The URL can be used to link to this page

Home My WebLink About11-10-11 1505610101 REV-1500 I:x t°'_1°' PA Department of Revenue pennsytvaMa Bureau of Individual Taxes °`""~"`"~°"~"`""` PO Box z8osoi INHERITANCE TAX RETURN Harrisburg PA 17128-osoi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY I~1 -~8 -22 IQ '02/12/2011 , . __-. ~_ . Decedent's Last Name Suffix ;Fry _ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix _. _. Spouse's Social Security Number .._ ....................... FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return OFFICUIL USE ONLY County Code Year File Number L1 ~/ _ oa3y THIS RETURN MUST BE FILED IN DUPLICATE WRH THE REGISTER OF WILLS O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13 82 O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) 1• 6. Decedent Died Testate (Attach Copy of Will) O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 C Name ONFIDENTIAL TAX INFORMATX)N SHOULD BE DIRECTED TO: - _ . Daytime Telephor~Number '_ Andrew C. Sheely, Esquire === 717-697-705(~O -_ ~, -r, _ ~ REGISTER ji ' USE OALY ' , ~j First line of address C C/> ~ - <7 ~ ~ L 4 127 South Market Street __ __ _ _ ~ t7 J~ ' ~ _- econd line of address _ ~ .~- ~ _ - , . _ ~ P.O. Box 95 _ _ ~ ~c ~ O -'-' City or Post Office State ZIP Code DATE FILED '..Mechanicsburg PA 17055 correspondent's e-mail addeas:andrewc.sheely@verizon.net Under penalties of perjury, I declare that 1 have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other than the personal representative is based on all infonnaticn of which preparer has any knowledge. SIGNAT PERSON R ILING URN t~ pn ~ I IQ J es K. Fry, Executor, 8 andy Lane, Camp Hill, PA 17011 SIGNAT ' OF RbRgBE T THAN REPRESENTATIVE ~ATF pnno cc C/•// S ~ /ZI('fy Andrew C. Sheely, Esquire, 127 South Market Street, P.O. Box 95, Mechanicsburg, PA 17 5 PLEASE USE ORIGINAL FORM ONLY " Side 1 L 1505610101 1505610101 C i REV-1500 EX Decedent's Name: Ffy, James M. 1505610105 Decedent's Social Security Number ~~~ _ a~- as ~ o_ RECAPITULATION $185,000.0 1. Real Estate (ScheduleA) ........................................... .. 1. $1,517.92' 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. 9 9 ( ) ......................... Mort a es and Notes Receivable Schedule D 4. .. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 111,153.98;. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 771.76 " 104 (Schedule G) O Separate Billing Requested...... .. 7. . , 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. $402,443.68' ' 13 245 30 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. . 10. 9 9 ( ) ............ Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 10. .. 65,546.69', 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. $78,791 99 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. $323,651.67; ..._ __ 13. Charitable and Governmental BequestslSec 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. $323,651.67 ", TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or _ __ transfers und~~ csc. 9116 (a)(1.2) X .0. 15. 16. Amount of Line 14 *=~~ble $323,651.67: at lineal rate X .045 16. $14,564.33 _, _,,. .. 17. Amount of Line 14 taxable _ at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 ' 18. $14,564.33. 19. . TAX DUE .............................................. .. 1s. _ ,.. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT d• Side 2 1505610105 1505610105 REV-1500 E!C Page 3 Decedent's Complete Address: , James M. Fry Silver Spring Road File Number ''„ 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments (1) $14,564.33 A. Prior Payments $14,000.00 - B. Discount $736 82 3. Interest Total Credits (A + B) (2) $14,736.82 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT: (3) 0.00 Fitt In oval on Page 2, Line 20 to request a refund. (4) $172.49 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. °.~ `xr~<" PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the Yes No property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or ifs income : ............................................ ^ c. retain a reversionary interest; or ........................... d. receive the promise for life of either payments, benefits or care? .................................... . 2. If death occurred after Dec• 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ................ 