HomeMy WebLinkAbout02-18-111505610149
EX (01 10)
REV-1500 OFFICIAL USE ONLY
pennsytvania
PA Department of Revenue °`''"'"`"'°`"`""" County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280801 ' ~"Y ~~
Harrisburg, PA 17128-0801 RESIDENT DECEDENT .~ I 'l.
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
006 34 6948 06 19 2010 0? 14 1939
Decedent's Last Name Suffix Decedent's Frst Name MI
Carignan Mr• Ronald G
(If Applicable) Enter Surviving Spouse's Information Beiow
Spouse's Last Name Suffix Spouse's First Name MI
Carignan Mrs Nancy L
spouse's Soclal Secunty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
00? 36 1166 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return D 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
D 4. Limited Estate O 4a. Future Interest Compromise (date of D 5. Federal Estate 1"ax Return Required
death after 12-12-82)
~ 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 8. Total Number oi` Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death C~ 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 Should be Directed to:
Name Daytime Telephone Number
Elyse E• Rogers, Esquire 717 612 5801,
~~,x~
Frst line of address
Keefer Wood Allen & Rahal, LLP
Second line of address
635 N• 12th Street, Suite 400
City or Post Office State ZIP Code
Lemoyne PA 1,7043
REGISTER 1K1J<LSUSEOf~,.4~
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DATE FILED ~"_"~
Correspondent's a-mail address: erOgerS~a keeferw00d.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 the preparer other than personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RET_U,/R'}N DATE y
ADDRESS 3507 Margo Road 4 /
Cam I , PA { 1 X011
SIGNA R FPREPARjtROTH R HANREPRESENTATIVE DATE
ADDR ss 35 North 12th t eet Suite 400
Lemoyne, PA 17043
PLEASE USE ORIGINAL FORM ONLY
1505610149
Side 1
150561149
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1505610249
Rev-1500 EX
Decedent's Social Security Number
0 0 6 3 4 b 9 4 8
Decedent's Name: Ronald G. Carignan Mr.
RECAPITULATION
D•OD
1. Real estate (Schedule A) •••.••.•••••••••••••••••••••••••••••••••• 1-
D•OD
2. Stocks and Bonds (Schedule B) ...••.•••••••••••••••••••••••••••••• 2•
D • 0 D
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . • • • • • 3.
4. Mortgages and Notes Receivable (Schedule D) .. • . • • • • • • • • • • • • • • • • • • • • • 4. D • 0 D
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... • • • • 5. D • 0 D
6. Jointly Owned Property (Schedule F) O Separate Billing Requested • . • .. • 6. D • 0 D
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 9 4 8 , 8 5 4 •9 0
(Schedule G) ~ Separate Billing Requested • • • • • • 7.
8. Total GrossAssets(totalLineslthrough7).......••••••••••••••••••••• 8. 948,854.9D
D • 0 0
9. Funeral Expenses and Administrative Costs (Schedule H) g,
D • 0 D
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ..... • . • • • • • • 10.
D•OD
11. Total Deductions (totalLines9and10) ••••.•••••••••••••-••••••••••• 11.
948,854.9D
12. Net Value of Estate(Line8minusLinell).•••.•••••••••••••••••••••••• 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which D • 0 0
an election to tax has not been made(Schedule ))..•.••••••••••••••••••• 13.
9 4 8 , 8 5 4 •9 0
14. Net Value Sub'ect 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
948, 854 •90
15
D • 00
(a)(1.2)x.oo .
16. Amount of Line 14 taxable
0 •0 0
0 •0 0
at lineal rate x .045 16.
17. Amount of Line 14 taxable
0• D O
0• D D
at sibling rate X .12 17•
18. Amount of Line 14 taxable
0. 0 0
0 •0 0
at collateral rate x .15 18
D • D 0
19. TAX DUE .................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q
Slde 2
15056],0249 1505610249
Rev-1500 EX Page 3
Decedent's Complete Address:
Fle Number
DECEDENTS NAME
Ronald G. Cari pan Mr.
STREET ADDRESS
3507 Mar o Road
CITY
Cam Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
(1) 0.00
0.00 Total Credits (A + B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Flll in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
Make Check Payable to: REGISTER OF WILLS, AGENT.
