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HomeMy WebLinkAbout08-30-12J 1505610143 REV-1500 Ex(°'-'°' ',~` PA Department of Revenue OFFICIAL USE ONLY Pennsylvania County Code Veer File Number Bureau of Individual Tazes ue•nanexro•-vexua Po Box.zaosol INHERITANCE TAX RETURN 21 12 273 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 12 07 2009 08 13 192,1 Decedent's Last Name Suffx Decedent's First Namme MI FULTON MARY P (If Applleable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS X^ 1. Original Retum ^ 2. Supplemental Return ^ 4. Limitetl Estate ^ qa, Future Interval Comppromiae (tlera or tlearh akar 12-12A2) g Decetlenl Dietl Teateta 7 Devcaadtle t Main1 ned a Living Tmst (Attach Copy of lMlp ^ (Attach HLOpy ot~rusl) ^ 9 L'f ' ^ 3, Remainder Retum (date of death prior to 12-13-92) ^ :i. Federal Estate Tax Retum Required tl. Total Number of Sate Deposit Boxes . Iigahon Proceeds Received ^ 10. ~°tweaen P$~~~~entlat{e gsjr deam ^ p1,Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDMUND G MYERS (717) 761 4540 First line of address 301 MARKET STREET Second line of address PO BOX 109 City or Post Office LEMOYNE Correspondent's a-mail address: llntler penalties, of perjury, I declare that I ADDRESS THAN State ZIP Code PA 17043 inclutling accompanying schedules and personal) representafive Is based on all EDMUND G. MYERS REGISTER O~LS USE Qi9LY ~ ~: 7 ~ ' - t. C.. { - -. ~-' ~ a C~; Gc _,. -, - _: J DBE FILED , U ~- ~ C ,-*1 l r7 1 l_J ':-~ -r .r-k DATE 301 MARKET STREET Lemoyne PA Side 1 15056'10143 1505610143 J 1505610243 REV-1500 EX oa~tlent'°"°me, FULTON, Mary P Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) .................................................................................... ... 1. 2. Stocks and Bonds (Schedule B) .......................................................................... ... 2. 13 , 518.2 5 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)....... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ..................................................... ... 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............. .. 5. 2 , 337.87 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6. 148 , 245.11 7. Inter-Vivos Transfers 8 Miscellaneous I~oq-Probate Property (Schedule G) a Separate Billing Requested........... . 7, 8. Total Gross Assets (total Lines 1-7) ................................................................... .. 8. 164 , 101.23 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................................... .. 9. 22 , 642.88 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................ .. 10. 51, 984.86 11. Total Deductions (total Lines 9 8 10) ................................................................. .. 11. 74 , 627.74 12. Net Value of Estate(LineBminusLinell) ......................................................... . 12. 89,473.49 13. Charitable and Governmental Bequests/Sac 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) ............................................. .. iq, $ 9 , 4 73 .4 9 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. i6. Amount of Line 14 taxable at lineal rate X .045 8 9 4 73 .4 9 i 16. 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 16. Amount of Line 14 taxable at collateral rate X .15 0.00 18. 19. Tax Due ................................................... .............................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 0.00 4,026.31 0.00 0.00 4,026.31 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-273 DECEDENT'S NAME FULTON, Mary P STREETADDRESS 6354 Mercury Drive CITY Mechanicsburg STAI"E PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Cheek box on Page 2 Line 20 to request a refund (1) 4,026.31 Total Credits (A + B) (2) 0.00 (3) 251.67 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,2]],9$ Make Check Pa able 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 :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ x 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 considaration? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?....... ^ ^x 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 Ci 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 defned under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-750] E%+ (B-9a) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENN6YLVANIA I NHERITANOE TA% RETURN RESIDENL DECEDENT ESTATE OF FILE NUMBER FULTON, Mary P 21-12-273 All property JdnHy-ovmsdwith dpht of aurvivonhlp must Dedi~closad on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 359604103 724 shares of General Electric Co -Com 16.125 11,874.50 2 591558108 50 shares of Metlife Inc -Com 36.135 1,808.75 Accrued dividend on Item 2 through date of death 37.00 TOTAL (Also enter on Line 2, Recapitulation) 13,518.25 (If mare space Is needed, additional pages of the same size) Copyright (c) 2002 fonn software only The Lackner Group, Inc. Form PA-1600 Schedule B (Rev. 6-98) Rev-7608 EX~ (e-eBJ COMMONN£ALTH OFPENNSYLVANIA INHERITANCE TAX gETURN RE8IDENT OECEOENT SCHEDULE E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY ESTATE OF (FILE NUMBER FULTON Mary P 27-12-273 InGutle the proceetla of IitiBelion end the tlete the proceeds were recaivetl by the valeta. All property JolnOyrownetlwiM the ripllt ofsurvivonhip moat Ds dlaclossd on sclletlule F • •~•~ ngnw .a nccuou, auulnOnal yagas Or IIle Same SRe) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule E (Rev. 6-98) R°v-0508 EX+(8-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENr DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FUL SURVIVING JOINT TENANT(S) NAME A. Mary Lynne Molnar ADDRESS 770 Poplar Church Road Camp Hill, PA 17011 B. C. JOINTLY OWNED PROPERTY: FILE NUMBER 21-12-273 on sehstlul° G. I RELATIONSHIP TO DECEDENT Daughter ITEM NUMBER LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE 01= ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 05/28/1984 M&T Bank Savings Account No. 3.918.21 50.000% 1 959 11 15004206018275 , . 2 A 09/12/2006 Real Estate located at 6354 Mercury Drive, 292,572.00 50.000% 146,286.00 Mechanicsburg, PA 17050 -Silver Creek at Hampden, Unit 38, Cumberland County, PA Assessed Value of Property in 2009 x CLR 1.28 TOTAL (Also enter on Line 6, Recapitulation) I 148,245.11 (If more space is needed, adtlitional popes of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule F (Rev. 6-98) REV-7767 EXa 170-08) COMM I T D~F~LVgNIA SCHEDULE H FUNERAL EXPENSES & i.DMINISTRATIVE COST; ESTATE OF FILE NUMBER _ FULTON, Mary P 21-12-273 Debts of decedent must be reported on Schedule I. ITEM _N UM&ER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 11,570.00 Street Address City State Zio _ Yearlsl Commission paid 2. Anornev's Fees JOHNSON DUFFIE 7,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Mary L. MOlnar Street Address 770 Poplar Church Road City Camp Hill state PA Zio 17011 Relationship of Claimant to Decedent Daughter 4. Probate Fees 124.50 5. Accountant's Fees 6. Tax Return Preparers Fees 7. Other Administrative Costs 448.38 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 22,642.68 Copyright (c) 2009 forth 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 _ FULTON Mary P 21-12-273 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exoenses 1 Malpeui Funeral Home 11,570.00 H-A 11,570.00 Other Administrativ -costs 2 Reserves: Additional Miscellaneous Administrative Costs 250.00 3 The Cumberland Law Journal -Notice of Estate Administration 75.00 4 The Patriot News Co. -Notice of Estate Administration 123.38 IH-87 448.38 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rsvd512 FJl+172-0a) SCHEDULE 1 DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA MORTGAGE LIABILITIES, & LIENS INHERITANCE TAX RETORN RE6IDENT pEDEDENT ESTATE OF FILE NUMBER FULTON, Mary P 21-12-273 Report dsbb Incumtl by Me tlecsdent prior to death that remained unpaid at Me date o/ tlsath, Includlnp unreimbuned medical expenau. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1/2 of First Mortgage Loan # 0059078808 on Real Estate located at 6354 Mercury Drive, 38.355.90 Mechanicsburg, PA 17050 2 Arrow Financial Services, LLC -1/2 of Mortgage Debt on Real Estate 1,018.83 3 Check clearing after date of death 1,087.85 4 Discover Bank vs. Mary Fulton -Judgment against Decedent on Credit Card Balance 11,087.56 5 MrYrT Bank Relationship with Checking -Service Charge 10.00 6 M&T Bank Relationship with Checking -Service Charge 10.00 7 OmniCare 7844 8 Silver Creek at Hampden Township vs. Mary Fulton -Judgment against Decedent 212.89 9 Southwest Credit - Verizon 133.59 TOTAL (Also enter on Line 10, Re<:apitulation) I 51,984.86 (If more space is needed, adtlitional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Forth PA-1500 Schedule I(Rev. 12-OS) REV-7673 EX• IH-asl ~ SCHEDULE J comr~~o~~n"~A BENEFICIARIES ESTATE OF FILE NUMBER FULTON, Ma P 21-12-273 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHF~RE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I• TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 RobeR K Fulton Son 1/2 of Residue 2800 One Commerce Square Philadelphia, PA 19103-7098 2 Mary L Molnar Daughter 1/2 of Residue 770 Poplar Church Road Camp Hill, PA 17011 Total Enter dollar amounts for distributions shown above on lines 1 5 throw 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 TOTA L OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHFFT Copyright (c) 2009 form software only The Lackner Group, Inc. Forth PA-1500 Schedule J (Rev. 11-08) ESTATE OFMARYP. FULTONar7r/a MARYPATRICIA FULTON SCHEDULE OF EXHIBIT EXHIBIT A EXHIBIT B EXHIBIT C EXHIBIT D :51/040 Last Will and Testament for Mary P. Fulton signed and dated January 14, 1998. Estate Val Valuation for General Electric Sto<;k. Estate Val Valuation for Metlife Stock. M&T Bank Date of Death Valuation of Accounts. ~~t~~ ; t1I tt~td ~e,~~~nt~~tt OF MARY P. FULTON I, MARY P. FULTON, of the Borough of Mechanicsburg., Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I direct that all my legal debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. II. I bequeath all of my silver, including, but not limited to, twelve (12) place settings, sterling tea service and tray to my daughter, MARY L. MOLNAR. III. I bequeath my Wedgewood China to my son, ROBERT K. FULTOPJ. IV. I bequeath my diamond dinner ring to my granddaughter, KERRY E3. FULTON. V. I bequeath my engagement ring and diamond wedding band to my daughter, MARY L. MOLNAR. ~ti~b~~- A 099999-00007/January 8 1998 /JRD/BMR/100633 VI. I bequeath my household goods, automobiles and other tangible personalty of a like nature (not including cash or securities), except those items of tangible personalty specifically bequeathed, together with any insurance thereon, to my children, ROBERT K. FULTON and MARY L. MOLNAR, to be divided between them by the Executor with due regard for their personal preferences, in as nearly equal shares as practical. VII. I devise and bequeath the"residua of my estate of every nature and wherever situate, in equal shares, to my children, ROBERT L. FULTON and MARY L. MOLNAR. VIII. Should any issue entitled to a share of my estate not attained the +Bge of twenty-five (25) at the time of distribution to him or her, I devise and bequeath his or her share to DAUPHIN DEPOSIT BANK AND TRUST COMPANY, IN SEPARATE TRUST, to hold, manage, invest and reinvest the shares so received and accumulation of income thereon, to use and apply the income and principal, or so much thereof, at Trustee's discretion, as may be necr:ssary or appropriate for such issue's support and education (including trade school and college education, both graduate and undergraduate) without regard for his or her parent's ability to provide for such support or education, or to make payments for these purposes, without further responsibility, to such issue or such issue's parent or to any person taking care of such issue. Any principal or income not so applied shall be distributed to such issue absolutely when he or she attains the age of iwenty-fire (25) years. If he or she dies before attaining the age of twenty-five (2;i) years, the Trust shall terminate and such share shall be distributed to his or her personal representative. IX. The interest to the beneficiaries herein shall not be subject to anl:icipation or voluntary or involuntary alienation. 099999-00007/January 8, 1998/JRD/BMR/100633 X. I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed shall be paid from my residuary estate as part of the expense of the administration of my estate. XI. I appoint my son, ROBERT K. FULTON, Executor of this, my Last Will. Should my son, ROBERT K. FULTON, fail to qualify or cease to act as Executor, I appoint my daughter, MARY L. MOLNAR, Executrix of this, my Last Will. XII. I direct that my Executor, Trustee, and their successors, shall not tie required to post bond for faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ) ~{' - day of ~~~+ , 1998. ~~~/2h~G(SEAL) MAY . FULTON Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have hereunto subscribed our names as witness. 099999-0Op07/January 8, 1998/JRD/BMR/100633 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA :ss: COUNTY OF CUMBERLAND I, MARY P. FULTON, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. MAR P. FULTON ~- S~w~~ggm or affirmed to and acknowledged before me, by MARY P. FULTON, the Testatrix, this /~/~day of 1998. Notary blic My commission expires: NOTARIAL SEAL NINA JUNE DAVIS, Notary Public Lemoyne Boro. Cumberland County M Commission Ex fires Oct. 31 1998 Member PennsylvaniaAssoclation of Notaries 4 099999-00007/January 8, 1998/JRD/8MR/100633 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA :ss: COUNTY OF CUMBERLAND We, ~£2,e y 7~ ,hli.~~ and Ci ~ l(E/~t= 2 the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix: sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it 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 at least 18 years of age, of sound mind and under no constraint or undue influence. n Sworn or affirmed to and subscribed to before me by~~,e and ~"~~r--e ~ ~_~~~Pr' witnesses, this /5l~day of C~vt 4 ~~, 1ggg. c~,~~=tea (SEAL) Notary Pub My commission expire:>: NOTARIAL SEAL NINA JUNE DAVIS, Notary Public Lemoyne Boro. Cumberland County M Co mission Fx i es Oct. 31 1998 Memher PenneylvanleAewcletlon of Notsrlse 5 Estate Valuation Date of Death: 12/07/2009 Valuation Date: 12/07/2009 Estat e of: FULTDN, Mary P. estate Processing Date: 09/20/2012 Account: 10862-1 Report Type: Date of Death Number of Securities: 2 File ID: Fulton Shares Security or Pax Description High/Ask Low/Bid Mean and/or Adjustments Div and Int Security A l ccrua s Value l) ~) _- COM New York Stock Exchange 12/07/2009 16.29000 16.01000 N/L 16.125000 11,674.50 2) 50 METLI FE INC (591568108) COM New York Stock Exchange 12/07/2009 36.79000 35.98000 H/L Div: 0.74 Ex: 11/05/2009 Rec: 11/09/2009 Pay: 12/14/2009 36.135000 1,806.75 37.00 Total Value: Total Accrual: Total: 513,518.25 $13,981.25 537.00 //!!)1 1~1~yy11 w ~~JAT a Page 1 This report was produced with EstateVal, a product of Estate Valuations 6 Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.1) Estate Valuation Date of Death: 12/07/2009 Estate of: FULTON, Mar P. estate Valuation Date: 12/07/2009 y Processing Date: 09/20/2012 Account: 10862-1 Report Type: Date of Death Number of Securities: 2 File ID: EVlton Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 724 GENERAL ELECTRIC CO 1369609103) COM New York Stock Exchange 12/07/2009 16.29000 16.01000 H/L 16,125000 21 ..i~~TlsZPID.PNkt~.:('9925fi$},pp~. COM New York Stock Exchange 12/07/2009 36.79000 35.48000 H/L Div: 0.74 Ex: 11/05/2009 Rec: 11/09/2009 Pay: 12/19/2009 36.135000 Total Value: Total Accrual: Total: $13,518.25 11,679.50 1,806.75 37.00 $13,481.25 $37.00 ~~J,b-i bi.~ ~- Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, :[nc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (RevSsion 7.1.1) p n~s~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Law Offices Johnson Duffie 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Re: Estate of Mary P Fulton Social Security: 078-12-3812 Date of Death: December 7 2009 Phone 888-502-4349 Fax (302) 934-2955 Apri14, 2012 Dear Sir or Madam: Per your inquiry on March 27, 2012, please be advised that at the time of death, the: above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names ofl Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account Number Ownership (Names of) Opening Date Balance on Date of Death Accrued Interest Total Checking Account 34630988 Mary Patricia Fulton Mary L Molnar (POA) 08282007 $1,287.85 $ .02 -- _.-_. .._.$1,287.87- -___ ... -- - __.. _ - Savings Account 15004206018275 Mary Patricia Fulton Mary 4Molnar 0528/1984 $3,918.17 $ .04 $3, 918.21 ~ ~`~