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HomeMy WebLinkAbout11-21-11 (2) J REV-1500 ~ t°~-~°' '~ PA Departmt'nt of Revenue Pennsylvania 1505610101 __ _ _ ureau o n ivi ua axes INHERITANCE TAX RETURN PO BOX z8t76o1 Harrisburg, pA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY >a ..e Decedent's Last Name Suffix (If Applicable) Enter Surviving Spouse's Information Below Spous/e's Last Name Suffix Spouses Social Security Number OFFICIAL USE ONLY County Code Year File Number <rv._ ,~,... .. Date of Birth d:1r,1C~vYYY .. a-..~ y. '~'~ Ob~,o~9wa.7 Decedent's First Name Teo 8 ,.~~,.-T Spouses First Nar,e . ~ _ ,.. . MI L ~:~_w-~ ~•~ -> ~ -y - -- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~~ ~ ~°~~ ~ REGISTER OF WILLS . , ,~ ~ FILL IN APPROPRIATE OIJALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82} ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes {Attach Copy of Will) (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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number C H f~ ~ G ES E ~ H l E ~ l7S ~ ~ 1 7'~ 7~7 6 6 ~o zD 9 First line of address 6 C ~ o u ~~~ R-o ~-~ Second line of address N ~ /~ City or Post Office Mate ~~c~~~1cs$u~r P~' Z}P Code REGISTE~F WILLS USF~NLY ~„ :-_ ~ ~.r. ~1. ~ ~ ~ ~ ~ - n-t -~ iti ~ ~ ~ -, . `' ~` ~ -- = _ _ .~OATE FILED ,- ~h 0 -~-, ~ ~©ssg~~~~, Correspondent's a-mail address: CeSI71 e!C>rS 3nq Co/~CuS1` ~8~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all hnformation of which preparer has any knowledge. SIGNATU OF PERSON RESPONSIBLE FILING RETURN DATE ADDRESS ~~'~ `I 1 ~ /L / x A~l~~ /f 33 s, York ~.`:, lY! ec,,,hctn i esbury, ,p/f 1,1osS /~/ /S/~/ ADDR ss ~- }J/} ~ S ~'• H ~ OS du Ser o.rd, A-?tejian;c s yr, /fig l 7D SS PLEASE USE ORIGINAL FORM ONLY Side 1 1~056101D1 15D5610101 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~~ ~~ L , /~ (exr~rtder ~ 2; o o ,..:. ~ ~ „ / ~{ D D RECAPITULATION 1. Real Estate (Schedule A) ..:............:........................:... . 2. Stocks and Bonds{Schedule B) ....................................... 3. Closely Held Corporation, Partnership or Soie-Proprietorship (Schedule C) .... . 4. Mortgages and Notes Receivable {Schedule D) .......................... . 5. Cash, Bank Deposits and Miscellaneous Persona! Property (Schedule E)...... . 1. ~ +' Q ~ 2 3~o c.E~~ o;~~~_. 3 ,~ ~ ,rp,~ ~ (~ .f 5. ~ ~ >'~~1~ 4' BS~3` 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...:.. . 6 ~; y ,,c " y~;b ~ D Y (a ;' ,~. Y~'~t csaz g' S-A > t r~ ~ n; ~ ~ ~fi~9Ft £~?M1 -::''~` 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property Blli t d t R S 7 . :. . „ - y s , 3 ~ ~ r D ~ ' s ~ ....... eques e epara e ng (Schedule G) Q . pr , • r .. ,.;~,c~rr~ f,~.~.~aa_ K..., .- " ~.. 8. Total Gross Assets (total Lines 1 through 7) ............................ . 8. 3 ~; Q~~ b ~ r 6 9 9. Funeral Expenses and Administrative Costs (S~hedule H) .................. . 9 1 . D 9 $' / +~ 9 ~,~ 10. 9 9 ( ) ............. Debts of Decedent, Mort a e Liabilities, and Liens Schedule f 10. . ~ I q~3; 3~2. 11. Total Deductions (total Lines 9 and 10) ................................ . 11 f , r ~ ' y ~/ ° ,Z alp , 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12 t q F ~ O c ~' a~ ~ ~ ~ . •' 13. Charitable and Governmental 8equestslSec 9113 Trusts for which ~ < ~ ~ ' `~" ~ `~' '"` " an election to tax has not been made (Schedule J) .............:......... . 13 ~ ~ ~ Q 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 3, ~ : 9 ~~ f q ~+ ~ f 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 .0~ f ~ ~.. ~ , ~ O 15. 16. Amount of Line 14 taxable '~` `~~.x~;'~`'~ "~~~ ~l' at lineal rate X .0 ~ ~ ~= a y y ~ 9 ~ 3 16. 17. Amount of Line 14 taxable ' "",``'''`r ' ` ~" at sibling rate X .12 ;~ t ar=m ~ 0 17. 18. Amount of Line 14 taxable ~~~T" at collateral rate X .15 ~ 0 18. 19. TAX DUE ...................................°..................:...19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ 1 " ~ ~ ~' ~7 DECEDENTS NAME ~ Ro_bu-~ ~.. ,A~l~amd Gr _ _ _ STREET ADDRESS ~ ~ ~ S. ~Or y c L ~m a ~ ~~ n4 I /' ~/ n C17L ~ l 1 1 Ct G~7A~ f"P_ S i CITY STATE IyJCG)'t art fC~~ K~ D 000 lu. ~OCC.t~i ~- . Cyr-1is/e, /~~ I7o~3 p~ ~ ZIP ~ ~a ss Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ D B. Discount ~ (1) Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. {4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) rWlake check payable to: REGISTER OF WILLS, AGENT. 13, 9 ~ 3. ~7 D f ~7, c{p l3, 9S/, z 7 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; 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-death bank account or security at his or her death? .............. ^ 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 ROVE 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)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)J. 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 valve 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. ~iEV-1503 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF ~ L-r~ `. FILE NUMBER 2l- !!-~!?g /¢~GX(lnr~cr, ~J'C All property jointty-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of tiie same size) EXC Historical PRices ~ Exelon Corporation Common Stock Stock -Yahoo! Finance 3/11/11 3:51 PM New User? Register :Sign In ;Help Trending; Lea Michele Yahoo! Mail ~~~~~~® F ~ N>~ ~ C E Search , Web Search Dow '~' 0.75Y Nasdaq '~' 0.699. HOME INVESTING NEWS S OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER ~~ GET QUOTES I::inance S~arLh ri: t~1ar t1: 2~11.:;.5~€~M'~`.~T - t;.'_~. Mari:ets close in 1;i mns. ;.Exelon Corp. (EXC) At 3:35PM EST: 43.18 t o.z2 ja.52^~} ~~ ~, ~• EXC _~ ~~~ a~ Y. + ~ D+vuN~ i. tn,~at Historical Prices j Set Date Range Daily Start Date: ~an P~ >~28 ; 2011 Eg. Jan i, 2010Weekly End Date::' an~~~ '28 .2011 i~Monthly Dividends Only r Prices Prices Date Jan 28, 2011 lDownload to Spreadsheet Currency in USD. Open ~~ Close 42.51 4' 2.82 41.8 41.91 ' Cbae price adjusted for dividends and splits. - =~~f2.3s First ~ Previous ~ Next ~ Last Volume Adj Close' 5,084,800 41.40 First ~ Previous ~ Next ~ Last 7 / 9, ZS skis. Copyright ®2011 Yahoo! Inc. All rights reserved. Privacy Policy -About Our Ads - Tenns of Service - CopyrightllP