HomeMy WebLinkAbout05-04-15 i
�FrerntSylvania
1505618288
EX(03-14)(FI)
OFFICIAL
S
REV-1500 CountyCodeYear File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 21 14 0986
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
09 25 2014 08 15 1917
Decedent's Last Name Suffix Decedent's First Name MI
Albert Henry L
(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 Q 2. Supplemental Return Q 3. Remainder Return(date of death
prior to 12-13-82)
Q 4.Agriculture Exemption(date of Q 5. Future Interest Compromise(date of Q 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
7.Decedent Died Testate Q 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
Q 10,Litigation Proceeds Received Q 11. Non-Probate Transferee Return Q 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
Q 13.Business Assets Q 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT—THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Robert R . Church , Esq . 717 2558059
First Line of Address
Keefer Wood Allen & Rahal , LLP
Second Line of Address
P . O . Box 11963
City or Post Office State ZIP Code
;v
Harrisburg PA 17108-1963 70rn
C= 171 c,
Correspondent's email address: rchurch@keeferwood.com
REGISTER= F�WIL',L�§USE(?NLY 1 ��
REGISTER OF WILLS USE ONLY
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1111111 IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
1505618288 1505618288 J
1505618296
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: H e n r y L Albert
RECAPITULATION
1. Real Estate(Schedule A) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 . 00
2. Stocks and Bonds(Schedule B) 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. ?5 ,825 • 35
6. Jointly Owned Property(Schedule F) tD Separate Billing P,ecluested . . . . . 6. 2,6 3 6 ,7 71 - 0 3`
7. Inter-Vivol Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested . . . . . 7. 0 • 00
8. Total Gross Assets(total Lines 1 through 7) . . . . .. . . . . . . . . . . . . . . . . . . . . 8. 2 ,7121596 • 38
9. Funeral Expenses and Administrative Costs(Schedule H) . .. .. . . . . . . . . . . . 9. 24 ,920 • 3 5
10. Debts of Decedent,'Mortgage Liabilities and Liens(Schedule I) . . . .. . . . . . . . . 10. 121758 • 53
11. Total'Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 37 ,678 • 88
1,2.,.Net.Value,of:Estate(Line 8 minus Line 11) . . . . . . . . . . . ... . . . .. . . . . . . . . 12. 2 ,674 ,917 •;5 0
Charifable arid'Governmental Bequests/Sec.9113 Trusts for which
an election_4o,4ax has not been made(Schedule J) . . . .. . . . . . . . . . . . . . . . . . 13. 0 • 00
„Nets Valu,a Subject to Tax(Line 12 minus Line 13) 14. 2-,674 -,917 • 50
T,AX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
'15. Amount bf Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.00 ❑ . ❑❑ 15. ❑ . ❑❑
16. Amount of Line 14 taxable
at lineal rate X.045 21674 ,917 - 50 16. 120A71 - 29
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. 120 ,371 - 29
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
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
anykrlowledge.:" $..i•.;.•
SIGNAT,�.RE.OF ,ERS,O-N,RESPONSIB FOR FILING RETURN DATE
!'. r
ADDRESS,' _.90 rgayberry Court
Williams• m,M-0 094
SIGNATURE •F R P,RE . TFPER THAN P RSONrKESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS P.O. Box 119632
Harrisburg, Pk 17108-1963
Side 2
15.05618296 1505618296 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 140986
DECEDENT'S NAME
Henry L. Albert
STREET ADDRESS
4905 East Trindle Road
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 120,371.29
2. Credits/Payments
A.Prior Payments 95,000.00
B.Discount 5,000.00
(See instructions.) Total Credits(A+B) (2) 100,000.00
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 20,371.29
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS r
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 . . . . . . . . . . . . . . . . . . ❑ IXXI
c. retain a reversionary interest. . . . . . . . . . . . . . . . . .. . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . ❑
91
d. receive the promise for life of either payments,benefits or care? . . . . . .. . . . . . . . . . . . . . . . . . . . . . . ❑
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ® ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?. . . . . . ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
"contains a beneficiary designation?. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a step-parent 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.
REV-1508 EX+ (08-12)
pennsyWeInia SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Henry L. Albert 21 140986
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 DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Wells Fargo Bank-Checking Account#1000615626991 - Principal 53,678.80
Balance-$53678.44; Accrued Interest-$0.36
2 Wells Fargo Bank-Savings Account#000003191814130- Principal 1,383.74
Balance-$1,383.66; Accrued Interest-$0.74
3 Wells Fargo Bank-Check Account#3790 0.00
4 Wells Fargo Bank- Savings Account#7270 - Principal Balance- 11,295.22
$11,294.60; Accrued Interest-$0.62
5 Wells Fargo Bank-Savings Account#1716 0.02
6 Wells Fargo Bank- Savings Account#3102 - Principal Balance- 4,321.09
$4,321.06; Accrued Interest-$0.03
7 U.S. Treasury- Decedent's 2014 Final Form 1040 Refund 4,232.00
8 Heartland Pharmacy Refund 623.22
9 IRA funds received from IRA of Decedent's wife's, Josephine D. Albert(who 291.26
died 6-24-14)
TOTAL (Also enter on Line 5, Recapitulation) 75,825.35
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+ (01-10)
pennsylvania
' SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Henry L. Albert 21 140986
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.
B.
C.
JOINTLY OWNED PROPERTY:
ITEM LETTER DATE DECSRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH
NUMBER FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER ORECEDENT'S VALUE OF
TENANT JOINT SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1 7/21/14 The following items (Nos. 2-36)were held in the 0.00 100.000 0.00
Decedent's Edward Jones Account#27018312,
which the Decedent made joint with his
daughter, Helen A. Bickett, within one year of
his death.
2 7/21/14 1570.93057 shares FirstEnergy Corp common 53,050.33 100.00C 53,050.33
stock
3 7/21/14 3326.35336 shares Public Svc Enterprise 125,603.10 100.000 125,603.10
Group common stock
7/21/14 Ex-Dividend on above Public Svc Enterprise 1,230.75 100.00C 1,230.75
Group common stock accrued as of
Decedent's death
4 7/21/14$15,000 Cumberland Cnty PA Mun Auth Re 15,359.70 100.000 15,359.70
Bond
7/21/14 Interest on above Cumberland Cnty PA Mun 201.88 100.00C 201.88
Auth Re Bond accrued as of Decedent's death
5 7/21/14$100,000 Garnet Valley PA Sch Dist. Bond 104,891.00 100.000 104,891.00
7/21/14 Interest on above Garnet Valley PA Sch Dist 2,054.17 100.00C 2,054.17
Bond accrued as of Decedent's death
Total from continuation Schedule(s) 2,334,380.10
TOTAL (Also enter on Line 6, Recapitulation) 2,636,771.03
If more space is needed, use additional sheets of paper of the same size.
Page 2
Estate of: Henry L. Albert 21 140986
Schedule F - Jointly-Owned Property
Letter Date %of Date of Death
Item for Joint Made Date of Death Decd's Value of
Num. Tenant Joint Description of Property Value of Asset Interest Decedent's Interest
6 07/21/14$20,000 Harrisburg PA Auth Wtr Rev Bond 19,497.40 100.000 19,497.40
07/21/14 Interest on above Harrisburg PA Auth Wtr Rev 204.17 100.000 204.17
Bond accrued as of Decedent's death
7 07/21/14$25,000 Lancaster Cnty PA Hosp Auth Re 25,551.75 100.000 25,551.75
Bond
07/21/14 Interest on above Lancaster Cnty PA Hosp 31.25 100.000 31.25
Auth Re Bond accrued as of Decedent's death
8 07/21/14$20,000 Pennsylvania Hsg Fin Agy Bond 20,009.00 100.000 20,009.00
07/21/14 Interest on above Pennsylvania Hsg Fin Agy 454.33 100.000 454.33
Bond accrued as of Decedent's death
9 07/21/14$45,000 Pennsylvania St Tpk Comm Tpk Bond 47,942.55 100.000 47,942.55
07/21/14 Interest on above Pennsylvania St Tpk Comm 712.50 100.000 712.50
Tpk Bond accrued as of Decedent's death
10 07/21/14$10,000 State Pub Sch Bldg Auth PA Sch 10,750.00 100.000 10,750.00
Bond
07/21/14 Interest on above State Pub Sch Bldg Auth PA 180.56 100.000 180.56
Sch Bond accrued as of Decedent's death
11 07/21/14$100,000 State Pub Sch Bldg Auth PA Rev 101,662.00 100.000 101,662.00
Bond
07/21/14 Interest on above State Pub Sch Bldg Auth PA 2,054.17 100.000 2,054.17
Rev Bond accrued as of Decedent's death
12 07/21/14$15,000 Hydro-Quebec Bond 20,837.07 100.000 20,837.07
07/21/14 Interest on above Hydro-Quebec Bond accrued 240.63 100.000 240.63
as of Decedent's death
13 07/21/14 9848.244 shares American Balanced Fd Cl A 250,440.84 100.000 250,440.84
common stock
14 07/21/14 1338.009 shares American Balanced Fd Cl B 33,958.67 100.000 33,958.67
common stock
15 07/21/1412717.124 shares DMC Tax Free Income Tr 103,644.56 100.000 103,644.56
PA Sh Ben Int A mutual fund
TOTAL. (Carry forward to main schedule) . . . . . . 638,171.45
Page 3
Estate of: Henry L. Albert 21 140986
Schedule F - Jointly-Owned Property
Letter Date %of Date of Death
Item for Joint Made Date of Death Decd's Value of
Num. Tenant Joint Description of Property Value of Asset Interest Decedent's Interest
07/21/14 Income on above DMC Tax Free Income Tr PA 30.42 100.000 30.42
Sh Ben Int A mutual fund accrued as of
Decedent's death
16 07/21/14 6119.500 shares Federated Mun Secs Income 66,947.33 100.000 66,947.33
Tr PA Mun Incm A mutual fund
17 07/21/14 588.35 shares Fundamental Invs Com mutual 31,753.25 100.000 31,753.25
fund
18 07/21/14 2830.727 shares Income Fd Amer Inc Cl A 60,719.09 100.000 60,719.09
mutual fund
19 07/21/14 1826.646 shares Aim Equity Fds Invesco Eqt 32,422.97 100.000 32,422.97
Fds Invsc Dvsfd Fd A mutual fund
20 07/21/14 10747.899 shares Aim Counselor Ser Tr Inv 120,913.86 100.000 120,913.86
Egty&Incm A mutual fund
21 07/21/14 905.819 shares Aim Counselor Ser Tr Inv 26,114.76 100.000 26,114.76
Gwth&Incm A mutual fund
22 07/21/14 23048.625 shares Aim Tax-Exempt Fds 227,489.93 100.000 227,489.93
Invesco Inv Hiyld Muni A mutual fund
07/21/14 Interest on above Aim Tax-Exempt Fds Invesco 816.00 100.000 816.00
Inv Hiyld Muni A mutual fund
23 07/21/14 17733.495 shares Aim Counselor Ser Tr Inv PA 292,248.00 100.000 292,248.00
Tfx Inc A mutual fund
07/21/14 Interest on above Aim Counselor Ser Tr Inv PA 717.92 100.000 717.92
Tfx Inc A mutual fund accrued as of Decedent's
death
24 07/21/14 1873.411 shares Lord Abbett Invt Tr Core Fx 20,626.26 100.000 20,626.26
Incm A mutual fund
07/21/14 Interest on above Lord Abbett Invt Tr Core Fx 32.02 100.000 32.02
Incm A mutual fund
25 07/21/14 380.663 shares Lord Abbett Muni Income Tr 4,457.56 100.000 4,457.56
Hiyld Munibd A mutual fund
07/21/14 Interest on above Lord Abbett Muni Income Tr 14.69 100.000 14.69
Hiyld Munibd A mutual fund
TOTAL. (Carry forward to main schedule) . . . . . . 885,304.06
Page 4
Estate of: Henry L. Albert 21 140986
Schedule F - Jointly-Owned Property
Letter Date %of Date of Death
Item for Joint Made Date of Death Decd's Value of
Num. Tenant Joint Description of Property Value of Asset Interest Decedent's Interest
26 07/21/14 2684.955 shares Lord Abbett Invt Tr Mltast Bal 34,018.38 100.000 34,018.38
Opp A mutual fund
27 07/21/14 2954.372 shares Lord Abbett Invt Tr Mltast 55,896.72 100.000 55,896.72
Grwth A mutual fund
28 07/21/14 18057.669 shares Lord Abbett Invt Tr Sh Dura 81,620.66 100.000 81,620.66
Incm A mutual fund
07/21/14 Interest on above Lord Abbett Invt Tr Sh Dura 195.07 100.000 195.07
Incm A mutual fund
29 07/21/14 2070.117 shares Lord Abbett Invt Tr Total 21,922.54 100.000 21,922.54
Return A mutual fund
07/21/14 Interest on above Lord Abbett Invt Tr Total 43.81 100.000 43.81
Return A mutual fund
30 07/21/14 3861.647 shares Oppenheimer Portfolio Ser 58,117.79 100.000 58,117.79
Aggressv Inv A mutual fund
31 07/21/14 14631.69 shares Oppenheimer Multi St 157,144.35 100.000 157.144.35
Municipal Roth PA Mun Cl A mutual fund
07/21/14 Interest on above Oppenheimer Multi St 52.26 100.000 52.26
Municipal Roch Pa Mun CI A mutual fund
32 07/21/14 8902.04 shares Vanguard Specialized Portfolio 198,248.43 100.000 198,248.43
Div Grw Fd mutual fund
33 07/21/14 8931.58 shares Vanguard Mun Bd Fd Inc Long 104,231.54 100.000 104,231.54
Term Port mutual fund
07/21/14 Interest on above Vanguard Mun Bd Fd Inc 284.76 100.000 284.76
Long Term Port mutual fund
34 07/21/14 2077.538 shares Washington Mut Invs Fd Inc 86,778.76 100.000 86,778.76
common stock
35 Cash in Edward Jones Account#27018312 184.20 100.000 184.20
36 Edward Jones Account#27018312 -Money 12,165.32 100.000 12,165.32
Market Cash
TOTAL. (Carry forward to main schedule) . . . . . . 810,904.59
REV-1510 EX+ (08-09)
pl noS Mn a SCHEDULE G
DEPARTMENT OF RMNUE
INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Henry L. Albert 21 140986
This schedule must be completed and filed if the answer to any of questions I through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIPTO DECEDENT VALUE OF ASSET INTEREST IF APPLICABLE VALUE
AND THE DATE OF TRANSFER.ATTACH COPY OF THE DEED FOR REAL ESATE.
1 12/24/14 Christmas gift to Thomas Bickett 1,000.00 1,000.00 0.00
2 12/24/14 Christmas Gift to Andrew Bickett 1,000.00 1,000.00 0.00
3 12/24/14 Christmas Gift to Kathryn Venini 1,000.00 1,000.00 0.00
I
TOTAL (Also enter on Line 7, Recapitulation) 0.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
iffpennsylvana SCHEDULE H
DEPARTMENT OF REVENUE
FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DE EDENTTURN ADMINSTRATIVE COSTS
ESTATE OF FILE NUMBER
Henry L. Albert 21 140986
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See schedule attached 2,679.79
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2. Attorney Fees: 19,500.00
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: 385.00
6. Tax Return Preparer Fees:
See schedule attached 1,462.56
TOTAL (Also enter on Line 9, Recapitulation) 24,920.35
If more space is needed, use additional sheets of paper of the same size.
Page 2
Estate of: Henry L. Albert 21 140986
Schedule H, Part A - Funeral Expenses
Item
Number Description Amount
1 Auer Cremation Service 637.20
2 Plainfield Cemetery 350.00
3 Applebees Restaurant 41.22
4 Boiling Springs Tavern 104.66
5 Garden Boquet- Flowers 84.80
6 Minister's Fee 100.00
7 Organist's Fee 75.00
8 Funeral Luncheon 51.91
9 Owen's Monument Company 1,235.00
TOTAL. (Carry forward to main schedule) . . . . . . 2,679.79
Page 3
Estate of: Henry L. Albert 21 140986
Schedule H, Part B - Administrative Costs
Miscellaneous Expenses
Item
Number Description Amount
7 Wingate Hotel - Executrix Lodging Expenses 100.35
8 Cracker Barrel Restaurant, Executrix Travel Expense 32.39
9 Bridge and Turnpike Tolls, Executrix Travel Expense 23.80
10 Wingate Hotel, Executrix's Lodging Expenses 119.52
11 U-Haul 181.81
12 Keefer Wood Allen & Rahal, LLP -attorney's disbursements thru 10-20- 154.69
2014
13 Keefer Wood Allen & Rahal, LLP attorney's estimated disbursements to 500.00
complete estate administration
14 Sek& Co. -2013 income tax preparation 350.00
TOTAL. (Carry forward to main schedule) . . . . . . 1,462.56
REV-1512 EX+ (12-12)
penrisAvania SCHEDULE I
DEPARTMENT DF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Henry L. Albert 21 140986
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 PA Department of Revenue- Decedent's 2013 Form PA-40 balance due 294.00
2 PA Department of Revenue- Decedent's 2014 Final Form PA-40 balance 841.00
due
3 PA Department of Revenue- Decedent's 2013 Form PA-40 (additional 19.39
payment)
4 Country Meadows- rent for Decedent 6,572.55
5 Country Meadows- private duty nurse for Decedent 3,815.75
6 State Employee's Retirement Fund - reimbursement for overpayment of 200.45
September final pension check
7 Diamond Pharmacy-co-pay on medications 362.28
8 Heartland Pharmacy-co-pays on Josephine Albert's medications 336.64
9 Holy Spirit Hospital -co-pay for Josephine Albert 50.00
10 Holy Spirit Hospital -co-pay for Henry Albert 50.00
11 Mid-State Mobile Health Partners-transportation to dialysis from 97.35
ManorCare-Carlisle
12 Pinnacle Health Hospitals-co-pay for emergency service 50.00
13 Diamond Medical Supply-medical equipment 69.12
TOTAL (Also enter on Line 10, Recapitulation) 12,758.53
If more space is needed, insert additional sheets of the same size
h
c
REV-1513 EX+ (01-10)
r pennsylvania SCHEDULE
DEPARTMENT.OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Henry L. Albert 21 140986
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and
transfers under Sec.9116(a)(1.2).]
1 Helen A. Bickett Daughter 2,674,917.50
909 Bayberry Court
Williamstown, NJ 08094
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:
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.
Last Will and Testament
OF
HENRY L. ALBERT
I, HENRY L. ALBERT, of Hampden Township, Cumberland County, Pennsylvania, do
make, publish aiid declare this to be my Last '\Vill and Testament, hereby revoking all Wills and
Codicils by me heretofore made.
ITEM 1: Fannily Information. I ann married to Josephine D. Albert, and all
references to my wife in this Will are to her. I have one child: Helen A. Bickett. Any person
born to or adopted by my daughter, Helen A. Bickett, shall be included in this Will as my issue.
Provided, however, no adopted person shall benefit under this Will unless the order or decree of
adoption is entered before the adopted person attains the age of twenty-one (21) years.
ITEM II: Death Taxes. I direct that all inheritance and estate taxes becoming due by
reason of my death, 'whether payable by my estate or by any recipient of any property, shall be
paid by the Executor out of the residue of m.y estate, as an expense and cost of administration of
nay estate, except that no taxes shall be charged against any gift qualifying for the marital or
charitable deduction in my estate, The Executor shall have no duty or obligation to obtain
reimbursement for any such tax so paid, even though on proceeds of insurance or other property
not passing under this Will.
ITEM III: Debts and Filial Expenses. I direct the Executor to pay the expenses of my
last illness, my legally enforceable debts, and in), funeral expenses from the residue of nn), estate
as an expense and cost of administration of nay estate.
Page 1
ITEM IV: Tangible Personal Property. I give my tangible personal property and all
casualty insurance that I am carrying ora said tangible personal property to my wife, Josephine D.
Albert, or, if she does not survive me, I give said property to my daughter, Helen A. Bickett, or if
she does not survive me, then to her then-surviving issue, per stupes. I have complete
confidence that my wife, my daughter or the Executor will honor any written instructions that I
may leave with regard to said tangible personal property. Any such property not so distributed
shall be sold, and the proceeds added to my residuary estate to pass as hereafter described.
ITEM V: Residue. I give the residue of nay estate, not disposed of in the preceding
portions of this Will, to my wife, Josephine D. Albert, if she survives me, If my wife or her
authorized agent disclaims any property or interest in property to which she would be entitled
under the provisions of this Item, the disclaimed property shall be held by the Trustee, IN
TRUST, and shall be administered and distributed as provided in ITEM VI. If my wife does not
survive me, the residue shall be distributed as provided in ITEM VI,paragraph (c) et M.
ITEM VI: Disclaimer Trust. The following provisions shall apply to any property
payable to the Trustee described in ITEM V as a result of the disclaimer of any such property by
my wife:
(a) Income to Spouse. The Trustee shall pay to or for the benefit of my wife,
Josephine D. Albert, all of the net income of this Trust in convenient installments, but not less
frequently than annually.
(b) Principal to Shouse. The Trustee shall pay to nay wife so much of the
principal of this Trust as may be necessary in the discretion of the Trustee for the reasonable
support, maintenance and health care of my wife. I direct the Trustee to be generous in
exercising the discretion granted by this paragraph, considering that my wife is the primary
object of my bounty.
Page 2 ` % ?r
(c) Upon Death of Spouse. Upon the death of my wife, the Trustee shall
distribute the then-remaining income and principal of this Trust to my daughter, Helen A.
Bickett, oLitright and free of trust, if she is then living. If for any reason my daughter does not
survive to such distribution date, the principal and undistributed income of the Trust shall be
divided and distributed in equal shares,per stirpes, to her then-surviving issue, subject,however,
{
to the custodial protections set forth in Item X(c) below for underage beneficiaries.
(d) Trust Without Beneficiaries. If before final distribution of the assets of
any Trust established herein,there is no living beneficiary of that Trust, it shall terminate. The
assets of such Trust shall be paid to the then living issue, on a per stirpital basis, of the nearest
deceased ancestor (with issue living at the time of distribution) of the beneficiary who is me or
my issue. However, if there is then in existence any Trust or custodial account created under this
Will for the benefit of that issue, the share which would have been distributed to that issue shall
be added to the principal of his or her Trust or custodial account,to be administered and
distributed as provided in this Will.
(e) Failure of Issue.'In the event I am not survived by my wife nor by any
issue, or if there are no issue of mine surviving upon the termination of any Trust, the remaining
residue (or principal) thereof shall be divided and distributed one-half('/7) to nay intestate heirs,
under the laws of the Commonwealth of Pennsylvania, and one-half(Y2) to the intestate heirs of
nay wife, under the laws of the Commonwealth of Pemasylvania, as if we had each died intestate
on the date of such distribution.
ITEM VII: Spendthrift Clause. No part of the income or principal of any Trust
created by this Will shall be subject to attachment, levy or seizure by any creditor, spouse,
assignee or trustee or receiver in barduuptcy of any benefrcimy prior to his or her actual receipt of
income or principal distributed. The Trustee shall pay the net income and the principal to the
beneficiaries specified by me, as their interests may appear, without regard to any attempted.
Page 3
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anticipation; pledging or assignment, and without regard to any claim or.attennpted levy,
attaclunent, seizure or other process against the beneficiary.
ITEM VIII: Administrative Powers. In addition to the powers granted at law,the
Executor and the Trustee shall each possess the following powers, each of which shall be
construed broadly and may be exercised without court approval, but in a fiduciary capacity only:
(a) To retain any investments I have at my death, including specifically those
consisting of stock of any bank even if I have named that bank as the Executor or Trustee,
(b) To vary investments, to make loans, and to invest in bonds, stocks, notes,
real estate mortgages or other securities or in other property, real or personal, without being
restricted to so-called "legal investments", and without being limited by any statute or rule of law
regarding investments by fiduciaries.
(c) In order to divide the principal of a Trust or for any other purpose,
including final distributions,the Executor and Trustee are authorized to divide and distribute
personal property and real property, partly or wholly in kind, and to allocate specific assets
among beneficiaries and Trusts so long as the total market value of each. share is not affected by
the division, distribution or allocation in kind. The Executor and Trustee are each authorized to
nnake,join in and consummate partitions of lands, voluntarily or involuntarily, including giving
of mutual deeds, or other obligations, with as wide powers as an individual owner in fee simple.
(d) To sell either at public or private sale real and personal property severally
or in conjunction with other persons, and to consummate sale(s)by deed(s) or other instrument(s)
to the purchaser(s), conveying a fee simple title. No purchaser shall be obligated to see to the
application of the purchase money or to make inquiry into the validity of any sale(s). The
Executor and Trustee are authorized to execute, acknowledge and deliver deeds, assigninents.
Page 4 -
�•. 7 c�=-,'rte. p i v �. ;: <- ..-.. ..-.:-"4"z ''.:{� `.�: '=�~�'ia. "�"an.f�:s:: kfv :.,�. ..Y ��V` ..}� re gC '' :.4_..5,.�'ad
F �
options or other writings as necessary or convenient to any of the power conferred upon the
Executor and Trustee.
(e) To mortgage real estate, and to make leases of real estate.
(f) To borrow money from any person, including the Executor or Trustee, to
pay indebtedness of aline or of my estate, expenses of administration or inheritance, legacy,
estate and other taxes, and to assign and pledge assets of my estate or any Trust established by
this Will.
(g) To pay all costs, taxes, expenses and charges in corn-ection with the
administration of- my estate or any Trust established under this Will.
(h) To make distributions of income and of principal to the proper
beneficiaries, during the administration of my estate,with or without court order, in such mariner
and in such amounts as the Executor deems prudent and appropriate.
(i) To vote shares of stock or other business interests which form a part of my
estate or any Trust established under this Will, and to exercise all the powers incident to the
ownership of the same.
(j) To unite with other owners of property similar to property in my estate to
carry out plans for the reorganization of any company or entity whose securities form a part of
ia.-y estate.
(k) To disclaim any interest in property which would devolve to me, to my
estate, or to any Trust created hereunder, with such disclaimer to be made by whatever means,
including but not limited to the following: as beneficiary under a will, as an appointee under the
j
Page 5 —� f
� c �--r ^i` �r'r,�u�„t��° y; s`�� �u,��� •r'�,s � 1�s� ,�r� "S k�'�s. �"-�� t '' �r h ,c � �¢c
exercise of a power of appointment, as a person entitled to take by intestacy, as a donee of an
inter vivos transfer, and as a donee under a third-party beneficiary contract.
(1) To prepare, execute and file tax returns of any type required by applicable
law, including but not limited to filing a joint tax return with my survivirng spouse, and to snake
all tax elections authorized by law.
!
(nn) To employ custodians of property, investment or business advisors,
accountants and attorneys as the Executor or Trustee deems appropriate, and to compensate these
persons from assets of nay estate or trust, without affecting the compensation to which the
Executor and Trustee are entitled,
(n) To divide any Trust created in this Will into two or more separate Trusts
so that inclusion ratio for purposes of the generation-skipping transfer tax shall be either zero or
one, in order that an election under Section 2652(a)(3) of the Internal Revernue Code of 1986, as
amended, may be made with respect to one of the separate Trusts, or for any other reason.
(o) To allocate administrative expenses to income or to principal, as the
Executor or Trustee deems appropriate. However, no allocation to incorne shall be made if the
effect of the allocation is to cause a reduction in the amount of any estate tax marital deduction or
estate tax charitable deduction.
(p) To tmalce any adjustment to basis authorized by law, including, but not
limited to increasing the basis of any property included in my estate, whether or not passing
under this Vtilill, by allocating any amount by which the bases of assets rimy be increased, The
Executor shall be under no duty and shall not be required to allocate basis increase exclusively,
primarily, or at all to assets which pass as part of my probate estate as opposed to other property
for which a basis adjustment is allowable. The Executor shall allocate basis increase equitab .y
Page 6
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.� d+ '?'"% n •�: -.i 3.'� �-S ..'�� '�i`-;c, r '" �vi.�u�.sis'.H�.,.s.�saz.a-a�,.�r.:e- �: -G;�ss .fir G''s',�,I
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among those beneficiaries receiving property as a result of my death, but shall not be liable to any
person, nor- subject to removal or surcharge, for any reasonable allocation of basis increase.
(q) To compromise claims.
(r) To terminate any Trust, if in the opinion of the Trustee, the expense of
administration of the Trust is not justified. Upon termination, the Trustee shall distribute the
trust property to the person(s) then entitled to receive or have the benefit of the income
therefrom. If there is more than one current income beneficiary, the Trustee shall distribute trust
assets to the income beneficiaries in the proportion in which they receive income, or if no
proportion is designated, in equal shares to the income beneficiaries. This power may only be
exercised by a Trustee who is an independent Trustee, and this power shall be ineffective to the
extent that the effect of the power is to vest in any Trustee or beneficiary a general power of
appointment.
(s) To do all other acts in his or her judgment necessary or desirable for the
proper and advantageous management, investment and distribution of the estate and Trusts
established under this Will.
ITEM IX: Accounting. The Trustee, on an annual basis, shall provide each income
beneficiary who has attained the age of eighteen (18) years, and the Guardian of the person of any
income beneficiary who has not attained the age of eighteen (18)years, statements showing
transactions of each Trust established for the benefit of that beneficiary. 'Flae beneficiary, or the
Guardian of the person of such beneficiary, may waive this right to receive an annual accounting.
The Trustee may, at any time, settle any account, or questions concerning the administration of
any Trust established under this Will, by agreement with the then current income beneficiaries of
the Trust, if legally competent, or if not legally competent, with the Guardian of the person of the
beneficiary; the legally competent spouse of the beneficiary, or the oldest legally competent
Palle 7 �� ��
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y
relative of the beneficiary who would take a portion of the estate of the beneficiary were the
beneficiary to die at that time intestate under the laws of the Commonwealth of Peruisylvania.
Any settlement made in accordance with this Item shall bind all persons who have an interest in
the Trust, and shall constitute a release and discharge of the Trustee with respect to transactions
specified in the settlement.
ITEM X: Distributions to or for Beneficiaries. The Trustee is authorized to
distribute principal and/or income in any one or more of the following ways if the Trustee, in the
discretion of the Trustee, considers the beneficiary unable to apply distributions.to the
beneficiary's own best interests, or if the beneficiary is under a legal disability:
(a) Directly to the beneficiary-,
(b) To the authorized agent (under a Power of Attorney), legal guardian or
conservator of such beneficiary-,
(c) To the Trustee, or to another person selected by the Trustee, as custodian
under the Pennsylvania Uniform Transfers to Minors Act as to a beneficiary under the age of
twenty-five (25) years;
(d.) To a relative of the beneficiary,to be expended by that relative for the
benefit of the berlefrci.aiy; or
(e) By directly applying distributions for the benefit of the beneficiary.
ITEM XI: Survival. Any person (other than nay wife) who has died within thirty (30)
days of nay death, or under such circumstances that the order of our deaths cannot be established
by proof, shall be deemed to have predeceased me. Any person (other than my wife) who has
Page 8 -
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died at the same time as any beneficiary under this Will, or in a common disaster with that
beneficiary.. or under such circumstances that the order of deaths cannot be established by proof,
shall be deemed to have predeceased that beneficiary. My wife shall be presumed to have
survived me if we should die simultaneously or if the order of our deaths cannot be established
by proof.
ITEM XII: Merger of Trusts. should my wife, by Will or Agreement of Trust,
establish Trusts similar to the Trusts I have established for the benefit of Illy issue,the Trustee of
each Trust created in this Will shall have the right to merge it with the similar Trust created by
my wife for the same beneficiaries. If merged,the Trustee shall operate the merged Trusts as a
single Trust.
ITEM XIII: Trust Situs. The initial situs of each Trust created under this Will shall be
the county of my domicile at my death. The Trustee may determine, from time to time, to change
the situs of any Trust established under this Will. However, no change in situs shall be effective
until written notice is provided to the living beneficiaries of the Trust.
ITEM XIV:. Executors and Trustees.
(a) I appoint my daughter, Helen A. Bicicett, to be the Executor and the
Trustee. If she is unable or unwilling to serve, for any reason, then her son, Thomas C. Bicicett,
shall serve as the alternate Executor and as the alternate Trustee. All references herein to the
Executor and/or the Trustee shall include their designated alternates, successors and substitutes.
(b) Any person(s) serving as the Trustee shall have U-ic power to appoint
additional Co-Trustees) at any time.
Page 9
(c) Any Co-Trustee appointed hereunder may be removed by the person who
appointed such Co-Trustee. Each appointment or removal of a Trustee shall be in writing and
shall be filed with the court in the jurisdiction which is the situs of the Trust. The written
instrument shall be signed by the person having the power to mare the appointment or removal.
r
(d) The Trustee shall have the power to designate a ternporary Trustee by an
instrument in writing delivered to such temporary Trustee. The temporary Trustee shall serve as
such only during the legal incapacity of the appointing Trustee, or, during such period of time as
the appointing Trustee in writing designates, and upon the expiration of that time, or at such time
as the legal incapacity of the appointing Trustee ceases, the appointing Trustee shall once again
become the Trustee,
(e) Any Co-Trustee may delegate investment and related management
functions to another Co-Trustee;provided the other Co-Trustee accepts the delegation in writing.
To the extent accepted, the delegating Co-Trustee shall be relieved of responsibility for the
investment decisions of the Co-Trustee to whom investment and related management functions
were delegated,
(f) No Co-Trustee shall be responsible for the acts or omissions of any other
Co-Trustee.
(g) In the absence of actual knowledge of a breach of trust, or information
concerning a possible breach of trust that would cause a reasonable person to inquire, a successor
Trustee is under no duty to examine the accounts and records of any predecessor Trustee, or to
inquire into the acts or omissions of such predecessor, is not liable for any failure to seek redress
for any act or omission of such predecessor, shall have responsibility only for property which is
actually delivered to the Trustee by such predecessor and shall have all of the powers conferred
upon a Trustee hereunder.
Page 10 r: t
rs��it',�,� `aac^�r,...g5'�����`L{�t�`�`'ds224kwSa.r �,��Yxe� L�' s'L� �...� c�so '- � ir -Yt..,-},s"��'`• � �:,� '�mer r��''� 'f�w z.`i, i s�K.c'�vt� 4'', i t r^r ���'.._,,�"�„�
ae y
(h) The Executor and the Trustee shall have the right to receive reasonable
compensation for services rendered and reimbursement for reasonable expenses.
(i) No Executor or Trustee shall be liable or accountable for any loss that may
result from the good faith exercise of the authority granted in this Will.
(j) The Executor and Trustee are specifically relieved from the duty of filing
bond or entering security in any jurisdiction.
IN WITNESS WHEREOF, I have set nay hand and seal on this nay Last Will and
i
Testament this f day of 'r �,,, '` > 2010.
n
(SEAL)
HENRY L. ALBERT
SIGNED, SEALED, PUBLISHED, and
r
DECLARED by HENRY L. ALBERT as and %' If
for his Last Will and Testament, on the day and
year last above written, in the presence of us, {
who, at his request, in his presence, and in the
presence of each other, all being present at the ✓` .
sane time, have hereunto subscribed our
names as witnesses:
Page 11
SELF-PROVING AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
SS.
COUNTY OF CUMBERLAND
WE, HENRY L. ALBERT, andi� g� \vmy and
the Testator and the witnesses, respectively, whose names are
signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrument as his Last Will and
that he had signed willingly (willingly directed another to sign for hien), and that he executed it as
his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testator, signed the Will as witness and to the best of his or her
knowledge the Testator was at that time eighteen (18) years of age or older, of sound mind, and
under no constraint or undue influence.
HENRY L. ALBERT, Testator
Witness.._,_
Witness
Subscribed, sworn to, and acluaowledged before me by HENRY L. ALBERT, the Testator, and
subscribed and sworn to before nye by2Aee , 1�� ��1 , and
witnesses, this �f� day of_ pV�_� 2010.
Notary Public
COMMONWEALTH OF PENNSVLVANIA
NOTARIAL SEAL
KRlSTI P.FOSTER,notary Public
City of Harrisburg,Dauphin County
My Commission Expires Septembar 8,2012 -
Page 12
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Estate Valuation
Date of Death: 09/25/2014 Estate of: Henry L. Albert
Valuation Date: 09/25/2014 Account: 462964
Processing Date: 11/14/2014 Report Type: Date of Death
Number of Securities: 33
File ID: Estate Valuation - Henry
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 1570.930571FIRSTENERGY CORP (337932107)
COM
New York Stock Exchange
09/25/2014 33.97000 33.57000 H/L
33.770000 53,050.33
2) 3326.35336 PUBLIC SVC ENTERPRISE GROUP (744573106)
COM
New York Stock Ez.change
09/25/2014 37.93000 37.59000 H/L
37.760000 125,603.10
Div: 0.37 Er: 09/03/2014 Rec: 09/06/2014 Pay: 09/30/2014 1,230.75
3) 15000 CUMBERLAND CNTY PA MUN AUTH RE (230614CB3)
Interactive Data Corporation
DTD: 12/01/2005 Mat: 12/01/2017 4.25%
09/25/2014 102.39800 Mkt
102.398000 15,359.70
Int: 06/01/2014 to 09/25/2014 201.88
4) 100000 GARNET VALLEY PA SCH DIST (366268MS6)
Interactive Data Corporation
DTD: 04/15/2007 Mat: 04/01/2027 4.25%
09/25/2014 104.89100 Mkt
104.891000 104,891.00
Int: 04/01/2014 to 09/25/2014 2,054.17
5) 20000 HARRISBURG PA AUTH WTR REV (41473MHF3)
Interactive Data Corporation
DTD: 08/15/2008 Mat: 07/15/2031 5.25%
09/25/2014 97.48700 Mkt
97.487000 19,497.40
Int: 07/15/2014 to 09/25/2014. 204.17
6) 25000 LANCASTER CNTY PA HOSP AUTH RE (514045YL1)
Interactive Data Corporation
DTD: 01/24/2007 Mat: 03/15/2036 4.5%
09/25/2014 102.20700 14kt
102.207000 25,551.75
Int: 09/15/2014 to 09/25/2014 31.25
7) 20000 PENNSYLVANIA HSG FIN AGY (708793JM7)
Interactive Data Corporation
DTD: 09/14/2005 Mat: 10/01/2025 4.7%
09/25/2014 100.04500 Mkt
100.045000 20,009.00
Int: 04/01/2014 to 09/25/2014 454.33
8) 45000 PENNSYLVANIA. ST TPK COMMN TPK (709223VW8)
Interactive Data Corporation
DTD: 01/22/2009 Mat: 06/01/2039 5%
09/25/2014 106.53900 MI:t
106.539000 47,942.55
Int: 06/01/2014 to 09/25/2014 712.50
9) 10000 STATE PUB SCH BLDG AUTH PA SCH (8573226A4)
Interactive Data Corporation
DTD: 05/01/2009 Mat: 11/15/2033 5%
09/25/2014 107.50000. 111a
107.500000 10,750.00
Int: 05/15/2014 to 09/25/2014 180.56
10) 100000 STATE PUB SCH BLDG AUTH PA REV (85732PBP4)
Interactive Data Corporation
DTD: 01/15/2007 Mat: 10/01/2032 4.25%
09/25/2014 101.66200 Mkt
101.662000 101,662.00
Int: 04/01/2014 to 09/25/2014 2,054.17
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.4.0)
Date of Death: 09/25/2014 Estate of: Henry L. Albert
valuation Date: 09/25/2014 Account: `62964
Processing Date: 11/14/2014 Report Type: Date of Death
Number of Securities: 33
File ID: Estate Valuation - Henry
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
11) 15000 HYDRO-QUEBEC (448814FH1)
Interactive Data Corporation
DTD: 01/15/1987 Mat: 01/15/2027 8.25%
09/25/2014 138.91380 M):t
138.913800 20,837.07
Int: 07/15/2014 to 09/25/2014 240.63
12) 9848.244 AMERICAN BALANCED FD (024071102)
CL A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 25.43000 Mkt
25.430000 250,440.84
13) 1338.009 AMERICAN BALANCED FD (024071201)
CL B SHS
Mutual Fund (as quoted by NASDAQ)
09/25/2014 25.38000 Mkt
25.380000 33,958.67
14) 12717.124 DMC TAY. FREE INCOME TR PA (233216100)
SH BEN INT A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 8.15000 Mkt
8.150000 103,644.56
Daily Div. Accrual as of 09/25/2014 30.42
15) 6119.5 FEDERATED HUN SECS INCOME TR (313923708)
PA HUN INCH A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 10.94000 M):t
10.940000 66,947.33
16) 588.35 FUNDAMENTAL INVS (360802102)
COM
Mutual Fund (as quoted by NASDAQ)
09/25/2014 53.97000 Mkt
53.970000 31,753.25
17) 2630.727 INCOME FD AMER INC (453320103)
CL A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 21.45000 M)ct
21.450000 60,719.09
18) 1826.646 AIM EQUITY FDS INVESCO EQT FDS (001413541)
INVSC DVSFD FD A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 17.75000 Mkt
17.750000 32,422.97
19) 10747.899 AI14 COUNSELOR SER TR (00142J479)
INV EQTY&INCM A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 11.25000 Mkt
11.250000 120,913.86
20) 905.819 AIM COUNSELOR SER TR (00142J362)
IMV GW.TH&INCM P.
Mutual Fund (as quoted by NASDAQ)
09/25/2014 28.83000 Mkt
28.830000 26,114.76
21) 23048.625 AIM TAY.-EXEMPT FDS INVESCO (001419688)
INV HIYLD MUNI A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 9.87000 Mkt
9.870000 227,989.93
Daily Div. Accrual as of 09/25/2014 816.00
Page 2
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have ouestions,
please contact EYP Systems at (818) 313-6300 or www.evpsys.com, (Revision 7.4.0)
Date of Death: 09/25/2014 Estate of: Henry L. Albert
Valuation Date: 09/25/2014 Account: `62964
Processing Date: 11/14/2014 Report Type: Date of Death
Number of Securities: 33
File ID: Estate Valuation - Henry
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
22) 17733.495 AIM COUNSELOR SER TR (00142J255)
INV PA TFY INC A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 16.48000 M):t
16.480000 292,248.00
Daily Div. Accrual as of 09/25/2014 717.92
23) 1873.411 LORD ABBETT INVT TR (543916878)
CORE FX INCM A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 11.01000 Mkt
11.010000 20,626.26
Daily Div. Accrual as of 09/25/2014 32.02
24) 380.663 LORD ABBETT MUNI INCOME TR (543912877)
HIYLD HUNIBD A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 11.71000 Mkt
11.710000 4,457.56
Daily Div. Accrual as of 09/25/2014 14.69
25) 2684.955 LORD ABBETT INVT TR (543916209)
MLTAST BAL OPP A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 12.67000 Mkt
12.670000 34,018.38
26) 2954.372 LORD ABBETT INVT TR (543916613)
MLTAST GRWTH A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 18.92000 l4kt
18.920000 -55,896.72
r-
27) 18057.669 LORD ABBETT INVT TR (543916100)
SH DURA INCM A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 4.52000 Mkt
4.520000 81,620.66
Daily Div. Accrual as of 09/25/2014 195.07
28) 2070.117 LORD ABBETT INVT TR (543916845)
TOTAL RETURN A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 10.59000 Mkt
10.590000 21,922.54
Daily Div. Accrual as of 09/25/2014 43.81
29) 3861.647 OPPENHEIMER PORTFOLIO SER (68382P844)
AGGRESSV INV A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 15.05000 Mht
15.0.50000 58,117.79
30) 14631.69 OPPENHEIMER MULTI ST MUNICIPAL (683940100)
ROCH PA 14UN CL A
Mutual Fund (as quoted by NASDAQ)
09/25/2014 10.74000 M1:t
10.740000 157,144.35
Daily Div. Accrual as of 09/25/2014 52.26
31) 8902.04 VANGUARD SPECIALIZED PORTFOLIO (921908604)
DIV GRW FD
Mutual Fund (as quoted by NASDAQ)
09/25/2014 22.27000 Mkt
22.270000 198,248.43
32) 8931.58 VANGUARD MUN BD FD INC (922907308)
LONG TERM PORT
Mutual Fund (as quoted by NASDAQ)
09/25/2014 11.67000 Ml:t
11.670000 104,231.54
Daily Div. Accrual as of 09/25/2014 284.76
Page 3
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. 1f you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.4.0)
Date of Death: 09/25/2014 Estate of: Henry L. Albert
Valuation Dote: 09/25/2014 Account: ;:62964
Processing Date: 11/14/2014 Report Type: Date of Death
Number of Securities: 33
File ID: Estate Valuation - Henry
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
33) 2077.538 WASHINGTON HUT INVS FD INC (939330106)
COM
Mutual Fund (as quoted by NASDAQ)
09/25/2014 41.77000 Mkt
41.770000 86,778.76
Total Value: $2,614,870.15
Total Accrual: $9,551.36
Total: $2,624,421.51
Page 4
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.4.0)
y FRANK FOREMAN: V.P. OWENS MONUMENTAL COMTAN Y BRAN K.JONES:President
owensco@frontiemet.net 245 South First Street, Bangor, PA 18013 Cell Phone:610-393-5397
MICKIE JONES:Secretary Office Phone: 610-588-3370 o Fax: 610-588-4519 T.KEITH JONES:Treasurer
2,./)GRANITE,MARBLE,BRONZE MEMORIALS AND MAUSOLEUMS
No . .... t y
-� Date
1. THIS AGREEMENT,entered into by and between the Owens Monumental Company, the First Party, and
:Ya..�.,....... - .�. arm........ .I.�. �- r.�-T
................................the Second Party
2. WITNESSETH,The First Party agrees to furnish and set in ......... 6.x. .. 't-�
Cemetery at ....:�:r l i...... r.......................................... certain memorial work described as follows:
L_ TO
1-4 ,r,;R
19 18
4.The First Party hereby guarantees this work to be.of their best quality in workmanship and material as represented herein.
t 4- 1`'"
5.This memorial work is to be completed by ....... .:5. -fir.....................20. .......�"br as soon thereafter as possible.
6. AND IN CONSIDERATION of the faithful performance of the foregoing by the First Party.,the Second Party hereby
agrees to pa the First Part in law ul money of the ited States,t sum of; _
.3.a )in payment as follows:
$ ............................... at the signing of this Agreement.
$ ... ..•................................... when the Memorial is erected in the Cemetery. E:Y-Y l— Q_3
*PLUS COST OF CONCRETE FOUNDATION.
`Foundation to be done by third party .. .•�' .X?�.�.!�.�....•�.,
Make checks payable to the First Party(Owens Monumental).
7.Remarks:
01i 3!'r n^,L_t, 'r�_- I-
8.Future inscribing of names and/or dates will be charged for at rates prevailing at such time.
9.In the event of non-payment of any part of obligation, the Second Patty hereby authorizes the Cemetery Company to
permit removal of the work by First Party or First Party may at their option collect by law.
10. All extended obligations draw 1% interest per month starting thirty days after work is completed and the Memorial
.remains the property of the First Party until paid for in full.
s 11. THIS AGREEMENT is made subject to the written approval and acceptance of the home office of the First Party and
any verbal understanding not expressed herein shall not be binding on the First Party.
SECOND PARTY FIRST PARTY
Name............................................................... OWENS MONUMENTAL COMPANY
Number/Street... . ..'...... ;,��. �,:� �. .''� ................ ......................................................
City/State/Zip,. .i..I.I.d.C . r>:;..� .c�. . ate.,....:yam;� «. ...��.1: .................................................
Phone....,... . .�s?.'"..: r.d.�......r� ! .�.. ..... ............................................................
Email/Fax..... a._ .�: .L.l... ...s"a ..s, V ,.-� '.�. .:.. �:t�--�t�....................................Salesman
Owens Monumental Co.
245 South first Street Invoice Phone: 610-588-3370
Bangor PA 18013 Fax: 610-588-4519
Bill To:
Mrs.Helen Bickett
909 Bayberry Ct.
Williamstown,N.J.08094
CONTRACT# 14-5023 Plainfield Cemetery
Date: 11/11/14 Plainfield Pa.
1- SALESPERSON- Ctimpletion Date-. Sliij) Via FOB,. Terms..
Frank 11/11/2014 30 days
1 Mt. Rose Grassmarker for Henry &Josephine Albert $1,060
1 Installation fee $150
. r
1 Cemetery fee $25
Subtotal $1,235
Deposit 11-12 visa for$300
Deposit $300
Balance $935
-ham P"
"A FLOCK SCS LICY COMPANY"
BAMCa On, PA
SERVING THE PUBLIC FOR OVER 100 YEARS
MERCHANDISE
Register Book
Memorial Cards
Thank You Cards
Remembrance Package
Alternative Container
X Granitone MK Urn $250 .00
Urn Burial Vault Container
Veterans .Flag Case
Grave/Memorial Marker
TOTAL MERCHANDISE $250.00 .
CASH ADVANCED ITEMS
Grave Opening
Cemetery Equipment
X Patriot Newspaper Notice $220 . 20
Newspaper. Notice
Newspaper Notice
Clergy
Church/Sexton/Organist/Soloist
Flowers
X Crematory Charge Included
X - Cumberland County Coroner Fee $30 . 00
X . 12 Certified Copies of Death Certificate $72 . 00
TOTAL CASH ADVANCED ITEMS $322 . 20
SUMMARY OF CHARGES
Special Charges $1 ,795.00
Professional Services $65 . 00
Automotive Equipment $0. 00
Merchandise $250.00
Cash Advanced Items $,$22 . 20
SUB TOTAL $2 ,432 . 20
CREDITS
AMOUNT PREPAID Date Feb 17 , 1.996 -$695 . 00
TOTAL $637 . 20
AMOUNT PAID Date Oct 2 , 2014 -$637 . 20
BALANCE DUE $0. 00
THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES
CREMRTION SOCIE Y
100 JONESTOWN i GENERAL HBG
9ROAD TION SOCIETY OF PENNSYI..VA Lk, INC.
HARRISBURG. PA 17109
PHONE u{717}545-4001
Jonestown Road•Harrisburg,PA 17109•1-800-720-8221• Fax 717-541-9943.Shawn E.Carper,Supervisor
1e-chant ID: 000019107677 Ref It: 0001 yore Avenue.North Apollo,PA 15673• 1-800-720-8221 • Fax 1-724-478-3900.Stephen V.Polinski,Supervisor
Phone Order
�XXXXX��XXXX1629
EISA Entry Method; Manual
Total: $ 637.20
10/02/14 11:03:21 141027 SVP5
Inv a: 000001 bpr Code: 03671D
Apprvd: Online BatchO: 000003
AUS Code: EXACT VCH Y
DV2 Code: MATCH M
Sep 25 , 2014
Customer COPY
THANK YOU
HAVE A NICE DRY!
"NE fieIen A.' Bickett
909 Bayberry Court
Williamstown, NJ 08094
Henry Luther Albert, Jr. - Deceased
SPECIAL CHARGES
X Direct Cremation $1 ,795 .00
Nationwide Guarantee Program
Worldwide Travel Protection Program
TOTAL SPECIAL CHARGES $1 ,795 . 00
PROFESSIONAL SERVICES
X Services of Funeral. Director & Staff Included
Bathing and Disinfection of Deceased
Facilities & Staff for Memorial Service
Staff & Equipment for Memorial Service
Private ID Family Viewing
Witnessing the Cremation
X Packaging/Forwarding of Cremated Remains $65 .00
Personal Delivery of Cremated Remains
Scattering of Cremated Remains
TOTAL PROFESSIONAL SERVICES $65. 00
AUTOMOTIVE EQUIPMENT
X Removal Vehicle Included
Lead Car/Clergy Car
Family Car
Service Vehicle
TOTAL AUTOMOTIVE EQUIPMENT $0 . 00