HomeMy WebLinkAbout05-22-13 (2) --� REV-1500 EXP2-11) 1606610143
PA Department of Revenue OFFICIAL USE ONLY
Pennsylvania
Bureau of Individual Taxes ummrmwror REVENUE courRy Coae veer Foe NUrrber
BOX f
Harrisburg,PA 1 7126-0Ut INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 12 01243
ENTER DECEDENT INFORMATION BELOW
11 24 2012 04 23 1925
Decedent's Last Name Suffix Decedent's First Name
Mt
SHAFER VERNA R
(It Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name ml
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 ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death
Prior to 124332)
❑ 4. Limited Estate ❑ 4a.Future Interest Compmmse S. Federal Estate Tax Return Required
(dated death after 12.12.32) ❑ q
3-{ADecedent t Copy of N6�} ❑ 7- (ACa Cry�T�7a LMrng Trust 1 B. Total Number of Safe Deposit Boxes
❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Deal h ❑ 11,Election to tax under Sac.9113(A)
barman 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
Daytime Telephone Number
ROBERT G FREY 717 24 X5838 M
rn
:�O Z3 4D o
v
REGISTER r
DO Wtt1r— ONLY_
-v ^> ry rr1
First Line of Address a `= M N
Z:
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5 SOUTH HANOVER STREET cn "
Second Line of Address
City or Post Office State ZIP Code DATE FILED "IQ `TI
CARLISLE PA 17013
Correspondent's e-mail address: rfrey @freytiley.com
Under penaHias of perjury,I declare that I havo exandiand this return,including a =Panying schedules and statements,and to the best of knows
it is flue,correct and complete.Declaration of preparer other,than the personal representative is based on all information of which preparer has any knoedgwtedge hehef,
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS Y
Michael Lee Railing A 2t zot3
67 Courtyard Drive, Carlisle, PA 17013
SIGN T R OF PR R FERT AN REPRf7ENT ATIVE
OR±E
Robert G Frey t Z/ �—°t
ADDRESS
Frey and Tiley
6 South Hanover Street, Carlisl , A 17013
Side 1
1606610143 1606610143
J 1605610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2. 393 , 048 . 52
3. Closely Held 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. 49 , 562 . 4 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 13 , 995 . 05
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7, 78 , 117 . 37
8. Total Gross Assets(total Lines 1 through 7).......................................................... B. 534 723 . 4 1
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 23 , 108 . 50
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 2 , 255 . 84
11. Total Deductions(total Lines 9 and 10).................................................................. 17 25 , 364 . 34
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12, 509 , 359 . 07
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. 13. 105 , 811 . 66
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14, 403 , 547 , 41
TAX COMPUTATION-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 15.
16. Amount of Line 14 taxable
at lineal rate X .045 16
17. Amount of Line 14 taxable
at sibling rate ,12 17
18. Amount of Line 14 taxable
at collateral rate .15 403 , 547 . 41 18. 60 , 532 . 11
19. TAX DUE................................................................................................................... 19.
60 , 532 . 11
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 1606610243 1505610243 J
REV-1500 EX Page 3 File Number 21 - 12 - 01243
Decedent's Complete Address:
DECEDENTS AM
Shafer, Verna R
STREETADDRESS
68 Magaw Avenue
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits-
1, Tax Due(Page 2,Line 19) (1) 60,632.11
2. CreditslPayments
A. Prior Payments 60,000.00
B. Discount 2,631.68
Total Credits(A +B) (2) 62,631.68
3. Interest
(3) 0.00
4, !f Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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) 7,900.63
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:................................................._........... T
b. retain the right to designate who shall use the property transferred or its income:....................................
c. retain a reversionary interest;or......................._..........................................................................._..._.......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
receivingadequate consideration?........................................................_.__....................................._.........._._.. ❑
3. Dirt decedent own an"in trust foe or payable upon death bank account or security at his or her death?......... ❑ ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?...........-......................................................................................................... ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
o . .. ,z, ,_ ... .
Far 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 RS_§9116
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) il)]. 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,wfiether by bloo�or adoption.
