HomeMy WebLinkAbout09-28-111505610143
REV-1500 Ex(°'-'°'
PA Department of Revenue OFFICIAL USE ONLY
pennsylvania County Code Year File Number
Bureau of Individual Taxes oEaueTMENTOF REVEMIE
Po Box.28oso~ INHERITANCE TAX RETURN 21 11 0057
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
040 18 4234 Ol 03 2011 07 15 1918
Decedent's Last Name Suffix Decedent's First Name MI
GREEN y~PiRO
E
(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 Return ^ 3, Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise
(date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required
g Decedent Died Testate ~ Decedent Maintained a Living Trusl 1 8. Total Number of Safe De osit Boxes
(Attach Copy of Will) ^ (Attach copy of Trust) p
^ 9. Litigation Proceeds Received ^ 1 °• b~hveenl2 31 ~~andit (dat8es~f death ^ 11 • Election to tax under Sec. 9113(A)
T (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
WILLIAM B ANSTINE JR 717 846 8811
First line of address
117 EAST MARKET STREET
Second line of address
City or Post Office State ZIP Code
YORK PA
Correspondent's a-mail address:
_,,~
,:
untler 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 preparer has any knowledge.
FOR FILING RETURN DATE
I ~U~ E OF PERSI,N RESPONSIBLE CarOI~/n G. Anstine ~~~. 2.-- ~ /
ADDRESS ~ (/'
211 N. 24th Street, Camp Hill, PA 17011
SI TURE OF PREPARE~HER T N REPRESENTATIVE DATE
t.~..,____. ~ William B. Anstine Jr. ~~ ~-ZZ'
ADDRESS
117 East Market Street, York, PA
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedents Name: Green, Ward E.
Decedent's Social Security Number
0 4 0 18 4 2 3 4
RECAPITULATION
1. Real Estate (Schedule A) ...................................................................................... . 1.
2. Stocks and Bonds (Schedule B) ........................................................................... .. 2. 220 , 104.31
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ . 3.
4. Mortgages 8~ Notes Receivable (Schedule D) ....................................................... . 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. . 5. 28 , 755.3 6
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous ~q Probate Property
(Schedule G) u Separate Billing Requested............ 7.
8. Total Gross Assets (total Lines 1-7) .................................................................... . 8. 2 4 8, 8 5 9. 6 7
9. Funeral Expenses & Administrative Costs (Schedule H) ..................................... .. 9. 18 , 3 9 9.34
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .. 10. 3 , 8 6 6.93
11. Total Deductions (total lines 9 i~ 10) ................................................................. .. 11. 2 2 , 2 6 6 , 2 7
12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12, 2 2 6 , 5 93.4 0
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) .............................................. . 1 q, 2 2 6 , 5 93.4 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15. 0 , 00
16. Amount of Line 14 taxable
at linealrateX .045 226,593.40
1s.
10,196.70
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 0.00 18. 0.00
19. Tax Due ................................................................................................................. . 19. 10 ,19 6. 7 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-0057
DECEDENT'S NAME
Green, Ward E.
STREET ADDRESS
1447 Hillcrest Court, Apt. 301
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
9,500.00
500.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT.
(1)
10,196.70
10,000.00
196.70_
Total Credits (A + B) (2)
(3)
(4)
(5)
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 :.................................. ^ ^x
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 consideration? .................................................................................................................... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1503 EX+ (8-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Green, Ward E. 21-11-0057
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 60 shares of People's United Bank - AFLAC, Inc. 57.361350 3,441.68
2 50 shares of People's United Bank -Abbott Labs 48.03 2,401.50
3 36 shares of People's United Bank - Allergan, Inc 70.06 2,522.16
4 910 shares of People's United Bank -American Centy Cap 9.19 8,362.90
Portfolios
5 30 shares of People's United Bank -Apache Corp 120.818650 3,624.56
6 10 shares of People's United Bank -Apple, Inc. 327.5480 3,275.48
7 70 shares of People's United Bank -Best Buy, Inc. 34.60 2,422.00
8 30 shares of People's United Bank -BHP Billiton LTD 93.3550 2,800.65
9 28 shares of People's United Bank -Boeing Co. 66.34 1,857.52
10 40 shares of People's United Bank - CSX Corp 65.645 2,625.80
11 59 shares of People's United Bank - CVS Caremark 34.98 2,063.82
Corporation
12 80 shares of People's United Bank -Capital One Finl Corp 43.555 3,484.40
13 33 shares of People's United Bank -Chevron Corp New 91.84 3,030.72
14 120 shares of People's United Bank -Cisco Sys, Inc. 20.50 2,460.00
15 46 shares of People's United Bank - Conocophillips 68.405 3,146.63
Total of Continuation Schedules See attached
a es
TOTAL (Also enter on Line 2, Recapitulation) 220,104.31
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-1503 EX+ (g.98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Green, Ward E.
