: Barbara F. Kriebal, Emily Ann Foust Johnson and Tilman H. Foust, Jr. 2 Janney Montgomery Scott IRA -Date of Death 279,775.84 279,775.84 Valuation from EstateVal is attached to this Return Beneficiaries: Barbara F. Kriebel, Emily Ann Foust Johnson and Tilman H. Foust, Jr. 3 Questar Capital Corp. Brokerage Account No. 4U7 3,292.02 3,292.02 -518541 -Transfer upon Death Account: Barbara F. Kriebel, Emily Ann Foust Johnson, Tilman H. Foust, J r. TOTAL iAlso enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 308,011.02 Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ i10-O6) COMMNHE~IETAN~E TAB RE1 ~RN ANIA REJJIDEN DEcc::EDEN i SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER FOUST, Nadine R 21-10-0239 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached ' 5,686.16 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address C itv State Zip 2, Attorney's Fees Johnson Duffle 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Year(sl Commission raid _ Street Address City State Zio Relationship of Claimant to Decedent 4. I Probate Fees 1,305.00 513.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 550.OtJ 7. Other Administrative Costs 580.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 8,634.66 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER FOUST, Nadine R 21-10-0239 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Funeral Luncheon 916.44 2 Mussleman's Funeral Home 4,619.72 3 Timothy Gearhart, Sexton to Open and Close Gravesite 150.00 H-A 5,686.16 Other Administrative Costs 4 C.G. Buser, Jewelry Appraisal 550.00 5 Cumberland County Register of Wills Office -Filing Fee for Inheritance Tax Return and 30.00 Inventory H-B7 580.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 E.X+ (12-OB} SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FOUST, Nadine R 21-10-0239 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 AAA -New Plates and Registration on Automobile 73.50 2 Agnes McNamara, Caregiver 1,580.00 3 Bethany West Apartments 4,235.17 4 Bethany West Apartments -Final Payment 2,412.64 5 Bobby Rahai Lexus -Check up for 2005 Lexus 461.51 6 Bonnie K. Miller, Treasurer -Lower Allen Township Per Capita Tax 10.00 7 Commonwealth of Pennsylvania -Transfer of Automobile 64.50 8 Continuing Care RX 7.34 9 FIA Card Services 310.17 10 Homestead Senior Care Services 3,130.95 11 PA Department of Revenue - 2009 Individual Income Taxes 8.00 12 Vicki Brewer, Caregiver 500.00 TOTAL (Also enter on Line 10, Recapitulation) , 12,793.78 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+(11-08) SCHEDULE J COMMNHERITANCE~ ~ RET~RiJANIA BENEFICIARIES RESIDENT DECEDEN ESTATE OF FILE NUMBER F~l1ST_ Nadine R 21-10-0239 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S1 RECEIVING PROPERTY DECEDENT (Words) ($$$) Do No List ustee s TAXABLE DISTRIBUTIONS jinclude outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Emily Ann Foust -Johnson Daughter 1/3rd of Residue PA 2 Tilman H Foust Jr Son 1/3rd of Residue PA 3 Barbara F Kriebel Daughter 1/3rd of Reside PA 4 Karen Leonard Friend Specific Bequest Palm Beach Gardens, FL of $10,000 Tota I Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET{ r Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ESTATE OF NADINE R. FO UST SCHEDULE OF EXHIBITS EXHIBIT A Last T~Vill and Testament for Nadine R. Foust signed and dated September 6, 2002. EXHIBIT B Estate Val Valuation for Janney Montgomery Scott Account No. 33928825 EXHIBIT C MFS Investment