HomeMy WebLinkAbout04-09-14 (2) REV-1500 EX(m-1e' 1505610101 3`
enns tvania OFFICIAL USE ONLY
Bu Department d Revenue PA E Y County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 /�5�/_"��
Harrlsburq PA 17128.0601 RESIDENT DECEDENT �{ („� LJLJ&�> _.
ENTER DECEDENT INFORMATION BELOW
08/05/2013 01/01/1936
Decedent's Last Name Suffix "Decedent's First Name MI
Peltier Rosemarie ; C
(if Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouses Social Security Numbe r _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
DID 1,Original Return C=> 2.Supplemental Return C7 3. Remainder Return(date of death
prior to 12-13-62)
Gt 4.Limited Estate C} 4a.Future Interest Compromise(date of O 5, Federal Estate Tax Return Required
death after 12-12-82)
DID 6,Decedent Died Testate C::> 7.Decedent Maintained a Living Trust 0 B. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
{� 9.Litigation Proceeds Received G'7 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95} (Attach Sch.0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Joseph G. Zerbe Esquire (570)622-1947
REGISTER 8 WILLS USE r93Y �
c —O m
C
First line of address DO
111 East Market Street M n m a
r— M
CID
Second line of address CDP
LE
City or Post Office State ZIP Code O
Pottsville PA J 17901
,.._A._• —C Vass
Correspondent's e-mail address:jzerbe@dziawoffice.com
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
il correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knawledge.
SIGNATURE SON PONSIB� LE FOR FILING RETURN DATE 4/4/2014
ADDRESS V�••-
Rehov Haboseln 4 Rehovot Israel, 76350
S{CiNATURE RE'ARER pTHE. REPR T E DATE
4/412014
ADDRESS
Joseph G. Z be, Es uire, 11 East ark Street, Pottsville, PA 17901
SE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101 J
1505610105
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A). .... ........ ..._... ... ......... 1. 275,99$10 ,
2. Stocks and Bonds(Schedule B) ....................................... 2. 240,941.76
i
3- Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Receivable(Schedule D)........................... 4. !.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 1 737,29912
6. Jointly Owned Property(Schedule F) C1 Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property '.
(Schedule G) O Separate Billing Requested........ Z ' 290,500.00
8. Total Gross Assets(total Lines 1 through 7)............................. 8. ; 1,544,739.58,
9. Funeral Expenses and Administrative Costs(Schedule H).........._..._.. 9. 61,148.59
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule t).............. 10. ° 3,064.58
11. Total Deductions(total Lines 9 and 10). 11. - 64,213.17!-
12. Net Value of Estate(Line 8 minus Line 11).............................. 12. j 1,480,526.41
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ""'°°--°•'°-•°°---__.-- ..,..._......._,..,�.._.�w_:
an election to tax has not been made(Schedule J) _.. ........ ............ 11
14. Net Value Subject to Tax Line 12 minus Line 13 ..... 14. • 1,480,526.41 !.
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0- 15.
16. Amount of Line 14 taxable -" '-' "-��' '�'--� ��
at lineal rate X.o 45 1,223 526 41 16,1 55,058.69
17. Amount of Line 14 taxable at sibling rate X,12 ` 17.
18. Amount of Line 14 taxable p 257 000 00 38,550.00'
at collateral rate X .15 ( 10.
19. TAX DUE ... .. .. ... .... ... ....... 19 93,608.69
20. FILL IN THE OVAL IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610105 1505610105
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Peiffer, Rosemarie C
STREETADDRESS i-i--'
120 Parkview Road
CITY STATE
New Cumberland Pa 17070
Tax Payments and Credits:
f, Tax Due(Page 2,Line 19) (1} 93,648.69
2. Credits/Payments 60,400.44
A.Prior Payments
B.Discount 3,000.00
—� Total Credits(A+8) (2) 63,400.40
3. Interest
(3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5, if Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 30,608,69
Make check payable 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;.......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income;..............._...._..................... ❑ E
c. retain a reversionary interest;or.......................................................................................................................... ❑ 9
d. receive the promise for life of either payments,benefits or care?..................................................................... ❑ El
2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. 0 ❑
1 Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ z
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ............................_....._............................................_......._.................._........ ❑ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU FAUST 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 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 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(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 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.
l
LAST WILL AND TESTAMENT
OF
ROSEMARIE C. PUFFER
I, ROSEMARIE C. PEIFFER, widow, of the Borough of New Cumberland,
Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do
hereby make this my Last Will and Testament, hereby revoking all Wills and Codicils at
any time heretofore made by me.
FIRST: I direct that my Executor hereinafter named shall pay and discharge all of
my legal debts and the expenses of my last illness and funeral as soon as possible after my
decease, as well as all estate, inheritance and other death taxes, together with interest and
penalties, payable with respect to property or interests under my Will or any Codicil, or
otherwise.
SECOND: I give and bequeath certain items of tangible personal property, if owned
by me at the time of my death, in accordance with a dated memorandum signed by me and
attached hereto and made a part hereof, making specific reference to this Will; provided,
however, that each such beneficiary is living at the.time of distribution of such tangible
personal property; and provided, further, in default of such memorandum, such tangible
personal property shall be added to and distributed as part of my residuary estate.
i
THIRD: I give and bequeath the sum of Ten Thousand Dollars ($10,000.00) unto
my nephew and godson, CHRISTOPHER COMISAC, if he survives me.
FOURTH:
A. I give, devise and bequeath my residential real estate situate at 120
Parkview Road, New Cumberland, Cumberland County,. Pennsylvania, and the
furniture, fixtures, household contents and similar items of tangible personal
property located therein, if I own the same at the time of my death, together with all
policies of insurance solely relating thereto, unto my son,DAVID H. PEIFFER, if he
survives me.
B. I am making the within devise of my aforesaid residential real estate
unto my son, DAVID H. PEIFFER, as a result of assurances made to me by my said
son that (1) said residential real estate will be maintained in good repair and
condition during my lifetime; and(2) my son, DAVID H. PEIFFER, will make every
effort to retain the ownership of my aforesaid residential real estate in the Peiffer
family or in an entity controlled by a member of the Peiffer family for as long as it is
reasonably possible to do so.
C. In the event my son, DAVID H. PEIFFER, predeceases me, I give,
devise and bequeath my aforesaid residential real estate, and the furniture, fixtures,
household contents and similar items of tangible personal property located therein, if
I own the same at the time of my death, together with all policies of insurance solely
relating thereto,unto my son, ERIC S. PEIFFER.
-2-
i
i
FIFTH:
A. During my Iifetime and the lifetime of my late husband, advances had
been made for the benefit of our daughter, KIMBERLY A. PEIFFER, in the amount
of Ninety Thousand Dollars ($90,000.00), with respect to certain real estate known
as 1819 Willow Road, Camp Hill, Pennsylvania. I therefore give and bequeath the
sum of Ninety Thousand Dollars ($90,000.00) unto each of my sons, DAVID H.
PEIFFER and ERIC S. PEIFFER.