Policy -Send Feedback - ~t'ah00! News Network Quotes delayed, except where indicate[i otheNrise. Delay times ere 15 mina for NASDAQ, NYSE and Amex. See also delay times for other e:cchanges. Quotes and omer information supplied by independent providers identified on the Yahoos Finance partrrer page.Quotes are updated automatically, fwt will be tamed oR attar 25 minutes of inactivity. Quotes are delayed at least 15 minutes All iMormation provided "as is" for informational purposes only, not intenped for trading purposes or advice. Neither Yahool nor any or independent providers is liable fix any informational errors, incompleteness, or delays, or for any actions taken in reliance on information contain9d herein. fay accessing the Yatwol sNe, you agree not to redistribute the information found therein. Fundamental tympany data provided by Captel IQ. Historical chart data and deity updates provided by Commodity Systems, Inc. (CSI). Intem.atlonal historical chart data, daily updates, fund summary, fund performance, dividend data and Morningstar lndtrx data provided by Morningstar, Inc. http://finance.yahoo.corn/q/hp?s=EXC6a=00&b=28&c=2011&d=00&e=28&f=2011bg=d Page 1 0l Get Historical Prices for. r~ rev-»oe a. ~,an SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHREEWSIDENrDECEDENTRN PERSONAL PROPERTY ESTATE OF ~ /~~ L • FILE NUMBER Indude the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. PNC irk, N , (S~t Y~t~tca~oa off. /~~und 1~oI1~ 3. R~ld ~M ~{, Rend ~o~ ~, C~ICGIC~iI ~~ No_ Sol 007 6 y 33 ~ / 3, 61 S. 3 3 ~~~ a~~ l(. S. ~reQSa ~~ ~ a,o~a Fit . [o ~fo ~ ?' eft ~ •oo . 7kao1: of ~et~nue ~~ o P~ ~a .T~. Ty`y° ~ 3 9, 00 ~ /NFo NuT~' : DeCe~tnt ~rarr~d a~ Con/tl~c~ ~is ~u amd ~e bulK e~ %ts C'on~nrs ~o !,s ~a ~ I~~Cblcr ~s U'iJ~iv+tf /T~/ /lSC/y,~/ias~ ~ a li~ CSfale_ ~ ilumbt~-- a1~ D~tr ifC~ls ivy a/ready ~i;.r so~,r• ~il- ~~Iv~`i/1q ~~t~l~ts n°./!1aihCq~~ar~ a~ a'eCP,~C/!~s cs~te ~ u5 ~'acl~ an- RSSCfia~lc ; ~ 7S.Oo ,I~. D1cl~ G'o/or 7Y ~l~P'pJ ~3s:m e• Oial ~~ ~~ SDJr.'rt~s ~/S.oo ' j'~O•DO ~ . ~Co~ lute fIl~1Q~6oA. ri/ OD ~ ~O ~~ C~ueSf ~ ,Qr,~~ru~ . ~ ~S-D.OD I I~IiSC. CQS~ ~ ~, o0 TOTAL (Also enter on line 5, Recapitulation) I ; /~f, 9dS. y3 (If more space is needed, insert additional sheets of the same size) __ _ Ma,r.?5. 20'1 11.~3AM PNC BANK 41?-705-2747 No, ?323 P. 1/1 ,tec,Q .3/~S~/~ ~~ ~ ~~ 1.Ei1Dlt~lG fiHE WAY March 25, 2011 Charles E Shields III Esq. 6 Clouser Rd Mechanicsburg, PA 17055 RE: Robert L Alexander SSN: 200-24-1400 DOD: 0'1-28-2011 Dear Mr. Shields: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Accaunt Account # 5070076433 Established: 01-01-1979 ROBERT L ALEXANDER DOD balance: $ 13,618.33 + 0.00 accrued ir-terest Please note that this o#Ece provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do~ not process any financial transactions or provide statements. If you need assistancc with any of these items, please call 1-888-PNC-BAND (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is sntended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited I, f 'you have received this communication ~n