Management Date of Death Value Letter,for Fund No. 30/8189603102 EXHIBIT D MTB Summary Account Statement Showing Value of Account at Date of Death EXHIBIT E M&T Bank Date of Death Letter for Joint Account EXHIBIT F Allianz Annuity Date of Death Valuation EXHIBIT G Estate Val Valuation for Janney Montgomery Scott IRA Account No. 33928844 EXHIBIT H QueStar Brokerage Statement for Transfer Upon Death Account 422374 ~Lttst ~iCC <znb ~e~tantent ~~~ NADINE IZ. FOUST I, NADINE R. FOUST, of the Township of Hampden, County of Cumberland, and Commonwealth of Pennsylvania, declare this to be my last Will and revoke any Will previously made by tee, ITEM I. I bequeath the sum of Ten Thousand (~ 10,000.00 j Dollars, to my ~ ena. I~--~-REN LEONAIaD, now of Palm Beach Gardens, Florida, if she survives me. ITEM II. I devise and bequeath the residue of my estate of every nature and wherever situate in equal shares to such of my children, BARBARA F. I~RIEBEL, TILMAN H. FOUST, JR., and EMILY ANN FOUST, as survive me. Should any of my above named children predecease me, I devise and bequeath the share of such child to his or her issue, per stitpes who survive me, and should any such child of mine leave no such issue who survive, I devise and bequeath the share of such child to my issue, per stirpes, who survive me. ITEM III. I direct that all taxes that may be assessed as a consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM V. I appoint my daughter, BARBARA F. I{~RIEBEL., Executrix of this mt- last ~~~ill. Should my daughter, BARBARA F. KI2IEBEL, fail to qualify or cease to act as Executrix, I appoint my son, TILMAN II. FOUST, JR., Executor of this my last Will. ITEM VI. I direct that my Executrix or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. EN ~VIT\TESS WTHEREOF, I ha~-e hzreur~ta szt r~~- ~~r~d ~.~ ~`~ --- t- ~~~~,~~,~,~ , 2002. r !(SEAL) ADINE R. FOU T ~IE~'~~D_ S:E._'~:..D. PU~LI~I~ _~'~ ~F~: Ii-;..~D _ , '+,; ~DL`'~~ ~~.. ~~:_~I ~T -.~~._ -~;- ---~ abV \~\v ~L33.L1L {lam fiJ Ll2-Yd 1Vl Li7L~1 ~R ~~. :y riz.t T'~.~w~i ~L:~i. .'...'`i~''LY .~.~1 ._~~~''y Vii. ~'L-~^4.Y~w `7~1 ../..~... 'Y~' .~~'Sr~'... w..r ~ ~...~~ -.-+ ~a presence and in the presence of each other, have subscribed our names as R~messes. /!fir ~'~e~~~~~~'4~~f~l ~~ Witness F". ..,.,. -~ ~y-,~ W ~ ess / ,l/J Address ~ ~~ .Address ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CL~LBERL AND I, NADINE R. FOUST, Testatrix, whose naYne 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 and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. w ~ ~~_ A INE R. FOUST Estate Valuation Date of Death: 03/05/2010 Valuation Date: 03/05/2010 Processing Date: 06/15/2010 Shares Security or Par Description High/Ask Low/Bid 1) 5000 PHILADELPHIA PA AUTH FOR INDL ARPT REV (71781ECZ6) Financial Times Interactive Data DTD: 07/10/2001 Mat: 07/01/2028 5.25% Estate of: Nadine Foust Account: 3392-8825 Report Type: Date of Death Number of Securities: 4 File ID: Nadine Foust-33928825- DOD 03-05-10 Mean and/or Div and Int Security Adjustments Accruals Value 03/05/2010 99.99200 Mkt 99.992000 4,999.60 Int: 01/01/2010 to 03/05/2010 46.67 2) 6780.15 Cash (CASH) 6,780.15 3) 1866.264 FPA PARAMOUNT MUT FD INC (302546106; FPRAX) COM Mutual Fund (as quoted by NASDAQ) 03/05/2010 15.91000 Mkt 15.910000 29,692.26 4) 900 PIMCO FDS PAC INVT MGMT SER (693391120; PRTNX) REAL RTN CL A Mutual Fund (as quoted by NASDAQ) 03/05/2010 10.87000 Mkt 10.870000 9,783.00 Total Value: $51,255.01 