B. I give, devise and bequeath all the rest, residue and remainder of my
estate, real, personal and mixed, of whatsoever nature and wheresoever the same
may be situate at the time of my death, in equal shares unto my children, DAVID H.
PEIFFER, ERIC S. PEIFFER and KIMBERLY A.PEIFFER
C. In the event any of my said children shall have predeceased me, I give,
devise and bequeath his or her respective share in equal shares unto my said children
who are then living.
SIXTH: I nominate, constitute and appoint my son, DAVID H. PEIFFER , to be the
Executor of this, my Last Will and Testament, and in the event my said son fails to survive
me or qualify, I nominate, constitute and appoint my son, ERIC S. PEIFFER, to be the
Executor of this, my Last Will and Testament, and in the event my said son fails to survive
me or qualify, I nominate, constitute and appoint my nephew and god-son,
CHRISTOPHER COMISAC, to be the Executor of this, my Last Will and Testament. I
-3-
direct that no such Executor acting hereunder shall be required to post bond or enter
security in this or any jurisdiction in which he may so serve.
SEVENTH: If any beneficiary under this Will shall in any manner contest or attack
this Will or any of its provisions, then any share or interest in my estate given to such
contesting beneficiary under this Will is hereby revoked and such contesting beneficiary
shall receive no part of my Estate, just as if said contesting beneficiary's name had never
been mentioned in this Will.
IN WITNESS WBEREOF, I,ROSEMARIE C. PEIFFER, widow, have hereunto set
my hand and seal to this,my Last Will and Testament,this 2 0 day of NArc l ,
2013.
A..�&',) (SEAL)
R MARIE C.PEIFFE
Signed, sealed, published and declared by the said ROSEMARIE C. PEUTER, as
and.for her Last Will and Testament, in the presence of us, who, at her request, in her
presence, and in the presence of each other,have subscribed our names as witnesses thereto.
-4-
4
COMMONWEALTH OF PENNSYLVANIA
SS[[V[[YY
.
COUNTY OF SCHUYLKILL
1, ROSEMARIE C. PEZFFER, testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my Last Will; that I signed it willingly; and that
I signed it as my free and voluntary act for the purposes therein expressed.
P 09P MARIE C. PEI E _
i
Sworn or affirmed to and acknowledged before me, by ROSEMARIE C. PEIFFER,
the testatrix, this 28th day of March 2013.
i
Nota Public
WANAL
xo M 411CROF WCDM t �€rsauear�ia zmt
-5-
�a
COMMONWEALTH OF PENNSYLVANIA.
ss.
COUNTY OF scaunKILL
We, Janice Chescavage and Bonnie D. Marshall
the witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw the testatrix
sign and execute the instrument as her Last Will; that she signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed; that each of us
in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of
our knowledge the testatrix was at that time eighteen or more years of age, of sound mind
and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by
Janice Chescavage and Bonnie D. Marshall
witnesses, this 28th day of March , 2013.
o Public
r
xuramwrs�t.
&zrse�,xor�xfrt�erte .
tm�earrmui.
t�rco>l�niss�ox aw+�s fmauurr r3.20i�
-6-
REV 1502 eX+(12-85) SCHEDULE A
Commonwealth of Pennsylvania
Inheritance Tax Return REAL.ESTATE
Resident Decedent
ESTATE OF FILE NUMBER
Pciffer,Rosemarie C. 2013 400863
(Property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair
market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither
beingeompelle d to buv or sell both having reasonable knowledge of the relevant facts.
ITEM VALUE AT
NUMBER DESCRIPTION DATE OF DEATH
1. 275,998.70
Residential Real Estate located at 120 Parkview Road,New Cumberland,
Cumberland County, Pennsylvania, known as Cumberland County Tax
Parcel No.26-25-10-5 and more fully described as:
ALL THAT CERTAIN piece or parcel of land, situate in the Borough of
New Cumberland, Cumberland County,Pennsylvania, bounded and described as
follows:
BEGINNING at a point on the circle terminating the Southerly line of
Parkview Road at the Southerly line of Lot No. 14, Block "Q"on the hereinafter
mentioned Plan; thence around the are of said circle Northeastwardly by a curve
to the left, having a radius of fifty (50) feet, an arc distance of one hundred
twenty-six and forty-five one-hundredths (126.45) feet to a point; thence South
76 degrees 06 minutes East along the Southerly line of a proposed street, ninety
(90) feet to a point on line of lands of John E. Fox, Jr.; thence by said Fox land
South 13 degrees 54 minutes West four hundred three and thirty-nine one-
hundredths (403.39) feet to a point; thence along lands of Drexel Hills Land
Company North 21 degrees 12 minutes West four hundred ten and fifty-four
one-hundredths (410.54) feet to a point on the Southerly fine of Lot No. 14,
Block "Q" aforesaid; thence by the latter North 68 degrees 48 minutes East
sixty-seven and four-tenths(67.4) feet to the place of beginning;
BEING Lot No. 15, Block "Q": on the Plan of Section 6, Drexel Hills,
said Plan being recorded in Plan Book 14, Page 19, Cumberland County
Records.
Fair Market Value determined by taking Cumberland County Total Assessed
Value of$267,700 and multiplying the same by the applicable Common Level
Ratio of 103.1% for a total of$275,998.70.
TOTAL (Also enter on line 1,Recapitulation) 275,998.70
0
No......................
C
from Curoorsti a.
WORTHINGTON LAND COMPA( -SCIG.
HOWARD R. PCLFFER and
...........
............._.._........_.._._............._.....,..........._.....__._..__.
ROSEMARIE C. PKMM.,_.._.._._......_....._.
........................_._................_......_ 1
r
His,_Wife . .
A
u
Dated � O :..
c b Ci
For LOt NO._15.x.._B1oCk_nQ na..,,......_._.
Sec. 6, Drexel Hills, New 5
..._............_.—......................... m
m � c
Cumberiandr...PAR-........
Consideration ......$5QO-.00..............................._._.... o
Recorded _............................................................. o $
ann.ed rm record in .he R..delr S A
y O
- u
Rero.dw V
P N;
HARRIS CO. 21 S. 3rd St. Harricbutp, Pe. d >
Myers, Myers & Flower
Attorneys at Law
Lemoyne, Pa.
