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01-21-14
1505610143 REV-1500 EX(02-11) 1 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 13 0454 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 04 18 2013 07 26 1938 Decedent's Last Name Suffix Decedent's First Name MI ARCHIBALD JANICE P (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 0 1. Original Return 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 41.Future Interest Compromise 5. Federal Estate Tax Return Required (date ofopdeath after 12-12-82) FKI 6 Decedent Died Testate 7. (Attach MainjIned a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of will) c 9. Litigation Proceeds Received 10.b8nveeniz-3i t antlitjl)ar f Death 11,Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephor)e,Number DAVID J LENOX 71,7 271 at7 5;0 n C_ G 7 GQ RMSTER,PF Wins AOT&Y First Line of Address 7d p CD 8 TRISTAN DRIVE SUITE 3 C�. c:> ::3 c� b °n c� Second Line of Address b N rn N CJ 11* DATE FILES City or Post Office State ZIP Code DILLSBURG PA 17019 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE O PERSO PONSIBLE FOR FILING RETURN DATE �XFG Steven D.Goss A,/-9 ADDRESS 47 Main St., Felton PA 17322 SIGN PR AN REPRESEN IVE David J. Lenox /,DATE/.7 Z0 ADDRES 8 Tristan Drive,Suite 3, Dillsburg, PA Side 1 L 1505610143 1505610143 \v 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Archibald, Janice P. RECAPITULATION 1. Real Estate(Schedule A)....................................................... ............................... 1. 157 ,000 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 26, 924 . 89 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 5 ,347 . 51 7. Inter-Vivos Transfers&Miscellaneous Ioq Probate Property (Schedule G) LJ Separate Billing Requested............ 7. 80 , 776.28 8. Total Gross Assets(total Lines 1 through 7)........................................................ . 8. 270 ,048 . 68 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 30 ,321 . 58 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 13 , 659. 21 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 43 , 980 .'79 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 226, 067 . 89 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: 226, 067 . 89 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 0 . 00 (a)(1.2)X.00 15. 16. Amount of Line 14 taxable 226, 049 . 29 - 16. 10 , 172 .22 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 18 . 60 17. 2 .23 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 10 , 174 . 45 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ s Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-13-0454 Decedent's Complete Address: DECEDENT'S NAME Archibald,Janice P. STREET ADDRESS 1903 Columbia Ave. CITY STATE ZIP Carnp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 10,174.45 2. Credits/Payments A. Prior Payments 9,000.00 B. Discount 473.68 Total Credits(A +13) (2) 9,473.68 3.. Interest (3) 4. If Line 2 is greater than Line I +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 700.77 Make Check Pa able 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;...............................__..........................__.......... b, retain the right to designate who shall use the property transferred or its income;..................._............ c. retain a reversionary interest;or.............................. ........................................................................... 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 death without receiving adequate consideration?......................... .............._............. ................ .............. ❑ M 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?................................................................................................................. GO ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 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[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1502 EX+(01-10) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that Is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Property situate at 1903 Columbia Ave.,Camp Hill, PA: 157,000.00 TOTAL(Also enter on Line 1,Recapitulation) 157,000.00 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev.01-10) Rev-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2000 Honda Odyssey Mini Van: 4,900.00 2 Metro Bank Certificates of Deposit: 4,460.77 3 Metro Bank checking account: 2,129.11 4 Milton S. Hershey Medical Center(refund): 20.00 5 Misc. personal property: 750.00 6 PA Media Group(refund): 20.47 7 PSECU Account-Reference#5196434797886: 12,974.84 8 PSERS(final amount): 233.78 9 Tax refund: 916.00 10 The Hartford(insurance refund): 157.00 11 Verizon(refunds): 159.39 12 Zions Bank(refund): 203.53 TOTAL(Also enter on Line 5, Recapitulation) 26,924.89 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 EX+(01.10) SCHEDULE F pennsylvania DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Ellen K. Goss 204 E. Main St. Daughter Shiremanstown, PA 17011 B. Carol A.Crafa 431 Rosewood Lane Sister Harrisburg, PA C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S DECEDENT'S INTEREST NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. 