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HomeMy WebLinkAbout06-04-15 i pennsylvania 1505614105 OEPARTMENTOFREVENUE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number HariOX 280601 issbu g PA 17128-0601 INHERITANCE TEDECEDENTTAX RN rry 1 1114 , ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ' _ .. ___ .. 08172014....._ _ ....._.- _� L07.01.. . ... _ ....-_. Decedent's Last Name Suffix Decedent's First Name MI BUTCHER NANN .. _ (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI _ _ ........ --............................ _- ... --� U THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CW 1. Original Return p 2. Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) C=:) 4.Agriculture Exemption(date of 0 5. Future Interest Compromise(date of C=) 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) O@D 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) O 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets C=:) 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ...... ... STEVE C. NICHOLAS, ESQ ' (717) 540-7746 First Line of Address [2215 FOREST HILLS DRIVE Second Line of Address SUITE 37 City or Post Office State ZIP Code [HARRISBURG PA F17112 Correspondent's email address: REGISTER OF WILLS USE ONLY -REGE-G - — - - -_ ISTER OF WILLS USE ONLY LED MMDDYYYY DATE FI YY. rn p c. ca DATE FILED STAND 'f-7 "tib PLEASE USE ORIGINAL FORM ONLY ��R �3 i 22 Side 1 h i ri-t { c� � o viii �iii�iiiii00 15 5614 0 1505614105 J J 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: BUTCHER, NANNETTE M. RECAPITULATION 1. Real Estate(Schedule A). .. .. . . .. ... .. ..... .. . ..... .. ........ . .. .. .. . 1. 2. Stocks and Bonds(Schedule B) .. . . ... .. ..... .. .. .. ..... .... .... .. .. .. 2. I 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. . .. 3. 4. Mortgages and Notes Receivable(Schedule D) . .. ... .. .... .... .. ..... .. .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .... 5. , 274,224.82 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . .... . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. 8. Total Gross Assets(total Lines 1 through 7). . .. .. .. .. .... ... .... .. .. .. .. 8. 274,224.82 i � 1 9. Funeral Expenses and Administrative Costs Schedule H 24,112.46 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). .... .... . . .... 10. I 416.00 i F 11. Total Deductions(total Lines 9 and 10) 11. 24 528.46 12. Net Value of Estate(Line 8 minus Line 11) ... .. .... ...... ........ ..... .. 12. 249,696.36 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which �� an election to tax has not been made(Schedule J) .. .... .. ... .. .. .... .. ... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) .... .... .... ... .... .. ... 14. 249,696.36 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0- 15. 16. Amount of Line 14 taxableat lineal rate X.0 45 197,744.65 16. 8,898.51 I 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable 51,951.71 7,792.76 at collateral rate X.15 18. ........ ..-_. _ - _..... -...--... 19. TAX DUE .. ..... . . ... ... ... ... .. .. .. . .. .. ....... 19. 16,691.27 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I de7axe examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, e, correct and c mpleteation preparer other than the person responsible for filing the return is based on all information of which preparer has any know e. NATUR - SO ONSIBL T DAT DRESS ADO RCLE S RG, PA 17055 SIGNATUR O REPARER rR$0NFfRSON RESPONSIBLE FOR FILING THE RETURN D E ADDRESS 2215 FOREST HILLS DRIVE, SUITE 37, HARRISBURG, PA 17112 1111111 IIIII 1111111111 viii[1111 iilypii 111111111111111111 Side 215 514 5 15056.14205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: [DECEDENT'S NAME annette M. Butcher REETADDRESS 0 Erford Road CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 16,691.27 2. Credits/Payments A.Prior Payments _ 8,200.00 B.Discount 431.58 (See instructions.) Total Credits(A+B) (2) 8,631.58 3. Interest (3) 26.00 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) 8,085.69 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .......................................................................................... ❑ E b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0 c. retain a reversionary interest .............................................................................................................................. ❑ 0 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?.............................................................................................................. ❑ E 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ E 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ 0 ❑ 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-15o8 EX+(08-12) Z pennsytvania SCHEDULE E T7 DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BUTCHER, NANNETTE M. 2114-0813 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PNC Bank CD#*******4950 14,063.33 2. PNC Bank CD#*******l 978 2,139.91 3. PNC Bank CD#*******8192 5,526.15 4. PNC Bank Ck#******7478 5,093.59 5. PNC Bank Sv#******9068 162,2 88.57 6. Prudential-Pinnacle Health System Pension 403(b)TSAT Plan 51,951.71 7. Prudential-Pinnacle Health System Pension Retirement Investment Account Plan 11,864.41 8., Lincoln Financial Group-Pinnacle Health System 403(b)Individual Fixed Annuity 17,297.15 9. Household furniture 3,500.00 10. Diamond ring 500.00 TOTAL(Also enter on Line 5, Recapitulation) $ 274,224.82 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(02-15) Q7Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER BUTCHER, NANNETTE M. 21 14-0813 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: _ 1' (Funeral-Neill Funeral Home, Inc. 10,335 18't 2. Church-St.Joseph Catholic Church 250.00 b�OC:R YMG'6�Yfka't$...X.17C Y.. 3. 