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HomeMy WebLinkAbout02-26-15 REV-1500 EX(02-11) 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 21 14 0778 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 05 25 2014 09 27 1946 Decedent's Last Name Suffix Decedent's First Name MI CLEGG JEAN A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI CLEGG LLOYD W Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ❑ 2. Supplemental Return F-1 3. Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 4a.Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) g Decedent Died Testate (Attach Copy of Trust a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ) 9. Litigation Proceeds Received 10.Spousal PovertyY CreditJDate of Death 11.Election to tax under Sec.9113(A) between 12-31 51 and -1-95) •(Attach Schedule 0) ( ) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number AMY M MOYA 717 652 7323 REGIi�Ef OF WILLSt+JSEr0iN ZI r*1 2 � First Line of Address - C� ._.1 t: r— N 17,1 r-'I 5011 LOCUST LANE ' Cn Second Line of Address - - ry - �.,:a .:DATE FILES !.. r City or Post Office State ZIP Code HARRISBURG PA 17109 00 _ Correspondent's e-mail address: Amyp_Ledererlaw.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG F PERS RESPONSIBLE ^ ILING RETURN DATE Lloyd W. Clegg ADDR 2905 Tinderlee Road Wimauma FL 33598 SIG URE OF P P R ER THAN REPRESENTATIVE DATE Amy M. Moya / J/ ADDR S 5011 Locust Lane, Harrisburg, PA 17109 Side 1 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Social Security Number Demdent'sName: Clegg, Jean A. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 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. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&MiscellaneousI�o.q-Probate Property (Schedule G) 1J Separate Billing Requested............ 7. 270 , 800 . 87 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 270 , 800 . 87 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 2 , 896 . 92 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 599 . 0 0 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 3, 495 . 92 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 267 ,304 . 95 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. 267 , 304 . 95 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 25 , 788 . 00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 241 ,516 . 95 16. 10 , 868 . 26 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 10 , 868 . 26 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-14-0778 Decedent's Complete Address: DECEDENT'S NAME Clegg,Jean A. STREET ADDRESS 556 Lewisberry Road CITY STATE ZIP New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 10,868.26 2. Credits/Payments A. Prior Payments 9,357.02 B. Discount 492.47 Total Credits(A +B) (2) 9,849.49 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) 1,01 8.77 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;............................................................................... ❑ [] b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ lxl c. retain a reversionary interest;or............................................................................................................... ❑ 0 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?.................................................................................................................... 1�1 ❑ 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 decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. i Rev-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE �+ INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Clegg,Jean A. 21-14-0778 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. ITEM DESCRIPTION OF PROPERTY ENT AND DATE OF DEATH k OF DECD'S EXCLUSION TAXABLE NUMBER THINCLUDE DATE OF TROANSER.SATTACH A FEREE CIOPY OF RELATIONSHIP DEIED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 6,260.51 shares of DFA US Core Equity 2, held in TD 104,894.86 100.000% 104,894.86 Ameritrade IRA Account No. 908-970900,Jean A. Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($16.76/NAV),CUSIP #233203397 2 3,639.40 shares of DFA Investment Grade PTF,held in 39,159.98 100.000% 39,159.98 TD Ameritrade IRA Account No. 908-970900,Jean A. Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($10.76/NAV),CUSIP #23320G448 3 2,349.96 shares of DFA International Core Equ Ptfl, 31,066.43 100.000% 31,066.43 held in TD Ameritrade IRA Account No.908-970900, Jean A. Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($13.22/NAV), CUSIP#233203371 4 1,770.50 shares of DFA Inflation Protected Sec PTF, 21,369.98 100.000% 21,369.98 held in TD Ameritrade IRA Account No. 908-970900, Jean A. Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($12.07/NAV), CUSIP#233203355 5 1,911.21 shares of DFA Short Term Ext Quality PTF, 20,793.95 100.000% 20,793.95 held in TD Ameritrade IRA Account No.908-970900, Jean A.Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($10.88/NAV), CUSIP#23320G521 Total of Continuation Schedules See attached pages TOTAL(Also enter on Line 7, Recapitulation) 270,800.87 (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 G(Rev.08-09) Rev-1510 EX+(08.09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Clegg,Jean A. 21-14-0778 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.SATTACH A COPY OF TFEREE THEIR HE DEIED FFOREREAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 6 1,292.04 shares of DFA Global Real Estate Sec PTF, 13,010.80 100.000% 13,010.80 held in TD Ameritrade IRA Account No. 908-970900, Jean A.Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($10.07/NAV), CUSIP#23320G554 7 530.72 shares of DFA Emerging Markets Core Equity, 10,879.68 100.000% 10,879.68 held in TD Ameritrade IRA Account No.908-970900, Jean A.Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($20.50/NAV), CUSIP#233203421 8 1,392.19 shares of FDIC Insured Deposit Account, 1,392.19 100.000% 1,392.19 held in TD Ameritrade IRA Account No. 908-970900, Jean A.Clegg,owner,Jennifer Lynn Morris,Julie Anne Nordmann,Jill Eileen Lester,and Jonathan Erick Moyer(children), beneficiaries($1.00/NAV), CUSIP#9ZZZFD989 9 1,752.15 shares of DFA Investment Grade PTF,held in 18,853.09 100.000% 18,853.09 TD Ameritrade Account No.908515790,Jean A.Clegg, owner,TOD Lloyd W.Clegg,spouse($10.76/NAV), CUSIP#23320G448 10 256.51 shares of DFA Global Equity PTF,held in TD 4,749.28 100.000% 4,749.28 Ameritrade Account No.908515790,Jean A.Clegg, owner,TOD Lloyd W. Clegg,spouse($18.52/NAV), CUSIP#2543413674 11 3,130.63 shares of FDIC Insured Deposit Account, 3,130.63 100.000% 3,130.63 held in TD Ameritrade Account No. 908515790,Jean A. Clegg,owner,TOD Lloyd W.Clegg,spouse ($1.00/NAV),CUSIP#9ZZZFD989 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) Rev-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE �+ INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Clegg,Jean A. 21-14-0778 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSLUDE NAME OF FER.SFEREE THEIRATTAck A COPY OF THE DEIP TO ED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 12 Check from TD Ameritrade Account No.908515790 1,500.00 100.000% 1,500.00 (Jean A.Clegg, owner,TOD Lloyd W.Clegg,spouse), issued prior to death but cashed after death 13 Checking Account No.51-1288-8246, held at PNC 2,546.93 100.000% 2,546.93 0.00 Bank,titled to Jean A. Clegg and Jennifer L. Morris (account was made joint on 10/21/2013,within a year of death)(reported for informational purposes only) TOTAL(Also enter on Line 7, Recapitulation) 270,800.87 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENTRETURN SIDENTDECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Clegg,Jean