error, please notify me immediately by reply or by telephone at 80a-762-1775 and immediately destroy this faxed document. Page 1 of 1 REV-15o9 FX • (197) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF r FILE NUMBER ff an asset was made joint within one year of the decedetrt's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS ~ELATIONSH{P TO DECEDENT A. ~IZrA~ L. ~l,~x~~~~ Y 33 S. York st. 111echani,csbNr~, P~ loss' son B. C. InwTl Y~IWNFR PR()PFRTY~ ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name Of financial institution and bank account numl>ar or similar identifying number. Attach deed r jointly-held real estate. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. I ~~I ~/ay n1 ~ C,n bors Jsf F~dera ~ C-rgd r ~ U.n ~ v n; ~cc/;nqs ~-c~. No. 3bq 3a8 -oo o5,av Soho {~,So ~~nt~t /Yl ont~r /116tn~t~f /Y'IEP/1. No• 36 9 328 *$2, ~6 8. Ib .SD~o ~~?(~ , 23 `f. D $ 2_ A. ~~,t. accr ~ d.o•d. o ~/. 3S SD~o 'x/0.68 ~- Ip/~°~ CB~>~i ~'riat ~ ~S~t' /VO. 3bq 3t lf- ~o $ 3 ~, 9 33, 01 ~~o ~t$~ 9 bb . 5/ 3 / _ I !<, dc~~. ~ d.o.d, {/7.yS Sn~o t 8.73 (mac r~/usfio~r /~~ir e~~~~~ ~'' ~'' ADS' 04Kil1erk Fcutds ~ ,K~rnSts ~ e ~I Sf,u~- . No. gD~D 043 6~7 ~GJCer symbol af~KQX a„ '130, 7.09 shm+es h. ~~?•97, to ~a~.4~ avP.= f1.~.R7 X66, ag~.9S 5b~~ 33, f47.3'8 (S4e Y~cluc.{--on Shut a111tK~lG~t, S, ~. aooS v uarr,~ Voyaye~" ~~trf" ~e,r"r;cts Aea~f: /Yo- ~ 33µ, IS~.JS S71~o flb7, 09I.OS~ D9 0?~- ate o ~.I (slot jfa/ua,ih'oivt Ca~cw,a.~'ovt s a ltfttclud) TOTAL (Also enter on line 6, Recapitulation) I S oZ y ~, y 60. 96 (If more space is needed, insert additional sheets of the same size) MEMBERS 1~ FEDERAL CRED11' UNION SAVINGS ACCOUNT: Account Number/Suffi* Date Account Establishhed Principal Balance at Date of Death Accrued Interest to Dake of Death Totai Principal and Accrued Interest Name of Joint Owner Date Joint Ownership established MONEY MANAGEMENT ACCOUNT: 369328-00 10/09/2009 $5.00 $.00 $5.00 Brian L. Alexander 10/17/2009 Account Number/Suffi~C 369328-05 Date Account Establislhed 10/17/2009 Principal Balance at D$te of Death $52,468.16 Accrued Interest to Dade of Death $21.35 Total Principal and Accrued Interest $52,489.51 Name of Joint Owner Brian L. Alexander Date Joint Ownership established 10/17/2009 CERTIFICATES OF D~POSIT: Account NumbedSuffi~c 369328-40 Date Account Established 10/09/2009 Principal Balance at Date of Death $31,933.01 Accrued Interest to Dake of Death $17.45 Total Principal and Accrued Interest $31,950.46 Name of Joint Owner Brian L. Alexander Date Joint Ownership established 10/15/2009 Q~XINtLi~(~ MEM ERS 1sT FEj1(=RAL CREDIT UNION Leigh-A Stallings Lending Insurance Support Specialist March 14, 2011 Estate of Robert L. Alexander Date of Death: 01/28/~t011 Social Security Number: 200-24-1400 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800;1 283-2328 wwwmemberslst.org OAKBX Historical Prices ~ OAKMARK EQUITY AND INCOME FUND Stock -Yahoo! Finance 11/9/11 11:53 AM lsiClSi User? IZuEJIS':t;:~ 'jiL3Et '!1 }~iE PJir~¢4x; '/ MY 'tiE)Itt CI30tjG .."