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HomeMy WebLinkAbout01-30-12 (2)1505610105 REV-1500 ex (°z_~~, (Ft, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania ~E .,a „E„. o, P~~~x~: County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN ~'` `' ~ ,~ `~ '' PO BOX 28o6oi Harrisburg PA1'71z8-o6o> RESIDENT DECEDENT "-~ ~ %~' ~-~(.~j;",,'~-~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 284-26-4158 01 /07/2012 10/12/1929 Decedent's Last Name Suffix Decedent's First Name MI Parsons Frances R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (~ 1. Original 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 _ ~ 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 Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Jacqueline M. Verney, Esq First Line of Address 44 S. Hanover Street Second Line of Address City or Post Office Carlisle, State ZIP Code PA 17013 REGISTER OF WILLS USE ONLY !-.~ ~ - l ~ ~.-._.. _ - ~ - ,. rTt ~.3 r~ \ ` '~ , ~ _ -~ ~ =- - . ~ "'1 t7ATEEJLED _-' ..,~? 1 11 ~/ -r.~ -;-; f. 7 _'.~~ a~ _ ,~ C .~ -1 'T' C it `'`,~ r Correspondent's a-mail address: JfnVerney a01.COfn 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 beuer, it is tru correct and complete. Declaration of reparer other than the personal representative is based on all information of which preparer has any knowledge. SIG RE OF PERSON R iB F R FILING REyURN PATE NATURE OF PREPARER OTH THAN EPRESENTATIVE ~ .DATE DR- o ~ ~ k S. !-E~4n/overL S~ ~g2~.sL~ ~a 1~a~3 150567,0105 Side 1 1505610105 t.._~ .f J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number 284 26 4158 Decedent's Name: Frances R. P'clrSOn$ - - RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 230,395.16 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 1,674.80 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 112 201 68 (Schedule G) O Separate Billing Requested..... ... 7. , . 8. 9 ) .......................... Total Gross Assets (total lines 1 throu h 7 8. ... 344,271.64 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 6,455.98 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 2,074.78 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 8,530.76 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 335,740.88 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. 335,740.88 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES __ - 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 335,740.88 (a)(1.2) X .045 15. 15,108.34 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 15,108.34 19 19. TAX DUE ...................................................... ... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: Frances R. Parsons STREET ADDRESS _ __ ', 128 Petersburg Road _ _ ___ CITY _ _ _ _ _ __ - _ __ STATE _ ZIP __ Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 15,108.34 2. CreditslPayments A. Prior Payments 0.00. B. Discount 755.42. -- __ -- __ Total Credits (A + B) (2) 755.42 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) 14,352.92 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 .............................................................................................................................. ^ 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 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 disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(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-1508 EX+ (u-io) ~ Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERRANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Frances R. Parsons 21-12-0035 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Citizens Bank 1 Citizens