Loading...
HomeMy WebLinkAbout01-29-14 REV-1500 EX 102-i1j 1505610143 PA Department of Revenue Pennsylvania USE ONLY p perms Ivania Counry Code Year File Number Bureau of Individual Taxes Mo�!N.aF ae,ESae PO 60X.280601 INHERITANCE TAX RETURN 21 13 0789 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 05 06 2013 09 04 1917 Decedent's Last Name Suffix Decedent's First Name Mi BOUGHTER RUTH M (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 L^J 1. Original Return 2. Supplemental Return 3. RReom`iinder Return(Date of Death 4. Limited Estate 41,Future Interest Compromise (date of deem aftio 12-12-92) 3. Federal]Estate Tax Return Required G.I 6, D6Wdem Died Teat®ta 7 (galacoaTGopy of inuel)a Living Trust __ a, Total Number of Safe Deposit Boxes LXJ (Attach Copy of Will) Ej S. Litigation Proceeds Received 10.beprp1:sen i ai �` t�-tom- }°r oeam 11.Election to tax under Sec.9113(A) (Attach Schedule 4) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SEAN M SHULTZ 717 243 6222 4 REGI3iE"F WILLS-USE ftljyLY1 First Line of Address M T C a 2 --I i1 rn 26 W HIGH STREET un 7 rl a C.G Second Line of Address cJ f, ��,.,*� —c: CN 4 i DATE FILEW t— Frl City or Post Office State ZIP Code v CARLISLE PA 17013 Cr> Correspondent's e-mail address: dhockenberrypssr-attomeys.com It is true,correect anperjury,mlette Declaration of prepaner examined the personal representative Ss based on and statements,nformation and hich preparer has any klnowledge.bolief, SIGNATURE OF PERSON RESPONN'SIISLE_FOR FILING RETURN DATE r,1. Lewis E.Eticker, 111 ( 12//� „_ ADE5RESS 519 North Road York PA 17403 SIG E OF PREP RER THE REPRESENTATIVE DATE i — [ 7` Sean M. Shultz I�2/1 ADDRESS 26 W. High Street Carlisle, PA 1505610143 Side 1 1505610143 j } �JY i PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE PLUMBER Boughter, Ruth M. 21-13-0788 Under penalties of perjury,1 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 kno edge. Signature#2 Name Ronald E.Bou hter Addressl 515 Hogestown Road Address2 City, State,Zip MachanicsburA,PA 17050 Date a �L 1 1505610243 •�•J REV-1500 EX Decedent's Social Security Number D..dwrs Nerve_ Boughter, Ruth M. RECAPITULATION 1. Real Estate(Schedule A)........................-.......-.....-............. ....... 1. 2. Stocks and Bonds(Schedule B)...............................__............... ....................... 2. 145,203.10 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D).........-...............--................. .... 4. 5, Cash,Bank Deposits&Miscellaneous Personal _sonal Property(Schedule E) ............. 5. 167,016. 61 6. Jointly Owned Property(Schedule F) U Separate Billing Requested...,........ 6. 895. 96 7. Inter-Vivos Transfers&MiscellaneousIr°�-Probate Property (Schedule G) u Separate Billing Requested............ 7, 22 ,487 .40 8. Total Gross Assets (total Lines 1 through 7)........................................................ 6, 335, 593 . 07 9. Funeral Expenses and Administrative Costs(Schedule H)..............._................-. 9. 15,055. 18 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1),................--....... 10. 11. Total Deductions(total Lines 9 and 10)................---....................................... 11. 15,055.18 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 320,537 . 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, 320 ,537 . 89 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 15 0 .00 (a)(1.2)X.00 16. Amount of Line 14 taxable 320,537 . 8,9 16. 14,424 .21 at lineal rate X .045 17. Amount of Line 14 taxable 0. 00 17 0 .00. -at sibling rate X.12 18. Amount of Line 14 taxable 0 . 00 19 0 . 00 at collateral rate X.15 19. TAX DUE......---..........---...........,. 19. 14,424 .21 , 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-13-0789 Decedent's Complete Address: DECEDENT'S NAME Boughter,Ruth M. STREETADDRESS 515 Hogestown Road CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 14,424.21 2. Credits/Payments - A. Prior Payments 582.72 B. Discount 29.22 Total Credits(A +B) (2) 611.94 3. Interest (3) 4, If Line 2 is greater than Line 1 +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) 13,812.27 Make Check a 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;............................................................................... El ❑x b. retain the right to designate who shall use the property transferred or its income:............................ .... El ❑x c. retain a reversionary interest;or............................................................................................................... ❑ d. receive the promise for life of either payments,benefits or care?...........................-............................... ❑ ❑x 2. If death occurred after Dec. 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 account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑ contains 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 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-1503 EX+(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RMRN RESIDENT DECEDENT ESTATE OF FILE NUMBER Boughter, Ruth M. 21-13-0789 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 MetLife Inc.Stock-42 shares-See attached letter dated 1,711.50 August 21,2013 from Computershare 2 U.S.Savings Bonds -See attached list of Savings Bonds 143,491.60 and values TOTAL(Also enter on Line 2, Recapitulation) 145,203.10 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98) [cuyou know?Most shareholders can manage their holdings online with free �� AUG 2 6 2013 ess to Computershare's Investor Centrer"website. Use this simple tool to (otnputershare kly and easily update account information,sign up for electronic delivery of ments and more. Enroll FREE today at www.computershare.com/investor. Computershare Investor Services 250 Royall Street Canton Massachusetts 02021 www.computershare.com SEAN M SHULTZ 26 WEST HIGH STREET CARLISLE PA 17013 August 21, 2013 Company: METLIFE INC Registration: RUTH M BOUGHTER Holder Account Number: C0005249848 Document I.D.: 13211WF00382886 Our Reference: METL/0002847352/7/ Dear Sir/Madam: Thank you for contacting Computershare regarding the above referenced MetLife account. On May 06, 2013, account number C0005249848 held 42 shares. On that date, the closing price was $40.75 per share. Our records indicate that we have only one account in the name of Ruth M Boughter and it is registered as an individual account.The above referenced account was opened on April 7, 2000 as a result of MetLife Inc's demutulization. For your convenience, we have enclosed the form and instructions needed to transfer stock to a new account or another holder. If you have any additional questions or concerns, please call our Customer Service Center at 1=800-649- 3593 or 1-201-680-6578. You may also 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: MetLife-US Holder-Deceased Transfer Package.pdf i Calculated Value of Your Paper Savings Bond(s) Page I of 1 Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 05/2013 Total Price Total Value Total Interest YTD Interest 38 504.40 $143,491.60 $104,991.60 $2,328.00 Bonds: 1-40 of 40 Serial # Series Denom Issue Next Final Issue Price Interest Interest Value Note Date Accrual Maturity Rate _M14473609EE;,,, EE :.$1,000 06%19$6 06%2913,06/2016:_ $500.00 .$1,508_00_ 4.00%1 $2,008.00 : ...... M15723 EE' EE :$1,000 06/1986 06/2013;_06/2016;__.._._$500.00; .$1,568.00!__4.00?/u,__$2,008.00i_ 415723395EE_ EE !$1,00006J19M;068013�06f2016 _ $500.00, . ,$1,54800,- 4.00°/x $2,00840 _... M14473610EE�,. EE ,.$1,040„4fif5486,06f2013,06/2016_. , $500 00„_„$1,508 40� 4!0Q0/V_... „ $2,008.00: M15723393EE _ EE $1,000,06%1986,06/201306/2016;_. $500.00: . $1,508 00 4.00%: V ,;$ ,,000,,06/1986,;06/201306/ 06;_ . . $500.00 M572394EE . ...,,$1,,,508,.00,, 4.00/ ', $2,,008.00 M15723392EE EE $1,006-66/1986;06/201306(2016 $500.00 $1,508.00; .4.00% $2,00840 _, M15723391EE EE $1,40006/1986 06(201306,12016_ $500.00 4.00% $2,008 00- M15 72 , . _ , , 0306/2016: $5000 4.00°/ ; $2,00800 V2279363EE EE ,$500010/199110/2013, 10/2021; $2,500.00 $ ,94.00 4.00% , 4 00: 2279362EE, EE $5,000;10/5991;108013_1oJ2921 $2,540.40 . 4 a 74 44.00$4,944.00„ __- __,...._. V2279984EE, EE ,$5,400,10J1995;IOJ201310j2025 $2,540 04 $4,904 00 4.00%- ,, $7,404 00_ V2279979EE, ,,EE._.$5,000.10/1991,10(2013; 10/2021;, $2,50,0,00 , ,,$4,904 00 „4 00%0,_, $7,404, V2113472EE._ EE _;$5 000,01/1991„07/2013;0112021;.., $2,500.00, V191017EE :,_ EE ;$5,000.03/1985,098413=03/201,5;_ $2,500.04, $8,154M, 0 $10,65444; _.., .V191018EE.. EE ,$5,00003j1985,09/2013!03/2015„ $2 500:00 ....,$8,154 00,. 4 00°!0 $10,654 00. M9232401EE, EE $1f000;04J1985,10(2013:04/20i5;. $500.00, ,$1,63080m;_4.00/ $2,13080. _M9232400EE...EE $1,000 04(1985;10[2013;04/2015; $500.00 80,.,.4.00%' , $2,119.49: _M9232402EE EE_.,_$1,000 44/1985,10/201304/2415,. $500.00,- 49232398EE; EE 000.04(1985,10%2013,04/2015; $500.00, _149232397EE; EE -.$1,000.04/1985,10(2013 04/2015;,. $500.00 , ,.,$1,630 80^ 4,00°/a, $2,130 80, __M9232394EE. .,EE..;$1,00004(1985�10(2013,04f2015, ,$500,00 .,„.$163080„,,4.00°/a,,,.._$2,13080x,_...,,. M9232395EE_ EE $1,000904/1985;10/2013,04'/2015., $540,00, „ $1,63086, _4.40'5$.__. M9232394EE; EE, ,$1,000 04/1985.10/2013, 04/2015; M9232393EE EE.__,$1,0,00,04/,1985,10(2013.:04/2015,,, $500.00, $1,630 80„ 4.00%„_ ..$2,180 M38924000EE EE $1,000,04(1990:10/2013 04(2020 $500.00 $1,071,60, 4.00°/a $1,571.64 M38923999EE- EE _„$1,400,04/1990,14/2013,948020; , _ $540.00.___. $1,071 60 4.00°fg; , $1,571.60. M38923998EE , EE_. ;$1,000 04/5990,10(2013,04j2620; $500.,00. .,_$1,07160 4,00%;, .$1,57160 ..., M38923997EE,,,EE -_.$1,000 04/1990,10%2013; V1902112 EE . EE ;$5,000;04/1990;10/2013; 04/2020; $2,500.00, _$5,358.90'_ 4.00%; $7,858.00: -. V192368EE; EE _ $5,000105/1985,11/2013;0512015;, $2,500.04 $8,154.W . 4.00%, $10`16.54.o.0- � VS'92369EE;. ,EE ;$5,00005(1985 118013;058015; ,$2,500.00; „ $8,154;004.,4.00°/0! $30,654,00.. , ,; _D6565020EE;_ EE $500�08/1984i08/20i3, 08/2014;, $259,00 „ $836 60, 4200%, $1,085 60 „ D__656 5021EE; EE_ 00,081984 . - _, $2- 50.00 ,.$8.3.6.60, 4..0--0-%a ,_$1,0$660 014 D6148255EE EE 8/1984;48 2113;08214 $250.00 403 $1, 66 08 .60 :--- ,.D3943890EE _ EE MA,,, D3943889EE; EE $500 03%1983, _ :03/2013„ $250.00 ,$903 20, $1,153.20 _MA D261114894Ej E , ._$504,021.1978,_ !42/2008.;_, $375.04. "$2,194.00' $2,559 OO D206072859E= E $500,03/19M :03j2008;,_ .$375X0: $1,795.8,4; $2,170 84 .MA. Totals for 40 Bonds'$38,SOO.00-$104r991.60 $143,491.601 Notes NI :Not Issued Ni ,Not eligible for payment_ PS 'Includes 3 month interest penalty 144, A Ma : tured and not ea rning Interest http://www.treasurydirect.gov/BC/SBCPrice 1/17/2014 Rev-0508 EX+(11-10) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Boughter, Ruth M. 21-13-0789 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the dght of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1993 Oldsmobile Cutlass-fair condition-See attached Kelly Blue Book valuation 650.00 2 Federated Equity Income fund Account No.XXX6394-See attached letter from Federated 12,143.85 Shareholder Services Company dated July 30,2013 3 Federated High Income Bond fund Account No.XXX6394-See attached letter from 31,321.70 Federated Shareholder Services Company dated July 30,2013 4 Oppenheimer Fund Account No.007407400331716-transfer on death to Linda A. Elicker and 24,471.35 Ronald E. Boughter-See attached letter from Oppenheimer Funds dated July 26, 2013 5 Union Community Bank Checking Account No. 130222-See attached letter from Union 2,062.11 Community Bank dated July 25, 2013 6 Wells Fargo Account No.8612-6288-See attached Estate Valuation Report dated September 96,367.60 18, 2013 TOTAL(Also enter on Line 5, Recapitulation) 167,016.61 (I1 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) 1993 Oldsmobile Cutlass Supreme S Sedan 4D Trade In Values- Kelley Blue Book Page 1 of 3 MZIPCODE:17070 I Sign in(or Signup) home I car values I cars for sale I car reviews I kbb top picks I research tools 2013 Volkswagen Passat T Popular at KBB.com Best.Thing.Ever, m,.I.ble at Event / SUTLIFF VOLKSWAGENS me 90 mpg Cars of 7013 Seespetaal Offers Clickfa Pno, pu,A. dO.MRMrtnt _.. . . n"Y aM' Home>Car values>Oldsmobile> Cutlass Supreme> 1993>Category>style>options> Oldsmobile vj Cutlass Supreme vl 1993 v"1 Go S Sedan 4D Your Blue Book®Value Show Used Car Prices l Price Your Next Car 1993 Oldsmobile Cutlass Supreme Style: 55edan 40 vi edit options 1 check specs Mileage: 9e:11650001 Change uke ftcar Trade-In Value Private Party Value when trading in at a dealership when selling the car yourself Print Report Excellent aavemsament $1,275 Shop for your next car Price a new car why ads, Very Good $1,175 Understand Your Credit Good Instant Trade-In Offer Get the otter Better Understand Greditor Decisions $1,125 Fair $650 Own it? Love it?Tell Us. write a review 623 Verify Conditions With enrpitnent In h>r r s Tack this cars _.-._ . .- dltscore.com"' VaI11e5 .. - ___ _ • ti • •YT k Values valid until Sell your current car Place an ad mWuL. 07/25/2013 (updated weekly) - Helpful Resources from KBB.com � � Apply for Financing Get Selling and Advice Check Local Prices Lock in your you, a.then See the pros and cons See what people near you shop for your next car. ofdifrerentways tosell areasking for theircars. 1 Search Cars for Sale Get a Used Car Report near New Cumberland Get the Information You Need on This i .Oldsmobil v CuOass Supreme Iv 1993 Oldsmobile Before You Buy Search Nhsdseme"t «,Iry ads> Recently Viewed Cars I MY Saved Cars Save car http://www.kbb.com/oldsmobile/cutlass-supreme/I 993-oldsmobile-cutlass-supreme/s-seda... 7/23/2013 AUG 0 2 2013 Federated Shareholder Services Company Pittsburgh,Pennsylvania NewYork,New York Boston,Massachusetts Dublin,Ireland Federatedlnveston.com Federated WORLD-CUSS IN TMWT MA MGM July 30,2013 Law Offices of Saidis Sullivan&Rogers A Proffessional Corporation Attn Sean M Shultz 26 W High St Carlisle PA 17013-2922 Reference: 00627621 Ruth M Boughter Dear Mr. Shultz: Thank you for contacting Federated. We welcome the opportunity to assist you. As of the close of business on May 6,2013,the balance of the Federated High Income Bond fund,account number 36394,was$31,321.70,based on 3,881.2520 shares at the net asset value of$8.07 per share. As of the close of business on May 6, 2013,the balance of the Federated Equity Income fund,account number XXX6394, was $12,143.85,based on 561.9550 shares at the net asset value of$21.61 per share. The account was established on May 12, 1997. The dividends were re-invested and there is no accrued interest. The capital gains and dividends are reinvested into the account. The account is registered as an Individual account in Ruth M. Boughter's name. If you have questions,please contact a Federated Client Service Representative for assistance from 8:00 a.m.to 6:00.p.m.,Eastern time,at 1-800-245-4770. Sincerely, D Steve Perry Vice President Au6 u t 0113 y � 6 OppenheimerFUnds Sees� z�� b�"'�; OPPENHEIMERFUNDS" THE RIGHT WAY TO INVEST Denver'CO 80217 5270+.x, sq �`. kt www.oppenheimer/unds'c'ofn .' 111111111111111 If III III 11'11111 July 26, 2013 i�� SAIDIS SULLIVAN&ROGERS r ATTN SEAN M SCHULTZ 26 WEST HIGH ST CARLISLE PA 17013 Re: Estate of Ruth M. Boughter Date of Death:May 6, 2013 Dear Mr. Schultz: We recently received your correspondence informing us that our client, Ruth Boughter recently passed away. Please extend our condolences to Ms. Boughter's family. We recognize that this is a difficult time for the family, and we want to do all we can to assist you with reregistering the account. Ms. Boughter designated Linda A. Elicker and Ronald E. Boughter as the transfer-on-death beneficiaries for her sole owner account. The account was opened and funded on September 20, 2002. The value of Ms. Boughter's account on the date of her passing, May 6, 2013,was as follows: Account Number Number of I Share Price at Total Account Shares Net Asset Value Value 007407400331716 2,120.568 $11.54 $24,471.35 Please remember that past performance does not guarantee future results. Ms. Boughter's account is invested in a mutual fund. The dividend distributions reinvested to her account between May 6, 2013 and July 25, 2013,were as follows: EDate of Dividend Share Price at Shares Order Dollars stribution Net Asset Value Purchased y 28, 2013 $11.51 9.031 $103.95 e 25, 2013 $10.60 9.849 8104.40 y23, 2013 $10.55 9.931 $104.77 To transfer the assets to the named transfer-on-death beneficiaries, we need the following: • A letter signed by each beneficiary stating specifically what should be done. • An Inheritance Tax Release or Consent to Transfer from the decedent's state of residence which specifically releases all shares owned in the account on the date of 6 P Nk death. It will be necessary to know the market value of these shares on the date of death or on the business day closest to the date of death. l+= To obtain an Inheritance Tax Release,you may wish to contact the following office: Commonwealth of Pennsylvania Department of Revenue Bureau of Individual Taxes Inheritance Tax Division—Security Reporting Unit Department 280601 Harrisburg, PA 17128-0601 Telephone number: (717)787-8327 • A completed and signed Account Application from each beneficiary. We have enclosed an Account Application for each beneficiary. Once completed,you may fax the paperwork to us at 303-768-1500 or mail the paperwork to us in the enclosed postage-paid reply envelope. Please reference IDOC#205840450, our case number for Ms. Boughter's accounts, in your correspondence with us. After we receive the required documentation,we will be pleased to honor the request. If you have any questions, please call the Estate Team at 1-800-228-7774. We are available Mondaythrough Friday from 8:00 a.m.to 7:00 p.m. Eastern Time. Sincerely, Patty Sward Oppenheimer Funds The Right Way to Invest Encl: Account Applications(2) Postage-Paid Reply Envelopes(2) IDOC# 205840450 OPPENHEIMERFUNDS" t, THE RIGHT WA Y TO INVEST Union JUL 2 61013 COMMUNITY BANK July 25, 2013 Law Offices of Saidis, Sullivan & Rogers Attn: Sean M Shultz - 26 West High Street Carlisle PA 17013 ' RE: Estate of - Ruth M Boughter Dear Sean: There follows the information you requested on the accounts of Ruth M Boughter as of May 6, 2013. This account is solely owned with Ronald E or Linda E Boughter as Attorney-in-fact: Opened Balance Acr Int Ytd Int Rate Checking 1 130222 1 05-02-91 12,062.11 0.00 0.00 0.008 This account was a solely owned Certificate of Deposit closed 04-01-13: CD 1520015172 03-25-05 lClosed 4-1-13 10.00 10.00 3.258 If you should have any questions, please do not hesitate to call me at 492-2251. Sincerely, UNION COMMUNITY BANK Audrey L Buckner Administrative Assistant 570 LAUSCH LANE,SUITE 300,LANCASTER, PA 17601 TEL 717-492-2222 www.unioncommunitybank.com ® Wells Fargo Advisors LLC One North Jefferson Ave � � • • St.Louis,MO 63103 September 18, 2013 Sean M. Shultz, Esquire 26 W. High Street Carlisle,PA 17013 RE: Estate of Ruth M.Boughter Dear Sean M. Shultz: Thank you for contacting Wells Fargo Advisors regarding the account(s)of Ruth M. Boughter. Attached is the information regarding the date of death valuation requested. If you need any further assistance,please contact Barry Krisko at 717-361-0002. Sincerely, L J�fi�ct luL ;7&z&e Kristin Fluchel Assistant Vice President Wells Fargo Advisors, LLC Together we'll go far Member FINRA/SIPC Estate Valuation Report Prepared for the accounts of RUTH M BOUGHTER ` LU t�s aet�a dins t S 2 �r 3RTFi MARKET STRE�T a � q -` ELlZABET[�TC?Vt7N �A 1022" �x I Together we'll go far ft---ows—m—W.' ' .f-W The Federal Estate Tax is an excise tax on the right to transfer Accruals are simply cash owed to the decedent the day he died. property at death. Therefore,if you re-evaluate the value of this cash six months later,it will still be worth the same amount.The value of accruals The gross estate includes all assets owned at death.This includes: is unchanged between the Date of Death and the Alternate assets held in individual names,the appropriate share of assets Valuation Date, owned as tenants in common,one-half of the jointly held property where the joint tenants are husband and wife,and all of jointly- Investment items that do not represent cash,however,are., held property wherejoint tenants are not married to each other re-valued on the Alternate Date because their worth may —subject to the surviving tenant's ability to prove contribution have changed Stock,for instance,can change in value with to the purchase of the property.Life insurance death benefits are the fortunes of the company and could potentially be worth included in the gross estate if the insured was the owner of the something much different six months later.It is,therefore,re- policy or if the death benefit was payable to the estate of evaluated for the Alternate Valuation Date. the insured. T-Bills,E and EE Bonds are bought at a discount and rise daring The Estate Valuation Report provides the value of assets the course of their lifetime to their face value.This increase is including:Equities,Municipal Bonds,Mutual Funds,Savings steady,predictable,and represents accrued interest.Therefore, Bonds,Corporate and Government Bonds,GNMAs,FNMAs, Alternate Valuation Date reports will show the same value.for FHLMCs,CMOs,Unit Investment Trusts(UlTs),U.S.Treasuries these securities as Date of Death reports. and Savings Bonds(E,EE,H and HH). Notes regarding Alternate Valuation Date: Terminology All assets are included in the gross estate at their"fair market Date of Death:If that date falls on a holiday or weekend,then value'on the Date of Death or if the executor elects,their value the previous and following market dates are used in determining six months after date of death,which is referred to as the Alternate value in the estate. Valuation Date.The election between the Date of Death and the Alternate Valuation Date exists to allow the tax burden on an Valuation Date:Date of the historical quotes requested,usually estate to reflect the value of that estate as accurately as possible. the same as the date of death. For example,the value of an estate can change dramatically during a six-month period of time depending on stock market conditions. Alternate Valuation Date:Date six months after the date of This fluctuation can dramatically affect the amount of estate death.Can only be used if estate tax burden is reduced. taxes owed. Security Description:Issuer name,CUSIP number,and other If the Alternate Valuation Date is elected,assets are revalued as of informational messages relating to the holding. that date.Assets sold or distributed during the six-month period between the Date of Death and Alternate Date are valued at the CUSIP Number:Unique identifiers assigned to every publicly date of the sale or distribution.Assets remaining are valued on the traded security in North America.While such identifiers as date six months after the Date of Death.The Alternate Valuation ticker symbols can be duplicated across different exchanges Date can only be used if it results in a reduced tax burden on and change with a company's name,CUSIPs change much an estate. less frequently and their re-use is tightly controlled by strict rules.The word"CUSIP"comes from the name of the group When requesting an Alternate Date evaluation,it is possible that that created them,the Committee for Uniform Securities not all of the asset values have changed,and you will notice that Identification Procedure,a committee of the American accruals do not continue to accumulate after the Date of Death. Banking Association. According to IRS Regulation 20.2032-1,any item in an estate that can change in value for any reason other than the simple passage Shares or Par: For stacks,the number of shares or units held, of time can be re-evaluated on the Alternate Valuation Date. For bonds,the face amount(par).If the quantity is unavailable, Anything else—accruals,for example,which would only change the information provided is based upon one share of stock or because more time has elapsed—keep their Date of Death value. $1,000 par for bonds. High/Ask,Low/Bid,Mean:The mean price is calculated as an �sce average of the high and low on the valuation date when available. 1 c If these prices are not available,such as on holidays or weekends. This Estate Valuation Report provides ^ ,.. 3 the mean price is the inversely weighted average of the high and historical securities pricing as of a particular.d low on the nearest trading dates before and after,when these prices , .' �p ko Date of Death;which you have'specified.,j.' are available within one week of the valuation date.If actual trades Wells Fargo Advisors(WFA)obtains tlui are not available,the nearest bid and ask prices are substituted. historical data from Estate Valuations; .< 4?, S S Securities traded on a Canadian exchange are reported with and Pricing Systems,Inc.,a company,not r AA Canadian prices and an exchange rate.The value of the security is reported in U.S.Dollars. related to WFA,which in turn compiles'Phis i Aq information from a number of sources.While X Security Value:For stocks,the number of shares times the mean we deem this information to be reliable,'WO,4 c' price For bonds,the par value times the mean price,divided by 100. do not warranty or guarantee its accuracy, O ca- - WFA assumes no responsibility for[he,", Accrued Dividend:If an equity is ex-dividend for a cash accuracy or completeness of the irifOrril z ato ionr. . , distribution on or before the valuation date but is of record after you provided,including the Date of Deathz the valuation date,the dividend is included in the valuation report and the specific securities whicli are value'd.S+3r' and is added to the security value.if the date of death is on or after cluded in q '+y , the record date and the dividend is payable after that date,the There will typically be assets in- _ . .. accrued dividend is listed separately on the report and added to the the estate for legal,probate,or,tax purposes,, Portfolio's total value. which are not listed on this repoit This service is not intended to constitute legal` v:1- Accrued Interest:Interest is accrued for bonds from and tax advice. You should consult with yotru_t8x�N including the last payable date up to but not including the date of professional and attorney to discuss estate death. Interest accruals are calculated on a 30/360-day basis for settlement and any legal matters.­' :A. corporate,government agency,and municipal bonds.An actual day basis is used for U.S.Treasury Bonds and Notes.It is assumed that Interest is paid semi-annually and coupon dates fall at six-month intervals corresponding to the maturity date. Stock Dividend(Div.)Dates:"E"denotes the date the dividend was declared."R"represents the date of record.'P"is the payable date. Bond Interest(Int.)Dates:"F"denotes the date current period interest began accruing and'T'the date to which interest due has been calculated. t INVESTMENT AND INSURANCE PRODUCTS: NOT INSURED BY FDIC I NOBANKGUARANTEE I MAYIOSEVAUIE Wells Fargo Advisors is the trade name used by two separate,registered broker-dealers:Wells Fargo Advisors.LLC and Wells Fargo Financial Network,LLC Members SIPC,non-bank affiliates of Wells Fargo&company. Wells Fargo Advisors does not provide tax or legal Advice.please consult with your own tax and legal advisors before taking any action that would have tax or legal consequences. m 2010 Wells Fargo Advisors,I.I.C.All rights reserved ECG-236104 0510-0414 586990 Rev00 Estate Valuation Ruth M Boughter Date of Death: 05/06/2013 Estate of: Ruth M Boughter Valuation Date: 05/06/2013 Account: 8612-6288 Processing Date: 09/18/2013 - Report Type: Date of Death Number of Securities: 12 File ID: Boughter Ruth 8612-6288 Shares Security Mean and/or Security Div and Int Identifier or Par Description High/Ask Low/Bid Adjustments Value Accruals 1) CASH 14591.17 BANK DEPOSIT SWEEP 14,591.17 Accrual 0.02 2) 260543103 58 DOW CHEM CO (DOW) CUM New York Stock Exchange 05/06/2013 34.18000 33.79000 H/L 33.985000 1,971.13 3) FEM 218 FIRST TA EXCH TRO ALPHA FD II EMERG MKT ALPS NYSE Arca Equities Exchange 05/06/2013 26.60000 26.41000 H/L 26.505000 5,778.09 4) FM 238 FIRST TR EXCHANGE TRADED FD II TECH ALPHADEX NYSE Arca Equities Exchange 05/06/2013 24.20880 24.08000 H/L 24.144400 5,746.37 5) 437076102 27 HOME DEPOT INC (RD) COM New York Stock Exchange 05/06/2013 75.37000 73.86000 H/L 74.625000 2,014.88 6) ACWI 148 ISHARES MSCI ACWI ETF The NASDAQ Stock Market LLC 05/06/2013 52.77000 52.59000 H/L 52.680000 7,796.64 7) 718172109 21 PHILIP MORRIS INTL INC (PM) CON. New York Stock Exchange 05/06/2013 94.08000 92.85000 H/L 93.465000 1,962.77 8) 78462£103 150 SPDR ESP 500 ETF TR (SPY) TR UNIT NYSE Arca Equities Exchange 05/06/2013 162.01000 161.42000 H/L 161.715000 24,257.25 9) 921937835 180 VANGUARD HD INDEX FD INC (BND) TOTAL BND MRHT NYSE Arca Equities Exchange 05/06/2013 83.81000 83.69000 H/L Div: 0.16195 Ex: OS/Ol Aec: O5/03 Pay: 05/07/13 83.750000 15,075.00 29.15 10) 92343V104 38 VERIZON COMMICATIONS INC (vZ) COM New York Stock Exchange 05/06/2013 52.65000 51.94000 H/L 52.295000 1,987.21 11) QISGX 384 FEDERATED MDT HER MDT SMLCP OR I Mutual Fund (as quoted by NASDAQ) 05/06/2013 14.77000 Mkt 14.770000 5,671.68 12) HWDIX 876.732 HARTFORD MUT PUS INC " WORLD ED FD I ,. Mutual Fund values reported to NASDAQ 05/06/2013 10.82000 Mkt 10.820000 9,486.24 Page 1 This report was produced with EstateVal, a product of Estate Valuations S Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.c=. (Revision 7.3.1) Date of Death: 05/06/2013 Estate of: Ruth M Boughter valuation Date: 05/06/2013 Account: 8612-6288 Processing Date: 09/18/2013 Report Type: Date of Death Number of Securities: 12 File ID: Boughter Ruth 8612-6288 Total Value: $96,338.43 Total Accrual: $29.17 Total: $96,367.60 Page 2 This report was produced with EstateVal, a product of Estate Valuations 6 Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1) Rev-1509 EX.(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Boughter, Ruth M. 21-13-0789 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. Linda E. Boughter 515 Hogestown Road Daughter-in-Law Mechanicsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER FORJOIN -MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE DECEDENTS INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST 1 A 09/10/2005 Members 1st FCU Checking Account No. 1,502.14 50.000% 751.07 271325-11 joint with Linda E. Boughter-See attached letter from Members 1st FCU dated July 25,2013 2 A 09110/2005. Members 1st FCU Savings Account No. 269.78 50.000% 134.89 271325-00 joint with Linda E. Boughter-See attached letter from Members 1st FCU dated July 25, 2013 TOTAL(Also enter on Line 6, Recapitulation) 885.96 (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) JUL 2 6 2093 It MEMBERS 151 FEDERAL CREWT MON PRIMARY OWNER: Ruth M Boughter REGULAR SAVINGS ACCOUNT: Account Number/Suffix 271325-00 Date Account Established 09/10/2005 Principal Balance at Date of Death $269.77 Accrued Interest to Date of Death $0.01 Total Principal and Accrued Interest $269.78 Name of Joint Owner Linda E Boughter Date Joint Added 09/10/2005 CHECKING ACCOUNT: Account Number/Suffix 271325-11 Date Account Established 09/10/2005 Principal Balance at Date of Death $1,502.14 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $1,502.14 Name of Joint Owner Linda E Boughter Date Joint Added 09/10/2005 MEMBERS 1sT FEDERAL CREDIT UNION Tessa L KI ✓ Lending Insurance Support Specialist July 25, 2013 Estate of: RUTH M-BOUGHTER Date of Death: 0510612013 Social Security Number: 183-10-0934 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www..membcrslst.org 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 Boughter, Ruth M. 21-13-0789 This schedule must Oe completed and filed 8 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 THE DATENOF TERANSFERSATTACH A CIOPYEOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Fidelity&Guaranty Life Insurance Company Annuity 22,487.40 22,487.40 Policy No. LS632801 -See attached letter from Fidelity &Guaranty Life Insurance Company dated July 29, 2013-beneficiaries are Ronald E. Boughter and Linda E. Boughter TOTAL (Also enter on Line 7, Recapitulation) 22,487.40 (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) AUG 0 12013 Fidelity & FIDELITY & GUARANTY LIFE INSURANCE COMPANY Guaranty Lifes"" 777 Research Drive, Lincoln,NE 68521 P O Box 82068,Lincoln,NE 68501 866-702-2194(Office) 402-479-0198 (Fax) www.fglife.com July 29,2013 SAIDIS, SULLIVAN& ROGERS ATTN: SEAN M.SHULTZ 26 W. HIGH STREET CARLISLE, PA 17013 Policy: L5632801 Owner: Ruth M. Boughter Annuitant: Ruth M. Boughter Dear Mr.Shultz: We have been notified of the death of the annuitant. We wish to convey our sincere sympathy to the family in their recent loss. Our records indicate that Ronald E. Boughter and Linda E. Boughter are the beneficiaries of this policy. Monthly payments under this policy are currently being made in the amount of $241.80. The remaining payments total$22,487.40. The beneficiary may choose only one of the following 2 settlement options: 1. Substitute Annuitant —the beneficiary will become the new annuitant of the policy and will continue to receive the remaining payments due under the policy, described above. The beneficiary may not later elect to receive a lump sum once this option is selected. 2. Lump Sum Payment—the beneficiary will receive a single lump sum payment of the remaining policy benefit. The lump sum payment has been calculated as described in the policy. The lump sum settlement amount is$17,976.82. The beneficiary will also need to complete and/or provide the following: 1. Claimant's Statement, having the beneficiary's signature WITNESSED. 2. Certified Death Certificate displaying the manner of death (a photocopy is NOT acceptable) If the claim is not processed in the time allowed under the applicable state law, interest on proceeds may be due and payable at a rate of 3%. A self-addressed return envelope is enclosed for your convenience. If you should have any questions,feel free to contact our office at 1-866-702-2194,option 5. Sincerely, Claims Department/ad Fidelity&Guaranty Life Insurance Company Fidelity&Guaranty Life is the marketing name of Fidelity&Guaranty Life Insurance Company and,In New York only,Fidelity&Guaranty Life Insurance Company of New York.Only Fidelity&Guaranty Life Insurance Company of New York is authorized to sell Insurance and annuities in New York. REV-1511 Ex.(10.09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Boughter, Ruth M. 21-13-0789 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 6,330.43 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission Paid 2. Attorney's Fees Saidis, Sullivan & Rogers 4,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) 3,500.00 Claimant Ronald E. Boughter Street Address 51'5.Hogestown Road City Mechanicsburg State PA Do 17050 Relationship of Claimant to Decedent Son 4. Probate Fees 433.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 791.25 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 15,055.18 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Boughter, Ruth M. 21-13-0789 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Estimated cost of headstone 2,000.00 2 Flowers 175.00 3 Harpist 50.00 4 Highspire Cemetery 300.00 5 Malpezzi Funeral Home 3,420.00 6 Payments to pastors 200.00 7 Wake 185.43 H-A 6,330.43 Other'Administrative Costs 8 Cumberland Law Journal-advertise letters 75.00 9 Short Certificate 10.00 10 Stambaugh-Ness-Income tax preparation 585.00 11 The News-Chronicle Co.-advertise letters 121.25 H-B7 791.25 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) REV-1513 EX.(e1-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Boughter, Ruth M. 21-13-0789 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT 0 Not List Irmsteel'i (Words) ($$$) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Linda E. Boughter Daughter-in-Law Cutlass, M1st 515 Hogestown Road Acts, 50%F&G Mechanicsburg, PA 17050 Annuity 2 Ronald E. Boughter Stepchild 50%,Opp.Act, 515 Hogestown Road 50%F&G Mechanicsburg, PA 17050 Annuity,50% residue 3 Linda A. Elicker Stepchild $25,000, 50% 519 North Road Opp.Act, 50% York,PA 17403 residue Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. 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-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) Last Will and Testament Ruth M,3kltgditCt i ti 'R:.' � � �Stlgast 12,t�Jtt i 2Enth4 t ougHt�rbeing o#'mM mhTd and it1a" t fly. kem last will and testimony wpm dn-y at 0075140kdry 1;7r.md all pGrtnittato attusttau;vAwe'given to Ronald Sand Linda E, ' JUG y,, aaK fti ytp h5� - -}�''+ ett�lttgrtt9t �tgj.an 419A - �' �,` CfBtt ob ftrvt tyfive iltowatiddolldrs)k to go to Utida Mfokerb ttso she reWvedno laud. 4 � ! Ilratntl tis g 3s to,t}atlfvltkd'�t t tt T ir[iJa isl1EWr and i sttYtit173oa tdf rYt m�?talwited kida. ..y; ;. ��q yy��... �y 5�� ygygy any �d9(Of mmw tear)*In �.QI'M'+' knit t ^rt',c=wmA .ale-gakfithuga ft 4 kia ltealr tal slay 31t l Id�9d Ron attd lud r tyu liter}tnt r3 tiered me so=h nod Ron&04 thlgt up 4 i Lvdttl>tHDYe3 'a zledtRt1y daset VS tt: 1"ak!'tthl7&&r1llatfl anzoGr(SCE aTf{�171it �tftl$414'�lXl td'getlteY',73t1, } y,tmffiletj a "P3ix xtiC�`�`gy qp„ ` S Oft tsi Y"vr i gdW1!4♦ �6{.ti" � U �M j4f !y%tl:4'(F^3�+fjA{{Wf[I V PWj � pp gXuy ya"tay 1 ` ,,,,,p3 J� M;;,,��{[uuaaia♦ii�'��..}} �gr.��.s�ee -�+q��Cp .�:. y�i, ,{,,,,t,,,�$ „�p� rt�i$ ku wy-• Fd a � l�p���'';�et�t�LMYCYrGb'�t slSFtA,at€dW>dd.�t+C#"tte t6.i.'N y�'rF�rtt'���XttUk�'K+4U `"J *' `t s 'r .. Uc"fel�btd m i11 MOnfe at`o tube Cunt l truer us tlteustate `I f "' rsdte ; 3a331311rtfx I {� - I C tleis v�ty a �clr yatt. heertnt " >sWltaE'Vformany pny } � d > P° ltntrfhiitughtdr o. ax �, 9 eg . t