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HomeMy WebLinkAbout12-03-10Q'~C•~'~'~~- _, 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 09 0598 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201-26-9119 06/08/2009 11 /18/1934 Decedent's Last Name Suffix Decedent's First Name MI Rivers Jerome J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) •_ 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULCI BE DIRECTED T0: Name Daytime Telephone Number Lisa Marie Coyne (717) 737-0464 Firm Name (If Applicable) ~~ '~-~ 12EtiISTER Of~ V'stl~#~ USE C3N '~"! -. - Coyne & Coyne, P.C. ~~ T---ti ~ ,~ { ' f '"~~ _ - '~ ~ ~ f _ ~ First line of address r ' -~ , I ~~ ~. , . 3901 Market Street ' -~, 3 ~ ~' ~. ~ ~ ~ ~ Second line of address _ ° ,...~ ' -~: ~ ~~ ~'? G -. ,} ~ _ - - ;_~ ~ .~ City or Post Office State ZIP Code DAB ~ li_ED rx> '~ ~' ~"1 Camp Hill PA 17011 Correspondent's a-mail address: 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 all information of which pre arer has any knowledge. SIGNATU E F E O SPONSIBLE FOR FILING RETURN D E ADD SS _ _ Mark R vers 20507 Quarterpath Trace Circle, Sterling, VA 20165 SIGNATURE OF PR ARER OTHER THAN REPRESENTATIVE DAfE ADDRESS PLEASE USE ORIrINAL FORM ONLY Side 1 15056051058 15056051058 -}'~ J 15056052059 REV-1500 EX Decedent's Social :iecurity Number Jerome J Rivers 201-26-9119 Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) ... . ..................................... .... 1. 135,000.00 2. Stocks and Bonds (Schedule B) ................................... .... 2. 2,373.14 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. 1$,883.98 6. Jointly Owned Property (Schedule F) Separate Billing Requested , , . .... 6. 9,905.10 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.... .... 7. 36,449.47 8, Total Gross Assets (total Lines 1-7) ................................ .... 8. 202,611.69 9. Funeral Expenses & Administrative Costs (Schedule H) ................. .... 9. 50,749.32 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10. 4,509.89 11. Total Deductions (total Lines 9 & 10) ............................... .... 11. 55,259.21 12. Net Value of Estate (Line 8 minus Line 11) .... . ................. . ... .... 12. 147,352.48 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. 147,352.48 __ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 45 147,352.48 16. 6,630.86 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ....... . ......... . ................................... .... 19. 6,630.86 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~;; 15056052059 Side 2 150560520)59 REV-1500 EX Page 3 File .Number Decedent's Complete Address: 21 09 0598 DECEDENT'S NAME DECEDENT'S SOCIAL SECUR'.ITY NUMBER Jerome J Rivers 201-26-9119 STREET ADDRESS 624 Colonial View Road - - ___ _ - CITY - _ ~, STATE _ - ZIP Mechanicsburg '~ PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 6,630.86 2. Credits/Payments A. Spousal Poverty Credit _-- -_ -- B. Prior Payments 6,500.00 C. Discount 331.54 - Total Credits (A + B + C) (2) 6,831.54 3. Interest/Penalty if applicable D. Interest E. Penalty - - Total Interest/Penalty (D + E) (3) 0.00 4, If Line 2 is greater than Line 1 + tine 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 200.68 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. 1f 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? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements 'for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (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 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)(1.31]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A ' ~ REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER RIVERS, JEROME J ~ 21 - 200'9 - 0598 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. __ ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 624 Colonial View Road, Upper Allen Twp., Cumberland County, PA-- See Attached Settlement Sheet 135,000.00 TOTAL (Also enter on Line 1, Recapitulation) 135,000.00 Settlement, Statement U.S. Department of Housing and Urban Development ~~~~ o i ype or Loan 1. ^FI-IA . ~ 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number ^ 2 - 21 0 ThIa form is famished to glue you a statement of actual aetdement costs. Amounts paid to and by the settlement agent are shown. C. Note: (tams marked "(p.o.c.)" were paid outside the dosing; they ere sham here for information purposes and are not Included in the totals. TitleExpress Settlement System WARNING: It Is a crime to knowingly make false statements to the United States on tMs or an other similar form. Penalties upon D. NAME OF BORROWER: Anthony Maydwell and Shawna Maydwell E. NAME OF SELLER: The Estate of 7erome T. Rivers F. NAME OF LENDER: Bank of America, N.A. 7105 Co rate Drive MS: TX2-981-03-18 Plano T 467 G. PROPERTY ADDRESS: 624 Colonial View Road, Mechanicsburg, PA 17055 U er Allen T wnshi x. sETTLEMENT AGENT: PA Real Estate Settlement Services LLC, Telephone: 717-249-6333 Fax: 717-249-7334 54 an er rin d ' 1 A 17015 1127!2 0 J. S MMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: R 135 000.00 135 000.00 6 459.00 r' 01 27 10 06 30 10 516.50 O1 27 10 06 30 10 516.50 27.06 27.06 142 002.56 135 543.56 1 000.00 108 000.00 7 998.10 654.00 Bank of America N.A. 4 000.00 4 000.00 O1 O1 10 O1 27 10 25.95 01 O1 10 O1 27.10 25.95 T ) 113 679.95 12 024.05 142 002.56 135 543.56 113 679.95 12 024.05 303. CASH FROM BORROWER 28 322.61 123 519.51 SUBSTITUTE FORM 1099 SELLER STATEMENT: The Information contained herein is important tax information and is being famished to the Internal Revenue Service. If you are required to file a return, a negllgan~e penalty or other sanction will be Imposed on you if this Item Is required to be reported and the IRS determines that it has not been reported. The ConUad Sales Price descrtbed on line 401 above constitutes tha Gross Proceeds of this trensadion. You are required bylaw to provide tha settlement agent (Fed. Taz ID No: )with your correct taxpayer idenrficallon number. H you do not provide your correct taxpayer Identification number, you maybe subject to civil or criminal penalties Imposed bylaw. n er pens ues perjury, I certify that the number shown on Uiis statement Is my cortect taxpayer idendfiw6on number. TIN: - / - -_ SELLER(S) SIGNATURE(S): ~ SELLER(S) NEW MAILING ADDRESS: SELLER(S) PHONE NUMBERS: _ u.~. iJhrAKINlh[V1 Ut' HUUJIN(iANU UN.NA.N I~hVh7.,Ul'MI~~I'1' File1`lumber:2010-007 PAGE2 JC I I LCIVICIV J I!1 c Clylt=l L SETTLEMENT CHARGES v I ______, _-__"_ -" PAID FROM PAID FROM T I I ~ sad on Dricg~135 000.00 = 5, 570.00 BORROWER'S SELLER'S FUNDS AT FUNDS AT 701 $ to ___ SETTLEMENT SETTLEMENT 5 570.00 _ ell S Hel -U- Sid at Settlement 70~ ommission _ _ 5 570.00 p -(F-}~S PAYABLE IN CONNECTI ___ ON WITH L4A 'on Fee % 0.625° __ Bank of America N.A. LR 675.00 Landsafe A raisal LR 385.00 Landsafe Credit Inc. LR 35.00 Bank of America N.A. LR 590.00 SAC Tax Service LR 89.00 Landsafe Flood Determination Inc. LR 26.00 O1 27 2010 02 O1 2010 14.4200 5 Da s LR 72.10 0 wont 0 mont Travelers 185.00 R 12 30.37 LR 364.44 8 101.36 LR 610.88 Bank of America N.A. LR -121.54 0.00 T Salzmann Hu hes P.C. 59.50 Lisa Co a Es POC Notes Public 30.00 Salzmann Hu hes P.C. 29.00 Stewart Title Guarant PA RE SS 1 137.12 108 000.00 - 135 000.00 - 1 137.12 Stewart Title Guarant PA RE 33 200.00 Stewart Titles Guarant PA RE SS 75.00 1 V RN T R I RAN ARG 52.00 84.00 136.00 1 350.00 1 350.00 1 350.00 1 350.00 30.50 30.50 30.00 30.00 1 IT U er Allen Townshi Authorit 112.00 Salzmann Hu hes P.C. 20.50 Salzmann Hu