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HomeMy WebLinkAbout03-27-13 J 1505610143 REV-1500 EX(02-11) OFFICIAL USE ONLY PA Department of Revenue pennsylvania county code Yew File Number Bureau of Individual Taxes °A'e1°.° PO BOx.280601 INHERITANCE TAX RETURN 21 12 0934 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 06 29 2012 12 16 1949 Decedent's Last Name Suffix Decedent's First Name MI FRY RAI+MA C (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI FRY DONALD A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ❑ 2. Supplemental Return ❑ 3. prior indder Return of Death 4. Limited Estate E] 4a.Future Interest compromise ❑ 5. Federal Estate Tax Return Required ❑ (date of death after 12-12-92) ❑ B Decedent Died Testate ❑ 7, DA fte OMairrteiN�)a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) l( aacchh G of T ❑ g. Litigation Proceeds Received ❑ 10. 1 P i t{°a w Dever ❑ 11 Election A Buie O) 9113(A) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GEORGE F DOUGLAS III ESQ 717 249 6333 �-5 W REGI9MER OF WILLKIISE X =3 G p First Line of Address rn s mzc� 354 ALEXANDER SPRING RO n z M co Second Litre of Address CD FATE FILED, = City or Post Office State ZIP Code --i CARLISLE PA 17015 3> � Correspondent's to-mail address: gdougiasl@salzmannhugheiiii Under penalties M perjury,I declare that,i have examined this return,inducting acoompanYing schedules and statements,and to the best of my knowledge and belief, N is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has arty knowledge. SIG NA N R ONSIBLE FOR FILING RETURN DA Donald A.F 3 z6 )3 ADDRESS 49 W Kina St Shippensbursr PA 17257 SIGNATURE OF PREPARER OTHER THAN REPRESENTAT E .� DATE }L!- t r— QJ George F Douglas,III Esq. 3 r 26 () 3 ADDRESS 354 Alexander Spring Road,Suite 1,Carlisle, PA 17015 Side 1 1505610143 1505610143 �� �\ 4 '�_ 1505610243 REV-1500 EX RECAPITULATION 1, Real Estate(Schedule A)....................................................................................... 1. 335,400 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 326,466. 13 3. Closely Hell Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 81,386. 52 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous I�aa Probate Property (Schedule G) u Separate Billing Requested............ 7. 225,328 . 69 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 968,581 .34 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 62 , 656.09 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 80,700 . 05 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 143,356. 14 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 825,225 . 20 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. 825,225.20 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 540,276. 94 15. 0. 00 (a)(1.2)X.00 16. Amount of Line 14 taxable 284, 948.26 16. 12,822 . 67 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 . 00 18. 0 . 00 at collateral rate X.1 5 19. TAX DUE................................................................................................................ 19. 12 , 822 . 67 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-12-0934 Decedent's Complete Address: DECEDENT'S NAME Fry, Ralma C. STREET ADDRESS 49 West King Street CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 12,822.67 2. Credits/Payments A. Prior Payments 13,000.00 B. Discount 641.13 Total Credits(A +B) (2) 13,641.13 3. Interest (3) 4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (4) 818.46 Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 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;............................................................................... ❑ lil b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ c. retain a reversionary interest;or............................................................................................................... x d. receive the promise for life of either payments,benefits or care?............................................................ El x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receivingadequate 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 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)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(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. Rw-ta02 EX+(01.10( SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry, Ralma C. 21-12-0934 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is darned as the price at which property would be exchanged between a willing buyer and a willing mailer,neither t compelled to buy or sell,both having reasonable knowledge of the relevant(a e. Real property Mat Is jointly-owned with ftM of survivorship must be dbdosed on schedule F. Attach a copy of the settlement sheet If the property has been sold Include a copy of the heed showing decedent's Interest H owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real estate situate at 49 W.King Street,Shippensburg,Cumberland Co., PA-assessed value 335,400.00 $335,400 x common level ratio 1%=$335,400 TOTAL(Also enter on Line 1,Recapitulation) 335,400.00 (H more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev.01-10) Rev-1503 EX-(848) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF FILE NUMBER Fry, Ralma C. 21-12-0934 All property)olmlyowned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH F&M Trust Co_.IMA 30298200 1 1,455.539 shares of Federated Total Return Bond Fund 328 11.45 16,665.92 2 269.211 shares of Harbor International Fund No.011 55.71 14,997.74 3 473.902 shares of Heartland Group Inc. 29.03 13,757.38 4 810.811 shares of Ivy Mid Cap Growth Fund No.490 17.95 14,554.06 5 926.646 shares of JP Morgan Val Adv Select Fund1399 20 18,532.92 6 1,363.636 shares of PIMCO Total Return Fund 35 11.3 15,409.09 7 620.417 shares of Thornburg International Value I No.209 25.21 15,640.71 8 962.037 shares of Vanguard Bond Index Fund No. 1349 10.63 10,226.45 9 2,235.733 shares of Vanguard Fixed Income Secs Fund 39 10.75 24,034.13 10 746.023 shares of Vanguard Index Fund No.861 23.52 17,546.46 F&M Trust Co..IMA 30298200 11 50 shares of 3M Co. 88.975 4,448.75 12 50 shares of Abbott Labs 63.785 3,189.25 13 100 shares of Accenture Plc Ireland She Class A 59.05 5,905.00 14 150 shares of Amerisource-Bergen Corp. 39.135 5,870.25 Total of Continuation Schedules See attached TOTAL(Also enter on Line 2, Recapitulation) 326,466.13 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1600 Schedule B(Rev.6-98) Rsv-1503 EX-(e-98) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry, Ralma C. 21-12-0934 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 15 50 shares of Apache Corp. 87.135 4,356.75 16 400 shares of Applied Materials Inc. 11.365 4,546.00 17 100 shares of Automatic Data Processing Inc. 55.255 5,525.50 18 50 shares of Becton Dickinson&Co. 74.215 3,710.75 19 50 shares of Caterpillar Inc. 84.375 4,218.75 20 150 shares of Comcast Corp New 31.76004 4,764.01 21 75 shares of Disney Walt Co. 48.585 3,643.88 22 50 shares of E.I.Du Pont De Nemours&Co. 50.34 2,517.00 23 115 shares of Exelon Corp. 37.60495 4,324.57 24 100 shares of Fastenal Co. 39.745 3,974.50 25 185 shares of Franklin Financial Services Corp 13.12 2,427.20 26 100 shares of General Mills Inc. 38.2576 3,825.76 27 100 shares of Halliburton Co. 28.355 2,835.50 28 50 shares of Heintz H J Co. 54.015 2,700.75 29 25 shares of International Business Machines 194.11 4,852.75 30 225 shares of IShares DJ US Telecom 22.41 5,042.25 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule 8(Rev.6-98) R".1503 EX+(648) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry, Ralma C. 21-12-0934 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 31 50 shares of IShares S&P Global Materials 55.78 2,789.00 32 35 shares of Johnson&Johnson 67.4575 2.361.01 33 100 shares of JP Morgan Chase&Co. 36.025 3,602.50 34 50 shares of L-3 Communications Holdings Inc. 73.275 3,663.75 35 75 shares of National Oilwell Varco Inc. 64,13 4,809.75 36 50 shares of Nike, Inc,Class B 87,8 4,390.00 37 50 shares of Norfolk Southern Corp. 71.40 3,570.00 38 50 shares of Nucor Corp. 37.885 1,894.25 39 25 shares of Occidental Petroleum Corp. 84.55 2,113.75 40 175 shares of Oracle Corp. 29.25 5,118.75 41 50 shares of Pepsico Inc. 70.235 3,511.75 42 100 shares of Procter&Gamble Co. 60.905 6,090.50 43 50 shares of Sempra Energy 68.76 3,438.00 44 175 shares of Sysco Corp. 29.665 5,191.38 45 100 shares of Technology Select Sector 28.565 2,856.50 46 100 shares of Travelers Companies Inc. 63.735 6,373.50 Copyright(c)2002 form software only The Lackner Group,Inc. Fonn PA-1500 Schedule 8(Rev.6-98) R".1507 EX*(6.96) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry,Ralma C. 21-12-0934 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 47 50 shares of United Parcel Service Inc. 78.02 3,901.00 48 25 shares of Visa Inc. 122.785 3,069.63 49 55 shares of Wal-Mart Stores Inc. 69.14 3,802.70 F&M Trust Co..ILIA 30298200 50 $10,000 $10,000 HSBC Financial Corporation -dated 98.65625 9,865.63 1212312012; due 12115/2012;rate 2.25% Accrued interest on Item 50 through date of death 8.75 TOTAL(Also enter on Line 2,Recapitulation) 326,466.13 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98) Rev-150e EXa(11.10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry,Ralma C. 21-12-0934 Ihdude the proceeds of lirpation and the tlete ttw proceeds were received by the estate. All property)aedyowrt.d vdth the rlyM of euMroraMp rrwat bs dlaclosed on aehsduk F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Dividend Declared to Shareholders of Record Prior to Death and Paid After Death: 1 Automatic Data Processing Inc.-Dividend recorded 610812012;payable 7/01/2012 39.50 2 Heintz H J Co.-Dividend recorded 6122/2012; payable 7/10/2012 25.75 3 Nike,Inc,Class B-Dividend recorded 6104/2012;payable 71212012 18.00 4 Nucor Corp.-Dividend recorded 612912012;payable 8/10/2012 18.25 5 Occidental Petroleum Corp.-Dividend recorded 6108 12012; payable 711512012 13.50 6 Sempra Energy -Dividend recorded 6/2712012; payable 711512012 30.00 7 Vanguard Bond Index Fund No.1349-Dividend recorded 6129/2012;payable 7/2/2012 13.03 8 Vanguard Fixed Income Secs Fund 39-Dividend recorded 612912012;payable 7/2/2012 45.23 FB,M Trust Co..IMA 30298200 9 $20,000 $20,000 BMW Bank,Certificate of Deposit-dated 0711812007;due 0711812012; rate 20,037.50 5.4% Accrued interest on Item 9 through date of death 482.30 10 $25,000 $25,000 Capital One Bank USA National Association-dated 09/0312008;due 26,250.00 09/03/2013;rate 5% Accrued interest on Item 10 through date of death 404.11 11 $30,000 $30,000 Ally Bank -dated 11/26/2010;due 1112612014;rate 1.75% 30,543.75 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 5, Recapitulation) 81,386.52 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rw-1IWW EXt(11.10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Fry, Ralma C. 21-12-0934 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Accrued interest on Item 11 through date of death 48.90 F&M Trust Co..IMA 30298200 12 F&M Trust Co., Money Market for Account No.30298200 416.70 13 Toyota 3,000.00 TOTAL(Also enter on Line 5,Recapitulation) 81,386.52 Copyright(c)2010 forth software only The Lackner Group,Inc. Forth PA-1500 Schedule E(Rev. 11-10) Rw-1610 EXt(06.00) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT TAX REVENUE RETURN INHERITANCE TAX RET MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry,Ralma C. 21-12-0934 This schedule must be completed aril filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THINCLUDE T NAME TROANSFER. ATTAC A COPRYEOF THE DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 F&M Trust Co., IRA 68299800-Beneficiary-Donald 225.328.69 100.000% 225,328.69 Fry,husband TOTAL(Also enter on Line 7,Recapitulation) 225,328.69 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1600 Schedule G(Rev.08-09) REV-1511 EXa(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDEN'TDECEDENT TURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Fry, Ralma C. 21-12-0934 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 10,252.01 _ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Donald A. Fry Street Address 49 W. King St. City Shippensburg State PA zip 17257 Year(s)Commission Paid 25,300.00 2. Attomev's Fees Salzmann Hughes, P.C. 20,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) 3,500.00 Claimant Donald A. Fry Street Address 49 West King Street City Shippensburg State PA ZiD 17257 Relationship of Claimant to Decedent Spouse 4. Probate Fees 596.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,007.58 See continuation schedule(s)attached TOTAL(Also enter on line 9,Recapitulation) 62,656.09 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10.09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Fry,Ralma C. 21-12-0934 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exuenses 1 Folgersanger-Bricker Funeral Home,Inc.-funeral services 6,865.84 2 Kathy's Deli,LLC-funeral luncheon 3,386.17 H-A 10,252.01 Other Administrative Costs 3 F&M Trust Co.-date of death valuation for assetslsecurities needed in order to administer 164.30 the estate 4 F&M Trust,fee based on Estate IMA 30298201 balance on-9/30112 219.74 5 F&M Trust,fee based on Estate IMA 30298201 balance on-10/25/2012 329.67 6 F&M Trust,fee based on Estate IMA 30298201 balance on-11/27/12 260.12 7 F&M Trust,fee based on IMA 30298200 balance on-8/27112 309.87 8 F&M Trust,fee based on IMA 30298200 balance on-7125/12 299.88 9 F&M Trust,fee based on IMA 30298200 balance on-9130112 114.84 10 Register of Wills -filing fees 30.00 11 Register of Wills -short certificate 4.00 12 Salzmann Hughes,P.C.-reimbursement for payment to Cumberland Law Journal for legal 75.00 advertising 13 Salzmann Hughes,P.C.-closing costs and final fees for Income tax preparation,recording 1,000.00 deed,postage and miscellaneous contingencies in order to administer the estate Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Fry,Ralma C. 21-12-0934 ITEM NUMBER DESCRIPTION AMOUNT 14 The Sentinel-Legal-Legal advertising 200.16 H-B7 3,007.58 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-7512 EX-(12-09) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT REVE INHERITANCE ANCE TAX RETURN NUE MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry,Ralma C. 21-12-0934 Report deft Incurred by dN decadent prior to death that remained unpaid at au daft of dsaM,Including umeimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 F&M Trust-Loan Account No.318367 18,198.75 2 F&M Trust-Loan Account No.705001004 62,501.30 TOTAL(Also enter on Line 10,Recapitulation) 80,700.05 (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) REV-1613 EX-101.10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Fry, Ralma C. 21-12-0934 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions,and transfers under Sec.9116(a)(1.2)] 1 Donald C. Fry Husband First$30,000 540,276.94 49 West King Street 1 12rd Residue Shippensburg, PA 17257 2 Colby A.R.Fry Son 1 18th Residue 71,237.07 405 Westover Road Shippensburg, PA 17257 3 Timothy D. Fry Son 1/8th Residue 71,237.07 24 Silver Maple Drive Boiling Springs, PA 17007 4 Abigail K. Hanson Daughter 1/8th Residue 71,237.06 5303 N.7th Street Unit 205 Phoenix,AZ 85014 5 Katherine Y.Fry Daughter 118th Residue 71,237.06 121 W. King Street Apt.4 Shippensburg,PA 17257 Total 825,225.20 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as approp 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 SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) m Tax Mapper Cumberland County, PA _ a r k 5 T { /W u t � P w a Lk , rte; :opyright 2011 Esri. All rights reserved. Mon Aug 27 2012 02:22:01 PM. 9 W KING STREET ;PIN: 34-34-2415-024 Oeed book: 0036K-00128 Owner: FRY, RAIMA C Land Use Code: 101 Property Type: R Acreage: 0.52 Square Feet: 5268 T'�xable Status: T Clean & Green Status: Land Assessed Value $: 38000 Building Assessed Value $: 297400 Total Assessed Value $: 335400 Sale Price $: 150000 $`ale Date: Wed Jul 14 1993 08:00:00 PM `('ear Built: 1840 Municipality: SHIPPENSBURG WEST WRD F4eight in Stories: 2 rYpe of Dwelling: DETACH Primary Exterior: Brick Gasement Percentage: 50 Air Conditioning: AC Total Rooms: 11 Gedrooms: 3 Full Bath: 3 Half Bath: Estate Valuation Date of Death: 06/29/2012 Estate of: Fry, Ralma C., IMA Valuation Date: 06/29/2012 Account: 30298200 Processing Date: 08/28/2012 Report Type: Date of Death Number of Securities: 53 File ID: FRY RALMA IMA Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 10000 HSBC FIN CORP HSBC FIN (40429XYM2) Financial Times Interactive Data DTD: 12/23/2010 Mat: 12/15/2013 2.25% 06/29/2012 98.65625 A/B 98.656250 9,865.63 Int: 06/15/2012 to 06/29/2012 8.75 2) 20000 BMW BK NORTH AMER UTAH (05568PBW6) Financial Times Interactive Data DTD: 07/18/2007 Mat: 07/18/2012 5.48 06/29/2012 100.18750 A/B 100.187500 20,037.50 Int: 01/18/2012 to 06/29/2012 482.30 Note: Put Option on DOD 3) 25000 CAPITAL ONE BK USA NATL ASSN (140420CS7) Financial Times Interactive Data DTD: 09/03/2008 Mat: 09/03/2013 58 06/29/2012 105.00000 A/B 105.000000 26,250.00 Int: 03/03/2012 to 06/2912012 404.11 Note: Put Option on DOD 4) 30000 ALLY BK MIDVALE UTAH (02004M7D9) Financial Times Interactive Data DTD: 11/26/2010 Mat: 11/26/2014 1.755 06/29/2012 101.81250 A/B 101.812500 30,543.75 Int: 05/26/2012 to 06/29/2012 48.90 Note: Put Option on DOD 5) 1455.539 FEDERATED TOTAL RETURN SERS (31428Q101) TOTL RET INSTL Mutual Fund (as quoted by NASDAQ) 06/29/2012 11.45000 Mkt 11.450000 16,665.92 6) 1363.636 PIMCO FDS PAC INVT MGMT SER (693390700) TOTAL RETRN PT Mutual Fund (as quoted by NASDAQ) 06/29/2012 11.30000 Mkt 11.300000 15,409.09 7) 2235.733 VANGUARD FIXED INCOME SECS FD (922031406) SHTM INVGR INV Mutual Fund (as quoted by NASDAQ) 06/29/2012 10.75000 Mkt 10.750000 24,034.13 Div: 0.01992 Ex: 06/29/2012 Rec: 06/29/2012 Pay: 07/02/2012 45-23 8) 962.037 VANGUARD BD INDEX FD INC (921937850) SHTRM BDIDX SI Mutual Fund (as quoted by NASDAQ) 06/29/2012 10.63000 Mkt 10.630000 10,226.45 Div: 0.01355 Ex: 06/29/2012 Rec: 06/29/2012 Pay: 07/02/2012 13-03 9) 926.646 JPMORGAN TR I (4812A2595) VAL ADVTG SEL Mutual Fund (as quoted by NASDAQ) 06/29/2012 20.00000 Mkt 20.000000 18,532.92 10) 810.811 IVY FDS INC (466001609) MID CAP GWTH I Mutual Fund (as quoted by NASDAQ) 06/29/2012 - 17.95000 Mkt 17.950000 14,554.06 Page I This report was produced with EstateVal, a product of Estate Valuations 6 Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) Date of Death: 06/29/2012 Estate of: Fry, Ralma C., IMA Valuation Date: 06/29/2012 Account: 30298200 Processing Date: 08/28/2012 Report Type: Date of Death Number of Securities: 53 File ID: FRY RALMA IMA Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 11) 746.023 VANGUARD INDEX FOS (922908827) SML CP GRW INV Mutual Fund (as quoted by NASDAQ) 06/29/2012 23.52000 Mkt 23.520000 17,546.46 12) 473.902 HEARTLAND GROUP INC (422352849) VAL PLUS INSTL Mutual Fund (as quoted by NASDAQ) 06/29/2012 29.03000 Mkt 29.030000 13,757.38 13) 269.211 HARBOR FD (411511306) INTL FD INSTL Mutual Fund (as quoted by NASDAQ) 06/29/2012 55.71000 Mkt 55.710000 14,997.79 14) 620.417 THORNBURG INVT TH. (885215566) GLOBAL VALUE I Mutual Fund (as quoted by NASDAQ) 06/29/2012 25.21000 Mkt 25.210000 15,690.71 15) 150 COMCAST CORP NEW (20030N101) CL A The NASDAQ Stock Market LLC 06/29/2012 31.99000 31.20500 H/L 31.597500 Div: 0.162500 Ex: 06/29/2012 Rec: 07/03/2012 Pay: 07/25/2012 + 0.162500 31.760000 4,764.01 16) 75 DISNEY WALT CO (254687106) COM DISNEY New York Stock Exchange 06/29/2012 48.95000 48.22000 H/L 48.585000 3,643.88 17) 55 WAL-MART STORES INC (931142103) COM New York Stock Exchange 06/29/2012 69.72000 68.56000 H/L 69.140000 3,602.70 18) 50 NIKE INC (654106103) CL B New York Stock Exchange 06/29/2012 90.50000 85.10000 H/L 87,800000 4,390.00 Div: 0.36 Ex: 05/31/2012 Rec: 06/04/2012 Pay: 07/02/2012 18.00 19) 100 GENERAL MLS INC (370334104) COM New York Stock Exchange 06/29/2012 38.54000 37.97520 H/L 38.257600 3,825.76 20) 50 HEINZ H J CO (423074103) COM New York Stock Exchange 06/29/2012 54.42000 53.61000 H/L 54.015000 2,700.75 Div: 0.515 Ex: 06/20/2012 Rec: 06/22/2012 Pay: 07/10/2012 25.75 211 50 PEPSICO INC (713948108) COM New York Stock Exchange 06/29/2012 70.66000 69.81000 H/L 70.235000 3,511.75 Page 2 This report was produced with EstateVal, a product of Estate Valuations s Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) Date of Death: 06/29/2012 Estate of: Fry, Ralma C., IMA Valuation Date: 06/29/2012 Account: 30298200 Processing Date: 08/28/2012 Report Type: Date of Death Number of Securities: 53 File ID: FRY RALMA IMA Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals value 22) 100 PROCTER & GAMBLE CO (742718109) COM New York Stock Exchange 06/29/2012 61.27000 60.54000 H/L 60.905000 6,090.50 23) 175 SYSCO CORP (871829107) COM New York Stock Exchange 06/29/2012 29.86000 29.47000 H/L 29.665000 5,191.38 24) 50 APACHE CORP (037411105) COM New York Stock Exchange 06/29/2012 87.93000 86.34000 H/L 87.135000 4,356.75 25) 100 HALLIBURTON CO (406216101) COM New York Stock Exchange 06/29/2012 28.61000 28.10000 H/L 28.355000 2,835.50 26) 75 NATIONAL OILWELL VARCO INC (637071101) COM New York Stock Exchange 06/29/2012 64.92000 63.34000 H/L 64.130000 4,809.75 27) 25 OCCIDENTAL PETE CORP DEL (674599105) COM New York Stock Exchange 06/29/2012 85.83000 83.27000 H/L 84.550000 2,113.75 Div: 0.54 Ex: 06/06/2012 Rec: 06/08/2012 Pay: 07/15/2012 13.50 28) 100 AUTOMATIC DATA PROCESSING INC (053015103) COM The NASDAQ Stock Market LLC 06/29/2012 55.66000 54.85000 H/L 55.255000 5,525.50 Div: 0.395 Ex: 06/06/2012 Rec: 06/08/2012 Pay: 07/01/2012 39.50 29) 185 FRANKLIN FINL SVCS CORP (353525108) COM OTC Bulletin Board 06/29/2012 13.12000 13.12000 H/L 13.120000 2,427.20 30) 100 JPMORGAN CHASE & CO (46625H100) COM New York Stock Exchange 06/29/2012 36.80000 35.25000 H/L 36.025000 3,602.50 31) 100 TRAVELERS COMPANIES INC (89417E109) COM New York Stock Exchange 06/29/2012 64.02000 63.45000 H/L 63.735000 6,373.50 32) 25 VISA INC (928260839) COM CL A New York Stock Exchange 06/29/2012 124.04000 121.53000 H/L 122.785000 3,069.63 33) 50 ABBOTT LABS (002824100) COM New York Stock Exchange 06/29/2012 64.47000 63.10000 H/L 63.785000 3,189.25 Page 3 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) Date of Death: 06/29/2012 Estate of: Fry, Ralma C., IMA Valuation Date: 06/29/2012 Account: 30298200 Pr3cessing Date: 08/28/2012 Report Type: Date of Death Number of Securities: 53 File ID: FRY RALMA IMA Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 34) 35 JOHNSON & JOHNSON (478160104) COM New York Stock Exchange 06/29/2012 67.70000 67.21500 H/L 67.457500 2,361.01 35) 50 BECTON DICKINSON & CO (075887109) COM New York Stock Exchange 06/29/2012 74.75000 73.68000 H/L 74.215000 3,710.75 36) 150 AMERISOURCEBERGEN CORP (03073E105) COM New York Stock Exchange 06/29/2012 39.35000 38.92000 H/L 39.135000 5,870.25 37) 50 CATERPILLAR INC DEL (149123101) COM New York Stock Exchange 06/29/2012 84.94000 83.81000 H/L 84.375000 4,218.75 38) 50 NORFOLK SOUTHERN CORP (655844108) COM New York Stock Exchange 06/29/2012 71.77000 71.03000 H/L 71.400000 3,570.00 39) 50 3M CO (88579Y101) COM New York Stock Exchange 06/29/2012 89.60000 88.35000 H/L 88.975000 4,448.75 401 50 UNITED PARCEL SERVICE INC (911312106) CL 8 New York Stock Exchange 06/29/2012 78.76000 77.28000 H/L 78.020000 3,901.00 41) 100 FASTENAL CO (311900104) COM The NASDAQ Stock Market LLC 06/29/2012 40.31000 39.18000 H/L 39.745000 3,974.50 42) 400 APPLIED MATLS INC (038222105) COM The NASDAQ Stock Market LLC 06/29/2012 11.47000 11.26000 H/L 11.365000 4,546.00 43) 25 INTERNATIONAL BUSINESS MACHS (459200101) COM New York Stock Exchange 06/29/2012 195.81000 192.41000 H/L 194.110000 4,852.75 44) 175 ORACLE CORP (68389X105) COM The NASDAQ Stock Market LLC 06/29/2012 29.71000 28.79000 H/L 29.250000 5,118.75 45) 50 L-3 COMMUNICATIONS HLDGS INC (502424104) COM New York Stock Exchange 06/29/2012 74.05000 72.50000 H/L 73.275000 3,663.75 Page 4 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.2.0) Date of Death: 06/29/2012 F&M TRUST - IMA 30298200 Estate of: Fry, lm a3C., IMA O Valuation Date: 06/29/2012 Report Type: Date of Death Processing Date: 08/26/2012 Number of Securities: 53 File ID: FRY RALMA IMA Mean and/or Div and Int Security Shares Security High/Ask Low/Bid Adjustments Accruals Value or Par Description 46) 100 SELECT SECTOR SPDR TR (81369Y803) TECHNOLOGY NYSE Arca Equities Exchange 28,77000 28.36000 H/L 06/29/2012 28.565000 2,856.50 47) 100 ACCENTURE PLC IRFLAND (G1151C101) SHS CLASS A New York Stock Exchange 60.09000 54.01000 H/L 06/29/2012 59.050000 5,905.00 48) 50 DU PONT E I DE NEMOURS & CO (263534109) COM New York Stock Exchange 50.70000 49.98000 H/L 06/29/2012 50.340000 2,517.00 49) 50 NUCOR CORP (670346105) COM New York Stock Exchange 38.10000 37.67000 H/L 06/29/2012 37.885000 1,894.25 Div: 0.365 Ex: 06/27/2012 Rec: 06/29/2012 Pay: 08/10/2012 18.25 50) 50 ISHARES TR (464288695) S&P GLB MTRLS NYSE Arca Equities Exchange 56.11000 55.95000 H/L 06/29/2012 55.780000 2,789.00 51) 225 ISHARES TR (464287713) DJ US TELECOMM NYSE Arca Equities Exchange 22 49000 22.33000 H/L 06/29/2012 22.410000 5,042.25 52) 115 EXELON CORP (30161N101) COM New York Stock Exchange 37.84000 37.36990 H/L 06/29/2012 37.604950 4,324.57 53) 50 SEMPRA ENERGY (816851109) COM New York Stock Exchange 69.23000 68.29000 H/L 06/29/2012 68.760000 3,438.00 Div: 0.6 EX: 06/25/2012 Rec: 06/27/2012 Pay: 07/15/2012 30.00 $403,280.63 Total Value: $1,141.32 Total Accrual: Total: $404,435.27 Money Market Account $ 416.70 Security Value 403,288.63 Div & Int Accurals 1,147.32 $404,852.6'5 Page 5 This report was produced have questions, x � r71 DO }•I w "0 w a � s ss' ss o s 's sa sa V p YYFff« O 1'l II~ O N M P O j5 p 1-r M • Y N M N N r it 99 IL M N = » s sp Aar as « p p ' as I g rn N 00 CD N R A 9 �! O N 819 MIS! aka yFyam RR� : aRA qF � ssge� /N� W » N M M N ul W� 8� 4 = N Lm .p. p , a s : Fax To: Salzmann Hughes PC From: Anita Henry Fax: 717-249-7334 Pages: 1 Date: 10/31/2012 Phone: 717-261-3605 Re: Date of Death Balances Email: anita.henry@f-mtrust.com AWL George Douglas 111 Urgent © For Review Q Please Comment Please Reply ❑Please Recycle Comments: Customer Name: Ralma C Fry 318367-$18,198,75 Line of Credit Account balance due at death' 705001004-$62,501.30 Mortgage Account balance due at death Mailing address:F&M Trust Company,Attn:Loan Servicing,P.O.Box 6010,Chambersburg,PA 17201 Overnight address is 20 S.Main St.Chambersburg PA 17201 THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE ADDRESSEE AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED AND CONFIDENTIAL, IF YOU ARE NOT THE INTENDED RECIPIENT.YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR,PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE. 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