0.00
0.00
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;........••••••••••••••••••••••••••••• C1
b. retain the right to designate who shall use the property transferred or its income; • .. • . • . • • • • • • • . • ^
c. retain a reversionary interest; or ................................................... Q
d. receive the promise for life of either payments, benefits or care? • • . • • • • • • • • • • • • • • • • • • • • • • • • ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year
of death without receiving adequate consideration? ••••••.•••••••••••••••••••••••••••••••• ^
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 containsabeneficiarydesignation? .•••••••••••••••••••••••••••••••••••••••••••• ~ ^
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. Sect. 9116(a)(1.1)(i)].
For dates of death on or after Jan. 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. Sect. 9116(a)(1.1)(ii)]. The statue 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. Sect. 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. Sect. 9116(1.2) [72 P, S. Sect. 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. Sect. 9116(a)(1.3)]. A sibling
is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1510 EX+(08-09)
Pennsylvania
I]~,~'ARTMkN7 t7 f" iti'VFN4iE
INHERITANCE TAX RETURN
RESIDENTDECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Ronald G. Carignan Mr.
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUM DESCRIPTION OF PROPERTY
iNCLUDENAMEOFTRANSFEREE,RELATIONSHIPTOOECEDENT&
DATE OFTRANSFER, ATTACH COPYOF DEED FOR REAL ESTATE
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
(IF APPLICABLE}
TAXABLE
VALUE
1 IRA account #2070-6147 6, 894.41 100 6, 894.41
Beneficiary: Decedent's surviving spouse,
Nancy L. Carignan
2 IRA Account #1036-3777 941, 960.49 100 941, 960.49
Beneficiary: Decedent's surviving spouse,
Nancy L. Carignan
TOTAL (Also enter on Line 7, Recapitulation) ~ 94$,854.90
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
~ Pennsylvania SCHEDULE J
ICI PAN'TMFNT t)F ~iE`Vt NUF
INHERITANCE TAX RETURN ~ BENEFICIARIES
RESIDENTDECEDENT
ESTATE OF: FILE NUMBER:
Ronald G. Carignan Mr.
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not List Trustees OF ESTATE
z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2).]
Nancy L. Carignan Surviving spouse 948,854.90
3507 Margo Road
Camp Hill, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SH EET, AS APPROPRIATE.
zz NON-TAXABLE DISTRIBUTIONS:
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.
If more space is needed, use additional sheets of paper of the same size.
1 - .~ - . ~1
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OF
RONALD G. CARIGNAN
I, RONALD G. CARIGNAN, of Hampden Township, Cumberland
County, Pennsylvania, do make, publish and declare this to be my Last Will and
Testament, hereby revoking all Wills and Codicils by me heretofore made.
ITEM I: I direct that all inheritance aril Estate
taxes becoming due by reason of my death, whether payable by my estate or by any
recipient of any property, shall be paid by the Executor out of the residue of my
estate, as an expense and cost of administration of my estate. The Executor 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 thi,~; Will.
ITEM II: I direct the Executor to pay the expenses
of my last illness and funeral expenses from the residue of my estate as an expense
and cost of administration of my estate.
ITEM III: If I die before my wife, NANCY L.
CARIGNAN, I give to her all of my household furniture and furnishings, books,
pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of
household or personal use or adornment and all policies of insurance thereon. If I
do not die before my wife, I may leave a written list in my safe deposit box or
elsewhere disposing of certain items of my tangible personal property. The
Executor shall dispose of items of my personal property as specified in the. written
list. If no written list is found in my safe deposit box or elsewhere and properly
Page 1
identified by the Executor within thirty (30) days after the probate of my Will, it
shall be presumed that there is no other statement or list. Any subsequent
discovered list shall be ignored. I give to my children living at the time of my death
any tangible personal property not set forth in a written list, to be divided between
them as they shall agree. If my children are unable to agree, the Executor shall
divide this property between my children in as nearly equal portions as they
Executor, in the sole discretion of the Executor, deems practical, having due regard
to the personal preferences of my children.
