HomeMy WebLinkAbout09-20-13 (2) � 1505611185
REV-1500 EX(02-71)(FI)
OFFICIAL USE ONLY
PA Departmant of Revenue
Bureau U Indi�MUel Taxes County Code Year File Number
ao eox zeosai INHERITANCE TAX RETURN 21 13 0114
Harrisburp,PA 1 71 2 8-080 7 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMODVriY Date of Birih MMDDYwY
12262012 05�11957
Decedent's LaSt Name Suffix DecedenYs First Name M I
ALEXANDER BRIAN L
(If Applicable) Enter Surviving Spouse's I�ormation Below
Spouse's Last Name Suffix Spouse's Firsl Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPtJCATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
� 1. Original Return � 2. Supplemental Retum � 3. Remaintler Return(Date of Death �
Pnor to 12-1&82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(tlate of ❑ 5. Federal Estate Tax Retum Required
death after 12-12-62)
� 6. Decedent Died Testate � 7. Decedent Maintained a l.iving Trust � 8. Total Number of Safe Deposit Bozes
(Attach Copy W Wiil) (Atlach CopyMTrusL)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty CredR(Date W Death ❑ 11. Election to Taz under Sec.9113(A)
Between 12-31-91 arW 1-t-95) (Aftach Sdiedule O)
CORRESPONDENT- 7HI5 SECTION MUST BE COMP4ETED.ALL CORRESP'ONDENCE AND CONFIDENTIAL TAX INFORM SHWLD BF-0IREG'�'E�'7p:
Name Daylime Tele�O�ir lumber - '%
p,7 � . � .. . "'s
T� ^' _,
LINDA J • LUNDBERG 717-7�-�2�'S
.,
REp9FE �LS U ONL`F���
� � .
C7 G ,.� _"') �--..
First Line of Atldress `� `-' �-'� '—' .
_,
p �-
. - CJ
PNC BANK, N• A • -� �-
p, �_::> u� �-
Second Line of Address CJ
P -0 • BOX 308
Ciry w Post Office State ZIP Cotle �TE��
CAMP HILL PA 170003�8
correapondeneseana��aearess: LINDA•LUNDBERGaIPNC•COM
UnAer pmaltiea of pe�ury, I Eeclero ihat I haw examineE Ihis rtum,irMuOing atcornpanying achetlulec en0 atateman4,entl b Me Dest o(my knoMetlge arM belief,
it ia trua,wnact and comple�e.DeUanlbn of prcperor other lhen the personal Yepresentatiw ia baaeA on all infamation of whiU preparar hu eny knaNedge.
SIGNA PERSON RESPONSIBLE FOR IU RETURN pq7E
�� Janet L. Yost, Executrix
D
/o III, Esq., 54 E Main St. , Mechanicsbur PA 17055
SIGNATUR PQ€P OlH SENTATIVE DATE
�
ADDRE y�.p,,,�
PNC BANK;N'-�f'-�`T�ys�Offi�BrX 3�8 CAMP HILL, PA 17011-�308
PLEASE USE ORIGINAL FORM ONLY
Side 7
� 1505611185 OM464]3.000 1505611185 � �
d
� 1505611285
REV-1500 EX(Fl)
DecedenYs Social Security Number
o d rsrv e ALEXANDER gRTpN L
RECAPITULATION
1. RealEState(ScheduleA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � 9(a,000 • 00
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2, 1,0 4 2,0 9 0 • �0
3. qosely Held Corporation,Partnership or Sole-Proprietwship(Schedule C), , , , , 3. 0-Q�
4. Mortgages and Notes ReceivaWe(Schedule D) , , , , , , , , , , , , , , , , , q, � • ��
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. 2$4 ,6 8 7 • 0 0
6. Jointly Owned Property(SChedule F) � Separate Billing Requestetl . . , , g, O.OO
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(SchedWeG) � SeparateBillingRequested . . . . 7. 423�161 . 00
8. 7otal Gross Assets(total Lines 7 through 7) . . . . . . . . . . . . . . . . . . g. 1,815,9 38 • 0 0
9. FunerelExpensesandAdministrativeCosts(ScheduleH). . . . . . . . . . . . . g, 135,739.00
10. Debts of Deceden[, Mortgage Liabilities,and Liens(Schedule I) , , _ , , , , , , �p. 32,8 50 • 00
11. Total DeduMbns(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. L 68�589 • 00
12. Netva�ueofEstate(LineSminusLineii) , , , , , , , , , , , , , , , , , , , �p. 1�647�349-00
73. CharitableandGovernmenlalBequests/Sec9173Trustsforwhich
an election to tax has not been matle(Schedule J), , , , , , , , , , , , , , , , �3. 1�152�996-00
14. Netva�ue Subjectto7ax(Line 12 minus Line 13) , . ia. 494 ,353 • �0
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taw�ble
at the spousal tax rate,or
transfers un�er Sec.9116
(a)(12)X.0_ 0-�� 75. �.��
16. Amount of Line 14 �rable
atiineairatex.o4� 0• 00 ,s. a.00
17. Amount of Line 14 taxable
atsiblingrateX.12 � • 0� 17. 0 • �0
18. Amount ot Line 14 taxable
atcollateralrateX.15 494,353• 00 �a. 74 ,153• 00
�s. rnxoue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . is. 74,153• 00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 1505611285 1505611285 �
OM4648 3.000
REV-7500 EX(FI) Page 3 File Number
DecedenYs Com lete Address: 21 13 0114
DECEDENTS NAME
Sif2EEf ADDRESS
CIN STATE ZIP
PA 7
Tax Payments and Credits:
1. Taz Due(Page 2, Line 19) �>> 7 4 ,153• 0 0
2. Credits/Payments
A. Prior Payments 5 3�8 6 5-0 0
B. Diswunt 2�835. 0❑
TotalCredits(A+B) �z� 56,700 •00
3. Interest
(3) ❑ .��
4. If line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2, Line ZO to request a refund. (4) o-o 0
5. If Line 1 + Line 3 is greater than Line 2,enter lhe diRerence.This is the 7AX�UE. (5) 17,4 53. 0 0
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 inwme of the property Vansferred . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑X
b. retain the right to designate who shall use Ihe property transferretl a its income . . . . . . . . . : � �
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ �
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of tleath ❑ �
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an"in trust for"or payaDle-upon-death bank account a security at his or her tleath? . ❑ �
4. Did decetlent own an individual retirement account,annuity,or other nonprobate prcperty,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MU9T COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, antl befwe Jan. 1, 1995,the tax rate imposed on the net value of transiers to or for the use of the surviving spouse
is 3 percent�72 P.S.§9116(a)(t.t)(i)1.
