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HomeMy WebLinkAbout06-11-12J 1505610190 REV-1500 ~` (°'-'°' PA Department Of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po BOX zaoaol INHERITANCE TAX RETURN 2 1 1 1 1 0 2 4 Hardsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Blrth MMUDYYYY 0 9 1 5 2 0 1 1 0 9 2 9 1 9 2 2 Decedent's Last Name H O E L L E R I C H Suffix Decedent's First Name K A R L MI H (If Applicable) Enfsr Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST 8E FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI FILL IN APPROPRIATE OVALS BELOW 0 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Return (date of death poor to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decadent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposl3 Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Electidn 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number J I L L M. W I N E K A E S Q U I R E N 7 1 7 4 4~ 7 8 REGISTE SUS~JLY r,. rn -- . ~ ~!' [J First line of address 1 7 1 9 NORTH F RONT STREET ~~''' Second line of address , r S~ r City or Post Office State ZIP Code DATE FILED H A R R I S B U R G P A 1 7 1 0 2 correspondents e-mail address: jwinekaC~pkh.com Under penalties of perjury, I tledare that I have examined this relum, inducting accompanying schedules antl statements, and to the best of my knowledge and belief, it is we, coned and complete. Declaration of preperer other than the personal representative is based on all Information of which preperer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETORN ner~ Jane Salisbury", 25 Rehobeth Road ~) Shippensbur PA 17257 tF~OFY~rj~PAI+~RfOTHER T,j1AN REPRESENTATNE DATE / JiIIWiI. Wineka, 1719 N. Front Street Harrisburg PA 17102 PLEASE USE ORIGINAL FORM ONLY Side 7 ~~ L 1505610140 1505610190 J 1505610290 REV-1500 EX Decedent's Social Security Number Decedent's Name: KARL H. HOELLERICH RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2. Stocks and Bonds (Schedule B) .................................... .. 2. 1 3 7 3 1 2, 3 8 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 2 5 8 9 0 , 1 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ..... .. 7. 5 2 7 9 9 . 5 2 8. Total Gross Assets (total Lines 1 through 7) ................. ........ .. 8. 2 1 6 0 0 2 . 0 8 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 11. Total Deductions (total Lines 9 and 10) ............................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 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. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 i6. Amount of Line 14 taxable at lineal rate X .045 2 0 2 1 1 5. 5 8 1 g, 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at wllateral rate X .15 0 . 0 ~0 1g. 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1 2 9 7 1.6 3 9 1 4. 8 7 1 3 8 8 6. 5 0 2 0 2 1 1 5. 5 8 202115.58 0. 0 0 9 0 9 5. 2 0 0. 0 0 0. 0 0 9 0 9 5. 2 0 Side 2 L 1505610240 1505610240 J tEV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21 11 1024 HOELLERICH BOTTOM ROAD clrr PATE 117257 SHIPPENSBURG Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 8, 300.00 B. Discount 436.83 3. Interest 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. (1) 9,095.20 Total Credits (A + B) (2) 8, 736.83 (3) (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 358.37 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 transfened or its income : .......................... ..... ^ Q c. retain a reversionary interest or ........................................................................................... ..... ^ d. receive the promise for life of either payments, benefits or care7 .................................................. ..... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ^ X^ 3. Did decedent own an'in trust for" or a able-u on-0eath bank account or securi at his or her death' PY P ty l .... .....