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Home My WebLink About12-21-12 (2)1 1505610143 J REV-1500 Ex`°2-"''~' PA De artment of Revenue OFFICIAL USE ONLY p Pennsylvania County Code veer File Number Bureau of Individual Taxes ~°""'"°"r°""a"a""r Po Box.zaosol INHERITANCE TAX RETURN 21 12 0852 Harrisburg, PA 17128-0601 RESIDENT DEGEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 30 2012 02 06 1918 Decedent's Last Name Suffix Decedent's First Nama MI KOGAN PEARL M (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 Retum ~ 2. Supplemental Return 4. Limitetl Estate ~ qa. FUWre Interest Campromiae (date of death after 2-12A2) ® a Decedent Dietl Teatate A h C f Wil ~ ~ Decedent Mainreinetla Living Trust (Attach opY Of ruaq ( ttac opy o p 8. Litigation Proceeds Received ~ 10. yg~"uBOai Pgw~rt~~ ~dit~De~esW Death AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Daytime Telephone Number 717 234 4161 CORRESPONDENT • THIS SECTION MUST BE COMPLETED. ALL Name ARNOLD B KOGAN First Line of Address 4250 CRUMS MILL ROAD Second Line oTAddress PO SOX 6991 City or POs[ Office HARRISBURG e-mail address: State ZIP Code PA 17112 3. Remainder Return (Date of Death Prior to 12-13-e2) 5. Federal Estate Tax Return Required Q B. Total Number of Sale Deposit Boxes 11.Election to tax untler Sec. 8113(A) (Attach Schedule 0) ~l8§ER OF V~!lL~LS l~ ~ILY m=~ ~ D r N -s PTt Iri r- y rn r-• - Yt - ra ,~ ,~, ^ n . ~ r., ... ,^ c~ ..~..f :.: ~ f;D C- F-' - ~ DATE FAD .. Lri ~` !: i/ a ~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules antl statements, and to the best of my knowledge and belief it is true, correct and complete. DeUaraaon of preparer other than the personal representative Is based on all information of which preparer has any knowledge. ~a 669 Fishing Creek Road, New Cumberland, PA 17070 SIGNATURE OF RRF~PAR~R Of MER THAN RETATIVE DATE l' Jy1t/nV-\•VX~I~ /111 ~T]V r~N~ Arnold B Kogan 1 Z - ADDRESS / ~+ 4250 Cruma Mill Road, Harrisburg, PA Side 1 L 1505610143 1505610143 J _I 1505610243 REV-1500 EX Decedent's Social Security Number o«adarn~.Nama~ Kogan, Pearl M RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 17 , 931.82 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 21 , 259.58 7. Inter-Vivos Transfers & Miscellaneous h(oq Probate Property (Schedule G) a Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1 through 7) ........................................................ 8. 39 , 191.40 9. Funeral Expenses and Administrative Costs (Schedule H) .................................... 9. 2 , 515.02 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ 10. 3 , 968.33 11. Total Deduetlons (total lines 9 and 10) ................................................................ 11. 6 , 483.35 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 32 , 708 . OS 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. 32 , 708 . O5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 O . OO (a)(1.2) X .00 . 16. Amount of Line l4 taxable 32 , 708.05 1s. 1, 471.86 at lineal rate X .045 17. Amount of Line 14 taxable 0 00 17 0.00 . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 OO 18 0 • OO • at collateral rate X .15 . 19. TAX DUE ................................................................................................................ 19. 1,471.86 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAY MENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21-12-0852 DECEDENT'S NAME Kogan, Pearl M STREET ADDRESS 442 Walnut Bottom Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 79) 2. Credits/Payments A. Prior Payments B. Discount 1,300.00 68.42 (7) Total Credits (A + B) (2) 3. Interest q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2, Llne 20 to request a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (4) (5) 1,471.88 1,388.42 103.44 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 :.................................. ^ c. retain a reversionary interest; or ............................................................................................................... LrYJ~ x d. receive the promise for life of either payments, benefits or care? ............................................................ 