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HomeMy WebLinkAbout01-21-15 (2) �i pennsylvania 1505614105 ..jpEYAF.IMENf OFfIEVENtIE ex(03-ta)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 15 MM//�� WKJ-] ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 12212014 12291926 Decedent's Last Name Suffix Decedent's First Name MI MAGLICH PEGGY A .... ..... _.... ; (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) C=:) 4.Agriculture Exemption(date of O 5. Future Interest Compromise(date of O 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) 7.Decedent Died Testate C=) 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) C=) 10. Litigation Proceeds Received O 11.Non-Probate Transferee Retum O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets C) 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NameDaytime Telephone Number THOMAS E. FLOWER (717) 243-5513 ....... _ ...... ..... .... ......... __ ............................... First Line of Address .. FLOWER LAW, LLC ....... .. ............... . ......... ........ .... Second Line of Address 10 W HIGH ST ....... ............_._.._.._.._...._ .. ..._.... .. ..... .... _.. City or Post Office State ZIP Code .......... .............. ........... . ......... .... .. ...._ _...._ ...... ......... .. ....... .. CARLISLE PA 17013 .... .... _. . _._ _ ......... Correspondent's email address: REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY v �a M Vz; DATE FiLE6AMP fV rT1 PLEASE USE ORIGINAL FORM ONLY Side 1 C:) r.__ m ^i _I __I_- v) o 00 —*I � 1111111 IIIII IIIII IIIII Illli III IIIII VIII VIII VIII IIII IIII 1505 14105 1505614105 J 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: PEGGY A. MAGLICH RECAPITULATION .....-__................... _........................_........._............_......._._........ �.__.._._....._._._..... 1. Real Estate(Schedule A). ... ... ... .... .. ...... ..... ...... .... ... ... .. 1. � 0.00 2. Stocks and Bonds(Schedule B) . .. ........ ..... .. . ...... ..... ... ... . .. 2. 1 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable Schedule D 4. � 0.00 . 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. . . 5. j 15,809.19 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ... ... 6. 100,759.20 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .. . . 7. 48,160.06 8. Total Gross Assets(total Lines 1 through 7).. .... ... .. ..... .... .. .. .... . 8. � 164,728.45 i I 9. Funeral Expenses and Administrative Costs(Schedule H). ..... ..... .. . .... . 9. 10,885.25 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)......... ..... . 10. 6,980.11 11. Total Deductions(total Lines 9 and 10).. . .... ... .. ... . ..... ... .. .... ... 11. EE� 17,865.36 12. Net Value of Estate(Line 8 minus Line 11) . ...... ..... ...... ..... .... ... 12. I 146,863.09 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) . .. ... .. . ... ... .. ... . .. . 13. ; 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) .. ..... .. .... ... . .... .. . 14. 146,863.09 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or .......... .. _--- _ ._._.._.. .............._..........._...................-. __......_._._.__..........._..............._....................-) transfers under Sec. 11 �' - " -" �""i (a)(1.2)X.0_ 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 146,863.09 1 16. i 6,608.84 17. Amount of Line 14 taxable at sibling rate X.12 17, 18. Amount of Line 14 taxable i at collateral rate X.15 j 18. _.........._.__.._.......-............................._... __.___....__.......-_......._........ _., 19. TAX DUE ............ ...... . .. . . 19. 6,608.84 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has an,y knowledge. IMiPER ON P NSIB FOR FILING RETURN D E^ ADDRESS Q V MICHELE M. BROWN, 912 MAPLEWOOD LANE, ENOLA, PA 17025 SIGN OF PREPARE ER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE 1� �� 0112012015 ADDRESS FLOWER LAW, LLC; 10 W. HIGH ST., CARLISLE, PA 17013 L �iiii��ui �im�iuii iiui ilii uii Side 2 1 0 14 0 1505614205 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME PEGGY A. MAGLICH STREET ADDRESS MESSIAH VILLAGE 100 MT ALLEN DRIVE CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6,608.84 2, Credits/Payments A.Prior Payments 6,278.41 B.Discount 330.43 Total Credits(A+B) (2) 6,608.84 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... ❑ 9 b. retain the right to designate who shall use the property transferred or its income;............................................ ❑ F c. retain a reversionary interest;or.......................................................................................................................... ❑ R1 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ Z 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? ........................................................................................................................ F ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116(a) (1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-15o8 EX+(ii-io) T= A -pennsytvania SCHEDULE DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: PEGGY A. MAGLICH Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Required minimum distribution from decedent's IRA processed 12/20/14 1,500.00 2. Hartford IRA annuity contract cash surrender proceeds,transacted 12/22/14 on pre-death instructions 14,309.19 TOTAL(Also enter on Line 5, Recapitulation) $1 15,809.19 If more space is needed, use additional sheets of paper of the same size. Retirement Plan Statement, 01-01-13 to 12-31-13 Al INDIVIDUAL RETIREMENT ACCOUNT M&T TELEPHONE BANKING CTR M&T BANK AS TRUSTEE FOR P O BOX 767 BUFFALO NY 14240 000011603 J 0602288 800-829-1924 .Y1 1208 28,337 PEGGY MAGLICH 912 MAPLEWOOD LN ENOLA PA 17025 .... .._Lft 16-0538020 �� .. ACCOUNT NO 35-004202730724 ACCOUNT TYPE. 60-72 MONTHS RATE 0 . 750 MATURING 01-31-16 REGULAR IRA 01-01- 13 BEGINNING BALANCE 42,887.02 03-2.1-13 TAX WITHHELD-NORMAL W/D 300 .00- 42,587..02 N 03-21-13 PAYOUT DISTRIBUTION 1 ,200 . 00- 41, 387 .02 06-21-13 TAX WITHHELD-NORMAL W/D 300 . 00- 41,087 . 02 06-21-13 PAYOUT DISTRIBUTION 1 ,200 . 00- 39,887. 02 09-20-13 .TAX WITHHELD-NORMAL W/D 300 . 00- 39,587. 02 09-20-13 PAYOUT DISTRIBUTION 1 ,200 . 00- 38,387 . 02 12-20-13 TAX WITHHELD-NORMAL W/D 300 . 00- 38, 087 . 02 12=20- 13 PAYOUT DISTRIBUTION 1 ,200 . 00- 36,887. 02 Y 12-31-13 INTEREST 304 .61 37, 191 .63 ACCRUED INTEREST AS OF 12-31-13 0 . 76 s m a w h S 5 S PLAN SUMMARY BEGIN PLAN BAL 42,887 . 02 DISBURSEMENTS 4,800 . 00 PLUS DEPOSITS. . 00 FED TAX WITHHELD 1 ,200 . 00 NET INTEREST 304.61 ST TAX WITHHELD . 00 LESS DEDUCTIONS 6 , 000 . 00 TOTAL PLAN VALUE 37, 191 .63 2013 IRA CONTRIBUTION INFORMATION THIS INFORMATION IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE BOX 1 - IRA CONTRIBUTIONS IN 2013 OR 2014 FOR 2013 0 . 00 BOX 2 - 2013 ROLLOVER CONTRIBUTIONS 0 . 00 BOX 5 - FAIR MARKET VALUE OF PLAN AT END OF 2013 37, 192 . 39 BOX 7 - IRA BOX 12A - REQUIRED MINIMUM DISTRIBUTION BY 12-31-14 BOX 12B - REQUIRED MINIMUM DISTRIBUTION AMOUNT . 2, 928 .53 1007(11n3) - Go paperless! Sign up for electronic document delivery at www.thehartford.com/edelivei-v or call THE 1-800-862-6668 to learn_ more. HARTFORD 01100078201 MBO.432 "AUTO T3 0 2248 17025-2073 IACL 0-POO782 ilniilll,,, i� ill,il'lllllllllf I'nlnlilllllillln,��ll '';�*�►� PEGGY A MAGLICH 912 MAPLEWOOD LN Date: December 22, 2014 ENOLA PA 17025-2073 Contract Number: 000012001/210089426 Type of Contract: IRA Owner Name: Peggy A Maglich Annuitant Name: Peggy A Maglich Your CRC®fixed annuity financial confirmation The total value of your annuity on December 22, 2014 is $0.00 Your Contract Details: Contract Effective Date: December 7, 1994 Current Guarantee Duration: NA Gross Contributions were: $15,343.28 Interest Rate: Multiple Details of your transaction(s): Full Surrender Transaction Date: December 22, 2014` Rate Duration Amount Rate Guaranteed Until FROM, 3.00% NA -$14,309.19 . 210089426 PAGE 1 OP 3 A Inn 7-Annnnn l-Inn 1A I.__1A 1gph1 p 1^110019 Details of your surrender: Your Net Surrender Amount will be distributed to you in a separate mailing. Gross Surrender Amount $14,309.19 Withholding Federal Income Tax -$1,43)0.92 PA State Income Tax -$715.46 Net Surrender Amount $12,162.81 The Taxable Amount for this surrender is $14,309.19 The Taxable Amount provided is for iqforniationalp-w73ose,�only. In the case (?f an TR.C. section . 1035 exchange, Direct Traasfer, 07-Direct Rollover, The Harford i,s,i//not report the Taxable Amount proi)ided as taxable to the IRS. For custodian accounts, the Taxable Amount provided may be different than the taxable amount determined and reported to the IRS by the custodian. The Har ford recommends consulting with a qualified lax advisor regarding the tax consequence,5 of your If federal taxes are withheld, state tax withholding may be applicable for certain states based on the owner's state of residence. Please contact your tax advisor for questions on tax withholding. Payee Information: Payee Name: Peggy A Maglich Under the terms of the Contract, if the contract value falls below the required minimum as the result of a partial surrender, we will close your Contract and return to you any surrender value. Reinstatements are not allowed. We are ismling this confirmation statement on behalf of the selling broker-dealer. Hartford Life Insurance Conipany Is�mier; Har ford Securities Diy1ribution Comj)any, Inc.- Principal Underwriter. 210089426 PAGE 2 OF 3 Date: December 22, 2014 Contract Number: 000012001/210089426 Type of Contract: IRA Owner Name: Peggy A Maglich Annuitant Name: Peggy A Maglich For assistance For investment-related questions contact your Investment Professional(s): Diane M Spinuzza or Gregg D Jensen at M& T Securities Inc For information on services offered by The Hartford, please visit www.hartfordinvestor.com or call 1-800-862-6668 (Monday -Thursday 8:00 a.m. to 7:00 p.m., Friday 9:15 a.m. to 6:00 p.m. Eastern. Standard Time) or write to Hartford Life.Insurance Company, P.O. Box 14293 Lexington, KY 40512-4293. "The Nm•t%vd"is The Hagford Ehia cial Seivices Group,hie., and ils Subsidiaries, including the issuing col' pallies Of LLL Hcir 210089426 PAGE 3 of 3 REV-1509 EX+(01-10) .r pennsylvania SCHEDULE F j DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: PEGGY A. MAGLICH If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. MICHAEL F. MAGLICH 9234 WRIGHT'S HOLLOW LANE SON LORTON,VA 22079 B. MICHELE M. BROWN 912 MAPLEWOOD LANE DAUGHTER ENOLA, PA 17025 C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 04/30/01 THREE(3)$1,000 FACE VALUE I SERIES US SAVINGS BONDS 6,602.40 50% 3,301.20 2. B. 04/30/01 THREE(3)$1,000 FACE VALUE I SERIES US SAVINGS BONDS 6,602.40 50% 3,301.20 3. A. 03/31/99 SIX(6)$1,000&ONE(1)$500 HH SERIES US SAVINGS BONDS 12,209.29 50% 6,104.65 4. B. 04/30/00 SIX(6)$1,000&ONE(1)$500 HH SERIES US SAVINGS BONDS 12,209.29 50% 6,104.65 5. AB M&T SECURITIES ACCT#AZD-514966:3718.548 SH.NTNYX @ 11.13 41,387.44 33% 13,795.81 6. AB 06/30/97 PUTNAM INVESTM'NT ACCT#274672080:5480 SH.PGRWX @ 21.755 119,217.40 33% 39,739.13 7. B FIRST NIAGARA BANK ACCOUNTS##XXXX-2376&-1756 1,615.56 50% 807.78 8. A FIRST NIAGARA BANK ACCOUNT#XXXX-9587 1,091.58 50% 545.79 9. AB CITIZENS BANK SVGS.&CKG.ACCOUNTS#622515-740-2 81,176.97 33% 27,058.99 TOTAL(Also enter on Line 6, Recapitulation) $ 100,759.20 If more space is needed, use additional sheets of paper of the same size. I I BOND VALUES for Date 12/2014 Issue st Price Rate M 0 0: 2 0 0,; 1 1,000;, 04/01 01/15 04/2031 1,000 1,200.80 5.27% $2,200.80 4 8 0 3 0: 4 1 1,0003 04/011 01/15 04/2031 1,000 1,200.80 5.27% $2,200.80 0 5 1 1,000- 04/01 . 01/15 04/2031' 1,000 1,200.80' 5.27%5 $2,200.80' ----------------- ------- 0 ------ 1 1,000; 04/01 ' 01/15; 04/2031: 1,000' 1,200.80 5.27% $2,200.80 6 0 1 1,000; 04/01 , 01/15 04/2031 1,000 1,200.80 5.27%; $2,200.80 7 8 0 1 1,000; 04/01 , 01/15 04/2031 1,000 1,200.80: 5.27% $2,200.80 Totals for 6 Bonds' 6,000. 7,204.80; $1 All I Bonds are joint with one child: Inheritance Tax Value @ 50% _$ ,§,§92.40 SERIES, 1 INTEREST CEASES 30YEAR9 FROM ISSUE DATE- 086 20 2586 r 4� 1 200 ��•�,'t. ., 'i0C1AL secueg'nc'ovNl ugwt. .. ).00", -e lssus DAr.a 444, PEGGY MAGLICH kFRB BUFF 04-13-0.1 ' . 6023-4 QUAKER HOLLOW,CR ,. ORCHARD. PARKl NY `. 14127-1866 J` � � 1111II111111Illlltli 111111111111111111111111111,111111111111111 "I " q,� r .OR MICHELE .MAGLICH BROWN", `RDS-A 021001088-0001 :0000000 041001 016 0002004808. 14. J11bert Erinateln ti ` - _ �"`"°s' . 10000.0900071: 2 ? 8000 2004808��' .� .. , . f . SERIES I INTEREST CEASES 30YEARS . FROM ISSUE DATE .086 20 2586 04200i�, I..l uhli V wf.-JUNE I.JMbEb ToPEGGY. MAGLICH FRB BUFF 04-13-01 6023-4 QUAKER HOLLOW CR 1 ORCHARD PARK NY 14127- 1866 ..we, rt�f,.,, 1111111111 I 11111/1111 1 a11111)11111111111/11111111111111111111 + . OR MICHELE MAGLICH BROWN • ''` RDS-A 021001088-0001. 0000000 041001 016 0002004807 M002004 01 8 I Elnste� fir^+$�xf y�°M o �� 1:0000 9000 71:2 7 7000 200 480 ?11' ---------------- ------------- SERIES I O INTEREST-CEASES 30YEARS FROM ISSUE,DATE 086 20 2586 �`:04, ( 200.1. To.PEGGY MAGLICH FRB BUFF 04-13-01 v 6023-4 QUAKER HOLLOW ,CR ORCHARD PARK NY . 14127- 1866 n^i3 ��Id�. .II1111111111111I 1111111 IIIIIIIIIIIIIIIIIIIl 11 111 11111111111111 , r OR . .MICHELE MAGLICH BROWN r M-'RDS-A 021001088-0001 0000000 041001 016 0002004806. . :Albert Einstein-� .�'"°' " -' - M002004806I 5....a.ry.�e1.T.�oy 1:00009000 71: 2 7 6000 2004806'15 2001;.2586 04 i \ ti GGY .MAGLICH FRB BUFF 04-`13 .0.1 f 6025' QUAKER HOLLOW APT 4..`` ' 1 D:RCHARD PARK NY 14127 1866. " �� Iris/�flit�st1��11It�11/1�/ti11�/tlst�ts/siisslls'ilt�si��tsts� �r y OR . MICHAEL F :MAGLICH hZjW T, �i #2Bt=A02!001088-0001 00000.00 041001016 0002004805 fiT - M002004805t„ »OC�009CDOQ ?j. i `..S.0 oo;200480S.It= ; SIERMS INTEREST C6YbARb .r r < PRaH1 ILBUH oAY@ 086 20 2586 114= 200T ?�t'PEGGY 'MAGLICH ARB. BUFF ' 04-'13`--01 6023 QUAKER HOLLOW APT 4 ORCHARD NY 14I27:.-1866 ft♦]11holitl1111101/1illh I OR : :MICHAEL F MAGLICH R1J5—.A 0Z1001088-0001 .0000000 041001..01,6 0.002004804 �•��g j(���2,0 0.�'S.l 4 . LJ' ' ' f ;.... 0000 9000 �1: 400'0 200 LIZ 4 IN .. YIEnL¢7 C4"A8$8 9A YPARS' a� r : 086 20 2586. 0 4 . :0 0-1 PEGGY MAGLICH rRB. BUFF . �r -04'"13-0;1 >, 60423 QUAKER HOLLOW APT 4 '_% 1 "ORCHARD PARKr NY} }14127. 1866 ���` ''� V � t�l�lti�/li«1lI,�EIt11�iIAAI1�11fliltlll/1�ltl�itlliliti[Ili� -,,OR : MICHAEL. F..:MAGLICH ,4�,.• ,.j'r r sS00:0200'4803'088-t0U1 0000000 041001 0 6tRBS--A• 021001 .. + OOC109000 ?�:,2 7 z ` 3000.200480 3u" HH BOND VALUES FOR 12/2014 A.SIX(6) BONDS OF$1,000 FACE VALUE W/$878.84 DEFERRED INTEREST JOINT WITH MICHELE B. ONE (1) BOND OF$500 FACE VALUE W/$436.25 DEFERRED INTEREST JOINT WITH MICHELE C.SIX(6) BONDS OF$1,000 FACE VALUE W/$878.84 DEFERRED INTEREST JOINT WITH MICHAEL D.ONE(1) BOND OF$500 FACE VALUE W/$436.25 DEFERRED INTEREST JOINT WITH MICHAEL E.SIX(6) BONDS OF$1,000 FACE VALUE W/$878.84 DEFERRED INTEREST POD TO MICHELE TAX VALUES(ALL BONDS PURCHASE 1999 OR 2000): A. $6,000+ $5,273.04_2 = $ 5,636.52 B. $500+ $ 436.25_ 2 = $ 468.13 C. $6,000+ $5,273.04- 2 = $ 5,636.52 D.$500+ $ 436.25_2 = $ 468.13 E. $6,000+ $5,273.04 $11,273.04 Total Inheritance tax value HH Bonds: $23,482.34 .SERIES-RR- - rr`y�"��yy���j{yy ^^ a}..1�t�`"-.�.yy. y ♦may A� Y:r^• l�19 Y '411�y (i1�6�:A�Y'yt'y INTEREST CEASES 20 YEARS vlA-J C1.. ..,d.1 w6� FROM ISSUE DATE OF 086 20-2586 QO8 2000 i r,. PEGGY1 MAGLICH -: 60213 QUAKER NOLLQW ;.CRES dPT '4 i ! OR6,1j;ARD:', EPA K',_ NY 1'41.27 -OR' MICHELE MAGLICH 07613146 UEFE#2RED INTEREST= -$ 8���flf �� U b 1314 b_H H 00432100245073 is 6000 7 G 13 14 GIla --- ° �=�!''�'� `` =c�'�=;�� it a / 1 v u:•1 1 _ —11: � — � /Y = ____1 81 — SERIES R .,...,,... qvmu •-k ��\V�If 645 IN7E REST-CEASES 20 YEARS _ - FROM ISSUE DATE OF r,�` 086-20-2586 i1 '2000 kart, ' PEGGY MAGLICH "'t = 6023 QUAKER HOLLOW CRES #4 ORCHARD PARK; NY 14127 OR MICHELE MAGLICH BROWN 07691002 DEFERRED INTEREST $ 87 M b 910 0 2 H H 00423100334059 1 5 4000 ?69 100 2n' L��...... y-w;;✓..:._:•...,.,.+....•,.�_w.w:,.....,_.'.ti,:,:.�.xu J.S.zysC�J7Uld+Lh4�'am1:1.aJ:,l.�l:.rvt i: u';�� .ixJ.J.yuvx?y.�Ffr�`,.m•�.,tfixr,y.UxA!�+�:AtMata•;;� 'ro•tt i� ��.:::...sa .^.•sv:.� 4 SERIES-RR _- _ Tw-11��+'OW9, ANN INTEREST CEASES 20.YEARS _ FROM ISSUE DATE OF f 086-20-2586 ill 1 2000 __ !t PEGiGY; MAGLICH j 6023 °Q.UAKLR HbL3LOW CRES #4 QRC.HA D.. PARK, NY 14127 i ,w OR MICHELE MAGLICH BROWN 07691003 DEFERRED-:INTEREST- $ 1872 950 Mjb91003HH I 00423100334059 15 5000 7 G 9 100 311' _ 81:'uSLF.,[.a..s�Y;.;.,vs:.r.,.r.,;r..p�,�sy,iaeayldWCCaD " " 1GY•YA:1,.nar�:- nn:>.0^x!uypy� .w.x4,u!AU 4e„n, - .xsrvs.•x�xevm.:fiJEZ'ffiSX5Y21NLtvnat+,..-,.: a .(�or,r�H...rr �py �•��(� Tr�` 'IiY�JI 116tr 17 INTEREST CEASES 20 YEARS — _ — FROM ISSUE DATEOF - 086 20-258_6 jE r. k `= P-EG ,YiiMAGLiICH �+�..' 7 IaIr-it E i 6:023�1QUAKEIR� HOLLOWCR #4 i'� �,`L� +E — i O:RGJI�AA:RD( PAjRK; NY,I;l'_.i27 �� r— _ la � l -_ _— ,oN= AOR MiCHELE MAGLICH BROWN - 05395914 TN��Es� _O0423.100334059 L 4 L000-5 39 5 9 141' mom! fS � i,, j..�in, r .r y 3.• � ,. 1'( ! . f 7t � s'1 • � ',�. ,� r. • .���.; i'] rte ', ,•r 1 ; ..` .. -s , ,4f"'t• 40 4 ' r _ _ 086 20-2586 �.. t PEG,GY'':MAGLICH 6023=4 ,QUAKERHOLLOW CR . -ORCHARDPARK ' 'NY •14127 F , • � 1 , n OR MICHAEL F, MAGLICH- 07489577 : ; DEE , - rMxHEkD3PTEREST r $ 584� _ 00432100131027 L 5 0000 7489 5 7.7Il' w+ uoa.._.. 4isti'ifh .. 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Ir +� t ) 1 i + +� 1 it ! t� j i i !• r 1 r r j f .� .t, r �i i Putnam 2014 YEAR-TO-DATE STATEMENT INVESTMENTS 01/01/2014 - 09/30/2014 CONTACT INFORMATION INVESTMENTS: ACCOUNT: HOUSE EXTERNAL MUTUAL Putnam Investments >10078 4570629 001 092033 007302946 FUNDS 1-800-225-1581 MORGAN STANLEY SMITH putnam.com PEGGY A MAGLICH BARNEY LLC MICHELE MAGLICH BROWN & 1-914-225-5510 MICHAEL F MAGLICH JTWROS 912 MAPLEWOOD LN ENOLA PA 17025-2073 YOUR PORTFOLIO VALUE as of 09/30/2014 YOUR PORTFOLIO HISTORY Current quarter Year to date (07/01/2014-0.9/30/2014) (01/01/2014-09/30/2014) $120,000 $107.175 $110.133 $116.223 $114298 Beginning value $116,223.68 $107.175.24 $96.000 $97,553 Additions(+) 0.00 0.00 $72.000 Withdrawals 0.00 0.00 $48.00 Change in value S-1,225.67 $7,822.77 ....;4;;..-T"'-t --1.1; --;=;-.11 1 $24.00 'j'.-;;� ­:r.�­ 0 glj ar.-a! 09 3./201.1 11211V2.1-1 03/3V2014 06/30/2014 09/30J2014 -.1 A+.:---'Rllmso ll SUMMARY OF ACCOUNTS Account Beginning value Additions/ Change in value Ending value Name number (01/01/2014) withdrawals (09/30/2014) PEGGY A MAGLICH 0274672080 MICHELE MAGLICH BROWN&JOINT ACCOUNT PUTNAM GROWTH&INCOME-A $107,175.24 $0.00 $7,822.77 $114,998.01 Value of Putnam portfolio $107.175.24 . $0.00 $7.822.77 $114,998.01 Visit putnamperspectives.com, where Putnam professionals offer new ways of thinking about the markets, the economy, and investing opportunities. • Q Q-5t- This is a summary of you,year-to-date slalmnt.Additional details follow and are available at the secure account section of pu1nam,cori,, PAGE I OF 4 10078 4570629 020156 036779 00001/00002 PEGGY A MAGLICH 2014 YEAR,-TO-DATE STATEMENT MICHELE MAGLICH BROWN & 01/01/2014 - 09/30/2014 Summary of your Putnam accounts ACCOUNTS Beginning balance Exchanges Change Ending balance Fund name (as of 01/01/2014) Additions in/out Withdrawals in value (as of 09/30/2014) PU.TNAM GROWTH& INCOME-A „7i�� $107,175.24 $0.00 $0.00 $0.00 $7,822.77 $114,998.01 c Total year to date $107,175.24 $0.00 $0.00 $0.00 $7,822.77 $114.998.01 Total this quarter $116,223.68 $0.00 $0.00 $0-00 -$1,225.67 $114,998.01 ACCOUNT N1�M_GRb -T. 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PER • - ANC Fund 5 years 10 years/life inception 1 year annualized annualized Fund name date NAV POP NAV POP NAV POP 1 PUTNAM GROWTH & INCOME-A 11/06/1957 17.88% .11.10% 14.40% 13.06% 6.31% 5.68% PAGE 3 OF 4 ' 10078 4570629 020157 036781 00002/00002 N, i FIRST ACCOUNT STATEMENT NIAGARA Staternent Date: January 09,2015 Primary Account Number: xxxxxxxx9587 Return M;ul Services PO Box 1237 South Windsor,CY 46074 /r ti Customer Service AB 01012129 46394 E 27 B h1#filfi�jlfiillrntlll�iittrfilrflitllt�rlfitlllrlrltidltr�llfil� Automated Telephone Banking PEGGY MAGLICI-I 1-804•-439-8230 MICHELE MAGLICH BROWN MICHELE MAGLICH BROWN } CustomeC_Service'@fnfg.com 912 MAPLEWOOD LNJ [KOLA PA 17025-2073 G� Customer Service-Bank by Mail P.d.Box 527 l.udrport,NY 14099-0527 rn N O Introducing person-to-person Popmoney from First Niagara makes sending and receiving money as easy as texting and emailing.Send money to pay for shared living payments with expenses,pay your babysitter,split dinner bills,and more.All you need is a Rrst Niagara checking account and access to Online Banking ��oney � with Bill pay.To get started lag onto Online Banking and go Into the popPayments tab to start using Popmoney. To[earn more visit firaniagara.com/popmoney FKST Popmaney is a registered trafemark of Fsav,Inc. t ..4 Nti W NLAGAM BANK BORROW INVEST PROTECT SUMMARY OF ACCOUNTS — ri te'it Lkicoup Account Type..: : .. :: �;.. .: : .. ........ . .:...... .: .. .:.'. :. .::::.._Balance F ).i Rate(%) .:.:.(%:): ': YIUl$} xnxxxxx9587 PinnaclePlus Checking 1,066.59 .010 0.01 01 — PinnaclePlus Checking-xxxxxxxx9587 Statement from 12/12/14 Through 01/09/15 Interest Earned$.01 Annual Percentage Yield lamed 0.01% Account Summary B Balari osrts•O<;:+`:..;.;.fnterest; :atd 25.71 1,065.87 _..._____ .01 .00 _ 25.00 1,066.59 I - Transactions by Date Posting _Date...... Transaction Description Debi,.'{=$).: Gretiit;(+$).. . Bala nc _,......._.-_........._._._... e.3) 12112 THE HARTFORD IAD SWP _. 1,065.87 1,091.58 01/09 Service Charge 25.00 1,066.58 01/09 Interest Credited Deposit .01 1,066.59 Page t of I FIRST ACCOUNT STATEMENT NIAGARA Statement Date: January 09,201S Primary Account Number: xxxxxxxx2376 Return Mail Services PO Box 1237 South W-indsor,CT 06074 Customer Service 1-600-421-0004 A9 01 042071 46394 E 27 B 111.111111111.111 It$is I II Automated Telephone Banking PEGGY MAOLICH 1-800-439-BM MICHAEL F MAGLICH MICHELE MAGUCH BROWN Customer.Service@fnt.com 912 MAPLEWOOD IN ENOLA PA 17025-2073 Customer Service-Bank by Mail P-0.Box 577 Lockport NY 14095-%27 Introducing person-to-person Popmoney from First Niagara makes sending and receiving money as easy as texting and emailing.Send money to pay for shared living payments with expenses,pay your babysitter,split dinner bills,and more.All you need is a First Niagara checking account and access to Online Banking 0 with Bill Pay.To get started log onto Online Banking and go into the pop�����yPayments tab to start using Popmoney. To learn more visit fir-stnilaglamcomil0opmomy hNNIN FIRST AAMMOK Popmoney is a registered trademark of Fiserv,Inc. Fh�Kv-10.04A NMOAAA BANK BOROTECT 6- SUMMARY OF ACCOUNTS 77777-77-77= Fucount. A09ount a xm=2376 PinnacleP Checking 1,67038 .010 0.01 .01 w=1756 PinnaclePlus Money Market 19.79 Pirmadeflus Checking-xxxxx—xxx23Z6 Statement from 12/12/14 Through 01109115 Interest Earned$.01 Annual Percentage Yield Earned 0.01% Account Summary D + 1..595-77 100.00 Transactions by Date os ni ,ncii + Baia `4 0 01/02 USPBGC-BETHLEHEM PN PMTS-BG 100.00 1,695.77 01/09 Service Charge 25,00 1,670.77 01/09 Interest Credited Deposit '01 1,670.78 Page 7 of 2 Checking Account lov• g,w Citizens Bank Statement 1-800-773-7373 0 OF 2 Call Citizens'special,dedicated Gold Customer service line anytime for account information,current rates,and answers to your questions. Beginning November 27,2014 through December 23,2014 US259 BR291 1 PEGGY A MAGLICH 912 MAPLEWOOD LN ENOLA PA 17025-2073 Checking SUMMARY PEGGY A MAGLICH Balance Calculation Balance MICHELE MAGLICH BROWN MICHAEL F MAGLICH Previous Balance 8,814.17 Average Daily Balance 9,899.87 Circle Gold Checking w/Interest Checks 450,60 - Interest 622515-740-2 Withdrawals&Debits 35.12 - Deposits&Credits 20,000.00 + Current Interest Rate Interest Paid .07 + Annual Percentage Yield Earned .01% Current Balance 28,328.52 = Number of Days Interest Earned 27 Interest Earned .07 Interest Paid this Year 1.70 You can waive the monthly maintenance fee of$20.00 by maintaining a monthly combined balance of$20,000. Your monthly combined balance used to qualify this statement period is: $81,284 Previous Balance TRANSACTION DETAILS 8,814.17 Checks'There is a break in check sequence Check# Amount Date Check# Amount Date 1101 450.60 12/02 TotaIChecks 450,6O Withdrawals&Debits Other Withdrawals&Debits Date Amount Description 12/02 35.12 Deluxe Check Check/Acc.141128 Total Withdrawals&Debits 35.12 Deposits&Credits Date Amount Description 12/22 20,000.00 Online Transfer From Savings 6256499876 Total Deposits&Credits 20,000.00 Interest Date Amount Description 12/23 .07 Interest Total InterestPaid 07 Member FDIC 1J Equal Housing Lender Citizens Bank Checking Account Statement 1-800-773-7373 © OF 2 Call Citizens'special,dedicated Gold Customer service line any time foraccount information,current rates,and answers to your questions. Beginning November 27,2014 through December 23,2014 Checking continued from previous page PEGGY A MAGLICH MICHELE MAGLICH BROWN MICHAELF MAGLICH Circle Gold Checking w/Interest 622515-740-2 n Current Balance Daily Balance 28,328.52 Date Balance Date Balance Date Balance 12/02 8,328.45 12/22 28,328.45 12/23 28,328.52 MEMO --Effective January 5,2015,the Savings Overdraft Transfer Plan will include a$6 Transfer Fee for each item covered by a plan transfer.No Transfer Fee will be charged for a Savings Overdraft Plan transfer made to cover an overdraft item of$5 or less.There will be no Annual Fee for the Savings Overdraft Plan-you only pay for the plan if you use it. If you don't have an Overdraft Plan,or if you'd like to review or change your current plan,it's easy to enroll or adjust your current Plan.Just call us at the number shown on your statement, NEWS FROM CITIZENS --We all have saving's goals:Whether it's a new home,a child's education,retirement or preparing for unexpected expenses,Citizens Bank makes it easy and rewarding for you to start saving.We have a range of solutions from savings accounts,money markets,CDs and IRAs,to.fit your needs.. For more information on which accounts and programs are right for: you or to open anew account,callus at 1-800-773-7373,visit citizensbank.com,or stop by your local branch. Member FDIC EQual Housing Lender Savings Account Citizens Bank Statement 1-800-773-7373 © of 1 Call Citizens'special,dedicated Gold Customer service line anytime for account information,current rates,and answers to your questions. Beginning November 27,2014 through December 23,2014 US259 BR291 1 PEGGY A MAGLICH 912 MAPLEWOOD LN ENOLA PA 17025-2073 Savings SUMMARY PEGGY A MAGLICH Balance Calculation Balance MICHELE MAGLICH BROWN MICHAEL F MAGLICH Previous Balance 72,847.92 Average Daily Balance 71,309.45 Circle Gold Savings Withdrawals&Debits 20,000.00 - Interest 6256-499876 Deposits&Credits .00 + Interest Paid .53 + Current Interest Rate .01% Current Balance 52,848.45 = Annual Percentage Yield Earned .01% Number of Days Interest Earned 26 Interest Earned .51 Interest Paid this Year 9.19 Previous Balance TRANSACTION DETAILS 72,847.92 Withdrawals&Debits Other Withdrawals&Debits Date Amount Description 12/22 20,000.00 Online Transfer To Checking 6225157402 Total Withdrawals&Debits 20,000.00 Interest Date Amount Description 12/23 .53 Interest n Total Interest Paid .53 nCurrent Balance Daily Balance 52,848.45 Date Balance Date Balance Date Balance 12/22 52,847.92 12/23 52,848.45 Member FDIC Q Equal Housing Lender REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER PEGGY A. MAGLICH This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEMDESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP To DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. 'SIX(6)HH SAVINGS BONDS$1,000 FACE VALUE WITH$878.84 IN 11,273.04 100 11,273.04 DEFERRED INTEREST PER BOND, POD TO MICHELE M.BROWN(DAU.) 2 M&T BANK IRA ACCT#35-004202730724, BENEFICIARIES:MICHAEL F. 36,887.02 100 36,887.02 MAGLICH&MICHELE M. BROWN(SON&DAUGHTER) TOTAL(Also enter on Line 7, Recapitulation) $ 48,160.06 If more space is needed,use additional sheets of paper of the same size. 'INTERESY_.EE ASE$20 VEARf, ' UE, AT OF:. .. 0.— T7 ��'LLM t7! ✓atil€r-�--rr � .� i i - RI`t + 0 �(� ..'na �;jSf OIT! 'I•R i•, h ; i: _ - ' V .•.;+'-A- .'o - 3T1. is.• .,s"'''-,�;£r>.._n' ..�. F. .NICHE LE` MAGLI:GH .BRAWN ;:..; -- =M. - - 896 86 — -_ 004320990.97041 . L"S' ��• . 0.0007010996 �,• - . 1 1 /r I Lim -- --- 086,-20 2586 INT EkEs'f E�A3E' FROM'ISSUE D 199 ', X, f - j`- .--- z, ] PEGGY� MAC��rIC'FF. 6023 ORCNA4I �UAAfK F�hP� NHOL.L'0W 'Y14 I:2'7R I - i — A6t9[i+ POD MICHELE MAGLICH BROWN . 1 07050995 ` __� R.fiEDJNERfST 896 88 --3 ..-o'S-50 l r 00+320:99097041'• ' L_5 1000.70.50 9 9'Sii� ff SE ---.. ._ •,�y�� - ___.. .�-::.::- _._. . ;2C-:YEARS:';', _ uEDAVE OF ' 086 20 2586 iO3 1999� - - - - r •'� st P4.ti li •'I�� I + �,a bfpz site -�. ���`llr Ir rr, .1151 i 60 R I P' f. yRf� �� _ _ .�1+;•a.,_�,� sU.._�41�'. 1. � UJ:a ,f�`-=.,_1-:.4,. ,•./�A.,.t. — .. _ -_ _ f rJ 7 i � 'U. y 07050994 :: POD MICHELE .MA'GLICH. BROWN 896 .-88 M 0 5 0.9:9.4 . ' .5'+M•.ry JlAr iiw.nry .00432099097041 . LS 9000 ?OS099411' v,w��dn�iiwsm+a>m�rst� - x v t tUN:it —N: t - 1 it Y glyin EARS`' g — 5 20 1r ... IN 1 fA::15 U —� A,~� �,`� # 0.8-&;._�-Gl 25;8b-:' _. .;.. :�•'�--.=:=.= �- �- Q 3� 19 9 9 -- ��..� .: _t __'oc�s e't'�'M �tf o - i'i•:.e��,� � ..toffvE p - _ i• t. - I - i - - _ __ . G •I' y, is�:.:�:=•r`Y:�_,.r.._ -;.�'w rte,.- - - - _ - - - _ _ :_- _ 3ct�� E ,_rsc►. c� .RowN:_ $�1 -87 - A.+y✓th w.oii,.v µ - - -- - - = - E- � v aa t AP 1NOW NT Rt`S7 C.£ASES ZO-YEARS, i.. ' FROM ISSUE bAfiE Of w� ! r z = 20 !0 > !i -086 5�6 3 19' 9 -r: � `'� ,• �'� � 682��{4, � 'itlpp,iCE}�2' H'0C E.�DW, `I i' ;>. - . .. ' OR� (At 'Pk1�R!<,,' ' 07050992 PDD =MLCHELE,.`MA'6LIEH Bi?OWN r• s,. r: IIA - _ t H 76' 'U'Q �• t�� ..., 004.32099.09704Y F 9 2110 _-� -- ;;, t -(ISTi!'7lSg'1T� U.J1�t'�„�•�gf S.T..4 ErA ES.O o ••«D _ _ iFtSFM:TSSUE_6RYE OP_RS TE .._...__..... _cam ._....._..__.. .. _ 2-M =2�8 -- .,.y�__-- •"` `"""� — _� _-_� _-_-'stSc^3 E'4+EitY :fb=::• _ _ Ot N _ -EAR.�:'�_ _ ~'•( - =:.;✓m:�1>'A:95-.r�o.'�tc".,� '"LY'. ,.*;cs*.:- - 'F`'-�-'r- f'• -^y�•1" r� - .._ �•c .rte-'�>..:>r.- -- _ 'a ff - s - t i - 1 - - i Y — _ - - It _ - Ailt. -- , • - -- - i i. - �� _?^ t5', _...,.._ -.•rv5 :s:v. air At ,: '�m_.«.:._ A 3)14„ P'.`y+ _ _ - - � I'0�3:' MICHELE' MAGL ICH BROWN 8 9 6"." _$.8 aU'4320.94.097041 j, P300070S'099 Lei` - - ON -. —_—=_ 1AV 11V� 1� -� � 711TEREST.GEASES 20-YEAR9__ :. ..�!. ISSUE DATE OF I r ! I )r,��ll I k i� I tl �� I - - t Iy7 R - C1LE MA_GLIEI . .. - _ - 0 64 ----- __ - q000 ?r3 13 's , : -�' -�0% Will TM MIJa4lrY:(RXdNYYtFIrY141feW IDLTE1iF51'CpA5E5.253'EAR3 _ D AT -8 -2Q X586'. t, .08 2000_ 1 ['� CItf;S' AVT! ,4 ` ORCIHf '.�,.I,P�1jIdK;, tkY 127. OR hFICHELE MA6LICH 0-7777777777 .x-1 _ -- QD4 iOIJ245073 s - ; &0.0076 L3 L4Iw 8t -_- ' a -- - -- - - EBcT=(37�C3ES'-2f>=-4EA fROtk'15HUE BATE O!_ 2-77- - ,?' _- 3 �._E_C/EMi.�D'O ii•-V � ���-� - —_ MO r _=YCAR=—__ �;px-moiWim-t nm I .7 - " 3 - ffR MICHELE MAOLICH. 873 414 ao4.32 100245073L 5 70.00 7 6 L 3 L 4 Iii' - REV-1511 EX+(10-09) r` a pennsylvania SCHEDULE H p DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER PEGGY A. MAGLICH Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPEN..SES; . 1' LOMBARDO FUNERAL HOME,ORCHARD PARK,NY•COST OF FUNERAL 5,030.00 2. INMAN SHIPPING,TRANSPORT REMAINS FROM PA TO BURIAL PLACE IN NY 1,372.00 3.: CLERGY HONORARIA 250.00 4. INTERMENT,HOLY CROSS CEMETERY 150.00 5. HAIR DRESSSER 125.00 6. OBITUARY,BUFFALO NEWS 781.24 7 MEMORIAL BANQUET 557.01 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City _—_ —._. _—__ _State____—•ZIP — Year(s)Commission Paid: 2,500.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) _ Claimant Street'Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. DEATH CERTIFICATES,20 @$6 120.00 TOTAL(Also enter on Line 9, Recapitulation) $: 10,885.25 If more space is needed,use additional sheets of paper of the same size. Rombafrbo juttera l jbome www.lombardofttneralhome.com E-Mail ir"lombardohmeralhome corn 3060 Abbott Road 102 Linwood Avenue 885 Niagara Palls Blvd 4614 Main Street Orchard Park,NY 14127 Buffalo,NY 14209 Amherst,NY 14226 Snyder,NY 14226 716-8234812 716-886-5363 716-837-7100 716-839-1133 PAID IN FULL STATEMENT January 7, 2015 Michelle Brown 912 Maplewood Lane Enols, PA 17025 RE: Peggy Maglich Date of Death: December 21,2014 Form of Amount of Received From Payment Check# Date Paid Payment Credit Dec 26, 2014 120.00 Family Paid Jan 2, 2015 4 910.00 Total of Payments: $5,030.00 Total Cost of Funeral: $5,030.00 Balance: $0.00 When you remit your payment, please include the name of the deceased and the day they passed away. If you have any questions or concerns please contact us at 716-837-7100. Thank you for your cooperation. Special Note: If there are any funds that are owed on the account and the agenciestfacilities deny payment you will be responsible for the balance(Ex: SS=Sociai Services,VA=Veteran's etc.). Please Remit Payment To: Lombardo Funeral Home 3060 Abbott Road Orchard Park, NY 14127 Sincerely, Lombardo Funeral Home (r;rt!�iC.S'5:137if.'17c:7 United I b'Stand 510003$21 MAGUO4,PEGGY ` }• '",; ¢y v�:...:. .,A. �`rajt ;, 'a t, ��' A;>v-(�jLL y µle.yT' ,�.N'��..:..::.. .. :v' .• . y� ♦Y �:a'(.rpl,, s:t2W i� ,yy' ���'„+L412R1J2fJ14 :22;04 ;; t COMPLETE SHIPPING SVC-ADULT 5 6926.00 i SA S92S.00 J, ;,�.,;>�e,.y5 ,d,, •: :,,{•. -.<':;g:?.`:4. 'f. ::i€•<<•.*,::=.•,. .. ... '->•. `. ..,•:,;;'�:a,rs�:::c �grkL""A��';: 12121rM14 122:04 Z0:„CiEATH CERTIFICATES .5120.00 1� 6' •k R':^”'l':.>:i57k'„''.:.4.�•r. o 'f a.. .;...::'.'.}.•:'r;:.• .. ..,,:.. ..,• ,!!.i?'. =�'1vnn.• :':aa'."�:tt:`r. 12!23!2014 859 I,PREPAID AIR FARE 6447.52 ;SIA L447.62 '` ?'�:,r,+ "�.'••.:x,..j.;rz`r�' :,;��•q; •`•..r•.t;;•:t:;�;...:::. :.R'�' •:i;..�:•fir,;... •..�.' ;:�i'6".�:�- t .�,�,,� �`�:'`'•a'�i:�•�����t,,.s�:'�i�.�-,;i��.;�.•....•x�Y '�, � r� $1,482.82 S . _ .rd.�,�vi•'f.�l .�.: ,i nt7 eI.•.`• 'a) s::,rT." :���� tl +`r,`•r'.�:�'�:'. i �.►2 1 Cr tics 13 f.a um E r g l�• (a0-) NN Ill ,$I,NN 112 (' L' IN i 111 8181" loo 0 C� o Z- C\ Tlvr—t 6 Roly Cc-05S CJQMC-6L/ �aell . d i(:paan BANQUET BILLING 3785 South Park Ave. • Biasdell, NY 14219 Phone: (716) 825-3675 • Fax: (716) 825-1054 www.iliodipaolos.com DATE: 10p� 4-1 2_c-,I T NAME OF FUNCTION: -r FOOD @ @ @ FOOD TOTAL: BEVERAGE @ co ( -r1 @ BEVERAGE TOTAL: S -Ci S SUBTOTAL: `+4 ,95 jr SALES TAX: Lp GRATUITY: TOTAL: f LESS DEPOSIT: (� } l BALANCE DUE: REV-1513 EX+(01-10) +� z pennsylvania SCHEDULE ] p DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: PEGGY A. MAGLICH RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. MICHAEL F.MAGLICH, 9234 WRIGHT'S HOLLOW LN, LORTON,VA SON 1/2 2., MICHELE M.BROWN,912 MAPLEWOOD LN, ENOLA,PA DAUGHTER 1/2 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-08) va pennsytvania SCHEDULEI DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER PEGGY A. MAGLICH 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 ,MESSIAH LIFEWAYS,NURSING HOME RESIDENCY COSTS 6,787.30 2. PAUL DALBEY,DPM 35.00 3- 'PHARMACY INVOICE 149.93 4. SYMPHONY DIAGNOSTIC SERVICES 7.88 TOTAL(Also enter on Line 10, Recapitulation) $ 6,980.11 If more space is needed,insert additional sheets of the same size. Voll a 'Q �eLament 1, PEGGY MAGLICH residing at 463 Martin Road_ In the City of Lackawanna, County of Erie and State of New York, being of sound mind and memory, do hereby make, publish and declare this as my LAST WILL AND TESTAMENT, in manner following that is to say: FIRST: I hereby direct that all of my just debts, funeral and administration expenses be paid as soon after my death as may be practicable. SECOND: Upon my death, I give, devise and bequeath all my property, real, personal and mixed of whatsoever kind or character and wheresoever located or situate or to which I shall be in any manner entitled, to my husband, FRANK J. MAGLICH, absolutely and without any restriction or limitation whatsoever. In the event, however, my said husband, FRANK J.. MAGLICH,. should predecease me or we should both die asa result of a common accident or disaster, then in such event, 1 give, devise and bequeath all, my property, real, personal :and,, mixed of whatsoever kind or character and wheresoever located or situate, .or to which I shall be in any manner entitled, to my children, MICHAEL and .MIC'HE`LE, in equal shares, per stirpes. THIRD: I hereby nominate, constitute and appoint, my husband;. FRANK J. MAGLICH, as Executor, of this my LAST WILL AND TESTAMENT. In the event, however, my said husband should predecease me or we should both die as a result of a common accident or disaster, then in such event, I nominate, constitute and appoint my son, MICHAEL and my daughter, MICHELE, as. Co-Executors of this . my.W i 11, I direct that the Executor or Co-Executors of this my Will, shall not be required to furnish any bond or other security,in_•an. -'j.uris­dicttion,:' and shall have b'.� ------------- -z- full power to sell, rent, mortgage, lease or to dispose and convey real and personal property belonging to my estate, at public or private sale and without order of the Court, and to execute any legal instrument to effect any such sale, mortgage, lease or other disposition. FOURTH: I hereby revoke any and all prior Wills and Codicils by me heretofore made. IN WITNESS WHEREOF, I havehereunto subscribed my name,.this 'day of� � - ter,.. ; �, 1989. PEGGY MA GLItH WE, whose names are hereunto subscribed, DO . CERTIFY, that on the - C l day of 1989, PEGGY MAGLICH, the Testatrix above named, subscribed her name to this instrument, in our presence, and in our presence and hearing declared the same to be her LAST WILL AND TESTAMENT, and 'then and there requested us and each of us to sign our names thereto as witnesses to the execution thereof, which we hereby do in the presence of the Testatrix and each other, on the said date, and write opposite our names, our respective places of residen residing at. t� (1 " ' residing at .� n �� - � .. � �% 1 w�w��