3. Did decedent own an "in trust for" or payable-upon~deafh bank account or security at his or her death? .............. ^ 4. Did decedent awn an individual retirement account, annuity or other non~probate property, which contains a beneficary designation? ........................................................................................................................ ® ^ „~~, IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU IYIUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1,1995, the tax rate im sed on the net value of transfers to or for the use of the survivin 3 percent [72 P.S. §9116 (a) (1.1) (i)]. pa g spouse is 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 survving 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 Juty 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age a 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){i.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficlaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) p2 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 sibkng is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. i COMMONWEALTH OF PENNSVIVANIA ~ DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HARRISBURG, PA 17126-0801 RECEIVED FROM: NO. CD 014427 FRY JAMES K 835 MANDY LANE CAMP HILL, PA 17011 -------- eoa PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssnl: ~7~.28_P210 FILE NUMBER: 2111-0234 DECEDENT NAME: FRY JAMES M DATE OF PAYMENT: 05/06/201 1 POSTMARK DATE: 05/06/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 02/ 12/201 1 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX(11-86) AMOUNT TOTAL AMOUNT PAID: 514,000.00 REMARKS: CHECK#1010 INITIALS: DB sEA~ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER REV-1502 EX+ (11-08) ~pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TA1C RETURN REAL ESTATE RESIDENT DEClU)ENi e~Inre vF FILE NUMBER James M. Fry 21-11-0234 ~H real Properly owned solely ar ee a tanarrt in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being crompelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that b jolMly-owned with right of survivorship must be ditdosed on SdNdule F. Attach a copy of the settlement sheet if the property has been sold. I1EM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. Decedent's real property bated at 524 Silver Spring Road, Mechanicsburg, Silver Spring $185,000.00 Township. Cumberland Countv. PA 17050. Tax Panel #38-19-1608-034A See attached appraisal by Brett Lechthaler, PA Certified Appraiser, Appraisal Solutions TOTAL (Also enter on Line 1, Recapitulation.) I # $185,000.00 If more space is needed, insert ~ditional sheets of the same size. ~:. i I, i APPRAISAL OF REAL PROPERTY LOCATED AT: su ska.aprp ~ Deed Book 28V Pepe 7St Mbtlenbebug, PA 17050.2870 FOR: Ths Eeuee d Jamse M Fry do Ardew SNely.127 3. Mrket 31. , PA AS OF: Z/122011-Fiehpspscyyr RY: APpeiee~ SokaDfOne Brolt LeciOrNr, PA CeAlfed Cwiwal Appraiser 16 Sen.kien Ohre Med~sdosbup,PA17066 ram 5A5-1NamrAL•+geeisr es8sre ey e r nntle, ~. _ ~,~ SUMMARY OF SALIENT FEATURES swwcc M~eea 5za ~ samp rm ~ ~~ Dees Book 29V Pape 752 ~r M.aren~ae„p cwq aaneenrw SWE PA Lp GfEe 7705U287p Ceneut i~act 0118A2 MTV Itlfaame Ms6o28g8/C>2 ~~ S NA oreasar ru Banowr~re NA Llll~f The Esfab d JYMa M Fry ~ ~e FMQ 1.321 PikxpxSgareFOOt : LOCM0 11 Avatape ~ 48 Yuen Can~Baa Gaod TehlRadn g 8eboans 3 BYS 1 ~Ppbe~ BnItUrJahalar,PASWSCwtCanAPPr DldAppr~YeAYalie "2H212011 gW6iimbofVikl S 185,000 fqm SBD -'MAnTpiAL• ~ppebA l08~NR by a 4 mo01, iic. -1~Op~ALAl100E TaxD6 Result Details DistrictNo 38 Parcel_,ID 38-19-1608-034A MspSailSx HoaseNo 524 Direction Street SILVER SPRING ROAD Ownerl FRY, JAMES M & EVA E C/O PropType R PropDesc LivArea 1120 CarLandVsl 97800 CnrImpVal 105100 Cwi'I'otVal 202900 CarPref Val Acreage 1.91 CIGreStat TaxEx 1 SaleAmt 1 SaleMo 07 SBdeDa 22 SaleCe 19 SaleYr g2 DeedBkPage 0029V-00752 YearBlt 1963 HF_File~ate 10/21/2004 ~~PProval_Statas A http: ((taxdb.ccpa.net/details.asp7id~ 38-19-1608-03aA8Kibselea=l Detailed Results for Parce138-19-1608-034A in the 2010 Tax Assessment Database 3/3/11 1:32 PM Page 1 of 1 REV-15p3 EX+ (8-98) scN~uu~e s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERRANCE TAX RETURN RESIDENT DECEDENT F.RT4TF nF James M. Fry FlLE NUMBER 21-11-0234 Historical Quotes: Charcing Tools for Looking Up a Secunty's Exatt Closing Price - BlgCharcs Non Entsr Symbol: r---.