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Home My WebLink About09-19-11_1 1505610140 REV-1500 ~` I°'~'°' OFFICU4L USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN Counly Code Year File Number Po sox z8~o1 2 1 1 1 0 4 3 0 Harrisburo. PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Data of Death MMDDYYYY Date of Birth MMDDYYW 2 0 4 1 2 3 3 6 7 0 3 1 2 2 0 1 1 0 3 0 6 1 9 2 5 Decedent's Last Name Suffoc Decedents First Name MI R O S A R A N T H O N Y F (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 Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prlorto 12-13-62) ^ 4. Limked Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required death after 12-12-82) ® 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposk Boxes (Attach Copy of WIII) (Attach Copy of Trust) ^ 9. Lkigation Proceeds Received ^ 10. Spousal Poverty Credk (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 INFORMATbN SHOULD BE DN2ECTED T0: Name Daytime Telephone Number D A V I D A F I T Z S I M O N S 7 1 7 2 4 3 3 3 4 1 Finn line of address M A R T S O N L A W O F F I C E S Second line of address 1 0 E H I G H S T City or Post Office C A R L I S L E State ZIP Code REGISTER OF tMLL~.USE ONLY C'7 "' ,._ .._. ~ 3~7 CJ? fv~i'il r ,,s z m -- ct7 try - ~ x xm ~ ' ~O Ti ~ 4 DATE FILfD ~ == C: -' ~ v7 ~^"~ P A 1 7 0 1 3 r ~' CorrespondenYse-mailaddross: DFITZSIMONSaMARTSONLAW•COM Under penaMlea of perjury, I declare that I have examined this return, inducting accomparrying ad»dulee and statements, and to the best of my knowledge and belief, ft fa We, correct and rbmpie~. Dedaradon of proparer other than the personal representative la based on all information of which preparer has any knowledge. SIGNATUREpF PERSON RESpOy$IBjrE FOR FILING R RN DATE ADDRESS BOILING SPRINGS P 10 EAST HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J Continuatlon of REV-1500 Inheritance Tax Return Resident Decadent ArAFgny F. Roar 21 FYa Number DaoadaM'e Name Papa t Name Fbat Rna of addnn Seaond Nna d addnna Cry Or Pat Ofltoa State ZIP Code Oaylhrb TeMphoa Wumber ~~ Name Ftrat Ana of addnaa Saoond Nns or addnwe Cily or Pat Ohba 8faoa ZIP Cade Daygma Tsleplwne Number 1505610240 REV-1500 EX Decedent's Social Security Number oe~edenf.Na~: Anthony F- Rosar 2 0 4 1 2 3 3 6 7 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. ~ • ~ 0 2. Stocks and Bonds (Schedule B) ...................................... 2. 5 6 7 6 2. 8 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ................... .... ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... ... 5. 2 9 0 8 0 1 . 1 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 5. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous I~Qg;Probate Property (Schedule G) u Separate Billing Requested .... ... 7. 7 6 6 9 D. 5 6 8. Total Gross Assets (total Lines 1 through 7) .................... .... ... 8. 4 2 4 2 5 4 , 5 5 9. Funeral Expenses and Administrative Costs (Schedule H) ........... .... ... 9. 3 1 3 3 5. 4 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... .... ... 10. 3 7 4 5 . 8 2 11. Total Deductions (total Lines 9 and 10) ........................ .... ... 11. 3 5 0 8 1 . 2 8 12. Net Valw of Estate (Line 8 minus Line 11) ..................... .... ... 12. 3 8 9 1 7 3. 2 7 13. Charitable and Governmental Bequeats/Sec 9173 Trusts for which an election to tax has not been made (Schedule J) ............... .... ... 13. 14. Nat Valw SubJsct to Tax (Line 12 minus Line 13) ............... .... ... 14. 3 8 9 1 7 3. 2 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rata, or transfers under Sec. 9116 (a)(1.2)X.0 _ 0 0 0 15. Q, O Q 16. Amount of Line 14 taxable at lineal rate X .045 3 8 9 1 7 3. 2 7 1 s. 1 7 5 1 2. 8 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 1 g, 0. 0 0 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1 7 5 1 2. 8 0 Side 2 L 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 0430 DECEDENTS NAME One Lon sdorf Wa STREET ADDRESS CITY Carlisle STATE PA ZIP 17015 Tax Payments and Credits: t• Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 15,s00.00 B. Discount 81s.77 (1) 17,s 12.so Total Credfts (A + B) (2) 16,315.77 3. Interest 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Page 2, Lfns 20 tp request a refund. (3) (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,197.03 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 properly 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, If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideratfon7 ....................................................................................... ^ 3. Did decadent own an'in trust for• orpayable-upon-death bank account or security at his or her death? ......... ^ 4. Did decedent own an Individual retirement acxounl, annuity or other non-probate property, which contains a benefiGary des(gnation? .................................................................................................. ® ^ 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 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 [!2 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 p2 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 least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX r (e-BB) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS 8 BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ANTHONY F. ROSAR 21 11 0430 All property Jolntyrownsd rdth fight of survhrorship must be dhtebsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Invest Brokerage Acct. # SHT157625 53,168.25 See attached 2. I24 shares MetLife CUSIP 59156R10 I 1,075.68 See attached 3. I66 shares Firstenergy Corp. CUSIP 337932107 I 2,518.89 See attached TOTAL (Also enter on line 2, Recapitulation) ~ i (If nwre apace b needed, Insert addNional sheet of the same size) REV-1508 EX + (8-9e) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. IN RES DENT D Eo K r" PERSONAL PROPERTY ESTATE OF FILE NUMBER ANTHONY F. ROSAR 21 11 0430 Indude the pproceeds of Ntigation and the date the proceeds were receNed by the estate. All properly lOintlyowned with rlgM of survivorship moat be disclosed on Seheduk F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Citizens Savings Bank checking 0611004945 74,939.81 (Includes accrued interest) 2. Citizens Savings Bank, savings 17,076.95 (Includes accrued interest) 3. Citizens Savings Bank, CD 3,87.32 (Includes accrued interest) 4. Net Federal Credit Union, savings Acct. # 151420, su1Fix 0 42,943.68 (Includes accrued interest) 5. Net Federal Credit Union, checking Acct. # 151420, suffix 7 13,405.26 (Includes accrued interest) 6. Orrstown Bank, checking Acct # 106004912 41,031.28 ($41,031.11 + $,17 accrued interest) 7. Metropolitan Life Total Control Account 5,556.92 8. US Savings Bonds, HH Series 34,000.00 See attached 9. US Savings Bonds, E, EE & I Series 55,104.26 See attached 10. 2010 1040 personal income tax refund 2,831.00 1 I . Vanguard Prime Money Market Fd, account 88051125985, cash in account 94.69 12. Nationwide Life Inswance policy # 1025604030, payable to Estate ($1,607.79) 0.00 13. Nationwide Life Inswance policy # 7609664555, payable to Estate ($999.37) 0.00 TOTAL (Also enter on line 5, Recapitulation) I i 29n sn t t ~ (It more space's needed, insert additlonal sheet of the same size) REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: ANTHONY F. ROSAR 21 11 0430 k an asset was made jointly owned wkhin one year of the dacederH's date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS A. B. C. JOINTLY-GWNED PROPERTY: RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTERESI 1. 