HomeMy WebLinkAbout07-15-13 (2) � 1505610140
REV-1500 E% (02-71)(FI)
OFFICIAL USE ONLV
PA Department of Revenue -
Bureau ot Individual Taxes County Code Year File Number
Po eox zaoeoi INHERITANCE TAX RETURN 2 1 1 2 1 3 0 3
Harrisburo PA 17728-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW � �
Social Security Number Date oi Death MMDDm'r Date of Birth MMDDVYVV
1 0 2 � 2 0 1 2 0 6 2 0 1 9 4 9
DecedenYs Last Name SuKx DecedenCS First Name MI
G U Y , W I L L I A M T
�1f Applicable)Enter Survlving Spouse's Information Below .
Spouse's Last Name Suffix Spouse's First Name MI
G U Y P A T R I C I A A
Spouse's Social Security Number �
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
1 8 L 4 2 9 9 1 3 REGISTER OF WILLS
FILL�N APPROPRIATE OVALS BELOW
Q 1.Original Retum � 2.Supplemental Retum � 3.Remainder Retum(Date of Death
' . Priorto 12-13-82)
� 4. Limited Estate � � 4a.Future Interest Compromise(date of � 5.Federel Estate Taz Retum Required
� dealh after 72-12-82)
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 ot Death � 11. Eleclion to Tax under Sec. 9773(A)
Between 1231-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT•THIS SECTION MUST BE COMPlETEO.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOUID BE DIRECTED T0:
Name Daytime Telephone Number '
D A V I D H S T 0 N E , E S Q U I R E 7 1 7 7 7 4 7 4 3 5
REGISTER OF WILLS USE ONLV
Firsl Line of Address �
4 1 4 B R I D G E S T R E E T � o w
�
Second line of Address � � � ni
� �
�� C� � � p
I_ DA�EE FA`E0� !�+ y �
Ciry or Post OHice Stale ZIP Code 0
N E W C U M B E R L A .N D P A 1 7 0 7 0 � , � � �
c� o 0 3 oa
oc '� 3 "� �
� ` 1r
Correspondent'se-mailaddress: DSTONEa�STONELAW • NET � � j" r n
UnEer Oenalties ol per�ury.I tleclare that I have ezamineE this return,includin8 accomDanying scheCules antl statements,and to t�e Oest of my know(eQ�je an elief.
't is true correct an0 complete Declaration of Oreparer other than the personal representative is�asetl on all information of which preparer has any Ifi�+letlge. T
. SI ATUREOF BERSON ESPON I LE FOR FILING RETURN DATE
� "`
AODRESS
333 EVERG E N, S REET NEW CUMBERLAND PA 17070 �
S OF PA E O H R7HAN REPRESENTATNE DA7E
- 3
AD ESS
414 BRIDGE REET NEW CUMBERLAND PA 17�70
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 � ^. �
'�l
� 1505610240
REV-7500 EX(Fp . Decedenfs Social Sewrity Number
oecedenes Name: W I L L I A M T • G U Y
RECAPITULATION ' � �
t. Real Estate(Schedule A) �� �
. . . . . . . . . . . . . . . . . .. . .. . .. . .. . . . . . . . . . . .. . . .
2. Stocks and Bonds(Schedule B) .. . . . . . . . :. . .. . . . . . . . . . . . . . . .. . . . .. . . . Z. 7 3 7 8 4 5 . 0 0
3. Closety Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. •
4. Mortgages and Notes Receiva6le(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. •
�5. Cash, Bank Deposits and Miscellaneous Personal Propeny(Schedule E). . . . . . . 5. 2 0 � 3 4 . 3 1
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 4 � S , S L
7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property 2 4 8 9 2 3 . 1 6
(Schedule G) � Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . .. . . . .. . . . 8. 1 � 0 7 2 0 7 . 9 8
9. Funeral Expenses and Administrative Costs(Schedule H) 9. 2 9, 8 7 5 . 9 0
. . . . . . . . .. . . . . . .. .
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . .. . . . 10. � •
77, ToWI Deductions(total Lines 9 and 70) : . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . 11. � 2 9 8 7 5 . .9 0
• t2. Net va�ue of Estate(Line 8 minus Line t t) .. . . . . . . . . . . . . . . . . . . . . . . . . . . 72. 9 7 7 3 3 2 . 0 8
13. Charilable and Govemmental Bequests/Sec 9713 Trusts for which
an election to tax has not been made(Schedule J)� . . . . . . . . . . .. . . . . . . . . . . 13. •
74. Net Value SubJect to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . .. . . . .. . . 14. 9 7 7 3 3 2 . � 8
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES �
15. Amount of Line 14 laxable
at the spousal lax rate,or
transfers under Sec.9116
(a)(�2)x �aa 9 7 6 9 2 6 . 5 7 ts. 0 . 0 0
i6. Amount of Line 14 taxable �
at�inea�rate x •o4s 4 0 5 . 5 1 t6. 1 8 . 2 5
17. Amount of Line 14 tazable
at sibling rate X .12 0 . 0 0 17. 0 . 0 �
18. Amount of Line ib tazable
at collateral rate X.75 . � • � 0 �B� � ' � �
19. TAX DUE L 8 • 2 5
. . . . . .. . .. . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .�. . . . . . . 19.
