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HomeMy WebLinkAbout12-12-12 1505611188 REV-1500 EX (02-11)(FI) pennsytyania OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of vidualTaxes PO BOX 2806 280801 INHERITANCE TAX RETURN PO BO Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 12 0 5 8 0 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYW 478 20 3671 05 08 2012 06 22 1924 Decedent's Last Name Suffix Decedent's First Name MI Mowery Marjorie W (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 0 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate o 4a. Future Interest Compromise (date of = 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate = 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 = 10. Spousal Poverty Credit (Date of Death = 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT - This section must be completed. All Correspondence and Confidential Tax Information Should be Directed to: Name Daytiff Telephone Pitt&ber Elyse E. Rogers, Esquire 71f 612 5BMlm an 'z' C7D a*> 6 M Itg, IMRO LLS Y Y First Line of Address p O C'7 -r1 -n Saidis, Sullivan 8 Rogers c~ t =3 yr:2 Second Line of Address CD `U 635 North 12th Street, Suite 400 ~t (n --n City or Post Office State ZIP Code DATE FILED Lemoyne PA 17043 Correspondent's e-mail address: erogerS@Ssf-attorneyS.com Under penalties of perjury, I declare that) have examined this return, including accompanying schedules and statements, and to the bestof my knowledgeand belief, it is true, correct and complete. Declaration of the preparer other than personal representative is based on all information of which preparer has any knowledge. SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN -71rlu DATE 7 ~`r J, / ICJ `.L A ADDREEE ~S, ~ Y a ~J i° 1 Q f C~> G'~ t_tL 64 Y C.t G I ' 1 JU G~ 4~ 1, SIGNAT E FPREPAR THERT REPRESENTATIVE DATE S ! / d0 "i=4 J4 ADDRESS 6 North 12th et Lemoyne, A 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611188 1505611188 Estate of: Marjorie W. Mowery 478-20-3671 Executor Brent M. Mowery Ann E. Mowery 7414 Georgetown Court 2456 140th Avenue McLean, VA 22102-2123 Carlisle, IA 50047-3184 1505611288 Rev-1500 IX (FI) Decedent's Social Security Number Decedent's Name: Mar j o r i e W Mowery 478 20 3671 RECAPITULATION 1. Real Estate (Schedule A) 1. 0.00 2. Stocks and Bonds (Schedule B) • • • 2. 2 0 6 , 2 0 4 .?9 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . . 3. 0 • 00 4. Mortgages and Notes Receivable (Schedule D) 4. 0 • 00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 1101049 • 05 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. 0 • 00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 317 , 17 6 .52 (Schedule G) 0 Separate Billing Requested • • • • • • 7. 8. Total Gross Assets (total Lines 1 through 7) 8. 6 3 3 -,4 3 0 • 36 9. Funeral Expenses and Administrative Costs Schedule H) 9. 131451 • 55 10. Debts of Decedent, Mortgage Liabilities, and Liens Schedule I 10. 3 , 0 7 8 • 09 11. Total Deductions (total Lines 9 and 10) 11. 16 , 5 2 9 .64 12. Net Value of Estate (Line 8 minus Line 11) 12. 6161900 • 7 2 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. 6161900 • 72 TAX CALCULATION - 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 0-00 15. 0.00 16. Amount of Line 14 taxable 7 7 6 0. 5 3 at lineal rate X .045 616,900-72 16. 271760-53 . 17. Amount of Line 14 taxable at sibling rate X .12 0-00 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0-00 18, 0.00 19. TAX DUE 19. 27,760-53 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505611288 1505611288 Rev-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 21 12 0580 DECEDENTS NAME Marjorie W. Mowery STREET ADDRESS 210 Big Spring Road CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 27.760.53 2. Credits/ Payments A. Prior Payments 26,000.00 B. Discount 1.368.42 Total Credits (A+ B) (2) 27,368.42 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 392.11 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 ❑ c. retain a reversionary interest ❑ d. receive the promise for life of either payments, benefits or care? ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ❑ N 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ❑ N 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? N ❑ 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. Sect. 9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. Sect. 9116(a)(1.1)(ii)]. The statue 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. Sect. 