A. 21-14-0778 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 881.92 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attorney's Fees Law Offices of Susan E. Lederer(estimate) 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationshio of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 2,896.92 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Clegg,Jean A. 21-14-0778 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hetrick Funeral Home(paid by Lloyd W.Clegg) 430.00 2 Organist for memorial (paid by Jennifer Lynn Morris) 100.00 3 RitePix(pictures for memorial service, paid by Jennifer Lynn Morris) 51.92 4 Women's Club(memorial lunch, paid by Jennifer Lynn Morris) 300.00 H-A 881.92 Other Administrative Costs 5 Cumberland County Register of Wills(filing fee-Inheritance Tax Return, paid by Lloyd W. 15.00 Clegg) H-B7 15.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1600 Schedule H(Rev.6-98) Rev-7512 EX+(112.08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Clegg,Jean A. 21-14-0778 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 Listing for sale of Bluegreen Resort Management timeshare in Georgia(paid to the Resort 599.00 Solution by Jennifer Lynn Morris prior to death, reimbursed after death) TOTAL(Also enter on Line 10, Recapitulation) 599.00 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Clegg,Jean A. 21-14-0778 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do of List stee s I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Lloyd W. Clegg Spouse TOD Account on 25,788.00 2905 Tinderlee Road Sch G9-12 Wimauma, FL 33598 2 Jill Eileen Lester Daughter 1/4 of Ameritrade 60,379.24 130 White Oak Drive IRA on Schedule York, PA 17406 G1-8 3 Jennifer Lynn Morris Daughter Jt.Acct. on Sch 60,379.23 162 Jackson Street G-13; 1/4 of Matawan, NJ 07747 Ameritrade IRA on Sch G1-8 4 Jonathan Erick Moyer Son 1/4 of Ameritrade 60,379.24 6330 Scottsfield Drive IRA on Schedule Suffolk,VA 23435 G1-8 5 Julie Anne Nordmann Daughter 1/4 of Ameritrade 60,379.24 Bernadottestrasse 190b IRA on Schedule 22605 Hamburg, Germany G1-8 Total 267,304.95 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) ` ���K�K��� ��K���K�� , ��"� ^ Valuation Account Number: 308970900 Date: 5Q5/2014 Balances: Client Address: Advisor Information: ^� Cash Balance: 0.00 Jean Clegg Ira Name: |S| Financial Group, Inc. Margin Balance: 0.80 TdAmehtrmdeClearing Custodian Primary Contact: Timothy Decker Closing Total Position: 243.020.69 556LEVV|SBERRYRDRT114 Telephone Number: (717) 393-3353 Closing Liquidation Value: 243.020.69 NEW CU&4BERLFY\ 17070 Fair Market Position Value: 242.56788 Positions Summary: Settled Fair Market Value Amount Security Type Quantity MUTUALFUND 17,754.34 241,175.69 STOCK 1.392.19 1.302.19 Positions: _ Account Sab|*d Fair Market Average Cumip Type Symbol Security Name Security Type Quantity Value Amount High Low 233203337 Cash DFOTX DFA USCORE EQUITY 2 K8UTUALFUND 6.260.51 104.884.86 16.76 2332OG448 Cash DFAPX DFA INVESTMENT GRADE PTF NiUTUALFUND 3.839.40 39'159.38 10\76 233203371 Cash DF/EX DFA INTERNATIONAL CORE EQUPTFL yWUTUALFUND ' 2.349.98 31.08643 1522 233203355 Cosh D|P8X DFA INFLATION PROTECTED SEC PTF K8UTU8LFUNO 1.770.50 21.369.98 12�07 25320G521 Cash DFEQX DFA SHORT TERM EXT QUALITY PTF YNUTUALFUND 1.911.21 20.793.95 10.88 2332DG554 uooh DFGEX DFA GLOBAL REAL ESTATE SEC PTF K8UTUALFUND 1.282.04 18.010.80 10D7 ' 283203421 Cash DFCEX DFA EMERGING MARKETS CORE EQUITY N1UTUALFUMD 530.72 10.879.08 -20.50 9ZZZFD389 Cash MMDA12 FDIC INSURED DEPUS|TACCOUMT |OAl2N0TCDVESTDCK 1.382.19 1.392.18 1.00 - Although prices are obtained from sources which are deemed to be reliable,TD Ameritrade cannot guarantee their accuracy.Prices for unlisted bonds are approximations,not actual market bids,and are provided only as a general guide, TD Ameritrade Institutional,Division of TD Ameritrade,Inc.,member FINRAISIPC/NFA.TD Ameritrade is a trademark jointly owned by TD Ameritrade IP Company,Inc.and The Toronto.Dominion Bank.©2014 TD Amerilrade IP Company, 812012014 1:02:24PM Page 1 of 1 Account Center - Overview- TD AMERITRADE VEO Page 1 of 2 Ameritrade, Institutional ``�'' Get Quota(s) Symnet lnnkma Hemel site Mata I ItIgIA I Message Center I Contact Us IyeoExpress' ex.MSFT,IBM.. 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Account Tools Research Resource Center I Preferences quick Links Ovorvtew I Consolidated view I Account Center I Account Services I Sgir-Service Account V — � Go $how aH accounts;Itec�nY 15SoyntS, Telles what you think Account Overview CLEGG,JEAN-IRA: 908970900 This account is currently blocked.Please contact your Account Representative for further information. 7 Retirement Overview Profile Documents Account information Account information I Forms Wizard Account Numbar: 908970900 Margin Trading Form No Margin Trading Form JEAN A CLEGG Option TradingForm Nona Opt Account Title: IRA ion Trading Form TD AMERITRADE CLEARING CUSTODI Account Status: BLOCKED Description: CLEGG,JEAN-IRA Checking: Inactive Type: IRA Debit card: Inactive Money Market: TO Bank USA FDIC Insured Deposit Account Proxy Authorization: Client votes Date Opened: 11/1012000 Statement Delivery Paper Notes: Confirmation Delivery: Paper Cost Basis Equity DRIP Status: Not enrolled Show Non-covered Basis on 1099: Yes Prime Brokerage: Not enrolled Equity: Highest Cost Fee Authorization: Active Mutual Funds: Highest Cost ETF Program: Enrolled Option: Highest Cost Fixed income: Highest Cost Client Information Primary Acct. JEAN CLEGG Street Address: 556 LEWISBERRY RD RT 114 Holder: NEW CUMBERLAND,PA 17070 SSN1Tax ID: 188-XX-XXXX Mailing Address: $56 LEWISBERRY RD RT 114 _. _.__... _. .....__�...._...-_... .. .._�__.____. NEW CUMBERLAND,PA 17070 DOB: 09/27/1946 _._.. _. __.. Primary Email: Assigned Advisor: YWT .. .. .. ..:. .. . ... ....w.,.,.:.,._.,,,..,__.: :..,_..._.....,....... _...:,Mw.....,,..._.:_... Secondary Email: Beneficiary: J;LL E LESTER PGR STIRPES DAUGHTER 25.090 ,............ .._._.. .._,. Primary Phone: 717.393-3353 JENNIFER L MORRIS PER STIRPES DAUGHTER 25.0% S"" "" Secondary Phone: JULIE,A NORMAN PER STIRPES DAUGHTER 25.0°/6 Fax: JONATHAN E MOYER PER STIRPES DAUGHTER 25.0% Groups Interested Paries IRA BENEFICIARY VIEW ONLY The table name is:"Payment transactions(checks,ACH,wires,and internal transfers)NOTE:Only Internal transfers entered on Veo are shown" No Standing Instructions to display. Privacy Policy I security ent=rI Mark-It fzala lwreement I Lik&UA Pun'I t1i=cl••stL,I Short Term Rcdewodgns Ior J Aaount]nfnnnatin,Q ,,Lj +s Conti,"iuity I Trode Roubin Aureement I AdvisorClienP"I TD Ampritrade tnsdtutienai K.Irket volatility,volume and system availability may deli+y Pkccouut access anst trade executiens. As ygVr'.sgreemetit for the receipt and use of market data provides,the securities markets(7)reserve all rights to the market data Ilrat they make available;(2)do not guarantee that'd1ra;and (3)shall not be liable for any loss due either to their negligence or to any cause beyond their control.The foregoing informauon is provided tot reference purposes only and 1'1)Amcntmde,inc., cannot guarantee its accuracy or completeness.Your monthly statements constitute the definitive source or account information.Any accmmt discrepancies should b,breugnt to our attention immed,wely.Access to services and your account may be affected by market conditions,system perlonnance or for other reasons. https://www.advisorservices.com/servlet/advisor/BlockedAccountProfile 8/5/2014 Account Valuation Account Number: 908515790 Date: 5/25/2014 'L_ Balances: Client Address: Advisor Information: Cash Balance: 0.00 Jean A Clegg Tod Name: ISI Financial Group, Inc. Margin Balance: 0.00 Primary Contact: Timothy Decker Closing Total Position: 26,718.89 556 LEWISBERRY RD RT 114 Telephone Number: (717) 393-3353 Closing Liquidation Value: 26,718.89 NEW CUMBPA 17070 Fair Market Position Value: 26,733.00 : v Positions Summary: Settled Fair Market Value Security Type Quantity Amount MUTUAL FUND 2,008.66 23,602.37 STOCK. 3,.130.63 3;130.63.. Positions: L: « t "¢ ," _' *s` .5" ✓ :m ti`r r t Riv 4>,i : T *.: # »,. !�ci.�«cer K Account Settled Fair Market Average Cusip Type Symbol Security Name Security Type Quantity Value Amount High Low 23320G448 Cash DFAPX DFA INVESTMENT GRADE PTF MUTUAL FUND- 1,752.15 18,853.09 10.,76 25434D674 Cash DGEIX DFA GLOBAL EQUITY PTF MUTUAL FUND 256.51 4,749.28 18.52 9ZZZFD989 Cash MMDA12 FDIC INSURED DEPOSITACCOUNT IDA12 NOT CSTOCK 3,130.63 3,130.63 1.00 Account Center - Overview- TD AMERITRADE VEO Page I of 2 i Ameritrade _ Institutional Hornet 5.iiS.M.A,R I Helo I MS5.5ane Center I contact us Iyeoexprgss^ Get Quotes) 5yylynl lonkyp vac.MSFT.IBM- Gp Chain too Dtf Trading Accounts Account Tools �'. Research Resource Center J Preferences Quick Links Ly Overview I Cons lid_ a y,",ted View I Account Center I Aceount rrvices I$elf-Servico AGCOUOI V 1GOShay/ I>'?c<_uats 1 Recent acco}rtlty TGli ,y£Mthal V tt 1 k Account Overview CLEGG,JEAN-Indio: 908515790 This account is currently blocked.Please contact your Account Representative for further information. Overview Profile Documents Account Information I Forms Wizard Account Number: 908515790 Margin Trading Form No le`.Margin Trading Form JEAN A CLEGG TOD Account Title: Option Trading Form None ',`�Option Trading form _ Account Status: BLOCKED Description: CLEGG,JEAN-Indio Checking: Inactive Type: INDIVIDUAL _. _.. .. . _-___._._._......__._.. ._._..._.___.,_._...__ Debit card: Inactive Money Market: TO Bank USA FDIC Insured Deposit Account _.».....,_Date .�.._._...,.. ».. Opened: 02/11/2004 y - " Prox Authorization: Client votes ..... ........_,,._..._...... ..._...._.._._....._�..._._.._..._........_.,.�.-...... ._. . Notes: Statement Delivery: Paper Cost Basis Confirmation Delivery: Paper _. Equity Show Non-covered Basis on 1099: Yes ..,,..wty Status: Not enrolled ,..: .. . .,..... ................. .. ..„_............ .. _. _.... ._- Prime Brokerage: Not enrolled Equity: Highest Cost __ -... ..__....... �...,_....___.._. _ _ _.............__. . ...,..,__.__..._......_..._.,_......_._...,.. —.. Fee Authorization: Active Mutual Funds: Highest Cost _.._ ._ .. _.... __.... OptiOn:. �kgh,.._. _.�.._... ETF Program: Enrolled Highest Cost Fixed Income: .". Highest Cost Client Information Primary Acct, JEAN CLEGG Street Address: $56 LEWISBERRY RD RT 114 Holder: NEW CUMBERLAND,PA 17070 SSN/Tax ID: 188•XX-XXXX Mailing Address: 556 LEWISBERRY RD RT 114 NEW CUMBERLAND,PA 17070 DOS: 09127/1946 _...._.._, __....- _.....____.._.......�...._.,....-......._. Primary Email: Assigned Advisor: YWT _._._ ........___ .. .. _... . _._..,. .... LLOYD W C .:... Secondary Email: Baneflcaa y: CLEGG SPOUSE 100.0 _. _....._. _._...__» Primary Phone: 717-393.3353 [,'j International Secondary Phone: Fax: Groups Interested Parties Account not included in any groups. No information to display, The table name ls:"Payment transactions(checks,ACH,wires,and Internal transfers)NOTE:Only internal transfers entered on Veo are shown" Type Amount Frequency Scheduled Date End Date Bank Information Check $1,500.00 Quarterly 07101/2014 Check $12,000.00 Non Recurring 0511612014 Privacy Pulicv I Security Cenccr I market Data Aa reemCnt l Ljyi�i al fund Disdgsurc 1 Short Term Redemu9 ns I BloCkcd Account»lnformalion Busloes5(:entiouity I Trade Roo hin Agreement I AnvisotOwnt I TD Ameritrade Institutional Market Volatility,volime and systein availability may delay account etcces,C antl trade,elf Cutions. As your agreement for the receipt and use of market data provides,the securities markets(1)reserve all rights to the market data that they make.available;(2)do not quaranter.that dota;and (J)stroll not be liable for any loss due either to their negligence or to any cause beyond their control.The foregoing information is provided for reference purposes only and 10 Amer,trad•:,Inc., cannot goaranlee its a ccm'acy or'compieten G55.your monthly 5010111CM5 Constitute the definitive Source of account information.Any dccuunt discrepancies should be brought to our aitc.olot, immediately,Access to services and your account may be affected by market conditions,system parformance or for ocher reasons. TD Ameritrade inabtutlanal,Division of TD Am"Rrnde,Inc.,member FINRA STP'NrA.TD Ainenuade is a trademark jointly ovif ed by TD Arneritradi0 IP Comf)any,Inc.and The TcwtAo- Dnntinion Rank. ;)014 TD Ainerurnde IP Cornpany.Inc.All riryhts res—ed.tiled with permission. 36 LI5C 220506 . https://www.advisorservices.com/servlet/advisorBlockedAccountProfile 7/22/2014 AMi1RITRAI�E CLEARING1}kaaz i �r O739656 co urtesy RITRADE INSTITUTIONAL errs o;»�J :rri L �!Y{J1►AF"i'ER= 1VON'�I ''� 4 Fremont Nutl[Sank y a ai n 4 a krnmontNE -1 �. krii i,fi " T`' .:4~tifa 'i rays r ier3 '^,y3A E 45 Aw , 1,5Ot� Doltars aracl(7t} cents 4 ; , � �rJ w;: . W od/ 1 02/L4 4 rl0-tlLe-O?"LLeT'of - �r 4( 1 i i� ». { e'JTANlA CLEGG } ra } 556 LEVi}15BERRY RD R 'n114 �r x a` �41U r 7311 }Nom. NEW CUMBERLAND'; A 17070 J p o 1 1 - 1110010 ? 396561: 40L490004al. 22 65aSLI 0116 ---.-..------------------------------------------------------------------------------------------------------------------------------------------------ PLEASE DETACH HERE I'D AMERITRADE CLEARING P.O.BOX 2226 0MA IA,NE 68103-2226 Courtesy of T,DAMERITRARE INSTITUTIONAL Check# 10739656 A/C XXXXX5790 Check Date: 04101/2014 Amount: 1,500.00 TD AMERITRADE CLEARING P.O.BOX 2226 OMAHA,NE 68103.2226 Courtesy of: Tt?AMERITRf1DE INSTIT17TIOAlAL 0 0 0 0 2 000519 TDPDDH0I 000000 0 JEAN A CLE GG $ 556 LEWISBERRY RD RT 114 NEW CUMBERLAND,PA 17070 0 Q a G. 4, 2014 2:54PM PNC Bank No. 2046 P. VN C September 4,2014 Amy , M Moya Susan E Lederer Lam-Offices 11 Loca.tst Ln Harrisbiz_g,PA 17109 U Jean A Clegg SSN: DOD: 05-25-2014 Dear Ms. Moya: In response to your request for Date of Death(DOD)balances for the customer noted abmre, oar records show the folloving: Cheeldng Account Accowit# :+114110462 Established: 10-21-2013 JEAN A CLEGG LLOYD W CLEGG DOD balance: $ 2,614,90+ 0.00 acenied interest Interest paid 01-01-2014 tlu-u 05-25-2014 S 0.15 YTD Sai4ngs Account Accowit* 5112888246 Established: 10-21-2013 JEAN A CLEGG JENNIFER L MORRIS DOD balance: S 2,546.92+0.01 accraed interest Interest paid 01-01-2014 thra 05-25-2014 S 1,12 YTD Please note that this office,provides date of death balances for deposit accounts CRAs, CDs., Checking and Savings), NVe do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-13ANK(1-988-762-2265)or stop by your local PNC Bank branch office. Sincerelv, National Financial Services Center PNC Bank-,NA- Member FDIC Page 1 of 2 4. 2014 2 55 PM PNC Bank No. 2046 P. 2 This message is intended for the use of the individual or entity to which it is addressed and trim., Contain information that is privileged confidential andexemptftom disclosure under qppZicable law, If the realer of this message is not the intemledreciplent or the employee or agent responsiblefor dissemination, deliveringmt�,yvu,'are hereby notified Haat ap�v this message to the intended recipie distribution or copying of this communications is strkrlyprohi6fted. tfyou have received this communication in error,please notift,7ne immedicitely by repky oi-ky telephone at 800-762-1 i 75 and immediately destpuv this jaxed document. Pa.e.2 of 2