HomeMy WebLinkAbout10-25-13 �11 REV-7,����X�QZ-"' 1505610143
,�,�,
PA pepaNnent of Revenue penrn�yivAnia OFPICIXL USE ONl.Y
BureauotindividualTaxes W^��'w� �MCOae vem Fueramme:
ao eaxzaoso� INHERITANCE TAX REl'URN p Y 13 013 2
Harcinburg,PA 17728-0601 RESIDENT pECEQENT
ENTER C�CE6ENT INFORMAT�N BEL4YM� ..`_ -.
Sociai SeCUrity Numbar Date of DeatN pate of BiRh
01 21 2013 12 31 1918
DecedenYs last F3ame SuKrz DecedenYs First Name M! . �
WALLACE LOI$ W
{if A�ikabte}Enfer Survlvktg Spcuse's IM'�enation 8ebw
Spouse's Laat Name . � SuNix Spouse's Piret Name MI
Spnuse's Socla�Securiry Number
THIS RETURN MUST BE�ILED IN dUPLICATE WITH THE
REGISTER OF WILLS
�Ilt IN APPR4PRUlTE 4VAlS 8Ei0W
� t. Orfginal Retum ❑ 2. Suppismental i2etum Q 3.pM fo a�2r 3�;(�ate of Death
� 4. Limi�C Eatate � .4a,Fwure Inv�rest Comfxommbe � 5. Fetleral Estete Taz Retum Requirad �
{3tlq�qeth N�i�-i282}
� g pecaesm oiee iestme �:� Ogceflsrlf Mainfamw 6 UNnB TNSt p 8. TnWI Numlwr M Safe Depasit Bo7cea - �
(Attecl�Copy of Wd0 � (AM.ach Copy M TruMy
❑ B. LNigBtlon Proceei38 fteceived Q 10.��POVerry�C�t�(�of Oea#t � N.��un�s Sec.9N3(A} -
CORRESPONDENT-TMIS$ECTON MUST BE COMPLETED.ALI.CORRESPONDENCE AND CONflDENTIAI TAX INCORMATION Si�1L0 C1ED TO:
Nama Daydrm►C"tfpphOnel4wqber� �
KBZTB D iPA6NER 71'7�;�38 6S�$ �n �
", �� ...� o
: r�.
r�o�r�1E or�?wu.fS'use�?+�
- ;::� o a
� �5 � ,
� flrstLineatAtldroas �::. `:, -:3 .. ��
6 E MAIN $TRB�T _ ~ r:.: �
Seoond lins ot Addres� ''� C3 � �
PO BOR 323
DATE Pq..ED
City ar P�t 4tflce 9tate ZiP Coele
PALMYRA PA 17078
corresparmeM�samsaaaaross: keith�bwzlavr.com
Untlar panaltfes of paryury,I dedere Nal I have oxamined tlNS reNm,in�Winq acCqrtpenyinp schBEubs antl Watemenb,and W tl+e best of my knowledge and bel4af,
it IB true,:Ain erW oompl8�e.DeWretlOn Of propefer Mher tl1ar1 Me peBOnel fepreaBntBiivA i5 b8eetl on ell iflfomletbn Of which prep8f9r tws any knMNedge.
ib� f�tJA�SUR£ F�ERSONRE PON51 F flllhA'+ftETLN2N '- 6ATE
I �-����%��� Geraid J.8rinser /v�2 ifi�
ADDR S'
� B E.Maln St
P.4.�x 3 h»yra,PA 17078
SIGNATUREOF P pTHERTHANREPRESEPfrRTIV6 DATE
Keith D Wagner 10�?+l►3
AOIX2ES5
��ff8@C aQfiBt�Z�Fi111MtiT18ti
6 E.iNa� Street, Paimyra PA 17078
Side 1
� 1505610143 1505630143 J
(P�l
1 1505630243
.��
� REV-1506 EX � � -
DecedenPS Social Security Numbar
��an�=rum.: WALLACE, tk3�8-W. D.
RECAFITULA7ION .
" 1. Re9I EstafB(SCheduk A)..........................................................--......._.,..............._. t.
2. Stocks arnl Bomis(Scheduie BY......................................................._......._............. 2. �
��. 3. qaeety Hetd Caryoration,PaAirership pr Soie�Proprietorohip(Sdiedu�e C).......... 3. . - ::
�. � A. Mortgages&Notes Receivabie(Scfwdule D).......................................................... 4. 1?$ � �0�6 . 1$
� 5. Cash,Bank Deposiis$Miacellanmous Personat Praperty(Schaduk�Ey................ 5. 7 3 2 r 8 2 0 . 5 7�' ...
�. � 6. JointlYt7wnedProPery'tSchedubF) ❑ 9epar9U�BipingRnquesMd............. 8.
_ 7. int6r-YrvoB Tra�sfers& . . �:: . FFDpeRy .
� (Sahedule G) Q 9eparete B�png Requested............. Z .
.. . 8. Total Grosa Aa1�ts(tofal Lines i�throuqh 7).......................................:.................. 8. 41 1 � 6 2 6 . 7 5
, � 9. Funeral Eacpanees and AdminisMetive Cqsts(Schedule H)..................................... 9. 4 6 , 9 31 . 2 0 .
�'�. . 10. Debts of Decedent,Mortgage Liebilitlee an0 Li�ns(Schedule q............................. 70. �$ r 16 6 . 6 9
� 11, TMeI DsductbOS(tqtel Lit1ls 9 arnl 1 D).........................................................._..... 7 t. 7 S , 0 9.9 .�8 4 .
t2. Nst VNw ot @Mw(L'me 9 minus�ine i t)............................................................. t 2. 8 3 6 , 5 2$ . 8 6
� 13. Charitetiis amt C,ouenrrnenfW�eiques�tSac 4713 7n3sts for which �
.. an electbn to tau has�nM been made(Schedule J)................................................. t 3. 418 , 2 6 4 . 4 9
.: 14. N�t YaluNr841�et W 7ax(Line 72 minus Une 13)......_......_................................. 1 a. 418 , 2 6 4 . 4 2
� - ---
- TpX COMiUTAT10t1•SE@ INBTRUCTIOMS FOR�APPLICABLE RATES
� 45. AmouM of line i4 Yaxabie � � � .�
�� ffi the apaucel tex nte,or - � � �
Vana�s urtdgr Sec 94 t5
�. (s)(1.2)X.00 15.
t8. nmoum ot t�e ta ta�bie - . �
af lineal rate X .Q45 - 16.
17. AmountofLinel<ta�ie �
� at aiblinq rate X .12 , ". .57. `
18. Amount of Lina id iaxabk , . . . � � � -
atcollaterelrateX .15 418 , 2�d4 . 42� - �a� . 6.2 , 73.9 . 66 �
: `"-
,�,�. 19. TA7(WE..:.........................:.................._............._.................:.........................:....... 19'. . 62 , 739�. 66
. 26. FIILIN�THEQVALIFY0UAR19��QkIHS7'11�10ANEFIJNEI�AN�OVEi11�i1MMEt1T. � - a -.
Sida 2
� �5t}5630243 �505610243 �
t2EV-1500 EX Paga 3 File Humher 21 . 13 - 0132
DecederN's Complete Address:
Waliace, Lois W. D.
STREETADDRESS .
Massiah �.ifeways, 100 Mt. Ailen Dr.
C4TY S7ATE ZIP
Meehanl¢sburg PA 1745�
Tau Paytrfents and Credit�s:
1. T�dua(Pa�e2��ine19} (1} $2,T$$.6$
2. Credita/Payments �
A. PriorPayments 8a,00n.Qd
a. oiscoant 3,1a6.as
TotalCredits(A +B) iz) 83,13$.8$
s. mtereat t3) O.d4
4. If Line 2 is greater than Line 1 +�ine 3,enter the diCference. This is the OVERPAYMENT. (4) 397.32 ' �.
Chack box crt Pags Z,Lins 2D W request a retund ---�—
5. it Line 1 +Line 3 is greafer ihan Line 2,enter the ditfarence. This is tAe TAX CNJE. i5� �__ ' �
Make Check Payabie to: REGISTER OF WILIS, AGEN7`. �
PLEA8E AN$WER THE FOLLOWIN(3 QUESTIONS BY PLACING AN"X"IN THE APPROPRIA7E BLQCKS
1. Did derecient make a tranater and: - �� Yos No � , '�
a. retain the use or income�the property trenstenetl::................................................................................. x � .
b. netain the right to deaignate who shall use Me propeAy transterred or ils income:.................................... �� � . .
c, retain a reve�sionary{nterest;or.............................................................._............._................................... x
d. raceive th�Rtomise Por kfe af either payments,benefits or care2................_..............--..................._.... x ..=
2. if death occurted after DeC. 12, 1982, did decedeM iransler property within one year of death wittrou[ � -
receNing adequete wnsideration?.......__,._...:........................:.::....................................................................... � Q .
�� 3. Did�decederrt own an"in trust for" o;peyatile uoo�daalh tiank aawunt or sec:urity at his or her death?.....:... � �,zl . , �
a. Did dacadent avn an irsdMduat rat�ement accovnt,annuity,w ott�ar norwproDake ProP��Y'++�+� �
coMains a bensfiaie+Y desipnadon?..................:................................................................................................. �� �J . .
IF THE ANSYYER TO ANY OF THE ABOVE GUEBTIQNS IS YES,YOU MUST COMPLETE SCHEDUIE 6 AND FIIE IT AS PART OF THE RETURN.�
For detea oi dsath on pr aite�Juk i,19Sa and defore Jan.1,1995,the tax rete imposed on the net valua af trenafers tp ar for the uss o(the surviving
spoux ia 3 perceM[72 P.S.§91 j6(a)(1.1)(i11. � . � .
Fnr dates IN da�h on or pfler Janualv 1,1998,1he fax rata knpoead an fha naf vaWg�of Nanafers tobr for the.uae of the wniving apouae�ie 0 pereeai
[T2�'.S.§9118{a){1.1} )]. Tfk stafute does twt e�rortu�e a Uamier to a survaru+g spouse from teu�,a�the atatutory reqn'uements for 6isUosureaE
asaetn arM fiting-a tax�m aro stiN appiic�b even Htfi wrviving spausaia the ot�iyberreficiary:. . .� .
For dates M death�on or after Jury 1.2000: . . � . � . .
�'The tax rateh�o sed o�the net volue of uanetars fmm a decaased ahiW��yt�are of sge ur Nouruger et deatir to or for ihe use ot s na'.cral parent,an
adoptive parersi,w a stepparent a€ttte cddd is 4 p�cerit(72 P.S.§Ht t8 ta}{9.2)j.
•1'he tax reds imposed pn the net velue of transfere�to or for�ha use ot the decetlenPs lineal benefidarias is 4.5 percent,except as noted in,.
(/2 P.S.§9116(a)(i)), . . .. - � .
*TM tsx rata imposed or�the net value fl#transfers to w fcr the usa of the decedeoYs sih8nga ia 12 perc»nt[72 P.S.89116(a}(1.311. A p
eibiing is defined under Sedion 9102,as an-individual.who has at le@st ane pareM in commern v�ith the decedeat,wfidther by b�aea or ado 6on.
,
l ..��— ..,..... ._._ . . .
pennsylvania �i /�+' ry
pEPARTMEN70FREVENUE �?CH�YVL� Y
INHERITANCETN(RETURN M4FLTGaGES 8 NC3TES RECEfVABIE
RESiOEpTDECE6ENT . -
FII.E NU(i!�£R
ESTATEBF WaNace, Lois W. D. 2t - �s-ots2
AII P►cpsrtS+jofnUyowrred wlth the rigM of surv3vora#�ip tn�t be diselo`sed at�Schadule F.
ITEM � � VALUE AT DATE OF
NUMBER DESCRIPTIQN DEATH
1 Dariene Dommet-tutortgage Receivabie �� 178,846.18
{Inciudes accnaed inferesf o#$3,Sd6.18}
TOTILL.{A#so enter on�ine 4.RaupFtufatlon} 178,�.1$
�
pennsylvania SCHEDULE E
REPARTMENT OF REVENUE
ir+r�a�uacETnxREruRN CASH, BANK QEPOStTS AND MISG.
Res�oENroeceoEo-rr PERSONAL PROPERTY
FI�E NtlM6ER
ESTATE OF t/�r�pace, Lois W. D. 21 - 13-0132
Ir�ciude the oroceeds of li#igatian and the date the proceeds were received by the estate.AII proparty Jairr�y-ownes#wlth the r{ght af
survivanhip must be disclosed on scheduie F,
ITEM VALUE AT DATE OF
NUMBER PESCRIPTIQN DEATH
t PNG Sank-Pertormance Checking AccauRt#51-4001-48� 48,088.24
2 PNC Bank- Prime Money Market Account#51-127&1326 62,045.34
3 PNC Bank-Certificate of Deposit#31400259109 13,986.19
4 PNG Bank-Certificate of Deposit#317Q0340456 7,521.45
5 L& R Coins-Miscellaneous Old Coins-Sale Proceeds 454.00
8 Stewatdship Advisors-Cambridge Account#5DK-463753 595,638.85
7 AXA Equitable-Balance of Annuity Payments 5,086.50
-- --- � ._�--TQTAi.{Also er�ter an L1ne 5.RacapituEatlon} 732,820.57
REY.t6N EX+(�408}
���� pennsylvania SCFB.'1U.E H
OEPARTMENTpFREVENUE .R�'����
INHERITANCE tAX RETUi2N Z�y��C.��y��
ftESiDENt'DECEOEN7 1•�,nrw»�rw
u FI4E NUMBER
ES7ATE OP Wallace, Lois W. D. 21 - 13-4132
DecedsnYs dabts must be reported on Schedule i. �
ITEM `
NUMBER FUNERAL EXPENSES: DESCRIPTION AMqUNT
A. 1 Neitl Funerai Hame-Balence Due � 148.50�
!
(
�
B. AtiNA1NISTRATIVE C05T$:
1,� � Per3onafRepresqntative'sCOmmissians � �
Name GF Perwnsi Represeritakive(s}
Gerald J. Brinser 31,000.00.
sveet t�aaress 8 E. Main Stre�t, P.O. Box S23
Gh Paimyra Sta�e PA ziP 1707$
vear(s)Commiasion Paid 2013
2. aaomey�s Fees Brinser, Wagner&Zimmerman--Keith D. Wagner 15,406.00
3. Famity Exemption: (If decedanYs address is not the 9ame as claimanYS,aHaoh explanakidn)
Claimant � �
Street Addre5s .
City State �ip
RaletiortshipqfCiaimantta6aeedent �~�
4. Probate Fees Register of Wiiis(Ltrs. Pd. $26D=$10d,000-$2D0,400) 373.5Q
5. AccountanFs Feos
B. Ta�c Return P�eparets Fees . . . .
7, Other Adminiatretive Costs _ ' ' �
1 Register of WIIES-Additional Cost of Letters 400.04
i $
— —� —
TQT,0.t.{Aisa enter an Ilne 9.RacapitulaUan} A6,831.28
� Sch��.�tfi,ia�H�`
COMMONWEALiN#PENNSYtVAN1R �y�.��y�, —/�T�,�'-�--�"�y,,�
INHERITANCETAXRETUftN '/{a��pay��R�w4J0641711�IWU
RESIL1ENt DECEDENT
ESTATE OF Waltace, Lais W. D. Fl�E NUkBER
21 - 13-0132
2 Postmaster-Stamps 9.20
-�----
�
�
�
Page 2 of Schedute H
ti F
pennsylvania SCWEDU�E I
� OEPARTMENTOFREVENUE d��.� ��.�E������ MC}RTGAt3E
iNHER(TANCE TRX RET{7RN �
,�S�o�T��EOEN� u,a�i�tri�s & �rENs
ESTATE tSF � Y Fl�E NUMBER
Waitace, Lois W. D. 21 - �a-0132
Repat deDts incurred by the decedent prior to deafh that remained unpa&!at the date of death,including unreimbursed medic2l e�enses.
ITEM u
NUMBER DESCRIPTION AMOUNT
y 1 PA Oept. of Revenue-2(}12 pR AO Tax Qtt� � � 7g�.pp
2 Dennis Zerbe, Tax CoUector-County/Municipal Tax 4.90
3 Messrah Lifeways{r�Messiah Viliage . _ - B,877.85
4 Alert Pharmacy " ` 126.14
5 Outstanding Checks at Time of Death 20,382.80
�
— --- ----- 34TAL(Alsa enter on Lltae 10,Recapi#Watbn} 28,168.$9
REY-1513EX+(Di-tQy .
pennsylvania SCHEDULE J
OEPARTMEM pF REVENUE
���,�T,��uRN BEl+tEFIC1ARIES
REStDENtDECEDENi � . .
ESTATE OF FILE NUMBER
Wallace,Lois W.D. 21 -13-0132
NAME AND ADDRESS OF PERSON S RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER RECEIVINO PROPERTY � � DECEDENT (Words) (535)
Oo Not LM Tn�,aba(s1
I. TAXABIEDISTRtBUT70NS[incE�autripMsp��� � .
d�nbut�ons and tremt�era -
under Sec.�116(a)(12)j
t Karen L. Barber,lotA-13 None 25°k Residue 209,f32.22
2271 North Black Ganyon H�hway
Phoe�ix,AZ $5027
2 Linda F. Kuchenbrad None 25°k Rasidt�e 2D9.13222
549 Surf Avenue
Beachwood, NJ 08722-2634
Entcr dollar amounts fcr distributtons sM*m afwva en Hr�es t5 thragh 13 on Rav 1506 cpver st�eet,as appropriate.
i� NON-TAXABIE OtSTRIBUTiON3: " �
A.SP4USAL DI5TRBUTIONS UNDER SECTION 9113 FOR WMICH AN ELECTION T6 TAX IS NdT TAKEN
B.CHARITAB�E AND GOVERNMENTAI.pISTRIBU7tQN5
1 St. George's UnRed Meihodist Church 12.5°� Residue 104,586.11
23S N.4th Skraet,Philadelphia,PA 19706
( 2 Henderson Setttement, P.O.Box 205 '!2.5%Residue 104,568.1 i
18773 Highway 190,Frakes,FC�' 40940 -
3 Bedfard Unfted Methodist Church 209,13222
132 E.Jahn Street, Bedford,PA 15522 25%Residue
TOTAL 6F P1UtT N-ENTER TQTAL NON-TAXABLE DISTRIBUT�ONS 6N LINE 13 OF REV-t5W COVER SHEET 41$,284.44
i .
1 . � � `•.."J � � .
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. �'" � "�'� � p
T,AST SP2LL AND T&STAM�'T m = � � r✓s �
dF r�,. Zm � � v
LOIS W. D. 9iALLAC� p, N �
a • �c a a
c,r sy a �a �r °+t
� 'n
x, LOIS W. n. WALLAC�, af Meseiah � �age,�a C�lan
-i
County, Pennsylvania, deelare this to be my �t Wi2�a� �est;a-
ment, hereby revoking any will ancl codicils previously made b
llt�.
I - I direct the payment of all my just debta and funeral
expenees out of my eetate as soon as may be practical after m
death.
II - I bequeath certain items af my tangible personal
praperty, noC including cash and securities, in accardanee with
written liet made by me during my lifetime . In the absence caf
r�esignation on suoh a liat, said items ahall be sold and added t
the residue of my estate.
7CTI - Z devise and bequeath a11 af my estate of whateve
nature and wherever situate unto my husband, Robert W. Waliace,
provifla.ng he survives rne.
YV - Shou.ld mv huskrand predecease me; then T direct �hat *:�
executar hereinafter named divide rny estate into twa separate an
equal shares to be distributed as follows:
SeA�LS'i,
�6c A. 4ne share shall be ciivided equally among Karen F.
� Barber, now of Box 26, Rachel, West Virginia, and Linda F,
:109 Mulcn 5vect
Camp Hill,PA
Knehenbrod, now o£ 549 Surf Avenue, Beaehwood, New Jersey.
Should either Karen F. Harber or Linda F. Kuchanbrad be decease
at the time of my tieath, their reep�etive shares ahall b -
1 f,��f��/
ii
distrzbutad -to their iesue per stirpea.
B. The ather said share shall be distribu�ed as
follows :
l. 25� of said Bhare 9hall be paid to St.
George' s United Methodi9t Church, 235 N. 4th SCreet,
Phi3adelphia, Pennsyivania.
2, 25� of saifl share shall be paid �o Henderson
Settlement, P.O. Hox 2d5, Frakes, Kentucky. If no longer in
existence saict share shall be clivided between 3t. �ecrrge`s
Church, Philadelphia, Pennsylvania, and United Methodist Church,
Bedford, Pennaylvania. �
3 . 50� of said share ahall be paid unto the
Unitefl Methodist Churck�, BedPord, Pennsylvania, to be known as
the Willoughiay-Davidson Fund, to be invested and reinvested by
them as2d the incame therefrom to be used for the maintenance af
the cametery at the rear of the ehurch, far chureh missians and
for such other current expensea as the governing body ahall from
time ta time determine.
4. If any of the organizations mentioned in
subparagraphs 1, 2 , and 3 are no langer �n exietence at the time
of my death, its share sha21 be divided proportionately among
�ID�yr those named organizatiqns still eurviving at the time of rny
1C'�1�4TFR�fi�
� ::@�3SAY death.
� 10�M"�"`s""` V _ I appoint my huaband, Rabert W, wallace, Executor of
. C¢mp FIi14.PA . .
this, my Last Wil2 and "Teetament. Should my said husband fail to
qualify or eease ta act as such, then I appoint PNC Bank,
2 .��',� W
�
to act in this capacity. Neither of my personal representatives
shall be required to past band in this or any jurisdiction.
I
vI - My spouse and I have executed complementary wi11s o
this date and entered inta an Agreacnent which prohibits certai
changes to the Wills without the written consent of the peraon' s
�pouse.
21+T WITNE33 Wli8RS4F, I have heraunto set my hanci and seal o
this, the � day of September, 2pp9 .
�i !-l�o Y�J,�` �'�u!�rCI (s�)
Lois W. D. Wallaae
Signed, sea2ed, publishad and declared by LOIS W. D. WALLACE,
Testatrix, therein named, on this and three (3) other sheeta of
paper as and for her Last Will and Testament, in our presence,
who, in his preaence, at her request, and in_ the presence af eac
other, have hereunto subscribed our names as attesting witnesaes.
'�-�., � t���-- �2.�,1 ,'� � ,
Name Addres��
-�..n..2..�. � � �4a—t,�..,� C.�.-� �-C-f , ,f�/5�
Name Addrees
!C}WF1i'6z
:a1�R?SeIY
ov M.��s�«
.. Camp Hill.PA
3
i� _ . _ _ �
COMMONWEALTH OF PENNSYLVANIA)
. 55 .
COUNTY OF CUMBERLAND)
WE, the undersigned, the teatatrix and the witnesses,
reapectively, whose names are aigned to the foregoing inatru-
ment, being first duly sworn, do hereby declare to the under-
signed authority that the testatrix signed and executed the
inetrument as her Last Will and Testament and that she signe
willingly (or willingly directed another to sign for her) , an
that she executed it as her free will and voluntary act for the
purposes therein expresaed, and that each of the witr:essea, i
tne presence and hearing of the teataGrix, signed the will as
witnesses and that to the best of their knowledge the testatrix
was at that time eighteen years of age or older, of sound mind,
and under no constraint or undue influence.
/ a
,�.� � .��� bt✓r���'.�,�-
Testatrix
n
! �
� -�Lc.� �� ��'...�
Witness
,/ y��
!\_GL'Zw- /� GGGri-4�
Witness
Subscribed, sworn to and acknowledged before me by the
testatrix, and subecribed and sworn to before me by both
witnesses, this IIf�` day of September, 2009 .
w�
uTH�PENNSriVAN1A Notary Public
MouilY 8al
� ��� Yvad 8a�ah,MuWY Rih1e
Camp INI Boto�/1mbeArd CantY
. ���.�Y �Assod�tlan�101�6
:t09 Market Saeec
Camp Hill.PA
4
CODICIL
I, LOIS W.D. WALLACE, of Upper Alten Toumship, Cumberland County,
Pennsylvania, declare this to be the sole Codicil to my Last Will dated September 11, 2009.
I. I hereby revoke Paragraph V af said Will, and in lien thereof grovide as follows:
"V, I apgoint Gerald J.Brinser,Executar of this my Will. In the
event he fails to qualit`y or ceases to act as Eaecutor, I appaint Keith D.
Wagner, Eaecutor of this my Will."
II. In all other r�spects, I hereby ratify, confinna and republish tny Last Will dated
September 11, 2009, together with this sole Codicil as and for my Last Wiil.
IN WITNESS WT�REOF,I have hereunto set my hand this.��day of fl�?��fht�t,
2010.
d �;i�f�/���/'� (SEAL}
LOIS W.D. WALLACE �
5igned, published and declared on the date thereof by the abave named
LOIS W.D. WALLACE, as and for the sole Codicil to her Last Will dated Septernber 11,
2020 in the presence of us,who,at her reqnest, in r presance and in the resence af eaeh
other, have subscribed aur names hereto this �,��day oP ��t��:�1�2010.
,��'C�����•e,-r�- Residingat ���y� z•
. ����,- _.._Residing at���l(�'1(('�U i' t'' 1
�
�
-1-
COMMONWEALTH OF PENNSYLVANIA .
COUNTY OF LEBANON .
WE, LOIS W.D. WALLACE, GERALD J. BRINSER and +'S�.I(� E �����
the testatrix and the witnesses, respectively, whose names aze signed to the foregoing
insrivment, being first duly sworn, do hereby declaze to the undersigned authority that the
testatrix signed and executed the instrument as her Last Will and that she signed willingly, and
that she executed it as her free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and
that to the best of the witnesses' knowledge the testatrix was at that time eighteen (18) years of
age or older, of sound mind and under no constraint or undue influence.
