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HomeMy WebLinkAbout12-05-11150561D140 REV-1500 ~` ~°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number Po sox 2aosol 2 1 1 1 1 0 0 9 Harrisburo, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth NMDDYYYY 2 1 5 1 6 4 0 5 2 0 9 1 4 2 0 1 1 0 6 2 1 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name Mi M O N T G O M E R Y J R F R A N K L I N p (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI M O N T G O M E R Y J O A N S REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ~ 2. Supplemental Return ~ 3.. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future interest Compromise (date of ~ 5.. Federal Estate Tax Return Required death after 12-12-82) © 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8~. Total Number of Safe Deposit Boxes (Attach Copy of Wili) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credk (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number W I L L I A M A D U N C A N 7 1 7 2 4 9 7 7 8 0 First line of address O N E I R V I N E Second line of address R 0 W City or Post Office C A R L I S L E State ZIP Code REGISTER OF ~S USE ONL'aK "'t3 P ' "? ~~~ ~--, ~~ "?] i !C~-'fl .. ,. P A 1 7 0 1 3 correspondent's e-mail address: b i 11 a d u n c_a n h a r t m a n l a w• c o m ~.~ , -~;'a f -`~ "Y, [_ _^ ~:.~ ~~, _'. f- ^. TI l.'7 \~~ -T~ under penalfks of perjury,) declare that i have examinsrl mis relum, inaludinp eccompar,yk,p schedules and statement, and to the hest or my krwwbdpe and beUM, a is true. correct and complete. Dedaratbn of preparer other than the personal repressnttlve is based on aN ir><onnatlon d which preparor teas any krxrwlerlpe. SIGNATURE OF PERSON RESPONSIBLE FOR NG ETURN DATE ADDRESS 240 LEPLEY ROAD WINFI LD PA 17889 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number DecadenrsName: FRANKLIN P• MONTGOMERY, JR 2 1 5 1 6 4 0 5 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 and Notes Receivable (Schedule D) ...................... .... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 1 7 4 ? 4 3 . 9 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ... .... 6. 7. Inter-Vrvos Transfers 8 Miscellaneous N -Probate Property (Schedule G) ~ S eparate Billing Requested ... .... 7. 8. Total Gross Assets (total Lines 1 through 7) ....................... .... 8. 1 7 4 7 4 3 , 9 3 9. Funeral Expenses and Administrative Costs (Schedule H) .............. .... 9. 3 1 4 5 . 0 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... .... 10. 2 2 8 4 7. 2 3 11. Total Deductions (total Lines 9 and 10) ........................... .... 11. 2 5 9 9 2. 2 7 12. Net Vatue of Estate (Line 8 minus Line 11) ........................ .... 12. 1 4 8 7 5 1. 6 6 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. 1 4 8 7 5 1. 6 6 TAX CALCULATION -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.oo 1 2 5 8 7. 4 6 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .045 1 4 4 8 8 5. 2 6 16. 6 5 1 9. 8 4 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 D. 0 0 18. D. O D 19. TAX DUE ................................................... ... 19. 6 5 1 9. 8 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 DECEDENTSNAME - FRANKLIN P• MONTGOMERY, JR STREET ADDRESS - 111 STRAYER DRIVE CITY STATE CARLISLE PA Tax Payments and Credits: ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3 2 5.9 8 3. Interest 4. If Line 2 is greater than line 1 + Line 3, enter the d'Ifference. This is the OVERPAYMENT. Fill in oval 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. 10D9 ZIP 17013 (1) 6,519.84 Total Credits (A + g) (2) 3 2 5.9 8 (3) (4) 0.00 (5) 6,193.86 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 : ............ . b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest; °r .................................................................................... ........... ^ 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 considerationT ............ ............................................................. ^ 0 . 3. Did decedent own an 'in trust for' or payable-upon~eath bank account or security at his or her death? .......... ^ 4. Did decent own an individual retirement account, annuity or other non-probate property, whk~r contains a benefaary 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 Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure 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 benefiaaries 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)). Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1510 EX* (OB-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER FRANKLIN P• MONTGOMERY, JR 2:1 11 1009 This schedule must be oompletad and filed ff the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER i~~~~~~~~~RaE~AT~oHS-sPTOOEC~ENrAND THE DATE aF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET 960FDECD'S INTEREST EXCLUSION ~F ~rrucAe~El TAXABLE VALUE ~. IRA #01011478-3979002 -AMERIPRISE 1,785.23 100.00 1,785.23 [SEE DOD LETTER ATTACHED] 2• IRA #01011478-3987002 - AMERPRISE 6,355.05 100.00 6,355.05 [SEE DOD LETTER ATTACHED] 3• IRA #01011478-4027002 - AMERPRISE 674.56 100.00 674.56 [SEE DOD LETTER ATTACHED] 4• IRA #01011478-4035002 - AMERIPRISE 556.26 100.00 556.26 [SEE DOD LETTER ATTACHED] 5• IRA #020145976252002 - AMERPRISE 3,216.36 100.00 3,216.36 [SEE DOD LETTER ATTACHED] 6• ANNUITY #930072939455004 90,755.78 100•DO 9D,755.78 [SEE DOD LETTER ATTACHED] 7• SPS ADV• ACCT• #000504659707021 0 71,400.69 100.00 71,400.69 [SEE DOD LETTER ATTACHED] TOTAL (Also enter on Line 7, Recapitulation) ~ i 17 4, 7 4 3 9 3 If more space b needed, use additional sheeb of paper of the same size. REV-1511 F,(+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS "" ^' ` "~ FILE NUMBER FRANKLIN P• MONTGOMERY, JR 21 11 1009 DecederK's debt must bs reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. PATRIOT NEWS OBITUARY 338.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2, AttomeyFees: DUNCAN 8 HARTMAN, PC 3. Famiy Exemption: (If deoedenfs address is not the same as daimanCs, attach explanation.) Claimant Street Address C~' State ZIP _ Relationsh~ of Claknant to Decedent 4• Probate Fees: REGISTER OF WILLS 5. Accountant Fees: 6. Tax Retum Preparer Fees: 7. CUMBERLAND LAW JOURNAL - LEGAL NOTICE 8• THE SENTINEL - LEGAL AD 9• FILING FEE 10• HELD IN RESERVE TOTAL (Also enter on Line 9„ Recapitulation) ~ _ 1,80D•00 32?•5D 75.00 189.54 15.00 400.00 3,145. ff nare space is needed, use additional sheets of paper of the same sine. REV-1512 EX+ (12-0e) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ LIENS RESIDENT DECEDENT "" ^' ` "~ FILE NUMBER FRANKLIN P• MONTGOMERY, JR 2L 11 1009 Report debts incurred by the decedent prior to death that remained unpaid at the date of death including unroimbursed medal ex ense , p s. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~. PHARMACY CUMBERLAND CROSSINGS 24.90 2• PHARMACY CUMBERLAND CROSSINGS 62.78 3• PHARMACY CONTINUING CARE 263.51 4• PHARMACY CONTINUING CARE 438.24 5• WEST SHORE EMS BSL 123.75 6• CUMBERLAND GOODWILL EMS 51.50 7• CUMBERLAND CROSSINGS NURSING HOME 3,931.56 8• CUMBERLAND CROSSINGS NURSING HOME 14,561.16 9• CUMBERLAND CROSSINGS NURSING HOME 3,340.20 10• OMNICORE CUMBERLAND CROSSINGS PHARMACY 49.63 TOTAL (Also enter on Line 10, Recapitulation) I i 2 2 , 8 4 7.2 3 If more space b needed, insert additional sheets of the same site. REV-1573 EX+ (Ot-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: FRANKLIN P• MONTGOMERY, JR 21 11 1009 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pncglde outrigh>(spousa;distr~utfons and Uansfers under Sec. 91 6 a)) 1.2. 1, JOAN SHRYOCK MONTGOMERY Spousal 111 STRAYER DRIVE IRA 12,587.46 CARLISLE, PA 17013 2• ROBIN P• MONTGOMERY Lineal 240 LEPLEY ROAD 1/3 REMAINDER WINFIELD, PA 17889 3• TRACY M• BLUMENTHAL Lineal 128 BULL HEAD ROAD 1/3 REMAINDER NEWFIELD, NY 14867 4• JOHN F• MONTGOMERY Lineal 1510 ALISON AVE• 1/3 REMAINDER MOUNTAIN VIEW, CA 94040 II. 1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I s If more space Is needed, use additional sheets of paper of the same size. LAST WILL TESTAMENT OF I, FRANK P. MONTGOMERY, of 111 Strayer Drive, Carlisle, Cumberland County, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Fast Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be cremated and my ashes be spread in accord with my expressed wishes. THIRD. I give, devise and bequeath any and all property owned by me at the time of my death , of whatever nature, be it real, personal or mixed, unto my Trustee, ROBIN MONTGOMERY, to be held IN TRUST for the benefit of my wife, JOAN SHRYOCK MONTGOMERY, provided she survives me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all said property, be it real, personal or mixed, unto JANE TRACY BLUMENTHAL, ROBIN MONTGOMERY and JOHN F. MONTGOMERY, in equal shares, per stirpes. FOURTH. If my wife, JOAN SHRYOCK MONTGOMERY, survives me, I give to ROBIN MONTGOMERY as Trustee all of my property of any kind, real, mixed or otherwise, to be held IN TRUST for JOAN SHRYOCK MONTGOMERY for her sole benefit during herlifetime to the extent of the income or use of such property to be known as the Montgomery Trust, PROVIDED HOWEVER, that under no circumstances shall the beneficiary, JOAN SHRYOCK MONTGOMERY, have access to the principal of the Trust for any purpose, Further, (A.) The Trustee shall invest and reinvest Trust funds and shall distribute the net income (hereinafter called "income") as follows: (1.) During the lifetime of my wife, JOAN SHRYOCK: MONTGOMERY, the Trustee shall pay the Income to her or for her benefit, in quarter-annual or more frequent installments, and may not expend any funds from the principal in any circumstance. If any unproductive assets are held in the Trust, my wifE may require that they be converted to income- producing assets within a reasonable period of time. (2.) Upon the death of JOAN SHRYOCK MONTGOMERY, any income accumulated or on hand shall not be paid over to her estate, rather the Trust shall terminate and the corpus and remaining income shall be distributed outright to my children JANE TRACY BLUMENTHAL, ROBIN MONTGOMERY and JOHN F. MONTGOMERY, in equal shares, per stirpes shazes, per stirpes. (B.) The right of my wife, JOAN SHRYOCK MONTGOMERY to the trust assets shall not be subject to assignment, alienation, pledge, attachment or claims of creditors. FIFTH. I hereby nominate, constitute and appoint my daughter„ ROBIN MONTGOMERY, as Executrix of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. IN WITNESS WHEREOF, I have hereunto set my hand and seal t this, my Last Will and Testament, consisting of two typewritten pages this ~ day of ~d /' 2008. FRANK P. MONTGOMERY Signed, sealed published and declared by the above named Testator FRANK P. MONTGOMERY as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. (~Q~ r ~~0 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . SS. I, FRANK P. MONTGOMERY ,Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; 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 FRANK P. MONTGOMERY this JIC~-y- of /1/ ©1/~~lilld ~ FRANK P. MONTGO ERY day 2008. ~' Not Public COMMONWEALTH OF PENNSYL VANL9 :SS. COUNTY OF CUMBERLAND coM~+onw~r-cTr+ of ~wr~snv,~-rru NOTARIAL SEAL JOAN D. ADAMS, Notary Public Carlisle Boro., Cumberland County Commission Ex ' es March 7, 2611 we, IN 1L1~/Ail~l i4. 17rJ/VC11/V a„d ~G, ~Qr>i ~ V~~~,~1~1 L 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 FRANK P. MONTGOMERY sign and execute the instrument as his Last Will; that he signed willingly and that he 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 C ~~' subscribed before me by W ~LL,N iV1 s~, ~ vNC~1 A/ and this ,witnesses, ~7y~ day of /~/'OS/.~~(,~~~ , 2008. ~' N Public c MMavNru-~tr~ of ~nrr~tsv~v~ NOTARIAL SEAL JOAN D. ADAMS, Notary PubC-c Carlisle Boro,, Cumberland County My Commission Ex ' es March 7, 2 11 October 12, 2011 DAVID RAYMOND LYON STE 106 3909 LOUISE DR Iv1ECHANICSBURG, PA 17055~i900 Dear DAVID RAYMOND LYON: 13634534 S 001 Thank you for your recent inquiry regaMing FRANK P MONTGOMERY's accounts. These are the values of the accounts as of 09/14/2011. Account Information Mutual Funds Account Number 01011478397 9002 01011478398 7002 01011478402 7002 01011478403 S 002 02014597625 2002 02014789558 3002 Annuities -Post 1985 n rshi 1RA -beneficiary designated IRA -beneficiary designated IRA -beneficiary designated IRA -beneficiary designated IRA -beneficiary designated Joint Tenancy With Right Of Survivorship Account Number Ownership 93007293945 5004 Individual SPS Advantage Account Number Ownership 00050465970 7 02 1 Individual - TOD SPS Advantage ONE Features Account Number Ownership 00045181104 6 021 Joint Tenancy With Right Of Survivorship Mutual Funds Account Number Total Value # of s s Asset Value Per Share 01011478397 9002 51,785.23 191.695 59.29 01011478398 7002 56,355.05 1,234.765 55.14 01011478402 7002 5674.56 96.091 57.02 01011378403 5002 5556.26 111.029 55.01 02014597625 2002 53,216.36 241.650 513.31 02014789558 3002 553,523.28 3,982.387 S 13.44 Annuities -Post 1985 Account Number Total Value 93007293945 5004 590.755.78 SPS Advantage Account Number Total Value 00050465970 7 021 $71,400.69 SPS Advantage ONE Features Account Number Total Value 00045181 104 6 021 S6S,072.63 Aed N~t:SPS AdvaiRaye wiw ONE Fs~Asas, FRANK P MONTGOMERY ANG JOAN SFtRYOCK INONTGOYERY JT Acct No:000451811011t~21 Acct T~:Non-OwiFied tJi~t n tiD1.ZP Ltp 511/211 FJCitJN P!- lTD MIY Ml1N - A t7QirX ~ ~ YMICE 54127 10 E 5 1W ti7 . , _ LEOt31AMIA d'f TiM 5118N - A ~.'fX LC~1 l~W / - ~.~ Q46 18„M5i.73 OPP IiOG~Etirit fURI MUltt - A OIiNAX ~ ~ opp 1,~~06 6.88 aT1D.31i WBlBIK[EINI'W[N/i-A ~~ ~?Elili -- /1~ ~p 1•'~.~ 11.1! 1S,oTJ.,56 WB18 lltT tilt tMAt NC - A 81UV1tX t 3,Z/p.75 4.ti2 15.7tifi.OD AooouR lt~fl' tit15,OT2.tJ3 Acd Naas:Slrabgic Pr>~Nolio ~vico Advandg~. FRAN(P MONTGOMERY TOD Aces No:00050~65970 021 ~ INtE 1Mti~ NR AY CFJdr 60UfiY tNCCbE - A c+~tt CJx 8'r'tWE(AC t1~0iE - A EleOr ~ p1YM1B0 *C - A EAJt]N N10L MIJMN MIC - A MFt! ItM H~1 NOOIE - A MFS r~BEAiiCi1 BOt~ - A t4dMCE aY~@~ NILUE 8110 TNMFX WOIIrD t~tt)iq( 1MIEAX 8 ~ td1P ~ 1~VFJrI~ Ai~W NE T aevn caea ~ us'~oriot~ EDIIIIC CAP ' M~CE F~WIIX ALONpIN tEgNi~ 1M~1-X F~ ~ rr OF ~ ~FX lt ~7ERMEd ~ OF 1~11OVJt t`JII 1~Nt?$ tRBt~ 1,443.Y1 ~tis:.st 2,1.56 tii6.0~ i,f0a.A6 1.Z~4JI2 ~7.2b /k[oult lEfy: Acct Tppr.Non-Qualified ~8tl 2,~1.tt1 aas a~>. 1.m l~t,M e-@ 13~163.~ ti.5o QN/.B2 92t tQ212~ 7.5D q?ti1Jb 111.6Y p s~.g4 8.f~1 ~1'SS.BO i71,400.~ The date of death values provided are for estate ta.~c purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance product(s) with the insured deceased reflect the gross death benefit at date of death and not the cash value. Values indicated for Life Insurance Products with only the owner deceased reflect the cash value as of the date of death. Values for arty proprietary mutual funds include accrued dividends as applicable. Values pro~~ded for brokerage products are manually calculated, and should be used as estimates only. The prices used to prrn~ide i:l~: ~~iit i<i:~1 ~1l~1~{14~iN~~J AF•IENIF'NI'.E FI'l~tICI~L _ F','~t~= ~1F,%Ft,: Benefici9ry ln~ormlation We have the fallowing beneficiaries on record for the deceased's accounts. Account Number: 0101 1478397 9002 besi8tgttion: PRIMARY BENEFTCIARY JOAN S MQNTGO1ViF.,.RY SPOUSI; 101),00°.'n SECONDARY BENEFICIARY LIVING, LAWFhJL Ci-IiLDREN IN EQUAi., SHARES IOU.UU?% Account Number: 0101147$398 7 002 Designation: ..°RIMARY BENF.F[CIAR~' JOnN S MONTGOMlRY SPOUSE 100 00'/~ SECONDARY BEN~FICTARY LIVINt:, t AWFUL CH1LbREN IN F,QUAL SHARES 100.00°i A Account Numbsr: 0101 1478402 7 002 btsignation: PRIMARY BENEFICIARY .LOAN S MONTGOMERY SPOUSE 1U0,00°'n SECONDARY BENEFICIARY LIVING. [.AVb'FUI_CFIILDREN IN EQUAL SHARF?S 100,00oib Account Niurnber: OID1 1478403 5 002 D~s!(-PAt1011: PRIMARY BENEFICIARY .IOAN 5 MONTGOMERY SPOUSC 100,0(1,,; SF,COND.4RY HFNEFICIARY I,IVINC, LAVVFTJL CI-IILDRFN iV F,(jUAL SHARES 100.00°/n Account Number: U2014597C25 2 OU2 Designstion: PRII\4ARY BENEFICIARY LOAN S MONTGOMERY SPOUSE IUU UOon SECONDARY BENF_FfC(ARY L[VINCi, L/1WFUL CHILDREN IN EQL'~I, s~rARES IUO.UO°.'n Account Number; 02014789548 3002 Designation: Not :>rpl•cable for thix owrcrship typa. Account Number: 93007293945 S 004 is 1 ~: ~~~li 1~: ~1 ; 1 ~ 4414~tJ~i ~ h1EAIFPI`::E FIrIAM:IikL tkyignation: PRI1vtAkY F3FNEFICTARY LIVING, LAWFUL CFITLDRt;N IN EQUAL SHARES iAO.QQ'ro .~ceouat Number: OOO~iS t S 1104 6 t}21 ~csi~nation; ~Vot applicable for Ihis product.f Accaant Numtx~: OOO,i0465970 7 02 1 ~SiRaAl10R: PRIMARY BENEF1CiARY PAGE tj r : ~~ LIVING, LAWS, ('HILDREN IN EQUAL. SH~l7ES IOO.UU"~o COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 260601 HARRISBURG PA 17128-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE REY-1561A AFP (7-RR) FILE N0. 21 11-1009 ACN 11502791 DATE 11-16-2011 TRACY M BLUMENTHAL 128 BULL HILL RD NEWFIELD NY 14867-4412 TYPE OF ACCOUNT EST. OF FRANKLIN P MONTGOMERY ® SECURITY S.S. N0. 215-16-4052 ^ sEC ACCT DATE OF DEATH 09-14-2011 ^ sTOCK COUNTY CUMBERLAND ^ aoNDs REMIT PAYMENT AND FORMS T0: REG:[STER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 AMERIPRISE has Drovfded the Department with the inforwation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above dace dent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer spent, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comwonweslth of Pennsylvania. Questions may be answered by calling C717) 767-8327. COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS -~ Account No. 13b345345 To insure proper credit to your account, two C2) copies of this notice must aceompamr your t DOD Valuation 162, 156 .47 pavman to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 33 .333 Amount Subject to Tax 54, 051 . b2 NOTE: If tax payments are ^ade within three C3) months of the decedent's data of death, Tax Rate X , 045 Yau say deduct a 5X discount of the tax due. Potential Tax Due 2,432.32 Ary inheritance tax due will become delinquent nine C9) months after the date of death. PART TAXPAYER RESPONSE A. ^The above inforaation and tax dw is corroct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of 0 N E \M/ Wills and sn official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ B. I/~ Tha above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART O and/or PART ~ below. PART If you indicate a different tax rate, please state your © relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) LINE 1. DOD Valuation 2. Percent Taxable 3. Amount Subject to Tax 4. Debts and Deductions 5. Amount Taxable 6. Tax Rate 7. Tax Due 1 2 X 3 4 5 6 X 7 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) ; Under penalties of perjury, I •clare that the facts I have report/ed above` are Gtrue, o¢rrect and co/mplete to the best of my kno le and belief. HOME C (t77'I 56Y yL~S l WORK ((~U7 ~' .3Z • ZbY ~ ~i ~ Il TaYPaVFD TGAIA TIIDC Tcl counuc u(iunco n•rr COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES FILE N0. 21 11-1009 Po sox 260601 AND ACN 11502792 HARRISBURG PA 171za-o6o1 TAXPAYER RESPONSE REV-I563~ ~FP (7-t0) DATE 11 - 16 - 2011 TYPE OF ACCOUNT EST. OF FRANKLIN P MONTGOMERY ® SECURITY S.S. N0. 