ITEM IV: I give the residue of my estate, not
disposed of in the preceding portions of this Will, as follows:
(a) To my wife, NANCY L. CARIGNAN, as Trustee, IN
TRUST, to be administered and distributed as provided in ITEM V, a
fraction of my residuary estate. The numerator shall be a sum equal
to the largest amount that can pass free of Federal estate tax under
my Will by reason of the applicable credit amount and the state death
tax credit (provided that the use of this credit does not require an
increase in state death taxes) allowable to my estate but no other
credit and after taking account of dispositions under other items of this
Will and property passing outside of this Will which do not qualify for
the marital or charitable deduction and after taking account of charges
to principal that are not allowed as deductions in computing my
Federal estate tax. The denominator shall be the value of my
residuary estate. For purposes of establishing this fraction, the values
finally fixed in the Federal estate tax proceeding relating to my estate
shall be used. I recognize that the numerator of such fraction may be
zero (0), in which case no property shall pass to this Trust. I also
Page 2
recognize that the numerator may be affected by the action of the
Executor in exercising certain tax elections.
(b) The balance of my residuary estate shall be paid to my
wife, NANCY L. CARIGNAN, if she survives me. If she does not
survive me, this portion of my estate shall be added to the Trust
funded pursuant to subsection (a) and shall be administered and
distributed as provided in ITEM V.
TTEM V: The following provisions shall apply to
the Trust established by ITEM IV (a):
(a) This Trust shall be known as The Carignan Family Trust.
(b) The Trustee shall pay to or for the benefit of my wife,
NANCY L. CARIGNAN, all of the net income of this Trust in
convenient installments, but not less frequently than annually. T]ze
Trustee shall also pay to my wife so much of the principal of this Trust
as may be necessary in the discretion of the Trustee for the proper
support, maintenance and medical care of my wife.
(c) Upon the death of my wife, the Trustee shall pay over al].
of the remaining assets, to one or all, or less than all of my issue, in the
amounts, and in the estates, in trust or otherwise, as my wife may
direct, making specific reference to this Power of Appointment, either
by written instrument filed with the Trustee during her lifetime or by
her V~'ill.
Page 3
In no event may this Power of Appointment be exercised
in favor of my wife, her estate or creditors of either.
(d) If my wife does not, for any reason, exercise this Powe~° of
Appointment in whole or in part during her lifetime, or in her Last
Will and Testament, then upon the death of my wife, or upon my death
if my wife fails to survive me, Trustee shall distribute the unappointed
principal to my daughter, PAIGE CARIGNAN, if she is living at t:he
time of distribution. If she is not living at the tune of distribution,
FIFTY (50%) PERCENT of the unappointed principal shall be
distributed to my son, GREGG CARIGNAN, and FIFTY (50%)
PERCENT of the unappointed principal shall be distributed to the
then living issue, per stirpes, of GREGG CARIGNAN.
ITEM VI: No part of the income or principal of any
Trust created by this Will shall be subject to attachment, levy or seizure by any
creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary
prior to his or her actual receipt of income or principal distributed. The Trustee
shall pay the net income and the principal to the beneficiaries specified by me, as
their interests may appear, without regard to any attempted anticipation, pledging
or assignment, and without regard to any claim or attempted levy, attachment,
seizure or other process against the beneficiary.
ITEM VII: In addition to the powers grant;ed at law,
the Executor and the Trustee shall each possess the following powers, each of which
may be exercised without court approval and in a fiduciary capacity only:
Page 4
(a) To retain any investments I have at my death, including
specifically those consisting of stock of any bank even if I have named
that bank as the Executor or Trustee.
(b) To vary investments, and to invest in bonds, stocks, notes,
real estate mortgages or other securities or in other property, real or
personal, without being restricted to so-called "legal investments", and
without being limited by any statute or rule of law regarding
investments by fiduciaries.
(c) In order to divide the principal of a Trust or for any other
purpose, including final distributions, the Executor and Trustee are
authorized to divide and distribute personal property and real
property, partly or wholly in kind, and to allocate specific .assets among
beneficiaries and Trusts so long as the total market value of each
share is not affected by the division, distribution or allocation in kiind..
The Executor and Trustee are each authorized to make, join in and
consummate partitions of lands, voluntarily or involuntarily, including
giving of mutual deeds, or other obligations, with as wide powers as a_n
individual owner in fee simple.
(d) To sell either at public or private sale real and personal.
property severally or in conjunction with other persons, and to
consummate sale(s) by deed(s) or other instrument(s) to the
purchaser(s), conveying a fee simple title. No purchaser shall be
obligated to see to the application of the purchase money or to make
inquiry into the validity of any sale(s). The Executor and Trustee are
authorized to execute, acknowledge and deliver deeds, assignments,
Page 5
options or other writings as necessary or convenient to any of the
power conferred upon the Executor and Trustee.