SCHEDULE B
STOCKS & BONDS
continued
FILE NUMBER
21-11-0057
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE
VALUE AT DATE
OF DEATH
16 27 shares of People's United Bank -Deere & Co. 84.1058 2,270.86
17 27 shares of People's United Bank -Deere & Co. 35
Dividend . 9.45
18 75 shares of People's United Bank -Disney Walt Co. 37.81 2,835.75
19 75 shares of People's United Bank -Disney Walt Co. .4 30
00
dividend .
20 49 shares of People's United Bank - Du Pont E I DE 50.18 2,458.82
DEMOURS 8 CO
21 141 shares of People's United Bank - E M C Corp Mass 23.165 3,266.27
22 54 shares of People's United Bank - Exelon Corp 41,82 2,258 28
23 60 shares of People's United Bank -Express Scripts, Inc. 55.41 3,324.60
24 180 shares of People's United Bank - Fairholme FD 36.11 6,499.80
25 14 shares of People's United Bank -Frontier 9.795 137.13
Communications Corp
26 25 shares of People's United Bank -General Dynamics Corp 70,22 1,755.50
27 125 shares of People's United Bank -General Electric Co. 18.36 2,295.00
28 125 shares of People's United Bank -General Electric Co. ,14 17.50
dividend
29 50 shares of People's United Bank -General Mls, Inc. 35.715 1,785.75
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1503 EX+ (6-98)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Green, Ward E. 21-11-0057
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
30 65 shares of People's United Bank -Genuine Parts Co 52.075 3,384.88
31 6 shares of People's United Bank - Google, Inc. 601.035 3,606.21
32 85 shares of People's United Bank -Home Depot, Inc. 35.38 3,007.30
33 150 shares of People's United Bank -Intel Corp 20.915 3,137.25
34 32 shares of People's United Bank -Johnson 8 Johnson 62.855 2,011.36
35 34 shares of People's United Bank - McDonalds Corp 77.095 2,621.23
36 100 shares of People's United Bank -Microsoft Corp 28.05 2,805.00
37 42 shares of People's United Bank - Nextera Energy, Inc 52.105 2,188.41
38 35 shares of People's United Bank -Occidental Pete Corp 98.50 3,447.50
Del
39 35 shares of People's United Bank -Occidental Pete Corp ,3g 13.30
Del
dividend
40 64 shares of People's United Bank - Omnicom Group, Inc 46.298250 2,963.09
41 64 shares of People's United Bank - Omnicom Group, Inc .2 12.80
dividend
42 32 shares of People's United Bank -Philip Morris Intl Inc. 58.71 1,878.72
43 32 shares of People's United Bank -Philip Morris Intl Inc. .64 20.48
dividend
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1503 EX+ (g_88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCFIEDULE B
STOCKS & BONDS
continued
CSIAIt OF
Green, Ward E.
FILE NUMBER
21-11-0057
ITEM CUSIP
NUMBER NUMBER DESCRIPTION UNIT VALUE
~ 61 shares of People's United Bank -Research in Motion Ltd
59.22
45 187 shares of People's United Bank - T. Rowe Price Mid-Ca
P
59
17
Growth Fund .
46 442 shares of People's United Bank - T. Rowe Price Mid Ca
P
23
93
Value Fund .
47 300 shares of People's United Bank - Spdr Series Trust
52.306
48 45 shares of People's United Bank -Schlumberger Ltd 83.96
49 45 shares of People's United Bank -Schlumberger Ltd 21
dividend .
50 2 shares of People's United Bank -Staples, Inc.
23.5075
51 2 shares of People's United Bank -Staples, Inc. 09
dividend .
52 63 shares of People's United Bank - Sysco Corp 29.365
53 45 shares of People's United Bank - Teva Pharmaceutical 53
085
Inds Ltd .
54 25 shares of People's United Bank - 3M Co 87.035
55 115 shares of People's United Bank - US Bancorp Del 27.16
56 115 shares of People's United Bank - US Bancorp Del 05
dividend .
VALUE AT DATE
OF DEATH
3,612.42
11,064.79
10,577.06
15,691.80
3,778.20
9.45
47.02
0.18
1,850.00
2,388.83
2,175.88
3,123.40
5.75
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
continued
ESTATE OF
Green, Ward E.
FILE NUMBER
21-11-0057
ITEM CUSIP
NUMBER NUMBER DESCRIPTION UNIT VALUE
57 29 shares of People's United Bank -United Parcel Service
73
375
Inc. .
