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HomeMy WebLinkAbout10-06-11 (2) -~ REV-1500 Ex `°'-'°' 1505610143 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code veEir File Number Bureau of Individual Taxes UEVARTMENT OF REVENUE Po Box.28oso1 INHERITANCE TAX RETURN 2 1 1 1 0 15 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 205 09 9182 O1 07 2011 06 19 1921 Decedent's Last Name MARTIN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Decedent's First Name MI SAMUEL I Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE: WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Retturn (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe De (Attach Copy of Will) (Attach Copy of Trust) posit Boxes ^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date or death 11. Election to tax under Sec. 9113 A between 12-31-91 and 1-1-95) ^ ( ) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number WILLIAM C CRAMER 717 264 3711 First line of address 14 NORTH MAIN STREET ST Second line of address City or Post Office CHAMBERSBURG REGISTER~6 WILLS USEtJNLY <~-) - ~ '~' - - ~7 =~ :.--- ' .~, - - -p g _ `; ` t - •~~ ~~ FILED r` " :', State ZIP Code PA 17201 Correspondent'se-maiiadaress: williamcramer@embargmail.com ~.: i'i Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the bes4 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. SIGNATURE OF PE ESPONSIe OR FILING RETU~ DATE /-~ / ~`~ a Samuel Richard Martin ~,-~ ADDRESS ~~~ 2236 Ritner Highway, Shippensburg, PA 17257 SIGNATURE OF PR6PARFilYf)THFR runuacnncccAirerivc 1505610143 1505610143 14 North Main Street, Ste. 414, Chambersburg, PA 17201 Side 1 ~ T 1505610243 REV-1500 EX Decedent's Social Security Number ~eceeenrs Name MARTIN , SAMUEL 1. 2 0 5 0 9 9 1 8 2 RECAPITULATION 1. Real Estate (Schedule A) ........................................................................................ .. 1. 2. Stocks and Bonds (Schedule B) ............................................................................. .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ .. 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ .. 4. 5• Cash, Bank De osits & Miscellaneous Personal Pro a P p rty (Schedule E) ............... . 5. is 5 9 , 3 6 0 . 5 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............ . 7, 8. Total Gross Assets (total Lines 1-7) ...................................................................... . g, 2; 5 9 , 3 6 0 . 5 8 9. Funeral Expenses 8 Administrative Costs (Schedule H) ...................................... ... 9. 31,897.22 10. Debts of Decedent, Mortgage Liabilities, i;< Liens (Schedule I) ............................. ... 10. 509.85 11. Total Deductions (total Lines 9& 10) ................................................................... ... 11. 3 2, 4 0 7 0 7 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. 2 2 6 , 9 5 3 5 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... .. 14, 2 2 6 , 9 5 3 5 1 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. 16. Amount of Line 14 taxable 2 2 6 9 5 3 5 1 at lineal rate X .045 ~ 16. 10 2 12.9 1 ~ 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................... ......... .................................................................................. . 19. 1 0 , 2 12.9 1 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 - 0153 N A Martin, Samuel I. STREET ADDRESS ------ -- 129 Walnut Bottom Road CITY Shippensburg STATE --- PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A• Prior Payments B. Discount 3. Interest (1) 10,212.91 9,000.00 473.68 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. Total Credits (A + B) (2) 9,473.68 (3} 0.00 (4) (5) 739.23 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................. ^ O b. retain the right to designate who shall use the property transferred or its income :.................................... ^ 0 c. retain a reversionary interest; or ................