^ ^D 4. Did decedent own an individual retirement acceunt, annuity or other non-probate property, which contains a beneficiary designalion? ............................................................................................. ..... © ^ 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 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.Ei 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 [7:? P.S. §9116(a)(1.3)]. Asibling is defined, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX * (6-9a) SCHEDULE B COMMONWEALTH OF PENNSYLVANU+ STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER KARL H. HOELLERICH 21 11 1024 All propertyjointty-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 10 shares of MetLife, Inc. common stock @ $31.97 per share. 319:70 (See attached printout from Yahoo showing the historical date of death value of stock). 2. 100 shares of MFS Charter Income Trust common stock @ $8.85 per share. (See attached printout from Yahoo showing the historical date of death value of stock). 3. Charter One Investment Services, Acct. No. L7C068748: Blackrock Global Allocation FD - 404.223 shares @ $17.51 per share Putnam Absolute Return 100 Fund - 12,633.625 shares @ $10.21 per share fe attached 12/23/11 letter from Charter One Investment Services documenting the cedent's sole ownership of the Account and the date of death values of the ividual investments.) TOTAL (Also enter on line 2, 885.00 7.118.37 128,989.31 s 137 (If more space is needed, insed additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, 8r MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY KARL H. HOELLERICH 21 11 1024 Include the proceeds of IiGgation and the date the proceeds were received by the estate. All properly JolMly owned whh dght of survivorship must be disclosed on Schedule F. ITEM I I VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Charter One Investments, Acct. No. L7C068730. Citizens Select Prime Money Market - 429.310 shares @ $1.00 per share. (See attached 12/23/11 letter from Charter One Investment Services documenting the Decedent's sole ownership of the Money Market shares and the date of death value.) 2. ~Carlisfe Regional Medical Center -refund 3. Citizens Bank Checking Acct. No. 6230310027 4. Citizens Bank Checking Acct. No. 6232789877 5. Citizens Bank Savings Acct. No. 6254686423 (See attached 12/16/11 letter from Citizens Bank documenting the Decedent's sole ownership of the three Accounts and the date of death values.) TOTAL (Also enter on Line 5, 33.74 6,758.53 18,668.60 0.00 If more space is needed, insert additional sheets of paper of the same size REV-1510 EX+ (0a-09) ESTATE OF Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FILE NUMBER KARL H. HOELLERICH 21 11 1024 This schedule must be completed and filed if the answer to any o(quesfions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDETHE NPME OFTHETRANSFEREE,THEIR flELAT10N5HiP TO DECEDEM AND THE DgTE aF TRANSFER. ATFACHACDPY DFTHE DEED FDfl REAL ESTATE DATE OF DEATH VALUE OF ASSET °kOF DECD'S INTEREST EXCLUSION pFnPPUC1&.E7 TAXABLE VALUE 1. Charter One Investment Services, Acct. No. L7C068730: a) Invesco Van Kampen American Franchise Fund - 1,110.683 shares @ $11.72 per share: 13,017.20 100.00 13,017.20 b) Blackrock Basic Value fund - 293.888 shares @ 7,003.35 100.00 7,003.35 $23.83 per share; c) Blackrock Capital Appreciation Investment Fund - 5,265.04 1(10.00 5,265.04 248 shares @ $21.23 per share d) Advent Claymore - 223.157 shares @ $7.11 per share 1,586.65 1(10.00 1,586.65 e) Sigman Aldrich Corp. - 406.830 shares @ $63.73 25,927.28 100.00 25,927:28 per share (See attached 12123/11 letter from Charter One Investment Services documenting the Decedent's sole ownership of the Account and the date of death values of the individual investments.) 0.00 TOTAL (Also enter on Line 7, Reca more space is needed, use add'Nonal sheets of paper of the same size. REV-1511 EX+(10-U9) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER KARL H. HOELLERICH 21 11 1024 Decedent's debts must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fogelsanger-Bricker Funeral Home, Inc., Shippensburg, PA 2,638.00 2. Clyde W. Kraft Funeral Home, Inc., Columbia, PA 747.40 3. St. John's Lutheran Church, Columbia, PA -stipend for Officiant 50.00 4. Laurel HiII Memorial Gardens -fee to open grave and for military honors 1,795.00 5. Golden Stories -post funeral luncheon 675.