hes P.C. 10.00 Wilbur Plumbin 6 Heatin 450.00 Marlin A. Yohn Tax Collector 5.00 Brandt Pro art Services 88.60 Colonial View 300.00 363.00 1dM T(ITAI CFTTI FMFNT (`HARt; FS /enter nn linee 1(l~. Section J and 502" Section K1 - 6 459.00 7 998.10 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HU0.1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursemenLS made on my account or by me in this transaction. I fu ar certify that I have received a copy of the HUD-1 Settlement Statement. Anlho a Shawna Maydwell The Estate of Jerome J. Rivers ~y'. M ry Stephen Rivers " - / ( (/ ' ING: IT IS A CRIME TO KNOWINGLY//MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which f have prepared is a We and accurate account of this Vansaction. UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION 1 have pused Or will cause the funds to be disb ed In accordance wiMr tMs statement. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTK)N 1001 AND SECTION 1010. ^ ~ / ~ Z ~ ~® By ~y I ' I '~~ SCHEDULE B '' ' I STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA I NHERITANCE TAX RETURN I 'i ___ RESIDENT DECEDENT - _ _ _ ~ - --- - --- _ - L _- - ESTATE OF - -- _ _ - _ _ - --- _ FILE NUMBER _ __ - RIVERS, JEROME J ' 21 - 2009 - 0598 All property j ointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE ~'I VALUE AT DATE OF NUMBER DEATH 1 11 Shares of Kraft 26.59 i, 292.49 2 66.91 Shares of GE ' 1.3.56 '~ '907.30 3 . 19.7586 Shares of Altria i 17.21 340.03 4 18.7137 Shares of Philip Morris Stock 44.53 ' 833.32 TOTAL (Also enter on line 2, Recapitulation) 2,373.14 10 39p Mark 703-404-1965 p,3 ' a.l~ Lti. 1~! 1 . G.:.. VY ,~"{'J - ~,/V1,! 1:-1t 1L'1LF'111 Y7L 1'J'an j"'J.-1 <JL L Vi L Shareo~rrner Services PO i3flx 84874 St. Pout, Minnesota 55? 640+37~~ wwuu.wellsfargo. c~rrjJsfiareotirn ernenrioes '~aY ~~~ 201 D Request Numbi3r: 7887334 NARK S R1VEa5, ExECUTOR 1D N~mb~:r: MY559C~ JER011AE .~ RIVERS ESTATE WFTYp~e: CO 20507 QL;ARTERPATH TRACE CERCLE POTOi~AC FALLS VA 20165 Regarding: Kraft FQOds Inc. for Jerome Jase~h Rivers .loan Mary Rivers Jt Ten Dear ~llarK Rivers, l Thank you far ~ro.~r correspondence regarding the above mentioned account Shareawner records are car~fidential. In order to release account specific irformation, we ~viil n'quire:~ • A CDUrt~@rtlf:ed copy ofime Letters of Appointment na-nJng the executor administrator or personal representative of the estate and, dated within past 60 darys_ ~6 months in f~Jew York and 1 year fn Gonnedicu~). I • A letter signed Gy the pel rsan named in the appointment papers requesting the account nforr~ati~~n ar authafizin9 us to release the account 'nformatian to you. if the estate is not bei*~g probated, please provide: A Small Estate Affidavit prepared in accordance with the provisions of Smap estate Requiremenj;s for the state w~rt1ere the decedent was a resident. Wlte recommend that you contact an attamey for assistance with preparing the affidavit. • A copy of the death certificate. A letter s fined toy xhe af`iant, Please note that documents presented jor the campletlon a# a transaction cr request wilt not t5s retume;d. The account number or tax l0 number on the account must be included with your request. If you have any questions: please call our Shareowner Relations Department at '-868-655-723?. Sincerely, Shareholder Gt~mrnunications Enclosures: Return all papers_ I jg(~ ~~~~ S~Z~ •s~~~hc~ x J 1 shcv~s ~ ZaZ.~~ ~~p Mark ru.s-4u~+- i~V~~ N.~ ,, ~' i~ _ , BNY Mellon Shareowner Services ~ ~ P.O. Box 358333 ~~` Pittsburgh? PA 15252-8333 ~~~1' ~~iFi.J.t7~1 }rt~i~=_~:~~~; r;~ ~ :ear: r~~~ I4~arch 31, 20I0 ~ C~inpany c1E~TERAL ELECTRIC Name 'CC-MPANY MARIA S RISERS . _ ..... .. - 20507 QtrARTERPATH TRACE CIR ~ Account Key .RI`S'ERS-_-JEROJO100 ------~ POTOMAC FALLS ~A 20165-7519 i Control ~20100331000~1979 Number' Telephone -:80+~-786-Z5~3--------._.._.. - RE; JEROI~IE JQSEPH Rl`~ERS & ~ ~Nurnber JOAN MARY RNERS JT TEN- -----..._.. _... _ - -.- -----.----__- .- -- .1 Dear Sir or vlada~n: Thank yrou for your inquiry requesting information for this account. Please lie informed that the number of shares as on tl6/0$!09 were 66.91. Also, note that the closing price? as on 46!08!09 was $~ 3.56Q4 per share. ~e hope you fFnd this information helpful. As a reminder, you may access our Investor ServiceDirect ~Neb site at y,,~w~w.bnyinellon.camishareowner!isd or call our automated voice res~~onse system at the above number far account infor<natian and to initiate certain transactions. You may also c~haase to speak with one of our Customer service Representatives who ~.re available from 9 a.m. until 7 p.m. on I~Ionday through Friday. Sincerely, ~' r II BNY Mellon•Si~areownzr Services 703-4041965 mid vas E~nt~w'' 4~tos~ sharehc~iders can manage their holdings oni~.ne Eviti', free aC~~SS %Q ~rJrilpU$~rShur~'S Inve~or C'Entre''"~ Vdr`i]Sit°. L1S~' tilJa Slll~r~l~ t~JOI ~0 quicitly are easily` :update account inforr~ato;Z~ sign u~ for elcCt~onic dMli~~er,~ o~ d~:rn2nts and mo;?. ~nrp1't FPE~ today of tiv~^ltiv.compu~er:~}~are.cam/investor. 10:31p Mark MARK 5 RIVERS 20507 QU~Ri~RPATH TRACE CIR STERLIi11G VA 24159-7519 Aprit lei, ~D10 Company: Registration ; Holder Account Number: Document I.D.: Our Reference: ALTRIA GROUP INC JERaNfE JOSEPH RIVERS & JQAN MARY RIVERS JT TE(V eaaa~s i4~~~ li)09aVtlFQ0566710 MQA/000~$74801.j25/SF55572 p.2 '~or~pu~+~r~~~re G~amputershare Itnrestor Servic~5 250 RD~~all Street Canton "ti4assachusetrs 0~0zt v:vrw.computershare.com Dear SirJMadarn: Than#c you for your inquiry regarding the above referenced account. We appreciate the opportunity do be of setvi~e to you. i $e~ow is the account balance informatian'you requested as of June Q8, 2flIJ~ for the above ,account. hype of Account: Common 5toek Total Shares: Y9.7.S~8b Closing I~rice Per Sham: $17:Zf We are currently maintaining a hero balance for this account. Ali shares were transferred an Juiy 30, 2009. Information pertaining to the other company accounts referenced in your letter wilt be separately mailed to the address shown above. Should you have other account related questions, please call us at 8~0-~i42-DQ77 during regular business hours. Please note that any available representative can assist you. You may write to us at t~mputershare, P.d. Box 4347$, Providence, RI 02440-3078. Sincerely, Service Representative Enclosure: None Mark 703-4041965 p,2 Did yc~a~ knc~~rar:~ Eyiost sliurel,~~lders can manage tl~er h3ldinc~s ~r~iinE ~.~rirh tree I acces ~ to tflmputershare`s In~esto, ~ entre~''' ~v~~ebsitc. Use ti~is simple tool t~~ quickie wnd casiiy update account inf~rrnatia~, sign up fcr eleccror3c delvorv of documents and more. ~nr~l! FF:EE Today at ~,~v~Fvv.~~ornputershare.ccrn/irn,estor. ~ I NARK S RIVERS 2051J7 QUARTirRI'ATH TRACE t~R 5TERLI~JG VA 2x155 April i6, 2010 Company: Registration; Holder Acxount Number: Document I,D.: Our Reference: PHILIP MORRIS TNTERNATIC1hIALIN0. JEROME JOSEPH RIVERS $c JEAN MARY RIVERS JT TEN 00006699276 IQQ9QWFQ05667a5 P HILJ0002879801/23/SF65572 ~omputershare Cnmloutershare Investor Services X50 R~yall Street Canton Mas$acf~usetts OzOZ1 vrww.COrriputershar2.com Dear Sir/Madam: . ThanCc yoc~ for your inquiry regarding the above referenced account. lNe appreciate the opp~~rtunity to be of service to you. , Below is the account balance information you requested as of June 08, 2009 for the above account. Type of Account: Common Stock Type of Holding: Book Entry '~ Total Shares: 18.7137 Closing Price Qer Share: $44.53 r. We are current{y maintair}ing a zero balance for this account. All shares were transferred are July 