---~ Enter DatO: ;02/11/11 (pDl .. . ............. ..........._J .. .______...... PPL Corp Clpeinp Prite~ 24.75 Oxen. 24.62 4~~w a~~`-~.~=~~r~. 24.a~ ~~; 24.86 Vduma' 3,891,713 Go ?o Charting w~ No Splits 2-Month Daily Chart of PPL Corp 9poreond links Flot Stock ANR - GTSO Profit From Mew Rare Eatlt Exporter! Chloe Rare EaM Exports Up 171% www.RaneaRhe~n.9.w,n Come expMisrwe Pen~stodc Ins w8h our flee 8 aauraro rnewslstter www.MrmYaraXVUnlwrse.com Troller Makes ie7 MIIUon G9forrrie Option TreOer Makes S87 MiNion in a Singh Yerl See How mrw TnetnresW~'NY.oom RMnanee Rath ffi 29X, S1eo,000 morlgpe: ieb&nro. Froe. NO OtNigtlion. Get a Quatal 3.1% APR Lanaps.cam+rorrysge _ • FM ErppkNp PIO/Meorelr TnEe Tngr® ~Y PaY~ TraOe b OCesnsHsim. tlOmtl AYatIIIfIfi14 Copyright m 2011 MarkstWatch, Inc. All rights reserved, By using this site, you agree to the Ierots of Use and Privacy Policy (updated 4/3!03). Intraday Data provided by Thomson Reuters and subject to tuts of use. Historical and current end-of-day data provided by Thomson Reuters. Intraday data delayed per exchange requirements. Dow Jones Indexes (SM) from Dow Jones 8 Company, Inc. All quotes aro in bcal exchange time. Real time leaf sale data provided by NASDAQ. More infOnnation on and their current financial status. Intraday data delayed 15 minutes for Nasdaq, and 20 mintttes for other exchanges. Dow Jones IndexeaSM from Dow Jones 8 Company, Inc. SEHK intraday data is provided by Comstock and is at least ti0-minutes delayed. All quotes aro in kits! exchange time. Enter Keyword(s) SEgRCH http: / /bigcharts.marlcetwatch.com/hlstoncal/default.asp?detect=16symtxll=ppl6close_date=02%2F11%2F11&x=38&y=21 3/3111 12:54 PM Page 1 of 1 This Historical Quotes tool allows you to look up a severity's exact dosing price. Simply type in the symbol and a historical date to view a quote and mini chart for that ~ security. Historical Quo[es: Charting Tools for Looking Up a Security's Exact Closing Price - BigCharts More Enter Keyword(s) gEq~w raavsaraaaa+ Errdr Symbol: Pp~~ ---~~ E~ftsr Wtc 02/14/11 i ...._____ . PPL Corp Morvixy.. 'ebruai} 'e. IRi' flpcing Pric¢~ 24.60 CPen. 24.78 H,i ^' g::. d~T'/_ClaVt ~ 1g3 24.76 ,,, irrw 24.60 Vaumo 6,681.027 ~' ~ No SPrits GO TO rherti~lg 2-Month Daiiy Chart of PPL Cerp SPOnaorad uti<, Hot Stock Alert - t3TSp Profit From Nsw Raro EaM Expwteri China Rare EaAh Exports Up 171 % wmw.RaroEarth6+roor»rs.mm Lwm to Trade QDaorw Thb Idaho Farm-doy dk! and tumW ~1,00o irno =19,910 in 30 Daycl www.TneMvanto,Cry.com a Raba Hlt 2.98% H You owa Naa than i729k You proWbly ~ih ~ 9oK Rdi Programs ++ww.deeReManoeRalassnm ReflrlaflCe Ratae at 2.9% 5190,000 nartgape: i0.49/mo. Fras. No ObRpa9m. Gat a quote) 3.1% APR leMpo.com'niprppe ~~ Tnga ~ Y_ Trade Faa EawNOro Fasr<vrM Ca dQO)t I BLOW I .aQ9~pe1dalL I f~OlvdSa I I ttet Copyright ®2011 MerketWatch, Inc. All rights reserved. BY using this site. you agree t0 the Terms of Use and P,_Sy Policv (updated 4/3/03). Intraday Data provided by Thomson Reuters and subject to terms of nom. Historical and current end-of-day data provided by Thomson Reuters. Intraday data delayed per exchange requirements. Dow Jones Indexes (SM) from Dow Jones & Company, Inc. All quotes aro in log) exchange time. Real time last sale data provided by NASDAQ. More intonnation on and their current flnandal status. Intraday data delayed 15 minutes for Nasdaq, and 20 minutes for other exchanges. Dow Jones IndexesSM from Dow Jones & Company, Inc. SEHK intraday data is provided by Comstock and is at least 50-minutes delayed. All quotes are in kcal exchange time. http: / /bigcharts.marketwatch.com/historical/default.asp7detect=1&symbol.ppl6ciose_date=02%2F14%2Fi 1&x=44&y.26 3/3/11 12:53 PM Page 1 of 1 This Historical Quotes tool allows you to look up a security's exad dosing price. Simply type in the symbol and a historical date to view a quote and mini chart for that ~ security. . ~ Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Bonds: 1-5 of 5 Page 1 of 1 NAy NA EE EE -- $50 $100 07/1998,03j2011 07 199 07/2023 $25.00 $14.66 1,50% X39.66; NA E ; $ / 8.;03/2011 07/2028 : $50.00 $29.32: 1.50% $79.32: _ . NA' E / / / 75.00 $ $367.48 . X442.48 MA NA ~ E ' $50 11 1974. / . _ ~ 1,2/2005 11/2004 $37.50 $37 50 $ 232.00 $225 02 ` #269.50 MA TA~'f le Fw~ C Qwwaw _ , d.7~r ww . a.-.