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of deaths without receiving adequate consideration? ...................................................................... f^ ^ ................................................. 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 retturn 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)1. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w etlher y blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. COAMAONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TA% RETURN RESIDENT DECEDENT FILE N MU BER - ---~~- ESTATE OF Martin, Samuel (. ~ 21 - 11 - 0153 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Checking account #15418030 maintained with Orrstown Bank held in decedent's name alone, 9,301.60 including interest accrued through date of death. See, Exhibit A attached 2 Money market account #828173 maintained with Orrstown Bank held in decedent's names alone, 54,100.65 incuding interest accrued through date of death. See, Exhibit A attached 3 I Certificate of Deposit #4000013955 maintained with Orrstown Bank held in decedent's name I 5,002.79 alone, includuing interest accrued through date of death. See, Exhibit A attached 4 I Certificate of Deposit #4000020905 maintained with Orrstown Bank held in decedent's name I 33,202.38 alone, including interest accrued through date of death. See, Exhibit A attached 5 I Certificate of Deposit #4000021368 maintained with Orrstown Bank held in decedent's name I 67,285.07 alone, including interest accrued through date of death. See, Exhibit A attached 6 Mutual fund #690015999 maintained with Invesco held in decedent's name alone, including I 2,138.42 interest accrued through date of death. See, Exhibit B attached 7 Mutual fund #6900160873 maintained with Invesco held in decedent's name alone, including I 5,762.85 interest accrued through date of death. See, Exhibit B attached 8 Mutual fund #6900161427 maintained with Invesco held in decedent's name alone, includiing I 13,868.73 interest accrued through date of death. See, Exhibit B attached 9 Retained Assets Insurance Account #9860059174 maintained with Northern Trust held in 60,441.49 decedent's name alone, including interest accrued through date of death. See, Exhibit C attached 10 I Refund from Elmcroft, for unused nursing home fee ~ 2,092.60 11 Refund from Internal Revenue Service, for decedent's 2010 income tax 6,164.00 TOTAL (Also enter on Line 5, Recapitulation) 259,360.58 Sq-EDIJLE H COMMONWEALTH OF PENNSYLVANIA /~~~~~~p/~~~ //'-/~~^~ INHERITANCE TAX RETURN /'~LJIr91Mv7 1 f\F\ I IYG VW 1 ~7 RESIDENT DECEDENT . _. --F ESTATE OF Martin, Samuel I. FILE NUMBER _ _ ~ 21-11-0153 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION ~ AMOUNT A. 1 Fogelsanger-Bricker. Funeral Home, for funeral service 9,606.43 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Samuel Richard Martin Street Address 2236 Ritner Highway city Shippensburg state PA zip 17257 Year(s) Commission paid 2011 2. Attorney's Fees William C. Cramer, Esq. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 5. I Accountant's Fees i 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland County Law Journal, for estate advertising - - _ _ TOTAL (Also enter on line 9, Recapitulation) 31,897.22 10, 780.00 10,780.00 407.50 75.00 Schedule H Funeral E~ens~s & COMMONWEALTH OF PENNSYLVANIA w,,~, INHERITANCE TAX RETURN /"1~1~n~~ ~~ RESIDENT DECEDENT ESTATE OF Martin, Samuel I. FILE NUMEIER 21 - 11 - 0153 2 Orrstown Bank, for estate checks 10.50 3 ,The Sentinel, for estate advertising 237 79 Pagel2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, DC LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMHER ESTATE OF Martin, Samuel I. 21 - 11 - 0153 