HomeMy WebLinkAbout04-26-13 (2) 1505610140
REV-1500 EX `01-10'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 1 6 1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW
0 1 2 6 2 0 1 3 0 2 2 1 1 9 3 2
Decedent's Last Name Suffix Decedent's First Name MI
TOLBERT ROD N EY N
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
TOLBERT JOAN
Spouse's Social Security Number
2 0 8 2 4 1 7 0 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
❑X
1.Original Return 2.Supplemental Return F1 3.Remainder Return(date of death
prior to 12-13-82)
4.Limited Estate 4a.Future interest Compromise(date of ❑ 5.Federal Estate Tax Return Required
death after 12-12-82)
Q 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
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 Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J OA W. TOL BERT 71 7 532 4502
REGISTER06 WILLS USE ONLY
First line of address
1 0 6 HAMMOND ROAD `'
Second line of address
City or Post Office State ZIP Code �E FIL
S H I P P E N S B U G PA 1 7 2 5 7j �° r , C)
Correspondent's e-mail address:
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERS N RESPONSIBLE F FILIN RETURN DATE
ADDRESS
JOAN W. TOLBERT, 106 H MMOND ROAD SHIPPENSBURG PA 17257
SI RE F AR OT THAN REPRESENTATIVE ATTE/0
S
A DR SI y l 4 woo C)a+
/V PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
1505610240
REV-1500 EX Decedent's Social Security Number
DecedenfsName: RODNEY N. TOLBERT
RECAPITULATION
1. Real Estate(Schedule A) . . ... . . . . . . ...... . . . . . . . . . . . . . . . . . . . . .. . . . . 1.
2. Stocks and Bonds(Schedule B) . . . . . . . . .. . . . . . . . . . . . . . . . ............ . 2.
285518 . 64
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . ... . 3.
4. Mortgages and Notes Receivable(Schedule D) . . . .. ... . . . .. . . . . . . . . . . . . . 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .. . . . . 5. 2 4 1 1 9 9 . 4 3
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . .. . 7.
8. Total Gross Assets(total Lines 1 through 7) ........ . . . . . . . .. . .. . . . . ... 8. 5 2 6 7 1 8 . 0 7
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . .. ... . . . . 9. 2 4 1 9 0 . 4 8
10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 6 0 1 9 . 1 9
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . ......... . . ..... . . 11. 3 0 2 0 9 . 6 7
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . ... ..... . . . . . . . . . . . . . 12• 4 9 6 5 0 8 . 4 0
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. 4 9 6 5 0 8 . 4 0
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.0 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 4 9 6 5 0 8 . 4 0 16. 2 2 3 4 2 . 8 8
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE .. . . . . . .. . . . . .. . . . ..... . . . . . . . . .. .. . ..... ... . . . . . . . . . . 19. 2 2 3 4 2 . 8 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240
REVA500 EX Page 3 File Number
Decedent's Complete Address: 21 13 0161
DECEDENTS NAME
RODNEY N. TOLBERT
STREET ADDRESS
106 Hammond Road
CITY STATE ZIP
IShippensburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 22,342.88
2. Credits/Payments
A.Prior Payments
B.Discount 1,117.18
Total Credits(A+B) (2) 1,117.18
3. Interest
(3)
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 21,225.70
Make check payable to: REGISTER OF WILLS, AGENT
i ih I':,i III I fil I it I i
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; ...................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income; ...............................