2. If death occurred after Dec. 12, 7982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^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 decadent own an individual retirement account, annuity, or other non-probate property which contains a beneficiary designatlon? .................................................................................................................. ^ ^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. §9176 (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. §9176 (a) (1.7) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fling a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. 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~160a E%+(1110) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OFRENNSYLVANIA INXERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Kogan. Pearl M 21-12-0852 Inclutle the proceetls of litipalion antl the tlale the procaetls were received by the estate. All property jolntlyawnetl with the right or aurvivorehip moat ba dlacloaetl on achedula F. (If more space is needed, adtlitional pages of the same size) Copyright (c) 2070 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 11-70) Rsv-1608 E%i (01-10) COMMONWFALTHOF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Pearl M NUMBER Man wat waa made joint within one year of the decedent's date of death, It must Ds roportstl on achstlule G. SURVIVING JOINT TENANT(S) NAME A. Kay 1. Rittenhouse B. C. JOINTLY OWNED PROPERTY: ADDRESS RELATIONSHIP TO DECEDENT 668 Fishing Creek Road New Cumberland, PA 17070 Daughter ITEM NUMBER FOR JOIN TENANT MADE JOINT DESCRIPTION OF PROPERTY INUMBER OR EMILAR DENTIFYI NSG INUMeERAATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALOE OF ASSE % OF DECD'S INTEREST DATE OF DEATH DECEDENT'S INTEREST 1 08/26/2002 PSECU Account No. 8448484647-CD52 -Joint 23,000.00 50.000% 11,500.00 certificate of deposit of Decedent and Kay I. Rittenhouse. 2 08/29/2002 PSECU Account No. 8448484647-CD53 -Joint 14,939.10 50.000% 7,469.55 certificate of deposit of Decedent and Kay I. Rittenhouse. 3 06/19/2001 PSECU AccountNo.8448484647-S1-Joint 537.69 50.000% 268.85 account of Decedent and Kay I. Rittenhouse. 4 06/19/2001 PSECU Account No. 8448484647.54 -Joint 4,042.36 50.000% 2,021.18 account of Decedent and Kay I. Rittenhouse. TOTAL (Also enter on Line 6, Recapitulation) I 21,259.58 (If more space is needed, atlditional pages of the same size) Copyright (c) 2010 form sottware only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. Ot-10) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kogan, Pearl M 21-12-0852 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Gingrich Memorials -Grave Marker 165.00 2 Parthemore Funerel Home -Funeral Home Expense. 347.42 H-A 512.42 3 Other Administrative Costs Carlisle Sentinel -Estate publication 221.40 4 Cumberland County Register of Wills -Fee to file Inheritance tax return. 15.00 5 Deluxe Checks -Estate Account checks 27.70 B Goldberg Katzman, P.C. -reimbursement for Estate Notice publication fees previously paid 75.00 to Cumberland County Law Journal by firm. 7 Kay I. Rittenhouse -Reimbursement of notary fee Incurred in order for successful Probate of 10.00 WIII. H-B7 349.10 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1300 Schedule H (Rev. 6-98) REV-1191 EX~110-09) COMt~~4i~CF~S ANIA SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kogan Pearl M 21-12-0852 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT All Ir,ARGR A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 512.42 Street Address City State Zio Year(s) Commission Paid 2. Attorney's Fees Goldberg Katzman, P.C. 1,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 153.50 5. Acwuntant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 349.10 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 2,515.02 Copyright (c) 2009 torm software only The Lackner Group, lnc. Form PA•1500 Schedule H (Rev. 10-09) Rav1a12 EX~ )12-0e) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMONWEALTH OF PENN6YLVANIA INHERITANCE TA%RETNRN RESIDENT DECEDENL ESTATE OF FILE NUMBER Kogan Pearl M 21-12-0852 Report debb Incumd by the tlecetlsnt prior to death that remained unpaltl at tha date M death, including unrelmburesd medical eapenaes. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Genesis Rehabilitation Services -physical therapy bill for services related to Decedent's 230.97 therapy for broken collar bone. 2 Heritage Medical Group, LLP 10.00 3 Kay I. Rittenhouse -Reimbursement of Decedent's debt owed to AT&T credit card, paid by 18.21 Rittenhouse. 4 Millennium Pharmacy -Balance due for Decedent's medication 10.35 5 Thomwald Home -Balance due to nursing home where decedent resided. 3,698.80 TOTAL (Also enter on Line 10, Recapitulation) ' 3,968.33 (If more space is needed, additional pages of the same size) Copyright (c) 2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) GN_1S1\ FYa /111A11\ SCHEDULE J COM M'iis<idS"o~~LE~i~^"~" BENEFICIARIES ESTATE OF FILE NUMBER Ko an, Pearl M 21-12-0852 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSONIS) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distnbubons, and transfers under Sec. 9116 a 1.2 1 Kay 1. Rittenhouse Daughter One-Ninth 1,992.43 589 Fishing Creek Road New Cumberland, PA 17070 2 Donald C Spangler Son One-Ninth 1,992.43 1800 Lambs Gap Road Mechanicsburg, PA 17050 3 Jay C Spangler Son One-Ninth 1,992.43 195 Evergreen Road New Cumberland, PA 17070 4 Kenneth G Spangler Son One-Ninth 1,992.43 The Woods at Cedar Run 824 Lisburn Road, Room 235 Camp Hill, PA 17011 5 Arnold B Kogan Stepchild One-Ninth 1,992.42 1224 Green Street Harrisburg, PA 17102 See continuation schedule attached Continuation 7,969.68 Total 17,931.82 Enter dollar amounts for distributions shown above on lines 15 throw h 16 on Rev 15 00 rover sheet as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright (c) 2010 form software only The Lackner Group, Inc. Forth PA-1500 Schedule J (Rev. 01-10) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Pearl M Kogan 07/30/2012 204-03-5893 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) o tamona F Kogan Stepchild One•Ninth 1,992.42 9305 Mainsail Drive Burke, VA 22015 7 Deborah Sue Young Stepchild One-Ninth 1,992.42 43A Flannaghan Drive Framingham, MA 01701 8 Brenda C. Poller Stepchild One•Ninth 1,992.42 138 Joewood Trail Bridgewood Lakes Davenport, FL 33837 9 Wanda Geesaman Granddaughter One-Twenty seventh 664.14 880 E. Possum Road Springfield, OH 45502 10 Carol Sue Fearnbaugh Granddaughter One-Twenty seventh 664.14 34 Hetrick Lane Elllottsburg, PA 17024 11 Dena Dupert Granddaughter One-Twenty seventh 664.14 6295 Haydon Court Mechanicsburg, PA 17050 Total 7.9ss.s8 1 C~ ~~ ~~~ QE I, PEARL M. KOGAN, now of the City of Harrisburg, Dauphin County, Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null and void all prior Wills and Codicils made by me at any time heretofore. ITEM I. I direct that all my legally valid debts, funeral and administrative expenses, and debts incurred or payable because of my death, shall be paid by my Executor, hereinafter named, from my residuary estate as soon after my death as practicable. All death taxes, including federal, state, and other death taxes, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of administration of my estate, without apportionment or right of reimbursement. Taxes on future interests may be prepaid. ITEM II. I give and bequeath certain items of tangible personal property that aze solely owned by me at the time of my death and that are identified in any sepazate writing directing distribution thereof after my death which is dated and is signed by me at the end thereof, to those persons designated in such separate writing who survive me. If any item of tangible personal property is identified in more than one sepazate writing, I direct that, unless stated to the contrary, the separate writing bearing the last date shall govern the disposition of such item. ITEM III. I bequeath my household and personal effects, jewelry, automobiles, and other tangible personalty of like nature, not effectively disposed of above, outright to my husband, MARTIN N. KOGAN (my "Husband"), if he survives me. If my Husband does not so survive me, then I make such bequest of tangible personal property as follows: A. One-half (%Z) thereof in equal shazes to my children who survive me by thirty (30) days; Provided, however, that if such a child of mine does not so survive me, then his or her shaze shall lapse. Presently, my living children include: KAY RITTENHOUSE, now of Etters, Pennsylvania; CAROL A. FEARNBAUGH, now of Harrisburg, Pennsylvania; KENNETH G. SPANGLER, now of New Cumberland, Pennsylvania; DONALD C. SPANGLER, now of Mechanicsburg, Pennsylvania; and JAY SPANGLER, now of New Cumberland, Pennsylvania. 2 B. One-half (''/z) thereof in equal shares to the children of my Husband who survive me by thirty (30) days; Provided, however, that if such a child of my Husband does not so survive me, then his or her shaze shall lapse. Presently, the living children of my Husband include: BRENDA KOGAN POLLER, now of Centerville, Massachusetts; ARNOLD B. KOGAN, now of Harrisburg, Pennsylvania; EDMOND F. KOGAN, now of Burke, Virginia; and DEBORAH SUE YOUNG, now of Framingham, Massachusetts. ITEM N. I give, devise and bequeath all of the residue of my estate, whether real, personal, or mixed, and wherever situate, outright to my Husband, MARTIN N. KOGAN, if he survives me. If my Husband does not so survive me, then I make such bequest of the residue of my estate, as follows: A. One-half ('/:) thereof in equal shares to my children who survive me by thirty (30) days; Provided, however, that if such a child of mine should not so survive me, but should leave descendants who so survive me, such descendants shall receive, per stirpes, the share that such child of mine would have received had he or she so survived me. Presently, my living children include: KAY RITTENHOUSE, now of Etters, Pennsylvania; CAROL A. FEARNBAUGH, now 3 of Ickesburg, Pennsylvania; KENNETH G. SPANGLER, now of New Cumberland, Pennsylvania; DONALD C. SPANGLER, now of Mechanicsburg, Pennsylvania, and JAY SPANGLER, now of New Cumberland, Pennsylvania. B. One-half (%:) thereof in equal shares to the children of my Husband who survive me by thirty (30) days; Provided, however, that if such a child of my Husband should not so survive me, but should leave descendants who so survive me, such descendants shall receive, per stirpes, the share that such child of my Husband would have received had he or she so survived me. Presently, the living children of my Husband include: BRENDA KOGAN POLLER, now of Centerville, Massachusetts; ARNOLD B. KOGAN, now of Harrisburg, Pennsylvania; EDMOND F. KOGAN, now of Burke, Virginia; and DEBORAH SUE YOUNG, now of Framingham, Massachusetts. ITEM V. The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM VI. I hereby appoint my Husband, MARTIN N. KOGAN, to serve as the executor (the "Executor") of this; my Last Will and Testament. In the event of his inability or unwillingness to so serve, then I nominate and appoint my son, DONALD C. SPANGLER, now 4 of Mechanicsburg, Pennsylvania, and my daughter, KAY RITTENHOUSE, now of Etters, Pennsylvania, acting together, to serve as such Executor. In the-event of the refusal or inability of either one of such named successors to so serve, then I appoint my son, KENNETH G. SPANGLER, now of New Cumberland, Pennsylvania, to serve together with the remaining successor as such Executor. If all of such named persons aze unable or unwilling to so serve, I then grant to the person last so nominated and capable of serving the right and power, exercisable in his or her exclusive discretion to nominate and appoint, whether in advance while competent, or at the time of a renunciation or resignation, a person or persons to serve as such Executor, which nomination shall be honored as if I had made such an appointment in this Will. ITEM VII. I direct that my Executor shall not be required to give bond or post any other security for the faithful performance of duties in any jurisdiction. ITEM VIII. Except as otherwise set forth herein, I appoint the surviving parent of any beneficiary who has not attained the age of twenty-one (21) years of age when his or her interest is distributable to him or her, as Custodian for that beneficiary under the Uniform Transfers (or Gifts) to Minors Act, as in effect from time to time in the state where such beneficiary resides. If there is no such surviving pazent to serve as such Custodian, then the Custodian shall be that person so appointed by my Executor. 5 ITEM IX. Any person who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. ITEM X. My Executor shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal of income, exercisable without Court approval, and effective until distribution of all property: A. To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate so to do. B. To vary investments, when deemed desirable by my Executor, and to invest in such bonds, common trust funds controlled by my Executor, stocks, notes, real estate mortgages, or other securities or in such other property, real or personal, as my Executor deem wise, without being restricted to so-called legal investments. C. In order to effect a division of the principal of my Estate or for any other purpose, including any final distribution, my Executor is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. 