HomeMy WebLinkAbout08-20-14 (2) J 1505610143
REV-1500 Ex�°,_,o, ,�
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENTOFREVENUE
Po Boxzsoso� INHERITANCE TAX RETURM 21 13 0707
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 10 2013 07 04 1931
DecedenYs Last Name Suffix DecedenYs First Name MI
HOLLIS ROBERT J
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M�
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return � 2. Supplemental Return � 3. Remainder Return(date of death
prior to 12-13-82)
4. Limited Estate � qa, Future Interest Compromise � 5. Federal Estate Tax Return Required
❑ (date of death after 12-12-82)
� g Decedent Died Testate � � (AttacheCo a�of T ust a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) PY �
� 9. litigation Proceeds Received � 10 betweenP2v3i�Crae dit,(dat�es�f death � ��.Election to tax under Sec.9113(A)
(Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRADLEY L GRIFFIE 717 243 5551
� �-; � `��
REGISTER OF��S USE O�I�.Y ;=j�.--�
� 7 � , �;
.��3T� G� � , 4—L.
First line of address `°� � � 1 �-��_
��;,- p .. -,-
200 NORTH HANOVER STREE v�-; - -;
C7 C:: � r.
� r;
Second line of address C)�3 %.<=`�~=�
!^.� _ rr+
y� _' ��Q
DATE FILED W �'�'
City or Post Office State ZIP Code
CARLISLE PA 17013
Correspondent's e-mail address: bgrlffle pCg�IfflelaW.00111
Under penalties of peryury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representatroe is based on all information of which preparer has any knowledge.
SIGNATURE F PERSON R�ONSIBL FILING RETURN DATE
L'
� Alan E. Gloger � /
ADDRESS
814 Kenneth Place S E Leesburq,VA 20175
SIGNAT ARER OTHER THAN REPRESENTATIVE DA E
Bradley L Griffie �
DDR
200 North Hanover Street, Carlisle, PA
Side 1
L 1505610143 1505610143 J �
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
DecedenYsName�. HOIIIS� RobertJ.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 1 , 47 6 . 25
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5� Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 2 95 , 0 6 9 . 53
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 489 . 80
7. Inter-Vivos Transfers&Miscellaneous N�q Probate Property
(Schedule G) U Separate Billinq Requested............ 7. 985 , 563 . 10
g, Total Gross Assets(total Lines 1-7)..................................................................... g. 1 ,282 , 598 . 68
9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 67 , �27 . 68
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I).............................. 10. 6,211 . 21
11. Total Deductions(total Lines 9&10)................................................................... 11. 73 ,238 . 89
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1 ,20 9 , 359 . 7 9
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 1 ,2 0 9 , 35 9 . 7 9
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers underSec.9116 15 O . 00
(a)(1.2)X.00
16. Amount of Line 14 taxable 1 ,2 0 9 , 35 9 . 7 9 �6. 54 , 421 . 19
at lineal rate X .045
17. Amount of Line 14 taxable � . �0 17. � . ��
at sibling rate X.12
18. Amount of Line 14 taxable � . �� 18. 0 . 0 0
at collateral rate X.15
19. Tax Due.................................................................................................................. 19. 54 , 421 . 19
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0707
Decedent's Complete Address:
DECEDENT'S NAME
Hollis, Robert J.
STREET ADDRESS
401 Orchard Lane
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 54,421.19
2. Credits/Payments
A. Prior Payments 45,000.00
B. Discount 2,250.00
Total Credits(A +B) (2) 47,250.00
3. Interest �3�
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 7,171.�9
Make Check Pa able to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:............................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income:.................................. ❑❑ �
c. retain a reversionary interest;or...............................................................................................................
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ 0
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without ❑ ❑
receivingadequate consideration?.................................................................................................................. .
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑X
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................................. � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
� ,
� ���, ��; � .
For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 1.2)[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1503 EX+(6-98)
SCHEDULE B
'� ; STOCKS & BONDS
COMMON W EALTH OF PENNSYLVANIA . � �
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 18.744 shares of Walmart, Inc.Stocks- 75.75 1,419.86
(18.744 shares x$75.75/share)
(See attached statement)
2 Alcatel-Lucent Stocks- 1.819 56.39
(31 Shares x$1.819)
(See attached statement)
TOTAL(Also enter on Line 2, Recapitulation) 1,476.25
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1508 EX+(6-98)
SCHEDULE E
� , . CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTHOFPENNSVLVANIA . �
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All propeRy jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Merrill Lynch Wealth Management Investment-Account No.XXXX1132 207,445.85
(See attached statement)
2 Personal Property - 3,110.00
(See attached appraisal)
3 Janus Investment Account-Transfer on Death Account- 8,512.70
Account No.XX/XXXXX2170
(See attached statement)
(Reported to Dept. of Revenue by Janus as Acct. No. 307)
4 Gross Personal Property Auctioned - 4,270.50
(See attached statement)
5 Vanguard - 13,607.70
Account No.XXXX-XXXXXXX8543
(See attached statement)
6 2012 Personal Federal Income Tax Refund 1,066.00
7 Unum Life Ins. Co.of America Refund 1,286.79
8 PA Turnpike Commission- 9'�4
(Refund of Easypass Account Overpayment)
9 Ameriprise Financial - 9,998.68
Basic Brokerage Account No.XXXXXXXXX4 3 133
(See attached statement)
10 Ameriprise final distribution 708.08
11 1991 Fleetwood Mobile Home/Motor Home- 35,000.00
(See attached statement)
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 5, Recapitulation) 295,069.53
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.6-98)
Rev-1508 EX+(6-98)
SCHEDULE E
t � , CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTHOFPENNSYLVANIA . � �
INHERITANCE TAX RETURN conti n ued
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
12 2007 Toyota Camry- 8,375.00
(See attached NADA value)
13 Tax proration/sewer proration for settlement- 1,591.49
401 Orchard Lane
Mechanicsburg, Cumberland County
(See attached HUD-1 Settlement Statement)
14 2013 Federal Income Tax Refund 87.00
TOTAL(Also enter on Line 5, Recapitulation) 295,069.53
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.6-98)
Rev-7509 EX+(6-98)
;� , ,
SCHEDULE F
COMMONWEALTHOFPENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Alan E. Gloger 814 Kenneth Piace S.E. Stepchild
Leesburg,VA 20175
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD�S DECE EN S NTEREST
NUMBER FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE.
1 A 3/13/2009 PNC Checking Account#XXXXXX9895- 979.60 50.000% 489.80
(See attached statement)
TOTAL(Also enter on Line 6, Recapitulation) 489.80
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.6-98)
Rev-1510 EX+�6-98�
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA � � �
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFERSATTACFi A COPY OF T��HE DEIED F�OR REAL ESTAT�E. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Thrivent Financial for Lutherans- 94,008.15 100.000% 94,008.15
Nonqualified Variable Annuity
Contract No.XXXXX5858
(See attached statement)
2 Prudential -Annuity 5,291.10 100.000% 5,291.10
Policy Number: XXXX1981
(See attached statement)
3 Vanguard-Roth IRA- 7,837.28 100.000% �.837•28
Account No.XXXX-XXXXX6918
(See attached statement)
4 RiverSource Life Ins. Co. - 46,426.60 100.000% 46,426.60
Annuity/Contract No.XXX-XXX2151
(See attached statement)
5 PNC Bank- 210,559.82 100.000% 210,559.82
Checking Account No.XX-XXXX-9895
Transferred to Alan E. Gloger
Relationship-Stepson
Transfer date: 6/5/13
(See attached statement)
6 Ameriprise Financial-(TOD Account)- 36,665.27 100.000% 36,665.27
IRA Account No.XXXXXXXXX6 8 133
(See attached statement)
7 Commonwealth of Pennsylvania- 91,255.90 100.000% 91,255.90
Deferred Compensation Program
Great-West Financial Plan#98979-01
(See attached statement)
Total of Continuation Schedule ee attached page
TOTAL(Also enter on Line 7, Recapitulation) 985,563.10
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.6-98)
_ _
Rev-1510 EX+�6-98)
SCHEDULE G
,� , . INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMON W EALTH OF PENNSV LVANIA �
INHERITANCE TAX RETURN conti n ued
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH �OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OFnT ANSFERSATTACN A COPYEOF T�HE DEIED F�OR REAL EST T�E VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
8 Ameriprise Financial -Transfer on Death Account- 334,490.66 100.000% 334,490.66
Basic Brokerage Account No.XXXXXXXXXX3 3 133
(See attached statement)
9 Residential Real Estate- 158,000.00 100.000% 158,000.00
401 Orchard Lane
Mechanicsburg, Cumberland County
(Transferred to Alan Gloger on 4/3/13)
(See attached HUD-1 Settlement Statement)
10 Defense Finance&Accounting Services - 1,028.32 100.000% 1,028.32
(Arrears of Military Retired Pay)
TOTAL(Also enter on Line 7, Recapitulation) 985,563.10
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.6-98)
REV-1151 EX+(10-06) �
SCHEDULE H
COMMONWEALTHOFPENNSYLVANIA FUNERAL EXPENSES &
�N RESIIDENTED�DENTRN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
q, FUNERAL EXPENSES:
See continuation schedule(s) attached 10,810.24
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(sl Commission oaid
2. attornev's Fees Griffie &Associates, P.C. 14,000.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zi�
Relationshio of Claimant to Decedent
4. Probate Fees 1,608.50
5. AccountanYs Fees 1,225.00
6. Tax Return Preparer's Fees �
7. Other Administrative Costs 39,383.94
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 67,027.68
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-06)
. _
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
ITEM AMOUNT
NUMBER DESCRIPTION
Funeral Exaenses
1 Malpezzi Funeral Home 10,810.24
H-Q 10,810.24
Other Administrative Costs
2 B&R Locksmithing-(Change locks at residence) 348.00
3 Rowe's Auction Service-(Personal property auction) 85.00
4 PPL Electric Utilities- 233.97
(Cumberland County Real Estate)
5 United Water- 30.68
(Cumberland County Real Estate)
6 York Waste Disposal 39.03
7 Upper Allen Township(sewer) 112.00
8 Lil Wonders Cleaning-Cleaning to prepare home for sale 280.00
9 Cumberland Law Journal (Advertising) 75.00
10 The Sentinel(Advertising) 168.30
11 Brandon Merritts Landscaping and Supplies 1,085.00
12 Bouder's Trash Removal &Hauling Svcs. - 1,275.00
Trash removal at residence
13 Personal Property Auction Costs 1,574.67
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
ITEM
NUMBER DESCRIPTION AMOUNT
14 Legal Fees and Costs to Bryan&Haar - 1,233.75
(Legal Fees and costs in SC ancillary estate)
(Real Estate)
15 Maintenance of Florida Property pending sale- 4,985.40
Harbor Lakes(lot rent)-$4,708.65
Florida Power&Light(electricity)-$206.23
Encore Harbor Lake(water)-$70.52
16 Waccamaw Insurance Services Inc.- 329.54
Homeowner's Insurance(S.C. Property)
17 Broker's Commission for Sale of Mobile Home(Florida) 2,450.00
18 Roof Repairs to Mobile Home Prior to Sale 100.00
19 UPS Overnight Fees 40.77
20 Credit to Purchasers of Mobile Home Due to Misunderstandings in Negotiations 250.00
21 Misc. out-of-pocket expenses of Executor- 160.97
(Overnight mail, postage,faxing,etc.)
22 American Reliable Ins.,Co. (Motor home insurance) 779•92
23 H&T Treadway, Inc. (Pest Services) 104.94
24 Orrstown Bank(bank fees) 50.00
25 Nationwide Insurance - 97.67
(Homeowner's insurance pending sale)
26 Dennis Zerbe,Tax Collector- 2,159.40
(Cumberland County Real Estate Tax)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
ITEM AMOUNT
NUMBER DESCRIPTION
27 Shipley Energy 7.33
28 Costs of real estate sale: -(See attached HUD-1 Statement) 17,429.60
Realtor's Commission $9,195.60
Broker Fee 295.00
Title Service 21.00
Realty Transfer Tax 1,580.00
American Radon Solutions 900.00
HB McClure(inspection) 224.00
Upper Allen Twp. 224.00
(final sewer)
Attorney's fees 250.00
Seller Assist 4,740.00
29 Cohick&Associates, P.C.(Professional Services)- 1,225.00
(2013-2014 Personal&Fiduciary Returns)
30 2013-2014 Fiduciary Income Tax due 905.00
31 2013 Personal Income Tax due 268.00
32 Reserves 1,500.00
H-B7 39,383.94
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+��2-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMON W EALTH OF PENNSYLVANIA . � � �
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
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 Holy Spirit Hospital (Medical) 29.75
2 H.T.Treadway, Inc. - 104.94
(Pest services)
3 Brandon Merritts Landscaping&Supplies(mowing) 280.00
4 West Shore EMS-BLS 439.98
5 Massey Services, Inc. -Pest Prevention for RV 30.00
6 H.T. Treadway, Inc. -Pest Control for RV 104.94
7 T-Mobile(Final billing) 194.11
8 Verizon 49.77
9 Refund of overpayment to PSERS 4,903.92
10 PPL Electric Utilities 73.80
TOTAL(Also enter on Line 10, Recapitulation) 6,211.21
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1573 EX+(11-08)
� � SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hollis, Robert J. 21-13-0707
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee s
TAXABLE DISTRIBUTIONS [include outright spousal
I• distributions,and transfers
under Sec.9116 a 1.2
1 Alan E. Gloger Stepson Entire residue of
814 Kenneth Place S.E. estate
Leesburg,VA 20175
2 Robert J. Hollis,Jr. Son Specific bequest
PO Box 332 of$7,500.00
Claremont,VA 23899
3 Matthew A. Gloger Step-grandson Non-probate only
814 Kenneth Place S.E.
Leesburg,VA 20175
4 Natasha A.Gloger Step- Non-probate only
814 Kenneth Place S.E. granddaughter
Leesburg,VA 20175
Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11-08)
.
♦ ° , , • '
LAST W ILL
OF
ROBERT J. HOLLIS
I; l3a�bQrt,T. _T�ollis, presently of 401 Orchard Lane, Upper Allen Township,
.umberlarid t:aunty, Pennsylvania, declare this to be my Last Will hereby revoking all Wills anu
odicils previously made by me.
[declare that I am married to Lucy C. Hollis and that all references in this Vv ill to
my Wife' are references to her.
ARTICLE I
Payment of Debts/Expenses: I direct the paymeiit of my legally enforceable debts,
e expenses�f my last illness and the final disposition of my remains, including my gravemarkcr.;
f any, from m}'residuary estate as soon after my death as may be convenient.
ARTICLE II
�ersonal Propert� alid Household :Effects: I give�ertain items of my househ�sid
' rnishings and tangible personal pxoperty to my friend� and fami]y in accordance with the terms ��r
����� �y�ei, written�x►emorandum which 1 have prepared. Any such property not disposed oF by such
�ftorney n4�.aW�
3�1,cb�u{s�t emorandum, or all of such property if the memorandum is not located or received by my Personal
Can,p�ill,P.�170fli
t�l:(717)7b1-5800
��:c�a��76�_500� epresentativ�, shall pass tc� my Wife, if�she sur��ives r►.ie.
� ,�,��«. >.M ��. �..�n� :w,�, , � � s.,� � .. _.
� < , • , .
-2-
If the written memorandum referred to in this ARTICLE II is not located or
ceived by my Personal Representative within sixty(60) days after taking o�ce as such, after and
pon the canducting of a reasonable search for such memorandum,my Personal Representative
hall be held harmless for distributing such property as hereinbefore provided.
A.RTTC.L.E [II
S�ecifxc Cash Be�uest: 1 bec{ueath the stun of Seven Thousand Five Hundred
$7,.500.) C�ol]ars tU my son.,Robert J. ��ollis, Jr.,presently of Spring Grove, Virginia.
ARTICLE IV
Residuary Estate: I do �ive and bequeath the rest,residue and remarnder of my
. state,boih re�l,persorial and mixed, of whatsoever kind and wheresoever situate tF��-�iy stepson,
lan E. Gloger, per stirpes. If any bequest or devise or portion of my residuary estate is tc� be
eceived by a beneficiary ��ho h��i�ot:attained age twenty-five (25),then my Personal
epresentative(s j x�e�:d not, in his�r her discretion,require the appointment of a guardian but shall
e authori�,ed tc� de�iver s�ar,h share to (i)the�erson havin��;�►sioay�.of suci��t����.a"ici�•3j; �ii�j suc�i
eneficiary without the intervention of a guardian; (ii:i) a legal guardian for such beneficiary if one
as already been appointed; or (iv) a suitable adult person under the Pennsylvania iJniform
['ransfers tn Minors AGt(or substantially simila:r laws of other states).