REV-0303 EX.(6-98)
SCHEDULE B
CCM.YMWEAITH OF PENNS VMIA STOCKS & BONDS
MHERRANCE TAX RETURN
RE9IOENT OECEOMT
ESTATE OF Shafer, Verna R FILE NUMBER
21 12 01243
All propertyjointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 Orrstown Financial Services Acct. 00068235190 15,308.00
2 Orrstown Financial Services Acct. 4N2009971 347,353.00
3 US Savings Bonds. See attached itemization 30,387.52
TOTAL(Also enter on line 2, Recapitulation) 393,048.52
T pennsylvania SCHEDULE E
DEPARTMENT A REVENUE LCASH,PBANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN RESIDEM DECEDEM ERSONAL PROPERTY
ESTATE OF Shafer, Verna R FILE NUMBER
21 12 01243
Include the proceeds of litigation and the date the proceeds were received by the estate. All propertyjointlyowned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF
DEATH
1 Furniture and miscellaneous tangible personal property, auctioneer list attached 5,445.00
2 Members 1st Account 304705-00 438.00
3 Members 1st Account 304705-50 5,061.00
4 Wells Fargo Account, checking account 0706 38.52
5 Furniture and miscellaneous tangible personal property distributed to heirs. List attached. 16,888.00
6 Wells Fargo certificate of deposit, 0767 10,284.50
7 Wells Fargo certificate of deposit, 7736 5,185.20
8 Wells Fargo certificate of deposit, 7737 6,222.25
TOTAL(Also enter on Line 5, Recapitulation) 49 r 562.47
REV-1509 EX.(01.1o)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE F
INHERITANCE TAX
RESIDENT DECEDENT RETURN JOINTLY-OWNED PROPERTY
ESTATE OF
Shafer, Verna R FILE NUMBER
21 - 12-01243
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS
RELATIONSHIP TO DECEDENT
Brenda K. Bradley, 88 Cedar St., Niece
A Mt. Holly Springs, PA 17065
JOINTLY OWNED PROPERTY: ppFF SUP ITEM LETTER DATE Include name OR ancialTnOstitSU anOd bank account numbe DATE OF DEATH %OF DATE OF BATH
NUMBER FOR JOINT MADE or similar identify! number.Attach deed for olntl held real VALUE OF ASSET DECD'S VALUEOF
TENANT JOINT estate. 9 ) Y INTEREST DECEDENT'SINTEREST
1 A 11/13/1991 Wells Fargo checking acct 0374 15,961.76 50% 7,980.88
2 A 07/28/2011 Wells Fargo Savings acct. 7030 12,028.33 50% 6,014.17
TOTAL(Also enter on line 6, Recapitulation) 13,995.05
REV-1510 EX+(0949)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE G
RESIDENT DECEDENT URN INTER-VIVOS TRANSFERS &
RESIDENT DECEDEM MISC. NON-PROBATE PROPERTY
ESTATE OF Shafer, Verna R
FILE NUMBER
21 12 01243
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER Include the name of the transferee,their relationship to decedent DATE OF DEATH `M OF EXCLUSION
andthedat eof tremfer. At fachacopyafthedeedforrealesta�. VALUE OF ASSET DECD'S TAXABLE VALUE
INTEREST (IF APPLICABLE)
1 Orrstown Financial IRA 52,304.00 100% 0.00 52,304.00
2 Massachusetts Mutual Annuity 13,896.00 100% 0.00 13,896.00
3 Wells Fargo IRA 11,917.37 10000% 0.00 11,917.37
TOTAL(Also enter on line 7, Recapitulation) 78,117.37
I
REV-1511 EX+110-091
livpennsylvania SCHMULEH E
OEPARTMEM-OF REVENUE FUNERALEVEMESAND
INHERITANCETAXRETURN ^M NLS w�CW7S
RESIDENT DE TAX RE /YAY.1�1�11 fY1
ESTATE OF Shafer, Verna R FILE NUMBER
21 - 12-01243
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Eby Granite Works 119.00
2 Georges Flowers 163.00
3 Ewing Brothers Funeral Home 4,099.00
4 Funeral Luncheon 243.00
B. ADMINISTRATIVE COSTS:
t. Personal Representative's Commissions
Name of Personal Representative(s)
Michael Lee Railing 12,350.00
Street Address 67 Courtyard Drive
city Carlisle State PA zip 17013
Year(s)Commission Paid 2013
2. Attorney's Fees Frey and Tiley 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
4. Probate Fees Filing fees and short certificates 502.50
S. Accountant's Fees
61 Tax Return Preparer's Fees Included in Attorney's fees
T Other Administrative Costs
1 Harold S. Irwin, fit, Esquire 250.00
TOTAL(Also enter on line 9, Recapitulation) 23,108.50
p. Schackie H p
COMMONWEALTH OF PENNSYLVANIA A G � &
INHERITANCE ErED RN AIJ ItiIscYVe Costs�11�
RESIDENT DECEDENT
ESTATE OF Shafer, Verna R FILE NUMBER
21 - 12- 01243
T3Automobile ing in Cumberland Law Journal and The Sentinel 302.00
repairs 80.00
Page 2 of Schedule H
i
pennsylvania SCHEDULE 1
DERARTMEM OE REVENUE
tWtiEf21TANCE TAXRE7URN f DEBTS OF DECEDENT MORTGAGE E
RESIDENT DECEDENT LIABILITIES & LIENS
FILE NUMBER
ESTATE OF Shafer, Verna R
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Diakon Lutheran Social Ministries, final home expense 1,598.00
2 The Bon Ton,final bill 147.00
3 UGI 186.82
4 Met Ed 78.53
5 Century Link 11.69
6 Diakon Lutheran Social Ministries 180.80
7 Income tax owed to Pennsylvania Department of Revenue 53.00
TOTAL(Also enter on Line 10,Recapitulation) 2,256,84
.. � .
t
REV-0sf3 ex.(0wo)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENTDECEDENT
ESTATE OF Shafer,Verna R FILE NUMBER
21 - 12-01243
Y RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Tros"S)
1 TAXABLE DISTRIBUTIONS[inGuda outright spousal
distnbutions and transfers
under Sec.> 116(a)(1.2)]
1 Michael Lee Railing,67 Courtyard Dr, Carlisle, Nephew 10.7%of residue
PA 17013
2 David Eugene Warner, 1504 Macintosh Way, Nephew 10.7% of residue
Hummelstown, PA 17036
3 Linda Sue Stamey, PO Box 96, Boiling Springs, Niece 10.7%of residue
PA 17007
4 Brenda K. Bradley, 88 Cedar St., Mt. Holly Niece 103%of residue
Springs,PA 17065
I
Enter dollar amounts for distributions shown above on lines 15 through 16 on Rev 1500 cover sheet,as appropriate.
11. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Second Presbyterian Church,25%of residue 103,811.66
2 American Red Cross 1,000.00
3 Central Pennsylvania Conservancy 1,000.00
TOTAL OF PART If-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 105,811.66
REV-1513 EX-(01-10)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE J
INHERITANCE TAX RETURN
URN
ED
RESIDENT CE BENEFICIARIES continued
ESTATE OF I FILE NUMBER
Shafer, Verna R
21 - 12-01243
NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
RECEIVING PROPERTY DECEDENT (Words) (ggg)
Do Not List Trus[ee(s)
I, TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)1
5 Dianne Sue Czupil, 2 Vicksburg Ct., Niece 10.7% of residue
Mechanicsburg, PA 17050
6 Sandra Lee Weibley, 49 South Pin Oak Dr., Niece 10.7% of residue
Boiling Springs, PA 17007
7 Amy Lou Wagner, 1710 Williamsburg Way, Niece 10.7% of residue
Mechanicsburg, PA 17050
Page 2 of Schedule J
Calculation of 25%share to 2nd Presbyterian Church
Probate assets:
Investments $ 393,048.52
Cash, Bank Accts. And tangible personal propert $ 49,562.47
Expenses of Administration $ (23,108.50)
Final Bills $ (2,255.84)
Specific Bequests $ (2,000.00)
Net probate estate $ 415,246.65
Share of Second Presbyterian Church $ 103,811.66
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LAST WILL AND TESTAMENT Q7 ° - O
rnS � c TESTAMENT - 0
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2 N C7
O O
1, VERNA R. SHAFER, of Carlisle, Cumberland County, Pennsylvania, do herZY'al,�O, p list5'
and declare this to be my last will and testament, hereby revoking all wills herefofr madly f i
me. > rn
c.a "Tt
1. 1 direct my personal representative to pay all of my debts, funeral and administrative
expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed
or payable by reason of my death and interest and penalties thereon with respect to all property,
whether or not such property passes under this Will, shall be paid by my personal
representative out of my estate.
2. 1 authorize and empower my personal representative to sell any realty and/or personalty
owned by me at my death and not specifically devised or bequeathed herein, at public or private
sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple,
as I could do if living. My representative is authorized and empowered to engage in any
business in which I may be engaged at my death, for such period of time after my death as
seems expedient to said representative.
3. 1 give, devise and bequeath all of my estate of whatever nature and wherever situate as
follows:
A. The sum of$1,000 to the Carlisle Chapter of the American Red Cross, for
general purposes;
B. The sum of$1,000 to the Central Pennsylvania Conservancy; and all the
C. My 3-diamond ring to my sister, Joyce Irene Warner(or if she is deceased then
this bequest shall lapse and become a part of my residuary estate;
D. Rest, residue and remainder as follows:
1.) 25%to Second Presbyterian Church of Carlisle, in memory of Cecil and
Jessie Shafer and Lee and Edith Railing,to be used in part of the upkeep
of the Church Memorial garden; and
Z) 75% to Michael Lee Railing, Linda Sue Stamy, Brenda Kay Bradley,
David Eugene Warner, Sandra Lee Weibley, Dianne Sue Czupil and Amy
Lou Wagner, share and share alike.
4. 1 nominate and appoint Michael Lee Railing to be the personal representative of my
estate, to serve without bond. If he cannot or does not serve, then I appoint Brenda Kay
Bradley to be the substitute personal representative, also without bond.
5. 1 suggest that my personal representative retain the services of Harold S. Irwin, III,
Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30''day of July, 2007.
(SEAL)
VERNA R. SHAFER -�-
Signed, seated, published and declared by the above-named person as and for a last will and
testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
l
Calculated Value of Your Paper Savings Bond(s) Page 1 of 2
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 01/2013
lD 7'a3� f
Total price Total Value Total Interest YTD Interest
$10,500.00 $30,287.52 $19,787.52 $176.72
Bonds: 1-77 of 77
Serial Series Denont Issue Next Final Interest Value Note
# pate Accrual Maturity Issue Price Interest Rate
NA. $1,000; 07'/1986! 07/2013; ,07/20161 .., $500.00 $1,548.00 4.00%! $2,008A0
NA EE $200 08/19W 02/2013; 08/2016i _.,. $100.00x .... ,$293.68. 4.00%,r_ $399.68!
NA EE $200' 06/1986:. 06/2013;,_06/2016; ... $100.00,`. $301.60 4.00°l0 $401.60.
NA: EE $200, 06/1986: 06/2013: ,,$100.00; , $301.60 ., 4.00%0 ..$401.60
NA E 08/1986 ,02%2013 „08/2016„ $100.00..,., $293.68 4.00°I°: $393.68
NA I $1r0D0r01/2003: 02(2013:-. 01/2033:_ $1,000.00 $534.80 $1,534.80
NA 1 $1 000 01/2003,,02%20131 01/2033_;_ $1,000.00 $534.80: 3.37%,1, $1,534.80..
NA I $1,000_.01'/2003; _02/2013x„ 01/2033; $534.W 3.37% $1,534.80: "
NA, I $1,000: 01/2003 i 02/20/31 01/2033; _$1,000.00 $534"80___ ,3.37°!°; $1,534.80
NA _ I $500 .04/2002 02/20131`04/20321 $500.00 $316.40 _ 4.22°!0 $816.40'
NA, .I $500_' 04/2002 02/24133 04'/2032: $500.00 .." $316.40_, 4.22°!0 $816.40'
NA 07/1986; 07/2013.: 07/2016, ._. $500 00 $1,508 00 __ 4,00% $2,008.00
NA EE $1'000; 07/1986; 07/2013 07/2016 . . . $500.W-,..$1,508 00 4 00°l0. , $2x008.00
NA EE $200; 06/1486 06/2013 „06/20163 $100.00;_.__ $301 601 409010 ._$401.60
.... .h .. .. . -
NA EE i $2001 06/1986,/.-,06/2013: 06/20161, . $100.00~ ,...., $301.60 4.00%: ,$401.60
NA EE $200: 06/1986!-06/2013, 06/2016-! $100.00, ... _-$301.60 4.00% $401.60'
NA: EE $200 ,06%1986.;.,06(2013 ..06(2016.'-.., $100.00. ._. $301.60 4.00%w._; $401.60:. ."
NA EE _ : $200 08/1986 0212013;_,08'/2016 . $100,001; $293.68, _ 4.00% $393.68
NA_ EE _$200 08/1986 02/2013i O8/2016„- $100.04 " " . _$293 68 4 0p°!° ", $393.68,
NA EE " $200:,08/1986 02/2013 08/2016; . . , $100,00 $293.68: 4.00%, $393.68
NA. ,EE, $200: 08/19W 02/2013*„08/2016 . ,._ $100.00, $293 68; 4,00-%.P. $393.68
NA EE $100: 1041985; 04%2013 ,.,1012015; ... _.. $154„80 0%
4.01 $204.80'
NA: EE 10/1985 04/2013 10'/2615,; _$50.00 $154.80 $204.80"
NA+ EE- $100 .1011985,i,04/2013,_ .10/20151_... _ $50.00 4.00°1°: $204.80
NA.' EE_ $100/..10'/1985;_04/20131_10/2015; $50.00 $154.80: 400.%0._ ..$204.80
NA! EE $100: 09/1985;-03/2013, 09/2015i $154.80: 4.00%; $204.80
NA' EE. $109: 09/1985 .03/2013: 0912015,; $50.00 $154.,80_ . 4.00% _ $204.80.
NA' EE $100, 09/19851 03/2013 I, 0912015: , $50.00:. $154.80: 4,00°fo'. $204.80.
NA. _EE... $100: 09(1985: 03/2013.; 09/2015, $50.00,.. _, $154.80. 4.00°Jo $204.80
NA EE $100. 08/1985 08/2015:, $_50.00 $154 80 4!00%., $204.80.
NA EE $100:,08/1985; 02/2013: .,08/2015' $56X0 ,.$154.80 4.00% $204.80
NA EE _ _.$100: 0811985 02/2013: .08/2015 $50.00, _ . $154.80 , 4.00%' $204.80.
NA; EE $100 08/1985 02/2013:.-,08/2015, $50.00 $154.80 4.00%' $204.80"
NA,_. EE _. - $100.,08/1985.:1 02/2013 08(2015.:_ .. ..$50..00, _.. . 4 . ... 4.00%: .-. $204.80
NA. $100: 07/1985 . 07/2013 07/2015/ $5000 $158.88. ,
4.00%. $208.88
NA: _ EE 07/1985'_ 07/2013`. 07(2015,,, __ $50.00: ... $158.88" „ 4.000/b $208.88
NA , _EE $100; 07(1985; 07/2013: 07/20151 _ $158.88 4.00%. $208.88
NA EE, „ $100 07/1985: 07/2013. ._07/2015' $50.00 ,. _.,,$158.88. . 4.00% $208.88
NA. EE $100. 06/1985: 06/2013: 06/2015:, $50.00, $158.88 4.00% $208.88
Calculated Value of Your Paper Savings Bond(s) Page 2 of 2
NA EE $100 06/1985 06/2013...06/2015 . $50.00: $158.88 4.00°l0
NA EE $100 06/1985 06/2013 06/2015!. .00
$$0 ' $158.88 4,00
NA EE $100 _06/1985 06/2013 06/2015 $50.00 $158.88. 4100%. $208.88.
NA EE $160 05/1985 05/2013. 05/2015,
$50.00 $158,88 4.6o% $208.88
NA EE $100 05/1985; 05/2013 05/20151 $50.00. $158 8$ 4,00% $208.88;
NA EE $100 05/1985. 05/2013 . 65/2015; $50.00, $158.88: 4,00%j $208:88
NA EE .. $100- 45fI9$5: 05/2013_.,,. 05'/2015;-_ 4.00%; $208.88x, _
NA .EE $100: 05/1985 05/2013'. 05/2015' . $50.00 .. . $158,88 „4.00%. $208.8$
NA EE $100: 04/1985; 04/2013,;,, 04 2015 0
l $so.001ss.8s „a oo /° $208.8s:.
NA EE $SOQ; 04/1985. 04J2013,_. 04/2015: ., .$5014 - ,,. $158.88_.. ..400°t° $20$.$8',
NA. EE $100 04/1985: 04/2013 64/20151"' 4,001°:
NA EE 64/2013; _ $50.00, ... ° .,.. $.208.88:..
$100. 04)1985: 04/2015:
$50.00 $158.$$. 4.00%: $208.8$;
NA; .,EE _ ,_$100, 03/1985: 03/2013; 03'/2015,
NA EE $50.00_ $158 $8` 4 00,10 _ $248.88
- ...
$100: 03/1985 03/2013. 03/2015w, $SO.QO $158,88 4.00%' $208:88:
NA . EE ,_$I00. 03/1985:;, 03/2013` _03/20151_; . $50.001 $158.88 .., 4. 00% . $208.88.
NA EE $100: 03/1985: 03/2013 03/2015/
$50 00 $158.88 4.00%i $208.88;
NA; EE__'. ..$,100 02/I985 02/2013 02/2025 ., $50.00 $158.W ._.4 00°l0 ...._ $208.88, _ .....
NA. EE $100 02%1985 02/2013 02/2015 $158 88_ __4 00% ... $208.88,; ,
NA EE $100 02/1985: 02%2013! 62/2015; _ $50.00' $158.8$; 4 00%:. $208.88',11 NA: EE _ $100: 02,119$5 02/2Q13 02/2015; .. $50.00 $15$.$$:.. 4,00%;
NA; EE $100; 01/1985; 07/2013 .01/20151, $56.00 $163,08; , 4.00%; $213.08;
NA EE_ $100;_01/1985, 07/2013' 'O1/2015/... $50.00 $163.08: 4 00% $213.0$
NA EE_ $I00, O1/1985 07/2013# 01/2015; _ $50.60: $163,08!,,,-, _4 00% i $213.08,NA: EE. $100...-01/1985; 07/2013} 0112015:..., $50.00 - $163 0$ .__. 4.00%; $213.0$, _
NA EE $100: 12/1984 06/2013: 12/20141 0
NA EE $50.00 .... ...$163 08,;... ._4 00,/0,...... $213.0$.., .
8100 12/1984 06/2013. 12/2014x ._,. $50.M $16308_ 4.00%i $213.08..
NA EE,
$100 12J1984 06!2013;. 12/2014 ,_ $56.06 163 08 ... 4 00°l0: _
._.$. .. $213.08(........
NA EE _ ; $100 12/1984 06/.120.1,3,;.,_12/2014y ., $50,.00 $163 08.,_.,4.00%:
$213.0$
NA, EE $100, 12/1984 06 2013; 12/20141 0
/ $50.00 $1630$ 400 l0; $213,08,
NA_ EE ..' $100 11'/1984 . 05/2013:- 11J2014:LL. -. o
.. _.. $50.00 ..._$163 08., ...4
NA. EE _$100; 11JI984; 05/2013 11/2014.; _ $5010 _, $163 08 _.. 4.00%1., $213.08 1.NA; EE ..,'. . $100;_11/1984 05/2013 11/2014y,. $50.00 $163 0$.; 4 00%0. $213.08}
NA: EE : _._$100 11/19841 05/2013 11/2014+ $5o.00 i $163,.08: 4.00W -_ $213.0$
NA. EE , ' __$100: 11/19$4 05%2013 -_11/2014'.., -, .$50.00 $163 0$„ _' 4.00%
. $213._08
NA EE„ ' $100 10%1984 04/20131 .10/2010 ..., $50 00 $163 08 .....4 00%q_ $213.081
NA EE . - $100t 10,11984._04/2013 10/2014 . $50.001 $163.08. 4.00%: $213 48;
NA :_ $100' 10/19$4: 04/2013? 10/2614: $50.0Q __.,.,.,$163 08„_ ..4 OD°!° _. „$213.08:
NA EE. .; $160: 10/1984; 04/2013; 1,0/2014
$50.00 $163 0$ 4.00%; $213.08;
Totals for 77 Bonds: 10 500.00: 1975752 30 2$7.52:
Notes
NI Not Issued
NE Not eliglble.for payment
P5 Includes 3 month interest penalty
MA .Matured and not earning interest
tp://www.treasurydirect.gov/BC/SBCPrice r iannnr
ORRSTOWN
FINANCIAL ADVISORS
A Tradition of Excellence
December 10. 2012
Robert G. Frey
Frey&Tiley
5 South Hanover Street
Carlisle PA 17013
RE: Estate of Verna R.Shafer
Dear Mr. Frey,
As per your request following is the account information for Verna R.Shafer.
Account 4N2-585640(Pershing) IRA FBO Verna R.Shafer
Established: October,2006
Beneficiaries: 7(see attached printout from Pershing)
Date of Death Value: $ 52,304.18
Account 4N2-009971(Pershing) Verna R.Shafer
Established: September,2007
Date of Death Value: $347,353.36
Account 68235190 Verna R.Shafer
Established: October,2002
Date of Death Value: $ 15,308.35
1 have included a Combined Account Portfolio which shows the holdings in each account as
of Date of Death.
Please feel free to call with any questions.
`Sincerely,/f
Lisa A. Riggleman
Registered Representative
Encl: Combined Acct Port
IRA Beneficiary List
Securities and other investment products offered though Financial Network Investment Corporation,Member SIPC.The Orrstown Bank and
Orrstown Financial Advisors are not affiliated with Financial Network.
Holdings Investor
Verna R Shafer Lisa Riggleman Combined Account Portfolio
68 Magaw Ave Orrstown Financial Services Date: 11/23/2012
Carlisle,PA 17015 427 Village Drive Created: 12/10/2012
Carlisle, PA 17015
717-249-3737
I
Verna R Shafer
Acct Name:IRA FBO VERNA R SHAFER CETERA INVSTMNT SVC AS CUST 68 MAGAW AVE CARLISLE PA 17015-
7618
Acct No:4N2585640 AcctType:Third Party As Custodian Retirement Account
Rep.No:AWZ
Asset Name Ticker Asset Type Mgt.Name Quantity Price{;} Value{;}
}___--__ - _—�
,AT&T INC DOM T US STOCKS 7.00 34.36 240.52'
BOND FUND OF AMERICA ABNDX FIXED INCOME AMERICAN 1,636.06 12.94 21,196.44
FUNDS
BROKERAGE MONEY MARKET CASH BROKERAGE 3,606.55 1.00 3,606.55
MONEY
MARKET
COMCAST CORP NEW CL A CMCSA EQUITY 22.00 36.91 812.02
FIDELITY ADV MORTGAGE FMGAX BONDS FIDELITY 740.39 11.32 8,381.19
SECURITIES FUNDS
INVESTMENT CO OF AMERICA AIVSX US STOCKS AMERICAN 391.73 30.44 11,92420
FUNDS
IVK EQUITY AND INCOME FUND- ACEIX US STOCKS INVESCO 664.72 9.14 6,075.58
CLASS A INVESTMENT
SERVICES INC.
SPRINT NEXTEL CORP COM SER 1 S US STOCKS 12.00 5.64 67.66
Account Total: ;52,304.18
Acct Name:VERNA R SHAFER 68 MAGAW AVE CARLISLE PA 17015-7618
Acct No:00068235190 Acct Type:Individual
Rep.No:19130
Asset Name Ticker Asset Type Mgt,Name Quantity Price{;} value(;)
S INC FND OF AMECX BLEND AMERICAN 376.21 18.00
AMERICAN FUNDS 6,771.73
AMR A FUNDS
BOND FUND OF AMERICA ABNDX FIXED INCOME AMERICAN 659.71 1194 8.536.62
FUNDS
Account Total: ;15,308.35
Itwomplete 9 presented without a=mpanying disclosure pages Page 1 of 3
� r .
Holdings by Investor
Verna R Shafer Lisa Riggleman Combined Account Portfolio
68 Magaw Ave Orrstown Financial Services Date: 11123/2012
Carlisle,PA 17015 427 Village Drive Created: 12/10/2012
Carlisle,PA 17015
717-249-3737
Acct Name:VERNA R SHAFER 68 MAGAW AVE CARLISLE PA 17015-7618
Acct No:4N2009971 Acct Type:individual
Rep.No:AWZ
Asset Name _ Ticker Asset Type Mgt.Name Quantity Price($) Value($)�
.AMERICAN FUNDS CAP INC BUILOR CAIBX EQUITY AMERICAN 2,067.91 52.86 109,309.83
A FUNDS
AMERICAN FUNDS INC FND OF AMECX BLEND AMERICAN 1,953.76 18.00 35,167.68
AMR A FUNDS
;BANK OF AMERICA CORPORATION BAD DOMESTIC 43100 9.90 4,286.70!
,COM EQUITY
BROKERAGE MONEY MARKET CASH BROKERAGE 23,848.82 1.00 23.848.82
MONEY
MARKET
COMCAST CORP NEW CL A CMCSA EQUITY 61.00 36.91 2,251.51'
EATON VANCE PA LTD MAT MUNI A EXPNX BONDS EATON VANCE 5,258.81 10.44 54,902.00
-EXPRESS SCRIPTS HLDG CO COM ESRX US STOCKS 12.00 52.24 626,88
FHLMC MULTICLASS MTGPARTN FMCC331 BONDS 7,000.00 0.01 55.48
CTFS GTO SER 175 CL 175—H 965
9.500%08/15/21 B/EDTD 06115/90
GENERAL AMERN INVS INC PFD B GAM.PRB OTHER 202.00 25.61 5.173.22
5.95%
CUM INGTON INGALLS INDS INC HII US STOCKS 4.00 41.00 16400
M&T BK CORP COM MTB US STOCKS 338.00 99.67 33,688.4611
NORTHROP GRUMMAN CORP COM NOC EQUITY 2800 65.36 1,830.08
ORRSTOWN FINL SVCS INC COM ORRF US STOCKS 499.00 8.50 4,241.50
PFIZER INC COM PFE US STOCKS 67.00 24.53 1,64151
PRAXAIR INC COM PX DOMESTIC 598.00 106.93 63,944.14
EOUITY
WELLS FARGO CAP VII TRUPS WPK BONDS 24400 25.49 6,219.56
5.85%
Account Total: $347,35136
Investor Total: $414,96549
Incomplete ii presented without accompanying disclosure pages Page 2 of 3
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MEMBERS V
FMEPALCRFDFr OMON
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 304705-00
Date Account Established 04/20/2007
Principal Balance at Date of Death $437.78
Accrued Interest to Date of Death $0.06
Total Principal and Accrued Interest $437.84
Name of Joint Owner None
CERTIFICATE OF DEPOSIT
Account Number/Suffix 304705-50
Date Established 11/01/2011
Principal Balance at Date of Death $5057.46
Accrued Interest to Date of Death $3.63
Total Principal and Accrued Interest $5061.09
Name of Joint Owner None
MEMBERS ISTT FEDERAL CREDIT UNION
Tessa L Klugh
Lending Insurance Support Specialist
December 11, 2012
Estate of: Verna R Shafer
Date of Death: 11/2412012
Social Security Number: 201-18-4322
5000 Louise Drive P.O. Box 40 Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www.memberslst.org