0.00 TOTAL (Also enter on Line 6, Recapitulation) a ~ ~ ~ ~ ~ 0.00 If more apace is needed, use addNbnal sheets of paper of the same size. REV-1510 EX+ (0a-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER•VIVOS TRANSFERS AND MISC. NON•PROBATE PROPERTY FILE NUMBER ANTHONY F. ROSAR 21 11 0430 This schedule must be completed and filed it the answer t0 any of questbns 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCIUDETFIENMa:OFTHETRANSFEREE,THEIRRELATIDNSFMPTODECEDENfAND THE DATE OFTRANBFERATrAC1iAC0PYDFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION pFawcna.fl TAXABLE VALUE 1. Invest IRA SHU-141767 28,278.53 100.00 0.00 28,278.53 Beneficiaries: Deborah A. Cianfichi, 50%; Diane Szostek, 50% 2. ~ Security Benefit Annunity No. 7003200161 48,412.03 100.00 0.00 48,412.03 Beneficiaries: Deborah A. Cianfichi, 50%; Diane Szostek, 50% TOTAL (Also enter on Line 7, Recapitulation) ~ S 76,690.56 If more space is needed, use additional sheets of paper of the same size. REV-1511 Ex+ (10.08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEOENr SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS PILE NUMBER ANTHONY F. ROSAR 21 11 0430 DecedeM'a debts moat be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Fttneral Home, Mechanicsburg, PA 11,160.00 2. Dupont Monument, grave marker 1,410.00 3. Funeral luncheon 718.00 4. Reimbursement of travel expenses for Diane Szostek to plan and attend funeral 300.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representatlve(s) Street Address City State ZIP Year(s) Commbsfon Paid: p, Attorney Fees: MARTSON LAW OFFICES 16,800.00 3. Famly Exemptbn: (If decedents address is not the same as daimanYs, attach explanation.) Claimant Street Address CHy State ZIP Relatlonship of Claimant to Decadent 4. p pay; Register of Wills 421.50 5 Accountant Fees: Keller and Associates 6. Taz Return Preparer Fees: 7. Filing Fee, Inheritance Tax Return 15.00 8 Postage, registered mailing of Savings Bonds 44.07 9. EVP stock valuation 3.10 10. Postage, Certified Mailing, BNY Mellon/MetLife stock 5.79 11. Short Certificates 8.00 12. Reserve for filing fees and miscellaneous expenses 400.00 13. Additional Probate fee 50.00 TOTAL (Also enter on Line 9, Recapitulation) S 31,335.46 If more space is needed, use additional sheets of paper of the same strs REV-1512 Ex+ (12-OB) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER ANTHONY F. ROSAR 21 11 0430 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Cumberland Crossings, account payable 3,135.23 2. Continuing Care RX, account payable 3. ~ In Your Home Care, account payable 4. ~Martson Law Offices, disbursements payable for POA services, Anthony Rosar TOTAL {Also enter on Line 10, Recapitulation) I S If more space is needed, insert additbnal sheets of the same size. 62.09 525.00 23.50 REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ca i..i c ~-r: FILE NUMBER: ANTHONY F. ROSAR 21 11 0430 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trusse(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [Include outnpM s usal disbibutfons and transfers under Sec. 91 f6 (a~1.2).1 1. Diane Szostek Lineal 194,586.63 5791 Nicholson Drive Hudson, OH 44236 2. Deborah A. Cianfichi Lineal 194,586.64 761 Dogwood Terrace Boiling Springs, PA 17007 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-15 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN; B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 SHEET, AS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I ; If more space is needed, use additional sheets of paper of the same size. I, ANTHONY R R,GSAR, of Scranton, State of Pennsylvania, being of sound mind. memory and understart~ng, do hereby malae, pubgsh and declare this document as and for my last WIII and Testament; and by doing so hereby revolae aN other WNIs and Codidls heretofar~e made by me. FIRST: I direct the payment of my debts and d my last ilfr~ and funeral from my estate as soon after my death as conveniently may be done. If there is no cerrrebery li. bt avaNable for my interment, owned by me at the tlme d my death, I authorize my personal represenbtlye bo purdwse a aeme6ery bt with a contract. for perpetual pre, uskrg tlter~e!lore fiJnds from my estate, In such amaxrt as they shall deem reasonable in view of my statlon in Iffe, and necessary and desirable. Further, I auffiortne my persorwl representatlve b cause tJtle or ownership of said bt, so purchased, ib vest to such person as my personal represerdatlve shaA designate. I also authorize my personal representatlve to expend funds from my estate, to such an amount as they shaA deem reasonable in view of my statlon In Iife, necessary and desirable, for the