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HomeMy WebLinkAbout05-23-12J 1505610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.2sosoi INHERITANCE TAX RETURN 21 12 0271 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 27 2012 06 30 1910 Decedent's Last Name FASICK Suffix Decedent's First Name FLORENCE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ^ 2. Supplemental Return ^ 4. Limited Estate ^ 4a_ Future Interest Compromise (date of death after 12-12-82) g Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit fdate of death between 12-31 51 and T-1-95) MI M MI ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tar: Return Required _ 8. Total Number of S+~fe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone (Number JAMES D BOGAR (717) 737 8761 ~a First line of address ONE WEST MAIN STREET Second line of address City or Post Office State ZIP Code SHIREMANSTOWN PA 17011 Correspondent's a-mail address: jbOgar@bOgarlaW.COm REGISTER OF~JCt~ USE Oft1f'Y - - r ,, •, ~; _ - rr~-; --, r - ~ .~ ~: f CJ - ~- :_, ~ ~. -. - C. - ~,,I - ~ . .,. is i . DATL~FIL.ED ~ n~^ n'~ ,` _~ ,r~~~, ,, :. , -.`1 ,~ unaer penalties or penury, I tleclare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corre t and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATU F ERSON SP IBLE FOR FILING RETURN DATE James D. Bogar 5 (,;2.t (LZ,,, One W SIGNATURE REPRESENTATIVE PA 1 James D. Bogar DATE ..l Z t I I.L One West Main Street, Slfiremanstown, PA 17011 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX °eceae~rSName: Fasick, Florence M. Decedent's Social :Security Number RECAPITULATION 1. Real Estate (Schedule A) ..................................................................................... .. 1. 2. Stocks and Bonds (Schedule B) .......................................................................... ... 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)....... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ...................................................... .. 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. .. 5. 74 9 , 002.05 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6. 7. Inter-Vivos Transfers & Miscellaneous N,oq Probate Property (Schedule G) u Separate Billing Requested........... . 7, 8. Total Gross Assets (total Lines 1-7) ................................................................... .. g. 749 , 002.05 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. E50 , 971.28 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 11. Total Deductions (total Lines 9 & 10) ................................................................. .. 11. 60 , 971.28 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. 688 , 030.77 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. . 13. 331 , 515.3 9 14. Net Value Subject to Taz (Line 12 minus Line 13) .............................................. . 14. 3 ~i 6 , 515.38 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 Q , 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 35 6 , 515.3 8 18. 19. Tax Due ................................................. ................................................................ . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 0.00 0.00 !53 , 477 .31 53,477.31 Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0271 DECEDENT'S NAME Fasick, Florence M. STREET ADDRESS -- Maplewood Assisted Living 5225 Wilson Lane, Suite 333 CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 2,673.87 (1) Total Credits (A + B) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 53,477.31 2,673.87 (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) rJ~,$03.44 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 :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death occurred after December 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? .................................................................................................................. L x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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 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)]. A sibling 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+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Fasick, Florence M. 21-12-0271 All property ~omtly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Cash 100.00 2 Metro Bank -Certificate of Deposit No. 7700174718. Principal balance at date of death 91,081.36 $90,986.63; accrued interest $94.73 3 PNC Bank -Certificate of Deposit No. 31600214329. Principal balance as of date of death 109,792.74 $109,587.34; accrued interest $205.40 4 PNC Bank -Checking Account No. 5140159833. Principal balance at date of death 35,789.23 $35,789.02; accrued interest $0.21 5 PNC Bank -Savings Account No. 5112502294. Principal balance at date of death $28,112.80; 28,114.30 accrued interest $1.50 6 PNC Investments -Account No. 005-637645. 434,592.16 7 Sovereign Bank -Certificate of Deposit No. 2335548638. Principal balance at date of death 39,214.26 $39,131.33; accrued interest $82.93 8 Personal Property -Property transferred in kind to Peter Montgomery -per appraisal 275.00 9 Personal Property -sold at auction 9,422.00 10 Erie Insurance -Premium Refund 7 00 11 U.S. Treasury - 2011 Personal Income Tax Refund 614.00 TOTAL (Also enter on Line 5, Recapitulation) I~~ 749,002.05 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) METRO BANK March 9, 2012 James D Bogar 1 W Main St Shuiremanstown PA 17011 3801 Paxton Street Harrisburg, PA 17111 RE: Estate of: Florence M. Fasick Tax Identification Number: 190-26-6600 Date of Death: February 27, 2012 888.937.0004 mymetrobank.com To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Time Deposit Account Number: 7700174718 Date Opened: 8/1/10 Date Closed:3/6/12 Primary Owner: Florence M. Fasick Principal Balance: $90986.63 Accrued Interest: $94.73 Date of Death Balance: $91081.36 Please feel free to contact me at (717) 412-6122 if I may be of further assistance. Sincerely, ~. Diana Reynolds Metro Bank Support Associate/Deposit Services I n /. ~~ ~ ~ I' •. A n ~ ~Jlxr. ~~ ~ ~~ ~ ;:'~;~ r~'~~ cl~i'V'K ~~ V~ 1~'l13~G7Hi_ I~~Y March 13, 2012 James D Bogar Esq. One West IVlain St 5hiremanstow-n,1'A 17011 RE: Florence M Fasick SSN: 190-26-6600 DOD; 02-27-2012 Dear Mr. Bogar: Zn xesponse to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Certificate of Deposit Account # 31600214329 Established: 07-13-2001 FLORENCE M FASICK DOD balance: $ 109;587.34 + 205.40 accrued interest Interest paid O 1-01-ZOl Z thru OZ-27-2012 $ 904.72 YTD Checking Account Account # 5140159833 Established: 07-01-1977 FLORENCE M FASICK DpD balance: $ 35,7$9.02 + 0.21 accrued interest Interest paid 01-01-2012 thuru OZ-27-20]2 $ 0.60 YTD Ravings Account Account # 5112502294 Established: 10-2i5-2009 FLORENCE M FASICK DOD balance: $ 28,112.80 + 1.50 accrued interest Interest paid 01-01-2012 thru 02-27-2012 ~ 8.41 YTD Investment Account The decedent maintained Investment Account # 5637645. For further ir~foz~matian, you may call the Brokerage Department at 1-S 00-762-6111. Page 1 o.f 2 i I i Please note ~;at this office provides date of death bala~ees for deposit aecauats (>;RAs, CDs, Checking and Savings). We do snot process any financial transactions yr provide statements. If you need assistance with any of these items, please call 1-8$8-PNC-BANK (1-588-762-2265) or stop 6y your local PNC Bank branch i office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intended for the use of the individual ar entity to which it is addressed and may contain information that is privileged confidential and exemptfram disclosure under applicable law. If the reader of this message is not the intended recipient or the employee ar agent re,~ponsible for ~, delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution ar copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by ~tedephane at 500-762-1775 and immediately destroy this faxed document. i Page 2 of 2 PNC INVESTMENTS Member F~INRA and SIPC April 5, 2012 James D. Bogar Attorney At Law One West Main Street Shiremanstown, PA 17011 RE: Account 005-637645/ Florence Fasick (individual) Dear Attorney Bogar: The value of the above-referenced account on February 27, 2012 is as follows: . ~-~ ~ ~ ~ '~~01,'1 DOD, 3: " A~m'otirit ~' ___ : -Des~c~`iptlon ~ r ?~Cuslp : ~ P,rl~e ' ~ bO~D,1/ali5e " _ ~ 2,503.180iFederated Prime Mgmt Obligations Fund SS IQPSSQ 15,412.186 ~ Lord Abbett Core Fixed Income Class A LCRAX _ 24,066.287jLord Abbett Intermediate Tax Free Fund Class A LISAX Grand Total (Market Value + Accrued Inte Sincerely, '~C• PNC Investments, LLC. Estate Resolution Desk $ 1_00_ I _$ :?,503.18 $11.14+$171,691.75 - --- ------ - $10.82 $ 260,397.23 $ 434,592.16 $ 434,592.16 The summaries, prices, quotes and/or statistics contained herein have been obtained from sources believed to be reliable but are not necessarily complete and cannot be guaranteed. They are provided for informational purposes only. Past performance does not guarantee future results. PNC Investments LLC Member of The PNC Financial Services Group 4242 Carlisle Pike Camp Hill Pennsylvania 17011 www.pnc.com ~ ~a t,osev~~~c , >~ ~ Importantlnvestorlnformation:Securities and brokerage services are provided by PNC Investments LLC, m?mber FINRA and SIPC. ~_yu[3ank GoaarneeJ Annuities and other Insurance products are offered by PNC Insurance Services LLC, a licensed insurance agene~. Sovereign Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. O. Box 841005 -Boston., MA 02284 March 12, 2012 James D. Bogar Attorney at Law 1 West Main St. Shiremanstown, PA 17011 RE: Estate of Florence M. Fasick Date of Death: 02/27/2012 Dear James D. Bogar: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yo , Donna Penta Lead specialist 617-514-5189 Sovereign Bank ESTATE OF Florence M Fasick SOCIAL SECURITY #: 190-26-6600 DATE OF DEATH: February 27, 2012 Account #: 2335129819 Type In the name of: Florence M Fasick CD Open date: 8/10/1995 Date of Death Balance: Closed Prior Int.(YTD) from to _ Accrued interest to date of death: Other Info: Closed 6/14/10 $38,757.54 N/.A N/A Account #: 2335548638 Type: CD Open date 6/21/2010 In the name of: Florence M Fasick (Peter C Montgomery POA ) Date of Death Balance: $39,131.33 Int.(YTD) from 1/1/2011 to 1/31/2012 $9L62 Accrued interest to date of death: $82.93 Other Info: Closed 3/6/12 Account #: 1271148633 Type: Checking Open date: _6/21/2010 In the name of: Florence M Fasick (Peter C Montgomery POA ) Date of Death Balance Closed Prior Int.(YTD) from to N/A Accrued interest to date of death: N/A Other Info: Closed 9/21/11 Page 1 of 1 LINDEN HALL ANTIQUES 211 N. OLD STONE HOUSE ROAD CARLISLE, PA 17015 717-249-1978 To: James D. Bogar, Esquire 1 West Main Street Shiremanstown, PA 17011 From: William G. Rowe, Appraiser 211 N. Old Stone House Road Carlisle, PA 17015 Re: Personal Property Appraisal Estate of Florence M. Fasick Date of Death -February 27, 2012 Date: March 8, 2012 Items removed from estate: Piano $100.00 Desk -painted $85.00, Television $90.0p~ TOTAL $275.00 C ~, w .s~...,~-=,1~- William G. Rowe Fasick Appraisal 1 03/08/2012 R ~ (RH 79L) O~VE S AUCTION SERVICE 2505 Ritner Highway Carlisle, PA 17015 Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L) Auction Is Action Call "R,owe" For Satisfaction SELLERS NAME ~-M ~ ~_. ~=- tom- : ~;.°~~,~,x~...~ 1~~ ~. Y .~ ; , :::._. _ DATE ~ ~ ..~ >. ~ ~~ , _-.. ~ ~ ~~.. RT, ;~,,~~ ,~.~.~~. -PHONE ~ _~ E _ , a:-. ADDRESS ~r°r _~r~ .-ter. ~;~. ~.> ~~.~.~i;~~#z_... ?` ,,.., r OTHER s ;~..^ ~; , ., ,'._, f~ , . ,~ -_ ... .-._. .~ `^~ ,~;t ~ r^-~= ~:~.~k1'.f ~±,: AUCTIONEER % .'`"`=, AUCTION DATE/LOCATION ~ ~` _ CLERK % DESCRIPTION OF MERCHANDISE ,~ 4!F'` 1„.x,~r ~*... 5... •-x ~"~ ! W..d JCe. F } "`.."` 3w^„{~ ~...~+Y.~.t:.r.,.s- .3,,•,~. ~.. ;$..~~.. ~-h ;; \... fi x ,_.s-' '' .~. ~ ~ ~'i h -~ ~ " ..~» y , ~,~ a_ ' rt ._ -. .. ,. -_- c. 4 a ="`.a ~ i. l_ ('C.,~ :~..a '} .,.. ~ ctae,,,w- ate ~~.4- ~., ~ t,., *:: s.Je'~,r~ t.,~ sx~., a , 5 s;.~'±.,~ 3. , i °^t;t~ .. t ,` ..,.~..+ c~ :.k c_.- ~ ~} to ~ ~ ~ ~ d 5 "" ft 1 A "'~ ~ .tr C C -:.~ x ~ n ~ 4 4 x.,r _..si. ~ a.w, 4 ; °~ ~4,7 ~.}....'r '~,'. -Y~ LE f:;: iL.-`irA ~++ °~ ~ 1..~ ~ Z.w^ ' n ~• 2~. t .V. +,..^.. c'Y ~...~. ~. I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agreetito hold harmless the Auctioneers against any claims of the nature referred to in this agreement. ~ } `. AUCTION SIGNATURE ~ SELLERSt IGNATURE Total Sales (Clerking Tickets Attached} $ -~~~ '~"~, Less Sale Expense: -t ~r % Commission Auctioneer $ ~ ~l-~`~. -l `-~ -_ % Commission Clerks $ _ _ OTHER: TJ~-s t~ p ~ ~,p_.~ ~5,~ ~ ~ "-- TOTAi. SALE EXPENSE DEDUCTED $ 3 ~ ~ ~ ~ ~ __.~ 30 SELLERS NET $ ~ ~ S~ ~ .... 1, - ' :' :_~ 'r i:.'.: ~ ) 1.... . .! ... _, . .~.... ...1 F. .. :: r r 1 i - ,.: 11 ~ ~ ' :-.'~ 1.1x'.-.' 1~1 .: i;:: i1t _ ~A ' _ t' :,. •1r . _. y ~ 1- ~_' .. i r n. 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'u'.dd<?I a,_ -- ~ -- -- - -- -i.. ~?"3ff Ti1-3-. t CSFS :,.°t :_~:.} « FiG /• - -- - -- -- ~ - -- _...--- -------- --- ---- .. p ... ._ ~ u . .. ~.._ ~ ~ ti s=t CI _7 I_f. ~-.`r ~: 1C1 C^' 7 ~'~; 5 n '~ y ~ ~'~~ . ~ ~d hd c-' t 1:~ i_i e 7; a _; ~ 7. 7. ~~ r~ .. l:~ y 7. ~ :4 . ,:s ~d '. REV-1151 EX+t10-O6) i COM INHERITANCE TAX RETURNANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Fasick, Florence M. 21-12-0271 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N MB R A. FUNERAL EXPENSES: See continuation schedule(s) attached ~ 293.20 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission paid 2. Attorney's Fees Bogar 8~ Hipp Law Offices 44,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 593.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15,584.58 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 60,971.28 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Fasick, Florence M. 21-12-0271 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Neill Funeral Home -balance of funeral bill 293.20 H-A 293.20 2 Other Administrative Costs Bethany Village -final bill 5,778.50 3 Cumberland Law Journal -Executor's Notice 75.00 4 H&R Block -tax preparation fee 162.00 5 Journal Publications -Executor's Notice 150.00 6 Mutual of America -reclamation of final annuity payment 136.52 7 Office of Personnel Management -Reclamation of final annuity payment 955.58 8 Omnicare 81.58 9 PA Department of Revenue - 2011 Personal Income Tax Due 362.70 10 RESERVES: -Costs to conclude administration of Estate, including preparation and filing of 4,500.00 final 2012 Personal Income Tax Returns, Federal and State Fiduciary Income Tax Returns, and First and Final Account and Statement of Proposed Distribution 11 Rowe's Auction Service -auctioneer's commission and trash removal fee 3,362.70 12 Sovereign Bank -fee for date of death valuation 20.00 H-B7 15,584.58 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (11-OS) SCHEDULE J COM INOHERITANCEOT~ RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF Fasick, Florence M. FILE NUMBER 21-12-0271 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(Sl RECEIVING PROPERTY (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 See attached schedule Total Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Bethesda Mission 33,151.54 2 Elizabethtown College ss,3o3.os 3 Nursing Foundation of Pennsylvania 232,oso.77 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 331,515 39 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Florence M. Fasick 02/27/2012 190-26-6600 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Virginia Bone Friend 126 Clearview Drive Camp Hill, PA 17011 2 Marianna Davis Sister-in-Law 8717 Valleyfield Road Lutherville Timonium, MD 21093 3 Marcia M. Montgomery Friend 6 Redwood Court Camp Hill, PA 17011 4 Peter Montgomery Friend 660 Bamberger Road Etters, PA 17319 1 $5,000.00 specific bequest $10,000.00 specific bequest $10,000.00 specific bequest One-half of rest, residue and remainder 1 f ~• y ' LAST WILL AND TESTAMENT OF FLORENCE. M. FASICK I , FLORENCE M . FASICK, of Mechanicsburg, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by m:e . FIRST: I give and bequeath the sum of five thousand dollars ($5, 000.00) to my friend, VIRGINIA. BONE, of 126 Clearview Drive, Camp Hill, Pennsylvania 17011, provided that should she predecease me, I direct that this specific bequest be made to my sister-in-law, MARIANA DAVIS, of 8717 Valleyf field Road, Luthervi l le, Maryland 21093. SECOND: I give and bequeath the sum of ten thousand dollars ($10,000.00) to my sister-in-law, MARIANA DAVIS, of 8717 Valleyfield Road, Lutherville, Maryland 21093, provided that should she predecease me, I direct that this specific bequest be made to her son, THOMAS DAVIS, of 2300 Dulaney Valley Road, Timonium, Maryland 21093. THIRD: I give and bequeath the sum of ten thousand dollars ($10, 000.00) to my friend, MARCIA M. MONTGOMERY, of 6 Redwood Court, Camp Hi 11 , Pennsylvani a 17 011, providedL that should she predecease me, I direct. that this specific bequest be made to her 2 son, PETER MONTGOMERY, of 660 Bamberger Road, Etters, Pennsylvania 17319. FOURTH: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, as fo1_lows (A) Five percent ( 5 % ) thereof to BETHESDA MISSION, of 611 Reilly Street, Harrisburg, Dauphin County, Pennsylvania 17102, to be used for. general purposes as the governing body of said organization deems appropriate. (B ) Ten percent (10 % ) thereof to ELIZABETHTOWN COLLEGE, of One Alpha Drive, Elizabethtown, Pennsylvania. 17022, to be used for general purposes 3 as the governing body of said organization deems appropriate. (C ) Thirty-five ( 3 5 % ) percent thereof to the NURSING FOUNDATION OF PENNSYLVANIA, of 2578 Interstate Drive, Suite 101, Harrisburg, Pennsylvania 17110, for the purpose of establishing The Florence (Madden) Grady-Fasick Scholarship Fund to be administered in accordance with the provisions of a Deed of Gift to be established with the NURSING FOUNDATION OF PENNSYLVANIA and, in the absence of a Deed of Gift , to be used for general purposes as the governing body of said organization deems appropriate. (D ) Fifty ( 5 0 % ) percent thereof to my friend, PETER MONTGOMERY, of 660 Bamberger Road, Etters, Pennsylvania 4 17319, provided that should he predecease me, then to his issue per stirpes by representation. FIFTH: Should any of the children of PETER MONTGOMERY (hereinafter referred to as "children" ) not have attained the age of twenty- f our ( 2 4 ) years at the t ime f or di s - tribution to him or her, I give, devise and bequeath the share of each such child to my hereinafter named Trustee or Trustees, IN SEPARATE TRUSTS, t:o hold, manage, invest and reinvest the shares so received, and to use and apply f rom t ime to t ime such port i.on of income and principal for the said child's education (including college, trade school or other similar training or education), as my Trustee or 5 Trustees, in their sole discretion, deem advisable. The Trustee or Trustees, in exercising their dis- cretionary authority with respect to the payment of income or principal. of the within Trust to the children, shall take into consideration any incomE~ or other resources available to the children from sources outside this Trust. Any income or principal not so appli ed shall be distributed to each child when he or she attains the a.ge of twenty-four (24) years. In the event any of the children die prior to the termination of this Trust established herein for their benefit, the interest of said child in said Trust shall cease with any income and principal being 6 divided evenly between or among the remaining children of PETER MONTGOMERY or the separate Trusts established hereunder for their benefit . SIXTH: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to al_1 property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for trans f e r of the property and to receive the proceeds of any disposition of i t . (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, improvement, zoning or management of real estate and to impose or extinguish restrictions on real_ estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common. trust funds and mortgage investment funds, without restriction to 8 investments authorized for Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of diversification, risk or productivity . (E) To exercise any option,, right or privilege granted in insurance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gif t and estate or inherit:ance tax laws. (G) To make distributions t:o my herein named beneficiaries in cash or in kind or partly in each. (H) To borrow money f rom themselves or others in order to pay debts, taxes, or estate or trust 9 administration expenses, to protect or improve any property held under my wi 11, and f or investment purposes ,. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to t:he extent the plan or the law permits them to do so, and to exercise any other rights which they may have under t:he plan, in whatever manner they consider advisable. SEVENTH: I nominate and appoint LAURA A . MONTGOMERY, wi f e of PETER MONTGOMERY, as Trustee of the hereinabove described trusts. In the event of the death, resignation or inability to serve for any reason what- 10 soever of the said LAURA A. MONTGOMERY, I nominate and appoint GRANT DIANDONATO, brother of LAURA A. MONTGOMERY, as Trustee of the hereinabove described trusts. I direct that my Trustee shall serve without bond and shall receive fair and reasonable compensation. EIGHTH: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will , shall be paid out of the pri.nci - pal of my residuary estate. Notwithstanding, I specifically direct that there be no allocation of inheritance, estate, transfer, 11 succession and death taxes, of anj,r kind, whatsoever, to any charitable beneficiary designated by me herein. NINTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distributable, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. TENTH: I nominate and appoint JAMES D. BOGAR, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of 12 JAMES D. BOGAR, I nominate and appoint JENNIFER B. HIPP and PETER MONTGOMERY, Co-Executors of this, my Last Will and Testament. I direct that my Executor or Co-Executors, Trustee or Trustees, as the case may be, and their successors, shall not be required to post security or a bond for the .performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~jf~t day o f ~,~-~ 2 0 l l. f - l~ ~.' . V `~ ( SEAL ) FLORENCE M. FASICK 13 Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attest_ Address Addre s s 14