'Funeral luncheon 800.00 a �Grave/Burial-Gate of Heaven Cemetery T —ate - 4,500.009 5. j8enchmark-Gate of Heaven Cemetery 2,500.00 i '_.^' - -"...""_ _•__. ..'.' - _.__.._ _.._ -..._.__._. __ - -. .— - _ - JyhaNa4bw".'�!!C'a�3't.:dR-sx Y�'w+lt f s B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: =5,600.00: 2, Attorney Fees: �: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent F taMrwwnxa.wwrxvwn ^v. 4. Probate Fees: 360.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7• Supplemental Probate Fee 5000 B. Short Certificate '� � 5.00 9.i Advertising Cumberland^ 86 _ Law Journal and The Sentinel 2 .78 �'I o !Postage,Copies,Notary-Nicholas Law Offices,PC — 25. ` TOTAL(Also enter on Line 9, Recapitulation) $9 24,112.46 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(02-15) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER BUTCHER, NANNETTE M. 21 140813 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• PPL-Open account 66.00 2. Azizkhan Internal Medicine-Open account 250.00 3. Check clearing PNC Bank after date of death 100.00 w { t i 1 ` i I f . TOTAL(Also enter on Line 10, Recapitulation) $ 416.00 If more space Is needed,insert additional sheets of the same size. REV-1513 EX+(02-15) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BUTCHER, NANNETTE M. 21 14-0813 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under �---- Sec.9116(a)(1.2).] I. =Eleni a Catherine Seipp, 1737 N.Meadow Cir.,Mechanicsburg,PA 17055 s Granddaughter D� is o d Ring L2.( 'Jennifer E.Seipp, 1737 N.Meadow Cir.,Mechanicsburg,PA 17055 Dau her 50/o residue ILisa M.Butcher, 17719 Chipping Court,Olney,MD 20832 Daughter 50% residue F I El 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 ONLINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. Butcher Nan M will son1wills LAST WILL AND TESTAMENT OF NANNETTE M.BUTCHER 1, NANNETTE M. BUTCHER, of 5485 Margaret Court, Mechanicsburg, Cumberland County, Pennsylvania 17050-7292, declare this to be my Last Will and revoke any Will or Codicil previously made by me. ITEM 1: 1 direct that all expenses of my last illness and funeral, including my grave marker and perpetual care, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM H: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate,without apportionment. ITEM III: I give, devise and bequeath my Diamond Ring to my granddaughter, ELENA CATHERINE SEIPP,providing that she survives me by thirty (30) days. ITEM IV: I give, devise and bequeath all the rest, residue, and remainder of my Estate of every nature and wherever situate, in equal shares, share and share alike, as follows: a. Fifty (50%) of my Estate to my daughter, LISA M. BUTCHER, now of 600 S. Dixie Highway, #609, West Palm Beach, Florida 33401, h providing that she survives me by thirty (30) days. Should LISA M. BUTCHER, predecease me or die on or before the thirtieth (30th) day following my death, her share of my estate shall then go to her issue, per stirpes, as are living on the thirty-first (31") day following my death. At this time, my daughter, LISA M. BUTCHER has one daughter, GIANA LUCIA DAYTON. b. Fifty (50%) of my Estate to my daughter, JENNIFER E. SEIPP, now of 5485 Margaret Court, Mechanicsburg, Pennsylvania 17050-7292, providing that she survives me by thirty (30) days. Should JENNIFER E. SEIPP, predecease me or die on or before the thirtieth (30th) day following my death,her share of my estate shall then go to her issue,per stirpes, as are living on the thirty-first(3 1 s) day following my death. At this time, my daughter,JENNIFER E. SEIPP has one daughter, ELENA CATHERINE SEIPP, and one son, BRADY RICHARD GIUSEPPE SEIPP. ITEM V: In the event any of my said beneficiaries shall not have reached the age of twenty-three (23) years, I give, devise and bequeath that beneficiary's share of my estate, to my Trustee, hereinafter designated, IN TRUST, for the benefit of said beneficiary to be administered as follows. a. To pay the net income from said trust to such beneficiary on a quarterly basis or more often, at the sole discretion of my Trustee. b. To pay so much of the principal as is deemed necessary for medical expenses, support, and other items of necessity of my beneficiary at the sole discretion of my Trustee. C. The amount to be paid from principal