purchase, erection and inscriptlon of a suitable marloer for my grave. SECOND: I give, devise and bequeath aN of my estate, be K real property, personalty or mbced, and it may be opted, bo my Wife ,ROMAINE R06AR, of Scranton, Petir~Mania, if my Wife ,above rrx:ntloned, should survive me by forty-flue (45) days. THIRD: In the event that my Wife ,ROMAINE RO6AR ,should predecease me or fail ip survive me by forty-flue clays, I tlren give devise and bequeath all of my estate, real personal or mbced unto my children, DEBORAH CIANFICHI , of BolNrg Springs, Pennsylvania and DIANE SZ06TIX, of Hudson, Ohb, in equal shares. FDURtH: If any benetldary OF ~ UrK~er this WIY in any manner/ directly or indirectly, contests of attad6 thb WiN or any: of its pruvisbns, any share or interest in my estate to thak conbastlr-9 beneficiary or rernainderman under this WIN Is revdaed and shall be disp~ooeEf of in the. same marxter provlderk herein as iF that contesting ber-efictary or remakrderman had predeceased me without I~ue or hefts. FIFTH: I direct that any and aN intrerltanoe, state and transfer taoaes Imposed upon my estate passing under my VVNI or dtarrwise, shah be pfd out of the prindpal of my residuary SIXTH: I nominate and direct that DAVID J. RATCHFORD, ESQUIRE, 538 ~~ Street, Suite 730 , Scanlon, PA, be appokrbed aftaT>eY for mY estate and tliat if for any reason he is not available or incapable Of acting as Sufi, my personal ~ choose an `~' attorney. SEVENTH: I appoint Wife. ROMAINE Rte, as f30eGJtOr of ti'1fs my last WIII arld Testament In the event of the renurrcfation, d~th, resignatlon, or Inability >p ad for any reason whatsoever of my Wife , ROMAIPIE ROSNt , I rrornirrabe Abe and appoint DEBORAH CiANFIOiI and DIANE SZO61'EK, as Alternate Go-Exectrbcx's cf the rrN Last WIII and Testament I i~ereblr relieve my F~cecutor, Wes. ROMAINE ROSAR and my NternaUe Doecutors, D®OIWi CIANFICHI and DIANE S~06TEK from the necessity of Prelln9 ~~ In oorwiectlon with thdr duties ~ such in any jurlsdFdlon in which they may be called upon to act Insofar as I am able b1~ law to do so. QGHTH: In addition to any powers conferred by law, I autltorixe my 6cecutor(s) in tl'teir absolute discretion: (a) To attain in the form received and/or m sell at publk or private sale any real or Personal Property 2 (b) To manage and give options upon real estaEe. (c) To Irnrest and reinvest in aN farms of properly wNhout bek~g conflrted do legal investrrrents and wNhout regard to the prlndpk of diversiflcatlort. (d) To exerdse arty rights or options arising from the ownership of investrrrents- (e) To compromise claims wN#wut Corot approval and without the coreaerat of any (f) To file any federal arxi/or stabs income toot redur>SS whidt may become due upon my death or whkfi I have not flied or fNe returns for arty year for which I have not flied such re4-ms prior tp my death. (g) MY t3aewbor/t3cecrab'bc shah have the power tp sell the personally of my estate at auctlor- or to vuFrahsoever fashion can best beneflt my eslabe in the evexK that my heirs are unable bo amkably agree on a division in kind. (h) N1y E~aecubor/E~cewb'bc shah have the power m carrptombe all my claims in the manner most advantageous b my estate. NIM'H: All headings used in this WNI tp described the contents of each artlde, paragraph or the proMsion are provided sok~y for the oonvenkaace only and shah not be oorrstaved to be part of this iMll. TENTH: This WIN shay be aonsb'ued M coraformRy with the Laws of the Comrranweattl~ of Pennsylvania. IN W1TNE5S WHEREgF I I>d~ hereur~o set my hand and seal to this, my Last WIII and Testament, cor>sisting of three (3) typewritten pagd5,~th~e fkst taro (2 ) of whkh bar my initlals in the margin for iderrtiflcatlon purposes this ~i~ "aaY of 007• 3 Slgrred, sealed; putted and declared ty the above Harried Testator , as and for his last Witl and Te5lament in the presence of us, who at his request, In his sight and presence and in the sight and presence of eadt other, have hereurmo subscribed our names as wrrne~es. W OF ~~ ~Cie,r<r~ 1~~ re. ~~r,F's SutiH; i P,~. 