20. FILL IN THE OVAL IF VOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 15�5610240 1505610240 J
REV-1500 E%(FI) Page 3 " � Flle Num6er
Decedent's Complete Address: 21 12 1303
DECEDENT'S NAME
WILLIAM T • GUY
STREETADDRESS
333 EVERGREEN STREET
C17y STATE 21P
NEW CUMBERLAND PA 1707�-
Tax Payments and Credits:
�. Tax Due(Page 2,line 19) (1) 18 • 2 5
2. Credits/Payments �•
A.Prior Payments
B.Diswunt
TotalCredits(A+g) (p) 0 • 0�
3. Interest
(3) 0 • D O
4. II Line 2 is greater than Line 1 +Line 3,enter ihe diHerence.This is ihe OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. � (4) o . o 0
5. If Line 1 �Line 3 is greater than Line 2,eNer the difterence.This is the TAX DUE. (5) 18 • 2 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 iranster and: � Yes No
a. retain the use or income of the property trans(ened ...................................................................... � �
b. retain the right to designate who shall use the property transferred or its income ............................... .
c. retain a reversionary interest ..................................................................................................... ❑ 0
d. receive ihe promise for li(e of either payments,benefils or care? .......................................................
2. If death cecurred afler December 12,7982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ . �
3. Did decedent own an'in trust for'or payable-upondeaih bank account or secunty at his or her death? ......... 0 ❑
4. Did decedent own an individual retiremem account,annuiry or other non-probate pwperty,which
� contains a beneficiary designation?.................................................................................................. ❑X ❑
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 daies of death on or after July 1, 1994, and before Jan. i, 1995,the tax rate imposed on the nel value of transfers to or for fhe use of the surviving spouse is
is 3 percent[72 P.S.§9116(a)(1.1)(i)�.
For dates of dealh on or after Jan. 1, 1995,the tax rate imposed on the net value of Iransfers to or for lhe use of the surviving spouse is 0 percent
(72 P.S.§9116(a)(1.1)(iiJ]. The statute does nol exempt a transfer to a surviving spouse from tax,and lhe stalulory requirements for disclosure of assets and
filing a!ax return are slill applicable even if the surviving spouse is the only benefciary.
For dales of death on or after July 1, 2000:
• The tax rate imposed on the nef value of trans(ers from a deceased child 21 years o(age or younger al death lo or for the use o(a natural parent,an
adoptive parenf or a sleppareni of the child is 0 perceni[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the nel value of transfers to or for Ihe use of ihe decedenfs lineal beneficiaries is 4.5 percent,except as noted in p2 a.S.§si ie(a�(i)�.
• The tax rate imposed on the net value of transfers to or for Ihe use of the decedenfs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under SecGon 9102,as an individual who has at least one parent in common with lhe decedent,whether by blood or adoption.
REV4503 E%+(8-12) . ,
pennsylvania SCHEDULE B .
DEPARTMENT OF REVENUE �
INHERITANCETAXRETURN STOCKS & BONDS �
RESIDEN7 DECEOENT '
ESTATE OF FILE NUMBER
WILLIAM T • GUY 21 12 1303
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER • DESCRIPTION OF DEATH
1 • 2 shs Gannett Fleming Affiliates Inc stock a 5835 • 00 1 ,670 • 00
each-Cert �1630 dtd 01-01-12
2 20 shs Gannett Fleming Affiliates Inc stock a 19,7�0 • 0�
5985 • 000 each-Cert �1394 citd 12-31-06
3 350 shares Gannett Fleming Affiliates Inc stock a 309,75� • 00
5885 . 000 each
Cert �971 dtd 12-17-96 150 shs = 9132,750.• 00
Cert �1038 dtd 1998-200 shs = 5177 ,��� • 00
4 435 shares Gannett Fleming Affiliates Inc stock a 406 ,725 • 00
5935 . 00 each
Cert �1061 dtd 2000-200 shs = $187,000
Cert �1106 dtd 2002-200 shs = $187,000
Cert �1152 dtd 12-31-02 15 shs = 514 ,025
' Cert �1285 dtd 12-31-OS 20 shs = 518 ,700 �
A
TOTAL(Also enter on Line 2,Recapitulation) 5 7 3 7, 8 4 5 • 0 0
If more space is needed,insert additional sheets of the same size �
REV-1508 E%.(08-12) " � .
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8 MISC.
INHERITANCE TAI(RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: � FILE NUMBER:
WILLIAM T • GUY 21 12 1303
Include the proceeds of litigation and the date the proceeds were received by the estafe.
All property jointly owned with right of sunivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 • Mass Mutual Financial Group-Policy �21076507 10,005 • 31
Owner is William T Guy and Insured is David T Guy.
which reverts to estate at owners death
2 Mass Mutual Financial Group-Policy �32015134 10,029 • 00
Owner is William T Guy and Insured is David T Guy
which reverts to estate at owners death
TOTAL(Also enter on Line 5,RecapiWlation) 5 2 0 ,�3 4 . 31
If more space is needetl, use additional sheets of paper of the same size.
REV�t509 EX�(07-10) �
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE �OINTLY-OWNED PROPERTY
INHERI7ANCE TA%RETURN
RESIDENT DECEDENi
ESTATE Of: FILE NUMBER:
WILLIAM T • GUY 21 12 1303
If an asset was made jointly owned within one year o(the decedenfs date of death,it must be reported on Schedule G.
SURVNING JOINT TENANT(S)NAME(5) ADDRESS RELATIONSMIP TO DECEDENT
n. P•ATRICIA A GUY 333 EVERGREEN STREET Surviving Spause
NEW CUMBERLAND, PA 17070-
s. DAVID T Gl1Y 117 FURMAN ROAD Son
' DILLSBURG , PA 17019-
c.