Dr. ROP 112 Riverside RI 02915 checking acct #6100437809 3,071.55 2. Citizens Bank 1 Citizens Dr. ROP 112 Riverside, RI 02915 checking acct #6214160032 4,211.61 3, SecurChoice-Prepaid Funeral Hoffman-Roth Funeral Home 219 N. Hanover St. Carlisle, PA 17013 1,951.00 4. Orrstown Bank 427 Village Dr. Carlisle, PA 17013 acct #4N2157887 60,533.34 5, Orrstown Bank 427 Village Dr. Carlisle, PA 17013 acct #50 00 1597 018 160,627.66 TOTAL (Also enter on Line 5, Recapitulation) $ I 230,395.16 If more space is needed, use additional sheets of paper of the same size. ~,z~rs a° Jaaaary 23, 2012 James W Parsons 1054 South Pitt St Carlisle PA 17013 Estate of Frances R parsons Date of Death: Jan 07, 2012 SSN: 284-26158 Dear Sir/Madam: One Citazezas Drive ROP112 Riverside, RI 0291 S In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his,~er date of death. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667, option 2. Sincerely, Pamela Breton Decedent Account Processing REF#: 527351 JAN. 23. 2012 1;28PM ACCOUNT SERVICES ,Account Number Account Title Date ~ Account Balance as of DOD Ynterest from Last Postin to DOD Account Balance as of DOD YTD Interest to DOD 6214160032 FRANCES R PARSONS 5/S/2006 $4211.42 $ .19 $4211.61 X8.21 N0. 499 P. 4 JRN.23.2012 1;28PM ACCOUNT SERVICES ~~~~ ~~~ N0. 499 P. 3 Account Number 6100437809 Account Title FRANCES R PARSONS Date ened 6/10/1983 Account T e Checkin Pzinci. al Balance as o:f DOD $3071.55 Interest front Last Postin to DOD $ .00 Account Balance as of DOD $3071.55 YTD Interest to DOD $ .50 1 FORM 1 Si-~u~choice TM (a pre-arranged funeral program administered and endorsed by the Pennsylvania Funeral Directors Association) PART Pre-Need and Individual Trust Agreement ("The Agreement") This Agreement is made this ~ ~ by and between DATE neral Home f u NAME Address -. ~' t3USINESS ADDRESS - - r >' ~ i. y~ - I 1 . J and the Purchaser D/O/B SOCIAL SECURITY # (hereinafter 'You') NAME ,-1 _ ; ; ~~ ~ i` ,. - ;-, ,~;~ - 4 . > f ADORESS for the Benefit of r .F. 1 - D!O/B SOCIAL SECURITY # (if Beneficiary 's -~° ~` NAME __ w: a. ~, ,_~ r ; ;, :. , . . ~ ~-:, , -~ : ~ - is different from ADDRESS the Purchaser) ANNUAL FINANCE Amount Financed Total of Payments Total Sale Price PERCENTAGE CHARGE The amount of credit The amount You witl have paid after You have made The total cost of Your purchase on Crecrd, RATE provided to You or on me dollar amount the your behalf. All payments as scheduled. including Your down- Payment of $ The cost of Your Credit credit wiil cost You. . ~ as a yearry rate. ~;,. i IY~~... ~; r ~. ~, - ..- ! ~ 0.00% 0.00% $ $ J $ '` -~ ~ ment Schedule will be: P Itemization of Amount Financed ay If not paid in full, Your No. of Amount of When Payments Are Due Cash Price $ payments payments Total Downpayment $ Monthly beginning (a) casn - $ fro. oa year (b) Death Benefit of Paid Up Life Insurance Poilcy Assigned:. $ See reverse side for any additional-information Unpaid Balance of Cash Price 8 -about Nonpayment and default. Amount Financed = ~ You hereby agree to buy and Funeral Home hereby agrees to sell the funeral goods ("Merchandise'), funeral services ("Services") and cash advance items for 3rd party charges ("Cash Advances") which are described in itemized list attached as Exhibit A for a Total Sale Price of $ (see paragraph 5 on the reverse side for price details) After payment of the Total Sale Price and all other payments required to be made, the Funeral Home will render, upon the death of the d t ons shown above and on the averse s de of th s pagan which you havenread and acceiPfeAd: This Agreement is subject to the terms and con- You ~ereby