3 s r,D,~.u C~~,~~~~n 4 ACbVOWLIDGIrIt~VT AND AFFIDAVIT COMMONWEALTH OF PENNSriVANIIt ) COUNfY OF t.ACKAWANNA ) rtE: win of ANTHONY F. RosAR We, ANTHONY F. R06AR, !'d~A-~d ~~ y-~ and ~AUi ~ ~ ll~rrCff~oR~ ,the TestatAr and wihiesses respecWely whose names are signed tp the attad~ed and foregoing irutri,ur~erK, being first duy sworn, do hereby declare to the ~ authority that the Tes4a6or signed and e~aecuhed this document in my presence as his Last Win and TesEament. Furtlter, that he ached wnlirgy In signing and he execubad the stgnatlue as hts free and vdurdary ad for the purposes therein expressed and that each of these wibtes,es in the presence and hearing of the Testator, signed itre WNI as witrresses and b the .best: of their laxrwledge he was of sound mgtd, under no constraNlt or undue intluerx~e and over the age of eighteen (18) years. y ~. (JC,o~ew' OF ! b / C 'I'~L~rcr~~.~.~'art'xr x ~a., ~en~l~7~, OF /.~~-~Ser~riy~r~yP~CIanYSutifr,~8/r 5 Subskaibed, sworn to and acknowledged before me, a Notary PubNt, ANTFIONY F. RO6AR, Testator, and subsdibed and stiwom to before me by .~^~~~ ~, ~`~~- and ,~A~1DJ: /C~r-rzs~s~eaco ~ , ~ ~~y of 2007. S~~rlo-.t) ~ b~~o~x~ NOTARY PUBLiC MOMMAL !M4 awukw~M owow~ ~waaka~ r-ooNNY wr~rrRr~iswwss; sne Holdings by Investor Anthony Rosar 761 Dogwood Ter Boiling Springs, PA 17007 Dwayne Keller Invest 17 E HIGH ST STE 103 CARLISLE, PA 17013 717-243-8553 Combined Aocount Portfolio Date: 03/14/2011 Created: 06/08/2011 Anthony Rosar Acct Name:ANTHONY ROSAR T61 DOGWOOD TER BOILING SPRGS PA 17007-9633 AcctNo:5HT157625 Acct Type:lndividual Inwmplete if presented without accompanying disclosure pages rC' /~`~-L`. /~ .~-`/`-` Page 1 of 4 L [_// 1 rU~/ / AccounlTotal: $53,188.25 Estate Valuation Date of Death: 03/14/2011 Valuation Date: 03/19/2011 Processing Date: 06/06/2011 Shares Security or Par Description 1) 24 METLIFE INC (591568108) NYSE 03/19/2011 2) 66 FIRSTENERGY CORD (337932107; FE) COM NYSE 03/19/2011 Total Value: Total Accrual: Total: 53,599.57 Estate of: Anthony F. Rosar Account: 10389.1 Report Type: Date of Death Number of Securities: 2 File ID: 10389.1.rosar Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 95.06000 99.58000 H/L 99.820000 1,075.68 38.54000 37.79000 H/L 38.165000 2,518.89 53,599.57 $0.00 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. (Revision 6.9.1) SAVINGS BANK May 16, 2011 Martin Law Offices 10 East High Street Carlisle, Pa. 17013 RE: Estate of Anthony F. Rosar, Deceased SS#204-12-3367 Dear Ms. Otto, Listed below is the information you requested: BAL (Inc Int.) DATE ACCOUNT # TYPE TITLE 03/14/2011 TAX ID# OPEN 0611004945 Checking Anthony Rosar $74,939.81 204-12-3367 01/05/81 Romaine Rosar ............................................................................................................ 0100082276 Savings Anthony Rosar 17,076.95 204-12-3367 01/24/96 Romaine Rosar ............................................................................................................ 0175000086 CD Anthony Rosar 3,817.32 204-12-3367 07/25/02 Romaine Rosar Also, we have no record of any loans and we do not offer safe deposit boxes. If you should have any questions, please feel free to contact me at (570)587-0660. S' cerely obin L. Conklin CIS/Savings Coordinator ADMINISTRATIVE OFFICE: 500 South State Street, Clarks Summit, PA 18411 (570) 587-0655 www.citizens-savings.com 1-800-692-6279 Fax (570) 586-8950 citizens@epix.net ~C~~cG.R-Qe_. c~ ~ ! - 3 FDIC Insured :~ , . May 20, 2011 Martson Law Offlcsa 10 East High Street Carlisle, FA 17013 Attn: Victoria Y.. Otto RE: Esmtc of Anthony F. Rosar Date of Death: March 14, 2011 SS # 204-12-3367 Aecpant #: 151420 Name or names which appear on the account: Anthony Rosar Romaino Ytoaar Date account was ope~ued: January 23,1991 Date of death balancoa: Savings: 342,943.68 Checking: 313,405.26 Accrued interest sluce date of death: $6535 NET doe not soppy safety deposit boxes. 8I eaa be of any ltirther assistance, please foal free to contact me at (370) 961-5300 extension 2209. Sincerely you , ~c~ Mary Lyn~u aetano Dtpartmeat head Z00/Z00'd OL88I960L8~Xdd c ~~~~ ~, /~ Ili Qdd 1,HN NId ~0~~0 IlH,L IjOZ-6I-~IdY~i d- .Lw-o yfs vntw iuwN B~.vx A Tradition of F.