The URL can be used to link to this page

Home My WebLink About06-24-15 (2) � • pennsylvania 1505618403 DEPARTMENT OF REVEN �X(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes Counry Code Year File Number PO BOx 28oso� INHERITANCE TAX RETURN Harrisburq, PA 17128-0601 RESIDENT DECEDEN7 21 15 0 4 6 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDY�Y 04 09 2015 04 04 1922 DecedenYs Last Name Suffix DecedenYs First Name MI ROTH ARLENE Z (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Originai Return � 2. Supplemental Return � 3. Remainder Return(date of death prior to 12-13-82) � 4, Agricultural Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust � 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) � 10. Litigation Proceeds Received � 11. Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) � 13. Business Assets � 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number IVO V OTTO III 717 243 3341 First Line of Address 10 EAST HIGH STREET Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17013 CorrespondenYs email address: _�otto a�martsonlaw.com REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY ,,-� :-__> )_._A � .._- �� c_t'7 .��-}, � -,F... -:..� �.� � � �� .-_'� �--._ '"�_� �.� .�=—' , .. �ATE F D STAMP�- r , r , .__._ :� , _ --�� _ --} , , : ..� . Side 1 c`� ,:r F---'� .., cr� II�'IIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIII � �r � 1505618403 1505618403 � _ � J 1505618411 REV-1500 EX DecedenYs Social Security Number oecedent's Name: ROth, Arlene Z. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 8 4 9,0 4 7 • 01 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. 41,9 6 3 • 7 4 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 18 2,9 81 -3 6 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 1,�7 3,9 9 2 � 11 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 6 8,5 8 9 • 8 2 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 4 ,4 5 8 • 4 2 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 7 3,0 4 8 • 2 4 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1,0 0 0,9 4 3 • 8? 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 4 0,0 0 0 • 0� 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 9 6 O,9 4 3 • 8 7 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.00 15. 0 •0 0 16. Amount of Line 14 taxable at�inea�rate X .045 960,943 • 87 �6. 43,242 • 47 17. Amount of Line 14 taxable at sibling rate X.12 0 -0 0 �7� 0 • 0 0 18. Amount of Line 14 taxable at collateral rate X.15 ❑ • 0 0 �$• 0 • 0 0 19. TAXDUE................................................................................................................ 19. 43,242 • 47 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Under penaities 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 compiete.Deciaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATURE OF R ON R P SIB FOR FILING RETURN Allen Z. Roth DATE Gb .�3 �o .�' ADDRESS 30 Shee y L n , 'ling S rin s, PA 17007 SIGNATURE PR A THAN REPRESENTATIVE IVO V. OttO III DA7E �3 �4/� ADDRESS 10 East High Street, Carlisle, PA � I I��I II�� IIIII�'�I'I I��I'I II�II IIIII�I�� I��I II�I I��I Side 2 1505618411 1505618411 � REV-1500 EX Page 3 File Number 21-15-0462 Decedent's Complete Address: DECEDENT'S NAME Roth,Arlene Z. STREET ADDRESS 2100 Bent Creek Blvd CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 43,242.47 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +g) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 43,242.47 Make Check Pa able to: REGISTER OF WILLS, AGENT. ��I � 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:............................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ � c. retain a reversionary interest;or............................................................................................................... ❑ 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 receivingadequate consideration?.................................................................................................................... ❑x ❑ 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ 0 4. Did decedent own an individual ret�rement account,annuity,or other non-probate property which ❑ ❑ containsa 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. 3'& 'i 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 aRer January 1,1995,the tax rate imposed on the net value of transfers to or for lhe use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer io 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 deaih 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 decedenYs 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 ihe 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-1503 EX+(OS-12) SCHEDULE B pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH Janney Montgomerv Scott Investment Account#7134-8324 See attached 1 353496805 10,399.697 shares of Franklin Custodian Funds Inc-Income 2.4299996 25,271.26 Fund CL C 2 01728AU20 $20,000 Allegheny Cnty PA Hosp Dev Aut-Interactive Data 114.956 22,991.20 corporation Accrued interest on Item 2 through date of death 150.00 3 36159UFG6 $25,000 GE Cap Retail Bk Draper Utah-Interactive Data 110.21372 27.553.43 Corporation Accrued interest on Item 3 through date of death 585.41 4 514045z62 $25,000 Lancaster Cnty PA Hosp Auth Re-Interactive Data 104.182 26,045.50 Corporation Accrued interest on Item 4 through date of death 442.36 5 7252767N3 $15,000 Pittsburgh PA Sch Dist-Interactive Data 101.594 15,239.10 Corporation Accrued interest on Item 5 through date of death 68.08 g 84129NHZ5 $10,000 Southcentral PA Gen Auth Rev-Interactive Data 114.238 11,423.80 Corporation Accrued interest on Item 6 through date of death 213.33 Total of Continuation Schedules See attached a es TOTAL(Also enter on Line 2, Recapitulation) 849,047.01 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.08-12) Rev-1503 EX+�OS-12) SCHEDULE B pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth, Ariene Z. 21-15-0462 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 7 84129NHT9 $15,000 Southcentral PA Gen Auth Rev-Interactive Data 115.539 17,330.85 Corporation Accrued interest on Item 7 through date of death 320.00 Wilming�on Tr�st Investment Acco�nt#617592605 See attached g 88579Y101 200 shares of 3M CO-Com 166.130000 33,226.00 g 02209S103 600 shares of Altria Group Inc-Com 51.7025 31,021.50 Accrued dividend on Item 9 through date of death 312.00 10 110122108 250 shares of Bristol Myers Squibb Co-Com 63.53 15,882.50 Accrued dividend on Item 10 through date of death 92.50 11 143658300 400 shares of Carnival Corp-Paired Ctf 48.355 19,342.00 12 25746U109 300 shares of Dominion Resources Inc Va New-Com 71.2 21,360.00 13 26441C204 106 shares of Duke Energy Corp New-Com New 76.865 8.147.69 14 291011104 200 shares of Emerson Electric Co-Com 56.865 11,373.00 15 30231G102 1,100 shares of Exxon Mobil Corp-Com 84.27 92,697.00 16 31417P858 83.17 shares of Federated Fixed Income Secs-MUN ULTSH 10.0300589 834.20 INW Accrued dividend on Item 16 through date of death 0.11 Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.08-12) Rev-1503 EX+�OS-12) SCHEDULE B pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN contin ued RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH �7 31428Q747 4,886.037 shares of Federated Total Return Sers-ULTSHT 9.1400004 44,658.38 INST NEW Accrued dividend on Item 17 through date of death 11.78 18 369604103 300 shares of General Electric Co-Com 25.3725 7,611.75 Accrued dividend on Item 18 through date of death 69.00 19 46625H100 1,100 shares of JPMorgan Chase&Co-Com 61.2025 67,322.75 Accrued dividend on Item 19 through date of death 440.00 20 50076Q1o6 138 shares of Kraft Foods Group Inc-Com 88.965 12,277.17 21 55261F104 600 shares of M&T Bank Corp-Com 124.34 74,604.00 22 609207105 414 shares of Mondelez Intl Inc-CI A 37.2775121 15,432.89 Accrued dividend on Item 22 through date of death 62.10 23 713448108 200 shares of Pepsico Inc-Com 96.135 19,227.00 24 718172109 600 shares of Philip Morris Intl Inc-Com 77.495 46,497.00 Accrued dividend on Item 24 th�ough date of death 600.00 25 773903109 600 shares of Rockwell Automation Inc-Com 111.615 66,969.00 26 774341101 800 shares of Rockwell Collins Inc-Com 97.0625 77,650.00 27 847560109 160 shares of Spectra Energy Corp-Com 36.885 5,901.60 Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.08-12) ��r iu w...i.r irmi n Rev-1503 EX+(OS-72) SCHEDULE B pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 2g 922907100 1,755.211 shares of Vanguard Municipal Bond Fund Inc- 15.8299999 27,784.99 Short Term Portfolio Accrued dividend on Item 28 through date of death 4.78 TOTAL(Also enter on Line 2, Recapitulation) 849,047.01 Copyright(c)2012 form software only The Lackner Group,inc. Form PA-1500 Schedule B(Rev.08-12) _,Mw �o..W..r..r irrni •. Rev-1508 EX+�OS-72) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE p E RSO NAL P RO P E RTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 Include the proceeds of litigation and the date the proceeds were received by the estate. All propeRy jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Janney Montgomery Scott Investment Account#7134-8324-Cash account,see attached 5,253.95 2 Wiimington Trust Investment Account#617592605-Cash account(1 of 2),Wilmington 2,973.53 Funds,see attached 3 Wilmington Trust Investment Account#617592605-Cash account(2 of 2),Wilmington 17,561.55 Funds,see attached 4 Miscelianeous cash deposit 82•$� 5 Proceeds from sale of decedent's dresser(chest of drawers) 60.00 6 Brethren Home-Annuity payment(first quarter 2014) 438.86 7 CNA-Check from decedent's long term care insurance 5,208.00 8 CNA-Final check from decedenYs long term care insurance 1,544.00 9 M&T Bank Checking Account#9830136793-Date of death value,see attached 3,774.80 Accrued interest on Item 9 through date of death 0.03 10 Social Security-April payment 2,185.00 11 Progressive Direct Insurance-Credit for disputed amount charges to pre-death M&T Bank 253.75 checking account on 4/29/2015(insurance premium) 12 ROBC Limited Partnership-Refund check from The Bridges at Bent Creek(nursing home) 2,575.00 13 ROBC Limited Partnership-Refund check from Bridges At Bent Creek of monies held in 52.46 decedent's cash account(nursing home) TOTAL(Also enter on Line 5, Recapitulation) 41,963.74 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12) �� m�-r r irrm Rev-1510 EX+�08-09) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND DEPARTMENTOFREVENUE MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth, Arlene Z. 21-15-0462 This schedule must be completed and filed if the answer to any of questions t through 4 on page three of lhe REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF^TRANSFERSATTACN A COPYEOF THE DEIED OR REAL ESTA E. VALUE OF ASSET INTEREST ��F APPLICABLE) VALUE 1 Janney Montgomery Scott IRA Account-IRA Account 94.559.08 100.000% 94,559.08 #7134-8375, Beneficiaries=William B. Roth(son)25%, Allen Z. Roth(son)25%,Constance H. Henry (daughter)25%, and Dean G. Roth (son)25%. See attached. Accrued income on Item 1 through date of death 422.28 100.000% 422.28 2 Cash gift within one year of date of death-Wiliiam B. 14,000.00 100.000% 3,000.00 11,000.00 Roth(son),gifted on 01/05/2015 3 Cash gift within one year of date of death-Debbie 14,000.00 100.000% 3,000.00 11,000.00 Roth(daughter-in-law),gifted on 01/05/2015 4 Cash gift within one year of date of death-Allen Z. 14,000.00 100.000% 3,000.00 11,000.00 Roth(son),gifted on 01/05/2015 5 Cash gift within one year of date of death-Cynthia B. 14,000.00 100.000% 3,000.00 11,000.00 Roth(daughter-in-law),gifted on 01/05/2015 6 Cash gift within one year of date of death -Constance 14,000.00 100.000% 3,000.00 11,000.00 H. Henry(daughter), gifted on 01/05/2015 7 Cash gift within one year of date of death -Kurt Henry 14,000.00 100.000% 3,000.00 11,000.00 (son-in-law),gifted on 01/05/2015 8 Cash gift within one year of date of death-Dean G. 14,000.00 100.000% 3,000.00 11,000.00 Roth(son),gifted on 01/05/2015 9 Cash gift within one year of date of death -Cindy Roth 14,000.00 100.000% 3,000.00 11,000.00 (daughter-in-law),gifted on 01/05/2015 TOTAL(Also enter on Line 7, Recapitulation) 182,981.36 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev. 08-09) _,�. ��a,, ,.-�,�� . REV-7511 EXr�08-13) SC H E D U L E H pennsylvania DEPARTMENT OF REVENUE F U N E RAL EXP E N S E S AN D RESIDENNDECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT M q, FUNERAL EXPENSES: See continuation schedule(s) attached 28,767.65 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid Waived z. Attorney's Fees Martson Law Offices 36,884.67 3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zip Relationshio of Claimant to Decedent 4. Probate Fees 510.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 2,427.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 68,589.82 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13) «� io.,l...i.�.irrm � SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Roth, Arlene Z. 21-15-0462 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Constance H. Henry-reimbursement for fees paid for printing funeral programs 496.08 2 Hoffman-Roth Funeral Home&Crematory, Inc.-Funeral expenses 17,584.97 3 Jim &Marla Abe-Ministerial services provided at funeral 75.00 4 Kyle Henry-Musician services provided at funeral 125.00 5 Paul Roth-Ministerial services provided at funeral 250.00 6 Ralph Moyer-Ministerial services provided at funeral 150.00 7 Reimbursement-travel expenses for decedent's children and grandchildren to attend 7,087.54 funeral 8 Sophia's On Market-Catering fees for memorial luncheon 2,799.06 9 Sylvia Weaver-Musician services provided at funeral 200.00 H-A 28,767.65 Other Administrative Gosts 10 EstateVal-Fees to obtain date of death valuation for investments at Wilmington Trust 42.00 Account#617592605 11 Register of Wills-Additional probate fees 200.00 12 Social Security Administration-Return of overpayment to decedent after date of death 2,185.00 H-67 2,427.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) �� m�,,, irnu F Rev-1512 EX+(72-72) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 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 Allen Z. Roth-reimbursement for paying final balance of decedent's Visa bill 138.43 2 Galen Roth-Replacement of lost check decedent had written to Galen prior to date of death 50.00 3 M&T Bank Checking Account#9830136793-Total of outstanding checks written prior to date 4,269.99 of death but posted to account after date of death TOTAL(Also enter on Line 10, Recapitulation) 4,458.42 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12) REV-1513 EX+(01-70) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (�/ords) ($$$) o ist T tee s I. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 1 Constance H. Henry Daughter Schedule G Item 239,235.97 512 Woodcrest Drive 6,Twenty-five Mechanicsburg, PA 17050 percent(25%)of residue 2 Kurt Henry Son-in-Law Schedule G Item 11,000.00 512 Woodcrest Drive 7 Mechanicsburg, PA 17050 3 Allen Z. Roth Son Schedule G Item 239,235.97 30 Sheeley Lane 4,Twenty-five Boiling Springs, PA 17007 percent(25%)of residue 4 Cindy Roth Daughter-in-Law Schedule G Item 11,000.00 1920 Armstrong Avenue 9 Morton, PA 19070 5 Cynthia B. Roth Daughter-in-Law Schedule G Item 11,000.00 30 Sheeley Lane 5 Boiling Springs, PA 17007 See continuation schedule attached Continuation 489,471.94 Total 1,000,943.88 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 The First Church of the Brethren 35,000.00 2 Children's Aid Society 5,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 40,000.00 Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) SCHEDULE J BENEFICIARIES (Part I,Taxable Distributions) ESTATE OF: Arlene Z. Roth 04/09/2015 179-14-7928 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Dean G. Roth Son Schedule G Item 8, 239.235.97 1920 Armstrong Avenue Twenty-five percent Morton, PA 19070 (25%)of residue 7 Debbie Roth Daughter-in-Law Schedule G Item 3 11,000.00 10008 Scott Plantation Drive North Mobile,AL 36695 8 William B. Roth Son Schedule G Item 2, 239,235.97 10008 Scott Plantation Drive North Twenty-five percent Mobile,AL 36695 (25%)of residue Tota I 489.471.94 1 I��.�Fl LLS'�UAI'.�FILE'�Estalc Planning5965_i,µ�.��ill � � � � C� op 0 LAST WILL AND TESTAMENT I, ARLENE Z. ROTH, of Carlisle Borough, Cumberland County, Pennsylvania,being of sound and disposing mind and memory,do hereby make,publish and declare this to be my Last W ill and Testament, hereby revoking any and all former Wills or Codicils made by me ITEM ONE I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all death taxes shall be paid to the extent possible from the assets held or passing under ITEM SEVEN hereof as soon as practicable after my decease and as part of the administration of my estate. ITEM TWO If my husband,G.BOOK ROTH,is living thirty(30)days after my death,I give a certain life insurance policy in the principal amount of Fifty Thousand Dollars ($50,000.00) issued by Continental American Life Insurance Company, Wilmington, Delaware, Policy No. 337008, unto my children, WILLIAM B. ROTH, ALLEN Z. ROTH, CONSTANCE H. HENRY and DEAN G. ROTH, in equal shares, absolutely. ITEM THREE If my said spouse, G. BOOK ROTH,does not so survive me,then I give the sum of Thirty- five Thousand Dollars($35,000.00)to The First Church of the Brethren,Carlisle,Pennsylvania,and the sum of Five Thousand Dollars($5,000.00)to the Children's Aid Society of the First Church of the Brethren;provided,however,that the foregoing bequests shall be reduced pro rata to the extent that such bequests, in the aggregate, exceed five percent (5%) of my gross estate. ITEM FOUR I bequeath any automobiles or motor vehicles I may own at my death,my personal effects, such household goods if any as may be my individual property and not the property of my spouse or owned jointly by me with my spouse, and other tangible personal property of like nature (not including cash or securities),together with any existing insurance thereon,to my spouse,G.BOOK ROTH, providing he survives me by thirty(30) days. Should my spouse predecease me or die on or before the thirtieth day following my death, I bequeath such tangible personal property and insurance thereon to such of my children as are living on the thirty-first day after my death, to be divided between or among them with due regard for their personal preferences in as nearly equal ��_�. [Initials) Page 1 of 7 Pages � iu�A rr irni � shares as practical and as they shall mutually agree. I direct that any of the foregoing articles not selected by such children or about which there is no agreement shall be sold at public or private sale by my personal representative,and i further direct that the net proceeds thereof shall be administered and distributed as a part of the residue of my estate. ITEM FNE If my spouse, G. BOO�ROTH, is living thirty(30)days after my death,then I give, devise and bequeath all of my estate,both real and personal property, unto my said spouse, absolutely. If my said spouse does not so survive me, then I give, devise and bequeath all the rest, residue and remainder of my estate,both real and personal property,unto my Trustees to be held or distributed by such Trustees under ITEM SEVEN hereof. ITEM SIX In the event my said spouse shall disclaim all or any portion of any devise or bequest made to my spouse under the foregoing ITEM FIVE,then the amount otherwise payable shall be held by my Trustees under ITEM SEVEN hereof. For purposes of the Trust established under ITEM SEVEN hereof, my said spouse shall not be deemed to have predeceased me by virtue of my said spouse's exercise of the right to disclaim set forth herein. ITEM SEVEN RESIDUARY AND DISCLAIMER TRUST My Trustees shall hold the assets received under ITEMS FNE and SIX hereof, if any, for the following purposes: A. My Trustees shall pay the net income, at least quarter-annually, to my spouse, G. BOOK ROTH, for life. In addition, my Trustees, in my Trustees' sole discretion, may invade the principal of the Trust for the proper and adequate support of my said spouse. B. My Trustees shall further pay to my said spouse, annually, such sum from the principal of the Trust as my said spouse may request in writing, provided, however, that said sum may not exceed the greater of Five Thousand Dollars ($5,000.00) or five percent (5%) of the aggregate value, at the time of said request, of the principal of the Trust hereunder. C. Upon the death of my said spouse, or upon my death if my spouse shall not survive me by thirty (30) days, my Trustees shall distribute the principal of the Trust to my children, �[Ini ials] Page 2 of 7 Pages -�«� iu�A-r�r�irmi�� WILLIAM B. ROTH, ALLEN Z. ROTH, CONSTANCE H. HENRY, DEAN G. ROTH, in equal shares, absolutely. D. In the event that any of my said children shall fail to survive my spouse and me,but shall leave issue surviving,then such deceased child's share shall be held by my Trustees and the net income therefrom shall be used for the support, maintenance and education of the issue of such deceased child. My Trustees shall use as much of the principal as it shall deem desirable for said purposes. My Trustees shall distribute absolutely the principal of such share of such deceased child to the issue of such deceased child per stirpes as each shall attain the age of twenty-five(25)years. In the event that any of my children shall fail to survive my spouse and me and not leave issue surviving, then such deceased child's share shall be added to the shares of my other children as if originally a part thereof. E. Notwithstanding any other provisions to the contrary, in no event shall any share be distributed to any beneficiary later than twenty(20)years after the later death of my spouse or me. ITEM EIGHT POWERS OF EXECUTOR AND TRUSTEES In addition to the powers conferred by case law,by statute, and by other provisions hereof, my Executor and Trustees and their successors, shall have the following discretionary powers applicable to all property held by them which powers shall be effective without order of any court and shall exist until final distribution. A. To retain any property of any nature received by them for whatever period they shall deem advisable; B. To invest and reinvest all or anypart of said property in such stocks,bonds,common trust funds, securities,accounts,certificates of deposit(including,but not limited to,stocks,bonds, common trust funds, securities,accounts or certificates of deposit of the Trustees)or other property, real or personal,as in their discretion they shall deem proper,without regard to statutes limiting the property which a fiduciary may purchase; C. To sell,transfer,exchange or otherwise dispose of,any part of said property,for cash or on tertns,publicly or privately,or to lease,even for a term exceeding five(5)years or the duration of any trust herein, without liability on the purchasers or lessees to see to the application of the r�l�. L Page 3 of 7 Pages ..�n m-a•.rr irm � �. proceeds, and to give options for these purchases without the obligation to repudiate them in favor of a higher offer; D. To execute and deliver any deeds, leases, assigrunents or other instruments as may be necessary to carry out the provisions of any trust hereunder; E. To borrow money, including the right to borrow money from any bank and to mortgage or pledge any asset of the estate as security; F. To assume continuance of the status of any beneficiary with regard to death,marriage, divorce, illness, incapacity and the like in the absence of information deemed reliable without liability for disbursements made on such assumption; G. To pay from the trust,or the income therefrom,all debts or claims against my estate, or any taxes or similar charges on my estate; H. To make any distribution hereunder either in kind or in money, or partially in kind and partially in money. Distribution in kind shall be made at the market value of the property distributed, and my Trustees, in my Trustees's absolute discretion,may cause the share distributed to any distributee to be composed of property similar to or different from that distributed to any other distributee; I. To exercise any subscription right in connection with any security held hereunder,to consent to or participate in any recapitalization, reorganization, consolidation or merger of any corporation, company or association, the securities of which may be held hereunder, to delegate authority with respect thereto, to deposit investments under agreements, to pay assessments, and generally to exercise all rights of investors; J. To invest in endowment, insurance or annuity policies on the lives of beneficiaries of any trust hereunder; K. To continue in any partnership, joint venture, joint ownership or other business enterprise of which I am a part at the time of my death; L. To compromise claims; M. To continue for whatever period of time as they shall deem necessary any ownership as a tenant in common or as a partner, in real estate or other property and to act as I could have done had I been living; ��. [Initials] Page 4 of 7 Pages N. To lend money to my estate or to any trust created hereunder or to purchase from the estate or from any trust created hereunder, at the market value thereof at the time of purchase, any securities or other property tendered to them by my estate or any trust created hereunder at any time and from time to time within a period of nine (9) months after my death; O. In the event that any amounts are payable hereunder or under any trust created hereunder to a minor, or to a person otherwise under legal disability, or to a person not adjudicated to be an incapacitated person,but who,by reason of illness or mental or physical disability is,in the opinion of the fiduciary(ies)hereunder,unable to properly administer such amounts, such amounts may be paid by the fiduciary(ies)hereunder in his,her or their sole discretion in any of the following ways as he, she or they may deem best: 1. Directly to such beneficiary; 2. To a legally appointed guardian of such beneficiary for the benefit of such beneficiary; 3. To a person having custody of such beneficiary for the benefit of such beneficiary; 4. By the fiduciary(ies)hereunder using such amounts directly to the benefit of such beneficiary. Evidence of the application of payment of an amount in such a manner shall be a full and complete discharge of the fiduciary(ies) hereunder to the extent of such payment or application. This paragraph shall be applicable to payments of income as well as principal. P. To employ agents, attorneys and proxies and to delegate to them such power as my personal representatives and Trusteess consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; Q. To conduct an inventory of any safe deposit box necessary to the administration of my estate. R. To do all other acts in their judgment necessary or desirable for the proper management, investment and distribution of my Estate. _�—� [Imtials] Page 5 of 7 Pages .�a m.a..i.r m•ni . ITEM NINE PROTECTNE PROVISIONS All income or principal held for the use and benefit of the beneficiaries of any trust hereunder shall not be in any way or manner subject to anticipation, assignment, pledge, sale or transfer,nor shall any such interest,while in the possession of my Trustees,be liable for or subject to the debts, contracts, obligations, liabilities or torts of any beneficiary, or to attachments, executions or sequestrations under process of law. ITEM TEN APPOINTMENT OF EXECUTOR AND TRUSTEES I nominate, constitute and appoint my spouse, G. BOOK. ROTH, as Executor of my estate. In the event that my said spouse shall predecease me or fail to act as Executor,then I appoint my son, ALLEN Z. ROTH as Executor of my estate. In the event my said son, ALLEN Z. ROTH, shall be unable or unwilling to so act, I appoint my daughter, CONSTANCE H. HENRY, as Executrix. I nominate, constitute and appoint my spouse, G. BOOK ROTH, and my son, ALLEN Z. ROTH, as co-Trustees of any trust created hereunder. ITEM ELEVEN WANER OF BOND I direct that neither my Executor nor my Trustees or their successors shall be required to file any bond in any jurisdiction to secure the faithful performance of their duties, nor shall they be required to obtain any order or approval of any court for the exercise of any power or discretion set forth in this Will. IN WITNESS WHEREOF I have hereunto set my hand and seal this �� day of C.�,��;�.�LJ ,,�0 3 . �, • `�o-��- (SEAL) Arlene Z. Roth SIGNED,SEALED,PUBLISHED AND DECLARED by the above-named Testatrix,as and for her Last Will and Testament,in the presence of us,who at her request,have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. �� . _� 1 ,, �� ,.� , �Z�..�c_--r' t. � _ � Page 6 of 7 Pages n„^� �u��i � n�ni � COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) We, Arlene Z. Roth, Ivo V. Otto III, and �Go'i r-i r"��-- � - �'� )��'�� , the Testatrix and the witnesses,respectively,whose names are signed to the foregoing instrument,being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will and that the Testatrix has signed willingly, and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. �%�-�. � �2�-�. , Arlene . Ro , Testatrix � Witness � � I ,_-,. Z.�-c. �L2. .. , . ;,. Wit'ness � Subscribed, sworn to and acknowledged before me by Arlene Z. Roth, the Testatrix, and subscribed and sworn to before me by Ivo V. Otto III and ��9�-� r�-�r- �- � ��`��r S , the witnesses, this��day of —7,%��t cG� , n'��`3 . ///` �� L, , ,�< <� ;<,.rt �� l: � Notary Public NOTARIAI SEAL rICfORIA l.4TT0 NOTARII PUBLIC CARLISI.E BORO. CI�MeERLAND COUNTY Nlr COMMISSI01��l(PIRES DEC. 2 2006 Page 7 of 7 Pages � nrn rr ir°ni > �;v;)�v�i�� C%�G�u��i �,�=�;�irL J Estate Valuation Date of Death: 04/09/2015 Estate of: Arlene Z Roth Valuation Date: 04/D9/2015 Account: �139-832�1 Processing Date: OS/18/2015 Report Type: Date of Death Number of Securities: B Sharas Security blean and/or Div and Int SeCurity or Par Oescription High/AsL• Lo�•�/Bid fidjustments Accruals Value 1) 15000 PITTSBURGH PA SCH DIST (7252�6"1N3) Interactive Data Corporation DTD: 11/O1/2005 I�at: 09/O1/2023 a.3$ 09/09/2015 101.59400 Mkt 101.594000 15,239.10 Int: 03/O1/2015 to 04/09/2015 68.08 2) 15000 SOUTHCENTRAL PA GEN AUTH REV (89129NHT9) Inteiactive Data Corporation DTD: 11/12/2008 D1at: 06/O1/2025 6� 09/09/2015 115.53900 MY.t 115.539000 17,330.65 Int: 12/O1/2014 to 09/09/2015 320.00 3) 20000 ALLEGHENY CNTY PA HOSP DEV AUT (01728AU20) Interactive Data Corporation DTD: 06/03/2009 Mat: 08/15/2021 5$ 04/09/2015 119.95600 t4kt 1L4.956000 22,991.20 Int: 02/15/2015 to 09/09/2015 150.00 q) 10000 SOUTHCENTRAL FA GEN AUTH REI+ (84129NH25� Interactive Data Corporation DTD: 11/12/7.008 tAat: 06/O1/2025 60 04/09/2015 119.23800 t4kt ].14.�.38000 11,923.80 Int; 12/Ol/2014 to 09/09/2015 ^<13.33 5) 2500D LANCASTER CNTY PA HOSP AUTH RE (514095Z82j Interactive Qata Corporation DTD: O1/23/2008 Dlat: 07/O1/2040 6.5� 04/09/^<O15 109.18200 t9kt 104.182000 26�045.50 Int: O1/O1/2015 to 09/09/2015 992.36 6) 25000 GE CAP RETAIL BK DRAPER UTAH (36159UFG6) Interactive Data Corporation DTD: 11/06/2008 t9at: 11/06/2018 5.55� 09/09/2015 110.21370 fdl:t 110.213700 27,553.93 Int: 11/06/2019 to 09/09/2015 585.41 Dtote: Put Option on DOD 7) 10399.697 FRAN1<LIN CUSTODIAN EDS INC (353996805; FCISX) INWME FD CL C Mutual Fund (as quoted by NASDAQ) 09/09/2015 2.93000 Mkt 2.930000 25,271.26 81 5253.95 Cash (CASH) 5,253.95 Total Value: 5151,109.09 Tota1 Accrual: 51,779.18 Total: $152,868.<^7 Page 1 This reporT. vras produced e�ith EstateVal, a product oE Estate Valuations G Pri.cinr� Systems, Inc. Janney P4ontgomer� Scott LLC assumes no responsibility for the accuracy or completeness of the information pxovided, the Date of Death and the specific securities, o�hich axe valued. Vlhile we deem this information to be reliable, ,re do not warranty or guarantee its accuracy. This service is not intended to constitute legai or tax advice. You should consult ��ith you ta� professional and attorney to discuss estate settlement and any leqal mat.ters. �; �� V!.�� ' � � � -- ._�� sC� � U� L� � , � I ,,�.i iu� i.r irm „ Estate Valuation - ROCh, A:lene Z. Hgency Date o: Death; G9/09/2015 Estate of: A:lene Z. Roth Ayency Valuation Date: 04/09/2015 Ar.count: 617592605 Processing Date, 09/30/2C15 Regort Type: Date oi Death Plu�nher of Secu:ities: 23 File ID: Arl�ne Z. Roth Aqency 617592605 Estate Val Shaces Security Mean -ind/o: Div and Int Security o� PaC Desctiption High/As}: Low/Bid Adjust:nents Accruals Value 1) 2973.53 Cash (CASH) 2,973.53 2) 1'1561.55 Cash (CASH) 17,561.55 3) 4886.037 FEDERATED TOTHL RETUR�1 SERS (319?8Q797) ULSHT INST NEW hlutual Eund (as quoted by NASDAQ) 04/09/2015 9.19000 Mkt. 9,140000 94,658.38 Daily Div. Accrual as of 04/09/2015 11.7B q} 83.17 E'EDERAT£D FIXED INCOME SECS (31Q1'IP858) �1UA1 ULTSH I tdW ^tutual Fund (as quoted by NASDA¢1 04/09/2015 10.03000 :�kt 10,030000 839.20 Daily Div. Accrual as of 04/09/2015 0.11 y) I755.211 VANGUARD MUN BD PD INC (922907100) SHORI' TRy PQRT Mutual Fund (as quoted by NASDAQ) 04/09/2015 15.83000 Ml:t 15.830000 2'7,799.99 Daily Div. Accrual as of 09/09/2015 9'78 () 200 EMERSON ELEC CO (?910111091 COM New Yozk StocY. Er.chanqe 09/09/2015 57.15000 56.58000 H/L 56.b65000 11,373.00 7) 300 GENERAL ELECTRIC CO (369604103) COM New York Stock E>:change 04/04/2015 25,83000 29.91500 H/L 25.372500 7,611.75 Div; 0.23 Ex: 02/19/2015 Rec: 02/23/2015 Pay: 09/27/2015 69.00 8) 600 ftOCKWELL AUTOMAPION INC (773903109) COy New Yo=Y. Stock Er.chan9e 04/09/2015 112.26000 110.97000 H/L 111.615000 66,969.00 9) 800 ROCKWELL COLLINS INC (7�9341101) COM New York Stock Er.change 04/09/2015 97.59500 96.53000 H/L 4/.06250D 77,650.00 10) 200 3M CO 188579Y101) COM New York Stock Er.change 09/09/2015 16�.18000 165.08000 H!L 166.130000 33,226.00 11) 400 CARNIVAL CORP {1436583001 PAIRED CTF New York Stock Er.chanqe 04/09/2015 98.66000 98.0500a H/L 4A.355000 19,392.00 12) 600 ALTRIA GROUP INC (02209S103) COM Neai York Stock Exchange 09/09/2015 51.93000 51.97500 H/L 51.702500 31,021.50 Div: 0.52 Ex: 03/12/2015 Rec: 03/16/2015 Pay: 09/10/2015 312.00 Page i This repott was produced riith EstateVal, a product of Estate Valuations b PL1'�lll� Syste:ns, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.c�on, ;Revision 7.3.1) ��^',��'�, �� 3 �' {�/,. .. '� � I � �} r ��C��.-�"i�. l. '�' T'� G,', . �.. ,r � ,� m-o...i...r ir'm �� Date of Death: 04/05/2015 Estate of: ALlene Z. Roth Agency valuation Date: 09/05/z015 Account: 61�5�2605 Processing Uate: 04/30/2015 Report Type: Date ef Death Number of Securities: 23 File ID: Arl�ne 2. Roth Agency 617592605 Estate Val Shares Security Mean and/or Div and Int Security or Par Description High/RsY, Lou/Bid Adjus�ments Acc:uals Value 13) 138 KRAFT FOODS GROOP IN� (500'16Q106) COM NASDAQ Stock rfarY,et 04/09/ZO15 69.50000 87.33000 H/L 88,415000 Div: 0.550000 Er.: 04/08/2015 Rec: 04/10/2015 Pay: 09/29/2015 + 0.550D00 88.965000 12,277.17 lq) 419 MONDELE2 ItJTL INC (60y207105} CL A NASDAQ Stock Market 04/09/2015 37.42500 37.13000 H/L 37.277500 15,932.89 Div: 0.15 Er.: 03/27/2015 Rec: 03/31/2915 Pay: 04/13/2015 62.10 15? 200 PEPSICO INC (713448108i COM New York Stock Er.chanqe 09/09/2015 96.63000 °5.69000 H/L 96.135000 19,227.00 16) 600 PHILIP MORRIS INTL ItJC (7181721091 �OM New Yo:k Stock E>:change 09/09/2015 77.99000 77.00000 H/L "]7.495000 46,997.00 Div: 1 Er.: 03/24/2015 Rec: 03/26/2615 Pay: 09/10/2015 600.00 17) 1100 EXXON MOBIL CORP 130231G102) COM New York Stock Er.change 09/09/z015 84.73000 83.8�004 H/L 84.270000 92,697.00 18) 160 SPECTRA FNERGY CORP (89756Q1091 COM New York Stock Er.change 04/09/2015 37,15000 36.6200G H/L 36.885000 5,901.60 19) 1100 JPMORGAN CHASE 6 CO (96625H100) COM New York StocY. Er.change 04/09/2015 61.57500 60.83000 H/I. 6i.202500 67,322.75 Div: 0.9 E>:: 09/O1/2015 Rec: 09/06/2015 Pay: 04/30/2015 940.00 2p) 60Q M 5 T BK CORP (55261F1041 COM New Yotk StocY. Exchanqe O4/09/2015 124.89000 123.79000 H/L 124.340000 74,609.00 21) 250 BRISTQL MYERS SQUIBB CO (110122108) COM New York Stock Er.change 09/09/2015 64.10000 62.56000 H1L 63.530000 15,862.50 �iv: 0.37 Ex: 04/O1/2015 Rec: 04/06/2015 Pay: OS/O1/2015 92.50 ZZ) 300 BOMINION RES INC VA NEW (25796U109) COM New York StocY. Exchange 04/09/2015 71.59000 70.81000 H/L 71.200000 21,360.00 23) 106 DUKE ENERvY CORP NEW (26491C204) COM NEW New York Stock Er.change 04/09/2015 77.20000 76.53000 H/L 76.665000 8,197.69 Paqe 2 This repo�t �aas produced with EstateVal, a product of Estate Valuations & Prir_inq Systems, Inc, If you have questions, please contact EVP Systems at (8181 313-6300 or www.evpsys.com, +.Revision 7.3.1) SC+-�� (�l� �, � c - ,::'..c'; ..-.«,vw nre-r-�r irmi fi Uate of Death: 04/09/2015 Estate o`: Arlene Z. Roth Agency Valuation Date: 04/09/2015 A�count: E17592605 Processing Date: 09/30/2015 Aepo�t Type: Date of Death tJunbe: of Secu_ities: 23 File ID: Arier.e '[,. Roth Agency 617592605 Estate val Tota1 Value: 5720,355,50 i'otal RCc_udl: 51,592.27 TOCalc 5�21,997.77 Page 3 This report was produced with EstateVal, a product of Estate Valuations a P:icing Syste�ns, Inc. If you have questions, please contact EVP Syste:ns at (818) 313-6300 or oiww.evpsys.com. IRevision 7.3.1) .,:�.wn rn..e.-r..r ir•ni 4 a �� 499 Mitchell Road,Milisboro,DE 19966 Records Management Phone 888-502-4349 F ax (302)934-2955 May 5,2015 Martson Law Offices 10 East High Street Carlisle,PA 17013 Re: Estate of: Arlene Z. Roth Social Security: 179-14-7928 Date of Death: April 9, 2015 Dear Sir or Madam: Per your inquiry on April 24,2015, please be advised that at the time of death,the above-named decedent had on deposit this bank the following: 1. Type of Account Checking Account Number 9830136793 Ownership(Names ofl Allen Z Roth(POA) Arlene Z Roth G Book Roth Opening Date OS/16/2002 Balance on Date of Death $3,774.80 Accn�ed Interest $ .03 Total $3,774.83 For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call High Street Carlisle at 717-240.4536 We were unable to locate any safe deposit box for the above-mentioned decedent. This letter dces not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers,Representative Payee,or Trustee under a Written Agreement. Sincerely, Tomara Williams Records Management ,C N��l� � � # �� nra-r r irm + ,�'cii,�'�:�n��% ,9cC'��i �� E,tate Val�ation Date of Death: 04/09/2015 Estate of: Arlene Z Roth Valuation Dat.e: 04/09/2015 Account: 713q-8375 Processing Date: OS/18/2015 Report Type: Date of Death IJumber of Securities: 8 Shares Security l9ean �and/or Div and Int Security or Par Description High/As}: Lo�•+/3id Adjus�ments Accruals Value 1) 188.01 MASSACHt1SETTS INVS TR (575736301; tAITC:S) SN BEN INT C Mutual Fund (as quoted by NASDAQ) 09/09/2015 26.90000 f4kt 28.100000 5,339.d8 2j 15000 GENWORTH FINL INC (37247DAN6) Nevt York Bond Exchange DTD: 11/22/2010 Mat: 02/15/LOLZ 7.2$ 09/09/�OZS 105.75400 Ml�t 105.150000 15,E362.50 Int: 02/15/2015 ta 09/09/2015 162.00 3) 25000 CASCADE NAT GAS CORP (147339AJ4) Interactive Data Corporation DTD: Oi/25/2005 Mat: 02/O1/2035 5.25� 09/09/2015 100.04690 t4kt lU0.G46900 25,011.73 Int: 02/O1/2015 to 09/09/2015 29�•9z 9) 500 ROYAL B[C SCOTLAND GROUP PLC (780097739) SP ADR PREF S Dleei YorY, StocY. Exchange 09/09/2015 25.2100D 25.06000 H/L 25.735000 12,567.50 5) 1709.962 LORD ABBETT BD DEB FD INC (594009203; LBNBX) CL B Mutual Fund (as quoted by NASDAQ) 04/09/2015 8.19000 Mkt 8.J.90000 19,009.59 Daily div, accrual as of 09/09/2015 12.36 6) 3325.992 DfAINSTAY FDS (56062F400; MKHCX) HI YLD CORP B Mutual Fund (as quoted by NHSDAQ) 04/09/2015 5.80000 Mkt S.E300000 19,290.96 7) 282.983 MAINSTAY FDS (56062F772; MHCAX) HI YIELD CP A Mutual Fund (as quoted by NASDAQ) 09/09/2015 5.83000 Mkt 5.330000 1,646.86 8) 835.94 Cash (CASH) 635.99 ' Total Value: 599,559.08 Total Accrual: $422.28 Total: 594,981.36 Page 1 This report aias produced �•iith EstateVal, a product of Estate Valuations o Pricing systems, Ine. Janney t�font9omery Scott LLC assumes no responsibility for the accuracy or completeness of the information pro•�ided, the Date of peath and the specific securitie�, �ihich are valued. Pihile we deem this information to be relinble, �re do not warranty or guarantee its accuracy. This service is not intended to constitute legal or tax advice. You :sFiould r,onsult �•rith you tax professional and attorney to discuss estate settlement and any lec,�al matters. � ! ��1 �� ,� P�' �� _ t"l C,1/ ✓