58 50 shares of People's United Bank -United Technologies 79
19
Corp .
59 647.346 shares of People's United Bank -Vanguard Star Fd 15.86
60 320 shares of People's United Bank -Vanguard Trustees 32
39
Equity Fd .
61 320 shares of People's United Bank -Vanguard Intl Equity 48
675
Index Fd .
62 110 shares of People's United Bank -Vanguard Index Fds 79.135
63 60 shares of People's United Bank - Verizon 36
165
Communications Inc. .
64 35 shares of People's United Bank - Wal Mart Stores Inc.
54.475
65 100 shares of People's United Bank -Wells Fargo & Co New 31.41
TOTAL (Also enter on Line 2, Recapitulation)
Copyright (c) 2002 form software only The Lackner Group, Inc.
VALUE AT DATE
OF DEATH
2,127.88
3,959.50
10,266.91
10,364.80
15,576.00
8,704.85
2,169.90
1,906.63
3,141.00
220,104.31
Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
tSTATE OF
Green, Ward E.
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1
Cash in safe deposit box OF DEATH
1,000.00
2 M&T Bank -Checking Account No. 9834652274
10,159.99
Accrued interest on Item 2 through date of death
0.03
3 People's United Bank -Dreyfus Inst Cash Mgmt Fd #288
3, 529.93
Accrued dividend on Item 3 through date of death
0.03
4 Sale of 2004 Honda Pilot EX Sport Utility 4d to L.B. Smith Ford
9,000.00
5 Sale of personal property and household furnishings, including guns and rugs
by Cordier
'
,
Antique
s 8 Fine Art 4,143.22
6 Refund, Cardin 8< Miller -overpayment of medical bill
70.00
7 Refund, Country Walk -security deposit from apartment
852.16
TOTAL (Also enter on Line 5, Recapitulation) I 28,755.36
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
FILE NUMBER
21-11-0057
REV-1151 EX+(10.06)
COMMONEWRIEALTjiO,Fg7P~ENETURN ANIA
tJ RESITDAEIVN4rtDTECERDENT
tJiAlt VF
Green, Ward E.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ITEM
NUMBE
A.
FUNERAL EXPENSES:
Debts of decedent must be reported on Schedule I.
DESCRIPTION
See continuation schedule(s) attached
FILE NUMBER
21-11-0057
AMOUNT
2,675.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Anstine 8 Sparler 12,442.00
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
108.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
3,173.84
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 18,399.34
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Green, Ward E. 21-11-0057
ITEM
NUMBER DESCRIPTION
Funeral Ex enses
1 Myers-Harner Funeral Home, Inc. -funeral services
9ther Administrative Costs
2 Anstine &Sparler -notary fee
3 Anstine &Sparler -preparation of fiduciary income taxes
4 Anstine &Sparler -notary fee on Disclaimer
5 Callen Kimback -oil change and repair wheel on car prior to selling
6 Carolyn Anstine -car title
7 Carolyn Anstine -reimbursement for miscellaneous administrative expenses
8 Carolyn Anstine -reimbursement for administrative expenses
9 Cordier -appraisal fee
10 Cordier -fee to remove furniture
11 Cumberland County Law Journal -advertise estate
12 Faulkner Honda -inspection and repairs to car
13 Linda Nye -clean apartment
H-A
AMOUNT
2,675.00
2,675.00
5.00
150.00
5.00
64.56
22.50
22.22
79.00
738.75
100.00
75.00
1,279.63
200.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Green, Ward E. 21-11-0057
ITEM
NUMBER DESCRIPTION AMOUNT
14 Miscellaneous administrative expenses: long distance telephone calls, photocopies, 25.00
facsimiles, etc.
15 Orphans' Court -filing fee to file Disclaimer
5.00
16 Register of Wills -filing fee to file PA 1500
15.00
17 Register of Wills -additional probate fee
265.00
18 The Patriot News -advertise estate
122.18
H-B7 3,173.84
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1572 EX+ (12-081
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
c.71A1C Vr'
/2 nse~.. \A/...J x-
FILE NUMBER
21-11-0057
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEAT
1
AARP H
-insurance
216.10
2 C. Walk -apartment rent
875.00
3 Card Services -credit card
162.00
4 Country Walk -rent
875.00
5 Liberty Mutual - renters insurance
30.00
6 Liberty Mutual -car insurance
230.75
7 Liberty Mutual -renters insurance
34.00
8 Liberty Mutual -renter's insurance
34.00
9 Liberty Mutual -car insurance
230.75
10 PA Dept of Revenue -income taxes
436.00
11 PP 8 L -electric bill
162.67
12 PP8:L -electric bill
76.41
13 PP&L -electric bill
76.41
14 PP&L -electric bill
54.65
15 PP&L -electric bill
48.32
16 PP&L -final electric bill
13.13
17 SF & Co. -income tax prep
289.20
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 10, Recapitulation) 3,866.93
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ (11-08)
COMMON pEA ~T~i~QTePEpN~NS,RL~V,ANIA
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Green, Ward E. 21-11-0057
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NAME AND ADDRESS OF DECEDENT
NUMBER PERSON(Sl RECEIVING PROPERTY oo Not List Trustees (Words) ($$$)
TAXABLE DISTRIBUTIONS [include outright spousal
I. distributions, and transfers
under Sec. 9116(a)(1.2)1
Carolyn G. Anstine
211 N. 24th Street
Camp Hill, PA 17011
Jeffrey D. Green
1780 Joan Avenue
Parkville, MD 21234
Ward E. Green III
3518 Chessington Street
Clermont, FL 34711
Daughter
Son
Son
residue of estate
$65,000.00
(by notice of
partial disclaimer)
$65,000.00
(by notice of
partial disclaimer)
I ~ Total ~
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet, as a ro i
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11 08)
WILL
OF
WARD E. GREEN
1, WARD E. GREEN, of the Borough of Camp Hill, Cumberland County,
Pennsylvania, declare .#his to be my last will and revoke any will previously made by
r, me.
"~ ITEM !. I direct #hat alt my just debts and funeral expenses inclu "
drug my
gravemarker and all expenses of my last illness, and any and all taxes and
assessments imposed b an overnmen
Y Y 9 tat body as a result of my death, whether
on property passing under this will or otherwise, shall be paid from my residuary
estate as soon as practicable after my decease as a art of the
p expense of the
administration of my estate.
ITEM !I. Upon my death, I direct that my remains be cremated.
~`~`~ ITEM tti. I give and bequeath all of my household goods, automobiles
_ _ "~ _ _
V' jewelry, and al! other articles of household and personal use, equipment and
ornament, together with all insurance thereon and relating thereto, to my daughter,
. ~ CAROLYN G. ANSTINE, of Camp Hill, Pennsylvania, provided she survives my
death by thirty (30y days. Should my said daughter predecease me or be deceased
on the thirty-first day after my death, I give and bequeath a!i such items and
insurance thereon to any of her issue, per stirpes, who survive my death by thirty
f 30} days. 1 am specifically not including any bequest to my sons, WARD E.
GREEN, lll, of Lemoyne, Pennsylvania, and JEFFREY D. GREEN, of Silver Spring,
Maryland. I have made this determination on my own without any coercion by
anyone and it is my desire that neither of them should share in my estate in any
way
ITEM IV. f give, devise, and be ueath all the re
q st, residue, and remainder of
my possessions and estate of every nature and wherever situate to my daughter,
GAROLYN G. ANSTINE provided she survives my death by thirty {30} days. Should
my said wife predecease me or be deceased on the thirty-first day after my death, I
give, devise, and bequeath all the rest, residue, and remainder of my possessions
and estate of every nature and wherever situate to any of her issue, per stirpes,
i
C~ who survive my death by thirty (30} days. 1 am specifically not including an
Y
bequest to my sons, WARD E. GREEN, lll, of Lemoyne, Pennsylvania, and JEFFREY
D. GREEN, of Silver Spring, Maryland, i have made this determination on my own
without any coercion by anyone and it is my desire that neither of them should
share in my estate 'rn any way.
ITEM V. I appoint my daugh#er, CAROLYN G. ANSTINE, executrix of this my
last wiU.
2
-~ - -
=` ~ -- -
ITEM VI. In addition to the other powers and authorities granted to my
personal representatives by Pennsylvania law and by the other terms and provisions
of this will, I hereby give to my personal representatives the following powers and
authorities effective without court approval and until actual distribution of a[I
property: to compromise any claim or controversy; fio make distributi_an in cash or
~, in kind, or partly in cash and partly in kind, and in such manner as m ersona!
Yp
representatives may determine and at valuations finally to be fixed by them; to
~.
invest in al{ forms of property, including any stock or other securities in any
corporate fiduciary or its successor without restriction to investments authorized
for Pennsylvania fiduciaries, as my personal representatives deem proper, without
regard to any principle of risk or diversification; to retain any or all assets of my
~, ~ estate, real or personal, without regard to any principle of risk or diversification; to
sell at public or private sale, to exchange, or to lease for any period of time, any
~~ 1
`~ real or personal property and to give options for sales, exchanges, ar leases, for
such prices ancl~upon such terms or conditions as my personal representatives
'~ deem proper; and to allocate receipts and expenses to principal or income or partly
to each as my personal representatives deem proper in their sole discretion.
