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HomeMy WebLinkAbout09-12-13 J 1505610140 REV-1 500 EX (02-11)(FI) UP61rfAl uSE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year Fite Number PO Box 280601 INHERITANCE TAX RETURN 2 1 1 3 0 0 1 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MNIDDYYYY 1 2 2 3 2 0 1 2 1 0 0 5 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI H I M M E L B E R G E R R A L P H H (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 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) Q 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 F� 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 Tki INFORMATION-SHOULD-BE DIRECTED TO: Name Dahne2elephone,Number; p D A V I D H S T O N E , E S Q U I R E 7 n1 r`1n 7 1; 4 r7-4 3 5 F�G(S7ER dFF LLS USE-ONLY C C7 First Line of Address 4 1 4 B R I D G E S T R E E T Second Lino of Address cJ'7 7T City or Post Office State ZIP Code __ DATE FILED N E W C U M B E R L A N D P A 1 7 0 7 0 Correspondent's e-mail address: DSTONE@STONELAW • 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 We,correct and complete.Decia3iftion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SiGNAT ERSO nerowsil..1LETOR FILING RETURN DATE P 1 ADDRESS 43 OAK KNOLL.DRTIVI BERWYN PA 19312 SIGNATURE O A ER O7HE=THAN DATE ADDRESS 414 BR S EET NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 � \� J 1505610240 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: RALPH H • HIMMELBERGER RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 9 1 1 9 6 , 9 1 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. 6 8 1 2 , 9 2 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 2 0 0 4 5 , 2 2 7. Inter-Vivos Transfers&Miscellaneous Ni��t-Probate Property (Schedule G) U Separate Billing Requested . . . . . . . 7. 2 3 5 2 5 , 6 4 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 4 1 5 8 0 , 6 9 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 1 3 6 5 9 . 2 5 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 1 0 3 6 8 . 8 8 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 4 0 2 8 . 1 3 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 1 7 5 5 2 . 5 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 1 7 5 5 2 . 5 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 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X - 0 4 5 1 1 7 5 5 2 . 5 6 16. 5 2 8 9 . 8 7 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 5 2 8 9 . 8 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J REV-1500 EX(F} Page 3 File Number Decedent's Complete Address: 21 13 0013 DECEDENT'S NAME RALPH H - HIMMELBERGER STREET ADDRESS - 325 WESLEY DRIVE, APT 3114 CITY STATE ZIP MECHANICSBURG PA 17055- Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5,289 .87 2, Credits/Payments 4,70000 A.Prior Payments B.Discount 247 - 37 3, Interest Total Credits{A+B) (2) 41947.37 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3) 0 . 00 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) 342 - 50 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 ...................................................................... ❑ IR b, retain the right to designate who shall use the property transferred or its Income .........................1 ❑ c. retain a reversionary interest .................._.........._.........._._...................................................... ❑ d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 2. If death occurred after December 12, 1902,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ IXI 3. Did decedent own an'in trust for'or payable-upon-death bank account or security at his or her death? ....... ❑ ❑X, 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ® ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 is 3 percent[72 P.S.