HomeMy WebLinkAbout05-23-14 1505610143
REV-1500 EX(02-11) 1 ,
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County code Year File Number
Bureau of Individual Taxes DERUenFW Cr R�Ne•
PO BOx.280601 INHERITANCE TAX RETURN 21 13 0299
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
02 28 2013 12 29 1930
Decedent's Last Name Suffix Decedent's First Name MI
SALISBURY LYDIA ANN
(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
XI 1. Original Return 2. Supplemental Return 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate 4,Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
fi Decedent Died Testate ❑ y Decedent Maintaineda Living Trust D 8. Total Number of Safe Deposit Boxes
(Attach Copy o/Will) (Attach Copy o/dTrust) P
9. Litigation Proceeds Received 10.b�iween P2]`t-9I andl1(Da95)f Death 11.Election to tax under Sec.9113(A)
(Attach Schedule O)
CORRESPONDENT•THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GEORGE F DOUGLAS III ESQ 717 2" 6333 ° -3
m CD
.`�. 47 O
REGISTER OFµR�LC'Si USQNLY� :;o
_
t)
First Line of Address r'— rn ry m n
� W ::1 c7
354 ALEXANDER SPRING RO �' o
Second Line of Address n C:) -T1 -%
a> C- _ C]
-„� Co r r-n
D FILED N Crt
City or Post Office State ZIP Code
CARLISLE PA 17015
Correspondent's e-mail address: _gdouglasCdsalzmannhughes.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,coned and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
S;1GRE OF PE ON SPONSIBLE OR FILING RETURN
DATE
GGC/ Michael S. Salisbury
AD E7'
361 Bellaire Park Road, C ' Ie, PA 17013
SIGNATU OF PREPARER OTHER THAN REPR ENTATIVE
DATE
C Ski � George F Douglas, III Esq. �'� a11•F
ADDRE S
354 Alexander Spring Road, Suite 1, Carlisle, PA
L
1505610143 Side 1
1505610143
J 1505610243
REV-1500 EX
Decedent's Social Security Number
DecedemfsName: Salisbury, Lydia Ann
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 74 , 305 . 11 '
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 520 , 929 . 42
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non,-Probate Property
(Schedule G) a Separate Billing Requested............ 7, 708 , 786 . 72
8. Total Gross Assets(total Lines 1 through 7),. .. .. .. ......................................... 8, 1 , 304 , 021 . 25
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 14 , 300 . 48
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 3 , 727 . 03
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 18 , 027 . 51
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1 ,285 , 993 . 74
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. 1 ,285 , 993 . 74
TAX COMPUTATION-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.00 15. 0 . 00
16. AmountX .0 45 taxable
rate at lineal rate e X .0 1 , 285 , 993 . 74 16. 57 r 869 . 72
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 57 , 869 . 72
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. El
Side 2
L 1505610243 1505610243
REV-1500 EX Page 3 File Number 21-13-0299
Decedent's Complete Address;
DECEDENT'S NAME
Salisbury, Lydia Ann
STREET ADDRESS
1 Longsdorf Way
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1} 57,$59.72
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +13) (2) 0.00
3. Interest (3) 835.05
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 I +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 558,704,77
Make Check Pa 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;................ ...............................__................_...... 0
b. retain the right to designate who shall use the property transferred or its income;....... .............I...........
c, retain a reversionary interest,or............................................................................................................... x
d. receive the promise for life of either payments,benefits or care?............................................................ H ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................................__........................_............_..................-- ❑ ❑x
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑
4. Did decedent own an Individual retirement account,annuity,or other non-probate property which ❑ ❑ .
contains a beneficiary designation?...........___..................................__...................................................
....... z
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-i)(8b
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 lax,and the statutory requirements for disclosure of assets and
fling 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 172 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.
4
Rev-1503 EX+(6-98)
SCHEDULE B
STOCKS & BONDS
OOMMONWEA THOFPENNSYLVANIA
INHERITANCE TP RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21-13-0299
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
Morgan Stanley Account No.410-895354-012-Mutual F nds
1 453320301 1,682.291 shares of American Inc. Fund of America CL C 18.5400029 31,189.68
2 524686615 949.261 shares of Legg Mason Global Asset Management Tr, 45.42 43,115.43
CL C
TOTAL(Also enter on Line 2, Recapitulation) 74,305.11
(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)
Revd SOO E%.(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21-13-0299
Include the proceeds of IIIlgallon and the date the proceeds"m moeNed by the estate.
All Propertyiointlyrowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Cash Accounts
1 M&T Bank, Checking Account No. 14297043 30,361.73
Accrued interest on Item 1 through date of death 0.12
2 Morgan Stanley Account No.410-895354-012-Cash 17,092.71
Morgan Stanley.Account No.410-89535 -C rtificat of D eoosit
3 $40,000 BMW Bank of North America Utah; 1.25%-dated 12/10/2012;due 2/28/2013; rate 40,312.50
1.25%
Accrued interest on Item 3 through date of death 109.59
4 $41,000 Discover Bank; Certificate of Deposit; .8%-dated 12/13/2012;due 12128/2013; 41,140.94
rate .8%
Accrued interest on Item 4 through date of death 69:19
5 $38,000 Discover Bank; Certificate of Deposit; 1.15%-dated 0 212 212 01 3; due 02128/2013; rate 38,201.88
1.15%
Accrued interest on Item 5 through date of death 7.18
6 $41,000 GE Capital Retail Bank; Certificate of Deposit; 1.1%-dated 06108/2012; due 41,153.75
6/0812015; rate 1.1%
Accrued interest on Item 6 through date of death 96.85
7 $50,000 GE Capital Retail Bank; Certificate of Deposit; 1.45%-dated 1212112012;due 50,546.88 .
02/28/2013; rate 1.45% ,
Total of Continuation Schedules See attached
pages
TOTAL(Also enter on Line 5, Recapitulation) 520,929.42
(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 E(Rev. 11-10)
Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS
DEPARTMENT OF REVENUE 1 & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21-13-0299
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Accrued interest on Item 7 through date of death 258.22
8 $37,000 Goldman Sachs Bank; Certificate of Deposit; .9%-dated 08/222012; due 08/22/2014; 37,060.94
rate.9%
Accrued interest on Item 8 through date of death 5.47
9 $76,000 Goldman Sachs Bank;Certificate of Deposit; .95%-dated 02/29/2012; due 76,142.50
03/0212015; rate .95%
10 $75,000 Metlife Bank; Certificate of Deposit; 1.3%-dated 1011312010; due 10/1512013; rate 75,515.63
1.3%
Accrued interest on Item 10 through date of death 368.63
11 $35,000 Ally Bank Midvale Utah,Certificate of Deposit; .9%-dated 1 211 912 01 2; due 35,043.75
1212112015; rate .9%
Accrued interest on Item 11 through date of death 61.27
12 $35,000 Ally Bank Midvale Utah, Certificate of Deposit; .7%-dated 12/19/2012; due 35,065.63
12/19/2014; rate.7%
Accrued interest on Item 12 through date of death 47.66
13 Commonwealth of PA-2013, PA40 income tax refund 284.40
14 Diakon Lutheran Social Ministries -refund 15.00
15 Highmark-refund 424.90
16 Highmark-refund 65.10
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1508 EX+(11.10)
SCHEDULE E
pennsylvania
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21.13-0299
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17 HMA Physician Management-refund 147.00
18 L.L. Bean -refund 43.44
19 RiverSource Life Insurance Co.-refund 1,264.56
TOTAL(Also enter on Line 5, Recapitulation) 520,929.42
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev4510 EX-(08-08)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE -
INNERITANCETAXRETURN MISC. NON_ -PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21.13-0299
This schedule meet be completed and riled if tae ana r to any of Questions 1 Mrough 4 on page three of the REV-1500Is yes.
-ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD-S EXCLUSION TAXABLE
NUMBER THE INCLUDE NAME OF TROANSFFER. ATTA&A COPY OF THE DEIED FOR ESTATE. VALUE OF ASSET (MEREST (IF APPLICABLE) VALUE
1 Aviva,Annuity Policy No. 30AB708294-equal 194.792.30 100.000% 194,792.30
beneficiaries are decedent's children: Michael
Salisbury and Debra Paulson
2 Morgan Stanley IRA Account No.410.894789 -Equal 513,994.42 100.000% 513,994.42 .
beneficiaries are decedents children: Michael S.
Salisbury and Debra Paulson
3 Janice Paulson-12/20/2012 cash gift-granddaughter 2,000.00 100.000% 2,000.00 0.00
TOTAL(Also enter on Line 7,Recapitulation) 708,786.72
(If more space Is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Fonn PA=1500 Schedule G(Rev.08-09)
REV-1511 EXi(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DEC ENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21-13-0299
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 4,004.31
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 Salzmann Hughes, P.C. 7,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationshio of Claimant to Decedent
4. Probate Fees 893.50
5. Accountant's Fees
6. Tax Return Preparers Fees 375.00
7. Other Administrative Costs 1,527.67
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 14,300.48
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
Salisbury, Lydia Ann 21-13-0299
ITEM
NUMBER DESCRIPTION - AMOUNT
Funeral Expenses
1 Hoffman-Roth Funeral Home-balance due for funeral services 487.18
2 Michael S. Salisbury-reimbursement for funeral expenses 1,076.13
3 Michael S. Salisbury-reimbursement for payment to Hoffman-Roth Funeral Home for funeral 2,441.00
expenses
H-A 4,004.31
Other Administrative Costs
4 Cumberland Law Journal-Legal advertising 75.00
5 Michael S.Salisbury-reimbursement for postage and office supplies in order to administer 192.51
the estate
6 Register of Wills-five short certificates 25.00
7 Register of Wills-three short certificates 15.00
8 Register of Wills-four short certificates 20.00
9 Salzmann Hughes, P.C.-closing costs and final fees for income tax preparation, postage 1,000.00
and miscellaneous contingencies in order to,administer the estate
10 The Sentinel-Legal advertising 200.16
H-B7 1,527.67
Copyright(c)2002 form software only The.Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-0512 EX•(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21-13-0299
Report debts Incurred by the decedent pdor to death that remained unpaid at the dale of death,Including unreimbureed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Janice Paulson -birthday gift,check written prior to death cleared after death 2,000.00
2 Michael S. Salisbury-reimbursement for payment to LL Bean, balance due on account 440.63
3 Michael S.Salisbury-reimbursement for payment to Pinnacle Health Medical Records, 10.31
balance due on account
4 Michael S. Salisbury-reimbursement for payment to Danbury Mint,balance due on account 44.70
5 Michael S.Salisbury-reimbursement for payment to US Health Care Medical Records, 5.00
balance due on account
6 Omnicare King of Prussia-balance due on account 4-21 848.39
7 PA Department of Revenue -income tax due for 2012, PA40 316.00
8 PA Department of Revenue-2013, PA40 income tax 62.00
TOTAL(Also enter on Line 10, Recapitulation) 3,727.03
(If more space Is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX.(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE p
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Salisbury, Lydia Ann 21-13-0299
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT
(Words) ($$$)
I. TAXABLE DISTRIBUTIONS (include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 . Janice Paulson Granddaughter Sch. G, Item 3
372 Mount Alverno Road
Media, PA 19063
2 Debra Paulson Daughter Sch.G, 1/2 Items 646,458.01
372 Mount Alverno Road 1 &2
Media, PA 19063 1/2 Residue
3 Michael S. Salisbury Son Sch.G, 112 Items 646,458.01
361 Bellaire Park Road 1 &2
Carlisle, PA 17013 1/2 Residue
Total 1,292,916.02
Enter dollar amounts for distributions shown above on lines 15 throw h 18 or Rev 1500 cover sheet,as a ro nate.