~~ X262.52 MA NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA `Matured and not earnin interest -_-_.. ?.. °. ~ ~ ~ _ fi C./) ~ ~ w c o g' ° ~° ~ 0 °~ m ~' ~ ~ O -.. Y ~ ~ r o. p e ~ ~ O 6 ."Y L R G .t (T7 O ~' ~ p A g ~ $ ~ "~ '~ .1 ~ ~ ~ S .+ ~ ~: ~ c ~~~~6'.: 6 ~ S ~ ~ A "w e~1 6 ~ ~ p ~i. 1 n--ia~ at ~~ p ~tD g~~ g 2 'gp ~ h Q C W ~' "'{ f'~' C 3 m x ~ N o Y441..~ ~J V `~ CD TNT n ~^ r+ ~ a~g.% l ` n~ H. F 'R ~. J ~ 1 k. a ~~ / ~~ A7 .J ~~ ~/ CT ~ ,p Calculator Results for Redemption Date 02/2011 REV-1508 EX+ (6-98) ESTATE OF James M. Fry FILE NUMBER 21-11-0234 Include the proceeds of litigation and the date the proceeds were received by the estate. All Property lolntly-owned with right of survivorehip must be diecbaed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Decedent's Members 1st Savings Account 320730-00, Principal Date of Death Balance $40.14 2. Decedenti;s Members 1st Checking Acx;ount 320730-11, Principal Balance $13,282.25, accrued interest to $13 282 65 date of death , . 3. Decedent's Members 1st Investment Savings Account 320730-05, Principal Balance $36,988.02, accrued $36 993 04 interest to date of death , . 4. Decedent's 2003 GMC Envoy, fair condition $6,000.00 5. Decedent's Member's 1st Supplemental Savings Acct. 320730-01 $205.51 6 Decedent's Model 12 Winchester Shotgun 250.00 7. Decedent's Farmall Tractor $500.00 Decedent's residence and personal property were substantially damaged by a fire which occurred on May 24, 2010. At the time of his death, decedent was in the course of negotiating with Nationwide Insurance Company and was entitled to certain insurance proceeds for damages to the residence, personal property and payments to the restoration contractor, Tuckey Restoration. The insurance proceeds received prior to death were deposited in the Member's 1st atxount identified in item 3 above. Additional insurance payments received after death are set forth below. Expenses due for renovations to the residence are listed on Schedule I. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY 8. Nationwide Insurance Payment made 02114/2011 for restoration/damage repairs by Tuckey $7,142.03 9. Nationwide Insurance Payment made 03/23/2011 for restoration/damage repairs by Tuckey $12,603.33 10. Nationwide Insurance Payment made 07/23/2011 for restoration/damage repairs by Tuckey $22,448.23 11. Nationwide Insurance Payment made 05124/2011 for restoration/damage repairs by Tuckey $11,689.05 TOTAL (Also enter on line 5, Recapitulation) S I 111,153.98 (If more space is needed, insert additional sheets of the same size) St MEMBERS 1~ Pli08RALCRHDrf UNION REGULAR SAVINGS ACCOUNT: Aocount Number/Suffix Date Account Established Prindpal Balance at Date of Death Accrued Interest to Date of Death Total Prindpal and Accxued Interest Name of Joint Owner CHECKING ACC 320730-00 01 /03/2008 $40.14 $.00 $40.14 None Account Number/Suffix 320730-11 Date Account Established 01/03/2008 Prindpal Balance at Date of Death $13,282.25 Accrued Interest to Date of Deattr - $.40 Total Principal and Accrued Interest $13,282.65 Name of Joint Owner None INVESTMENT 8AVINGS ACCOUNT: Axount NumberlSuffix 320730-05 Date Account Established 08/16/2010 Principal Balance at Date of Death $36,988.02 Accrued Interest to Date of Death $5.02 Total Prindpal and Accrued Interest $36,993.04 Name of Jofnt Owner None SUPPLEMENTAL SAVINGS ACCOUNT: Account Number/Suffix 320730-01 Date Account Established 08/16/2010 Principal Balance at Date of Death $205.49 Accrued Interest to Date of Death $.02 Total Prindpal and Accrued Interest $205.51 Name of Joint Owner None LOAN ACCOUNT: Account Number/Suffix Date Opened Prindpal Balance at Date of Death Loan Type Name of Co-Borrower SAFE DEPOSIT BOX: Location YES Carlisle Pike Branch M BERS 1sT FEDERAL C DIT UNION Danielle A. Kline Lending Insurance Support Spedalist February 28, 2011 Estate of: JAMES M. FRY Date of Death: 02/12/2011 Soetal Security Number: 171-28-2210 320730-02 01/04/2008 $0.00 Personal Service Loan None 5000 Louise Drive P.O. Box 40 • Mechanicsburg, Pennsylvania 17055 (800) 283-2328 • wwwmemberslst.org Nwlonwfd~ Marna Al4~d Marna NntlawNdt iAyrfMrM~n rrri Inwnau On 1Swr side' vlctorB Marana One Nationwide Gateway, Dept 5867 'Des Moines, IA 50391-5887 •" February 14, 2011 James M Fry 524 Silver Spring Rd Mechanicsburg, PA 17050-2870 OUR INSURED : James M Fry OUR CLAIM NUMBER : 58 37 MP 852285 05242010 01 DATE OF LO33 : 05-24-2010 Dear Mr. Fry: Thank you for the opportunity to assist you with your claim. EnGosed is a check in the amount of $7,142.03 your damaged property. The amount is based on actual cash value. Actual cash value replacement cost of any identical item or an item of comparable quality less the depreciated value ~ property. The following is a breakdown of the payment: $67,752.44(Replacement Cost) .less $7,300.86{Recoverable Depreciation) equals $6Q,451.58 less $31,119.12(Contractor Contents Cle. less $6,300.27(dry-cleaning) equals $23,032.19 less $15,390.16((PriorAdvance on Contents) equr $7,642.03 less $500(Ded) equals $7,142.03. A copy of the contents estimate will be sent with a separate mailing. The replacement cost provision of your policy provides that payment is to be made oh actual cash the items are not replaced. It also provides that you may make an additional claim for differences between the replacement cost and the actual cash value if you intend to replace the property. You tell us of your intent within 180 days from the date of loss. The receipt for the replacement item m~ submitted. If you decide to replace the items, please let me know within 180 days and send the receipts to me copy of this letter. We will then reimburse you according to the replacement provision. Please contact me if you have any questions or concerns. Thank you for choosing Nationwide Mut Fire Insurance Company to serve your insurance needs. It has been a pleasure to serve you. Si r y vid anci PA-20-MONT) Claims Department Nationwide Mutual Fire Insurance Company (570)233-7188 Any person who knowingly and with intent to defraud any insurance company or other person files REV-1510 EX+ (08-09) Pennsylvarria DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF James M. Fry ITEM SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FILE NUMBER 21-11-0234 This schedule must be wmpleted and filed if the answer to any of questions i through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY IHCUmE THE NWE of THE TAAl6FFREE, THEiR PEUnoRSIUP ro oECEOaIr Nw DATE OF DEATH °~, OF DECD'S EXCLUSION THE DATE OF TRMiSFER. AITACH A COPT Oi THE DEE° Fna aFm ccrrtc ,,. ~ , ,~ .... ---- I _. __ 1. Prinapal Variable Annuity Acct. #540207 Beneficiaries: James K. Fry, 835 Mandy Lane, Camp Hill, PA 17011 Karen S. Fry, 1892 Meadow Ridge Road, Hummelstown, PA 17036 Deborah K. Quidort, 209 Jerryanne Court, Apex, NC 27502 Cynthia L. Thrush, 126 South Ridge Road, Boiling Springs, PA 17007 2• I Prinapal IRAAcct. #4189-0010635896 Beneficiaries: James K. Fry, 835 Mandy Lane, Camp Hill, PA 17011 3• I Prinapal Investment Acct. #4189-0016042042 Beneficiaries: James K. Fry, 835 Mandy Lane, Camp Hill, PA 17011 4. 1 Teamsters Pension Fund 5. I Prinapal IRAAoct. #8900033276 Beneficiaries: James K. Fry, 835 Mandy Lane, Camp Hilf, PA 17011 100°k 100% 100°h 100% TOTAL (Also enter on Line 7, Recapitulation) S TAXABLE $71,857.48 $12,500.00 $19,500,00 $434,00 $480.28 104,771.76 $71,857.481 100% Ir more space is needed, use additional sheets of paper of the same size. DAVID.. M. EDWARDS INSURANCE 527 W. Chocolate Ave., Suite B Hershey, PA 171}33 Life and Health Disability Long Term Care Annuities IRA's and Rollovers Pension and Retirement Plans March 1, 20i 1 Andrew C. Shealy Attorney at Law 127 S: Market S#reet PO Box 95 Mechanicsburg,.PA 17055 Nom. MEMBER Serving Central PA Since 1971 Phone:717-533-6243 Toll Free: 888-464-3252 Fax:717-533-6244 Email: , davidaaechvacomcasknet Regarding: Estate of James M. Fry, Date of Death February 12, 2011 Dear Andrew: Mr. Fry had three accounts with Principal. Two Mutual Funds accounts and 1 Variable Annuity, the status of each follows: Account # 4189-0010635896 is an IRA account on which James I~. Fry (3in~ny), his son, was named the sole' beneficiary. I have suggested.Jimmy consider offtring .to buy out his sisters share of this account and keep it as an inherited' iItA for. his benefit: His Dad and I had discussed this possibility. Approximate value $12,500:00. Account # 4189-0016043042-was anon-qualified investment account held antler the STA Transfer on Death Rtales. We have processed the paperwork for a cash distribution of these fiords to Jimmy. Approximate value $19,500.00: The third Principal account was anon-qualified