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Home My WebLink About10-03-12~. e ~ 1505610101 REV-15l?0 Ex ~o~_~o, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania T County Code Year File Number Bureau of Individual axes INHERITANCE TAX RETURN PO BOX 280601 2 ~ ~ Z ~ ~ ? Harrisburg, PA 1'7128-0601. RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY pate of Birth MMDDYYYY 174-05-3179 07/19/2012 03/22/1918 Decedent's Last Name Suffix Decedent's First Name MI HARTZELL DALE O (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} C/7 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 Cred+t {date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number THOMAS E. FLOWER (717) 243-5513 First line of address FLOWER LAW, LLC Second line of address 10 W. HIGH ST City or Post Office State ZIP Code CARLISLE PA 17013 REGISTER {~F°~WILLS USE ONt~f ~ ~ r •.. c~ r~y ~ ~~ ~~ ,v" 1 ~ 7 ~-~ t c~a DA'f~ ~FtLED " I''.., ~i Corresponden#'s a-mail address: TOm Flower-law.com '~"~- t' i'C r - -1 l ~? ..~ - , ,-.. -~_ ..t w -.~N_t ~, e~: ~r~ ."~9 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true correct and complete. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG T F N SP ING RETURN DATE~D~~~®~ ADDRESS ~ - ~ ~ ~ DALE O. HARTZELL, I , 44 KINGS GAP RD., CARLISLE, PA 17015 SI ATUR F PREP THAN REPRESENTATIVE DATE 10/01/12 ADDRE55 FLOWER LAW, LLC, 10 W. HIGH ST., CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY 150561101 Side 1 15~56101~1 J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: DALE O. HARTZELL 174-05-3179 RECAPITULATION 1. Real Estate (Schedule A) ......................................... .... 1. 154,000.00 2. Stocks and Bonds (Schedule B) ................................... .... 2. 614,669.96 3. Closely Held Corporation; Partnership or Sole-Proprietorship {Schedule C} . .... 3. 0.00 4. Mort a es and Notes Receivable Schedule D 9 9 ( ) ....................... 4. .... 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property {Schedule E)... .... 5. 128,813.51 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Proba#e Property (Schedule G} C? Separate Billing Requested.... .... 7. 0.00 8. Total Gross Assets {total Lines 1 through 7) ......................... .... 8. 897,483.47 9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. ' 40,759.55 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... .... 10. 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. 40,759.55 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 856,723.92 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J} .................... .... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. 856,723.92 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate x .0 45 856,723.92 16, 38,552.58 17. Amount of Line 14 taxable at sibling rate X .12 17. 1$. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ........................... ..............................19. 38,552.58 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 150567,0105 1505610105 r REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME DALE O. HARTZELL STREET ADDRESS 128 PARKER STREET CITY CARLISLE Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 36,625.00 B. Discount 1,927.57 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 2Q to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number ~ I .. ' ~ D ~~ STATE ZIP PA 17013 (1) 38,552.58 Total Credits (A + B) (2) 38,552.57 (3) 0.00 ~4) 0.00 f5) 0.00 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 : ............................................ ^ 0 c. retain a reversionary interest; or .......................................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 0 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)]. Far 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 far 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 Juiy 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-15G? EX+ (11.-U8j pennsylvania SCHEDULE A DEPARTMENT OF REVENUE - - - REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DALE O. HARTZELL 21-12-0834 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a wiling buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real oronerty that is iointly-owned with right of survivorship must be disclosed on Schedule F, If more space is needed, insert additional sheets of the same size. TaxDB Result Details Page 1 of 1 Detailed Results for Parcel 04-21-0322-072. in the 2010 Tax Assessment Database DistrictNo 04 Parcel ID 04-21-0322-072. MapSuffix HouseNo 128 Direction Street PARKER STREET Ownerl HARTZELL, DALE O C/O PropType R PropDesc LivArea 1216 CurLandVal 50000 CurImpVal 104000 CurTotVal 154000 CurPrefVal Acreage .06 CIGrnStat TaxEx 1 SaleAmt SaleMo SaleDa SaleCe SaleYr DeedBkPage 0014G-00054 YearBlt 1924 HF File Date 02/ 14/2005 HF_Approval_Status A http://taxdb.ccpa.net/details.asp?id=04-21-0322-072.&dbselect=l 7/30/2012 REV-i5o3 EX+ (~-ii) ~` Pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER DALE O. HARTZELL 21-12-0834 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' CUNA Brokerage account no. 57C-017589 303,295.75 2 763.147 shares AllianceBernstein Growth and Income Fund-A @ 3.79 2,892.33 3 Ameriprise Investment Acct. No. 20 1455 3751 9 002 - 455.834 shares Columbia Bal Fd CIA 12,220.30 4 1,005 shares ConocoPhillips @ 56.255 56,536.28 5 103 shares Windstream Corp @ 99.3 1,022.79 g 900 shares Norfolk Southern Corporation @ 74.385 66,946.50 7 3,200 shares Cabot Corporation @ 39.42 126,144.00 g 897 shares Cabot Microelectronics Corporation @ 29.435 26,403.20 g 221 shares M&T Bank Corporation @ 86.615 19,141.92 TOTAL (Also enter on Line 2, Recapitulation) I $ 614,603.07 If more space is needed, insert additional sheets of the same size D 0 o~ O ~ 'v d I~ m ~ N tir ~~ O~ O~ ~D ow nW ~o ~Ao~ ~_~ ~~_ z ~ N n N -D+ 3 o ~ z o~ ~a S ~ o7a ~ o'o r ~ S r ~ n ~ o 3 ova zT ~ f ~ ~ N o T z 'r o'o D ~? ~ o n z ~ a ~ t~i~ (1 ~n Cp m O C ~ N O ~ ~ v n ~; d ~, o '~ V ~i ff v a m .n c~--+• N. w 0 V O W 00 Y7 a H 0 ~^ w 0 V O W In N N tD ~ yW W ~ i, A ~ V ~~+I 0 0 ', 0 0 n 0 c ~~ g CD n. 5' m .a m K R C O ~ n ZC J ~ y'~~ O n '+ 31 - `d C~ o ~ 00 od _ = v,y'p ~, W m ~ = r ~ ~ ~+ `~ y ~~ ~ ~ . 1 o n ' = . ~ O ~ C r: - w r ~ 1'J O _ a W ~_ O O o N 0 o N N >C r 0 N ro d N O O O O 0 0 w N W o C i" ° ' w rn - , wo~~eo po ~I l0 O l.Jt Ul O V1 O N 0 0 0 0 ~ N OD i N N V :~ - Q1 i O1 O OD W Q~ OD W ~ Vl Q1 N U1 tV O 0o O O W O O'1 N O W ~T ~~,. ~ ef;~p S rD ~ d d :7. ~~ ~ ~ ~ a~s~ C ..~ ~ ~ a- _. a.~~Oq ~ ~ a a° a p v ° '~ a ~ o ~ p a c C ~ ° --~ `^ ~ d ~ rt o ~ ~ rp d G ~ '° n d n ea 1~+NQ ~$~ g ~ ~ m ~ ~~~ ~ N ~ ~~ ~ ~ ~ Cr ~~~ ~e X• C/1 o ~ ~. ~ ~ ~ y S ~ i 0 ~ ~ Z a T '11 m D T r r1 C a n 3 f D ~ O ' ~' ~ a~ ~ ~ 8. `~ C N 3 O A N .~ O ~ n i r O O ~ N ~ t ~, ~ C ~ w o v, o ~ C T ~ ~ C ~ ~ ~ v~ o ~ C ~ ~ ~ ~ ~n C ~ ~ 0 ~ ~ ; ~ m ~H ~ rnD :gz O ~ per ~ ~ rD~~ W 3 C. ~ o~ o- C C C ~ ~ ~ 0 . ~ O ~ ~ ~ rt .T.~- ~ D ~G ~ ~' ~ ~ln v ~ '~ 0 p.N a o ~ aN O ~ o ~ 3 ~ ~ ~ ~ ' ~ o - - . - v+ ~' ~ ~e fie _ o o o a ~ o ~ o v ~p ~ 0 r r r O N N N O O ~_ ~~ Z O n ~ w m O O a w ~j O = rt rt~ ~ ~ ~ ~ i S ? ~ S H ~ 1?7 S O 0 Z p O ~ ~ ~ ~i~~i 3 -a ~ ~ -~ z o ~ ~ ~ ~ ~ _v v v o ~ ~ saQa ~ ~ g g < ~ v a a -., -,. ~' ~~~ • r • ~ H 3 O C 0~= ~_,°' ~ = c e~ ' d = a v a: , N ~ 2 ~ D n ~ a ~ a ~ ~ ~' n C C ~ C ~ C ~ ""~ ~ ~ O . . 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N d (1N 4 ~ M a+'r 000 ~~ ow noo `°o O~ rv~ ~Ao~ ~ D O o0 c~ ~ zo n o, D m ~ 3 O ~ z ~ ~ o, n ~ d T ~ m ov d o0 F s n o ~ ~, c m Z ~' ~ f m o T T '~ Z ~ ~ 3 D ~ ~ o n z ~ ~ n m O ~ V1 V N -D ~ a n d a o''~ stein San Mtonia, 7X78278-6003 02 041998 16455B215 A**3DGT II"III~I~'~I~'~I~~'III~II'I'~II'tl~'~'~~'I"~~'~l"1~~11~11111~~ DALE 0 HARTZELL 128 PARKER ST CARLISLE PA 17013-2820 A.LLI.A.NCE~ERNSTEIN Investments Page 1 of 5 Account Statement Period Apri101, 2012 -June 30, 2012 ALLIANCEBERNSTEIN INVESTMENTS Dealer11000 1345 AVENUE OF THE AMERICAS Branch No :000 NEW YORK NY 10105-3100 Adl-isor No. 000001 Advisor Name: PLEASE PROVIDE NS Introducing Context, our new blog on investing! Context provides you with quick and easy access to timely insights on today's investment issues. Take a look! You can access Context at blog.alliancebernstein.com. You can also follow Context on AllianceBernstein's Twitter channel.(@AllianceBernstn) as well as the AllianceBernstein Facebook page. Ount Fund Name FundfAccount Number Shares NAV Value Beginning Portfolio Balance $2, 961.01 nmary ALLIANCEBERNSTEIN GROWTH AND INCA ~a/s9o0o35s~,3 763.147 53.750 Sz,861.so Ending Portfolio Balance $2,861.80 = Wings Interestl Tax-Exempt Short-Term Long-Term _ Year -_ Fund Name Dividends Dividends Cap Gain Cap Gain To Date nmary = ALLIANCEBERNSTEIN GROWTH AND INCA 50.00 50.00 50.00 50.00 50.00 _ Total Earnings $0.00 #0.00 $0.00 30.00 #0.00 tual Fund ALLIANCEBERNSTEIN GROWTH AND INCA Fund Symbol: CABDX FUND/ACCOUNT NUMBER 94/6900035853 ~~~ty Confirm Trade. Dollar Amount Share .Shares This _ Total Date Date Transaction of Transaction Price Transaction Shares 06-30 06-30 NO TRANSACTIONS THIS PERIOD 50.00 53.75 0.000 763.147 Your Payment Option Dividends Cap. Gains CASH REINVEST Your Cost Basis Method ACST =AVERAGE COST t R 041998/0000001 ,_~ d c~ ~ ii o ~. rn A v- c~ o ~' o ~ o ,.:.,; o ~ 0 J (J ~ n 8 ~' ~ ~ 0 ~ ~ 0 o ~ J r} N N ~ O ? N ~ cu n c~ 0 c .-. ~_ u> ~L ~ `Q ~ rn O ~ CD ' _~ 00 ~ N o N ~ ~ ~ r~ cp r-~ z (7 ~ ~ O n ~ ~ 0 c a cD c-~ 5. ro c~ N ~~ i c ~` ~ (~ n A~ .p N 0 O ~ ~ ~ ~ W ~ ~ a ~ ^~ ~ ~ o` n ~ CD d ~ n ~ r v ~= 0~.1 = o as O o ~ ~ C G ~ < ~ < _ cn ~ <~ ~ ~ ~, ~ D N LJ O ~ p ~ 0 O °-~ ~ O ~ ~ 'i'I a ~ ~ :-f cfl ~ C7 ~ -~ ~ o - O r+ n ~ o ~ ~ ~ rl ~ C ~ C O n ~7 ~o c~ ~ cp _ ~ b- ~ ~ ~ O N p t~- ~ ~ O N ~ N ~ ~ ~ W N W O ~ 0 O rn ~ N N ~P ~ ~ O ~ N N ,~" 'v ~ N cD ~ ~ ~ IV co O o IV co C4 o W c0 ~..~ O O w ~ rn ~-' b~- N O O iA N 0 ~ O W ~ ---' W O O O rn ~ O O N p0 a (~D oD~ Q'4 0 ~ ~ o ~ RO C `° Q'° ~ ~ _O ~ rn ~ ~ n. m ~ D o ~ ~ r ~ O ~ - v f ~ ~ ~ ~' ~" ~ O N c n rn U? O ..h ~ O . ~ ~ ° O N O '. O ` ~ G ~' ~ tA ~7 L~ ~ ~ Q F~ N ~ `~ .~ ~ ~ N t~ ~ ~ ~ o C (n ~ ~ ~ , N O ~ 64 ~ < ~ Y ~ o Q ~ O c~ii r~ m N y '~ ~ N ~ o (D ~~ W O 11 Cfl O W '~ ' a C O 0 0~ O rn o~ ~ ~ ~ N G ~ ~ ~~ v Q S` ~ ~ ,~ C7 ~ G 0 3 ~ -. - ~ ~ G --~ IV ~ ~ Z .~ ~ c ~ ~ N ~ ~ ~ O ~ O ,~ (p O ~ H4 N (n ~ O' rh =~ ~ Q O N c~ .A '9 cD ~ ro ~ O G ~~ W O O ~ fV ~. ~ ,~.. ~ ~ O Cfl O Ct~ O CO pp G. (D N ~ N ® O ~ ~' Fes-' ~ .: -: __ ,.. , -.I ~ ~ O Ul w n W ~ ~ ~ cn :~ " 0 ~ ~ 0 ~ ~ ~ ~- ~, ~ p I-' N ( Jl ~ O N Ti v ( O Hi O Q O O O O O ~ 0 0 0 0 0 0 0 0 ~ ------------ --- - p c~ O .o O ~~a=y O -°n c ~ _' o~-S.m~ c .a ~? ° O .pro -NIT. ~ o CAD:: ~ "~Wm~` ~O O c o' a :n ~ ~ N c co -, oo ~ ~ -~ Fn ~ o ; cn ; ;. ~ o <~roh~.~ -~, ~ ~ ~ z o ~ ~ n~ m ~ ,o ~ O 0 ~ O~ o o cn ~ ~. .~ ~ N ~ ` ~. a ~ O ,o O cn ~ D ~ O o ~ w :: N ~ ~ -~_ ~ -~ ~~ O ~ N ~ ~ ~ cn ~ o '~ ~~ ~ ~ ~ - ! Z ~ ~ N c N V1 ~ rn ~~ ~ (D i~ r~ N ~ ~ m ~ N ~ N ~ ,o N :: N ~ ~ ~ O ~~ fn C N (~ _ ~ c~ ~ ' ~ ~ n ~ ~. ~ -, N - G LU -F n ,. r CD CD d THE CHECK t :PRESENTS A DIVIDEND PAYMENT . ~ `,i ConocoPhillips To inquire about your account, contact BNY Mellon Shareowner Services Toll Free Number 800-356-0066 Outside the U.S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 ~rlU t'llJ1i'~ZC'IZl L~~JUJIle[~l lrit0_yUlll' DdI1K dCGOUIIL 1nSteact or rece»>>ng criecKs Simply enroll in our self-service program by using the option below. Login ~~ Investor ServiceDirect~ ar www. bnymel lon.com/shareowner/isd Have one of your personal checks handy. You will need to refer to the bank information printed across the bottom of your check. RETAIN FOR YOUR RECORDS - SHAREHOLDER OF j TRANSACTION DESCRIPTION CONOCOPHILLIPS j DIVIDEND INVESTOR ID j CUSIP i ACCOUNT KEY ISSUElCLASS OF STOCK I RECORD DATE ;PAYABLE DATE 125413224452 ~ 001 750 20825C10 I HARTZELL-DALE000 00 ~ COMMON I 02/21/2012 I 03/01/2012 _____,. ___. _. RATE PER SHARE _ ----- CERTIFICATED SHARES . _ _ - BOOK-ENTRY SHARES _ ;GROSS AMOUNT _ ---- TAX WITHHELD !CURRENT DIVIDEND $0.6600000 ~ 0 i 1,005.0000 l $663.30 $0.00 ~ $663.30 -_ _ DIVIDEND PAID YEAR TO DATE _ _... __ ..- --- - __ ___- ~ TAX WITHHELD YEAR TO DATE TAX IDENTIFICATION NUMBER _ Please detach and re ---- - - -- our records tain this form for $663.30 ~ $0.00 ~ ON FILE . y i PLEASE DETACH BELOW CHECK NUMBER: 76341519 a X00322 III'I'llllllllll~lllllll'llllllll'1111""'lllll~l~lll~llllllll~l DALE 0 HARTZELL II EX EST DALE 0 HARTZELL 44 KINGS GAP RD CARLISLE PA 17013 ~omputershare Computershare Trust Company, N.A. PO Box 43078 Providence, RI 02940-3078 Within USA, US territories ~ Canada 800-546-5141 Outside USA, US territories i3 Canada 781-575-2765 www.computershare.com/investor WINDSTREAM CORPORATION is incorporated under the laws of the State of DE. Holder Account Number 01100369067 CompanylD WIN SSNITIN Certified Yes WINDSTREAM CORPORATION -Direct Registration (DRS) Advice Transaction(s) Date ( Transaction Description CUSIP ShareslUnits Descr ption 22 Aug 2012 Transfer 103.000000 97381W104 Common Account Information: Date: 22 Aug 2012 (Excludes transactions pending settlement) Current Current Total Dividend Direct Shared Price Value ($) CUSIP Class Reinvestment Registration Units Per Share Description Balance Balance I 0.000000 103.000000 103.000000 9.590000 987.77 97381W104 Common s IMPORTANT INFORMATION -RETAIN FOR YOUR RECORDS. This advice is your record of the share transaction in your account on the books of the Company as part of the Direct Registration System. This advice is neither a negotiable instrument nor a security, and delivery of it does not of itself confer any rights to the recipient. It should be kept with your important documents as a record of your ownership of these shares. No action on your part is required. The IRS requires that we report the cost basis of certain shares acquired after January 1, 2011. ff your shares were covered by the legislation and you have sold or transferred the shares and requested a speck cost basis calculation method, we have processed as requested. If you did not specify a cost basis calculation method, we have defaulted to the first in, first out (FIFO) method. Please visit our website or consult your tax advisor 'rf you need additional information about cost basis. Upon request, the Company will furnish to any shareholder, without charge, a full statement of the designations, rights {including rights under any Company's Rights Agreement, if any), preferences and limitations of the shares of each class and series authorized to be issued, and the authority of the Board of Directors to divide the shares into series and to determine and change rights, preferences and limitations of any class or series. Assets are not deposits of Computershare and are not insured by the Federal Deposit Insurance Corporation, the Securities Investor Protection Corporation, or any other federal or state agency. If you do not keep in contact with us or do not have any activity in your account for the time periods specified by state law, your property could become subject to state unclaimed property laws and transferred to the appropriate state. 40UDR W I N ~' nf1HfiAR lRPV ~/~~~ Please see important PRIVACY NOTICE on reverse side of statement (IOlCS0003.dse.mixA42254_37 1 1 /11003 23/0009R9 ~`,. ~ -~ .Y, . z Fl :.y C" ~~~,, f., ~ I ~~, . I ~ ~. I W Q W d ~~;~ y ~ ~ a Z , ' 'j i I i~ili ~i Ali. J ~ ~ Q~ LL Z ~ 'iJ ti ~~~ W ~ I I I t ~~~ ~ I~NII ~ W W ~ ~S ~. LL ~ 2~~~ '~ z ~ t.~Y' t U \~•~ ~ ..Z~ N N //////,~,. ~ p ~ LL ~ v ~ ~ L.l) W ~ ~' ~ i Z~.. ~ mod. Z ~~ .D o ~ I ~ ~~ Z ~ ~ i% ~ ~ w 0 w H ' w ~ - O I ~ ~~~.~ O~ Q d l '~ ~ ~I. ..,~. 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V .~J O'~fn+L.'~ Q 'ON~.~O OU~~~~ O O O O Q >,~ ~ ~,N IL >_ +• ~ ` O ,- Q O mom,,, L p O O crS ~, ~ ~ Z Q_ C ~ ~ (~ ~ O '- >, Y ~ ~.N ~ ~ ~ 0 oac ~ ° U -~' ~ o ~ ~- ~ -~ n. mom ~ o Z ~ U ~ y- ~- O O o -o ~ ~-~ ~ C~ ~ ~ ,~ CL ~ ~ ~ U p cts c ~ Z boo ~.~ ~ ~ ~ ~ a~ = w ~~~~~ CA W O p O I- .~ U co~~ ~. ~ ~ cw F' o .~ ~ c o cn O ~ o >_ _a, ~. Z Q ~ O~ O ~ >_ O V N ~ ~ ~ Q Z N._ ~ C O ~L ~ ~ ~ z .c°~~ v U Q j O p Q >,~ p O O ~ --~ G Z7 - J ~, O ~ > (n ~ ~ ~ ~ r-. ~ LL >_ m ~ ~ C ~ ~ .O .~ r O U ~~~-~ ~ 1 O O O. o U ;~ ,~ 1 ,~ CO~U ~ ~ ~m~ __ ~ ~ ~~ Z W Q U 2 lui ~~ ~n > ¢s av w x w w _w 2 U ,,,,~161111111----,, , ~~~` QpRATIpH , ~'~i ~' .•~ ~'• c,~:'~~ J 's ~ . 0 3 Q rn a Z __ ~.o ~ i ~ ~ T' _ ~ J u~. (/~ ~ ~= ,O. . ~'~i ~J~W 109dp ~ .`~ , ~~-~111 n 1 n u NI` ~, o~ zw QU p0 J fn Q ~U az wz U IL > tL w ~ U s O ~ a~ ~ ~ ~ ~ W V.,j W ~ ¢ Z a a ~W H o H V w~ a~ w °C O tLLq O ~U F- _ ~U W y Q ~ U~ LL } ~ W WZ U ~_ 2 H .I ~~' 0 ~~ `Y Q O } w O z w 0 w ~. w O F- ,.p . '~ w z w 0 z D W Q a Q O ~_ ..i LL O ~~ Y U ~ ~ c ~~.a W r "~,~,u fib'. . 2 ~ ."~,~ O ~ ~' , Q 2 c~ ~ W ~ ~. J m .~ Q ~, ~ •~ , W ~~` . '' Q ~~ Z Q 4s h Q. ~ ~ ~~ LL r .~ : \Ol ~, ~~~ ~ ~ ~ ~ U x N W °~ U • U v ro c m v .y m ~a ro ~~ ~ U M*~' ~~ ¢r z ~ C7 ~ LL 2 to Q F- a N_ Z ~ O Z Q a a ~ O V w N Q ~ ~ H ~ w w ~ ~ W z N a ~ °w ~ z W C7 Q O m M REV-iso8 EX+ (li-lo) SCHEDULE E ~ pennsylvania DEPARTMENT Of REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DALE O. HARTZELL 21-12-0834 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, Cornerstone Federal Credit Union account no. 82813, regular share account 5,899.11 2. Cornerstone Federal Credit Union account no. 82813, money market plus ccount 30,968.77 3. Cornerstone Federal Credit Union account no. 12813, regular share account 2,965.47 4. Cornerstone Federal Credit Union account no. 12813, share draft account 5,399.02 5. Cornerstone Federal Credit Union account no. 12813, share 10 certificate 25,000.00 g, Cornerstone Federal Credit Union account no. 12813, share 11 certificate 25,000.00 7. Cornerstone Federal Credit Union account no. 12813, share 12 certificate 25,000.00 g. Cornerstone Federal Credit Union account no. 12813, share 30 IRA (payable to estate) 7,581.14 g. Household furnishings, estimated value 1,000.00 TOTAL {Also enter on Line 5, Recapitulation) $ ( 128,813.51 If more space is needed, use additional sheets of paper of the same size. 193397 CO-ATM-3278 STATEMENT OF ACCOUNT r, ~ ~ NOTICE, ~ SEE LAST PAGE FOR 1MPORTANT • INFORMATION REGARDING YOUR RIGHTS TO DISPU"I'E BILLING ERRORS PO Box 1 181, 5 Eastgate Drive> Carlisle, PA 17013 NOTICC Telephone (7l 7) 249-1661 Fax (_717) 249-8208 SEE LAST PAGE FOR IMPORTANT INFORMATION IN CASE OF F,RRORS OR QUESTIONS ABOUT YOUR ELECTRONIC 193397 CO-ATM-3278 t2 'CRANSFERSIDENTIFIEDWITHLE'ITERS'EFT' DALE OWEN HARTZELL 128 PARKER ST CARLI SLE PA 17 013 - 2 8 2 0 Account Number 12813 ~~~~~~~~~ ~~~~~~ a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~) Statement Period 07/01/2012 - 07/31/2012 TKANSACTK)N TRANSACTION PRINCIPAL PAYMENTS ~ FINANCE, DATI? TRANSACTION DESCRIPTION AMOUNT ANI~( ILI sD TS CHAKGF. BALANCE SHARE Ol..REGULAR SHARE ACCOUNT 07-O1 Previous Balance 1980.83 07-01 TRANSFER IN 51.37 2032.20 CERT INT 07-O1 TR~JSFER IN 51.37 2083.57 CERT INT 07-O1 TRANSFER IN 51.37 2134.94 CERT INT 06-30e DIVIDEND .39 2135.33 > Annual Percentage Yield earned from 04/01/2012 - 06/30/2012< > on an average daily balance of $ 621.80 was .25% < 07-16 DEPOSIT 1069.77 3205.10 07-18 WITHDRAWAL -239.63 2965.47 EIS-MADISON-CR CD PMT 07-24 DEPOSIT 25.75 2991.22 07-31 New Balance 2991.22 » Year-to-Date Dividends this ac count - - - - - - - 3.13 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 04..IRA SHARE ACCOUNT - - » Deposits This Year .00 07-01 Previous Balance .00 07-31 Fair Market Value .00 "The value of your IRA is being provided to the IRS." » Year-to-Date Dividends this account - - - - - - - .00 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 07..SHARE DRAFT ACCOUNT - - 07-01 Previous Balance 383.64 06-30e DIVIDEND .34 383.98 > Annual Percentage Yield earned from 04/01/2012 - 06/30/2012; > on an average daily balance of $ 1348.43 was .100 < 07-02 DEPOSIT 89.07 EFT 473.05 AETNA INC-BENFT PYMT 07-03 DEPOSIT 1023.30 EFT 1496.35 US TREASURY 303-XXSOC SEC 07-10 WITHDRAWAL -61.64 1434.71 CenturyLink-SPEEDPAY 07-16 DEPOSIT 4000.00 5434.71 07-17 WITHDRAWAL -35.69 5399.02 PPL EU-ELEC SVC 07-20 WITHDRAWAL -320.00 5079.02 AERO ENERGY 1-DEBITS 07-20 DRAFT # 1549 0031870222 -73.79 5005.23. 07-31 New Balance 5005.23 » Year-to-Date Dividends this account .80 « Draft# Amount Draft# Amount Draft# Amount Draft# Amount 1549 73.79 *** CONTINUED NEXT PAGE *** 193397 CO-ATM-3278 STATEMENT OF ACCOUNT ~ ~ t N b A um er ccoun 12813 PO Box 1181, 5 Eastgate Drive, Carlisle, PA 17013 Statement Period Telephone (717) 249-1661 Fax (717) ?49-8208 PAGE 2 07/01/2012 - 07/31/2012 TRANSACTION TRANSACTION PRINCIPAL PAYMENTS FINANCE NEW LOANS DATE TRANSACTION DESCRIPTION AMOUNT AND CR[iDITS CHARGE BALANCE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 10..SHARE CERTIFICATE SHARE CERTIFICATE « » Rate 2.5000 Maturing on 06/01/2015 « 07- 01 Previous Balance 25000.00 07- O1 CERTIFICATE DIVIDEND 51.37 25051.37 07- O1 TRANSFER OUT -51.37 25000.00 REG SH > A Dividend of 53.08 will be posted to this account on AUG Ol < 07- 31 New Balance 25000.00 Year-to-Date Dividends this account 364.72 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 11..SHARE CERTIFICATE SHARE CERTIFICATE « » Rate 2.5000 Maturing on 04/13/2015 07- 01 Previous Balance 25000.00 07- O1 CERTIFICATE DIVIDEND 51.37 25051.37 07- 01 TRANSFER OUT -51.37 25000.00 REG SH > A Dividend of 53.08 will be posted to this account on AUG Ol < 07- 31 New Balance 25000.00 » Year-to-Date Dividends this account 364.72 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 12..SHARE CERTIFICATE » SHARE CERTIFICATE Rate 2.5000 Maturing on 06/09/2015 « 07 -O1 Previous Balance 25000.00 07 -O1 CERTIFICATE DIVIDEND 51.37 25051.37 07 -O1 TRANSFER OUT -51.37 25000.00 REG SH > A Dividend of 53.08 will be posted to this account on AUG 01 < 07 -31 New Balance 25000.00 Year-to-Date Dividends this account 364.72 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 30..TRAD. IRA CERTIFICATE » IRA CERTIFICATE » Rate 3.7000 Maturing on 04/1.8/2013 « » Deposits This Year .00 07 -O1 Previous Balance 7558.15 07 -O1 CERTIFICATE DIVIDEND 22.99 7581.14 > A Dividend of 23.82 will be posted to this account on AUG 01 < 07 -31 Fair Market Value 7581.14 "The value of your IRA is being provided to the IRS." Year-to-Date Dividends this account 161.70 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total Dividends Earned This Year $ 1098.09 Total Loan Interest Paid This Year $ .00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Low Rates For Your Grand Plans We 've lowered our Home Equity rates so now is the time to put your plans into ac tio n! If you've been wanting to make some improvements around your house, wait no lo nger. Also, if you're sitting on a high rate mortgage and have less than 15 ye ars left to pay, give us a call. We may be able to lower your rate or cut your te rm by a few months. Check out these rates: Ter m 80% loan-to-value 85% loan-to-value *** CONTINUED NEXT PAGE *** 193397 CO-ATM-3278 STATEMENT OF ACCOUNT PO Box 1181, 5 Eastgate Drive, Carlisle, PA 1701; Telephone (717) 249-1661 Fax (717) 249-8208 PAGE 3 M' Account Number 12813 Statement Period 07/01/2012 - 07/31/2012 TKANSACTION TKANSACTK)N PRINCIPAI, PAYMENTS FINANCE N[?VV LOANS CHARGE BALANCE DATE TRANSACTION DESCRiP'I'ION AMOliNT AND CRI:DI'TS ~ 1-60 mo. 3.25% APR* 3.500 61-84 mo. 3.75a 4.25% 85-120 mo. 4.00% 4.75% 121-180 mo. 5.250 6.00% *APR=annual percentage rate. Subject to Loan Policy Guidelines. Call for details 193397 CO-ATM-986 STATEMENT OF ACCOUNT ~ ~ ~ ~ NOTICE I ~ SEE LAST PAGE FOR IMPOKTANT INFORMA'T'ION REGARDING YOU1Z R[GHTS TO DISPUTE BILLING ERRORS PO Box 1181, 5 Eastgate Drive, Carlisle, PA 17013 NOTICE Telephone (717) 249-1661 Fax (717) 249-8208 sEE LAST PAGE FOR IMPOR~rANT INFORMATION IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC 19 3 3 9 7 C 0 -ATM - 9 8 6 t 1 TRANSFERS IDENTIFIED WITH LET'T'ERS 'FIT' DALE OtnTEN HARTZELL 128 PARKER ST CARLISLE PA 17 013 - 2 8 2 0 Account Number 82813 ~i~i~~~~ii~~~iii~~i~~n ~~i~i~i~~~~~~~~~~~~~~ u~i~~~~~~~i~~~~~~ Statement Period 07/01/2012 - 07/31/2012 "CRANSAC77ON TRANSACTION I'RINCII'AL. PAYMENTS ~ FINANCE DATE TRANSACTION DESCRIPTION AMOUNT AND CRFD 7 S CHARGE BALANCE SHARE Ol..REGULAR SHARE ACCOUNT 07-01 Previous Balance 5877.73 06-30e DIVIDEND 1.88 5879.61 > Annual Percentage Yield earned from 04/01/2012 - 06/30/2012< > on ari average daily balance of $ 3021.30 was .254 < 07-09 DEPOSIT 1 9.50 EFT 5899.11 PERSHING-BROKERAGE 07-31 New Balance 5899.11 Year-to-Date Dividends this account - 5.20 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SHARE 18..MONEY MARKET PLUS ACCOUNT 07-01 Previous Balance 30962.41 06-30e DIVIDEND 6.36 30968.77 > Annual Percentage Yield earned from 06/01/2012 - 06/30/2012< > on an average daily balance of $ 30962.41 was .250 < > A Dividend of 6.58 will be posted to this account on AUG 01 < 07-31 New Balance 30968.77 » Year-to-Date Dividends this account 72.69 « - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total Dividends Earned This Year - - - - - - - $ 77.89 Total Loan Interest Paid This Year $ .00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Low Rates For Your Grand Plans We've lowered our Home Equity rates so now is the time to put your plans into action! If you've been wanting to make some i mprovements around your house, wait no longer. Also, if you're sitting on a high rate mortgage and have less than 15 years left to pay, give us a call. We may be able to lower your rate or cut your term by a few months. Check out these rates: Term 80% loan-to-value 850 loan-to-value 1-60 mo. 3.25% APR* 3.50% 61-84 mo. 3.75% 4.25% 85-120 mo. 4.OOo 4.750 121-180 mo. 5.250 6.OOo *APR=annual percentage rate. Subject to Loan Policy Guidelines. Call for details RE~J-1.5II E;C+ (1ta-09j Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DALE O. HARTZELL 21-12-0834 Decedent's debts must be reported on Schedule Y. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' HOLLINGER FUNERAL HOME & CREMATORY, INC. -TRADITIONAL GRAVESIDE SERVICE 4,425.00 2. CASKET AND VAULT 3,390.00 3. DEATH CERTIFICATES 180.00 4. FLOWERS 259.00 5. OBITUARIES, SENTINEL - 88.50; PATRIOT NEWS -166.42 254.92 s. CEMETERY EQUIPMENT 425.00 ~. CLERGY HONORARIUM 125.00 B. ADMINISTRATIVE COSTS: 1. Personai Representative Commissions: Name(s) of Personai Representative(s) Street Address City _ -- - _ - _ _ State ZIP __ Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~• PUBLISH ESTATE NOTICES, SENTINEL -189.50; CUMB LAW JOURNAL - 75.00 s. SHORT CERTIFICATES 9. 2012-2012 SCHOOL DISTRICT PROPERTY TAX ~o. THE TRAVELERS, HOME & AUTO INSURANCE PREMIUM ~ ~. UTILITIES: PPL (42.41), CENTURYLINK (56.32), AERO ENERGY (320.00) 12. TAX RETURN FILING FEE 27,500.00 ZIP 365.50 274.50 36.00 1,739.90 1,351.00 418.73 15.00 ------- TOTAL (Also enter on Line 9, Recapitulation) $ 40,759.55 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) ~ Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DALE O. HARTZELL 21-12-0834 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. Patricia L. Prague, 142 Grange Street Quincy, MA 02170-2502 DAUGHTER 1/2 2. ~ Dale 0. Hartzell, II, 44 Kings Gap Road, Carlisle, PA 17015 SON 1/2 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II 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 AND TESTAMENT OF DALE O. HARTZELL a I, DALE O. HARTZELL, of the Borough of Carlisle, Cumberland County, 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 all other ~,Nills and Codicils heretofore mas~P by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, . .._- authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all the rest, residue and remainder of my estate in equal shares unto my children, Patricia Lee Hartzell and Dale O. Hartzell II, provided they survive me. THIRD In the event that my daughter, Patricia Lee Hartzell should fail to survive me, then I leave her share of my estate to her daughter, my granddaughter, Lauren. In the event that my son, Dale O. Hartzell II, should fail to survive me, then I leave his share of my estate to his wife, my daughter-in-law, Kimberl y Hartzell. FOURTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FIFTH I do hereby nominate, constitute and appoint my son, DALE O. HARTZELL II, to act as Executor of this my Last Will and Testament. Provided, however, that if he is unwilling or unable to act as Executor, I direct the duties of Executix to be performed by my daughter, Patricia Lee Hartzell. SIXTH I direct that no personal representative or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of his or her duties in any jurisdiction. IN WITNESS WHEREOF, I, DALE O. HARTZELL, have hereunto set my hand and seal to this my Last Will and Testament, consisting of two (2) typewritten pages, the first of which bears my signature in the margin for identification, this l~~' day of January, 2012. r DALE O. HARTZEL ,testator 2 Signed, sealed, published and declared by the above-named Dale O. Hartzell, Testator, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto, in the presence of said Testator and of each other. 7 l~ ~~ ~ ~-IK,~L~, ~ • ~~'L!~J ADDRESS 44 N. East Street Carlisle, PA 17013 ADDRESS 404 W. South Street Carlisle, PA 17013 COMMOINV!/EALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Dale O. Hartzell, Pamela F. Bowman and James D. Flower, Jr., the Testator and witnesses, respectively, whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of their knowledge the Testator was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. DALE O. HARTZELL, test or ~~ ~~ Pamela F. Bowman ,Witness ames D. Flower, Jr., Witness Subscribed, sworn to and acknowledged before me by Dale O. Hartzell, the Testator, and subscribed to and sworn or affirmed to before me by Pamela F. Bowman and James D. Flower, Jr., witnesses, this ~~~day of January, 2012. Notary Public COMMQhJy1/ AL'~H QF PRNNSYLVANIA NOTARIAL SEAL TM01~~ ~, ~I,QWER, Notary Public Carlisle ~or~., Cumbedand County My Commission Expires Qctober 26, 2014 3 ~~ \ ~ ~" „ l ~~ ~'` ' ' ~, ~ ~ G~~ .~ ~~, ~~ ~' ..