3
ITEM V11. 1 direct that my personal representatives and fiduciaries shalt not
be required to give bond for the faithful performance of their duties in any
jurisdiction. ,.~i
(N WITNESS WHEREOF, I have hereunto set my hand this d' day of
~ J
_,_1996.,
~~
WARD E. GREEN
4
The preceding instrument, consisting of this and FOUR other typewritten
pages, each identified by the signature of the testator was on the date thereof
signed, published, and declared by WARD E. GREEN, the testator therein named, as
and for his last will, in the presence of us, who at his request, in his presence, and
in the presence of each other, ha~ie subscribed our names as witnesses hereto.
~~~ l ~
~~~ i~~
~.
~,
~,
~'~~ ,
;:
.~~`
~.
~v
~~
J ~
5
COMMONWEALTH OF PENNSYLVANIA 1
( SS:
COUNTY OF CUMBERLAND )
The undersigned, being the testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, does hereby
acknowledge that I signed and executed the foregoing instrument as my fast will, that I
signed it willingly; and that I signed it as my free a d~voluntary act #or the purposes therein
expressed. L:.~'~/„~ _ ~~-~ /~/ _
WARD E. GRE1=N
_~ __ ~ ~ ~ voin. or afifirmed to and acknowledged
= ' befo~`"~. a by the stator amed above
_ %liis a.ay of ~ 7 996.
a
C O M M O N W E~A~b~-~-E.~A~A>~--~
( SS:
COUNTY OF CUMBERLAND ~
WE, ~ L~2~_ ~ l %~ ~ae.l ~ 6 S ,the witnesses
whose names are si ed'tp the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the testator sign and
execute the instrument as his Last will; that he signed it willingly and that he executed it as
his free and voluntary act for the purposes therein expressed; that each ofi 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 7 8 or more years of age, of sound mind, and
under no constraint or undue influence.
Sworn. or affirmed to and
- - . ~cktzowiedge befiore me this
- - ~~ day.of = ~,.Q.. 1998.
-~ ~~~~~
V'Ju~tvY 5. Ch~~"'?, P•c:a: J c..J:- ~ 6
Cpn;p i%ii ?zoo, Cz:r~r.~~ae,~ Co., PA E
My Cam+resu4n ~x~-,i, os eY~t~ i 0, i?99
Estate Valuation
Cate of Death : O1/U3/2U11
"aiuation Dat
e;
U1/O3/2D11 Estate of: WARD E. GREEN
Processing Da
te:
02/03/2011 Account: 61N020013
Report Tyne: Date of Geath
Number of Securities: 57
File ID: 6iN020013 WARD E GREEN
Shapes
or ar Security
Description Mean and/or Div and Int Security
High/Ask Low/Bid Adjustments Accruals '/alue
i) 60 AFLAC INC (CO1G55102)
COM
New York Stack Exchange
01/03/2011 57.89000 56.88270 H/L
57.361350 3,441.68
2) 50 ABBOTT LABS (002829100)
COM
New York. Stock Exchange
D1/03/2011 48.29000 47.,,000 H/L
96.030000 2,401.50
3) 36 ALLERGAN INC (016990102)
COM
New York Stock Exchange
01/03/2011 70,73000 69.39000 H/L
70.060000 2,522 ~6
4) 910 AMERICAN CENTY CAP PORTFOLIOS (02507 6845)
S CP VAL INSTL
Mutual Fund (as quoted by NASDAQ)
01/03/2011 9.19000 Mkt
9.190000 8,362.90
5) 30 APACHE CORP (O379111D5)
COM
New York. Stoc}: Exchange
01/03/2011 121.63000 120,00730 H/L
120.818650 3,629.56
61 10 APPLE INC (03783310D)
COM
The NASDAQ Stack Market LLC
01/03/2011 330.26000 329.83600 H/L
327.598000 3,275.98
') 70 BEST BUY INC (086516101)
COM
New York Stock Exchange
01/03/2011 39.900D0 39.00000 H/L
Div: 0.150000 Ex: 12/31/2010 Rec: 01/04/2011 Pay:
01/25/2011
+ 34.950000
0.150000
39.600000 2,922.00
E; 30 BHP BILLITON LTD (088606108)
SPONSORED ADR
New York Stock Exchange
01/03/2011 93.930D0 92.78000 H/L
93.355000 2,8G0.6`
9) 20 BOEING CO (097023105)
COM