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address CiN State ZIP Year(s) Commissbn Paid: 2, AttomeyFees: Purcell, Krug & Haller 3. Fatuity Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address CiN Relationship of Claimantlo Decedent 4. ~ Probate Fees: Register of Wills State ZIP 5. ~ Accountant Fees: H&R Block -preparation of Decedent's 2011 Tax Returns 6. ~ Tax Retum Preparer Fees: 7. Register of Wills -fee to file Will, Short Certificates; JCS/ACH fees 8. Register of Wills -fee to file Inheritance Tax Return 9. Cinda Jane Salisbury -reimbursement for 554 miles @ $.555 10. Postage 6,200.00 210.00 200.00 67.00 15.00 307.47 66.76 TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. REV-1572 EX+ (~ 2-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER KARL H. HOELLERICH 21 11 1024 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Chambersburg Hospital -medical services 71.11 2. Carlisle Regional Medical Center -medical services 55.46 3. Carlisle Regional Medical Center -medical services 68.42 4. West Shore Emergency Medical Services -ambulance services 158.49 5. First Care Pharmacy Services -prescription medications 352.95 6. Giant -food 38.85 7. Cisco Consumer -garden supplies needed to finalize sale of Decedent's home shortly 169.59 prior to death TOTAL (Also enter on Line 1 J, Recapitulation) $ If more space is needed, insert additional sheets of fhe same size. REV-1513 EX+(Ot-10) Pennsylvania I SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT KARL H. HOELLERICH L1 11 1UL4 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 [Indude ou6' ht spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. Cinda Jane Salisbury Lineal 25 Rehobeth Road 100% of residuary Shippensburg, PA 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E If more space is needed, use additional sheets of paper of the same size. IN RE: ESTATE OF KARL H. HOELLERICH, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-11-1024 TABLE OF CONTENTS 1. 2. 3. 4. 5. Last Will and Testament of Karl H. Hoellerich dated February 6, :?003. Printout from Yahoo showing historical date of death value of MetLife, Inc. stock. Printout from Yahoo showing historical date of death value of MF~S Charter Income Trust stock. Letter dated 12/23/11 from Charter One Investment Services documenting Decedent's sole ownership of Accounts and the date of death values for the individual investments. Letter dated 12/16/11 from Citizens Bank documenting Decedent's sole ownership of three Accounts and date of death values. LAST WILL AND TESTAMENT OF EARL H. HOELLERICH I, KARL H. HOELLERICH, of the Borough of Columbia, County of Lancaster and onwealth of Pennsylvania, hereby revoke al( Wills and Codicils, as well as all other of a testamentary nature heretofore made by me, and do hereby make, publish declare [his to be my Last Will and Testament. FHLST: I direct my hereinafter named Executrix pay all my expenses of last and funeral as soon after my decease as maybe convenient, including all Death and lance Taxes, State and/or Federal, and, also, including a suitable marker for my if the same has not been purchased during my lifetime. SECOND: I give, devise and bequeath my entire estate, both real and personal property, to which I may be entitled or over which I may have any disposing power at the time of my death to my Wife, JANE E. HOELLERICH. THHiD: In the event my wife should predecease me, or in the event we are killed in a common catastrophe, I give, devise and bequeath my entire estate, both real and persona] property, to my Daughter, CINDA JANE SALISBURY. FOURTH: Should my Daughter, CBQDA JANE SALISBURY, predecease me, I give, devise and bequeath my entire estate, both real and personal property, as follows: A. I give, devise and bequeath Twenty-Five (25%) percent to my Grandson, KARL NORMAN SALISBURY. B. I give, devise and bequeath Twenty-Five (25%) percent to my Granddaughter, SONYA SALISBURY. C. I give, devise and bequeath Twenty-Five (25%) percent to my Grandson, SEAN SALISBURY. D. I give, devise and bequeath Twenty-Five (2540) percent to my Son-in- Law, ARTHUR SALISBURY. FIFTH: I nominate, constitute and appoint my Wife, JANE E. HOELLERICH, to be the sole Executrix of this my Last Will and Testament. In the event that my wife shall predecease me or for some other reason is unable to serve in that capacity, then, I my Daughter, CINDA JANE SALISBURY, to be the alternate Executrix of this my Wilt and Testament. Executrices under this my Last Will and Testament shall serve Bond. IN WITNESS WHEREOF, I, KARL H. HOELLERICH, the Testator, hJave to this _~ ~ FJ~11 Last Will and Testament set my hand and seal this day of ~`~~=_ 3. (~//~ KARL . HOELLERICH Signed, Sealed, Published and Declared by the within named KARL H. as and for his Last Will and Testament in the presence of us, who at his est, have hereunto subscribed our names as witnesses ther`1eto, in]]]the prese/nce of the Testator and of each other. %~ ~ ~ /l~ /~ /.l / ~ //lam/' /~~2, ~. / ~{ n ~ „ \ ~-. ~ J orical Ptices ~ MetLife, Ina Common Stock Stock- Yahoo! ... Set Date Range Start Date: ;Sep 'i;15 2011 ; Eg. Jan 7, 2010 _. End Date Sep !15 2011 i hup://finance.yahoo. com/q/hp?a=08&b=15&c=2011 &d~ 8&e=15&... ..................................... Get Prices '. Prices Date Sep 15, 2011 'S'.Download to Spreadsheet Currency in USD. Open High Low 31.59 32.57 31.37 %7 Daily G Weekly O Monthly r: Dividends Only First ~ Previous ~ NeM ~ Last Close Volume Adj Close' 32.52 Close price adjusted for dividends and splits. 11,995,700 31.83 First ~ Previous ~ Next ~ Last Copyright ®2012 Vahoo! Inc. Pll rights reserved. Privacy Polley -Nwut Our Pds - Terms of Service - CopyrghiAP Policy- SerM Feedback - Yahc Quotes are real-time for NASDAQ, NYSE, and Amex.See also delay times for other exchanges. All information provided "as is" for informatio purposes or advice. Neither Yahoo! nor any of independent providers is liable for any informational ercors; incompleteness, or delays, or for a contained herein. By accessing the Yahoo! site, you agree not to redistribute the information found therein. Rea6Time continuous strearrdng service. You may turn streaming quotes on or off. Fundamental company data provided by Capital IO. Historical chart data and daily updates provided by Commodity Systems, Inc. (CSI). li updates, fund summary, fund performance, dividend data and Morningstar Index data provided by Morning: 2 of 2 1/3/2012 2:20 PM J J P V V 7 A D (1 ~~ O` ~ _ _ _~ N _. _. f f ° ~ ° o C n v m ~ ~ ~ 0 0 N -"' ~ I m m m ~ ~ j ~ m ~ ~ a ~ n i a w ~ m 0 N ~ m m _ ',. m ~ , '~~'~i ~ 'a ' ,~ N ~ ~ V1 VI ! ~. N N `._ O i O ~~,~.. w O v [o co (n ~ ~ m i ~ d n y I ~ O d i ~ ~ p ~ N £ I ~. N S. ~ __ n ! n ~ ~ ~ ~ ~°, Q O O ~ m m O~~ O I a ~ ~ ~~ x ~ a ~ ~ ~ N ~ ~ N < ~ ~ m O O ~ fD M _ i 'O 'O ' m < 'm < y N 2 Z N D n ~ Z (D H ~S n ~ ~ a - H m N o N I ~ ~ - ~ N ~ _ n A O ~l_: a i ~ ~ O I -:.C. N O 3 r~ __ O ~ f to .> o u ~ ~ N ~ Z'. ~D o. ~ ~ 7 ~ O ~ o N C N n D 0 D m tD O w 0 O O tl~~ \ • "'( 1 x; A ii3L -~ c O m O W N O O m C 3 d ID N n 0 N R N N m 7 a m 3 N d n a N O (p s ~ m ~ __ ~ S a ~ ^ O ~" ,. N..._, ~ p N o S m ' Os y n N y~ Charter One 71f~ Investment Services December 23, 2011 Purcell, Krug & Haller Attn Lill M Wineka 1719 North Front St Harrisburg PA 17102 RE: Accounts L7C068730 and L7C068748 RE: Kazl Hoellerich Accounts Deaz Ivls. Wineka: PO Box 42025 Providence, RI 02940 I am writing with regazd to your recent correspondence regazding the above referenced account. On behalf of our organization, please extend our condolences to Cinda Salisbury on the passing of her father. I am providing the value of Ivlr. Hoellerich's accounts, as of September 15, 2011, n the tables below. Account L7C068730: Fund/Position Symbol Number of Price per Total Shares Share INVESCO VAN KAMPEN AMERICAN VAFAX 1,110.683 $11.72 $13 017.20 FRANCHISE FUND , CLASS A BLACKROCK BASIC VALUE FUND MDBAX 293.888 $23.83 $7,003.35 CLASS A BLACKROCK CAPITAL APPRECIATION INVT MDFGX 248.000 $21.23 $5,265.04 FUND CLASS A ADVENT CLAYMORE AGC 223.157 $7.11 $1,586.65 SIGMA ALDRICH SIAL 406.830 $63.73 $25 927.28 CORP , CITIZENS SELECT PRIME MONEY CZDXX 429.310 $1.00 $429.31 MARKET CLASS D ~ Total Account Value as of September 15, 2011 1 $53,228.83 ~ Please continue to page 2 of [his letter for the Cable regazding value for account L7C068748. Securities, Insurance and Investment Advisory Services offered through CCO Investment Services Corp. Member FINRA, SIPC. 28 State Street, MS1310, Boston, MA 02109. (888) 411-8311. CCO Investment Services Corp. is an affiliate of RBS Citizens, N.A. and Citizens Bank of Pennsylvania. ~€ RBS Secun[les ano Insurance Protlucts are: • NOT FDIC INSURED • NOT BANK GUARANTEE=D • MAY LOSE VALUE • NOT A DEPOSIT • NOT INSURED BY ANY FEDERAL GOVERNMENT ~\GENCY y~ Charter-One 711 Investment Services AccountL7C068748: PO Box 42025 Providence, RI 02940 Fund/Position Symbol Number of Price per Total Shares Share BLACKROCK GLOBAL MCLOX 404.223 $17.51 $7,118.37 ALLOCATION FD CLASS C PUTNAM ABSOLUTE RETURN 100 FUND PARTX 12,633.625 $10.21 $128,989.31 CL A Total Account Value as of September 15, 2011 $136,107.68 If we can be of further assistance, please contact our department a[ 800-942-8300 Option 4, between the hours of 8:30 am and 5:00 pm, EST, Monday tluough Friday. ~~ Peter Yunger Beneficiary Account ;Services Specialist SecudOes, Insurance and Investment Advisory Services offered through CCO Investment Services Corp. Member FINRA, SIPC. 28 State Street, MS1310, Boston, MA 02109. (888) 411-831'1. CCO Investment Services Corp. is an affiliate of RBS Citizens, N.A. and Citizens Bank of Pennsylvania. ~ RBS and Insurance Products are: • NOT FDIC INSURED • NOT BANK GUARANTEED • MAY LOSE VALUE • NOT A DEPOSIT • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY ~ ~~iz~ns ~a~~~ December 16, 2011 Law Offices Purcell, Krug & Haller Attn: JIlI M. Wineka 1719 North Front Street Harrisburg PA 17102-2392 Estate of Kazl H Hoellerich Date of Death: Sep 15, 2011 SSN: 184-05-8166 Deaz Sir/Madam: One Citizens Drive ROP112 Riverside, RI 02915 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. The decedent has a Brokerage account as well. We have forwazded your request to our Investment Services Department. If you should have any questions regazding the Investment please contactl-800-942-8300. 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 Sincerely, l~~o~~~ Kristen L. Petrucci ~.~rC~! Decedent Account Processing REF#:513615 i~~z~ns ~~~~ Account Number 6230310027 Account Title KARL H HOELLERICH Date ened 6/4/2010 Account T e Checkin Princi al Balance as of DOD $6758.33 Interest from Last Postin to DOD $ .20 Account Balance as of DOD $6758.53 YT'D Interest to DOD $3.21 ~~ +~it~er~s ~~~~~ Account Number 6232789877 Account Title KARL H HOELLERICH Date O ened 8/26/2011 Account T e Checkin Princi al Balance as ofDOD $18598.88 Interest from Last Postin to DOD $69.72 Account Balance as of DOD $18668.60 Y'TD Interest to DOD $ .00 Account Number 6254686423 Account Title KARL H HOELLELtICH Date ened 6/4/2010 Account T e Savin s Princi al Balance as of DOD $ .00 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $ .00 YTD Interest to DOD $ .00 LAW OFFICES Purcell, Krug ~ Haller HOWARD B. KRUG 1719 NORTH FRONT STREET LEON P. HALLER HARRISBURG, PENNSYLVANIA 17102-2392 JOHN W. PURCELLJR. TELEPHONE (717) 234-417$ JILL M. WINEKA Fax (717) 783-4939 LISA A. RYNARD June 7, 2012 Register of Wills Cumberland County Court House One Courthouse Square Carlisle, PA 17013 Re: Estate of Karl H. Hoellerich a/k/a Karl Hoellerich No. 21-11-1024 Dear Register of Wills: HERSHEY (]1]) 533-3836 JOHN W. PU RC ELL(1924~2009) IOSEPH NIS SLEY (1910-1982) Per my Assistant's telephone call with your office, enclosed is a check payable to the Register of Wills in the amount of $15.00 as payment for the filing fee for the Inheritance Tax Return mailed to you on June 6, 2012 in the above-captioned Estate. Thank you. Sincerely, . ~~ II M. Wineka JMW/bas Enclosure N t~ C iii ccc»7 . ~, .'L ~j- :.: aD :3:, *~ <U<~~,,, ._. <';'i yam.' C _ ~o Z gs w ar b b V m ~ A Z r' ,n ~ ~ a z o v r„ '~' m N A Q ~ N m (S° ~ y N ~ `1 , A.c ,,p\~~yJ ....~ 1"y (..~. ~` t b N:: c,i ` ~ m - ~ y y y'~3<c= v ,~ m r"L c7a~•- ~o aC": ~ W ~m O N O `= ~ W C7 [~ y _-• O~ :'• W ,a ~ ~ n l ~ C ~. C y N ~, `. ~. ti ~. o .. a o ,° UNITE ~, a ~ ~~sa ~: o~i ~ v ~' A d , ;d °N 'e',1 ~ ~c`bi o z0 =1C1~' °~~~ N~ o ~~ ~ N N Q