For tlates 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 survivirg spouse from tax,and the statutory requirements for disclasure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For Cates of death on a after July 1,2000:
• The tax rate imposetl on [he ne[ value of transfers from a deceased chiltl 21 years of age or younger a[ death to o�for the use of a natural parent, an
adoptive parent or a slepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of[ransfers to or for the use of the tlecedenPs lineal beneficiaries is 4.5 percent,e�o:ept as rroted in[72 P.S.§9176(a)(1)�.
• The tax rate imposed on [he net value of trensfers[o or for the use of the decedenPs siblings is 12 percent [72 P.S.§9116(a)(1.3)]. A sibling is defineq
under Section 9102,as an individual who has at least one parent in common with the decetlent,whether by blood or atloption.
OM46]1 2.000
uEV,���"`°,,°, SCHEDULE A
pennsylvania
DEPPRTAENTOF REVENUE
INHERRANCETPXRETURN REAL ESTATE
RESIOEI�RDCCEDENT
ESTATE OF: Fi�E NuMe�R:
Hrian Alexander 21 13 0114
All real properry owned solely or as a tenant in tommon musl ba mporfed a!hir marketvalue.Fair market value is definetl as the price at which property
would be exc�anged between a willing buyer antl a willing seller,neiMer Eaing canpelled to buy or sell,both having reasonable knowletlge of lhe rekvant fads.
Real property thal ia joinityowned wNh righto(survivorship muat be Aisclosetl on Schedule F.
Attach a copy ot�he settlement sheel'rft�e pmpdty has been sold.
ITEM Include a copy of t�e deed shwving dacedenPS inlerest if a+med as lmant in common. VALUE AT DATE
NUMBER DESCRIPiION OF DEATH
1. Real Property:
433 S. York Street
Mechanicsburg, PA 17055 - per
HUD Settlement Statement dated O5/30/2013 96,000
TOTAL (Also enter on Line 1,Recapitulation.) S 96,000
9W1695 2.000 Ii more space is needed,use additimal sheets ot paper oi the same size.
REV4503 EX*(698)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERRANCETAXRETURN
RESIDEM DECEDENT
ESTATE OF FILE NUMBER
Brian Alexander 21 13 0114
All property jointly-owned with right ot surv'rvorship must be disclosetl on Schedule F.
ITEM VALUE AT DATE
NUMBER OESCRIPTON �p�TM
1. 2,607.671 Shares
Artisan Ptrns Fds Inc Gbl Oppt
Inv
CUSIP: 04314HB24 41,079
2 8,781.945 Shares
Doubleline Fds Tr Ttl Rtn Bd N
CUSZP: 25B620202 99,939
3 7,616. 975 Shares
Janus Invt Fd
Aigh-Yield Fd
CUSIP: 471023762 71,143
4 15,390.494 Shares
Metropolitan West Fda
High Yield Bd M
CUSIP: 592905871 160,369
5 11,205.193 Shares
Metropolitan West Fds
Unconstrained M
CUSIP: 592905756 131,661
6 1,947.747 Shares
Primecap Odyssey Ehnds Aggressive Grw
CUSIP: 74160Q202 37,669
7 860.077 Shares
T. Rowe Price, Health Sciences 36,180
8 6,353.192 Shares
T. Rowe Price, Emerging Markets Bd 90,152
Dividend accrued on 12/26/2012 306
9 7,584. 976 Shares
Vanguard Conv Secs Fd
Sh Ben Int
CU32P: 922023106 99,591
Total from continuation schedules . 274,001
TOTAL (Also enter on line 2,Recapttulation) S 1,042,090
3W4696 1.000 Qf more space is needed,insert adtlitanal sheets of the same size)
Estate of: Brian Alexander 21 13 0114
Schedule B (Page 2)
=t� Value at Date
No. Description of Death
10 12,047. 69 Shares
Vanguard Fixed Income Sec Fd
Gnma Fd Admiral
CUSIP: 922031794 132,525
Dividend accrued on 12/26/2012 213
11 16,437.351 Shares
Vanguard Fixed Income Sec Fd
Hi-Yld Corp Adm .