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses ITEM NUMBER -- DESCRIPTION AMOUNT 1 WSEMS-Chambersburg, for decedent's final ambulance bill 222 94 2 Care First Pharmacy Services, for decedent's final pharmecutical bill 15.91 3 Chambersburg Imaging, for decedent's final medical bill ~ gp 4 Summit Physicians Service, for decedent's final medical bill 223.44 5 Chambersburg Hospital, for decedent's final medical bill 39.66 I TOTAL (Also enter on Line 10, Recapitulation) I 509.85 REV-1513 EX+ (11-08) SCHEDULE J 1 Melinda Foltz 608 Walnut Bottom Road Shippensburg, PA 17257 COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES ~ INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Martin, Samuel I. ~ FILE NUMBER _ ~ 21-11-0153 RELATIONSHIP TO i SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not Llet Trustee(s) -- I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. X116 (a) (1.2)] 2 Steven Peiper 109 Dane Brook Drive Amherst, NY 14226 3 Melissa Burch 12712 Grandview Road Grandview, MO 64030 II. Granddaughter One-tenth of net estate Grandson I One-tenth of net i estate Daughter One-fifth of net estate Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS j I TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET i 0.00 REV-1673 EX+ (9.00) SCHEDULE J COMMNHERITANCE TAX R TURNANIA BENEFICIARIES continued -RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER Martin, Samuel I. 21-11-0153 NUMBER NAME AND ADDRESS OF PERSONS O RE _ RELATIONSHIP TO DECEDENT SHARE OF ESTATE i (Words) AMOUNT OF ESTATE ($$$) CEIVING PROPERTY Do Not Llet Trustee(s) I, TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 4 Samuel R. Martin Son One-fifth of riet 2236 Ritner Highway estate Shippensburg, PA 17257 5 Norma Jean Keefer Daughter One-fifth of net 138 Horsekiller Road estate Shippensburg, PA 17257 6 Mary Hare Daughter One-fifth of net 120 Rehobeth Road estate Shippensburg, PA 17257 Page 2 of Schedule J REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2011- 00153 PA No . 21- 11- 0153 Estate Of : SAMUEL /MART/N /First, Middle, LasU Late Of : SOUTHAMPTON TOWNSHIP CUMBERLAND COUNTY Deceased Soci a1 Securi ty No : 205-09-9182 WHEREAS, on the 7th day of February 2011 an instrumf=nt dated July 9th 2004 was admitted to probate as the last will o~_` SAMUEL l MARTIN /First, Midd/e, Lasll late of SOUTHAMPTON TOWNSH/P, CUMBERLAND County, who died on the 7th day of January 2011 and, WHEREAS, a true copy of the will as probated is anne~,~ed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register- of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTAR)/to: SAMUEL RICHARD MARTIN who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLANDCOUNTti'COURTHOUSE, CARL/SLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 7th day of February 2011. '-. r ~ '~ ~ / ~ ~ -~ , t ~ ~ C. egrster o L ills ~ ~ l `~ ~~.r t ~v ~>< ` ~r ~~ v --~: * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ' ~ ~ ~ ~ - ------ ~, ,-z-~ ~~'_ '-~ C7 C7 ?» ~i t O -~ ~ ~ t'r'y ~ W N4W THt~ ,~, day of July, 2p04,, I~ Saimua~ 1, Martin, presently residing in the ~.: '-.4n v'{ X+'r~~2'f`;#' +W .: r ?. ~' -r 7'~ zl L3'Sy, .fin,( ~'t±' ti ~ •~ ~~ Walt1lJt~ i~08~, ~E!!"i 1~ ~ a i~ ~- - 3' - and body, but nevertheless mindful of my mortal nature, do hereby pubUsh and declare, ~i11 the presence and hearing of the undersigned witnesses, this as my Last Will and Testament, hereby revoking all previous wills and codicils executed by me. I direct my executor or executrix to first pay my funeral expenses as soon after my demise as may be found convenient, and also first pay all estate, inheritance, succession and other death transfer taxes, of whatever nature and by whatever jurisdiction imposed and interest and penalties in respect thereto, assessed against my estate or payable b~ reason of my demise, with respect to any and all property, life insurance