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. Sect. 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. Sect. 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-1503 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Marjorie W. Mowery 21 12 0580 All property jointly-owned with right of survivorhsip must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Abbott Labs 1,929.44 Dividend on above stock declared prior to decedent's death 15.81 2 Amerisourcebergen Corp 1,290.60 3 Aetna Inc New 2,434.19 4 AT&T Inc 1,221.00 5 Amgen Inc 1,820.39 6 Apache Corp 2,421.44 Dividend on above stock declared prior to decedent's death 4.76 7 Apple Inc 3,955.81 8 Berkshire Hathaway Inc Del Cl B New 1,065.87 9 Bristol-Myers Squibb Co 1,657.25 10 Comcast Corp New 2,292.42 11 Cardinal Health Inc 2,264.69 12 Chevron Corp New 4,299.96 13 Conocophillips 2,412.45 14 CF Inds Hldgs Inc 2,344.75 15 CA Inc 1,443.61 16 Cliffs Natural Resources Inc 850.13 Dividend on above stock declared prior to decedent's death 9.38 17 Coca-Cola Co 1,308.17 18 Dell Inc 2,626.68 19 Discover Finl Svcs 3,290.76 Total from continuation Schedule(s) 165,245.23 TOTAL (Also enter on line 2, Recapitulation) 206,204.79 (If more space is needed, insert additional sheets of the same size) Page 2 Estate of: Marjorie W. Mowery 21 12 0580 Schedule B - Stocks and Bonds Item Value at Date Number Description of Death 20 Exxon Mobil Corp 3,259.91 21 Fluor Corp New 1,102.20 22 Gap Inc Del 1,591.44 23 General Dynamics Corp 1,342.70 Dividend on above stock declared prior to decedent's death 10.20 24 General Electric Co 1,131.33 25 Google Inc 1,217.60 26 Intel Corp 3,058.16 Dividend on above stock declared prior to decedent's death 23.52 27 International Business Machines 3,235.82 28 Intl Paper Co 1,377.64 29 JP Morgan Chase & Co 3,104.63 30 Johnson & Johnson 1,230.54 31 Kroger Co 2,175.50 32 Lockheed Martin Corp 2,948.99 33 L-3 Communications Hldgs Inc 993.37 34 Eli Lilly & Co 3,157.04 35 Limited Brands Inc 1,612.79 36 McKesson Corp 2,764.89 37 Marathon Oil Corp 2,149.70 38 Marathon Pete Corp 1,905.86 39 Microsoft Corp 4,083.65 40 Nabors Industries Ltd 744.07 TOTAL. (Carry forward to main schedule) 44,221.55 Page 3 Estate of: Marjorie W. Mowery 21 12 0580 Schedule B - Stocks and Bonds Item Value at Date Number Description of Death 41 Northrop Grumman Corp 2,141.48 42 Prudential Finl Inc 1,236.60 43 Parker Hannifin Corp 2,370.48 44 Philip Morris Intl Inc 2,808.32 45 Pfizer Inc 1,993.16 46 Procter & Gamble Co 1,092.68 Dividend on above stock declared prior to decedent's death 9.55 47 Raytheon Co 2,025.40 48 Southwest Airls Co 1,122.00 49 Sprint Nextel Corp 920.61 50 Symantec Corp 1,829.90 51 Tyco International Ltd 2,937.60 Dividend on above stock declared prior to decedent's death 13.50 52 Time Warner Cable Inc 3,052.11 53 Unum Group 1,008.55 Dividend on above stock declared prior to decedent's death 4.83 54 Unitedhealth Group Inc 3,381.99 55 Valero Energy Corp New 2,527.25 56 Verizon Communications 3,325.10 57 Western Un Co 2,202.17 58 Wells Fargo & Co New 1,029.20 Dividend on above stock declared prior to decedent's death 6.82 59 Wellpoint Inc 1,529.73 TOTAL. (Carry forward to main schedule) 38,569.03 Page 4 Estate of: Marjorie W. Mowery 21 12 0580 Schedule B - Stocks and Bonds Item Value at Date Number Description of Death 60 Blackrock Bd Alloc Target Shs Bats Ser C 17,488.84 61 Blackrock Bd Alloc Target Shares Bats Series M 16,604.06 62 FNMA Pass-Thru Long 30 Year 5.0% dated 12/01/03, matures 11/01/2033 498.07 Interest on above bond accrued as of decedent's death 4.24 63 FNMA Pass Thru Long 30 Year 4.0% dated 1/1/11, matures 2/1/2041 4,608.32 Interest on above bond accrued as of decedent's death 32.32 64 FNMA TBA 30 Year 3.5% 2,082.50 Interest on above bond accrued as of decedent's death 1.36 65 Federal Home Loan Mtg Corp 4.875% dated 10/17/2003, matures 1,070.11 11/15/2013 Interest on above bond accrued as of decedent's death 23.43 66 Federal National Mtg Assn 1.25% dated 1/9/2012, matures 1130/2017 4,059.15 Interest on above bond accrued as of decedent's death 13.47 67 United States Treas Nts .25% dated 1/31/12, matures 1/31/14 2,999.88 Interest on above bond accrued as of decedent's death 2.04 68 United