❑ 191
c. retain a reversionary interest;or ................................................................................................ El ❑X
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ X❑
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... El 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?.................................................................................................. 0 ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
„I
II!!llil I i' IIII,IIIIIr�llbll I I �I �II�IVar I� !ILI�IIIIII IIII�I I ���� � IRuL01;111�IIII�'I� �a;41 �::-. I 'lltldi�,Vb,� VIII h i ,u',tlo II I,ualVll1 ur�'I L IOI�,J
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 Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-150-,A EX+(8-12)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE
INHEMTANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RODNEY N. TOLBERT 21 13 0161
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Janey Montomery Scott, LLC Acct.#8238-4979, consisting of the following
assets:
59 shares Michael Baker Corporation @25.36500 per share 1,496.54
10,905.7080 shares Wells Fargo Advantage Premium Large Company Growth-A 123,289.03
@11.305 00per share
561.4130 shares Wells Fargo Advantage Enterprise-A @39.80500 per share 22,347.04
456.3400 shares Wells Fargo Advantage Opportunity-A @41.38000 18,883.35
2. Putman Investments,Acct.#13-296368976, consisting of 786.6870 shares Putnam 37,524.97
Global Health Care Fund-A @47.70000
3. Invesco Investments, Inc., Acct.#C0000030121, consisting of 2745.186884 shares 43,991.62
Invesco, PA Value Municipal Income Trust @16.02500
4. Invesco, Investments, Inc.,Acct. #C0000022501, consisting of 2400.425090 shares 32,915.83
Invesco Advantage Municipal Income Trust@1 3.71250
5. 135 shares Metl-ife @37.55750 5,070.26
TOTAL(Also enter on Line 2,Recapitulation) $ 285,518.64
REV-1508 EY+(08-12)
Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
RODNEY N. TOLBERT 21 13 0161
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. Acct.#1710010933, Susquehanna Bank 38,119.66
2. Acct.#6210354347, Citizens Bank 59,064.65
3. Acct,#10286977, M&T Bank 0.01
4. Acct.#97555266, M&T Bank 143,865.11
5. Small two wheeled trailer for hauling in used condition 150.00
TOTAL(Also enter on Line 5,Recapitulations 1 $ 241 199.43
fr..........................,,.,.f...l .........4,4:4:-....1..hn,+a....r...----- 46...----.......
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RODNEY N. TOLBERT 21 13 0161
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 INCLUDETHE NAME OFTHETRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST OFAPPLICABLQ VALUE
1. The decedent held accounts titled in his name alone with
named beneficiary of his surviving spouse, Joan W. Tolbert.
Since there is no inheritance tax between spouses the
accounts are not listed. The decedent held no other non-
probate property other than those accounts with his
surviving spouse as the named beneficiary.
TOTAL (Also enter on Line 7,Recapitulation) $
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RODNEY N. TOLBERT 21 13 0161
Decedent's debts must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Dugan Funeral Home and Crematory,inc., funeral services 8,950.19
2. Dugan Funeral Home and Crematory, Inc., grave opening 1,495.00
3. Rolling Green Cemetery, marker 2,719.00
4. Funeral Reception 4,392.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. Attomey Fees: Joel R. Zullinger 2,500.00
3, Family Exemption:(If decedents address is not the same as claimant's,attach explanation) 3,500.00
Claimant Joan W. Tolbert
Street Address 106 Hammond Road
city Shippensburg state PA zip 17257
Relationship of Claimant to Decedent surviving spouse
4. Probate Fees: Letters-410.00; short certificates-50.00; will- 15.00; JCS fee-23.50; 583.50
automation 5.00; filing inventory 15.00; filing return 15.00; additional probate fee-50.00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. U.S. Postal Service, certified mailing for stock transfers 14.29
8. AAA Southern Pennsylvania, change joint registration on automobiles 36.00
TOTAL(Also enter on Line 9,Recapitulation) $ 24 190.48
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RODNEY N. TOLBERT 21 13 0161
Report debts incurred by the 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. Dr.Donald P.DeLorenzo, Jr., balance due for medical services 15.60
2. Chambersburg Hospital, balance due for medical services 14.03
3. West Shore Ambulance Service, balance due for medical transport 1,560.42
4. Fayetteville Volunteer Fire, ambulance transport 205.50
5. Fayetteville Volunteer Fire, ambulance transport 99.00
7. Fayetteville Volunteer Fire, ambulance transport 99.00
8. Joel R. Zullinger, Esquire, balance due for attorney fee services prior to death 200.00
9. Balance due for routine medical transport services 3,825.64
TOTAL(Also enter on Line 10,Recapitulation) $ 6,019.19
If more space is needed,insert additional sheets of the same size.
REV-1513 E;+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RODNEY N. TOLBERT 21 13 0161
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Douglas Tolbert, 150 Stony Point Avenue, Shippensburg, Lineal
PA 17257 one-third of residue
2. Jeffrey Tolbert, 34111 Juniper Drive, Sandy Brae, Lewes, Lineal
DE 19958 one-third of residue
3. Cynthia Tolbert, 31620 Post Oak Trail, Fair Oaks Ranch, Lineal
TX 78015 one-third of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
MAr. 11. 2013 1 : 15PM HC DAVIS Rio. 1231 ?. 2 --
LAST WILL rail]' 'TESTAMEIT-r
T, Rodney M. Tolbert, of 106 Hammond Road., shippensburg,
Cumberland county, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by T a
heretofore made_
1.
I direct that all my just debts and funeral expenses,
z` including all expenses of my last illness, shah be pa . f� my
3-- ° -r r rn c7r
` estate as soon. as practicable after my decease�� a pgt 6`�'j!2the
CA car
expense of the administration of my estate_ c�a
L -TT -=3
r
c,a Cn O
I give, devise and bequeath the residue of my estate of every
nature and wherever situate to my children, namely Cynthia R_
Tolbert, Jeffrey W_ Tolbert, and Douglas R_ Tolbert, in equal
shares, provided that the share of any child who predeceases me or
dies on or before the thirtieth day following my death shall be
distributed to said beneficiary's issue, per stirpes, Living on the
thirty-first day following my death, and in default of any such
then-living issue, such share shall be added to> tl'ie share or snares
far. 11. 2413 1 : 15PM HC DAVIS No. 1231 P. 3
of my other- then-Living children.
III.
rn. the event all of my children and their issue predecease me,
or die on or before the thirtieth day following my death, I give
and devise the residue of my estate of every nature and wherever
situate as follows:
A. Thirty percent thereof to Middle Spring Pxesbytexr an
Church, Shippensbuxg, Pennsylvania;
B. Ten percent thereof to the American Heart Association,
Dallas, Texas;
C. Fifteen percent thereof to the American Cancer Society,
Atlanta, Georgia;
D. Ten percent thereof to the Alzheimer's Disease & Related
Disorders Association, Chicago, Illinois;
Ten, percent thereof to the Chambexsbu.rgg Ilospita.l, Cancer
Division, Ch-ambexsburg, Pennsylvania;
F. Ten percent thereof to the Leukemia Society of America,
New York, .New York;
G. Fifteen percent thereof to the Shippern.sburg Public
Library, shippensburg,. Pennsylvania.
IV.
in the event any grandchild of mine is to receive a share of
Page 2
War. 11. 2013 1 : 15PM HC DAVIS Pia. 1231 4
my estate, his or her share shall be held, IN F JR.TH_ER SEPARATE TRUST
by .y trustees herein., Cynthia R. Tolbert, Jeffrey W. Tolbert and
Douglas R. Tolbert, for the following uses and purposes:
A. if my grandchild is under the age of eighteen years, to
expend and apply so much of the net income (any income
not expended or applied to be accumulated and added to
principal) and so much of the principal of his or her
trust as trustees shall consider advisable for the
support and education (including co?lege edur-aticxn, bcr-h
graduate and undergraduate) of that child until he or she
attains the age of twenty-three years;
B. After my grandchild attains the age of twenty-three
years, thereafter to pay such child the net income
together with so much of the principal thereof as trustee
\ shall consider advisable for the support and education.
(including college education, both graduate and
undergraduate) of such grandchild after taking into
consideration his or her other readily available assets
and sources of income;
C_ Up to one-half of the then.-remaining principal and
accumulated income at age twenty-five on the request of
the grandchild shall be distributed to the grandchild.
At or after age thirty, up to the entire balance of the
principal and accumulated income then remaining on the
request of the grandchild. Distributions at or after
these stated ages shall be made only in the event the
Page 3
Mar. N. 2013 1 : 15PM 11C DAVIS No. 1231 P. 5
grandchild requests such distribution by a wrriti ng
intended to take effect during life by that child upon or
after attaining the stated ages and delivered to the
trustee.
D. if any such grandchild shall die before receiving final
distribution of his or her entire share, the
undistributed balance shall be distributed to -ny other
grandchildren living at the time of said grand- ; id-s
death.
V.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
1
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investnterAt .funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
C_ To sell at public or private sale, to exchange or to
Page 4
'Mar. 11. 2013 1: 15PM HC DAVIS No. 1231 P. 6
lease for any period of time any rea3. of peTs��l
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
F_ To distribute in cash or in kind or partly in each-
G. To hold property in their names witbtxit desi patic t c&
any fiduciary capacity or in the name of a nominee ox-
unregistered_
J VI
I direct that all taxes that may be assessed in consequence of
r
my death of whatever nature and by whatever jurisdiction inposed,
r
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VII.
The interest of the beneficiaries hereunder shall not be
subj ect to anticipation or to voluntary or involuntary alienation;
and the principal, and income shall be paid by the trustee or
guardian directly to or for the use of the beneficiary entitled
thereto, without regard to any assignment, order, attachment or
Page 5
War. 11. 2013 1: 15PM HC DAVID No. 1231 P. 7
claim whatever.
VII1.
i appoint my wife, Joan �1, Tolbert, also known as Toarn W.
Tolbert, and my soya, Douglas R. Tolbert, as co-executors of this my
will.
IX.
No bond shall be required of any fiduciary hereunder in any
jurisdiction..
IN wITNESS w HEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of seven typewritten pages, the
first five of which bear my signature in the margin, for the purpose
of identification this � Y of „� P "
,/'C�,' �f1 �c� (SEAL)
Signed, sealed, published and declared by the above- --ted
testator as and for his last will and testament in our presence,
who in his presence, at his request and in the presence of each
other have hereunto set our hands as attesting witnesses.
y
V
44 -Al
Page 5
Isar. 11. 2413 1 : 15PM HC DAVIS No. 1231 P. 8
we, RRod�Ytey N_ Tolbert, �/�G"'/���J/.'� and
the testator and the witnesses respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn., do hereby declare to the undersigned
authority that the testator signed and executed the instrument as
his last will and testament and that he executed it as his free and
voluntary act for the purposes therein expressed and that each of
the witnesses, in the presence and .hearing of the said testator
signed the will as witnesses and to the best of their knowledge
said signer was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
Te a or
79 2
Witness
Witness
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
above-named witnesses this , day o:E
2 3 -
Nc axy Public
C211MONWtALLFH O PENNSYL.V,+ N A
Notmai Seas —"-
Cann L Wade,Nata�y p,jb
Chambers6urQ Rom.FrankM County
My 4'tttT.n15rba Expires MEy 43,2843
Page 7
Institution Name, Stock Shares field Friday 1125t20i3 Friday 112512013 Friday 1/2512013
Address Account Number Symbol Stock Name CUISP number 112612013 High Price Low Price Close Price
Janney Montogomery
Scott,LLC.
1717 Arch Street
Philadelphia,PA 19103 8238-4979 BKR Michael Baker Corporation 57149106 59.0000 $25.50000 $25.25000 $25.47000
Janney Montogomery
Scam LLC.
1717 Arch Street Wells Fargo Advantage Premium Large
Philadelphia,PA 19103 8238-4979 EKJAX Company Gwroth-A 949848496 10,905.7080 $11.32000 $11.32000 $11.32000
Janney Montogomery
Scott,LLC.
1717 Arch Street
Philadelphia,PA 19103 8238-4979 SENAX Wells Fargo Advantage Enterprise-A 949915375 561.4130 $39.87000 $39.87000 $39.87000
Janney Montogomery
Scott,LLC.
1717 Arch Street
Philadelphia PA 19103 8238-4979 SOPVX Wells Fargo Advantage Opportunity-A 949915458 456.3400 $41,40000 $41.40000 $41.40000
Putnam lnvestments
One Post Office Square
Boston,MA 02109 13-296368976 PHSTX Putnam Global Health Care Fund-A 746778-10-9 786.6870 $47.82000 $47.82000 $47.82000
invesco investment.
services,Inc.
P.O.Box 219319
Kansas City,MO
64121-9319 00000030921 VPV Imresco PA Value Municipal Income Trust 461321(109 2745.186884 $16.16000 $16.06000 $16.06000
invescoInvestment
services,Inc.
P.O.Box 219319
Kansas City,MO
64121-9319 00000022501 VKi Invesco Advantage Minicipal Income Trust 46132E103 2400.425090 $13.81000 $13.70000 $13.79000
MetL'rfe 1095
Avenue of the Americas
New York,NY 10036 00061301739 MET Met Life Inc_ 591568108 135.0000 $37.69000 $36.99000 $37.65000
RANKS
Susquehanna Bank
801 Noriand Avenue
Chambersburg,PA
17201-4212 1710010933
Citizens Bank One
Citizens Drive
Riverside,RI 02915 6210354347
M&T Bank
29 Walnut Bottom Road
Shippensburg,PA 17257 10286977
M&T Bank
29 Walnut Bottom Road
Shippensburg,PA 17257 97555266
hncfay 11Z512U13 Monday Monday Monday Monday 1128/2013 Calculated Average 1 otal Share value
Institution Name, High&ow 112812013 112WO13 112812013 HightLowAVERAGE Price for Saturday Calculated for
Address AVERAGE Price High Price Low Price Close Price Price 112612013 Saturday 1126/2013 TOTALS
Janney Montogomery
Scott,LLC.
1717 Arch Street
Phifadelphia,PA 19103 $25.37500 $25.46000 $25.25000 $25.44000 $25.35500 $25.36500 $1,496,53500
Janney Montogomery
Sc A LLC,
1717 Arch Sheaf
Philadelphia,PA 19103 $11.32000 $11.29000 $11.29000 $11.29000 $11.29000 $11.30500 $123,289.02894
Janney Montogomery
Scott,LLC.
1717 Arch Street
Philadelphia,PA 19103 $39.87000 $39.74000 $39.74000 $39.74000 $39.74000 $39.80500 $22,347.04447
Janney Montogomery
Scott LLC.
1717 Arch Street
Philadelphia,PA 19103 $41.40000 $41.36000 $41.36000 $41.36000 $41.36000 $4138000 $18,883.34920
$166,015,95761
Putnam Investments
One Post Office Square
Boston,MA 02109 $47.82000 $47.58000 $47.58000 $47.58000 $47.58000 $47.70000 $37,524.96990
$37,524.96990
Invesco investment
services,Inc.
P.O.Box 219319
Kansas City,MO
64121-9319 $16.11000 $16.12000 $1536000 $15.76000 $15.94000 $16.02500 $43,991.61982
Invesco investment
services,Inc.
P.O.Box 219319
Kansas City.MO
64121-9319 $13.75500 $13.82000 $1152000 $13.65000 $13.67000 $13.71250 $32,915.82905
$76,907.44886
MeX fe 1095
Avenue of the Americas
New York,NY 10036 $37.34000 $38.10000 $37.45000 $37.63000 $37.77500 $37.55750 $5,070.26250
$5,070.26250
BANKS
Susquehanna Bank
B01 Norland Avenue
Chambersburg,PA
17201-4212
$38,119.66
Citizens Bank One
Citizens Drive
Riverside,RI 02915 $59,064.66
M&T Bank
29 Walnut Bottom Road
Shippensburg,PA 17257
$0.01
M&T Bank
29 Walnut Bottom Road
Shfppensburg,PA 17257 $143,865.11
$528,568.07 1