JOINTLY•OWNEO PROPERTY:
LEiTER DATE OESCRIPTION OF PROPER7Y %OF DATE OF DEATH
ITEM FORJOINT NJ�DE - INCLUOENAMEOffINANCIALINSTITUTIONANOBANKACWUNTNUMBERORSIMILAR DATEOFDEATH OECEDENPS VALUEOF
NUMBER TENANT JOINT IDENTIFYINGNUMBER.ATTACHDEEDFORIOINTIY�HEIDREALESTATE. VALUEOFASSET INTEREST OECEDENPSIMEREST
1 • A B oaiobi�oPNC Bank-Checking Acct �514002545 1 ,216 • 3� 33 • 34 405 • 51
joint w/David T Guy and Patricia
A • Guy
' TOTAI(Also enter on Line 6,Recapitulation) 5 4 0 5 • S 1
II more space Is needed,use addilional sheets of paper ot Ne same size.
REV�i 510 EX+(OB-09)
pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER-VIVOSTRANSFERSAND
INHERI7ANCETAXRETURN MISC. NON•PROBATE PROPERTY
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
WILLIAM T • GUY 21 12 1303
This schedule must be completed and filed il the answer to any of questbns 1 lhrough 4 on page three of fhe REV-1500 is yes.
� DESCRIPTION Of PROPERN DATE OF DEATH °�OF DECD'S EXCLUSION TAXABLE
ITEM IYCWOETNENPMEOfTHETRANSFEREE.THE1RflEUTI0N5MPT00ECEUEMPND
NUMBER THEDATEOFTRPNSFER.ATiACHnCOPYOFTMEOEEDFOFRFALESTATE. VALUEOFASSET INTEREST �r.an� VALUE
1 Mass Mutual Financial Group-Policy 15,666 • 30 100 • 00 15,666 • 30
�6652505 Owner is William T Guy,
Insured is David T Guy • This is a
lifetime ownership and at time of
death, ownership would be trans-
ferred to Patricia A Guy
2 Prudential Insurance Co-Tax Deferred 233,256 • 86 100 • 0� 33,256 • 86
401-K Plan beneficiary is Patricia �
A Guy, surviving spouse
TO7AL (Also enter on Line 7,Recapitu�ation) S 2 4 8 ,9 2 3 • 16
II more space is needed,use adtlilional sheets of paper ol the same size.
REV-1511 E%+(10-09)
pennsylvania SCHEDULE H
DEPFRTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TA%RETURN ADMINISTRATIVE COSTS
RESIDENTDECEDENi
ESTATE OF FILE NUMBER
WILLIAM T • GUY 21 12 1303
DecedenYs debts must be reported on Schedule I. ,
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAIEXPENSES:
1 • Parthemore Funeral Home-funeral expenses 12 ,099 • 40
2 • Rolling Green Cemetery-opening of grave 1, 445 . �0
3 • Rolling Green Cemetery-headstone and engraving 4 ,574 • 00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: � �
Name(s)ol Personal Representative(s)
Street Address
City Slate ZIP �
Year(s)Commission Paid:
2 . AtlomeyFees: Ddvld H Stone , Esquire 7,saa . 00
3. Famity ExempUon;(It decedenfs address is not the same as UaimanYS,atlach explanaGon.) 3, S 0 0 • 0 0 .
Ciaimam PdtriCla A Guy
StreetAddress 333 Everqreen Street
�;ryNew Cumberland s�a�ePA zia17070
. Relatlonship of Claimant to Decedent $U I'V 1 V 1 fl q 5 p O U S B �
4 • ProbateFees: Cumberland Co Register of Wills 627 • 50
5 , AxountantFees: _
6 • Tax Retum Preparer Fees: .
7 • Register of Wills-filing Inh tax ret & Inv 30 • 0�
2 Reserve for closing expenses 1�� . 00
� TOTAL(Also enter on Line 9,Recapitulation) S 2 9,8 7 5 • 9 0
If more space is neeEeO,use adCilional sheeLS of paper of the same size.
r+ev-isia ex.�o�-�o� -
pennsylvania SCHEDULE J
OEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TA%RETURN . -
. RESIDEN7DECEDEM
� ESTATE OF: FILE NUMBER:
WILLIAM T • GUY 21 12 1303
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee�s) OF ESTATE
� TAXABLE DISTRIBUTIONS pnGude outright spousal disVibuUons and translers under �
- Sec.9116(a��72).� .
1 • PATRICIA A GUY Spousal 976 ,926 • 57
333 EVERGREEN STREET
NEW CUMBERLAND PA 17070-
2 • DAVID T . GUY Lineal 405 • 51
117 FURMAN ROAD .
DILL3BURG , PA 17019
/
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOi TAKEN: .
1 .
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1 •
TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S
If more space is needed,use additional sheets of paper of the same size.
STONF., LAFAVF,R & St1F:KLEf6KI
� Af(ORNEYS Ai LAW
. aia BRIDGE STREEi
yl;W GU2111F.NL.�YD P1 17070
t
LAST WILL AND TESTAMENT
OF
WILLIAM T . GUY
I, WILLIAM T . GUY, of the Borough of New Cumberland, Cumberland
County, Penn�ylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I : All federal, sCate and other death ta�es payable because
of my death, with respect to Che property forming my gross estate for
tax purposes, whether or not passing under this will, together with any
interest or penalty imposed in connection with such tax, shall be
considered a part of the expense of the administration of my estate and
sha11 be paio from my residuary estate without apportionment or right of
re.imbursement .
ITEM IS : I devise and bequeath all of my estate of every nature
and wherever situate to my spouse, PATRICIA A. GUY, if she survives me .
ITEM III : Should my spouse, PATRICIA A. GUY, fail to survive me, I
bequeath such of my tangible personal property which is set forth in a
seoarate memr,randum which I shall place �dith this will to �he oersons
therein desiynated . I bequest the balance of my tangible personal
property to my son, DAVID T. GUY.
ITEM ZV: Should my spouse, PATRICIR A. GUY, fail to survive me, I
devise and bequeatn che residue my estate, ox every nature and caherever
situate, as follows :
Page 1 of 9
,
A. Ninety-Two and one-half ( 92-1/2�) thereof to my son,
DAVID T. GUY.
B. Seven and one-half (7-1/2�) thereof to KIM TA, should she
survive me.
ITEM V: I appoint my spouse, PATRICIA A. GUY, Executrix of this my
last will . Should my spouse, PATRICIA A. GUY, fail to qualify or cease
to act as Executrix, I appoint my son, DAVID T. GUY, Executor of this my
last will .
ITEM VZ : No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his or her duties
in any jurisdiction.
IN WITNESS WHEREOF, I, WILLIAM T . GUY, have hereunto set my hand
and seal this _� day of �h�..1 , 2012 .
�,v ? �
WI'LLIAM T. GUY
SIGNED, SEALED, Pt78LISHED and DECLARED by WILLIAM T. GUY, the
Testator above named, as and for his Last Will and Testament, and in the
presence of us, wh at his request, in his presence and in the presence
of each ot , av subscribed our names as witnesses .
914 BridQe St New Cumberland, PA
Witnes Address
��--�� 419 Bridae St . . New Cumberland. PA
Witness Address
Page 2 of 9
,
COMMONWEALTH OF PENNSYLVANIA:
: SS:
COUNTY OF CUMBERLAND .
I, WILLIAM T. GUY, the Testator whose name is signed to the
attached or foreg±ing instrument, having been duly qualified according
�
to law do hereby acknowledge that I signed and executed this instrument
i
as my last will; ythat I signed it willingly. and that I signed it .as my
free and voluntary act for the purposes therein co'ntained.
I .
� �(/�%GG�/n-__�z�=�-}'
� WILLIAM T. GUY
�
�
1
Sworn to or ,affirmed to and acknowledged before me by WILLIAM T.
� �
GUY, the Testator�; this � day of �����_, 2012 .
I ��COMMONWEALTH OF PENNSYLVANIA �
JENNIFEAA MFiWKLE.Notary Publlc Notary Public
New Cumberland Boro.CumbeAand Co.
My Commisalon Irea Ju 7, 2012
Page 3 of 9
,
COMMONWEALTH OF PENNSYLVANIA :
. : SS:
COUNTY OF CUMBERLAND .
We� —����� d`�j1cs and \Qiv�. � �F-�Q\� ,
the witnesses whose names are signed to the attached or foregoing
instrument, being .duly qualified according to law, depose and say that
we were present and saw Testator sign and execute the instrument as his
� last will; that Testator signed"wi11"ingTy and°that" fie executed it as his �` �
free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the Testator signed the wi11 as
witnesses; that to the best of our knowledge, the Testator was at that
time eighteen or more years of age, of sound mind and under no
constraint or undue influence .
Witness
Witness
Sworn to or affirmed to and acknowledged before 'me by
a,�)_Q�� f M� and �CQ,e� L \���(.-t\� ,
� \
witnesses, this � day of �OC'� l , 2012.
r"7
COMMONWEALTH OP PENNSYLVANIA %J -
S �-_
JENNIfERAMEARIa.E, NoteryPublio Notary Public
New Cumberland Boro.Cumberlend Co.
Canmiesion Ires Ju 7,2012
�Page 9 of 4
� � GannettF/eming
Excetlence.De(ive�ed As Promised
November 21, 2012
Mrs. Patricia Guy
� 333 Evergreen Street
New Cumberland, PA 17070
Redemation of Gannett Fleminq Affiliates Inc Common Stock
Dear Pat,
It was good to see you doing so well when we came to the visitation. I hope and
pray that you are comforted in knowing that Bill is at peace. Please let us know if we
can be of any assistance.
Effective October 20, 2012, Bill's Gannett Fleming Affiliates, Inc. Common Stock
was redeemed under Article 2A of the Stock Redemption Agreement. The following
. outlines the terms and procedures regarding the Gannett Fleming Aftiliates, Inc. stock
and its disposition.
Bill owned 807 shares, which are represented by Certificate numbers listed
below. The Redemption Amount for the shares is the Per Share Value which is based
on Formula Value as of July 1, 2012, which is $1,035.00 per share, less the Tranche
Discount applicable to that share, and is calculated below:
Share Issue Tranche Discount Discount Per Share Redemption Value
Date AmounUShare Redem tion Value
5994 80°fo of vaivation $200/share $835 $1,670
Cert. # 7630 difference #ot shares: 2
1996 60°/a of valuation $150/share $885 $132;750
Cert. # 971 difference k of sharas: 150
1998 60%of valuation $150/share $885 $177,000
Cert. lt 1038 difference #of shares: 200
2000 40°/,of valuation $100/share $935 $187,000
Cert. k 1061 difference #oi shares: 200
2002 40%ofvaluation $100/share $935 $187,000
Cert. # 1106 diHerence #of shares: 200
2002 40% ot valuation $100/share $935 $14,025
Cert. !t 1152 diNerence # of shares: 15
2005 40%of valuation $100lshare $935 $18,700
Cert. # 1285 difference ri of shares: 20
2006 20°!,ot valuation $50lshare $985 $19,700
Cert. H 1394 difference #of shares: 20
Stock Redem tion Amount $737,845
Gannett Fleming Affiliates, Inc.
, P.O.Box 8985•Wilmington, DE 19899•Suite 1300• 1105 N.Market Street•Wilminyton.DE 19801
� t: 302.651.8300
. www.gannettfleming.com '
6annettFlem/ng
• , PaMcia Guy
November21,2012
Page 2
The Redemption Amount will be reduced by fhe outstanding stock purchase
notes and interest due as of the date of redemption. These amounts are $48,234.83 of
principal and $1,146.88 of interest for a total of $49,381.71. The total Redemption
Amount less the outstanding balance on the stock purchase notes is $688,463.29. In
accordance with the Stock Redemption Agreement, the initial payment is 25 percent of
the net Redemption Amount payable in 90 days. Thus, the first payment in the amount
of $172,118.29 will be made no later than January 18, 2013. The balance of the net
Redemption Amount will be paid in five equal annual instaliments of $103,269.00 each
and secured in the form of promissory notes dated October 20, 2013 through 2017 with
interest payable on a semi-annual basis.
✓ �
According to our records, Certificate Nos. 971, ir52, 1�85, 1�94, and 1630 are
in your possession. Please endorse the stock eertificates to the Company by having the
executor or administrator of the Estate sign the right-hand signature line and having a
witness sign at the left-hand signature line under "In presence of". You can leave the
rest blank for the Company to finalize. Once completed, please send the signed
certificates to Barbara McLemore at P.O. Box 67100, Harrisburg, PA.17106-7100. We
also need a copy of a short certificate for fhe estate for our records. If you prefer, you
can come to Barbara McLemore's office to process the certificates.
If you have any questions regarding the stock redemption or any other benefits,
please contact me at 717-763-7211 (x2200), Lynn Knepp, Controller (x2581), or
Barbara McLemore, General Counsel (x2227).
Sincerely yours,
William M. Stout
Chairman and President
W MS/BRM/jdb
cc: L. Knepp
B. McLemore
R. Artman
� MaSSMUtU� POLICYOWNER ANNUAL
)I4� fINANC1Al GPOUP'
STATEiV1EiVT
� 'i'his.�lutrmrnt us>umcs nll prcmimnc hm�c Ixrn P�id 6,ihc unniccnarv Julr.
""W360"' 'LIFE' •000443« AGGNCY H 037
ESTATE OF WILLIAM T GUY DGI3�)RAH [ PAJAK
333 EVERGREEN ST CCNTRAL PCNNSYLVANIA 037
NEW,CUMBERLAND, PA 17070-1325 ����»�'3-�'�"
Fur morc informafion,call �•uur financial scrviccs
rcpresentativc or call a MassMufual customcr scrvicc
representativc at t-Rp0-272-2216.�ccekdays 8 a.m.to ti pen.
Enstern Time or Internef Service Cunnection
w����c.massmufu�I.com.
Pol;cy Roles
I,t+und's A!'smc DAV ID T GI�Y
Primury(hvncr N;unc GSTATG OF WILLIAM T GUY
Nolicy Covcragc Type
Ty���f In>uruncc \Vholc Lilc In,ur.uicc �
Poficy Status Prcmium P;rying
policy Intormation as of Dccembcr N,2012 Activity Summary for Policy Ycar 2012 201 I
Po{icy Numlxr ?U176i07 8asic PolicyCash V:tlue S1n4S0 Sn.oO
Pulicy Gflcctivc Date I?/OX/2�IDy lia,ic AJds Cu,h V,ilUC S1.2U SII.00
Toial Rillcd Promiunt SIZ65
Frryucncy Munthly EnAing Policy Cash ValuC $1U5.7U 50.00
liasc Fucc Antuunt S10,00q.00 Lcss @nding Loan N;il:+na� SO.Uq SII.011
�ividcnJ<)piion P�id Up AJJilion:J Insurancc Endin�Net Cash Valuc �1U5.7Q SlLllll
Death Benefit Information as of Decembcr A, 2012 Premiums Paid ,
Gsiimutcd fhhulh licn�li� (N�I�il 510 UIl5.31 liuu PolicY Prcmium* 5211.�+11
r�,r�y �,:nu
*Thc ba,c Fxilicy prcmium will includc.my xhcdulcd ridcr li.lyd in
Ilw Ridcr scciion including scltadulcd LISR and ALIR.cscluding
unschcdulcJ LISR unJ ALIR.
Loan Activity for Nolicy Ycar 2012 Rider Informatinn
13cginning Loun Balancc � S�1.00 \Vaivcr of Prcmium Ridcr
Plu,Nc�v Lonns Takcn SII.OU 7ranslcr nl'In,umd Ridcr
Plus INcresl Charcrd` $q.00
Lc++ Lo.m Rcpaymcnls $0.00
I ass hticrcii P;iid - 50.00
Gndin� Loan 13alancc SO.QO
°Tlic lo;m r.itc for the policy yrar 4.fi0%
co��cred bv ihis st.atcmcm i;:
Scc revcrsc siAC(or AAditianal Facts.
A7assachusc�is��Iwual Li@ Insur,mtt Cnmp:in}'L��d�fliliaiec • Spnneficld.�1A UI I I 6(HI01 � 1•1131 7RN.YJ I I
/ �
J- M��ssachusctls Mulual Lifc Insumncc Company and aRliatcs
SpringfieldMA01111-0001 �hvw.mnssmutual.mm 1-(800)-272Q216
� FMass,Mutual
October 29, 2012
•••M233"' •
ESTATE OF WILLIAM T GUY
333 EVERGREEN ST
NEW CUMBERLAND PA 17070-1325
Dear SidMadam:
Re: Policy Number Insured Name Issuing Company
(referred to herein as "MassMutual")
21076507 David T Guy Massachusetts Mutual Life Insurance Co
Thank you for advising us of the death of William T Guy. Please accept our sincere condolences
for your loss.
The ownership of this policy was vested in William T Guy, and upon death, reverts to the estate.
We have received and filed a copy of the death certificafe. In order to update our records, we will
need one of the following:
If the Estate was probated, a ceRified copy of the court's appointment of an Executor(tris),
Administrator, or Personal Representative of the decedent's estate. The appointment can be dated
within three yeazs. •
If the Estate was not probated, we suggest that you contact your attorney or the local probate
court for your state's Small Estates procedure. The proper estate procedure is determined by the
state where the owner lived and maintained his permanent residence at the time of death.
If the estate propeRy has already been distributed, we wiil need a copy of the final accounting of
_ the estate that was presented to the court to verify who received the policy.
When that documentation is submitted, please also fumish us with the name of the new owner
and the desired beneficiary arrangement. We will then provide you with the appropriate forms
necessary to change the owner and beneficiary of this policy.
This policy is being paid by automatic withdrawal and we will continue to drafr from the current
account until we are otherwise noiified by you as the new owner. This change can be made by
calling our Customer Service Center at the number below or by visiting
www.m ass m utua l.com/qac.
� P�ge 2 - 21076507
In addition to the above, please confirm who the new premium payor should be. If we do not
receive a response conceming the new premium payor name and address, we will automatically .
identify the new owner as the premium payor.
If you have any questions, please contact our Service Center at 1-800-272-2216. Representatives
are available to help you Monday thiough Friday from 8 a.m. to 8 p.m., Easiem Time. You may
also contact your MassMutual financial professional, Deborah E Pajak.
Sincerely,
���d i�2�tCGl
Nicholas Mullaney
Customer Service Representative
Insurance Operations .
Enclosure: 1
cc: Deborah E Pajak (A037)
a�2012 Msssnchuseus Mutual Life Insurance Company,Springficld,MA 01 I I I•0001. All righls reservcd,www.mnssmuwal mm.MassMutual
� Financial Group is e marf:cling namc for Massochusctts Munial Lifc Insuranc�Campnny(MassMutual)nnd its n�limed comppnics and solcs
represenmtives. �
� 1VIassMutual
F I NA N CIAL GflOUP"
Policyowner Annual
Statement
+000sssR Anniversary Date: December 8, 2012
EST OF WILLIAH 7 GUY Da[e Prepared: 12-07-2012
333 EVERGREEN ST
NEW CUMBERLAND Pq This statement assumes ail premiums have
17070-1325 heen paid in cash to the �nniversary date.
Policy Number: 32 OIS 134
Insured's Name: DAV]D"T GUY
Plan of lnsurance: Whole Life
Issue Date: 12/08/2006
Dividend Option: Paid Up Additional Insurance
Insurance S(smmary 2012 Anniversary �
01 ] Anniversary
Basic Policy $ 10,'000.00 $ 10,000.00
Pully PaiA AAditiunal Insurance 29.00 22. 00
Totalinsurance Coverage S 10,029.00 S 10,022.00
Cash Value Summary
Basic Policy S 401 .00 $ 293.00
Fully Paid Additional Jnsurance 6.67
Total Cash value 4.98
S 407.67 S 297.98
Your MassMutua[ Representative Your Servicing Agency MassMutual Customer
DEBORAH E Pq]AK CEN'fRAL PENN AGENCY Service Center
SUITE 201 MATTHEW J DOBBIE.
100 CORPORAiE CENTER DR 100 CORPORA7'E CTR DR /�201 1-800-272-2216
CAMP HILL Pp 17011 ��P HILL PA 17011
I'EL: (717) 763-7365
- See reverse sidc for Additional Facts -
.\1nsaschuscus\7mual 1_i(c In.urnncc Cnmpany:md:J7ilimcc . Springlield\9A 1111 I I.�NI01 • .
f:l l 11 733-Ra I 1
/
' ' ' . hlossachuseUS 4hnuol Life Insumncc Company and a(filialcs
— SpringficlJ AIA 111 I�LO(101 www.inna numal c�n 6(8110}?7?Q:ih �
� � � FMassMutual _...:
October 29, 2012
•••M231•.• . . � .
ESTATE OF WILLIAM T GUY
333 EVERGREEN ST
NEW CUMBERLAND PA 17070
Dear Sir/Madam:
Re: Policy Number Insured Name Issuing Company
(referred to herein as "NtassMutual")
32015134 David T Guy Massachusetts Mutual Life Insurance Co
Thank you for advising us of the death of Wiiliam T Guy. Please accept our sincere condolences
For your loss. „
The ownership of this policy(s) was vested in William T Guy, and upon death, reverts to the
estate. At this time, a copy of the death certiticate is not required since a death claim is now
, pending. You may receive a request From our Claims department for this information. In order to
update our records, we will need one of the following:
If the Estate was probated, a certified copy of the court's appointment of an Executor(trix),
Administraror, or Personal Representative of the decedent's estate. The appointment can be dated
within five years.
If the Estate wns not probated, we suggest that you contact your attorney or the bcal probate.
court for your state's Small Esmtes procedure. The proper estate procedure is determined by the
state where the owner lived and maintained his permanent residence at the time of death.
If the estate property has already been distributed, we will need a copy of the final accounting of
the estate that was presented ro the court ro verify who received the policy.
When that documentation is submitted, please also furnish us with the name of the new owner
and the desired beneficiary arrangement. We will then provide you with the appropriate forms
necessary to change the owner and beneficiary of this policy(s).
This policy is being paid by auromatic withdrawal and we will continue to draft from the current
account until we are otherwise notified by you as the new owner. This change can be made by
calling our Cusromer Service Center at the number below or by visiting
www.massm u iu al.com/oac.
1 �
Pagc 2 .
In addition to the above, please confirrti who the new premium payor should be. If we do not
receive a response concerning the new premium payor name and address, we will automatically
identify the new owner as the premium payor.
If you have any questions, please contact our Service Center at 1-800-272-221fi. Representatives
are available ro help you Monday through Friday From 8 a.m. to 8 p.m., Eastern Time. You may
also contact your MassMutual financial professional, Deborah E Pajak.
Sincerely,
//G ���LZGdCQQCL
M Chriscola "
Customer Service Representative
insurance Operations
Enclosure: 1
cc: Deborah E Pajak (A037)
�2012 Massachuscus Mumnl Life Insumnce Company,Springfield,MA 01 I I I-OOOL All dgh�s reserved.www.,nassm m al co .MassMmual
Fn�zial Gmup is m m�rketing name for Messachusens MWUaI Life Insumnce Company(Mas.aMulwq and iu alTilinted Mmponics and sa��y
rcprestnmlivcs.
Jul. 1, 2013 2: 32P�1h FNC Baok No 845� P. 1
� �I.V�.
7uly 2,2013
3ennifer A Meazk]e
Stone Lafaver& Shekletski
414 Bridge St
New Cumber]and, PA 17070
RE: Nazne: GVilliazn T Cruy
SSN:
DOD: 10-20-2012
Deaz Sir/1�ladam:
Tn response to your request for Date of Death(AOD)balances for the customer noted above, our
recards show the following:
Cheeldng Account
Account# 5114027669 Bstablished: 03-19-2012
WIT.,LTAM T CrTJY
PATRICIAA GUY
DOD balance: $ 10,225.65 +0.02 accrued interest
Intezest paid 01-01-2012 thru 10-20-2012 $ 134 YTD
Account# 5114027677 . Established: 03-19-2012
WII.LIAM T GC7Y
PATRICIA A GUY
DOD balance: $ 0.00 + 0.00 accrued interest
Interest paid O1-01-2012 thru 10-20-2012 $ 0.35 YT'D
Account# 5140025456 Established: OS-01-1970
WII,LIAIvZ T GUY
PATRICIA A GUY
llAVTD T GUY
DOD balance: $ 1,216.30 non interest bearing
Sa'aings Account
Account# 5004889321 Established: OS-17-2006
PATRICIA A GUY
WTLT.TAM T GUY
bAVTb T CrTJY
]�011 balance: $ 0.00 + 0.00 acctued interest
Tnterest paid OI-01-2012 tlu�u 10-20-2012 $ 0.35 Y1'A
Page 1 of 2
Jul. 1. 2U13 1: 32PiN PNC 6ank No. v°45i P. 2
Savings Account
Account# 5]14027685 Established: 03-19-2012
VdILLIAM T GUX
PATRICIA A GUY
bOb balance: $ 63,277.61 � 19.13 accnud interest
Interest paid 01-01-2012 thru 10-20-2012 $ 69.81 Y''T'D
Tnvestment Account
The decedent maintained Investment Account#4064220. For furthez information, you may call the
Brokerage Departmentatl-800-762-6111. �
Loan Aceoant
The decedent maintained T,oan Account 400304811089617. Por furrher information and assistance,
please concact 1-888-762-2265. Ihis is a voice activated system. Please state the word "operator"
and follow>the prompts to speak to a Loan Financial Service Consultant
, Please note thaz this office provides date of death balances for deposit accounts(IRAs, CDs,.Checking and
Savings). R'e do noi process any financial transactions or pmride statemeots. Tf you need assistance adth
eny of�ese items,please call 1-888-PNC-BAI�TK(1-888-762-2265)or stop b}�your local PNC Bank branch
office.
Sincerelq,
3 v�t-B. �l;�e -5..�QS�I.na..r
National Financial Services Center c� � �n �} ,�
PIJC Bank,N.A. P c�x u,.
Member FbTC •
l,a�.�c J�,..t w��,y. s�m.�se,
This message is intended for the use of the ir,d • • „�,
conrain infornration that isprivileger� con,f:de: ����«` � G"J` :able Zaw.
Ijthe reader ojthis message is not the intende 51e for ,
deliverrng this message to the intended recipif mo�
distribution or copying of this communicartion �I5
communication in error,please not�me imm 1775 and
immediately destroy this faxed document.
Page 2 of 2
� FMassMutual
Policyowner Annual
Statement
*000sas• Anniversary Date: December 3, 2012
PATRICIA A GUY Date Prepared: 12-06-2012
333 EVERGREEN STREET
NEW CUMBERLAND PA This statement assumes all premiums have
17070-1325 been paid in cash to the anniversary date.
Policy Number: 6 652 505
Insured's Name: DAV1D T GUY
Plan of Insur�nce: Whole Life
Issue Date: 12/08/1982
Dividend Option: Paid Up Additional insurance
/nsurance Summary ?012 Anniversar ?
y, O11 Anniversary
Basic Policy $ 10,000.00 $ 10,000.00
Fully Paid Additional Insurance 5,476.00 5,518.00
Setdement Dividend 190.30 181 .70
Total Insurance Coverage $ �15,666.30- $ 15,699. 70
Cash Value Summary
B�sicPoiicy S 1, 756.30 $ 1,657.60
F=ully Paid Additional Insurance 1,384.62 1 ,345.96
Settlement Dividend 190.30 181. 70
TotalCashValue S 3,331.22 $ 3, 185.26
Your tYlussMutuaL Representative Your Servicing Agency MassMutual Customer
CENTRAL PENN AGENCY $2rviCe CBntBr
DEBORAH E .PAJAK MAiTHEW J DOBBIE
SUITE 201 100 CORPORATE CTR DR //201 ]-800-272-22I6
100 CORPORATE CENTER DR CAHP HILL PA 17011�
CAMP HILL PA 17011 TEL: (717) 763-7365
• See reverse side for Additional Facts -
�\lassnchusettc\qulual Life Insurance Conipany:md af7ilialcs • Sprinelicld.\1A 01111-IMlbl • N13i 74ti-Rql l
r ,.n Masmchusells Mutual Lik Insumnco Compnny und nmliuta
�. - Spnngficld MA 01 I I I-0001 www.mnsstnulual,com I{800}272-2216
� MassMutual
November 7, 2012
"'M231"'
PATRICIA A GUY
333 EVERGREEN STREET
NEW CUMBERLAND PA 17070
Deaz Mrs. Guy:
Re: Policy Number Insured Name [ssuing Company
(referred to herein as "MassMutual")
6652505 David T Guy Massachusetts Mutual Life [nsurance Co
Thank you for advising us of the death of William T Guy. Please accept ouF sincere condolences
for your loss.
The ownership arrangement for this policy was vested in William T Guy, during his'lifetime, and
thereafter, the owner of the policy would be you, Patricia A Guy, during your life[ime and
thereafter the Insured,At this time, a copy of the death certificate is not required since a death
claim is now pending. You may receive a request from our Claims deparhnent for this
information. We have adjusted our records to show you, Patricia A Guy, as the owner.
Due to Federa!Law, we are required to obtain, verify, and record information on our customers
for identification purposes. Please have the new owner complete the enclosed Customer
/dentification form and return it in the enclosed self-addressed envelope.
The ownership of this policy was recenHy trac�sferred to you. The previous owner had
established the policy on a Standing Dividend Order(SDO), or part of a Standing Dividend
Order arrangement, which allowed MassMutual to surrender dividends each yeaz to pay the
annual premium. Please note if the dividend is not sufficient to cover the amount due, a bill will
be sent which indicates the net amount due. This method of payment will be continued unless we
are notified by you to remove the policy from SDO.
For your convenience, enclosed is an explanation of the Standing Dividend Order plan in the
Premiums and the SDO brochure. If you have further questions or would like to change this
option call our Service Center at the number below.
1"
Page 2
If you have any questions,please contact our Service Center at 1-500-272-2216. Representatives
are available to help you Monday through Friday from 8 a.m, to 8 p.m., Eastem Time. You may
also contact your MassMutual financial professional, Deborah E Pajak.
Sincerely,
//G ��¢
M Brooks
Customer Service Representative
Insurance Operations
Enclosures: (2)
cc: Deborah E Pajak(A037)
O 2012 Messachusetts Mutuel Life Inswancc Compony,Springficld,MA 01 I I 1-0001. Ali rights resmed.www,massmutuaf_com.M¢ssMutua!
Financiel Cloup is n merkcting nnmc far Me.csachusc�ts Mutunl Life Insumnce Company(MassMucunl)ond iu�liatcd companien and sales
rcprtsrnmtives. � � •
riuueiwai iceurement Page 1 of 1
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https://www.retirement.prudentiaLcom/DCStrutsWeb/accountDetail.do 2/1 i/2013 �
V�.6 Prudential Pmdential Retirement
� 30 S�ant�n�Officle Pa k nce Company of America
Scranron,PA 18507-1789
1-817-77&2100
�w+w.retirementpmdentia l.com
Patricia Guy Plan Numher: 71909g
333 Evergreen St. Sub-Plan: 000002
New Cumberland, PA 17070 Reference Number: 71909880981
Dececlent's Name: William T Guy
February 1, 2013
Dear Mrs. Guy:
We have heen informed about the death of your spouse. Please accept our sincere condolences for
your loss. My goal is to make the proe;essing of your reyuest for death benetits as pmmpt and
convenient for you as �ssible.
Our rec;ords indicate you are�the sole beneficiary for,the account referenced above.
As the beneficiary of this account; there are spec ial rule,g that appty to your receipt of a
distribution from this account. Penalties may be incurred if the account is not distributed
within the timing standards set by ihe Internal Revenue Service.
As a heneficiary, you have the same rights as a participant with re,epect to annuiry options and
making exchanges between investment accounts. If you would like a pmspec;tus or relatecl
materials, please call us at our toll-free number.
At this time, I would appree;iate your help in providing the following so we can pmc�.ss this claim:
• In order to pmcess a disbursement, selec:t an annuity, or set up a separate account in your
name, we need an original or certified copy of the death ceniticate. If the cause of death is
listed as 'Pending Investigation' or'Undetermined' it will not be accepted. Avdential will
reyuire an amended death cenificate that indicates natural causes, accident or suicide for
reason of death, or a �lice report stating that the beneficiary is not a suspect in the death of
the dececlent. I've enclosed a form you may complete and retum to us in order to have your
portion transferred to a separate account under your name and Social Security number or paid
in a single sum. If you elect ro set up a separate aaount in your name, please complete the
Beneficiary Designation Form. You may reyue�ct a disbursement at any time in addition to the
requiretl minimum distrihution (if applicable).
• This is a Second Request. Please complete the enclosecl forms and submit for further processing.
It is our understanding that any funds paid to you should be re�rted as ordinary income for federal
income tax purposes for the year in which the funds are received. You may wish to consult with
your legal or tax advisor if you have any questions regarding the tax treatment of any payment, as
Prudential Retirement cannot offer lega] or tax advice.
If you have any yuestions regarding this letter or the plan in general, please contact our oftice at
I-877-778-2100.
Sincerely,
Prudential Retirement
Enclosure
j