6 If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. D. To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or interests therein owned by my Estate severally or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge, and deliver any and all deeds, assignments, options, or other writings which may be necessary or desirable, in carrying out any of the powers conferred upon my Executor in this paragraph or elsewhere in my Will. E. To mortgage real estate, and to make leases of real estate for any period of time as is deemed reasonable by them. 7 F. To borrow money from any party to pay indebtedness of mine, or of my Estate, expenses of administration, or inheritance, legacy, estate or other taxes. G. To pay all costs, taxes, expenses, and chazges in commection with the administration of my Estate. My Executor shall pay expenses of my last illness and funeral expenses. H. To vote any shazes of stock which form a part of my Estate, and to otherwise exercise all the powers incident to the ownership of such stock. I. In the discretion of my Executor, to unite with other owners of similaz property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of eight (8) typewritten pages, this ~ day of June, 1997. _a~ PEARL M. K 8 We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declazed by the above-named Testatrix, PEARL M. KOGAN, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and yeaz above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. pL~.~.D~a-'F/~ residing at 773 ~ Lam- v~ '~e,~ ~- da.~ residing at ~ 7 ~/ Qrii,c~ COMMONWEALTH OF PENNSYLVANIA . SS.. COUNTY OF DAUPHIN We, PEARL M. KOGAN, the Testatrix, and ~~ i ( 1~C~1 clCr shot ,and /1 Q hr f PQ. K . Ko:,e ,the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness Subscribed, sworn to and acknowledged before me by the Testatrix, PEARL M. KOGAN, and s~scribed and sworn to before me by l~Pi! l~lChClC/'shot and eh coca. K. IBS OSe ,witnesses, this 14th day of June, 1997. ~ ~. ~~. Notary Public (SEAL) [NEH: SCN:~F:VCOGAN~KO(3 W 9A. W PD] 10 Sovereign Bank ESTATE OF SOCIAL SECURITY #: Peazl M. 204-03-5893 DATE OF DEATH: July 30, 2012 Account #: 0351061886 Type: Checking Open date: 2/18/1987 In the name of: Peazl Mildred Kogan (Kay I Rittenhouse POA) Date of Death Balance: $6,095.59 Int.(1''I'D) from 1/1/2012 to 7/26/2012 $0.39 Accrued interest to date of death: $0.01 Otherlnfo: Account #: 2334086452 Type: Money Market Open date: 10/29/2009 In the name of: Pearl Mildred Kogan (Kay I Rittenhouse POA) Date of Death Balance: $11,836.23 Int.(I'TD) from 1/1/2012 to 7/25/2012 $17.11 Accrued interest to date of death: $0.45 Otherlnfo: Account#: 0465112902 Type: CD Open date: 10/8/1994 In the name of: Peazl Mildred Kogan or Martin N Kogan Date of Death Balance: Account closed prior to death Int.(YTD) from Accrued interest to date of death: to Otherlnfo: Account closed on 09/08/2010. Page 1 of 1 BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-ebgll~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE ND. 21 12-0852 ~ecl~tPlf~j AND ACN 12150182 7a~ruTng ~1'I~~ TAXPAYER RESPONSE pgTE 09-11-2D12 's.a.R era tae-th U12 SEP 19 PM 1 ~ 17 ~•J~U.Ar~~y~~a'~~- ~ryay KAY I RITTENHOUSE 669 FISHING CREEK RD NEW CUMBERLND PA 17070-2748 EST. OF PEARL M KOGAN SSN 204-03-5893 DATE OF DEATH 07-30-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. PSECU provttled the department ui th the information below, uhf ch was usetl in calculating the inheritance tax due. 0.ecords indicate that at the death of the above-named decedent, you were a ,l of nt owner/beneficiary of this account. If yoU are the spoUSe Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C to PART 1 below and writing "spouse" in PART 2. If yyou believe the information is incorrect, please obtain written correction from the financiai institution, attach a copy Lo this farm and return tt to the above address. Please call 717-787-9327 with ouesttons. COMPLETE PART I BELOW x-SEE"REVERSE SIDE FOR FILING ANDPAYMENT INSTRUCTIONS - Account No. 8448464647-CD53 Date 08-29-2002 To ensure proper credit to the account. two Established copies of this notice gust eecoeparo payagnt to the Register of Wills. Make check Account Balance ~ 14, 939.10 DaVabla to "Register of Wills, AganY. Percent Taxable X 50.000 NOTE. If tax paveants are each wikhin throe Amount Subject to Tax $ 7,469.55 aonths of the tlacedant's eats of death, Tax Rate X , p45 detluct a 5 pa rcent discount on the tax dua. Aro inharitenea tax duo will becoee dal ineu ant Potential Tax Due S 336.13 nine aonths after the data of death. PART TAXPAYER RESPONSE t^ A. ~ The above inforeation and tax dua is correct. Reait pavaent to the Rae inter of Wills with two copies of this not fee to obtain a discount or avoid iota rest, or roturn this notiu to the RaBister of Wills and CHECK an official assessaant will bo issued by the PA De parteant of Ravanue. ONE BLOCK B. The above asset has bean or will be reported end tax void with the Pennsylvania inharitenea tax return ONLY filed by the estate representat SVa. C. ~ Tha above inforea ion is incorrec4 and/or debts and deductions ware paid. Coepleta PART ~ and/or PART ~ below. PART It Sndicatin9 a different tax rate, please state re latig nship to tlecedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Es tablishetl 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amcunt Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due B 'S PART OESTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK C ) Under penalties o} perjury. I dec lard that the facts I reported above arm truepcnorre~t a,~n[[d~~ 'o mplete to th~ best f my knowledge antl belSef. HOME C1~7) /!~ /, L~y BUREAU OF INDIVIDUAL TAXES ( FILE N0. 21 12-0852 PO BOX 280601 pe ~ ~ 'pCN 12150181 HARRISBURG PA 17128-8601 DEP ~ DATE 09-11-2012 aavaxs sx acv usauy ~ PENNSYLVANIA INHERITANCE TAX Fi_, F~~~ ,,,INFORMATION NOTICE ~m•aL~~~)_ gyp' AND AarNmlYOBadvEnua ` ~~` ~ Q TAXPAYER RESPONSE g~ 12 SEP 19 PN 1 ~ 17 vi~Ltt. ~_-: OFiPhiAN'S COURT CUMBERLAND CO., PA EST. OF PEARL M KOGAN SSN 204-03-5893 DATE OF DEATH o7-30-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 KAY I RITTENHOUSE 669 FISHING CREEK RD NEW CUMBERLND PA 17070-2748 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. PSECD provided the deDa rtment with the information below, which was used in calculating the inheritance tax due. Records Indicate that at the death of the above-nametl decedent, you were a Joint owner/benefi ti ary of this account. If you ere the Spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department oT your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If YYou helieve the infermati on is incorrect. Dl ease obtain written correction from the fi nantial institution, attach a copy to this Porm and return 1t to the above atltlress. Please call 717-7B7-8327 with Questions. COMPLETE PART 1 BELOW ~ SE.E REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8448464647-CD52 Date OS-26-2002 To ensure proper credit to the account. two Established copies of this notiea must aeeoeparo payment to the Register of Wills. Make she ek AGCOUnt Balance 23v 000.00 payable to "Rap istar of Wills, Apent". Percent Taxable X 50.000 NOTES If tax Pavnants era matle within three Amount Subject tp Tax $ 11 s500.00 months of the deeetlent's date of death, Tax Rate X . 045 aeduet a 5 percent discount on the tax duo. Aro inha rit once tax due will bacoee dalinouant Potential TaX Dua b` 517.50 nine months after the data of da ath. PART TAXPAYER RESPONSE 1^ A. ~ The above information and tax due is correct. Resit paymen4 to tho Rapistar of Wills with two goo Ses of this notiea to obtain a discount or avoid interask. or return this notiea to the Rep ister of Wills and r CHECK ~l en official assassaent will be issued by the PA Deoartmant of Revenue. I ONE I L BLOCK J B. ~ The above asset has been or will be reoo rtad and tax paid with the Pannsvlvania inheritance tax return ONLY tiled by the estate representat3va. C. ~ Tha above info rea ion is incorrect and/or debts and deductions were Paid. Coepleta PART 2~ and/or PART ~ below. ppRT It indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subiect to Tax 4 5. Debts and Deductions 5 - 6. Amcunt Taxable 6 7. Tax Rate 7 X e. Tax Due 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK C ) Untler penalties of perjury. I decla ra that the facts I reported above [tea react ruepcgo rre ct and~/L~ 'e~mplete no thg bash ~ f my ~ wledga and belief. HOME C/~/ ) J /~ 07 7 / s _ r PENNSYLVANIA INHERITANCE T INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND PD a0X 200601 HARRISBURG PA vlze-o6d1 PerA0.Visac~e~ entr '.~ ~ TAXPAYER RESPONSE FILE N0. 21 12-0852 ACN 12150180 DATE 09-11-2012 r~ares~P i9 Pn i~ i~ LLI ;..." Of~P1iAfJ'S (BUR' ~.. KAY I RITTENHOUSE 669 FISHING CREEK RD NEW CUMBERLND PA 17070-2748 EST. OF PEARL M KOGAN SSN 204-03-5893 DATE OF DEATH 07-30-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PSECU provi tletl the department with the information below. which was used in celcui atin9 the inheritance tax due. Records indicate that at the death of the above-nametl tlecedent, you were a Joint owner/beneficiary of this account. If you are the spoUSe of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and wri ttn9 "spouse" in PART 2. I1 you believe he Information is incorrect please obtain written correction from the financial institution, attach a copy to this form end return it to the above address. Please call 717 -7~7-9327 with puesti ons. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account Na. 8448464647-S4 Date 06-19-2001 To ensure proper credit to the account, two Estab if shed copies of this notice must aeeomparo Account Helence 4,042.36 payment to kha Register of Wills. Make check payable to "Rea aster of Wills. Agent". Percent Taxable X 50.000 NOTE: If tax oeymants era Wade within three Amount Su bl act t0 Tex ~ 2,021.1B nonths of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Aro inheritance tent due will bacoaa dalinmuant Potential Tax Dua y` 90.95 nine months eftar the data of death. PART TAXPAYER RESPONSE 1^ A. ~ Tha abovo information end tax due is correct. Resit payment to kha Register of Wills with two copies of this notice to obtain CHECK s discount or avoid interest, or return this notice to the Rae aster of Willa and en off ieial assa ssment will ba issued by the PA Department of Ravenna. ONE ,,,r-,~f BLOCK B. xi Tha abovo asset has bean or will ba re DO rked and tax paid with the Pennsylvania inheritance tax return ONLY 7Y-' filed by the estab rap resentativa. C. ~ Tha above inf arena Son is incorrect and/or debts and tletluetions ware paitl. Complete PART ~2 and/or PART ~ below. PART if indtcatinm a Oifferant taX rate, Please state relationship t0 tlecedent: TAX RETURN - CALCULATION OF TAX DN JOINT/TRUST ACCOUNTS LINE 1. Date Establlshetl 1 2. Aeepunt Halanea 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 $ 7. lax Rate 7 X 8. Tax Due e Under penalties of perjury, I declare that the facts I reparied above are true, correct antl complete to the bast of my knowle doe and belief. NOME (7~7 ) 97a'rr- n WORK C J pART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 12-0852 BUREAU OF INDIVIDUAL TAXES PO BOX 280601 @~ ~ ~ ~ AND '-d'~[ ACN 12150179 HARRISBURG PA 17128-0601 ' ~ per Nra{a~nf-aPa+. s., ' ~ ~ TAXPAYER RESPONSE DATE D9-11-2012 TYPE OF ACCOUNT 2~l1 SEP 19 PM I~ 16 EST. OF PEARL M KOGAN ® SAVINGS SSN 204-03-5893 ^ CHECKING i,~~ ~; DATE OF DEATH 07-30-2012 ^ reusr 'S ~~j COUNTY CUMBERLAND ^ CERTIF. /ry~~~~/~pp~pa VlwBlpEnLA~1~ ~ f1A Ali REMIT PAYMENT AND FORMS TD: KAY I RITTENHOUSE REGISTER OF WILLS 669 FISHING CREEK RD 1 COURTHOUSE SQUARE NEW CUMBERLND PA 17D70-2748 CARLISLE PA 17013 PSECU provided the department with the 7nfarmatl on helow. which was used in calcul etin0 the inheritance tax due. Recortls intli cate that at the death of the above-named decedent, you were a ,7 Dint owner/beneficiary of this account. If you are the spouse of the deceased and any amount other than zero is raft acted below on the Potentlal Tax Bue line, note no tax may be due, but you must notify the department oT your relatt ons hip to the deceased by checking-Box C in PART 1 below and wrt ti ng "spouse" in PART 2. [f you believe the infprmati on is incorrect please obtain written correction from the financial institution, attach a copy to this form and return it Lo the above address. Please call 717-7157-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 8448464647-51 Data 06-19-2001 To ensure proper credit to the account, two ESteb 115hed copies of 4his notice vast eccowpergl Account Balance 537.69 passant to the Reeister of Wills. Make check pawable to "ReBf star of Wills, Agent". Percent Taxable X 50.000 NOTE. If tax pavvants era vade wikhin three Amount Subject to Tax ~ 268.85 months of 4he decedent's data of death, Tax Rake X . 045 deduct a 5 pareant tlizeount on the tax due. A,y inheritance tax duo will be cove delinquent Potentlal Tex Du• $ 12.10 nine soot hs after the data of death. PART TAXPAYER RESPONSE 1^ A. ^ Tha above information and tax due is correct. Rawit pavwant to the Register of Wills with two cosies of this notice to obtain CHECK a tlizeount or avoitl inkerast, or return this notice to the Register of Wills and an official assassven4 will ba issued by the PA Oepartaant of Ravanua. ONE BLOCK B. ~Tha above ssset has been or will be repo rt sd end tax paid with the Pennsvlvanla inheritance tax return ONLY filed by the estate reo resentativa. C. ^ The above inforve xon is incorrect and/or debts and deductions ware paid. Covpleta PART 2~ and/or PART ~ below. PART If indieating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Halanee 2 3. Percent Taxable 3 X 4. Amount Subl eat to Tax 4 >i 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X e. Tax Dua 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK ( ) Under panalYies of pe rdurY. I deals re that the facts I reported above are true, correct and complete to the best of my knowledge and belief. n e HOME ( ~,) Q~~-af/S"~ cTeTFreFN1T OF ACCOUNT PLEASE SEND CHECK OR MONEY ORDER TO: Genesis Rehabilitation Services P.O.BOx 7247-6524 Philadelphia, PA 19170.6524 Territory 2 Kogan, Pearl D r T r : 10/10/2012 MAKE CHECK PAYABLE TO: Genesis Rehabilitation FOR MORE INFORMATION, TELEPHONE IF ADDRESS INFORMATKN! IS INCORRECT. PLEASE MAKE ADDRESS CHANGE ON BACK 666-671-6046 DETACH AND RETURN TOP PORTKIN WITH LOU R PAYMENT •• , ~' ' Kogan, Pead 04/172012-0427/2012 oT 805.00 Aetna Payment -364.14 Aetna ContracWal -209.89 Kogan, Pearl Transfer 230.97 / ~V ' ~/d ' I a BALANCE DUE> 230.97 ow nrv~c we d~~~~~d Kogan, Pearl D "~ 826.1.icbd ~6 9 ~s :h~ ~y~~~ ~~- N~icJ cvm6 ~ r ~~ti ~ ~ P~ ACCOUNT NUMBER STATEMENT DATE 70776 10/102012 / ~O ~~ Territory 2 FGH-253 .Rev. 10/Dt) BPI6a5.[b Milne&IA 5090~1000)4lT-23O raxreowuu Thornwald Home 442 Walnut Bottom Road Carlisle, PA 17013 Telephone: (717) 249-4118 Kay Rittenhouse 669 Fshing Creek Road New Cumberland, PA 17070 STATEMENT Statement Date: 09/01/2012 Due Date: 09/25/2012 Amount Enclosed $ _ Amount Due: $ .00 Account #: 20017 RE: Pearl D Kogan ~ jd ~ Date Descri lion Days uant Rate Cha a Pa a lances Balance B/F 3,698.8 3, 8.80 08/27/12 RITTENHOUSE, KAY I 3,698.80 .00 Current 31-60 Days 61-90 Days Over 90 Days Amount Due .00 .00 .00 .00 .00 Payments MUSr be received by the 25th of each month. ATTENTION: Due to a scheduling change, dental check-ups have been rescheduled for September 26th and 27th. Pearl DKogan -Account #: 20017 Thornwald Home 442 Walnut Bottom Road Carlisle, PA 17013 Telephone: (717) 249-4118 Statement Date: 09/01/2012 Due Date: 09/25/2012 Account #: 79410 Please Pay: $10.00 Due Date: 09/11/12 ~~ Go Green! Register today and pay your bill online at www heritagemedg~.com. Insurance Patient Date Description Charges Balance Balance PEARL M KOGAN ID# 79410/JOHN H NIPPLE DO 02/07/2012 OFFICE /OUTPATIENT VISIT ESTABLISHED PATIENT DETAILED 184.00 174.00 10.00 02/07/2012 PAYMEM FROM RITTENHOUSE, KAY -60 74 -10.00 02/16/2012 CONTRACTUAL ADJUSTMENT FROM AETNA NON HMO . _ 02/16/2012 PAYMENT FROM AETNA NON HMO -65.26 00 -28 28.00 02/16/2012 PATIENT RESPONSIBILITY -THE BALANCE IS YOUR DEDUCTIBLE WHICH IS . NOT COVERED BY YOUR INSURANCE. HOIdEVER, IF YOU ARE ENROLLED IN AN HRA OR HSA PLEASE CONFACT YOUR PLAN ADMINISTRATOR PRIOR TO MAKING PAYMENT. THIS WILL AVOID AN OVERPAYMENT ON YOUR ACCOUNT. 02/24/2012 PAYMENT FROM RITTENHOUSE, KAY 26 -93 -28.00 06/20/2012 CONTRACTUAL ADJUSTMENT FROM AETNA NON HMO . 06/20/2012 PAYMENT FROM AETNA NON HMO 26 93 D7/17/20]2 CONTRACTUAL ADJUSTMENT FROM AETNA LIFE INSURANCE COMPANY . 07/30/2012 PAYMENT FROM AETNA LIFE INSURANCE COMPANY 08/15/2012 REFUND PAYMENT FROM AETNA LIFE INSURANCE COMPANY 10.00 08/15/2012 PATIENT RESPONSIBILITY -10.00 10.00 BALANCE TICKET #WNA015596 0 0 10.00 Important Messa a About Your Account Total Balance 10.00 PAYMENT IS DUE WITHIN 14 DAYS FROM THE DATE OF THIS STATEMENT. -Insurance Pending 0.00 Amount Due 10.00 Make Checks Payab-e To: Heritage Medical Group, LLP PLEASE DO NOT SEND CASH THROUGH THE MAIL or_nvon ',jam For Billing Questions Call: ® (717) 233.6791 ~o,.. r 1 1 1 $0.00 $10.00 $0.00 $0.00 $0.00 $0.00 $10.00 .$0.00 $10.00 Prompt payment is greatly appreciated! \Ah44in Ninnle ~cenr * D(1Rnv A1A0 * I anrnefer DA ~7RnA e*en *. /~*~~ ~+'» q~n* _