HomeMy WebLinkAbout04-23-15 i i� . .
Estate of Robert E. Germond
Pennsylvania lnheritance Tax Return Resident Decedent (Form REV-1500)
SSN: 059-22-5843
DOD: O l/22/2014
TABLE OF CONTENTS
1. Copies of DecedenYs Last Will and Tes[ament and Codicil
2. Pennsylvania lnheri[ance Tax Retum Resident Decedent(Form REV-1500)
Schedule B Stocks and Bonds
Schedule E Cash, Bank Deposits & Misa Personal Proper[y
Schedule G Inter-Vivos Transfers and Misc.Non-Probate Property
Schedule H Funeral Expenses and Administrative Costs
Schedule I Debts of Decedent, Mortgage Liabilities & Liens
Schedule 7 Beneficiaries
�
, LAST WII.L AND TESTAMENT
OF
� ROBERT E. GERMOND
,�
I,ROBERT E.GERMOND, of 4190 Nanlucket Drive,Mechwicsbwg,Cumberland County,
Pennsylvaoia, being of sound and disposing mind, hereby make, publish and declare this my Las[
Will and Testament,hereby revoldng and malriog void all prior Wills and other tesfamentary writin�
at any time heretofore made by me.
I. I direct my Executrix or successor Executrie, hereinafter named, to pay all of my just
debts, funeral and testamentary expenses as soon as convenieutly can be done after my demise.
II. I give, devise aod bequeath my endre es[ate of whafsoever Irind and wherescever situate,
unto my beloved wife, MARGARET M. GERMOND.
III. Should my said wife, MARGARET M. GERMOND, predecease me, or should she
survive me by a period of less than two (2)months or should she die simultaneously with me, or in
a coromon disas[er, it being my direclion and in[ent that in the event of such simul[aneous death or
common disaster no Unifortn AM regarding such event shall apply and only [he above sfated
provision of this Will shall apply, [hen and ody then, I �ve, devise and bequeath my entire es[ate,
oF whatsoever ldnd aud wheresoever situate unto my children, WENDY J. GERMOND, of Johnsan
City,New York, JIJLIE K. HART, of Seven Fields, Pemsylvania and TRACY R. BROOKS, of Gten
Burnie, Marylaud, shaze and share alike, per stirpes.
1
_ - -
N. ShoWd there be any proper[y of whakscever ldnd and wherescever silna[e of which I have
the right to dispose at the time of my deat�, including�but not limited to any special or general power
of appoinhnent or both, I hereby appoint.the same to my legatees set forth in Paragraphs TWO aud
'I'HItEE hereof. �
V. I noa�inate, constilute and appoint my wife, MARGARET M. GERMOND as Execuhic
of this, my Last Wtll and Testament and further direct that she shaR serve without bond.
VI. If the said MARGARET M. GERMOND is for any reason unable or unwilling to serve
as Executrix of this, my Last Will and Testament, then I nominate, cons[itute and appoint my
daughter, WENDY J. GERMOND, of Johnson City, New York, as successor Executrix. She, too,
shall serve without bond.
VII. Said Executrix or successor Execuhvc shall have the power to discharge all the debfs,
dens and encumbrances upon my estate, as well as any taYes thereon, to pay for the cos[ of the fmal
disposition of my remaius and final illness, if any, to receive any and all commissious and other
compeusatlan for services rendered by me during my lifetime and to perForm auy and all fiduciary
duties authorized by statute. F�rther, I direct my Execuhic or successor Fcecutdc to preserve my
estate and any instn�ctlons pertandng to the distribution of the same from any aHachment or
a¢ticipation wttile in the hands of my said personal represertative, it bemg my express iutent tLat all
legacies shall be free from any attachment or anticipation while in the hauds of the accountant for
my estate.
2
V�II. I reques[my Executrix or successor Executrix to coasWt with ROBERT L. KNUPP,
ESQiRRE, and KN[JPP,KODAK & ➢1-IBLiJM, P.C., of Harrisburg, Peunsylvania, as attorneys for
t
my es[ate, they being familiar with my aPkairs.
IN WITNESS Wf�REOF, I have to thi4,my I,ast Will and Tesfament,typewritten on three
(3) pages of pa er, set my hand and seal at We end thereof this o��L day of
, 2001.
O (SEAL)
ROBERT E. GERMOND
SIGNED, �'Ai Fn, pUBLISF�D AND DECLARF.D by fhe above-named Tettator, ROBERT
E. GERMOND, as and for his Las[ Will and Testameot in the presence of us who, at his request, in
his presence and in the presence of each other, all being pr e�rt at the same t�e, have hereunto set
our hands as witnesses.
(S$AI.)
� /l`�J1�n��/� (SEAI.)
/
3
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF DAUPHIN .
I, ROBERT E. GERMOND, Te4ator ivhose name is si�ed ta the attached or faregoiug instrument,
hsving been dWy qn�ed accordiog to law, do�hueby acimowledge tLat I�ed and executed the instr�ent
as my I.ast Will aud Tesfament; that I signed it willingly; and that I signed it as my free and volmtary ad for
the purposes therein expressed. .
� ( � <_ _ �U.P/1�17dGi�
RdBERT E. GERMOND
Sworn to and subscribed before me
this a0'� day of�.� , 2001.
�jfl,u,l'v,e/ L'� � �� (SEAL)
Notary Public �
M Commission Ex ires: Notanal Seai
Y P Frances A.Aumiller, Notary Pudic .
Herrisburg. OaupMn Counry .
My Commission Er.pires Mar.16,2002
Member Pennsvlvaniz 4ssociaWnINNdLIBS
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COIINTY OF DAUPHIN .
� �6 �LfL�- �- I�O flE#IL aud �n� �o �+c L
the wimesscs whose names are a�ed to the attached or foregoiug u�s[n�ment, being ddy qnalitied according
to law, do depose and say that we were preseut and saw ROBERT E. GERMOND, TesYator, sign and esecute
[he iash�mnent as ttis Last Will and Testament;that he signed williogly and tLat he executed it as Lis free and
voluntary act for the pm•�Oses therein erzprecsed;that each of us in the 6earing and sight of the Tesfator signed
[he W�71 as witness, and that to the best of our Imowledge, the Tes � r was at that time 18 or more years of
age, of sound mind and under no wnstraint or mdue influe
n �
Sworn to aud subscribed before me _
[his a��� day uf ��ii. , 2001. . .
0 �
��j p,y�pOJ �. t�X-�1h. (SEA[,)
Notary Public ruotariel See�
1�'� COIDmISSIDO E% Il'25: Frarroes A.Aumille�,NOtary PuMc
Y P Merrisburg. Oauphin Caunry
My Commissian Expires Mar.16,2002
Mem�Bl.PetlnsYNBnie Aasaciatlon M No19li85
�
C�DICIL TO THE
LAST WILL AND TESTAMENT
OF
ROBERT �. GERMOND
I, ROBBRT E. GERMOND, of the Mechanicsburg the County of Cumberland, and the
Commonwealth of Pennsylvania,being of sound and disposing mind,do hereby make,publish and
declaze this Codicil to my Last Wil] and Testament, dated[he 20'" of July, 2001, hereby revoking
and making void all prior Codicils at any time heretofore made by me.
I. �Pazagraph VI of my Last Will and Testament dated the 20`" day of July, 2001, shall
now read:
If the said MARGARET M. GERMOND is for any reason unable or
unwilling to serve as Executdx of this,my Last Will and Testament,
then I nominate, consti[ute and appoint my daugh[er, TRACY R.
BROOKS, of Glen Bucnie, Maryland, as successor Executrix. She,
too, shall serve wi[hout bond.
II. All other parts, portions and Pazagraphs of the aforesaid Last Will and Testament
shall remain unchanged.
IN WITNESS WHEREOF,I have to this,my Codicil ro my Last Will and Testament,dated
�b
the 21"day of Suly,2001, set my hand and seal at the end thereof this ;� o day of
i1 � �
_____i� 2004. ..
I <J
� � ����,� � ��,��,�D �SE�.>
ROBERT E. GERMOND
SIGNED,SEALED,PLJBLISHED AND DECLARED bythe above-named Testaror,Robert
E. Germond, as and for his Codicil to the Last Will and Testament dated the 21"day of July,2001,
in the presence of us who,at lus request,in his presence and in the presence of each other,all being
present at the same time, have hereunto set our hands as witnesses.
� ��LC�'(il �-'� / � T�/.1f�y� (SEAL)
I '—'\ � �-� (SEAL)
z
.OMMONWEALTHOFPENNSYLVANIA .
SS.
COUNTY OF DAUPHIN .
I,ROBERT E.GERMOND,Testa[or whose nair�is signed to[he attached or foregoing instrumenl,having been duly qualified
acrordiug[o law,do heceby aclmowledge that I sigued and�txew[ed the instument as my Codicil to my Last Will and TesWnrnt dated
Ihe 2 P'day of 7uly, 2001;tha[I signed it willingly;a¢d that I signed it as my free and voluntary act for the purposes t6erein ezpressed.
, � �✓� � � 'y/9.T�C
Robert .Gemwnd
Swom ro and subscribed before me tlils
�1Q� day of Ju�,2004.
�"���. � Notary Public
My Co �—
Ceml V.SheV.Nde�Y P�blc
M�Cpry��.�
ManOx.PMRY��AS°°���p NYanes
COMMONWEALTH OFPENNSYLVANIA .
SS.
"7UNTY OF DAUPHIN .
p �
wE, !¢TRiCr,� ,,4. ,ZQG�,�'..0! aoa I�eb�ell �� � �Qh0.i�S��-, _
[he wiNesses ose names are signed[o the a[[ached or fomgoing iasWment, emg duly ualified according to law,do depose and say
tha[we were present and saw Robert E.Ge�mond,Testa[oc,si�and execute the instmmeut as his Codicil to[he Last Will and Tes[ament
dated the 2P'day of July, 2001; [hat he signed willingly and that he exewted it as ttis Gee aud volmfary act for the puryoses [herein
expressed;that each of us in the hearing and sight of the Testator signed the Codicil as wimess,aud thaCto the best of our Imowledgq[he
Testaror was at that time I S or more yeazs of age,of sound mind and uvder no constraint or mdue influence.
���LL.f.l6✓ L^ /��.,��✓
� � ��_
Swom to and subscribed before me[his �
.lQ� dayof �ul� . 2004.
f
Notary Public
My Comrttission Ex ' r
Na�a�lel Seal
Ceid V.9iaY.��Y PWtic
�,}��69qnE�¢Yesfe0.�
r.�.r�nm�e'onar�
J 15 0 5 618 6 2 7 auaca�+o aoo
pen�nsY�n^a
°IX1031011�1
R EV-1500 OFFICIAL USE ONLT
�o���v��,e .ea, F�e��mee,
a�,ea�m ma�.�e�ai ra.�: INHERITANCE TAX RETURN
PO BO%280601
Harriso�� .vn n+zeosoi RESIDENT UECEDENT
ENTER DECEDENTINFORMATON eELOW
Social Securiry Number Date o(�eath MMooWvv Da�e of Birt� MMoovrrv
01222014 02031930
Decedenl'sLastName Suffix DecetlenfsFirstName MI
GERMOND ROBERT E
(I(Applicable) Enter Surviving Spouse's I�rtormation Below
Spouse's Las�Name SUHix Spouse's First Name M�
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1. OriginalReWm ❑ Z, Supplemen�alReWrn � 3. RemainEerReWm(tlaleofdeat�
priorto 1243-82)
� 4.AgriculWreExemption(tlateof ❑ 5. FuWreln�erestCompromise(tlaleof � 6. FederalESWteTaxReWrnRequired
dea[h on or after]-0-2012) tlea�h aiter 124282)
� ]. pecedent Dietl Testate ❑ 8� Decetlent Main�ained a LiNng Tmst � 9. To�al Number of Safe Deposit Boces
(Atlach oopy of wlL) (A�tac�wpY of hus�)
� 10. Li�igalion P�oceetls Receivetl � 11. Non-0mbate Transferee ReWrn � ��� Deferral/Elec�ion of Spousal Tmsts
❑ (Schetlule F and G Assets Only)
13. Business Assets ❑ 14. Spouse Is Sole Beneficiary
(No�mst Involvatl)
GORRESPONOENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONOENCE NNO CONFI�ENTIAL TA%MFORMATION SHOULU BE DIRECTEO TO:
Name Daylime Telep�one Number
MAYER E • GUTTMAN, ESQ • 410-321-06��
Firsl Line of Atldress
502 WASHINGTON AVENUE
Secontl Llna of Address
SUITE 800
Gity or Posl OHIce S�a�e ZIP Gotle
TOWSON MD 212�4
correspo�ae�es aman.ames.: T M U R R A Y al L E V I N G A N N • C 0 M
REGISTEROF WILLS OSE Q1�.'Y
n � �
REGISiEROPWILL5U5E0NLY � � '�
OFTE FILED MMDOYYYY � � � �'?
_7 � �
' N . jM1
= '; 1 W
DPTEFILEDSTAMP _D �TI
�
� _ [ n
�_., r- m
� N o
PLEASE USE ORIGINAL FORM ONLY . �
Side 7
L IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIilllll
1505618627 1505618627 �
Estate of Robert E. Germond 059-22-5843
Executors (Page 1)
Name Tracy A. Brooks
Address 125 Foxview Drive
Glen Burnie, bID 21061-
Tax ID 056-56-9170
J1505618635
REV.1500 EX(�) papQeM'e Sodel Securlty Numbm
om.mw�,:6ERMOND ROBERT E �
necarrtuuna+
1. RealEMate(StldulsA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0.00
z. s�o�x.aoem�miscnoaweel. . . . . . . . . . . . . . . . . . . . . . . . . z. 142,598.24
a. cioaeNHeiec«poraum,ren�aamo«sao-Rw�+eia.niolsmea,�c). . . . . 3. 0.00
.. M��a�d�„�a«.��.o�. . . . . . . . . . . . . . . . . . ,. o.00
5. Cec�,BenkDepa4benEMi�wllaneausPancrelPmpeily(Cw3�eEukE), , . . . . 5. 348+265-71
6. JoinllY�^'^�P�opeily(SCM1SEuIeF) � SeO�aBlltlnpReWubtl. . . . . B. O.00
]. Inler-Viws Trero(en 8 Mima�bnaws NmAobele RWeM1Y
�sc+,sawec) � awn�enimoneo�w.a. . . . . z 334,888. 44
8. rm�IGrm�uau(m�alLmeetMraupnt) . . . . . . . . . . . . . . . . . . e. 825�752.39
B. FunarelE�onsesarbMminlWtllwCdLLISGrMIeHI. . . . . . . . . . . . . 9. 4L,538.86
�o. oamc or oocedem.M«�0eue u.aeues a�a��nu(se�eau�e p. . . . . . . . . . io. 12,564.22
�i. ra.io.a�aw�.cmmiu�ae�eio�. . . . . . . . . . . . . . . . . . . . . �i. 59,103.08
ts. Nat vawe ot Emoe(�ms B mtrws�ne��) . . . . . . . . . . . . . . . . . . . �2. 766.6 49•31
t3. CherilnblecnE6wemmenlalBeQwsislSx8tt3T�uebfav.TlM
en eleGlan�o bK ha�nW been metle(��uk J). . . . . . . . . . . . . . . . 1J. �•��
14. x�tv�NaEuelonmrn(unel2MnusWnl3l. . . . . . . . . . . . . . . . t1. 766,649•31
TA%CALCULATION-SEE INSTRUCTIONS FOR MPLICABLE RATES
15. AmouM oi Lirre 1J inuble
M Ihe apouul tax rab,a
Vanafarsu Sec.B116
ux,.2ix.�°` o.00 +5. a•oo
18. AmauntotLtrq �a�eae 1e. 34,499.22
mnnsaiieiez. _ 766+649•32
11. Amount of LNa t4 b�uEb Q.�Q
e�emn�re�u x.�z 0•00 +��
18. AmWnIOILIM11��vOb
e�mna�«eiwx.is 0.00 �e. 0•UO
ia. rnrzoue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ic. 34,499.22
20. FILLINTHEBO%IFYOUMEfiEWE8TN0AFFFUNDdFN1OVEMFAYl�NT �
UnUp pneqY W pe�ury.10K4re I�tl I Mra eYnINM HW�eEen.0ulu0hg aCCOmpYrylnO�����uN^�b.NO M Na M01 mY knpNaEpG Y'd Eellef.
X 4 Wa '1 eM comDW.OMuetlm d papms Ww tl+�lM pw�m ieWonWN br Rlhq Me rtum�bueE an tll Infamalim M+AiI�M1 D�Wm re^
mryknw.le0pe. p/p�
9 OF PERSON RESPON981EF Fl NG OH/?-//��
��
FDO
125 FO�VIEW DRIVE G I + nD 1
9Z3JATRiE PFEPMER QiTHIWPEFSONPE&PfYJAI&EFORFRING1XEf�lu1W
PDO�SS
L iiamiimmii���4,�u14�iii��u�d S,d°z J
15056E9635
v�.eaw.om
i
REv-0500 EX(TG) Page 3 File Number
Decedent's Complete Address:
DECE�ENTS NAME
G RM ROB RT
STREEfRDDRESS
ecur� �Tnn �uc_ CIITTF 8�0
AND
CITV STATE ZIP
LO ER N A 17
Tax Payments and Credits:
�. 1axo�e�aayaz�neiel (i> _ 34,499•22
Z CreditslPayments
A.Prior Paymenls 4$�0�� •�0
B.Discount 0•��
�saa��sw�ro�:-� ro�eic�eansfn.el (z� 45,000 -00
3. Interest
13) � • 00
4. If Line 2 Is greater Ihan Line 1 +Line 3.enter the Dif�erence.This Is IM1e OVERPAYMENT.
r�n�n o.ei o�Page 3,Line 40 mrequesta rehnd. (4) 1 0,500•78
5. Ii Llne 1 a Llna 9 Is greeterihen Llne 2,anterthe dfference.This Is roe�AX DUE. (5) _ � • 0�
Make check payable to: REGISTER OF W ILLS,AGENT.
PLEASE ANSWER THE FOLLOWING�UESTIONS BY PLACING AN "%"IN THE APPROPRIATE BLOCKS
ves No
1. �iE Oecedent make a transfer antl:
a. relain the use or Income of ihe pmpetly Iransferretl . . . . . . . . . . . . . . . . . . . . . . . . . . . x
b. re�aln Ne rigM1l to Oeslgnale wM10 sM1all use�M1e pm0erry Vansferred or its lncome . . . . . . . . . . . . . O �
c. retain a reversionary inlerest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ �
d receive the pmmise for life oi eit�er payments,benefi�s or care? . . . . . . . . . . . . . . . . . . . . .
2. Ii deaN ocwrred afler Dec. 12. 1982,tlld deceden�vans(er pmpetly withln one year of tleath ❑ �
wilhou�receiving atlequa�e consiEeration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Ditl deceCen�own an"m tms�for"or paYable-upon-tleath bank accoun�or secwi�y a�hls or�er deaN4 . . . . . ❑ �
4. �Id tlecedenlown an intlividualretiremen�accoun�,annuity,orother non-probale proparty,which ❑ ❑
contains a beneficiary tlesignation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
IF THE ANSWER TO ANY OF THE ABOVE �VESTIONS IS VES, YOU MUST COMPLETE SCHEOULE G ANO FILE IT AS PART OF THE RETURN.
Por dates of deatM1 on or aper July 1, 1994, and before Jan. 1, 1995, Ihe lax rate imposed on tM1e net value ol lrans(ers m or�or(he use of��e surviving spouse
is 3 percent�]2 P.S.�811 B(a)(1 17(i)].
Fa dates oi deatM1 on or after Jan. 1, 1995, tM1e lax rate ImOosetl on Ne ne� value of transfers �o or for ihe use o( the surviving spouse Is 0 percent
[]2 PS.�B11fi (a)(1.1)QI��.The slatule tloas no�exampl alransierto a suniving spouselrom tax,and�he stalutory reqWremenlsfordlsciosure of assets end
filing a tax re�um are still aOPllwble even If�be surviving spouse Is IM1e onty bene�l<iary.
Fw dates o�death on or after July t 2000'.
• The tax ra�e Imposetl on Ihe net value oi Vans(ers fmm a deceased chiltl 21 years of age or younger at tlealh to orfor the use oi a nalural parenL an
ado0�ive parent or a step-parenl of the chila is 0 percent�]2 P 55 9116(a)(12)].
• The tax rate Imposed on ihe ne�value of Vansfers�o or(or Ne use o(iM1e decetlenCs lineal beneficiaries is 45 percen�,emeD�as notetl In�]2 PS.§9116(a)(i)].
• The�ex rate ImposeE on Ihe nel value oftrensiers to oriorthe use o(Ihe tlaceeenfs slblings Is 12 parcen� []2 P.S.Q911fi(a)(19�]. A si�ling Is defineq
untler Section 9102,as an Individual who has al least one Oarent in common wltM1 Ne Jecedent,whether Ey blood or aGoption.
3masn a000
EXHIBIT B
aev-iso3ex.ta�z�
pennsylvania SCHEDULE B
�EPARTMEMOF REVENUE STOCKS F� BONDS
INHERRANCE7AXRETURN
RESIDENT DECEDENT �
ESTATE OF FILE NIIMBER
Robert S Germond
All property lo�^��Y owned wifh tlgM1t oi survlrorsM1ip musl be tlisdosetl an ScM1eduk F.
VAW E NT DATE
IIEM
NUMBER OESCRIPiION OFOEAiH
L $� $1ia2BH
50 Truet Interasts of MetLife @ $52.66 Der ehnre
CVSIP: 59156R108 2,633.00
2 870 3haree
870 sharas of MET Hauk Corpora[!on 2 112.16 Der ehare
CUSIP: 55261F104 97,579.20
3 30,000 Par
Thirty (30) US Savinge Honde (Sezies I) each with a Eace
..siue oe Sl,000.00 so,000.00
Interest accrvad to 1/22/2014 12,312.00
6 25 Par
One (1) US Savinge Bonda (Sezies E¢) each aith a face
value of $50.00 25.00
Interest accrued to 1/2Z/201G 49.04
TOTAL (Also enfer on Llne 2,RecapiWlation) E 162,598.24
xwaess z.000 Ii more space is needeQ insetl atldllional sM1ee�s of Ne same size
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Calculated Value of Your Paper Savings Bond(s)
Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 01/2014
Total Value Totalinterest ViD Interest
Total Price 12 312.00 80.00
30 000.00 42 312.00
Bonds: 1-30 of 30
Issue Next Final Interest Value No[e
Issue Price Interest Rate
Serial i1 SeriesDenom Date Accrual Maturity q71.60
M0051867931. I $1,000 09/2003 02/2014 09/2033 $1,000.00 $471.60 2.29% �1,
M005188794I I $1,000 09/2003 02/2014 09/2033 $1,000.00� $471.fi0 2.29°/a 51,471.60 i
M0051887951 I $1,000 09/2003 02/2014 09/2033 $1,000.00 $471.60 2.29% §1,471.60
M0051887901 I $1,000 09/2003 02/2014 09/2033 $1,000.00 $471.60 2.29% 51,471.60 I
M005168791I I $1,000 09/2D03 02/2014 09/2033 $1,000.00 $471.60 Z.Z9� ;1'471 60
M0051867921 I $1,000 09/2003 02/2014 09/2033 $1,000.00 5471.60 2.29% 51,
M005873983I I $1,000 OS/2004 02/2014 OS/2034 $1,000.00 $420.00 2.19% ;1,420.00 �I
M0051867881 I $1,000 09/2003 02/2014 09/2033 $1,000.00 $471.60 2.29% 51,471.60
M0051887891 I $1,000 09/2003 02/2014 09/2033 $1'000.00 $471 60 2.29% 51,471.60 �
M005168796I I $1,000 09/2003 02/2014 09/2033 $1, I
M0058739811 I S1,o00.05/2U04 02/2014 OS/2034 $1,000.00 $420.00 2.19% 51,420.00
M005873982I I $1,�00 OS/2004 02/2014 OS/2034 $1,000.00 $420.00 2.19�0 ;1•420.00 I
M0058739841 I $1,000 OS/2004 02/2014 OS/2034 $1,000.00 $420.00 2.19% S1�QZ0.00
M005873985I I $1,000 OS/2004 02/2014 OS/2034 $1,000.00 $420.00 2.19% 51,
M0058739861 I $1,000 OS/2004 02/2014 OS/2034 $1,000.00 $420.00 2.19Wo 51,420.00 �I
M0058739871 I $1,000 OS/2004 02/2014 OS/2034 $1'000.00 $420 00 2.19% ;1,420 00
M005673988I 1 $1,000 OS/2004 02/2014 �5/2034 $1, I
M005873989I � �$1'aQQ OS/2004 02/2014 OS/034 $1 000 00 $420.00 2.19% ;1,420.00
M0058739901 I $1,
M006440829I I $1,000 11/2005 02/2014 11/2035 $1'000.00 $339 60 2.19% 51,339.60 �
M006440830I I $1,000 11/2005 02/2014 11/2035 $1,
M006440831I I $1,000 11/20D5 02/2014 11/2035 $1'000.00 $339.60 219% 51,339.fi0 II
M006440832I I $1,000 11/2005 02/2014 11/2035 $1,
M0064408331 I $1,000 11/2005 02/2014 11/2035 $1,000.00 $339.60 2.19% 51,339.60
M006440837I � $1�000 11/2005 02/2014 11/2035 $1 000.00 $339.60 2.19% $1,339.60 II
M006440838I I S1� 000.00 $471.60 2.29°/a 51,471.60
M005188]97I I $1,000 09/2003 02/2014 09/2033 $1'000.00 $339.60 2.19% $1�339.60
M006440834I I $1,000 11/2005 02/2014 11/2035 $1,
M0064408351 � $1'00o u/zoos oz/zoia 11/2035 $1,000.00 $339 60 2.19°/a ;1 339.60
M006440636I I $1� Totals for 30 Bonds 30 000.00 12 312.00 42 312.00
Notes�
NI No[Issued I
NE .Not eli9ible for payment
PS includes 3 month interest penalty �
MA Matured and no[ earnin interest
htto://ww�*'•treasurydirect,govBGSBCPrice
4/21Y2015
Calculated Value of Youc Paper Savings Bond(s)
Page 1 of I
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 01/2014
Total Value Total Interest V7D Interest
Total Price 49 04 0.00
$25.00 74.04 $
Bonds: 1-1 of 1
Issue Ne�ct Final Issue Interes[=�Ratest Value Note
Serial # Series Denom Date Accrual Maturity Price
L495159924EE EE $50 04/199Tot Is for 1 Bonds $25 00 S<B 04 4'00% $�4.04
Notes
NI NotIssued
NE Not eligible for payment �
P5 Includes 3 month interest penalty �
MA Matured and not earnin interest
nm,d/www.treasurydirect.govBGSBCPrice
4/21/2015
EX�I�3IT E
AE�-�soaE..�oa��� SCHEDULE E �
pennsylvania l
�Purm�morrvevenue CASH, BANK DEPOSITS 8 MISC.
PERSONALPROPERN
FILE NUMBER
ESTATE OF:
RobeLt E GeSmoIId p o Pe ga
mowaeme asonw uooa�amaez�emeom�as�+erea,z�"ee�rmees�a�a.
All ro ert ointl ownetlwilhri hlolsurvivorsM1i muslLetllsclosetlonSCM1etluleF. VAWEATDATE
REM OFDEATH
NtIMBER �ESCRIPTION I
__i aoo 00
i. gax�tander Checkivg Accovnt 551�5
51,056.03
2 Santan8er Certi£icate of DeHoeit #6951 30 �y
Interest accrued to 1/22/2014
sa,asa.ia
3 Santaader Certificata of DeH�sit M�6a� 30.66
Intereet aecrved to 1/22/2016
q Asbury C��itiee Inc. (Sethany Village resideace 5"/,034.85
deHosit refund)
5 b16T Saak IRA #6010
Sinca ao beneficiary was daeignad, accovnt yroceeds were a9,392.02
yaid to the 8state of Robert E. Gexmond 55.01
Interest accrved to 1/22/3014
2,351.00
6 VniCed Statee Treasury (2013 Cax refund)
18,911.71
7 Susquehanna Sank #9196 17.21
Intereet acerued to 1/22/2016
70,753.60
g MhT Baak Checking #0851 0.16
In[arest accrved to 1/27/3U14
66,626.71
9 MET Henk Money Market #9750 1.41
xneereac accruea eo 1/zz/aola
ent) 713.29
ip Geueral Board of Peneioa nnd Henith (D
eneion HaN^
139.32
11 M6T Bank Cozy. Fesseion Pa1'ment
7p7q�(Also enler on line 5,RecaDiWlation) E
9qg,265.71
I�more spacels needed,use aUEM1bnalsM1cets olpapero���e ume size.
0 W<6A�3 000
� • /
November 28, 2014
Tracy Murtay
Law Offces of Levin &Gann
Nottingham Centre
502 Washington Ave, Bth Floor
Towson, MD 21204
RE: Esiate of ROBERT E GERMOND
Date of Death: 01122/2014
Dear Sir or Madam:
Per your request,enclosed please find the account infortnation as of the date of death for ihe above-named
decedent. For your information, accrued iMerest is not included in Ihe date of death balance.
The requesi to close had 6een forwarded to the brench of account. If you do not receive the funds please
contact[hem direct at 168 South 32nd Sireet, Camp Hill, PA 17011 or(717)737-2323
Please feel free to contact me if I can be of any fuAher assistance.
Very Iruly yours,
� P 1 ��������
Ashley Nobrega
SaMander Bank, N.A
Decedent Processing I MAi-M83-02-10
P.O. Box 841005
Boston, MA 02264
Enclosures
Santander
ESTATE OF: ROBERT E GERMOND
SOCIAL SECURITY M:059-22-5843
DATE OF DEATH:01/22I2014
Account#:2002425175 g�RING) ECKING (INTERESTOpendate:01/23/2013
In the name of:MARGARET M GERMOND or ROBERT E GERMOND
Date M death balance:$200.00
Int.(YTD�from: 01/OV2014 To:01/2D2014 $0.00
Accrued Inlerest to date of tleath:$0.00
Otherinfo:
n�the name of:6dARGARET M GERMONO oEROBERT E GERMOND �Pe�date:01/23/2013
Date of death balance: $51,056.03
Int.(YTD)Rom:01/OV2014 To:01/22/2014 $0.00
Accruetl interest to date oi death:$30.79
Otherinfo:
n�the name of: MARGARET M GERMOND oE ROBERT E GERMOND Open date:01/23/2013
Date of tleath balance: $50,854.14
Int.(VTD�from: 0�/01/2014 To:01/2D2014 $0.00
Accrued Interesl to tlale of death: $30.66
Otherinfo:
Page P2
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� MBTBank
499 Miahcll Road,Millsbom,DE 19966 Rmords Managemrnt
Phone 888-502-C349
Fa� (3W)934�2955
Apn16,2015
Shakiera Carter
Towson-01
Re: Estate of Mazeazet M Germond
Social Securi[v 146-24-2989
DateofDeath� Aori103 2013
Dear Sir or Madam:
Per your inquiry on January 28,2015,Please be advised that at the[ime of dea[h,[he above-named decedent had
on deposit with kus bank the following:
�, TypeofAccoun! fndivklva]RefironenEAao�mf
AccountNumber 35004203236070
Ownership lNames oJJ Morgaref M. Germond
OpeninKDate OU25/7995
Balance on Date oJDeatN $ 29,392.02
Accnted/nterest $ 55.01
__.______..__..
___-
__.__'___.
Total �3�29,447.03
For mY oddi6ond infarmation an tM1e�bwe�ceoun�;inaludinR ownenhip and any chonge4 closurts anNor relmbur�emem af(unds,
plau all tFe Downlown Bin6�on at 60]-T19-2121.
We xere u�de to locale any safe dePusM box h/�M1e�b°�+^eMionetl decedeM
TNs ktter Aau�w���d�de any eanune+in wNch Ne dsaud maY w�b°e"��'�as Power of AMmry,CustoNan of Uniform TnnAen,
Repraenmtiveriy�e.orTrus�n under a WriXen Agreen�enl.
$li10EfL�Y,
Valarie Mercer
Records Management
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Susquehann�
November 24, 2014 Susquehanna Bancshares,Inc.
26 Notlh Cetlar Street
PA. Boz1000
Li�ifz,PA 1]543-]000
Tel 1.800.311.3182
LEVM&GANN Fax�n 6z5.44�e
NOTTINGHAM CENTRE
502WASHINGTONAVENUE 8�"FLOOR
TOWSON MD 21204
RE: Robert E Germond Esla[e
DOD: ]/22/2014
SS#: XXX-XX-5843
Tracking# 394244
7'o Whom It Mav Concem:
In response[o your letter of November 2l,2014, here is[he above cus[omer account informa[ion
as of January 22,2014.
Account#1 Acoount#2 Accoun[#3
• Account Title: Robert Germond
Margare[M Germond
• Account Typel# GT60M Rate Riser
3000739196
. Da[e Opened/Maturity l2/14/09
12/14/14
• Inrerest Rate: 3.692°fo
. Accou�tBalance•: $18,911.71
• AccmeAlnterest $1721
• YTD Interct: $637.97
'Accoun[balance does not include accrued in[erest.
� There is no safe deposit box in the name of[he decedent.
❑ There is a safe deposit box# 0 in[he narne of the deceden[located at Ihe branch name.
If I can be of further assislance,please feel @ee to call.
Dawn M Bertier
Susquehanna Bank
Deposit Research Department Lead
I-717-625-6546
DMB/csr
� , o .
STATEMEM PERIOD Vi6E�� '�
JAN.14-FEB.13�2014 1 OF 5
00 0 014DOM MI I1]
000000666 FIDS1501G]OW4131402 03 000000 8930
� REV ROBER7 E GERMOND
MARGARET M GERMOND
125 FOXVIEW DR
GLEN BURNIE MD 21061-6325
SEL�:ECTED AGCOIINT SUMMARY
p��pMT ACCdMT IMEREST EARNED IMTURITY E�IDIN6
TypE MRBER YEAR-TO-DATE D�TE BALRNCE
POIIEM [HECKIN6 000000350130851 1.18 61,626.84
TOT�L OEPOSITS 61,62b.84
3
8
g A C R V ERT E 6ERNOHD
POWER CMEGKING rxne'�. �� wxs�xer n eertnam
� �CCWN� N0. 3 6 01 3 0 651 WMNTOMII BIMGHAMfON
� INTEREST EARNED FOR STATEMEMT PERI00 0.56
ACCOUNT SUMMARY
' .�.�.�..8 9 N6 .. T ER iNG
:�.BkLAMCE DTNER AODITIONS ��� CHKKS PMIO � kACTIQIS MT qES? PD H�L1tICp
� Iq. �IqIMT Iq. NIWNT ND. � AMqMT
]0�]53.40 2 9 2.61 11 30,�]9.13 0 0.00 0.56 61�626.84
�
� ACCOUNT ACTIVITV
;� � .E H H ILY '�
UATE. YRANSAQTIpI 9ESC PYTUN ����� 6 6TNER A�iTTd6 511BTRAfTIIX6 B�LJNCE ��
01-16-14 BE6INIING B�LNICE t]0,]53.40
01-28-14 DEPOSIT 713.29
01-28-14 CMEp( MRBER ]607 96.89 ]1�369.80
01-29-14 CNECK IMmER 7b06 40.00 ]1�329.80
O1-3od4 CXECK IMmER )600 563.➢6
01-30-14 CHECK MROER ]602 13.]0
01-30-14 CHEtI( NUDER ]604 250.00 ]0�462.34
01-31-14 CNECK IMOER 7601 18.61
01-31-14 CNECK MMIBER ]605 1�169.25
01-31-14 CNECK M110ER ]60E ].559.93 61�]34.55
02-03-14 M T B�N( CORPO PEMS PMTS 239.32
02-03-14 CHECK MIMBEP ]599 21.94
02-03-14 CMECK MMBEP 7603 1.69
wou4cs�vtU
C .
STAtEIEM PERIOp PABE �;�
J�N.14-FE8.13�2014 2 OF 5�
REV ROBERT E GERMOND
MARGARET M GERMOND
ACCOUNT ACTIVITY
9ATE Tku16ACTYtl1 bE pTt -� ��: t dTHCk AtffiYTYata StIeTRatTi � ��.
02-03-14 CHEp( MIIBER ]610 31].96 61�62f.26
02-13-14 INTEREST PAVIENT 0.56 61�626.64
EMIN6 &1LNICE t61�626.l4
LNECI(g Pa1YD SIMRIhRY
� ]599 02-03-14 2].94 ]b00 01-30-16 563.]6 1601 91-31-16 18.61
8 ]602 01-30-14 13.70 ]603 02-03-14 1.69 ]604 O1-3D-14 250.OD
� J605 01-31-14 1�169.25 ]606 01-29-14 40.00 ]60] O1-2B-14 9fi.89
]608 01-31-14 ].559.93 ]630� 02-03-14 319.9fi
�
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�ACCd1NT NO.. � �ACGOIMT TYPE SUTEMENT PERZOD� PRGE �
15004226]59)50 PWER MONEY MI�RI(ET I JAN.O]-APR.04,2014 1 OF 1
00 0 04350N NII OU
OODOOI301 FID51549D01I000414P1 OB OH000 ]0143
� MARGARET M GERMONO
`• ROBERT E 6ERNONO
125 FOXVIEW DR
GLEN BURNIE MD 21061-6325
INTEREST E�RNEU FOR STATEMENT PERIOD l.03 TRINUIE RO�D OFFICE
IMTEREST P�IO YEAR TO D�TE 30.l6
ACCOUNT SUMMARY
�. E6INNIN6 . ..f�DEPO5IT5 i ' . � N4 . N � GURRENT�. . . . . E�IN6 . .
�-EILMICE OTHER.IiO�IIIIX6 � - SYliMACTI0115 INTEREST��P�IO 8kLY10E�
� N0. �lpIMT N0. �IqIMT
66.624.11 0 0.00 0 0.00 E.03 66�632.]4
ACCOUNT ACTIVITV
TFp� � � � .: qEPOSITS.ZNTERES ;N/OR�M�LS ER �� � �DAILY� ' �
�� O�TE TRAt6ACTiIX1 OESCRI�TION � �- i OTHER.4DDITIQIS � ���`SUBTRACTIOlG� �� � BALANCE '
01-0]-14 6E6SM/ING l�L1NCE i66�624.11
- '-0644 IMEREST P�VMENT 2.93 66.62].54
$ .-Ob-14 INTEREST P�YMENi 2.56 66,fi30.30
8 04-04d4 StREREST P�VMEM 2.64 66,b32.)4
�
- E10ING BR�RNCE �66.fi32.]4
AIMIAL PERCENfAGE YIELO E�RNEU = 0.05 %
00 VW NN011 Sp1E0NE Mlp CWLD USE ADOITIOIUL MONEY WRIN6 RETI
$ IIfT'S REVERSE MORT616E, NOMEONIIERS WEP 62 H�VE TNE ABILITY TO
OF TNEIR IqME EWITY IMTO MOMEY TNAT IS TVPICR��Y IqT TA%EDJ f '- � �
FOF ALIqST �NYTHING �ND TMERE ARE MO M011THLY LOYI PAYMENTS. TO
BY AN Mfi BRFNCH� [�LL 1-GlL-253-0112 OR M�TCN WR YIDEO AT �� ��
NTl.COM/REVERSEVIDEO. NONSULi YWR T1% 1WISOR TO UISCUSS YWA -. �: ,
SITUAiION. �VAIL�l�E IN OE, DC, 10, NJ� NV, P� �10 VA. Mfi IS / ' '
LEMDER 2014 NiT l�NL MEMlER FDIC. N1L511 3l30]6 , /� 1 ;�
imel��a
E�I-�IBIT C�
aev-ima ex.meus� SCHEDULE G
pennsylvania
oEanrem�eNror�veHue INTER•VIVOSTRANSFERSAND
iHrEairnHCErnxaeTuar� MISC.NON-PROBATEPROPERTY
FILE NUMBER
ESTATE OF
Robert E Gaimond
Tnls schedule musl be completetl antl flleE If t�e answer lo any o!puestions 1 IhmugM1 4 on Oage ihree of the REV-0500 is yes.
pESCRIPfIONOFPROP�ERTV pATEOF�EATH %OFDEG�S EXCWSION TNtABLE
ITEM
rvurvteE _ VALUEOFASSET INiEREST irutticneie VALUE
�� Genworth Aw�uity Contract p2184
BenefiCiariee are decedent'e
children: Tracy Hzooks, Julie
HarC nnd Wendy Gexmond 36,357.56 100.�000 0.00 36,357.56
2 Nationmide Life Iasurance
ComDaay o£ America Wixiuity #80
eeneficiaries are decedeat'e
children: Tracy Hrooke, .Tulie
Hart and Wex�dy Gaxmond 11,306.15 100.0000 0.00 11,306.15
9 Geveral Board of Pension anfl
�Health Henefits oE The Vnited
[4ethodiet Church
Bene£ieiaries are decedent's .
children: Tracy Brooke, Julie
Hart and Wendy Gexmond 210,26G.19 100.0000 0.00 210,766.19
4 M&T Hank IAA #'/fi63
Beneficiaries are decedesst's
� children: Tzacy Brooks, Julie
Aar[ anfl Wendy Gernwnd 38,640.67 100.0000 0.00 38,640.67
Iatereet accrued to 1/22/2014 23.35 1U0.0000 . 23.35
5 eaNcers Life end Caeualty
Anxiuity #716
Beneficiariee ara dacedeat's
children: Tracy Brooke, Julie
Hart and Wendy Germoad 38,201.95 100.0000 0.00 38,201.95
Iaterest nccrued to 1/32/2014 94.5'/ 100.0000 96.5'/
TOTAL�Also enler on line�,RecapiWlation�5 934 888.44
II more space is neNed uu atlOhional sneets M paper of Ne ume sue.
9\VdfiAF I.000
�`�j Information regarding claim
�7e11WOCt�I j�� Fee��arys, zois
PO Box 15]2
smo nroan�a«a ome Decedent Name
��ncro�rg vn 2uosa s�z Robert Germontl
Coniract Number Phone:
Levin&Gann 31N0002784 gg8.325.5433
Noningham Centre Fa"�
502 Washington Ave,8'"Floor 434.948.5783
Towson, MD 21204 Website:
Genworih.com
7racy Murray:
This letler is in response to ihe request tor values for ihe above referenced con�racL The contract was titled as
Robert Germontl as sole primary owner.We have pmcessed paymenis for all ot ihe beneficiaries arid�he coMract is
now closed. Benefidaries Ihat were paid in tull were Tracy Bmoks,Julie Hart and Wendy Germond.
The values as of 01/22/2014-$36,357.56
11 you have any questions, please feel free to contact our office at 888.325.5433 x8124962.
Sincerety,
Claims Depanment
ac
qmYaktl companes'.Genv.vM LMeaM annuAy Insua`x Cunpany,cenwoM Lne Imuraxe Compviy,GenwM ue hsurnce Companyo�Newvo�k
Fax Server 4/16/2015 12 :22: 12 PM PAGE 2/002 Fax Server
'°""��� Life Insuranee Statement ( „o ,.
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16 In�m'mdyMneL[s . . . . . . . . . . . . . . . . . . . . . . . . . . 16 '__
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33 Amcuat of mvrnwl premiom . . . . . . . . . . . . . . . . . . . . . �� S SY39.92
3� nnnum nl ploceeds if payanle ir one sum . . . . . . . . . . . 1� t 311.706.15
ts Valun uf poceeds es of oate a Jce:L(J not payabl¢in nna Sum7 , . . . . . . . . . 2� S
26 Poley pcvsans roncunirg tlefervd pa{memz ai li�s[allmenls b?
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Fcbrumy 2ti,2015 - �
Lcvin&Gnmr . -
Trncy Murrey . .
Notlinghnm Cu�tn. � ' ' . .
502 WasLington Avq 8tL FL �
Towson, MD 21204 - � �
RE: RuLert E. GermonJ -
� Participaul#0209927 � � �
Uear Ms: Mmrag � .
W e are.writing in respunse to yom'rocenl myucst fbr inl'oxmilliun regardiug Ihc dcaiL uf RcvcreaA Robeit
, E. Gemiond 1'he Gener.+l Board uCPnusiun nnJ Hcallh Baiclils(G�cral Iloard)ndministeis the
mtir�incnl and wclf;rrc ylans fur Tl�c Umlod McthoAist C7mrch.
llcnth BeneFit.r �
� Th�7'c was n dr.nil�b�nclil paid fium oUr Comprehensrve Pmtection Plan(CPP)Welfare Plnn which was
. payablc to thc dcsi�atcd b�wclicierics bclow: . . �
Nxme Percentaee Aeai6 Reneflt Amnnnt ,
� TracyR. Rmoks , 33% S(i,45341
Julic K. C, ��Aik 13% $(i,453 41
. - - Wendy 1 GermonA � 34'%a , �(,(i4fr9R . . ,
i � TOTAL � � ' ' S19,555.%0 . �
� Refire�ne�rtPlanlsa�ance(s) � � � .
� �1'he balance as of detrt6 date af 1/22@014 wn�$190,70839.
Plcase Nnte thnt retirement plan accounts are invesfed und umounls are suhjec!(o chamgc.
The balance w:isdiviJal as fulluws: � � � . -
� � Nnmc Percentuee Awouul
- � Trncy R.Broolcs 33% AG2,937.77 �
Julic K. G,.11S�Y 17% :�G2,917 77
. . Wcy�dy 1.Ciermond J4'%a � ' Slvl %4U.R5
� TOTAI, � S7�NI,711N.37
� The 2013 1099 fonn wa.a mailed to du peiticipnntc uddress I/70/14 as well as the 2014 1099 fumi beui�;
, mailcd on I/JO/I5. Copies of thcse fm�ms will be remuiled to y`+ur o�ce as requested �
� � Thc 2012 .md 2013 RML)'s were sa�islieA with dte monthly annuity paymencs heing received each year.
Tlie 2014 RMD was lor a tutul 0l'$12,494.31 anA was cvenly disU'ibutM between the[hree heneficiaries.
�� 'I'he(ieneral Bourd pruvidns eligible p:�rlie3pxnts wilh linancial planping assfstancrat no chnryc$om NY,
' a glnbal financial seivices finn. E'.Y's experienccJ linancinl planners havc bccn specially U'ainitil ut topics-
importnni to pxnicipanPS in Geneml Aoa��d-administered re[irement planr. �:Y Fin.m��nl Plum�ing Scrvicc5
p4/16/2015 xxV A: E6 PAx 8618694412 �402/002
IA;vill cQ'.Cilillll
. . . Fl;�ll'1111I}'2�� Z0�S
. PAbI:2 O�Z
is ovniloble[o benefici¢ries as long us they maintaiu an accoun[bnlance nf at least$10,000 in yuur Geneinl
13onrA-aAministered retirement plun accnwits. .
� Ifyou have any ques[ions,plense call die(ienerul l3narA at 1-800-%51-2201. Representatives ure availahle '
fmnt N'011 a.�n.fi 6:110 p-m.,Cenb�uf time, Moitday thraugh I�riduy.
' Sincerely,
���
Angcliyuc Bmwn
Gcncral Buanl of Pwsiun anJ Hcal�h Bcncfii�
Q M81�Bank
C99 Mimhell Road,Millsboro,DE 19966 Records Menagement
PM1one 888-502-0349
Fex (302)99C-2955
Dmember 23,2014
Shakiera Carter
Towson-01
Re: Estate of Robert E. Gennond
Social Securiri' 059-22-5843
Da[e of Death: 7anuary 22.2014
Dear Sir or Madam:
Per your inquiry on December 15, 2014,please be advised that at the[ime of dealh,Ihe above-named decedent
had on deposit with this bank the following:
L TypeofAccoun( lndiviVua7RefiramentAaount
Accoun�Number 35W4202577663
Ownership(NamesofJ RobenE.Germond
OpeningDate OS/31/1012
BalanceonDateofDeath S 38,640.67
Accrued]nteres( 8 2335
.. .____. .____._._..
Totol � $�38.664.02 ... .
Par any�dditionvl inform�lion an the vbove�ceaunh,including owner�M1ip vnd my cM1mRes,closures anNor ramburvement of(unds,
plpu nll Ibe Mmhv�icvbmg el�Pfi97-I515.
We were uneble[a loule any safe tlepwil box for Ihe ebovtmm�loncd dettOenL
11Js Idler das�w�indude any�cwunu in whi<M1 tM1e decnsed may luve been 11s�ed u Powx of Attomry,GLslodivn of[lniform Trvns(en,
Reprvenm4ve Payeqor Trushe under e Wril4rn Ageemmt
Sincerely,
Valatie Mercer
Records Managemen[
Bankers Life and Casually Company
Administrative Office: 11825 Pennsylvania SVeet �
Cartnel,IN 46032
1�00-821-3724 �
1317-817-6400(ourside the USA)
Mnuity Statement
Single Premium Deferred Mnuity
Shatement period of 05/302013 ihrough OS/302014
pa�i�, For local service, contact :
Owner: ROBERT E GERMOND BranCh Sales OffiCe 2173
125 FOXVIEW DR 2219 YORK RD STE 301
GLEN BURNIE, MD 21061 LUTHVLE TIMON, MD 21093-3101
qnnWb�R: ROBERT E GERMONO Phone: (410 ) 252-0168
Pd'wyNumber: ��63116 Agent : ASHLEY BLANKENSHIP
Pdiry Oale: OS/30/2003
TUCotle: Non-Oualiti¢tl
Beginning Statement Period Information
Bepiming AccwM AEI����/Fees/ IMeres[ Bepinninp Cach
yg�ye p�g Wpb�yq�g Eanietl SurratlerValue
E37.333.50 $0.00 $0.00 E�.493.36 $3],333.50
Ending Statement Period Information
�p�p Conhsc� EnEinp Gsl�
Accouirt Value Value SurtaWer Velue
$38.826.86 E38,82fi.86 E38,826.86
Additional Information
An anniel anvice he in Eetluchtl m wch PdKY annNersary.
THIS STATEMENT IS NOT INTENDED FOR TAX PURPOSES.
u.a�so-idnwi was maae dxna me r�r oeina��ea.w�wui reroi.e.�aeaa rmn eeaa�ae�v. n wui sno«me amoum em u,e hm m
dbhibWm. ThetlisbibWianamouMkrepvteCbticlRS.
TM Oeam VYue is equel to tle acm�M value a the premlums paiG.whkhe�er b Isrper bss airy prbr paWN.
It Yau hrve a�Y 9�^%�kinB Mis etelement.Wease wMad N�r agent. Or.YW can wrke a P�K us et tlw atltlmelGlwia numha elrnm
ebove.
ReyueafeGby: Sys�am Papa t ot 2 52 O6B620195 0531H4
Detailed Account Activity
Trensactions Por tliis period
T�eneacliwi T�aMwib� Adl�b/Fees/ IMxW
� T� p�yg WIIltlraxWs _ AEtlatl --
O6/30/2013 INTEREST AUOEU E0.00 E0.00 5124.5"!
0]/30/2013 INTEREST AODEO 50.00 EQ.00 5120.95
OB/30/2013 1NTEREST AODEU 84.� E0.00 E125.39
09/30/2013 INTEPEST AUOEO 50.00 80.00 E125.81
7p/30/4013 ]NTEREST AOUEU 50.00 f0.00 E122.15
11/30/2013 INTEREST ADOED E0.00 80.00 5�26.63
12/30/2013 INTEREST AOUEO EQ'� EO�� $�z2 95
01/30/2014 INTEHEST AD�EU 50.00 E0.00 512].49
02/2B/2014 INTEREST AOUEO 5��� E0.00 5119.63
03/30/2014 INTEREST AUOED ED'� E��� E�24 �5
04/30/2014 INTEREST AOOEO 50.00 E0.00 E128.'!0
05/30/1014 INTEftEST ADUED E0.00 E0.00 $124.96
� ' IkcrucQ -i q . 5 i :.
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Pnn. 6e.A � � . . � ;..i • '. . .
12�+�p'13
ReP�bY� SY+� PNs 2 d 2 52 OBB87DIB5 OS/�iH4
EXHI� IT I�
°°,�„'.`°'," SCHEDULE H
pennsylvania
oeP�+mcr+raFr+E�eH�e FUNERALEXPENSESAND
iHHeni,nrvce*�ae.uaH ADMINISTRATIVECOSTS
ESTATE OF FILE NIIMBER
R b t E G d
DecetlenPs tleEh mmt be reporte0 on ScM1etlule I.
ITEM
NUMBER DESCRIPrION AMOUNT
A. FUNERPLFJ�ENSES:
� Myara-Bubrig Elu�eral Home and Crematory 10,119.00
g. ADMINISTRATIVE COSTS:
1. PersonalRepresenlativeGommissions'
Name�s)ot aersonal Revresencative(s)
Sveel Pddress
Ciry Slate ZIG
Vear�s)Commisslon Peltl:
2. AuorneyFees: 31,864.14
3. Family Exemption'(Ii tlecetlenfs atlEress Is nol l�e same as claimanCs,atlac�eq9analion.)
Claimanl
Street Atltlress
Clly Stale ZIP
RelationsM1ip o(Claimant to Decetlenl
6. Robate Fees: 610.50
5. AcmumamFees: 3,000.00
6. TvReWrnPreparerFees:
].
1 Santander
Fee foz date o£ death valuation 20.OD
2 Santander
Inactivity Fee 16.00
Total from continuation achedulea . . . . . . . . . 9z9.22
TOTAL(AlsoenteronLlne9,Recapiwiauon) S 46 538.86
arvasns a.000 If more space Is neeCetl,use aEditional snaets of paper of tne same sire.
Estate of: Robezt E Germond
Schedule H Part � (Page 2)
3 Santander
16.00
Inactivity Fee
4 Santandec
16.00
Inactivity Fee
5 Santander 16.00
Inactivity Fee
6 Santander 16.00
Inactivity Fee
7 Santander
1fi.00
Inactivity Fee
8 Levin 6 Gann, P.A. 184.22
Federal Espreea chacgea
9 Thomson Reuters
Tax Processing Software for Inheritance Tax Aetuzn 665.00
Total (Carry £orward to main schedule) 929'Zz
E��II� IT I
��",s"°`."',�, SCHEDULE I �
pennsylvania
oe>uv.�.Er.rorAe�eH�e DEBTS OF DECEDENT, I
uwew.u+cerarae.ua�+ MORTGAGE LIABILITIES& LIENS
ESTATE OF FILE NUMBER
Aobert E Germond
Repotl tlebb IncurreE by�M1e tleceEenl prior to aeatM1 IM1at remalnetl unpaltl attM1e tlab ot tleatM1,Inclutlin8 unreimbureeE meElcal expensea.
irEM VALUE AT OATE
NUMBER �ESCRIPTION OF DEATH
�� Bethany Village at Home 1,1fi9.25
2 M.S Hershey Medical Center 13.']0
3 MSFPIC Physicians Group 18. 61
6 Omnione xing of Pruasia 583.76
5 ��Omnione Kinq o£ Pzussia 696.80
6 Jamas Norton, DPM z�'94
'] Bethany Village at Home 682.50
8 M.5 Herahey Madical Center 236.00
9 MSHMC Phyaiciana Group 38.83
10 Flagship Rehabilitation 32.23
11 Jamas Noiton, DPM 42'84
12 Omnione King of Prvssia 755.29
13 Bank of Amexica 96.89
14 In Youi Home Care 40.00
15 Holy Spirit Hospital 250.00
16 Hethany VIllage 7,559.93
17 Zolatz, Gilbezt b Gold 1. 69
18 ,Lowen Allen Township EMS 31'/.96
TOTAL(Also en�¢�on Line 10,Recapilulation) S 12 564.22
2 W<fiFM?000 I�TOf2 SpdCC IS 022dEd, �IIISE1�2ddlb00dl 51@E15 O��h8 ShcOE SIZE.
EXHI�IT J
a�°,s"'�".`°, ,°, SCHEDULE J
pennsylvania
°""'"�'"°`a`�`"�E BENEFICIARIES
INHERITFNGE TAX RENRN
f�510EMDECECENT
ESTATE OF: FILE NUMBER:
Robert E Ges'moad
REIATIONSHIPTO�ECEDEM AMOUNTORSHARE
NUMBER �MEANDFDDRESSOFPERSON�S�RECEIVINGPROPERTY OONafLic�Tms[ee�s) OFESTATE
I TAXABLEDISiRIBUTI0N5�IntlutleoutngM1�spouSaltlistnbNion5an0�2nslersuntle�
Sec.8116(a)(12�.]
i. Taacy R. Biooke
125 Foxviea Dsive
Glea Surnie, PID 21061
33.333333� of Rasidue: 255,Si9.7'/ Daughter 255,549.77
2 Julie K. Hart
fi20 Toftree Dsive
��Czenberry TovmahSD. PA 1fi066
33.3333339s of Aesidue: 255,569.77 Davghter 255,549.77
3 Wendy S. Garmoad
]2 Richard Street, ist Floor
Soffieon City, NY 13790
33.3333349s of Reeidue: ]55,569.78 Daughter 255,569.'/B
ENIER WLLAR AMOUMS FOR OISiRIBMONS SMOWN NBOVE ON LINE515lHR0UGH 18 OF REV-0500 COVER SMEET,l�5 APPROPRIhTE.
II �N-TAXABLEOISTRIBUilONS
A SPOUSN.�ISIRIBUtI0N5 UN�ER 5 W➢ON 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARRABLE ANO GOVERNMENTAL�ISIRIBOTIONS�.
1
TOTAL OF Pr1RT II-ENTER TOTAL NON-TNXABLE DISTRIBUTIONS ON LME 13 OF REV-1500 COVER SHEET. S 0.00
I!more space Is neetled,use addltional sheets o!paoer of�M1e same size.
9W<6F13D0�
Page 1 of 1
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https://www.fedex.com/shipping/html/en/PrinUFrame.html 4/21/2015
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TELEFAX 910-29tid90I
Apri122, 2015
VIA FEDERAL EXPRESS
Register of Wills for Cumberland County
Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
Re: Decedent: Rober[ E. Gertnond
Pennsylvania lnheritance Tax Retum Resident Decedent(Form REV-1500)
Dear Sir/Madam:
Enclosed please find two (2) original Pennsylvania lnheritance Tax Retum Resident
Decedent(Form REV-1500)along with the appropriate schedules and attachments to be filed forthe
above referenced Decedent.
Please call if you have any questions.
Sincerely,
Tracy���Parale��
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