elect that this Agreement shall be: -Revocable by You at Your option at all times Irrevocable upon payment in full of the Total Sale Price You rand the Funeral Home agree that Services and Merchandise shown on Exhibit A are: TX Guaranteed by the Funeral Home upon timely payment of the Total Sale Price Not Guaranteed by the Funeral Home You and the Funeral Home agree that Cash Advances shown on Exhibit A are: ~: Guaranteed by the Funeral Home upon timely payment of the Total Sale Price Not Guaranteed by the Funeral Home EXCLUSION WARRANTIES: THE FUNERAL HOME IS NOT PROVIDING TO YOU ANY WARRANTY OF MERCHANTABILITY OR WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE FOR THE MERCHANDISE. The only warranties You are receiving for the Merchandise are the express written warranties, if any, which are provided by the manufacturers of the Merchandise sold to You under this Agreement. Only the manufacturer shall have any liability to You under such warranties. You and the Funeral Home have signed this Agreement on the day and year written above and intend to be legally bound.. fay signing this Agreement, the Funeral Home, as agent for the Purchaser, hereby agrees td establish an individual trust with the Trustee under the Master Pre-Need Trust Agreement (the 'Master Trust") between the Funeral Home and the Trustee (the 'Trust"). ~~ -- ;ir, '' Signature of Licensed Funeral Dtrector ;j Signature of.Purchaser~ i License Number of Funeral Director J SUBJECT TO TERMS AND CONDITIONS ON REVERSE SIDE: You acknowledge receipt of a completed copy hereof. You, the buyer, Holdings by Investor Frances R Parsons Lisa Riggleman 1054 Pitt Street Orrstown Financial Services Carlisle, PA 17013 427 Village Drive Carlisle, PA 17015 717-249-3737 Frances R Parsons Acct Name: FRANCES R PARSONS 1054 PITT STREET CARLISLE PA 17013 Acct No:4N2157887 Rep. No:AWZ Asset Name Tlt~ter Asset Type Mgt Name BROKERAGE MONEY MARKET CASH BROKERAGE MONEY MARKET DWS CORE PLUS INCOME FUND-C SZICX BONDS DWS SCUDDER INVESTMENTS DWS U.S. GOVT SECURITIES C KUSCX BONDS DWS SCUDDER INVESTMENTS FRONTIER COMMUNICATIONS FTR US STOCKS CORP COM VERIZON COMMUNICATIONS INC VZ US STOCKS COM Combined Account Portfolio Date: 01 /06/2012 Created: 01 /13/2012 Acct Type:lndividual Quantity Price (S) Value (~) 1,881.54 1.00 1,881.54 2,244.16 10.78 24,192.04 3,257.11 9.05 29,476.87 30.00 5.11 153.30 126.00 38.33 4,829.58 Account Total: $60,533.34 Investor Total: x60,533.34 Incomplete if presented without accompanying disclosure pages Page 1 of 2 Orratown Financial Advisors Charlene L. Feuchtenberger Assistant Vice President / Fiduciary Officer Date of Death; 01/07/2012 Valuation Date: 01/07/2012 Processing Date: 01/13/2012 Stares Security or Par Description High/Ask Low/Bid 1) 2769.13 FEDERATED EQUITY FDS (3141725601 STRG VAL DV INST Mutual Fund (as quoted by NASDAQ) 01/06/2012 2) 1736.228 FEDERATED TOTAL RETURN SERB (31428Q101) TOIL RET INSTL Mutual Fund (as quoted by NASDAQ) 01/06/2012 31 386.491 ROS9E T PRICE EQUITY INCOME FD {779547108} SH BEN INT Mutual Fund (as quoted by NASDAQ) 01/06/2012 4} 3399.853 ROWE T PRICfi SHORT TERM BD FD (77957P105) COM Mutual Fund (as quoted by NASDAQ) 01/06/2012 5) 1346.726 VANGUARD/WELLESLEY INCOME FD (921938106) COM Mutual Fund (as quoted by NASDAQ) 01/06/2012 6) 1643.129 VANGUARD FIXBD INCOME SECS FD {922031810) INTRM lOWGRDAD Mutual Fund ias quoted by NASDAQ) 01106/2012 7) 2304.848 VANGUARD FIXED INCOME BECS FD (922031836) STRM INVGRA AD Mutual Fund (as quoted by NASDAQ} 01/06/2012 8) 1392,746 VANGUARD FIXED INCOMH SECS FD (922031869} INFL PROT SECS Mutual Fund (as quoted by NASDAQ) G1/06/2012 Total Value: Total