Variable Annuity # 5420207, on which the children were named as equal share be~teficiariea. We hav~~processed tla claims for this contract atul each cli~d will z+mceiv~ heir "sl~t+e dir`ectiy~ Mr. Fry also had several small Prudential Lift insurance policies with a total benefit of approximately $10,000,00. Jimmy was named the sole beneficiary of these policies and I assisted him in making claim for the benefits directly with the Prudential. If I ca>r be of further assistance; please contact: me: Sin r David M. Edwards Securities offered through Princor Financial Services Corporation, 800/247-4123, member S. FPC, Oes Moines, IA 50392. David M Edwards Insurance is not an affiliate of Princor. David M Edyvards, Princor Registered Representative. JAMES KEVIN FRY 835 MANDY LANE CAMP HILL, PA 17011 _- - _ _ ~.a ~b _.~~~k~,=,.,y._ _ _ .._. _ .. JAMS ~~ FEY ~~ ~ 3Q27 03/1012011 DE[AL8 AND1l61fAdt7li SiA7>il1~7f! 11e atadeCted ae~ i i ~ des ~eaeroiei ie~ if~ateeneet. gene ~f asstiaeJy. RFAg N077FY US 1!'110~11'LYaF ANY QAI!If'FS ~ ADDR84S JS 50% BENEFITS FOR FEBRUARY 2(II i FOR JAMES MFRY -FINAL PAY 1-800343-0136 (in PA) 1-800-331.042(1(NaGomvide) Social Security Number rtatst appear ou all wrrespondaox submitted ro the Fund. This check may only be asked if the payee is living on the date the bercfit check is isairod. DETACH HERE '®" ~ ~ +~{'. S,ft~~ '~' 9 ~ ~. PA 19612-5223 ~~~} { fR r~9 r' dsr '7~`'E~NIr~Y!''Y _. t4 ,~' ~ ~,,~ , / ~ _ .. yx 2' I PAY ' T r. , ~~~:r ar t~~ J i ~ r p !b ° ~ p/~}~p { a i ~ ,i tt Y I y^ i TO THE ~~ 1€E'VII!I p~Z. ~ ~ i r ~ ~ ' } ~ , ~ ORDER OF' ~' ~r~ ,. ` q , ,, ~-~ ~ l~pl'1 Elora . r ~. ~. r. ~ ~ i , - ~h r ~ . ~ ~k ~ , Y55 ~Y-f f '.T{"v.. I r'YI. .r J f` yl. T E'.~ ~ ' I a ~ X.ftR: I , ' ~ h +~ '' ra ~ . tau' y,,s;,,, .,a~.~.y ~. A_ . ,. n'000 2 i 2 58 70na 1• .0 3 1000 • ~ ~; 50 31 . 2000 506 26 1 i 34~ ~.~~ ~~~e~~~ ~~ ~.~. a~ C ~y ~ > ~.I~.~ ~. PnnClpBl Funds PLEASE REFERENCE YOUR FUND AND ACCOUNT NUMBER P.O. BOX 8024 IN ALL CORRESPONDENCE AND MAIL TO: Boston, MA 02286-8024 ~~y CONFIRMATION OF A REDEMPTION 2011 S A M BALANCED PORTFOLIO (A) JAMES M FRY 835 MALADY LN CAMP HILL PA 17011-1538 FUND NO. 0004189 PRINCIPAL LIFE INSURANCE CO IRA (DCD) JAMES M FRY FBO JAMES K FRY 835 MALADY LN CAMP HILL PA 17011-1538 ACCOUNrNO. 8900033276 ~, a.variuaa ; rRwus i TRANBACTIOdP DOLLAR AIEDDDiT 88AR8 PRICB 98AR8S TBIS ~ TOTAL DATB RATS _'_....._ __._ _. OF TRAM87LCTIOH TRA1tSACTION SHAR83 ONNlcSD 8]3GINNING 88ARE BALAtQCB ~ _._.. _ .._ 3/14 I 3/07 RBDBI@ DDE TO D87LTH i I $480.2$ 13.10 36.663 I ~ i i T98 RBDSI~TION CB8C1C ATTACSED BSLOIf 26 1fADB PAYABLt TO YOII BY RBQIIBST OF T86 SBARSONNBR. YOUR DISTRIBUTION OPTION tS SHARES YOU NOW OWN ucor¢ wvoeYOS cAwru GAITS CERTI:ICA7E sNABFB NELD BY roU + uN~IED SHARBS RELD Br AGENT = TOTU SNARES REINVESTMENT REINVESTMENT i _ -_ _ f NUMBER OF CHECK 1569200 8900093278 3/14/2011 PAY: °•Four Hundred Eighty DoBa~s And 28 Cents"."'~^~•.••••••'••~~~----~--~---»-».».,.»..»«,. "- T3CILl~ARS '. '' o-a To Ttw OTdsT Oi no ~ '==5480.28' JAMES M FRY 835 MALADY LN ' PAYABLE THROUGFI CAMP HILL PA 17011-1536 STATE STREET BANK - .AND TRUST COMPANY' BOSTON. MA REDEMPTION CHECK I S A M BALANCED Pt CHECK ' NUMBER ACCOUNT DATE AUTtgRIZFD SIGNATURE ~~. .___ . ~' i 569 200' 40 i iD000 28~: ~'99056707w DETACH THIS CONFIRMATION AND RETAIN FOR YOUR RECORDS BEFORE CASHING OR DEPOSITING CHECK _., .. REV-1511 EX+ (30-09) Pennsylvania DEPl1RTMENT OF REVENUE 1NHER[TANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OP FILE NUMBER James M. Fry 21-11-0234 Decedent's debts must be reported on Scheduk I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES; 1. Hollinger Funeral Home I $9,490.00 2. Trindle Springs Luttteran Church -Donation for Funeral Luncheon $100.00 B. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: $0.00 Name(s) of Personal Representative(s) James K. Fry street address 835 Mandy Lane City .Camp Hill _... State PA zIP 17011 Year(s) Commission Paid: z• Attorney Fees: ~Y~r~2~e~ G b4~ee /y) ~q CI; ~J $2,500.00 3• Family Exemption: (If decedent's address is not the same as claimant'slattach explanation.) Claimant Street Address _ City _ __ State ZIP Relationship of Claimant to Decedent 4• Probate Fees: $369.50 S• Accountant Fees: f~CCC-Uf'Z~t~~~55000t~s°5,. 