1 A 06/0912009 Metro Bank Checking Account: 8.74 0.500% 4.37 2 A 12103/1992 PSECU Account-Reference 10,649.08 0.500% 5,324.54 #8706926309727: 3 B 02101/2000 PSECU Account-Reference 37.20 0.500% 18.60 #9139072530879: TOTAL(Also enter on Line 6, Recapitulation) 5,347.51 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) Rev-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 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. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER INCLUDE TE OF RANSER.SATTACH THEIR CO Y OF THHE RELATIONSHIP OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Ameriprise Financial Annuity 93006442644 6 004: - 11,037.07 11,037.07 (Estate of Janice P.Archibald is the beneficiary) 2 Ameriprise Financial Annuity 93006444075 1 004:- 41,420.35 41,420.35 Ellen K.Goss trust is the beneficiary) 3 Ameriprise Financial Basic Brokerage Account 28,318.86 28,318.86 00045531546 133:-TOD to the Estate of Janice P. Archibald) TOTAL(Also enter on Line 7, Recapitulation) 80,776.28 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 Decedent's debts must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 3,104.98 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Steven D. Goss Street Address 47 Main St. city Felton state PA ZiD 17322 Year(s)Commission Paid 2014 10,110.96 2. Attornev's Fees David J. Lenox 8,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 433.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 8,672.14 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 30,321.58 2 09 form software only The Lackner Group,'Inc. Form PA-1500 Schedule H Rev. 10-09) Copyright(c) 0 y SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 George's Flowers: 75.26 2 Malpezzi Funeral Home: 3,029.72 H-A 3,104.98 Other Administrative Costs 3 Cordier Auctions(advertise real estate): 1,200.00 4 Cumberland Law Journal(estate advertising): 75.00 5 John Clemmer(house painter): 1,620.00 6 Lisa Little(housecleaning): 377.00 7 Peak Construction(windows and installation): 4,090.00, 8 Penn Dot(car title): 93.00 9 R&R Tree Service: 550.00 10 Register of wills(filing fees): 30.00 11 Steven Goss(reimbursement): 240.64 12 The Carpet House(floor repairs): 300.00 13 The News Chronicle(estate advertising): 96.50 H-B7 8,672.14 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1 512 EX+(12-08) SCHEDULE I pehnsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 Report debts incurred by the decedent priorto death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I Camp Hill Borough(sewer and water): 564.86 2 Central Medical Equipment: 17.55 3 Cumberland Goodwille Ambulance: 54.19 5 HCI US Inc.(medical equipment rental): 355.97 6 Hershey Medical Center: 75.00 7 Home Instead Sr.Care(night nurse): 2,028.85 8 Janet L.Miller,Tax Collector: 8§1.02 9 Janet Miller,Tax Collector: 2,090.04 10 MSHMC Physician's Group: 20.00 I I PA American Water: 299.92 12 Penn Waste(trash): 102.69 13 PP&L Electric: 387.47 14 PSECU Loans Owed: 6,404.97 15 Special Event Emergency Services(ambulance): 25.00 16 UGI(gas bill): 118.84 17 UGI Utilities: 200.00 TOTAL(Also enter on Line 10, Recapitulation) 13,659.21 (if more space is needed,additional pages of the same'size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1 500 Schedule I(Rev. 12-08) --- - REVA 513 EX+(01-10) pennsylvania SCHEDULEJ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Archibald,Janice P. 21-13-0454 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT Do Not List Tnistee(s) (Words) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Carol A Crafa Sister 18.60 431 Rosewood Lane Harrisburg, PA 2 Ellen K.Goss Daughter Ameriprise TOD, 100,636.20 204 E. Main St.,Apt.#2 and 113 of Shiremanstown, PA 17011 residual 3 Loraine C.Goss,III Son 59,215.84 160 Old State Rd. Shermans Dale, PA 17090 4 Lillian M.Goss Great-grandchild 500.00 c/o Steven D.Goss,Jr. 47 Main St Felton, PA 17322 5 Matthew C.Goss Grandson 1,000.00 47 Main St. Felton, PA 17322 See continuation schedule attached Continuation 64,715.84 Total 226,086.48 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1 500 COVER SHEETI Copyright(c)2010 form software only The Lackner Group,Inc, Form PA-1500 Schedule J(Rev.01-10) SCHEDULEJ BENEFICIARIES (Part 1,Taxable Distributions) ESTATE OF: Janice P.Archibald 04/18/2013 160-36-5039 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Owen S.Goss Great-grandchild 500.00 cto Steven D.Goss,Jr. 47 Main St. Felton,PA 17322 7 Robert S.Goss Grandson 1,000.00 47 Main St. Felton,PA 17322 8 Steven D.Goss Son 59,215.84 47 Main St. Felton, PA 17322 9 Steven D.Goss,Jr. Grandson 1,000.00 47 Main St. Felton, PA 17322 10 Christina Kristofic Granddaughter 1,000.00 2100 N.Line St.Apt L204 Lansdale,PA 19446 11 Gavin L.Minney Great-grandchild 500.00 c/o Jennifer C. Minney 2985 Rainbow Rd. Dover,PA 17315 12 Jennifer C.Minney Granddaughter 1,000.00 2985 Rainbow Rd. Dover, PA 17315 13 Rowan P.Minney Great-granddaughter 500.00 c/o Jennifer Minney 2985 Rainbow Rd. Dover,PA 17315 Total 64,715.84 C> E3 M N) cl� Rafst Vill aub