!]z+ii i4?Y l' ":ii`i;E: Search ~_~ ~~. ' ~ Search Web • Home • Investing ° Market Overview ° Market Stat ° Stocks ° Mutual Funds ° ETFs ° Bonds ° Options ° Industries ° Currencies ° Education ° Commodities • New ° Markets ° Investing Ideas ', ° Special Editions ° Company Finances ° Providers ° Video • Personal Finance ° Banking & Budgeting ° Career & Work ° ~ College & Education ° Family ~ Home ° Insurance ° Loans ° Real Estate ° Retirement ° Taxes ° lifelong Investing • My Portfolios ° Sign in to access My Portfolios ° Free treat of Real-Time Quotes • EXCLUSIVES ° Breakout ° ~ The Daily Ticker ° Daniel Gross ° Financially Fit Search for share prices Search for share prices _ _ _ 3 Cet Quotes' Wed, Nov 9, 2011, 11:52AM EST - U.S. Markets Gose in 4 hrs 8 mins Dow i 1.64h6 Nasdaq • 2.06°h Oakmark Equity $ Income I (IOAKBX) _= _ as+avaerarceuNr ,. ~ On Nov e: 28.7 'f 11.23 {0.83%} :Historical Prices Set Date Range Daily Start Dats: ~an ;;~ , 28 ~0 Ey. Jan 1, 2010Weekly End Oate: ~an~ ~P.' 28 ~ ~ 011 ~ Monthly s : , Dividends Only het Pk3e~'`. Get HistoNcal PACes for. C0 -- AdChoices First ~ Previous ~ Next ~ Last http://finance.yahoo.com/q/hp?s=OAKBX&a=00&b=28&c=2011&d=00&e=28bf=2011&g=d Page 1 of 2 i _., f UAKMARK EQUITY AND INCOME FUND Stock -Yahoo! Finance , 3 i Prices 1 Date Open High Low Close Jan 28, 2011 27.97 27.97 27.97 27.97 Cbse price adjusted for dividends and splits. r'~`1Download to Spreadsheet ~un'ency in USO. 11/9/11 13:53 AM Volume Ad'j Close" 0 27.97 First ~ Previous ~ Next ~ Lasi Copyright O 2011 Yahoo! Inc. All rights reserved. Privacy Policy - Af~ouf Our Ads -Terms of Service - CopyrighUlP Policy -Send Feetlback - Yahool News Netwoflc Quotes delayed, except where indicated oth'~erwise. Delay Imes are 15 mans for NASDAQ, NYSE and Amex. See also delay times for other exchanges. Quotes and other formation supplied by independent providers id tified on the Yatrool Finance partner page.Quotes are updated automatically, but will be fumed off after 25 minutes of inactivity. ' Quotes are delayed at least 15 minutes. All fnf~rmation provided "as is" for informational purposes only, not intended for trading purposes or advice. Neither Yahool nor any of ependeM providers is liable for arty irrtonnationpl errors, incompleteness, or delays, or for any actions taken in reliance on information contained herein. By accessing the Yahoof '; site, you agree not to tedistritxtfe the iMonnation found therein. =undamentai company data provided by Capital lQ. Historigl chart data and daily updates provided by Commodity Systems, In<:. (CSI). Intemafionai historical chart data, daily updates, fund surttmary, fund performance, dividend data and Morningstar Index data provided by Morningstar, Inc. of 2 lance.yahoo.corn/q(hp?s=OAKBX&a=006b~28&c=2011&d=00&e=28&f=2011&g=d Page 2 of 2 __ ~ _ _ ___ REV-1570 EX • (7-97), COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF n ~ L , n~a~~ SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NttMBER a, ~ "/D - l78 This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-15x0 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIRREIATIONSHIPTO DECEDENTAND THE DATE OF TRANSFER, ATT HACOPE OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °~ OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~' VArn~um~d VDya~tr ,Salto' ~i'ricts /~-~~' /I~v. 0o d! - 098 598 ~bS b~ ~Z~~ ~, v 33.81 ~ta.KS Q X31, 5~1 ,pcr s 1-art = ~31, 658.A1v !0090 --o'-- ~3~~ 658.Gb I~i~a~lt; fio ~riaa~f ~. fHcicc~er'~ sort, TOTAL (Also enter on line 7, Recapitulation) I ~ 3~~ b $8; Db {If more space is needed, insert additionai sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ~/_ ~ f _ , 7 ~ ~/r~curytf~tr, ~~d~t L . Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: / ,{. //~~ ~~~ L,B~ 1. ~uYKxa~ W QS P rY. PAr cl C QA /1 Yhjlf~i/;t - 1Jlr.~ ri~q /Z 4.,! lstY) rfGf1 rY1P,rnorl'a1$ Tprr" CP~1'I~'U'y ~15G^f17~Ov1 / /~i0.0~ ~i ./ g. ~ ADMINISTRATIVE COSTS: ~ , Personal Representative's Commissions '[3r'~ L. ~le~c~rndcr Lei red Name of Rersonal Representative(s) ~ Street Address,, _ L~ 3 3 5 . Yo f-K ~f City m(:ulanf C Sb ~it~( State/ zr Zip ~~O SS^ Year(s) Commission Paid: 2. Attorney Fees ~ YI Q r~CS ~- o~9rG~Q S ~ T~oj 000, OO 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. (t Probate Fees Ci~l~ Ot'!41 n~ ~t 55 t~tG f)'f ~r~ p L CGI'~l l7•Ca 1 GS f ~ 0 $'. SO 5. Accountant's Fees tl~~b L V-~rk o1' rc""k ~,~~~ ~~ M r P Do ~ 3 . A-41s, ~, "IC~b`"'~ ~ Pkp. 1 o41s ' oD• 6. s Fees Tax Return Prep~rer ~. ~ololr fiDrla~ a~~ L'prfil~~Ga~s ~ B;~ ~~ ~dr~rf%san ;n Cwn+b~rlarrd I.af~ ~ourraal `~ ~~s~po 4'. rl.s ~Seilhn~/ ~¢ drrdrf%~%n, in ~t ~i * ~I'P~r Alerts ~ ~ r~. yr~ ~ (~• /Itq~a~i 1~iiria~ ~Sfio/`~ Cu'~i ~i Cct.~S ~/(~, DD t SCG 11/1 ~ll uQ~7~-1 c-7/1LG~ TOTAL (Also enter on line 9, Recapitulation) $ /O/ QS~ 9~ (If more space is needed, insert additional sheets of the same size) r ~- N -... N ~[7 .a o ,~ o c ~a~N ~ doa.~ ,,, . , ~ ~~r .~ s ~ ~` '~. ~ c ti ~M_" ~ ~~ a~ .~ H G' .~Q U IC ,`mCy ~~ d' a 0 r- Q a 6.. +~ ~ N ~ ((S 4 Q V ~cc m M G d o c O O O a ~ ~" co '~ ~ ~ I D ~ ~ 3 C p V ~y ~ C °~ `~ m 1 ~~ N a~ N_ ~ O '~ ~L ~ ~ ~ '`~~ •:31 1 L (~ 1 m ~~ U ~l '~+ _ _ __ _ __ INSCRIPTION ORDER FORM ~ ~ I ~~~3.y~ • • N~. 12- zngric MEMORIALS Since 1921 5243 Simpson Ferry Road, Mechanicsburg, PA 17050 (717) '766-5622 • Fax (717) 766-8007 • www.gingrichmemorials.com CEMETERY ~,'~ ~ ~~~-r s~~a LOCATION NAME OF DECEASED ~~ ~ r r~ ~ i;. K (fit Yt ~ E` ~°" LETTERING REQUIRED:' ~'~.~ r .-. ~ ~ € _ FAMILY NAME MEMORI~-L t`t ~ ~ ~ ~ ~ ~ ~- ~ IND. NAMES ON MEMORIAL ~tY ~ V~;~ ~ ~ TYPE OF MONUMENT 1 COLOR OF GRANITE ~~~ LOCATION: DRAW A PRECISE MAP OF L ATION OF MEMORIAL ON CEMETERY (Use bads of work osier ff necessary) BILL TO: r~r~ ~~ f. t~~ ~ Y~ I c .ti ~ x' 't vi ~ I~ ~ ~ b DATE OF ORDER ~p~. - ~ ~ ' ( ~ ORDERED BY l~~'~rt~ ~"~ve~'3 ~ ~~c~r~ ~, °~. -T PHONE # UPON EXAMINING THEM ABOVE INSCRIPTIONS, UWE THE UNDERSIGNED, FIND THE SPELLING AND DATES TO BE CORRECT. THE WORD WILL BE COMPLETED AS IT IS ACCUMULATED. NO SPECIFIC COMPLETION DATE IS ;,~.~,~ GUARANTEED. SIGNED SIGNED .~.