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Home My WebLink About08-18-14 REV-1500 EX (02^f'(F9 1505610140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po BOX 260601 INHERITANCE TAX RETURN 2 1 1 4 0 0 9 5 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 1 2 7 2 0 1 3 0 8 0 5 1 9 3 2 Decedent's Last Name Suffix Decedent's First Name MI SI MKO SR EDWARD J (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 © 1.Original Return 2.Supplemental Return 3.Remainder Return(Date of Death Prior to 12-13.82) 4. Limited Estate O 4a.Future Interest Compromise(date of 0 5. Federal Estate Tax Return Required death after 12-12-82) © 6.Decedent Died Testate C] 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received E] 10.Spousal Poverty Credit(Date of Death Ej 11.Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1.95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number J I L L M WI N E K A 71 7 234 41 78 REGISTER yO�F�yWILLS USE ONLY S' First Line of AddresstJ 1 7 1 9 N O R T H F R O N T S T R E E T �-T r- ¢ c Second Line of Address -. q n �OjQfy. City or Post Office State ZIP Code IS)DIE"FILED == - r rV �-`� C_-• HARRI SB URG PA 1 7 1 02 Correspondent's e-mail address: jwlfleka(ftk11.COm Under penalties of perjury,I dedare that I have examined this return,including accompanying schedules and statemems,and to the best of my knowledge and belief, It is true.correct and complete.Declaration of preparer other than the personal representative is based on all information of whip`s preparer has any knowledge. SQUU R F O RESPONSIBLE FOR FILING RETURN �LSty ail ADDRESS Thomas A. Simko, 1310 Abington Way, Mechanicsburg PA 17050 SIGnLj,.0F PA R��TYL:REPRESENTATIVE ADD SS .faLj I! Jill . Wineka, Esq., 1719 North Front Street Harrisburg PA 17102 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 ,�Q; J 1505610240 REV-1500 EX(FI) Decedent's Social Security Number DecedeersName: EDWARD J. SIMKO, SR. RECAPITULATION 1. Real Estate(Schedule A) 1. .. ... .... .. .. . .. .... . . .... . . . ...... . .. ... . . 2. Stocks and Bonds(Schedule B) . .. .. .. .. . .. .. . .. .. .. . . .. .. .. .. .... . . . 2. 4 7 2 7 4 6 . 5 2 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .. . . 3. 4. Mortgages and Notes Receivable(Schedule D) .. . . . ... . .. . .. .. .. . .. ... . . 4. r 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). ..... . 5. 2 5 1 0 8 1 . 0 4 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . ... . . . 6. 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property 2 1 9 5 4 7 , 4 6 (Schedule G) � Separate Billing Requested ... .. . . 7. 8. Total Gross Assets(total Lines 1 through 7) ... . . .. .. .. . .. . .. .. . .. ... . . 8. 9 4 3 3 7 5 , 0 2 9. Funeral Expenses and Administrative Costs Schedule H 9. 8 1 5 5 3 . 7 1 10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 3 9 2 2 • 8 3 11. Total Deductions(total Lines 9 and 10) .. . .. .. . .. .... . . .. .... . .. ... . . . 11. 8 5 4 7 6 . 5 4 12. Net Value of Estate(Line 8 minus Line 11) .. .. . ..... .. . .. . ... . . ... .. . . 12. 8 5 7 8 9 8 . 4 8 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. 8 5 7 8 9 8 • 4 8 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 8 5 7 8 9 8 . 4 8 16. 3 8 6 0 5 . 4 3 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE .. . . . .. . .. . . . .. .. ... .... . .. ... . . . ... . .. . .... ... ..... . . 19. 3 8 6 0 5 . 4 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 L 1505610240 1505610240 REV-1500 EX(Fl) Page 3 File Number Decedent's Complete Address: 21 14 0095 DECEDENTS NAME EDWARD J. SIMKO SR. STREET ADDRESS 4182 ELK COURT CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 38,605.43 2. CreditsfPayments A.Prior Payments 33,000.00 B.Discount 1,736.79 Total Credits(A+B) (2) 34,736.79 3. Interest (3) 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 3,868.64 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 ................................................................... ID b. retain the right to designate who shall use the property transferred or its income ............................ El 0 c. retain a reversionary interest ..................................................................................................... ❑ d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ Ej 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ I] 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)(i)). For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in V2 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. REVA 503 EX*(6-12) pennsylvania SCHEDULE B DEPARTMENT INHERITANCE STOCKS & BONDS INHERITANCE TAX AX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD J. SIMKO, SR. 21 14 0095 All property Jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 118 shares of CenturyLink (CTL) common stock valued at$30.74/share 3,627.32 2. 390.5863 shares of Nuveen Investments (NPP)common stock valued at$12.97/share 5,065.90 3. 995 shares of Comcast(CMCSA)common stock valued at$49.68/share 48,934.80 4. 1,237 shares of AT&T (T)common stock valued at$35.31/share 43,678.47 5. 673 shares of Verizon Communications, Inc. (VZ)common stock valued at 33,596.16 $49.92/share 6. 673 shares of Vodafone Group PLC (VOID) common stock valued at$37.20/share 25,035.60 7. 214 shares of Frontier Communications (FTR) common stock valued at$4.69/share 1,003.66 See attached Estate document listing the high, low and median price for each stock individually owned by the Decedent. Also see attached Yahoo Finance Historical price pages showing the high, low and median date of death values for each individually owned stock identified on Schedule B as items 1 through 7, which was the source of information for the above referenced Estate document. 8. Dividends issued on 118 shares of Century Link (CTL) common stock at$.54/share. 63.72 Record date of 11/25/13 and Payment date of 12/6/13. 9. Dividends issued on 390.5863 shares of Nuveen Investments (NPP) common stock 30.08 at$.077/share. Record date of 11/15/13 and Payment date of 12/2/13. 10. Dividends issued on 673 shares of Vodafone Group PLC (VOID) common stock 393.13 at$.58415/share. Record date of 11/22/13 and Payment date of 2/5/14. See attached Nasdaq Dividend History documents showing the Record and Payment dates for dividends paid on stocks individually owned by the Decedent which were paid post-death but resulted from the Decedent's ownership at the time of his death. TOTAL(Also enter on Line 2,Recapitulation) $ 472 746.52 If more space is needed,insert additional sheets of the same size Continuation of REV-1500 Inheritance Tax Return Resident Decedent EDWARD J. SIMKO, SR. 21 14 0095 Decedent's Name Page t File Number Schedule B -Stocks & Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 11. Ameriprise One Financial Acct. No. 0000259377612133 consisting of the following 7 equities and 1 real estate investment trust: a) 3,704 shares of AT&T, Inc. (T) common stock valued at$35.31/share 130,788.24 b) 122 shares of Alcatel Lucent(ALU)common stock valued at$4.22/share 514.84 c) 15 shares of Fairpoint Communications, Inc. common stock valued at O/share 0.00 d) 194 shares of Frontier Communications (FTR) common stock valued at$4.69/share 909.86 e) 40 shares of Idearc, Inc. common stock valued at 0/share 0.00 0 34 shares of LSI Corp. (LSI) common stock valued at$8.07/share 274.38 g) 809 shares of Verizon Communications, Inc. (VZ) common stock valued at 40,385.28 $49.92/share h) Corporate Property Associates 16 Global, Inc. 42,279.89 See attached 11/1/13-11/29/13 Ameriprise Statement documenting the types of equities and number of shares in Decedent's Ameriprise One Financial Acct. No. 0000 2593 77612133. Also see attached Estate document listing the high, low and median price for each stock part of Decedent's Ameriprise Acct. No. 0000 2593 77612133. Also see attached Yahoo Finance Historical pages showing the high, low and median date of death values for each equity in Ameriprise Acct. No. 0000 2593 77612133 identified on Schedule B as items 11.(a)through (g), with the exception of LSI Corp. because historical stock data was not available. Date of death value for LSI Corp. was taken from attached Ameriprise Statement dated 11/1/13-11/30/13. 12. Ameriprise Active DA CONS Acct. No. 0000 5987 6719 2 133 consisting of the following 17 mutual funds: a) 193.252 shares of AQR Managed Futures Strategy CLN (AQMNX)valued at 1,992.43 $10.31/share SUBTOTAL SCHEDULE B 217,144.92 Continuation of REV-1500 Inheritance Tax Return Resident Decedent EDWARD J.SIMKO. SR. 21 14 0095 Decedent's Name Page 2 File Number Schedule B-Stocks& Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH b) 77.72 shares of Aribitrage CLR (ARBFX) valued at$12.62/share 980.83 c) 710.791 shares of Blackrock High Yield Bond Investor CLA(BHYAX)valued at 5,899.57 $8.30/share d) 262.468 shares of Blackrock Inflation Protected Bond Investor CLA(BPRAX)valued 2,884.52 at$10.99/share e) 113.333 shares of Calamos Market Neutral Income CLA(CVSIX) valued at 1,492.60 $13.17/share 0 299.143 shares of Columbia Income Opportunity CLA(AIOAX)valued at$10.03 1share 3,000.40 g) 1,937.651 shares of Columbia Intermediate Bond CLA(LIBAX)valued at$9.07/share 17,574.49 h) 506.487 shares of Eaton Vance Fltg Rate & High Income CLA (EVFHX)valued 4,867.34 at$9.61/share i) 198.901 shares of Eaton Vance Global Macro Absolute Return Advantage CLA 1,897.52 (EGRAX) valued at$9.54/share j) 1,572.727 shares of Fidelity Advisor Total Bond CLA(FEPAX)valued at$10.51/share 16,529.36 k) 113.545 shares of John Hancock International Core CLA(GIDEX)valued at 3,928.66 $34.60/share 1) 139.302 shares of John Hancock Ranier Growth CLA(RGROX)valued at 4,160.95 $2987/share m) 135.088 shares of John Hancock Global Absolute Return Strategy CLA(JHAAX) 1,499.48 valued at$11.10/share n) 571.58 shares of JPMorgan Strategic Income Opportunity CLA(JSOAX)valued at 6,790.37 $11.88/share o) 181.428 shares of MFS Value CLA(MEIAX)valued at$33.17/share 6,017.97 P) 122.796 shares of Wasatch Long Short Investor CLA (FMLSX) valued at$16.43/share 2,017.54 SUBTOTAL SCHEDULE B 79,541.60 Continuation of REV-1500 Inheritance Tax Return Resident Decedent EDWARD J. SIMKO, SR. 21 14 0095 Decedent's Name Page 3 File Number Schedule B -Stocks & Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH q) 1,141.276 shares of Wells Fargo Advantage Core Bond CIA(MBFAX) valued at 14,631.16 $12.82/share See attached 11/1/13-11/29/13 Ameriprise Statement documenting the types of mutual funds and number of shares in Decedent's Ameriprise Active DA CONS Acct. No. 0000 5987 6719 2 133. Also see attached printouts from Yahoo Finance Historical pages documenting the date of death value for each mutual fund identified on Schedule B as items 12.(a) through (q). SUBTOTAL SCHEDULE B 14,631.16 GRAND TOTAL SCHEDULE B $ 472,746.52 REV-1508 EXt(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERRANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: EDWARD J. SIMKO, SR. 21 14 0095 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Citizens Bank Checking Acct. No. xxxxxx3762 4,460.96 2. Citizens Bank Savings Acct. No. xxxxxx3608 1,000.80 3. Citizens Bank Checking Acct. No. xxxxxx3584 76,028.16 See attached 3/11/14 Citizens Bank letter documenting the Decedent's sole ownership of the three accounts and the date of death values. 4. Verizon-uncashed dividend check 356.69 5. Alcatel-Lucent- Medicare refund 169.00 6. 2004 Ford Crown Victoria, V-8 1,850.00 See attached NADA documents to support date of death value for Decedent's car. 7. People's United Bank- uncashed check from Decedent's New York Account closed 124,245.79 shortly prior to death. See attached copy of People's United Bank check dated 11/23/13. 8. New York Commercial Bank-uncashed check from Decedent's New York Account 9,361.63 closed shortly prior to death. See attached copy of New York Commercial Bank check dated 11/23/13. 9. Ameriprise Insured Money Market 31,181.08 See attached 11/1/13-11/29/13 Ameriprise Statement documenting Decedent's sole ownership and date of death value. The Ameriprise Insured Money Market was part of Ameriprise One Financial Acct. No. 0000 2593 77612 133 that also contained 7 equities and 1 real estate investment trust. 10. Comcast- uncashed dividend check 164.00 11. Comcast-uncashed dividend check 28.08 12. United States Treasury-2013 Federal Income Tax refund 947.00 TOTAL(Also enter on Une 5,Recapitulation) $ 251 081.04 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent EDWARD J. SIMKO, SR. 21 14 0095 Decedent's Name Page 4 File Number Schedule E -Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 13. State Farm -rental insurance refund 78.09 14. Mountain View Village-security deposit refund 5.00 15. Alcatel-Lucent- Medicare refund 92.00 16. New York Office of Unclaimed Funds- unclaimed property 385.56 17. State Farm -car insurance refund 43.42 18. Alcatel-Lucent-Medicare refund 332.20 19. Personal property-bed; dresser; nightstand; chest of drawers; kitchen table and 300.00 4 chairs; lamps; end tables; coffee table; recliner 20. Apria Healthcare - refund 51.58 SUBTOTAL SCHEDULE 1,287.85 GRAND TOTAL SCHEDULE $ 251,081.04 REV-1510 EX+(0a-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD J. SIMKO SR. 21 14 0095 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. DESCRIPTION OF PROPERTY ITEM INCLIIDETHE NAME OF THE TRANSFEREE,THEIR REIATIONSKPTO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH ACOPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST RTAPRJC&Q VALUE 1. Jackson National Life Insurance Company Annuity 42,439.70 100.00 42,439.70 Contract No. 029041916A. See attached 3/12/14 Jackson National Life Insurance Company letter and enclosure documenting the value of 1/5 of the value of the Annuity distributed to the Decedent's son, Thomas A. Simko. Each of the Decedent's other 4 sons received an identical gross distribution of$8,487.94. Also see attached 2/22/14 Jackson National Life Insurance Company letter documenting that ail 5 of the Decedent's sons were equal beneficiaries. 2. Ameriprise Brokerage Account, IRA Acct. No. 565.41 100.00 565.41 0000 1794 2720 8 1333 3. River Source Retirement Advisor 4 Advantage VA IRA 93,198.88 100.00 93,198.88 Acct. No. 0991 0914 5810 9 005 4. River Source Advantage Fixed Annuity Value Plus Adv. 40,606.07 100.00 40,606.07 Rollover IRA Acct. No. 0991 0907 4957 3 005 See attached 11/1/13-11/30/13 Ameriprise Statement documenting date of death values for each of Decedent's 3 IRAs. All 3 IRAs were divided equally among the Decedent's 5 children. Also see attached 3/4/14 email and form from Ameriprise broker documenting that all 5 of the Decedent's sons were equal beneficiaries of the 3 IRAs. 5. Empire Fidelity Investments Life Insurance Company 42,737.40 100.00 42,737.40 Annuity Contract No. 410024562. See attached documentation from Empire Fidelity Investments Life Insurance Company dated 3/3114 documenting the gross distribution of the Annuity to the Decedent's son, Thomas A. Simko. TOTAL Also enter on tine 7,Recapitulation $ 219 547.46 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD J SIMKO SR. 21 14 0095 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Whalen & Ball Funeral Home 13,655.00 2. Clarkes Bar& Restaurant-post-funeral luncheon 888.09 3. Wally's Florist& Gifts -flowers 375.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Namels)of Personal Representative(s) Thomas A. Simko 36,191.00 Street Address 131OAbington Way Cary Mechanicsburg sate PA ZIP 17050 Years)Commission Paid: Not yet paid 2, Attorney Fees: Purcell, Krug & Haller 27,529.00 3. Family Exemption:(If deoedenrs address is not the same as daimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. PmbateFees: Register of Wills 560.00 5 Accountant Fees: LaGreca & LaGreca - preparation of Decedent's 2013 Personal Income 300.00 Tax Returns 6. Tax Return Preparer Fees: 7. Register of Wills-fee to file Will; Short Certificates; Automation fee; fee to file 113.50 Inventory; fee to file Inheritance Tax Return; JCS fee 8. Uncle Bob's Self Storage 829.50 9. Hampton Inn & Suites-lodging for Executor for funeral and administrative issues 338.58 10. Thomas A. Simko- reimbursement for mileage (444 miles @$.56/mile) 248.64 11. Postage 43.42 12. Register of Wills-fee to file Family Settlement Agreement 20.00 13. Estate Checking Account-service fees 24.00 14. Estate Checking Account-fee for additional checks 37.98 15. Samuel Thuma, CPA-preparation of Fiduciary Income Tax Returns 400.00 TOTAL(Also enter on Line 9,Recapitulation) $ 81 553.71 If more space is needed,use additional sheets of paper of the same size. REV-1612 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD J. SIMKO SR, 21 14 0095 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Citizens Bank Card Services-credit card 2,225.26 2. Mechanicsburg Area Meals on Wheels 56.00 3. Verizon-phone services-final bill 134.27 4. Comcast-TV services 176.68 5. Mountain View Village-rent 865.00 6. PA Department of Revenue-2013 State Income Tax liability 143.00 7. Comcast-TV services -final bill 85.99 8. PA American Water-water services-final bill 44.98 9. PP!_-electric services-final bill 75.46 10. UGI -gas services-final bill 116.19 TOTAL(Also enter on Line 1D,Recapitulation) $ 3,922.83 If more space is needed,insert additional sheets of the same size. REV-1513 EX.(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: EDWARD J. SIMKO SR. 21 14 0095 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Tnistee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pndude ou�IphIs usal distributions and transfers under' Sec.91f6(a (1.2).] 1. Edward J. Simko, Jr. Lineal 4424'Easl Kirkland Road 1/5 of residuary Phoenix, AZ 85050 2. John K. Simko Lineal 4 Windaway Road 1/5 of residuary Bethel, CT 06801 3. David Simko Lineal 116 Windsor Terrace 1/5 of residuary Yonkers, NY '10701 4. William T. Simko Lineal 23 Kayview Avenue 1/5 of residuary Bethel, CT 06801 5. Thomas A. Simko Lineal 1310 Abington Way . 1/5 of residuary Mechanicsburg, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. n, NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART I1-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. �,,.�P` PT. I�� d y..p•� ]. ! A k Y1 Fr � 1 "5 go {'`^ i, ,}`" Ja°/!dI rli bons)s) 7+15..",".'J u V u+ti`.L:;? `}t F. + t 1lP5`..`'iYl 'fi2tr— Khoo o NG_Y .if{r Ins Insrs dome f'.£1;'am <.r;w' mr x'i'? W"TAI ANN. '3[>1i..1+Jt :'1' rt' b. 1 _.r 't, .a t'iS;?_I ✓i:"v. :..'t„i�' ?_ .. . ,. . own,? nil Wit.;.,,;, .t-. 'e:4J`..,'r:T, .'t Z ,.i71 c+ P ,» �F:''4 +a w�;.'� ( ' ' ..,•Iry'r F;1 '1. :. r a i .[r;: w�'.'.... ..,n: r L.,r-;+�, !< ' . . . Shot : DODO .00 Al '. P _ : M 1Q . , 'uor, M "M cc all 1.:r° A ATO AV 9,,{'-{R•w0A A 10 is'/% ..:ll:'',. - ,ri ' .co Y'al T.�'.r tj.r ,r�,r1:�Sf7i rl�i4 .. ±1... t.i(.1s'::-: F I i3fi<' S .m.+ L� pl } .._ , sT rxP it Vie. ;'O .h:"M t., t y.,_ } �.17.•i,':a, '.n .,(/:.. ,°.`, �t,t`s;+fH ' . F'-i^•t? .{” _,.",V "_ . , _.'}I TO do 57, ; L 9 -P.:."'}'-.. . J1 m !b Syr! in Q'(le.t-arAc: '4,w4 'f%r z :!:::' S 3 511 11 MCI, 'Is b ald! .0 .w y n.^, ? + E.:. 5'^-1 °1`rw `Ne,r} ,i'16'd 4'Q ,' 1L%) n5..+( .. :7 _ . . ,. S. .,( ' ., 01 i7;: 1 f. _, 47 9"0 :)�al ..%�S; :n.:..4, .. f_ .)". •Y:. '.)., rrr€' �"rr :r:». .� a J.r� < ,;,lL21 fi '.fit Y; .--iR� i i 1410 Wo [ PONS swig, 10 a l- o XOV40 1 Sol 3 HIL ' ?"poll Pt `.�...�..�...,...,. _...._...:.� _ ........_ ....... _......_.�....uw.rv..w...w+r. i.>.r.....M.._w..v...im. _ iorosravca.o->v=c:e=•s .cJ`3eC:Ml':'.4z_i...+*::aS:Yil: �4' 12. New York Commercial Bank check dated 11/23/13 in the amount of$9,361.63. 13. Jackson National Life Insurance Company letter dated 3/12/14 and enclosure documenting one-fifth of the value of the Annuity distributed to one of five beneficiaries, all of whom were the Decedent's children. 14. Jackson National Life Insurance Company letter dated 2/22/14 confirming that all five of the Decedent's sons were equal beneficiaries of his Jackson National Life Insurance Company Annuity Contract No. 029041916A. 15. 3/4/14 email from the Ameriprise broker documenting that all five of the Decedent's sons were equal beneficiaries of the three IRAs held in the Ameriprise Brokerage Account. 16. Empire Fidelity Investments Life Insurance Company document dated 3/3/14 documenting the gross distribution of the Annuity to the Decedent's one son, Thomas A. Simko. LAST WILL AND TESTAMENT OF EDWARD I SEAKO I, EDWARD J. SUAKO, residing at 8 Larrimore Road, Yonkers, NY 10710 being of sound and disposing mind and memory, do hereby revoke all wills and codicils, as well as all other instruments of a testamentary nature heretofore made by me and do hereby make, publish and declare this to be my Last Will and Testament in the manner and form following: FIRST: I hereby direct the payment by my Executor or Executors of all of my debts then actively due and owing and funeral expenses incurred in the administration of my Estate, as soon after my death as shall be convenient. I direct that all inheritance, estate, transfer, succession and other death taxes or duties (including any interest and penalties thereon) imposed by any jurisdiction whatsoever by reason of my death upon or with respect to any property includible in my estate for the purposes of any such taxes or duties, whether such property passes under or outside, or has passed outside, the provisions of this Will or any Codicils hereto, be paid from my general estate as an expense of the administration thereof, without apportionment. SECOND: I herby give, devise and bequeath all of my estate whether real, personal, mixed, wheresoever situated, and over which I may have the power of testamentary disposal at my decease to my five (5) children, EDWARD J. SD,IKO, JR-, JOHN K. SNKO, THOMAS A. SIIOKO, DAVID SDgTO and WILLIAM SlMKO, as follows: (a) one-fifth (1/5) of the principal shall be turned over to each child. (b) If any of said children shall have predeceased me or in the event that we shall both die within thirty (30) days of each other as a result of a common disaster or during a joint last illness, or under such circumstances that the order of our deaths cannot be ascertained with reasonable certainty, then in that event, I give, devise and bequeath that child's share of the principal to the descendants of said child, in equal shares, per stirpes and not per capita. (c) In the event that any one of my children shall have predeceased me or in the event that we shall both die-within thirty (30) days of each other as a result of a common disaster or during a joint last illness, or under such circumstances that the order of our deaths cannot be ascertained with*reasonable certainty, and that child leaves no descendants, then that child's share shall be equally divided by the remaining children surviving_ THIRD: If pursuant to any provision of this, my Will, all or any part of my estate shall vest in absolute ownership in a minor or minors, then I authorize . my Trustee(s), in their discretion in each such case, to hold administer, invest and re-invest such part for such minor's benefit during his or her minority and to apply so much of the net income of said part of the principal of said share as said Trustee(s), in their discretion, shall deem necessary to seal minor's proper case, maintenance, support and education. FOURTH: I hereby nominate, constitute and appoint my beloved son, THOMAS A. OvIKO, as Executor of this, my Last Will and Testament, without requiring his to give any bond, security or surety whatsoever. In the event that my beloved son, THOMAS A. SDAKO, shall predecease me, or for any reason be unable or unwilling to serve as Executor, then, and in such event, I hereby nominate, constitute and appoint my beloved son, JOHN K. SU KO, to serve -2- without bond, security or surety whatsoever, as Executor, Trustee and Guardian of this, my Last Will and Testament. FIFTH: I Hereby give my Executor the same full power to sell, lease transfer or convey any real property or personal property of which I might die seized or possessed as I might exercise were I alive and personally acting. SIXTH: It is my wish that my Executor and Guardian be not required to furnish any bond or ther security for his faithful performance of.his duties in that behalf,whether in the State of New York or elsewhere. SEVENTH: Except as may be otherwise provided in this, my Will, I have intentionally omitted to provide herein for any other relatives or for any other person, whether claiming to be an heir of mine or not. EIGHT: It is my wish and I recommend that the probate proceedings in connection with this my Last Will and Testament and all legal matter connected with the settlement fo my estate and final accounting in the Surrogate's Court shall be conducted by my attorneys: RIEBLING, PROTO, SCHMIDT & SACHS, LLP, 190 East Post Road, Suite 402, White Plains,New York 10601. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 19th day of September, Two Thousand and seven. c � EDWARD 1 DVIKO -3- THE FOREGOING INSTRUMENT, consisting of this and three (3) preceding and two (2) subsequent typewritten pages, was signed, sealed, published and declared by EDWARD J. SHAKO, the Testator, to be his Last Will and Testament, in our presence, and we, at his request and in his presence and in the presence of each,other, have hereunto subscribed our names as witnesses this 19th day of September, 2007. residing at 2 y S,f'•�� S �' Qa residing at /d A4,- -4- STATE OF NEW YORK ) )SS: COUNTY OF WESTCHSTER ) 1) error? SchlrldV' address ��vae Sfi 2) /Y ��r , f� address Az ,/, n ,• each being duly sworn, depose and say: That they witnessed the execution of the Will of EDWARD J. SD\dKO consisting of three (3) pages, dated September 19, 2007. That the Will was executed at 190 East Post Road, White Plains, New York, uffder the supervision of Stephen J. Riebling, Jr., an attorney at law and member of the firm of Riebling, Proto & Schmidt, LLP, with offices at 190 East Post Road, White Plains, New York. That this affidavit is made at the request of the Testator. That the Testator in our presence subscribed his name to the Will at the end thereof, and at the time of making such subscription, published and declared that same to be his LAST WILL AND TESTAMENT; thereupon, we, at his request and in his presence and in the presence of each other, signed our names thereto as subscribing witnesses. That the said Testator at the time of such execution was more than eighteen (18) years of age, and in our opinion, of sound mind, memory and understanding, not under any restraint or in any respect incompetent to make a Will. That the Testator indicated to us that he had read the Will,knew the contents thereof, and that provisions therein contained expressed the manner in which his estate is to be administered and distributed. -5- That the Testator could read, write and converse in the English language, and was suffering from no defect of sight, hearing or speech, or from any physical or mental impairment which would affect his capacity to make a valid Will. That the said Testator signed only one copy of the said Will on said occasion. �n S-/ Sworn to before me this �9 Day of 2007 0 STEPHEN J.RIEBLING NOTARY PUBLIC,STATE OF NEW YORK NO.02RI6I43208 QUALIFIED IN WESTCHESTERCOUNTY COMMISSION EXPIRES 413/2,,./v -6- P4 a a xC J� UD Lin a :9 3 L7 z a w 7 STOCKS OWNED INDIVIDUALLY BY THE DECEDENT VALUATIONS ARE AS OF DATE OF DEATH — NOVEMBER 27, 2013 Name Hiqh Low Median 1. CTL Century Link 118 shares $3,627.32 30.92 30.55 30.74 2. NTP Nuveen Investments 390.5863 shares $5,065.90 13.00 12.94 12.97 3. CMCSA Comcast 995 shares $48,934.80 50.02 49.34 49.68 4. T AT&T 1,237 shares $43,678.47 35.42 35.20 35.31 5. VOID Vodafone Group PLC 673 shares $25,035.60 37.31 37.09 37.20 6. FTR Frontier Communications 214 shares $1,003.66 4.71 4.67 4.69 7. Vz Verizon Communications, Inc. 673 shares $33,596.16 50.20 49.64 49.92 CTL Historical Prices I CenturyLink, Inc. Common Stock Stock-Yahoo! Finance Page 1 of 2 'It°nance tl$fi4e Nay Por1M60 F09&%Dat?ea!ner Bus?n(%V&FAW A"Monalh`nallce FI!ckr Yahe UFIgirhisgre CNBC Emer 6ymbd LOOA UV Tue,Febta, 14oViVz{kia;;Feq/5 ehe�g6ilpNArShras �t2>)nina Dow.60.03%Na3daq?0.59% CTL O.o1 r CTL IS UP (t Amnibadn O OPEN AP1 ACCOUNT f Centu`ryLink,Inc.(CTL) -NYSE Follow Add to Portfolio, 30.72 2 i 0.07(0.2 1%) 10:47AM EST-Nasdaq Real Time Plies Historical Prices Get Histodul Prices fb:0 co Set Date Range Cs Daly Stad Date: Nov v 27 2013 Ep.An 1,2010 Q Weekly EM Oates: Nov v 27 2013 Q Monthly O Divide es ony, Gel Prices F'ust I Previous I Next I Lest average,On other mutual Pdcn Date open High Low Clete volume Adj Closes' funds _ Nw27,2013 30.70 30.92 30.55 30.72 4,176,500 30.72 times • a Close price a Mbel ror dMOeMS eM spab. •- _ First I Previous I Next I Las; t 1Downioad to Spreadsheet Currerxy M USD. . �"/vanguard' Ad Topics That Might Interest You... 1.CTL Stock Predictions 6.Top 10 Smanphones .... ........... ............. .........I.,........._... ....................... ..... 2. 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McMr Yahool nor ens e o n-t toen:prodaen is fiPAle far cry mfam•wnel.I.Tee!ncompkt. t or delays.afar any.V.ble rnxen in rdNrsx on Wormadm u—Y turn herein.9Y eaessvq Ina Ya'roo!atte,you spree not to r�smbde IM'vllamte0on fonts dwM^.Reel-Tpne condnuaa aveaminp quotes ere available tbrouph oa premMn seMra.You may Nm .".he owtes on or off: Fudamental cem,&M data provided by CVAWl 10.Hiskmm chart data dal,updates provk!ed by Commodl ySystems.Inc.(CSII.Inuenawnol Matalcel dart des:•,daily 4datbe,M1md aanmary,NM pedamano, wWar,date aM Manlnpswr IMex date previdM by Momkpsmr.Im. htto://finance.yahoo.com/q/hp?a:--10&b=27&c=2013&d=l 0&e=27&f�-20I3&g=d&s=CTL... 2/18/2014 N Historical Prices I Nuveen Performance Plus Municip Stock - Yahoo! Finance Page 1 of 2 'nonce 140e Ne v y PoRI'Ro ibs FIvSIAcA Dal Bather Bus�n%TI&FinSnMs AnVerrsSonal�kinpCe Ebel,YahAob?,gI1YOre CNBC Enter SymEal look Up I Tue,Feb 18, 1C>CP.Pdd�IB84cej3 .M.`BitTR'dRNNAdn a 6�lnlns Dow 40.07%Nasdaq?0.65% Trade hce Id F-0dm/re E+;TRADE' r getW1.SGWanh. " OPEN An ACCOUM :ED Ameritrado O Nuveen Performance Plus Municip(NPP( -NYSE Follow Add to Pomolto 14.22 i0.05(0.35%) 12:19PM EST-Nasdaq Real Time Price Historical Prices Oct Historical Pdcas lor.F---------7 GO Sat Date Range Q Deily Start D. Novv 27 2013 Ea.dsn t,solo QWaeky End Date: Novv = 2013 0 Monthly O Dividends Only Don't iust Get Poces First I Prevdus I Naat I Lest invest Prices -- money. Date Open High Law Close volume A4 Col... Vanguard it. Nov 27,2013 12.98 13.00 12.94 13.00 133,500 12.78 Close prka adrysled W dhlde,ks end spills. x First I Ple ious I Nee I Last A�.Download to Spreadsheet Curency in USD. 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Fundamental company data pmvded by Capital 10.HlstonW bnrt Erna ale daily undoes Pmvged by Commoday Systems.IM.(CSlt.lniemanmel Nstodcei clarl fete,drily upeates,fund summary.NM performance,dMdend data and Morningstar Index data pnwided by Momingstar.Inc. http://finance.yahoo.com/q/hp?a=10&b=27&c=2013&d=10&e=27& 2013&g=d&s=NPP... 2/18/2014 CMCSA Historical Prices I Comcast Corporation Stock- Yahoo! Finance Page 1 of 2 °�7naoe 0age Neny poRpoo ds F � el DatraNer BusrRM F �RMS A f3onal�7a°Qe "'Yahe ngirlas CN13C Enter Synod lmkUp T.,Feb 18. 14 adiaAMiance:1 .erk P><0i/1rSWse (rzSNns Dow 30.09%Nasdaq 10.45% 1: E TRACE' , 1[: :OPEN AN ACCOUNT Ava.inada o r Comcast Corporation(CMCSA) -NesdagGS Follow Add to Portfolio. 53.58 40.12(0.22°/0) 10:38AM EST.Nasdaq RealTimePrice 15 Historical Prices Got Historical Prices far. 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Dow 40.08%Nasdaq 10.55% ��--11 TI_S DOWN ED ArrrWaM a OPEN AN ACCOUNT ATBT,Inc.(T) -NYSE Follow Add to Podfollo 32.84 iO.31(0.95%) 1197AM EST.Nasdaq Real Tlme Pdce Historical Prices cat Hi.tadc.l Pdz.lonF------1 Go Set Date Range Q Daly Start Dah: NoV V 27 2013 Eg.Jan 1,2010 O We" Susie Esposito Feld Date: Nov V 27 2013 Qstonmly vevusaoer. :a mr Q DKIdeM9 Only Fkal I Prevlas I Naxt I Lest US`Prices Date Open High Law Close Volume Ad Close-Nov 27,2013 35.29 35.42 3520 35.41 11,471,30D 34.96 Ckse pim adjusted br d eds and.pits. First I Previous I Next I Last r'1Download to Spreadsheet currency in USD. 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Sun Date: N- V 27 2013 Eg.Jen 1,2010 Q we" Eno Data 0 ov t O Dividends only i Fast I Pnwious I Nee;i Lam - - Paces Date Open High Lox Close Volume Ad,Close' , Nov 27,21)13 4.66 4.71 4.67 4.69 4,933,600 4.42 • - a Gvse pdm adWed for dnidends and aPFU. • - First I Previous First Ne c I Lest t•lDoweload to spreadsheet Currency in USD. i Vr Ad Topics That Might Interest You... 1.10 Best Income Funds 5.Invest In Gold 2.Top Stocks to Invest In 6.High Return Investments 3.Best Stook Picks 7.High-Yield Dividend ETFa 4.Best CD Rates e.Fixed Income Funds Feedback Fdv.ry.Aeou ovr Ads-Tema-smd Fenead.-Yahool-ABC News Nelvnrk Dumas are real-time for NASDAQ,NYSE.and NYSE MKT.Sea aim debt'dmas for olner eedra s Alhllonnm5m provided•as W W brorrnmm pumoses qtly,no etlendad for Lading paposas w.d *,NMVIer Y•trooj mr arry a IMependaM pmmdara o I .for any inibm clonal etmrs.IMOmpalenne,adaLrya,or iar any anions takM In nnance-mform.ti-comae herein.6t'aasakg the Yeneol site,you agree not m redimb to the informa:bn found therein. ti + •//f, a P vahnn rnm/n/hn9R=FTR&a=10&b=27&C=2013&d=10&e=27& 2013&g=d 7/15/2014 CenturyLink, Inc. (CTL) Dividend Date & History -NASDAQ.cotn Page I of 2 Heins>0wies>CTL>01ri anO History CenturyLink, Inc. Dividend Date&History CTL $39.86' 0.91 2.34% 'Delayed-data as of Aug.6,2014 - FM a broker to begin bedb9 CTL now The Dividend History page provides a single page to review all of the aggregated Dividend payment Infonna ton.visit our Dividend Calendar.Our partner,Zacks Investment Research,provides the upcoming ex-dividend dates for the next month. E,JEH Data Typo Cash Amourd Declam6on Date Record Date Payment Data 61512014 Cash 0.54 5282014 692014 61202014 352014 Cash 0.54 22412014 31102014 32112014 11212013 Cash 0.54 11/122013 112512013 1252013 9142013 Cash 0.54 8272013 9/62013 9/192013 5502013 Cash 0.54 52612013 022013 61142013 3172013 Cash 0.54 2272013 3/112013 3222013 1222012 Cash 0.725 11/132012 12/11/2012 12212012 9/72012 Cash 0.725 8212012 9/112012 9212012 6112012 Cash 0.725 5242012 6152012 611512012 37X1012 Cash 0.725 2212012 35/2012 3116=12 1222011 Cash 0.725 11/152011 12/5/2011 12/162011 9/12011 Cash 0.725 8232011 91812011 9/162011 622011 Cash 0.725 5718/2011 6162011 61162011 211612011 Cain 0.725 1242011 2/182011 2/252011 12!.2010 Cash 0.725 115/2010 122/2010 12202010 922010 Cash 0.725 8242010 9/2/X110 9/20(1010 614/2010 Cash 0.725 5212010 618=10 61212010 , 3152010 Cash 0.725 225/1010 319/2010 3222010 11502009 Cash 0.7 11/182009 1222009 121152009 952009 Cash 0.7 8242009 9=2009 9212009 61122009 Cash 0.7 51182009 61162009 6902009 31132009 Cash 0.7 2262009 3/172009 3=12009 11282008 Cash 0.7 111192008 1222008 12/152008 9152008 Cash 0.7 a262008 9192008 9/222008 722008 Cash 0.6325 — — — 6192008 Cash 0.0675 5292009 6111f1008 6242008 352008 Cash 0.0675 2262008 31102008 3242000 11!13/2107 Cash 0.065 11/142007 11272007 17/102007 6x302007 Cash 0.085 82112007 9142007 91172007 51312007 Cash 0.055 5222007 6142007 61152007 3182007 Cash 0.065 2272007 3/122007 3232007 1122!2006 Cash 0.0625 11/152005 ll27nDD6 1252008 8/312oos Cash 0.0625 8222006 9152006 91152006 61112006 Cash 0.0625 5232008 6152006 61162006 322006 Cash 0.0525 2212006 352000 31172006 1 Nuveen Performance Plus Municipal Fund, Inc. (NPP) Dividend Date& History -NASD... Pagel of 5 C Horne a Cwtas a NPP a D{Ad d Hilwry Nuveen Performance Plus Municipal Fund, Inc. Dividend Date&History NPP $14.45" 0.03 0.21% 'Delayed-data as of Aug,8,2014 - F a broker to begin trad'mg NPP r1Pw The Dividend History page provides a single page to review all of the aggregated Dividend payment irdomlation.Visit our Dividend Calendar.Our partner,Zacks Investment Research,provides the upcoming ex-dividend dates for the next month. E.tEO Data Type Cash Amount Declaration Data Record Data Payment Date 81132014 Cash 0.077 8/12014 8/752014 922014 7/112014 Cash 0.077 7012014 71152014 8112014 61112014 Cash 0.077 622014 61732014 7/12014 5/132014 Cash 0.077 512014 5/152014 822014 41112014 Cash 0.077 4172014 41152014 5/12014 1122014 Cash 0.077 3132014 311412014 4112014 2/122014 Cash 0.077 2112014 2/142014 3132014 11732014 Cash 0.077 122014 1/15/2014 2112014 12/112013 Cash 0.0776 12/112013 12/132013 12//12013 111132013 Cash 0.077 11/1/1013 111501 21 101102013 Cash 0.077 10'72013 101162013 11112013 ' 9/172013 Cash 0,077 9(12013 911312013 10/12013 81132013 Cash 0.077 8'/2013 81152013 9WO13 71112013 Cash 0.077 7112013 7/152013 8/12013 61122013 Cash 0.077. 8112013 61142013 7112013 51132013 Cash 0.077 5/72013 51152013 622013 41112013 Cash 0.077 4112013 41152013 5112013 1132013 Cash oon 112013 1152013 4/12013 2/132013 Cash 0.077 2112013 2/152013 112013 1/112013 Cash 0.077 122013 1/152013 2112013 12/122012 Cash 0.077 12(12012 121142012 12/112012 11113/2012 Cash 0.08 11/12012 11/152012 1222012 10/112012 Cash 0.08 1N12012 101152012 11112012 9/122012 Cash 0.08 9142012 9/142012 10112012 61132012 Cash 0.08 8112012 81152012 9142012 7/112012 Cash 0.08 722012 7/132012 8112012 61132012 Cash 0.08 6112012 61152012 7211012 51112012 Cash 0.05 5/12012 5152012 6/12012 4/112012 Cash 0.08 422012 4/13/2012 5112012 1132012 Cash 0.08 312012 31152012 422012 2/132012 Cash 0.06 2112012 2/152012 3172012 1/112012 Cash 0.08 1/32012 11132012 2112012 12/132011 Cash 0.08 12/72011 12/152011 12/102011 111102011 Cash 0.08 11112011 11/152011 12/12011 101122011 Cash 0.08 10/12011 10/162011 11112011 8/9/2014 1/ —/a�•r�rtu—/1-t1r of,,, Vodafone Group Plc (VOD) Dividend Date & History -NASDAQ.com Page 1 of 1 Horne>Owes;>VCD>O e:xf History . i)vodofone Vodafone Group Plc Dividend Date& History $32.18` 0.52 1.59% 'Delayed-date es of Aug.8,2014 -Find a broker to begin trading VoD now - The Dividend History page provides a single page to review all of the aggregated Dividend payment information.Visit our Dividend Calendar:Our partner,lacks Investment Research,provides the upcoming ex-dividend dates for the next month. Ex/EH Data Type Cash Amount Declaration Date Record Date Payment Date 6/112014 Cash 1273D37 — 6/132014 x/62014 11202013 Cash 0.585415 111122013 11222013 7/52014 6/122013 Cash 1.062635 — 61142013 842013 11202012 Cash 0.516033 11/1312012 11232012 7/6/2013 6/62012 Cash 1.010808 — 6182012 8112012 11/162011 Cash 1.094653 11woll 1111&2011 2/02012 6/12011 Cash 0.986876 — Gwoil 8152011 11/172010 Cash 0.455743 — 11/192010 7142011 6212010 Cash 0.791622 — 6142010 8162010 11/18209 Cash 0.437571 — 11202009 21512010 6/32009 Cash 0.789412 620/2009 6/52009 8172009 111192008 Cash 0.3840351 11/122008 11212008 2/62009 6/42008 Cash 0.99215 6282008 652008 8/12008 11202007 Cash 0.51525 111142007 11232007 7/12008 652007 Cash 0.8715 5302007 6162007 832007 11212006 Cash 0.44579 111142006 11242006 7112007 642006 Cash 0.72615 5312006 682006 8142006 1122!1005 Cash 0.38205 11/152005 11252008 2142006 6/12005 Cash 0.3948 5242005 622005 8152005 11232004 Cam 0.3543 111162004 11262004 2/42005 672004 Cash 0.1951 — 6142004 852004 11252003 Cash 0.1621 — — — 642003 Cash 0.1437 — 652003 6182003 11202002 Cash 0.1402 — 11222002 2/172003 8/52002 Cash 0.1216 — 8/72002 — 11202001 Cash 0.1157 — 11202001 — swoon Cash 0.1012 — 6182001 — 11212000 Cash 0.109 — 11242000 — httn://www nasdaci.com/svmhol/vod/dividend-history 9/9/2014 m m c� 2 fT1 n z w m m m w > > a end n � a� m CD i F C `�° C 3 nw O O 1 b' m t°ir 6C7 °i �i' d D M o m y om � C R= m O CD m CD a o CL _ CD 8 mo'aF d T' cD Q O Z9 m 8 m °10 n N 3 mm EA 0 O CD o ? m 00 N W c c 0 W N �, Z in p 3 o < mN N (n0 d N N W tT N O -1 '� �fi 0 0 o 0 n w tNii w w ?' 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Finance Page 1 of 2 Home Mail News Sports Finance Weather Games Groups Ansvaers Screen Flicor Mobile I More Search Finance SeEStIt, It Mail Finance Home My Portfolio Market Data Yahoo Originals Business&Finance Personal Finance CNBC Enter Symool lmk Up Tue.Jd 15,2014,10:a6AM EDT-US MarMO dose in 5 Ns and td nim Pepon m Insuv Dvx 40.05%Nasdaq 30.61°) � ALU MOVE Y D Amedtredo O Alcatel-Lucent(ALU) -NYSE *Follow 3.48 40.04(1.14%) 10:44AM EDT-NYSE Real Time Price Historical Prices Get Hlatodo.l PH...fan GO Set Date Range p.Daily start Date:FN----1 27 2013 Ea,Jan 1,2010 O Weekly Kpdn d Sutivrshan Murthy End Date: v�2013 OMonthty Nov O Dividends,Only IrS� _;. . . Gel Prices � i) I Find I Previous I Next I Lsst :Isla Date Open High Lox Clow vohane Ad Close• Nov 27,2013 4.20 4.26 4.17 4.23 18,257,500 4.07 ita Case price adjusted for dividends eM spits. First I Prevwus I Next I Lest YY + r tiDownload to Spreadsheet Currency in USD. 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Com Stock- Yahoo! Finance Page I of 2 Home Mail News Sports Finance Weather Games Groups Ans,mm Screen Flickr Mobile I Mora 1 Search Finance SeglfnV/Eb Man Finance Home My Portfolio Market Data Yahoo Originals Business 8 Finance Personal Finance CNBC Contributors Erner SAnbol Look Up Tm.AU 12,2014,1D.09AMEDT-USMeMe6rJOS Shsand5lmbe Reponanumue Dow 40.04%Nasdaq-to,03" Y"z 0.08 r Im Aese,lvada a Verizon Communications Inc.(VZ) -NYSE *Fonow 48.60 i0.07(0.14%) 10:09AM EDT-Nasdaq Real The Price Historical Prices Dee HIVodo.l Pdo.s mn0 GO Set Date Range Q. Daily start D.ro: Nw `/ 27 2013 Eq.Jm 1,2010 Q wonky, Kann d sudaMan Munhy End Date: Nov v 27 2013 0MomNy vwwuAAc1M-veE Q Dividends Only Get Prices Fast I Previous I Next I Len -r; i r Data Open High Low croaa vokvnp Aecroae• , Nm 27,2013 50.14 50.20 49.64 49.93 7,320,300 48.33 t • Close price adjusted for dWends and sprits. First I Provian I Next I Lag �. r iDownlood to Spreadsheet -%.a-�a- cunencyinUSD. 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OJ Our Ade-Temn.sera Feels.e..Yahcol-ABC News Network tTMSS arc for NASDAD.NYSE,and NYSE MKT.See ebo delry times for 0",tdche ps.AP knfom ,lw ixa dad•.s iC Iw lnlon idi lal purxws only,not ImarMad Im trodnll herei,B ..dv I thMar Yahoo!roc ell al I rot W rent Hh't. rs r IaNe Iw aro nol th M1mwl mos.Incondnenesv.m debya,m fweery ectisns Mken In reeance m IMOrmeGOn eanb!ried nwain.By av,:essirp the Y.Iwol sae,you acres not to r�izlribute the Intomeilon foJnO Mereln. 1,11T.J/finanr•>vahnn Pnm/n/hn?A=I O&h=27,9rc=7111 Ik A=10Rre=27&f=2013&a=d&s=nhfa... 7/15/2014 E�� c 1 ` '• l °6� .� r One Citizens Drive � ` ROP112 Riverside, RI 02915 March 11,2014 Law Offices Pucell, Krug&Haller Attn Jill M Wineka 1719 North Front St Harrisburg PA 17102-2392 Estate of Edward J Simko Date of Death: Nov 27, 2013. SSN: 055-26-2944 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedents name as of his/her date of death. For any other inquiries,please call 1-877-579-2667. S" er a ger Decedent A t Processing REF#: 631870 Account Number 6231293762 Account Title Edward J Simko Date Opened 5/25/2012 Account Type Checking Principal Balance as of DOD $4460.95 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $4460.95 YTD Interest to DOD $ .77 ct'rt' : F e n 2 pp Account Number 6257893608 Account Title Edward.J Simko Date Opened 5/25/2012 Account Tye Savings Principal Balance as of DOD $1000.79 Interest from Last Posting to DOD $ .01 Account Balance as of DOD $1000.80 YTD Interest to DOD $ .17 fy y F: a o f e Account Number 6231293584 Account Title Edward J Simko Date Opened 5/25/2012 Account Tye Checking Principal Balance as of DOD $76028.04 Interest from Last Posting to DOD $ .12 Account Balance as of DOD $76028.16 . 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G U y mN H .0 Eo EC? j d Uk } } JACKSDN� NATIONAL LIFE INSURANCE COMPANY Claims Administration OF NEW YORK March 12, 2014 Thomas A Simko 1310 Abington Way Mechanicsburg, PA 17050 Deceased: Edward Simko Dear Thomas A Simko: Thank you for your patience during our processing of this claim. Please refer to the attached statement for a breakdown of benefits received. The Internal Revenue Service(IRS) requires us to report payments made, so we will be sending both you and the IRS tax form 1099R(for Annuity benefit payments) and form 10991NT (for the interest amounts over $600.00), in January of next year. If there is a check attached, it is important that you sign the check(s) exactly as made payable. If you have any questions or need additional information,please contact our Service Center toll free at 888/565-4995. Sincerely, Toni Klus AVP, Claims Administration Enclosure: Check; Statement of Benefits Jackson National Life Insurance Company of New York 1 Corporate Way,Lansing, MI 48951 888/965-6569 JACKSDN NATIONAL LIFE INSURANCE COMPANY Claims Administration OF NEW YORK Proceeds Payable to: Thomas A Simko Policy Number: 029041916A Claim Number: 201401230000244 Policy Information: Policy Benefit: $8,487.94 Loan Payoff: $0.00 Premium Due: $0.00 Beneficiary Information: Benefit Paid: $8,487.94 Interest Paid: $0.00 Mise Interest Paid: $0.00 Premium Refund: $0.00 Foreign Withholding: $0.00 Federal Withholding: $715.40 State Withholding: $76.65 Distribution Amount: $7,695.89 Jackson National Life Insurance Company of New York I Corporate Way,Lansing,MI 48951 888/965-6569 March 12, 2014 JACKSON(1) NATIONAL LIFE INSURANCE COMPANY OF NEW YORK SMARTO Check Number 0080354623 LONG-TERM Check Amount $7,695.89 111rIlILLILrLId111111LLd111hIIlIrIIIILIIIILjILI1111Illlrll1i11 Prepared For: THOMAS A SIMKO 1310 ABINGTON WAY MECHANICSBURG, PA 17050 Description of items paid by the attached check CLAIM PAYMENT Policy Number: 029041916A Federal Withholding: $715.40 State Withholding: $76.65 Net Payment Amount $7,695.89 c ntact La' n YrsR www.jackson.com 7-e001644-0666 '24-hour automated service;representatives available Monday thru Friday,8 am-8 pm ET s1 Jackson Service Center,1 Corporate Way,Lansirg,MI 48951 e 4 °0509 DETACH THIS CONFIRMATION AND RETAIN FORdIH@9 RECORDS BEFORE CASHING OF.0513WITING CHECK. My 4 AanR p� _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ -- L JACKSDN� NATIONAL LIFE INSURANCE COMPANY ims Administration OF NEW YORK February 22, 2014 Thomas A Simko 1310 Abington Way Mechanicsburg, PA 17050 Deceased: Edward Simko Policy No.: 029041916A Dear Thomas A Simko: We are sorry to hear about the death of Edward Simko and wish to extend our condolences...Based on the information provided, we have established a claim for the following: Policy Number Named Beneficiary Preselected Benefit Option 029041916A Thomas A Simko, John K Simko, David Simko, Edward J Simko, William T Simko Please be advised that any scheduled distributions will cease and any un-cashed payments, issued in the deceased's name, have been stopped. In order to process the claim promptly, please return to us the following: Claim Form For Variable Annuities, the death benefit is calculated as of the date we receive the claim requirements in good order and will be processed within 7 days. The contract value allocated to the investment divisions, on Variable contracts, will go up or down From day to day, depending on the performance of the divisions. The investment divisions may be ;hanged, or copies of the prospectus obtained, by contacting our Service Center. Jackson National Life Insurance Company of New York I Corporate Way,Lansing,MI 48951 888/965-6569 MB()10 M W OC C.4 OIDYI)nl .. .. ! Fwd: A Note from Larry Boxer-Ameriprise Financial Tom Simko to: Thomas Simko 03/04/2014 04:08 PM 1 attachment R List of beneficiaries.docx Tom Simko Sent from my iphone Begin forwarded message: From: Lisa Baviello <lisa.n.baviello @ampfcom> Date: March 4, 2014 at 1:43:47 PM EST To: "tomsimkol @gmail.com" <tomsimkol @gmail.com> Subject: A Note from Larry Boxer- Ameriprise Financial Hi,Tom! We need one more thing to process the annuities. Attached is a letter that lists all your names. Please sign and notarize this letter and mail back to us. I will forward to our home office for processing. Thanks. Lisa Lisa Baviello Office Assistant for Larry R. Boxer, CFP® "Work hours: Tues/Thurs 9:00am-3:00pm" Ameriprise Financial Services, Inc. 100 Summit Lake Drive I Valhalla, New York 10595 Office: 914-747-0200 1 Fax: 914-747-0203 Lisa.N.Baviello @ampf.com ameriprise.com We shape financial solutions for a lifetimes Ameriprise Financial Services, Inc. offers financial advisory services, investments, insurance and annuity products. RiverSourceO and Columbia ManagementSM products are offered by affiliates of Ameriprise Financial Services, Inc., Member FINRA and SIPC. .««...«««.«.««««..««.«......,«.«.«....,.«.,«..«««......«"This message and any attachments are solely for the intended recipient and may contain confidential or privileged information. If you are not the intended recipient, any disclosure, copying, use, or distribution of the information included in this message and any attachments is prohibited. If you have received this communication in error, please notify us by reply e-mail and immediately and permanently delete this message and any attachments. Thank you." RHYF YFRHHHFHHH FRHRRRRFMFRRFFFRRRHHF#Y IRl11FIFFHFH<F!llFF11HFFFH ****** "This message and any attachments are solely for the intended recipient and may contain confidential or privileged information. If you are not the intended recipient, any disclosure, copying, use, or distribution of the information included in this message and any attachments is prohibited. If you have received this communication in error, please notify us by reply e-mail and immediately and permanently delete this message and any attachments. Thank you." THOMAS SEgKo 1310 Abington Way, Mechanicsburg, PA 17050 March 4, 2014 Riversource Minneapolis, MN To Whom it May Concern: Re: Edward Simko, Sr. Client#: 1299-7444 Below please find the names of all beneficiaries listed on the accounts of the above deceased client: Edward J. Simko, Jr. 4424 East Kirkland Road Phoenix, AZ 85050 Thomas Simko 1310 Abington Way Mechanicsburg, PA 17050 John K. Simko 4 Windaway Road Bethel, CT David Simko 116 Windsor Terrace Yonkers, NY 10701 William T. Simko 23 Kayview Road Bethel, CT 06801 Thank you. X N Notary Stamp Thomas Simko COMMONWEALTH OF PENNSYLVANIA Notarial Seal X / Earl Franldin Horh,Notary PuMc Mary oty of Harrisburg,Dauphin County My G=misslbn fires Nov.10,2016 M848M PEOG MIA AMCIAT1 OF NorARIS Empire Fide/i[y Invesdnents Life Insurance Company® Env # 422000551 THOMAS A SIMKO 1310 ABINGTON WAY MECHANICSBURG PA 10750 CHECK DATE 03/03/14 NET AMOUNT $33,435.87 CHECK NUMBER %252 Empire Fidelity Investments Life Insurance Company (A) (B) (C) DATE REFERENCE DESCRIPTION FED.TAX STATE TAX AMOUNT WITHHELD %A111MELD OTHER TOTAL 03/03/14 410024562 Death Benefit $42,737.40 $8,38+2.45 ^$919.08 0.00 $33,435.87 t i � L40303 0002 422000551