CUSIP: 922031760 100,432
Dividend accrued on 12/26/2012 435
12 522.65 Shares
Vanguard Horizon Fd Inc
Capital Opp Adm
CUSIP: 922038500 40,396
Total (Carry £orward to main achedule) 274,001
aev-i soa ex«�i i-io�
pennsylvania SCHEDULE E
pEPMTMEMOF REVENUE CASH, BANK DEPOSITS, 8 MISC.
iNHeairnHCeTa�aeruaH pERSONAL PROPERTY
RESIDEMDECEDENT
ESTATE OF: FILE NUMBER:
Brian Alexander 21 13 0114
InUude the Droceetls of litigation end the dale the proceads v.e2 received by Ihe estete.
All ro ert �ointl owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
i. PNC Checking Account #x�cxxxx2457 131,447
2 Cash - £ound in decedent's home 242
3 Vanguard Money Mkt Resvs Inc
Prime Mm Fd -
Money Market Fds �
CUSIP: 922906201 . 100,592
Interest accrued to 12/26/2012 � - 2
4 Flight Systems Industrial pro-rated medical loss ratio
rebate due to employee from Aetna health Care 13
5 Cash Re£und - 123
Travelers Insurance - re insurance cancellation
6 Cash Refund - 46
Fundx Investment Group LLC - re no load fundx
subscription cancellation
7 Cash Refund - 912
Boston Mutual - final long term disability payment
8 Cash Refund - 76
Flight Systems Industrial - final paycheck
9 Cash Re£und - ��
Allstate Insurance Co - re£und o£ unused premium on
cancellatin o£ auto policy #xxx xxx 800
10 Proceeds from sale of 2004 Toyota Corolla 6,200
11 Proceeds re sale o£ personal property 14,604
12 Cash Refund - 119
Bank of America - credit card refund re: MIS Moringstar
subscription cancellationn
13 Cash Re£und - 41
Citibank - refund on credit balance
T07AL Also enter on line 5,Reca "fulation S 254,687
oWa6no z o0o If more space is needetl,use eddAional shMS d paper of ihe same srze.
REV-1509IX+(0140)
pennsylvania SCHEDULE F
VEPMLUErviOFREYENVE
iHr�eairnHOe Tnx aer�aH JOINTLY-OWNED PROPERTY
RESI�ENT DECEDENT
ESTATE OF: FILE NUMBER:
Srian Alexander 21 13 0114
H an asset became jointly avned wHhin one year of Ne tlecede�R's date of death,R must 6e repated on Schedule G
SIFNNNG JOIMTEI4M(S)N41.£�5) AOORESS RAATIONSFiIPTO�EC�BJ�
JOINTLY OWNED PROPERTY:
�r,�R °^T� cESCarnoraoFina�n vsoF �a�oFOEnn�
� �an�aHr M40E ixcwocmr.Eavnrwrsu�nsm�rwn�xoen�cr.ccmrtma.eErzwswun M7E�OEATH OEC�BdI'S VALUEOF
NASgt T�uwuT ,pN� ioEmmiwween.nrr�cnceEOrwiaxnv�io�r.�[s*�*e VALI£OFASSET MHEE$T OEC�@JI'$NfH7E$7
None
TOTAL (Aiso enter on Lirie 6,Recapituiation) 5 0
9WI6AE I.000 H more space is needed,use addilional sheets of paper o/the same size.
I II
REV4510EX+(OB-09) SCHEDU�E G
pennsylvania
o�nr�n�rrr�r�riue INTER-VIVOS TRANSFERS AND
INF�PoTANCE TAX REIUftN MISC.NON-PROBATE P120PERFY
FESIDEM`DECE�EM
ESTATE pF FILE NUMBER
Brian Alexander 21 13 O11A
This schedule must be completetl and filed if the answer to any qf questions 7 through 4 0o page three of the REV-1500 is yes.
CiF.,SCRIPiION OF PROPEftN �
ITEM muuer-etra�cFttemasr��,lec-�xxctarw'svarooES_oeKrw.n CA41E4FDEATH %OFDEC�'S EXCLUSVON TAXABLE
hiJMeE ���mussan�rr+a+,c�raF*�o�oca+aFS�.ESrnrc. YALUE4FAS3ET kJTEREST MI'�di�,1�.e VALUE
�� 2,184.023 Shaxes
T.Rowe Price, New 4iorixons,
Traditi.onal IRP, Aecount,
payable to Estate 71,549 IOp.0000 0 71,549
2 4,533.911 Shar+�s
T.Rowe Price, 7iiversified
3ma11-Cap Growth - Traditional
IRA Account, payable to Estate 78,119 100.Q000 0 78,119
3 1,130.046 Shares
T.Rowe Price, Mid-Cap Growth -
Traditional ZRA Aaaount,
payable to Estate 63�2d9 106.6000 0 63,249
4 2,218.3 Shares
T.ROwe Price, Blue Chzp Grawth
- Traditional IRA Account,
payable to Estate 100,223 100.0000 o ioo,2as
5 A,415.668 Sharcas
Vanguard Fenway Fds Prime Cap
Co Inv - IRA Account payable to
Janet Xost, beneficiary 54,�96 100.6000 0 59,796
6 1,718.274 Sha.res
Vanguard Bd Zndex Fc} Zne
Y�IDCP Gwt Idx Adm - IRA Accoant
payable to Janet Yost,
b�ne£ioiary 50,225 100.0000 4 50,225
TQTAL(Aisa enter on iine 7,Recapituiatim}$ 423 161
If more space is needeA,uae add'NOnal sheets of papM M the seme Size.
9W46AF 2A00
____..._..
HE°-,s„EX'°°�, SCHEDULE H
pennsylvania
oePnangNroF ReveNUe FUNERAL EXPENSES AND
NJHFRITANCE TAX RETURN ADMINISTRATIVE COSTS
RESDENTDECE�ENT
ESTATE OF FILE NUN�ER
i Alexander 21 13 0114
Decedent's debts must be�eported on Schedule I.
REM AMOUNT
NUMBER DESCRIPTION
A. FUNERALEXPENSES:
� Myers Bugrig Funeral Home 11,702
B. ADMINISTRA7IVE COSTS:
1. Personal Representative Commissions: 62,375
Name(s)of Personal Representative(s)fl**� �k �q t fnr Fxo utrix
SireetAddress PNC Bank N.A.
��ry State ZIP
Year(s)Commission Paid:
2. Attomey Fees: 52,375
3. Family Exemption:(If decedenYs address is not Me same as cWimanCs,altach e�rylanation.)
Claimant NONE
Street Address
City State ZIP
Relationship of ClaimaM to Decedent
4. Probate Fees: 1,184
5. AccountantFees:
6. Taz Retum Preparer Fees:
7.
1 Cumberland Law Journal - legal advertising 75
2 Superior Plus Energy Svcs - heating £uel oil
delivery
770
Total from continuation schedules . . . . . . . . . �.25g
TOTAL(Also enfer on Line 9,Recaqtulation) $ 135 739
swasnc z.000 It more space is needed,use additional sheets of paper of the same size.
Estate o£: Brian .Alexander 21 13 0114
Schedule H Part 7 (Page 2)
3 SE3 Insurance Brakerage 9vos, Inc. - Insuranae
coverage £ar 433 S. York Street (1/31/13 -
5/31/2013) 260
4 PPL Electric Utilities - electrio service for
acct#16201-24013 LZ�
5 Commanwealth of Pennsyloania - £ee £or duplicate car
title 23
fi Freeman Real Estate Zne - Appraisal fee per
Inv#0005222 350
? The Batript News - legal advertising 114
8 Auctioneers Commission re: 2004 Toyota Corolla sale 310
9 Autianeer's Expenses re: sale o£ persana2 property 3,A22
10 Michael C�ase - Trash removal from property 75
11 Settlement apportionment charges per 05/36/2013
HUD-1 Statement
Coamission Paid $144Q.00
Tax certification 16.00
1B trans£er Tax 960.00 2,410
12 Uaited Water - water serviae 45
13 Boroagh of Mechanicsbuxg - quarterly s�wer and trash
removal 126
Total {Carry £orward tfl main sehedule} 7,258
��.
a��.,s,��`"z-�, SCHEDULE I
pennsylvania
( oc��,+�°f R�""E DEBTS oF DECEOENT,
INHERITANCETAXRETURN MQRTGAGE LIABIUTIES&UENS
RE510ENi�ECEpENT
ESTATE QF FILE NUMBER
Brian Alexander 21 13 011d
Report debta inwrred by the decedent prior to death that remai�red pnpaW at the date of death,including unreimbursed medical expenses.
��M VALUE AT OATE
NUh58ER DESCRtP71C7N OF PEATH
�� Claremaat Nursing 6 Rehab Ctx - Balance dixe for
ftoomfBoard 12/26/12 Reaident#5255 Zg�
2 Buperior Plua Energy Svcs - heating fuel oil delivery 661
3 Hameinstead Senior Care - Balance due for svcs rendered
12/16/12 - 12/21/12 per invaice #1']79-1212-2 3r5$B
A PPL Electric Utilitiea - electric service for
acat#16201-2s1013 ld4
5 Heartland Home Health S Hospice - Hoepice services
rendered 9/7j12, 9f11J12 and 4f18f12, Znvoice#1897249 3?1
6 AUL - final balance due on Advantage plan
Acet#0$?5150768 �g
7 Andrewe 6 Patel Assac - medical service� rendered 40
8 Citicards - credit card balance dixe 3,�$Z
9 Comcast Service g�
10 Verizon Servioe a�
ll United Water - wate= aervica 2g
12 Internal Revenue Service - balanaa due 2012 Individual
Tncome tax 22r525
13 Borough o£ Mechaniasburg - quarterly sewer and trash
xemoval �76
14 PA Dept of Revenue - 2012 Balance due individual income
taz 1,695
T4TAL Also enter on Line 10,Reca ttulation S 32,850
awaaar+z.aoo If more space is needetl,insert additional sheets of the same size.
I
REV-05738Xr(6LSOj SCHEDULE J
pennsylvania
�"�'"�"`°�RE"E"°E BENEFICIARIES
MFERITNJCE TAX C2ENRN
RESIDEM DECEOEN[ -
ES7ATE C�: FII.E NUf�ER:
Bra.an A1 x der 21 1 0114
RELA770NSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER N�1ME AND ADpRESS OF PERSON(S)RECENING PR4PERN Do Not List Trustee(s) OF ESTATE
( TAXABLE piSTitiBUTiONS[Inciude outright spwsai tlatributions antl traiakrs untler
Sec.9116(a)(12),J
�. Sanet L. Yast
115 E 5impsan Street
Mechanicsburg, PA 1
i,�xe.2� Shares
Vanguard H8 Index Fd Inc
III}CP Gwt Id�c Adm - IRA Accpunt
payable to Janet Yost, benaficiary
Snventary Valus: 54,225
4,015.8� Sharas
Vanguard Eenway Fds Prims Cep Co Inv
- IRA Account payable to Janet Yost,
henePiciary
Inventory Value: 59,796
One Quarter of Residue: 384,332 Aunt 444,353
ENiER DOU?J2 AMOUMS FOR�I5TRIBlfiiONS StiOWN ABOVE ON tMES 157HROUGt118 OF REV-7506 C6VER SHEET,AS APPR07RIA7E.