States Treasury Notes .25% dated 2/15/12, matures 2/15/15 2,991.56 Interest on above bond accrued as of decedent's death 1.73 69 United States Treas Notes 3.625% 2/15/20 3,491.02 Interest on above bond accrued as of decedent's death 25.10 70 United States Treas Bds 4.375% 11/15/2039 2,544.69 Interest on above bond accrued as of decedent's death 42.31 71 United States Treas Nts 1.375% dated 5/15/09, matures 5/15/12 4,000.62 Interest on above bond accrued as of decedent's death 26.59 72 United States Treas Nts 4.25% dated 11/15/2007, matures 11/15/17 1,179.69 TOTAL. (Carry forward to main schedule) 63,791.10 Page 5 Estate of: Marjorie W. Mowery 21 12 0580 Schedule B - Stocks and Bonds Item Value at Date Number Description of Death Interest on above bond accrued as of decedent's death 20.55 73 United States Treas Nts 2.875% dated 1/31/08, matures 1/31/2013 1,019.57 Interest on above bond accrued as of decedent's death 7.82 74 United States Treas Nts 3.625% dated 8/15/09, matures 8/15/19 2,325.62 Interest on above bond accrued as of decedent's death 16.73 75 United States Treas Nts .5% dated 5/31/11, matures 5/31/13 4,012.19 Interest on above bond accrued as of decedent's death 8.80 76 FNMA Pass-Thru Int 15 Year 5.5% dated 4/1/05, matures 3/1/2020 670.07 Interest on above bond accrued as of decedent's death 6.25 77 FNMA Pass-Thru Long 30 Year 5.0% dated 1/1/2006, matures 1/1/2036 209.09 Interest on above bond accrued as of decedent's death 1.79 78 FNMA Pass-Thru Int 15 Year 5.5% dated 1/1/06, matures 1/1/2021 1,219.21 Interest on above bond accrued as of decedent's death 11.37 79 FNMA Pass-Thru Long 30 Year 5.0% dated 11/1/08, matures 11/1/2038 568.48 Interest on above bond accrued as of decedent's death 4.85 80 Anheuser Busch Inbev Worldwide Sr Note 4.125% dated 10/16/09, matures 2,168.09 1/15/2015 Interest on above bond accrued as of decedent's death 25.90 81 Enterprise Prods Oper LLC Gtd Sr Note 3.2% dated 1/13/11, matures 3,195.93 2/1/2016 Interest on above bond accrued as of decedent's death 25.87 82 JP Morgan Chase & Co Sr Nt 3.15% dated 6/29/11, matures 7/5/2016 1,040.98 Interest on above bond accrued as of decedent's death 10.76 83 Anheuser Busch Inbev Worldwide Gtd Nt 2.875% dated 1/27/11, matures 1,063.57 2/15/2016 TOTAL. (Carry forward to main schedule) 17,633.49 Page 6 Estate of: Marjorie W. Mowery 21 12 0580 Schedule B - Stocks and Bonds Item Value at Date Number Description of Death Interest on above bond accrued as of decedent's death 6.63 84 General Elec Cap Corp 5.25% dated 10/19/07, matures 10/19/12 1,020.66 Interest on above bond accrued as of decedent's death 2.77 TOTAL. (Carry forward to main schedule) 1,030.06 REV-1508 EX+(11-10) M~ pennsylvania SCHEDULE E C_k'FHR'IMFNi ~F RFV=: N:3F 1WW CASH, BANK DEPOSITS, & MISC. INHERITANCETAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Marjorie W. Mowery 21 12 0580 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 M&T Bank Checking Account 61961353 20,295.24 Per 6/1/12 letter Interest on above item accrued as of decedent's death 0.11 2 Withdrawal by Ross Mowery from Merrill Lynch Acct 872-56573 on 4/23/12 25,000.00 for payment of Marjorie M. Mowery expenses 3 Merrill Lynch Money Market Account 872-56573 50,095.42 4 Merrill Lynch Money Market Account 872-56572 ($7,747.00 minus $468.39) 7,278.61 5 US Treasury, 2011 Income Tax Refund 829.00 6 Highmark Refund 215.81 7 Newspaper Refund 134.86 8 Genworth Payment 200.00 9 Genworth Life Insurance, Long Term Care Insurance Deposit 6,000.00 TOTAL (Also enter on line 5, Recapitulation) 110,049.05 If more space is needed, insert additional sheets of the same size REV-1510 EX+(08-09) a pennsylvania SCHEDULE G iiH~pAN'I'h7FNi~G R~+dr NN' INTER-VIVOS TRANSFERS AND E TURN RESIDENT DE MISC. NON-PROBATE PROPERTY RESIDENT ESTATE OF FILE NUMBER Marjorie W. Mowery 21 12 0580 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE NAME OFTRANSFEREE, RELATIONSHIPTO DECEDENT& DATE OF DEATH %OFDECD,s EXCLUSION TAXABLE NUM DATE OFTRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE 1 Merrill Lynch IRA Account 872-86302 210,611.81 100 210,611.81 Per ML valuation Beneficiaries: Decedent's children, Ann Mowery, Brent Mowery, Kathryn L. Lohr, and Ross S. Mowery 2 Sun America Annuity Contract P3799507795 41,580.68 100 41,580.68 Per 06/29/12 letter Beneficiaries: Decedent's children, Ann