.�coE��. �ia►mer
.�4Eorncy aE�.avr L'11�1 1l.LE 1 V,
31�7 Cbesfnut Strce4
C�p T�;11,P.�370fl1
E�1:i7i7D 75i-5800 Protection from�Im�rovidenee: Na interest of any beneficiary under this Last WiIJ
f�:t717)7bi-500�
' r any codicil her.eto shall be sul?ject to ant:icipation or voluntary or involuntary alienation.
.
< < , , • '
-3-
ARTICLE V
Personal Re�resentative: I nominate and appoint Alan E. Gloger,presently of
eesburg, Virginia,to serve as Personal Representative of this Last Will. In the event of his death,
esignation,renwnciation or inability to act, then I appoint (in the order hereinafter named) Valerie
. Gloger,presently of Leesburg, Virginia and my son, Robert J. Hollis, Jr.,presently of Spring
ove, Virginia, as my successor Personal Representative(s).
ARTICLE VI
Death Taxes: I direct that all inheritance, estate,transfer, succession�nd death taxes,
f any kind whatsoever, other than any generation skipping taxes, (including any irs€erest and
enalties thereon),which may be payable by reason of my death with respect to: (i) prc�pe�ty passin �;
der this Will o.r(ii) any of my nonprobate property, shall be paid out of my residuary estate as an ,
xpense of ac�ministration, and no part of said t�es sha11 be apportioned or prorated to any
erson/beneficiary under this Will or any person/beileficiary owning or receiving any property not
as�ing under tk�is Will.
ARTICLE VII
Invalidi : If any provision of this Will or of any codicil hereto is held to be
inoperative, invalid or illegal, it is my intention that all of the remaining hereof shall continue to b�.
.�co�.$�. �inner
��,�e,a4 Le�. fully operative and effective so far as it is possible and reasonable.
3117 C6�at�.�t Sc�t
�amp$'�ill,P'.�17011
EeL•(717)763-58�0
f�:t717)7G1-5005
� , , , � -
-4-
ARTICLE V1II
Fiduciary's Performance and Powers: No fiduciary under this will shall be required
give bond or other security for the faithful performance of the fiduciary's duties.
Any such fiduciary shall have the following powers, in addition to those given by law:
1. To retain a.ny property,pending distribution hereunder,to invest in or
��:�r.ch�ase an�nrnpez�ty without restriction to legal investments for fiduciaries (exce�t for
those tiduciaries subject to the Pennsylvania Prudent Investor Act), to distribute property
in kind,to disclaim any interest in property, and to sell any property at public or private
sale;
2. To hold shares of stock or other securities in nominee registration fprrn,
including that of a clearing c�rpoxation or depository, or in book entry form or .;
unregistered or in such other form as will pass by delivery; _
3. To engage in litigation anci compxomise, arbitrate or abandon clai�ns; -
4. To make distributions in cash, or in kind at current values, or partly in each, .
all�aeating specific as�ets to particular distributee on a non-prorata basis, and for such
purposes to make reasonable determinations of current values; �.;�
5. 'I'o make elections, decisions, concessions and settlements in connection with
all income,estate,inheritanGe, gift or other tax returns and the payment of such taxes,
without obligation to adjust the distr.ibutive share of income or principal of a any�erson
affected thereby;
6. To borrow money from any�ersGZ;inclut�i�ig a�ly fiduciary acfiilg hereunder, ana
to mortgage�r pledge any real or personal property;
7. To manage, control,repair and improve all estate property;
8. To procure and carry at the expense of the Estate, insurance of the kinds,
forms and amounts deemed advisable by my Personal Representative to protect the Estate
against any hazard;
.�co��. �iaines
�����af�-°�� 9. To employ any attorney, investment adviser, accountant,broker,tax specialist
'.e117 CLeelnvE.�Ercet
camp�a�,�.���o�l or any other agent deemed necessary in the discretion of my Personal Representative;
f�l:t717➢751-5800 and to pay from my estate reasonable compensation for all services performed by any of
{�:t�����b�_soas them.
�> �.� ,� �,_ �, ���.�.� ���. �; «.��.��:�..�..,�,,a„�� �-�, , �.,��,�. .�..,�
` , , , , � �
-5-
IN WITNESS WHEREOF, I have subscribed hereunto and caused this my Last
ill, consisting of six (6)typewritten pages, includin�this attestation clause,to be executed,
eclared and published this 19th day of January, 2010, at Camp Hill,Pennsylvania.
�/i �- ,r���
ROBERT J. HOLLIS
itnesses:
LResiding at 1 53 Faith Circle
Carlisle, Pennsylvania
,_----_
• � + 412 Boxwood Court
�. Res.i�':n..g a�^.-- -- -•--- —
Mechanicsbur_q, Pennsylvania
s�co��. �eaiu►er
f$Etorney nt fl.ar�
3117 Che�uc St�f
�amp H[ill,$�.�17011
teL•(7i7➢761-5800
{�:(7i7➢761-5008
-6-
ACKNOWLEDGMENT AND AFFIDAVIT
OMMONWEALTH OF PENNSYLVANIA)
OUNTY OF CUMBERLAND )
We, Robert J. Hollis, Gary L. Kelley and Beryl A. Dinner,the Testator and the
ubscribing witnesses,respectively, whose names are signed to the foregoing instrument, being duly
ualified according to law, do hereby declare to the undersigned authority that the Testator signed
d executed the instrument as his Last Will,that he signed willingly and executed it as his free and
oluntary act for the purposes therein expressed, that each subscribing witness in the hearing and
ight of the Testator signed the Will as a witness; and that to the best of the witnesses' knowledge,
he Testator was at the time eighteen or more years of age, of sound mind and under no constraint or
ndue influence.
a�, �.
ROBER . HOLLIS, Testator
itnesses:
.
On this,the 1� day of Janua.ry, 2010, before me, i3 r v a�, J�� ' �1,����
he undersigned officer,personally appeared Scott M. Diruier, Esquire, known to me to be a
ember of the Bar of the Supreme Court of Pennsylvania, and certified that he was personally
resent when the foregoing Acknowledgment and Affidavit was signed by the'Testator and
ubscribing witnesses.
.�cod-��. �inner
.�Lforney eE Law
3➢17 Chec�ut SEroef
i�
Camp�ill,P�r'3�7O11 �
eeL•(717D 761-5800 COMMONWEALTH OF PENNSYLVANUI `
f�:(7i7)7Gi-5008 N0�„a�� Notar,y Ublic
Bryan Phlllips,Notary Publk
Camp HIII eoro,Cumberland CouMy
My C,ommission Expires Nov.5,2013
Member,Penn.�vlvanla Assoclatlon of Nolaries
J 4BSD0041046
REV-485 EX(05-04)
SAF.E DEPDSIT
BOX INVENTORY
PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY
Social Security or Death Certificate Number Date of Death County Code Year File Number
,....._..-�------------._..__._..._._.._...----------- ------.._... _._ .. __..__._..._____ - --- --_.._....._...._..---- _-
Iv02Z (� S9 (�ll0 i3 :
...--�--...__. --- �---.._._....--------........---
_.._.__._..._._.__..__.__-----_�.____`_�.._ : ._________ _ ..___._.___. ____.
DecedenYs Last Name Suffix First Name MI
,_�._..._�._________-----�--- ...__.._.._..--- -------._...__.._. _....---. _......._....--- _._.�_..._.... ... .._ ---.�__--__....___.._._._.... _. .__
��-t S I���r� J
_ . _ ��---------------...----_
:.__.__-----_-__---------.----------___------._.._..__:�__-____._-�_-�_�__�_=-:-.-_..._..--------__�--- -------------_-___.__.:_.___.
ADDRESS OF DECEDENT STREET: CITY• ST ZIP CODE: �
Q.--_____�_�.__..._._.__._._—_�o ` �b��.�rd ��- t�.��,,.►
c�� `� i—�o��' '
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OP THE SAFE DEPOSIT BOX
NAME: �.L�s' N�CTlO CTG �-
STREETADDRESS: � ty ������ ('�I �� CITY��� STAT�� ZIP CODE: ��
C ��
. NAME,ADDRESS AND RELATIONSHIP(IF ANI�TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING
a, � • RELATIONSHIP:
�-l..�l � �E,t�^� �.�SJ ?t��—t,J�'0�r'� _
STREET ADDRESS: �„ �„ ITY: STATE: ZI�i� '
i\� �L�,�e�?� '� 1 � ''� �,.����7�t'r,,• u�fi `
b. NAME: RELATIONSHIP: '
, i
STREET ADDRESS: CITY: STATE: ZIP CODE:
i
c. NAME: RELATIONSHIP:
STREETADDRESS: CITY: STATE: ZIP CODE:
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
NAME: � A r� �
1� Q Ct"�n,
STREETADDRESS: t Z� � CITY� � STATE:/�� �PtCODE: ;
l l.`S 4' �
t • �NAMEOF•FE SON*MAKING.L•AST-:ENTRY ; �DA E-AN TIME=OF:4A ENTRY 3
�a�er T• o I� i S � I 2o�Z l2:2S .�
: DATE OF C TRA TO RENT BOX : ' NUMBER OF BOX . 1 TITLE UNDE �WHI H.BOX IS REQUESTED
1 o ZOm Z � 00 �'o/e r � ✓. /��J'
NAME AN ADD SS OF PERSON(S)HAVING ACCESS"f0 BOX
a. NAME: b. NAME:
F'.�he.r�-` .� k1-c►��c S , <D�r`� .
STREETADDRESS: STREETADDRESS:
, ��1 �c�Y�.vt� (�r+ .v�(�
CITY�:/ S TE: ZIP CODE: CITY: STATE: ZIP CODE:
1`�-�-Q'� (.� )(ti r.�r�
NAM�AND TRLE OF�PLOYEE AKING THE INVENTORY
�-1 �
WAS A WILL IN THE BOX7 YES � NO If yes, a. Date of will:
h. Name and address of personal representative,if named in the wili
NAME:
: STREETADDRESS: C(TY: STATE: ZIPCODE:
c. Name and address of attorney,if any
NAME:
STREET ADDRESS: CITY: STATE: ZIP CODE:
� 4B500041046 4B500041046 J
REV-485EX SA�.� D'EPOSt�' B�X IN��NTORY Page of
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 fnsurance Policies or other evidences of indebtedness: List and describe as fully as possible.
(8) Ali other contents.
(9) Return completed form to: DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT.280601
HARRISBURG,PA 17128-0601
ITEM ITEM DESCRIPTION
NO. '
CU v� 1�r� c �erS 2. e c� � C'Otic(o so)
� -e '� r n.� �
� �-t '{' v — �n c � /a-(�� Re�lvPy�eN �
� J Cli �
a � . D _ sG`/� Pr e v��v�
e 0. U � e -eE.c
( YN (C S SC I l 7Z GV ItKi•l. VAYIUVS SC Q CG
� Se c� u�-<<n-. er � � /3c�we a � a- 1-lolls + /'+ �t f4�rrci
y`� �'G -� P e e
r/ �C.�v� �?—�� t YS • r c � k G..l S C Cc t--
l�+ �
�n 4 -e�. L� � o � i rz.�H d� �rc Fdc.. c — �
1 cc ►� � � - Lc,� .
�� c < I�s� � - Ro ��- Na 1
CC� � I.�Pu �- ►3 4 -eiv �ksw K ce yu � l c.c Nc���il
� ��r�. ` — Lvi c e — c� i
� ^\vi VGvCe 4� ✓ � G r�ti �IG��t
� �i � C �-� -e �c, � d .. a �e i—
I z , 13��� + L� I-tol! 's
2 1 �C Lt QlSuhr��� �e t ve I\lv7��-1,ta7-!a
� � Svr rtr r 2 � e. — 1-�c ct> �en� +cic�,-
o . v
I Vlo t o� i� �2 w►-�^F�'Yc��e o _ GY L� I nJ vrci►�c� �Irn.
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERS N RECEIVING C�PY OF
CORRECT AND COMPLETE TO'THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATURE ^ �{ SIGNATURE
���\ �o-
PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
l�lan �. G-(o �
PRINTTITLE DATE CHECKAPPROPRIATE BOX:
�xP G U.�� �„1 y 3(�2013 Sa�eculor(Uix) ❑Administratar(trix)
�Estate RepresenteGve ❑Jant owner ot sa/e deposil box
NOTE:Attach additional 8'/=°x 11"sheet(s) if necessary or use duplicates of this page of form.
The Department is author¢ed by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Social Security numbers in connec6on with administedng state tax laws.The Department uses the
Social Security number to idenGfy the decedent and personal representatives of the estate.The Commonwealth may also use the informa6on in exchange of tax informa6on agreements
wifh Federal and local tapn aulhori8es.The state law rohibits the Commonwealth's ersonnel from disdosin confiden6al tax informafion exce t for offiaal u ses.
REV-485EX SAe�E DEPOSIT �OX INVENTORY Page of
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 ITEM DESCRIPTION
NO.
1 �' V YO�P31iDK� ��GtCVItVI I�PV�Ir�l4�(' ^. �f�G �'_ld��l�
2✓����faT�un I'ICJI ')S, 1'+'1Cim`jP.l�l�� t p' S'�cn7f IlC lYPyylPnT J l��P
O.JPS� Yirn'�u-� a �nc ` •- � � V pol Gt � �2 G-2dt �c! �'►'t� �
INGm i tic. �G -P � �Ct ies '- S 2 !'�C�l v�t�-✓.�` �jOQ
Ie "+' 'S' �UC' � L� Nc����J � /�v � .�c�co�� r'1c7-�vem />U
�A 1 _ R� �rt
r1 S c,c e Vbt S'�-c.� s e FIQ r� v �e t� S v rVi vor�•e vi �S
� e �o e Ko11� e J��K CesS -hc.r. s ec�a l a �f � ��"`�
I P �-e1^ �O e✓ — eX 1c<<n�K G�Y��I�e AG�IU
ISo . e v , v n�K s Vl �.S'�a�r cQ a e� / gi.1� L� �'fc� �`
�G� v ._rvv����c ��i L�c c. F� I, Mcr a . ^ ..�/.e,:�, _►-clku� .Ga>��
� Old Co 1V� cn e v v�s�r c — ��G�ea-� �!- l-�c
I o�a �o �� � s �� G, � � � w, ,� S+_ +iG�� �R� S
� V C�QVt e �ea� ric��ClaYi — g c�rt��c.a Lt,� �F 1 1� ` �xSurq.cc�
I ,,,w � + �. �;� (a l�
C�1 Q �
� t � � Q v,ti p c,� veecinw��' e s��
6�� Ce Y"t� Qce� �vt S v✓c� Ce a ' CG o W e �/ ti p
.
c\c� FI� �4 I�.r�� re C�ev�� c�G — � L�� 1�11� �� 3
c91 b c�r. � a.�l �c�a ce /Ct7 S vos (u I /J rs s c /9 9 2 L° ���t
�h � — �o e ���lJ ' C�r��T�2c.'�+ - g '��'swl
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD 1S PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOS�T BOX INVENTORY:
SIGNATURE /�, S�GNATURE
�•
PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW:
� � Cr1� er
PRINT TfRE DATE CHECK APPROPRIATE BOX:
�X��-U�V� ,uty 3f zO13 �Execuwr(lrix) ❑ndministra�or(trix)
/
�Estale Represenla6ve �Joint owner of sa(e deposil box
NOTE:Attach additional 8'/:"x 11"sheet(s)if necessary or use duplicates of this page of form.
The Departmenl is aulhorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disdosure of Sodal Security numbers in connecfion wilh administering state ta�c laws.The Department uses the
Social Security number to idenlify Ihe decedent and personal represenlatives of the estate.The Commonwealth may also use ihe informa6on in exchange of fax information agreemenls
with Federal and local taxin aulhoritles.The state law rohibils ihe Commonweallh's personnel from disclosin confidential lax intortna6an except for offiaal urposes.