~aoellence May 18, 2011 Victoria L. Otto Martson Law Offices 10 East High Street Carlisle, PA 17013 Fax: 243-1850 Re: Estate of Anthony F. Rosar Social Security Number 204-12-3367 Date of Death 3/12/11 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE FOLLOWING ACCOUNT WITH ORRSTOWN BANK: CHECKING ACCOUNT Account No: 106004912 Account Type- 50+ Interest Checking Image Date Opened- 9/08/08 Joint Account (name/date)- Romaine A Rosar-Deceased-Date of death 1/11/i0 Balance- $41,031.11 Accrued Interest- $0:17 Best Regards, R~ ~~`~ Jill R. Worthington Deposit Processing Clerk 2695 Philadelphia Avenue Chambersburg, PA 17201 1.888.ORRSTOWN www.orrstown.com Merl.ite and At)'iliates TC.A Administration P.Q. ltox 65l 1 Utica, NY 13504-6511 ANT80NY ROSAR 761 DOGWOOD TERRACE BOILING SPRINGS PA 17007-9633 C ~ ~. ....b :~k ACCOUNT NUMBER: ISSUE DATE: OPENING BALANCE: INTEREST YIELD: 4059027924 MARCH 8, 2010 $5,556.92 3.008 S7o? 3. ~3 Dear Beneficiary: Please accept our heartfelt sympathy, and be assured that Metropolitan Life Insurance Company is here to help you through this difficult time. Enclosed are your proceeds, which have been paid to you through ttte Total Control Account• (TCA} Settlement Option, as detailed above. Please review all enclosed materials listed below, and keep them in a safe place: • TCA booklet -explains the account's features and offers advice to help you at this time • Personalized checkbook -provides immediate access your proceeds simply by writing a check (minimum $250) • Customer Agreement -uses an easy-to-read question and answer format • Change of Accountholder Information Form -should your name or address change • Beneficiary Designation Form -you can complete and send to us to name a beneficiary • Customer Privacy Notice • TCA on eSERVICEInformation Flyer -provides benefits and instructions for getting your TCA information on-line if the accountholder is a minor beneficiary for whom there is no court appointed guardian to manage his or her assets, no checkbook will be enclosed. In addition, a minor can not name a beneficiary for his or her account. Banking services for your Total Control Account are provided by PNC Global Investment Servicing an affiliate of PNC Bank, NA, pursuant to an administrative agreement. If you have any questions about your Account, please call 7'CA Customer Service at 800-638-7283. Callers with a Telecommunications llevice for the Deaf (TDll) should call 800-229-3037. Once again, we extend our condolences, and assure you that we are here to help you. Sincerely, Home Office Metropolitan Life insurance Company New York, NY IYa41S.S(:R (l ll09) ~~;~7 0 w r O O O O t O r W n~ p~a r °o w ~. ~, R - O W r O O O O r 0 0 0 w o~ w r LJl O O O 0~ ~~~~~ ~ Investor Anthony Rosar 761 Dogwood Ter Boiling Springs, PA 17007 Dwayne Keller Invest 17 E HIGH ST STE 103 CARLISLE, PA 17013 717-243-8553 Combined Account Portfolio Date: 03/14/2011 Created: 06!08!2011 Acct Name:IRA FBO ANTHONY ROSAR PERSHING LLC AS CUSTODIAN 761- DOGWOOD TERRACE BOILING SPRGS PA 17007-9633 Acct No:5HU141767 Acct Type:Retirement Acxount Investor Total: 587,448.78 Incomplete 'rf presented without accompanying disdosure pages ~~~ J ~ /1 Page 2 of 4 Account Total: $28,278.53 ~5~~~~H ~~ ~ 8 Sep. 8. 2011 3;09PM secur~6ene6twm • bW.A8824b1 No, 1510 P, 2 ~i~ SECURITY BENEFIT` September 8, 2011 VINCENT KUBILUS INVESTMENT FINANCIAL CORD ke: Contract Number: 7003200161, ANTHONY RbSAR (Deceased) Dear Mr. Kubilus: We are writing in response to your request for information regarding the above referenced contract. Our records indicate that Mr. Rosar passed away March 12, 2011. The acwunt Value as of that date was $48,412.03 If we may assist you with other ques0ona, please contact our National Service Center at (800) 888-2461. Our Customer Censer assoaates are available from 7:00 am - B:00 pm Central Standard Time. $InCefely, Client Service Specialist IV Service Operations Security Benefd A3051 OneSewrily8ene5lPlece • Topeke,Kensas6fi638-0001 ~~~~