(e) To mortgage real estate, and to make leases of real estate.
(f) To borrow money from any person, including the Executor
or Trustee, to pay indebtedness of mine or of my estate, expenses of
administration or inheritance, legacy, estate and other taxes, and t;o
assign and pledge assets of my estate or any Trust established by this
Will.
(g) To pay all costs, taxes, expenses and charges in
connection with the administration of my estate or any Trust
established under this Will.
(h) To make distributions of income and of principal to the
proper beneficiaries, during the administration of my estate, with or
without court order, in such manner and in such amounts as the
Executor deems prudent and appropriate.
(i) To vote shares of stock which form a part of my estate or
any Trust established under this Will, and to exercise all the powers
incident to the ownership of stock.
(j) To unite with other owners of property similar to property
in my estate to carry out plans for the reorganization of any compa:r~y
whose securities form a part of my estate.
Page 6
(k) To disclaim any interest in property which would devolve
to me or my estate by whatever means, including but not limited to the
following means: as beneficiary under a will, as an appointee under
the exercise of a power of appointment, as a person entitled to take ~-y
intestacy, as a donee of an inter vivos transfer, and as a donee under a
third-party beneficiary contract.
(1) To prepare, execute and file tax returns of any t~Tpe
required by applicable law, and to make all tax elections authorized ~by
law.
(m) To employ custodians of property, investment or business
advisors, accountants and attorneys as the Executor or Trustee deems
appropriate, and to compensate these persons from assets of my est;ate
or trust, without affecting the compensation to which the Executor and
Trustee are entitled.
(n) To divide any Trust created in this Will into two or more
separate Trusts so that inclusion ratio for purposes of the generation-
skipping transfer tax shall be either zero or one, in order that an
election under Section 2652(a)(3) of the Internal Revenue Code may be
made with respect to one of the separate Trusts, or for any other
reason.
(o) To allocate administrative expenses to income or to
principal, as the Executor or Trustee deems appropriate. However, no
allocation to income shall be made if the effect of the allocation is to
cause a reduction in the amount of any estate tax marital deduction o:r
estate tax charitable deduction.
Page 7
(p) To do all other acts in their judgment necessary or
desirable for the proper and advantageous management, investment
and distribution of the estate and Trusts established under this Will.
ITEM VIII: The Trustee is authorized to distribute
principal and/or income in any one or more of the following ways if the Trustee, in
the sole discretion of the Trustee, considers the beneficiary unable to apply
distributions to the beneficiary's own best interests, or if the beneficiary- is under a
legal disability:
(a) Directly to the beneficiary;
(b) To the legal guardian or conservator of such beneficiary;
(c) To the Trustee, or to another person selected by the
Trustee, as custodian under the Pennsylvania Uniform Transfers to
Minors Act as to a beneficiary under the age of twenty-one (21) years;
(d} To a relative of the beneficiary, to be expended by that
relative for the benefit of the beneficiary; or
(e) By directly applying distributions for the benefit of the
beneficiary.
ITEM IX: Should my wife, NANCY L. CARIGNAN,
by Will or Agreement of Trust, establish Trusts similar to the Trusts I have
established for the benefit of my issue, the Trustee of each Trust created in this Will
shall have the right to merge it with the similar Trust created by my wife for the
Page 8
same beneficiaries. If merged, the Trustee shall operate the merged Trusts as a
single Trust.
ITEM X: If a beneficiary under the age of
twenty-one (21) years is entitled to receive assets under this Will, my daughter,
PAIGE CARIGNAN, shall receive those assets as Custodian for the beneficiary
under the Pennsylvania Uniform Transfers to Minors Act. The Custodian nay
receive and administer all assets authorized by law, and shall have full authority as
provided in the Pennsylvania Uniform Transfers to Minors Act to use assets in the
manner the Custodian deems advisable for the best interests of the beneficiary. I
also designate my daughter, PAIGE CARIGNAN, as successor Custodian of any
property for which I am custodian under any Uniform Gifts to Minors Act o:r
Uniform Transfers to Minors Act.
ITEM XI: Any person who has died within thirty
(30) days of my death, or under such circumstances that the order of our deaths
cannot be established by proof, shall be deemed to have predeceased me. Any
person (other than myself} who has died at the same time as any beneficiary under
this Wi11, or in a common disaster with that beneficiary, or under such
circumstances that the order of deaths cannot be established by proof, shall be
deemed to have predeceased that beneficiary.
ITEM XII: I appoint my wife, NANCY L.
CARIGNAN, to be the Executrix, hereafter referred to as "Executor". In the event
of her death, inability or refusal to serve, I appoint my daughter, PAIGE
CARIGNAN, to be the Executor. In the event of the death, inability or refusal of my
wife, NANCY L. CARIGNAN, to serve as Trustee, I appoint my daughter, PAIGE
CARIGNAN, to serve as successor Trustee. In the event of the death, inability or
refusal of both my wife and my daughter to serve as Executor or Trustee, I appoint
Page 9
my brother, LARRY CARIGNAN, to serve as successor Executor or Trustee. The
Executor and Trustee are specifically relieved from the obligation of filing bond or
entering security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my
Last Will and Testament, consisting of this and the preceding nine (9) pages, at the
end of each page of which I have also set my initials for greater security and better
identification this ~ ~ day of , 20 ~' .~-
(SE.~L)
ONALD G. CARIGNAN
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published and declared by the above-named Testator as and for his Last
Will and Testament, in the presence of us, who, at his request and in his presence
and in the presence of each other, have hereunto set our hands and seals t;he day
and year first above written, and we certify that at the time of the execution
thereof, the said Testator was of sound and disposing mind and memory.
(SEAL) Residing at
(SEAL)
Residing at
ACKNOWLEDGMENT
COMMON~jEALTH OF PENNSYLVANIA }
SS:
COUNTY OF )
I, RONALD G. CARIGNAN, Testator, 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 and
Testament; that I signed it willingly; and that I signed. it as my free and. voluntary
act for the purposes therein expressed.
RONALD G . CARIGNAN
Sworn to and subscribed before
me this day of
20
Notary Public
My Commission Expires:
(SEAL)
(SEAL)
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF )
We,
and
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 Testator, RONALD G. CARIGNAN, sign and execute the instrument as his
Last Will and Testament; that Testator signed willingly and that he executed said
Will as his free and voluntary act for the purposes therein expressed; that; each of us
in the hearing and sight of the Testator signed the Will as Witnesses; and. that to
the best of our knowledge the Testator was at that time eighteen (18) or more years
of age, of sound mind and under no constraint or undue influence.
Witness
Witness
Sworn to and subscribed before
me this day of
20
Notary Public
My Commission Expires:
(SEAL)
58323 1
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r,.n :,,7..~~~ a d "w ra
M£h16CR F,~dRA SfPC, MSRtl
756 SHREWSBURY AVENUE 4+ FLOOR TINTON FALLS. N~ 07'2»
003442 O1 MAAD 12 AUTO**MIXED AADC 280
I~~~III~~~lll~~~~~~ll~~~ll~~~ll~l~l~~l~~l~l~~lll~~~l~~~ll~l~~l
RON G CARIGNAN (DECD) (IRA)
FCC AS CUSTODIAN
3507 MARCO RD
CAMP HILL PA 17011-1544
~~
~..~.~
SOLD QUANTITY
BIONOVO INC 5,385
415
i00
100
6,000
SYMBOL BNVI ACCOUNT TYPE CASH
SECURITY NUMBER 1320-329 TRADE DATE 06/28/10
CUSIP 090643-10-7 SETTLEMENT DATE 07/01/10
UNSOLICITED
MARKET OVER THE COUNTER
TRADE INFORMATION: PREFERRED RATE APPLIED.
CONFIRMATION
DATED 06/28/10
Account Number 2070-6147
YOUR ACCOUNT EXECUTIVE
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888-226-8663
PRICE - _ __
PRINCIPAL
0.41010 2, 208.39
0.41050 170.36
C. ;1 ^v20 41.v^2
0.41040 41.04
0.41014 2,460.81
average price
CHARGE/COMMISSION 25.00
CHARGE/OTHER FEE' 25.07
NET AMOUNT $2,41Q.74
'INCLUDES $25..00 TRANSACTION FEE
SEE ITEM 15 ON PAGE 2
SOLD QUANTITY PRICE PRWCIPAL
NYMOX PHARMACEUTICAL 1,500 3.02250 4,533.75
CORP
SYMBOL NYMX ACCOUNT TYPE CASH CHARGE/COMMISSION 25.00
SECURITY NUMBER 2822-814 TRADE DATE 06/28!10 CHARGE/OTHER FEE' 25.08
CUSIP 67076P-10-2 SETTLEMENT DATE 07/01/10
SOLICITED NET AMOUNT $4,483.67
'INCLUDES $25.00 TRANSACTION FEE
SEE ITEM 15 ON PAGE 2
MARKET OVER THE COUNTER
TRADE INFORMATION: PREFERRED RATE APPLIED.
SECURITY INFORMATION: FOREIGN SECURITY SUBJECT TO TAX.
._.
Account carried by First Clearing, LLC, member NYSEISIPC.
For Address Correction And Payment Due Instructions Please Refer To Contact Information On Page 2 Of This ~Gonfirmation
159 CN CN09
I L)C la 1lJ UC3442 1 -~0t 18zD1 la NtJNNN NNNNPJ IdNIVNNNNN 0( 0001 Page 1 of 2
Creega~~ cP~ Nassoura Financial Group, LLC
117 Bow Street, Suite 111
Portsmouth, NH 03801
603 778-0794
PORTFOLIO STATEMENT
As of 06/19/2010
Ronald G Carignan SEP-IRA Acct #: 1036-3777
3507 Margo Rd
Camp Hill, PA 17011
Estimated
Unit Cost Current Current Current Annual YTM
Weight Description Quantity Cost Basis Price Value Yield [ncome Cost
Equities
Utilities
1.5% Exelon Corporation 350 43.18 ] 5, 111.45 41.24 l 4,434.00 5.l °ro 735
1,7% Progress Energy lnc 400 42.56 17,024.95 40.34 16,136.00 6.1 °ro 992
3.2% 32,136.40 30,570.00 5.6°/~ _
1,727
Energy
1.8% Amerigas Partners Lp 400 28.42 11,369.95 41.78 16,712.00 6.7% 1,128
0.8% BP, Plc Adr 225 68.49 15,411.20 31.76 7,146.00 0.0% 0
1.8% Conocophillips 300 58.03 17,409.95 56.01 16,803.00 3.9% 660
4.5% Enterprise Products Prtnrs L 1,220 25.13 30,659.90 34.82 42,480.40 6.5% 2,769
2.5% NuStar Energy Lp 409 36.85 15,069.95 57.07 23,341.63 7.5% :1,742
2.1% T C Pipelines Lp 500 32.17 16,084.95 39.02 19,510.00 7.5% 1,460
13.4% 106,005.90 125,993.03 62% _
7,760
Financial
2.3% Alliancebernstein Hldg 750 33.07 24,804.95 29.40 22,050.00 6.3% 1.,380
1.3% American Express Company 300 44.64 13,392.09 42.03 12,609.00 1.7% 216
0.8% Apollo Investment Corp 750 21.08 15,807.88 ] 0.3 I 7,732.50 10.9% 840
1.8% Metro Bancorp Inc 1,322 18.82 24,885.00 12.93 17,093.46 0.0% 0
6.3% 78,889.92 59,484.96 4.1% 2'.,436
Real Estate Investment Trusts
0.3% First Industrial Rlt}~ Tr 500 29.81 14,904.95 6.11 3,055.00 0.0% 0
2.4% HCP, Inc 700 16.79 11,753.00 32.72 22,904.00 5.7% 1,302
0.3% Hersha Hospitality TRUST 500 6.50 3,250.00 5.14 2,570.00 3.9% 100
1.2% Hospitality Pptys Trust 500 25.03 12,514.46 23.02 1 1,510.00 7.8% 900
1.7% Senior Housing Ppt)~s Tr 750 17.74 13,304.95 21.39 16,042.50 6.7% 1,080
6.0% 55,727.36 56,081.50 6.0% _
3,382
Industrials
2.6% Minnesota Mining & Mfg 300 76.67 22,999.90 81.18 24,354.00 2.6% 630
l.5% RPM International 750 14.78 11,087.45 19.04 14,280.00 4.3% 615
2.9% United Technologies Corp 400 42.3 ] 16,924.95 69.18 27,672.00 2.5% 680
7.0% 51,012.30 66,306.00 _
2.9% 1.,925
Basic Materials
l .5% Natural Resource Partners L 600 26.91 16,145.09 23.85 14,310.00 9.1 % 1,296
Consumer Staples
2.1% Diageo Plc New Adr 300 54.72 16,417.43 65.89 19,767.00 2.7% 531
3.3% General Mills 800 22.76 18,209.95 38.54 30,832.00 2.5% 784
Page 2
PORTFOLIO STATEMENT
As of 06/19/2010
Ronald G Carignan SEP-IRA Acct #: 1036-3777
Estimated
Unit Cost Current Current Current Annual YTM
tion
i
D Quantih' Cost Basis Price Value Yield Income Cost
escr
p
Weight
Equities
Consumer Staples
2.0% Procter & Gamble Co 300 52.03 15,609.95 61.30 18,390.00 3.1% 578
7.3% 50,237.33 68,989.00 2.7°io 1,893
Services
0.7% General Maritime Corp 1,000 20.21 20,209.90 6.76 6,760.00 7.4°ro 500
1.0% Seaspan Corp 800 20.63 16,500.90 11.38 9,104.00 3.5°~a 320
1.5% United Parcel Service B 225 69.53 15,643.53 62.50 14,062.50 3.0% 423
3 2% 52,354.33 29,926.50 4.2% ].243
Heath Care
1.0% Baxter International Inc 225 49.99 11,247.70 42.01 9,452.25 2.8% 261
1.6% Johnson & Johnson 250 49.60 12,400.00 59.18 14,795.00 3.6% 540
1.2% Pfizer, Inc. 750 28.49 21,364.95 15.21 11,407.50 4.7% 540
1.7% Stryker Corp 300 43.60 13,079.51 51.82 15,546.00 0.3% 45
5 4% 58,092.16 51,200.75 2.7% 1,386
Technology
1.1% Intel Corporation 500 22.50 11,250.00 21.40 10,700.00 2.9% 315
2.8% International Business Mach 200 88.12 ] 7,624.95 130.15 26,030.00 2.0% 520
1.4% Microsoft 500 27.92 13,959.95 26.44 13,220.00 2.0% 260
5.3% 42,834.90 49,950.00 2.2% 1.,095
International Stock
1.5% Pshares Int'1 Dividend Achiv 1,000 14.82 14,823.75 13.67 13,670.00 2.3% 313
60.7% 558,259.44 566,481.74 4.3% 24,456
Mutual Funds
3.8% Schwab Value Advantage 35,373.14 1.00 35,373.14 1.00 35,373.14 0.1% 35
Small Cap Blend
0.6% Nb Genesis Fund Investor- 191.19 34.48 6,591.80 28.64 5,475.80 0.6% 31
Speciality Health
2.0% Vanguard Health Care Fd 162.15 1 13.22 18,357.91 1 15.36 18,705.28 0.9% 163
International Stoclc
0.6% First Eagle Overseas 276.57 25.22 6,974.52 20.09 5,556. l9 3.0% 165
0.8°lo Laudus Intl Mkt Masters 491.18 19.21 9,437.13 16.01 7,863.71 1.2% ! 98
1.4% l 6,411.65 13,4 ] 9.90 2.0% 263
Closed-end Mutual Funds
2.0% Evergreen Incm Advantge 2,000 15.00 30,000.00 9.48 18,960.00 10.8% 2..040
9.8% lOb,734.50 91,934.12 2.8% 2,533
Preferred Stock
2.6% Househld Fin Cp 6.875xxx 1,000 25.00 25,000.00 24.35 24,354.30 7.l % 1,719
Page 3
PORTFOLIO STATEMENT
As of 06/19/2010
Ronald G Carignan SEP-IRA Acct #: 1036-3777
Estimated
Unit Cost Current Current Current Annual YTM
Weight Description Quantih~ Cost Basis Price Value field Income Cost
Preferred Stock
2.3% M S Cap Tr III 1,000 25.00 25,000.00 21.63 21,630.00 7.2% 1,562
4.9% 50,000.00 45,984.30 7.1°,'v 3,281
Fixed Income
1.1% Daimlerchrysler 10,000 98.60 9,860.00 100.30 10,030.33 5.0°io SOU 6.36%
08/15/2010 5.00%
Accrued Interest 173.61
1.1% Simon Prop Grp 10.000 95.06 9,506.25 100.32 10,032.39 4.9% 488 8.73%
08/15/2010 4.875%
Accrued Interest 169.27
1.1 % Ohio Power Co 10,000 99.21 9,921.40 101.38 10, l 38.24 5.2°io 530 5.67%
1 l /01 /2010 5.30%
Accrued Interest 72.14
1.1 % Unitrin, Inc 10,000 99.83 9,982.50 100.68 10,068.00 4.8°io 488 5.03%
11/01/2010 4.875%
Accrued Interest 66.35
1. ] % Autozone, Inc 10,000 97.00 9,700.00 101.13 10,113.13 4.7% 475 6.48%
11/15/2010 4.75%
Accrued Interest 46.18
1.1 % Hsbc Finance Crp 10,000 99.60 9,960.20 101.63 10,162.92 5.1 % 520 5.35%
02/15/201 1 5.20%
Accrued Interest 180.56
I.I% Gatx Finl Corp 10,000 97.52 9,752.00 103.48 10,347.86 6.1% 627 7.50%
06/15/201 1 6.273%
Accrued Interest 8.71
I.0% US Leasing Intl Inc 10,000 98.79 9,879.00 93.36 9,336.38 6.4% 600 6.20%
09/06/2011 6.00%
Accrued Interest 173.33
1.1 % Protective Life Var 10,000 100.00 10,000.00 99.62 9,961.70 3.8% 375 3.75%
09/10/2011 3.75%
Accrued Interest 10.42
1.1 % Capital One Finl 10,000 96.97 9,697.26 104.14 10,414.16 5.5% 570 7.13%
09/15/2011 5.70%
Accrued Interest 150.42
1.1% Health Care Prop 10,000 96.38 9,637.70 103.74 10,374.22 5.7°io 595 7.31%
09/15/201 1 5.95%
Accrued Interest 157.0]
1.1 % Gen Elec Cap 10,000 90.18 9,018.29 ] 06.16 10,615.99 5.5% 588 9.81
02/15/2012 5.875%
Accrued Interest 203.99
1.2% Consol Energy I 10,000 99.93 9,993. ] 7 107.75 10,775.00 7.3% 788 7.90%
03/01/2012 7.875%
Accrued Interest 238.44
1.7% Ryder Sys Inc 15,000 92.10 13,814.42 104.37 15,654.84 4.8% 750 7.83%
06/ 15/2012 5.00%
Accrued Interest 10.42
1.1% Weatherford Intl ]0,000 96.38 9,638.07 105.89 10,588.50 5.6% 595 7.19%
06/15/2012 5.95%
Accrued Interest 8.26
1.1 % Erp Operating 10,000 98.27 9,827.24 106.42 10,641.53 5.2% 550 6.08%
10/01/2012 5.50%
Accrued Interest 120.69
Page 4
PORTFOLIO STATEMENT
As of 06/19/2010
Ronald G Carignan SEP-IRA Acct #: 1036-3777
Estimated
Unit Cost Current Current Current Annual YTM
Weight Description puantity Cost Basis Price Value Yield Income Cost
Fixed Income
1.2% Boston Propertie 10,000 99.01 9,901.00 108.50 10,850.32 5.8°io 625 6.56%
01/15/2013 6.25%
Accrued Interest 269.10
1.1% Berkley W R Cor 10.000 94.83 9,483.33 103.85 10,385.04 5.7% 588 7.48%
02/15/2013 5.875%
Accrued Interest 203.99
1.1 % Federal Realty 10,000 98.60 9,860.00 106.82 10,681.89 5.1 °ro 540 5.77%
12/01/2013 5.40%
Accrued Interest 28.50
1.0% Household Finance Floater 10,000 100.00 10,000.00 92.53 9,252.81 4.9% 453 4.53%
12/10/2013 4.53%
Accrued Interest 12.58
1.1 % Keybank Na 10,000 98.00 9,800.00 105.42 10,541.70 5.5% 580 6.29%
07/01/2014 5.80%
Accrued Interest 272.28
1.1 % Goldman Sachs l 0,000 99.32 9,932.00 99.73 9,972.50 5.6% 563 5.75%
01/15/2017 5.625%
Accrued Interest 242.19
24.8%
219,163.83
233,757.89
5.4% _
12,385
6.58%
Cash and Money Funds
0.4% Schwab Money Market Fun 3,802.44 3,802.44 0.0% 0
99.7% 937,960.21 939, ] 42.05 4.5% 42,657 6.58%
Total Accrued Interest 2,818.44
100.0% 941,960.49
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