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
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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
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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,
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fti ytp
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4 � !
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