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Home My WebLink About08-14-13 � �, . r� a� . _ _ . _ .�, � 1505610140 REV-1500 EX �°,_,°, PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburq PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 8 9 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 6 8 2 6 4 2 2 ], 0 7 2 4 2 0 1 2 0 5 1 6 1 9 3 3 DecedenYs Last Name Suffix Decedent's First Name MI R o h r e r B e t t y J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return � 2.Supplemental Return � 3. Remainder Return(date of death prior to 12-13-82) � 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust � 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) � 9. Litigation Proceeds Received � 10.Spousal Poverty Credit(date of death � 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number W a y n e F • S h a d e , E s q u i r e 7�1 7 2 :4;� 3 0 2 2 0 C �; ...�K �T3 '?°' �ISTER OE,INILLS CFS�NLY C�J " �_`- �a.) 17l i�) ,_ First line of address � ' � ,p°'' �;,. �- .. ' �: , .y,' 5 3 W e s t P o m f r e t S t r e e t -P ' � ,�-:. ,.- Second line of address �� ..., .., ___,� , t_,., i_. �- .. ., . _ y �, � �....y ....... ;...�1� City or Post Office State ZIP Code � QA�E Fi��4� � �'t C a r 1 i s 1 e P A 17 0 13 CorrespondenYs e-mau address: waynefshade(�n,comcast.net Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA E OF P�O�SIBLE FOR FILING RETURN �//3 / `� �G�p�i /b%C% ADDRESS 457 Wolf Bridqe Road Carlisle PA 17013 SIGN RE OF PREP R THAN REPRESENTATIVE ATE �� %��__.�� /3,f 13 ADDRES 53 West Pomfret Street Carlisle PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 15�5610140 J � 1505610240 REV-1500 EX DecedenYs Social Security Number �ecedent's rvame: B e t t y J - R o h r e r li 6 8 2 6 4 2 2 1 RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. • 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 1 3 6 0 4 3 . 9 6 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. 1 2 2 3 0 . � 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. • 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. 2 8 1 3 9 . 1 6 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 7 6 4 1 3 , 1 3 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 1 4 1 2 � . 6 6 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 1 2 1 2 . 8 � 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 5 3 3 3 . 4 6 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 6 1 � � 9 . 6 � 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. 1 6 1 � � 9 . 6 7 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxabie at the spousal tax rate,or transfers under Sec. 9116 �a)�1.2)X.0 _ O . 0 � 15. � . 0 � 16. Amount of Line 14 taxable at�inea�rate X .045 1 6 1, 0 7 9 . 6 7 16. 7 2 4 8 . 5 9 17. Amount of Line 14 taxable at sibling rate X.12 � . � 0 17. 0 . � 0 18. Amount of Line 14 taxable at collateral rate X.15 � • 0 0 18. 0 . � � 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. � 2 4 8 . 5 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610240 1505610240 � REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 12 899 DECEDENT'S NAME Betty J. Rohrer STREET ADDRESS Chapel Pointe 770 South Hanover Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 7,248.59 2. Credits/Payments A.Prior Payments 5,000.00 B.Discount 263.15 Total Credits(A+B) (2) 5,263.15 3. Interest (s) 18.39 4. If Line 2 is greater than Line 1 +Line 3,enter the tlifference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,003.83 Make check payable to; REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decetlent make a transfer antl: Yes No a. retain the use or income of the property transferred: ...................................................................... ❑❑ � b. retain the right to designate who shall use the property transferred or its income; ............................... X c. retain a reversionary interest;or .....................................�......................................................... ❑ X❑ tl. receive the promise for life of either payments,benefits or care. ....................................................... 2. If death occurred after December 12,1982,did tlecedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her tleath? ......... ❑ 0 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 i: 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the chiltl is 0 percent[72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, unde� Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1503 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Rohrer 21 12 899 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �, Orrstown Financial Advisors, account 11012001700 equities 136,043.96 TOTAL(Also enter on line 2,Recapitulation) $ 136,043.96 (If more space is neetled,inseR additional sheets of the same size) Forward Funds Web System Page 1 of 2 �� T/"'tij�►]"��' pownloads 14�.J Y Or 1•1! Logout ��. r1 Trcuiitinre ajE�rellence Shareholder Date Range .....,�..,�., �...... _........ Account No. 110i2D01700 As of: ;D7/24/2012 i� 6etty J.Rohrer 457 WolFBridge Road �SeERates:� Car11s1e,PA 17013 ACCOUntBalances �1 PriaterFriendlv Settled Unsettied Total Cos Total Fu�d Name Shares Share Shares Fric Easis* Valu Forward US Government Mone -Instltutfonal 2 622.280 .00 2 622.280 1.Utl 2 622.28 Fonvard Balanced Allocatfon-Institutional 9 408.296 .00 9 408.296 14.46 1 358.52 136 043.96 otal $138,666.24 *The cost basls Is anly being cal�ulated and reparted on covered shares.Any shares acqulred prior to]anuary 1,�012 are not constdered cuvered shares and are not lncluded In this flgure. Snapshotof: PRM3-Premler Balanced Allocatfon Obje�ti�e/Strategy: Seeks zrtoderate current Intnme and some capltal apprecfadon, UNDERLYING FUND PERCENT MONEY MANAGEii Commoditv Lona/Short Strateav 3.5 Farward Management.San Frencfsca.CA Fund Seeks exposure to the cnmmodity markets and returns that correspond to the Credit Sulsse Mamentum and Vplatility Enhanced Return Strategy(MOVERS)Index. CorePlus Fund 31.1 Forward Manaoement.San Fran�lsco.CA SeekK capltal growYh and employs a stretegy Intended to exceed the total return of the 5&P SOD Index by Investing In structured products wlth e�onomic characteristics slmtlar to common stocks - oF large capltallzatlon equitles. EM Cornorate Debt Fund 5.D SW Asset Manaaement.Newoort Beach.CA Seeks to provlde long-term capital appreclation and Income hy fnvestlng ln assets with historfcally low correlatlons to stocks and bond. Fxtended MarketPl�s Fund 3.4 Forward Manaoement.San Frenclsco.CA SeekS to pravide capttal growth by investing In struckured products wlCh economic cha2cteristics stmflar to common stocks oF small and medfum capftallzadan equities(typiplly Issuers with a capltallzatlon of$SO billion or less). Frontier Strateov Fund 3.8 Forward Manag�ment.5an_Er�acf�fo CA Seeks to provlde capitaf growth by Investing fn frontfer markets equitles located in the Mlddle East, Afrfca,Eastern Eurape and Asia as determined by the MSCI FM Index. Hlgh YIQ,j�i Bond Fund 4.6 Fi��wpctam rnva�r.++a�r mar,ar, m_n�,So$Angeles• CA and Denver.CO Employs well-deFlned,dfscipllned,time-tested strategles In pursult oF attractive and consfstent af[er-tax returns. I[tvestment Grade Flxed-Income 31.1 PaclFlc Invecr_ment Manapement Comoanv.Newoort Rlsk Level Fund Beach.CA Uses bottom-up research through sector speclallsts charged with determining relatfve value and top-down analysls formalEzed during annual Se�ular Forums. Manaaed Futures Strateoy�und 3.6 Fonvard Manaaement San Franclsca C9 Employs a sysCematic pracess that invests fong or short In the futures cantracts in the �ommadlties,currencles,equlty indices and tixed Income asset classes which correspond to the long and short Futures contract posiYloning of the CSMF. Select EM Divldend Fund 1.2 Forward Management San Francisco CA Invests fn the securltfes of dividend-paying companles located in emergfng market countries and seeks investments based on fundamental quality,dividend yteld,dividend growth patentiat, valuaUon and anticipated price appredation. Stratealc Alkernatives Fund 4.0 Forwe d�M?negement,San Frandsco.CA Seeks to pravide long-term capital appreciatlon and Income by[nve5ting in assets with historically low correlations to stocks and bond. Investing involves risk,fnciuding possible loss oF princlpaf.When fnvesting in small�ap stocks you may notice greater fluctuations in markeC value.Hy investing in international sto�ks,Includfng emergfng markets and frontEer markets,yau may be subject to currency https://www.forwardrk.com/FF Web/changeViewData.do?toDate=07%2F24%2F2412&Set... 8/15/2012 Forward Funds Web System Page 2 of 2 fluctuaCions and polltical and economic instabillty.8y tnvesting fn hlgh yleld honds you may be subJected to greater price voladllty based on Fluctuatlons In issuer and credit quality.When Investlng in honds,you are su6Ject,but not limlted to,the same interest rate,inflatlon and credlt risks assaciated wlth the underiying bonds owned by the Fund.Mortgage-backed secu�itles are subject to prepayment and extenslon risk and therefore react dltFerenNy to changes in Interest rates than other bonds.Small movements ln Interest rates may quickly and signiFcantly reduce the value oF certain mortgage-backed securitles.The Frontler Niarke[s and Strategic Alternatives Funds are non-dlverslFled funds.An investor will Indirectly bear the expenses oF the fund75 underlying Investrnents.In addltlon,the fund75 underlyfng Investments(such as structured notes,derivatives,commodltles and levered EI'Fs) wlll involve heightened rlsks related to Iiquldlty,fncreased valatfflty,and unfavarable fluctuatlons In currency values.The underlying internatlonal and real estate lnvestments oF the Frontler Markeks and Streteglc AlternaClveS Funds may also be suhject to economlc or poliqcal Instabfltty In the US and other countries,Credlt risk and interest rate Fluctuadans.s 7he Fund7s actu�l allo[ations may dlffer due to mar �-fluch+akln�s..aarLnthe.�Ear2ac�F�oua�MaoaaRnoranth�_tbn.dLsc.�e�lon.tn_d�annratJaa_Euudc3_alla �� Buy and Seti Rep Account Transactions Forms ilseful Links The Funds'a�tual allocations may dfffer due to market Fluctuatians and other factors.Forward Management hes the dlscretlon to change the Funds'allocatlons.For a Iist of ailocatlona current to the mo5t recent month end,vlsfC www.fanvardlnvesting.�om NOT FDIC]NSURED Na BANK GUAFiANTEE MAY LOSE VALUE You should cartsfder the Investment o6jectives,rlsks,charges and e�rpenses of the Fonvard Furrds carefully 6efare Jnvesting.A prospectus wtth this and otherinformadon may be abfalrred by calling(BOD)9B2-9bI2 or try downloading ane fram www.farwardlnvesting.cam.It should be read carefully 6efore lnvesdng. Privvcy Aolir.y�Contact I Fonvard Funds are distri6uted by ALPS Distnbutors,Inc. https://www.forwardrk.com/FFWeb/changeViewData.do?taDate=07%2F24%2F2012&Set... S/15/2012 REV-1508 EX+(11-10) pennsylvania SCHEDULE E DEPARTMENT OFREVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Betty J. Rohrer 21 12 899 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 �, M&T Bank, checking account# 892033 8,307.62 2. Chapel Pointe, personal care refund 589.00 3. Capital BlueCross,premium refund 415.11 4. Orrstown Financial Advisors, account# 11012001700 2,622.28 5. Department of the Treasury, 2012 federal income tax refund 296.00 TOTAL(Also enter on Line 5,Recapitulation) $ 12,230.01 If more space is needed,insert atlditional sheets of paper of the same size p ��zB� 499 Mi[cheil Road,Millsboro,DE 19966 Adjustment Services Phone 888-502�349 F ax (302)9342955 August 21,2012 Wayne Shade,Esq. 53 W.Pomfret Street Carlisle,PA 1�013 Re: Estate of Betty J.Rohrer ._ Social Security: 168-26-4221 Date of Death:July 24,2012 Dear Sir or Madam: Per your inquiry on August 16,2012,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: I. Type of Account Checking Account Account Number 892033 Ownership(Names ofl Betty J.Rohrer Scon P.Rohrer{POA) Opening Date 04R?4/1989 Balance on Date of Dearh $8,307.62 Accraed Interest $ .00 Total $8,307.62 �----------------------------------- For eny additional informatioa on the above aocoants,induding ownership sod any changes,closures sod/or reimbursement of f�wds, please call the Hip�Street Carlide at 717-TA0�4536. We were unable W locate any safe deposit box for the above-menHoned decedenL 1Lic Idter dces not indude any eaounts in which the dea�sed may have be�listed ac Power of Attomey,CS�Stodian of Uniform 1tan�'ers, Itepr�tative Payee,or Trustee und�a Written Agremn�t Sincerely, Valarie Mercer Adjustment Services Forward Funds Web System Page 1 of 2 �� /"'�'�� Downioads ��J lagaut D�'7AlV dl A Traciition of Earelleiice Sharel�otder Date Range Account No. 1101200170D � As of: ;07/24/2D12 �� 6etty J.Rahrer 457 WoIF Bridge 13oad m�e��:-' Car1151e,PA 17013 ACCOUnt BalattC25 LI Prin[erfriendlv Settled Unsettled Total Cos Tokal Fund Name Shares Share Shares Pric Basis* Valu Forward US Govemment Mone -Instltutfonal 2 622.280 .00 2 622,280 1.Utl 2 622.2 Forward Balanced Allacatlon-InstEtudonal 9 408.296 .00 9 408.296 14.46 1 358.52 136 a43.96 otai $138,666.24 *The cost 6asls Is only being�alculated and reporCed on covered shares.Any shares acqulred prior to January 1,201Z are not �onsidered covered shares and are not included In this flgure. Snapshot af: PRM3-Premler Balanced Alioc�tion objective/Strategy: Seeks moderate current Income and some capltal appreciation. UNDERLYING FUND PERCENT MONEY MANAGER Commodltv Lona/Shart Strateav 3.5 Forward Manaaement.San Francisco.CA Fund Seeks exposure to the commadity markets and returns that correspond to the Credlt Suisse Mamenturr�and Volattllty Enhanced Fteturn Strategy{MOVERS)Index. CorePlus Fund 31.1 Forward Manaoement.San Frenclsco.CA Seeks capltal growth and emplays a strategy Intended to exceed the total return of the S&P 500 Index 6y Investing In structured products with economlc�hara�teristics simllar to common stocks - of large tapitallzatlon equltles. _ _ EM Cornorete DQ,�k Fun� SA SW Asset ManaaemenC.Rewoort Beach.CA Seeks to provlde long-term capital appreclatfon and(ncome by InvesUng In assets with hfstorlca3ly low correlatlans to stocks and hond. Extended MarketPlus Fund 3,4 Forward Manaoement San Frandsco.CA SeekS to pravide capilal growth by Investing In skructured products with econnml�characterlstics stmtlar to common stocks af small and medium capitallzadon equities(typiplly issuers with a capltallzatlan oF$10 btllion or less). Frontler Streteoy Fund 3.8 Forward ManaqEment.San Fr�aclsco.[A Seeks to provfde Capitat growth by Investing In frontfer markeks equitle5 lorated In the Mlddle East, AFrfca,Eastern Europe and Asia as determined by the MSG FM Index. Hlah YIQ,J�1 8ond Fund 4.6 �irct Wnctam fnvPCtmanh Manaa m �k �p$Angeles" [A and benver.CO Emplays well-deFlned,dlscipllned,time-tested strategles In pursult of attracdve and consistent after-tax returns. Investment Grede Flxed-]ncome 31.1 Paclftc Tn� crment Manapement Comoanv.Newoort Rlsk Level Fund Beaeh.CA Uses bottom-up research thrnugh sector speclallsts charged with deterrnlning relative value and top-down analysis formalized during annual Secular Forums. Mananed Futures Strateav Fund 3.6 Fg,rward Manaaement.San Franclsco.CA Employs a systematic process thak invesm long or short In the futures contracts!n the commodities,currencies,equlty ind{ces and flxed lncome asset classes which rorrespond to the long and short Futures contract positloning of the CSMF. Select EM Divldend Fund 1.2 Forward Manaaement San Francl�o.CA Invests In the securlttes of div(dend-paying companles located in emerging market countries and seeks Investments based on fundamental quality,dividend yteld,dividend growth potential, valuatlqn and anticipated price appredation. Strateolc Alternatives Fund 4.D Farward Management.San Frandsco.CA Seeks to provide lang-term capitaf appreciatlon and fncome by InveSting tn assets wlth histor{cally low correlattons to stock5 end hond. Investing involves risk,inciuding posslhle loss of prin�ipal.When fnvesting in small�ap sCocks you may natice greater Fluctvations in market value.By tnvestfng in international stocks,Including emerging markats and frantEer markets,yau may be suhje�t to currency https://www.forwardrk.com/FF Web/changeViewData.do?toDate=07%2F24%2F2012&Set... 8/15/2012 Farward Funds Web System Page 2 of 2 Fluctuations and polltl�al and economic InsYabillry.8y lnvesting In high yleld bonds you may 6e subjected to greater pNCe volatlllty based on Fluctuatfons ln issuer and credit quality.When Investlng in bonds,you are suhJect,but not limlted to,the same interest rate,inflatlon and credlt rlsks associated with the underlying bonds owned by the Fund.Mortgage-backed securiCtes are subject to prepayment and extension rlsk and thereFore react dlfferently to changes in Interest rates than other bonds.Small mavements ln Interest rates may quickly and signiFcantly reduce the value aF certain mortgage-backed securitles.The Frontler N{arke�s and Strategic Alternatives Funds are nan-dlverslfled Funds.An Investor witl Indirectly bear the expenses of the fund3s underlying Investments.In additlon,the fund7s underlying Investments(such as structured notes,derlvadves,commodities and lavered ETFs) wlll involve heightened rlsks related to Iiquldlty,fncreased valattfity,and unfavareble fluctuations in currency values.The underlying interna[lonal and real estate Investments of the Frontler Markets and Streteglt Alternatives Funds may also be subject to ecanom(c or polidcal Instabllity In the US and other countrles,credit risk and interest rate Fluctuadons.'7he Fund7s attual allocadons may dlffer due to mar �-flucl'uaklna�..anrLnY.hec..Eactn�s��ouacdlvlaoaaamant_hu.tb�dlrc[tahJon�.chauaa_thaEundcZalln � �Buy and SeE! Rep Account Transactions Forms Useful Links ^ The Funds'actual alfocations may dlffer due to market Fluctuadons and other fa�tors.Forward Management has the dlscretlon to change the Funds'allocatlons.For a list of allocatlans current to the most recent month end,v151C www.forwardlnvesting.com NOT FDIC INSURED NO BANK GUARANTEE MAY LOSE VALUE Yau shoufd cottslder the lnvestment o6jer[lves,rlsks,charges and expenses of the Fonvard Funds carefu!!y before irtvest/ng.A prospectus wfth this and otherinformadon may be a6falned by caffing(BOtl)88Z-96I2 or try downloading one from www.forwardlnvesting.com.It should be 2ad carefu!!y before lnvesdng, Privacy Polrr.y�Contact I Fonvard Funds are distri6uteG by ALPS Disttibufors,Inc. https://vtn�vw.forwardrk.com/FF Web/changeViewData.do?toDate=07%2F24%2F2012&Set... 8/15/2012 REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Rohrer 21 12 899 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: �, Hoffman-Roth Funeral Home & Crematory, Inc., funeral expense 7,216.00 B. ADMINISTRATIVE COSTS: . 1. Personal Representative Commissions; Name(s)of Personal Representative(s) Scott Phillip Rohrer 2,500.00 streeta,ddress 457 Wolf Bridge Road c;�y Carlisle state PA Z1P 17013 Year(s)Commission Paid: 2. Attorney Fees: Wayne F. Shade, Esquire 2,500.00 3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. P�obate Fees: Register of Wills of Cumberland County, PA 334.50 5 ,acco�ntantFees: Smith Elliott Kearns & Co.,preparation of 2012 income tax 330.00 returns 6. Tax Return Preparer Fees: Smith Elliott Kearns & Co., preparation of fiduciary income 450.00 tax returns �, Cumberland Law Journal, advertise Letters Testamentary 75.00 8. The Sentinel, advertise Letters Testamentary 200.16 9. Register of Wills, filing inheritance tax return 15.00 10. Register of Wills, reserve for filing Account, etc. 500.00 TOTAL(Also enter on Line 9,Recapitulation) $ 14,120.66 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty J. Rohrer 21 12 899 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 �. Millennium Pharmacy Systems, Inc., unreimbursed pharmaceuticals 444.99 2. Cumberland Goodwill Fire Rescue EMS, ambulance service 83.85 3. Pennsylvania Department of Revenue, 2012 income tax 82.00 4. SEI Private Trust Company, return of August benefit 601.96 TOTAL(Also enter on Line 10,Recapitulation) $ 1,212.80 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Bett J. Rohrer 21 12 899 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 tlistributions and transfers under Sec.9116(a)(1.2).] �. Scott P. Rohrer Lineal 80,539.84 457 Wolf Bridge Road Carlisle, PA 17013 2. Kimber L. Rohrer-Varner Lineal 80,539.83 1131 Harrisburg Pike Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. Il. 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. REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedenYs date of death: 5,000.00 Discount: 263.15 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 through 1991 1992 1993 through 1994 1995 through 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 through 2012 113 18.39 18.39 TOTALS 113 18.39 Penalty Calculation If the decedenYs date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: . 4� � . t� � �� LAST WILL AND TESTAMENT � �� OF � I� j 1 BETTY J. ROHRER ; � i I, BETTY J. ROHRER, of Middlesex Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memary and understanding, do hereby make, publish and declare this as and far my Last Will and Testament, hereby revokinq all other Wilis and Codicils heretof ore made by me. I � ' FIRST � ' ! I direct the payment of my just debts and expenses of my � .Iast illness and funeral from my estate as soon after my death as i conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate . � in such amount as he shall consider necessary and desirable, and � , I authorize my personal representative to cause title ta or # � ( ;� ownership of such lot so purchased to be vested in such person as± �: i m� personal representative shall designate. � s Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal SAtUts, C;UIDO representative shall consider necessary and desirable for the & MASLAND 26 W. Higfi Street ( �.��15��, P�. Purchase, erection and inscription of a suitable marker far my + � grave. � � ' � �� 3 � �� I �f � f� � I� � �4 - i �� 1 �� F SECOND ' �I � I qive, devise and bequeath all the rest, residue and � �� remainder of my estate in equal shares untv my children, � ii ,� I �� KIMBER L. ROHRER-VARNER and SCOTT P. ROHRER, per stirpes. ; � THIRD I direct that any and all inheritance, estate, and transfer ; taxes imposed upon my estate passing under this t�i�� dr otherwise� i i sha�l be paid out of the principal of my residuary estate. I 3 !� FOURTH �� i� In addition to the powers conferred by law, I authorize any i � � ! personal representatives acting under this instrument, in ; � � their absolute discretion: i4 � �� (a} To retain in the form received, or to sell ; � either at public or private sale any real or personal praperty; i (; (b) Ta exercise any options to subscribe for � �' S �� ' stocks, bonds, ar other investments. j � j �'� 1' ! '; : I� (c) To join in any plan of lease, mortgage, � }; '' consolidatian, exchange, reorganization or foreclosure ; of any corporatian in which my estate or any trust ma�r ' �r j ';` hold stocks, bonds or other securities; i' (d) Ta sell, transfer, convey, mortgage, pledge, � SAIi)t5, E;U1D0 f� ��ase or exchange any property, real or personal, which � & MASI.ANU �� ?�w. lf��n s`r"` 5 at any time ma form c.:�ril��L, �,,,, j� Y part of my estate, for the payment �� ;� of debts or taxes, or for any purpose of administration i �i ;; or distribution, far such prices and upon such terms � � -2- i �( � i' _' � �i I ! 4 ; � i '; { as my personal representatives, in their sole ' discretion, may deem wise, and to execute and deliver � i deeds ot canveyance or transfer thereof; ' (e) To make settlements and compromises an such i terms as my personal representatives in their sole �� discretion may deem wise without the necessity of � � obtaining any court approval thereof; � (f) Ta make distribution hereunder either in cash or kind, as my persanal representatives in their discretion may deem wise. ( �FIFTH I do hereby nominate, constitute and appoint my i children, KIMBER L. ROHRER-VARNER and SCOTT P. ROHRER, to � act as Co-Executors, of this my Last Will and Testament. i I SIXTH � t i I direct that no persanal representative, guardian, trustee � � or ather fiduciary appointed under this instrument shall be � ? required to give bond for the faithful performance of their ; (I 4 � duties in any jurisdiction. ? yAIDIS, GUIllO � -3- � & MASLANI) � � �',6'4t'. High Street � ; C,arliste, Pa. 1 i �I i II E � � � � �� ' . i; . ; � ',i i �� P � ( � j IN WITNESS WHEREOF, I , BETTY J. ROHRER, have hereunto set � '� i ��my hand and seal to this my Last Will and Testament, f� `s'iconsisting of four ( 4) typewritten pages, the first three ij �� t3} af which bear my signature in the margin for i � ��..1, ' t� identification, this � day of � 1989. ` ,� �" � � E �j � Betty J. er f � � 'f � i�Signed, sealed, published and declared by the above-named A i, t I�Testatrix, BETTY J. ROHRER, as and for her Last Will and � i= ;iTestament in the presence of us, who have hereunta subscrihed aur i i names at her request as witnesses thereto, In the presence of said Testatrix and of each other. - ..-- , � �. � _ �.� ; � ., a . � '! .-..v�.,.,:„',�� .. ADDRESS � �' �1J. l'�� i��c.��..1'. � �. � � , ,� �r"` � !� _ ��-�--.�� . / �r/ 3 �, , . � ,� �:,-� ,� �� ,. .� , u�,�°-�: , ,~ ' �✓ ADDRESS °-��=` �'`,� . �°'��,, �' �. " � ,,` � � :. � � 7 � i � � .�c.�R .a 4- �- -4- 1( SAIUI5, GUIUO & MASLAND Z6 t4'. High Strera ( t ('zm#islc,Pa. j � �i d� ( 1 3 � �� . - � i 1 OMMONWEALTH OF PENNSYLVANIA: � . js � OUNTY OF CUMBERLAND . � WE, BETTY J. ROHRER, EDWARD E. GUIDO, and JOAN E. WILK, the estatrix and witnesses, respectively whose names are signed to he foregoing or attached instrument, being first duly sworn, do ereby declare to the undersigned authority that the Testatrix ! I igned and executed the instrument as her Last Will and Testament � � �and �chat she signed willingly and that she executed as her free �i � nd voluntary act for the purposes therein expressed, and that � I ach of the witnesses, in the presence and hearing of the � estatrix signed the Will as witness and that to the best of their nowiedge the Testatrix was at the time 18 or more years of age, � f sound mind and under no constraint or undue influence. � � i <� i � i Betty J � _ ,:.;.,. y,.-��_. _i�,_6� Edward E. Guido, Witness n �...��.:�`__�''' G�G-'G��, J�n E. Wilk, Witness � (_ Subscribed, sworn to and acknowledged before me by BETTY J. � i �' OHRER, the Testatrix, and subscribed to and sworn or affirmed to a �before me by EDWARD E. GUIDO, and JOAN E. WILK, ;� ; r SAtTSt�> GUIllU itnesses, this �°'i� day af �� ^��, , 1989. �i � 1 & MASLANll ; Z6 W. Hi�h Strcet NOTARIAI SEAI ,._. �•��, pa lJ�ARIA A. Bf,RIETTA, N4TARY PUBIIC .ry , CAS�tISIE 6(1�0, t:U�Aiycf3lF�NR COUtQTY ' ' � �,,t MM COMA315SiGN EXPIRES hiAY 6, f99i � ! i � � i i � f FIRST {1�} COQICIL TO THE WILL OF BETI�YY JANE ROMRER i, Betty Jane Rohrer, of Cumberland County, Carlisle, Pennsylvania, 17013, declare this ta be my FIRST {1St} Codicil to my Will which was executed by me on May 9, 1989, [as modified by the FiRST {1S'} Codicil thereto executed by me on March 24,20�8, bath of which documents toge#her may be ceferred to collectively herein as my "Wip'�. PART C�NE Part 5, Sectian of my Wiii is amended to dele#e the presen# language and to subs#itute the following: 1, Beity Jane Rohr�er, do her�by nominafe, constifute and appoin�my san, Scoft Phitlip Rohr�er, to act as execufor of this, my Last�11 and Tes�ament. PART TV�O in ali other respects, i hereby ra#'�fy and confirm my said iNill [and the aforesaid Codicil] thereto. 4 . 1FJ WlTNESS WHER OF, t have set my hand and seai ta this Codicii to my last Will and Testament this, 4��___day of �a�,. ��o � r etty Jane F2ohrer, Testatr�x Alyssa H.Bniselq,Esq. PA Supreme�outt ID#286414 21b Seeond Street Bailing Springs,PA 1700'7 Signed, sealed, published and declared by Betty Jane Rohrer, the above-named testatrix, as and for a Codicil to her last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses. Robin R. Hermansen 457 Wolf Bridge Road Carlisle, PA 17013 " Amanda L. Hermansen 275 South Pitt Street Carlisle, PA 17Q13 Jessica L. Hermansen 275 South Pitt Street Carlisle, PA 17013 Alyssa H.Snisely,Esq. PA Supreme Court ID#206414 116 Second Sireet Boiling Springs,PA 17007 We, Robin R. Hermansen, Amanda L. Hermansen, and Jessica L. Hermansen, and Betty Jane Rohrer, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby deciare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will and that she had signed wiilingly, and that she executed it as he�free and voluntary aet far the purposes therein expressed, and that each of the witnesses, in the presence a�d hearing of the Testatrix, signed the Wil( as witness and that to the best of each such witness's knawledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. � Testatrix � � `�C ___•� Witness � Witness � � �tness Subscribed, swom to and acknawledged befare me by the Testatrix, Betty Jane Rohrer, and subscribed and sworn to before me by Robin R. Hermansen, Amanda L. Hermansen, and Jessica �. Hermansen witness�� ' of �1�'ur',� �?r.�� Or►v��►M�tAVE ,� No1on Put�C C�YCf HARRI�IURCi.D11iMi CqMtY � fj My CanriM�ion�M�U»�20011 '� ��{�,*��tl' . ` otary Public . AI ss ' H. Knisely, Esq. Alyssa H.Knisely,Esq. PA Supreme Court ID#206414 11G Second Street Boiling Springs,PA 27007 COM[�IONWEALTH OF PENNSYLVANIA ) } SS: GOUNTY OF CUMBERLAND ) I, �� • , having been duly swam according to law, do hereby depos and say that: (1) i was present on March 24, 2008, when Betty Jane Rohrer signed and executed the foregoing instrument as her last Will, that i saw her sign it, that she signed it wiliingfy and executed it as her free and voluntary act for the purposes expressed in it, that I signed it as a witness in her presence and the presence of each other witness, and that, to the best of my knowledge, when she signed and executed the instrument she was age eighteen years or older and was of sound mind and under no constraint or undue influence. (2) I am a member of the bar of the Supreme Court of Pennsylvania and f was persona(!y present when the acknawledgement and a�davit on the preceding page were signed by the Testator and each other subscribing witness. Swarn to or affirrned and subscribed to before me this ,��'/� day of /%'�t� �c,�'�' wowauu s�u ln witness whereof, I hereunto set my hand and official seal. �� troton+fh,bac t�'OF 1iARtl1561JRt'v.QAIN�IIN C!C�{![�l11!' � �' � �.'� My Cwnmiaion Eatpirer May 1 i.�00li No ry Public Alyssa H, Knisely, Esq. �iygs�x.��S�1y,Esq. PA Suprerae Court TD#206414 116 Second Street $oiling Sprengs,PA 1700? � 1505610240 REV-1500 EX DecedenYs Social Security Number �ecedent's Name: B e t t y J • R o h r e r 1 6 8 2 6 4 2 2 1 RECAPITULATION , 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. • 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 1 3 6 0 4 3 . 9 6 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. 1 2 2 3 0 . � 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. • 7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. 2 8 1 3 9 . 1 6 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 7 6 4 1 3 , 1 3 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9 1 4 1 2 � . 6 6 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 1 2 1 2 . 8 � 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 5 3 3 3 . 4 6 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 6 1 � 7 9 . 6 � 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. 1 6 1 � � 9 . 6 � TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ � . 0 � 15. 0 . � 0 16. Amount of Line 14 taxable at�inea�rate X .045 1 6 1 0 7 9 . 6 7 16. 7 2 4 8 . 5 9 17. Amount of Line 14 taxable at sibling rate X.12 � . 0 � 17. � . � 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. � 2 4 8 . 5 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610240 1505610240 J