New York Stock Exchange
01/03/2011 66.68000 66,00000 H/L
66.390000 1,857.52
iG~ 90 CSX CORP (126908103)
COM
New York Stock Exchange
C1/03/2O11 66.28000 65.OlOCD H/L
65.695000 2,625.80
111 59 CVS CAREMARK CORPORATION (126650100)
COM
New York Stock Exchange
01/03/2011 35.17D00 34,79000 H/L
34.980000 2,063.86
Page 1
This report was produced with EstateVal, a product of Estate 'valuations s Pricing Systems, Inc. Tf you Nave questions,
please contact EVP Systems at (818; 313-0300 or www.evpsys.com. {Revision 7.1.C
Date of Death: 01/03/2011 Estate of: [^'ARD E. GREEN
'Jalua tion Dace: 01/03/2011
Account: 61N020013
Proce ssing Date: 02/03/2011 Report Type: Dote of Dea th
Number of Securities: 57
File ID: 61N020013 WARD E GFEEIJ
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
12) 80 CAPITAL ONE FINL CORP (19040H105)
COM
New York Stock Exchange
01/03/2011 99.10000 43.0'_000 H/L
93.555000 3,984. 40
l±) 33 CHEVRON CORP NEia (166769100)
COM
New York Stock Exchange
01/03/2011 92.38000 91.30000 H/L
91.840000 3,030. 72
14) 120 CISCO SYS INC (172758102)
coM
The NASDAQ Stock Market LLC
01/03/2011 20.62000 20.38000 H/L
20.500000 2,460. 00
1) 96 CONOCOPHTLLIPS (208250109)
COM
New York Stock Exchange
01%03/2011 68.81000 66.00000 H/L
68.905000 3,196. 63
16) 27 DEERE b CO (294199105)
COM
New Pork Stock Exchange
01/03/2011 84.75000 83.96160 H1L
84.105800 2,270. 86
Div: 0.35 Ex: 12/29/2010 Rec: 12/31/2010 Pay: 02/01/2011 9,q5
17) 75 DISNEY WALT CO (259687106)
COM DISNEY
New York Stack Exchange
01/03/2011 38.00000 37.62000 H/L
37.810000 2,835. 7
Div: 0.4 Ex: 12/09/2010 Rec: 12/13/2010 Pay: 01/18/2011 30.00
18) 3529.93 Dreyfus Inst Cash Mgmt FD #288 (26188,7206) 3,529, 93
interest/div 1/1/2011 - 1/3/2011 0.03
19) 49 DU PONT E I DE NEMOLRS & CO (263539109)
COM
New York Stock Exchange
01/03/2011 50.90000 99,96000 H/L
50.180000 ',958. 82
20) 141 E M C CORP MASS (268698102)
COM
New York Stock Exchange
01/03/2011 23.93000 22.90000 H/L
23.165000 3,266 .27
21) 59 EXELON CORP (30161N101)
COM
New York Stock Exchange
01/03/2011 92.01000 91.63000 H/L
91.87.0000 2,258 .29
22) 60 EXPRESS SCRIPTS INC (302182100)
COM
The NASDAQ Stock Market LLC
01/03/2011 56.43000 54.39000 H/L
55.410000 3,329 .60
23 180 FAIRHOLME FD (304871106)
COM
Mutual Fund (as quoted by NASDAQ)
01/03/2011 36,1100G Mkt
36.110000 6,g9y ,80
Page 2
This report was produced with EstateVal, a product of Estate Valuations b Pricing Systems, Inc. If you have questions,
please contact EVF Systems at (818) 313-6300 or www,evpsys.com. (Revision 7.l.Oj
Date of Death; 01/03/2011 Esta'_e of: WARD E. GREEN
Valuation Date: 01/03/2011 Account: 61N020013
Processing Date: 02/03/2011 Repc_i Type: Date of Dea*_h
Number of Securities: 57
File IC: 61N020D13 WARD E GREEN
Shares Security Mean and/or Div a;,d Int Security
or Par Description High/Rsk Low/Bid Adjustments Accruals Value
29) 19 FRONTIER COMN,UNICATIONS CORP (35906A108)
COM
New York Stock Exchange
01/03/2011 9.89000 9. 75000 H/L
9.795000
25) 25 GENERAL DYNAMICS CORP (369550108)
COM
New York Stock Exchange
01/03/2011 70.57000 69. 67000 H/L
70.220000
26} 125 GENERAL ELECTRIC CO (369609103)
COM
New York Stock Exchange
01/03/2011 18.50000 18. 22000 H/L
16.360000
Div: 0.19 Ex: 12/22/2010 Rec: 12/27/ 2010 Pay: 01/25/201 1
2%) 50 GENERAL MLS INC (370334109)
COM
New York Stock Exchange
01/03/2011 35.9600D 35. 97000 H/L
35.715000
28) 65 GENUINE PARTS CO (372960105)