30, 2009. Should you have other account related questions, please call us at 877-7459350 durirkg regular business hours. Please note that any available representative can assist you. You may write to us at ~:amputershare, P.O. Box 4307$, Providence, RI 02940-307$. Sincerely, Service Representative Enclosure: None i I~ SCHEDULE E f CASH, BANK DEPOSITS, & MISC. li ,~ COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERT 1 INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER RIVERS, JEROME J ~' 21 - 2009 - 0598 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-ovWned with the right of survivorship must be disclosed on schedule F. -_ ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Cash 208.97 2 3 4 5 Misc. Contents of house Wells Fargo Advantage Fund 1992 Hond Accord-- Sale Price 2002 Ford Ranger (20,000 miles)-- Blue Book Value 3,817.00 10,183.01 500.00 4,175.00 TOTAL (Also enter on Line 5, Recapitulation) 18,883.98 Mark 703-4041965 p.2 i Wefts Farga Ad,rantage Funds`° • P.O. Box 82b6 ~ Boston, Massac"usett5 0~2b6 . VJW~N.4'~Cll$f8 rgacom!adva rtageFunds April 9, 2Q 10 i A-fAR~ S RI~II/RS ~ 20547 QLTARTERPATH TRACE~CZRCLIE POTOMAC FALLS ~A 20I65 REFERENCE: 05157536 ~eax Mr. Rivers: Thank you for your request to ~~erify assets far our mutual client, Jerome J. R.ivers_ Please accept this letter as your official verification of assets held with our company. The assefi balance as of June 8, ~00~, uras ~I0,18~.01. In order to secure our ciients' privacy, we rnaintaii~ physical, electronic and procedural safeguards to prt~tect sensitive information. In accordance with our privacy policy, personal account numbers and Social Security numbers have been Omitted. 7:'o further safeguaxd against identity theft and fraud, ~~e will no longer enclose copies a_E original documents v~ith our correspondence. rf you have any questions or require further assistan.Ge, please call us at 1-80~I-222-8222. Representatives are available 2~ ho>ars a day, 7 days a week. Sincerely,. ~~~~~ Ronald F. Morganelli Shareholder Servil/es Representative ,~ bells Fargo Funds 1tifanagement, LLC, a tivholly owned subsidiary of Wells Fargo & Company, provides investment advisory and adminisLratitie services for tf'ells Frngo tJd+arrnlage Funds'. flier affiliates of V~Ieils largo & Company provide subadvisory and other services for the Funds. The funds arc distnbuted bg ~~ells Farga Funds Distributor, LLC, hiem3~er FINRAISII'C, an at~liate of V4'el]s Fargo & Company. NOT FDIC INSURED ~ N4 BA11EK GUARANTEE MAl' I.flSE VALUE i .~Q~v ~~. ~v ~~r ~~~~. Q~~ .~ . .~>~~Rt ~~l~Xixi ~~i 1 Party Pricing Report -Kelley Blue Book Page 1 of ~; Send to Print advertisement i ,~: lWlfl i ~I~ ~ .. . ,._.. l 2Q02 Fard Ranger Regular Cab Shart Bed BLUE BUOKC~ PRIVATE PARTY VALUE ~~~. ~~;~ A ~ ~ Condition 6 13 x ~ ~ E~~ellent $;~~ load fair (Selected) Value $5,~~~ $~p $4,17 S r .~: Vehicle Highlights ' Mileage: 20,000 Engine: 4-Cyl, 2.3 Lifer Transmission: Manual, 5-Spd Drivetrain: 2WD Selected Equipment Standard ' 4~'~. ~ w t Power Steering Dual Air Bags Steel Wheels AM/FM Stereo ABS (4-Wheei) Blue Book Private Party Value • Kelley Blue Book Private Party Value is the amount a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (other than any remaining factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Vehicle Condition Ratings E~rue~l~nt ':`' $~,~~Q Cl05e WlndaW . Loal;s neW, is in excellent mechanical condition and needs no recanditianing. s l~lever had any paint ar body Work and is free of rust. Clean t'stle history and ~1;i11 pass a smog and safety inspection. ~ !=r}gine compartment is clean, with no fluid leaks and is free of any Wear or visibie defects. ~ Can"€~lete and verifiable service records, http://www.kbb.com/used-cars/ford/ranger-regular-cab/2002/private-party-value/pricing-report`?c... 11/16%? O l 0 advertisement ,, ~¢ „ ,. i ~-' i~ .