Accnaal: Total: $149,949.97 4..79000 Mkt Estate o`: Frances R. Parsons Accounts 1597 Report Type: Date of Death Number of Securities: 8 Fiie ID: F. PARSONS X1597 Mean and/or Div and Int Security Adjustments Accxvals Value 4.790000 13,264.13 11.29000 Mkt 11.290000 19,602.01 23.46000 Mkt 23.460000 9,067.08 a.eaooo nskt 4.820000 16,387.29 22.96000 Mkt "12.960000 30,920.83 9.98000 Mkt 9.980000 16,398.43 10.65000 Mkt 10.650000 24,546.63 14.19000 Mkt 14.190000 19,763.07 $149,949.47 $0.00 Page 1 This report was produced with Satateval, a product of Estate Valuations ~ Pricing Systems, inc, if you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) Date of Death: 01/07/2012 Valuation Date: 01/07/2012 Processing Date: O1/i3/2012 Portfolio Bndnotes Federated Money Market #60934N625 $10,b78.19 Accrued Interest $ 0.54 f ,. ~ a , ~~ ~._~.- _ - ; Date: p''~ ~~ ~. Charlene L. Feuchtenberger A9at. Vice ~reaident / Fiduciary Officer 3state of: Sra.°~cee R. Pa18oSia Account: 1597 Report Type: Date of Death Number of Securities: 8 fiile ID: F. PARSONS #1597 Page 2 This report was produced with EatateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact BVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) REV-isog EX+ (o>->o) ~: Pennsylvania ' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: Frances R. Parsons SCHEDULE F )OINTLY-OWNED PROPERTY FILE NUMBER: 21-12-0035 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• James W. Parsons B C. JOINTLY OWNED PROPERTY: 1054 S. Pitt Street Carlisle, PA 17013 son LETTER DATE DES RIP ITEM NUMBER FOR JOIN TENANT T MADE C TION OF PROPERLY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH % OF DEC ' DATE OF DEATH JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE VALUE OF EDENT S VALUE OF 1 A . ASSET INTEREST DECEDENT'S INTEREST . • 04124/06 Orrstown Bank acct # 146000667 371.06 50 185.53 2. A 08/03106 Orrstown Bank acct # 146000735 2,978.54 50 1,489.27 TOTAL (Also enter on Line 6, Recapitulation) I $ 1,674.80 If more space is needed, use additional sheets of paper of the same size. ORRSTOWN B~vx A Tradition of Excellence To Whom It May Concern, As of 01-07-2012 the balance in account 146000667 was $371.06 and it was opened 4/24/2006. The balance for account 146000735 was $2,978.54 and it was opened 8/03/2006. These are the only two deposit accounts that Frances R Parsons' had at Orrstown Bank and they were joint with James W Parsons. If there are any questions or concerns please feel free to contact Vanessa L Albright by the information listed below. ~~ Vanessa L Albright Customer Service Representative Orrstown Bank 717-240-0801 valbri ght@orrstown. com 1.888.ORRSTOWN REV-1510 EX+ (08-09) ~ Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Frances R. Parsons 21-12-0035 Th~< crhari~i~a must he completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. If more space is needed, use aomlionai sneers or paper ui uie oaiuc ~~«. Orrstown Financial Advisors Charlene L. Feuchtenberger Assistant vice President / Fiduciary Officer Date of Death: 01/07/2012 Valuation Date: 01/07/2012 Processing. Date: 01/13./2012. Shares Security or Par Description HighJASk Low/Bid 1) 1850.827 FEDERATED EQUITY FDS (314172560) STRG VAL DV INST Mutual Fund (as quoted by NASDAQ) 01/06/2012 2} 1160.641 FEDERATED TOTAL RETURN SERE (31428Q101) TOTL RET INSTL Mutual Fund (as quoted by NASDAQ) 01/06/2012 3) 258.229 ROWS T PRICE EQUITY INCOME FD (?79547108) SH BEN INT Mutual Fund (as quoted by NASDAQ) 01/06/2012 4) 2272.77 RCWS T PRICE SHORT TERM BD FD (77957P105) COM Mutual Fund las quoted by NASDAQ) 01/06/207.2 5) 900.116 VANGUARD/WELLESLEY INCOME FD (.921938106) COM Mutual Fund (as quoted by NASDAQ) 01/06/2012 6) 1098.414 VANGUARD FIXED INCOME SECS FD (922031810) INTRM INVGRDAD Mutual Fund (as quoted by NASDAQ) O1/G6/2012 7) 1540.765 VANGUARD FIXED INCOME SECS FD (922031836) STRAP INVGRA AD Mutual Fund (ae quoted by NASDAQ) 01/06/2012 8) 931.049 VANGUARD FIXED INCOME SECS FD (922031869) INFL PROT SECS Mutual Fund (as quoted by NASDAQ) 01/06/2012 Total Value: Total Accrual: Total: $100,231.68 4.79000 Mkt Estate of: Frances R. Parsons Accounts 1596 IRA Report Type: Date of Death Number of Securities: e File ID: P. PARSONS IRA # 1596 Mean and/or Div and Int Security Adjustments Accruals Value 4.790000 8,865,46 11.29000 Mkt 11.290000 13,103.64 23.46000 Mkt 23.460000 6,058.05 4.82000 Mkt 4.E2000C 10,954.75 22.96000 POct 22.960000 20,666.66 9.98000 Mkt 9.980000 10,962.17 10.650D0 Afxt 10.E50000 16,409.36 14.19000 Mkt 14.190000 13,21.1.59 $100,231.68 $0.00 Page i This report was produced with Estateval, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.e•~pays.com. (Revision 7,2.0) Date of Death: 01/07/2012 Valuation Date: 01/07/2012 Processing Data: 01/13/2012 Federated Money Market #60934N625 $11,970.00 i ~~~ ~~ L. Feuchtenberger, Anat. vice President Portfolio Sndnotes Accrued Interest $0.37 Estate of: Frances R. Parsons Account: 1595 IRA Report Type: Date of Death Number of Securities: 8 File ZD: F. PARSONS IRA # 1596 Date: ~ ~~ / / Fiduciary Officer Page 2 This report was produced with SstateVal, a product of Estate valuations ~ Pricing Systems, Inc. If you have questions, please contact SVP Syatema at (818) 313-6300 or www.evpays.com, (Revision 7.2.0) REV-1511 EX+ (1d-09) ;~~i Pennsylvania SCHEDULE H ~ DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Frances R . Parsons 21-12-0035 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. fUNERALEXPENSES: I' Hoffman-Roth Funeral Home 219 N. Hanover St. Carlisle, PA 17013 1,951.00 2. Patriot News Obit 274.72 3. Sentinel Obit 147.58 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) ____ __ _ _ _ Street Address City State ZIP Year(s) Commission Paid: 3,000.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address _ _ _ __ City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 500.00 5. Accountant Fees: 6. Tax Return Preparer fees: 350.00 ~~ Advertise estate: Cumberland Law Journal-$75.OOISentinel-$157.68 232.68 TOTAL (Also enter on Line 9, Recapitulation) I $ 6,455.98 If more space is needed, use additional sheets of paper of the same size. ~ ~ V ~ ~ ~ D Z ~ a m O o ~ "-' ~ -+ < D 1 C7 Z D m m L7 ~ W ~ O ~ D ~ m ~ r O ~ a N y D ~ ~ ~ V D_ ~p T Z ~3 O -Ni n o. 3 0 D D O -O m m ~ a c c z z m m ~ ~ ~ D x x m m --I 0 m D ~ ~ m m d ~ ~ m n a m d o m ~ N n m m O m W C D n O z D z m D m 4 D --i va cn y~ t» f» vj v3 Fn vj Fn ~,, .~i ORIGINAL-F. F. D. OF A. N DUPLI CATE-CLIENT "~~ N TRIPL ICATE-FUNERAL HOME ao.0 ~ ~ m ~ O < m m ~ D ' D ~ m mN N N. j m 17. ~ef~tpm~ W N moN ~ • d a °? 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Customer Account jrogers 132287 Order Taker Customer Address jrogers 219 North Hanover Street Carlisle PA 17013 USA Order Source Phone Customer Phone 717-243-4511 PO Number Ordered By Linda Pipp Customer Fax Customer EMail linda@hoffmanroth.com Pavor Customer HOFFMAN-ROTH Pavor Account 132287 Pavor Address 219 North Hanover Street Carlisle PA 17013 USA Pavor Phone 717-243-4511 Special Pricing None Tear Sheets Proofs Affidavits Blind Box 0 0 0 Invoice Text Materials Net Amount $274.72 Payment Method Payment Amount $0.00 Order Confirmation Tax Amount $0.00 Amount Due $274.72 Promo Tvpe Total Amount $274.72 Ad Number Ad Tvpe Ad Size Color 0002188698-01 Obits Paid : 1.0 X 76 Li <NONE>, Production Method Production Notes Ad Booker External Ad Number Ad Attributes Ad Released Pick Up No 1/25/2012 2:43:06PM 1 REV-1512 EX+ (12-08) j ~l Pennsylvania SCHEDULE I ~ DEPARTMENT DF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT t~iAie vF FILE NUMBER Frances R. Parsons 21-12-0035 Report debts incurred by the decedent prior to death that remained unpaid at the dare ~f dowrh ~.,..~„aL,.. ,..,.e:_.~..___~ __~:__, ____ lr more space is needed, insert additional sheets of the same size. STATEMENT Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Date: 01/12/2012 Due Date: 01/25/2012 Amount Enclosed $ Amount Due: $ 2,007.56 Account #: 102347 RE: Frances R Parsons James Parsons 1054 S. Pitt Street Carlisle, PA 17013 ~.~~~^~~1 ^~J S~rtf _ ' r "Ifl "'~ a..=. .'f5 ~ a A ~~, ~ ' 7 ¢T^ w vPl W .h :i 2~ t ~ ~.~,_ ~., t _.~ t 4~ Balance B/F 10,389.70 10,389.70 12/22/11 PARSONS, JAMES 10,389.70 .00 12/01/11 Medical Supplies 210 .68 170.20 170.20 12/01/11 Personal Supplies 62 2.04 132.56 302.76 12/18/11 Incontinence Supplies 7 10.40 72.80 375.56 12/31/11 Personal Laundry Services 1 30.00 30.00 405.56 01/01/12 - 01/06/1 Room & Board -Semi-Private 6 267.00 1,602.00 2,007.56 Current 1-30 Days 31-60 Days 61-90 Days Over 90 Days Amount Due .00 2,007.56 .00 .00 .00 ;~,. -~~> NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THE 25tH OF THE MONTH ***** Please remit the LAST AMOUNT your statement. Include the ACCT# from the statement on the MEMO of your check. Payments after 1/10/12 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25% LATE CHARGE PER A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Frances RParsons -Account #: 102347 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Date: 01/12/2012 Due Date: 01/25/2012 Millennium Phcy. Systems Mechanicst 5020 Ritter Road, Suite 110 Mechanicsburg PA, 17055 INVOICE 12/28/2011 Due by 1/27/2012 Billing office hours: Mon-Fri gam - 5pm. Toll Free: 1-866.-466-7779 Account Number: sTMFi1971 FRANCES PARSONS 102347 c/o James Parsons 128 Petersburg Road PVT Carlisle PA, 17013 Amount Due: 67.22 Amount Paid: Please Detach Here and Return Top Portion With Your Payment Invoice Date:12/28/2011, Acct#:STMH1971, PARSONS, FRANCES, Sarah Todd NC, A, KAUFFMAN, WILLIAM -X Date ~ Rx Number I( uanti ' Descriation Amount SalesTax Total Tvoe 11/23/2011 6387864 5.00 Fondaparinux Sodium Subcutaneous Solution 2.5 MG/0.5ML $ 16.18 c $ 0.00 $ 16.18 RX 60505-6078-04 11/29/2011 6387089 60.00 Vitamin D Oral Tablet 1000 UNIT $ 1.39 $ 0.00 $ 1.39 OTC 00904-5824-60 11/29/2011 6395641 30.00 Therems M Oral Tablet $ 0.94 $ 0.00 $ 0.94 OTC 00536-4661-10 11 /30!2011 6387004 30.00 Exelon Transdermal Patch 24 Hour 4.6 MG/24HR $ 46.71 c $ 0.00 $ 46.71 RX 00078-0501-15 12/05/2011 6407669 1.00 Olanzapine Oral Tab 2.5 MG $ 2.00 c $ 0.00 $ 2.00 RX 66993-0047-30 Pr v B Last Pymt Last Payment Finance Chg. YTD Fin Chq Other ~ ~ IV P iVPR T $ 0.00 $ 0.00 ~ $ 0.00 $ 0.00 $ 0.00 $ 64.89 $ 2.33 $ 0.00 $ 0.00 67.22 REV-1513 EX+ (01-10) ail Pennsylvania SCHEDULE J ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Frances R. Parsons 21-12-0035 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 [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• James W. Parsons 1054 S. Pitt Street Carlisle, PA 17013 son 100 II 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: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. LAST WILL TESTAMENT OF I, FRANCES R. PARSONS, of 11236 Donation Road, Waterford, Erie County, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last 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 interred within my family's burial plot in accord with nny expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath any and all tangible personal property owned by me at'the time of my death unto my son, JAMES W. PARSONS provided he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all said tangible personal property unto PATTIE PARSONS. In the event JAMES W. PARSONS fails to survive by thirty (30) days, I give, devise and bequeath all said tangible personal property unto PATTIE PARSONS. In the event PATTIE PARSONS fails to survive by thirty (30) days, I give, devise and bequeath all said tangible personal property unto my dear friends, THOMAS SEKULA and CYNTHIA SEKULA, or the survivor thereof. FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto nny son, JAMES W. PARSONS provided he survives me by thirty days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all said real estate unto PATTIE PARSONS. In the event JAMES W. PARSONS fails to survive by thirty (30) days, I give, devise and bequeath alI said real estate unto PATTIE PARSONS. In the event PATTIE PARSONS fails to survive by thirty (30) days, I give, devise and bequeath all said real estate unto my dear friends, THOMAS SEKULA and CYNTHIA SEKULA, or the survivor thereof. SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto my son, JAMES W. PARSONS provided he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all. the rest, residue and remainder of my estate unto PATTIE PARSONS. In the event JAMES W. PARSONS fails to survive by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate unto PATTIE PARSONS. In the event PATTIE PARSONS fails to survive by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate unto my dear friends, THOMAS SEKULA and CI'NTHIA SEKULA, or the survivor thereof. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my son, JAMES W. PARSONS as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of JAMES W. PARSONS, I nominate, constitute and appoint MICHAEL DEVLIN as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of MICHAEL DEVLIN, I nominate, constitute and appoint WILLIAM A. DUNCAN as Executor of this my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he 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 Executor, in his 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. NINTH.. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two typewritten pages this .; fir' ~' ~~~ day of ::_~.~ ~ti - , 2006. f FRANCES R. PARSONS Signed, sealed, published and declared by the above named Testatrix FRANCES R. PARSONS as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYL VANL4 COUNTY OF CUMBERLAND . SS. I, FRANCES R. PARSONS, Testatrix 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. FRANCES R. PARSONS Sworn or affirmed to and acknowledged before me, by FRANCES R. PARSONS this <:~ t-( day t~L1TlARIAL SEAL of ~t i 1 , 206. Katfi~y l.. ~~ummPrt, ('dotary Public 1 IF=~ro.agh of Carlisle, Cumberland Co., PA `~,,', a.~ ,~~ `~`. ~,~~il J ~~~'L'~1Ut`~?C~ idly Co~~;r~;'s~~laR~ E~Pires Aug. 11, 2~g7 Notary,. P~bI c y~ COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, ~C~rW;,_~\ _ ; ~1t~.C~t~,,.~ and '~`L~ t ~ i C!,VYI ~ ~~~~~ Ili .Cl ti\ 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 FRANCES R. PARSONS sign and execute the instrument as her Last Will; that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and _subscribed before me by ,111 ~ 4~c.~~;~1~> and 1„4U ; ~ { ~~~ `~ ~~;1LCC~t~ ,witnesses, this ~~i day of ~~;; ~. ( , 2006. ,, ~`i a ~~ ~ ~.' ~ Notary Pub' is IVO'! AERIAL ; EA`~~ ~tatS~y L. t~tifiurn~:art, "4o~tasy Public ~ ~~~-° ,+c~h of Garllsle, Cumberland Co., PA i 6~9gr G©r~mis~lun Ex~ltes Aug. 11, 2007