HomeMy WebLinkAbout01-06-14 (2) _ _ ___,�. , __ --_ :___�___. _
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. � ,
� � 1505610140
REV-1500 �` �°,_,°,
PA Department of Revenue
Bureau of individual Taxes �NHERITANCE TAX RETURN County Code Year File Number
Po Box Zs�o� 2 1 1 3 1 1 0 4
Harrisbu ,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
Suffix DecedenYs First Name M�
T R O U T O N A R L E N E �
(If Applicable)Eriter Surviving Spouse's InfoRnation Below
Spouse's Last Name Suffix Spouse's First Name Mt
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF W1LLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum � 2.Supplemental Retum � 3.Remainder Retum(date of death
prior to 12-13-82)
� 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federat Estate Tax Retum Required �
death aRer 12-12-82)
QX 6.Deoedent Died Testate � 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of�II) (Attach Copy of Trust)
� 9.Litigation Prooeeds Received � 10.Spousal Poverty Credit(date of death � 11.Election to tax under Sec.91't3(A)
befinreen 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONDEN'F-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE-.DIRFFjFD T0:
Name Daytime Telephone ,I�nber ,`;.�,'
� �
R . MA RK T HOMAS 7 1 7 7 9��°►2 1- 0 � �
i� `� � "` �
�
REGI3TER OF $�"p�,Y -� �l
� � �E7 � � �i►
First line of address '' �
� � `e� „�.�,�„�, "�'! '"'�
1 01 S . MARKET STREE � � � :� -�-
Second tine of address
� � � � rn
� C!`t f�'� C�
CJ3 "�
Ciry or Post Offic:e State ZIP Code DATE FILED
MEC HA NI CS BU RG �- � PA 1 7 0 5 5
Comespondent's e-mail address: RMARKTHOMAS .GMAIL.COM
Under penalties of perjury,1 dedare that 1 have examined this�+etum,induding a000rnpanying schedules and statements,and to the best of my knowledge�d belief.
it is true.�o�d a�d oornplete•Declaration of other than the personal representative is based on all information of which pneparer has arry krwwledge.
RTC1R'!�'9 ERSON RESP OR FILING RN DA � /
AD ESS � �3 !''1
838 OAK OVAL . MECHANICSBURG � PA 17055
SIG F ARE THAN REPRESENTATNE DA
ADD
/ �3 .'�O/�
101 S. MARKET STREET ME�HANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
� , 1505610140 1505610140 �
�
� 1505610240
REV-1500 EX
Decedent's Social Security Number
� oeoedern'g Name: ARLENE L. TROUTON
RECAPITULATtON
1. Real Estate(Schedule A) ..................... ..... ... .............. 1. •
2. stodcs and Bonds(sct�edu�e g> ................. .... .... .........'.... 2. 9 5 0 1 1 5 . 6 9
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. •
4. Mortgages and Notes Receivable(Schedule D) ............. ............. 4. •
5. Cash,Bank De sits and Miscellaneous Personal Pro � 4 4 4 9 7 . � 2
Po PertY(Schedule E ....... 5.
6. Jointly Ownect Property(Schedule F) ❑ Separate Billing Requested ..... .. 6. •
7. Inter-V'rvos Transfers�Miscellaneous N -Probate Property
(Schedu�e G) � Separate Billing Requested . ..... . 7. 2 3 9 1 5 4 , 5 7
8. Total Gross Assets(total Lines 1 through 7) ... ....... .... .......... . s. 1 2 3 3 7 6 7 , 2 8
9. Funeral Expenses and Administrative Costs(Schedule H) ... .. ............. 9• 2 5 7 2 4 . 3 9
10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 1 p. � 2 6 � . 4 �
9 9 ( ) ........... ..
11. Total Deductions(total Lines 9 and 10) . .......... .................... 11. Z C g H 4 . $ �
12. Net Valus of Estate(Line 8 minus Line 11) ............ .... ........ .... 12. � 2 0 6 7 8 2 . 4 8
13. Charitable and Govemmental 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. � 2 � 6 ? 8 2 . Q� 8
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X•0 � . � � 15. Q . Q Q
16. Amount of�ine 14 taxable
at lineal rate X•045 1 2 0 6 7 8 2 . 4 8 �s. 5 4 3 0 5 . 2 1
17. Amount of Line 14 taxable
at sibling rate X.12 0 • � � 17. 0 . 0 �
18. Amount of Line 14 taxable
at callateral rate X.15 � • � � 1 g. � . � �
19. TAX DUE ................................. ...... .. ............. 19. rJ 4 3 0 5 . 2 1
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610240 1505610240 J
REV 1500 EX Page 3 Fils Number
� 21 13 1104
Decedent's Complete Address:
DECEDENTS NAN�
ARLENE L.TROUTON
STREET ADDRESS
CITI( STATE ZIP
Tax Payments and Credits:
�• Tax Due(Page 2,line 19) (1) 54,305.21
2. Cr�editslPayrrients
A.Prior Payments 51,582.75
B.Discount 2,714.80
Total Credits(A+B} (2) 54,297.55
3. Interest
(3)
4. if Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fil1 in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 7.66
Make check payable to: REGISTER OF WILLS, AGENT
_ _ _ _
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS
1. Did devedent make a transfer and: Yes No
a. retain the use or inc�ome of the ProPertY transferred: ...................................................................... ❑ �
b. retain�he right to designate who shall use the property transferred or its income; ........,...................... ❑ �
c. ret�n a reversionary interest;or ................................................................................................ ❑ �
d. reoeive the promise for life of either payments,benefits or care? ....................................................... ❑ �
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ 0
3. Did dec�dent own an"in trust fa'or payable-upon-death bank account or security at his or her death? ......... ❑ 0
4. Did decedent own an individual retir�ment ac�ount,annuity or other na�-probate property,which
c�ontains a benefiaary designation?.................................................................................................. � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse i;
3 peroent[72 P.S.§9116(a)(1.1)(i)).
For dat�s of death on or after Jan.1,1995,the tax rate imposed on the net value of trartsfers to or for the use of the sunriving spouse is 0 percent
[72 P.S.§9t16(a)(1.1)(ii)].The sta�te doe.s not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disdosu�e of assets and
filing a tax retum 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 dec�ased 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 decedenYs lineal benefiaaries is 4.5 peroent,except as noted in
72 P.S.§9116(1.2)[72 P.S.§91t6(a)(1}].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's sibliRgs is 12 peroent[72 P.S.§9116(a)(1.3)].A sibling is defined,under
Secfion 9102,as an individual who has at least one parent in common with the dec�dent,whether by blood or adoption.
� REV-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ARLENE L. TROUTON 21 13 1104
Ail property jointty owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. WELLS FARGO-DOD-ACCOUNT#8415-1875 683,505.47
ACCRUED INTEREST AND DIV INCLUDED(909.15)
2. EDWARD JONES-ESTATE VALUATION-ACCOUNT#851-17683 266,610.22
ACCRUED INTEREST AND DIV-INCLUDED(357.85)
TOTAL(Also enter on Line 2,Recapitulation) s 950115.69
If more space is needed,insert additional sheets of the same size
� REV-1508 EX+(0&12)
pennsylvania SCHEDULE E
DEPARTMENTOF REVENUE CASH, BANK DEPOSITS � MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ARLENE L. TROUTON 21 13 1104
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SANTANDER BANK 37,610.44
CHECKING ACCOUNT# 1681714914
ACCRUED INTEREST INCLUDED(.12)
2. REFUND FROM MYERS FUNERAL 100.00
3. CNA LONG TERM CARE CHECK 6,786.58
TOTAL(Also enter on Line 5,Recapitulation) s 44 497.02
If more space is needed,use additional sheets of paper of the same size.
.
REV-1510 EX+(OS-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REYENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC, NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ARLENE L. TROUTON 21 13 1104
This schedule must be completed and filed if the answer to any of questions 1 tl�rough 4 on page three of the REV-1500 is yes.
DESCRIPTlON OF PROPERTY
ITEM ����ryq�pF�J�q�REE,TH�R RaAT10NSHiP TO DECEDENT AND DATE OF DEATH °�6 OF DECD'S EXCLUSION TAXABLE
Nt1MBER THE DATE OF 7RANSFER.AITACFi A COPY OF TIiE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST nF�wruc� VALUE
1. PRUDENTIAL ANNUITIES ACCT#94509054 98,856.21 100.00 98,856.21
THOMAS TROUTON-SON-50%
SANDRA STILZ-DAUGHTER-50%
2. iNG USA ANNUITY-GOLDEN AM. LIFE INS/ANNUITY 117,357.03 100.00 117,357.03
Thomas Trouton-son,-50%Sandra Stilz-daughter-50%
ACCT#1�01157-0X
3. SANTANDER BANK 9,357.12 100.00 9,357.12
IRA CD 7676176158
ACCRUED INTEREST INCLUDED(2.31 )
4. SANTANDER BANK 13,584.21 100.00 � 13,584.21
I RA CD 1688181633
ACCRUED INTEREST INCLUDED(3.98}
TOTAL Also enter on Line 7,Recapitula6on) S 239154.57
If more space is needed,use additional sheels of paper of the same size.
.
REV 15tti EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ARLENE L. TROUTON 21 13 1104
Deceder�s debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERI�L EXPENSES:
1. MYERS BUHRIG FUNERAL HOME 4,181.84
2. FUNERAL MEAL AND EXPEWSES 672.91
3.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personai Repr�esentative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attomey Fees: 19,893.00
3, Family Exemption:(If decedenCs address is not the same as daimanCs,attach explanation.)
Claimant
Street Add�ess
Cit�r State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 768.50
5 Acxountant Fees:
6. Tan Retum Preparer Fees:
7. SANTANDER RECORDS FEE 20.00
8. COPY PAPER, INK-ADMINISTRATIVE EXPENSES-CVS 38.14
9. EDWARD JONES-BROKERAGE FEE 150.00
TOTAL(Also enter on Une 9,Recapitulatia�) S 25 724.39
If more spaoe is needed,use additior►al shceis of paper of fhe same size.
• REV 1512 EX+(12-12)
pennsylvania SCHEDULE 1
°EP"R"`"E"T oF R�""E DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILiTIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ARLENE L. TROUTON 21 13 1104
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses,
ITEM VALUE AT DATE
NUMBER DESCRtPTION OF DEATH
1. WEST SHORE EMS BILL FOR 10/3 TRANSPORT 157.63
2. FINAL PAYMENT-BRIDGES-Cleared- 10/10/2013 ck 2310 - ggg 78
3. ck 2311 Cleared- 10/16/13 Alert Pharmacy 104.00
TOTAL(Also enter on Une 10,Recapitula�on) S 1 260.41
If more spaoe is needecf,insert addfional sheets of the same size.
REV-1513�X+(01-10)
�
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
tNHEWTANCE TAX RETURN
RESiDENT DECEDENT
ESTATE OF: FILE NUMBER:
ARLENE L. TROUTON 21 13 1104
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [Indudeou�ht spousai distributions and transfers under
Sec.91 f6(a)(1.2).]
1. THOMAS R. TROUTON Lineal 50.00
838 OAK OVAL
MECHANICSBURG, PA 17055
2. SANDRA L. STILZ Lineal 50.00
15300 ALSASK CIRCLE
PORT CHARLOTTE, FL 33981
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET. s
If more space is needed,use additional sheets of paper of the same size.
• ' � REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death: 51.582.75
Discount: 2,714.80
interest Tabie
Year Days Delinquent Balance Due Interest
this time period this year this period
Before 1981
1982
1983
1984
1985 �
1986
1987
1988 throu h 1991
1992
1893 throu h 1994
1995 throu h 1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011 throu h 2013
TOTALS
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17, 1996:
Penalty:
4 y
Santander Bank
ESTATE OF Ar�ene L. Trouton
SOCIAL SECURITY#: 157-I4-0700
DATE OF DEATH: October 8,ZOl 3
Account#: 1681714914 Type: Checking Open date: 9/15/1988
In the name of: Arlene L Trouton (Thomas R Trouton Sr POA)
Date of Death Baiance: $37,610.32
Int.(YTD)from 1/1/2Q 13 to 10/8/2013 $2.3�
Accrued interest to date of death: $0.12
Other lnfo:
Accounf#: 1688181237 Type: IRA CD Open date: 7/14/1989
In the name of: Arlene L Trouton
Date of Death Balance: $0.00
In�(YTD)from 1/I/2013 to 10/8/2013 • $4.45
.
Accrued interest to date of death: $0.00
Other 1nfo: Closed on 1/22/2013 at$9,290.69 transferred into CD 7676176158
Accouat#: 7676176158 Type: IRA CD Open date: 1/22/2013
In the name of� Arlene L Trouton
Date of Death Balance: $9,354.8I
In�(YTD)from 1/1/2013 to 10/8/2013 : $64.12
Accrued interest to date of death: $2.31
Other tnfo: The beneficiaries ate Thomas Trouton and Sandra Stilz
Account#: 1688181633 Type: IRA CD Open date: I O/19/1992
In the name of: Arlene L Trouton
Date of Death Balance: $13,580.23
Int.(YTD}from 1/1/2013 to 10/8/2013 $120.31
Accrued interest to date of death: $3.98
Other tnfo: The beneficiaries are Thomas Trouton and Sandra Stilz
Page � of�I
. F �
� ;,�,�;:.��:s � .;
' , ' �'1��;'i�
. �g
Estate Valuation
Arlene L. Trouton
Da t?of Deathc IO/08/2013 Estate of: Arlene L. Trouton
Va 1 mtion Date: IO/08/2013 Account: 8415-Z875 Individual
Pr o assing Date: 11/2I/2013 Report Type: Date of Death
Number of Securities: 15
File ID: Troutoa, Arlene L. 8415-1875
Shares Secnrity Mean and/or Seaurity Div and Int
ldentifier or Par Description High/Ask Low/Bid Adjustments Value Accruals
�) CASH 1933.58 Cash 1,933.58
2) 04010L103 913 ARES CAP CORP
COM
The NASDAQ Stock Market LLC
IO/08/2013 17.17990 17.05Q00 H/L
I7.114950 15,625.95
3► 27826H578 3341.028 EATON VANCS INVT TR
PA LTD MN INCM A
Mutual Fund (as quoted by NASDA¢)
10/08j20I3 9.88000 Mkt
9.880000 33,009.36
Daily Div. Accrual as of 10/08/2013 63.12
4) 36240H2O6 1486.408 GABBLLI VALIIE PD INC
COM
Mutual Puad (as quoted by NASDAQ)
10/OS/2013 1.8.35000 Mkt
18.350000 27,275.59
5) 369604103 IOQO GENBRAL SLSGTRIC CO
COM
New York Stock Exchaage
10/OS/2013 23.92000 23.67000 H/L
23.795000 23,795.00
Div: 0.19 Ex: 09/19 Rec: 09/23 Pay: 10/25/13 190.00
6) 370SSC725 2662 GB�TBRAL MTRS CO�P 0.00
NT SR OSI548 ESCROW
PRICH NOT AVAILABLS
7) 37043V100 507 GBNERAL I�lTRS CO •
COM
New York Stock Sxchange
10/08/2013 35.27000 34.17000 H/L
34.7200Q0 17,603.04
� 8) 46132RI09 24149.39I INVESCO PA VALIIE MIIN INCOME TR
� COM
New York Stock Exchange
10/06/2013 I2.28800 I2.20000 H/L
12.240000 295,588.55
9) 62010II101 128.0726 MOTORS LZQ CQ GIIC TR
�T BBN INT
Iateractive Data Corporatioa
10/OS/2013 34.30000 33.70000 H/L
34.000000 4,354.47
X 10) 746853100 41508.561 PUTNAM PREMIBR INCOi� TR �
SH BSN INT
New York Stock Exchange
10/08/2013 5.21000 5.18000 H/L
5.195000 215,636.97
11) 949746101 199 WSLLS FARGO & CO NEW
COM
New York Stock Exchange
10/08/2013 40.T7000 40.2100Q H/L
40.490000 8,057.51
12) 37Q45V118 460 GENERAL MTRS CO '
PiT SXP 0710I6
New York Stock Exchaage
10/08/20Z3 25.66000 24.85QOQ S/L
25.255000 11,617.30
Page 1
* Please see the final page for IMPORTANT INFORMATION ABOIIT THE ESTATS VALUATION RBPORT. ,►
Wells Pargo Advisors does aot render tax or legal advice. If you have aay questions please coasult with your tax
and legal advisors. Welis Fargo Advisors is the trade aame u�ed by three separate registered broker-dealers: Fiells Fargo
Advisors, LLC, Wells Pargo Advisors Pinaacial Network, LLC and Wells Pargo Investmeats, LLC, Members SIPC, non-bank
af€iliates of Wells Pargo & Compaay.
i '
Date of Death: 10/08/20I3 Esta�e of: ArZeae L. Trouton
Valuation Date: 10/08/2013 Account: 8415-1875 Individual
Frocessiag Date: I1/21/2013 Report Type: Date of Death
Number of Securities: 15
Pile ID: Troutoa, Arlene L. 8a15-I875
Shares Security Mean and/or Security Div an.d Int
Identifier or Par Description High/Ask Low/Bid Adjustments Value Accruals
133 37045V126 460 GENERAL MTRS CO
WT EXP 0�1019
New York Stock Exchange
10/08/2013 17.90000 17.10000 H/L
17.500000 8,050.00
I4} 37QESCAJ4 600Q0 GENSRAL RS CORP ; 0.00
DEB PUTABLE 0/O1/98@I00 �. ��,����;,� : �� ,ff �
ESCROW C N 8.800$ DUE 03/OI/2I � 1� .7 T , 1.,;���'�.i.. ���� �
PRICE NO AVAILABL�• � �-;;�.�C�'�Y�����'�
ACCrual �;r`���t�/f�C'-°'� G G�r� f 542.6?
I5) 954498PH8 20000 ATEST MIP LIN PA AREA SCH DIST
Interact ve Data Corporation
DTD: 11/ 5/2003 Mat: 08/15/20I4 3.85� .
IO/08/20 3 100.2450Q Mkt
100.245000 20,049.00
Iat: 08/ 5/20I3 to IO/08/2013 II3.36
Total Value: $682,596.32
Total Accrual: $909.15
Total: $683,505.47
Page 2
* Please see the final page for IMPORTANT INFORMATION ABOUT THE ESTATE VALUATION REPORT. *
We17.s Pargo Advisors does aot render tax or legal advice. If you have any questioas please consult with your tax
aad legal advisors. Wells Fargo Advisors is the trade name used by three separate registered broker-dealers: Piells Pargo
Advisors, LLC, Wells Pargo Advisors Pinaacial Network, LLC and Wells Pargo Investments, LLC, Members SIPC, aoa-bank
affiliates of Wells Fargo & Company.
1 �
Date of Death: IO/08/2013 Estate of: Arlene L. Trouton
Valuation IIate: IO/08/2013 Account: 8415-18T5 Individual
Processing Date: 11/21/20I3 Report Type: Date of Death
Number of Securities: 15
File ID: Trouton, Arlene L. 8415-1g75
Portfoiio Endnotes
IMPORTANT INPORMATION ABOiJT THE ESTATfi VALUATION REPORT
The information in this Estate Valuation Report (referenced below as the Report? is based oa the Estate Valuatioa
Worksheet provided to us by the Fiaancial Advisor requesting the Report. We have aot used clieat statements, internal
accouatiag data, or any other resources to independeatly verify the identity or quantity of securities held, the date of
death, or the alternate valuatioa date, if applicable.
The Report may include assets that you currently hold away from our firm, which may or ma.y aot be ideatified as beiag held
aavay. Information oa assets held away from Wells Fargo Advisors ovas provided by you and may not be covered by SIPC.
Wells Pargo Advisors makes no representation with respect to accuracy of information on outside holdings.
In most cases, we use Estate Vai, a valuation and griciag program, to provide iaformation on the value of securities oa
the requested date. Sstate Val software is provi@ed by Sstate Valuations & Pricing Systems, Iac., (EVPj, a third-party
vendor unrelated to Wells Pargo Advisors. The priciag and valuations geaerated by EVP are derived from sources it
believes to be reliable, but the accuracy and completeness of this information is not guaranteed.
Depeading oa how the Report will be used, the pricing generated by EVP for some securities may warraat additioaal
consideration. Users may waat to supplemeat or adjust the values provided for certaia tyges of securities. For example;
- Brokered Certificates of Deposft, and certaia boads, may possess a death put feature. EVP provides a value which does
not accouat for the possibility that a successor owaer may be able to put the security back to the issuer at par, upoa the
death of the original owner.
- Treasury Inflatioa Protection Securities (TIPS) are often not identified as such ia the Report, so the inflation factor
may not be reflected ia the value aad accrued interest shown.
- varfable rate auctioa securities may be reported by EVP at par, without reflecting acerued interest or market
coaditioas. Other types of variable rate securities may aot refZect accrued interest.
The databases used by SvP do aot eacompass all markets or types of iavestmeats. Por example, Sstate Val does aot provide
vaZuatfoa data on investmeats such as aannities, equity optioas, limited partnerships, or maaaged futures funcis, amoag
others. If the Pinaacial Advisor is able to obtai.a priciag or va2uatioa data from other sources with respect to such
iavestments, we may iaclude that data in the Report for iaformational aad convenience purposes. Pte will fdentify such
investmeats ia the Report. We do aot audit or indepeadently verify the data provided to us, aad make no representatioas
as to the accuracy or completeness of information provided to us by others.
This Report does not fn an,y aay supersede the informatioa contained ia client statemeats and trade coufirmatioas, which
are the o€�ici.al record of account positioas aad activfty. '
We make ao represeatatfoas that the iaformatioa contaiaed in this Report is suitable for aay particular purpose. It is
the responsibility of the clieat, together with hfs or her tax aad legai advisors, to determiae the appropriate
iaformation to iaclude oa aay tax return, iaveutory, or other accountiag.
Page 3
* Please see the final page for IMPORTANT INPORMATION ABOLTT THE SSTATE VALIIATION REPORT. *
Wells Fargo Advisors does aot reader tax or Iegal advice. If you have any questions please coasult with your tax
and legal advfsors. Wells Pargo Advisors is the trade aame used by three separate registered broker-dealers: Wells Pargo
Advisors, LLC, Wells Pargo Advisors Pinancial Network, LLC and Wells Pargo Investments, LLC, Members SIPC, aoa-bank
affiliates of Wells Fargo & Company.
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(888)778-:888 TI'Y:(804j 6�a-;637
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ATTN R.MARK THC�M�S Re: Arl�ne L Trouton
FA��717-796 3600 Conlracl Ntunbcr:9450905�
November 5,2013
Dear�ir.T'homas:
Than�you for your inquiry an the above contract
�l�e date of death value as of Uctober 8:2U 13 was''9�,�56.21
If you have any questions,please call the Prudential Annuity Service Center at(888)77&2888. The
Service Center is open Monday through Thursday between 8:00 a.m.and 7:00 p.m.and F.rida.y between
8:00 a.m. and b:00 a.m.Eastcm timc. �you��u�g a t�l��,�i�a�ions a�i��fo��hc h��
unpaired,you may call(800)654-7637,1�'tonday through Frida_y between 8:00 a.m. and 3:00 p.m.Eastem
time.
sinc:er�ly,
Annuifiy Service Genter
Prt�dential Financial
Variabte umuities ue issued by Pruce Life�ance Coa�any(in Nece Yodc,by Fcuco Life lnsurance Compazry of Ncw Jecsey}.Both co�anies are
located in Newuic,NJ.i'aziabl�arnwities are di�ibutcd by Frudadiat ArnutiGes Dishributors.1r►c.,Shetton,CT.Fixed auaiities arc issved by Tlx
I�rsuiential Inairance('cxr�anS of�lmarica.Atl�e IfitefaRial Minancia.l campaniec and ea.ch ic�lely recEun.eible fnr iLc e►vm financial cc�ndition anci
co�xractual obtigatioos.
[Pagc I af 1]
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a�
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November 1, 20 I�i
Estate of Arlene L. Trouton
��
c/o R. Mark Thoma�
� IO1 South Market St
Mechanicsbura, PA 17055
� ING USA Annuity and Life Insurance Company
Decedent: Arlene Lucinda Trouton
Contract Number: I001157-OX
Claim Code: 01010
Dear Mr. Thomas,
Thank you for your recent inquiry regarding the annuity contract listed above. Please find
the contract information below.
; �
� Death Benefit Value $117,357.03 as of 10/8/13
: If you have questions regarding this �nformation, please contact our Customer.Contact
Center, available Monday—Thursday, 8:30 a.m. to 6:30 p.m., Eastern Time, and Friday,
8:30 a.m. to 5:30 p.m.,Eastern Time. Call 800-366-0066 and press 3 to identify yourself
as a beneficiary. When prompted, enter the five digit Claim Code above and press#.
Your call will be addressed by a claims specialist.
Sincerely, .
Customer Service
Ii�iG
/lirnuuic�.s i�rc�issued nnd/r,rudminislc�rc-d 1»�/NG USA A�unrilv and[.ijc�ln.cc�rcrnr��Cc»�r��un�•IDc�.c Mni�cc�s./A)unt!cfrs►ribu�c�cl 1���
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November 9,2013
Thomas Trouton
838 Oak Oval
Mechanicsburg,PA 17055
Dear Mr.'Fro�ton:
Thank you for allowi.ng us the privilege of serving you and your family. We applied for a county
benefit available for widows of veterans and are pleased to tell you tha.t we received it. Please f nd
enclosed a refund check for$100.00.
Please call us at aay time that we may be of service. -
Wittt Wann Regards,
,
JC. - _
Michelle L.Buhrig �
_ _ ....
Treasurer -
Enclosure
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`37 East Mam..Streef _�. DATE
III�CCh3f1iCS6U1'g,PA:17O55 USTENING ISJUS'f THE BEGINNING� IVOV G,2��3
(717)765-3421
_ : ,60-142-3I3
. : : Annout�cf -:
� 100 A0
PAY C1ne Hundced and OQ/100 Dolfar5 '
ro TME :
ORDER
�F:
Thomas Tresuton
838�ak Ouai f
Mechanicsburg,PA 17055
: � �
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AUTHi�RI�ED 'FURE.
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October 14,2013
Thomas Trouton
838 Oak Oval
Mechanicsburg,PA 1705 5
Dear Tom:
Th�c you,for allowing us the priviiege of serving you and your family. We know that financial
s�atements can be confusing,so below is a sum�ary of your account.
Statement of Goods&Services $6,247.00
Less:Contract Addendums (165.00)
Subtotal: Invoice#�0942 S 6,082.00
Less:Estimated Payment from Insurance (1,430.16)
470.00
Less:Terms Discount { }
3�our Balance Due b November 8,20�3 $4,181.84 :
We have enclosed a complete invoice for your records.
Please call us at any time that we may be of service.
With Warm Regards,
,
. ��
. _� �S
Michelle L.Buhrig / �p �'
Treasurer • , ,. Gy �,
���r
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Enclosure
Walking with Those in Grief
Robert"Bob"L.Bnhrig,Jr.,F�.s��+•��•William"Bill"L.Ciiristopher,�o
Phone: (7i��7663421 • Fax: t7�%)795.7291 • 37 East Main Street • Mechanicsburg,PA 17055 • w�vw.Myers-Buhrig.com • DirectorsGMyers-Buhrig.com
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1 DI FIRESII� CHICKEN SALA 5.75 SC UTZ PRETZELS 0.4�3-F no dQ: on� i ne
10 �ISC 10.0 X - 0.5$ UTZ TH PRETZ PC 3.99 F
1 DI DELI SAPDwICH 5.76 SC UTZ PRET2ELS o.49-F PRE-TIP Ah1 ���,Z�
10 xDISC 10.0 Y - 0.58
1 DI Chef�S S8�8d 7,15 DR PEPRER TEN PC 1.89 8
Ti� ----------��
10 Xl}ISC 10.Q X - 0.72 s� PEPSI 2 LITER 0.39-B ��� _
1 DI - Ct.�ly Fries 2.� 2 � ,.�y TOTAL ------- �
1 4 X D I S C 1 0.0 X - �.2 3 DT DR PEPpER PC 3.7$ B
SI�TUTAL 41.33 � PE�SI 2 LI�fR 0.39-B CU3TOMER COPY
StBte 2.Q8 SC PEPSI 2 LITER 0.39-8
TOTAL 43.81 FRES�A PC 1 .89 B
r*�r�rxx�t�r�r�rx��cx�r�r�tx�rx�t�r�x�r�r�rx�r�rx�rxx�r�r��r�rxx� '---SC _-.- CE)1(E 2 LITER � 0.3�-B _
Narae: TROUTON, SAI�►IA / TOM
' SPRITE PC 1.89 B
p��/q��p�t; � � SC COKE 2 LITER 0.39-B
(�ar�ged to Acc: � 43.81 CLRSSIC COKE PC 1.89 B -_._.w_._..�.._,.,___�. _,,.�._._.---_--.--. .
New Balarlce: $- 248.51 ` SC COKE 2 LITER p.39-B
rx�rx*�r�r*x�r�r�nr�rxxx�r�rxxx*x�r�rx*x�r�r�rx�r�r*�r�rx�c�r� �
� COKE ZERO PC 1.89 B
t�1ar'ge 43.81 SC COKE 2 LITER 0.39-B
2 � 1 .89
j� Y� DICT COKE PC 3.78 B
Cape Again �C COKE 2 LITEP, 0.39-B
Sat Oct 12, 2013 1:23 PM SC COKE 2 LITER 0.39-B
MC DR PEPPER TEN 1.00-B
TA?i 4.75
� � ��I� *�** BALANCE 19.25
1* . : *1 *10/ 13 ��*��*��*�������*�**�������*��**�r*�*
CREDIT PAYMENT
� REF : 04030C
ACCT: *�*****�**��3483 EXP: XXX
SEQ: 373250481
TOTAL: $19.25
(�iEDIT 19.25
CNAN6E 0.00
TOTAL NUMBER OF ITEMS SOtD = 11
Cou�on Savin9s 1.00
Weis Club Savin9s Total 4.49 �
. Messiah Village Ca.terin� Service Req uest/Bill
-
Date: Saturday October 12, 2013 Time: 5:00 PM
Contact: Tom Trouton Telephone:Address:
Organization/EventTrouton Family Dinner
Event Style: Sandwich Luncheon _
Service Time: 5:� PM
Room: Terrace Room
Sandwich Luncheon 30 @ $7.50 $225.00
Dessert Upgrade (piesj 30 @ $ .50 $15.00
Labor 30 @ $ 4.50 $135.40
Final Count: 30
Sub Totaf: $375.00
Tax: $ 22.50 .
Room Charge: $0.00
Arnount Due: �397.50
Please malce checks payable to: Messiah �ifeways at Messiah w!lage
Piease maif payment to:
Messia h �llage
100 Mt.At�en Drive
Nfechain�ESb�rg, Pa 17055
�4ttr�: �rar��Ciin Cliier
Village��nter Catering
SANI�IA MOI�ITIEi�1lYE TRQUTON s—�s✓3en
Tt�M/AS R.T1�0E1`f'ON 2 7$7
83s o�ova� �
MECHAN1eSBUR�,PA 17055 oa'i'E�.1 ���� �
Rl4Y TO TkE �°�
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�;rv�,'?3 Cs,it��'3���2t3 M4KHANICsBUR� P/� $9.�0
G��€RY sf{3�E
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i ;; •��.���c`�����'L���!��'�iz^�,'38tJR�: PA $13'.Ol
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80833395fib ,
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10�1 d{�3; 1��Li�������t.&�QU/#�i.L�E�rFQ1!{!!Y P�4 #4127 `
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10l78I13 Gl�ii�IT�i333 �f€4l�it�1tC58t1RG PA #19.12
YST�3RE � _
10/18l73 U5P5415248�S101i:Z4MECHANtC.SBURG PA �'�� Q �9.20 .
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8Q0-27587�7 . . _ .
10/ZQ/t 3 CRA�KER BARREL#550 MECHANKSBURG PA �4755
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8003339566
_
Descri�ion.: _
_ REST/�(�RAf�TCHARGES �
10/20/13 C1lS 1626D1626 MECHANKSB�IRG PA $38.14
I�RUG`StORE/PHARMACY
10/22/13 SHEEfZE}2010201. MECHANtCSBURG PA $1253
8149463611 .
. . _
��+��" - � _ _
Amount
Total�ees for this Period �•�
lnterest Gnarg�d'
Amount
Totai Interest Charged for this Period � ��•�
Continued on next page
� �
WEST SH4RE EMS - BLS �' � .- ��'��.
( !' �:i ��:-�s,�,.�r-^
205 GRANDVIEW AVE SUITE 211 _ _. L____ � '�
__ _ .
CAMP HILL, PA 170'!1-1708 ON REVERSE SIDE
��ST S�ORE ER�S Phone#: (800) 367-0512 Federai Tax tQ: 23-2463002
�Hq Y SPQtTI'fffi1LTH SYS'iEM
�n�T�E ARLENE TR�UTON �iNSU�wc�: NOVITAS SOLUTI4NS,INC. W�
HIGHMARK NONE
CALL NUMBER: DATE OF CALL• 'i O103/2013
252300129W
FRp�W; HOLY SPIRIT HOSP[TAL
TO: MESSIAH LIFEWAYS
/�CC�UNT:St11�1�4�Y
ARLENE TROUTON .
2100 BENT CREEK BLVD#322 TOTAI.CHARGES: 157.63
MECHANICSBURG,PA 17050 PAYMENTS/ADJUSTl1AENTS: 0.00
PLEASE PAY THtS AMOUNT 157.fi3
DETACHALOl1tG PER�ORAfiONAND RE7URN STUB WRH PAYMEM
. . . < -�-
_ . _ . _ .
....
: �i�1P'�1E3�N_�CH14RGE; ---__ �.:_QUANTiTY - --UN1T PHICE_-:-- ---- -l�llOt1NT-._ _- �--:--- -
STRETCHER VAN-1 Way Transport T2005 1.0 125.81 125.81
Transport Van Mileage S0209 6.8 � 4.68 31.82
Total Charges 157.63
,. . ;
- � D�E'�`.�£R- .1P77C)N C�F PA1fNlEN'F RECEtPT �►�'MENT D/�4TE AMOURiT -
' Tota!Credits 0.00
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- AVE SUITE 2'f 1 C14�l���A 17011-1708 �
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205 GRANDVIEW AVE SUITE 211 � ` � ► - R a -`
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CAMP HILL, PA 17�11-1708 ON REVERSE SIDE
�Si�ORE Eiv�s Phone#: (800)367-0512 Federat Tax fD: 23-2463002
�HOI.Y�fftTf'HFJ1[.'[H SYSTEM
PAn�N�r NA��: ARLENE TROUTON ����su�cE NOVITAS SOLUTIONS,INC. WCS
HIGHMARK NONE
CALL NUMBER: 252300129W oarE oF cau.: 1010�/2013
�p�: HOLY SPIRIT HOSPITAL
TO: MESSIAH LIFEWAYS
_ �
AC�t)[!Nt SIJNtMARY
_ _
ARLENE TROUTON
210Q BENT CREEK BLVD#322 TOTAL CHARGES: 157.63
MECHANICSBURG,PA 1T050 PAYMENTS/ADJUSTIWENTS: 0.00
Pt.�►sE�►Y ni�s a�wou�rrc 157.63
DETACHALONG PERFaF�i4T10NAND RETURN STC/B WJTH PAYMENT "
. . , : , _-
�D�fiCRIP_'170N t�F CHAt�GE _ .:_ ^__QU�1NTt1Y _. -__�;1l�ttT P13t�E_._.__ _�.+ _.AMQUi�'i- .__ � .
STRETCHER VAN-1 Way Transport T2005 1.0 125.81 125.81
Transport Van Mileage S0209 6.8 4.68 31.82
Total Chan,�es 15T.63
_. .> -� QESC131PT1E)N C1F.�kYMENT � fiECEtPT P�►YAAENT DATE '- AA�4Ui�tT -
_�_. _�_ ^.--- -----. --- -- -_. _ __ _._.
Total Credits 0.00
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30 Ea(�t SIMPS[?N RD MECHANI(;St3URu, .f'R
PHRR��IACY: 7�6-�253� S�f ORE: 766-�2221
REC�1tG1 1�RN#9690 CSNf�#0�31 G3�3 S(Ktt1 fi26
- He 1 Ped b�-�: MARCUS
ExtraCare C�rd'�: �t***��**1816
� �
1 G P h�7T �'IJRPUSE �(k�5 6:99T
1 E� �7��T5 COM60 1�RI'E� 90.99r
1 25r CUS COIJPON 12.00 -
2 ITEMS
SUBTOTAL 35.923
� PA 6.0`ti TAX 2.16
� mra. �s.�a
: `} w�x �s.�q
*�������***l007 MS
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RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date: 10/18/2013
Cumberland County - Register Of Wills Receipt Time: 09 :22 : 52
One Courthouse S quare � Receipt No. : 1075943
Carlisle, PA 17613
TROUTON ARLENE LUCINDA
Estate File No. : 2013-01104 - -
Paid By Remarks : R MARK THOMAS
DB1
------------------------ Receipt Distribution -------------------_____
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 660 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 35 . 00 CUMBERLAND COUNTY GENERAL FLT1V
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENER.AL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 768 . 50 $768 . 50
Total Received. . . . . . . . . $768 . 50
No�. 1. � 2013 11 : 14AM � No. 4834 P. 1
r �
Court Ordered Processing\Decedents- MA,1-lVffi3-02-10 - P.O.Box 84I005 - Bostoq MA 02284
November 1, 2013
� R. Mark Thomas �
Attomey at Law
' 10'i South Markef St (
� Mechanicsburg, Pa '(7Q55-385� ; .� � '��
� � ��� 1__�
� VIA FaCSIMiLE 717-796-3600 i t ' t
B �
� ��
� Re: Estate of Artene �..�7'routon :
a
� � . : Date of Death: 10/08/20'I3 . �,� �`- .
� � . �- �� ��
a Dear R. Mark Thomas: � '"
� /
.� . . ��.
� We have received your requesf for date of death balances on �he accounts of the .
�� abQVe-named decedenf. Piease refer to the additionat item(s} indicated be(ow tha�are �
required to complete your request; some o�which are required in order to compl with
� y
� privacy laws af�ecfing bank accounts. We need to ensure that we provide account
� information only to those individuals authorized to receive it.
!
a
� Pfease send the d�cumen�ation checked off below.to my..attention at tfie addcess listed
j above. .
� _._. . � .
� XX�`$20.�00�`ate o�Qea� �alance �ee payabie fo: Sanfander effect�ve 6/1/09
'� • � ■�/■A h-F-'��r ifira4c� l �
� riv/��� �fV�t���VLA�V _ .
� Court Appointment of Executo�{trix)or Admmistrator(fri�c} ("Certificate of
- � appointment") ��
� Authorization from Executor/Administrator/Joint Or�rneNBenef�ciary t� release
information
� - Qther:
�
.�
� If you would like to �iquidate the accounts, please retum c�r�ified copies of the Death
�. Certificate. Certificate of Appointmeht, if applicable, and a notarized ►etter of instruction
� from the executor, co-holder, or beneficiary, as appropriate.
� Very truly yours,
�
��
.
�
U
� ' �,�'y
� Asf�ley Nobreg
� [COP Specialis {I]
z !'hone: 6'f 7-514-5169
�� Fax: 617-287-OS29
� .
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