�� �r.��-d2'�,�,--
LOIS .D. WALLACE
SS
�' -
Subscribed, sworn or ed d aclmowledged before me by
GERALD J. BRINSER, witness, this o�h y of ��/EY►�4,2010.
eoM�wNw ��n+ �vu+�vu+u
NOTARIAL SEAL
WENDY L.CRAWFORO,Note�y Pub�c (SEAL)
P�m�a B°ro,'�ee°�°�Ca�Y otary Public
On this, the day of ��e+u�i , 2010, before me, a Notary Public,the undersigned
officer, personally appearPd GERALD J. BRINSER, Attorney I.D. No. 09655, known to me or
satisfactorily proven to be a member of the Bar of the Supreme Court of Pennsylvania, and
certified that he was personally present when the forgoing instrument, including
acknowled ement and �davit was signed by testahix, LOIS W.D. WALLACE, and
��� �. -��'�, witness.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
eow�+avw��n+oF Pe�+rnnvnw� SEAL)
NOTARIAL SEAL Not Public. �
WENDY L.CRAYVFOR�.Notery PuWfe aT3' -
palmyra Boro.,LeDanon CouMY
Mat-
-2-
_
COMMONWEqLTHOF?ENNSVLVAWq REV-1162 EX(�1-96)
OEPARTMENT OFPEVENUE
BUREAU OF INDIVIDUAL TAXES
DEPL 280601
HARFI58URG,PA 1]128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017439
BRINSER GERALD J
6 E MAIN ST
PO BOX 323
PLAMYRA, PA 17078
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
----- �aw ---------- -------
101 � S 60,000.00
ESTATE INFORMATION: SSN: i96-22-5oii �
FILE NUMBER: 2113-01 32 I
DECEDENT NAME: WALLACE LOIS W D �
DATE OFPAYMENT: 04/12/2013 �
POSTMARK DATE: 04/11/2013 I
CouNTY: CUMBERLAND �
DATE OF DEATH: 01/21/2013 I
�
TOTAL AMOUNT PAID: 560,000.00
REMARKS: RECEIPT TO ATTY
CHECK# 8
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYEFi
_ _ __
Fe'b. 19. 2�13 1 : 12PM.. PNC Bank . . Ro. 775'f P. 1 . .
���.
February 19, 2013
Gerald Brinser
6 E Main St
P O Box 323
Palmyra; PA 17078
RE: Lois W D Wallace
SSN: 196-22-5011
DOD: Ol-2]-2013
Aeaz Mr. Brinser:
In response to your request for bate of lleath (DOD) balanccs for the customer noted above, our
records show the following:
Certificate of Deposit
Accounc#31400259109 Esrablished: 03-21-2005
LOTS W D WALLACE
DOD balance: S 13,985.57 +0.00 accruedinterest
Account#3 1 70034045 6 $stablished: 06-03-2009
�,ots w D w�,r,ACE
DOD balance: S 7,520,09+ 0.75 accnud interost
Checlting Account
Account#5140014896 Establishod: 06-01-1972
LOIS vV D WAI.-LACE
DOD balance: $ 48,088.24+0.1 S acctued interest
Saviugs Accoant
Account#5112781326 Established: 08-03-2010
LOZS W D WALLACE
DOD balance: $ 62,04534+ 3.57 accrued intorest
/l
Page 1 of 2
. Feb 19. 2013 � : 12pM PNC Bank No. 7752 P� 7 .
Please aote that this office provides date of deaLh balances for depo8it accounts(IRAs,CDs, Checking end
Savings). 'We do not ptocess any Snancisl tramactions or provide atstements. If you need assisrance with
any of these items;pleace call 1-888-PNC-BANK(1-868-762-2265)or stop by your locaJ PNC Bao1<branch
office.
Sincerely,
Narional Financial Services Center
PNC Hank; N.A.
Member FDIC
Thzs message is intended for the use of the individua!or entity to which it is addressed a»d may
contain information that is privileged, cor�dential and exempr fram dzsclosure under applicable law.
If the reader of this rnessage is not the intended recipient or the employee or agenr responsibde for
delivering this message ro the intended recip�ent, you are hereby notified that mry dissemination,
distriburion or copying ojthis communications is strictly prohtbited. Ifyou have received this
eommunication in error,pleare notJy me immedsately by reply or by telephone at 800-762-177.i and
immediately destroy this fazed document.
hage 2 of 2
L& R COINS LLC ��7
PO BOX 204
ANNVILLE,PA 17003-0204 `''� 60-12f15/313
PH:717-228-8553 � ' I� } I J DATE
o��a��c�s c�l9/, k �4 c C �s ��}T E � � l,�b y GD
.
� ��4__�� " / �_ ��u ��.....
�X` /��...a..a
. �
Jopotorn Mnk f ire�t Co.
�JonaeMn,PannqMnls 17038
MEMO �
�:03i3i2055�: 56��� 393��� 2iN 26i7
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Advisors, LLC
�.;-� w�������
Portfolio Summary
l.ois Waiiace
1/21J13
*Mark A. Brinser, CFP�
Stewardship Advisors, LLC
1013 W. Main Street, Suite 3
Mount 7ay, FA 17552
(�17) 492-4797
M Brinser@ mystewardshipadvis4r.cam
I
i
i
�
r
. The abave�nPormatlon Is 4ased on spurces belleved to be accu2[e. However,it cannot be guaranteed. It Is not to be
ronsfdered an WflcWl stakement of your accov�t wtth Cambridge. In this regartl,piease rePer M tfle conNrtnaUOn nctkes
: and clic�t statemer��ks raeived€ram Cambrkdge andlM�Indlviduai product�mr(s}. The flgurcs are net{gr�)of
� appikabte fees,charqes and expenses. They incuda(do not Inciude)reinvestmeM ot dlvidentls,dAStributlons,addltbnal
�� tontHbutlons,andJor withdraws. This portfolb summary Is NtlT a consolldakeA account statemenk,and DOES NOT rcplace
any mnBrmatlans or scatements sent to you by the respective tompanles.
•Req�sieretl Prtrrc�pai,SecurtGes oRered through Cambcidge Irtvesimertf Research,lnc.a 6roksr/Dealer,Member
FIfJRq/SIPC. Invr.stment Adviwr RepreserMaWe,Cbmbrldge Tnvestmen[Research Advisors,Inc.,a Registered Inves[ment
AdWSOr. Stewardshtp Advisors and Cambridqe are not aMllated.
Certitletl FlnanClal Plan�er 0oard of StandardSInc.oWns tAe cerdflcadon merks CFP�f,CERTIFIED FiNANQAI PtANNER*"
arni federaiiy rtv�istered CFP(wtth flame design7 in the US.,whicir ft avrards to IntlMduais who successfuity compkte tFP
- BoarG'S initlai and ongoinQ cMlflcatirn rtt�uirements.
I .___—_. __ ..... _... ... . . . .. . . . . . . . .
_ _ _ __ _ _.
Las Wallace 01/21113
Account/FundlStock Valus
Lois, Indlvidual (ACH)
Brokerege Money Market(S2,00amontn swa� 28,683.01
Global Diversified Income A-Principal Funds 71,584.21
Ishares Tr DJ Sel Div Inx 31,995.00
Ishares Tr JPMorgan USD 32,50520
Ishares Tr US Pfd Stk Idx 31,�9.50
Metropolitan West Total Retum Bond Fund CI M 94,682.35
MFS Lifetime Re6rement Income Fund A 95,591.47
Principal Investors High Yield Fund II A 101,338.14
Principal Investors Mid Cap Blend Fund CI A 33,333.33
Vanguard Bond Index Fund Inc 74,g�,g4
595,638.85
Grand Total �ggg.gg
Dividends Received 01/01/2013-01/21/2013 1,763.02
Interest Received 01/01/2013-01/21/2013 2.40
Dividends Received 01/22/2013-02/28/2013 1,628.55
Interest Received 01/22/2013-02/28/2013 2.68
��U(qEQUITi�LE STATEMENT OF ACCOUNT
.
pAYMENT FOR CONTRACT 000-0005524463 55,016 . 10
BALANCE OF FUNDS DUE 13/05/30 565 .97
INTEREST 54.43
INTEREST ALLOWANCE
AMOUNTOFCHECK *55,086 .50
E9- 00222617
DATE MAY 30 , 2013
GERALD J BRINSER
6 E MAIN STREET LOIS W D WALLACE
PO BOX 323 EMpt,6P`EFIANNUIT
PALMYRA PA 17078 _-.-_.
PLEASE DETACH BEFORE DEPOSITING CHECK
� AX/a1 �QU�T"�l.�
�M�yd;/$tarrz��rds
April 17, 2013
Geraid Brinser
222 Messiah Circle
Mechanicsburg, PA 17055
RE Contract Number: 5524463EQ0
Lois W D Wallace, Payee
Date of Death: Q2121f2013
BENEFTT INEORMATIQN �
Dear Mr. Brinser:
We extend our condalences to the family. The Contract (s) provide for the
follawing payments:
I. CONTRACT INFOkMATION
Contract # Amaunt Payable BenePiciary
------------ ---------—--- -----------
5524463EQ0 $5,016.10 Estate pf Lois W D Wallace*
* See below for payment details
II. Td CQMPLETE 5ETTLEMENT AS DESCRIBED ABOVE, PLEASE CQMPLETE THE �
FOLI,pWING:
1. The enclosed Claimant's statement(s) by the person or persons entitled
ta payment.
2. Certified Copy of the fleath certificate.
3. Fteturn of the Cpntract {s} . 7:f they cannot be located, we would accept
a statement by a beneficiary indicating this fact.
9. In ordar ta pay the amount due the Estate, we require name and address
of the Estate Representative.
5. Tf no estate is to be administered, the surviving Next of Kin rnay
complete the enclosed Payment without Administration Form.
6. Tax wiChholding form. $2, 705.87 is reportable as ordinary income i❑
the year in which it is paid.
Neill Funeral Home
February 21,2013
Gerald Brirner
6 East Main Street
Palmyra. PA 17078
RE Las Wallace
St. BenedicYs Cemetery... f125.00
Postage... ?3So
Total Amount Due: 514850
( i3
Please submit paymern to: a I2-�
Neill Funerol Home � rl�
3so1 �env Street e r•
Harrisburg, PA 171ii
Thanit You!
D1�..,�tY"
� 3501 Derry Street• Harrieburg, PA 17111 • 717-564-2633 • Fex 717-561-9918•3tephen J.Wi}abach,Sup.
3401 Market Street• Camp Hill,PA 17011 • 717-737-8726 • Faa 717-737-1859 • Kevin J. Shillabeer, Sup.
DignityMemodal.com �
_ _ ,�.,a -�r ,+�— _.
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///��� ME5SIAH �..� '� ��� � ��� ___ __ . ___, '��✓
L���� � FortnPB-07
� �
at MESSIAH VILLAGE
100 MT.ALLEN DRIVE,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE
99207 257 D 03/31/2013
RESIDENT S
GERALD J BRINSER Mrs. LOIS W.WALLACE
22 N RAILROAD STREET
P.O.BOX 323 TOTAL AMOUNT DUE $p,p0
PALMYRA, PA 1707&0323 DATE DUE 04/30/2013
$
DATE DESCRIPTION RATE ��� CHARGES CREDITS BALANCE
Balance Forward 6,877.85
03/20/2013 PAYMENT RECEIVED -THANK YOU!!! 6,877.85 0.00
03/31R013 PAYMENT RECEIVED-THANK YOU!!! 40.00 -40.00
03/20-03/21/13
03/21/2013 GUEST ROOM-APARTMENT 40.00 1.00 40.00 0.00
GIJEST ROOM 3/20-3l21/13
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE
�07 0.� �.� �.�� � �.QO 0.� $�.0�
RESIDENT NAME Mrs.LOIS W. WALLACE F0R^P��
wn
Plesae mske check payable to Messish Lifeways at Meesiah Village.
A 1%8aance charge may be aeseased on accounts for wluch payment has not been received by the due date. Thank you!
If you have any questiona or concerns about your bill,please address t6em dtrectly to FIscal Services at 790-8220. Thank You!
_ _ _ _ _ _
ALERT PHARMACY SEFtV. INC.2].9 NORTH BAI.TIMORE AV�:. MT FIOLLY SP(35, PA 17065 �
( ;. . � . � � .� ; , x � , �y , , � v�
'*. �,�'"3'�I�'TTX� FK'SR S�AZ+iaA�Br �� �A��, � � � °- ��"� t'
18/�,2/l� 5422122 ��60 ��cYRR ,��J�P�"t�;' ���. ' :,#r�i ��» , .�,i f8 �:f�
�.a/a�lxz so�zxia �so z�'� .�����+�` :�a, �, ;�� 2 � � ��t �� �� �
O1fI,�113 9Q3�146 27 8+�l�Z2'�rr�tivaet S��K3. G7� �3�3 �,9 ; . .�iY : �� ��,.'
o�tsgf�3 s���s�o i ��z� <�r�xa ' , .�� _ ° :.` ���., ! . -�, , � ��;�,
$tf18ti3 9�z21o� �'15 �MLRfiA�?��1�'1� ���, ' �'1,�; � , �<��' . ;: ���� '
aztsill3 �iraa�.o€ � ��ai+ti�s�t•��t� �� x.i� .��i �..s.s�
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: ;<"�"�'����°��, . ': �
f1�
lt�b:�4 `��
�, AMOUNT dtiE
i13:75 � + �1. 00 � + �.�5 �� �� �9'6i ��} - °; 1b;��6- ° 126.14
�bRALLRHRRMACYit�LAtE47ilYQIJt12ESAL�`GALL.A��li�ia��.��'�-�1� (
Statement Terminalopy on reverse
Total Banking Statement
� � � �a'� '
� �For24hourinfprmation,sfynontoPNC6ankOnlfneBanlong � �
on pnc.com. mary aaau(rt rtu or.51-0t�i-A896
_ Page2of6 �
. . . Lois W D Wallace �
MMnwst G�swtwy Ae+eoaiwt �ae�/
�1eoo�t.war.es s�-nool-a8ss
Ov4riatt�rat�nUew has not been estabUshed tor ihis account.
Pfease corrtact us if Yau wauk Ikke to set up tbis service. �
A+n�eAra�ft Co+r�eay�-Your account is currentlyOpt�d�Ort.
You or your ioiM awner may revoke your opt-in or opt-ou[chqice at any time. � � �7^� i Ja`�� .
Toleammona6outPNCOwrdraRSolutamvisitwoni6»atpnc.mmpveMntbalutio�». �'"� �
Cell 7-877-%b3805,visit any branch,pr Sipn on ro PNC ONirw 8ankine,and wiacttM"Ov�rdr�k
Solutions'link under the Account Ssrvic�n wction to manage both your Ovartlrah Covsrep�s�Ov�rdraft
Protection seRtings.
�i1��SIIItl111wArr .
8eyinni� oaposfts aM CMCks amf ather EnCinp�
balance MMratldithns dWUtt(ons Wlance
+1G,o8S29 2,000.81 20,392.80 27,596.75
nwraqs mromniy cnary.s
ta�a�e ana ra.s
s7,ssi.ai .00
Traiwsaotien laerMrry
ChickspNid' ChKkGrtIPOS CtreckCartflBini¢a17)
wltlMrBwala signe0 tr7insacdlons POS PIN transaetlons
s o a
7da3 AT6.i Pt�0ank OtMr 8ank ,
lwnsac4lons ATM transactlons ATM tronaldtons � - -
0 0 0
�� As of 02fi6,a total of�.�t in interert was
.MinualperceMaqe Numbsrof0ays AwmyecailMad IM�nstPaid W�thisy88r.
YMid Ean�ed{RPYE} in kManrt psr4o6 bak�forRPYE t�is ptt{cG
0.01% $0 87,991.51 .91
� �
�fll��IIMd MIMr AIti1M�w! There wene 2 Omposits ard OtMr AddkMns
ww amau�rt oasenptlon xotaHng#.iN3i.
ol/is 2,00a.ao r��«c Depo�;c-���
Pershiug SDka�x58-1Pcd
02f06 .81 Intereet Fayment
al��I4$���Okf
CMa7c Wte ReM1nnce Chock � Wte RNarr�n
numM Amoum , pak7 number number � Mwu,a peW num6er
�� ��.�,� o,,x4 � 9� jm ,��. o�,�s �
8095 4Y.00 `1 41J28 oasss�7�
•Gap in aheck ee4uemos Tt»re wero 3 ehecke Ibted totaE{ng
�.�fi.N.
� � �
ONe Batana OMe Bala�q brU BalaMe
oi/os ¢s,aes.2� ai�2s xa,�1�.44 azfga 27,ssa.�
O1f16 48,088.R9 Ol/24 Y7,787.49 02/O6 27,695.75
. �