§9116(a)(11)(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 child is 0 percent 172 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 F2 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(x)(1.3)1.A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1503 EX+(8-12) pennsylvania SCNEDUlE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER RALPH H . HIMMELBERGER 21 13 0013 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 100 shares Altria Group Inc stock a9 $31 . 737 each 3,173 . 75 Wells Fargo Acct 12-21-12 average $31. 801 12-24-12 average $31.675 = $31.7375 per share 2 48 shares Frontier Communications stock B $4 . 275 ea 205 . 20 Wells Fargo Acct 12-21-12 average $4 .3451 12-24-12 average $4 .205 = $4 .275 per share 3 80 shares Johnson & Johnson stock a $70 . 287 each 5,623 .00 Wells Fargo Acct 12-21-12 average $70 . 405, 12-24-12 average $70.17 = $70.2875 per share ! 4 23 shares Kraft Foods Grp Inc stock @ $45.780 each 1,052.94 Wells Fargo Acct 12-21-12 average $45. 96, 12-24-12 average $45.60 = $45. 78 per share 5 69 shares Mondeliz Intl stock B $25.670 each 1,771. 23 Wells Fargo Acct 12-21-12 average $25 . 641 12-24-12 average $25. 70 = $25. 67 per share 6 200 shares New York Community stock B $13.022 each 2,604 .50 Wells Fargo Acct 12-21-12 average 13.12, 12-24-12 average $13. 025 = $13. 0225 per share 7 200 shares Pfizer Incorporated stock a $25.195 each 5,039.00 Wells Fargo Acct 12-21-12 average $25.285, 12-24-12 average $25. 105 = $25. 195 per share 8 100 shares Philip Morris Intl Inc stock a $84 . 930 8,493.00 each Wells Fargo Acct 12-21-12 averagea $84 .93, 12-24-12 average $84 .93 = $84 .93 per share 9 100 shares PPL Corporation stock a $28 . 907 each 21890 . 75 Wells Fargo Acct 12-21-12 average $28.985, 12-24-12 average $28.83 = $28.9075 per share 10 265 shares PWRSHS H/Y EQ DVD AC ETF stock a $9 . 460 2 ,506 . 90 ea Wells Fargo Acct 12-21-12 average $9 . 48, 12-24-12 average $9.44 = $9. 46 per share 11 100 shares Royal Dutch Shl Adr Cl A stock a9 $69.002 6,900. 25 ea Wells Fargo Acct 12-21-12 average 569 . 01, 12-24-12 average $68 . 995 = $69.0025 per share 12 200 shares Verizon Communications stock a9 $43. 542 8,708. 50 each Wells Fargo Acct 12-21-12 average $43 . 61 , 12-24-12 average $43 . 475 = $43 . 5425 per share 13 2719.117 shares Wells Fargo-Loomis Syls Strat Incm 42,227.89 C W $15. 530 each TOTAL(Also enter on Line 2,Recapitulation) $ 91,196 -91 If more space is needed,insert additional sheets of the same size REV-1508 EX-(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: RALPH H . HIMMELBERGER 21 13 0013 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 1 • AXA Equitable Annuity payments received 233 . 59 2 Bankers Life and Casualty-premium refund 269 .99 3 Bethany Village and Patriot News Co-refunds 936 .00 4 Cash on hand 255.27 5 NGL-Prearranged funeral account 3,918 - 76 6 Wells Fargo-Money Market Acct #4143-5981 1,199.29 TOTAL(Also enter on Line 5,Recapitulation) E 6,612 -92 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX-(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RALPH H. HIMMELBERGER 21 13 0013 If an asset was made Jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURMVING JOINT TENANT($)NAME($) ADDRESS RELATIONSHIP TO DECEDENT A. LINDA K HIMMELBERGER 43 OAK KNOLL DRIVE DAUGHTER BERWYN, PA 19312 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH OECEOENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FORJOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 9/28/76M&T Bank-Checking Acct #42987636 40,090 .43 50- 201045.22 Princ $40,090.16, Int $.27 TOTAL(Also enter on Line 6,Recapitulation) $ 20,045-22 If more space is needed,ase additional sheets of paper of the same sze. REV-1510 EX+(08-08) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RALPH H . HZMMELBERGER 21 13 0013 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE.THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECUS EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IPAPRICA&F.1 VALUE 1- Bankers Life and Casualty-Annuity 23,525.64 100.00 231525 .64 Policy #7791368 w/Douglas Himmel- berger and Linda Himmelberger as beneficiaries TOTAL (Also enter on Line 7,Recapitulation) $ 23,525-64 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX-(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECE ENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER RALPH H - HIMMELBERGER 21 13 0013 Decedenfs debts must be reported on Scheduk 1, ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Camp Hill Presbyterian Church—donation for food 378. 00 2. Myers-Harner Funeral Home-funeral expenses 1 ,699. 00 3 . Myers-Harner Funeral Home-funeral expenses 3,960. 00 B. ADMINISTRATIVE COSTS: 11 Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City state ZIP Years)Commission Paid: 2 . AhomeyFees: David H Stone, Esquire 61000 . 00 3. Family Exemption:(it decedents address is not the same as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Clalmam to Decedent 4 . Probate Fees: Register of Wills, Cumberland Co 283.50 5 . Accountant fees: 6. Tax Return Preparer Fees: 7 . US Treasury-4th quarter est taxes on 2012 taxes 700 .00 2 AXA Equitable-reclaim of 2 checks received 233.59 3 David H Stone-Reimb for advertising in newspapers 275. 16 4 Register of Wills-Filing Inh tax return and Inv 30 .00 5 Reserve for closing expenses 100.00 TOTAL(Also enter on Line 9,Recapitulation) $ 13,659-25 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, NHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER RALPH H . HIMMELBERGER 21 13 0013 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 . Omni{are-services rendered 84 , 76 2 Christopher Royer PsyD-services rendered 53.71 3 Checks written prior to death but not cleared 5,119. 73 4 Home Instead-private duty expenses 3,332 .20 5 Medical Express Ambulance Sery-ambulance sery 578 . 48 6 Camp Hill Presbyterian Church-debt of decedent 1,200 . 00 TOTAL(Also enter on Line 10,Recapitulation) E 10,368 - 88 If more space is needed,insert additional sheets of the same size. REV-1513EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RALPH H. HIMMELBERGER 21 13 0013 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS (Include out�'gIT spousal distributions and transfers under Sec.9118(a)(1.2).j 1 LINDA K HIMMELBERGER Lineal 581776 . 28 43 OAK KNOLL DRIVE BERWYN PA 19312- 2 DOUGLAS R HIMMELBERGER Lineal 581776 . 28 2529 E CINNABAR AVENUE PHOENIX AZ 85028- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 11. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN; B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1• TOTAL OF PART 11 -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, STON E. LA F tV Ex & SHExLErsxi ATTORNEYS AT LAW 414 BRIDGE STREET - - S NEW CUMBERLAND PA 17070 LAST WILL AND TESTAMENT OF RALPH H. HIMMELBERGER I, RALPH H . HIMMELBERGER, of the Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me . I ITEM I : I direct that my Executrix hereinafter named shall pay all j my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II : I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate, as follows : A. One-half thereof to my daughter, LINDA K. HIMMELBERGER. B. One-half thereof to my son, DOUGLAS R. HIMMELBERGER. Should my son, DOUGLAS R. HIMMELBERGER, predecease me, I devise and j i bequest his share to his wife, LYNETTE H. HIMMELBERGER, and in default I thereof, to the issue of my son, DOUGLAS R. HIMMELBERGER, per stirpes . ITEM III : I appoint my Executrix and her successors guardian of i any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this I appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or I to another for the minor ' s benefit . Such guardian shall have the power to use principal as well as income from time to time for the minor ' s support and education (including college education, both graduate and I undergraduate) without regard to his or her parent ' s ability to provide Page 1 of 4 I I for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor ' s parent or to any person taking care of the minor. ITEM IV: I appoint my daughter, LINDA K. HIMMELBERGER, Executrix of this my last will . Should my daughter, LINDA K. HIMMELBERGER, fail to qualify or cease to act as Executrix, I appoint my son, DOUGLAS R. HIMMELBERGER, Executor of this my last will . ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction . IN WITNESS WHEREOF, I, RALPH H. HIMMELBERGER, have hereunto set my hand and seal this Ik day of 2011 . r U �) RALPH H. HIIMMELBERGER SIGNED, SEALED, PUBLISHED and DECLARED by RALPH H. HIMMELBERGER, the Testator above named, as and for his Last Will and Testament, and in the presence of us, who at his request_ , in his presence and in the presence of eaFq other, have subscribed our names as witnesses . 414 BRIDGE ST . , NEW CUMBERLAND PA L Address J 914 BRIDGE ST. NEW CUMBERLAND PA s Address Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND SS : I, RALPH H. HIMMELBERGER, the 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 this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. RALPH H. HIMMELBERGER Sworn to or affirmed to and acknowledged before me by RALPH H. HIMMELBERGER, the Testator, this day of �I [` \ff �-- 2011 . CO3m20,NKTMF THOFp NoARIAL PENN YfIUJ (Xl C�kU SEAL 44 I<ELLYA. BIRDSALL, t`'e" Cumberland No1a'yl'ublic Notary Public L1v Commission Boro.,Cumberland Co. Expires June 18, 20C Page 3 of 4 COMMONWEALTH OF PENNSYLVANIA SS : COUNTY OF CUMBERLAND We,L���\ C��_i and 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 willingly and that he 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 will 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 . i i ss Witness Sworn to or affirmed to and acknowledged before me by and witnesses, this ��� day of �� M�IY 2011 . COMMONWEALTH OF PENNSYLVANIA Notary Public t NOTARIAL ^:Ei_LY A. 31RDSALL. Notary Public NcN Cumberland Boro.,Cumberland Co. i Li7 Commission Expires June ift, 201; Page 4 of 4 DATE OF DEATH VALUATION DECEMBER 23, 2012 Ralph Himmelberger Account:4143.5981 Date of Death: 12/23/2012 December 21 2612 Quantity Position CUSIP Symbol High Low Mean Value 100 ALTRIA GROUP INC 022095-10-3 MO 32.20 31.40 31.80 3,180.00 48 FRONTIER COMMUNICATIONS 35906A-10-8 FTR 4.48 4.21 4.35 208.56 80 JOHNSON&JOHNSON 478160-10-4 JNJ 70.75 70.06 70.41 5,632.40 23 KRAFT FOODS GRP INC 500760.10-6 KRFT 46.43 45.49 45.96 1,057.08 69 MONDELEZ INTL 609207-10-5 MDLZ 25.81 25.47 25.64 1,769.16 200 NEW YORK COMMUNITY 649445.10-3 NYCB 13.20 13.04 1312 2,624.00 100 PPL CORPORATION 693517-10-6 PPL 29.18 28.79 28.99 2,898.50 200 PFIZER INCORPORATED 717081-10-3 PFE 25.52 25.05 25.29 5,057.00 100 PHILIP MORRIS INTL INC 718172-10-9 PM 85.76 84.10 84.93 8,493.00 265 PWRSHS HN EQ DVD AC ETF 73935X-30-2 PEY 9.52 9.44 9.48 2,512.20 100 ROYAL DUTCH SHL ADR CL A 780259.20-6 RDS'A 69.32 68.70 69.01 6,901.00 200 VERIZON COMMUNICATIONS 92343V-10-4 VZ 43.97 43.25 43.61 8,722.00 NAV 2,719.1170 LOOMIS SYLS STRAT INCM C 543487-26-8 NECZX 15.53 42,227.89 MONEY MARKET 1199.29 TOTAL ACCOUNT VALUE 92,482.08 December 24,2012 Quantity Name CUSIP Symbol - High Low Mean Value 100 ALTRtA GROUP INC 02209S-10-3 