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 II -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
n -
e
o
OF �
c:7 a _3 rri
LYDIA A. SALISBURY
c w r rrr
lo
I, LYDIA A. SALISBURY, now domiciled in Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may
have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate
shall be paid by my Executor from the principal of my residuary estate as soon as practicable
after my death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but
not including any generation skipping tax) payable by reason of my death shall be paid out of
and be charged generally against the principal of my residuary estate without reimbursement
from any person. This provision is not a waiver of any right which my Executor has to claim
reimbursement for any such taxes which become payable as the result of any property over
which I have the power of'appointment.
Article III
I give, -devise and bequeath my tangible personal property in accordance with any
memorandum I have handwritten or signed, located with my will or with my valuable papers and
found within thirty (30) days of the probate of my will. Gifts may only be to persons who
survive me or to organizations which exist at my death, and if there is a conflict, the
memorandum having the latest date shall govern. To the extent no such memorandum is found,
or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal
property shall be added to my residuary estate and pass under Article IV hereof.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath in equal shares to my children, DEBRA PAULSON, of
Media, Delaware County, Pennsylvania,per stirpes, and my son, MICHAEL S. SALISBURY,
of Carlisle, Cumberland County, Pennsylvania, per stirpes. If either of my children fail to
survive my death by thirty (30) days, his or her share shall be distributed to his or her issue,per
stirpes. The share of either of my children who fails to so survive my death leaving no surviving
issue shall be distributed to my remaining child,per stirpes.
Article V
I nominate, constitute and appoint my son, MICHAEL S. SALISBURY, of Cumberland
County, Pennsylvania as Executor of my Last Will and Testament. In the event of the
renunciation, death, or inability to act, for any reason whatsoever of my Executor, I nominate,
constitute and appoint my daughter, DEBRA PAULSON, of Media, Pennsylvania, as successor
Executor of my Last Will and Testament. I direct that my Executor or successor Executor be
permitted to serve without bond. In addition to those powers granted by law, I grant them power
to distribute in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I
could have filed if living. My Executor or successor Executor shall receive reasonable
compensation for services rendered to my estate.
2
f
Article VI
In addition to the powers conferred by law, I authorize my Executor or successor
Executor, in his or her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
any such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executor or successor Executor; and to pay from my estate reasonable compensation for all
their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have
an interest in at time of my death,
(j) to disclaim, in whole or in part, any property or interest therein which passed to
me or which was created for my benefit, for any reason in the discretion of my Executor or
successor Executor, and
i
3
(k) to receive reasonable compensation in accordance with the standard schedule of
fees in effect while their services are performed.
IN WITNESS WHEREOF, I, LYDIA A. SALISBURY, hereby set my hand to this my
Last Will and Testament, on ALCi-1 ' / 2012, at Harrisburg, Pennsylvania.
LY61A A. SALISBURY
In our presence, the above-named LYDIA A. SALISBURY signed this and declared this
to be her Last Will and Testament and now at her request, in her presence, and in the presence of
each other, we sign as witnesses.
Name Address
2000 Linalestown Rd.. Suite 202, Harrisburg. PA 17110
1 tl Quo �J__)p36&na__ 2000 Linelestown Rd., Suite 202, Harrisburg, PA 17110
( J
4
I, LYDIA A. SALISBURY, Testator, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affirmed and
Acknowledged before me by
LYDIA A. SALISBURY,the Testator
on !}L.,bu-i7 1 12012.
Notary Public LYDIA A. SALISBURY
COMMONM/FALTH OF PENNSYI-VAJIA
Mootarcal Seal
Meriisa M.Kain,Nots PuIft
Susquehanna Np.,4auPh'n Count'
My Commission cxPIM Au .12,7.d14p
We, the undersigned witnesses who signed the foregoing instrument,being duly qualified
according to law, depose and say that we were present and saw the Testator sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for
the purposes therein expressed; that each of us in her sight and hearing signed the Will as
witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years.or
more of age, of sound mind, and under no constraint or undue influence.
Swom to or affirmed and
Subscribed to before me
by Lima J- fI4y A.l lic
and 1JNt e> F V)6''ra�ivyn Witnes V
witnesses,—won Au&o5T I 2012.
Witne's
Notary Public
COMMONWEALTH OF PENNSYLVANIA
No3nal seal --'
Melissa M.Koln,Notary Public .w. `
snsquehanna ivP.,dauphin Col/
My commission E)Vres Au.j.li,2014_ '
5
02/04/2014 11:28 FAX Q0002/0003
Estate Valuation
Date of Death: 02128/2013 Estate of: Salisbury
Valuation Date: 02/28/2013 Account: d10-895354
Processing Date: 0112912014 Report Type: Date of Death
Number of Securities: 13
File ID: Salisbury 410.895354
Shares Security Mean and/or Div and Int Security
or Par Description Nigh/Ask Lou/Hid Adjustnwtnts Accruals Value
1) 17092.42 Cash (CASH) 17,092,7 1
2) 1682.29Lucm PD AMER INC (453320301; IFACX)
CL C
Mutual Pund (as quoted by NASDAQ)
0212812013 18.54000 Mkt
1e.540000 31,189.68
3) 949.261LECC MASON GLOBAL ASSET MW TR (524686615; LMVPX)
Cl, C
Mutual Fund values reported to NASDAQ
02128/2013 45.42000 Mkt
45.420000 43,us.43
U 35000 ALLY BE MIDVALS UTAR (02005QU761
Interactive Data Corporation
DM; 12/19/2012 Mat: 12/21/2015 0.9t
02/28/2013 100.12500 A/B
100.125000 35,043.73
Inc: 12/19/2012 to 02/28/2013 61.27
Note: Put Option on DOD
5) 35000 ALLY BR MIDVALE UTAH (020050084)
Interactive Data Corporation
DID: 12/19/2012 Mat: 12/19/2014 0.7E
02/28/2013 100418750 A/B
100.187500 35,065.67
Int: 12/19/2012 to 02/2812013 47.66
Note; Put Option on DOD
6) 40000 UMW BR NORTH AMER UTAH (05568PASO)
Interactive Data Corporation
DYD: 12/10/2010 Mat: 12110/2013 1.25E
02/28/2013 100.78125 A/B
100.783240 40,312.50
Int: 12/10/2012 to 02/28/2013 109.59
Note: Put Option on DOD
7) 41000 DISCOVER BR (254671CL2) '
Interactive Data Corporation
DTD: 06/13/2012 Mat: 06/13/2014 0.8E
02/28/2013 100.34375 A/B
100.347750 41,340.94
lot: 12/13/2012 to 02/2812013 69.19
Note: Put Option on DOD
81 38000 DISCMW BE (254671FS4)
Interactive Data Corporation
DID: 08/2212012 Mat: 08/24/20LS 1.15E
02/28/2013 100.53125 A/B
300.531250 18,201,88
Int: 02/22/2013 to 02129/2013 7.18
Note: Put Option on DOD
9) 50000 GE CAP RETAIL OX DRAPER UTAH (36199CW51
Interactive Data Corporation
DTD: 10121/2011 Mat: 10/21/2014 1.45%
02/28/2013 101.09375 A/B
101.093750 50,546.88 ,
Int: 10/2112012 to 02/28/2013 258.22
Note: Put Option on DOD
10) 41000 GE CAP BR INC RETAIL (36161TAP0)
Interactive Data Corporation
DTD: 06/08/2012 Mat: 06/08/2015 1.1E
02/28/2013 100.37500 A/B
300.375000 41,153.75
Intl 12/10/2012 to 02/28/2013 98.85 - -
Note: Put Option on DOD- - . . . . ._. .. -.. - .. . .......
Page 1
This report was produced with EstateVal, a product of Estate Valuations i Pricing Systems, Inc. if you have questions,
please contact WF Systems at (818) 313-6300 or www.evPGY2.c0m. (Revision 7.1.1)
02/04/2014 11:29 FAX Ia 0003/0003
Date of Death: 02/28/2013 Estate of: Salisbury
Valuation Date: 02/28/2013 Account: 410-895354
Processing Date: 01/2912014 Report Type: Date of Death
Number of Securities: 13
File ID: Salisbury 410-895354
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Law/Hid Adjustments Accruals Value
11,1 76000 GOL MAN SACKS BE USA NY i38143AM21
Interactive Data Corporation
Urn: 02/29/2012 Mat: 03/02/2015 0.95%
02/26/2013 100.18750 A/S
100.187500 76,142.50
Full coupon paid on 02/28/2013
12) 37000 GDLDMAN SACKS BR USA NY (38143AZFS1
Interactive Data Corporation
DTD: 08/22/2012 Mat: 08122/2014 0.99
02128/2013 100.21875 A/D
100.218750 37,080.94
Int: 02122/2013 to 02/28/2013 5.47
Note: Put Option on DOD
13) 15000 METLIFE BR MATL ASSN NJ (59155108)
Interactive Data Corporation
DTD: 10/1312010 Fat: 10/15/2013 1.3E
02/28/2013 100.68750 A/B
100.687500 75,515.63
Int: 10/1312012 to 02128/2013 368.63
Note: Put Option On DOD
Total Value: $561,602.22
Total Accrual: $1,026.06
Total: $562,628.28
Page 2
This report was produced with EstateVal, a product of Estate Valuations a Pricing Systems, Inc. if you have questions,
please aontact EVP Systems at (818) 313-6300 or www.evpsys.COm. (Revision 7.3.1)
f
® MKTBank
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-5024349
Fax (302)934-2955
November 20,2013
Salzmann Hughes, P.C.
Attorneys at Law
354 Alexander Spring Road, Suite 1
Carlisle, PA 17015
Re: Estate of Lydia Ann Salisbury
Social Security: 208-28-6933
Date of Death: February 28, 2013
Dear Sir or Madam:
Per your inquiry on November 12, 2013,please be advised that at the time of death,the above-named decedent
had on deposit with this bank the following:
1. T)peofAccouni Checking Account
AccouniNumber 14297043
Ownership(Names oJ) Debra S.Paulson(POA)
Lydia A.Salisbury
Opening Date 0912811990
Balance on Date of Death S 30,361.73
Accrued Interest S .12
----------------------------------
Total S 30,361.85
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds,
please all the High Street Carlisle at 717-240-4536.
This letter does not include any amounts in which the deceased may hme been listed as Power of Attorney,Custodian of Uniform Transfer,
Representative Payee,or Trustee under a written Agreement.
Sincerely,
Valarie Mercer
Adjustment Services
ANNA
Aviva Life and Annuity Company 7700 Mills Civic Parkway West Desimones IA 50266-3862
Mail?recessing Center: PC Bey 1555 Des Moines IA 50306-1555 Tel 800 800 9832 Fax 800 531 0038 w>vw.avivausa.cor..
December 4, 2013
SALZMANN HUGHES PC
ATTORNEY AT LAW
ATTN GEORGE F DOUGLAS III
354 ALEXANDER SPRING RD STE 1
CARLISLE PA 17015
Re: Deceased: Lydia Ann Salisbury
Policy#: 30AB708294
Dear Mr. Douglas:
We are in receipt of your request for the date of death value for the above referenced non-qualified
annuity. Please find the account value below.
Date of Death: 2/28/13
Account Value: $194,792.30
Cost Basis: $13,200.00
Beneficiary: Michael Salisbury & Debra Paulson
Please note that we have received claim forms from Michael and Debra. They elected the 5 year
deferral option and are receiving payments on a yearly basis.
If there is anything we can assist you with or if you have any questions, please do not hesitate to
contact one of our Claims Representatives toll-free at 1-800-800-9882.
Sincerely,
Customer Service
.I
i
1
Aviva USA Corporation Aviva Lite and Annuity Company
Aviva Life end Annuity Company of New York Avva Investors North America.Inc.
Estate of Lydia Ann Salisbury Morgan Stanle� IRA Account Equal Beneficiaries are:
Estate aluat on Michael S. Salisbury Debra Paulson
Date of Death: 02/28/2013
Estate of: Salisbury
Valuation Date: 02/28/2013 - Account: 110-899789
Processing Date: 06/25/2013 Report Type: Date of Death
Number of Securities: 12
Pile ID: Salisbury IRA 410-894789
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 89671.12 Cash (CASH) 89,671,12
2) 4258.06 INCOME FD AMER INC (453320301; IFACX)
CL C
Mutual Fund (as quoted by NASDAQ)
02128/2013 16.54000 Mkt
.. 18.540000 78,944.43
31 1460,86 LEGG MASON GLOBAL ASSET MMG TR (524686615; LYVTX)
CL C
Mutual Fund values reported to NASDAQ
02128/2013 65.42000 Mkt
45.420000 66,352.26
4) 30000 ALLY BK MIDVALE UTAH (02004ML351
Interactive Data Corporation
DTD: 08/27/2010 Mat: 08/27/2013 1.55%
02128/2013 100.53125 AIR
100.531250 30,159,38
Int: 02/27/2013 to 02128/2013 1.27
Note: Put Option on DOD
5) 7000 ALLY BK MIDVALE UTAH (020050QK2)
Interactive Data Corporation
DTD: 06108/2011 Mat: 06/09/2014 1.45%
02128/2013 101,00000 AIR
101.000000 7,070.00
Int: 12/08/2012 to 02/28/2013 22.80
Note: Put Option on DOD
6) 30000 ALLY EK MIDVALE UTAH (02005QRD7)
Interactive Data Corporation
DTD: 06/15/2011 Mat: 06/16/2014 1.4E
02/2812013 101.00000 AIR
101.000000 30,300.00
Int: 12/15/2012 to 02/28/2013 86.30
Note: Put Option on DOD
11 3000D BMW BK NORTH AMER UTAH (05568PA80)
Interactive Data Corporation
DID: 32/10/2010 Mat: 12/10/2013 1.25E
02/28/2013 100.78125 AIR
100.781250 30,234.38
Int: 12/1012D12 to 02128/2013 82.19
Note: Put Option on DOD
8) 29000 DISCOVER EK (254671FS4)
Interactive Data Corporation
DID: 08/22/2012 Mat: 08/2412015 1.15%
02128/2013 100.53125 AIR
100.511250 29,154.06
Int: 02/22/2013 to 02/28/2013 5.48
Note: Put Option on DOD
9) 10000 GE CAP RETAIL BK DRAPER UTAH (36159CW36)
Interactive Data Corporation
DTD: 08/26/2011 Mat: 08/2612014 1.2%
02/28/2013 100.65625 AIR
100.656250 10,065.63
Int: 02/2612013 to 02128/2013 0.66
Note: Put Option on DOD
10) 220DO GE CAP BK INC RETAIL (36160TRB4)
Interactive Data Corporation
DTD: 0313112031 Mat: 03/3112014 1.3%
02/28/2013 100,71875 AID
100.718750 I 22,158.13
Intl: 09/3012012 to 02/28/2013 118.]2
Note: Put Option on DOD
Page 1
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)
t
Date of Death: 02/28/2013 Estate of: Salisbury
Valuation Date: 02/28/2013 - Account: 410-894789
Processing Date: 06/25/2013 Report Type: Date of Death
Number of Securities: 12
Pile ID: Salisbury IRA 410-894189
Shares Security Mean and/or Div and Int Security
or Par Description Nigh/Ask Lop/Bid Adjustments Accruals Value
11) 60000 CE CAP BK INC RETAIL (36161TAPO)
Interactive Data Corporation
Dig: 06/08/2012 Mat: 06/08/2015 1.1%
02/28/2013 100.37500 A/B
100.375000 60,225.00
Int: 12/10/2012 to 02/28/2013 144.66
Note: Pit Option on DOD
12) 590DO OOLDMAN SACHS BK USA NY (38143AU29)
Interactive Data Corporation
- DID: 11/14/2012 Mat: 11/16/2015 1.05%
02/28/2013 100.03125 A/B
100.031250 59,018.44
Int: 11/14/2012 to 02/28/2013 179.91
Note: Put Option on DOD
Total Value: $513,352.83
Total Accrual: $641.59
Total, $513,994.42
Page 2
This report was produced with EstateVal, a product of Estate Valuations a Pricing Systems, Inc. If you have Questions,
please contact RVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)