Tettameaf _'R rj i— cr, C, OF JANICE P.ARCHIBALD BE IT REMEMBERED,that 1,JANICE P.ARCHIBALD,of 1903 Columbia Avenue,Camp Hill,Cumberland County,Pennsylvania,being of sound mind,memory and understanding,do make,publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings ngs in the nature thereof by me at any time heretofore made. ITEM 1: A. I direct that my Executor shall pay all my just debts as soon after my demise as may be convenient. B. I direct that my Executor arrange for the preparation of my body by the Relief Society President of my Mormon Church,and to further arrange for my cremation in my temple clothing,and for the least expensive container for my ashes,which shall be given to my next of kin for division and/or disbursement as they deem proper. I direct that no viewing of my remains be held except if deemed necessary and then so as to be limited to my Executor and immediate family members. I have pre-arranged the disposition of my remains and I prefer no memorial service,however if a minimum memorial service is held it shall not include a viewing and shall be conducted as a Mormon service. In order to stress to my family the importance of the above burial instructions I further direct that any beneficiary of this my Last Will and Testament who violates said instructions shall thereby absolutely forfeit any and all beneficial interests ofwbatsoever kind and nature which such beneficiar✓ might otherwise have under this instrument and the interests of the other beneficiaries hereunder shall thereupon be appropriately and proportionally increased. C. Provided they survive me.I specifically bequeath to each of the following named individua!s the amount of 51.000.00: Christina Kristofic; Steven D. Goss," Jr.; Robert S.Goss: Matthew C.Goss;and Jennifer Beek MinnLy. Provided they survive me, I specifically bequeath to each of the following named individuals the amount of$500.00: Rowan Page Minney;Gavin Lloyd Minney;Lillian Marie Goss;and Owen Steven Goss. D. I give and bequeath all tangible personal property.as directed on a separate memorandum,if any,and any such property not so directed shall be divided as equally as possible among my surviving children. All"Mormon"items that are not chosen by my children shall be donated to the Camp Hill Ward Library of the Church of Jesus Christ of Latter Day Saints(LDS). ITEM 2: All the rest,residue and remainder of my estate,ofwhatsoever nature and wheresoever situate, whether it be real,personal or mixed, including property over which 1 have a power of appointment,I give,devise and bequeath unto my children as follows: A. One third(1/3)share to my son,Steven D.Goss. In the event that Steven D.Goss does not survive me,then his share shall be distributed to his issue in equal shares per stirpes; B. One third (1/3) share to my son, Lorane C. Goss, III. In the event that Lorane C. Goss,III does not survive me.then his share shall be distributed to my other surviving children, in equal shares per capita; C. One third(1/3)share to my daughter,Ellen K.Goss. In the event that Ellen K. Goss does not survive me, then her share shall be distributed to my other surviving children, in equal shares per capita. ITEM 3: A. The share of my son.Steven D.Goss,shall be distributed outright and free from any restraints of Trust. B. The share of my son,Lorane C.Goss,III,shall be distributed as follows: 1) My Executor shall distribute as soon as reasonably practical the amount of$5;000.00 to said beneficiary,the executor's judgment as to the timing of such distribution to be final and not subject to 2 review. 2) The balance of said share to be used as the premium or deposit into a commercially available non-assignable immediate fixed 10-year certain annuity to be purchased by the executor on the life of said beneficiary and to be ultimately arranged so that said beneficiary is the owner,annuitant,and payee of said annuity contract. C. The share of my daughter,Ellen K.Goss,shall be delivered to and shall be held by my Trustees,hereinafter named,IN TRUST,for the following uses and purposes: 1) The Trustee shall pay to or apply for the benefit of the beneficiary for his or her lifetime,such amounts from the principal or income, up to the whole thereof,as the Trustee,in his or her sole discretion, may from time to time deem necessary or advisable for the satisfaction of the beneficiary's special needs,and any income not distributed shall be accumulated and added to principal. As used in this Trust,"special needs" refers to the requisites for maintaining the beneficiary's good health, safety and welfare when, in the discretion of the Trustee,such requisites are not being provided by any public agent,office or department of the State of Pennsylvania, or of any other state,or of the United States. "Special needs"shall include, but not be limited to, medical and dental expenses, insurance therefor,clothing and equipment,travel;entertainment, programs of training,education and treatment and essential dietary needs. 2) This Trust is created expressly for the beneficiary's extra and supplemental care,maintenance,support and education in addition to and over and above the benefits she or he otherwise receives or may receive as a result of his or her handicap or disability from any local, state or federal government, or from any other private agencies,any of which provide services or benefits to supplement other benefits received by him or her. 3) The Trustee shall take into consideration the applicable resource and income limitations of any public assistance programs for resource and income limitations of any public assistance programs for which the beneficiary is eligible when determining whether or not to make any discretionary distributions. In carrying out the provisions of this Article, the Trustee shall be mindful of the probable future needs of the remaindermen of this Trust, and it shall. No decision of the Trustee may be questioned or challenged for the reason that the Trustee may also a remainderman under the terms of such trust,in that it is my express desire that my appointed trustee serve in that capacity, and that he is best suited to make observations and evaluate evolving circumstances so as to determine the course of action which will best carry out my intentions with respect to both the lifetime and remainder beneficiaries. 3 4) It is my further intent that no part of the corpus of the Trust created herein shall be used to supplant or replace public assistance benefits of any county,state,federal or governmental agency which serves persons with disabilities which are the same or. similar to the impairments of the beneficiary. For purposes of determining the beneficiary's eligibility for such benefits,no part of the principal or income of the Trust estate shall be considered available to him or her. In the event the Trustee is requested by any department or agency to release principal or income of the Trust to or on behalf of him or her to pay for equipment,medication or services which other organizations or agencies are authorized to provide,or in the event the Trustee is requested by any department of agency administering such benefits to petition the Court or any other administrative agency for the release of Trust principal or income for this purpose, the Trustee shall deny such request and is directed to defend,at the expense of the Trust estate,any contest or other attack or any nature of this Item. In addition, the Trustee may apply to a Court of competent jurisdiction for authority to amend the Trust to carry out my intent. I specifically recognize and request that any such Court modify this Trust Agreement as necessary to insure that my directions for the care of the beneficiary are followed and that this Trust is not considered an asset so as to disqualify the beneficiary from federal and state assistance. 5) No interest in the principal or income of this Trust shall be anticipated, assigned or encumbered. or shall be subject to any creditor's claim or to legal process,prior to its actual receipt by the beneficiary. Furthermore,I declare that it is my intent as expressed herein,that because this Trust is to be conserved and maintained primarily for the special needs of the beneficiary, no part of the corpus thereof, nor principal nor undistributed income, shall be subject to the claims of voluntary or involuntary creditors for the provision of care and services, including residential care, by any public entity, office, department or agency of the State of Pennsylvania or of any other state,or of the United States,or any other governmental agency. 6) Upon the death of the beneficiary,the Trustee may pay the expenses of'the last illness and funeral, and all administrative expenses relating to this Trust and the beneficiary's estate, including reasonable attorney's and accountant's fees,if,in the Trustee's sole discretion,other satisfactory provisions have not been made for the payment of such expenses. 7) This Trust shall cease and terminate on the death of the beneficiary and thereupon the Trustee shall distribute the balance of the trust estate, after expenses, in equal shares to my other surviving children. 4 l ITEM 4: I direct my hereinafter named Executor to pay all inheritance,estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate,it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate,under the provisions of any state or federal law now in force or hereafter enacted,shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my son,STEVEN D.GOSS,as Executor of this my Last Will and Testament. Should my son predecease me, fail to qualify, cease to act or renounce probate,I then appoint DAVID J.LENOX,ESQUIRE,as Contingent Executor of this my Last Will and Testament. ITEM 6: . I appoint STEVEN D.GOSS,as Trustee of the Trust established hereby for the benefit of Ellen K.Goss. Should STEVEN D.GOSS,fail to qualify,cease to act, or renounce this appointment as Trustee, I then appoint, CHRISTINA KRISTOFIC as Contingent-Trustee of said Trust. If any income or principal shall be payable hereunder or pursuant to a beneficiary designation in any insurance contract, annuity contract or qualified retirement plan,or any like third party contract,to any person who shall be incompetent to receive the same by reason of age or incapacity,I appoint I appoint my herein named Trustee as custodian over such property for the benefit of said beneficiary and hereby direct my executor or any insurer,or plan administrator to deliver such property to said custodian. I further nominate said Trustee as the representative payee for Ellen K. Goss, if such a role needs to be filled after my death,for the benefit of Ellen K.Goss. ITEM 7: I direct that my Executor,Trustee or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 5 ITEM 8: My Personal Representatives shall have the following powers in addition to those vested in them by Law and by other provisions of this,my Last Will and Testament; exercisable without court approval, and effective until distribution of all property: A. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries,as they from time to time may deem proper, without regard to any principal of diversification or risk. B. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as they from time to time may deem proper,without regard to any principal of diversification or risk. C. To sell at public or private sale,to exchange,or to lease for any period of time,any real or personal property and to give options for sales,exchanges or leases,for such prices and upon such terms or conditions as they from time to time may deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time may deem proper. E. To borrow money from persons or institutions,themselves included,and to mortgage or pledge any or all real or personal property as they in their sole discretion shall choose,without regard to the dispositive provisions of. this instrument. F. To compromise any claim or controversy asserted by or against my estate or Trust estate. G. To make distribution in cash or in kind or partly in cash and partly in kind, and in such manner as they may determine,and at valuations finally to be fixed by them. ITEM 9: Finally, I wish to advise my Executor that the health insurance coverage currently maintained for the benefit of my daughter,Ellen K.Goss, through and under my Highmark benefit plan will continue to be available to provide health insurance for her after my death conditioned on the company receiving notice within 30 days of the date of my death, and the payment of continued premium. Please review my personal papers for literature regarding Highmark benefits and contact phone numbers and addresses. 6 IN WITNESS WHEREOF,I have hereunto set my hand and seal this 4"day of June, 2012. 'ES e (SEAL) ANICE P.ARCHIBALD 7 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We,JANICE P.ARCHIBALD,DAVID J.LENOX,ESQUIRE and M.SUSAN McMICHAEL,the Testatrix and the witnesses respectively,whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly(or willingly directed another to sign for her), 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 this Last Will and Testament as witness and that to the best of their knowledge the Testatrix was at the time eighteen(18)years of age or older,of sound mind and under no constraint or undue influence. J E P.ARCHIBALD WITNE WITNESS Sworn to and subscribed before me this 4'b day of June.2012. NOTARY PUBLIC MY COMMISSION EXPIRES: COMMONWEALTH OF PENNSYLVANIA Notarial Seal S.Dawn Glatlfefter,Notary public Dlllsburg 8om.York County Commission Expires May 17,2013 Emmy ber,Pennsylvania AssoclaVon of NotarleS 8 y DO REV-485 EX(05-04) ^ i` b py� 1 SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY . Certificate•ficate Num ier Date Death County ' Decedent's Last Name / Suffix First Name MI ADDRESS OF DECEDENT STREET. [[ �� CITY: ` / STATE ZIP CODE: NAME AND ADDRESS OF ERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT B X NAME: �GC V t 3 , _ e.✓LU STREETADDRESS: CITY: ) ATE: ZIP CODE: -w, c J— e �S JU NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX 0 ENING ` a. NAME: RELATIONSHIP: S+e 0 e"'1 605-5 1F-,o C_ SU)4 STREET E: ZIP CODE: 10 Mat; St . "/pan DDRESS: SJf f'H- b. NAME: RELATIONSHIP: j olgj4 e 6©s-s Sc STREETADDRESS: t CY IITY:— SRTE: ZIP CODE: n g DaA1 1 0r & 6. c. NAME: RELATIONSHIP: STREETADDRESS: CITY: STATE: ZIP CODE: i I NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: I/1il e�\J o &, tC STREETADDRESS: CITY: S ATE: ZIP CODE: NAME OF PERSON MAKIN ST ENTRY . ( DATE D ME OF LAST ENTRY � DATE F CON CT TO RENT BOX NUMBER OF BOX 1 TITLE UNDER IC OX IS'-EQUE TED NAM9 AND AADPESS OF PERSON(S)HAVING ACCESS TO BOX a. NAME: b. NAME: O,j o � 0-1/k (� r•:c eu s e ` STREETADDRESS: T— STREETADDRESS: CITY: STATE: ZIP CODE: CITY. STATE: ZIP CODE: I 1111 NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY WAS A WILL IN THE BOX? ❑ YES, NO If yes, a.Date of will: b. Name and address of personal representative,if named In the will NAME: STREETADDRESS: CITY: STATE: ZIP CODE: c. Name and address of attorney,If any i NAME: ; STREETADDRESS: CITY: STATE: ZIP CODE: 48500041046 48500041046 J -1-5— REV-485 EX SAFE DEPOSIT BOX INVENTORY Page Of INSTRUCTIONS (1) Cash:Report total only. (2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government:Number of items,date of issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book,name of bank and branch,and balance. (6) Jewelry,Coins,Stamps,Manuscripts,etc:List and describe as fully as possible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of Indebtedness:List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280601 HARRISBURG,PA 17128-0601 ITEM ITEM DESCRIPTION NO. tA)t t I tif rz� / 7. "J e-r 6 440 J, 0 ir F<- 6055 A L>T 5'Z 0A, 51 0c 5 ir� dyt—ta Re C-ei I :11 N- 6ei, !�+ T T/ It 4 4� Qo. 14 bi, t'Q1 IzA e CC A> M-11/'ta x 4e 7 k\,,^ �� rlr t Po- P 10(rr-1.ce:t -q'S e(.•t J I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT A COMPLE E TO THE BEST OF MY KNOWLEDGE AND BELIEF, SAFE DEPOSIT BOX INVENTORY: MRE ---7"' SIG 54 NATURE e-V k_- --i 60�5 zale�— PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW: $Executor(trix) []Administrator(trix) F1 Estate Representative ❑Joint owner of safe deposit box PRINT TITLE DATE CHECK APPROPRIATE BOX: Affo,'O'c - NOTE:Attach additional$112"x 11"sheet(s)if necessary or use duplicates of this page of form. The Department is authorized by law;42 U.S.C,§405(c)(2)(C)@,to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the informaton in exchange of tax information agreements with Federal and local taxing authorities.The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. 1903 Columbia Ave,Camp Hill,PA 17011 is For Sale-Zillow http://www.zillow.com/homes/1903-Columbia-Avenue,-Camp-Hill,-... Get more information 1903 Columbia Ave, Camp Hill, PA 17011 Eric Hoffer (25) Photos Map Bird's Eye Street View ii _ 27_Recent sales For Sale:$170,000 (717)884-9918 Zestimate":$165,381 - Est.Mortgage:$671/mr See current rates on Zillow A Bad Credit Score is 598.See Yours for$1 t I t. Bedrooms: 3 beds N x� ® ■Ii .� Csil� r Bathrooms: 2 baths I I am interested in 1903 Columbia Ave,Camp ■■■ Hill,PA 17011. Single Family: 1,204 sq ft VIA ■■■ - Lot: 8,276 sgft ------�.. ,*'""'�v `__ - r^` ,aY* ❑1 want to get pre-approved. Year Built: 1977 w t�Fw+ -. Last Sold: Dec 1986 for$68,000 "'', wxX�� `a J c e Heating Type: Forced air Learn how to appear as the agent above View virtual tour Get more info I Save this home Get updates Email r I more- I Report Listing i Description r Charming and move in ready Camp Hill borough cape codl Two blocks to sports fields,short walk to schools. First floor full bath.Updated kitchen open to a large family room with fireplace.Hardwood floors in every room. 3 season addition.Large fenced side yard,partially finished lower level with recently updated full bath.Freshly painted throughout All new windows,recent furnace and central air.Custom built storage... More Days on Zillow Cooling Parking Similar Homes for Sale i 9 Central,Other Garage-Attached _ _ _ 213 S 17th St,Camp Hill... j Basement Type Fireplace Floor Covering LI m.•;1 Unknown Unknown Unknown i i For Sale:$199,900 Beds:3 Sgft:1536 More County website See data sources Baths:2.5 Lot:6,098 Zestimates W 100 S 15th St.Camp Hill... For Sale:$147,900 Value Ra a 30-day change $/sgft Last updated Beds:2 Sgft:1377 Zestimate _ $165,381 $157K- 174K— $125 —$137 -01/14/2014 ; Baths:1.0 Lot:7,840 Rent Zestimate $1,205 1mo _$1.3K/mo +$25 $1.00 01/13/2014 L all -� 46 S 18th St.Camp Hill,... Owner tools Post your own estimate For Sale:$239,900 ` Market guide Zillow predicts 17011 home values will increase 1.6%next year,compared to a 1.6% — Beds:6 Sqft:2400 increase for Camp Hill as a whole.Among 17011... Baths:3.0 Lot:7,405 ` more See listings near 1903 Columbia Ave I Zestimate Listing price;Rent Zestimate; more 1 year 15 years 10 years �a. J 111L! nt 2 of 3 1/16/2014 9:18 AM 1903 Columbia Ave,Camp Hill,PA 17011 is For Sale-Zillow http://www.zillow.com/homes/1903-Columbia-Avenue,-Camp-Hill,-... Nearby Cities Nearby Zip Codes Other Camp Hill Topics Homes For Sale in Carlisle Homes For Sale in 17011 Apartments for Rent in 17011 Homes For Sale In East Homes For Sale in 17240 Houses for Sale in 17011 Pennsboro Homes For Sale in 17257 Houses for Rent In 17011 Homes For Sale in Hampden 17011 Real Estate Township Camp Hill Condos Homes For Sale in Lower Allen Houses for Sale in Camp Hill Township Newest Listings in Camp Hill Homes For Sale in Camp Hill Home Values Mechanicsburg Camp Hill Real Estate Agents Homes For Sale in North Camp Hill Refinance Middleton Camp Hill Mortgage Rates Homes For Sale in Shippensburg Township Homes For Sale in Silver Spring Township - Homes For Sale in South Middleton Homes For Sale in Upper Allen Homes For Sale in Bloserville Homes For Sale in Defense Depot Homes For Sale in Hampden Station Homes For Sale in Hampden Township Homes For Sale in Hampden Homes For Sale In Little Wash Homes For Sale in Navy Ships Homes For Sale in Navy Sup Opt Homes For Sale in Rudytown Homes For Sale in South Enola 1903 Columbia Ave,Camp Hill,PA,17011 is a single family home of 1,204 sgft on a lot of 8,276 sgft(or 0.19 acres).Zillow's Zestimate®for 1903 Columbia Ave is$165,381 and the Rent Zestimate®Is $1,205/mo.This single family home has 3 bedrooms,2 baths,and was built in 1977.The 3 bed single family home at 213 S 17th St in Camp Hill is comparable and for sale for$199,900.This home is located in Camp Hill in zip code 17011.The closest ZIP codes are 17257 and 17240.Bloserville,Defense Depot,and Hampden Station are the nearest cities. ._.... ......__........ ...._ ..... ......._..... ................._.. ......,........ .. ......... ... ......... ... . .......... . .......... ._............. ............................... ... ............ ........._...... ...._......,..... .........._............... About Zestimates Jobs Help Advertise Terms of Use&Privacy Policy Blog Mobile Yahoo!-Zillow Real Estate Network ©2006-2014 Zillow Follow us V f p+ 3 of 3 1/16/2014 9:18 AM METRO 3801 Paxton Street 888.937.0004 BANK Harrisburg, PA 17111 my t oba k.com July 3 2013 To Whom It May Concern: This letter is being written to give date of death values and accumulated interest for accounts with Metro Bank for the Estate of Janice P.Archibald. As of April 18th 2013 Janice Archibald had two checking accounts and two CDs with Metro Bank. Her individual checking account had a balance of$2,128.02 with accrued interest of$1.09; this account was opened January 12, 2009.The second checking account was a joint account,the balance was$8.69 with accrued interest of$0.05;this account was opened June 9, 2009. As of April 18th 2013 Janice Archibald had two CDs with Metro Bank.The first CD was individually owned,the balance was$2,208.88 with accrued interest of$10.84; and this CD was opened August 4, 2009.The second CD was individually owned,the balance was$2,229.21 with accrued interest of $11.84; and this CD was opened August 4, 2009. Thank You, r Angelique Waters Customer Service Representative Metro Bank-Camp Hill Mall 717-920-5740 2013-04-30 11 :44 Ameriprise Financial 7177613686 >> 72717178 P 1/4 Ameriprise Financial West Shore Office Center Ameriprise 214 Senate Avenue, Ste. 604 Financial Camp Hill, Pa 17011 Phone: 717-761-3300 Fax: 717-761-3686 Fax To: Dave Lennox From: Susan H. Fulginiti,CFP®,CFS,CRPC® Fax: 717-271-7178 Phone: Date: 04/30/2013 Pages: 3 ❑ Urgent ❑ Per Your Request ❑ For Review ❑ Please Reply Comments: Dave, Per our phone conversation, I have attached DOD valuations for Janice Archibald's estate. As well, there are current valuations of her 3 accounts. Please let me know if you need anything else. Susan This communication and all attachments are confidential and may be legally privileged.If you are not the intended recipient, (i)please do not read or disclose any content to others,(ii)please notify the sender by reply(e-mail or fax)immediately,and (iii)please destroy this document.Failure to follow this process may be unlawful and subject to prosecution.Thank you for your cooperation. 2013-04-30 11 :45 Ameriprise Financial 7177613686 >> 72717178 P 2/4 Fulginiti, Susan H From: Kharatmal,Anilkumar I on behalf of SDLifeEventsCommunicationCenter Sent: Friday,April 26,2013 6:16 PM To: Fulginiti;Susan H Subject: 16196212 1 001 JANICE P ARCHIBALD- DEATH SETTLEMENT REQUIREMENTS PLS DO NOT DELETE- DODV TO BE SENT SEPARATELY. RiverSource Life Insurance Company Ameriprise Financial Company 70100 Ameriprise Financial Center Minneapolis,MN 55474 April 26,2013 SUSAN HORNER FULGINITI 214 SENATE AVE STE 604 CAMP HILL,PA 17011-2382 16196212 1 001 Dear SUSAN HORNER FULGINITI: We have received notification of JANICE P ARCHIBALD's death. The deceased's name appears on the following accounts. Account values as of 04/18/2013 are listed below. At the end of this letter,you will find a list of beneficiaries shown in our initial review of the accounts Account Information Annuities-Post 1985 Account Number Ownership 93006442644 6 004 Individual 93006444075 1 004 Individual Basic Brokerage with ONE Account Number Ownership 00045531546 5 133 Individual-TOD Annuities-Post 1985 Account Number Total Value 93006442644 6 004 $11,037.07 930064440751004 $41,420.35 Basic Brokerage with ONE Account Number Total Value 1 2013-04-30 11 :45 Ameriprise Financial 7177613686 >> 72717178 P 3/4 00045531546 5 I 33 $28,318.86 Aeat Name An*6Vise ONE FiaartciW Aecawt.JMrr:P ARCHMALG TOD A=t Na.,00045531546 133 AzaTYPrJ4on-CusV�d A55ONAme Tieker. ,.q Broad ," Y_p�:#lanrt. x; 1blauifity Pnaej t;,W.1!!�.l31 GASH .. CASH EGUNALt7ST5 W&M tAO 50080. . COL13bk81AIHCDWtBSUi[DMCLA ABBAX BALANCED COLUMBIA 491.49 11.00 5.70!.37 RMS COLUWAIHTSUCa AYSBOND MAX E�EDIAT COLUUM" 2.321.90 440 73.1st178 CLA A=VM 7otat 578.31886 The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance products with the insured deceased reflect the gross death benefit at date of death and not the cash value. Values indicated for Life Insurance products with only. the owner deceased reflect the cash value as of the date of death. Values for any proprietary mutual funds include accrued dividends as applicable.Values provided for brokerage products are manually calculated,and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be verified by your legal and accounting advisors. 2013-04-30 11 :46 Ameriprise Financial 7177613686 >> 72717178 P 4/4 4-1 AW M n a . r CO CC CL ri Cd cq � 4 N ml! 3 " a 0 LL m V �` ^ 0 I U i to S O CL 0 w w w m e 3•' Q ggC C.'Q Q OJ a m it ! � m j rc o N ? c E . w m b W a oiio s g o ' 0 It O 8 '� J E O X a eg : ZQ; W a o V plOV, WO >0 t 2 g o� ) t- ++ 0 w o y o z t Vi ao� ;, Page 1 of 1 Client Viewer �.mi����ri AdvisorCompass o Financial Selected Client: MS JANICE P ARCHIBALD Client ID: 1619 6212 1 001 _... . .... .... is page Client Beneficiaries By Plan Plan Type No,n Qualified ccount Designation _ Request Spelling Correction �F' IXED RET ANN VP JANICE P ARCHIBALD PRIMARY BENEFICIARY 0000 0930 0644 2644 6 004 ESTATE OF MS JANICE P ARCHIBALD 100.00% ccount Designation Request Spelling Correction RET ADV V ANN NQ JANICE P ARCHIBALD HE TESTAMENTARY TRUST FOR ELLEN K GOSS,CAROL A 0000 0930 0644 4075 1 004 CRAFA,TRUSTEE,AS DEFINED IN THE LAST WILL AND TESTAMENT OF JANICE P RCHIBALD. Account Designation Request Spelling Correction MERIPRISE ONE ACCT JANICE P ARCHIBALD TOD PRIMARY BENEFICIARY 0000 0000 4553 1546 5 133 ESTATE OF MS JANICE P ARCHIBALD 100.00% Notes: . Information for Annuities held in accounts on the Ameriprise Brokerage Platform is not included. For Beneficiary Information refer to the Account Profile pages or the carrier. FOR INTERNAL USE ONLY. NOT FOR USE WITH CLIENTS UNLESS DISCLOSURE IS PROVIDED. View Corporate Entities and Important Disclosures,Web Site Rules and Regulations, Privacy&Security Center and About E-mail Fraud. Copyright©2009-2010 Ameriprise Financial.All Rights Reserved.Users of this site agree to be bound by the terms of the Ameriprise Web Site Rules and Regulations. https://wwwg.ex.is.ameriprise.com/ost/secure/clientibeneficiaries.asp?binlsInFrame=true 4/19/2013 PSECO 05/10/2013 David J.Lenox Attornev at Law 8 Tristan Drive, Suite 3 Dillsburg,PA 17019 Re:JANICE P ARCHIBALD,Deceased. PSECU Reference#5196434797886 Dear Attorney Lenox: The above referenced person has an account with PSECU which was opened on November 15, 1978. The Share accounts were individually held by JANICE P ARCHIBALD.The PSL(Personal Service Loan),Visa and Real Estate Equity loans were individually held. The following are the Date of Death Balances for JANICE P ARCHIBALD's account with PSECU: Account Date of Death Balances Interest—April 1-18 Shares: (S1)Savings $818.38 $0.06 (S2)Vacation $155.17 $0.01 (S3)Christmas $150.08 $0.01 (S4)Money Handler $1,689.20 $0.10 (S7)Money Market $162.01 $0.00 (S5O)Certificate $2000.00 $1.17 (S51)Certificate $4000.00 $2.74 (S52)Certificate $2000.00 $2.15 (S53)Certificate $2000.00 $1.77 oans: �1 (L I)PSL $293.28 (11 Visa $0.00 ` (S52)Real Estate Equity $6,111.69 The account has been closed. If you have any questions,please contact me at(717)234-8484 or toll-free at(800)237-7328,press 6, extension 3120. Sincerely, SFa 1� U Y Y Member Service Representative PSECU Pennsylvania State Employees Credit Union 1 Credit Union Place, P.O. Box 67013, Harrisburg, PA 17106-7013 • 800.237.7328 • >>psecu.com THIS CREDIT UNION IS FEDERALLY INSURED BYTHE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER. PSECO 05/10/2013 David J. Lenox Attorney at Law 8 Tristan Drive, Suite 3 Dillsburg, PA 17019 Re: Janice Archibald, Deceased: PSECU Reference#8706926309727 Dear Attorney Lenox: The above referenced person was added as a joint owner on December 3, 1992 on the above 'referenced account with PSECU. The primary owner is Ellen K. Goss. All share accounts are held jointly by Ellen K. Gross and Janice Archibald. The following are the April 18, 2013 Date of Death Balances for ELLEN K GOSS's account with PSECU: Account Date of Death Balances Interest—April 1-18 Shares: (S1) Savings $22.00 $0.00 (S2)Vacation $120.47 $0.01 (S4)Checking $519.45 $0.02 (S7)Money Market $182.39 $0.00 (S50)Certificate $2,241.97 $3.27 (S51) Certificate $2,221.32 $2.98 (S52) Certificate $2,185.75 $1.28 (S53)Certificate $2,152.28 $1.37 (S54) Certificate $1,003.45 $0.20 If you have any questions, please contact me at (717)234-8484 or toll-free at(800) 237- 7328,press 6, extension 3120. Sincerely, S�t3 �Fley Member Service Representative {} PSECU Pennsylvania State Employees Credit Union 1 Credit Union Place,P.O. Box 67013, Harrisburg, PA 17106-7013 •800.237.7328 • >>psecu.com THIS CREDIT UNION IS FEDERALLY INSURED BYTHE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER. PSECO 05/10/2013 David J. Lenox Attorney at Law 8 Tristan Drive, Suite 3 Dillsburg,PA 17019 Re: Janice Archibald,Deceased: PSECU Reference#9139072530879 Dear Attorney Lenox: The above referenced person was a joint owner on the above referenced account PSECU which was opened on February 1, 2000. The Share accounts were jointly held by Carol A. Crafa and Janice Archibald. The following are the April 18, 2013Date of Death Balances for CAROL A CRAFA's account with PSECU: Account Date of Death Balances Interest—April 1-18 Shares: (S1) Savings $5.00 $0.00 (S4) Checking $31.76 $0.0T (S5) Summer Pay $0.44 $0.00 If you have any questions,please contact me at(717) 234-8484 or toll-free at(800)237- 7328,press 6, extension 3120. Sincerely, �. Sand F ' ley Y g Member Service Representative PSECU Pennsylvania State Employees Credit Union 1 Credit Union Place, P.O. Box 67013, Harrisburg, PA 17106-7013 • 800.237.7328 • >>psecu.com THIS CREDIT UNION IS FEDERALLY INSURED BYTHE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER.