HomeMy WebLinkAbout06-06-14 1505610149
J REV-1500 Ex(02-11)pern anla OFFICIAL USE ONLY
PA Department of Revenue '°"°""`—.. County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 20 12 00526
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04 11 2012 01 02 1935
Decedent's Last Name Suffix Decedent's First Name MI
Dittenhafer , Jr . Clarence A
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Dittenhafer Jackolyn R
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
M 1.Original Return 2. Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a. Future Interest Compromise(date of 5. Federal Estate Tax Return Required
death after 12-12-82)
6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Anna Borro Hays , Esquire 717 612 5804ry
0
REGISrFER OF WILLS USE ONLYJ
O _
n
71 z n
First Line of Address %' L+ r-
— m rn r
Saidis, Sullivan Rogers T co y
Second Line of Address r-. n _
635 North 12th Street, Suite 400 " C=
RITE FILE r
City or Post Office State ZIP Code cg C/f O
Lemoyne PA 17043 c �
Correspondent's e-mail address: aborrohays @ssr-attorneys.com
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,conect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN E OF PE ON RESPONSIB F NG RETURN DATE
GI 11
ADDR s 166 fiver Road
Pe ea P 7565
SIGNA URE OF PARER T ER THAN REPRESENTATIVE D TE
err 61 ►�I
ADDRESS 635 North 12th Sjreet, Suite 400
Lemoyne, PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610149 1505610149
1505610249
REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name:
Clarence A Dittenhafer Jr
RECAPITULATION
0 . 00
1. Real Estate(Schedule A) ... ... .. . .. . . . .. . . . . ... . .. . .. . . . . . . . . ... . . 1.
35,672 . 58
2. Stocks and Bonds(Schedule B) . . .. . . . .. . .. . .. . .. . .. . . . . . . .. . .. . .. . 2.
0 . 00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .. . . 3. .
0 . 00
4. Mortgages and Notes Receivable(Schedule D) . . . . . . .. . .. . . .. . .. . . . . . .. 4.
44 ,235 . 00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) . . .. . . 5.
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . .. 6. 374 . 40
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 514 , 00 0 - 00
(Schedule G) O Separate Billing Requested ... . 7.
594 ,281 . 98
8. Total Gross Assets(total Lines 1 through 7) . . . .. . .. . .. . .. . . .. ... . . .. . . 8.
9. Funeral Expenses and Administrative Costs(Schedule H) . .. . . 46 ,727 - 19
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 10. 8 ,079 - 57
11. Total Deductions(total Lines 9 and 10) .. . . .. . .. . .. . .. . .. . . . . . .. . .. . . 11. 54 1806 . 76
12. Net Value of Estate(Line 8 minus Line 11) 539, 475 . 22
12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0 . 00
an election to tax has not been made(Schedule J) . .. . .. . .. . .... .. . .. . .. . 13.
539 ,475 . 22
14. Net Value Subject to Tax(Line 12 minus Line 13) . ... . .. . . . . ... . .. . .. . . 14.
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 350,000 - 00 0 . 0 0
(a)(1.2)X.0 0 15.
16. Amount of Line 14 taxable 189 , 475 . 22 8 ,526 . 38
at lineal rate X.0 45 16.
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 . 00 0 . 0 0
18
19. TAX DUE 19 8,526 . 38
. . . . ... ... .. . .. .. . .. . . . .. . .. . . . .. . .. . .. . ... . . .. . .. . .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610249 1505610249
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 20 12 00526
DECEDENT'S NAME
Clarence A. Dittenhafer, Jr.
STREET ADDRESS
431 Croghan Drive
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 8 526.38
2. Credits/Payments
A.Prior Payments 28,500.00
B.Discount 448.75
Total Credits 1 A+g 1 121 28,948.75
3. Interest (3) 0.00
4. If Line 2 is greater than Line i+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 20,422.37
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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 .. . ... . .. . .. . .. . .. . .. . .. . . . .. . L1 N
b. retain the right to designate who shall use the property transferred or its income . .. . .. . 1-1 X
c. retain a reversionary interest . . . .. ... .. . .. . . . . . .. . . .. . . . . . .. ... .. . .. . . . . . . .. . . El 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? . . .... . .. . .. . .. . . . . .. . .. . .. . . . .. .. . ❑ IR
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?.. . ... . .. . .. . .. . .. . .. . .. . .. . . . . . . . ® ❑
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)(1)].
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 F2 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-1502 EX+ (12-12)
. . pennsAvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Clarence A. Dittenhafer, Jr. 20 12 00526
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly- coed with right of survivorship must be disclosed on Schedule F.
ITEM Attach a copy of the settlement sheet if the property has been sold. VALUE AT DATE
NUMBER Include a copy of the deed showing decedent's interest if owned as tenant in common. OF DEATH
DESCRIPTION
1 431 Croghan Drive, Carlisle, PA 0.00
2010 tax assessment: $234,900
For Information Only:
Jackolyn Dittenhafer, surviving spouse of Clarence Dittenhafer, has a fully
vested life estate. The remainder interest is subject to inheritance tax upon
her death.
TOTAL (Also enter on Line 1, Recapitulation.) 0.00
If more space is needed, use additional sheets of paper of the same size.
REV-1503 EX+ (8-12)
. ; pennsylvania SCHEDULE B
pEPARTMEW OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clarence A. Dittenhafer, Jr. 20 12 00526
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 350.7597 shares of Chevron Corp 35,64245
Number of shares per statement
Value per yahoofinance.com
2 1 share of Foot Locker, Inc. 30.13
Number of shares per statement
Value per yahoofinance.com
TOTAL (Also enter on Line 2, Recapitulation) 35,672.58
If more space is needed, insert additional sheets of the same size
REV-1508 EX+ (08-12)
Iffpennsytvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Clarence A. Dittenhafer, Jr. 20 12 00526
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 PSECU Checking Account 0195268389-04 18,743.98
Per statement
2 PSECU Regular Shares Account 01953268389-01 5.00
Per statement
3 PSECU Money Market Account 01953268389-07 4,643.73
Per statement
4 2007 Lexus Es350 -54,000 miles 20,000.00
Per kbb.com
5 Genworth Financial Premium Refund 55.84
6 HMA Physician Refund 5.00
7 Apria Healthcare Refund 38.22
8 PA Treasury Dept Annuity Payment 743.23
($2,026.98 minus $1.283.75 returned on 9/13/12)
TOTAL (Also enter on Line 5, Recapitulation) 44,235.00
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+ (01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Clarence A. Dittenhafer, Jr. 20 12 00526
If an asset became jointly owned within one year of the decedents date of death,it must be reported on Schedule G.
SURVIVING 30INT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Jeffrey B. Dittenhafer 166 River Road Son
Pequea, PA 17565
B. Jackolyn R. Dittenhafer Trust c/o Jeffrey B. Dittenhafer, Trustee Surviving spouse
166 River Road
Pequea, PA 17565
C.
JOINTLY OWNED PROPERTY:
ITEM LETTER DATE DECERIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH
NUMBEF FORJOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR VALUE OF ASSET DECEDENT'S VALUE OF
TENANT JOINT SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE INTEREST DECEDENT'S INTEREST
1 AB 3/30/06 Members 1st Federal Credit Union account 9.95 33.3333 3.32
owned jointly with Decedent's surviving spouse,
Jackolyn R. Dittenhafer and Decedent's son,
Jeffrey B. Dittenhafer
2 AB 3/30/06 Members 1st Certificate of Deposit 248267- 1,113.23 33.3333 371.08
0040 owned jointly with Decedent's surviving
spouse, Jackolyn Dittenhafer, and Decedent's
son, Jeffrey Dittenhafer
TOTAL (Also enter on Line 6, Recapitulation) 374.40
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE
INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clarence A. Dittenhafer, Jr. 20 12 00526
This schedule must be completed and fled if 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
NUMBEF INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
AND THE DATE OF TRANSFER.ATTACH COPY OF THE DEED FOR REAL ESATE.
1 US Savings Bonds Payable on death to 26,742.00 100 26,742.00
Decedent's surviving spouse, Jackolyn R.
Dittenhafer
Series I V0021090921 $5,000 issued 10/2001
Series I X0012830401 $10,000 issued 10/2001
($15,000 plus $11,742 accrued interest)
Per Savings Bond Calculator
2 Guardian Annuity Contract 210083483 21,569.33 100 21,569.33
Per statement$26,961.66 death claim minus
$5,392.33 federal tax withheld
Beneficiary: Estate of Clarence Dittenhafer
3 Ameritrade Account 915-985852Nalley Forge 2,877.41 100 2,877.41
Account 368-63618- Roth IRA Money Market
Fd
Beneficiary: Estate of Clarence A. Dittenhafer
Per valuation
4 AT&T Inc. 3,045.00 100 3,045.00
(Held in Ameritrade Roth IRA Account 915-
985852Nalley Forge account 368-63618)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
5 Analog Devices Inc. 3% due 4/15/16 21,209.20 100 21,209.20
(Held in Ameritrade Roth IRA Account 915-
985852Nalley Forge account 368-63618)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
6 Ameritrade TOD Account 915-056185Nalley 10,332.15 100 10,332.15
Forge Account 368-63616
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
7 Teva Pharmaceutical Fin 1.7% due 3/21/14 20,234.40 100 20,234.40
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
Total from continuation Schedule(s) 407,990.51
TOTAL (Also enter on Line 7, Recapitulation) 514,000.00
If more space is needed, use additional sheets of paper of the same size.
Page 2
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
8 Hewlett Packard Co 2.2% due 1211/2015 20,280.00 100 20,280.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
9 JP Morgan Chase &Co 3.45% due 3/1/16 20,841.60 100 20,841.60
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
10 General Electric Capital Corp 2.95% due 20,811.00 100 20,811.00
5/9/2016
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
11 Statoil Asa 3.125%due 8/17/2017 21,513.40 100 21,513.40
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
12 People's United Financial Inc 4,404.75 100 4,404.75
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
13 Thomson Reuters Corp 4,230.00 100 4,230.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
14 Paychex Inc. 4,644.00 100 4,644.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
15 Johnson &Johnson 6,413.00 100 6,413.00
(Held in Ameritrade TOD Account 915-
TOTAL. (Carry forward to main schedule) . . . . . . 103,137.75
Page 3
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
15 056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
16 Waste Management Inc. Del 2,616.75 100 2,616.75
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
17 Kraft Foods Inc 3,716.00 100 3,716.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
($3,687.00 plus $29.00 accrued dividends)
Per valuation
18 Clorox Co 5,211.00 100 5,211.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
19 Walt Disney Co 4,137.00 100 4,137.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
20 Newmont Mining Corp 4,800.00 100 4,800.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
21 Bristol Myers Squibb Co 6,518.00 100 6,518.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
22 Merck&Co 3,848.00 100 3,848.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
TOTAL. (Carry forward to main schedule) . . . . . . 30,846.75
Page 4
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
22 Per valuation
23 China Mobile Ltd 5,399.00 100 5,399.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
24 Vodafone 6,782.50 100 6,782.50
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
25 Verizon Communications 1,869.00 100 1,869.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
26 Altria Group Inc. 6,242.00 100 6,242.00
(Held in Ameritrade TOD Account 915-
056185Valley Forge account 368-63616)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
27 Ameritrade Account 915-985857Nalley Forge 19,099.43 100 19,099.43
Account 368-63617 - IRA Money Market Fund
Beneficiary: Estate of Clarence A. Dittenhafer
Per valuation
28 Dell Inc. 3.1% due 4/1/16 21,290.40 100 21,290.40
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
29 Verizon Communications 3.0% due 4/1116 21,285.20 100 21,285.20
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
30 AT&T Inc. 2.95% due 5/15/16 21,202.40 100 21,202.40
(Held in Ameritrade IRA Account 915-
TOTAL. (Carry forward to main schedule) . . . . . . 103,169.93
Page 5
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
30 985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
31 Applied Materials Inc. 2.65%due 6/15/16 20,860.60 100 20,860.60
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
32 Coca Cola 7,212.00 100 7,212.b0
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
33 Pepsico Inc. 6,515.00 100 6,515.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
34 DuPont E I De Nemours & Co 5,145.00 100 5,145.00
(Held in Ameritrade IRA Account 915-
985857/Valley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
35 Automatic Data Processing 5,462.00 100 5,462.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
36 Intel Corp 2,785.00 100 2,785.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
TOTAL. (Carry forward to main schedule) . . . . . . 47,979.60
Page 6
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
37 Microsoft Corp 6,069.00 100 6,069.00
(Held in Ameritrade IRA Account 915-
985857/Valley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
38 Abbott Labs 8,949.00 100 8,949.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
39 Johnson &Johnson 4,809.75 100 4,809.75
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
40 General Electric 3,836.00 100 3,836.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
($3,802.00 plus $34.00 accrued dividends)
Per valuation
41 Exelon Corporation 3,818.00 100 3,818.00
(Held in Ameritrade IRA Account 915-
985857/Valley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
42 Waste Mgmt Inc. 5,233.50 100 5,233.50
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
43 Sysco Corp 4,392.00 100 4,392.00
(Held in Ameritrade IRA Account 915-
TOTAL. (Carry forward to main schedule) . . . . . . 37,107.25
Page 7
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
43 985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
44 Archer Daniels Midland 3,099.00 100 3,099.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
45 Procter& Gamble 4,983.00 100 4,983.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
46 Barrick Gold Corp 6,156.00 100 6,156.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
.Per valuation
47 Goldcorp Inc. 10,161.25 100 10,161.25
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
($10,150 plus $11.25 accrued dividends)
Per valuation
48 Newmont Mining Corp 4,944.00 100 4,944.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
49 Yamana Gold Inc. 3,043.00 100 3,043.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
TOTAL. (Carry forward to main schedule) . . . . . . 32,386.25
Page 8
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dee's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
49 ($3,032 plus $11.00 accrued dividends)
Per valuation
50 Eli Lilly& Co 5,920.50 100 5,920.50
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
51 Merck & Co 5,772.00 100 5,772.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
52 Pfizer 10,975.00 100 10,975.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
53 Transcanada Corp 6,483.44 100 6,483.44
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
($6,394.50 plus $88.94 accrued dividends)
Per valuation
54 AT&T Inc. 6,090.00 100 6,090.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
55 Cisco Sys Inc 6,028.50 100 6,028.50
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
($6,004.50 plus$24.00 accrued dividends)
TOTAL. (Carry forward to main schedule) . . . . . . 41,269.44
Page 9
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exclusion Taxable
Num Description of Property Value of Asset Interest (if applicable) Value
55 Per valuation
56 Verizon Communications 5,607.00 100 5,607.00
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
57 Central Fund of Canada 6,486.54 100 6,486.54
(Held in Ameritrade IRA Account 915-
985857Nalley Forge account 368-63617)
Beneficiary: Estate of Clarence Dittenhafer
Per valuation
TOTAL. (Carry forward to main schedule) . . . . . . 12,093.54
REV-1511 EX+ (10-09)
pennsyLvania SCHEDULE H
DEPARTMENT OF NUE
FUNERAL EXPENSE AND
RESIDENT DECEDENT ADMINSTRATIVE COSTS
ESTATE OF FILE NUMBER
Clarence A. Dittenhafer, Jr. 20 12 00526
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See schedule attached 7,844.88
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions: 17,000.00
Name(s) of Personal Representative(s) Jeffrey B. Dittenhafer
Street Address 166 River Road
city Peguea state PA zip 17565
Year(s) Commission Paid: 2014
2. Attorney Fees: 17,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00
Claimant Jackolyn R. Dittenhafer
Street Address 431 Croghan Drive
City Carlisle state ?A zip 17013
Relationship of Claimant to Decedent Surviving Spouse
4. Probate Fees: 443.50
S. Accountant Fees: 561.00
6. Tax Return Preparer Fees:
See schedule attached 377.81
TOTAL (Also enter on Line 9, Recapitulation) 46,727.19
If more space is needed, use additional sheets of paper of the same size.
Page 2
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule H, Part A - Funeral Expenses
Item
Number Description Amount
1 Jeffrey Dittenhafer, reimbursement for payment of funeral planning meal 40.00
2 Jeffrey Dittenhafer, reimbursement for payment of flowers 324.81
3 Jeffrey Dittenhafer, reimbursement for payment of after funeral meal 406.46
4 Jeffrey Dittenhafter, reimbursement for payment to funeral home 6,975.66
5 Jeffrey Dittenhafer, reimbursement for payment for urn 97.95
TOTAL. (Carry forward to main schedule) . . . . . . 7,844.88
Page 3
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule H, Part B - Administrative Costs
Miscellaneous Expenses
Item
Number Description Amount
7 Valley Forge Asset Mgmt, management fee 13.58
8 Valley Forge Ass,et Mgmt, management fee 126.13
9 Valley Forge Asset Mgmt, management fee 91.91
10 McNees Wallace& Nurick, LLC, out of pocket expenses 139.19
11 McNees Wallace & Nurick, LLC, out of pocket expenses 4.80
12 McNees Wallace & Nurick LLC;out of pocket expenses 2.20
TOTAL. (Carry forward to main schedule) . . . . . . 377.81
l
REV-1512 EX+ (12-12)
pennWyania SCHEDULE I
DEPAMEM OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Clarence A. Dittenhafer, Jr. 20 12 00526
"Report debts maned by the decedent prior to death that remained unpaid atthe date of death,induding unreimbursed medical expenses.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Discover, credit card payments 2,621.69
2 Jeffrey Dittenhafer, reimbursement for payment of records requested by 299.88
Decedent prior to date of death
3 Jeffrey Dittenhafer, reimbursement for payment to Hospice 4,070.00
4 Jeffrey Dittenhafer, reimbursement for payment to Hershey Medical Center 230.00
5 Jeffrey Dittenhafer, reimbursement for payment to Hershey Medical Center 858.00
TOTAL (Also enter on Line 10, Recapitulation) 8,079.57
If more space is needed, insert additional sheets of the same size
REV-1513 EX+ (01-10)
. , pennsylvania SCHEDULE
DEAM'FMEW OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Clarence A. Dittenhafer, Jr. 20 12 00526
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and
transfers under Sec.9116(a)(1.2).]
See schedule attached
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
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.
If more space is needed, use additional sheets of paper of the same size.
Page 2
Estate of: Clarence A. Dittenhafer, Jr. 20 12 00526
Schedule J, Part I - Taxable Distributions
Amount or Share
Num. Name and Address of Person(s)Receiving Property Relationship to Decedent of Estate
1 Jeffrey B. Dittenhafer Son 47,368.80
166 River Road
Pequea, PA 17565
2 Christopher M. Dittenhafer Son 47,368.80
550 27th Street
San Francisco, CA 94131
3 Rodney D. Dittenhafer Son 47,368.81
33 Larcridge Lane
Ashland, MA 01721
4 Spendthrift Trust FBO Eric S. Dittenhafer Son 47,368.81
c/o Jeffrey B. Dittenhafer, Trustee
166 River Road
Pequea, PA 17565
5 Jackolyn R. Dittenhafer Trust Surviving spouse 350,000.00
c/o Jeffrey B. Dittenhafer, Trustee
166 River Road
Pequea, PA 17565
SHAREOWNER Page,c1,
Shareholder Of:
SERVICES CHEVRON CORPORATION
INVESTOR SERVICES PROGRAM
P.O. Box 3526 STATEMENT PRINT DATE: 12/11/2012
So. Hackensack, NJ 07606-9226 CUSIP: 001-750-16676410
SYMBOL: CVX
ACCOUNT KEY: DITENHAFCLARAOODO
INVESTOR ID: 124880285976
00009729 01 AT 0.374 01 TR 00051 SOUD7101 100000 YOU CAN OBTAIN ACCOUNT AND INVESTMENT INFORMATION AT
1-80D-368-8357,24 HOURS A DAY,SEVEN DAYS A WEEK VIA
SHAREOWNER SERVICES INTERACTIVE VOICE RESPONSE SYSTEM.
CLARENCE A DITTENHAFER ? .vu0
431 CROGHAN DRIVE
CARLISLE PA 17013
I,u.rl,nr,pgrrrlllllPPrlllhrPlrlydddlrlPl,rlhlPlrl
Computershare Trust Company,N.A.,as plan administrator or service provider for the plan administrator,upon Written request and within a reasonable amount of time,vnll provide the
name of the ezecubry brolrer,the source and amount of compensation,if any,received from third parties in connection with the transaction(s)and transachontrade dales)and tlme(s),if
available.
Year-To-Date Account Summary Final Cost Basis for your covered shares will be provided on your year-end Form 10998.
AS OF:121112012 CASH ADDITIONAL DIVIDENDS I NET AMOUNT
TOTAL MARKET VALUE(S) CLOSING PRICE($) INVESTMENTS($)' INCOME .TOTAL IS) TAX WITHHELD($)AMOUNT TO INVEST(5) INVESTED I$1
38,738.84 107.7400 1,237.13 1 1 1,237.13 1,237.13
TRADING FEES PAID BY(S) SERVICE FEES PAID BY(a) SALE OF PLAN SHARES(S) I CERTIFICATED SHARES HELD I SHARES HELD BY TOTAL
COMPANY I SHAREHOLDER COMPANY SHAREHOLDER GROSS PROCEEDS TAX WITHHELD SHARES HELD BY YOU 8Y PLAN OTHER PLAN(S) SHARES
12.00 359.5586 359.5586
Current Activity Information
RECORD DATE TRANSACTION DIVIDEND SHARESAOQUIRED - ADDITIONAL CASH TOTAL
PAYABLE DATE OESCRIPTION RATE OR WITHDRAWN INCOME INVESTMENT($1 GROSS I$)
11/16/2012 COMMON DIVIDEND 0.9000000 2.9577 320.94
12/162012
PARTICIPATING RECORD DATE DISTRIBUTION
TA% TRADING FEES PAID BY($) SERVICE FEES PAID BY(SI TOTAL CERTIFICATED SHARES SHARES MELD SHARES HELD BY TOTAL
WITHHELD(E) COMPANY SHAREHOLDER COMPANY SHAREHOLDER NET($) HELD BY YOU BY PLAN OTHER PLAN(S) . SHARES
3.00 320.94 356.6009 356.5009
Z
O
Year-To-Date Transaction Detail
z
TRANSACTION CASH NET TRADING SERVICE AMOUNT PRICE PER HARES ACQUIRED1 SHARES HELD
DATE DESCRIPTION INVESTMENTS($)DISTRIBUTION($) FEES(S) FEES(S) INVESTED($) SHARE(S) OR WITHDRAWN BY PLAN
BALANCE FORWARD 3 8
03/12/12 COMMON DIVIDEND 282.05 3.00 279.05 109.5879000 2.5464 350.7597
06/11/12 COMMON DIVIDEND 315.68 3.00 312.6E 101.3665767 3.0646 43
09110/12 COMMON DIVIDEND 318.46 3.00 315.45 114.4395000 2.7566 356.6009
12/10112 COMMON DMDEND 320.94 3.00 317.94 107.4942000 2.9577 359.5586
CHEVRON CORPORATION Partial Withdrawal(Continue Plan Participation) Additional Cash Investments
CUSIP: 6410
ACCOUNT NT KEY:DIT DID TENHAFCLARA0000 Write the amount enclosed:
CLARENCE A DITTENHAFER
431 CROGHAN DRIVE
CARLISLE PA 17013 Sell this number of Shares: Make check payable lo:
CO a check SHA le to: VRON
YOU MAY INCREASE YOUR SHARES
WITH OPTIONAL CASH INVESTMENTS
Full Withdrawal(Terminate Plan Participation) OF$SD UP TO$t00,D60ANNUALLY.
All owuer(s)must sign and date above Deposit of Certificates
Deposit the enclosed
( ) F7 Sell all plan shares. � number of shares:
Contact Number
7 575 124880285976 00175016676410DITTENHAFCLARAOOOOIR00168
CVX Historical Prices I Chevron Corporation Common Stoc Stock - Yahoo! Finance Page 1 of 2
Home Mail News Sports Finance Weather Games Groups Answers Screen Flickr Mobile I More
Search Finance �gtclRWeb wag
Finance Home My Portfolio Market Data Business&Finance Personal Finance Yahoo Originals CNBC
Enter Ms-b., Up Tie Apr 29,2014,12:30PM EDT-U.S.Markets close in 3 lr s 30 mms
Dow 0.59%Nasdaq 0.73%
Spend e ' CVX 41.30
your,casM1. {
Chevron Corporation(CVX) -NYSE *Follow Get the big picture on all your Investments.
126.93 1.20(0.95%) 12:30PM EDT-Nasdaq Real Time Price Sync your Yahoo portfolio now
Historical Prices Get Historical Prices for: GO
....... ................. -....... ..._- __.-.__ ....-.. .......... -...__ ...___ _........
Set Date Range
O=� eQ Daily
Start Date: Apr v 11 2012 Eg.Jan 1,2010 Weekly
End Date: Apr v t1 2012 Q Monthly
Q Dividends Only
Get Prices
First I Previous I Next I Last
Prices
I �
Date Open High Low Close Volume Adj Closer i t
Apr 11,2012 102.31 102.45 10078 100.95 8,570,100 94.43
Close price adjusted for dividends and splits.
First I Previous I Next I Last
Download to Spreadsheet
Currency in USD.
s Ad Topics That Might Interest You..
i 1.Top Stocks to Buy 5. Best Income Funds
.._.._. __.. .. ..._... ..._....__. ...........................E
2.Penny Stocks to Own 6. Best CD Rates
3.High-Dividend ETFS 7. Invest in Gold
4.Dividend Income Funds S. High Return Investments
Feedback =es
Pdvacy-AbnNonrvds Te,ms-sand recd'nonk-Yahoo'-ABC News Nebvork
http://finance.yahoo.conz/q/hp?s=CVX&a=03&b=11&c=2012&d=03&e=11&f=2012&gi=d 4/29/2014
FL Historical Prices I Foot Locker, Inc. Stock - Yahoo! Finance Page 1 of 2
Home Mail News Sports Finance Weather Games Groups Answers Screen Flickr Mobile I More
Search Finance �ndnWeb Man
Finance Home My Portfolio Market Data Business 8 Finance Personal Finance Yahoo Originals CNBC
Erder 6ymbM tml'.Up Tue,Apr 2e.2014,12:35PM EDT-U.S.Markel dose in 3 ns 24 reins
Dow 0.67%Nasdaq 0.88%
Ira
Foot Locker,Inc.(FL) -NYSE *Follow Get the big picture on all your Investments.
46.53 0.25(0.54%) 12:35PM EDT-Nasdaq Real Time Price Sync your Yahoo portfolio now
Historical Prices Get tgeadeel prices tan GO
Set Date Range
p Daly
start Date: A r v 11 2012 Eg.Jan 1.2010 0 Weekly
LG oochEnd Date: r v 11 2012 0 MonmN 4aorvr• a>ss
Q Dividends Only
Get Prices
First I PreAms I Next I Last _
Pdces `�-
Date Open High Loa Close Vdume Ad Close'
Apr 11,2012 30.22 30.47 29.79 30.01 3,271,100 28.73
Apr 11,2012 0.18 Divkend
Close peke adjusted for dwldeMS ark spits.
Fast I Previous I Ned I Lest
A Download to Spreadsheot
Currency In USD.
Vanguard'
Ad Topics That Might Interest You...
1.Top Stocks to Buy 5.Best Income Funds
.........................................._....._.._. .......__..._........._..._..._......................
2.High-Dividend ETFS 6.Best CD Rates
---- . _........_.....................................
3.Penny Stocks To Own 7.High Return Investments
.._...............................I..............._...................... ......................._......................._.......
...............
4.Dividend Income Funds 8.Invest In Gold
FoedSark ads
Pdvary-noan arc Ads-rema-send Faedmw: Yahoo!-ABC News Nebvork
httn•//finannP.vahnn nnm/n/hn9c=Fi..f�.a=f1�R..h=11 R!r.�M 2Rr.11=(1�Rr.e=1 1 Ar.f--2fYl2Ar.o=A 4/29/x(114
THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT To Inquire about your account,contact
BNY Mellon Shareowner Services`Q j LdnKER, INC.
Toll Ftee Number 866-657-2216
Outside the U.S.(Collect) 201-680-6578
Hearing Impaired 800-231-5469
BNY Mellon Shareowner Services is dedicated to providing you with the best shareowner experience/
Did you know that you could manage your portfolio online 24 hours a day,seven days a week?
,V11111jI dog in to Investor ServiceDirecM(ISD)at www.bnymellon.comishareownerrtsd '
e:e.�to �oant a7 age�for�r,�fof�e artdfrttrnsrrct�n 1„�1ttr�r ,,trt.�r,���it se�z � ...�
to s3urco a lniomlalDnr e
rnroliynsN Unk�9F� r aec s!o odf- &8r@ taierrle?1L�,an 99 ax ft nris
•�,Ge rFyy�rryryazpf7lcienll 'caha�umbe
�9].yS .��Y4r � S•-��TM'Y E1' Tr6"A E�� ly� � �� �.Fr����TV ¢ ti'`f
•"a�R�q� t'�d dt tl��e�)(�cetl`1�e�t C��DK'{w��p�hcah(e�; �'•� jc�'-er < ., ,,� .�R• , ^:
} e uasfir�eGt a Dsli�`'�'d v den��U��ren�ol� i`vni��"n`t�Rhin 5t en w`�te Ea It i � �'
'Qn(/ne srmiret nm T�errd hp all itnurt, '
L'73��z�1�' r•a
UP ���+5-'�
- tr �t7E5 r t2/l�iO�f'y'Ope O "dlj ry SQrJiD11151
ath�than'�dl ingyo"�7yyour Sal Sec�lrRµy Number rye a (gne i o �i'ge
r ,
��`71Fgt v ort[��o.�>act�va"te-'�oilr�}n'r�estb`3It fl to �h�in �1[or'�.°co ''tiareBi �P�r"
r
F
e
,
i -
i
RETAIN FOR YOUR RECORDS I
SHAREHOLDER OF I TRANSACTION DESCMPTJDN
F_O_OTIOCRER,INC. DMDENO
lNYES70R lD ICUSIP ACCWrR KEY lSSUElCLA6S OF STOCK RECORDOATE PAYABLE DATE
_
72488028$97& 0014603448491D O1TTENHA,FCLAF 4 I00 COMLMON aTOCK i 071154411 DMV2011
__. .......__ _..._._ __.__. __._.. ._._...__._..�..__ ..._._..„__._..__..__._1__....__._., ._._.e _,_____,.___.
RATEPEFis,"a CERTIFICATED SHARES WOK-BtTRYGWRES OROSSAMO 1AXWRHHEW CURREtn OIVIDEHD
_ $0.1650000 ___ _ 1 O,DO_OD $0.17 ,SOD D 50.17 Y_
DIVIDEND PAID YEAR TO DATE [TAX WRTIHELO YEAR TO DATE -- TN(IDENTIFICATION NUM9ER Please detach and retaln INS fomF for Ut records.
50.49 $0.00 ON FILE tj 1'D
PLEASE DETACH BELOW k CHECK NUMBER;76185530
l
2
X�
}
------------------------------------------------------------------------------
Pennsylvania State Employees Credit Union
1 Credit Union Place
Harrisburg, PA 17110
717-234-8484
------------------------------------------------------------------------------
CLARENCE A DITTENHAFER Account: 0195268389
--------------------------------------------------------
p
Post Effect Transaction Description Amount New Balance
04/01 ID O1 REGULAR SHARES Balance Forward --------------------------
--5. 00
04/30 Ending Balance -------------------------------------------- 0
04/01 ID 02 VACATION SHARES Balance Forward --------------------------- 0 . 00
04/30 Ending Balance ---------------------------------------------0. 00
04/01 ID 04 CHECKING Balance Forward ----------------------------- 18 839 . 09
04/02 Deposit: US TREASURY 312 1 , 373 . 40 20,212 . 49
04/02 TYPE: XXCIV SERV ID: 3121736156
04/02 CO: US TREASURY 312
04/02 Draft: 004699 1 , 050 . 00- 19 , 162 . 49
04/05 Withdrawal Transfer 2 , 000 . 00- 17, 162 . 49
04/05 To DITTENHAFER,JEFF 0159562611 Share 04
04/09 Withdrawal: COMCAST CENTRAL 101 . 51- 17, 060. 98
04/09 TYPE: CENTRAL PA ID: 0000009547
04/09 CO: COMCAST CENTRAL
04/10 Draft: 004816 50.00- 1
04/11 Deposit: US TREASURY 303 1, 733 . 00 18-;743 . 98
04/11 TYPE: XXSOC SEC ID: 3031036030
04/11 CO: US TREASURY 303
04/30 Deposit: PA TREASURY DEPT 2 , 026 . 98 20, 770 . 96
04/30 TYPE: ANNUITANT ID: 1236003133
04/30 DATA: A7004131217015029
04/30 CO: PA TREASURY DEPT
04/30 Dividends : 0.. 100% 1 . 52 20, 772 . 48
04/30 %% APY Earned 0 . 10% 04/01/12 to 04/30/12
04/30 %% APYE Avg Daily Bal - 18, 531 . 84
04/30 Ending Balance ----------------------------------------20, 772. 48
04/01 ID 07 MONEY MARKET Balance Forward ------------------------- 4, 643. 73
04/30 DIVIDEND RATE CHANGED FROM . 30% TO . 20%
04/30 Dividends : 0 .200% 1 . 14 4, 644 . 87
04/30 %% APY Earned 0 . 30% 04/01/12 to 04/30/12
04/30 Ending Balance -----------------------------------------4, 644 . 87
04/01 ID O1 PSL LOAN Balance Forward ---------------------------------- 0. 00
04/30 Ending Balance -------------------------------------------- 0 . 00
04/01 ID 09 VISA LOAN Balance Forward --------------------------------- 0 . 00
04/30 Ending Balance -------------------------------------------- 0 . 00
?: ��� CERTlFJCATE�F ITLE FO yA V;EMC.LE
:r4 ts': A
«. Y.....}•�_q-T•_S.'.tpea�.Y:{..y_�5.(-'.II..}-.�_ .»PS}��__._ .._ ..."a.:'.:'._b. c:...._..:•. J ..,.,.... ,_: '..:[ '.."..�1.'_':_4i.'r:".. ...
Vb
p lilk t%L�_4L11.tL P:J13�YAf L:.:r: _ ^.y.Y.'.'[.i' �^.•r. �J". :: ^..}':.-__".t l.t..•:a.^.. '_r"
JTtt$J4663 �2I359b '! 2i3i37 l.EX1l ... ^6394241990# D3::'
.� ;�... �;vErxt�'msmFiunon xuM9ER k 'gyp E o�A�
'MDDY t 69P 6..AT GM D Dmm P DQdf DOOM 4IU:6 ODOtA 6TATU5
,/
DATE PA 11ilID � DATE DF t56UE � UNVDEN wEJGNF i GVWR GGwR .. .�.`• •'TRtE @Mti09':^^^. y�"
� t' ri!: P
n MQEY'G $ iq 9�LAi�� ( i8:
t+'b J'INZ, i EuA+PI CM
VCI:cS 410 A P�,^7'0 9 " fix.' H:W� '
P t5WA5APo:%£YCMCiE
1 R R:LEtJ51RUCf4EJ
6 BTREEC RGO � Sw
y+�.�r� 7" wiwaaeyxs»=iss{um vW�'
&tea}' ASwu w.iA� S' i';
t)l.T' !�} S *�[v# Vv'Si•t i, .: -. Y,i,
15
�i \� � �, r�-k',...• yt� � �. der "� 'k®>kacrl5��t �e ,.y ..qqg�
( A r� f{;n te..,. 1 h��tX>mve.'•has'Iam ,Pr�+�`�ti' A" 3
J� LATE N f $ r{3t s � � •Tr` D� _ _
GEDDNV UOJ,RELFASFD
AUTNDFUZED RE➢RESENfATR•E DATE
- YA8IPJD ADDRES6
8Y =_
. 031°°? AUMDR6ED REPiiE6EMATFJE -
C A DITTENHAFER JR
491, CROGHAN DR
CARLISLE PA 17013 ;
pennsy.lvania
DEPARTMENT OF TRANSPORTATION
• e m.T.a. em��_rm rd,e¢°", ±KNft.D. •BARRY J- SCHOCH'i ACTING --
61 T MtlrENd6 $CRe16fj Or'1}N11PPf1➢4m v
•. -if a co-purcheserauleT I"n TLNrr%=W is listed¢Od YW w¢zn the M le w
SUl6CREiED AND 6vARN + be li ¢U es'Jofm TEnems tJt Rlght OI$u _ On de
om
AMIL
i'• NMd9�. f
a I uMN g CME,C ERE 0. ¢rvA¢ h e
6Ssas'Tenan s rtunun d`e h 6 An e�A.-I
j y}�'' ^T:ft ';'' „Q2. •Y:'i,.i � er B�6es`:mh EeErhelie Dr' 51e ,'�'3'x' M�„I C,„ii°'
�Y K n.. :.r# Ifen _ .:nhi5TN4.W+Lt F6 A T` ruA 5�g
.T ''t .Z 4 �'2'i'1' _ NKD .......ZZ ..t.._s�RM •,E� lti?F't�NOL'7
Q o- `.r.. 6h'f• t*•7` .c;.Hv 2.:TwR'. ” '!i::✓
tST 11FNND40ER FWANGIAL IN$IRI1f1ON NIIMOER
IF D UW.:O<CK O 19 frs AN Ein tl%rcg,+jRDO"I DI r s,pp
s�q
wymeY.a>v .sne ePep2Gia M4PNn w^ s-».$ �,. u-z Tro..x.;�r�? - 4S.}J' s r*t,, ,,5£yae' 1•',v7'r§ ;aNu ot NN�Ort[onr;R?wNkVr U JCtAt u. A l -
1 NUma
to
W x' mmn'*JOiemiPruummnunc%®so#many
co s
JPAUTUafmmueucu+rmmf mMmoxmnsro%m DRY: 6TATE LP
A 5Send 000L uisesm' Statement of Accounts 3
5000 Louise give
Po Box 40
Mechanicsburg,PA 17055 Apr 01 2012 thru Apr www.nnernbersls4org p i p 30, 2012
Main Switchboard: (717)697-1161 or(800)283-2328
IV 10 EZ Can: (717)697-4372 or(80D)2834372 Account Number: 248267
Too: (717)697-5312 or(500)283-2328 ext.5312
TeleBranch: (717)795-6049 or(800)237-7288
MEMBERS 1st Balances at a Glance:
FEDERAL CREDIT UNION Checking: 0.00
Savings: 9.95
Certificates: 1,113.50
CLARENCE A DITTENHAFER JR Loans: 0.00
JACKOLYN R DITTENHAFER Money Management: 0.00
C/O JACKOLYN DITTENHAFER
431 CROGHAN DRIVE Swipe 5 YTD Reward: 0.00
CARLISLE PA 1 7013-1 71 3
Page: 1 of 1
Your aggregate balance as of April 1st is $1,123.18.
An aggregate balance of$2,500 and having 3 products
will place you in the Silver MLR level.
SAVINGS ACCOUNTS
0000- REGULAR SAVINGS
Date Transaction Description Additions Subtractions 8
Apr 01 Balance Forward
Apr 30 Ending Balance g5
CERTIFICATE ACCOUNTS
0040- 6 MONTH CERT Maturity Date- Sep 28, 2012
Date Transaction Description Additions Subtractions
Apr 01 Balance Forward 113.23
Apr 30 Deposit Dividend 0.300% 0.27 1,113-.50
Annual Percentage Yield Earned 0.300%from 0410112012 through 0413012012
Apr 30 Ending Balance 1,113.50
YTD SUMMARIES
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 0. i's
0040 6 MONTH CERT 1.37
Total Year To Date Dividends Paid 1.55
NOTE:Total includes closed shares
Don't forget about our new Member Loyalty Rewards Program.
The more products you have with us,the more benefits you'll receive.
Ask an associate for details or visit our website at www.memberslst.org for details.
Calculated Value of Your Paper Savings Bond(s) Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 04/2012
Total Price Total Value Total Interest YTD Interest
$15,000.00 $26,742.00 $11 742.00 $666.00
Bonds: 1-2 of 2
Serial # Series Denom Issue Next Final Issue Price Interest Interest Value Note
Date Accrual Maturity Rate
V0021090921 I $5,000 10/2001;05/2012: 10/2031 $5,000.00 $3,914.00 6.11% $8,914.00_
X001.2830401 I $10,000 10/2001;05/2012' 10/2031 $10,000.00 $7,828.00_ 6.11% 117,828.00
Totals for 2 Bonds.$15,066.00z$11,742.00: $26,742.00
Notes
NI Not Issued
NE Not eligible for payment
PS Includes 3 month interest penalty
MA Matured and not earning interest
REV-485 EX SAFE DEPOSIT BOX INVENTORY Page 2 of 2
INSTRUCTIONS
(1) Cash.Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box.Stocks are to be designated by
name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock.
(3) Obligations of U.S.Government: Number of items, date of issue,face value, names in which registered and type of ownership,
i.e.,jointly held,payable on death,etc.
(4) Bonds:Designate by name, amount, serial number,or other designation.(Bearer Bonds)
(5) Bank and Savings and Loan Passbooks:State name of depositor, number of book, last date appearing in book, name of bank
and branch,and balance.
(6) Jewelry, Coins, Stamps,Manuscripts, etc: List and describe as fully as possible.
(7) Deeds,Mortgages,Current Insurance Policies or other evidences of Indebtedness: List and describe as fully as possible.
(8) All other contents.
(9) Return completed form to: DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT.280601
HARRISBURG,PA 17128-0601
ITEM
NO. ITEM DESCRIPTION
21 Series 1$10,000.00 Payable to Jackolyn R Dittenhafer dated 10-2001 #X0012830411
22 Series 1$5000.00 Payable to Jackolyn R Dittenhafer dated 10-2001 #V0021090931
23 Series I $10,000.00 Payable to Clarence A Dittenhafer Jr POD Jackolyn R Dittenhafer dated 10-2001 #X0012830401
24 Series 1$5000.00 Payable to Clarence A Dittenhafer Jr POD Jackolyn R Dittenhafer dated 10-2001#V0021090921
R-
I CERTIFY UNDER PENALTY OF PERJURYTHAT THEASOVE RECORD IS PERSON RECEIVING COPY OF
CO ECTAND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
S NA E SIGNATURE ^�
J
PRINT NAME PRINT NAM AND CH KAPPRDPRIATE BOX BELOW:
Denise Harman Jeffrey afer
PRINT TITLE DATE CHECK APPROPRIATE BOX-
R1 Execulor(uix) ❑Administrator(VIx)
Assistant Branch Manager 07/05/2012 ❑Estate Representative ❑Joint owner of safe deposit box
NOTE:Attach additional 81/3"x 11"sheet(s) if necessary or use duplicates of this page of form.
The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the
Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of lax information agreements- - - -
with Federal ar ioral taxing authorities.The state law prohlbils the Commonwealth's personnel from disclosing confidential tax information except for official purposes.
GUARDIAN'
The Guardian Insurance 6
Annuity Company,Inc.
3900 Burgess Place
Bethlehem,PA 1801 Check No. 664544
(BDO)221-3253
Contract No. : 210083483 Check Date : 08/1512012
ESTATE OF CLARENCE A DITTENHAFER
166 RIVER ROAD
PEQUEA, PA 17565
On behalf of Guardian,we would like to express our sincere condolences
.to you for your loss.
Net Amount: $21,569.33
PP58BCK
'
No GUARDIA Box 26210ncIONffice
Lehigh Vah9y,PA 18002-6210 ANNUITY CONTRACT
1-800-221-3253 CONFIRMATION AND STATEMENT
(1)Insured (3)Purchase Payment (7)Contract Number (8)Case Number
DITTENHAFER, CLARENCE A NONE 210083483 91533
(4)Contractual Deductions (9)Statement Date Contract type
(2) . NONE 08115/2012 INVSGL-TSA
ESTATE OF CLARENCE A DITTENHAFER
166 RIVER ROAD (5)Premium Tax - (10)Agent/Broker-Dealer
PEQUEA, PA 17565 NONE GIAC,GIAC
(6)Net Payment' (11)Agent's Code (12)Servicing OHiice
$-21,569.33 95-NON 95
This is not a notice of payment due. 'A positive amount refers to a net increase in your contract value resulting from the
transaction activity shown below. A negative(-)amount denotes a net decrease.
TRANSAGT{ON DETi�1L --
(13)ACCOUNT (14)TRANSACTION (15)TRANSACTION (16)NEr (17)UNITVALUE (18)UNfTSTHIS
DATE DESCRIPTION AMOUNT ON TRANS,[DATE TRANSACTION
RS LARGE CAP ALPHA VIP SERIES 08115/2012 Death Claim $.6,226.77 $7236574 -134.672
RS INTERNATIONAL GROWTH VIP SRS 08/1512012 Death Claim $-20,734.89 $28.406271 -729.941
FEDERAL TAX - $5,392.33
WITHHELD
-. 1MPIDRTANT ME$§AGES '
IN ACCORDANCE WITH THE TERMS OF THE CONTRACT, THIS PAYMENT REPRESENTS THE DEATH BENEFIT,
Form GIAC 42 The portion of this statement reflecting transactions in a Separate Account is being sent on behalf of Park Avenue Securities or the Broker-Dealer shown in
Rev.3/02 Box 10above acting as agentfor The Guardian Insurance&Annuity Company,Inc.Please direct al inpuides concerning your account to your Broker-Dealer.
CONTRACT OWNER
Valley Forge Asset Mglnt
PORTFOLIO APPRAISAL
CLARCENCEA. A7TTEA1HA.FF;R)Z0TIfIR4
368-63618
APrrl71, 2012
Unit Total Market
uantify Security Cost Pct. Qtr.
q
- — . Price, Velne _ Assets Yield
Cash and Gquiw)cnb
Advisory FeeAecrual Aceeunt di7.83 0.0
-67.63 -0,3
Money Markot Fund 2,945,24
--.. —„ 2,945.24 10.9 0.0
2,877A1 2,877.41 10.6 0.0
Corporate ponds
20,000 Analog Devi.,,Joe 103.37 20.07100 106.05 21,209.20 78,2 2,8
3.000 Due 04.15.16
-- - 20,G7360 2120920 78.2 78
Common Stock
Telec¢mmunicstlons
100,000 AT&Tine 30.50 -_ 3,049,94 30.45 3,045,OD _ 11.2 518
3,049.94 3.045.00 11.2 S,A
Common Stock TOTAL. 3,049.94 3,045.00 11,2 5.8
TOTAL 2G;50G35r 270161 100,0 2;9
The statements you receive direeflyfrom Elie custodian are the official record of your account, Valley Fargo ASSet Management Corp.enceuragesynutocvmpm Mdverify
amount fromon on Otis canon ntwiOta quarE ty,bmnon the stntemcntymi receive from the euptodinn. Pleapc notify us promptly if you do not receive suuements on your
account from the custodian on at Icas[a qunrlmly,basis.
Prices may differ on certain securities between VFAM's prices and your custodian's prices due W different pricing sourcea.
Valley Forge Asset Mgmt
PORTFOLIO APPRAISAL
CCARCNCEA. DITT,ENFjAFER TOD
3 68-63 61 6
April 11. 2012
Unit Total
__. Qusntl(y Security Cast Cost Market Pct Cur,
... - .,-_.._ _Price _-.Vain' _ Assen Vieid
Cn90 and ligNvslenb
Advisory Fee Amount Aemmn -467.56 \
Dividend Accrual 29.D0 kkrlPl-Gbd-4) -467.56 -0.3 0.0
Money Market Fund 10_799 71 29.00 0.0 0.0
-- 10,799:71 _5,8 0.0
10,36L15 10,361,15 5.6 0,0
Corpnrale Bands
20,000 Tern Pharmneeuflcal 101.38 20,276,60 101.17 20,234,40 10.9 1,T
Finnnm
1,700%Due 03.21.14
20,000 Hewlen Packard Co 100.17 20,034,40 101.40 20,280.00 1 t,0 2,2
2200%Due 12-01.15
20,000 JP Morgan Clime&Co 102.53 Z%506.60 10411
3,450%Due 03-01.16 20,841,60 11,3 3,3
20,000 General Electric Cnp 100,88 20,176.40 104.06 20,811.00 11.3 7..8
corp
2.950%Due 05-O9-t6
20,000 Stmoiltlydro ASA 102.19 20,437.60 107.57 21,513,40 11,6 2.9
3,125%Due 0&17.17
101,431.60 103,68040 56J A6
Cmnmon Stock
Bank
350,000 Peoples United 13.15 4,603.41 12,59 4,404,75 2.4 5.0
Financial Inc
-- 4,603.41 - ---4,404.75 2.4 510
Business services -
150.000 Thomson Reuters Carp 29.55 4,431.94
CDm 2820 41230.00 2.3 4.5
- 4431,94 - -- 4,230.00 2.3 0.S
Commrreial smicey
150.000 Poychcx lnc 26,32 _ 3,947.5_4 30.9/r 4,644,64 2.5 4.1
3,947,54 4,644.00 2.5 4,1
Diversified Hedmcare
100.000 .Iolmson Mohnson 60,54 _ _6,653.85 64,13 6,41100 _ 3S 3,6
6,653.85 6,413.00 3,5 3.6
Environment
15.000 Wnstc Mgmtine Dcl 34,26 21569.33 34.89 2,616,75 1,4 41
Com
21569.33 2,61695 1.4 4.1
Foods
100.000 Kraft Poodslnc CIA 34.13 _ 3,412,77 36.87 3,687.00 2,0 311
3,412.77 3,687.00 - 2.0 3.1
Household Prodw,
Valley Forge Asset Mgmt
PORTFOLIO APPRAISAL
C.LARENCEA,DITTENfL4,VE R TOD
365-6. 616
Aprit 11,2012
Unit Total
_.Qunntlty Seenrity_ Cost Coat Market Pet. Cur,
75,600 Clorox Co - - - �r"p Vatae Assets VIeIU
'4_890.24 69,48 __5,211.00 2.8 3.5
4,890,24 5,2f 1.00 2,8 3.$
Medi4
100,000 WnIt Disney Co 32.55 _3,25543 41.37 4,137.00 2,2 1,5
3,255,43 4,137.00 2.2 1.5
Mntarinb Expl9mUon and Producing
100.000 Ncwmont Mining Cory $1.87 5,186.79 48.00
Cum 4,800,00 2,6 29 -
-� S,IR6.79 4,800,00 2,6
Pharmaceuticals 2,9
200,000 136901-Mye"Squibb Co 29.66 - 5,932.29 32,59
6,518,00 315 4.2
100,00 MOrck 5e Co 34,28 -- 3,427_77 38.48
_. 3,848,00 211 4.4
9,360.06 10,366.00 5.6 4.2
Talecommunienlians
100.000 Chino Mobilc LTD 44,53 4,452,94
53.99 5,399,00 2.9 3.4
250.000 Vodafone 27.30 6,824.65 2713 6782_50 37 3.4
11,277,59 - 12,181.50 6.6 3.4
Telephone
50,000 Vcrizon 37.87 1,893.51 37,38 1,869,00 1.0 5,4
Communications Core
1,89},51 l,RG9.00 1.0 3.4
Tobacco
200.000 AltriaGroupinc. 21,80 4,359.99 31,21 __ 6,242,00 3A 5.3
4,359,99 6,242.00 3.4 L3
Common Stock TOTAI. 65,642.45 10,602,00 3R.3 3.8 -
TOTAL, 177,63128 184,84345 100,6 3:9
Thestntements yourcoeivedimetly Rom thecustodianwo the official rccardofyouraceotru. Valley Pnrgc Asset Management Corp.encourages you to compare and verify
(hC Infortiln[1nn on Ibis s[alement With dlc Iltfnnnation on the statemcnly0u m=fvc$om the outtodlan. Pleaset notify us promptly Iryou 60 not recelve statements on your
occount from the custodian on nt Least a quarterly basic.
PrioCS may differ on certain sceuritieS between VPAMfs prices and your ountodlnn's prices due to diflenwt pricing sources,
Valley Forge Asset Mgmt.
PORTFOLIO APPRABAL
C.LARENCE A. PITTENHAFER IRA(
3 68-63 61 7
April 11, 2012
Unit Totn1 Market Pct. , Car.
Qnn ty ScmrHry _ Cwt Cost _Price Value _ Assets Vield
Cash and Equivalents
Advisory Fee Accrual Account -647.24 -647,24 -0,3 010
Dividend Accrual 167.57(At'ie� 167.57 0.1 O,p
Money MATLct Fund 19,746,82 19,746,62 7.8 0.0
19,267.15 19,267,15 7.6 0.0
Corporate Bonds
20,000 Dell Inc 103,74 20,748.44 106.45 21,290,40 8,4 2.9
3.100%Due 04.01.16
20,000 Vcrizon 102.22 20,444.80 106.43 21285.20 8.4 2.8
Communications Inc
3.000 0/Due 04.01.16
20,000 AT&T Inc 101.52 20,303.00 106.01 ,21,202,40 8.4 2,8
2,950%Duc 05.15.16
20,000 Applied Materials Inc 101,80 20,360.00 144,30 20,860.60 82 2,5
2.650%Due 06.15-16
81,856.20 84,638.60 33,4 2.8
Common Stock
Beverage
100,000 Coca Cole 67.42 6,741.94 72.12 7,212,00 2.8 2.8
100.000 PepsiCo Inc 64,05 6,404,85 65.15 6,515.00 2.6 3,2
13,146.79 13,727.00 5.4 3.0
Chemicals
100.000 Du Pont E.I.De 45.66 4,566.32 51,45 5,145.00 2.0 3.2
Ncmours&Co.
4,566.32 5,145.00 2.0 3.2
Commercial Scrvicas
100,000 Automatic Data 52,74 5,273,79 54.62 5,462,00 2.2 2.9
Processing
5,273.79 5,462.00 2.2 2.9
Computer(semi-conductor)
100.000 Intcl Corp 2192 2,091.5_0 27.85 4785.00 1.1 310
2,091,$0 - 4,765.00 1.1 3,0
Computer(softwelserviecs)
200.000 Microsoft Corp 25.60 5,120.77 30.35 6,069.00 2.4 2.6
5,120,77 6,069.00 2,4 .....2.6
Diversified Hoslthcare
150.000 Abbott Labs 51.98 7,797.66 59fi6 8,949,00 3.5 3.4
75.000 Johnson&Johnson - 65.52 4,914.18 64,13 _ 4,809.75 I.9 .__ 3.6
12,7]1.84 13,758.75 5.4 3.5
Electrical Equipment -
Valley Forge Asset Myatt
PORTFOLIO APPRAISAL
CLARENCEA.BlITTENHIfFER IRA
368-63617
A.PHI 11, 2012 Unit Quatstlty Smrity Cost Todd Mnrket Pet Cnr,
Cost Price Vnlue Assets Yield
200.000 Genernl Llarric 16,43 _ 3,286.48 19,01 3,802,00
1.5 _ 3,6
3,286.48 3,802.00 15 3.G
Electric Utility
100.000 E=Ion Corporation 41.92 .__ 4,191,77 3R.Is _ 3,818.00 1.5 5,5
4,191.77 3,81 It,00 1.5 5,5
Environrncm
150,000 Waslt MBmt Ina Del 37,28 5,592.26 34.89 5,233.50 2.1 4,1
Com
.- 5,592.26 -- 5,233,50 2.1 4,1
Food Servim
150.000 Syacro Corp 27.90 __4,,185,66 29.28 4,392.00 1.7 - 3.7
4,185,66 4,392.00 1,7 3.7
Food-Confectionary "
100,000 Archer-Dmdela Midiand 31,21 3,120.63 30,99 3,099.00 1.2 2.3
Com
3,120.63 3,099.00 1,2 2.3
Household Products
75.000 Pmcterand Cnmhle 64.3$ _ 4,826.14 66.44 __4,983.00 2,0 32
4,826,14 4,98100 2,0 3.2
Materiels Pspiorntion mid Producing
150.060 13arrick Cold Corp Com 44,10 6,614.46 41,04 6,1$6.00 2.4 1.5
250.000 Goldcorp lne, 47,32 1L830,53 40.60 10,150.00 4.0 L3
103.000 Nowmont Mining Corp ON 0100 48,00 4,944,00 119 2.9
Com
200.000 Ymnaus Gold➢ro 14.35 _ 2,970.01 15.16 _.._._3,032,00 1.2 _I_5
.00
21,315 24,282,00 9.6 1.7
Pharmawuticals
150,000 Eli Lilly&Co 36.84 5,526.66 39,47 5,920,50 2.3 5,0
150,000 Merck&CO 35.67 $,350.22 38.48 5,772.00 23 4,4
500.000 Pfrter 19.85 _ 9,927.09 21.95 10,975.00 4.3 4.0
20.803.97 22,667,$0 8,9 43
Pipelines
150.000 Transcanhdn Corp 39.71 -5.955.92 42.63 6,394.50 2.5 4.1
5,955,92 6,394.50 2.5 4,1
Tdccommunlcatiom
200.000 AT&Tint 30.72 _ 6,143.80 3DAS 6,090.00 2.4 5,8
6,143.80 6,090.00 24 5.8
Tticcommunicationa(.Egnipmano
300.000 CiscoSyslncCom 15.71 4.713.49 20,02 6,004.50 2.4 1.6
4,713.49 6,00450 2,4 1.6
Valley Forge Asset Mgmt
PORTFOLIO APPRAISAL
CLARENCEA. DIPTENHAPE'R IRA
3 68-63 61 7
April 11,2012
Unit Total Market
Telephone __ Saenrify Cos[_ Assets. Geld
Telephone � � �— Cost— , P=co.. Vxloc _ Assen Vicltl
150000 Vorizon 36.94 S,541,68 37,38 5,60200 2,2 5.4
Communications Com
5,541.68 5,607.OU 2.2 5.4
McWs(Gold)
300.000 Central Fund• 21,50 6,450.65 21,62 6.486.54 _ 2.6 0.6
6,450.65 -- 6,486.54 2.6 0.0
Common Stock TOTAL t39, 338.45 149,806.29 59.0 3.2
TOTAL 7,40461M 253,712,04 104.0 2:a
f
The statetnenCs you mccive directly from the custodian are the drichtl record of your account. Valley Forge Asset Manogoment Corp.eneouragcs you to cnmparc and verify
the information on this statement%dill dic information on dre sratamenl you reeeive from the custodian. Plcasc notify us promptly if you do not receive 5mmmets on your
account fmm the custodian on at least a rawtorly,basis.
Prices may differ on ccr nin seeuritics between VFAM's prioea and your-wsaidlants prima due to different pricing aow0e6
CERTIFIED AS A TRUE
LAST WILL AND TE R ECT COPY
O�F� p� I
CLARENCE A.`C�ELFLQ ER & LII\!DSAY
1, CLARENCE A. DITTENHAFER, of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this as and for my Last Will and Testament, hereby
revoking all other Wills and Codicils heretofore made by me.
FIRST
i direct the payment of my just debts and the expenses of my last illness and
r�
ti funeral from my estate as soon after my death as conveniently may be done. If there
be no cemetery lot available for my interment owned by me at the time of my death, I
authorize my personal representative to purchase such cemetery lot with a contract for
G
perpetual care, using therefor funds from my estate in such amount as he shall
r
consider necessary and desirable, and 1 authorize my personal representative to
t� cause title to or ownership of such lot so purchased to be vested in such person as my
personal representative shall designate.
Further, I authorize my personal representative to expend funds from my estate,
in such amount as my personal representative shall consider necessary and desirable
for the purchase, erection and inscription of a suitable marker for my.grave.
SAIDIS, SECOND
FLOWER &
LINDSAY If my beloved''wife, JACKOLYN R. DITTENHAFER, survives me by thirty (30)
rN'mnvreauw
26 W=High S=,
c"°sk,`A days, then I give the sum of Three Hundred Fifty Thousand ($350,000) Dollars to my
Trustee hereinafter named, IN TRUST, NEVERTHELESS, upon the following terms
and conditions:
A. This trust shall be held and administered for the benefit of my wife,
JACKOLYN R. DITTENHAFER, in recognition that there may be a number of needs
other than support and maintenance which may be unavailable to JACKOLYN except
through this trust. This trust is intended to satisfy those non-support needs, as
deemed appropriate in the absolute discretion of the trustee. This trust is not intended
to supplant or displace any source of income otherwise available to JACKOLYN for
her basic support (such as food and shelter), including any governmental assistance
program to which she is or may be entitled. It is not intended to be a resource of
JACKOLYN R. DITTENHAFER. It is not available to JACKOLYN R. DITTENHAFER. It
is intended to be a discretionary spendthrift trust created for non-support purposes.
B. No part of the corpus of this trust shall be used to supplant or replace
any public-assistance benefits received by or through any county, state, federal or
other governmental agency.
C. Trustee shall hold and distribute the principal and income of this trust as
follows:
1. During the lifetime of JACKOLYN R. DITTENHAFER, to the extent
that benefits are not made available to her for other than basic living expenses,
n including food and shelter, my trustee, in his absolute discretion, may distribute
l.' from income and principal to or for the benefit of JACKOLYN, for her needs
other than basic support. Trustee's discretion in making distributions authorized
hereunder is absolute with regard to distributions from the trust estate, and shall
be binding on all interested persons.
2. As this trust is specifically not intended to provide basic support
and maintenance needs for JACKOLYN R. DITTENHAFER, if JACKOLYN is
unable to maintain and support herself from her own resources and sources of
income, my trustee shall seek such support for JACKOLYN from public
p sources. The trust has specifically not been created to supplant or replace
public-assistance benefits. My trustee should, therefore, seek entitlements
which are available to members of the community who are experiencing
C disabilities that are substantially similar to those that JACKOLYN experiences.
My trustee shall deny any request made by any agency or governmental entity
requesting disbursement of trust funds to satisfy JACKOLYN's support needs.
3. My trustee shall take whatever legal steps may be necessary to
initiate or continue any public-assistance program for which JACKOLYN R.
SAIDIS, DITTENHAFER is or may become eligible. Trustee shall bring such action in
FLOWER & any court having jurisdiction over the matter, to secure a ruling or order that this
LINDSAY
un trust is not available to JACKOLYN for support purposes. Any expenses of the
vw
26 WstEgh Srm. trustee, including reasonable attorney fees, in connection with matters relating
CV,Ua .PA to determination of eligibility of JACKOLYN R. DITTENHAFER for public
support, shall be a proper charge to the trust.
D. On the death of JACKOLYN R. DITTENHAFER, the then-remaining
principal and any accumulated and undistributed income shall be paid and distributed,
in four (4) equal shares, to my sons, JEFFREY B. DITTENHAFER, CHRISTOPHER M.
DITTENHAFER and RODNEY D. DITTENHAFER, per sfirpes, and to the Trustee of
2
that Spendthrift Trust created by paragraph FOURTH hereunder, for the benefit of my
son, ERIC S. DITTENHAFER.
E. No income or principal shall be assignable by a beneficiary or available
to anyone having a claim against a beneficiary before actual payment to the
beneficiary. No part of the trust shall be subject to the claims of any beneficiary's
creditors, or specifically JACKOLYN R. DITTENHAFER 's voluntary or involuntary
creditors for the provision of care and services to her during her lifetime, including
payments for residential care and maintenance by any public entity or private creditor.
F. Under no circumstances can the beneficiary compel a distribution from
the trust for any purpose. My trustee's discretion in making non-support distributions is
final, even If my trustee elects to make no distributions at all. Further, my trustee may
be arbitrary and unreasonable. My trustee's absolute and independent judgment,
rather than any other party's determination, is intended to be the criterion on which
distributions are made. No court or any other person should substitute its or their
judgment for the decision or decisions made by my trustee.
ti
t�
j G. No fiduciary serving hereunder shall be required to fumish bond in any
Fjurisdiction, and If any bond is necessary, no surety shall be required.
THIRD
I give, devise and,bequeath all the rest, residue and remainder of my estate, in
four (4) equal shares, to my sons, JEFFREY B. DITTENHAFER, CHRISTOPHER M.
DITTENHAFER and RODNEY D. DITTENHAFER, per stirpes, and to the Trustee of
that Spendthrift Trust created by Article FOURTH hereunder, for the benefit of my son,
ERIC S. DITTENHAFER.
FOURTH
That share of the residue of my estate distributable to my Trustee hereinafter
named, in trust for the benefit of my son, ERIC S. DITTENHAFER, shall be held and
SAoaS,
FLOWER& administered under the following terms and conditions: Trustee shall distribute the
LINDSAY
=G Wes HighSa= income to or for the benefit of my son, ERIC S. DITTENHAFER (and for his spouse
Gdisk,PA -
and issue) during his lifetime. Trustee shall from time to time distribute to or for the
benefit of my son, ERIC S. DITTENHAFER (and his spouse and issue) as much of the
principal of the share as trustee, in its absolute discretion, may consider desirable for
3
the health, maintenance, support, and education of my son, ERIC S. DITTENHAFER
(and his spouse and issue). If any distributions are made to or for the benefit of the
issue of my son, ERIC S. DITTENHAFER, to cover expenses related to health or
education, then trustee shall make the distribution directly to the healthcare provider or
educational institution, as the case may be. No interest in principal or income shall be
assignable by my son (or any beneficiary), or be made available to anyone having a
claim against my son (or any beneficiary).until actual distribution to my son, ERIC S.
DITTENHAFER (or any beneficiary). Trustee shall have the power to authorize the
release of all principal and income from said trust to ERIC S. DITTENHAFER upon
satisfaction, in Trustee's sole discretion, that ERIC S. DITTENHAFER has refrained
from using any narcotics for a period of five (5) years. Any principal and undistributed
income that may remain in this trust at the death of my son, ERIC S. DITTENHAFER,
shall be distributed to his issue, per stirpes. In default of issue, the remainder shall be
C distributed to my sons, JEFFREY B. DITTENHAFER, CHRISTOPHER M.
DITTENHAFER and RODNEY D. DITTENHAFER, in equal shares, per stirpes.
r
r� �9
y FIFTH
I direct that any and all inheritance, estate, and transfer taxes imposed upon my
estate passing under this MI or otherwise shall be paid out of the principal of my
residuary estate.
SAIDLS, SIXTH
FLOWER &
LINDSAY In addition to the powers conferred b law, I authorize an
DSA p y y personal
26 W.,Hi¢h Sacs
Gdld ,PA
representative, trustee or guardian acting under this instrument, in his/her absolute
discretion:
(a) To retain in the form received, or to sell either at public or private
sale any real or personal property;
4
(b) To exercise any options to subscribe for stocks, bonds, or other
investments;
(c) To join in any plan of lease, mortgage, consolidation, exchange,
reorganization or foreclosure of any corporation in which my estate or any trust
may hold stocks, bonds or other securities;
�J (d) To sell, transfer, convey, mortgage, pledge, lease or exchange
any property, real or personal, which at any time may form part of my estate, for
the payment of debts or taxes, or for any purpose of administration or
distribution, for such prices and upon such terms as my personal
re presentative(s), in their sole discretion, may deem wise, and to execute and
deliver deeds of conveyance or transfer thereof;
(e) To make settlements and compromises on such terms as my
tpl.
personal representative(s), in their sole discretion may deem wise without the
necessity of obtaining any court approval thereof;
IN (t) To make distribution hereunder either in cash or kind, as my
r
personal representative(s), in their discretion may deem wise.
(g) In the event that my Trustee, in its absolute discretion, should
determine that the size of any fund or share held in any trust under this my will
has so diminished as not to warrant continuing the same in trust, or that its
administration would be impractical for any reason, Trustee may, without further
SAIDIS,
FLOWER s' responsibility, pay such fund or share to the person entitled at the time to the
LENIDSM
,muiw[vs.nTuw
,6 W.t High ktr c income from it and thereby terminate the trust.
Ge{itl<,P.4
SEVENTH
I hereby appoint my son JEFFREY B. DITTENHAFER, as trustee of any trust
created hereunder or if he is.unwilling or unable to act as trustee, I appoint my sons
5
CHRISTOPHER M. DITTENHAFER and RODNEY D. DITTENHAFER to serve as co-
Trustees. My Trustee shall be compensated in accordance with its schedule of fees in
effect from time to time when such services are rendered.
EIGHTH
I do hereby nominate, constitute and appoint my son, JEFFREY B.
DITTENHAFER, to act as Executor of this my Last Will and Testament. Provided,
�J
however, that if he is unwilling or unable to act as Executor, i appoint my sons,
N CHRISTOPHER M. DITTENHAFER and RODNEY D, DITTENHAFER to serve jointly
P
r as Co-Executors.
r
NINTH
I direct that no personal representative, guardian, trustee or other fiduciary
appointed under this instrument shall be required to give bond for the faithful
performance of his duties in any jurisdiction.
C — IN WITNESS WHEREOF, I, CLARENCE A. DITTENHAFER, have hereunto set
my hand and seal to this my Last Will and Testament, consisting of seven (7)
typewritten pages, the first six (6) of which bear my signature in- the margin for
n
identification,this c? day of ( „ 2006.
SAIDIS, CLARENCE A. DITTENHAFER, T6statcr
k'I SOWER &
LINDSAY
25 Vi=High Su=
C.chdt,PA
6
Signed, sealed, published and declared by the above-named Testator,
Clarence A. Dittenhafer, as and for his Last Will and Testament in the presence of us,
who have hereunto subscribed our names at his request as witnesses thereto, in the
presence of said Testator and of each other.
ADDRESS
` ,C, • uc ADDRESS ( CcyC� �r
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, CLARENCE A. DITTENHAFER, S-rz,1Vtr c and
yr. L • tirp the Testator and witnesses, respectively whose names are
signed fo the foregoing or attached instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator signed and executed the
instrument as his Last Will and Testament and that he signed willingly and that he
executed as his free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the Testator signed the Will as
witness and that to the best of their knowledge the Testator was at the time IS or more
years of age, of sound mind and under no constraint or undue influence.
1 fCCQ C
In a
CLARENCE A. DITTENHAF Testator
C11
W by ss
SADDIS, W itpess
TZOWER &
LINDSAY Subscribed, sworn to and acknowledged before me by CLARENCE A.
nnonms.a-uw
26 W.HlghSv. DI4TE NHAFER, he Testator, and ubscribed to and sworn or affirmed to before me
C 11e'n" by au, v and/ ,t . �� c witnesses, this I C�''"`day of
M2006.
n
NoTARw EAL Notary f blic
MERLENE J.MARNEVKP!NOTARY PUBLIC ll
CARLISLE,CUMBERLAND COUNTY.PA
MY COMMISSION EXPIRES JUNE S.2008
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601 -
HARRISBURG,PA1]128-0601 -
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 016243
DITTENHAFER JEFFREY B
166 RIVER ROAD
PEQUEA, PA 17565
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
------
fold
101 $28,500.00
ESTATE INFORMATION: SSN: 195-26-8369
FILE NUMBER: 2112-0526 '
DECEDENT NAME: DITTENHAFER_JR CLARENCE-Y L ERT
DATE OF PAYMENT: 07/11 /2012
POSTMARK DATE: 07/10/2012
COUNTY: CUMBERLAND
DATE OF DEATH: 04/11/2012
TOTAL AMOUNT PAID: $28,500.00
REMARKS: RECEIPT TO ATTY
CHECK# 1001
INITIALS: DMB
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
7160 3901 9848 6659 1227
TO: PA Department of Revenue
Bureau of Individual Taxes
Inheritance Tax Division-EXT
PO Box 280601
Harrisburg,PA 17128-0601 r
i
SENDER: Vance E. Antonacci
REFERENCE:
Clarence A.Dittenhafer
PS Form 3800,Janus 2005
RETURN Postage �s i
RECEIPT
SERVICE Certified Fee
Return Receipt Fee 5
Restricted Delivery
Total Postage&Fees
/cll
us Postal Service POSTMARK-OR DATE
Receipt for
Certified
No Insurance Coverage Provided l\
Do Not Use for International Mail °\
2. Article Number _—_—_----- _-- � e SECTION ON DELIVERY
PLETIETHIS IIII III VIII IIII IIIIIIII III( ved ease SP ntClearly) B of
C Sig a
Agent
7160 3901 9848 6659 1227 X 9Ftp ❑Addressed,
D. Is delive �I ress different Irom item 1? ❑Yes -
IIYES,ente�a�j�ryaddrets below: ❑No
3. Service Type CERTIFIED MAIL
4. Restricted Delivery?(Extra Fee) ❑Yes
1. Article Addressed to:
PA Department of Revenue
Bureau of Individual Taxes
Inheritance Tax Division-EXT Clarence A.Dittenhafer
PO Bo
c280601
Harriirg, PA 17128-0601
Vance E.Antonacci
4
lhlli1,1101111 lPilii 11,1I1iji Ii!it
PS - estic Return Receipt
i
McNees
Wallace & Nurick LAC
570 Lausch Lare+ Suite 200+ Lancaster,FA 17601-3057 Vance E.Antonacci
Direct Dial:717.581.3701
T 717291.15 77+ Fax. 717.295 2 i 8S Direct Fax:717.260.1772
vantonacci @mwn.com
December 21, 2012
7160 3901 9648 6659 1227
VIA CERTIFIED MAIL
PA Department of Revenue
Bureau of Individual Taxes
Inheritance Tax Division - EXT
PO Box 280601
Harrisburg, PA 17128-0601
RE: Estate of Clarence A. Dittenhafer
No, 21-12-0526
Dear Sir or Madam:
I represent Jeffrey B. Dittenhafer, Executor of the Estate of Clarence A. Dittenhafer, who
died on April 11, 2012, The Pennsylvania Inheritance Tax Return for the Estate is due to be filed
on or before January 11, 2013. In attempting to prepare the return for filing, we have identified a
number of unresolved issues for which final information is not yet available. As a result, we
hereby request a six-month extension for the filing of the return.
I would appreciate if you would confirm your approval of this request in writing to my
attention.
Sincerely,
McNEES WALLACE & NURICK LLC
By
Vance E. Antonacci
dim
c: Jeffrey B. Dittenhafer
www.mwn.com
........ DA m cr,rc rrmivrc P8 a l.nninncnc nH a 1h omrrmw nn.
Law Offices of
SAIDIS, SULLIVAN & ROGERS
A PROFESSIONAL CORPORATION -
635 NORTH 12TH STREET,SUITE 400 CARLISLE OFFICE:
ROBERT C.SAIDIS LEMOYNE,PENNSYLVANIA 17043 26 WEST HIGH STREET
DANIEL L.SULLIVAN TELEPHONE:(717)612-5800-FACSIMILIE(717)612-5805 CARLISLE,PA 17013
ELYSE E.ROGERS EMAIL:attorney®ssr-attorneys.com TELEPHONE:(717)243-6222
JOHN A.FEICHTEL www.ssr-attorneys.com FACSIMILE:(717)243-6486
MARYLOU MATAS
ANNA BORRO HAYS Of Counsel
DEAN E.REYNOSA STEPHEN L.GROSE
TODD F.TRUNTZ
SEAN M.SHULTZ REPLY TO LEMOYNE
HANNAH WHITE-GIBSON June 6, 2014
717-612-5804
aborrohavAssr-attornevs.com
Register of Wills of
Cumberland County
One Courthouse Square
Carlisle, PA 17013
en °
Re: Estate of Clarence A. Dittenhafer, Jr. p C_
File No: 2012-00526 cn z c'n M
C7)Dear Madam: v o
Enclosed for filing with your office are the following: �' T ry c
rn
1. Original and one copy of the Pennsylvania Inheritance Tax Retuw.
Please note there is a refund due.
2. Inventory; and
3. Check in the amount of$30 representing your filing fees.
Please timestamp and return the enclosed copy of this letter acknowledging receipt
of these items.
If you have any questions or require additional information, please do not
hesitate to contact me.
Sincerely yours,
(;Levl �CmU
Anna Borro Hays
cjr .
Enclosures
cc: Jeffrey B. Dittenhafer