215-16-4052 ^ sec Accr DATE OF DEATH 09-14-2011 ^ STOCK COUNTY CUMBERLAND ^ BONDS REMIT PAYMENT AND FORMS T0: JOHN F MONTGOMERY REGISTER OF WILLS 1510 ALISON AVE 1 COURTHOUSE SQUARE MOUNTAIN VIEW CA 94040-3014 CARLISLE PA 17013 AMERIPRISE has provided the Department with the information listecl below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were s beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. puestions may he answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 136345345 To insure proper credit to your account, two (2) copies of this notice must accompany your 162,156.47 payment to the Register of Wills. Make check DOD Valuation payable to: "Register of Wills, Apent". Percent Taxable X 33.333 NOTES If tax payments era ^ade within three Amount Subject to Tax 54, 051.62 (3) ^ontlhs of the decedent's date of death, Tax Rate X . 045 You ^ay deduct a 5X discount of the tax due. Ary inheritance tax due will become delinquent Potential Tax Due 2, 432.32 nine (9) months after the date of death. P~T TAXPAYER RESPONSE A. ^ The above inforaation and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or .avoid interest, or you ^ay check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Dep,artmant of Revenue. BLOC K ~ B. ® The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your © relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) LINE 1. DOD Valuation 1 2. Percent Taxable 2 X 3. Amount Subject to Tax 3 4. Debts and Deductions 4 5. Amount Taxable 5 6. Tax Rate 6 x 7. Tax Due T PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) t Under penalties of perjury, I declare that the facts I have reported above are true, correct and com ~to t m of my knowledge and beliet. HOME C ) WORK C(s50 ) 5,20 ~ ~ ~~ / TA eVFD CTGAIA TIIDF rci counur -niuocn n.rr COMNONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES Po Box 280601 AND HARRISBURG PA 17128-o6o1 TAXPAYER RESPONSE REY-1543A AFV (7•RR) FILE N0. 21 11-1009 ACN 11502790 DATE 11-16-2011 TYPE OF EST. OF FRANKLIN P MONTGOMERY S.S. N0. 215-16-4052 DATE OF DEATH 09-14-2011 COUNTY CUMBERLAND ACCOUNT ® SECURITY SEC ACCT STOCK BONDS REMIT PAYMENT AND FORMS T0: ROBIN P MONTGOMERY REGISTER OF WILLS 240 LEPLEY RD 1 COURTHOUSE SQUARE WINFIELD PA 17889-8932 CARLISLE PA 17013 AMERIPRISE has provided the Oepartmant with the information listed below which has been used in calculating the potential taz due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this inforwation is incorrect, please obtain written correction from the transfer agent, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comwonwealth of Pennsylvania puestions way be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 136345345 To insure proper credit to your account, two (2) copies of this notice ^ust accowpany your Daywent to the Register of Wills. Mak• check DOD Valuation 162, 156.47 payable to: "Register of Wills. Agent". Percent Taxable X 33.333 NOTE: If tax paywents are wade within three Amount Subject to Tax 54, 051 .62 (3) wonths of the decedent's date of death, Tax Rate X . 045 you way deduct a 5X discount of the tax due. Any inheritance tax due will becowe delinquent Potential TaX Due 2,432.32 nine (9) wonths after the date of death. PART TAXPAYER RESPONSE ~~.~~_~ . _:.. ~~ ,K~ ,,, - :. A. ~ The above inforwation and tax du• is correct. 1. You ^ay chooso to remit paywent to the Register of Wills wit hi two copies of this notice to obtain C H E C K a discount or avoid interest, or you ^ay check box "A" and ra~turn this notice to the Register of 0 N E Wills and an official assesswent will be issued by the PA Dep~artwent of Revenue. B L 0 C K B. ~e above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ~ Tha above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your © relationship to decedent: ~' TAX RETURN - COMPUTATION LINE 1. DOD Valuation 2. Percent Taxable 3. Amount Subject to Tax 4. Debts and Deductions 5. Amount Taxable OF TAX ON ABOVE ASSET(S) 1 2 X 3 4 - 5 6. Tax Rate 6 X 7. Tax Due 7 PART DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above are true, correct and ,~.c.,,o//~~mplete~to the best ofd my knowledge and belief. HOME C °.570 ) ~7~} Q7j~ ~('~t'1~ ! ' ~ ~d~m Q~,~i-- WORK C S7b ) 523 ~ 322.0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID