Loading...
HomeMy WebLinkAbout07-26-13 (2) J 1505610105 REV-1500 Ex l�rr'(R) OFFICIAL USE ONLY Department of Revenue Pennsylvania Bureau County Code Year File Number PO BOX 8o6 Bureau Individual Taxes „w..., INHERITANCE TAX RETURN _- Harrisburg PA 17128-o6o1 RESIDENT DECEDENT 12- ENTER DECEDENT INFORMATION BELOW L 10/29/2012 10119/1926 Decedent's Last Name Suffix Decedent's First Name MI Emey Edwin S (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Erney Caroline M Spouse's Social Security Number THIS RETURN MUST BE PILED IN DUPLICATE WITH THE 287-26-6970 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CID 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) D@D 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust _� 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 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 Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number E. Ralph Godfrey, Esquire (717)975-9600 REGIb"r�Elj OF WILLS USE ONLYn T -- `.-d O First Line of Address M 1011 Mumma Road r C-1 Second Line of Address Suite 201 - a City or Post Office State ZIP Code DATE FILED ''1 Lemoyne PA 17043 cA Correspondent's e-mail address:rgodfrey @c-wlaw.com Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knovedge and belief, it is true,correct and cam a ration of preps o er than the personal representative is based on all information of which preparer has any knowledge. SIGNA URE OF P R ESP SIBLE FO II G RETURN DATE 07/12/2013 ADD S 50 ark Avenue. N umbefland PA 17070 SI5Najj0 O EPAR ATHERT EPRESENTATIVE - pg7E 07/12/2013 AD5RESS 1011 Mumma Road, Suite oyne, PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 U J 1505610205 REV-1500 EX(FT RECAPITULATION 1. Real Estate(Schedule A). ...... . ...... .. .. ..................... ..... . 1. 2. Stocks and Bonds(Schedule B) .. .. .. ......... .. .. . .. .. ... .. ..... . 76,804.06 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .. . . 3. i 4. Mortgages and Notes Receivable(Schedule D) ...... ... ....... . ......... . 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . ..... 5. 2,920.32 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. .. .. 6. 130,420.70 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 86,003.19 B. Total Gross Assets(total Lines 1 through 7)............. . .... ........... B. 296,148.27 9. Funeral Expenses and Administrative Costs(Schedule H)... ....... ... .... . 9. 23,726.80 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. ....... .... . . 10. 3,405.34 ) .... .. .. .......... .. .. ... .. .... 27,132.14 11. Total Deductions total Lines 9 and 10 .. 11. 12, Net Value of Estate(Line 8 minus Line 11) .. ..... ........... . .... .. ... .. 12. 269,016.13 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. 269,016.13 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 ( 235,281.32 (a)(1.2)x.0_ 15. - --- 0.00 16. Amount of Line 14 taxable at lineal rate x.0 45 33,734.81 16. 1,518.07 17. Amount of Line 14 taxable at sibling rate X.12 0.00 17. 0.00 18. Amount of Line 14 taxable at collateral rate X.15 L- 0.00 1 18 0.00 19. TAX DUE ... ... .. .. . .. .. . .. .. ... .. ....... .. ..... ..... ..... .. .. . .. . 19. 1,518.07 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610205 1505610205 J REW 500 Ex(Fp Page 3 File Number '(!/ 1.1 &f Decedent's Complete Address: DECEDENT'S NAME Erney, Edwin S. STREETADDRESS 336 Messiah Circle CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,518.07 2. CreditslPayments A.Prior Payments 0.00 6.Discount Total Credits(A+g) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line i+Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 28 to request a refund. (4) 0.00 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,51$.07 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.......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ a c. retain a reversionary interest.......................___.........................................................._........._...............__....... ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2, If death occurred after Dec.12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 3. Did decedent own an"in trust for or payable•upon-0eath 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? ........................................................................................................................ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent]72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent F2 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)1. • 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 f72 P.S. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 172 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. gym: LAST WILL AND TESTAMENT OF EDWIN S. ERNEY I, EDWIN S. ERNEY, of Harrisburg, Dauphin County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by the Executrix out of the property passing under ITEM III of this Will,as an expense and cost of administration of my estate: The Executrix shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executrix to pay my just debts and the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. 1 UEM III: I devise and bequeath all the rest,residue and remainder of my estate as follows: (a) One-half(1/2) to my wife, CAROLINE M. ERNEY. In the event my wife predeceases me, this share shall be paid to the beneficiaries set forth in this paragraph at subsection(b)below; (b) One-half(1/2)to be divided in equal shares as follows: 1) One share to my son, DAVID S. ERNEY. In the event my son predeceases me, this share shall be paid to his issue,per stirpes; 2) One share to my daughter, LESLIE ERNEY PANKEY. In the event my daughter predeceases me, this share shall be paid to her issue, per stirpes; and 3) One share to my daughter, JOAN L. ERNEY. In the event my daughter predeceases me, this share shall be paid to her issue, per stirpes. In the event my daughters or my son should predecease me leaving no surviving issue, his or her share shall be equally paid to the other named beneficiaries in(b) above. rrEM IV: In the settlement of my estate, my Executrix shall possess, among others,the following powers: (a) To.retain any investments I may have at my death, as long as the Executrix may deem it advisable to my estate to do so; 2 (b) To sell either at private or public sale and upon such terms and conditions as the Executrix may deem advantageous to the estate, any or all real or personal property or interest therein owned by the estate; (c) To pay all costs, taxes, expenses and charges in connection with the administration of my estate; (d) To compromise controversies; and (e) To do all other acts in the Executrix's judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the estate. ITEM V: Any person who shall have died at the same time as I shall have,or in a common disaster with me, or under circumstance that the order of deaths cannot be established by proof, or within thirty (30) days of my death, shall be deemed to have predeceased me. ITEM VI: I appoint my daughter,JOAN L.ERNEY,to be Executrix of my Estate. In the event my daughter cannot act or refuses to act as Executrix for any reason,I no , 3 constitute and appoint my son,DAVID S.ERNEY, as alternate Executor. Any Executrix/or is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding three (3)pages, at the end of each page of which I have also set my initials for greater security and better identification this 22nd day of May, 2006. (SEAL) *16WIN S. E:rego:; We, the undersigned, hereby certify that the f Wi<Wsigned, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof,the said Testator was of sound mind and memory. Residing at: 123 7ffi Street Laura J. Hugys New Cumberland,PA 17070 Residing at: 129 Herman Avenue Amanda L. Baker Lemoyne, PA 17043 4 f y r. _ .. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND I, EDWIN S. ERNEY, Testator, 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. (SEAL) EDWIN S. ERNEY Sworn to and subscribed before 2nd day of ay, NOTARY PUBLIC My Commission Expires: SEAL (SEAL) SUMPIESULLNAN tary Pubnc ERLAND BOROUGH RLAND COUNTY [7NOTAREAL n Espires Nov 15,2007 - AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND We,Amanda L.Baker and Laura J.Hughes-Doyle,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, EDWIN S. ERNEY, sign and execute the instrument as his Last Will and Testament;that Testator signed willingly and he executed said Will 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 Will as witnesses;and that to the best of our knowledge the Testator was at that time eighteen(18)or more years of age,of sound mind and under no constraint or undue influence. Amanda L. Baker laura J ugh s Sworn to s bscribed bef me 's nd day 6. NOTARY PUBLIC NOTARIAL SEAL BARBARA SUMPLE-SULWAN Notary Public My Commission Expires: � " My CommissWn s Nov 15,20d7 (SEAL) REV-1503 EX+(8-12) Pennsylvania SCHEDULES DEPARTMENT OF REVENUE 1WERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWIN S. ERNEY 21 12 1161 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I. Rite Aid Stock 100 shares 116.00 (See attached statement) 2. McDermott International, Inc. Stock 73.774386 shares 794.55 (See attached statement) 3. Allegheny Stock 2 shares 696.80 (See attached statement) 4. Vanguard Stock Account 14,779.79 Acct. No. 65791031 (See attached statement) 5. Wellesley Income Fund Adm-Vanguard 58,021.96 Acct. No. 0527-88005286391 6. Met-ite Stock 68 Shares 2,394.96 Acct No. 806292057216 See attached documents TOTAL(Also enter on Line 2,Recapitulation) $ 76,804.06 If more space is needed,insert additional sheets of the same size AMERICAN STOCK Operations Center 6201 15th Avenue Transfer&Trust Company,LLC Brooklyn,IVY 11219 LiNK GROUP n-twoNr www.amstock.com (866)207-5349 January 14,2013 Attn:Ralph Godfrey 1011 Mumma Road Suite 201 Lemoyne, PA 17043 Re: EDWIN S ERNEY Company: RITE AD CORPORATION Account: 6000000940 .Clear Mr.Godfrey: We have received your request regarding the above-referenced account. Our records indicate as of the date of death the account held a balance of 100 outstanding shares.. This share position is held in book entry form under your account as shown below: Book Entry# Issue Date #of Shares BK*0000121 12110/2007 100 The price per share for the company at the close of business on October 29,2012 was $1,16 per share. The stock price is provided by an independent third party. American Stock Transfer&s Trust Company does not guarantee the timeliness or accuracy of such information.The company trades on the NYSE and the symbol is RAD. Enclosed please find a transfer instruction package providing necessary requirements needed to effect the transaction. If we can be of any further assistance,please contact our Shareholder Services Department at the number listed above, We trust the above information is helpful. Sincerely, .. Charles Cale' Shareholder.Services ASTI 5144206000000940 P Computershare Did you know?Most shareholders can manage their holdings online with free � mputershare access to Computershare's Investor Centre?`"website. Use this simple tool to CCC quickly and easily update account information, sign up for electronic delivery of documents and more. Enroll FREE today at www.computershare.com/investor. Computershare Investor Services 250 Royail Street Canton Massachusetts 02027 www.computershare.com E RALPH GODFREY CIPRIANI&WERNER 1011 MUMMA ROAD SUITE 201 LEMOYNE PA 17043 February 28, 2013 Company: MCDERMOTT INTERNATIONAL INC Registration: EDWIN S ERNEY Holder Account Number: C0000069485 Document I.D.: 13015WF00923093 Our Reference: MDR/0002803339/3/ Dear Sir/Madam: Thank you for contacting Computershare,the transfer agent for MCDERMOTT INTERNATIONAL INC. We appreciate the opportunity to be of service to you. On October 29, 2012 the market was dosed. On October 26, 2012, McDermott IntEmational account number C0000069485 held 73.774386 shares. On that date,the dosing price was $10.77 per share. On October 26, 2012, Alleghany account number C0000014630 held 2 shares. On that date, the dosing price was $348.40 per share. On October 26, 2012, McDonald account number C0003854086 held 133.755651 shares. On that date, the closing price was$86.71 per share. For transfer information, please visit the Computershare stock transfer wizard at www.transfemmtDxk.com.The wizard will walk you through the transfer process and assist you in completing certain of the necessary documentation to complete the transfer. Please note that you will need the following information to use the transfer wizard: • Company name or ticker symbol; dick here to look up your company • Current holder account number(Beginning with a C) • Current holder five-digit US ZIP code • Name and address of new holder • Number of shares you wish to transfer Additional security information may also be required. Important: Please also note that if you are transferring certificate shares,the certificate(s) must be mailed with your transfer request Vanguard Brokerage Services® A Division of Vanguard Marketing Corporation Edwin S Emey 336 Messiah Or Mechanicsburg, PA 17055-8620 Brokerage Account--65791031 Below is your Date of Death Account Valuation for the above referenced account. Holdings Summary Values on: 10129/2012 Stocks Total $14,779.78 FundAccess Total $0.00 Bonds Total $0.00 Accrued Income Total $27.9179 Total Account Value: $14,779.78 Holdings Stocks symbol Quantity Price per Share Current Value Accrued Dividends Deere&Company DE 60,6910 $85.3175 $5,178.0044 $27.9179 Microsoft Corp MSFT 107.9770 $28.3900 $3,065A670 Rite Aid Corp RAD 700A000 $11150 $780.5000 Union Pacific Corp UNP 46.7230 $123.1900 $5,755.8064 Total stocks $14,779.78 $27.9179 FundAccess Symbol Quantity Price per Share Current Value Accrued Dividends No FundAccess®securities held in the account. Total FundAccess $0.00 $0.0000 Fixed Income Cusip Quantity Price per Share Current Value Accrued Interest No fixed Income securities held in the account. Total Fixed Income $0.0000 $0.0000 Disclosure: The fair market value of individual stocks and bonds is generally calculated using the mean between the highest and lowest selling prices quoted on the valuallon date,If selling priced are not available on the valuation data,such as a weekend or holiday,a weighted average of the means belwean the highest and lowest prices on the nearest trading days before and after the valuation date is used.The fair market value of open end mutual rums Is calculated using Rte latest public redemption ante available an the valuation date.For bonds.R a high antl low price are not amimles,the rrean betwaxt the quoted dosing seeing price an me valuagon date and on Me trading day before ma valuation data is used b detamvns the fair market value.9 Me vatuafien date is on a waskand or hdiday,a weighted avarage of the mi between the highest and lowest prices an the nearest trading days before and after Me valuation date is Verdi if high and low prices are not available on these date&the mean between the quoted closing selling price on the nearest business days before and after the valuation date is used. 'Fair market value provided includes an adjustment for a dividend because the stock was trading ex•eividend a r required under Tress.Reg.20.2031Q(i). Page 1 of 1 Page> 1 of 1 Vanguard' Edwin S Erney o 10 t 12 336 Messiah Cir Voyager Services:800-284-7245 Mechanicsburg, PA 17055-8620 Total report value: $58,021.96 (Total report value Includes any accrued dividends.) n SsErneyt'-dixt ual' CUM ' AC n a o su ma. Room ;Name' i' -x ,t ec,Fund Acsbd'nt'« r' Date sdtt '^`' k, v, "x- r;,,; 'fAAocr' ued*' a a R 1 s Pttce Per 1t v ,, ac ��yr^ '"^u lehhz^^3h ,ir ,Nurriiie t p S.7' Y F +' .§'a�5,- teA{:c t. 5u S ?' qtr . enad��a Share-'� v- {'Yaiue�t�'�`ti�"Dividendsr: PA Tax-Exempt Money Mkt 0063-88005286391 02/24/2005 0.000 $1.00 $0.00 $0.00 s4N l e #j me F d�1dm; `t 0527 80052&639 093t}1201"�i $78 61m3�6 r�$58.29 T Totals $58,021.96 $0.00 'Doesn't include accrued dividends. 0414395905 01/1512013 09:20:49 /• FEB-26-2013 12:25 717 431 2013 717 431 2013 P.002 McU!&Stock Account Information System Page 1 of 1 / Perform andtw awch Results for Social Security Number"xxx-xx-3729" as of October 26,2012 Investor 10 Policy SSN CertMled4 Shares 8062820S721S 400ea7065 Yes 68 Number ofCerdfied Shares .... . .. ...... . . ........ ... .. 68 Number of UncrertHled Shares . .. .......... . . . . . . .... ..... 0 Total Shares. ... . ..... . . .. . . . . .... .. .. .. 88 Pgrrorm anoprerS�rcb htpsJ/Xolea&mctlife.corn*oleads/scoureisharesearch.do?action—m 1/4/2013 TOTAL P.002 7/25113 Mellife,Inc.Historical Prices MET Dailyfinance DJIA 15,541.11 -1.13 -0.01' / GET MORE ON -s AmeHtrade ' - 1 NASDAQ 3,599.80 20.20 0 56', MET d ., 1 AT E*TRAOE u --- --"' ` ' S&P 500 1,687.32 1.38 0.085 E Add'h ��to Sponsored Links Portfolio My Free Credit Scores 10 Best-0%Credit Cards Get An 3 Scores See Online Now Do You Have Excellent to Good Credit?Receive 0%APR for 18 Mor Jump to another company w .ldentltyGuard.com v—comparecamacom/mAntr"PR MET .. I *,<GO., _ ....... .._ ...... conpany name or ticker Start Date(YYYY•MM-DD) x2012-10.26 ;7 31 End Date(YYYY-MM4)0) 2012-10-26 � CI • j Date Open High Low Close Volume Change% Histd `� 10/262012 35.48 35.74 34.92 35.22 27,311,284 i-121% . ............ . Summary Profile Rates&Ratios EamingsiGrowth Rates E Financial Ratios Key Statistics I Price &Chart jCharts Dividends i Historical Prices Options Chains Financials S,Filing: Recent Quotes (MET $48.67 -0.82% 3 MLG $25.20 -0.12% MLU $57.15 -0.83% i I MEU $0.00 0.00% w w.dailYfironce.COnJquote/NYSEJmaflife-irr/METR xistor tcal-priem?source=ibaehiM0000011 1/3 REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAX RETURN CASH, BANK DEPOSITS &MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: EDWIN S. ERNEY FILE NUMBER: 21 12 1161 Include the proceeds of litigation and the date the proceeds were received by the estate. ITEM All property jointly owned with right of survivorship must be disclosed on Schedule F. NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. John Hancock- Long Term Care Payment 2,870.00 2. Metlife Dividend check 50.32 TOTAL(Also enter on Line 5,Recapitulation) $ 2,920.32 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) - pennsyivania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: EDWIN S. ERNEY 21 12 1161 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAMES) ADDRESS RELATIONSHIP TO DECEDENT A.Caroline M. Erney c/o Robert Stump, RR#4, Box 165 wife RR#4, Box 165 Newport, PA 17074 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND SANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. McDonald Corporation stock 133.755651 shares 11,597.95 50. 5,798.98 Acct No. 00003854086 Computershare 2. A Metlife, Inc. stock 36 shares 1,267.92 50. 633.96 Acct. No. 00004067321 Computershare 3. A. 2008 PNC Checking Account No.5005956717 23,563.62 50. 11,781.81 4. A 718/11 Wellington Fund 2562.674 shares 151,300.27 50. 75,650.14 Acct. No. 0521-09880491380 Vanguard 5. A 7/8/11 GNMA Fund Admiral Shares 5520.941 shares 60,840.77 50. 30,420.39 Acct No.0536-09880491380 Vanguard 6. A 9/24/07 PA Tax-Exempt Money Market 398.130 shares 398.13 50. 199.07 Acct No.0063-09880491380 Vanguard 7. A Vanguard Brokerage Account 10,466.91 50. 5,233.46 Acct No. 34222522 8, A Qualcomm Stock 22.082511 shares 1,405.77 50. 702.89 Computershare Acct No.C0002342669 9, A ALL OTHER PROPERTY NOT LISTED IN THIS RETURN IS JOINT WITH SPOUSE TOTAL(Also enter on Line 6,Recapitulation) $ 130 420.70 If more space Is needed,use additional sheets of paper of the same size. REV-1510 EX-(o8-00) pennsytvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWIN S. ERNEY 21 12 1161 This schedule must be completed and Ned 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 °l OF DECD'S EXCLUSION TAXABLE NUMBER THEOATEOFTRASFER ATTACH A COPY OFTHEDEED FOR HEAL ESTATE VALUE OF ASSET INTEREST PFAPFr MLE) VALUE 1. Fidelity IRA Account 341-048585 to wife Caroline Erney 43,993.66 100.00 0-00 43,993.66 on date of death as beneficiary 2. Vanguard IRA 36,664.13 100.00 0.00 36,664.13 Wellington Fund Inv. 1072.364 shares Acct No. 0021-97847253670 3, Vanguard IRA 5,345.40 100.00 0.00 5,345.40 Windsor II Fund Inv 182.624 shares Acct No.0073-97847253667 TOTAL (Also enter on Line 7,Recapitulation) $ 86,003.19 It more space is needed,use additional sheets of paper of the same size. I Laid you know?Most shareholders can manage their holdings online with free omputershure access to Cornputersnare`s Investor CentreT°'website. Use this simple coal to (� quickly and easily update account information, sign up for electronic delivery of d9ciimens and rnore. Enroll FREE today at wsAtty,computershare,corl2/invp-ctor. Computershare Investor services 250 Royall Street Canton Massachusetts 02021 www.computershare.com E RALPH GODFREY CIPRIANI &WERNER 1011 MUMMA RD STE 201 LEMOYNE PA 17043 March 1, 2013 Company: Ate. Registration: EDWIN S ERNEY& CAROLINE M ERNEY IT TEN Holder Account Number: C0004067321 Document I.D.: 13059WF00486531 Our Reference: ATT/0120130228/41026989/ Dear Sir/Madam: Thank you for your inquiry regarding the above referenced account. We appreciate the opportunity to be of service to you. We were unable to provide a market price for the date of death as October 29, 2012 was a non-trading day. Below is the account balance information for the previous business day for Metlife Inc. on October 26, 2012. Company Name: Metlife Inc. Account Number: C0004067321 Shares Held by Agent: 36 Shares Held in Certificate Form by Holder: 0 Total Shares: 36 Closing Price Per Share: $35.22 If you have any further questions, please visit our website at www.computershare,com/att or you may contact us by phone at 800-351-7221. We offer an automated telephone service to assist you at any time, or you may reach a representative during regular business days, 8:30 a.m. to 8 p.m. Eastern Time. Please note that any available representative can assist you. You may write to us at Computershare, P.O. Box 43078, Providence, RI 029'40-3078:' Sincerely, Service Representative Enclosure: None �an. 11. 2013 10:26AM PNC Bank Vo. 4920 P. 111 PNC m4aft mr January 11,2013 Cipriani 1k Werner Attorneys at Law 1011 Mumma Rd Ste 201 Lemoyne, PA 17043-1145 RE: Edwin S Erney SSN: 201-16-3729 DOD: 10-29-2012 Dear Sir/Madam: In response to vour request for Date of Death (DOD' balances for the customer noted above,our records shorn the following: Checking Account _ Account r#5005956717 Established: 10-28-2008 EDWIN S ERNEY CAROLINE M ERNEY DOD balance: $ 23,563.62 non interest bearing Please note that This office provides date of death balances for deposit accounts(I)RAs,CDs,Checking and Savings). We do not process any financial transactions or provide statements. if you need assistance with any of these items,please call 1-888-PNC-BANK,(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC This message is inrended for the use of the individual or entity to which it is addressed and may contain information that is privileged confidential and exempr from disclosure under applicable law. rf the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient,you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy rhis foxed document. Page 1 of I ����. i� p `� `�, nor �.'� 5�.�� '.,J ���� �" w' ,..';a, �'r.��, Page > 1 of 1 Vanguard® Edwin S.Erney& Re o� o>10/2 M . Caroline M.Erney Voyager Services:800-284-7245 A Ten WROS C/O Robert J Stump Total report value: $212,661.36 191 Oak Hall Rd (Total report value Includes any ammed dividends.) Newport, PA 17074-7696 Itt$_Emey; arnoli a mey=Joi4-A cd n MINE W. 4 r- A co' ntvalu�gs a, } F4 m--- r �� r.F n �A " S'YiarY � .w n •z „ r t .it_ .9n w a ,1�, 's , xyy,and&Accoun 9 i� Date ,pnceiPer z Y Accrued {41y i1y+ e.?'�7 bli�c.. � .. ��n x any. h -31 � n ')�Y'}-"n o�5 sr fir, '"W Yd Yt� s� pr at R y �ej,fJ � nYS t r,1g Number #a �•• <Opened "Shares �sMhace� a Value #r, S `Dvidefids .S .3JannL 4iCun v� ...x.w.cs.4.t3.0 ±.xe- .�.,t¢.Xx.. Wellington Fund Admiral 0521-09880491380 07/08/2011 2,562.674 $59.04 $151,300.27 - EGNMA+F nr`,Yi raal)Sha er s k} 50 36 09880499860'X07/08/2011'$ ""',y$60,8 0 7tT rna j'u:z.. ..�mra'+Fps...nrt.:;>�l.aa.-.6?-m_1ahfi...tev,:�a1?B3 avtsy�..x .IL.M$60.. 40e7rri PA Tax-Exempt Money Mkt 0063-09880491380 09/24/2007 398.130 $1.00 $398.13 $0.00 f. .• u:.. �� f"ty"Pi,t;_:v �xr S:i'r `,.e1:!C:..:nr ta• �.z.:,rG„Fait^.+f:....jia:_+ii 'C{:� ... :':v;: v ;tJ%:>^.�;ru e�i. _ $212339 _ ,17,3+ $12219`' =}a : .r'��ifF-v A:•.k .c?>n..+s.; �?� i?t+�..�'..... 51 t1c. r::'@�+vl � .t=:�.+ `._?.,r�`i�..�'`�:3'�i'.�".'.�r'�'`"r�.ld. :,..i:.y,"..::'•°iii 'Doesn't Include accrued dividends. 0024919415 01/15/2013 09:21:54 Vanguard Brokerage Services@ A Division of Vanguard Marketing Corporation Edwin S Erney& Caroline M Erney 336 Messiah CIR Mechanicsburg, PA 17055-8620 Brokerage Account-34222522 Below is your Date of Death Account Valuation for the above referenced account. Holdings Summary Values on: 10/2912012 Stacks Total $10,465.91 FundAccess Total $0.00 Bonds Total $090 Accrued Income Total $0.0000 Total Account Value: $10,465.91 Holdings Stocks Symbol Quantity Price per Share Current Value Accrued Dividends Automatic Data Processing Inc ADP 38.3500 $58.1125 $2,228.6144 General Electric Company GE 219.4610 $21.1887 $4,650.0933 Rite Aid Corp RAD 800.0000 $11150 $892.0000 Enterprise Products Partners Ltd EPD 50.1410 $517525 $2,695.2041 Partnership Total stocks $10,465.91 $0.0000 FundAccess Symbol Quantity Price per Share Current Value Accrued Dividends No FundAccess securities held in the account. Total FundAccess $0.00 $0.0000 Fixed Income Cusp Quantity Price per Share Current Value Accrued Interest No fixed Income securities held in the account. Total Fixed Income $0.0000 $0.0000 Disclosure: The fair market value of Individual stocks and bonds Is generally calculated using the man between the highest and lowest selling prices quoted on the valuation dale.If selling prices are not Valldele on me valuation data,such as a weekend or hdiday,a w0ight0d average 01 the treans between he highest and lowest pass an fire nearest trading days before and after fie valuation data Q usetl.The fair market value of open and annual funds is calculated using he latest pub4c redemption pace available on he valuation date.For bens,if a high and low price are not available,the mean between he quoted Closing selling once on the valuation date and on the trading day before the valuation date is used to calamine he fair market value,If the valuation date is on a weekend or holiday,a weighted overage of the means between he highest and lowest once$on the nearest trading days before and after the valuation date is used.If high and law prices are not available on these dates,he mean between he quoted closing selling price on he nearest business days before and after the valuation date Is used. 'Fair market value provided includes an adjustment for a dividend because he stock was trading ex-dividen as required underTroas.Reg.291431-2(i), Page 1 of 1 Page 1 of 2 QUALCONM &mputershore Computershare Trust Company,N.A. PO Box 43078 Providence,RI 02940-3078 Within USA,US territories 6 Canada 800 619 9612 m Outside USA,US territories li Canada 312 588 4157 1102240 www.computershare.corrOnvestor 11��1�'111''rrlrl�II�11(ulr!}sr}IHII�}�nul}'I�d�llr}tl��'9 QUALCOMM Incorporated is incorporated under the laws of the State of DE. EDWIN S ERNEY &CAROLINE M ERNEY JT TEN 336 MESSIAH CIR Holder Account Number MECHANICSBURG PA 17055-8620 00002342669 SSWI IN certil ed Symbol Yes QCoM DDtCS0006_r(a.DLQCnM.085036_409591002240/002329r, QU ILCOMM 1�lcacporated-Si tn1040 of Accoulit til ings anti T7ar}sa�c#(a f arnr It is important to retain this statement for tax reoortina ourposes and for use as a reference Holder Account Number.C0002342669 when you access your account online at our webstle or when contacting Computershare. ►ACCOUNT SUMMARY As of close of stock market on 26 Sep 2012 Dec ptisi I G�t ifirated Shares! Direst Registration lnvestrirent Plan Total .. , ..Closing Price �<;Market nits Hold by You Book Sharesltinits I Book Shares/Units ShareslUnits I Per SharelUnit($) I Value($) Dspp-Common Stock 0.000000 1.000000 21,082511 &082511 62.320000 1,37618 Dividend Reinvestment Activity As of record date This section Includes information only for shares/units for which dividends are reinvested. Record Payment f Dividend Stock Class Dividend Reinvestment Gross I Taxes Net I Date Date ! Rate{$) I Description I ShareslUnits I Dividend($) 1 Withheld($) 1 Dividend($) 07 Sep 2012 26 Sep 2012 0250000 Common 21.994246 5.50 5.50 Transaction History From:01 Jan 2012 To:26 Sep 2012 This section pertains only to book-entry shamstunifs. Date I Transaction (Transaction I Deduction( Deduction I Net I Price Per I Transaction I Total Book Description Amount($} Description( Amount($) Amount($) SharefUnit($) Shares/Units Shares/Units Plan Transactions Dspp-Common Stock Balance Forward 20.828082 23 Mar 2012 Dividend Reinvestment 4.69 4.69 66.378600 0.070655 20.898737 20 Jun 2012 Dividend Reinvestment 5.47 5.47 57.272183 0.095509 20.994246 26 Sep 2012 Dividend Reinvestment 5.50 5.50 62.312328 0.088265 21.082511 DOTPPA(Re%12111) FF � Page 1 of 2 New User?Re con, Sign in Heip Make w MY Hpmepand Mak MY try Yafipo' Search Search Web HOME {NYESTING NEWS PERSONAL FINANCE �A9Y PORiFO1.i00 EXCLUSIVES �T Get QUOteS Flnanm Seamh Thu,Apr 18,2013,4 Wpm EDT-US Mal are closed Dow4l Nasdaq 41.20% Fidg/ily E-EMRADE' QCOM oxe" -OPEN AN ACCOUNT I4 Areeetteide O TYdEO -1.c mrsexxre ua L© ., tlonr QUALCOMM Incorporated(QCOM)-Nasdall Add to l eke f6T 63.66 40.57(0.89%) 4 OOPM EDT I After Haws:63.6040.06(0.09%)4;04PM EDT-Nasdaq Real Tim Price Historical Prices Get Hlelonael"-a far —GO Set Date Range abwmueralur«ar,�P.dvr �� �•'Dairy mvmenrv.mlu. Stan Date:�OCt II7- I�`° �_j 7�1 Eg,Jan 1,2010 r Wendy - End DilI_-'-J .012 0Monthly O Dividends Only N.'S NttvaRirtg no Tommy Via,api rit First I Previous I Next I Last •m vyava imaMh pmmd _— _ _.� tbnaWag be 6ixi4tl Gim ire,vmaoe nsmaat beinsarletlT later. Date Open High Low Close Volume Adj Close` BCROUDOWAITT NEW 0026,2012 57.80 59.21 57.70 59.04 13,302,400 58.59 Impprmtl Safety )n(amNiimt: ( . `Close pnCe 8djV rpr,d4sil AM ap.i (.`Igaeei®ynokina First I Previous I Next I Last increase the nav m umeen oumrama aem el in use Download to Spreadsheet ysehori met ttntracep6»S.ThiR elak Currency in USD H. ereay.,ageasanaeyou nmob Is cr mom cigarette a day.Women who ae.mmblavBea Imrmanalc essibaphnnir ma�agN„ownaaro nano. eWieN(iptPo Raiv. Patine mrmnegan Pressmfbinghdwraaem learn More Pe NUVARING' (ew raddep 16,11 x..+u.Pn+n.w Oepfirmo C 2013'rei Inc All riOMC reserved Prlvaey Policy-Aboutour Pas-Terms Of 9enfica-CopyripMAP Policy-send Feenback-Yahl-ABC News Network Quotes are maLtime for Ni NYSE,and NYSE MKT.See also delay times for other exchanger All Information provided"as W for informational purposes city,Mt intended for tral WrFOSes or ativu;9.Neither YaF.op!nw arc/of independent providers iS liable im'any inkrmatormi ettpr3,incanpieteriass,wdelays,pr tar any actiM1A taken in reliance on kdmmatian 4pniainetl tNrern}�afAesskig Ere Yatrodl s{te,you agree nat to red�sfiWte ere infU•maLnn fRmd iheretn-fteaFTime cm[mdeus sheatnmg giwtos aze evade lfirou�:wry,em8rtn srervicz you may tun saeamirg quolea on w off Fundamental company data poi lded by Captor IQ.Historical chart data and daily updates provided by Commodity Systems,Inc.(CS17.International h'mtoncel Dart data,dadyupdame,fund summary,fund performance,dividend data and Morningstar Index data provided by Morningstar,Inc. H H H rT1i W m a rOT w N H r- (RD �-' w w w R• m rt 0 0 0 n w o n o ro Q ((DD R N H(D N ° N O N tJ a N .. w n En o H Id O w o 0 ¢ W N O N w (D O N N (D n N w N N N W N N t) R N O H O K ' H O X H O d H Nm NGxm NGCC7 \ rt > t7 mn R R � r rnw G] r o,w n tt- rnN K7 Cm' n G a \ H \ HK " \ Hny H \ F-' t7 H N-N- m (D ° K Ho` G O K �G H K NC K m N> NQ13 m NP. N 0 Np H O G _ P Z b x ) C) H (D w x1 ,pm y ran H N O w 0 H G � m m G O C H rOr 7y O O (D m D (D R O. O LL A Y H On t G O G K z N wt-I En yz m R m (D Q b b b (D w (D C oPC) q F' X ra+ O r- 0 O 0 (D m H H w 8 p m n H- 3 (4 rXr X rn rt m ¢� (D (D ~ w N. y O° Jp lTt Ut N R w nO O °p 00 rt O n0 J ' G w C (D p H N a n (D R 0 m zo � R H iP J R R H a G w W rn N w � vii rn � � rry 'G a (D C rn o rn N w (D TJ mO a1 N O �p ip O (D to M H FI) •• W .. t) En 0 m n C �cn w 00 rt m G (D H - F,- a to ry r+p o w p mP-o 0 y o N rt (D N rY O W aO• �K Vanguard" Page > 1 of 1 Edwin S.Erney 336 Messiah Cir Voyager Services:800-284-7245 Mechanicsburg, PA 17055-8620 Total report value: $42,009.53 (Total report value includes any accrued dividends.) -Mill III lill mill 11111111:11111111 1 NIN am r ,"`; �; 'Name 'r Fund&Account r`, '' Dates �' Prlce Per Accrued A y r �i a9 �� •�5 " i ,i, J� F ' cil �. �,� .3 a ,a�%Va 16 x d , U � Number , O enetl � Bhares:�, Shale Yae � Dlvitlends Wellington Fund Inv 0021-97847253670 03/17/1998 1,072.364 $34.19 $36,664.13 - VlndsorllFundlnv 0073 97847253667 .08/09/2005. : 1$2624 $2927 , :$4~345404 Totals $42,009.53 $0.00 'Doesn't include accrued dividends. 0676675015 01/15/2013 09:21:10 REV-1511 EX+f10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER EDWIN S. ERNEY 21 12 1161 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. Headstone memorial for grave 1,718,00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal RepresentaWe(s) Joan Erney 6,000.00 street Address 505 Park Avenue Cary New Cumberland State PA Zip 17070 Year(s)Commission Paid: 2013 2. Attorney Fees: Cipriani&Werner, P.C. 10,750.00 3. Family Exemption:(If decedents address is not the same as claimants,attach explanation.) 3,500.00 ClaRnant Caroline M. Emey Street Address c/o Robert J. Stump,Agent RR#4 Box 165 City Newport state PA ZIP 17074 Relationship of Claimant to Decadent Wife 4. Probate Fees: Cumberland County Register of Wills 27150 . 5 Accountant Fees: BoreMan &Babbs 350.00 6. Tax Return Procurer Fees: 7. 2012 Federal Tax Payment 638,00 8. 2012 State Tax Payment 274.00 9. Estate Notice-Sentinel 168.30 10. Estate Notice-Cumberland County Law Journal 75.00 11. Payment to Computershare for date of death balances for stock accounts 50.00 12 Fee to Register of Wills for Inheritance Tax Return and Inventory riling 30.00 TOTAL(Also enter on Line 9,Recapitulation) $ 23 726.80 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, I*IERiTANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWIN S. ERNEY 21 12 1161 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. Messiah Retirement Village 3,260.20 2. Discover Card 10.99 3. Alert Pharmacy 69.43 4. Verizon 24.72 5. Capital Area Health Associates 40.00 TOTAL(Also enter on Line 10,Recapitulation) $ 3,405.34 If more space is needed,insert additional sheets of the same size. REV-1513 EX.l01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: EDWIN S. ERNEY 21 12 1161 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 [Includeoutright sal districdons and transfers under 19 ec.3116 ta7 o-41 I. Caroline M. Erney Spousal 50.00 clo Robert Stump, RR#4, Box 165 Newport, PA 17074 2. David E. Erney Linea[ 16.67 317 East Park Drive State College, PA 16803 3. Leslie Erney Pankey Lineal 16.67 5002 Grand Phillip Lane Katy,TX 77450 4. Joan L. Erney Lineal 16.66 505 Park Avenue New Cumberland, PA 17070 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 NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART It-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.