Mowery, Brent Mowery, Kathryn L. Lohr, and Ross S. Mowery 3 Transamerica Advisors Annuity Contract 64,984.03 100 64,984.03 M011740588 Per 6/18/12 letter Beneficiaries: Decedent's children, Ann Mowery, Brent Mowery, Kathryn L. Lohr, and Ross S. Mowery TOTAL (Also enter on Line 7, Recapitulation) 317,176.52 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) i pennsylvania SCHEDULE H DF.PARrMFN'' QV RFV' ,)f FUNERAL EXPENSES AND IN HE ESIDETAXRETURN R ESiENTNTDECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Marjorie W. Mowery 21 12 0580 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 7,502.53 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Zip Relationship of Claimant to Decedent a. Probate Fees: 369.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 579.52 TOTAL (Also enter on Line 9, Recapitulation) 13,451.55 If more space is needed, use additional sheets of paper of the same size. Page 2 Estate of: Marjorie W. Mowery 21 12 0580 Schedule H, Part A - Funeral Expenses Item Number Description Amount 1 Funeral expenses 500.00 2 Alan Powers, reimbursement for funeral dinner 1,111.69 3 Bookwalter Photo, photos at funeral 79.50 4 Melissa Dresen, reimbursement for gasoline costs from funeral travel 135.00 5 Jim Powers, reimbursement for kennel costs from funeral travel 120.00 6 Ann E. Mowery, reimbursement for travel costs from funeral 2,477.00 7 Brent M. Mowery, reimbursement for travel costs from funeral 829.96 8 Auer Cremation Services of PA 1,261.88 9 Ross S. Mowery, hotel costs from funeral 352.98 10 Ann E. Mowery, reimbursement for payment of flowers 89.04 11 Brent Mowery, reimbursement for travel expenses for funeral 175.00 12 Ross Mowery, reimbursement for travel expenses for funeral 195.00 13 St John's, post funeral refreshments 175.48 TOTAL. (Carry forward to main schedule) 7,502.53 Page 3 Estate of: Marjorie W. Mowery 21 12 0580 Schedule H, Part B - Administrative Costs Miscellaneous Expenses Item Number Description Amount 7 Death certiticates 55.00 8 Ann Mowery, reimbursement for postage 18.95 9 Saidis, Sullivan & Rogers, out of pocket expenses 265.77 10 Ann Mowery, reimbursement for stamps & copies 9.80 11 Register of Wills, filing fees 30.00 12 Saidis, Sullivan & Rogers, reserve for out of pocket expenses 150.00 13 Register of Wills, additional probate fee 50.00 TOTAL. (Carry forward to main schedule) 579.52 REV-1512 EX+(12-08) pennsylvania SCHEDULE I E~~~ MFN t. ~FVrN~t DEBTS OF DECEDENT, INH ETAX RETURN RESIDENTNTDECEDENT MORTGAGE LIABILITIES & LIENS ESI ESTATE OF FILE NUMBER Marjorie W. Mowery 21 12 0580 Report debts incurred by decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Kuhn Communications 17.49 2 Green Ridge Village 2,510.29 3 Green Ridge Village 56.00 4 Millennium Pharmacy Systems 191.75 5 Deborah Piper, tax collector 5.00 6 Green Ridge Village 242.56 7 Saidis, Sullivan & Rogers, pre-death services 55.00 TOTAL (Also enter on Line 10, Recapitulation) 3,078.09 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J 41EPARl MFW OF RFVFNF,1'.- INHERITANCETAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Marjorie W. Mowery 21 12 0580 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE T TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116(a)(1.2).] Ann E. Mowery Daughter 154,225.18 2456 140th Avenue Carlisle, IA 50047-3184 Brent M. Mowery Son 154,225.18 7414 Georgetown Court McLean, VA 22102-2123 Kathryn L. Lohr Daughter 154,225.18 2148 Baihly Hills Drive SW Rochester, MN 55902 Ross S. Mowery Son 154,22518 8817 Cunningham Drive Berwyn Hts, MD 20740-2351 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15THROUGH 180E REV-1500 COVER SHEET, AS APPROPRIATE. zz NON-TAXABLE DISTRIBUTIONS: 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 SHEET. If more space is needed, use additional sheets of paper of the same size. & 'f 1~,~I111 ~i1,nd Tes~&innen f OF MARJORIE W. MOWER), i I, MARJORIE W. MOWERY, of Newville, Cumberland County, i Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me heretofore made. i ITEM L I direct that all inheritance and estate taxes becoming due by reason of my death, whether payable by my estate or by any i recipient of any property, shall be paid by the Executor out of the residue of my estate, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even i though on proceeds of insurance or other property not passing under this Will. ITEM IL I direct the Executor to pay the expenses i of my last illness and funeral expenses from the residue of my estate as an expense and cost of administration of my estate. i ITEM III. I may leave a written list in my safe i deposit box or elsewhere disposing of certain items of my tangible personal f property. The Executor shall dispose of items of my personal property as specified I in the written list. If no written list is found in my safe deposit box or elsewhere ~ I and properly identified by the Executor within thirty (30) days after the probate of I ~ my Will, it shall be presumed that there is no list; any subsequently discovered list shall be ignored. j I Page 1 i I i I 7: If l die before my husband, ROBERT L. ITEM MOWERZ', I give to him all of my household furniture and furnishings, books, ewelrv. silverware, automobiles; wearing apparel and all other articles of p ictui e. J , i household or personal use or adornment which are not set forth on the list i I referenced in ITEM III and all policies of insurance thereon. If I do not die before my husband, I make this gift. to my children living at the time of m~ death, to be I divided among them as they shall agree. If my children are unable to agree, the j Executor shall divide this propert-, 7 among my children in as nearly equal portions as the Executor. in the discretion of the Executor, deems practical, having due rega d to the personal preferences of my children. ITEM V: I give the residue of my estate, not disposed of in the preceding portions of this Will, to my husband, ROBERT L. MOWERY, if he survives me. If he does not survive me, I give the residue to my children, ANN E. MOWERY, BRENT M. MOVATERY, KATHRYN L. LOHR and ROSS S. MOWERY, in equal shares. If an-% of my children is not living at my death, the share of my deceased child shall be paid to his or her then living issue, per stirpes. I ITEM In addition to the powers granted at law, the Executor shall possess the following powers, exercisable without court approval I and in a fiduciary capacity only: i ~ I (a) To retain any investments I have at my death, including specifically those consisting of stock of any bank even if I have named j i that bank as the Executor. (i,) To vary investments and to invest in bonds, stocks, notes, f real estate mortgages or other securities or in other property, real or 1 Page 2 personal, without being restricted to so-called "legal investmentsand without being limited by any statute or rule of law regarding investments by fiduciaries. f (c) In order to divide the principal of my estate or make i I distributions; the Executor is authorized to distribute personal property and real property partly or wholly in kind, and to allocate II I specific assets among beneficiaries so long as the total market, value of each share is not affected by the division, distribution or allocation in ~I kind. The Executor is authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale any or all real or personal property severally or in conjunction with other persons, and to consummate sale(s) by deed(s) or other instrument(s) to the i purchaser(s), conveying a fee simple title. No purchaser shall be obligated to see to the application of the purchase money or to make inquiry into the validity of any sale. The Executor is authorized to I I make, execute, acknowledge and deliver deeds, assignments, options or i other writings as necessary or convenient to carry out the powers conferred upon the Executor. ~ (e) To mortgage real. estate, and to make leases of real estate. I (f) To borrow money from any person, including the Executor, to pay indebtedness of mine or of my estate, expenses of i ~ Page 3 i i I I i administration or inheritance, legacy, estate and other taxes. and to { assign and pledge assets of my estate. I (gTo pay all costs, taxes, expenses and charges in i connection with the administration of my estate. i (h) To make distributions of income and of principal to the proper beneficiaries, during the administration of my estate, with or I without court order, in such manner and in such amounts as my I Executor deems prudent and appropriate. i (1) To vote shares of stock which form a part of my estate, and to exercise all the powers incident to the ownership of stock. I ii (j) To unite with other owners of property similar to property in my estate to carry out any plans for the reorganization of any company whose securities form a part of my estate. l (k) To disclaim an)= interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under ~ the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee of an inter vivos transfer, and as a donee under a j third-party beneficiary contract. j (1) To prepare, execute and file tax returns of any type i required by applicable law; and to make all tax elections authorized by law. I i I~ I Page 4 I (m) To allocate administrative expenses to income or to j principal, as the Executor deems appropriate. However, no allocation to income shall be made if the effect. of the allocation is to cause a reduction in the amount of any estate tax marital deduction or estate tax charitable deduction. I (n) To employ custodians of property investment or business I advisors, accountants and attorneys as the Executor deems I appropriate, and to compensate these persons from assets of my estate. without affecting the compensation to which the Executor is entitled. (o) To make any adjustment to basis authorized by law, including, but not limited to increasing the basis of any property included in my estate, whether or not passing under this Will, by allocating any amount by which the bases of assets may be increased. The Executor shall be under no duty and shall not be required to allocate basis increase exclusively, primarily, or at all to assets which I pass as part of my probate estate as opposed to other property for which a basis adjustment is allowable. The Executor shall allocate basis increase equitably among those beneficiaries receiving property i as a result of my death, but shall not be liable to any person, nor ~ I subject to removal or surcharge, for any reasonable allocation of basis I ~I i increase, i~ li (p) To do all other acts in the Executor's judgment deemed j I necessary or desirable for the proper and advantageous management, 1 investment and distribution of the estate. In the exercise of judgment, I I request the Executor to seek the counsel of my accountant, RAYMOND C. KELLER. ~ 1« Page 5 I I ' i I ITEM VI: Any person who has died at the same time as I have. or in a common disaster with me, or under such circumstances that ~ the order of our deaths cannot be established by proof, or within thirty (30) days of I my death, shall be deemed to have predeceased me. I ITEM VIL: If a beneficiary under the age of twenty- five (25) years is entitled to receive assets under this Will, my oldest surviving child shall receive those assets as Custodian for the beneficlar57 under the Pennsylvania I i Uniform Transfers to Minors Act. The Custodian may receive and administer all assets authorized by law, and shall have full authority as provided in the Pennsylvania Uniform Transfers to Minors Act to use assets in the manner the Custodian deems advisable for the best interests of the beneficiary. I also designate my oldest surviving child as successor Custodian of any property for which I am custodian under any Uniform Gifts to Minors Act or Uniform Transfers to Minors Act. ITEM VIII: I appoint my husband, ROBERT L. MOWERY to be the Executor. In the event of his death, inability or refusal to ~ i serve. I appoint my son, BRENT M. MOWERY. and my daughter, ANN E. MOWERY, to be the Executors. The Executor is specifically relieved from the obligation of filing bond or entering security. IN WITNESS WHEREOF, I have set my hand and seal to this, my i Last Will and Testament, consisting of this and the preceding five (5) pages, at the end of each page of which I have also set my initials for greater security and better identification this i day of 20 cz (SEAL) MAR- 0 R I E VT. MOWERY 1 I i II ~ i ~Ne. the undersigned, hereby- certify that the foregoing Vvill was signed, sealed, published and declared by the above-named Testatrix as and for her Last «-ill 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 j ~ and year first above written, and we cerQ7 that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. f,~ C: -~~E SL) Residing at (SEAL) Residing at i i i j I I ~ Ili i i 'I I i ACKNOWLEDGMENT COMMONWEALTH OF PENNS-LVANI_A j SS: OF I I, I, MARJORIE W. MOWERY, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and i Testament; that I signed it willingly; and that I signed it as my fee and voluntary act for the purposes therein expressed. i I / SEAL) MARJORIE W. IVIOWERY I I Sworn to and subscribed before me this QS day of 200). Notary Public I My Commission Expires: =PATRICII RiaL sE/aL YARNIK, Notary Public , Cumberland C ount (SEAL) O~IesrHu9ust 27, 26 Erpi I I i i ~ j i i i I ii it ~i i I i I I, AFFIDAVIT i COMMONNA"EALTE OF PENNSYLVANIA COUNTY OF ',j ) I ~A'e, and LQ f the Witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and l saw Testatrix, 1VLkRJORIE W. MOWERY, sign and execute the instrument as her Last. W111 and Testament; that Testatrix signed willingly and that she executed said ! Will 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 eighteen (18) or more j years of age, of sound mind and under no constraint or undue influence. Witness Witn s I Sworn to and subscribed before me this day of 2042. I I ~ Notary Public ! My Commission Expires: I~~T~P~A-_ (SEAL) PATRICIA D. OLY.ARNIf;`µ , Notary Public Her~ptlen Tv~p., Cumberian~ Coun y Ccxnmission Ex fires P r A~yusi 7_.m7. 2o 1I ! I I I I REV-IIG-EX -9Ci COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OFF INDIVIDUAL TAXES DEPT.280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 016318 MOWERY BRENT M 7414 GEORGETOWN COURT MCLEAN, VA 22102-2123 ACN ASSESSMENT AMOUNT CONTROL NUMBER - told 101 $26,000.00 ESTATE INFORMATION: SSN: 478-20-3671 FILE NUMBER: 211 2-0580 DECEDENT NAME: MOWERY MARJORIE W DATE OF PAYMENT: 07/30/2012 POSTMARK DATE: 07/27/2012 COUNTY: CUMBERLAND DATE OF DEATH: 05/08/2012 TOTAL AMOUNT PAID: $26,000.00 REMARKS: RECEIPT TO ATTY CHECK#107 INITIALS: WZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER > 67 M a0 r o rn rn R oo ui o u > O O ~Y O ~ o V) N M _ rn W - R _ LO O C L N N r- O Q 0 L) C (0 a) } ao W O L N a) O O 00 O c U') 00 =a L IT LO o a E oo cfl 0 w 'N Q 0 L = N O E O Q- N Q Z'a O O O JYl to r co C14 >N 0 w 0~ O 3 O m O a) LO w a) o -0 O I? ~ a E J o O O N (6 N a) 7 r Qo > W W' Z _ 'a Q).0 Q a 0 2) > _ (1) = O N V a) U) ~ Q •L W o 0 0 Q M O LO .~.r M N O c- ~ N Cl) o N 0 r > O J O 0 LO N !Y N LO N W O CL N0 O O O O m p N O O N C) O N 00 00 00 Z 2 C :)LO LO 0 c° o w g < LO o U C) O r- U) Lo a, o Of o Q o CD a N 2 cfl _ o m o o W c+j 0 r U N C OLO N p CO ~ N C-) Z~ ~ O O LLJ~~ mN N XZ M -N N <LO NcN- N N N N (l1 F d p o LO Q Q' O O (D Cl) U' 0 0 O 0 0- ON N c V (n mo 0 =Lf)Zm~O O I-~m~ OD 0) o n) 0 QoCOZ0o s w(Dz00 aU)z0o 0 0 u~ L LO = coo WU) L C) O o C m a ° L C4 0 00 00_ = d o L N M r ri) a) 00 O R a m ,0 C 3 .i U O Q O C f 3 a O~ Q o U N M m > d LO M M 00 06 N O U > O 'cCD C) OD r C.O O O a) fn ~ V N _ V1 M O V- V- LC) CD M CD o). 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C C d C U 0 E C C Q Q oy ? d « w +-a -0 co = N N 'O O > N T d E •E ~ d m mm rum m u) to a O ° O7 m C v1 N.N. 0-O a 06 ad w C _ d •p V CO N ~ U .0 d d C N m C N O O N m C = 2 y > d m N L O_ U m U w O d d ,N 7 N m N > m C L G LL LL u N i U c o o a) m pia ` u 2a a 2 L U O= C 7 7 y d d C d 3 L co p• ° E aa) N m L m U a C a a E rji y 0 0) c § cm 0° C C N O m 0> > •o °U- O. V V V d 4j O a) c: O m y o m OU ~ o o y a L a s L) ° E°" o m° io m E c J J a c ayi c'2 mr m d v° ami E YLV° E E . « ° c m= N m c c o 0 LL E U Q Q ti Q w o c- Q 2 (D 0) 0 2 Z oa Q M&T Bank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 Fax (302) 934-2955 June 1. 2012 Saidis, Sullivan & Rogers 635 North 12th Street, Suite 400 Lemoyne, PA 17043 Re: Estate of Marjorie W. Mowery Social Security: 478-20-3671 Date of Death: May 8. 2012 Dear Sir or Madam: Per your inquiry on May 23, 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 Checking Account Account Number 61961353 Ownership (Names of) Ross Mowed, (POA) Robert L. Mowery Ann E. Mowen, (POA) Marjorie W. Mowery Opening Date 0828/1964 Balance on Date of Death $20,295.24 Accru..ed Interest $ .11 Total $20,295.35 C O' to < Q V/V D ~ > - -N ~ v ~ ~ N al s co ° A W IV C (o n . O0 D w R N N o O O O O O O - D (O i=. 3 u,' c N fl3 Ill A7 'Q7 v v n cn o C o o nDU) DG O CD cn C> n ID 7 _T n n (7 r v Q 0' a ° N to 7 CD CY C C (D N C'I.. fn a cD. SU K.. 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(Q D 0 Q m m N m_J' C a > m d E ° m o cc M> Z c m 'B `O U a) m U -0 N d C m U > m C T O N N ti-O a) O U Q) E m O - C r C r N U) Q d d N C E c m 70 o N m 06 3 u, T J r.'r O p O ~ m j -p m C: O U d X U d E c C m C d N - T a) m C o E 4° m 0 2 s O C) O Oia O d L m C ! E c " 3 0 _ o o> 1 d L o a m e o m a 9- c c 0 - m s C - L N m T O - Q~ m N d N N N m N 7 J U = N 'O •O N > m m = 6 = .J an d O. d d jp ° OU d chi, E w N C OU W d L N c0 d co u,: C, U0 T~ o o m a) m C m> a EL o E d a) x v, L co 7 d E J o o U u w e 'O U C C a _ N -d° U G L N(D Q. a d -C L d O Q N m m L C C Q" a+ C -0 0 m o o❑ d y c° m m r m m to to CD •D o c ° L c N .N N n a 06 06 N c m O Q m U d m w, Y co C o7 OO C O N_ > C C d d cp d L -O a U m U C O d d !V) i 'O E 'O 'O d m o> m II. LL LL F, N m> d o c o ° d p = a N d ai a dO o N d c° U m o o 7 mU ~ ) m U m a d '6 O C L_ C Y C 7 C N U d d o d j v 'N E E n E°° L o C ID N o 3 m> c m o a a E o d m c (O ° N d j -O oU U U aN, N O > c c o m p _ E C O m V) O m 0:2 O O d LL c a 7 w U .O a U 'C m 0 J J 6a vi c, U E m o L i m E o - "o c d a r m L N .N vdi d E .dC d C E N Z - - d L U O C m = U d d i L A Q Li o U Q Q ii Q= o 0 0 Q d z a SunAmerica the retirement specialist 2012JULIG A!`i ~~5~' X5:3 June 29, 2012 Sharon J Steiner Merrill Lynch Life Agency INC 214 Senate Avenue 5t1i Floor Camp Hill, PA 17011 Re: SunAmerica Annuity and Life Assurance Company Policy Number: P3799507795 Owner: Marjorie W Mowery Annuitant: Marjorie W Mowery Dear Sharon J Steiner: Thank you for your recent inquiry on the account reference above. In an effort to assist you, we have provided the following information as requested: Account value as of 05/08/2012: $41,580.68 Please keep the following information as part of your permanent records. If you have any questions or require further assistance, please contact our Financial Service Representatives, available Monday through Friday, 5:00 AM to 5:00 PM Pacific Time, at (800) 445-7862. We appreciate this opportunity to serve you. Sincerely, Jennifer Quinn Financial Services Representative SunAmerica Annuity and Life Assurance Company SunAmerica Annuity and Life Assurance company • us Life Insurance Company AnnuitN service Center 21650 Oxnard Street Stc.75013• Woodland Hills. CA 91367-4901 P.O. Box 54299 • Los Angeles. CA 90054-0299 MMISI)-arivc Office: IRANSA-MERICA 4 a , Ei{ e4vcxac; Road ?tiL CRS ADVISORS LIFE INSURA,tiC% CONII'ANY Cedar Rapids. 1.', 52495 June 18, 2012 Estate of Marjorie W Mowery c/o Saidis Sullivan & Rogers 635 N 12th St Ste 400 Lemoyne PA 17043 RE: Annuity Number(s) M011740588 Dear Estate of Marjorie W Mowery: We have received your request regarding this annuity. A Form 712 is not issued on tax deferred annuities. The taxable portion of this policy will be reported on a Form 1099-R as taxable to the beneficiary upon receipt of the funds. The value as of May 8, 2012, the date of death for Marjorie W Mowery is $64,984.03. If you have any questions, please contact your financial professional, or call us at 1-800-535-5549 Monday - Thursday, 7:00 a.m. - 5:30 p.m. or Friday, 7:00 a.m. - 4:30 p.m. Central time. We appreciate your business and look forward to serving you in the future. Sincerely, Administrative Services Claims Knh an AEGON company Law Offices of SAIDIS, SULLIVAN & ROGERS A PROFESSIONAL CORPORATION 635 NORTH 12TH STREET, SUITE 400 CARLISLE OFFICE: ROBERT C. SAIDIS LEMOYNE, PENNSYLVANIA 17043 26 WEST HIGH STREET DANIEL L. SULLIVAN TELEPHONE: (717) 612-5800 - FACSIMILIE (717) 612-5805 CARLISLE, PA 17013 ELYSE E. ROGERS EMAIL: attorney@ssr-attorneys.com TELEPHONE: (71.7)243-6222 JOHN A. FEICHTEL www.ssr-attorneys.com FACSIMILE: (717)243-6486 DEAN E. REYNOSA TODD F. TRUNTZ Of Counsel MARYLOU MATAS SLIKE SEAN M. SHULTZ JOHN E. STEPHEN L. . GRO GROSE ROBERT B. HAMILTON December 11, 2012 HANNAH WHITE-GIBSON ' REPLY TO LEMOYNE 717-612-5801 erogersAssr-attorneys.com CERTIFIED MAIL R/R/R C: rn Q M Register of Wills of Cumberland County oo rte, ca One Courthouse Square Carlisle, PA 17013 r X ~ c~ Re: Estate of Marjorie W. Mowery e, rz~, File No: 2012-0580 rn Dear Madam: n Cn u~ n cn " Enclosed are the following: 1. Original and one copy of the Pennsylvania Inheritance Tax Return; 2. Check in the amount of $392.11 representing payment of inheritance tax; and 3. Inventory. Please timestamp and return the copy of this letter which is enclosed. If you have any questions or require additional information, please do not hesitate to contact me. Sincerely yours, Elyse E. Rogers cjr Enclosures cc: Ann E. Mowery (w/o enclosures) Brent M. 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