for the benefit of my beneficiary shall be determined from time to time by the need of my beneficiary, and the amounts and times of said payments shall be determined by such need. The said payments may be made by the Trustee directly to my beneficiary or may be made in the discretion of the Trustee, directly to the person having the custody and care of my beneficiary or may be made by the Trustee directly to any institution entitled to such payment by reason of services rendered or to be rendered to said beneficiary. In making the aforesaid payments, the Trustee shall give primary consideration to the individual needs of my beneficiary and to other sources of income and funds, such as insurance proceeds, etc., available for the support of my beneficiary. d. To pay the accumulated income and principal to my beneficiary when my beneficiary attains the age of twenty-three (23) years. e. Should my beneficiary under the terms of this trust not have reached the age of twenty-three (23) years, he or she shall be considered a minor for purposes of this trust. f. Should my beneficiary die before reaching the age of twenty-three (23) years, the remaining principal and accumulated income of the trust shall be paid: (1) To such one or more persons or organization, excepting my beneficiary's estate, his or her creditors, or the creditors of his or her estate, under such terms as my beneficiary shall have appointed by Will. (2) In default of appointment by Will as aforesaid, or insofar as it is not effectual,to my beneficiary's then living issue,per sfirpes. (3) In default of such issue, to my then living issue, per girpes, with any portion thus accruing to a child for whom principal is then held in trust thereunder to be added and thereafter treated as a part of such principal. 2 ITEM VI: Should the principal of any trust herein provided for, be or become too small in the Trustee's discretion so as to make establishment or continuance of the trust inadvisable, the Trustee or my personal representative may make immediate distribution of the then-remaining principal and any accumulated or undistributed income outright to the person or persons and in the proportion they are then entitled to receive income. If any such person is then a minor, distribution may be made to the guardian of the person of such minor. Upon such termination, the rights of all persons who might otherwise have an interest as succeeding income beneficiaries or in remainder shall cease. ITEM WE In addition to the power conferred upon my fiduciaries previously in this instrument, and by law, I authorize all fiduciaries without any order of court and in their sole discretion to: a. Retain any property and invest and reinvest any property, including by way of illustration and not by way of limitation, common stocks up to one hundred (100%) percent of corpus, stock of any fiduciary or parent corporation, any common or diversified trust funds maintained by any fiduciary or affiliated, related subsidiary or parent corporations, and any form of life insurance, except in any marital trust, annuity or endowment policies; and in so doing, any fiduciary may act without restriction to so-called legal investments and without responsibility for diversification. Any fiduciary may also keep reasonable amounts of cash in bank uninvested. b. Sell at public or private sale, for cash or credit, with or without security, and exchange or partition property and give options for sales or exchanges. C. Borrow and lend money from and to any person and/or corporation, including any fiduciary, and mortgage or pledge any property. d. Repair, alter, improve or lease for a period of time, any property and give options for leases. e. Vote in person or by proxy securities held by it and in such connection to delegate its discretionary powers. f. Subscribe for stocks, bonds, or other investments; exercise any stock option or similar rights; join in any plan of lease, mortgage, merger, consolidation, reorganization, foreclosure or voting trust and private securities thereunder, and generally exercise all the rights of security holders of any corporation. 9. Purchase investments at premiums and charge premiums to income or principal or partly to each. 3 h. So that title may pass by delivery, any fiduciary may register securities in the name of a nominee as designated by any corporate fiduciary or in the name of such other nominee as may be convenient. i. Compromise claims by or against my estate or trust including, without limitation, any questions relating to taxes or to any policy of life insurance. However, my fiduciaries need not institute litigation to collect on any policy unless they are reasonably indemnified for all costs, counsel fees and other expenses of such litigation. j. Retain and pay agent, employees, accountant and counsel (including investment counsel)for advice and other professional services. k. Make distribution in cash or in kind or partly in each. 1. Determine whether any stock dividend, stock split, extraordinary dividend or other item or receipt or expenditure shall be allocated to income or principal or partly to principal. My fiduciaries are relieved of all liability in making such allocations, and distribution shall be made without their being required to file an account for confirmation provided that these powers shall not be exercised with respect to any marital deduction trust. In. Hold, manage, invest and account for separate trusts either as separate funds or in one or more consolidated funds in which each trust shall own an undivided interest. n. Add to the principal of any trust created thereunder, any property received from any person by Deed, Will or in any other manner. 