� -
�
{ l }
�
\ | |
;
. �_,^'';F--• 1�}, 'rY t;�,n� {�' ��N. nn �9a�. 1tr,� �+
kbenture,
f.{abi, tttr f day of -' `A A.D. one thoasand nine
hundred and sixty-four (1964), between the Corporation by the "me,
style and title of WORTHINGTON LAND COMPANY, INC., a Pennsylvania Corporation with its
principal place of business in Hampden Township, Cumberland County, Pennsylvania,
GRANTOR, Party of the one part and HOWARD R. PEIFFER and ROSEMARIE C. PEIFFER,
His Wife,
of County of
in the State of GRANTEES, Parties of the other part mittleBBrtti
That the sold Grantor for and in corset
sideration of the sum of Five Thousand Four Hundred ($5,400:00) Dollars,
E*HHt6;<lawful money of the United States, to it in hand paid by the said
Grantees,
at the time of the execution hereof, the receipt whereuf is hereby acknowledged, boa granted, bargained, sold,'
aliened, en(eofred, released and confirmed, and by these presents does grant, bargain, sell, alien, enfeoB, re-
lease and confirm unto the said Grantees, their heirs
and assigns,
all that certain piece or parcel of land,situate in the Borough of New Cumberland, Cumberland
County, Pennsylvania, bounded and described as follows:
BEGIN1,ING at a point or, the circle texr„iz"tiag cne auurneriy z>.te UL
Parkview Road at the Southerly line of Lot No. 14, Block '42" on the hereinafter
mentioned Plan; thence around the are of said circle Northeastwardly by a curve
to the left, having a radius of fifty (50) feet, an arc distance of one hundred
twenty-six and forty-five one-hundredths (126.45) feet to a point; thence South
76 degrees 06 minutes East along the Southerly line of a proposed street, ninety
(90) feet to a point on line of lands of John E. Fox, Jr.; thence by said Fox
land South 13 degrees 54 minutes West four hundred three and thirty-nine one-
hundredths (403.39) feet to a point; thence along lands of Drexel Hills Land
Company North 21 degrees 12 minutes West four hundred ten and fifty-four one-
hundredths (410.54) feet to a point on the Southerly line of Lot No. 14, Block
"Q" aforesaid; thence by the latter North 68 degrees 48 minutes East sixty-
. seven and four-tenths (67.4) feet to the place of beginning;
BEING Lot No. 15, Block "Q" on the Plan of Section 6, Drexel Hills,
said Plan being recorded in Plan Book 14, Page 19, Cumberland County Records.
BEING a portion of promises which Drexel Hills Land Company by deed
dated March 5, 1964, and recorded in the Recorder's Office of Cumberland County
in Deed Book 21 "D", Page 363, conveyed to Worthington Land Company, Inc., the
Grantor herein.
UNDER AND SUBJECT, NEVERTHELESS, to Building and Use Restrictions set
forth in Miscellaneous Book 160, Page 993, Cumberland County Records, and to the
rights of American Telephone and Telegraph Company for maintenance of buried and
overhead cable lines on an easement, the center line of which is the western
line of the lot above described, as more fully set forth in instruments of prior
record, and to the southern half of a ten foot drainage easement along the
Northwest line of said lot as shown on said Plan, and to the rights of the
Bell Telephone Company of Pennsylvania, and the Pennsylbania Power and Light
Company as set forth in instruments of prior record. -- —
I �1=1
� r
J,�
`FtQ4 tj; t Ces 6 r r:�""' +,1Mi' 1 s „
to 9r*!
S J1 ' 'r_1 saet 36
Together with all and singular the buildings, privileges, hereditament& and appurtenances whatsoever
thereunto belonging, or in anywise appertaining, and the reversions and remainders, rents, issues and
profits thereof; and nil the estate, right, title, interest, property, claim and demand whatsocrerof it,
the said Grantor
either in law or equity,of,in and to the same.
t� u 4aur anb to 4111b the said measnage or tenement and lot or
piece of ground above. described, hereditaments and premises hereby granted, bargained and
sold, or mentioned, or intended so to be, with the appurtenances,unto the said Grantees, their heirs
and assigns,to and for the only proper use and behoof of the said Grantees, their heirs
and assigns forever.
And the said party of the first part for itself and its successors, does hereby covenant and
agree to and with the said Grantees, their heirs
and assigns,that it
the said party of the Brat part and its successors, all and singular the said hereby g,ant<d,
premises,with the appurtenances, unto the said Grantees, their heirs
againss a rte sa i party at tee brat part and its successors, and against all and cvm
other person and persons whomsoever lawfully claiming or to claim the same or any part thereof
ftnll anb Will Warrant ttnb Forrurr i3drncl by these presents.
Anb the said Worthington Land Company, -Inc. Cloth
hereby constitute and appoint Harry S. Claypool
to be its attorney, for it and in its name, and as and for its corporate act and deed to acknowledge this
deed before any person having authority by the laws of the Commonwealth of Pennsylvania to take such
acknowledgment,to the intent that the same may be duly recorded.
3n UP$fimAn fIPYPnf the aid Worthington.Land Company, Inc..
has caused this Indenture to be signed by its President, attested by its See-
. retary and affixed berennto the common and corporate seal of the said Corpo-
ration, that the seal affixed hereto is the seal of said Corporation, that it was
so affixed by order of the Board of Directors of said Corporation, and that
they signed their names hereto by like order,the day and year first above ivrittop,
WORTHINGTON LAND COMPANY, INC., ' Q,.- •••,•e�
Signed, Sealed and Delivered
m the presence of By......./'i` r- �,-4-I S�.^. r 15'��•,t'.t
g Attest, z 1i i,Y
. .
_........__........_......_..._.._..._.__._.._...._....._.._.....__..._.
L - ,
I ' pl,, �� Sec�e`tkt1fj41�.�
Attorneyr. .....C......)( ...................
� m J.
�T m a
N r o Z
n
r o �I bm N0
o
rn n -D
s +
_ oDo I A n � °, �
n." " r
O m Z IO Oraingge D F
�• 0 �n Bement m r n
�.
m so' so
9rn r
0 MGd 4 0
8_ p
Z rn .D 1 67.4 S 9
� � S r � oS P
tj
� o� c_i2vh 9006,
m z o o �Cl
n o n Co
d
nmv ? \z
yzv m !
z
3C � , 0C
v z r = /
s m
to
G m
O N
A N /
O
n
N m
O
p� N
N �
0
G1
REV-1501 EX t(4-86) SCHEDULE B
Commonwealth of Pennsylvania
Inheritance Tax Return STOCKS AND BONDS
Resident Decedent
ESTATE OF FILE NUMBER
PUFFER,ROSEMARIE, C 2013-863
All property 'ointl -owned with Right of Survivorship must be disclosed on Schedule F.
ITEM VALUE AT
NUMBER DESCRIPTION DATE OF DEATH
1. Vanguard Dividend Growth Fund (VDIGX) 2,431.434 Shares at 48,507.11
19.95 per share.
2. Vanguard Explorer Fund Investor(VEXPX) 112.083 Shares at 11,532.22
$102.89 per share
3. Vanguard Inter- Term Tax Exempt Inv (V WITX) 1,093.566 Shares at 14,970.92
$13.69 per share
4. Vanguard Ltd Term Tax Exempt Inv (VMLTX) 1,151.355 Shares at 12,676.42
$11.01 per share
5. Vanguard Pa Tax Exempt Money Market(VPTXX) 116,732.18 116,732.18
Shares at 1.00 per share
6. Vanguard 500 Index Fund Adm (VFIAX) 231.698 Shares at 36,513.29
$157.59
7. Value of Accrued Dividends in Vanguard Account 9.62
See Vanguard Explorer Account Date of Death Letter Attached as
Exhibit "A"to this Schedule
TOTAL (Also enter on line 2,Recapitulation) 240,941.76
r
i
i
DAVID H. PEIFFER
120 PARKVIEW ROAD
NEW CUMBERLAND, PA 17070
November 7, 2013
Via-Fax No. 484-582-4833
Vanguard Transition Team
455 Devan Park Drive
Wayne, PA 19087
Re: The Estate of Rosemarie Peiffer,Deceased- SS# 196-28-8831
Authorization Letter for Joseph G. Zerbe, Esquire of Derenzo & Zerbe
for Vanguard Accounts
Gentlemen:
My mother, Rosemarie Peiffer, passed away on August 5, 2013. I have been appointed
Executor of my mother's Estate and have already closed her Vanguard accounts.