Total Accrual: $46.67 Total: $51,301.68 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818} 313-6300 or www.evpsys.com. (Revision 7.1.1} ®©®~, INVESTMENT MANAGEMENT MFS Service Center, Inc. P.O. Box 55824, Boston, MA 02205-5824 800.225.2606 mfs.com June 14, 2010 BARBARA F KRIEBEL 5903 STEPHENS CROSSING MECHANICSBURG PA 17050-6866 Reference: 01868953 MFS Pennsylvania Muni Bond Fund-A Account Number 8189603102 Nadine R Foust Dear Ms. Kriebel: I am writing regarding your request for written verification of the balance of the referenced MFS account on March 5, 2010. The following information represents the value of the account on March 5, 2010: Fund/Account Number Total Shares Net Asset Value Dollar Value 30/8189603102 7,365.705 $10.08 $74,246.31 If you have any questions, please call our Client Services Department at 1-800-225-2606 any business day between 8 a.m. and 7 p.m. Eastern time. One of our service representatives will be happy to assist you. In addition, you can obtain fund information 24 hours a day by calling our automated line at 1-800-MFS-TALK or visiting our website at www.mfs.com. Sincerely, Shawn Wesolowski Client Services cc: LPL Financial Corporation Summarv Account Statement Mailing Address: NADINE R FOUST 59Q3 STEPHENS XING MEGHANIGSBURG PA 1705Q-6$66 Account Haldinas an 315!2010 Account Registration: NADINE R FOUST Account Number: 2939928 SSNlTIN : On Fiie Fund Shares Owned Price Total Value Avg. Iota! Cost Avg. Cost / Sh. PA MUNICIPAL BOND A 12,103.6620 10.16 USD 122,973.21 USD 92.63 USD 0.01 USD * Total Account Value in USD: 122,973.21 32.63 * Total Account Value includes a-I applicable funds Year-Ta-Date Earnings Summary On 3/5/2010 Income Fund Dividend PA MUNICIPAL BOND A 699.21 USD * Total Account Earnings in USD: 699.21 "Total Account Earnings includes all applicable funds Transaction Sumrnarv Fram 3/5/2010 to 3/5/2010 Activity in PA MUNICIPAL BOND A Trade Date Transaction Type Gross Amount 03/05f2010 Beginning Shares Balance 122,973.21 USD Short Term Capital Gains 0.00 USD 0.00 Totat Div 8~ STCG 699.21 USD 699.21 10.16 USD Share Amount 12,103.6620 Long Term Capital Gains 0.00 USD o.a© 12,103.6620 Printed By: Josh Eihausen. Print Date and Time: 6IT/2010 02:41 PM. Fund Group Name: MTBFunds Page 1 of 1 I~1 M&T Banlc 5528 Carlisle Pike, Mechanicsburg, PA 17050 717 766 0507 Fnx 717 766 1793 March 23, 2010 Barbara Kriebel Estate of Nadine R Foust 5903 Stephens Crossing Mechanicsburg, Pa 17050 RE:Estate of Nadine R Foust Account number:33884854 Date of Death:March 5,2010 At the time of death the balance on the above referenced account was: Relationship with interest checking account Account number:33884854 Account in the names of Nadine R Foust or Barbara Kriebel Opening date:December 19,2006 Balance on date of death:$10060.28 Accrued interest: $.03 Total:$10060.31 If you need any additional information please contact me at 717-766-0507. Sincerely, Margie H Fealtman Personal Banker Hampden Branch Date of Death: Valuation Date: Processing Date: Shares or Par Estate Valuation 03/05/2010 Estate of: Nadine Foust 03/05/2010 P_ccount: 3392-8844 06/15/2010 Report Type: Date of Death Number of Securities: 20 File ID: Nadine Foust-33928844- DOD 03-05-10 Security Mean and/or Div and Int Security Description High/Ask Low/Bid Adjustments Accruals Value 1) 220 BARRICK GOLD CORP (067901108; ABX) COM New York Stock Exchange 03/05/2010 40.66000 40.04000 H/L 40.350000 8,877.00 2) 35000 FHLMC PC GOLD MULTI 15 (31335KGJ9) Financial Times Interactive Data Mat: 10/01/2010 7.5000 Fact: 0.00133461 03/05/2010 102.07017 A/B 102.070173 47.68 Int: 03/01/2010 to 03/05/2010 0.04 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 0.35 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 9.29 3) 25000 GNMA PASS-THRU X SINGLE FAMILY (36208UF85) Financial Times Interactive Data Mat: 12/15/2012 7.000% Fact: 0.01274449 03/05/2010 106.37596 A/B 106.375957 338.93 Int: 03/01/2010 to 03/05/2010 0.25 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 1.91 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 8.67 4) 75000 GNMA PASS-THRU X SINGLE FAMILY (362162DL0) Financial Times Interactive Data Mat: 10/15/2016 8.500% Fact: 0.01226038 03/05/2010 109.48739 A/B 109.487385 1,006.77 Int: 03/01/2010 to 03/05/2010 p,87 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 6.58 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 8.71 5) 50000 GNMA PASS-THRU X SINGLE FAMILY (36217WJN3) Financial Times Interactive Data Mat: 02/15/2017 7.500% Fact: 0.01594796 03/05/2010 109.81895 A/B 109.818953 875.69 Int: 03/01/2010 to 03/05/2010 0.66 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 5.04 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 g,94 6) 25000 GNMA PASS-THRU X SINGLE FAMILY (36217X4J6) Financial Times Interactive Data Mat: 04/15/2017 B.OOOo Fact: 0.01278438 03/05/2010 111.45804 A/B 111.458043 356.23 Int: 03/01/2010 to 03/05/2010 0,28 Int: 02/C1/2010 to 02/28/2010, payable 03/15/2010 2.15 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 3.25 7) 100000 GNMA PASS-THRU X SINGLE FAMILY (36217FVR7) Financial Times Interactive Data Mat: 04/15/2017 7.5000 Fact: 0.02163585 03/05/2010 109.81895 A/B 109.818953 2,376.03 Int: 03/01/2010 to 03/05/2010 1.80 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 13.73 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 33.64 8) 40000 GNMA PASS-THRU X SINGLE FAMILY (36217JRX11 Financial Times Interactive Data Mat: 06/15/2017 7.500% Fact: 0.06146217 03/05/2010 109.81895 A/B 109.818953 2,699.88 Int: 03/01/2010 to 03/05/2010 2.05 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 15.56 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 31.30 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.1) Date of Death: Valuation Date: Processing Date: Shares or Par 03/05/2010 03/05/2010 06/15/2010 File ID: Nadine Security Mean and/or Description High/Ask Low/Bid Adjustments Estate of: Nadine Foust Account: 3392-8844 Report Type: Date of Death Number of Securities: 20 Foust-33928844- DOD 03-05-10 Div and Int Security Accruals Value 9) 47848 GNMA PASS-THRU X SINGLE FAMILY (36219N3M0) Financial Times Interactive Data Mat: 05/15/2018 9.0000 Fact: 0.04309485 03/05/2010 113.49553 A/B 113.495533 2,340.28 Int: 03/01/2010 to 03/05/2010 2.06 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 15.59 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 16.50 10) 75000 GNMA FASS-THRU X SINGLE FAMILY (36223X5E8) Financial Times Interactive Data Mat: 04/15/2022 7.5000 Fact: 0.03285096 03/05/2010 112.58550 A/B 112.585504 2,773.91 Int: 03/01/2010 to 03/05/2010 2.05 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 15.46 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 10.21 11) 100000 GNMA PASS-THRU M SINGLE FAMILY (36202AS99) Financial Times Interactive Data Mat: 12/20/2022 7.0000 Fact: 0.01825999 03/05/2010 111.00400 A/B 111.003997 2,026.93 Int: 03/01/2010 to 03/05/2010 1.42 Int: 02/01/2010 to 02/28/2010, payable 03/20/2010 11.44 Prin: 02/01/2010 to 02/28/2010, payable 03/20/2010 135.69 12) 14000 FNMA PASS-THRU LNG 30 YEAR (31369HPX4) Financial Times Interactive Data Mat: 04/01/2023 6.5000 Fact: 0.00653136 03/05/2010 107.19542 A/B 107.195420 98.02 Int: 03/01/2010 to 03/05/2010 0.07 Int: 02/01/2010 to 02/28/2010, payable 03/25/2010 0..50 Prin: 02/01/2010 to 02/28/2010, payable 03/25/2010 0.35 13) 45000 GNMA PASS-THRU X SINGLE FAMILY (36203RF53) Financial Times Interactive Data Mat: 07/15/2023 7.0000 Fact: 0.02593939 03/05/2010 111.00972 A/B 111.009722 1,295.79 Int: 03/01/2010 to 03/05/2010 0.91 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 6.86 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 8.22 14) 50000 FHLMC REMIC SERIES 2925 (31395LBG5) Financial Times Interactive Data Mat: 01/15/2035 5.000°s Fact: 0.20692487 03/05/2010 100.29391 Mkt 100.293910 10,376.65 Int: 03/01/2010 to 03/05/2010 5.75 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 58.30 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 3,646.39 15) 100000 FHLMC REMIC SERIES 3004 (31395VYE3) Financial Times Interactive Data Mat: 07/15/2035 5.250% Fact: 0.32439563 03/05/2010 99.11319 Mkt 99.113190 32,151.89 Int: 03/01/2010 to 03/05/2010 18.92 Int: 02/01/2010 to 02/28/2010, payable 03/15/2010 144.92 Prin: 02/01/2010 to 02/28/2010, payable 03/15/2010 685.60 16) 100000 GNMA REMIC TRUST 2009-122 (38375ABH6) Financial Times Interactive Data Mat: 11%20/2038 4.5000 Fact: 0.99389239 03/05/2010 97.61873 Mkt 97.618730 97,022.51 Int: 03/01/2010 to 03/05/2010 49.69 Int: 02/01/2010 to 02/28/2010, payable 03%20/2010 373.44 Prin: 02/01/2010 to 02/28/2010, payable 03/20/2010 195.52 Page 2 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.1) Date of Death: 03/05/2010 Estate of: Nadine Foust Valuation Date: 03/05/2010 Account: 3392-8844 Processing Date: 06/15/2010 Report Type: Date of Death Number of Securities: 20 File ID: Nadine Foust-33928844- DOD 03-05-10 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 17) 300 NATURAL RESOURCE PARTNERS L P (63900P103; NRP) COM UNIT L P New York Stock Exchange 03/05/2010 26.85000 26.40000 H/L 26.625000 7,987.50 18) 300 PENN VA RESOURCES PARTNERS LP (707884102; PVR) COM New York Stock Exchange 03/05/2010 23.00000 22.20000 H/L 22.600000 6,780.00 19) 150 PLAINS ALL AMERN PIPELINE L P (726503105; PAA) UNIT LTD PARTN New York Stock Exchange 03/05/2010 56.41000 55.89010 H/L 56.150050 8,422.51 20) 86360.71 Cash (CASH) 86,360.71 Total Value: $279,017.19 Total Accrual: $758.65 Total: $2 79,775.84 Page 3 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.1) Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, MN 55459-0060 800.950.1962 June 28, 2010 ESTATE OF NADINE FOUST C/O BARBARA KIEBEL 5903 STEPHEN S CROSSING MECHANICSBURG PA 17050 Re: Nadine Foust, deceased Dear Executor: Allianz ill This letter is in reference to your request for the date of death value on the following policy number(s). Annuity Policy Number 30755031 Cash Surrender Value as of 03/05/2010 $24,943.16 Should you have any questions, please feel free to contact our office at 800.950.1962. Thank you. Annuity Claims Allianz Life Insurance Company of North America LCL-1020 rev 7/1 /09 DI o ° ~~ ~W o a ~ A ~ a c ~ z v n 0 z b 0 N ro w N ' b N O N -U D AI W ~ o ~p N -~ ° w w ~ 0 n 4 0 _ ~ ~ , 2f` o ~ ~ ~. ~~ T __, ~ o D ~ ~ v m ~ in ~ ~ ~. n ~ r r n v ~' p ° ~' ~ Q N ~ C~ ~ y d j. 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