~ PRICE $ ~ ~ ~ ~. ^"" DEPOSIT $ BALANCE DUE $ VitalChek Receipt Transaction ID: VI99-1306686-1 Date/I'ime Requested: 3X19/2011 (a7 9:30 am Certificate Type: DIEATH Name on Certificate: Ii~OBERT LIGHT ALEXANDER Father's Name: I~tV1N S ALEXANDER Copies: 5 Carrier: ~.EGULAR MAIL Delivery Telephone(s): ('17)766-6428 / (71'n766-6428 I~~~,®'~~~~~~I~~ Credit Card Authorization Code: 11837P AVS Response: Y Request Fee this Item: $ 45.00 Other Agency Fees this Item: $ 0.00 Handling Agency Other VCN Fee Fee Carrier Fee Request Fee Agency Fee Total Fee $ 10.00 $ 0.00 $ 0.00 S 45.00 $ 0.00 $ 55.00 Ship To: BRIAN AL XANDER 433 S YO STREET MECHArTI SBURG, PA 17055 REV-1512 EX+ (12-08) j i~ pennsylv~ania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Report debts incurred dy the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER D SCRIPTION E VALUE AT DATE OF DEATH 1 • t, . _ h'j - 11 ei1 l u M ~l1 a r)1'14.t~ SySI cm$, ~-r1c - bZ~f. ?10 o~. 11,12Sf hone - ~~YIS (- A-m bu.l a~wec ~rv~ cis ~/ 3~, 70 3. /yJ~%/ehiurm f~har~n~ ~ysfcn:s, ~. '~3o,3b TOTAL (Also enter on Line 10, Recapitulation) I; ~Y3 Sa • if more space is needed, insert additional sheets of the same size. d. --------- - _ --------- --- ----------- --------------------- -- ----------- ----------- _--- - --------- Invoice Date:01/7~8/20 11, Acct#:STMH1865, ALEXANDER, ROBERT, Sarah Todd NC, A, BRANSCUM , GEORGE -X „ ..._ .,. . ,,. , n ,~ - _ -- - ___ 01/07/2011 6230103 28 00 Bacitracin Exterrrel Oirrtrnent500 UNIT/GM 45802-0080-03 $ 4.20 $ 0.00 $ 4.20 OTC 01 /07/2011 6230182 25$.00 PoNethMerre Ghfcol 3350 Oral Powder $ 2.49 c $ 0.00 $ 2.49 RX 51991-0457-68 01!08/2011 6230085 25100 Vitamin C Oral Tablet 500 MG $ 0.82 $ 0.00 $ 0.82 OTC 00536-3292-01 01/08/2011 6230086 25G00 Vdeurrin E Oral Capsule 400 UNIT $ 2:.49 $ 0.00 $ 2.49 OTC 00904.0274-00 o1ros/2o11 s23238s 1.ID0 omeprazde oral capsule Delayed Release 20 MG $ 0.40 ~ $ 0.00 $ 0.40 RX 62, 75-011837 01 /09!2011 6229974 24100 Prilosec OTC Oral Tablet Delayed Release 20 MG $ 1:3.24 $ 0.00 $ 13.24 OTC 37000-0455.04 01/09/2011 6230612 3.100 Beta Carotene Oral Capsule 25000 UNIT $ (1.11 $ 0.00 $ 0.11 OTC 00904-43150 01/10/2011 6231865 12~~00 Ibuprofen Oral Tablet 200 MG $ 0.51 $ 0.00 $ 0.51 OTC 00904-7915.69 $ o.oo $ 2.a $ 21.3 $ o.oo $ o.o0 24.2s DESCRIPTION OF CHARE3E QUANTITY UNIT PRICE AMOUNT Stretcher One Way Tram Member T2005 1.0 96.06 96.06 Transport Van Mileage S0209 11.4 3.74 42.64 Total Charges 138.70 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT _ _ _- - - _ ~- _ -__- _ dotal Credits. _ - .0.00 PLEASE PA~r' THIS AtVtOUNT - fNV04CE DUE UPt)N RECEIPT ~~'- 5138.70 ~CTi iDA1Ct~ hL1Cl^Zf CCC . 4:29 t\f1 PATIENT NAME: ALEXANDE~2, ROBERT L , CALL NUMBER: 2~ 26~ TW AMOUNT PAID: 02/07/2011 IIViPORTANT IVIESSAGES: ', THIS SERVICE IS NOT COVERED BY MEDICARE OR MEDICAL ASSISTANCE. WEST SHOIRE EMS -CARLISLE 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 SQ20 Ritter Road, Suite 110 - Mechanicsburg PA, 17055 INVOICE 02/28/2011 Due by 3130/201linasf~ Gouts: Mrt= S.,TssN~~pee' 1~'~73~9 -: .- ~ . _. - . Account Number: STMH1865 ROBERT ALEXANDER 102250 Go Brian Alexander 433 S. York Street PVT Mechanicsburg PA, 17055 ~ : - . ~` Amount Die: ~ . - }Q-~~ - Arnot'Pa ~ c~ ~'" _. .