1~cec{e~{~S ~Olt~ $60.00 r~c_owie~ fax Re~.xr~ 6• Tax Return Preparer Fees: ~• Misc. Postage and Mailings $10.80 a. Filing Fees to Register of Wills $15.00 s. Reserves to Conclude Estate administration, including decedent's 2011 Final Income Tax Return, First and Final Accounting and costs of advertising $700.00 TOTAL (Also enter on Line 9, Recapitulation) $ 13,245.30 If more space is needed, use additlonal sheets of paper of the same size 03-09-'11 14;15 FROM-Hollinger FH 717-486-3433 T-304 P0001f0001 F-617 .. ,. m~rs M Hollinger Funeral Home & Crematarq, Inc. Er9c I~ Hollinger, Supervisor February 22, 2011 Jimmy Fry 835 Mandy Lane Camp Hill, PA 17011 The Funeral Service for James M. Fry: We sincerely appreciate the confidence you have placed in us and wlll continue to assist you in every way we can. Please feel free to contact us ff you have any questions in n~gard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILIT'IES,AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Prohssional Service Treditianai Package $5150.00 Merchandise Casket 2495.00 Vault -Gift from Annan & Eric Memorial Package -;'register Book, Memorial Folders, Acknowledgement Cards, Bookmarks Included AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING r5 AN ACCOUNTING FOR THOSE CHARGES. Cssh AdMSaces Newspaper Notices -Sentinel/ Patriot - nr, charge Grave Opening 900 ~ Cemetery Equipment 325.00 CertMad Copies of Death Certlflcate (li~1$ti) 120.00 Clergy 125.00 Organist 75.OD Etching - no charge Flowers 300,00 Total Charles ~ 41 ~~, $8490.00 ~' ~'~ ~ 2, 5D1 NORTH BALT[MpRE A9P_NUE • MOUNT HOLLY SP32FNG5, PENNSYL~RNIA 17065 • (717) 486-3455 • PAX (7k7) 488-SE15 ww~ao.hollirtgertunerelhome.com RECEIPT_FOR_PAYMENT GLENDA FARMER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 FRY JAMES M Estate File No.: 2011-00234 Paid By Remarks: JAMES K FRY CJ Receipt Distribution Receipt Date: 2/22/2011 Receipt Time: 10:40:21 Receipt No.: 1064504 Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 260.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15.00 16.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN JCS FEE AUTOMATION FEE 23.50 5 00 BUREAU OF RECEIPTS CUMB & CNTR M.D -- . ERLAND COUNTY GENERAL FUN - Check# 2898 ------------- $319 50 Total Received......... . $319.50 REV-1512 EX+ {12-08) pelnnsylvania V~r1 DEPARTMENT OF REVENUE INNERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS 0~ DECEDENT, MORTGAGE LIABILITIES 8i LIENS ESTATE OF FILE NUMBER James M. Fry 21-11-0234 Report debts inwnad by the decedent prior to death that remained unpaid at the date of death, includlny unraimbursad medical expenses. ITEM NUMBER „~,...,,,,,-.,,.. VALUE AT DATE 1. Brett Lechthaler, Appraisal Solutions - aapraisal of Decedents home $300.00 2. Boscov's -final bill $38.73 3. Penn Waste -final bill $133.05 4. Andrew & Patel -final medical bill $162.00 5. PPL -final bill $355.09 6• Silver Spring township tax collector, decedent's aawred county/township taxes $566.60 7• Lawlicare supplies to maintain property $42.39 8• Commonwealth of Pennsylvania - trailer registration $6.00 9• PNC Bank check prinfing fee $37.54 10. Nationwide Insurance -final bill $758.85 11. Home Depot -dehumidifier $238.48 12. Dumpster rental $505.00 13. Fine Line Auto repairs - rar repairs $140.98 14. Silver Spring Township tax collector, decedent's accured sdiool taxes $1,679.37 15. Tudcey Restoration, Invoice for the fire damage repair to decedent's home, paid on 6/13/2011 $38, 894.27 16. Tudcey Restoration, Invoice for the fire damage repair to deoedents home, paid on 07/07!2011 $21,450.29 17. Tudcey Restoration, Invoice for the fire damage repair to decedent's home aid 08/08/2011 , p on $238.05 TOTAL (Also enter on Line 10, Recapitulation) I ~ 65,546.69 If more space is needed, Insert additional sheets of the same size. "'~ INVOICE ~ ~ ;:~~ ~ t8 San Jusn Or 11Fry MsdrNcabug, PA 17056 .. ' ~ ,..: ~.. 4M52D77 MaiMr. 77787-18'ffi Fsc11~M~~ 71787.0220 ra ere.ioarr. 7M EWab d Jams M Fry OldR1 t. MY~Fi/asbe: 71-Fry plrrN4/mfaac Tak~Ma~Maswc FaNas3~r. RiadTa0c Ai~rMMaiw: Eili Eapbysra lsadac lhs Eskds d Jsmea M Fry ~8; The EsOals d James M Fry PlnisslNBsawE IIA RopMyAYsaC 524 SMr SpAnp Rd MsdisnMaary Glanbarland SYIR PA 21pc 17050.2870 taPl Oaarplap Dssd Book 28V Page 752 Farm 1004 300.00 $UgjQjA~ 300.00 Guilt D~ OISpMBOiC quakt. D~ OwayMac gull!/: Wlr ONaaac ~~~ TOT>1l. DUE S 300.00 Fane Mrs-wrrar>r,~+oo~er sotwabra rmotle, i,c.