COM
New York Stock Exchange
01/03/2011 52.38000 51. 77000 H/L
52.075000
29) 6 GOGGLE INC (38259P508)
CL A
The NASDAQ Stock Market LLC
01/03/2011 605.59000 596. 98000 H/L
601.035000
30) 85 HOME DEPOT INC (937076102)
COM
New York Stock Exchange
01(03/2011 35.57000 35. 19000 H/L
35.380000
3i) 15C INTEL CORP (958190100)
QOM
The NASDAQ Stock Market LLC
O1/D3/2011 21.05000 20. 78000 H/L
20.915000
32J 32 JOHNSON & JOHNSON (478160104)
COM
New York Stock Exchange
01/03/2011 63.18000 62. 53000 H/L
62.855000
33) 39 MCDONALDS CORP (580135101)
COM
New York Stoc4: Exchange
01/03/2011 77.59D00 76 .60000 H/L
,,,095000
39) 100 N,ICROSOFT CORP (599918109)
COM
The NASDAQ Stock Market LLC
01/03/2011 28.18000 27 .92000 H/L
28.050000
35) 92 NEXTERA ENERGY INC (65339F101)
coM
New York Stock Exchange
137.13
1,755.50
2,295.00
17.50
1,185.75
3,389.98
3,606.21
~,G07.30
3,1x7.25
2,Oll.36
',621.23
,805.^~
01/03/2011 52.90000 51.81000 H/L
52.105000 2,188.91
Page 3
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. I you have questions,
olease contact EVP Systems at (818) 313-6300 or wwo-r.evpsys.com. (Revision 7.1.0)
Date of Dzath: 01/03/2011 Estate of: WARD E. GREEN
`Jaluation Date: 01/03/2011 Accou nt: 61N020013
Prccessing Date: 02/03!2011 Report Type: Date of Geath
Number of S ecurities: 57
File IC: 61N020013 WARD E GREEK
Shares Security Mean and/or Div and Int Security
cr Par Description High/Ask Low/Bid Adjustments Accruals Value
36) 35 OCCIDENTAL PETE CORP DEL (679599105)
COM
New York Stock Exchange
01/03/2011 99.15000 97.85000 H/L
98.500000 3,997.5p
Div: 0.38 Ex: 12/08/2010 Rec: 12/10/2010 Pay: 01/15/2011 13.30
37) 64 OMNICOM CROUP INC (681919106)
COM
New Yori: Stock. Exchange
01/03/2011 96.55000 46.09650 H/L
96.296250 2,963.09
Div: 0.2 Ex: 12/20/2010 Rec: 12/22/2010 Pay: 01/1 0/2011 12.80
38) 32 PHILIP MORRIS INTL I'NC (718172109)
COM
New York Stock Exchange
01/03/2011 58.990D0 58.43000 H/L
58.710000 1,878.72
Div; 0.69 Ex: 12/21/2010 Rec: 12/23/2010 Pay: 01/10/2011 20.98
39) 61 RESEARCH IN MOTION LTD (7609751D2)
COM
The NASDAQ Stock Market LLC
01/03/2011 59.86000 58.58000 H/L
59.220000 3,612,92
90) 187 ROWS T PRICE MID-CAP GROWTH F'D (~~9556109)
COM
Mutual Fund (as quoted by NASDAQ)
D1/03/2G11 59,1'000 Mka
59.170000 11,G69.59
911 992 ROWS T PRICE MID CAP VALUE FD (77957Y106)
COM
Mutual Fund (as quoted by NASDAQ)
01/03/2011 23.93000 Mkt
23.930000 10,517.06
921 300 SPDR SERIES TRUST (78969A763)
S&P DIVID ETF
NYSE Arca Equities Exchange
01/03/2011 52.93000 52.18200 H/L
52.306000 15,691.80
93j 95 SCHLUMBERGER LTD (806857108)
COM
New York Stock Exchange
G1/03/2011 89.55000 83.37000 H/L
83.960000 3,773.20
Div: 0.,'.1 Ex: 11/29/2010 Rec: 12/01/2010 Pay: O1i07/2011 9,q5
49) 2 STAPLES INC (855030102)
COM
The NASDAQ Stock Market LLC
01/03/2011 23.73000 23.28500 H/L
23.507500 97,02
Div: 0.09 Ex: 12/21/2010 Rec: 12/23/2010 Pay: 01 /13/2011 0.16
451 63 SYSCO CORP (871829107)
COM
Ivew York Stock Exchange
01/03/2011 29.53000 29.20000 H/L
29.365000 1,850.G0
96) 45 TEVA PHARMACEUTICAL INDS LTD (b81629209)
ADR
The NASDAQ Stock Market LLC
01/03/2011 53.66000 52.51000 H/L
53.08500G 2,38g,g
Page 9
This report was produced with EstateVal, a product of Estate valuations & Pricing Systems, Inc. I'_ you have questions,
please contact EvP Systems at 1818) 313-6300 or www.evpsys.com. (Revision 7,1.C)
Date of Death: 01/03/2011 Estate of: WARD E. GREEN
