HomeMy WebLinkAbout07-09-13 (2) J 1505610101 .
REV-1500 SK(01-10)
OFFICIAL USE ONLY
Bu Department d Revenue Pennsylvania
County Code Year File Number
Bureau 2IndividualTaxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg,PA 19128-o6oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number _ Date of Death MMDDYYYY Date of Birth MMDDYYYY
ogl9Ao13 1ao3r9a0
Decedent's Last Name .Suffix Decedent's First Name MI
N
L T L A D I I I I I J.0 ® t U C i ILILISI 0
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix ' Spouse's First Name T MI
® I 1 11 1 T-i 1 ❑
Spouse's Social Security Number
— THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
tililillill 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
p 4.Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
6.Decedent Died Testate p 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
p 9.Litigation Proceeds Received p 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT- THIS SE_CTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name L. j G' '.-f� Daytime Telephone Number
ICIAIFJOILI A REV Tt1AN a _ A 5173 33
„f CYO f REC,;f6TRR OFW_LLS USE 69LY
r m m rn
First line of address i. 'P cio r
ca o
I'll IFINWAYALIANI OWN IMLI VD
Second line of address
1111111111 M L*
City of Post Office _ State ZIP Code DATE FILED
Q ,}}}. I A P fl 19 l D3 12y �
Correspondent's e-mail address: ` 4 e V QL.{.l`n 0.t% S @ CSC.&&,'Q,
Under penalties of perjury,I declare that 1 have examined this return,Inducing accompanying schedules and statements,and to the best of my knovdedge 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.
SIGNATI/�s�E OF PERSON,RESPONSIBLEFhOR�fI�.ING RETURN DATE x
ADDRESS
I FPy-MY.L)N tow N I,LVO RcT 161a
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
"> ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101 ,
a
1505610105
REV-1500 EX
Decedent's
��Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate(Schedule A). ..... ..... ........ ...... ..... ....... ...... .. 1.
-2. Stocks and Bonds(Schedule B) .. ..... ................... .... ... ... ... . 2. • .
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. .,
4. Mortgages and Notes Receivable(Schedule D). .......... ..... ..... ...... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. d 4. 7 9 a: 0
6. Jointly Owned Property(Schedule F) p Separate Billing Requested .. ..... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property d
(Schedule G) O Separate Billing Requested... ..... 7. a O 0
8. Total Gross Assets(total Lines 1 through 7). ..... .... .... ..... .... ... ... 8.
9. Funeral Expenses and Administrative Costs(Schedule H)......... ..... ..... 9. '� 7 ,• & O =
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . .... .... ..... 10.
11. Total Deductions(total Lines 9 and 10). ............ ... ........ ..... .... 11. 00 - s p
12. Net Value of Estate(Line 8 minus Line 11) .. .... ............... ..... ... . 12.
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. l S 3 C
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_
16. Amount of Line 14,9xAble
at lineal rate X.0_ T 9 � _ Q ,(j 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17,
18. Amount of Line 141axable a"
at collateral rate X.15 . 18.
19. TAX DUE .... ........... ... .. .... ..................... ....:. .i... `. 19.•
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610105 1505610105
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
L Lit.t-t t-LI5 F A LTLf+NU
STREETADDRESS
o0I S?
C c%h u.<C1r., aF
CITY n 0-C \ \.S ke STATE ZIP / 9013
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19)
2. Credits/Payments
A.Prior Payments
B.Discount �� -7 7
Total Credits(A+B) (2) 4 7 a. 5
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) I f 7
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:.......................................................................................... El 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 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?.............. ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa 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.§9116(a)(1.1)(1)].
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)172 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-aSo6 EX.(ii-10)
e pennsytvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS BE MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
LtAcILLE F AL-ELAND a( (3 65,10
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
I M b T 9) K PO 6Y, 7407 6 WEST-lo MY f 4;4 a
c�ec�1 n� GG71 ,
Sa.vtvu�s 130PS„
cAsh 34
3 E Ab0"9 Ra4�a�rne�� 't�e. 5�rnn vwlt- QdA�C+vr t &30
!�
P,-I~ )Ertr (TO�c pc,�'Mwar +6 13 +� '1' Iq 15, I0 S
Hlpha ')tkcjvNC 4-c-5, LGc re +�� ak ouctQo �vw+ti� 01
rig
TOTAL(Also enter on Line 5, Recapitulation) $ a y 17 9
If more space Is needed,use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
r� pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TM RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LtxCILLC F• ALTL4Ai> 2'1 IS 0
This schedule must he 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 THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTADI A COPY OF ME DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST if APPUCAIRE) VALUE
1. r4'MeciQ (% ALTLAM0 T0.u5T , 15.;L 100 '0 r -Igo) IS ::k
�5 hA4tH+ae+ c.kFc.v�t��
TOTAL(Also enter on Line 7, Recapitulation) $ a �C) I S a
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EXi (10-06) f
E SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LLLGI LLE ( (-1C(Lf7N9 7,1 I3 aS'ID
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1.
tie 0)*5 F% nu e_1 IAcn.L , C&.v" 1 11 PA 5H"I
R-ov�ucs Qlowass, C.o�s1.s�., �A 7q. so
140V.6ca�'twm �� Fu n�,r4 I Orb oD IC;.?„
1\ec o.�>'� Puvwwll 9.D6
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid: _
2. Attorney Fees
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 c�C�,Yt'e-� WW;11 '70 C-5-v 1t ne-b Le5 I Q 0' SC, 113H . v
5. Accountant's Fees C,11
6. Tax Return Preparer's Fees v
F � IseNa rl � Ps7. er e� }• ��
=
X 5 91-1 '1 2S 5.1 5-1 ro 6110 715
,� . S5 r-a-Q- =
TOTAL(Also enter on line 9, Recapitulation) $
(If more space is needed,insert additional sheets of the same size)
REV-1512 EX+ (12-08)
r pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
L•LlGILLOr (" ITI•'('LAPFP At 13 oyD
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 A'm\,*wlax s- CC\k%A\w&v6 . Co . 8L• 30
�• Rlec� "P�nt`amo •y sarv (oes 'i4.43 94 . II S
3 • We115Q,,,,, fY�Lca2 Crwu� 6-4•70 S(, , -� D
l{ . Cos+ p� $2}f�1 N[� 11��v;,,�C�� nct 'f'CLLS� : Ri\�•e.c CA, ls00 ' 6�
S. FL.,1 �1\ m�•��k �� a� 1� ��� �° C�nt,u�.� of I&co • ov
TOTAL(Also enter on Line 10, Recapitulation) $ :J 13 b V
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+ (01-10)
e pennsytvania SCHEDULE ]
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
C, I.LE 1- ALlLANO at 13 osfo
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(Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).)
1. C69DL A TFL-VnTHA(V
I FELYtNKI.IAI 76wN 6LV6
? 4de\p�k C.. P R ►9103
a, LANE j. hTL1LtaM �
Soh
9b0 ST
A 11o�S
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IS OF REV-1500 COVER SHEET,AS APPROPRIATE.
II 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.
--- REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
No. 2013- 00510 PA No. 21- 13- 0510
Estate Of: LUCILLEFALTLAND
- - - -- --- -- — - — -
7F71v,Middle,LWs
Late Of: CUMBERLAND BOROUGH
Deceased
Social Security No:
1
WHEREAS, on the 1st day of May 2013 an instrument dated
April 11th 2006 was admitted to probate as the last will of
L UCILL E F AL TLAND
/First Middle,Last)
late of CARLISLE BOROUGH, CUMBERLAND County,
who died on the 19th day of April 2013 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBA UGH , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARYto:
CAROL A TREVA THAN
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYLVANIA,
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 1st day of May 2013.
4 .�P11 rnon �� Ll
DINo Wdls /
DIR N I D a F-42 aa�Ph� �f
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) \
LAST WILL AND TESTAMENT
- - - OF
LUCILLE F. ALTLAND
I, LUCILLE F. ALTLAND, of Todd Memorial Home,4 Todd Circle, Apartment
A, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do make, publish and declare this to be my Last Will and
Testament, hereby revoking and making void all previous Wills and Codicils heretofore
made by me.
FIRST
I direct that on my death my remains be cremated and the ashes be disposed of as
my adult children shall decide.
SECOND
I order and direct my personal representative hereinafter named to pay all of my
just debts, funeral expenses and expenses involved or connected with the administration
of my estate as soon after my death as is reasonably possible. However, my personal
representative need not accelerate and pay those unmatured obligations which, in his, her
or its opinion, it might be proper and more advantageous to retain or renew and pay as
they become due and payable. If I do not own a burial plot or a grave marker at the time
of my death, I authorize my personal representative, in his, her or its sole discretion, to
purchase a burial plot and erect a suitable grave marker at my grave, and to expend sums
from my estate for this purpose.
_ Cn Z%
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THIRD
I give, devise and bequeath my entire estate, with all insurance proceeds, to my
two children, CAROL TREVATHAN and LANCE J. ALTLAND, in equal shares, per
stirpes.
FOURTH
I give, devise and bequeath the rest, residue and remainder of my estate, together
with all insurance proceeds thereon of whatever nature and wheresoever situate to my
two children, CAROL TREVATHAN, and LANCE J. ALTLAND, in equal shares, per
stirpes.
FIFTH
Any devise or distribution under this Last Will and Testament which is payable to
any beneficiary who may be under 18 years of age or, in the judgment of my personal
representative,mentally disabled, shall be held in a separate trust by my personal
representative as trustee until such beneficiary reaches 18 years of age or during such period
of disability. In the case of a beneficiary under 18 years of age, the Trustee may distribute
up to one-half(%z) of the then remaining principal and accumulated income on the request of
the said beneficiary, at or after attaining 18 years of age; and up to the entire remaining
balance of principal and accumulated interest at or after attaining 21 years of age. During
the term of any trust created pursuant to this paragraph, the Trustee is authorized to expand
and apply so much of the net income and principal of each such trust as the Trustee shall
consider advisable for the health, maintenance, support, and education(including college
education, undergraduate and graduate)of each such beneficiary until he or she attains 21
years of age, or until all such amounts are paid out of trust. I direct that no Guardian shall be
2 of 8
required to give or post bond for the faithful performance of the Guardian's duties in this or
any other jurisdiction.
SIXTH
I grant my personal representative the following powers in addition to and not in
limitation of such powers as my personal representative shall hold by law:
(a) To retain all property received including the stock of any corporate
fiduciary acting hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger,
reorganization or voting trust plan; to delegate authority with respect
thereto; to deposit investments under agreements and pay assessments;
and generally to exercise all rights of investors, including but not limited
to, the voting of shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any
real estate held or owned by my estate.
(d) To operate any business that I may own at my death.
(e) To invest any funds of my estate in any stocks, bonds, notes or other
securities or property, real or personal, without regard to the principle of
diversification or any other statute or general rule of law in his, her or its
absolute discretion, it being my intention to give my personal
representative the broadest investment powers possible, providing such
investments do not unnecessarily prevent the prompt settlement of my
estate.
J
3 o f 8
_:
(f) To sell or otherwise dispose of any property,real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on
such terms and conditions as my personal representative shall see fit in
his, her its absolute discretion.
(g) To borrow money for the payment of taxes of for any other proper
purposes in the administration of my estate, and to mortgage or pledge
estate assets as security.
(h) To compromise claims without court approval including,but not limited
to, any controversies with the United States of America or the
Commonwealth of Pennsylvania concerning estate and inheritance taxes
on any interests that may pass under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my
estate.
(j) To undertake any and all acts deemed necessary and proper by my
personal representative for the proper, advantageous and prompt
management of the settlement of my estate.
(k) In general,to exercise all powers in the management of my estate which
any individual could exercise in the management of similar property
owned in his own right, upon such terms and conditions as to him,her or it
may seem best and to execute and deliver all instruments and to do all acts
which he, she or it deems necessary or proper to carry out the purposes of
this, my Last Will and Testament.
"}
4 of 8 .tr 'ls
SEVENTH
No interest of any beneficiary of my estate, either in income or in principal, shall
be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall
any beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my personal representative for the liability of such
beneficiary.
EIGHTH
I nominate, constitute and appoint my Daughter, CAROL TREVATHAN, as
Personal Representative of this my Last Will and Testament. In the event that my
Daughter, CAROL TREVATHAN, is unable or unwilling to serve, or shall cease to serve
for any reason whatsoever, then I nominate, constitute and appoint my Son, LANCE J.
ALTLAND, to act as Personal Representative of this my Last Will and Testament. I
direct that my personal representative shall not be required to give or post bond for the
faithful performance of his, her or its duties in this or any other jurisdiction.
NINTH
I hereby declare it to be my expressed desire that my personal representatives
employ the law firm of Stephanie E. Chertok, R.N., Esquire, of Cumberland County,
Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament,
they having considerable knowledge of my affairs,views and wishes respecting any
matters that may arise at the probate.
5 of 8 y` j'k`c, :1 C rya. _e4-.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and
Testament this JLday of , 2006.
WITNESSES:
•�a e.� %)jo ��, rt.��`.ti.Lv�J
LUCILLE F. ALTLAND
6of8
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
I, LUCILLE F. ALTLAND,the 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 Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
LUCILLE F. ALTLAND
Sworn or affirmed and acknowledged before me by LUCILLE F. ALTLAND the
Testatrix this ILL day of r r 2006.
OL(
Notary Public
kl
7of8
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND ` I
WE,(
r
witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw LUCILLE F.
ALTLAND, Testatrix, sign and execute the instrument as her Last Will and Testament;
that she signed willingly and that she executed it as her free and voluntary act for the
purposes therein expressed; that each subscribing witness in the hearing and sight of the
Testatrix signed the Last Will and Testament as witnesses and that to the best of our
knowledge the Testatrix was at the time 18 or more years of age, of sound mind and
under no constraint or undue influence.
T
Sworn or affirmed and subscribed before me by
and =>: a�f, oM., ? L< ": y this day of
2006.
Notary Public
8of8
STATEMENT PERIOD PAGE
APR.13-MAY.10,2013 2 OF 3
L
� LUCILLE ALTLAND
CH CKS'PAIDSUMMARY
1223 04-24-13 1,600.00
ANNUAL PERCENTAGE YIELD EARNED = 0.00 7.
WHETHER YOU ARE LOOKING FOR A GREAT RATE, REWARDS, SUPERIOR BENEFITS OR A
COMBINATION OF ALL, MST HAS THE CARD FOR YOU. VISIT ANY MST BRANCH, CALL OUR
TELEPHONE BANKING CENTER AT 1-877-794-2373 OR VISIT MTB.COM TODAY FOR DETAILS.
g SUBJECT TO CREDIT APPROVAL.
gS
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2
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:ACCOUNT.. LUCILLE ALTLAND
RELATIONSHIP SAVINGS rirLE">
ACCOUNT NO. 15004218082804 STONEHEDGE
INTEREST EARNED FOR STATEMENT PERIOD 0.13
ACCOUNT SUMMARY
BEGINNING'77771 DEPOSITS S WITHDRAWALS. B. OTHER .. .CURRENT ENDING:.:::
BALANCE:` OTHER';ABDITIONS ;.'.SUBTRACTIONS :INTEREST PAID BALANCE.
NO. i AMOUNT I N0. AMOUNT
15,005.29 1 0 0.00 1 21 15,005.421 0.13 0.00
ACCOUNT ACTIVITY
.POSTING' < -. - :.' -. DEPOSITS,INTEREST N/DRAWACS 8 OTHER: DAILY. -
DATE - : :':i:.TRANSACTION DESCRIPTION'. 8 OTHER ADDITIONS SUBTRACTIONS - BALANCE,:-
04-13-13 BEGINNING BALANCE 515,005.29 \
04-16-13 WEB XFER TO CHK 00009848437142 2,000.00 13,005.29 O
05-01-13 INTEREST PAYMENT 0.13
05-01-13 CLOSEOUT 13,005.42 0.00
ENDING BALANCE *0.00
13 00 S.')!
ANNUAL PERCENTAGE YIELD EARNED = 0.01 % &6� l(o
G� 7�25
i
LOMACS w12)
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STATEMENT PERIOD PAGE
APR.13-MAY.10,2013 1 OF 3
00 0 04345M NM I17
q
000002153 FIDS154IG70205101305 02 010000 16393 V Q
LUCILLE ALTLAND
E 1 FRANKLIN TOWN BLVD
APT
PHILADELPHIA PA 19103
SELECTED ACCOUNT SUMMARY
ACCOUNT ACCOUNT INTEREST EARNED MATURITY ENDING
TYPE NUMBER YEAR-TO-DATE DATE BALANCE
M&T CLASSIC CHECKING W/INTEREST 000009848437142 0.16 0.00
RELATIONSHIP SAVINGS 015004218082804 1.15 0.00
.ACCOUNT- LUCILLE ALTLAND
M&T CLASSIC CHECKING W/INTEREST I :' TITLE '
ACCOUNT NO. 9848437142 STONEHEOGE
u INTEREST EARNED FOR STATEMENT PERIOD 0.02
R
N
ACCOUNT SUMMARY
BEGINNING DEPOSITS B - - - OTHER CURRENT : ENDING
BALANCE. OTHER ADDITIONS CHECKS PAID SUBTRACTIONS INTEREST: PO BALANCE'.
N0. I AMOUNT NO. AMOUNT N0. I AMOUNT
4,662.35 1 31 2,268.80 1 11 11600.00 1 7 1 5,331.18 1 0.03 0.00
ACCOUNT ACTIVITY
POSTING - DEPOSIT ,INTEREST CHECKS 8 OTHER DAILY .
a DATE TRANSACTIONS DESCRIPTION 8 OTHER ADDITIONS SUBTRACTIONS BALANCE
04-13-13 BEGINNING BALANCE $4,662.35
04-15-13 M&T ATM CASH WITHDRAWAL ON 04/13 60.00
100 SOUTH SPRING GARDEN STREET,CARLISLE,PA17013 4,602.35
04-16-13 WEB XFER FROM SAV 15004218082804 2,000.00 6,602.35
04-17-13 AMERIPRISE FINC AMP PAYOUT 147.03
04-17-13 AMERIPRISE FINC AMP PAYOUT 121.77 ,,871.15
04-18-13 NEB PMT Church_ of the Brethren 200.0_0 ~1.15- �C
04-22-13 PIN HESS 38358 CARLISLE 23.02
04-22-13 M&T ATM CASH WITHDRAWAL ON 04/21 40.00
RUTIE S/1150 HARRISBURG PIKE, CARLISLE, PA 7, 6,608.13
04-23-3f�' SCALD CARLISLE Q� .^-,.�' �31�V (iD�
04-23-13 WEB PMT ALERT Pharmacy Services 106.82 6,449.85
04-24-13 CHECK NUMBER 1223 1,600.00 4,849.85
05-01-13 INTEREST PAYMENT 0.03
05-01-13 CLOSEOUT 4,849.88 0.00
ENDING BALANCE $0.00
LODWS,61111
RiverSource M.
LONG TERM CARE INSURANCE DIVISION
P.O.Box 40007
LYNCHBURG VA 24506-9939
L
M1lf" 000 0002353 00000000 001 002 W817 INS:00
THE ESTATE OF LUCILLE ALTLAND
1 FRANKLIN TOWN BLVD APT 1512
PHILADELPHIA PA 19103
Page 1 of 2
A275836 Claimant: LUCILLE F ALTLAND Claims: (888) 320-8741
Payment for Apr 1 2013 through Apr 14 2013 $1,050.00
Section A - Policy Details
Daily Max: $75.00
Deductible Period: 20 Days
Deductible Period Met: Oct 11 2011
Lifetime Max: $109, 500.00
Benefits Paid to Date: $41, 325.00
Remaining Balance as of May 10 2013: $68,175.00
IF YOUR ADDRESS IS NOT CORRECT
STATE STREET. PLEASE PRINT THE CORRECT
ADDRESS ON THE BACK OF THIS
STUB AND RETURN IT TO THE
ADDRESS ABOVE.
RETIREE SERVICES �y
P.O. BOX 5149 o j�
BOSTON MA 02206-5149
LUCILLE ALTLAND
801 N HANOVER ST
CARLISLE, PA 17013 ACCOUNT ID: CTL EMB BENE
Plan Name: EMBARQ RETIREMENT PENSION PLAN
PAYEE INFORMATION .
PAYMENT DA.Tb CHECK NO. PAYEE SOC.SEC. NO. NET PAYAHiNT
05106/13 10384005 ********* $629.83
PAYMENT DETAIL
Current DEDUC7FIONS Current
PAYNIENT SOURCES
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Alpha Diagnostics, LLC
945 East Park Drive Ste. 102
Harrisburg, PA 17111
Dear Lucille Altland,
Enclosed is a refund check in the amount o $9.04 a are refunding you because your
Highmark benefits have reprocessed and pai date of service 10/15/12 in full. If you have
any questions about this refund please call 717-561-4940 EXT. 211.
Patient Address:
Lucille Altland
801 N. Hanover Street
Carlisle, PA 17013-1599
2/14/2013
L
r y'
Historical Performance by Investor
��,1''7t] Altland Fam Jt Rev Tr MR BRENT S HILLERICH CFPO Combined Account Portfolio
Arneri YISe `1I!
Carol A Trevathan Private Wealth Advisor Period:04/1 91201 3-04/1 9/201 3•-
�Piawuia) Lucille F Altland Created:05/14/201
Stuart F Altland ��
U'
Lucille F Altland
Acct Name: Columbia Money Market Fund,LUCILLE F ALTLAND AS TTEE OF STUART F& LUCILLE ALTLAND REV TR U/A
DTD 4-18-90
Acct No: XXXXXXX9375 002 Acct7ype: Non-Qualified
Since Start Date(1) 6Yearto OneYear(°/.)'Three Years ,6y,
am Ton Years Selected,
0110112004 Date(%) _ M _(%.) (%)_ Period(%)�
Account Performance: 2.41% 0.00% 0.02% 0100%� 0.27% N/A rt�0.00%
Asset Name Current Value($)as Year to One Year(%)Three Years Five Years Ton Years t Selected
of 0_4119/13 Date(%) _ - _ (°/,) (%) -(%) Poriod(%)j
COLUMBIA MONEY MARKET CL A - 308.36 0.00 0.02 N/A NIA - N/A 0.00
Account Total: 5308.36
Acct Name: Single Premium Deferred Annuity,LUCILLE F ALTLAND
Acct No: XXXXXXX9958 004 Acct Type: Non-Qualified
• Slnce Slarl bate(%)��Year to One Year(%j-Three Y°ars• Fiva Voara Ton Yoars- 'Saloctedj
j 0410212006 Date(%) (%)_ _ _ I%) (%) Porlod(%)l
Account Performance: 3.05% 0.91% 3.04% 3.03% 3.06% NIA 0.06%
'An es tName Ce ent Value(E}as• -Yearto Ona Year(°/.)'Three Years-Five Yoars TTen Yeats;Selected
i-.__ y .� y- • �" _. of 04119113 ,Date(%) _ I%) VA) - (%) -Perlodr/.
RVS Life Fixed 25,398.77 NIA --•N/A N/A� N/A Y N/A f w NIA
Account Total: 25,398.77
Acct Name: STRATEGIC PORTFOLIO SERVICE ADVANTAGE ONE FEATURES,,CAROL A TREVATHAN AS TTEE OF THE
ALTLAND FAM JT REV TR U/A DTD 4-18-90
Acct No: XXXXXXX2684133 Acct Type: Non-Qualified
� Since'—s-- -
tart Date(%.) Yearto One Year(/°)Three Years' Five Years Tan Y°ars�'Solected
_
09101/2000 Date(%°) (%) (%) (°/) Perlod(%)
Account Performance: 1.79% 1.18"/a 2.50% 4.39% 2.13*% 3.34% 0.11%
°a6 tNamo Current Value(E)as Yearto One Year(°6)Three Years Five Yoars Tan YoarsSel°cted
_ _ _ - of 04119113 Date(%) (%} - _(%} ,r.. (%) Period(%)]
AtM INVESCO_BALANCED RISK .V. `121,540.32 1.04 ~N/A N/A NIA - NIAl 0.16
ALLOCATION CL A
CASH 5,028.76 N/A N/A NIA N/A N/A NIA
COLUMBIA DIVIDEND 14,866.28 10.41 NIA NIA NIA N/A 0.84
OPPORTUNITY CL A
GOODYEAR TIRE 8 RUBBER 5,865.26 2,69 NIA NIA N/A NIA 0.02
COMPANY NOTE SIE
Please see the end of this report for important disclosure information. Amedprise Financial Services.Inc.-Page t of 4
Mstorical Performance by Investor
Allland Fam A Rev Tr MR BRENT S HILLERICH CFP® Combined Account Portfolio
7 Carol A Trevathan Private Wealth Advisor Period: 04/19/2013-04/19/2013
Ameriprise Lucille F Allland Created:05/14/2013
Pinunciul Stuart F Altland
... '... +t-,KYear(-..-'Year( FIva ears -ars S+-I mot
Ansel Name Current Value(5)ae Year to One Year(%),•Three Years Five Years . Ten Years Solecledj
_ a_f_0.4/19113 Date(%)_ (%) N, (%) Period(%
LUMBERMENS MUT CAS CO 12.50 0.00 N/A N/A N/A N/A 0.00
SURPLUS NOTE -
OPPENHEIMER ROCHESTER LTD 49,793.61 1.10 N/A N/A NIA N/A -0.07
TERM MUNICIPAL CL
VIRTUS MULTI SECTOR SHORT 57,338.51 1.12 N/A N/A N/A NIA 0.00
TERM BOND CL A
Account Total: / S254 445.27'
Investor Total: $280,152.40 1.16% 3.72% 3.85% 1.19% NIA 0.11%
Portfolio Total: 5280,152.40 1.16% 3.72% 3.85% 1.19% NIA 0.11%
Please see the and of this report for important disclosure information. Ameriprise Financial Sawices,Inc.-Page 2 of 4
Neill Fuheral Home, Inc. \
3401 Market Street
Camp Hill,PA 170114428
(717)737-8726
Supervisor:Kevin J.Shillabeer
The following Is a detailed bill for the professional services and/or merchandise arranged for
Lucille F.Altand
Date of Service:April 26,2013
Lance Altland Statement Date April 29,2013
960 S Humer St Contract Number 741101000404
Enola, PA 17025-2925 Arranger Name Kevin J Shillabeer
Initial Selection Final Selection Difference
Package Offerings
Direct Cremation $2,055.00 $2,055.00 —
Basic Professional Service Fee Ind Ind —
Refrigeration Ind Ind --
Transfer of Remains to Funeral Home Ind Ind
Transfer to or From Crematory Ind Ind —
Service Vehicle Ind Ind —
Total Package Offerings $2,055.00 $2,055.00
Other Goods and Services
Cremation Fee $395.00 $395.00 -
Total Other Goods and Services $395.00 $395.00 —
Cash Advance
Certified Copies of the Death Certificate $96.00 $96.00 —
Permit $30.00 $30.00 --
Newspaper Notice — $421.58 $421.58
Total Cash Advance $126.00 $547.58 $421.58
Total Services,Merchandise and Cash Advance $2,576.00 $2,997.58 $321.58
Allowances
PN Trust Maturity ($510.00) ($510.00) —
Trust Allowance ($1„940.00) ($1,940.00) --
Total Allowances ($2,450.00) ($2,450.00) —
Initial Selection Final Selection DlBerenca
Total Charges(rotalServlces+/-Allowances+Taxes) $126.00 $547.58 $421.58
Less Cash Received $0,00
Unpaid Balance Due $547.58
�1 l
e gYEMS"
Jto users&y;/rs
100 York Rd,
CARLISLE, PA
i
(717)241-6100
Clerk#: 234 LIZABETN 05/02/2013
Transaction: 23898 REG #1 12:10am
FUNERAL ARRANGEMENT 023 75.00
Validated order: 53810
Tax: 4.50
Total : 79.50
Check Tender: 79.50
Thank-You For Your Patronage
wwti.royers.com
I
Order Number: 53810 Will Call
** ACTIVITY FOR ALTLAND, LUCILLE -ALTLL2 - -802936
04/05/13 9059878 5 SULFAMETH/TMP DS 01 1.85 .00 1.85c
04/05/13 9059879 5 FLORASTOR 250 MG 01 * 5.47 .00 5.47
04/07/13 7975904 4 METOPROLOL *XL* 5 01 4 .00 .00 4.00c
04/07/13 7866208 5 ASPIRIN 81MG CHEW 01 * 2.28 .00 2.28
04/07/13 9024126 4 LEVOTHYROXINE 75 01 3.28 .00 3.28c
04/07/13 9004235 4 ATORVASTATIN 10MG 01 6.35 .00 6.35c
04/07/13 7975750 3 LA DETROL 4MG 01 5.46 .00 5.46c
04/07/13 7958063 4 OLANZAPINE 5MG 01 4 .00 .00 4 .00C
04/07/13 9057271 4 FUROSEMIDE 20MG 01 2 .94 .00 2 .94c
04/07/13 9057272 4 LISINOPRIL 5 MG 01 3 .27 .00 3.27c
04/07./13 9059878 8 SULFAMETH/TMP DS 01 3 .85 .00 3.850
X04/07%13 9059879 9 FLORASTOR 250 MG 01 * 7.18 .00 7.18
04/26/13 Payment-Thank You 106.82- .00 106.82-
CK# 28856019
b
. 00
35 . 00 14 . 93
LEGEND NON-LEGEND TOTAL TAX
FOR MONTH FOR MONTH -- -
Previous Balance Charges this month Finance Charge TQTALCHARGES. Total Payment&Crellb AMOUNT DUE
106 . 82 + 49 . 93 + . 00 = 156 . 75 - 106 . 82 = 49 . 93
FOR ALL PHARMACY RELATED INQUIRES PLEASE CALL Alert Pharmacy Services, Inc at 1-800-266-9954
Statement Terminology on reverse - ---- - -
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Ameriprise Enterprise Investment Services, Inc.
An affiliate of Ameriprise Financial Services, Inc. Ameriprise 0
70400 Ameriprise Financial Center Financial.
Minneapolis, MN 55474
May 3, 2013
I 'I°Illlllyd II'u' III,'•nlll ,.1.•• Irrrl 'llll"III
Account Number:
0000 1207 2684 9 133
0
0
Altland Fam Jt Rev Tr
U 1 Franklin Town Blvd Apt 1512 '
Philadelphia PA 19103-1247 Fi 4u' k-ftk(-Rf
Dear Family of Altland Fam Jt Rev Tr,
Please accept our sincere condolences on your loss.
We are writing to provide confirmation of recent transactions processed for the above referenced
account.
Cash Related Ameriprise Transfer
Date of Transaction May 1,2013
Amount of Transactio 00.00
Destination Account xxxx0339
We are currently working to settle the account(s) according to instructions we have on record. We
will send related financial documents in the account holder's name to this address throughout the
settlement process.
For more information or assistance, please contact:
> An Ameriprise Financial client service representative at800.862.7919,
Monday through Friday, 7 a.m. to 6 p.m. Central time
We appreciate the opportunity to serve you.
Sincerely,
George Tsafaridis
Vice President, Service Delivery
Ameriprise Financial Services, Inc.
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