-~-eeo~u~rooe so1/eu m~eer-,5~ REV-1513 EX+ (9-00) ' scNeou~ ~ coMMONwEAiTH of PENNSnvnNIA BENEFICIAR~E5 INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF James M. Fry NUMBER I I 1. 2. 3. 4. 5 n NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distnbulions, and transfers um Sec. 9116 (a) (1.2)) James K. Fry, 835 Mandy Lane, Camp Hill, PA 17011 Cynthia L. Thrush, 126 South Ridge Road, Boiling Springs, PA 17007 Deborah K. Quidort, 209 Jerryanne Court, Apex, NC 27502 Karen S. Fry, 1892 Meadow Ridge Road, Hummelstown, PA 17036 Scott A. Amold, 126 South Ridge Road, Boiling Springs, PA 17007 FILE NUMBER 21-11-0234 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Truatse(s) I OF ESTATE Son Daughter Daughter Daughter Grandson 25% Rest, Residue 8 Remainrlar 25% Rest, Residue & Remainder 25% Rest, Residue 8 Remainder 25% Rest, Residue 8 Remainder Ford farm tractor w/ attachments ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9713 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I; (If more apace is needed, insert addiitisonal stbets of the same size) LAST WILL AND TESTAMENT OF JAMES M. FRY I, JAMES M. FRY, of 524 Silver Spring Road, Mechanicsburg, (Silver Spring Township), Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I direct that all inheritance, estate, transfer, succession and death taxes, as well as my just debts and funeral expenses, of any kind whatsoever, which may be payable by reason of my death, shall be paid out of the principal of my estate as the same can conveniently be done. SECOND: I specifically give and bequeath my Mode197 Winchester 12 gauge shotgun and my Model 12 Winchester 12 gauge shotgun to my son, JAMES K. FRY, of Carlisle, Pennsylvania. THIRD: I specifically give and bequeath my Ford farm tractor ~~ with all attachments to my grandson, SCOTT A. ARNOLD, of Boiling Springs, Pennsylvania. FOURTH: I give, devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, as follows: (a) Twenty-five percent (25 %) thereof unto my son, JAMES K. FRY, of Carlisle, Pennsylvania, provided that should JAMES K. FRY predecease me, I give and bequeath his share unto his issue, share and share alike; and (b) Twenty-five percent (25 %) thereof unto my daughter, CYNTHIA L. THRUSH, of Boiling Springs, Pennsylvania, provided that should CYNTHIA L. THRUSH predecease me, I give and bequeath her share unto her issue, share and share alike; and (c) Twenty-five percent (25 %) thereof unto my daughter, DEBORAH K. QUIDORT, of Apex, North Carolina, provided that should DEBORAH K. QUIDORT predecease me, I give and bequeath her share unto her issue, share and share alike; and (d) Twenty-five percent (25 %) thereof unto my daughter, KAREN S. FRY, of Hummelstown, Pennsylvania, provided that should KAREN S. FRY predecease me, I give and bequeath her share unto her issue, share and share alike, and if there be a failure of same, then I give ~~ and bequeath her share unto my surviving children as named herein, share and share alike. FIFTH: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period 2 . . of time, any real or personal property and to give options for sales, ex- changes or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, improvement, zoning or management of real estate and to impose or extinguish restric- tions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named beneficiaries in cash or in kind or partly in each. 3 (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retire- ment plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent provided for by the plan or the law. SI H: I nominate and appoint JAMES K. FRY, Executor, of this, my Last Will and Testament. In the event of the death, resigna- tion or inability to serve for any reason whatsoever of JAMES K. FRY, I nominate and appoint CYNTHIA L. THRUSH, Executrix, of this, my Last Will and Testament. I direct that my Executor or Executrix, as the case may be, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~.. ~ day of September, 2005. (SEAL) AMES M. FRY 4 Signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament in our presence, who, at his request, in his presence and in the presence of each other, have hereunto subscxibed our names as attesting witnesses. 701 vC.~i'1a- ~T • ,/~'~~~A1ri5~Jr/~ ~ l ~oS~ Address ~ Name ti Address l~v4- /7osS d a e 5 ~~~ ~1J~ ~/ ~-U`~ I~