and other interest comprising my estate for death tax purposes, whether or not such property or interests pass under this will or any codicil thereto, without reimbursement as if such taxes were administration expense, and also to first pay, from my estate, all administration expense. ~~ ~. ,i I give, devise and bequeath my entire estate and all my property, whether personal, real, mixed, tangible or intangible, wherever situated, whenever acquired and of whatever description, which I may own, possess or have any right to dispose of at the time of my demise to my six children, namely, William Martin, Mary Hare, Norma Jean Keefer, Samuel Richard Martin, Susan Peiper and Melissa Gilkison, in equal shares. Providing, however, should any child of. mine fail to survive my demise by thirty (30) days and also ;~ ; leave a child or children (my grandchild or grandchildren) surviving my demise by tfiirty (30) days, then the share of such deceased child shall lapse or be divested and shall pass, instead, in equal shares, to their child or children (being my grandchild or grandchildren). However, should any child of mine not survive my demise by thirty (30) days and also fail to leave a child or children (my grandchild or grandchildren) surviving my demise by thirty (30) days, then the share of such deceased child shall lapse or be divested and shall pass, instead, to my remaining child/children, in equal shares. I appoint and nominate my son, Samuel Richard Martin, as executor of this will and should he predecease me, renounce or decline this appointment or for any reason fail to qualify or accept this appointment, I then appoint and nominate my daughter, Melissa Gilkison, executrix of this will. ~'~ ~- 2 No bond or other security shall be posted or required of my executor or executrix appointed in this will or otherwise qualifying for such position. In addition to all other powers which my executor or executrix may have at the time of my demise, whether by statutory law or common law, I also grant them the power to sell, transfer or assign any and all property in my estate, both personal and real. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ., day of 2004, to this and the preceding two (2) pages and I have also placed my initials on each page herein for purposes of greater security and better identification. Samuel I. Martin, _ ~4.9~ t~ SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testator, Samuel I. Martin, as and for his Last Will and Testament, in the pr®spnce and hearing of us, who at his request, in his presen©e elnd itt the gre~pnae Qf Qther, IuNVp hu, subscribed r mes 'tnesses on the date ~rBt wrftte~ above. (SEAL) /yam! ~~in/-t7 sr~. Sips! C4~n_--,.e~,~,~sr,,,a~ ,~ Address ~~~~ (SEAL) /y N. r~r s } Ste, ~ii-2 C~i9s+•~E/2SS(/R6 ~9 Address ~~ y~- 3 x.f,~J COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF FRANKLIN , I, Samuel I. Martin, whose name is signed to the attached and foregoing instrument, having been duly sworn and qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Samuel I. Martin, this day of , 2004. n Notary Public NOTARIAL SEAL SUSAN K ROTE. NOTARY PUBLIC CHAMBERSBURG F30R0 FRANKLIN CO.. PA MY CU'AMIS;ION EXP~PES JUNE 20. 2GOF ~~9 ~~ oaf) ~.~-~-~ Q ~ ~'1~t ct+r~ Sam~,el~Sl. M~a-rtin 4 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF FRANKLIN W e, GJ/u.~.,~-~ e. r!~~e. and ~~,ea .Z --rTCGc: F~ , 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 the Testator sign and execute the instrument as his Last Will; that Samuel I. Martin signed willingly and that Samuel I. Martin executed 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. Sworn or affirmed to and subscribed to before me b ~/c.~.~i~,~ ~ ~i~~. and ~~~,q,e~ ~ Sr~,r.~~ ,witnesses, this ~th day of , 2004. ~ /~ ~/' v ~f .~~.. Notary Public NOTARIAL SEAL SUSAN K. ROTE. NdT:?Y PU©Ur CHAMBERSBURG EORO FRANKLIN G~ P4 MY COMMISSION EXPIRES JUNE 20. ;?COS 5 MflR-10-2011(THU) 10:24 BANK A Tradition oj~xrrRertce March 9, 2011 William C. Cramer, Esq. 14 North Main Street Suite 4I4 Chambersburg, PA 17201 Fax 264-0554 Re: Estate of Samuel I. Martin Social Security Number 205-09-91$2 Date of Death January 7, 2011 IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT' HAD THE FOLLOWING ACCOUNTS W1TH ORRSTOWN BANK.• C,HECKTNG ACCOUNT Account No. - 15418030 Account 'I~pe -- RMA Checlflng Date Opened - 4/29/$5 Joint Account (name/date) - None Balance - $9,301.60 Accrued Interest - $0 MONEY MARKET Account No. - 828173 Date ripened -- 10/29/04 Joint Account {Warne/date) - None Balance - $54,094.43 Accrued Interest - $6.22 Exhibit A P. 001 /002 77 Easi King Street P.O, Box 250 Shippensburg, PA 17257' 1.888.ORRSTOWN www arrstown.co~n hIAR-10-2011(THU) 10: 2Q CERTIFICATES OF DEPQSIT Account No. - 4000013955 Account Type - 6-11 Month Income Date Opened - 11 / 14/ 06 Joint Account (name/date) - None Balance - $5,000.00 Accrued Interest - $2.79 Account No. - 4000020905 Account Type- 3-5 Month Growth Date Opened -- 11/6/07 Joint Account (name/date) - None Balance ~ $33,201.75 Accrued Interest - x.63 Account. No. - 400002].368 Account Type - 3-5 Month Growth Date Opened - 11/23/07 Joint Account (name/date) - Nonc Balance - $67,265.72 Accrued Interest - $19.35 TRUST ACCOUNTS Date of death values for Mr. Martin's trust accounts will be sent to you under separate cover. est Regards, Vicld L. Gullixon Customer Service Specialist P. 002/002 2. MDR-1 D) 12:16 via i vvr lv FINANCIAL AUVTSOZtS A Tiodilion of ExYxpenr,~ March 15, 2011 William C. Cramer Attorney at Law 14 North Main Street, Suite 414 Chambersburg, PA 17201 Mr. Cratncr: This letter is in response to your letter dated February 17, 2011 regarding the Estate of Samuel 1. Martin. As of January 7, 2011, Mr. Martin owned individual mutual fund accounrts with Inv-seo. "1"he values a,~ oFdate ofdcath, January 7, 2011, follow: Account No. G900] 59999 $2,138.42 Account No. 6900160873 $S,7b2.SS Account No. b9001 61427 $13,868.73 CTpon the inception date of 2115/1999, these accounts were registered as joint tenant accounts under the names of Samuel 1. Martin and Eva S. Martin. On September 1 S; 2004, Mr. Martin sibmed a letter written to the fund family requesting that the accounts be changed from joint to individual, due to the death of Mrs. Martin on June 1 S, 2004. Earlier in the month, you received information concerning Mr. Martin's Orrstown Bank accounts. Phis information covers the accounts handled through Orrstown Financial Advisors with Financial Network Investment Corporation. If you need further a,~sistanee, please call 717-530-3525. Sincerely, Ronda P Dick Register Administrative Assistant 'Registered Representative of and Securities and Advisory SenrlceS offered through l=tnancial Network Irlvostmertt CorparatiprLas[ Kin Street Member SIPC, Orratown Financial Advisors end ~inanClal Network are not AtTiliated. 7// tt g NOT A DEPOSIT•NOT FDIC INSURED-NCtT SANK GUARANTEE-NOT INSURED BY ANY FEpERAL GOVERNMENT AGENCY- P.O. BOX 250 MAY LOSE vALUt:. Shippensburc~, PA 17257 Exhibit B 1,888.ORRSTOWN Northern Trust ESTATE OF SAMUEL I MARTIN SAMUEL R MARTIN, EXECUTOR 2236 RITNER HIGHWAY SHIPPENSBURG PA 17257 September 23, 2011 Re: Retained Assets Insurance Account # 9860059174 Dear Account Holder, Thank you for contacting us regarding your Retained Assets Insurance Account. Verification of the information that you requested is provided below. Date of Death Balance: $60,441.49 If you have any questions or if we can be of further assistance please contact us at our toll-free phone number, (800) 343-2551 Monday through Friday, 8:30 AM to 7:00 PM (EST). Sincerely, AH Retained Assets Insurance Account Customer Service Encl.: As Stated Exhibit C