The Attorney for the Estate, Joseph G. Zerbe, Esquire, requires a letter from Vanguard
detailing the amount of securities, cash and other assets and their value as of the date of my
mother's death on August 5, 2013. Attorney Zerbe needs this report to prepare the Estate's
Inheritance Tax Return.
Vanguard is hereby authorized to release this report and any other information to Attorney
Zerbe or anyone at his firm,Derenzo &Zerbe.
Please send the report as of August 5, 2013 to Attorney Zerbe at the following address:
Derenzo&Zerbe
111 East Market Street
Pottsville,PA 17901
Telephone: 570-622-1947
Fax No: 570-622-3261
If you have any questions or comments, please advise
Very truly yours,
David H. Peiffer
cc: Joseph G. Zerbe, Esquire � "
COMM TH OF PEN11 VANIA
Notarial seal
Tammy M.Grigas,Notary Public
city of Pottsville,Schuylkill county
My commission Expires June 27,2016
MEMBER,PENNSriVAN1A ASSOQATION ' NOTARIES
Vanguard®
P.O.Box 2600
November 12, 2013 Valley Forge, PA 19482-2600
www.v nguard.com
JOSEPH G ZERBE
DERENZO & ZERBE
111 E MARKET ST
POTTSVILLE PA 17901
Re: Estate of Rosemarie C. Peiffer
Dear Mr. Zerbe:
We are responding to the letter we received requesting a valuation of Rosemarie
C. Peiffer's Vanguard account as of August 5, 2013. The information requested is
included on the enclosed account value report.
If you have any questions, please call Vanguard Voyager Services® at
800-284-7245. You can reach us on business days from 8 a.m. to 10 p.m. and on
Saturdays from 9 a.m. to 4 p.m., Eastern time.
Sincerely,
Retail Investor Group
Vanguard
mj
Enclosure(s): "Rosemarie C. Peiffer Individual Account Value Report
52490098
u27
Vanguard' Page > 1 of 1
Rosemarie C.Peiffer
120 Parkview Rd Voyager Services:800-284-7245
New Cumberland,PA 17070-17:
Total report value: $240,941.76
(Total report value includes any accrued dividends.)
h
Name Fund-8 Account Date Price Per Accrued
Number Opened Shares Share Value* Dividends
PA Tax-Exempt Money Mkt 0063-09937628653 07/1912004 116,732.180 $1.00 $116,732.18 $0.16
Dividend Growth Fund 0057-09937628653 11/24/1999 I 2,431.434 $19.951 $48,507.11 -
Inter-Term Tax-Exempt Inv 0042-09937628653 07/19/20041 1,093.566 $13.691 $14,970.92 $6.63
500 Index Fund Adm 0540-09937628653 12/0212010 . 231.698 $157:59 $36,513.29 - - -
Explorer Fund Investor 0024-09937628653 07/19/2004 112.083 $102.89 $11,532.22 -
Ltd-TermTax-Exempt Inv 0031-09937628653 07/19/2004 1,151.355 - $11.01 $12,676.42 $2.83
Totals - $240,932.14 $9.62
Doesn't include accrued dividends.
0177053706 08/26/2013 16:00:57
_ r
t
r4
f
. . y
i
' t
{
REV4508 EX+(Y-89) SCHEDULE E
Commonwealth of Pennsylvania
Inheritance Tax Return CASH,BANK DEPOSITS AND
Resident Decedent MISCELLANEOUS
PERSONAL PROPERTY Please Print or Type
ESTATE OF FILE NUMBER
Peiffer. Rosemarie C. 2013-0863
All propertV 'ointl -owned with the Right of Survivorship must be disclosed on Schedule
ITEM VALUE AT
NUMBER DESCRIPTION DATE OF DEATH
1. PNC Bank Checking Account– See Bank Letter Attached $00.84
2. 2010 Accura TL-- Value determined by arms' length sale 21,000.00
Copy of proceeds check attached
750.00
3. Furniture and Miscellaneous Household items
114,635.22
4. IRA Account with Chapin Davis Acct # 7712-1936
See Account Report Attached
5. Individual Investment Account with Chapin Davis Acct #1392-8096 527,792.07
See Account Report Attached
6. Nationwide Retirement Solutions Account—See Report Attached 30,782.32
7. Cash on Hand 42,338.67
TOTAL (Also enter on line 5,Recapitulation) 737,299.12
Derenzo & Zerbe
Attorneys at Law
Ronald T. Derenzo 111 East Market Street Telephone(570) 622-1947
Joseph G. Zerbe Pottsville,PA 17901 Fax(570) 622-3261
August 19, 2013
PNC Bank
331 Bridge Street
New Cumberland, PA 17070
Re: Estate of Rosemarie Peiffer, Deceased
Social Security # 196-28-8831
Borough of New Cumberland,Cumberland County, Pennsylvania
Gentlemen:
This office represents David H. Peiffer, Executor of the above-captioned estate, the decedent
having died on August 5, 2013. The decedent resided in the Borough of New Cumberland,
Cumberland County,Pennsylvania.
For inheritance tax purposes, it would be appreciated if you would check your records and
provide me with a letter concerning any types of accounts, either solely or jointly owned, which the
decedent maintained with your institution, setting forth the nature of the account, the owners of the
account, the date each account was opened or made joint and the amount on deposit as of the date of
death, together with accrued interest as well as interest from January 1 to the date of death.
Would you also kindly advise whether the decedent had an ' terest in any safe deposit box
with your institution, or owed any indebtedness to your i stitutio
Ver trul ur
Josep G.'Zerbe
jgzijc
cc: David H. Peiffer
N
t
Q PNCBANK
Derenzo&Zerbe
Attorneys at Law
111 East Market St
Pottsville,PA 17901
Attention: Joseph G. Zerbe
September 9, 2013
Re: Estate of Rosemarie Peiffer, Decd
Dear Attorney Zerbe,
In reference to your letter dated August 19,2013,below is the requested information regarding Rosemarie
Peiffer's account at the time of her death:
Type of account-Checking account
Account name-Rosemarie Peiffer
Date opened- 8/22/1991
Date of Death Balance- $.84 cents
Accrued interest-$1.28
Interest from 111113 -&10.64
If you require further information,please contact me at 717-774-8743. Thank you.
Sincerely,
Wanda L. Wert
AVP& Branch Manager
A member of the PNC Financial Services Group
w .pncbank.com
q C SR /® toll CHECK# 28497
lLill� V:. , ,_. I':�. � . 28497
ACURA
**TWENTY ONE THOUSAND DOLLARS AND 00/100"*
' AN',O NT
10/31/13 $21,000.00
THE ESTATE OF ROSEMARIE C PEIFFER
120 PARKVIEW RD
NEW CUMBERLAND PA 17670
v02849 ?"' 1:031302955,: 990204888ii'
THE ESTATE OF ROSEMARIE C PEIFFER 10/31/13
DATE CTRL# ACCT# AMOUNT DESC
10/31/13 AP1578 A308 21000.00 PURCH OF 10 TL PEIFFER
CHECK NO. NET --r— -- — —
28497 AMOUNT i $21,000.00 1
Derenzo & Zerbe
Attorneys at Law
Ronald T.Derenzo 111 East Market Street Telephone(570) 622-1947
Joseph G. Zerbe Pottsville,PA 17901 Fax (570) 622-3261
August 19, 2013
Chapin-Davis
Two Village Square, Suite 4200
Baltimore, MD 21210
Re: Estate of Rosemarie Peiffer, Deceased
Social Security# 196-28-8831
Borough of New Cumberland, Cumberland County, Pennsylvania
Gentlemen:
This office represents David H. Peiffer, Executor of the above-captioned estate, the decedent
having died on August 5, 2013. The decedent resided in the Borough of New Cumberland,
Cumberland County, Pennsylvania.
For inheritance tax purposes, it would be appreciated if you would check your records and
provide me with a letter concerning any types of accounts, either solely or jointly owned, which the
decedent maintained with your institution, setting forth the nature of the account, the owners of the
account,the date each account was opened or made joint and the amount on deposit as of the date of
death,together with accrued interest as well as interest from January 1 to the date of death.
Would you also kindly advise whether the decedent had an interest in any safe deposit box
with your institution or owed any indebtedness to your ins ' 'on.
Very t ly yo s
Joseph G. Z rbe
jgz/jc
cc: David H. Peiffer
Estate Valuation
A. C. Peiffer IRA
Data of Death: 08/05/2013 Estate of: Rosemarie C. Peiffer
Valuation Date: 08/05/2013 Account: 7712-1936 IRA
Processing ate: 09/09/2013
4 Report Type: Dace of Death
Number of Securities: 9
File ID: Peiffer, Rosemarie 7712-1936
Shares Security Mean and/or Security Div and Int
Identifier or Par Description High/Ask Low/Bid Adjustments Value Accruals
1) CASH 58272.21 Cash 58,272.21
2) 17275RI02 260 CISCO SYS INC
COM
The NASDAQ Stock Market LLC
08/05/2013 26.42000 26.11000 H/L
26.265000 6,828.90
3) 231021106 45 CUMMINS INC
COM
New York Stock Exchange
08/05/2013 123.05000 121.81000 H/L
122.430000 5,509.35
4) 29265NI05 100 ENERGEN CORP
COM
New York Stock Exchange
08/05/2013 66.68000 64.95000 H/L
65.815000 6,581.50
5) 478160104 75 JOHNSON 6 JOHNSON
COM
New York Stock Exchange
08/05/2013 94.30000 93.43000 H/L
93.865000 7,039.88
6) 65473P105 200 NISOURCE INC
COM
New York Stock Exchange
08/05/2013 31.16000 30.83000 H/L
30.995000 6,199.00
Div: 0.25 Ex: 07/29 Aec: 07/31 Pay: 08/20/13 50.00
7) 667655104 200 NORTHWEST NAT GAS CO
COM
New York Stock Exchange
08/05/2013 44.21000 43.70000 H/L
Div: 0.955 Ex: 07/29 Rec: 07/31 Pay: 08/15/13 43.955000 8,791.00 91.00
8) 870875101 477 SWISS HELVETIA FD INC
COM
New York Stock Exchange
08/05/2013 13.14000 12.94000 H/L
13.040000 6,220.08
9) 92924F106 200 WGL HLDGS INC
COM
New York Stock Exchange
08/05/2013 46.31000 45.62300 H/L
45.966500 9,193.30
Total Value: $114,635.22
Total Accrual: $141.00
Total: $114,776.22
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.com. (Revision 7.3.1)
w
; .
Date of Death: 08/05/2013 Estate of: Rosemarie C. Peiffer
Valuation Date: 08/05/2013 Account: 7712-1936 IRA
Processing Date: 09/09/2013 Report Type: Date of Death
Number of Securities: 9
File ID: Peiffer, Rosemarie 7712-1936
Portfolio Endnotes
IMPORTANT INFORMATION ABOUT THE ESTATE VALUATION REPORT
The information in this Estate Valuation Report (referenced below as the Report) is based on the Estate Valuation
Worksheet provided to us by the Financial Advisor requesting the Report. We have not used client statements, internal
accounting data, or any other resources to independently verify the identity or quantity of securities held, the date of
death, or the alternate valuation date, if applicable.
The Report may include assets that you currently hold away from our firm, which may or may not be identified as being held
away. Information on assets held away from Wells Fargo Advisors was provided by you and may not be covered by SIPC.
Wells Fargo Advisors makes no representation with respect to accuracy of information on outside holdings.
In most cases, we use Estate Val, a valuation and pricing program, to provide information on the value of securities on
the requested date. Estate Val software is provided by Estate Valuations 6 Pricing Systems, Inc., (EVP) , a third-party
vendor unrelated to Wells Fargo Advisors. The pricing and valuations generated by EVP are derived from sources it
believes to be reliable, but the accuracy and completeness of this information is not guaranteed.
Depending on how the Report will be used, the pricing generated by EVP for some securities may warrant additional
consideration. Users may want to supplement or adjust the values provided for certain types of securities. For example:
- Brokered Certificates of Deposit, and certain bonds, may possess a death put feature. EVP provides a value which does
not account for the possibility that a successor owner may be able to put the security back to the issuer at par, upon the
death of the original owner.
- Treasury Inflation Protection Securities (TIPS) are often not identified as such in the Report, so the inflation factor
may not be reflected in the value and accrued interest shown.
- Variable rate auction securities may be reported by EVP at par, without reflecting accrued interest or market
conditions. Other types of variable rate securities may not reflect accrued interest.
The databases used by EVP do not encompass all markets or types of investments. For example, Estate Val does not provide
valuation data on investments such as annuities, equity options, limited partnerships, or managed futures funds, among
others. If the Financial Advisor is able to obtain pricing or valuation data from other sources with respect to such
investments, we may include that data in the Report for informational and convenience purposes. We will identify such
investments in the Report. We do not audit or independently verify the data provided to us, and make no representations
as to the accuracy or completeness of information provided to us by others.
This Report does not in any way supersede the information contained in client statements and trade confirmations, which
are the official record of account positions and activity.
We make no representations that the information contained in this Report is suitable for any particular purpose. It is
the responsibility of the client, together with his or her tax and legal advisors, to determine the appropriate
information to include on any tax return, inventory, or other accounting.
Page 2
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.com. (Revision 7.3.1)
Estate Valuation
Rosemarie C. Peiffer
Date of Death: 08/05/2013 Estate of: Rosemarie C. Peiffer
Valuation Date: 08/05/2013 Account: 1392-8096 Individual
Processing Date: 09/09/2013 Report Type: Date of Death
Number of Securities: 19
File ID: Peiffer, Rosemarie 1392-8096
Shares Security Mean and/or Security Div and Int
Identifier or Par Description High/Ask Low/Bid Adjustments Value Accruals
1) CASH 289679.3 Cash 289,679.30
2) 036642106 1000 ANTARES PHARMA INC
COM
NYSE AMEX Equities
08/05/2013 4.42000 4.31000 H/L
4.365000 4,365,00
3) 171607104 73 CHYRONHEGO CORP
COM
NASDAQ Stock Market
08/05/2013 1.59000 1.51000 H/L
1.550000 113.15
4) 126408103 750 CSX CORP
COM
New York Stock Exchange
08/05/2013 26.26000 25.70000 H/L
25.980000 19,485.00
5) 156700106 250 CENTURYLINK INC
COM
New York Stock Exchange
08/05/2013 36.23000 35.81000 H/L
36.020000 9,005.00
6) 244199105 200 DEERE 6 CO
COM
New York Stock Exchange
08/05/2013 83.48000 82.67000 H/L
83.075000 16,615.00
7) 2574GU109 300 DOMINION RES INC VA NEW
COM
New York Stock Exchange
08/05/2013 59.96000 58.90000 H/L
59.430000 17,829.00
8) 277911491 2220.829 EATON VANCE MUT FDS TR
FLT RT CL I
Mutual Fund (as quoted by NASDAQ)
08/05/2013 9.18000 Mkt
Daily Div. Accrual as of 08/05/2013 9.180000 20,387.21 10.69
9) 29265N108 400 ENERGEN CORP
COM
New York Stock Exchange
08/05/2013 66.68000 64.95000 H/L
65.815000 26,326.00
10) 345370860 1000 FORD MTR CO DEL
COM PAR $0.01
New York Stock Exchange
08/05/2013 17.50000 17.11000 H/L
Div: 0.1 Ex: 07/31 Rec: 08/02 Pay: 09/03/13 17.305000 17,305.00 100.00
11) 369300108 300 GENERAL CABLE CORP DEL NEW
COM
New York Stock Exchange
08/05/2013 32.48000 31.82000 H/L
32.150000 9,645.00
12) 46269C102 500 IRIDIUM COMMUNICATIONS INC
COM
The NASDAQ Stock Market LLC
08/05/2013 7.10000 6.81000 H/L
6.955000 3,477.50
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.com. (Revision 7.3.1)
f
r
s
R
• A
.. k r � -
f
}
Date of Death: 08/05/2013 Estate of: Rosemarie C. Peiffer
Valuation Date: 08/05/2013 Account: 1392-8096 Individual
Processing Date: 09/09/2013 Report Type: Date of Death
Number of Securities: 19
File ID: Peiffer, Rosemarie 1392-8096
Shares Security Mean and/or Security Div and Int
Identifier or Par Description High/Ask Low/Bid Adjustments Value Accruals
13) 464287234 250 ISHARES
MSCI EMG MKT ETF
NYSE Arta Equities Exchange
08/05/2013 39.59000 39.29500 H/L
39.442500 9,860.63
14) 478160104 200 JOHNSON S JOHNSON
COM
New York Stock Exchange
08/05/2013 94.30000 93.43000 H/L
93.865000 18,773.00
15) 667655104 150 NORTHWEST NAT GAS CO
COM
New York Stock Exchange
08/05/2013 44.21000 43.70000 H/L
Div: 0.455 Ex: 07/29 Aec: 07/31 Pay: 08/15/13 43.955000 6,593.25 68.25
16) 720186105 200 PIEDMONT NAT GAS INC
COM
New York Stock Exchange
08/05/2013 34.74000 34.50380 H/L
34.621900 6,924.38
17) 742718109 100 PROCTER S GAMBLE CO
COM
New York Stock Exchange
08/05/2013 81.65000 80.96000 H/L
Div: 0.6015 Ex: 07/17 Rec: 07/19 Pay: 08/15/13 81.305000 8,130.50 60.15
18) 847560109 750 SPECTRA ENERGY CORP
COM
New York Stock Exchange
08/05/2013 36.13000 35.74000 H/L
35.935000 26,951.25
19) 887389104 270 TIMKEN CO
COM
New York Stock Exchange
08/05/2013 61.56000 59.38000 H/L
60.470000 16,326.90
Total Value: $527,792.07
Total Accrual:
Total: $528,031.16 $239.09
Page 2
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)
Date of Death: 08/05/2013 Estate of: Rosemarie C. Peiffer
Valuation Date: 08/05/2013 Account: 1392-5096 Individual
Processing Date: 09/09/2013 Report Type: Date of Death
Number of Securities: 19
File ID: Peiffer, Rosemarie 1392-8096
Portfolio Endnotes
IMPORTANT INFORMATION ABOUT THE ESTATE VALUATION REPORT
The information in this Estate Valuation Report (referenced below as the Report) is based on the Estate Valuation
Worksheet provided to us by the Financial Advisor requesting the Report. We have not used client statements, internal
accounting data, or any other resources to independently verify the identity or quantity of securities held, the date of
death, or the alternate valuation date, if applicable.
The Report may include assets that you currently hold away from our firm, which may or may not be identified as being held
away. Information on assets held away from Wells Fargo Advisors was provided by you and may not be covered by SIPC.
Wells Fargo Advisors makes no representation with respect to accuracy of information on outside holdings.
In most cases, we use Estate Val, a valuation and pricing program, to provide information on the value of securities on
the requested date. Estate Val software is provided by Estate Valuations S Pricing Systems, Inc., (EVP), a third-party
vendor unrelated to Wells Fargo Advisors. The pricing and valuations generated by EVP are derived from sources it
believes to be reliable, but the accuracy and completeness of this information is not guaranteed.
Depending on how the Report will be used, the pricing generated by EVP for some securities may warrant additional
consideration. Users may want to supplement or adjust the values provided for certain types of securities. For example:
- Brokered Certificates of Deposit, and certain bonds, may possess a death put feature. EVP provides a value which does
not account for the possibility that a successor owner may be able to put the security back to the issuer at par, upon the
death of the original owner.
- Treasury Inflation Protection Securities (TIPS) are often not identified as such in the Report, so the inflation factor
may not be reflected in the value and accrued interest shown.
- Variable rate auction securities may be reported by EVP at par, without reflecting accrued interest or market
conditions. Other types of variable rate securities may not reflect accrued interest.
The databases used by EVP do not encompass all markets or types of investments. For example, Estate Val does not provide
valuation data on investments such as annuities, equity options, limited partnerships, or managed futures funds, among
others. if the Financial Advisor is able to obtain pricing or valuation data from other sources with respect to such
investments, we may include that data in the Report for informational and convenience purposes. We will identify such
investments in the Report. We do not audit or independently verify the data provided to us, and make no representations
as to the accuracy or completeness of information provided to us by others.
This Report does not in any way supersede the information contained in client statements and trade confirmations, which
are the official record of account positions and activity.
We make no representations that the information contained in this Report is suitable for any particular purpose. It is
the responsibility of the client, together with his or her tax and legal advisors, to determine the appropriate
information to include on any tax return, inventory, or other accounting.
Page 3
This report was produced with Estatevai, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)
� .
� .
� `
n
DAVID H. PEIFFER
120 PARKVIEW ROAD
NEW CUMBERLAND, PA 17070
November 7, 2013
Via Fax No. 877-677-4329
Nationwide Retirement Solutions
Re: The Estate of Rosemarie Peiffer,Deceased-SS# 196-28-8831
Authorization Letter for Joseph G. Zerbe,Esquire of Derenzo & Zerbe
Nationwide Retirement Solutions Account 48518482
Gentlemen:
My mother, Rosemarie Peiffer, passed away on August 5, 2013. I have been appointed
Executor of my mother's Estate and have already closed her Nationwide retirement accounts.
The Attorney for the Estate, Joseph G. Zerbe, Esquire, requires a letter from Nationwide
detailing the amount of securities, cash and other assets and their value as of the date of my
mother's death on August 5, 2013. Attorney Zerbe needs this report to prepare the Estate's
Inheritance Tax Return.
Nationwide is hereby authorized to release this report and any other information to Attorney
Zerbe or anyone at his firm,Derenzo &Zerbe.
Please send the report as of August 5, 2013 to Attorney Zerbe at the following address:
Derenzo&Zerbe
111 East Market Street
Pottsville,PA 17901
Telephone: 570-622-1947
Fax No: 570-622-3261
If you have any questions or comments,please advise
Very truly yours,
David H. Peiffer
cc: Joseph G. Zerbe, Esquire
r
® Nationwide
Retirement Solutions
November 14, 2013
Derenzo&Zerbe
Attn: Joseph Zerbe
111 E. Market Street
Pottsville, PA 17901
Re: Rosemarie C. Peiffer, Deceased
Case: Cumberland County 457(b) Deferred Compensation Plan
bear Mr. Zerbe:
This letter is in response to your request for information for the Deferred
Compensation Account of Rosemarie C. Peiffer from Nationwide Retirement
Solutions (Nationwide).
I have enclosed a selective statement providing the account value on Ms.
Peiffer's date of death, per your request.
If you have any questions or concerns, please feel free to contact our Customer
Service Center by calling 1-877-677-3878, weekdays between 8:00 a.m. and
11:00 p.m., Eastern time, and a representative will be glad to help you.
ULisa Palmer
Financial Services Specialist
Nationwide Retirement Solutions -
cc: David H. Peiffer w/enclosure
Retirement Specialists are Registered Representatives of Nationwide Investment Services Corporation.Member FINRA
DC-4003-12/12 In Michigan only:Nationwide Investment Svcs.Corporation
10 West Nationwide Boulevard,Columbus,OH 43215
CUMBERLAND COUNTY
IlBoer
cwir,ra6r
Acct#:8518482
August 1, 2013-August 5, 2013
ROSEMARIE C PEIFFER Questions?Contact Usl
EW RD
NEW CUMBERLAND W CUMB CUSTOMER SERVICE: (877)677-3678
NEERLAND PA 17070-1733 (ESPANOL): (800)649-9494
Please review your statement carefully.Corrections may not be accepted TTY: (800)848-0833
more than 45 days after the dosing date of the statement. Webslte: www.nrstoru.com
Write us at: NATIONWIDE RETIREMENT
SOLUTIONS
PO BOX 182797
COLUMBUS OH 43218-2797
Netlo a Invectrront a ,xe Capora"M nlern0ar FINRA In MltlHpen Only:
Netionwge Inveebnmt Svice.Carppetion
Activity at a Glance
Balance as of oer11.13 457fb),Plall
Contributiona/rransfers In' $30,767'74
Gain/Loss/interest $0.00
Withdrawals/Transfers Out-- $14.50
Charges/Fees $0.00
Balance as of 08-05-13 $0.00
$30,782.24
'Including,but not limited to,Employee and Employer Contributions,Rollovers and Transfers In.
"Including,but not limited to,Rollovers and Transfers Out,Partial and Lump Sum Payments.
Total Gain Loss Since Joining
Contributions Total Ga1rJLoss
Plan Type Since J01nin0 Since Joint
no
457(b)Plan $11,505.00 $62,091.13
If applicable,"Total Gain/Loss Since Joining'includes investment performance,asset fees charged against core accounts and is reflective of fees and
transfers associated with Self Directed Option(SDO). 'Since Joining'refers to the period of time your account has been administered by Nationwide
Retirement Solutions(NRS).
For information about asset fees,contact your customer service center.
Contributions and Distributions Summary -August 1, 2013 to August 5, 2013
Last Contributions Contributions Last Distributions
Contribution This Year Distribution Year
457(b)Plan Amoun Period to Date Amount to Dale
$0.00 $0.00 -$3,500.00
Your Asset Allocation -August 1, 2013 to August 5, 2013
r To the right is your Account Allocation. Your Account Allocation
Your Account Allocation is how the money Investment Type
in your account is divided among the
investment options you have selected. 100% Fixed Asseta/Cash $30,782.24
,A 1 rf 100% Total ParoanUValue $30,782.24
For more information on contribution and � v
account allocation, log on to "
W W W.NRSFORO.COM
'Percentages and totals may not be exact due to
rounding.
WWW.NRSFORU.COM Questions? Call usl (877)677-3678 1
Statement Details
Investment Option Summary -August 1, 2013 to August 5, 2013
Unit Value is as of 8/512013
Investment Option - Current Investment
Election Endina Price Units Value
157(b)Plan
Nationwide Fixed Account 100.00%
TOTAL 100.00% $30,762.24
$30,762.24
Your Account Values by Investment Option -August 1 2013 to August 5 2013
Beginning Contributions/ Withdrawals! Charges/ Gsin/Losel Ending
4A(h)P4e(0007g5/001) I In Exchanges Transfers Out Credas/Fees Interest Bolan
Netbnwide Fixed AO l $30,787.74
50.00 50.00 $000 30
.
TOTAL- 50.00 111.50 $ .76234
$30,787.74 $0.00 Sam 50.00
$0.00 511.50 f30,7eu4
GeINLOSe Is the difference between the account balance on the first and last day of the period,8118'allow0lg for the effects of transactions.
Transaction Details -August 1, 2013 to August 5, 2013
Pay Period Effective Total Transaction Money Investment mo
Aunt
EEnd Date 12818 Announ LM source J3LQ0 Per
No Transaction Activity For This Period P� SlOIIC Fund
Your Beneficiary Information
457(b)Plan Primary Beneficiia
ROSEMARIE PEIFFER ESTATE 100.00%
2 QUARTERLY REPORT FOR ROSEMARIE C PEIFFER
REV-1510 EX*(2-87) SCHEDULE
Commonwealth Inheritance INTER-VIVOSTRANSFERS&
inheritance Tax Return
Resident Decedent MISC.NON-PROBATE PROPERTY
Please Print or Type
ESTATE OF FILE NUMBER
PEIFFER,ROSEMARIE C. 2013--0863
THIS SCHEDULE MUST DE COMPLETED AND FILED IF TICE ANSWER TO ANV OF THE OUFSTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS VFS
REM
cue'sEA DESCRIPTION OF PROPERTY DATE OF %OF DECEDENT'S ECLIJ N TAXABLEVALUE
Include name oJ7he lrantferce,Meir rdanonship m deaedem and the dale flan fie' DEATH INTEREST
Attach a copy oflhe deedJor real ovate. VALUE OF
ASSET
I. Daniel Peiffer, Grandson Monetary Gift 7-29-2013 $10,000.00 100% $3,000 $7,000,00
2. Michelle Peiffer, Granddaughter-Monetary Gift 7-29-13 $15,000.00 100% $3,000 $12,000.00
3. Aelon Peiffer,Grandson,Monetary Gift 7-29-2013 $15,000.00 100% $3,000 $12,000,00
4. Amit Peiffer,Grandson Monetary Gift 7-29-2013 $15,000.00 100% $3,000 $12,000,00
5. Pennsylvania State University Monetary Gift 5-27-2013 $15,000.00 100% 100% OM
6. Pennsylvania State University Monetary Gift 7-29-2013 $30,000.00 100% 100% 0.00
7. The Peiffer Memorial Arboretum and Nature Preserve,
Inc. Monetary Gift 7-29-2013 $250,000.00 100% $3,000 $247,000.00
8, Amit Peiffer, Grandson Monetary Gift 2-20-2013 $500.00 100% 0 500.00
9. Aryn Medley,Granddaughter Monetary Gift 2-20-2013 $500.00 100% $500 0.00
TOTAL(Also enter on line 7,Rwapitulation) $290,500.00
REV-151 I Ex+p-881 SI.HEDULE H
Commonwealth of Pennsylvania FUNERAL EXPENSES,
Resident ADMINISTRATIVE COSTS AND
t Decedennurn t MISCELLANEOUS EXPENSES Please Print or Type
ESTATE OF FILE NUMBER
PEIFFER ROSEMARIE C. 2013-0863
Debts of decedent must he reported on Schedule 1.
ITEM _.-
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I. Auer Funeral Home $315.00
2. Grave and Franklin Bronze Marker 2,008.09
3. Obituary Times News 184.20
4. Obituary Sentinel News 53820
5. Obituary Harrisburg Patriot New 572.92
6. Funeral Meals 820.06
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions- 18,000.00
Name of Personal Representative(s) David H. Peiffer
Social Security Numbers)/EIN Number of Personal Representative(s) 188502068
Street Address Rehov Habosem 4
City Rehovot Country ISRAEL Zip 76350
Year(s)Commissions paid 2013
2. Attorneys' Fees-Derenzo&Zerbe 16,500.00
3. Family Exemption: (if decedent's address is not the same as claimant's attached explanation)
Claimant
Street Address
City State_. Zip
Relationship of Claimant to Decedent
4. Probate Fees-Register of Wills 923.50
5. Accountant's Fees---Sudbury CPA, Pitcvage CPA:Consultation&Tax Prep Fees 1,457.00
6, PNC Bank Fees to Open Estate Account and Order Checks 137.49
7. Pennsylvania Water Company 158.83
8, JMK Grass Cutting Service 240.62
9. Maintenance Expenses on Real Estate 599.88
10. Gasoline Reimbursement to Executor and Family Members Assisting Estate 416.48
IL Tall Road Expenses 13.70
11 Office Supplies and Miscellaneous Expenses 1,121.54
13. Eric Peiffer,for Truck to remove Refuse from Home 215.52
14. Vehicle Rental&Airport Transfer 3,106.60
15. ATT Internet Service 151.13
16. UPS and Postage 244.66
17. Airfare(Executor Resides in Israel Most of the Year) 5,951.96
18. Hotel Expense for Executor 12931
19. Meals and Grocery Expenses for Executor 929.52
21. Utilities: Electricity, Oil,Telephone, Sewer Aug-Dec 2013 1,042.47
21 Chapin Davis Account Valuation Fees(on Accounts Listed as Items 4 and 5 on Schedule E) 60.00
ITEM
NUMBER DESCRIPTION
AMOUNT
23. Chapin Davis Investment Account Liquidation Fee (Account is Item No. 5 on Schedule E) 4,131.81
24. Chapin Davis Retirement Account Liquidation Fee (On Account listed as Item 4 on 1,177.70
Schedule E)
TOTAL(Also enter on line 9,Rmapllulwion) $61,148.59
�V-15)2 EX+(7-88) EDULE
I
Commonwealth of Pennsylvania DE SCHSCH DECEDENT,ULL I
Inheritance Tax Return
Resident Decedent MORTGAGE LIABILITIES AND LIENS
Please Print or Type
ESTATE OF FILE NUMBER
PUFFER,ROSEMARIE C.
2013-0863
11 EM
NUMBER DESCRIPTION
AMOUNT
1. Griswald Home Care Nursing $2,054.00
2. Reimburse David H. Peiffer for living expenses, grocery, pharmacy 421.59
for Decedent prior to death
3. Reimburse David H. Peiffer for home maintenance and landscaping 494.99
at decedent's home prior to death
4. Dr. M. Pastuka, DDS Dental Treatment July 15, 2013 94.00
TOTAL (Also enter on line 10,Recapitulation) 3,064.58
REV-1513 EX+(2-67) SCHED V LE J
Commonwealth of Pennsylvania
Inheritance Tax Return BENEFICIARIES
Resident Decedent
ESTATE OF FILE NUMBER
PEIFFER, ROSEMARIE C. 2013-0863
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNTORSHARE
Do NOT LIST TROsTEES OF ESTATE
I. A. TAXABLE DISTRIBUTIONS(include outright spousal distributions)
1. DAVID H. PEIFFER, Rehov Habosem 4 SON -$90,000.00;
Rehovot Israel, 76350 -Real estate on
Schedule A;
and
- 1/3 of
Residue
2. ERIC S. PEIFFER, 1918 Roxbury Court, SON -$90,000.00
Mechanicsburg, Pa 17955 And
- 1/3 of
Residue
3. KIMBERLY A. PEIFFER, 1729 Forest Cove, DAUGHTER 1/3 of Residue
Apartment #105, Mt. Prospect, Il 60056
4. CHRISTOPHER COMISAC, 6 Leiter Drive Nephew $10,000.00
Duncannon, Pa 17020
ENTER DOLLAR AMOUNT FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17,AS APPROPRIATE,ON REV. 1500 COVER SHEET
II, NON-TAXABLE DISTRIBUTIONS; -
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV 1500 COVER SHEET
(117 more space is needed,insert additional shads ofthe same size)