valua tion Date: 01/03/2011 Account: 61N02O013
Prcce ssinq Date: 02/03/2011 Report Type: Date of Death
Number of Securities: 57
File ID: 6iN020013 WARD E GREEN
Shares Security Mean and/or Div and Int Security
or Par Description Hig h/Ask Low/Bid Adjustments Accruals Value
97) 25 3M, CO (88579Y101)
COM
New York StocF; Exchange
01/03/2011 87.33000 86.79000 H/L
87.035000 2,175.88
98) 115 US 6ANCORP DEL (902973304)
COM NEW
New York Stock Exchange
01/03/2011 27,40000 26,92000 H/L
27.160000 3,123.40
Div: 0.05 Ex": 12/29/2010 Rec: 12/31/2010 Pay: 01/ 18/2011 5.75
99} 29 UNITED PARCEL SERVICE INC (911312106)
CL B
New York Stock Exchange
01/03/2011 73.89000 72.86000 H/L
73.375000 2,127.88
50) 50 UNITED TECHNOLOGIES CORP (9130171091
COM
New York Stock Exchange
01/03/2011 79.42000 78.96000 H/L
79.190000 3,959.50
51) 697.396 VANGUARD STAR FD (921909602)
TOTAL INTL STK
Mutual Fund (as quoted by NASDAQ}
01/03/2011 15.86000 Mkt
15.860000 10,266.91
52) 320 VANGUARD TRUSTEES EQUITY ED (921939203)
INTL VALUE FD
Mutual Fund (as quoted by NASDAQ}
01/03/2011 32.39000 Mkt
32.390000 10,369.80
53) 320 VANGUARD IN'PL EQUIT'f INDEX FD (922092858 )
EMR MKT ETF
NYSE Arca Equities Exchange
01/03/2011 95.80000 98.55000 H/L
98.675000 15,576.00
54) 110 VANGUARD INDEX FDS (922908595)
SML CP GRW ETF
NYSE Arca Equities Exchange
01/03/2011 79.6'1000 78.60000 rt/L
79.135000 8,704.85
55) 60 VERTZGN COMMUNICATIONS INC (92393V109)
COM
New York Stock Exchange
01/03/2011 36.45000 35.88000 H/L
36.165000 2,169.90
56} 35 WAL MART STORES INC (931192103)
COM
New York StocY, Exchange
01/03/2011 54.80000 59.15000 H/L
59.475000 1,905.63
57) 100 WELLS FARGO 5 CO NEW (999746101)
COM
New York Stock Exchange
01/03/2011 31.66000 31.16000 H/L
31.910000 3,191.00
Tot al Value: 5223,E L`.33
Total Accrual: $118.99
Total: $2 23,634.27
Page 5
This report was produced with Estateval, a product of Estate Valuations L Pricing Systems, Ir.c. I` you have questions,
please contact EVP Systems at (916) 313-6300 cr www.evpsys.com. rRevisicr. 7.1.0)
Date of Death: 01/03/2011
Valuation Date: 01/03/2011
Proe:essing Date: 02/03/2011
MML
Portfolio Endnotes
Estate of: WARD E. GREEN
Account: 61N0?0013
Report Type: Date of Death
Number of Securities: 5'
Eile ID: 61N020013 WARD E GREEN
Page 6
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please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7,1.0;
a ~~
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Phone 888-502-4349
F ax (302) 934-2955
February ~, 2011
Anstine and Sparler
117 East Market Street
York, PA 17401
Re: Estate of Ward E Green
Social Security: 040-1 R-4234
Date of Death: January 3, 2011
Dear Sir or Madam:
Per your inquiry on January 27, 2011, please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
l . Type of Account
Account Number
Ownership (Names ofJ
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
9834652274
Ward E Green
Carolyn G Anstine (POA)
12/20/05
$10,159.99
$ .03
$10,160.02
2. Type of Account Safe Deposit Box
Box Number/Location 1905/Wert S{tore Plaza
Ownership (Names o~ Ward E Green
Carolyn G Anstine
Opening Date 01/05/06
For further account information, closures and/or reimbursement of funds please call the West Shore Plaza Office at#'717-731-1730.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers,
Representative Payee, or Trustee under a Written Agreement
Sincerely,
Tammy ~pencer
Adjustment Services