Attachment to Schedule "B"
WMT Historical Stock Quotes - Wal-Mart Stores Inc. Historical Stock Quotes - MarketW... Page 1 of 2
_ __._.__. _._____ ____-
------- ---------
rkets Inve e Economy Industries e@t�,R Symbol�@f��v�chlist Ale gE�yq�ps
Stoeks Funds ETFs tions Bonds Commodities Currencies Futures He e un s nsider rades Tools Gettin Started Premium Newsletters Hulbert Interactivg
.. . . . .. .. P . i .t:S.^.�L°JS � 9 �v:�ll�� � �� �Di�.� 9 . . .. . I �
4:O6p PVH Corp.shares down 4.4%in after-hours trade
4:O5p BREAKING PHILIP VAN DOORN
saP soo�io5e5 ac�e�o�a�s�n c�me ro�2o�a 10 cheap manufacturing stocks
June 4,2014 4:08 PM EDT 4:01p Dow industrials gain 0.1%;Nasdaq climbs 0.4% These companies are benefiting from industry
+�7.56 S8P 500 +3.64 revivals and still are cheap.
New York London Tokyo DOW +15.19 NASDAQ � •REITs that pay
After Closed Closed 16,737.53 +0.09% 4,251.64 +0.42% 1,927.88 +0.19% �
BULLETIN S&P 500 closes at record for 76th time this year» NEW YORK MARKETS AFTER HOURS
After Hours EarningsWatch
E�TRADE i ����
�r v��r
.
EXPAND � I XE PAND� EXPAND_ _� EXPAND _ `EXPAND
Wal-Mart Stores Inc. Se�A�e� FindaBroker —
�Enter Symbols or Keywords GO
AddtoWatchlist TredeatE'TRADE.. �_.._..__...__—.—__._
NYSE:WMT
OVERVIEW PROFILE NEWS CHARTS FINANCIALS�HISTORICAL QUOTES��,ANALYST ESTIMATES OPTIONS SEC FILINGS HULBERT INSIDERS
�� Aeer Hours—Real time quotes Jun 4.2014 4:04 p.m. Todays tlose Day low Day high 52 week low 52 week high
$77 13 +0.01+0.01°k h/'r—�.�./�^'�.�"""'�'`° $]7,�2 576.53 E77.30 E71.51 581.37
■ Volume 51,146 F � � +0.41+0.53k * '
10a 11a 12p 1p 2p 3p
,. �,... _ ... .Set..
Historical quote for: WMT
�da i June 10 20 _eo
Open. s76.28 �e
High: f76.65
I 76
Low: f75.66
Volume: 6.73M ;74
'.���.���..72
. .M,.,. ... ... J... . �,J,..�
Advertisement
MarketWatch.com iEnter Symbols or Keywords : SEARCH
Site Index : Company Info MarketWatch on Facebook �� WSJ.com '
Topics ' Code of Coaduct I Barron's Online ���
Help '�, Corrections '�, BigChaRs '�.
�� MarketWatch on Twitter � ���..
Feedback j Advertising Media Kit ��. Virtual Stock Exchange .
Newsroom Roster ���.. Advertise Localty ..
Media Archive '- License our Content RSS � ; Pinancial News Online .
Premium Products ! Broker Center Podcasts �. �� WSJ.com Small Business �
Mobile '�: YourAdChoices ��
Intraday Data provided by SIX Financial Information and�ubject ro terms of use.His[orical and cu«ent end-of-day data provided by SIX
Financial Information.Intraday data delayed per exchange requirements.S&P/Dow Jones Indices(SM)from Dow Jones 8 Company,Inc.All
puotes are in local exchange tlme.Real time last sale data provided by NASDAQ.More In(ormation on NASDA�traded symbols antl their
Copyright�2014 MarketWatch,Inc.All rights reserve0. current financial staNs.Intratlay tlata tlelayed t5 minutes for Nasdaq,antl 20 minutes for other exchanges.5&P/DOw Jones Indices(SM)from
By using this site,you agree to Ihe Terms of Service,Privacy Policy,and Cookie Policy. Do�n Jones 8 Company,Inc.SEHN intraday data is provided by SIX Financial Information and Is at least"0-minutes delayed.All quotes are In
local exchange tlme
http://www.marketwatch.com/investing/Stock/WMT/historical?CountryCode=US 6/4/2014
J.P.Morgan JPMorgan Chase Bank, N.A.
Post Office Box 64504
St. Paul, MN 55164-0504
www.adr.comJshareholder
ALAN E GLOGER May 7, 2014
814 KENNETH PL SE
LEESBURG VA 20175-8984
Re: Financial Confirmation
Dear Shareholder:
Account Number: 7100050364
Registration: ROBERT J HOLLIS
814 KENNETH PL SE
LEESBURG VA 20175-8984
Account Creation Date: 1/8/13
Issue Name of Stock: Alcatel-Lucent
Total Share Balance on 6/10/13: 31.000
Certificate Shares: 0.000
DRS/Book-Entry Shares: 31.000
Dividend Reinvestment Plan Shares: 0.000
Dividend Amount Paid YTD: N/A
Closing Price per Share on 6/10/13: $1.81900
Ticker Symbol for the Company is: ALU
Stock Exchange: NYSE
Please note that as a depositary, we are not directly connected to the stocic market. i he above price is given as an
estimate and is not a guarantee of a specific price.
If you have any questions, please call our Contact Center toll-free at 888-582-3686. Our Contact Center Specialists are
available to assist you Monday through Friday from 7 AM to 7 PM Central Time. You may also send an email to us by
selecting "Contact Us"at any time while online at www.adr.com/shareholder.
Sincerely,
JPMorgan Chase Bank, N.A.
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII *ZFNCJ127�70�1�1�Y�Y�YIY. �o
Attachment to Schedule "E"
, O � � � � '
'A � � �- n � � � .
`� � � � O 3 ��
n �' � � � � �
p �p (D � .T'7
� � � � o S�
� � � ? o 'mTi�
" Gi W � (iW � p 00 � � d �
�1 �I �I 00 � af 00 .. .. .. ' � 3 .3
O O O O � fd� � _
O O O 7
� � � � rt
� rn�Drv�O � °� �D �p �. :��$D,vm � ��� �m � �N r°v o 0
p � �� �ir p -�D �� r O '°0(n;� p ..a N C� � � �.
� � Q 0 � � " � • p .� :0 �,. C7 G,� O � mZ� � � N N N
'' o°�,�t� � o °� �� o �o° D:�� � o �°a Nm .o� o 0 0
W ��p�_� N � ��� D � � 0A°t `t �� � O • W W W
pW` :A,Z N� W \ U7 Z rNO ;W � �j� � w N � 3
� N �`(n: � N Cn � N � N ��
w o � D w o D w o Z w ° � n
� �N ` n p N n p N n,p N
.2 = _' :tl �
�� � �cn � � �n � � m � � �
o ` � � o .-D,I � o : -D-I ?D o ,-D.I �
N ";' O :C N O C N O !. .^: N O �
o � ; D o � D o o ,� o � �
w N . .Z W N Z W N "''_�''� N N
? O � O � z O p: O N
�i �l � � > w
.A � cn � m � v W =
': � � _' .P � � -�^ N G�
o u, o wD ` O o v fA .
Y �-r
- o � o G� � o O
� o C�'
��
� ❑
�,�
2 p�D
� s S�,
- D ��
;: > . m
.� �..,�;�:�, �--=�-� ,. ,� �-�»,-,,:.��_� � ���
� � _. � z � m < "3'
0 0 0 o r � o � � o
v � � �
�.W'! N .N W � � � � �
� 0 � � � �
'Q O 'O O �C � N � O
,� � y� � � � fl. �
C
'�'+ � �
. � ~' � <
� ` � j .. � a �v� �,
o• o o . o � w � .. .. .. c
o. : � � .;: � y � _ �
�. N N .. � � w =•
cr, . cn co, o � = -' � � �
co rn •n�. o � � � Cn
o °o o : o N �� � � �
.. p � z
N � n
_ � (D
N O `�
3 m �
v �
� ` -�
.. IV N : � � Ol
�
.�: . - - � ,.J� _ _ , 3 C Q
N
,N � � O N .3+�
�WI V v ` Oo U1
<D
C�
(�p W CD (O N C
O�D , v O O �D �
N � ' O t0 :00 �I '� Cn �
... � :... _ r,... .� .�
_ ._ ._ �
n
n
O
N C
;. �
K
C�JI - 'C��J7 - � � �: �� —� � OD
� ' _�I (O � t0
A1 OD
. � '� W � � U�Nt O d ��a
�O' O 'O O •O O - O_ O � M�
, ;..: ,.;_ _. ,::
._ - �•;:-;� :..�:, .:� -� --- ---`< -,::- �a
`D_ °� C-CI� :; °� C:zD m � c�u '� rnCO�oo° °�C�;o".Do ^. °� �D�� � mni
.�; ''-Ir � -� -'��-? � m �, ; _op � ,� r � :�n_r,,� � o � p �� D �n �
= o Z � - _ -n = o C� o oo.m � o .. �, —I � �
NTn� ' N � Zm r m r _ � N 'il � � N�'I(/)NZ fj NO �om .
� zC� r �Zwc�i�'� � � � � � ZCO �ZC�,u''�2 �' ° NfJjoo �'�
a,� p Z wp;^•� �- m :�= >,�,v `'' onc� . `'' p cc°�o�m o �' c�n w � �
� ',: ty! �; �i' _
C OvFn: � �: Z� ITI',W � 0
�'.- n� m ' � <v '. � o W D
v ?: ,o � ,: � n� m rn � m
D D
� � `_ `�: � '�� o _ ro -1 �
-� � m �
-Zn � m' io ;� c�"i, ` �� o ° p
Q `: :� CO p� � —� �j �
� :. rn '� 2 .;: Y w �, �
z c :� � `� m; o z
c�:.: o ,� � ,�; � �
: � � o�
w o o_ Z. o�
� �
� � ' v OND , �' N N
� _ O
� `. � o ,p
O � �' CO .
m ' ' ."`: ,,' �
_
N �
, S
_ ���c;i �: `
:,, . . : . = �` :: <: :
a
�
.. _ �
.�:v-, .���,.�;:>�i=�•-� .a�... �`�;�: �>.ti.tt'�,m. �.:<:�c';�r;:::
�
IA �' � •Ga 0 O
� ',.W ' N 'N. N �
,
O O O :O; O �
O ` O - O O' O W Z
Q=
� � � �'. � �
..
... � ..-. 7C„ :. ..: .. �, .-T'i. .7C.; ' ' ` �
' ' ' �
-.��. -:.�: - . - ..-,. � - .. -.:: .. , , . ..-.,.;;, �
1
�t
j � ��
.� � . � iv o a � cD
` � o. -• w o = �
`I '..:_ IV �I . CT �y-► _ �
� � S1 �,
O .:O O O� . O � �
� a c�
°o ro °o :o° : o � p tn
O Q, O O O (A -��
�
N
- v v
� d
� �
- - ' rn 'c n,
- °� 5
N
(O N �
N -�, , �
' Cn W � �J .A O (O UJ
� � �
� .� � �� � � -.0 . � =� . �7 d =
�7
CO N W O O . N Q Oo C '+
�I , O ;CO O O W -i � ID K
O y
�� � � � D � o o � „ D T D D n o T � D � D -i � � d�
n S ��. �. � � y � fD V/ - N � � � — � fD fD C� � fD �. 4.•
�� a= = Z � d m �� o m �. cu � ?d 'm rn o � � o d � �, -I � -I �-i -i
!��n .r r .°. 3 0 � � ° v 3 c � �c o � � v+ m o 0 0 0 0 0 0
'fl °' <> > 'n > > > m� �O � ° � y °c � �• � � Z � d y� u� N N N ID N cDi
� °1 2 ,`�-� C1
� = N? ? n 9 n�i�� �-c�» � N � � m N -��' 0 5. p 0 3 � o C7 D Cn D C O
� a ?� � � � � � C c° � � �O n °�' � � o a o y N�� p-C = C N '"r
m e� � � �� fn d m o ° '_ `� (� m � � v, m •N • v ..
y o a m m m Fd � a � a _< oi � �c u, v v, � °�> > �c o0
= y e�i -n � °' ? Q� m ¢ m w � Q � n � m c, .��.. y m m� Q m. C � � tO
fD C y 7 7 O C ? fp� N C 'O a 7 � N � Q t�i� � � ��.ai N •� ,,,� OD
y(�C O > > � N H O �. ,�,�, C O t� N 7 � d < �' �p � Q � C p) (D�.
pl y f.�ll � -�i laD n fD 7 l0 fD O. 6�1 fn " n O7 � N C �� �.� � _ � �'7 (/)
.a
� .+ A, � c co v, y y • 7 � o Q � a � 5. ? � � (p • p W
e� � 3 fD � v; a co � � °, a d Q ° � � y � o� Ul c�i N
o � . Q C
�� s s 3 a� m y � w � m � n��i � m u��, m � �m -s -,
� y > > _• a v '� m v c�i � a � a a � � � �a '^'`�
� � � � - o � d � d o ri � � °� � d o O Q o O
y 3 � v 'e � n � y o. � �' � m v � � n d � o.� �
:': o o � m�c m � F in � ^ � � = y � �'o o m
�
m c o � m m m o u,
d a a �y � m �-» o� _ °�' � y o °, � C� �.°c
� � < �
N y y � y C�t tG= O �G N N � � C �' � j
S n d (p 7 7 7 'O
C � � � � � �� d � N � y C p. y � � �
K
a °y p � ._°..m ;� °��' o o c ° � °-' o, v ? � ��-°
N � �. 0 � � � y � � d � N y �
K �G � C n C 7 N y fD C � 7 fD fA N <
O p p '+ G/ N � O/ � 7 a N N C � N a N
� '� �i S� d y _v O O C � N • ? pt O
� cc 1D D � m c�i � m r��n � �' ° c�i ? $ n m
a -. 3 m • o m y o ,�
� d y cp �. n m < c� fi � � m p 'o °: m m
a n� c Z � c m °1 0 � » a � m � .
N < y .�► n C �•y d y y fD .n�. y � y Q�
O �. N C (D
� � d � ''O j � ,�,� � Gf� � C C O 7 � C C
3 c� o o 'm � �o �• � �. � o � S m F
y � -o � � � c m �' � � n arn
� Oo fn o. ? � _ „ -�° m � o o a
� � m y � d � � S, �, o, o � � o
o � x � � ?< v � d � c a �, �°
N C -�i� = C) O � �p = y 7' cf n x 'O�
� O• D � y N n n � � f/1 N � � '� -�i
f�l O � .�. ^' O � � � "'" N � O N � _
fD 7 �j lD N d�• � t��D y O � � O N (Q
W N C � O. � y 7 fp' C C tp � O -r._, �
p :. n ni C O� y m o� O N m < y �
-� � �O fD N Q - N O O�- � y � n
Cl 'O 'p 0' �p � � tn 0I a n D
� �p p � 'U_. y O a � Cl y �C (A
C f�l 0� ' W� `C y y n j �p N 7C
.p ,� ? N_C ...�p �p m C n
fD N
W d � �D ..�.0 C C z y �' ��
W X � C � 7 v+ O Q � O 0
� a r � � m w °'� C
� N ID �' N � N � � � � � C
N �
7
� � � N n � C � � � � y � �Z
O � N a � „ p N � y � y �'�
-�, a � � � m a, T � � m o .
n < c, m y� a � � O'
3 p Q = yc t�o � nv o �fD -�i
N .� � — fD � N m O 07 � N c
� '
f1 Q 7OC �+ �G N 7 .7�• � �j O
O p-+� � � � Cl� o. � � � X 3 a S(n
3 1D o�i N v; �m � � � . � � � d n
�^� m ° � a N �
� d � 1D ,�o., � � 'm d d °:,� 3 a►�,
— 3 � d (p � y � N Ci f�i, y 3 �
� �° a A v m c�i m � o' v.�°.. 7 �
3 � � � ��
� 'o N -i
c
CY �C y N � � � C1 � ..
'� o � m °o m � � o m N
n � ,�y� O � N C �G y X
C �'
W 51 Z � C N � 7 �O n v
� n � ° o� a n � � Efl 4fl n pt
R° < a ^' a N Q n'to � � � 3
o C Q-
N .N.. N � O p � ° � � � �
3 3 -fl v � d .p .p N �
� � � � � � o m
� � � � °� � �' N N N N
� o a ? �
� p `� m T X � �l rn � rn fn
m � m � n y D .A tn .A cn: cD
a N m � � c�i�'c � c�o � c�0 � C
o - c o o ... _
� � y N ,�„X CJ7 -� U7 -� <D 'G
01 7' � !p
N
ROWE'S AUCTION SERVICE
211 N. OLD STONE HOUSE ROAD
CARLISLE,PA 17015
717-249-1978
To: Bradley L. Griffie, Esquire
Griffie&Associates
200 North Hanover Street
Carlisle, PA 17013
From: William G.Rowe
Rowe's Auction Service
211 N.Old Stone House Road
Carlisle, PA 17015
Re: Personal Property Appraisal
Robert J. Hollis Estate
401 Orchard Lane
Mechanicsburg,PA 17055
Date: July 3,2013
Personal propertv retained bv familv
Desk $50.00
Pictures $40.00
Bird prints(3) $120.00
Prints-European scenes(5) $65.00
T.V. $100.00
Set dishes $40.00
Wing chairs(2) $160.00
High chest $100.00
Vanity $30:00
Cradle $150.00
Poster $10.00
Prints(3) $15.00
Night stand $20.00
O�ce chair � $45.00
Marble-top stand $175.00
Banquet lamp $125.00
Victorian silver-plate compote $50.00
German steins $20.00
Drop-leaf table $325.00
T.V. $60.00
Glassware $40.00
3-pc.Coffee table set $50.00
LIVING ROOM
2-pc.Sofa set $65.00
Bookcase $40.00
Books $35.00
Miscelianeous housewares $55.00
Knick knacks $30.00 �
Hollis Appraisal 1 07/03/2013
- _ _ -
DINING ROOM
Dining room set . $225.00
Glassware $45.00
Knick knacks $30.00
Housewares $20.00
KITCHEN
Pots/pans $25.00
Dishes $30.00
Housewares $20.00
OFFICE
Computer/etc.-no value $0.00
Desk-no value $0.00
Miscellaneous office items $20.00
FAMILY ROOM
Bar $50.00
Bar items $35.00
Bar stools-no value $O.UO
Upholstered sofa/chair $45.00
� Upholstered sofa-no value $0.00
Misceilaneous housewares $95.00
Heater $10.00
Knick knacks $60.00
Desk/chair $30.00
BASEMENT
Househoid $65.00
Washer/dryer $100.00
Refrigerator $50.00
Lots non-saleable items $0.00
Low-value household $20.00
GARAGE
Mower $25.00
Air-conditioner $20.00
Cart $30.00
Ladder $10.00
Tools $20.00
PORCH
Gas grlll-as is $5.00
Housewares $10.00
TOTAL $3,110.00
�___'�—�—"`"_-- r" � "`_
William G. Rowe
Holiis Appraisal 2 07/03/2013
�q ,� JANUS
lL�'
��
ar. �:.. �;'�.'` �.— . WF };"� s .w3 °,�i^°�^�i* �y �,'t 3�,���'av�ca�,� . ��, , .,,,y�;,�. ` + �� t �. "`�er �`--s �.
.F P Bo 5 .3 E 800525�3�7��3�i -t} t ��, � �' �: _ ��,, g €s '� � �� � �,"`'���
��' � ��, � �s- ��� �z c ��� �
Bo,s o 22 5�6 Li E �anu oom�� � �'�"�' ,� �� �' � ���'� -� � �
�� ��, �� :���`"��� � �
�:>r ;{�'E'a, .a."_ .`^``.'� �.� ..'�; .r�r'?� s,--�,. e�.. �,,.�, ,�, �'
July 29,2013
GRIFFIE &ASSOCIATES
ATTN BRADLEY GRIFFIE
200 N HANOVER ST
CARLISLE PA 17013-2423
REFERENCE: 02160872
Dear Mr. Griffie:
This letter is in response to your request for Janus account information. Robert J. Hollis opened
his individual account on January 24,2012.The account information provided below is
unaudited.
Date Fund/Account Number Transaction Share Price Shares Dollar Amount
06/13/13 52/307112170 Balance $3.07 2,772.865 $8,512.70
If you have any questions,or if Janus may be of additional assistance, please contact us at 800-
525-3713 or visit us online at janus.com.Representatives are available Monday through Friday
from 9:00 a.m.to 6:00 p.m. Eastern Time.
Sincerely,
i
, ; ,'
�, x i�;� r�,�'
1 L{.. �i�': t�;/i�L
\ .
Keni Johnson
Investor Services
ZAUJAN5011
.�'.<��'
:�-
ROWE'S ATJCTIO�N SER,VICE �RH 79L)
2505 Ritner Highway • Carlisle,PA 17015
Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L)
Auction Is Action Call "Rowe" For Satisfaction
SELLERS NAME Q m-d3n+►� a 1-��-��,. � �'�.�4-`zF DATE �--'1-'-[� '�-c' �3
ADDRESS L�.�t�-�3�L•�.�, /�_ �-;I��r��- ,�S�t'..-'-.��. PHONE 2��-5�5,
OTHER �� �o L'l�r✓8ur�►'�- S'< <°-��� AUCTIONEER�% ��
AUCTION DATE/LOCATION CLERK %
DESCRIPTION OF MERCHANDISE
t � lF�� rvG.- i �zr��� .. '��s,-
y, �J..A.��� ��,.,_. .�a� `��F S
I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction.Merchandise
to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise,goods and or property and have good title and the right to sell and that they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in
this agreement.
� �.� } , ....v
AUCTION SIGNATURE SELLERS SIGNATURE
s�`° .
Total Sales (Clerking Tickets Attached) $ tl�-�1 �
Less Sale Expense:
�
'3� %Commission Auctioneer $ t �-l.�t � �
% Commission Clerks $
OTHER: '� FQ�k� � s �
o-�
taC,�..,t��,�►- '�.S` —
TOTAL SALE EXPENSE DEDUCTED $ I S �T �' ��
,� � � � �S3
SELLERS NET $
Page > 1 of 1
���"� Van �trd�
�
Robert J Hollis Report for 06/10/2013 " 3 ` � � { �
.<,.. _—'._.,..,�...c..........u..-...y9...,..c�..,�_.,� . ..».,. . ...« .x�..._.W s.�.a..c<&..�.. ,.�w,s�w3e:
401 Orchard Ln Client Services:800-662-2739
Mechanicsburg, PA 17055-6142
Total report value: $13,609.66
(Total report value includes any accrued dividends.)
, ::- �� s .,-�.-� �
Robert:l:Hoilis ,�Intlrvidual Accoiint ; ; 3 ,�; ;: ��� � "� -:�� ��� .�f ��7u{��'�,�;
aa �,. ,�?r .,� x�:,�. s�. s��; �'� �'a�r �'"s z
Account�alue summary' � � ��-�� ,� >� ��.� � d , ��� � y�. � �
.
, � �__��.
;
�.. ...._. .x ..,. ._. .,..... >_.._ . �� .. .. _.+,_t..va.�3_.r .. Z.�, .. ..z..._ �'.....«...W.... ��..a,t.uw.�2.�.ri?.:..-.. !$..._�..K....a»�s SR,u..'� 3,.s��e.�,kuL"+'�'!a.*flCt
Name Fund&Account � Date Price Per Accrued
Number Opened Shares Share Value* Dividends
Short-Term Federal Inv 0049-88054548543 12/29/2011 1,268.192 $10.73 $13,607.70 $1.96
Totals $13,607.70 $1.96
*Doesn't include accrued dividends.
0213300192 07/22/2013 15:29:31
�
Ameriprise �
FIYIQYlC1Ql RiverSource Life Insurance Company
Ameriprise Financial Company
70100 Ameriprise Financial Center
Minneapolis,MN 55474
October 3,2013
[3RADLFY GRIFFIE
200 NORT!-I HANOVER STREET
CARLISLE,PA 17013-2423
Dear BRADLEY GRIFFIE:
We have received notification of ROBERT J HOLLIS's death. Please accept our condolences on
your loss. The deceased's name is associated with the following accounts. Account values as of
06/10/2013 are listed below. At the end of this letter,you will find a list of beneficiaries shown in
our initial review of the accounts.
Regarding you►•specific request for information about account 80995530 133 in the registration,
Robert J Hollis as Administrator of the Estate of Lucy C Hollis; All of the assets that were in this
account were transferred into Robert Hollis's account,42880573 l33 on 5/7/12(�vel]before he
passed away).
Account Information
Basic Brokerage
Account Nwnber Ownership
00037226744 3 133 Uniform Transfer to Minor Act-UTMA
00042880486 S l33 IRA-beneficiary desi;nated
00042880573 3 133 Individua] -TOD
Basic Brokerage
Account Number Total Value
00037226744 3 133 $9,998.68
Aee}Namepme�ip�iye B�ukerdgeAoFant, ROBHiT J HQLL[S.AS CUSi'D FQR NATASHAA GLOGER UNOER7t1E PA
UNIFORM7RAt�75FER5'T�Ml[i{)t�AC�
/Eect Na'.UD037728744 433 AoaETjtpe:NarQa►ab6ed
� �_N� _ F��t� � i�p�
11e � ��.�_� ,.�,�, Hr
AM6EN',NC „ 'MIGN :LAHGECAP;STOCK s tQ4.�U.:: 4831 "s 9 831[Od
,, _ :.
_. � _.,_
,._ . ._
CRSH CASH EQUIVAlEtdT'S 16f_69 1_4fl i'6I:68 i
I1COOUni'Ibtal: i�94&bS
Insurance and annuities
are issued by RiverSource
Life Insurance Company,
an Ameriprise Financial
company.Ameriprise
Brokerage is provided
by Ameriprise Financial
Services,Inc.Ameriprise
Financial Services,Inc.
Member FINRA and SIPC.
00042580486 8 133 $36,665.27
Acct Rlame:Ameri�uise Brokerage Rc�aunt,. AAIERiPRtSETRUST COI/AFi1NY C!O R4HERT J HOLLaS AS CUSTd FOR Tli�
R(9BERT.J HOL1.t51RA
,ped M!o-.pppq2ggpq8g q33 AccfType:INDN[DtJAL IRA
}�8��79RId�a�,t�xS„��'�-�s���,��..a`��l���r�f.�`i' `:��8fOH0` ra q�AiOLHBI08 ::_ r :x�g�r=C'.x��SPfi�B'����� tVeUl9,��':
.��xs�.��:��ara..xc a-�.,..,� .s �S':.��».. s^....,.,xW, ...,......,...�.z. _,::��._t...u.....,... _. � .t�.x,,..a.,...n ,.,...,_.>_.�. ,.a..av.:_,
. . _ . . . . . . . . .
A13/1VNC�ER1{S'fElh]t.AftGE.�AP 'A[?G8]C 'IARGE GiYF„STOCK ALtIANCEBER 87.01' 32:48 2,C2fi:'IB
GRDLNTH'CL�fti-.: NS'fEB�f
_. _ : _
CRSN CASN EQUNAlEtlTS 8�E53Ad i.U� B,b53.44
M�RSt1�Y COR1f31NY YSY LARGE CA�STOCK 217.32- 83.D5 2t,775.35
ORhCLE CORP ORCL LARGE CAo STOCh t06.00 34.05 3,6+]9.30
AcoountTCrd�: 5:9c,6fi5.Ti
00042880573 3 133 $334,490.66
A�t Mame:Ameriprise Srok�age P�cr�mt,. i308�RT J:t{QLLlS TQD
A�cc!litc-.0��42H805T3't33 AccETiype:Nar4luati6ed
d,� *����AI�pE9Hai�a'�'���f �P�����, ��
/�ME'AiCA61�Ei�RESS�R►1FktlEY AXR '#IARGE�APr3"fOBK E �' �617313� 7'E.26s �&17"7�
_,._�,.,R.�,:<. ,.,.,_ ..�;. , ..,.._F.:.u......._.,_c:.-.w.........,.v�> ,....�. .....n;�.�_ . ,<, h ..,�-w+ „�... �n
.a 1 �..
J
n►nc�Ni�c "...' : i �!±Mc1+ i:�R�e�srocK ,: . .. . ; �26aa ..; !saai gTb3a.�;
AflUA Ah1ERlCA 1NC 4lTit .�i1�0�lS�iALi;CRP 3U699 �36 8.541."l�
;; ' 57���P: , ` '..:
, , . . _ , . . ,.. _ .
: _
ATXT INC. T'. '�GE C,HP S'FOGK . 26:6Q 3�99 957_!5
; . , .
CFI�SJSPEAKEEIJ�RGYCdRF' .. CH� ' `l�RGE"C:P�P:STO�K : 2Dd� Z1.9T d,38:.55, ..
. .
_ ,; ., .. .., .. . , : .
�l�i3CFi�7ELEl�h1 PG.Sf?fJhl D'iEEGY itBTE�i�t�0.7f4NRL 1087'v 'E1.93 i�87.d7
AQR 'Sl�]CK'' i'
[}33ME'Flifl'ALTGQIAPJ6N! .,D13 -�LA,FCGE�;SFOCK ' 374.U➢ 'G3t6: 23�7�3
GEN=Rl4�LEL�CTRtCCOh1F§�NY �,E LAF�GEGAP.S'FOGF: 2DB�o ' .'3.7L� d.45937
)NyE3CO Rk VA.0 AIUN 1NGC9MEFti ;VPV 'LON�TtdT'cR1.fEDIAT 5�'q6 t3.Gi� 383.a1
. , .. : ;;c-3ERA4` ` _ __..
LTC AROPEit71:S ING LT� _Z:1+!_�ST�,, 9:+:69 A 1.83 39.e5iAo
y���� . :CASN E{�1tMhLEft'TS: „32d_8b i.04 324.86
, . . , , _
PNC FIttANGWL ScFtiV1C.ESkGRQU� PWC lAR6E ICFlP°�"COGK 9d093 72.53 oB�17Ao
ar+c _
PFL GDRP PPL LiAI�GE CAF?'u�FOGK,. ,9+Ff_71 ;'29.13 2d.fr9�,b5
_._.�. .:.� _....�.� -.. _.,�. . - .� _._. �_. _._ ,.: . ,_� . �
.,
.
.._. .. ,...,.�.. ..
i�G€NERdN RHRRh1kCEUT[CALS Rf.r`xH ' 'Li4itGE C.J4P S'FOCK tOQA� 2�83 25.283.OU
h�W.MART�iORESPNCr _ F�iT L-`A.�GE Cf+Q STOCK .1�3a2 75'7$ 7.063.fi9
: _._;, .. . ., _. ._. . :, _ _
Ne��trttTbtaC �i3d,d9tY.56
The date of death values provided are for estate tax purposes and are not a value to be paid.
Accounts may be subject to market fluctuation as governed by each product. Please note that the
values indicated for any Life Insurance products with the insured deceased reflect the gross death
benefit at date of death and not the cash value. Values indicated for Life Insurance products with
only the owner deceased reflect the cash value as of the date of death. Values for any proprietary
mutual funds include accrued dividends as applicable.Values provided for brokerage products are
manually calculated,and should be used as estimates only. The prices used to provide values are
estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides
these values as a service to its clients. Actual values used in preparation of tax returns or for
planning purposes should be verified by your legal and accounting advisors.
,
I
I
Seller's Settlement Statement
For Sale of Manufactured Home
c9rerr�8 saies
Cammunib ���KIDe� L�S PO# �Qf0��0 y� SP# �
Seller Pu haser -
Q�/ l0 ?�C �i✓o%��i�,e�au/,� �c L�Za c��-e.
Year �9 9/ Make�..QQ�Ol,G' S�X � Se/�`�� �0 � ����/
Address� J G / �Jl/6Q+9�+✓ /� �/ # / //
L
City d�� /(��O �� State /�/2��Q. �P ���/ �
1. Amount of Sale ����D� -��
(Does not inlcude sales tax and tag and title fees)
2. Payoff-Lien
3. Broker fee �.r,�.�'�p . fl�7
4. Other deductions
Total Deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ � 7`�� ��� -
BALANCE DUE TO SELLER.................................... .... $ ✓�� S�� . �Z� _
Approved and accepted this day of , 2014.
Receipt of a signed copy of this document is hereby acknowledged.
��iv�. C• l.�xe Cu��-of� G,�
Seller Caren Sales Agent
Selfer
_ �, .� -� �. x. :� . � z� �.�_.�.�_ _
2007 Toyota Camry Sedan 4D CE Pnces, Values & (,amry Sedan 4D CE P... Page 1 of 1
NADA°
"^ .G,UlDES '"" Tha Power of Vehicla Infortnation
:x,:,,.
Autos Classic Cars Motorcycles Boats RVs Manufactured Homes Product Store
ADVER775EMENT
.���� ��� �� �� �. . ��Q%o �FF:..r . �. �:�
BRAKE PADS 8�SHOES �«�ar�a�a�
° FREE BRAKE INSPECTION
•. . ._ .. ..... .... ... ...... . . .. .... . . . ADVE0.TISEMENT
Chanae Make>Q�anae YeaF&Model>Chance Trim>Change Mileaae&Ootioru>Vaiues � �� � � . � ��
���:.. . � . .
2007 Toyota Camry-4 CyL ��
Sedan 4D CE B�E
� Comoare Styles ������0��
Values ' Specifications Pictures&Video Reviews&Ratings Safety f���NSP��OH
_ -- _ ____ _ _ _ _ . _
Values CPO Pricing CPO IncenUves&Deals Cost to Own Calculate Payments �
_ _ —--
-- - — �Y,, �w�rrwrur
� � • � `krrF4�►rJ�� ... �
V'd'Ves ADVERTlSEMEM
- �, .�
��
��.'�;,., ' '�•r° � :�- ���;
Rough Average Clean Clean y
Trade-In Trade-In Trade-In Retaii •
Base Price $7,375 $8,475 $9,375 $12,075 M,AZ DA C X 5
�.
Mileage(97,500) -$550 -$550 -$550 -$550 ��,��.� 4���, ,.._.�� ��
Total Base Price $6,825 $7,925 $8,825 $11,525
' Toyota Camry
options:f��t ootions) Shoppers Also Considered:
Power Sunroof $450 $450 $450 $500 _ _ _
Price with Options �7�275 $8,375 �9�275 '�12�025 z012 Mazda MF;zda3 1
- �
Search Local Listings Vehicle History Report zo�s MaZda MaZda3
We found 14 2007 Toyota listings within �AutoCheck
25 miles of your zip code. Free VIN Search � ��
2013 Honda Accord Sdn
PoweredbyAUmTrader.mm Submit Enter VIN(optional) Submit
,°^�x^m^---
2013 Volkswagen Jetta Sedan
Car Buying&Selling Services
Sell your car now on AutoT2der.com Get pre-approved for an auto loan _
Get up to 40%off with State Farm Instant extended warranty quote-Free 2013 Hyundai Elantra �'
Ins�ntly See Your$0 Gedi[Score Free new pr dealer quote
Next:CPO Pricing
Home�Media Room�About Us�He�p/FAQ�Contact Us I Advertise�Link to Us I Product Store�Business Users�Change ZIP I Follow Us s7�;��
Co ri h �Privacv Poli[v�Disclaimer� AdChoices�
�Copyright 2013 NADAguitles.NI Pogh[s Reservetl.OO Copyright Z013 NADASC.All Rights Reserve0. --
NADAguiGes Is an allian[e partner of NADA Services Corpora[lon.
http://www.nadaguides.com/Cars/2007/Toyota/Camry-4-CyUSedan-4D-CE/... 6/24/2013
TptMbNrq�h OMB Approval No.2502-0265
k� IIIII�II�,� A. Settlement Statement (H U D-1)
�aRN olJE�'d
B.rype of Loan
1.Q FHA 2.Q RHS 3.�Conu Un(ns. 6. FAe Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.�VA 5.Q Conv ins. 201308206.PFD 115130820000
C. Note: This/orm is fumished to gPoe�rou a stetement of acfual�ttfement cnsts Amounts pakl to and by the seklemenf agent are shown.
Items marked"(p.o.a)"were pa�d outsfde the dosng;fhey are shown here for informational purposes and are not induded in fhe tota/s.
D. Name and Address of Borrower: E. Name and Address of SeAer: F. Name and Address of Lender:
Theodore D.Pavefc Alan E Gloger E Mortgage Management,LLC
Kacey M.Pavelic 401 Orchard Lane ISAOAATIMA
405 Vista Drive Mechanicsburg,PA 17055 222 Haddon Avenue,Sufle 2A
West Chester,PA 19380 Haddon Township,NJ 08108
G. Properly Location: H. SettlementAgent: I. SetGement Date:
401 Orchard Lane Central Penn Land Transfer,LLC
Mechanhsburg,PA 17055 3800 Market Street October 15,2013
Cumberland County,Pennsyhrania Camp H�,PA 17011 Ph. (717)695-3166
Place of Settlement:
3800 Market Street
Ca HN,PA 17071
J. Summary of Borrowefs transaction K. Summary of Sellefs transaction
100. GrossAmount Due from Borrower. 400. GrossAmount Due to Seller.
101. Contracl saks rloe 158 000.00 401. Contrad sales rice 158,000.00
102. Personei ro e ' 402. Personal r e
103. Sefllement Char es to Borrower L6�a 1400 10,506.60 403.
104. 404.
105. 405.
Ad ustments for Items atd b Seiler In advance Ad ustmants for Items aid b Seller in advance
106. C lTown Taxes to 406.C /Town Taxes to
107. Coun Ta�aes 10HBH3 to 01/01H4 137.89 407.Coun Taxes 10I16H3 to 01I01H4 137.89
108. SdioolTaxes 10/16/13 to 07/01H4 1359.86 408.SchoolTaxes 10H6l13 to 07/01H4 1,359.86
109. Final Sewer 10I16H3 to 01/01H4 93.74 408. Final Sewer 10H6N3 to 01/O7/14 93.74
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 170,098.09 420.Gross Amount Due to Seller 159,591.49
200.Amounts Pald b or in Behaif of Borrower 500. Reductlons In Amount Due Seller.
201. De osft or earnest mon 2 500.00 501. Exaess d osR see Instructions
202. PrM al amount of new loan s 152 871.00 502. SeHlemenl cher es to Seller Lfne 1400 12 688.60
Z03. Exislin ban s taken su ed W 503. ExistN loen s teken sub to
�• 504.Pa ff First Mortgage
205. 505.Pe ff Second Mort a e
206. 508.
207. 507. De osit disb.as roceeds
208. 508.
209. SederAssist 4740.00 509.SeBerAssist 4,740.00
Ad ustments for items un aid b Sellar Ad ustments for items un aid b Seller
210. C /fown Taxes to 510.C /Town Taxes to
211. Coun Tazes to 511. Coun Taxes to
212. SchoolTaxes to 512.SchoolTaxes to
z13• 513.
214. 514.
215. 515.
2�6• 516.
217. 517.
218. 518.
279. 519.
220.Total Paid b Ifor Bortower 160,111.00 b20.Total Reduction Amount Due Seller 17,429.60
300. Cash at 8attlement fromlto Borrower 800. Cash at settlement tolfrom Selier
301. Gross amount due from Bortower Ane 120 170,098.09 601. Gross amount due to Selier I'me 420 159 591.49
302. Less amount akl byHor Borcower(One 220 ( 160,111.OD) 602. Less reducGons due SeUer Me 520) ( 17,429.
303. Cash O From � To Borrower 9,987.09 603. Cash X�To � From Seller 142,161.89
•PaIdalNdsaltlavinDMhorrotix(61�etlIM y. rbpsrb(n
The undersfgned hereby adm dge ipt of a compieted copy of th's statement&any altachmenlsset erein
Borrower �-. Selle� ��,�_�
' T e dore D.Pavelic q� � `"�v
✓li�//
aey M.Pa f
TM Rtllc Reyv9rg Budnfar Ws ctlleetlmatlrtamWmit esUmakE e135mInIss pa respanefv Wlaetlng,reulaidtg,aMtepartlnglledeta Thle sgnwy my tplcdled We Irlarmetlat�andyau erenolreqJrod lotompele
Oia tam,uima Ildspeyc e arrqtly vaIItlOMB corbd nun6a.NocMltlrWelly Is asaveQ tHa dttlm�re Ia mertlmay.TMa la AnsipnedbpraAdelhe partlee ba RESA4mrered Irareac6o�xilh IAarmetlmdrlrglheadtlemad
R��.
Page 1 of 3 HUD-1
(201308206.PF DC201308206.PF D/32)
L.Settlement Cha es
700:Total Reaf,Eskate BlrokerFees.. $9,19¢.60' Paid From Paid Fran
D/visron of oommissJon(fine 700)as follows Borrouvefa Shcers
701.$4,597.80 to Cenlu 21 at the HeM Funds at Funds at
702.S 4,597.8D to Prudenlial Homesak Service Settlemerrt Seulement
703.Commission aid at settiement 9195.80
704.Broker Fee to Prudential Homesale Services 295.00
800y�tems Payapj�:ih Oohneatloh wlfil Loan. .;. ' "
_:.:. . ,. . � ;:
801.Our or inatbn char e $ 895 00 from GFE#1
802.Your credit or ehar e oinls tor the s '�c Interest rate chosen trom GFE#2
803.Your a usted or inatio char es fram GFE i!A 895.00
804.A raLsal fee to BurkhoklerA raisel irom GFE#3 P.O.C. 425.00 8•
805.Cred�t Re ort to E Mort a e Mana ement,LLC ISAOAATIMA from GFE#3 25,qq
806.Tax servke to from GFE#3
807.Flood cert�ication to E Mort a e Mana ement LLC ISAOAATIMA irom GFE#3 g,pp
808. irom GFE#3
809. irom GFE#3
810. trom GFE#3
811 (from GFE#3)
900 (tetijs ReqUlieB'by Lehder,..to�e:Ra�d:lh AdVapoe
901.Da interest char es from 10/15N3 to 11/Ot/13 17 $19.894200/da from GFE#10 338.20
902.Mortgage tnsurance premium tor months to Private Mortgage Ins. (from GFE#3) 5,141.00
903.Homeowner's insurence for 1.0 years to State Farm Insurance (from GFE#11) P.O.C.$652.00(B)'
9�• (from GFE#11)
905. (from GFE#11)
. . ..
1000 ReseNes De.ositetl,viiith:Lender .- ' "
1001.InAta1 deposR for your escrow axaunt (from GFE#9) gpp,qg
1002.Homeowner's(nsuranca 2.000 months (a� $ 54.33 per monfh $ 108.66
1003.Mort a e insurance months $ r month $
1004.Pro e taxes $ ,�.,�
Coun Taxes 8.000 monlhs $ 55.56 er month
SchoolTaxes months � $ per month
1005.
1006.SchoolTa�ms 4.000 months Q $ 163.59 per month $ 654.36
1007. months Qa $ per month $
�oos. a
1009.AggregalaAdjustment $ -387.04
9400„rftle�aha�ees;� ,
_.
1101. T'dle servfces and lendar's tNle tnsurance (from GFE 114) 1,509.50 21.00
1102. SetUement or dosin fee $
1103. Owner's 1�ie fnwrance to FlrstAmeriean T�tle Insurance Company (from GFE#�ry 25.00
1104. Lenders Ulle insurance to FlrstAmerkan Tille Insurance Company $ 1,315.00
1105. Lender's title oqcy�nk $ 152,871.00
1106. Owner's t81e poNcy Gmit $ 158,000.00
1107. /�enYs porUon of the total t�le insurance premium to Central Penn Land Transfer,LLC $ 1,139.00
1108. Underwriter's portion of the totel tttle insurance prem(um to FtrstAmeripn Tille Insurance Company $ 201.00
1109. $
1110. $
1111. $
1112. §
1113 $
42b0,Gove►qme�t:ReaoM4n .ahd TrahsfBr�Ohe�es'
1201.Government record6� char es to Cumberland
Coun Recorder of Deeds from GFE# 186.00
1202.Deed 3 62.00 Mo�t a e$ 104.00 Releases$ Olher$
1203.Transfer t�ces to Cumberland CouMy Recorder of Deeds (from GFE#8) 1,5BO.OD
1204.C lCoun taxlstam s Deed $ 1 580.00 Mort a e S ��p�
1205.State taxlslam s Deed $ 1 580.00 Mort a e$
1206.
1207.
laoo naaitiona!smnimfient che�g�s ~ , ;
..,... ,,
. ,
1301.Required services that you can shop for (f�om GFE p6)
1302. Radon to Amerkan Radon Soiuttons $ 900.00
1303.HB McClure to HB McClure $ 224.00
1304.Ffnal Sewer to UpperAlbn Twp $ Act#53q003 224.00
1305 Ntorney Fees to Gritfre&Assodates $ 250.00
1400 �ofa�`S�ttleryjaht�Gharges;(ente�ofi:l�ryes 103�;Seokion J+srid 802.Sedtlo�K):.,`;` ' '10;506;6q'-' 12;889i60'
•rraan�deaaalnublr oormFx(�,au�er(S7.�eqatU.or wrapany(n
8P�4�NPBP1dlhbsteEendillheal9��esaeWioMeAge�ectlpldarnmplele0aqdpaga233a1WSUrea s ert
Central Penn Land r fe LLC ementAgent
Page 2 of 3 HUD-1
(201308206.PFD/201308206.PFD/32)
Attachment to Schedule "F"
uc�, 3. [uI3 �;�t�rm riv� DdIIK �•�. �� „ � . L
. � ��.�•
,�
October 3,20l 3
BradJe�L Griffie Esquire
Attorney at Law
200 N l�anovcr St � �
Carlisle PA 17013
RE: Robert J��lo.11is
SSN: 100-22-6594
DOD: 06/10/2013
Dear Sir/1vladam:
In response to pour request for Date of beath(DOD)balances for the cust�mer noted above,oux
recozds show the following:
Correctecl Letter:
Cb�eeking,A.ceou�nt
Account#5140029895 Established: 03/X3/2009
ROBERT J H�LLIS
ALAN EDWARD GLOG�R
DOD balance: $979.60+0.00 accrued interest
** This account was transferred to an 7ndividual acet under Alan Bdward Gloger on 07/08/2013. **
Safe Deposit$ox
The decedent maintained sa�e deposit box 04�001]200�00
located ar.
Upper Allen}3ranch
127 Kim Acres Dri�ve
Mechanicsburg PA 17055
717-795-8630 �
Page 1 of 2
_ _
- iJct, 1, LU Ij j:47rM rNl, �ank iuo. �+� i�+ r. �
Please note that this office provides date of death balances for de�nsit accounts(IItAs,CDs,Checking and
Saviugs). We do�aot process an�fi�n�ociat transacfions or pro�vide statetnents. If�ou need assistance r�vith
any of these items,please call 1-888-pNGB.AN�(1-888-?62-2265)or stop by your local�NC Bank branch
office. �
Sincerely,
Natiqnal Financial Services Center
PNC Baz�k,N.�4.
Member FD1C
7'his message rs intend'ed'for fhe use of the ind'ivid'uar or enfity to which it is addressed and may
conlain injorr�ration�hal is,privileged', corrfidenliaY and excmptfrom disclosure r�nder applica�ble
Taw tf the rercder ojthis»ressage zs not the fntended recipient or ihe e�nployee or agent
responsible for deliverireg this mesrage to the Yntended recrpien[,you are hereby�oi�d that any
disseminaliori,dislribution or copyrng of this communications is striclly prohiliited 1'f you have
received'this communicafion in error,please notify me immediatery by reply or by telephone at
800 762 I77�and in�med'iately destroy�his jaxed document.
Page 2 of 2
Uct. j. LUIj j,4brm rNt, �anK �Y�. �+c�Y �. �+
`���
October 3,20�3
Bradley T,Crriffie Esquire
Attomep at Law
200 N'Hanover St •
Carlisle PA 17013
RE: Robert r Hollis
SSN: 100-22-6594
DOD: 06/10/2013
Dear Mr. Griffie:
Tn response to�our request regarding the Date of Death(DOD)balances for the customer noted
above, our records shovv the following: .
Checking account#51�40029$95 was established on 10/01/1972 as a joint account between�tobert�
&Lucy C Hollis.
Alan Bdward Crloger was added as a joint owner on 03/13/2009.
Lucy C Hollis r�vas removed from the account on 04/02/2012 due to her death on 12iQ7/20I].
Robert J Hollis rxras zemoved on 07/0$/2Q13 due to his death on Ob/10/2013 leaving the account under
th.e sole ownerskxip of Alaxz Tdwacd Glogez.
Ho�efully,this answers all of your questions. Feel free to call with any questions.
Sincerely,
National Financial Services Centez
PNC Bank,N.A.
Mernber FDIC . .
7"I'iis message is rntend'edfor ihe use of the�ndivid'uaC vr entity to which it is addressed arred may
conta�ri confdenlial injorniatron that is pr�ivrCeged, con�dential and exempt from disciosure under
appl�icable law If Ehe reader of fhrs message is r�ot the ir�tereafed recYprent or the employee or agent
resporisible fvr delivering this�nessage to the intended recipient,you are hereby notifi�ed't�iat any
dissemination,distribution or copying of t�Cis communications rs strictCy prohibited 1'f you have
received'lhis communication in error,p!'ease notify me irnmediately by reply or by teCephone al
800 7621'775 and immediatel.y destroy this jaxed docr�rnent
Page 1 of 1 .
Attachment to Schedule "G"
�Thrivent Financial for Lutherans�
4321 N.Ballard Road,Appleton,WI 54919-0001
Thrivent.com•800-THRIVENT(800-847-4836)
July 10,2013
Bradley L Griffie, Esquire �
Griffie Si Associates
200 North Hanover Street
Carlisle PA 17013
Subject: Robert J Hollis,Deceased
Variable Annuity Contract LC3365818
Dear Attorney Griffie:
Thank you for your letter of June 27,2013.
Robert j Hollis held Non-qualified Variable Annuity Contract LC3365818 issued on November 22,2000
at the time of liis death. The date of death value is $94,008.15. The taxable gain is $44,008.15.
The Primary Beneficiary(s) of this contract are Natasha Gloger and Matthew Gloger, grandchildren. If
they are adult age and elect to disclaim their interest in the proceeds you will need to DRAFT a
disclaimer and provide a eopy to Thrivent Finaneial to review if it is acceptable before the form is
completed.
Our Financial Representative Todd Heidelberger is handling this claim and he can be reached at 540-
450-1515.
Please let us know if you have any additional questions. You may reach us at 800-847-4836.
Sincerely,
U U �-�'t l,�J�'�
Lori A.Van Alem,ALHC,ACS _
Advanced Claims Examiner
Death Claims and Service
Claims Operations, Member Interactions
lav
cc:T Heidelberger 052410569
Robert J Hollis, deceased,507723424
. I
. .07/09/2013 11:51 9043136320 CCCU OUTGOING PAGE 02
'� ���e���[LJ. Customer Senrice Office
P.O.Box 13902
•Philetlelphia,PA 19178
(800)496•7Q35
www.prudential.com
Allan.C�toger . Insuxe8:Rob�re i.Hollis
���.o Policy�tumber:20651981
544-1150-15�7
duly 8,2013
Deax,Atian Glogcr:
I aux writing in respo;�se to a xequest foz xnformat�or�on the po�.i.ey shown above.I tz'ust this i�afoxmation
will pc bene�xcial.
Th�a�aroximatc deat�benefit�or policy z�umber 20651981,as o'FJune l0,2d13 is$5,291.10.
�f.you have any quesdans or would like z�oxc inforn�a�ion,please call our customer sexvice office at
(800)496-J 035. Wc are a,vailable Monday through�riday betwcen$:04 a.m.and 8:00 p.m.Ba,cfcrn
time. If you axc using a telecomnaunieations device for tbe heaxing iux�aired,pl�ase c�tll
(80U)778-8633,Monday throu�*,J.�k'riday betwccn 8:Od am.and 6:00 p.m.Bxstcrn time. Oztc af our
customcr sez'viee represcntatives will be glad tq help you.
Sincerely,
��t,�jl,�C�tmRr�R�c�'r�
Lea Alaiae T.?avis
Sr.Claisns Examiner
Li.�:'e insura�ee issued by Tbe Prudc»tial Insuranee Company o�Ameriea,located at 751 Broad St�eet,
Ncwark,NJ 07102-3777,a Prudcn�kial Financial,�nc.compan.y solely responsible for its own finaz�cial
co�n.di�ion and contractual obtig�tions_
Pruc�entiat,the Prudential lbgo,and the Roek symbol are scrvice maxJcs of Prudent�at FinRncial,�f,�.e. �
a:n.d its related cntities,zegistered'zn�oc�.any juriadictions worldwide.
Page > 1 of 1
i Y Vc'111�RI2�Td�
Robert J Hollis ReporFfor 06/10l2013�` €. } sa;` „ �w��,. ;� ���_ ^����,���,s�
401 Orchard Ln Client Services:800-662-2739 �
Mechanicsburg, PA 17055-6142
Total report value: $7,842.07
(Total report value includes any accrued dividends.)
�
Robert J<Hollis�=Rofh`IRA � , � .���"'S�s�� �������#�;c' ��':� � � f.
� � �, ,., .�� �� �_� �r <�a�
. .�.. .., �� :; ?. . a.�,�.t „�s� .. �"t t'�."�.�' 4 �"u:"`�. ��-m'�,',� r>g = R . ..
Account value summary: � , � : ����. �. �_�� _��
„ . .. _<: ...__>.._....�.��.^a._.. .��...._ . ,. .��,:. . r.:.....,s_,x.s:. ........::...:..__,.,;........� .�tY.�... ,.�_s. _.� _.aa�+,....,iz ��<>;;�i,�x�i-x.�,��#..xi'�'�-� ,.�� �_�'�
�
Name Fund&Account Date YPrice Per Accrued
Number Opened Shares Share Value` Dividends
GNMA Fund Investor Shares 0036-88054636918 01/03/2012 739.366 $10.60 $7,837.28 $4.79
Totals $7,837.28 $4.79
'Doesn't include accrued dividends.
0166186392 07/22/2013 15:29:43
RiverSource Life insurance Company =
1751 Ameriprise Financiai Center .
Minneapolis,MN 55474 RiverSource �m
Alan E Gloger
814 Kenneth Place SE
Leesburg VA 20175
July 2, 2013 .
Contract Owner(s): Robert J Hollis
Contract Number: FXA-6802151
Dear Alan E Gloger:
***CONTRACT VALUE ASOF DATE***
Value as of:June 10,2013 •
Contract Value: $46,426.60
We are committed to providing you with quality products and exceptionai service. if you have any
questions or further service needs, please contact your financial professional or call our office at
800.633.4003. Client Senrice Professionals are available Monday through Friday 8 a.m.to 5:30 p.m.
Centrai time.
We appreciate your business with RiverSource Life Insurance Company.
Sincerely,
Client Services
RiverSource Distributors, Inc.(Distributor), Member FINRA.Insurance and annuity products are issued by Choose a
company
�O 2013 RiverSource Life Insurance Company. AII rights reserved. 10035 4/13 j
_
Performance Select Statement
PNC Bank
Primary account number:53-3536-1601
Page 1 of 2
For the period 06/05/2013 to 0611912013 Number of enclosures:0
y
� For 24hour banking,and transaction or
z ALAN EDWARD GLOGER interest rate infortnation,sign on to
814 KENNETH PL SE PNC Bank Oniine Banking at pnc.com.
LEESBURG VA 20175-8989 'a Forcustomerservicecaill-888-PNC-BANK
Monday-Friday: 7 AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espanoT,1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNGBANK
� Write to:Customer Service
PO Box 609
Pittsburgh PA 15230-9738
�Visit us at pnc.com
� TDD tertninal:1-800-531-1648
For hearing impaired clients only
IMPORTANT ACCOUNT INFORMATION FOR PERFORMANCE SELECT CHECKING CUSTOMERS
The information below amends certain information in our Consumer Schedule of Charges and Fees('Schedule').Al]other information in our
Schedule continues to apply to your account.Please read this information and retain it with your records.
EFFECTIVE JUNE 9,2013
Avoid the monthly service charge with any one of the following:
>$5,000 average monthly balance in your checking
>$25,000 combined average monthly balance in linked PNC consumer deposit and/or investment accounts
>New-$5,000 in qualifying d'uect deposits*during the statement period
_ ..._ ..._. __ ..:..,. __ __ _. _
EFFECTIVE AUGUST 18,2013,the fee for Retumed Deposited and Cash Items will be$12 for all accounts.
Please see the enclosed insert for information about other changes to our checking products.For more information,stop by your local PNC
branch office,visit our website at pnc.com/mycheckingoptions or call us at the Customer Service phone number listed above.
*A qtral�ing drrect deposit rs n recurring electronic deposit made by an employer a•crn outside agency. Ti•ansfers made from one accoun[to another or
�leposits made via a brnnch,ATM,online trnnsfe�',mobile device or the mnil are not eliQible to mee�this requirement.
Performance Select Alan Edward Gloger
Interest Checking Account Summary
Account number: 53-3536-1601
Overdraft Protection has not been established for this account.
Please contact us if you would like to set up this service.
Overdraft Coverage -Your account is currentiy Opted-Out.
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To leam more aboul PNC Overdraft SoluUons visit us online al pnc.com/overdraflsolu6ons.
Call 1-877-588-3805,visit any branch,or Sfgn on to PNC Online Banking,and select Ihe"Overdraft
Solutions"link under lhe Accounl Services section to manage both your OverdraN Coverage and Overdraft
ProtecUon settings.
Performance Select Statement
For the period 06105/2013 to 06/19l2013
Ip For 24-hour infortnation,sign on to PNC Bank Online Banking ALAN EDWARD GLOGER
�on pnc.com. Primary account number.53-3536-1601
Account number:53-3536-1601 -continued Page 2 of 2
Balance Summary
Beginning Deposils and Checks and olher Ending
balance other additions deduclions balance
.00 210,560.66 5,361.59 205,199.07
Average monthly Charges
balance and fees
206,660.24 .00
Transaction Summary
Checks paid/ Check Card POS Check CardBankcard
withdrawals signed Iransactions POS PIN transactions
3 0 0
Total ATM PNC Bank Olher Bank
UansacUons ATM transacUons ATM Iransactions
0 0 0
Interest Summary As of O6/19,a total of $.84 in interest was
Annual Percentage Numberof days Average collected Interest Paid paid thiS year.
Yieid Eamed(APYE) in interest period balance for APYE lhis period
0.01� 15 206,660.24 .84
Activity Detaii
Deposits and Other Additions There were 2 Deposiis and Other Additions
Date Amount Description lotaling $210,560.66 .
06/05 210,559.82 Deposit Reference No. 522239337
06/19 .84 Interest Payment
Checks and Substitute Checks
Check Dale Reference Check Date Reference
number Amount paid number �umber Amoun( paid number
3.0.21 O6l•1qf.. .:.oaa�25szs . . __ .... .__._.... _21,40_ ,,..0.6/.11. o�as2�a�s
'Gap in check sequence There were 2 checks iisted totaling $51.61 .
Online and Electronic Banking Deductions There were 2 Online or Electronic Banking
Date � Amount Description DeducGons totaling $4,009.98 .
OC�10 3,661.98 Direct Payment-ACH Pmt Amex Epayment C0680
OC�10 348.00 Direct Payment-Paybyphone
Bk Of Am Crd ACH 01699381
Other DeduCtiolls There were 2 Other Deductions totaling
Date Amount Description $1,300.00 .
O6/06 1,000.00 Tel 0400065701 0003 Transfer To XXXXXX9895
06/07 300.00 �thdrawal Tel 0400011214 0088
Daily Balance Detail
Date Balance Date Balance Date Balance
06/05 210,559.82 06/07 209,259.82 O6/11 205,198.23
06/06 209,559.82 06/10 205,219.63 06/19 205,199.07
�Total Banking Statement
PNC Bank
Primary account number:51-4002-9895
Page 1 of 3
For the period 0 510 712 0 1 3 to 06106l2013 Number of enclosures:0
Y
ROBERT J HOLL I S � For 24hour banking,and iransaction or
interest rate infortnation,sign on to
ALAN EDWARD GLOGER PNC Bank Online Banking at pnc.com.
4 O 1 ORCHARD LN 'a For customer service call 1-888-PNGBANK
MECHANICSBURG PA 17055-6142 Monday-Friday: 7AM-10PMET
Saturday&Sunday: S AM-5 PM ET
Para servicio en espanoT,1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
� Write to:Customer Service
PO Box 609
Pitisburgn PA 15230-9738
�Visit us at pnc.com
� TDD tertninal:1-800-531-1648
For hearing impaired ciients only
Relationship Overview
Bank Deposit Accounts
Description Account Number Deposit Balance
Interest Checking 51-4002-9895 691.75
Premium Money Market 50-0318-1145 .00
Total"Deposits 691.75
Loan Accounts
Description Account Number Type of Loan Balance As of Outstanding
Line Of Credit 25 854067 From Last Statement 05/25 .00
Total Loan Accounts .00
Balances may not reflect most recent payment(s)or advances after date listed.
This infortnation is not intended to replace your regular loan account statement(s)and inquiries should be made in accordance with the instructions on
your loan account statement(s).
;., _:_� ,
� � � �, ,- '
�l4nte�rest�he;�k�ng�A�cCO:unt¢Sum mary Rabert�Ho�rs
Account number: 51-4002-9895 Alan Edward Gloger
Overdraft Protection 'has'not been estabiished for this account.
P.lease.contact.us-if:.you-would-like-to.setup�this service.
Overdraft Coverage -Xour account is currently Opted-Out.
You or your joint owner may revoke your opt-in or opt�out choice at any time.
To leam more about PNC Overdraft Solu6ons visit us online at pnc.com/overdraffsoluGons.
Call 1-877-588-3805,visit any branch,or Sign on to PNC Online Banking,and select the"Overdraft
Solutions'iink under the Account Services seclion to manage both your Overdraft Coverage and Overdrafl
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
211,716.14 9,370.55 220,394.94 691.75
Average monthly Charges
balance and fees
199,647.29 3.00
�\',
�
Total Banking Statement
For the period 05/07I2013 to 06/06/2013 i
rO-1 For 24-hour infortnation,sign on to PNC Bank Online Banking ROBERT J HOLLIS
�on pnc.com. Primary account number.51-4002-9895
Account number:51-4002-9895-continued Page 2 of 3
Transaction Summary
Checks paid/ Check Card POS Check CardlBankcard
withdrawals signed transacUons POS PIN transactions
9 0 0
Total ATM PNC Bank Other Bank
Uansactions ATM Vansactions ATM transactions
0 0 0
Interest Summary As of O6/06,a total of $8.74 in interest was
Mnual Percentage Number of days Average collected Interest Paid paid this year.
Yeld Eamed(APYE) in interest period balance for APYE lhis period
0.00$ 30 206,302.20 .00
Activ9ty Detaii
Deposits and Other Additions There were 8 Deposits and OtherAdditions
Date Amount Description totaling $9,370.55 .
05l08 2,132:00 Direct Deposit-Xxsoc':Sec
SSA Treas 310�CXXX6594A
05/OS 400�Q0 'Direcf'Deposit-Annuitant
_ _, _ .,,. _ PA Treasury Dept XkJ�JOCKXXXXX9136
05/10 490.00 Direct Deposit-Dir Dep Sloanrealty Mgt
05/31 - 2;8U6.58 Direct Deposit-Ret Net
DFAS-Cleveland XXXXX6594
05/31 253.00 Direct Deposit-Pcs Svc T-Mobile 6820601
05/31 _ 1,838.97 Direct Deposit-Annuitant
.__,_._ .. _, _._..... ...__._-_. _ _ __
PA Treasury Dept X�CJ�JCCKXXXXX3583
06/04 450.00 Direct Deposit-Credit Aeis•XXXXXXXXX4861
06/O6 1,000.00 Tel 0400065701 0003 Transfer From XXXXXX1601
Checks and Substitute Checks
Check Date Reference Check Date Reference
number Amount paid number number Amount paid number
2183 100.00 05/15 085025349 2208* 1,000.00 05129 .o8aaosxas
.22Q4' ,_ 35:60 A5/08�, . ; . osassssss . -., --. - _2209- : �850.00 05/24 oasnaa��
2�2����a��5�0eQ0���0"5�a8��.;��.�oasis5zao�.. :; . 2210 305:25 06/06 085564180
.220:6- 70.00 �05/24 s2�oaso�s
'Gap in check sequence There were 7 checks listed totaling
$2,810.85 .
Online and Electronic Banking Deductions Tnere were�o orn�ne or eieotronic ear,k�r,9
Date Amount Description Deduc6ons totaling $6,421.27 .
Oy09 115.15 Direct Payment-Paymentrec Verizon)OOCXXX9168
05�15 17.41 Direct Payment-Water Bill
United Water Pen XX�OCX)CXXX0000
05�20 27.90 Payment,E-Check Check Pymt
-Giticard-Payment 2207
05�22 55.88 Direct Payment-Elec Svc Ppl Eu XXXXXX8108Ws
0928 253.00 Web Pmt Recur-Pcs Svc T-Mobile 7185664
05�28 253.00 Web Pmt Recur-Pcs Svc T-Mobile 7185665
05�29 95.88 Direct Payment-Ins Prem
Nationwide Wxxxxxxx1221
OC�04 5,534.21 Web Pmt Recur-ACH Pmt Amex Epayment A3628
Online and Electronic Banking Deductions continued on next page
,al Banking Statement
For the period 05/07I2013 to 06/0612013
�For 24-hour information,sign on to PNC Bank Online Banking ROBERT J HOLLIS
on p�c.com. Primary account number.51-4002-9895
;: Account number:51-4002-9895-continued Page 3 of 3
;' Online and Electronic Banking Deductions -continued
Date Amount DescripUon
06'04 56.85 Direct Payment-Ins Prem
Nationwide Wxxxxxxx4830
OC�04 11.99 Direct Payment-Elec Pymt
Fpl Direct Debit XXXXXX7115 Ppda
Other Deductions There were 5 Other Deductions totaling
Date Amount Description $211,162.82 .
05/28 300.00 Withdrawal Tel 0400011214 0107
06/03 300.00 Withdrawal Tel 0400011214 0061
06/05 .00 Outstanding Item Close
06/05 210,559.82 Debitl+Aemo Reference No. 522239286
06/06 3.00 Check images In Statement Fee
Daily Balance Detail
Date Balance Date Balance Date Balance Date Balance
05/07 211,716.14 05/15 214,019.98 05/24 212,016.20 06/03 215,712.87
05/OS 213,762.54 05/20 213,992.08 05/28 211;210.20 06/04 210,559.82
05/09 213,647.39 05/21 212,922.08 05/29 211,114.32 06l05 .00
05/10 214,137.39 05/22 212,866.20 05/31 216,012.87 06/06 691.75
Premium Money Market Account Summary RobertJ Hollis
Account number: 50-0318-1145 Alan Edward Gloger
Overdraft Coverage '-Your account is currenUy Opted-Out.
You or yourjoint owner may revoke your opt-in or opt-0ut choice at any time.
To leam more about PNC OvercJraft Solutions visit us o�line at pnc.com/overdraitsolu0ons.
Call 1$77588-3605,visil any branch,or Sign on to PNC Online Banking,and selecl the"Overdraft
Soiutions"link under the Account Services section to manage both your Overdratt Coverege and Overdraft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
117,386.06 .00 117,386.06 .00
« , �������'i��� a�',�,✓ ,.� � .Average`morithly' Charges
;,,.,Y . .
' °'�``� �'�'� '�• �"� � " �` balance and fees
��*'�"�-�,�,� -'�.� _
109,812.76 .00
Int@I'eSt`Summa_ry_ - As of 06/06,a total of $91.02 in interest was
Mnual Percenlage Number of days Averege collt�cte� Interest Paid Paid this year.
�eld Eamed(APYE) in interest period balance for APYE ihis period
0.00$ 29 117,386.06 .00
Activity Detaii
Other Deductions There were 2 Other Deductions totaling
Date Amount DescripGon $117,386.06 .
06/05 .00 Outstanding Item Close
06/05 117,386.06 Debit Memo Reference No. 522239284
Daily Balance Detail
Date Balance Date Balance
05/07 117,386.06 06/05 .00
�
Amerip�ise �
F`IYIQYlC1Ql RiverSource Life Insurance Company
Ameriprise Financial Company
70100 Ameriprise Financial Center
Minneapolis,MN 55474
October 3,2013
I3RAD1_FY GRIFPIE
200 NORTI-I HANOVER STREET
CARLISLE,PA 17013-2423
Dear BRADLEY GRIFFIE:
We have received notification of ROBERT J HOLLIS's death. Please accept our condolences on
your loss. The deceased's name is associated with the following accounts. Account values as of
06/10/2013 are listed below. At the end of this letter,you will find a list of beneficiaries shown in
our initial review of the accounts.
Regarding your specific request for information about account 80995530 133 in the re�istration,
Robert J Hollis as Administrator of the Estate of Lucy C Hollis; All of the assets that were in this
account were transferred into Robert Hollis's account,42880573 ]33 on 5/7/12(�vel]before he
passed away).
Account Information
Basic Brokerage
Account Number Ownership
00037226744 3 133 Uniform Transfer to Minor Act-UTMA
00042880486 � 133 IRA-beneficiary designated
00042880573 3 133 Individua]-TOD
Basic Brokerage
Account Number Total Value
00037226744 3 133 $9,998.68
Aoa#Name,4me�ipri9e 8roloerdpeA�nk ROBH�J HQII[S.AS CllSiD F4R NATASHAA GLaGER !ltV�ERTHE PA
UNIFQRM7RANSFERSTOMINflRS ACf
Red qa'.!lDD37Z28744 t33 1�wctTjf{re:NarG�taL6ed
�,�� � � � �`�T.:t���� ...�!�a
nrnc�N�tc . ae+t�r :uutcEr.�+P.sro�K : toaaa >' sa:�i < �aai:ao
, , _. , ,__.
__ , ,_ _
cnstt cnstt Equnr�Etrrs t6��ss _ �no �s'r:�s i
i�co�WllTatai: �9448.�
Insurance and annuities
are issued by RiverSource
Life Insurance Company,
an Ameriprise Financial
company.Ameriprise
Brokerage is provided
by Ameriprise Financial
Services,Inc.Ameriprise
Financial Services,Inc.
Member FINRA and SIPC.
00042880486 S 133 $36,665.27
Acct IitamefvnergiaisE Srokerage Acmunk. kidERiPR[SETRUST CO#APtINY C�O P.OBERT J HOLL15•A5�USTd FOR Tl-�
ROBER�J HOLL&S IRA
,f�ed Mt�.UDD42880488 433 A�cfTjrp�:INDN[[))l1AL IRA
�1hSBeF-R�RIdw.`.4`z,i,`�-H^r,������-e��.s�.����CIG��,�.�f�$� n�',��a-t.�`u2y�IL0d W81oBr;r�' ..i .....,£�Ii118(F�:C�``�PfwB t�1i�b d :, }V8�p8��}
, ..... .�_�
,� . , . . . . ._. . _,
ALLIIVNC�ER125'fEIhI LAftGE.�AP AP�AX l:ARGE GAP SCOCK .ALC:lANCEBEft ��7.07 32i46 2,626:16
Gh`81Ht1�CL•A-:: iNSSER�f
CASH CASH EQUNAlENTS 8,t53A4 i.fl10 B�A53.4A
H�RSN'�'COAiPANY YSY IARGE CAfl STOCK - 24Z.32 83.D5 2f,776.35
OW.CLE CORP ORCL LARGE CA.o STOCK lO6.00 3E.05 3,69?.30
AcwunETOtaI: 530.655.27
00042880573 3 133 $334,490.66
Acct kame:Ame�rise 8�k�age Accwmt,., ROB�RT J l-[Q4LLi5 TO�
Ace:t Ffo-�Q428805�T3'F33 AcctT+�pe:Nar4�ified
Ha ��� gE.Ntmm�� � Oua�►� FP�6�@����°���'1tu�l'ue��i�}?
�
/SM@ifGJ161�E?fPRESS'�R�tA!11�Y �� i.L?FIftGE C6PaSFOEK .: ' �5i 73 7E.26� �:b17"73i
� '� 4 ,�
AM6Ehtl�LC. ,�Ah�Gr1 l�4RGE CAA S'TOCK. 92fi:Q4 ' ,.',98 3i . 91.X}3R6�`
OSJtL4 e3MERl�A 1NC `Plfi� :li.t�alS�(AIi CP,P 306�8 30.96 5.5D1.1'9
tSTi1�P: .:, _::.
_
, ,.... ,. ,
AT&T.IF1G. '; S-> LJtTtGE CJtQ 3TQGK 2654 3599 95f_t5
`, i ,
�CFI`SP,PEAKEEAI�RGYCOFFP �?i!:' LAitGE,�5T06K '. 20dS�J; 21.92 d;d84.55 .,
L1�UiS�FLTEiE1Ci767'tLG.SP�718 �TEGY �1t8TEf3iJ:0.3fi3�1�lA[. 408_� 41.93 ].247.d'f
ADR ; - ,,'S3�CK..,-:: '::.
[?75NE'fYYALTG4A9PS9.HY �IIIS �LA3�GE�;SFdCK:, 37+tflU. 83t8:� 23,�7��'�
,. , .
_ „ . _ ;; _.,.; .-,. , ,. �
GEN�Rfd.EL�CTRtCCOh1F�k[dY �E I:ARGECA.A�.°'FOCF; 2D6:53 '23:7fi A.359.Z7
1NHESCO P'41Jf�.0 MUN 1NCOh1EFit ;VPV ,'LONGrtKTcRAIEDIAT 6d 46 t3.66 383_b'i
, ..:. .. . __,: , , E-TEstA4_:: _ _ .
LTC PROPEs'�TI.'-.S INC LT�C _rZ:AL�ST� 9:�:69 :77.;3 39,85i_O6
_ ;_._ .. _ ,
Ala�gln`. ; _ :CASN EQUNAI.EHTS,. 33d.8� i.[i4_ 324.86
_.,:. . , ,�. ,... ,
lPhN�C Flh}ANCWL S'cfiN10E^��ROiI� f�NC LAiiGE iC.A?f,"COCK 9+fA98 72.53 06,417Ao
PPl:CORP ` f!PL ' L�9l�tGE`CfiP STOGK = bk7_�i '2913 .2A.b93�.fi5
_._._;_ u .. _,.... _..._ _ ..._ .�- ..., �_.. ., _.._. � _ _ �. ... ,.
_
,t�1CGE�NEftt3N'RHRRk1RCElJF[CALS Af�N ' liRft6E CA�S'F�CIC���' tOQAf] .2�83 . 25�3AD .
hY11L Ml1KTSSORE3•�fiCs ;. Y�i'T Lf�.1iGE-CJiQSTOCK", 1�3a2 73.75 7.843:69
<: ,..:. _...: . .. , _ _
_ Amoun(T�1: 3�3d.d�.b6
The date of death values provided are for estate tax purposes and are not a value to be paid.
Accounts may be subject to market fluctuation as governed by each product. Please note that the
values indicated for any Life Insurance products with the insured deceased reflect the gross death
benefit at date of death and not the cash value. Values indicated for Life Insurance products with
only the owner deceased reflect the cash value as of the date of death. Values for any proprietary
mutual funds include accrued dividends as applicable.Values provided for brokerage products are
manually calculated,and should be used as estimates only. The prices used to provide values are
estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides
these values as a service to its clients. Actual values used in preparation of tax returns or for
planning purposes should be verified by your legal and accounting advisors.
I
i
�
� :
GREAT-'4'VES'�
FINANCIAL
IIright tamorrocvs begtn toda��r
July 31,2013
BRADLEY L GRIFFIE ESQ
200 N HANOVER ST
CARLISLE PA 17013
RE: Participant Name: Robert J. Hollis (Deceased)
Plan#: 98978-01 �
Dear Mr. Griffie:
We are in receipt of your correspondence regarding Robert J. Hollis' Commonwealth of
Pennsylvania Deferred Compensation Program. We were sorry to hear of Mr. Hollis' passing.
The above referenced, sole-owned account is the only account we hold for Robert J. Hollis. We
do not have accrued interest information for this account as it is invested in mutual funds whose
value fluctuates daily with the pricing of the markets. Please note Mr. Hollis had a monthly
periodic clisbursement on this account in the amount of$500.00.
Per your request, please find enclosed Statements on Demand reflecting the account balance as of
the�c�lose-of business on June 1-0,2013.
Our records indicate Lucy C. Hollis is the designated primary beneficiary. Since she pre-deceased
Robert.J..,Hollisthe.£unds.of.the.accountFpassto_the-contingentbenefciar.ies,:Matthew;A. Gloger
-andl�latasl�a:A:�Glo:ge'r.:Pleasenofetliat`since�lVfatthew A. Gloger is a minor,we will need to be
provided with court issued guardianship paperwork which lists the name of the legal guardian
authorized to act on Matthew's behalf under the Uniform Transfer to Minors Act. For your
convenience,I have enclosed a Death Benefit Claim Request Form,Death Benefit Claim Guide
and a Beneficiary Designation Form to be completed for each beneficiary.
If you have questions,please contact us at 1-866-360-1192, option 4.
,.
Sincerely,
�
,�
Mike V.Bond
Retirement Correspondent
Financial Services Division
Enclosures
8515 E.ORCHARD ROAD•GREENWOOD VILLAGE,CO 80111 •(303)737-3000
Statement On Demand
for Pian 98978-01
Commonwealth of Pennsylvania Deferred Compensation Program457 Plan
For the period: 10-Jun-2013 to 10-Jun-2013
ROBERT HOLLIS
401 ORCHARD LN
MECHANICSBURG,PA17055-6142
Your Account At A Glance
Beginning Balance Totel` � Total•:-: Total, ,'-Tota1 Clismg�In :. Endmg�Balance ?
as of Deposits Witlidra�vals/ Drvidends Value asrof= �
10-Jun-2013 Expenses k - ,� ,,,r. �10 JuR 2013
�91,234.G7 $0.00 $0.00 $0.00 $21.23 $91,255.90
Activity By Contribution Source . �
Contribution Source Beginning : Deposits: � , .`Withdrawals) Dmdends:' Clienge.In:: Endmg ,
Balance " iExpenses/:`: ':Value Balance _
as of 5 �Transfers. z, S � as�bfk s
10-Jun-2013` - � " �;, � ' �� < � t��?' �� ..:� j�io J�j�Oia_
,
-- , �._, ..i . - z . -
:-,__ . __ ..
EMPLOYEE BEFORE $91,234.67 $0.00 $0.00 $0.00 � $21.23 $91,255.90
TAX
Total $91,234.67 $0.00 $0.00 $0.00 $21.23 $91,255.90
Activity By Investment Option
Investment Beginning Deposits �Transfers. °'Withdrawals/ �Divitlends Change =Endmg�_ Unit/Shares ?
Option Balance . - 'Espenses _ InrValue �Balance: 'as of � .. .
as of `? as of, 10-J6n-2013=
10-Jun-2013 10 Jun-2013 :.
, Stuble Value $91,234.67 $0.00 $0.00 $0.00 $0.00 $21.23 $91,255.90 44,876.47
Fund
Total $91,234.67 $0.00 $0.00 $0.00 $0.00 $21.23 $91,255.90
I
: r
�
�
j
L
Page 1 of 1 98978-0]-3393263
�
;
�Ta�MENrq�h
a OMB Approval No.2502-0265
��II�IIIII�� A. Settlement Statement (HUD-1)
9�,H o���e
B.rype of Loan
1.Q FHA 2.Q RHS 3.�Conv.Unins. 6. FNe Number: 7. Loan Number: 8. MoRgage Insurance Case Number.
4.❑�A 5.�Conv Ins. 201308206.PFD 115130820000
C. Note: Thls form is fumished to gi�you a statement of acfual setNement costs. Amounts pakl to end by the sefBement agent are shown.
Rems marked"(p.o.c.)"were pa(d oufslde the cfosing;they are shown here for informa�nal purposes end are nof�duded in fhe totals
D. Name and Address of Borrower: E. Name and Address oi SeAer: F. Name andAddress of Lender:
Theodore D.Pavefic Alan E Gloger E Mortgage Management,LLC
Kacey M.Pavetic 401 Orehard Lane ISAOAATIMA
405 V'�sta Orive Mechanhsburg,PA 17055 222 Haddon Avenue,Sufte 2A
West Chester,PA 19380 Haddon Township,NJ 08108
G. Property Locatbn: H. SefllementAgent: I. SetUement Date:
401 Orchard Lane Central Penn land Transfer,LLC
Mechanksburg,PA 17055 3800 Market Street Oetober 15,2013
Cumberland Counly,PennsyNan(a Camp H61,PA 17011 Ph. (717)695-3166
Place of SeUlement:
3800 Ma�icet Street
Cam Hfil,PA 17011
J. Summary of Borrowers transaction K. Summary of Sellers transadion
100. GrossAmount Due from Borrower. 400. GrossAmount Due to SeBer.
101. ConUecl sales rke 158 000.00 401. Contract seles rlca 158,000.00
102. Personei ro e ' 402. Personal r e
103. SetUemenl Char es to Borrower Line 1400 10,506.60 403.
104. 404.
105. 405.
Ad ustments for Items atd b Seiler In advance Ad ustments for items aid b Seiler in advance
106. C lTown Te�res to 4p6,Gl/Town Ta�s to
107. Coun Taxes 10/16N3 to 01/01H4 137.89 407.Coun Taxes 1N16H3 to 01J01N4 137.89
108. SchoolTaxes 10H6113 to 07I01/14 1,359.88 408.SchodTaxes 10/1fiH3 to 07I01114 1,359.88
109. F(nai Sewer 10/16H3 to 01/01/14 93.74 409.Final Sewer 10H6113 to Ot101/14 93.74
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 770,098.09 420.Gross Amount Due to 3eller 159,597.49
200.Amounts Pald b or in Behalf of Borrower 600. Reductions in Amount Due Selter.
201. De osH or earnest mon 2 500.00 501. Exaess de osk see InsUuctbns
202. Prfn al amount of new loan s 152 871.00 502. SeHlement cher es to Seller Line 1400 12,688.60
203. E�dstfn loan s taken su ect to 503. Exislin ben s taken su to
�• 504.Payoff Ffrst Mortga e
�5• 505.Pa Second ort e e
206. 506.
207• 507. De osft dfsb.as roeeeds
208• 508.
209. SeperAssist 4740.00 509.SelerAssist 4,740.00
Ad ustments for items un aid b Seller Ad ustments for ttems un aid b Seller
210. C /Town Ta�s to 510.C /Town Taxes to
211. Coun Taxes to 511. Coun Taxes to
212. Sehool Taxes to 512.School Ta�oss lo
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid b Ifor Borrower 160,111.00 520.Total Reductlon Amount Due Seller 17,429.60
300. Cash at Settiament fromlto Bortower 600. Cash at settlement tolfrom Selle�
301. Gross amaunt due trom Borrower Ihe 120 170,088.09 601. Grass amount due to Seller Itne 420 159 591.49
302. Less amount aid /for Borcower(Ane 220) ( 160,111.00) 602. Less reducUons due Seler One 520) ( 17,428.
303. Cash �From � To Borrower 9,987.09 603. Cash �X To � From Seller 142,161.89
•aeiaawimadadonyreorrwwr(e�.sdiMS7 a u. rav■bin
The undersigned hereby adm dge ipt of a completed copy of this statement 8 any aBachmentssef erein
Borrowe��----�. Selle� �""0
ore D.Pavelic / e
✓li�/ �
cey M.Pa I'
TM P�tllc Repatlrg drdmtvlHS ctllectlmdlrlmnaUm la esYma�eC tl35minlas pr respanefa mllxtlng,rMadng end rqprtlngtho dma Thb egen�,y mey mledlad Ws Irtmnetla�entl youerend req�IreCbcanpele
mIRe�MA,irlsas Itaspeya a arrally veIItlOMB mNd nmba.NocorAdeiyyiy Is avs�req Wa Qs�mUela mrqalay.THS Is dasigbdto prwlde Ihepatles baRESAim✓eredUaeatlmxith Irdarmetlm prinppieaq9em W
Page 1 of 3 HUD-1
(201308206.PFDR01308206.PFD/32)
L.Settlement Cha es
700 iofalReal,�slate BrokerF.ees: g'9,'�95.60' . Paid From Paid From
Diuisron of commissfon(fine 700)as foBOws Baraxe�'s Sellers
701.$4,597.80 to Centu 21 at the HeM Funds et Funds at
702.$ 4,597.80 to Prudenlial Homesa�Service Settlamem Settlement
703.Commissbn aid at setUement 9195.80
704.Broker Fee to Prudential Homesale Services 295.00
BOOF Items:Payabj�:i�Oohneat�oh witil Loan ''
. $ 895.00 from
_:._� .
801.Our o inatfon char e GFE#1
802.Your aedit or cha e oints tor the s '�c Interest rate chosen from GFE#2
803.You usted or' inat ar es from GFE#A 895.00
804.A re(sal fee to BurkhokierA raisal from GFE#3 P.O.C. 425.00 8•
805.Cred�Re ort to E Mort a e Mana ement,LLC ISAOAATIMA ftom GFE#3 25.44
806.Tax serv�e to from GFE#3
807.Flood cert7rcation to E MoA a e Mana ement LLC ISAOAATIMA irom GFE#3 6.00
808. irom GFE tl3
�9• irom GFE if3
81�• from GFE#3
811 (from GFE#3)
900:�tums'ReqUtred!6y Lerydef.to Be pa(diih Advapo'e-, :
901.Da interest cha es from 10N5M3 to 11/01113 17 $19.894200/da trom GFE#10 33820
962.Mortgage insurance premtum for months to Private Mortgage Ins. (Gom GFE#3) 5,141.00
803.Homeowner's insurance for 1.0 years to Stata Farm Insurance (from GFE#11) P.O.C.$652.00(Bp
9�• (from GFE#11)
905. (from GFE#11)
... .
1000 ReseNes Depo'sfted Hiith:Lender ,'. � `
1001.IniUal deposit for your esaow axount (from GFE#9) 820.46
1002.Homeowner's insurance 2.000 monlhs @ $ 54.33 per month $ 108.66
1003.MoA a e insurance months $ r month $
1004.Pro e taxes g qqq.qg
Coun Taxes 8.000 months $ 55.56 er month
SchooiTaxes months (a3 $ per month
1005.
1006.School Taxes 4.000 months � g 163.59 per month $ 654.36
1007. manths @ $ per month $
1008. $
1009.I�gregateAdjustment g _387.pq
��oo ritle�aha�ees.. : , , . _
. __ , .
1101. T�le services and lender's tftle insurance (irom GFE#4) 1,509.50 21.00
1102. Settlement or dosin fee $
1103. Owner's t�le insurance to F�stAmerirdn Tdle Insurance Company (ftom GFE#5) 25.00
1104. Lender's tftle insuranoe to FIr�Amerkan Title Insurance Company $ 1,315.00
1105. Letrcler's tftle polhar fmd $ 152,871.00
1106. Owner's tit�policy Gm� $ 158,000.00
1107. AgenPs portbn of ihe total tltle fnsurance premium to Central Penn Land Trensfer,LLC $ 1,139.00
1108. Underwr�er's port(on of the totat title insurence prem(um lo FirstAmerican Tftle Insuranae Company $ 201.00
1108. $
1110. $
1111. $
1112. $
1113 $
,.. : . _
2 0 Ciovem�ne�t ReaoMth atid TrahsfA��Qha�g'es':: '
1201.Government reeordfn cha es to Cumberland
:_. . ., ;:..> _
Coun Recorder oF Deeds from GFE# 166.00
1202.Deed $ 62.00 Mort a e$ 104.00 Releasea$ Olher$
1203.Transter t�ces to CumbeAand Counly Reoorder of Deeds (from GFE#8) 1,580.00
1204.C /Coun taxlstam Deed $ 1,580.00 Mort a e$ ����
1205.State tawstam s Deed$ 1,580.00 Mort e e$
1206.
1207.
4300 Ad"dltfonal smtti�ment Clieiges. :, .
,_.. • . , '. '
_ . __..: .. ,
1301.Requlred services that you can shop for (from GFE p6)
1302. Radon to Amerkan Radon Soiutions $ 900.00
1303.HB McClure to HB McClure $ 224.00
1304.Final Sewer to UpperAllen Twp $ p�ct#53qpp3 224.00
1305 Altorney Fees to Griffie&Associates $ 250.00
1400.�ota1'Settlemeht�Ghargys'(enter oti..l�„es 103;;5eotion J+aiid 502+9eotfon K).;` " . 90;SO6;6U� 12,889i60'
..�Pxaan�atlam�mMeorrw«(B�.senertS7.�e�lorfU.amr6wMfn
B�ISIqY�gpapataftliaalaraner{Iheslg�arleseelmvMedgereetlqclearnqeledxqdpage283aftlVSUree ste ert
Central Penn Land r fe LLC ementAgenl
Page 2 of 3 HUD-1
(201308206.PFD/201308206.PFD/32)
Attachment to Schedule "H"
�?a�Me�.o�.�, OMB Approval No.2502-0265
�� ����a
` A. Settlement Statement (HUD-1)
N�ifN OE`1E�,0
B.rype of Loan
1.�FHA 2.Q RHS 3.�Conv.Unins. 6. File Number: 7. Loan Number: 8. Mongage Insurance Case Number:
4.Q Vq 5.�Conv.Ins. 201308206.PFD 115130820000
C. Note: This form is/umished to gi�yvu a statement of adual sefflemenf costa Amounts peid to and by the seftlement agent are shown.
Items marked"(p.o.a)"were pald oufside the dosing;they are shown here for iNormational purposes and are nof induded'm fhe totals.
D. Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender:
Theodore D.Pavel� Alan E Gloger E Mortgage Managemanl,LLC
Kacey M.Pavelic 401 Orchard Lane ISAOAATIMA
405 V'�sta Drive Mechanicsburg,PA 17055 222 Haddon Avenue,Suite 2A
West Chester,PA 19380 Haddon Township,NJ 08108
G. Property Location: H. SettlementP�gent: I. Settlement Date:
401 Ord�ard Lane Centrel Penn Land Transfer,LLC
Mechanicsburg,PA 17055 3800 Market Street October 15,2013
Cumberland Counry,Pennsytvania Camp H�I,PA 17011 Ph. (717)695-3166
Place of Settlement:
3800 Marl�t Street
Cam Hul,PA 17011
J. Summary of Borrowers transaction K. Summary ot Sellers transaction
100. GrossAmount Due from Borrower: 400. GrossAmount Due to Seller:
101. Contrad sales rioe 158,000.00 401. Contrect sa�s rice 158,000.00
102. Personal ro ert ' 402. Personal r e
103. SeHlement Char es to Borrower Line 1400 10,506.60 403.
104. 404.
105. 405.
Ad ustments for Items aid b Seller in advance Ad ustments for items aid b Selier in advance
106. C' lfown Taxes to 406.Cit/Town Taxes to
107. Coun Taxes 10l16/13 to 01/01/14 137.89 407.Coun Taxes 10/16/13 to 01/01/14 137.89
108. School Taxes 10/16/13 lo W/01l14 1,359.66 408.School Taxes 10l16/13 to 07/01/14 1,359.86
109. Final Sewer 10/18/13 to 01/01/14 93.74 409. Final Sewer 10/16/13 to 01/01/14 93.74
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 170,098.09 420.Gross Amount Due to Seller 159,591.49
200. Amounts Pald b or in Behalf of Bortower 500. Reductions in Amount Due Seller.
201. De os�t or earnest mon 2,500.00 501. Exoess d osk see instructbns
202. Prin'al emount of new loan s 152 871.00 502. Settlement char s to Seller Line 1400 12 689.60
203. Fxistin ban s teken su ect to 503. Existin loan s taken sub' to
204. 504. Payoff Fir�Mortgage
205. 505. Pa B Second Mort a e
206. 506.
207. 507. D osit dkb.as roceeds
208. 508.
209. SellerAssfst 4740.00 509.SekerAssist 4,740.00
Ad uatments for items un aid b Seller Ad ustments for items un aid b Selle�
210. C /Town Ta�s to 510.C lfown Ta�ces to
211. Cou Texes to 511. Coun Taxes to
212. School Ta�s to 512.School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517,
218. 518.
219. 519.
220. Total Paid b Ifor Borrower 160,111.00 520. Total Reduction Amount Due Seller 17,429.80
300. Cash at Settlement from/to 8ortower 800. Cash at settlement to/from Seller
301. Gross amount due from Borrower line 120 170 098.09 601. Gross amount due W Seller Iine 420 159 591.49
302. Less amount akl /for Borrower(line 220 ( 160,111.00) 602. Less reductiona due Seler Bne 520) ( 17,429.60
303. Cash a From � To Borrower 9,987.09 803. Cash X�To � Prom Seller 142,161.89
•Pela aAeldeardoGna M mrwwrtel,eel�xts) U. raaert'i(T>
The undersfgned hereby adcn dge ipt af a completed copy of this statement 8 any attachmentsset erein
Borrower �-�� Selle� �✓`'�d""_
` T e dore D.Pa Cc / e
�L�
cey M.Pa f
The Rtlic Repartlrg Birtlen fa tlYS cdlectlon af INameUm le eslimete0 e135 mirnles per respane far cdleUing,reNeMng,eM repMtlrq Ihe Eela.Thla eggcy mey not oalleel IHa It/ametlan,endywae M rapiretl bcamqele
W s form,uiess It dnplaye e urrerpy velid OMB eoMrd nunher.No corflder�allry I s eseire�Uis 6sdaeire is meMetay.Thls Is desigiatlta proAtlethe pertlm to e RESPAwvered VemeGlmvAlh INam Wmdeirqtheaetllemere
a�••
Page 1 of 3 HUD-1
(201308206.PFDI201308206.PFD/32)
L Settlement Cha es
700,Tot81 Real Fstate Broker'Fees $9,195.80' Paid From Paid Fr«n
Division of commissfon(6ne 700)as IoNows: Baro�ver's Sellei's
701.$4,597.80 to Centu 21 at the Hekn Furds at Fur�ds�
702.$ 4,597.80 to Prudential Homesele Service S�tlement S�tlaneM
703.Commission ab at settlemenl 9195.60
704. Broker Fee to Prudential Homesale Services 295.00
800:Ite�ns Payable fn Qohneatloh witli toan
__ _:
801.Our or' ination char e $ 895.00 from GFE#1
802.Your credd or char e oints for the s �c interest rate chosen from GFE#2
803.Your ad'usted or' inetan char es from GFE#A 895.00
804.A raisal fee to BurkholderA raisal from GFE#3 P.O.C. 25.0 B•
805.Credit Re ort ta E Mort a e Mana ement,LLC ISAOAATIMA from GFE#3 25.44
806.Tax service to from GFE#3
807.Flood aert�cation ta E Mort a e Mana ement LLC ISAOAATIMA from GFE#3 6.00
�B• from GFE#3
�9• from GFE#3
810. from GFE#3
81�� (from GFE 113)
900,�tems Required by Lendef to Be Paltl in Ativanae
901.Dai interest char es from 10/15/13 to 11/01/73 17 $19.894200/da from GFE#10 338.20
902.Mortgage insurance prem�m for months to Private Mortgage Ins. (ftom GFE#3) 5,141.00
903.Homeowner's insuranca for 1.0 years to State Farm�nsurance (from GFE#11) P.O.C.$652.00(B)•
9�• (from GFE#11)
905. (from GFE#11)
1000.Resenres De osited with Lender
1001.Indial deposit for your escrow account (from GFE#9) 820.46
1002.Homeowner's Insurence 2.000 months Qa $ 54.33 par month $ 108.66
1003.Mort a e insurance months $ r month $
1004.Pro e taxes $ qqq,qg
Coun Taxes 8.000 months $ 55.56 r month
SchoolTaxes months @ $ per month
1005.
1008. School Taxes 4.000 months Q $ 163.59 per month $ 654.36
1007• months @ $ per month $
1008. $
1009./�gregateAdjustment $ _387,pq
9100.Title'QIIdf9es
1101. Title services and lender's tftle insurance (from GFE#4) 1,509.50 21.00
1102. SeHlement or dosi fee g
1103. Owner's t81e insurance to FirstAmerican TRIe Inwrance Company (from GFE#5) 25.00
1104. Lender's title insurance to FirstAmer�an Tftle Insurance Company $ 1,315.00
1105. Lender's title poYcy kmk $ 152,871.00
1106. Owner's title policy dmit $ 158,000.00
1107. AgenPs portan of the totel title insurance premfum to Central Penn Land Transfer,LLC $ 1,139.00
1108. Underwriters portion of the total title insurance premium to FfrstAmerican TRIe Insurance Company $ 201.00
1109. $
1110. $
1111. $
1112. $
1113. $
1200�GoVemmenl.R§aordin"!.ahd Trahsfer Oha; es <:
1201.Government recordin char es to Cumberland Coun Recorder of Deeds from GFE# 166.00
1202.Deed $ 62.00 Mort a e $ 104.00 Releases$ p�►�e� $
1203.Transfer t�ces to Cumberlend County Recorder of Deeds (irom GFE#8) 1,580.00
1204.C' /Coun tax/stam Deed $ 1,580.00 Mort a e$ �580 pp
1205.State taxlstam s Deed $ 1,580.00 Mort e$
1206.
1207.
73G0�Adilitlon�l S�ttiemerlt Cfiarges-
, ._ .....
1301.Required services that you cen shop for (ftom GFE q6)
1302. Radon to Americen Radon Solutans $ 900.00
1303. HB McCh�re ta HB McClure $ 224.00
1304. Final Sewer to UpperAllen Twp $ Ad#534003 224.00
1305.Attorney Fees to Griffie 8 Assodates $ 250.00
1400,Tofal'Settle►neht Charges(eriter oi�Iiqes 103`;Seotion J;+and.502,3eotiop K)`. 10,b06;60 12;689i60'
•ce�d walae aaaeire M mrrw.er(�..gier(s�.�ender(�).ar wrd.vam(r)
��ery�aa�»mas�ecenaq�neno�esecwu�aeagereee�pcaecanpe�eacapyapage2aaawearee s�e mac
Central Penn Land ra fe LLC ement Agent
Page 2 of 3 HUD-1
(201308206.PFDYZ01308206.PFD/32)