�I NNOhiTAX��8lE4IS7RlBU174NS
A.SPqUSAL DISTRIBUTIONS UNDER SECTON 8773 FqR WHICH AN ELECTON TO TAX IS NOT TAKEN:
7.
B.CHARI7AeLE ANb GOVERNMENTAL D151RIBUTONS:
�� �See Attached
1
T4TAL OF PART II-ENTER TOTAL NON-TAXABLE ptSTRi6UT10NS Otd LME 13 OF REV-1506 COVER SHEET. S 1 152 996
awasni z ooa If more space is needetl,use sddtipnal sheets oT Qaper of the same aize.
Estate of: Brian Alexander 21 13 0114
Schedule J Part 2B (Page 1)
Item
No. Description Amount
1 Per Ztem 3 (H) o£ the Last Will S Testament of Hrian 1.
Alexander, dated September 28, 2012 to:
Bethesda Mission
2101 North Front Street
Harrisburg, PA 17110
259 of Residue to Bethesda Mission
2101 North Front Street
Harrisburg, PA 17110: 384,332 384,332
2 Per Item 3 (C) o£ the Last Will 6 Testament of Hrian 1.
Alexander, dated September 28, 2012 to:
Salvation Army Harrisburq Capital City Region
1122 Green Street
Harrisburg, PA 17102
One Quarter of Residue t: 384,332 384,332
3 per Item 3 (D) of the Last Will 6 Teatament of Brian 1.
Alexander, dated September 28, 2012 to:
American Red Crosa
1804 North Sixth Street
Harrisburg, PA 17110
One Quarter of Reaidue: 384,332 384,332
HIOS.µns RFV 19/Ili
LC�CAL REGlSTRAR'S CERTIFICATION OF DEATH
WARMNG: R is iilega! to dupiicate this eopy by photosta#or photograph.
Fee far this certificate, $6.170 n ,,�1 This is to eerEify that the infarmation here given is
����,tN OF pf�,�s �fl�cdy copied from an originai Certificate of C?eath
,��'� 'ff= doly filed with me as Local Registrar. The original
� +yc�� `� ;_�3 certifieate will be forwarded to the State Vital
3,°.a � Js:i Reeords Office for permanent ftting.
�,t ' +.�r ,
P 1. 9 1 7 �I O � �F ��q'49l ---�`A`c�o�`'°� W.t.iv+> IS . ��� ��.�� �..
' �ENT 4� ��
CeRification Namber "�����""'" Local Ra�istrar daCe ISSUed
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LAST WTLL f1ND TESTAMCNT C7F'BRIA.N L_�sLF',.XANDER
I,BT2TASV L.dLEXAtVI3ER,single maa,cuzxently of Mecbanicsbu=g,Cwnberlaad
C;ou¢ry,Pennsyivania,being of sormd and dlsposing mind,memozy and imderstanding,do maice,
pubLisfi and dectaze this m be my T.ast Will and Test�iment,hereby revoIang and maldng void any
and all priox wills kry me at any time herekof�e made.
1.
T direct fhe payment of alT my just debts and fimecal expenses as saon aftez my dacease as
thc same can convenicntly be done.
2.
Thexe are assor[ed fanuly heirlooms ia my hame. L direc[my Exccuhix named in
Paragraph 5 betow fo take passcssion and co�ol of these aad to dishibute them between b�th
sides of my family. In ordcr to avoid any atgvments among my nsiduary tsenefieiazies as to
what constitutcs an hoirloom,my F�cecutmc shall ha.ve fiill,final and absoFutc discrefioa in
making that decision. These fieirlooms aze to be dishibuted as fairly and teasonably as
pracTicable.Iu thc event of dispntes,my Execulsix is ta t�ave the final and absolute say;I am
trusting hec jndgnenY in this maTtu completely.
These items are to be wnsidered Ya be`sn the nariae of sgecific bcguexts. All fets,
commissions,expenses and the t�Tce typieally assessed andtor ealeulafed agaiast thcix values are
to be paid from the residue of my Estata and are not be assessed against the recipicntr.
Additiovally,I d'uect tbai all death ta�ces aze to be paid from the entire r�sidue of my Fstace
� before an�v cal.cvlatian of tho 5na1 net distxibWable shares. I realizc$iat this meane iho tt�rae(3}
charitirs named hereiabclow will sbsre ia the expease of the death Uixes and tkris is my desire_
The balance of parsonatty not considered ta he heirloams by my Executriac shall fatl into
the residue of my Estau and be�admini,tezed in tfie custnmary manner_
3.
tUt the rest,residue and reznaiader af my Estate,real,personal and mixed,whatsoever
and wherespever sicuatq is to be dividcd aad distributed as follows:
A. Qnc-fouerh(1/4)to my Aunt,JANET L.YOST,aer stirnes.
$. One-fouxth{1/4)to the$E'TRESDA MISSZON,cuttendy located az?.101 tlarth
Pront Street,BuiLding 1,Svitc 301,Hazrisbm'g,PA 17110.
p�j
_ _------ -- _
��.
,.�..�.--- - _
_ ._
C. Onc-fpur[h(I/4)to the SALVATION ATtMY HAFt.RTSBi3RG CAPITAT.�
CITY REGION,currentLy iocated at 11?.2 Crrcen Strtet,Hamsburg,PA 17102,
to be osed in the co'snties o#Dauphin,Cumlxrland andJor Perry.
D. One-fouzth(1/4)to the AMERICAN IiED CROSS,cvnen8y]ocated at 1804
North St�cth Strect,Harrisburg,PA 17114,tfl be used in the cavniies of Dauphus,
Cum6ertand andlar Pecry.
4_
It is my intention that baneficiaries named befoze or aftex the date of this VJill�on my Iife
insvrance,aanuities,individua3 retirement accounts{IItAs),in Txust for or joint bank accounis
and aay other assets for which I may desigaate benefic4aries ws41 xeceive such investments and
ihat my Will provisions shall not controt such investrncnts.
5.
I nominate,constimte and appoint my Aunt,JANET L.YOST,to be the Executrix of
tbis my Last Will and Testament. In the event thaf my said Aunt is unabie or vnwilling to serve
as Executax,I appoint my cousin,KATHX'J.YOST,in her place and stead. I fiuther direct
that they shaiI not bc roquired to fiie bond or othec securiry in the O��e of ihe Register of Wills
for the purpose of administering my Estatt.
AY S'�ST`N�$5'tN�i'EER�+CSF,I have hezeimm set my hand and seaI this �.day of
��_ _,A.D.2012.
—T•
f�. ! .;.%,�� (SEAL)
BRIAN L.ALEXANDER
Signed,seaied,published and declerr.d by thc above-narned BRItIN I,.ALEXA,NDEE2,
u and for kus Last Will and Testament,in the presemce af us,who ai his request and in his
presence,and in the presence of each othez,have herevnto subsczibed our names as witnesses.
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Vanguerd Brokerage Servkes�
A DiWsion of Vanguarci Marketirg Corporation
Srian L Alexander
433 S Yo�ic St
Meohanicsburg,PA 17Q55-6405
Individual Brokerage Account 28576342
Below is your Date af Death Accaunt Valuation for the a6ove referenced account.
Hoklinga 8ummary Valuex on: 12f�6f2012
Stxks Tota! $O.W
FuMACCass Totel E7�,542.Sb
Bonds TMnI $O.W
Accrusd Income i'otal E6.60W
Total Accoutrt Va#ie: 571,142.55
Hoklings
Srocks Symbd 4uen4ty Pt�CS P�r Shpre Cument Yakro Atxniad OMkfends
No stock hslG v�the acwun4
Totaf stacks $0.00 $O.p00p
FurdAucess Symboi �uantily Pric9 peu'Shane Curtertit Vakie Acctued Dividends
Jatws tiigM1 Y�aM CI T SAHYX 7,818.9760 5�.34Q0 $77.142.5485
Totai FundA�ecs 571.142.56 SO.OD00
Ffxad Income Cusip Quentlty Priae per Shere CurtaM Vakre Ac�ueti ln4erast
No flxed�rcoms sewrtties haM in tt�e armuM.
Tafai Fzed income $O.00OQ $Q.0000
okdosure:
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Page 1 of i
Page> 1 of 1
��� Vanguard�
_:, .
srian.L Alexander
A93 S York St Gtient Services:8W-662-2739
Mechanicsburg,PA 17655-&t05 �
Total repor!value: $333,194.83
{TMaI report value incWdes arry eaCnxfU dWidends.)
a,
'�Name � -:.FUnd$�Accopnt ' '�Date `.P}ice�Pe[ , Accnied ';:��. '
. � � . . .. � ��. �-Numtier � �. .Opened !:.Sheras� -�.� Share �� VeCue* :� Diaidends._�
Prime Money MM Fund � � 0036-884d$718213 03J5i/2011 + 0.�6 $1.00 $0.00....�. � $4.00
}9igh-Yleld`CorpFundlrn��.� ; . �. 0029-88(M87162i3� 03t17P1011� �:_- 0.��-� �.tt - ;$0:04 ,:$6,�.
PRiMECAP Core Fund 1220-880A8716213 03/1712011 ;t 0.000 $fi4.89 $6.00 -
Cirmert16le5ecudties � '� :'�� :W82-880�{8718213 03f17/2011i .'�.�. 7,584:976 -- �St3.t3 :" ` $99,590J3 ���� -,
GNMA Fu�Admiral Shares 0536-88048716213 09/171�11 � 12,047.89� $t'1.00 5132,52d.59 3212.55�
High-Yield"GoryFund.Atlm � .- :052.9-88048718213� iT7t812011 �..,- �1$.#37.351 -; �$6.71 ::; .$1{7@��Q322t � $4�4.75-
S-T Imestment-Grerle fnv 6039-8$046715213� 0312312D11 i Q.� $10.87 $0.00 $0.00
WebingtonFUndtnv 0021-860�87162/3 031i7/Z(31i -0.� $34:54� . � .�,3Q.pQ .-
Totals 5332.5d7.53 ... i647.30
..�____.�.___..._--__..__���. J_�.—_._,____._ ._�_.—
'Doeen't IncNde accryed tliNdentls.
0515027789 081Q9Y201315:06:57
i
Page> t of 1
K
Vanguard'
Brisn C.Atexarnier
433 S York St Client Senices:&DO-662-2738
Mechanics6urg,FA 17055-BA05
Tota!raport value: � � �110,021.42
{Total re�wrt vaWe inpludes eny accruai dividends,) _
4�. pc.a y � r#� �c
Y �.,-�'�?H �..... �°��;;����-:, ...,�'h��':. . � � , y � �
� ; i
Neme � Fund&Account Dete Price i?er Accnred
Number Opened .Snares Shere �� � �Velue"� : DhriGends -
Dividend Growth Fund iJ057-880036T706T ty20t2011 0.000 $1&.82 $4.40 -
Mid-Gap Gr idx Admiral 5832-88003677067 �43109CZQ12 �:.. �� t,718.27A.�' �J,Y3, :�'�. $5tf,22¢:}5� .. '
PRIMECAP Gore Fund 1220-88003877067 11/11P2005 4,p15,868 $54.88 $59,7�.27 -
CMUw�tiinilenFundAdm: - ' � ��4509-88003&7T087. 89721r2612 O.p00.-:.'$3G.�3 -.- ".5Q;f70
. .. ... � � Totals ._ S1t4,921.42 .... ,54.06
'Doasn't indude accrued dividends, ��— —�— --�.�� �
4819703879 08t09l2013 15:47:08
��I
I
pB�B b � Of �
�i��i`J V'it[1�17,�!'ds
Brian L Rlexarider � . �� '� �
�,,„r+:,,::-...:._..,.a_^, . - . . _ .,:, .
ass s vor�st cuenc sen��s:aoo-ssz-2ras
Mechanicst�urg,PA 17455-8405
Total report va�ue: $1AO.S89.55
(Tot�repart val�uu�udes arry sxrued dividends.)
..,, � ,.. .. . ., . .
�� Name .�:�. Fund&Accoarrt ��-�Date . ,.. Pr�e Per � � Azuued.�,:..
.. . . .Number :. 4Pe�� .•:� 5hares ��:-. 8hate :. _ , Ysf4e'"'. , DWid'eaid�. :'�
Prima A,bney Mkt Fund 0030-09884775530 06/02/1994 100,591.896 $1.00 � $tOp,597.89 $2.04
Cap'rfai,pppottunityAdm- � . 5714-(l9884775530 .OBl10/2005 '.���� 5?2„$5p $7729 -�, . St0,395.82 -
" ..'�Y� ��� iTotais ^ + � 5140,987.51 �.�f2.04
"Doesn't i�dude accrued tlhddends.
0256535569 08l09l2013 15:06:45
Fab. 14. 2013 11 :48AM PNC � 1�, 72'.Q � °. 2/2 � �
� � .������� � � �
Pebruary 14,2013
Carol Koscienski
PI�IC k3ank
Weaith Msnagement
T2.�: . Brian L Alexandcr
SSN: 2I0-44-6388
bOD: 12126l2012
Dear Sir(M2dam:
In response ta yaur request for Uate of 17eath (DOD)batances for the customer noied abtrve, aur
rccords shbw the fatlowing:
`CheckSng A.ccaunt
Accovnt#507p032457 Established- 07/01/1979 '
BRTAN L ALSXAhDER
DOl7 balence: $131,446.91 ttpn interestbeazzng ,
please note that this o�ce prat�ides date of death balances for dcposic accounts{p2AS,CDs,Checking and .
SaWiugs). '�'e do not procese any financaial transaetions or provide statements. Tf yoix need sssistance rwith.
any of these items,please call 1-888-PNC-Be#NK{I-888-762-22b5}or stop by yQUr locai PNC'Banle bzanoh
office.
Sincerely, ,
Nationall�inancialScrvices Center -
PNC Bank,I�I-A. �
Membez FDIC
Tliis»tessage is iniended for the use ajihe ind'ividuai�r errtrfy tcr which it rs addrarsed ar�d m�y
• eoniain rnformtu'iun that is priviCxgerY, co�fdential and exempt f`rom drsetosure under apptecabCe
daw. 1'f the reader of thls tnessdge is noi the interaded recipient or tlie emp/vyee or agent
responsible for deXivering th3s message to the intended recipient,you ttse hereby noh'fizd tleat any
tiissemination, distrfhx�ifora ot copying ojihis communicaCions is sd�icYly prohibited ifyou httve,
received dhr`s communientipn in error,ptease notify me immediately 6y rep[y or by te[ephone at
80p 762-1775 and in►mediately destroy this faxed dacum�nr.
Page 1,Of 1
�NC BA�K I
' RECElVEi�
T. ROWE PRfGE SERVICES, wc. �AR � �Z�t3 wwwrRaveaRrce,coM
� P.O.8ox 17302
� Baltimore,Maryland
CPA WEALTFI MGMT z�zs�-�soz
45i 51�ainters Miil Road
Owings Miiis,Maryiand
251'17-4943
�a1'C�i rJ. Z�}l3
Linda 3 Lundberg
PNC Bank
PO Box 348
Camp Hiii PA 17001-d348
Subject: Est,ate c�f Brian L. Alexander
Dear Ms. Lundberg:
Thank yau for your letter dated February 26, 2013, regarding the late Brian L. Alexander.
We uansferred Mr. Alexander's assets to accounts registered to the estaie on March 4, 2013.
We redeemed the Jnherited Il2As that were established for the estate based on the instrucrions
provided on the IRA Distributian form that the executr4x, 3anet L. Yost, cornpleted. However,
we will need to receive instructions from Ms. Yost to redeem the assets in the nonretirement
accounts that were estabiished for the estata, as we are ixnable to redeern the assets based on
your instructions. Please note that she wili need ta obtain a Medallian Signature Guarantee to
have the redemptian proceeds mailed tp an address other than the address that she requested be
used for the address on record. I have enclosed a gostage-paid envelope for your convenience.
In the meantime, I can provide the account information that you requested in your letter. As of
the data of Mr. Alexander's passing, I7ecember 26, 2412, aur records show the following
balance information for his accounts:
Nonretirement Accounts
Fund Name Account Shares Share Balanca Accrued Date
I�tumber Price Dividends* Established
Ernerging 52$63609-5 b,353.192 $i4.19 $90,151.79 $345.50 14l16l2Q12
Markets
Bond
Health 7150422797-8 88d.077 $41.11 $36,179.97 N/A 6/8l2011
Sciences
'�The accrued dividends are not inctuded in the balance shown ttnd were electronically
transferred to the bank on fzle on December 31, 2tI12.
T.Rtc�wePkite�
INVEST WITH CONFIDENCE
, �
Traditionat IRAs
Fund Name Accaant Shares Share Balance Accrued Aate
Nurnber Price Dividends Established
New 7150290459-4 2,184A23 $32.76 $71,548.59 N!A 4112/2d12
Horizons
Mid-Cap 540321413-9 1,130.446 $55.97 $63,24$.67 N/A 4116/2q04
Grawth
Blue Chip 7150282380-8 2,218.300 $45.18 $100,222.79 NIA 4J12J2d12
Growth
Diversified 527728Q1-4 4,533.911 $17.23 $78,119.29 N!A Si/11l2Q10
Small-Cap
Growth
Mr. Alexander designated his esiate as the beneficiary of the Traditional IRAs.
If you have any questions ar require additional infarmation, please call a telephone services
representative at 1-8Q4-225-5132. Representatives are available Monday through Friday from $
a.m. to 10 p.m. ET and Saturday from 83d a.m. ta 5 p.rn. ET.
Sincerely,
c`/���.�:.t�'�
Jenny Kirkpatrick
Senior Accaunt Services Representative
Carrespondence Number: 02371008
Enclosure(s): Envelope (PPD-RAS}
T.Fi�ePlric��
INVEST WITH CpNFipENCE
i
�bancorp• �E�
Fund Services,LLC MAR 12 2���
P.O.Box 701 �PA W���-S� MGMT
Milwaukee,WI 53201-0701 .
Ivlarch 7,2013
PNC BANK
ATTN L Lt.1NDBERG
PO IiOX 30$
�A�rSP HILL PA 11001-Q308
REFERENCE NUMBER: 00489060
PRIMECAP OL)YSSEY AGGRESSIVE
GRO WTI�Fi`TD
ACCC3i.JNT N�.7MBE12: l ib5104207
BRIAN L ALEXANLIER
17ear Ms. Lundberg:
Thank You far contaeting the PRIMECAP O�yss�y�'��s.
accountQrThe aboveQaccount�Was establ shed an�September15�2449�t�e above referenced
The following table shows the value of the account as of the close of business an December 26,
2012 :.:-,,, � ��. .; t , : , i , ;. �;
I}ate l�iumber of Shares Net Asset Vaiue Total Value
12/26/2Q12
1,447.747 $19.34 $37,659.43
piease cansides this the written confirmation requested.
please contact aur Shazehalder Services Department,Mondaq through Friday &:00 a.m.—7:00
p.m. centraT standard time, at{8dd)729-2307 if we can grov±de any actditic�nal assistance.
Szncerely,
`"�� �+��~
7enna Hannon,. ,. . ._
L3.S.Bancorp Eund Seruioes,LLC. - --._. .. -
_ ___ �.
_ .
As Transfer Agent for the PRIMECAP 4dyssey Funds
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Janet L. Yast 1 N V+Q t G E
118 East Simpson Street
Mechanicsbu�,PA 17055 fnvoice Number. 14628
' � fnvoice Date: Dec 27,2U12
�__ Psge: �
Brian Alexander December 26,2012 Net 30 Days i RabeR t.Buhrig Jr.
P5 Professionai Sesvfces $4,841.00
I FSE Facilfties, Staff and Equipment $ 1,334.00 I
� v vBn�GeS t $ �az.00
M ( Merchandise 1 $3,2�5.00
CA-Cemetery Cash Rdvance-Cemetery � $ 950.00
CA-Clergy � Cash Advance-Ciergy S $ 300.06 �
CA-Death Ceet 30.00 � Cash Advance-4eath Certiflicates $ 6.W $ 18Q.04
CA-Flowers � Cash Advance-Fiowers $ 300.00
CA-Monument I Cash Advance-Monumerrt Inscription $ 185.d0 �
CA-Newspape Cash Advance-Newspapers $ fi50.4Q
CA-Newspape Adjustment to Cash Advance-Newspapers � {$ 3$5.00)
. ( {
S v b in this irnoice by January 27;2d13. �
Piease pay$11,'702.00. <.(,t.rJ� f f�.1 � 3 4
1�,,,��� 11�'�j
� � � 1�3�1 � -#t.3f.37
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i
_.___�._u_�I'hank you for allawing us to serve you d our famil .
Subtoiat $12,397.40
We giadly accept the following fortns af payment: $fi�pp�ng_ __—_�_ $ 0.00
Cash,Check, �lisa,MasterCard,Discover, American Express Sa{es Tax g p.pp
K�dly make yaur check payable to: Totaf lnvace Arnount �� ��$12,397A0
Myers -8uhrig Fuherat Hama and Crematory Paym UC 4ed $ 0.00
Pa�due accounts are subject to interest charges of 1.5°Jo per month.
Watking with Those in Grief
RobeM"Sob°L.Suhrig,]r.,F�,s�p��o�•W i11iAm"Bill°L.Chriskopher,eo
Phone: (vn)7h6.342! • Fax: {�n�"I45.72<JI • 37 East Main Sfreet • Mechanicsburg,PA t705S • www.Myers-&uhrig.com � Directors@Myers-Buhrig.com