MO 31.85 31.50 31.68 3,167.50 48 FRONTIER COMMUNICATIONS 35906A-10-8 FTR 4.25 4.16 4.21 201.84 80 JOHNSON&JOHNSON 478160.10-4 JNJ 70.40 69.94 70.17 5,613.60 23 KRAFT FOODS GRP INC 500760-10-5 KRFT 45.86 45.34 45.60 1,048.80 69 MONDELEZ INTL 609207-10-5 MDLZ 25.80 25.60 25.70 1,773.30 200 NEW YORK COMMUNITY 649445.10-3 NYCB 13.15 12.90 13.03 2,605.00 100 PPL CORPORATION 69351T-10-6 PPL 28.96 28.70 28.83 2,883.00 200 PFIZER INCORPORATED 717081-10-3 PFE 25.21 25.00 25.11 5,021.00 100 PHILIP MORRIS INTL INC 718172-10-9 PM 84.26 83.60 83.93 8,393.00 265 PWRSHS H/Y EQ DVD AC ETF 73935X-30-2 PEY 9.47 9.41 9.44 2,501.60 100 ROYAL DUTCH SHL ADR CL A 780259-20-6 RDS'A 6925 6874 69.00 6,899.50 200 VERIZON CCMMUNICATIONS 92343V-10-4 VZ 43.69 43.26 43.48 8,695.00 NAV 2,719.1170 LOOMIS SYL S STRAT INCM C 543487-26-8 NECZX 15.53 42,227.89 MONET MARKET 1199.29 TOTAL ACCOUNT VALUE 92,230.32 stock value calculation:quantity x mean mutual fund value calculation:quantity x NAV The above summary of prices/quotes/statistics has been obtained from sources believed to be reliable,but is not necessarily complete and cannot be guaranteed. Ralph Himmelberger Stocks in the name of Ralph Himmelberger with average for December 21, 2012 and December 24 , 2012 as follows : Altria Group stock $31 . 800 + $31 . 675 = $63 . 475 divided by 2 = $31 . 7375 per sh Frontier Communications stock $4 . 345 + $4 . 205 = $8 . 550 divided by 2 = $4 . 275 per sh Johnson & Johnson stock $70 .405 + $70 . 17 = $140 . 575 divided by 2 = $70 . 2875 per sh Kraft Foods stock $45 . 96 + $45 . 60 = $91 . 56 divided by 2 = $45 . 78 per sh Mondeliz Intl stock $25 . 64 + $25 . 70 = $51 . 34 divided by 2 = $25 . 67 per sh New York Community stock $13 . 12 + $13 . 025 = $26 . 145 divided by 2 = $13 . 0225 per sh PPL Corporation stock $28 . 985 + $28 . 30 = $57 . 815 divided by 2 = $28 . 9075 per sh Pfizer Inc stock $25 . 285 + $25 . 105 = $50 . 39 divided by 2 = $25 . 195 per sh Philip Morris Int stock $84 . 93 + $83 . 93 = $168 . 96 divided by 2 = $84 . 93 per sh PWRSHS H/Y EQ stock $9 . 48 + $9 . 44 = $18 . 92 divided by 2 = $9 . 46 per sh Royal Dutch Shl ADR CL A stock $69 . 01 + $68 . 995 = $138 . 005 divided by 2 = $69 . 0025 per sh Verizon stock $43 . 61 + $43 .475 = $87 . 085 divided by 2 = $43 . 5425 per sh TOTAL STOCK VALUES ONLY $48, 969 . 02 M M&T Bank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services Phone 888-502-4349 F ax (302)934-2955 January 15,2013 Stone LaFaver & Shekletski Attorneys at Law 414 Bridge Street P.O. Box E New Cumberland, PA 17070 Re: Estate of Ralph H. Himmelberger Social Security: 172-01-4006 Date of Death: December 23 2012 Dear Sir or Madam: Per your inquiry on January 8,2013,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 42987636 Ownership(Names qfi Linda K Himmelberger Ralph H Himmelberger Opening Date 0912811976 Balance on Date of Death $40,090.16 Accrued Interest $ .27 Total 4Q 09,- $ 0.43 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the Paxton Street at 717-2552240. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement. Sincerely, Valarie Mercer Adjustment Services BANKERS LIFE AND CASUALTY COMPANY Home Office: 222 Merchandise Mart Plaza • Chicago, Illinois 60654.2001 (312) 396-6000 ANNUITANT RALPH H HIMMELBERGER 84 MALE AGE AND SEX POLICY NUMBER 7791368 JUNE 24, 2004 DATE OF ISSUE SINGLE PREMIUM $20,000.00 JUNE 24, 2014 DATE INCOME BEGINS In this policy: You or Your refers to the Annuitant named in the Schedule on page 2 of this policy. We, Us or Our refers to Bankers Life and Casualty Company. Owner refers to the Owner orjoint Owners of this policy. The Owner maybe someone other than the Annuitant. See WHO OWNS AND CONTROLS YOUR POLICY on page 11 of this policy. MONTHLY INCOME BENEFIT We will pay You the Monthly Income if You are alive on the Date Income Begins, The Monthly Income amount will be determined by the cash amount placed under the payment plan chosen. See HOW WE PAY POLICY BENEFITS on pages 6 through 10 of this policy. The Date Income Begins is as shown in the Schedule or as later changed. The Monthly Income payments are subject to the provisions of this policy. DEATH OF ANNUITANT We will pay the Death Value to Your Beneficiary if You die before the Date Income Begins. The Death Value is the greater of: 1. The Cash Value of this policy on Your date of death minus any payments made by Us after Your date of death under this policy: or 2. The Single Premium paid for this policy, including any Premium Increases, minus any Withdrawals. We will pay the Death Value in one sum, unless otherwise agreed. This payment is subject to the provisions of this policy. See DEATH OF OWNER BEFORE DATE INCOME BEGINS on page 5 of this policy. THIRTY DAY RIGHT TO RETURN THIS POLICY If the Owner is not satisfied with this policy, he or she may return it to Us within 30 days after getting it. The Owner may return it to Us by mail or to the agent who sold it. We will then refund any premium paid. This policy will then be void. THIS POLICY AND THE DATE IT BEGINS This policy is a legal contract between the Owner and Us. It consists of this and the following pages. READ THIS POLICY CAREFULLY. See the POLICY GUIDE on page 1A of this policy. This policy begins on the Date of Issue shown in the Schedule. Signed for Us at Our Administrative Office on the Date of Issue. Secretary V, r—.p W President Examined by SINGLE PREMIUM DEFERRED ANNUITY POLICY IF YOU ARE ALIVE ON THE DATE INCOME BEGINS WE WILL PAY THE MONTHLY INCOME - IF YOU DIE BEFORE SUCH DATE WE WILL PAYTHE DEATH VALUE- SINGLE PREMIUM IS DUE ON THE DATE OF ISSUE- SINGLE PREMIUM INCREASES ALLOWED DURING THE FIRST 180 DAYS - THIS POLICY DOES NOT PAY DIVIDENDS. LA-06T Page 1 948J vr+.T ry . t 0089390270 ,w BANKERS LIFE AND CASUALTY COMPANY . 11825 N. PENNSYLVANIA ST. , CARREL, IN 46032 THE BANk OF NEW YORK MELLON PHILADELPHIA, PA 62-4 311 = ELEVEN THOUSAND, SEVEN HUNDRED SIXTY- TWO AND 831100 . . . . . . . ...."" . . . . . . DATE - CHECK AMOUNT LINDA HIWIIELBERGER 03/10/2013..,. ******11 , 762 . 83 ' 43 OAJC KNOLL DR DR=+ER BERVYN. PA 19312 " OF .. , :, . ..:...:........... ........ .. .. VOID AFTER 180 DAYS AUTHORIZED SIGNATURE 1141008939027011' 1:0 3 1 1000 4 71: 2111969 5581:' BANKERS LIFE AND CASUALTY COMPANY I DATE cHECKNo 103/10/201 0089390270 11825 N. PENNSYLVANIA ST. , CARMEL, IN 46032 VENDOR#: PAYEE: LINDA HIMMELBERGER POL/AGT#: 7791368 TOTAL] 1 ,762.83 BLC /OIOPA/ 5026/ 1-ARC! Page 1 of 1 JPMorgan Q r _ 089390269 Posting Date:03/15/20 13 SANKERA-WE AND'CASUALTY COMPANY 9 w pw N.rtAnnyau cy.,aNm,.a aw Time we hr¢a yak Sequence Number. 1390710383 PAY ELEVEN tNOUSAW, AVER HWWREO$IXTY-lU AAD aP/YEO . . . Amount: 11,762.82 To DOW MaNaa ¢ ¢ ¢M 03/30/201};' ***A*-1?,76a 83 Account:2969558 TM: sea ¢cunA¢AM AV[ r :e, ¢�¢a Routing Transit Number. •^^. —05 03110004 I n Check/Serial Number: 000089390269 ¢-COB 93902A 90 C03116000474 2.969 55110 i Bank Number:601 --- IRD:0 i Image type: P BOFD: 111900057 / Cost Center: sYg ��, /��' ' Teller Number: X// Teller Sequence Number: Capture Source:VP Entry Number: 0000006592 Q � A.. /j/i � �/ ' i - - 601130315001390710383 Copyright O 2010 J.P. Morgan Chase&Co.All Rights Reserved https://transviewer.jpmchase.net/aidwviewer/CARequest.do?bankNumber=601&accountN... 3/16/2013 UANAtNJ Litt ANU LAJUALIY LUMPANY V CHECICNQ HO Di 08 026 11825 N. PENNSYLVANIA ST. , CARMEL, IN 46032 VENDOR#: PAYEE: DOUGLAS HIMMELBERGER POL/AGT#: 7791368 TOTAL 11 ,762.82 BLC /OIOPA/ 5026/