%` ~~ ~ ,. / ~~ A B C 1 The Estate of Jerome J. Rivers 2 Personal Property Inventory 3 4 Item Value 5 Bedroom Set -Master Bedroom 250.00 6 Dresser 25.00 7 Dining Room Table and Chairs - 75.00 8 Curio Cabinet 250.00 9 Baker's Rack 50.00 10 Television 25.00 11 Living Room Set 150.00 12 Decorative Plates - 8 120.00 13 Golf Clubs 50.00 14 Fly Rod 50.00 -15 Baldwin Brass Sconces 35.00 16 Canoe 200.00 17 Jewelry 1,850.00 18 Shop Tools 387.00 19 Hand Tools 100.00 20 Roto Tiller 200.00 21 22 23 Total $ 3,817.00 ' I SCHEDULpEpF p COMMONWEALTH OF PENNSYLVANIA ' JOINTLY~OWNED PROPERTY I INHERITANCE TAX RETURN RESIDENT DECEDENT ___ --- _ - ESTATE OF FILE NUMBER RIVERS JEROME J ' ~I 21 - 2009 - 0598 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. Jerome B. Rivers Son JOINTLY OWNED PROPERTY; DESCRIPTION OF PROPERTY I LETTER ITEM ', FOR JOINT DATE MADE OF I °/~ ,Include name of financial institution and bank account number) DATE OF DEATH DECD'S DATE OF DEATH VALUE OF NUMBER TENANT JOINT for similar identifying number. Attach deed for jointly-held real 'VALUE OF ASSET INTEREST DECEDENT'S INTEREST estate. ._ _ ___ -- 1 A. 09/06/1996 --- _ _ , g ~ - Metro Bank-- Joint Checkin Acct. 19 810.19' S0%; I - - -- 9,905.10 __ __ _. _ - -- - --- _ ,_ TOTAL Also enter on line 6 Reca ~tulation 9,905.10 BANK 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 October 8, 2009 Coyne & Coyne Attn: Lisa Marie Coyne 3901 Market St Camp Hill, PA 17011 RE: Estate of: Jerome J. Rivers Tax Identification Number: 201-26-9119 Date of Death: June 8, 2009 To Whom It May Concern: $~a i~ ` '„v ~F ' ~°' ,v ~L, a„R ~ i t ~~~~ l ~ ~; ~~M1~ I~ r "' .,~ ,. ~ p x a This letter is in reference to decedent account informatidn you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 32067993 Date Opened: 09/06/1996 Date Closed:06/29/2009 Primary Owner: Jerome J. Rivers Secondary Owner: Jerome B. Rivers Date of Death Balance: $19810.19 Please feel free to contact me at (717) 412-6127 if !may be of further assistance. Sincerely, Diana Reynolds Metro Bank Research Associate/Deposit Services ., SCHEDULE G " INTER-VIVOS TRANSFERS & j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY ~ RESIDENT DECEDENT ESTATE OF I FILE NUMBER RIVERS, JEROME J ! 21 - 2009 - 0598 This schedule must be completed and filed if the answer to and of questions 1 through 4 on page 2 is des. DESCRIPTION OF PROPERTY T ITEM I Include the name of the transferee, their relationship to decedent and the date of transfer.) DATE OF DEATH % OF ~ EXCLUSION DECD'S TAXABLE VALUE NUMBER i Attach a copy of the deed for read estate.VALUE OF ASSET INTEREST (IF APPUCAI3LE) l _ __ _ - __ _ __ _, ~ 1 Fidelity IRA ~~ 7,051.29 100% ~ C 7,051.29 j I 2 'Janus Fund IRA 6,005.55] 100% 6,005.55 ~~~ I ~~ j II 3 ~ Vanguard IRA I 23,392.63 100% II, 23,392.63 i it ~I ~' 'I I ' ' I I'I ~! '. I~ ~I I~, 'I ~' I ~ i ~~ i ~ ~ '~ j i it i I i i '~ I~ I i I '~ ~ ~ ~~ ' I i TOTAL (Also enter on line 7, Recapitulation) ~ 36,449.47 P Mark 703-4041965 p.3 ~I- ~ ~ ~ Page > 1 of 1 - ~ ~t~~ ..._ ~ Jerome J. Rivers Report,for.06(l)8124Q9 ` :. ~ ~~~~ ~ ~ - . , . t3 .. 62d Colonic! Vie~N Rd ~ Client Services: 800-662-2739 Mechanicsburg, PA 17055-5855 Teta] report value: ~r23,392.63 ~ {Total repark value includes any accred dividends.) ~Jeramg J: R1vehS RTr'2rditio . al IRA' ~~ .- ~ ;~ . .- ...- - __- - -- _ ._.._._ ., f. ~ rrt .~atue~ummary. . v ~ ..+ r: • .. i J ~^• ~. .Z ..: , - v ... ~ _~ _ > • . a.• 1.. ...;A: ` Name Fund & Account -._ Qate • Price P9r _ 1 _ _ Accrued Number opened Shares Share Value" Dividends Total Stock Mkt Idx Inv 0085-099fl8520816 ©61261997 1,013.985 $23.07 $2:3,392.63 - Totals 52;3,392.83 $0.0{} Oaesn'i Include accrued dividends. - ~' - -- ~. 151495911 i:- 04!051201(} 10.51:51 MARK S RIVERS EXECUTQR JEROME J RIVERS ESTATE 20507 QUARTERRATH TRACE C[R i' P~TONiAC FALLS VA 2D155-7519 REFERENCE: 01982751 ACCOUNT NUM[iER 2 552 STATE ST BANK CIS IRA JDAN MARY RIVERS C--~"" Dear Mr. Rivers: This letter is in response fo a request for Janus account information. The account information provided below is unaudited. We appreciate the opportunity to be of service. if ~rre can be of additional assistance, please give us a call. . Sincerely, .~ ~~ t ft~; ~"~ ~. ; i ~: t i C~ r'~ fem. ~~~~\./fit.,,, !~ ~~.~"'~.... Y 1. Michel a Studer Invest r Seruices Date FundlAccount Number Transaction Share Price Shares Doliar Amount Ogr04~99 54/2D25o1552 Balance $23.02 121.178 $2,789.52 0/08/09 54~21}25D1552 Balance I $35.26 17U.322 _ $6,005.55 Z~d .'i. ~c:, ,.ii:;~~i..., ..... ...._ .... ..:..... :.:.!:.,.. _.i_._, .:; ~ r:~.r~::.:; ..:;:~.... r .;i ..~'c:y; ..~o ~AUJAN50 996 ~-t~4~-~OL ~a~W d6Z~0 ~ 0 L ~ ~ nc Mark ~ :- r ~ .. ~--t ~ v ~ ~ r ~- ..~ c}..i .s.~ ~ ~ ~ ~ -•-+ s~ ° u ~ ~ a~ ~ , ,~ ` ~' ~ o ~ `n .vr .. u.-, ~ ~ ~ ~ fJ ~ ~~~~ d '~'+ ~ ~ ~~ :J t ~ ~-~~1~"~t~ 'A~ p r-~ O .~'~.~ O ~ ~ ~ ~ . ~ ~ ~ .. ~ ~ ~ ~ M h ~ n ~ ~ ~ ~ ~ o v ° ~ ~ ~a ~ ~ ~ ~ ' .+. a ~~ a ~ , .~ x ' I ~ ~ ~ ~ '" ~ ~ .~ x ~, w d ;+ ~ ~ ~ c-s R ~'~' ~ ~" v ~,D ~ r-{ O M .3 -,~ ~+ Q ~ ~ R+ ~ v v ,~ ,; ~ ~~~~ ~~ .~, ~ :v o~``~ G7 ~~.~ ~~ `nom ~ p ~.. ?~ W ~ ~ j -.,.. ~, ~ tU ~, C7 ~ ~ '..~ -___ 1 ZI1 ` ~i? ~ © 1 O G ~ cn c-'~ ~ 1'' ~ ~ ~~ i ._ ~ .. ~ ~ ~ ~ ~p rS~ ~ ~ k s ~~ ;~ ~~~ ~ ~ ~ ~ ~i~~ ~o~ ~~~ r ~ , C3 ~ ~ ~ cd ~ ~ ! ~ ~ ~ ~ ~ P ~ 703-404'1965 rn ~- O r-- .cJr ~ ~ ~ ~ ~ ~ ~ ~ O ~ ~ E-^ '~` c.~ u ~ Q ~~ ~~ C1 ~ E-' N' u~ 0 _,-~ m w a~ 0 w N t-~ ~ •r G ~ H ~ _-~ ,.:n ~ ~> c~t7 ~ ~ ~ _~ t) U ~ +~ ;Y, ~ ~ 0.+ ~ ~ ~ ~ o _~ ~ ~ ~ ~ ~ ~~ m ~ v~ +~ ~ M a.+ ~ r1 ~ ~ v7 ~~ o ~-' ~~ ~~ ,,~ ~s o ~ ~ ~ ~" m ~~ _~ ~, {'-' ~~ ~ ~ ~' u ~ ~ W ~ ~ ~ a U 3 ~ ~ ~ ~ ~ V ~ 0 ,~ ~a 3 O ~-c tQ .~ F' REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA =---.~ CERTIFICATE OF GRA~IT OF= LETTERS No . 2009- 00598 ~ PA No . 21- 09- 0598 Estate Of : JEROME J RI VERS (First, Middle, Lasil Late Of : UPPER ALLEN .TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : 20 ~-26-9 ~ 79 WHEREAS, on the 26th day of June 2009 an ir~strument dated September 10th 1999 was admitted to probate as the last will of (First, Midd/e, Lastl late of UPPER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 8th day of June 2009 and, WHEREAS, a true copy of the will as probated i s annexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH Register of~ Wi 11 s in and for CUMBERLAND County, in ~ the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: MARK STEPHEN RIVERS who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CA RL lSL E, PENNS YL VA NlA . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 26th day of June 2009. ,n * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ~--~ ,~ `; ~C-'-~ ~ - .c_' t~fJ ~~ ~~ P ----t f U e'er f~rr r //~,.'~' ,~+ 1 ~ `~ j ~~ '(~~.,,,a,~^"j~L'!1.~-'~„rf"'~," 6~4~ r^ (. ~r ~-=' ~~ ~ .~ f ~, .. .__~._.- .r/ ~i. ~:.. ,, w '7 > '', ~ ~ ~~~ ~ ~. -'~ / ~~ ~ r, __? ~~ ~r°~~~A~ ~ ~ /u/ ~ t...''.. `..! 1 ~~~ e r f t I~ f ~. '~ 9i../J 1YY~: ~f - ~;~.++.e..vna.- ~.- _ ~ ter. .,.~ __.: .:. , _.. _ __ L.. 1 .~'r--~.' +...~ ......_...~._,..a...~...--1 r ;~ P ~ ~~ ~ ~ ~-~ P ~' _~. ^„~ 1 ~\~ .. 1 r~ J ~' °• ~, '~ ,~ L. .~ ~~` ~~~ f/'- /pp ' ~. /~~? .ti Y'~ .J.Y. d' ~~ fl ~% ~, ../" //` i , r~~ ~~ n ~' ~ .~ y / _` ~` R r +` ~.. j ~ ~~ ~, ~~ ~ t ,~ ~~ E #~ - '" ~ :~ ~ .. ' t, { f'~. ~f ~.:~ 1 w/ % r ~ ~~ • 'i 1 i'=r ~ 3 f (i' wiF: r w.r~.y 2 ~ .1 ' /,.-. t ~,~ ' ~ rr 1 ,.,ice ~~';{".~ tt%% ,:! , i ~ s l/ 1~ ~ ' t ~ ``' ,_...--~- ~ ''~ ~~ ,/~~ - .i ,,rte ~;;~` L-~ ~~ ~ r :t - i~J• ,~,4F~.F y _ .~,,,,~.~ ., ,, f7 ,.~ ~- ~. ,, v'~'~ ~~,, ' Y~ f~~1 r, ~ ~' r ,~"7 r ` ~ ~i~ ~~r Y * wry./,~, {,,t! f ~~ ~ !~~ ~.1~ ~ +~.. l4 ~~ ~-~ jJr\ „ `yj i ~_tif ~ rF ~~ j//~~~ B 1 ~ ~ P~ r. . " f ~ r ' ~ ~~ 6+ ~~j -~ n ~"~...~:-- -~,. ~ ~~- Y ~~ t G` . ~ roc ,,(({JJ~/~~ ., a ~~~ r "~ ~! s ~ ~- ~~-- Y ~r , ~, ~/_,~'~ 7 J a ~ J4°' y' ~ .J. ? Y '~ ;1 / ~, .~ -- .`3 _`? ~ ~ SCHEDULE H ` FUNERAL DCPENSES & COMMONWEALTH OF PENNSYLVANIA ~'~ „r, ~~ ~~ INHERITANCE 7AX RETURN N~ I RESIDENT DECEDENT ESTATE OF FILE NUMBER RIVERS, JEROME J 21 - 2009 - 0598 Debts of decedent must be reported on Schedule I. ITEM.... _ _ _ - _ _ _- _ _ _ _- _ __ _ _ - - - -- -- _ -- NUMBER' DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~ Malpezzi Funeral Home ~ 10,928.37 2. Headstone & Engraving 3,450.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees COYNE & COYNE, P.C. 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 Cumberland County Register of Wills i 6,000.00 5. Accountant's Fees 6. ! Tax Return Preparer's Fees 7. Other Administrative Costs 1 Postage 2 ~' Patriot News-- Legal Advertisement 345.00 88.00 130.31 ', Total of Continuation Schedule(s) 29,807.64 TOTAL (Also enter on line 9, Recapitulation) 50,749.32 Schedule H '', Funet~ ~~~ ~""' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~ ~~~~ ~~ ~~~~ ~ RESIDENT DECEDENT ESTATE OF j FILE NUMBEIR RIVERS, JEROME J 21 - 2009 - 0598 3 Cumberland Law Journal-- Legal Advertisement i 75.00 4 Inheritance Tax Filing Fee 15.00 5 '~ Homeowners Association Fee 512.00 6 Bank Fees & Estate Checks ~ 75.00 7 Refund of Overpayment of Pension 855.90 8 Haller Enterprises--Repair of Heat pump for Sale of House 4,100.00 9 Material for Repairs to House required for Sale 6,002.94 10 Dumpster Rental 476.17 11 Ashcombe Farm & Greenhouse-- Shrubs 176.91 12 Mechanicsburg Carpentry ~' 259.38 13 Closing Costs for Sale of Residence 12,024.05 14 Uncleared Checks 250.00 15 Reserves 3,000.00 16 Income Tax Preparation Fees ; 1,000.00 17 State Farm Bond ~ 100.00 18 ! D. Frank-- Trash Hauling 600.00 19 Rappers Rollbak Towing 75.00 20 ~, American Complete Security-- Change Locks on Doors 100.00 21 ~'~ Classic Dry Cleaners ~ 2.69 22 Joseph A. Bank--Burial Atiire ' 106.60 23 Change of Address-- USPS 1.00 Page 2 of Schedule H '' SCHEDULEI y ~ DEBTS OF DECEDENT, MORTGAGE ICI Q COMMONWEALTH OFPENNSYWANIq LIABILITIES, VL LIENS INHERITANCE TAX RETURN ' RESIDENT DECEDENT l ESTATE OF FILE NUMBER RIVERS, JEROME J 21 - 2009 - 0598 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 2 3 4 5 6 7 8 9 10 Sewer & Trash 229.66 Verizon 40.40 Bank of America 67.20 PP&L 429.18 AT&T 54.94 Central Pennsylvania Hemotology 8..00 United Water 80.09 Kerry's Lawn & Garden 376.42 Pat's Home & Services 2,007.72 Marlin Yahn Tax collector 1,216.28 TOTAL (Also enter on Line 10, Recapitulation) 4,509.89 REV~1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARfES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER - RIVERS, JEROME J ~~ 21 - 2009 - 0598 ' RELATIONSHIP TO AMOUNT OR SHARE NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I DECEDENT I OF ESTATE -- _ ' _ - D2NoIList TLUStes(sl I __ _ _ _ - _ _ I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Wayne P. Rivers i Son ~~~ ll4 of Residual 444 W. Areva Ave. Hershey, PA 17033 ~I ll. I 2 Jerome B. Rivers ~ Son i $10,000 and 1/4 of 170 Hudson Drive ~ I Residual Phoenixvill, PA 19460 3 Michael V. Rivers ~ Son 1/4 of Residual 6520 Valley Stream Way Cumming, GA 30040 i 4 Mark S, Rivers ~ Son i 114 of Residual 507 Quarterpath Trace Cir. j Potomac Falls, VA 20165 ~ i !Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shE:e~t NON-TAXABLE DISTRIBUTIONS: ~ ~A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT ,BEING MADE I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS i ~i ' i TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET