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Home My WebLink About01-28-14 (2) s t � . . r r �� 1505610140 REV-1500 �` �°'_,°, PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes �NHERITANCE TAX RETURN ty PO BOX 280601 2 1 1 2 0 9 1 2 Harrisburg,PA 17128-06Q1 REStDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death ru��Ymr Date of Birth MMDDYYW 07172012 0� 6091927 DeoedenYs Last Name Suffix Deoedent's First Name MI COR N E L L RI C HARD (If Applicable)Enter Sunriving Spouse's Ir�formation 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 D 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.Federal Estate Tax Retum Required death after 12-12-82) ❑ 6.Decedent Died Testate � 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) . � 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(date of death � 11.Election to tax under Sec.9113(A) . � .. between 12-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R . MARK THOMAS , ESQUI RE 71 7 796 21 00 ,�.a � f�,.�i... RE�T�OF WILL:!"�1SE �N�'1 � � � �"� First line of address M � � � � � � � �-t� � t�r'1 i"r`t 1 0 1 SOUTH MARKET ST REET � �n � � "� Second line of address � � ,� � � -� � � � � � t� � * "Wf DATE FILED � City or Post Office State ZIP Code �`" � MEC HA NI CS BU RG PA 1 7 0 5 5 �" �' Comespondent's e-mail address: RMARKTHOMAS@GMAIL.GOM Under penalties of pery'ury,I dedare that 1 have examined this retum,indudir�g aa:ompanying schedule.s and statements,and to the best of my kno�wledge and belief, it is true,aorrect ar�oomplete.Declaration of preparer other than the personal representative is based on a!1 information of which preparer has any knowledge. 1 RE F PERSON NSIBLE FOR FILING RETURN DATE ADDR SS 10 OAK LANE MECHANICSBURG PA 17050 SIG PARE R REPR�TATNE DA Q�� a?�� ADDRESS 101 SOUTH MARKET STREET MECHANICSBURG PA 17 55 PLEASE USE ORIGINAL FORM ONLY , Side 1 � 1505610140 1505610140 , r . � � ' J 1505610240 REV-1500 EX DecedenYs Social Security Number . �e�d�t�s Name: RICHARD CORNELL RECAPITULATION l 1. Real Estate(Schedule A) .. . . . . .. . .. . . .. . . . . . . . . . . . . . ... .. . .. . . . . . .. 1• • 2. Stocks and Bonds(Schedule B) . .. . . . .. . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . 2. • 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. • 4. Mortgages and Notes Receivable(Schedule D) . . . .. . . .. ... .. . . ... .. . . . .. 4. • 5. Cash,Bank De osits and Miscellaneous Personal Pro 2 � 2 8 7 • � 5 p perty(Schedule E). . . . . . . 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . .. . .. 6. 2 0 1 5 , 6 6 7. Inter-Vivos Transfers 8 Miscellaneous N n-Probate Property (Schedule G) � Separate Biliing Requested . . . . . . . 7. � 0 0 3 9 � 2 4 8. Total Gross Assets(total Lines 1 through 7) . . . . .. . . . ... ... . . .. . .. .. . .. s. 3 2 3 4 2 , 0 5 9. Funeral Expenses and Administrative Costs(Schedule H) . . . ..... .. .... . ... 9• 8 $ 7 4 . 6 6 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) .. . . .. .... . .. 10. 4 9 � . 3 9 11. Total Deductions(total Lines 9 and 10) . . . .. . . . . .. . . . .. ... .. . . .. .. . . . . 11. 9 3 6 6 . � 5 12. Net Value of Estate(Line 8 minus Line 11) . . . .. .. .. . .. ..... . . .. . . . . . .. 12. 2 2 9 7 6 . � 0 13. Charitabte 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 2 9 7 6 . 0 � TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 O . O O (a)(1.2)X•0 � . � � 15. 16. Amount of Line 14 taxabte at lineal rate X.045 2 2 9 7 6 . 0 0 �g, � 0 3 3 . 9 2 17. Amount of Line 14 taxable at sibting rate X.12 0 . 0 � 17. � . � � 18. Amount of Line 14 taxable • at collateral rate X.15 0 . � � �g. �..,�=�.b..,�.�.,Q,�Q�` ..� 19. TAX DUE . . .... . . .. .. . . .. .. .. . . . . .. . . . . . . . . .. . . ... .... . . . . . . . . . 19. � � 3 3 • 9 2 � _......._....._-----.�..._...___...._,_.....,�"'"�. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610240 _ 1505610240 J , r �� REV-15b0 EX Page 3 Fite Number .Decedent's Complete Address: 2� �2 0912 DECEDENTS NAME RICHARD CORNELL ----- --—__^ STREETADDRESS --------- -- — ------_-------- CITY STATE ZIP Tax Payments and Credits: �. Tax Due(Page 2,Line 19) (1) 1,033.92 2. Credits/Payments A.Prior Payments B.Discount To#al Credits(A+B) (2) 0.00 3. Interest (3) 0.00 4. lf Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in ovat 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) 1,033.92 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTI�NS 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 ..............................................................�--•--•--......................... ❑ Q d. receive 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? ....................................................................................... ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank acoount or security at his or her death? ......... ❑ [� 4. Did decederrt own an individual retirement account,annuity or other non-probate property,which c�ntains a beneficiary designation?.................................................................................................. � ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers#o or for the use of the surviving spouse 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disdosure of assets and filing a tax retum are still app(icable even if the surviving spouse is the only benefiaary. For dates of death on or after Juty 1,2Q00: • 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. � The tax rate imposed on the net value of transfers to or for the use of the deoedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,undE Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. # r, REV-15b8 EX+(11-10) ' pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, � MtSC. INNERlTANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FtLE NUMBER: RICHARD CORNELL 21 12 0912 Indude the proceeds of litigati�and the date the prooeeds were received by the estate. All p�roperty jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TD BANK, N.A. PO BOX 746, KEENE, NH 03431-0746 13,632.14 ACCOUNT#9243677650 DOD VALUE 2. TD BANK N.A. 6,655.01 ACCOUNT#9725971900(INTEREST-.31 inciuded) TOTAL(Also enter on Line 5,Recapitulation) S 20 287.15 If more space is needed,insert additional sheets of paper of the same size � REV-1509 EX+(01-10) � ' pennsyivania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RICHARD CORNELL 21 12 0912 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVNING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. PAUL CORNELL 36 MURPHY STREET SON MANCHESTER, NH 03103 g. c. JOINTI.Y-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY 96 OF DATE OF DEATH ITEM FOR JOINT MADE INClUDE NAME OF FINANCIAI INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST �CEDENTS INTEREST 9. A. CRANSTON MUNICIPAL CREDIT UNION 4,031.31 50. 2,015.66 1615 PONTIAG AVE CRANSTON, RI 02920 ACCOUNT 7034 TOTAL(Aiso enter on Line 6.Reeapitulation) S 2 015.66 If more space is needed,use additional sheets of paper of the same size. t ' REV 1510 EX+(08-09) � ' pennsylvania SCHEDULE G DEPARTMENTOF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCETAXl2ETURN� MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RICHARD CORNELL 21 12 0912 This schedul�must be oompleted and filed if the answer to any of questions 1 th�ough 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM i��,�Ranno�P ro o�cm��ra�m DATE OF DEATH 96 OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.A1TA�H A COPY OF THE DE�FOR REAL ESTATE. VALUE OF ASSET INTEREST pF,wa,c�e� VALUE 1. MET LIFE-COMPUTER SHARES 431.76 100.00 431.76 ACCOUNT C001094203914 shares @$30.84-DOD value 2. PRUDENTIAL FINANCIAL -DOD value 8,651.44 100.00 8,651.44 ACCOUNT 8677904 3 MET LIFE-COMPUTER SHARES 956.04 100.00 956.04 ACCOUNT C0010942012 31 shares�$30.84-DOD value TOTAL(Also enter on Line 7,Rec�itulation t 10 039.24 if more spaoe is needed,use addibonai sheets of paper of the same size. < � " REV-1511 EX+(10-09) • ' pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETtJRN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER RICHARD CORNELL 21 12 0912 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HIGHLAND PARK 1,225.00 2. FUNERAL MEAL-NINOS 609.16 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)ofPersonalRepresentative(s} STEPHANIE J. RICHARDSON, ADMIN. 1,617.00 Street Address 10 OAK LAN E �;�MECHANICSBURG S�� PA Z�P 17050 Year(s)Commmisssion Paid: 2, Attomey Fee.s: 5,130.00 3. Family Enemption:(if deoedent's address is not the same as daimanYs,attach explanation.) Claimant Str�et Address City State ZIP Relationship of Claimant to Decedent , 4• Probate Fees: petition, shorts, exemplified records x 2, citation, petitions, , 283.50 5 Aocountant Fees: 6. Tax Retum Preparer Fees: �. snorts �o.00 TOTAL(Also enter on Line 9,Recapitulation) s' 8 874.66 If more space is needed,use addibonal sheeLs of paper of the same size. ' < a '� ' REV-1512 EX+(12-08) • ' pennsylvania SCHEDULE I ' °EP`ux""E"T oF R�"�E DEBTS OF DECEDENT, ', iNHEwrawcE rax�ruw�► MORTGAGE LIABILITIES,8�LIENS ' RESIDENT OECEDENT I ESTATE OF FILE NUMBER ' RICHARD CORNELL 2.1 12 0912 I Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed edical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION �! OF DEATH 1. United Healthcare Insurance-8/6/13 deduction ' 190.00 2. Alert Pharmacy-8/16 check# 1169 ', 301.39 3. � � � ; TOTAL(Also enter on Une 10,Recapitulati�) S'�, 491.39 if more space is needed,insert additional sheets of the same size. I�, I _ e ' � , REV-15°I3 EX�(01-10) � ' pennsylvania SCHEDULE J ' DEPARTMENT OF REVENUE BENEFICIARfES ' INHERITAMCE TAX RETURN � RESIDEWT DECEDENT � ESTATE aF: FILE NUMBER: I!, RICHARD CORNELL 21 12 0912 '� RELATIONSHIP TO DECEDENT , AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) I OF ESTATE I. TAXABLE DISTRIBUTIONS pndude outright spousai distributions and transfers under ' Sec.9116(a)(1.2).j 1. STEPHANIE J. RICHARDSON Lineal ' 25.00 10 OAK LANE MECHANICSBURG, PA 17050 2. KIMBERLY CORNELL Lineal - 25.00 PO BOX 478 TRURO, MA 02652 3. MARK A. CORNELL Lineal 25.00 115 TOWN FARM ROAD � COVENTRY, RI 02816 ' 4. PAUL CORNELL, DECEASED-(LORRAINE-SPOUSE) Lineal 25.00 36 MURPHY STREET ' MANCHESTER, NH 03103 ' , '� I ,, ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SNEE ,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 DlSTRIBUTIONS: � 1. , I TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. s �I If more space is needed,use additional sheets of paper of the same size. ��, 11-07-'�2 �3:53 FROM-CMCU 4��-a63-33�9 T-558 P0802l0003 �-7�4 � ► ► ► . . . ' i 6 r s,�oNrlae A��tvu�.c�a�vs�o�v.�o��rs�;�:HD o��2a-a4p� . . . T�r�:��a�}�6�-�oro��,�x�(�QI j 463-33!9 . . � � www.cransroriu�ecti.org � CRANSTON : . . NtUNIGIPdL EMPlOYEES � i � CREOI7 tJNt4f�E � iVovemfoer 7,Z012 . . . . . . R.Mark T,�ornas, Esg. . � . . I01 South�Mark�et Street � � � ' � . Mecf�anicsburg,PA I7055-3851 . � � � Re: Richa�d W.Co"rneil--A/C#7034 . � � . � . � Dear Mr.Thorimas: � . . . � �. . � � . I apotogize for the apparent confusion in this matter_ I had noC receivec!the authorizaiion etter � � . from Paul Comell and my correspondence to you was sLilf in.my pending fi(e. Paul had bee� wa�k' � � _ h �ng �� directly w�th another credit union emptoyee and tl�e authorization tetter had gone directl�r'to that � � � .other employeQ. An account history�printout that was included i�n the documents that yot�',had � . faxed to me Coday�did in fact contain the DOD.account balance that you had been requesti�hg of � $4,403.31.The printout was datec!from 2/1/2022 to 8/16/2022 but admittedly;this was n�it very � ciear for your purposes. � , � - � � ' . : . Mr.Cornefl hed maintained a savings account with the credit union that was j��intl.y owned I,by. Paul . � Cornell_The credtt�union pays for a share life insurance policy for alt primary members on�ir � � . primary s�vings account with a rrsaximum benefit of$2,000.A cfaim was made ior ri�is benejft 6y the � credit union through our insurance company and a benefit with interesC was paic!to the acaounF on � 10/3/12 in the amounC of$2,008.33�.Paul Cornel{ctosed this account witi�the credit union on � �� . _ 20/15/2012�with a closing balance�of$6,414.42. 1 have attached a history printout from 1/1,�2012 to . � 11/7�2012 Chat details.atE�of this activity on this account during that period for your review. � - � . . I trust Ehat�this"tr�formation satisfies your requirements in this matter.SF�ould you require additional � � �. �nforrnation please contact me. � � � � � Sincerelyt . � � � , � . . . Denrtis!.Crawtey . � � President/CEO E�� , /�!37?C.Cc�S{�G:f�O;'T12^f?�?;��r±�.'�, �'��ZEai, �.f4. Cper�tions Center P�_ ;ox 746 T{aPna 1�TT-r �1�=-:.'??-�,�"F„+ .. — �': 8S�-%S�-gd@�t www_[�ban�.cot�� f . _ _f __ _ _-�� . y _ ._�. .. .? : The Estate o : Ricliard Willianr Cornell Date o Death: T�tesda Jul 17 201 Account Type Efite Savinqs Stat�ment Account Number 97259 I 1900 Balance as of Date of Deatlz 6 65�i4.70 �nterest,c?�te: ,.,��,� Current YTD I�iterest Posted Up to Date of Death .48 Accrued Interest Uv To Date of Death 0.31 Titlin�of,4ccount Richard W Cqrnell Pfease note tFiat if you have requested the accvunt(s)to be cfused an�f the funds sent to you,your rer�uest has been forwarded to the branch for processing. You wil!recieve a seperate package from the brar�ch. . . _ . SincereIy, -�� - ,. ., _ , .� ,� .-�. �� .�� Patte Mills Research Clerk II TD Bank, N.A. Member FDIC Tuesday,October 02,2012 Pd,ge 2 of Z � ��,r� /_':�°r��=.`S:�rQS'::�G:?Y�.ile(?,_��^(;J �� I2�{.�.�3.. Q�ZI'8[IGt1S ��FiC�I- PQ. BOX 7�-�F, zS.eere, NI�T Q3�1�1_�t7_� ?': 8��-'75�-��Q� www_tdb4nk.;:om R. Mark Thomas Attorney at Law �01 South Market Street N[echar��csbc�rg , Pennsylvan�a 17055-5328 RE: The Estate af Richard d�illiam �ornell �Q�e�f1?eatli: �'tj�s�iz�, ,��[;�i? ZQ i� To Whom it may concern, Enclosed piease find the information you requested on the above referenced name. If�ou have any questions on the information provided, please feei free to contact us at TD Bank, N.A. 1-888,751-9000 Account Tvpe Convenience Che 'kin .4ccount Number 924367 650 Balan ce as of Date of Death 13 632.14� Interest Rate: � I 0,� --� Current YTD Interest Posted Uv to Date ofDeath 0'00 .4ccrued Interest Up Tv Date ofDeatl: Titdin�ofAccount Richard W Cor�nel! Tuesday,October 02,2012 Page J of 2 � � � f",j.rR? .a.+ . a ;:r,:�h� ' . .1�� .:sc x 7 x` �b 1D.K�'.t�1 . ... ��. :a.:�,.L� .al_�^ �.- �. N '' .. �o€r:�€.t:p3si�are i�ves�or�e�v'sces - ---____.------------------------------------_---_._----_—_._--------------- �S�I-��j/u-�t( J`t�°at C3n40n M��S�ChtrS�}FS C�2�Z! dv;��:�.r_ornp�;rG;;;ZarC'.CC�:T. RICHARD CORNELL 10 OAK LN MECHANICSBURG PA 17050-1668 December 23, 2013 Company: METLIFE INC Registration: RICHARD CORNELL Holder Account Number: C0010942012 Document I.D.: 13357WF00958681 Our Reference: METL/012Q131223/�6199999/ Dear Srr/Madam: Thank you for contacting Computershare regarding the above referenced MetLif�account. Below is the account balance information you requested as of.7uly I7, 2012 for the above accourht. Shares Held by Agent: 31 Shares Held in Certificate Form by Holder: 0 Total Shares: 31 Closing Price Per Share: $30.84 � � � If you have any additional questions or concerns, please cai! our Customer Service Center at 1-80!0-649- 3593 or 1-201-680-6578. You may atso access your MetLife stock account on the Internet at ' www.computershare.com/investor. Our mailing address is Computershare, P.O. Box 43078, Providence, RI 02940-3078. Sincerely, . Service Representative Enclosure: None ' - _. �� om , utershane -f � � "� Computershare i PO Box 43006 �—�' Providemce,Rt 02g4Q-3006 ""' Within USA,US territories�t Canad� 800 649 3593 �.. ............. .. ,� AUTO 3-DIG►T 031 oppp�1�p003749 Outside USA,US territories fr Canad� 201 680 6578 � a Q 3�7�f�i Nearing Impaired(TDD� 201 680 6611 �.�.. �tl��'ll��[��i��r(�1'1�'�'t��llltl(IIl��II��I�IIrlt[I'! www.computer$hare.com�nvestor � RICHARD CORNELt. ' � MAM�RPHY ST � NCHESTER NH 03103-6025 � Hotder Account Number � '= C0010942012 I N D � � Record Date ', 09 Aug 2013 Check Number 0007417292 $�«.-n-R:-�:.�- ' ,.,,::., _. .�:�:,; >t:��,��rt-�,, ,�.," ''�' ,,,� : .��°�;-��g.�:��--..��._ „:.,,. 001 CSOOOS DomMETL_PG TL�3�7 �>:.. MetLife Policyhol ♦ . �.z..- ._ .. . . ._._� .�_��'�...r,r ^;h,. . .�.a��, �.^�.�^�¢F der T �� 57478/0037� �US1." :: ....:. _� �IVI _.,. _ �. ., dend Distribution �� " �� :: . 3749/i12 ' ^- �..,.:...`TM. _...._{ :x.::."' 03:^."2?Fi'.'�t�Y'�'.'[3.S'.'PIL�Tx4'� T "P.w St. � � . � +� ,:�: � ee �ver for DireCt De � -�� posit Form Attached is your Third Quarber Dividend Summary and check.You can now elect to have �y��s� � .�-�.��w.��,��-��,��-�:��,� _ accoun�To participate,piease complete the enrdiment form on the back of this statemen our d�vidends depositecJ d�re�tly into your bank You may also enroti by ca��ing 1-800-649-3593,and at the main menu say"Direct De ��t a��tum it in the enciosed before ernofling. P or Press 5.Please refer to th�er�lo��o�' Dividend Summary Record Payabie Securi HO�' nt Number C0�10942012 Date I p�e tY Totat Trust Dividend Current Tax I Descri 6on , Net � P I Interests f Deduction Totat St I Rate Distrib ' ock Pnce as of I ubon f Amou Divide 06 Feb nt � I nd a Macket 2013 13 Mar � ) � )I alue 2013 TRUST I I Record Date NTERESTS 31 � �MaY 2013 13 Jun 2013 TRUST tNTERESTS �� 5'74 0•� 5.74 09 Aug 2Q13 13 Sep 2013 TRUST INTERESTS 31 $0.27500 8.53 . 1,1�4.67 37.57000 31 0.00 8.53 1,2$8.29 40.590pQ Year-To-Date Paid $0'27� 8.53 p.pp 8.53 1,542.87 49.77000 22.80 0.00 ■ ,?.'��,v. � 1 U D C M !E T y - OOHXDA-PP ! � � �Q.�-.:E.. c)-J�—��j� li`�,�,c-C�... -- � , c� / � ��"�J ��'tC�'/uC,_ ..-.,-: ��r��°��r� �` ""' ',Computershare -== ' PO Box 43006 � -- Providence„R(Q2940-3006 � Vl�thin USA,US territories b Canada ' 800 649 3593 "— Outs�de USA,US territories b Canada 201 68Q 6578 !_ y+.s�tsr��s ss � AUTO 3-DIGIT 031 000012/0003977 0 Q 3 9 7 7 Hearing Impaired(TDD� 201 68Q 66 t 1 � = �It��lf««If��`��`��IE�Ittlf��"i!'�'li��'�'��'ll�t't �W-computershafe.com/investor = RtCHARD CORNELL _ 36 MURPNY S7 � = MANCHESTER NH 031Q3-6025 Fio[derAccount Number ' ._.. � COQ 10942039 i IV D � � � f I Record Date 09 May 2013 Check i�umber ' f)004149QT9 nr>��Crxu�S. _ �_�.{2r,inx►3�)77nx)�977�it2 . . .._ .R,_.., ,. _Y-:�._.r r..:en.:�-.:..: ... _. .,> F�m 1 _ I. . � _ �_,..�-.._.r.:_... . P �lFTL IQ,tJ MetLife P�licyholder Trust-�Dividend�Distribution�� Enrol�l Now�fo�Direct De f osit! ��^ ,v;:s.:�,.:�:..::�-:a.�..:�..� , �.. � p .._ , .:�,.�...'i��.,......�w:N w`^y..c:.:,1 .. . ....:.....:.:...u"`S.E:.+vS'N:F'a:....:...'Sa:' .''::.::._. ..�..:�-.�:i . - .�_..•. �.'!x.:'..- ',.�.:.:.;�...�._. ...:.gC.s...T_;v*_.^t...""^..:.A.,.-'C2'_�!r.ei3sPE".�'��"43'3!L��..'.RtY..X:'}?7L".�? . :,.r.':�":'.._..::-...: Effecfive May9,2013,MetVfe has increased the quarterfy dividend rate to�0.275 per share.!n addition,you are etigible t receive your funds immediate[y a�d convenie�tty by having your dividends directty d�posited into your bank account Just complete the en /lment for►rr on ti►e back of this s�temenf and retum it in the envetope enclosed.You can also enrott by togging into www com utershare.co /investor or by calling toll-free at 80a649-3593.Ptease see the enclosed insert for further instructions. ' Dividend Sunmary ��, Holder Ac unt Number C0010942039 Record � Payable� Security Totat Trust Dividend Current Tax Net otat Stock Price as of Date Date Descri tian I Interests( � Deduction I P Rate Distribution� Amount $ I Dividend(�)! Market V'lue Record Date � ) � 06 Feb 2013 �Mar 2013 7RUST INTERESTS 14 $0.185Q0 2.59 0.00 2.59 56�.26 40.59000 09 May 2013 �Jun 2013 TRt1ST INTERESTS 14 $0.27500 3.85 0.00 3.85 56$.26 40.59000 Year-TaDate Paid 6.44 0.00 ' � � uQC M � T L "'f- _ OOHXDA-PP � j .`� /� --;�, ! �i _tlit•: � /' f '� • `f' t � ._� . . i�,�`_.� '•✓�-i..��i�l..X.�' � �L.J •�� ` .�v ��S./'��—�; �� RECEIPT FOR PAYMENT GLENDA FARNER STR.ASBAUGH Receipt Date: ' 9/19/2012 Cumberland County - Register Of Wills Receipt Time: 13 :56 :50 One Courthouse S quare Receipt No. : 1071394 Carlisle, PA 17 613 CORNELL RICHARD WILLIAM Estate File No. : 2012-00912 --- Paid By Remarks: R MARK THOMAS DMB ------------------------ Receipt Distribution ------------- ---------- Fee/Tax Description Payment Amount Payee Name ' ' EXEMP LTRS ISSUING 40 . 00 CUMBERLAND COUNTY CENERAL FUN Check# 3831 ---------40 . 00 ' Total Received. . . . . . . . . �40 . 00 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date : 8/20/2012 C�zmberland County - Register Of Wills Receipt Time : I0 :15 :48 Qze Courthouse S quare Receipt No. : 1071066 C"arlisle, PA 17613 C4RNELL RICHARD WILLIAM Estate File No. : 2012-00912 -- - Paid By Remarks : R MARK THOMAS DMB ------------------------ Receipt Distribution -------------___________ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 60 _ 00 CUMBERLAND COUNTY C�ENER.AL FUN WILL 15 . 00 CUMBERLAND COUNTY C3ENERAL FUN SHORT CERTIFICATE 20 . 00 CUMBERLAND COUNTY (�ENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY C�ENERAL FUN Check# 3797 --------123 . 50 Total Received. . . . . . . . . �123 . 50 RECEIPT FOR PAYMENT GLSNDA FARNER STRASBAUGH Receipt Date : 6/11/2013 C��berland County - Register Of Wills Receipt Time: 09 :46 •48 O r� Courthouse S quare Receipt No. : 1074483 C a�lisle, PA 17613 CORNELL RICHARD WILLIAM Estate File No. : 2012-00912 -- - Pa zl By Remarks : R MARK THOMAS HMW -- -`-------------------- Receipt Distribution --------------__________ �'�C':��T�.x L;scription Palrmert Am��an� Payee �TaP.1.E' E�F�IP LTRS ISSUING _________40 . 00 CUMBERLAND COUNTY GENER.AL FUN Cherk# 4152 40 . 00 To t�.l Received. . . . . . . . . �40 . 00 RECEIPT FOR PAYMENT ------------------- ------------------- �ZENDA FARNER STR.ASBAUGH Receipt Date : 4/10/2013 Cumberland County - Register Of Wills Receipt Time : 12 : 10 : 16 ane Courthouse S quare Receipt No. : 1073761 C arlisle, PA 17613 CORNELL RICHARD WILLIAM E state File No. : 2012-00912 Paid By Remarks : R MARK THOMAS WZ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Pa�ree Name PETITIONS 15 . 00 CUMBERLAND COUNTY GENERAL FUN CITATION 20 . 00 CUMBERLAND COUNTY GENER.AL FUN Check# 4085 $35 . 00 Total Received. . . . . . . . . $35 . 00 RECEIPT FOR PAYMENT Receipt Date: 6/11/2013 GLENDA FARNER STR.ASBAUGH Receipt Time : 09 •46 •48 Cumberland County - Register Of Wills Receipt No. : 1074483 �arllslethPAse17�l3re CORNELL RICHARD WILLIAM Estate File No. : 2012-00912 Paid By Remarks : R MARK THOMAS HMW ---------- ________________________ Re�eipt Distribution ------------`- c Ta�. ��li tion Paymer.t Amc�ant P�yEe ?�T�'•"le F� / v �r+/'t r � ING 40 . 00__ CUMBERLAND COUNTY GENERAL FUN EXEMP LTRS ISSU _____________ Check# 4152 - . . . . . . • $40 . 00 Total Received. $40 . 00 � i _ __ _ __ _ _ . r + � ' finaneiaf PrirrcN�at�.�fe �fQU�I �nsur�nce CQmpar�y Princpr Financia[ January 13,2014 Servi�es Corporation R. 1�2ARI�THOMAS 101 SOUTH MARI�ET ST MECHANICSBURG, PA 17055 Re: Richard W Corneli ' Contract No. 8677904 ' Deax R. Mark Thomas: Thank you for contacting the Principal Financiai Group for further information on the above�isted policy.Per your request I am providing you with the Date of Death value. ' Value as of 7/17/2012 was 8,651.44 with a Cost Basis of$7,000.00. If you have additional questions concerning this information or need further assistance,a custpmer service representative can be reached at 1-800-852-4450,Monday through Friday,7 a.m.,to�p.m., CST Sincerely, The Principal Financial Group� RIS Annuity Services (800}852-4450 Enc: ' Corporate Cer�ter:Qes Moines,lowa 50392-177Q(800►852-4450 Securities offered through Princor Financia!Services Corporation,(S00)247-1737,member SIPC. Frincipal Life and Frrncor'�are memoers of tne Frincipaf Financiai Group�,Ges f'vloines,l�4 50392 EE67t7-6 �� RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 12/18/2013 Cumberland County - Register Of Wills Receipt Time : 09 : 06 :40 One Courthouse S quare Receipt No. : 1076506 Carlisle, PA 17613 CORNELL RICHARD WILLIAM Estate File No. : 2012-00912 Paid By Remarks : R MAR.K THOMAS DMB ------------------------ Receipt Distribution -�---------------------- Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY G�NERAL FUN ---------------- Cash $10 . 00 Total Received. . . . . . . . . $10 . 00 �:� * � «' �'�� i11 �n� �P�fttmPnt uf :._� �� T T �` -'- �; Of ��— � ... �z�-� o .. ;v.' RICHARD W.CORNELL v�'` � `-;`�� :-�c:. �� -., o� �.:-�.. KNOW ALL PERSONS BY THESE PRESENTS that I,Richazd W.Corr�of � �� c.� T, Wakefield,Catroll County,New Hampshire,being of sound and disposing mind and memory do hereby revoke any and all prior wills and or codicils by me made and do make,publish and declare my Last Will and Testament to be as follows: FIRST: I direct my executor or executrix,hereinafter named,to pay all my legal debts and funeral/cremation exnenses,and eXnensP�Qf a�1mj:�igtrat.�r.as soo::2f#er my death as practical. I further direct that all such debts and expenses,as well as all estate, inheritance,transfer,legacy or succession taxes(state and federal),and any interest and/or penalties thereon which may be assessed or imposed with respect to my estate or my will, including the taxable value of all policies of insurance on my life,and all transfers, powers,rights or interest includable on my estate for the purposes of such taxes and duties shall be paid out of my residuary estate as an expense of administration and without apportionment,and shall not be pro-rated or charged against any of the other gifts in this will or against property not passing under this will. SECOND: In the event I am survived by my wife,Naomi A.Comell,I specifically give,devise and bequeath nothing to her and I give,devise and bequeath all the rest, residue and remainder of my estate,real,personal or mixed,wherever found and however si#uate,including property over which I may have the power of appointment or disposition to my children that survive me in equal shares per stirpes. 1 I-iiKD: In the event I am not survived by my wife,Naomi A.Cornell,I give,devise and bequeath all of the rest,residue and remainder of my estate,real,personal ar mixed, wherever found and however situate,including property over which I may have the power �f appointment or disposition to my children that survive me in equai sharzs per stirpes. LASTLY: I nominate and appoint Paul R.Cornell as executor of this,my Last Will and Testament. I request that no bond shall be required of any fiduciary named pursuant to the terms of this my Last Will and Testament,except insofar as may be required by law. •�,.�►a��z� �/ �` '� w �� PAGE� IN WITNESS WHEREOF,I have hereunto set my hand to this,my Last Will and Testament,consisting of two(2)pages this�h day of �"��af . ,200�. —� �.t,�� [;.�✓�� Richazd W.Cornell Witnesses: Addresses: � _ Effingham,New Hampshire Marilynn aughan _ ��-;:�r� %'{'.�,�_: �..: ��=��''�'.---- West Ossipee,New Hampshire r Kathleen Zervas-� State of New Hampshire Carroll,SS. The foregoing instrument was acknowledged before me this `� '�day of _�: - � ,2005 by Richard W.Comell,the testator,Marilynn Maughan and Kathleen Zervas,the witnesses,who under oath do swear as follows: l. The testator signed the instrument as his wiil or expressly directed another to sign for him. 2. This was the testator's free and voluntary act for the purposes expressed in the will. .�. F.aC11 Wlt2?PCC ci��l at thn r�l�,PCt�frh��St3tJZ,:�h;s�•�S�r••� �•.a ' L�'1' � . •a_ 1�. ��L�r�.�411�1 lil �r presence of the other witne�s. 4. To the best of my knowledge,at the time of the signing the testator was at least 18 years of age,or if under 18 years,was a married person,and was of sane mind and under no constraints or undue influence. .��.s/� �.�c c�/i � Jay S.Clough Justice of the Peace My commission expires:May 19,2009 .� '�� r� ..'t✓C ¢ � i