0. 1 hereby authorize my Executrix and Trustee to continue any business or businesses in which I may be interested at the time of my death, whether or not said business is conducted by me at the time of my death, individually, as a partnership, or through a corporation wholly owned or controlled by me, with full authority to sell, settle and discontinue any of them, at such time or times and upon such terms or conditions which, in the judgment of my Executrix and Trustee, are for the best interests of my estate or any trust created by my Will. p. Each fiduciary serving thereunder shall have the right from time to time, by instrument in writing, to relinquish, in whole or in part, any power given to him by law or under the provisions of this Will,provided that such relinquishment shall not bind his successors unless similarly relinquished in writing by them. I ITEM VIII: I hereby authorize and empower my Executrix hereinafter named to sell all of the real property and any or all of the personal property not specifically bequeathed herein, which I may own or to which I am entitled at the time of my death, in the sole discretion of my Executrix at private or public sale, without an Order of Court, at such time or times and upon 4 such terms as the said Executrix shall deem proper for the best interests of my estate or of my beneficiaries, thereby converting the same into cash. I further authorize and empower my said Executrix to execute, acknowledge and deliver all proper writings and deeds of conveyance and transfer thereof. ITEM IX: All references herein to a child of mine, or to the children or issue of my child, shall include any children born after the date of this Will and any persons lawfully adopted by me and their issue. ITEM X: Wherever the word "minor" is used herein it shall mean any person under the age of twenty-three (23)years. ITEM XI: I appoint my daughter, JENNIFER E. SEIPP, Trustee of any trusts created by this, my Last Will. Should JENNIFER E. SEIPP fail to qualify or cease to act as Trustee, I appoint my friend and attorney, STEVE C. NICHOLAS, Trustee of this, my Last Will- I direct that my Trustee, at her discretion, may retain the services of a Corporate Trustee for the purpose of assisting them in the administration of any trust herein created. ITEM XII: The principal and income of any trusts created thereunder shall be free from anticipation, assignment, pledge or obligation of any beneficiaries and shall not be subject to any execution or attachment or to voluntary or involuntary alienation. ITEM XIII: I appoint my daughter, JENNIFER E. SEIPP, Executrix of this, my Last Will. Should JENNIFER E. SEIPP fail to qualify or cease to act as Executrix, I appoint my friend and attorney, STEVE C. NICHOLAS, Executor of this, my Last Will. ITEM XIV: I direct that my Executrix or Trustee appointed herein, or their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal the 28th day of July 2011. NANNETTf M. BUT HER 5 The preceding instrument, consisting of this and five (5) other typewritten pages, identified by the signature of the Testatrix, was on the day and date thereof signed,published and declared by NANNETTE M. BUTCHER, the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request and in her presence and in the presence of each other, have subscribed our names as witnesses hereto. of 1",4 of 6 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA :ss. COUNTY OF DAUPHIN 1, NANNETTE M. BUTCHER, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by NANNETTE M. BUTCHER this 28u'day of July 2011. NANNETTE M.BUTCHER Notary Public COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL 7 CHRISTINA L.NICHOLAS,Notary Public Low Paxton Twp.,Da*In County WCommission Expires June 20,2013 7 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF DAUPHIN WE, the undersigned witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix, sign and execute the instrument as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind and under,no constraint or undue influence. Sworn to or affirmed and subscribed before me by the undersigned witnesses, this 28th day of July 2011. Witness itne s Witness Notary Public COMMOI' HEALTH OF PENNSYLVANIA NOTARIAL SERI. CHRISTINA L NICHOLAS,No tary PublicLower Paxton Dauphin County June 20, 13 8 Dec, 18. 2014 3:OOPM PNC Bank No. 0283 P. i R,. PNC December 18,2014 Steve C Nicholas,Esq Nicholas Law Offices PC Northwood Office Center 2215 Forest Hills Dr, Ste 37 Harrisburg,PA 17112-1099 RE: Nannette M Butcher SSN: DOD: 08-17-2014 Dear Ms. Duffy: In response to your request for Date of Death(DOD)balances for the customer noted above, our records show the following: Certificate of Deposit Account# 31800204950 Established: 01-05-2001 NANNETTE M BUTCHER DOD balance: $14,062.17+ 1.16 accrued interest Interest paid 01/01/2014 thru 08/17/2014 S 23.38 YTD Account#31100231978 Established: 07-29-2002 NANNETTE M BUTCHER DOD balance: $2,139.51 +0.40 accrued interest Interest paid 01/01/2014 thm 08/17/2014 S 4.35 YTD Account# 31500298192 Established: 0803-2006 NANNETTE M:BUTCHER DOD balance: $5,526.02+0.13 accrued interest Interest paid 01/01/2414 thru 08/17/2014$ 2.24 YTD Checking Account Account# 5113547478 Established: 01-13-2011 NANNETTE M:BUTCHER DOD balance: $5,093.59+0.00 accrued interest Interest paid 01/01/2014 thru 08/17/2014 S 0.50 YTD Page 1 of 2 Dec, 18, 2014 3.00PM PNC Bank No. 0283 P. 2 Savings Account Account#5112709068 Established: 08-13-2010 NANNETTE M BUTCHER DOD balance: $162,285.01 +3.56 accrued interest Interest paid 01/01/2014 tbm 08/17/2014$ 173.48 YTD Please note that this office provides date of death balances for deposit accounts(IRAs,CDs,Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items;please call 1-888-PNC-$ANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exemptfrom disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient,yozi are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication inn error,please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 2 of 2 Prudential Retirement Post Office Box 8ob0 Milvifle, NJ 08332 PINNACLEHEALTH Pinnacle Health System January 1,2014-March 31,2014 At Your Service DFPF;A,)I Visit www.prudenbal.com/online/rebrement NANNETTE M. BUTCHER 800-458-6333 5485 MARGARET COURT Hearing Impaired:Call(TDD)877-760-5166 MECHANICSBURG PA 17050-7292 Consolidated Account Snapshot Consolidated Asset Allocation Value Vested Amount Account on 03/31/14 on 03/31/14 This is the allocation of your 403(b)TSAT Plap,,. $5-1,951.71 $51,951.71 Retirement Invcurrent investments. J 1,864. 11,864Al Investment Account Plan Percentages may not be Total Value $63,816.12 $63,816.12 exact due to rounding. j 33%Stable Value 11%Fixed Income/Money Market �rj 41%Large Cap Stock 15%Global/Int'l Stock Simplify your financial life through consolidation If you're like many people.you've had multiple jobs, which could mean multiple retirement plans.Rather than trying to keep track of all of those accounts, About Your Accounts consider consolidating them into your account with Prudential.This means you'll be able to track all of your If you are eligible for the Cash Balance Pension Plan your Accrued Benefit represents the projected savings with one statement,one website,and one Cash Balance Benefit at NRD converted to an Annual Annuity Benefit. phone number.For help consolidating,call 1-877-778-2100,Monday through Friday,8a.m.-9 p.m.p.m.ET. Rollover assets may be assessed fees or other surrender charges.Please contact current account prov er r is information. (kyj Prudential Pagel of 10 gam W0j][.Zj_n C0 Lincoln Financial Group PO Box 2340 Financial Groupe Fort Wayne,IN 46801-2340 Your Retirement Account #tBWNGYDD 07!01120!4-0913012014 AB 02 151102 31738 H 992 A ll�litllll„Illrll��l,,r,1,rlrl�llltrllli�nllrlllltllllllrlll�l Lincoln Individual Fixed Annuity NANNETTE M BUTCHER a APT 311 AAccountIn�c or¢ ation 158 ERFORD RD Name: Butcher Nannette M CAMP HILL PA 17011-1855 Account Number: 97-5701683 Plan Type: 403(b)Tax Deferred Effective Date : 06/23/1992 Information for You! Account Summary Total Account Value as of 09/30/2014 $17,297.15 J:urre.;:`Period Contributions V�•© Investment Earnings 5'49.::.' Withdrawals ^•n0 �= Total contributions to date $7,662.03 Total withdrawals to date(excluding sales charges &annual fees) $0.00 Fees and Expenses $0.00 Annualized 3-Month YTD 1-Year 3-Year 5-Year 0.87% 2.61% 3.50% 3.50% 3.50% -- `Personalized rate of return represents the individual performance of your account.The calculation includes activity in your account(such as contdbutions,withdrawals,etc.). Because the timing of your contributions and withdrawals will vary,your personal investment results will generally not be the same as the returns quoted. Quoted performance data represents past performance.Past performance does not guarantee nor predict future performance.Current performance may be lower or higher than the performance data quoted. Contact Information for your Lincoln Individual Fixed Annuity Our customer service representatives are available Monday-Friday from 8 to 8 EST at 1-800-41-incoln (1-800-454-6265) For your updated account values and to make address changes,go to www.LincolnFinancial.com o Lincoln Financial Group is the marketing name for Lincoln National Corporation and Its affiliates.Affiliates are separately responsible for their own financial and contractual obligations.. PAID1111-0773 _<