- - P Detach Here and Return Top Portion With Your Payment Invoice Date:02/2!6/2011, Acct#:STMH1865, ALEXANDER, ROBERT, Sarah Todd NC, A, BRANSCUM, GEORGE _X - _. .. .. . ,Y _ _ _ ,~ . ~_ ~._-. _ _01/08J2011 6230613 7. RautNc Oral 7abkt 50 MG $ 3p.36 c $ .0.00 $ 30.36 RX 00075-7700-60 $ 0. $ 24.26 021 0/2011 $ 0. $ 0.00 $ 0.00 $ 30.36 $ 0.00 $ 0. $ 0.00 30.36 60-1213/313 ~~ ~ rG"~ 5 ~ G % ~ 041 Pa to the ~ ,~f ~ Order of : ' ' ~ ~C> i'~ VU ~ M ~ ~? GL !"}v\ cy G ~ l~ ~/~inrl 5 i N ~ ~ ~ '~' ~ ` ~ ~G' ~ ~ 1 1"! l~ Li f~C~ ~ ~ / CD - '_ Dollars ~ ~ ~ Pl\1CBANK PNC Bak, N.A. 040 Central PA For i~4rt'~ctc`'° e~(?!~f 1fi65 ~~r ~x~r ' ` ar ~;03 13 1 2? 8~: 5 i L 2536304~-• 'REV-1513 EX+ (9-00) SCHEDVLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RE7IURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME ANa ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHkP TO DECEDENT Do Not Llst Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ~r~ an L. A-I~XUi--td~ ~S'u~ /oo~ ~ 33 s. ,~.r k sf // ENTER DOLLAR AM~UNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DIST IBUTIONS: A. SPOUSAL DIST IBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE ANb GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I s (Ii more space is needed, insert additional sheets of the same size) LAST WILL A1~1D TESTAMENT OF ROBERT L. ALEXANDER I, ROBERT L. ALEXAiNDER, an unremarried widower, currently of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will ahd Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I direct the payment of all my just debts and funeral expenses as soon after my decease as the samr, can conveniently be done. All the rest, residue and Iremainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath unto my son, BRIAN L. ALEXANDER, to his own use and benefit absolutely. In the event, however, that my son, BRIAN L. ALEXANDER, should predecease me or should die at about the same time as I die, Such as in a disaster common to both of us, I give, devise and bequeath all the rest, residue and remainder of t-~y Estate, real, personal and mixed, whatsoever and wheresoever situate to THE BRETHREN HOME O)~ NEW OXFORD, PENNSYLVANIA. I nominate, constitute aid appoint my son, BRIAN L. ALEXANDER, to be the Executor of this my Last Will and Testament. In th@ event that my said son is unable or unwilling to serve as Executor, I appoint THE BRETHREN HOME O~ NEW OXFORD, PENNSYLVANIA or its Chief Executor Officer to be Executor in his place and stead:. In the event that the HOME in its own capacity is unable to qualify to receive Letters Testamentary, tlhen I appoint its CHIEF EXECUTIVE OFFICER to serve as my Executor. I further direct that they shall nbt be required to file bond or other security in the Oflice of the Register of Wills for the purpose of adminilstering my Estate. IN WI/TNESS/WHERIEOF, I have hereunto set my hand and seal this ~'~+~ day of ~ ~~,c~ ~ , A.D. 2005. ROBERT L. ALEXAN ~ R Signed, sealed, publis}~ed and declared by the above-named ROBERT L. ALEXANDER, as and for his Last Will and Testament, i~ the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as/witnesses. ~~ ,.. ~~ ~~~~~~\`~ ~ ~~ ~~t ~~\ ~~~