HomeMy WebLinkAbout07-09-15 (3) J Lsos6lavoa
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REV-1500 OFFICIPL USE ONLY
CounryCotle Year Flk rvumoer
Bureau of Intlivitluai Taxes INHERITANCE TAX RETURN
POBO%280601 2y y4 1167
Harris0ur . PA 1�128-0501 RESIDENT DECEDENT
ENTER OECEOENT INFORMATION BELOW
SOcial S¢W�i�y NUmb2! Oa[e of Oeath MMDDVYVY Dd�2 Of BiM1h MM�OVriY
11 29 201v 12 20 1953
�ecetlenPs Last Name
Suffx DecetlenPsFirslName MI
POWERS f1ARY JANE
(If Applicable)Enter Surviving Spouse's Into�malion Below MI
Spouse's�ast Name Suffix Spouse's First Name
THIS RETURN MUST 8E FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O t OngindlReWm � 2 Suppl¢men�dlReWm � 3. R¢maintl¢�ReNm(tlateoftl¢d(h
prlorlo 12-13-827
� p Agncullu2l Exemption(date of � & FUWre In�eres[Compmmise(Oate o� � 6. Fetleal Es�ate Tax ReWm Requlretl
tlea�honoraflerJ-0-2012) tlea�halle��442-82)
O i. oecetlent oiee Testete e. Decetlen�Main�alned a Living Tmsf �. 9. To�al NumDe�of Sa�e Deposit Boxes
(AVacM1copyolwlll) � (Ht�achmpyot�msLJ
� t0. Li[igabonProceeOSReceIveO ❑ ��' �5<M1etlueFanrtlGAsulsOnly) � ��' DeferrallElectionof5pousalTms�s
� ll. Buslness Assets ❑ 14. Spouse is Sole Benefaary
(No1ms�InvoNetl)
CORRESPONDENT�THIS SECTION MUST BE COMPLETE�.ALL CORRESPoNOENCE ANO CONFIOENTNL TA%MFORMATION SHOOLD BE DIRECiED T0:
Name Oaytime TelapM1one Number
IVO V OTTO III 717 243 3341
First Line of PCtlress
10 EAST HIGH STREET
Semntl Line o(AdOress
CiryorPwtOKw Sta[e ZIPCotle
CARLLSLE PA 17013
Correspontlent'semailatltlress: � tt � � I
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
�ATEFILEUMMDDYYYY n � ,p �1
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Side 1 � � s V' �
-� N
I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII /'� �
L 1505618403 1505618403 � �1
\l
J 1505618413
REV4500 EX DecedenCs Social5ewrity Number
oe�aenrsname: Powers, Mary Jane _ _ . _ .
RECAPITULATION
1. RealEstate(SchetluleA)_... ... ____. ...___.. 1. 172.50�-00
2. SrocksantlBontls(Schetlulee) .......__. __.._. _. Z. 107,583 •OS
3. Closely Heltl Coiporation.Partnership ot Sole-Pmprietorship(Schedule C)....__. 3.
4. MortgagesantlNotesReceivable(Schedule�) ...___. .___. 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).....__. 5. 13,6 4 8 •O S
6. Jointly Ownetl Property(Schetlule F) [I Separate Billing Reques�ed........_. 6. 77,085 • 91
]. Inter-Viws Transfers&Miscellaneous NomP�o�ate Property
(ScneauleG) , � SepareteeiiiingRequesretl............ �. 469,976 • 61
8. Total Gross Asseb(to�al Lines 1 �hrough 1) ......_. ._........... 8. _ 8 4�,795 •62
9. FunerelEzpensesandAtlminis�retiveCos[s(ScheOuleH)....... ......__.. 9. 58�538 • 97
10. DebhofDecetlent,MortgageLiabilitiesandLiens(Schetlulel)._........_____....... 10. $7,304 • 66
11. Total DeaucHons(lotal Lines 9 antl 10).._... .......... .__...... �1. 115,B 43 • 63
12. NatValueofESW[e(LineBminusLinell).. .__.... ...__.... 72. 724 ,951 .99
13. Charitable and Govemmental Bequesis/Sec 9113 Tmsis for which
an elepion to tax has no�been matle(Schedule J).......__............___......____.... 13.
ia. NetValueSubjecttoTaz(Linel2minusLinel3) .__.... .__...._ �4. 724 ,951-99
._- . . . _ ._ _ ..-.
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14�anaEle
althe spousal tax rate,or
transfere untler Sec.9116
(a)(12)X.00 75. 0 .0 0
i6. AmountofLinel4taxable
atiineairateX .o45 55,805 • 1❑ �6. 2,511-23
1Z Amaunto(Linel4taxable
a�siDnngrate %.tx 624 ,146 •89 ». 74 ,697 •63
18. AmountofLinel4�axable
atw��atera�rateX.ts 45.000-00 �e. 6�750 •00
79. TA%DUE ._. ._....___. 19. 84 .158 .86
...._. ........... ._........
2D. FILL IN TME OVAL IF YOU ARE RE�l1E5TING A REFUND OF AN OVERPAVMENT �
❑ntler penal�ies ol perjury,I tleclare I M1ave examinetl�Ms reNm,inclu�ng accomvpanying u�etlu9les an0 statemenls,anE�o Ne Oes�ol my knowl�rege an0 Oeliel,
illswe,wrreclanCwmplete.oeclarationotprevarero�nerinaniM1e ersonresonsibleforfilln tM1ereNmisoasetlonalllnbrtnatlonotwM1icn ernas
any knowletlge.
SIGNNT�N�I�A��ERS�P e P� ONSI6LE FOR FI�ING RETURN pnn F. Bero r-� �Aie
K W/!//�� U �'�C���� / � 7���
AODRE55
5020 hetla tl uR, Mechanicsbur , PA 17050
SIGNATU EO P � OTHERTHANREPRESENTATNE IVOV. OIIOIII ry /a/�.O/�
! !
/
AD�RE55
10 East Hi h Street, Carlisle, PA 17013
IIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIII Sitle2
L 1505618411 1505618411 �
REV-1500 E%Page 3 File Number 27-'14-1167
DecedenPs Complete Address:
OECEDENT'S NAME
Powers. Mary Jane _ _ . . . _ _ _ .. .. _ -
STREETAD�RESS
2244 Gleim Court _ ._ . .
CITV . . . � .. .. . . . . . ., STATE �ZIP
Enola PA � 17025
Tax Payments and Credits:
1. TaxOue(Page2, LIne1B) (1) . 84,158.66
2. CredilslPayments
A. PriorPaymen�s 75,000.00
e. Discounl 3,947.37
Total CreOits(A i B) �2) 78,947.37
3. Interest (3) � � -
q. If Line 2 is greate��han Line 1 +Line 3,enter ihe tliHerence. This is Ne OVERPAYMENT. (4) _
Check box on Page P,Line 2U to request a retuntl
5, If Line i +Line 3 is grea[er than Line 2,enter the diHerence. This is Ihe TA%DUE. (5) $�211.49
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedenl make a trans(er antl-. Yes No
a. retain ihe use or inwme of lhe pmperty iransferred __._.... ... .... ��'
b. re[ain lhe righ�lo tlesigna�e who shall use Ihe property�rensferretl or its mcome _. .... � �
c. re�ainareversionaryln[arest;oc. .__.... .._. ._ _.� �I ]
E. rewivethepromiseforlifeofeitherpayments,beneftsorcare�.._. .... ._ LI x
2. I(tleath occurred a%er Dec. 12, 1982, tlitl decedent trenshr pmpeM1y within one year of Geath without _
receivingatle9uateconsitleratlon?....... ..._._.. ............. ..___. ............ i.., ''�
3. Ditl tlecedent own an'in tmsl fol' or paya0le upon tlealh�ank account or sewrity at his or her tleath9....... = ❑
4. Ditl tlecedent own an intlivitlual retiremen�account,annuity,or other non-probate property whicM1 ❑ � .I
con�ainsabeneficiarytlesignalion?__.. �-- ---- x ��
........_._ ._... ........._
IF THE ANSWERTO ANY OF THE ABOVE QUESTION515 VES,VOII MUST COMPLETE SCHEOULE G AND FILE IT AS PART OF THE RETURN.
Por dates of dea�h on or afler July 1,199a a�d before Jan. 1, 1995,the lax rate impoud on�he net value of�ransfers to or for�he use of the surviving sDouse
is 3 Dercent[2 P.S.§91 tfi(a)(1.1)(i)1-
Por daks of death on or afler January 1.1995.Ihe tax rate imposed on the net value of Vanskrs to or for the use oi Ihe suniving apoux is 0 percent
�'RP.S.§911fi(a�(1.1�(ii)�. Thestatutetloesnotexemptatmnsferloasurvivingspousefmmtax,anGlhestatutoryrequirementsfordisdosureotassetsand
fling a tax reNm are still applicable even i(�he surviving spouse is ihe ony benefmiary.
For tlates of death on or after July 1,2040�.
. The tax rote imposed on ihe net value oi tranaters from a deceased chiltl 21 pears o!age or younger al deaM to or for the use of a naturol parenl,an
atloptive parent,or a sre0-Oarent of Ihe c�ild is 0 percent�72 P 5.§911fi(a)(12)].
• The Ux ate imposed on Ihe net value of Vansfers to orlor the use o!the decetlenfs lineal benefciaries is a.5 perce^C except as wted in p2 PS.§9116(a)(t�].
. The la.rate impoxd on the nel value of Vansfen lo or kr ihe use o(the decedeM's siblings Is 12 percenl p2 P 5.§9116(a)(1.3p. A sibling is Defined,
un0er Section 91�2,es an indiviEual wfio has al least one parent in mmmon vn�h the decedent,wne�her Oy Elood or atloption.
Pw-0 W]E%��13-031
SCHEDULE A
pennsylvania REAL ESTATE
oeauerMErv1 or aevEHue
INHERRANCE TA%RETUIiN
RESI�ENT DECE�fNT
ESTATE OF FILE NUMBER
Powers Mary Jane 21-14-1167
q�l re.�pmwM ownea.ole�ya....�.n.nt m mmmon mua�o.nP^n.a.u.b mado<r.we.Fan marxe�vaw.re eennea es ire on<e at vmic P'�wM wowe ee
ex�fangeE heWeen a willin8�uyar enE e wllling ealler,nait�m be�ng wmpBIIBE to�uy oO mlu,'Eol��aving reamnaEle MowleOge o�I�e relevan�lacls.
PealpMpeM��s�Itpin�lycwneJMl�tlqO�MeurvlvomFl �Oetllaclo[e0onecM1atlubF.
PX¢h e copy ol�N�eXbnxnl��ee�II Ma O�oOeM�ae been ao10
Inc�utle e capy o1 Me Ew0 s�Owinp ExetlenlS In�oiaal i�owne0 n lenenl ln common.
ITEM VALUE FT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Esfate-Locatetl at 2244 Gleim Court,Hampdem Twp.,Cumberlantl Co., PA, known as 172,500.00
Wx Parcel No. 70-74-0838A93;value is sale price,see attached.
TOTAL IAlso enler on line 1, Recapitulation) 772.500.00
pr more sDace is neetlea,atltlitional pages of tM1e same size)
Copyright(c)2012 tortn sotlware only The Lackner Gmup.Inc. Form PA-1500 5chedule A(Rev. 12-12)
Rev-150]EY�(W�II�
SCHEDULE B
pennsylvania STOCKS 8 BONDS
OEPPRTMENTOFREVENVE
INHERITANCETMRETURN
RESI�ENiOECEOENT
ESTATE OF FILE NUMBER
Powers MaryJane Z�-�4-��s�
<��o��v.m Ioionpwn.e.nn xe��o�.um.orenio m�•�o.ai.tlosaa e�smmm.F.
ITEM WSIP VALUEATDATE
NUMBER NUMBER DESCRIPTION UNIT VALUE pF DEATH
l"�> � B k VG091818
7 3,857.236 shares of Franklin Incoma Class A 2.45 9,450.23
2 802.444 shares of F2nklin Stretegic Income Class A 10.36 8.373.32
3 627.632 shares of Templeton Global Bond Class A 13.21 $•Z9��OZ
F'tlelijy 67]-636100
4 282.473 shares of Alliance Bernstein Global Bontl 8.60 2�<29.2�
5 251.566 shares of American Beacon Large Cap Value 30.11 7,574.65
6 159.574 shares of American Funds New Perspective 39.40 8•Zb7.PP
7 36.766 shares of American Funds Washington 43.25 1,59D.13
g 233.74 shares of AOR Managed Futures Stretegy 11.1599897 Zb�7.84
9 174.63 shares of Diamond Hill Long/Short 23.63 4,72fi.51
10 349787 shares of Eaton Vance Glabal Macro Absolute 9.39 3.284.44
Retum
17 90.771 shares of Fideliry Diversifed Intemational 36.70 3,331.30
�p 229.989 shares of Hartfortl Floating Rate 8.87 2.040.00
73 52.54 shares of Iry Asset Strategy 31.42 1.650.87
Total of Conlinuation Schedule See attachetl page
TOTAL(Also enter on Line 2, Recapitulation) 107,583.05
Qt mora sDace Is nreEeC,aatlilional pages oriM1e same size)
Copyrig�t(c)2012 form software onty The Lackner Group,Ina Form PA-1500 Schedule 8(Rev.0842)
Rev150]EX��0043�
SCNEDULE B
pennsylvania STOCKS 8 BONDS
OEPPPTMENT OF REVENIIE
INHERITANCETACREtVRN continued
RESIDENT pELE�ENi
ESTATE OF FILE NUMBER
Powers Mary Jane 21-14-1167
ITEM CUSIP VAIUE AT DATE
NUMeER NUMBER DESCRIPTION UNITVALUE pFDEATH
14 134.436 shares of JP Morgan Stretegic Income 11.74 7.57818
Opportunities ,
15 167.172 shares of JPMorgan US Large Cap Core Plus 31.54 5.272.60
16 119.994 shares of Lazard Emerging Markets 19.66 2.359.08
77 177.679 shares of Leuthold Core Investment 18.32 ' 3,255.08
�g 68.005 shares of MainsWy High Yieltl Opportunities 11.89 808.56
�9 300.714 shares of Metropolitan West TOWI Return Bontl 10.93 3286.80
Fund
20 80.671 shares of PIMCO Commotlities Plus Strategy 8.80 I 709.90
y� 741.965 shares of PIMCO Total Return Admin 11.03 8.783.87
py 106.286 shares ot Rayce Value Plus 17.30 �� 1.873.35
23 740.125 shares of T. Rowe Price Growth Stock 57.22 8.017.95
24 12.248 shares ot T. Rowe Price Small Cap Value 48.85 598.37
25 270.674sharesoTTempletonGlobalBontl 13.21 3.575.60
26 369.23 shares of Templeton Worltl 19.21 i 7.092.91
TOTAL IAlso enter on Line 2.Recapitulation) 707,583.05
Copyrigh�(c)2012(orm software only The Lackner Group,Ina Form PA-i50U Schetlule B(Rev.08-12)
Rev-0S�B E%��OB-03�
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
°E'aa'"'`"'oFaE�E��E pERSONAL PROPERTY
INHERITqNCE TA%PETUFN
RESI�ENT oELE�ENT
ESTATE OF FILE NUMBER
Powers Mary Jane 21-14-1167
mawamac,o�aammrtig im�a�ainaaa�emaororeea:ware,xe�.eeeymee:�sa.
NI p�op[M b���lycwneE wI1M1 Me n8��ol aurvlvoMlp muc�be ElttloseE on scM1edule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF oEATH
1 Fitleliry-Rafund ����
2 Fideliry-Refuntl ����
3 Vehicle-2009 Saturn-Valua[lon is per Kelley Blue Book,see attached 8,800.00
4 2nd QuaRer Sewer/Trash proretion at real esfate settlement-2244 Gleim Court-2nd�uaRer 26.50
SewerlTrash O6-i 6-2015 to 0630-2015
5 Bon-Ton-Creditrefuntl 20.39
6 Citibank-Refuntl 73.29
7 Duke-Payment for participation in Stutly Program 283.37
B HOA dues proration at real estate settlement-2246 Gleim Court-HOA dues 06-76-2015 to O6 37.50
30-2075
9 Infinisource-Reimbursement of premium ��2.4�
10 Reimbursement for half of cost to replace roof of tlecedent's residence 1,957.50
71 Stephen Powers-Reimbursement to Esta[e 40.00
12 Taa proration at real estate settlement-2244 Gleim CouR-County Wxes 06-16-2015 to 7231 223.47
-2075
13 Tax proration at real estate settlement-2244 Gleim Court-School tazes 06-76-2075 to O6J0 57.79
-2075
14 USTreasury-20141040refund 1,438.00
Total of Continualion Schedule See attached page
TOTAL(Also enter on Line 5.Recaoitulationl 73.648.05
Qt more space Is neeUeO,aCditional pages oi�M1e same slze)
Copy�ight(c)2012 form sottware onty The Lackner Gmup,Ina Form PA-0500 Sc�etlule E(Rev.08-12)
a..ism ex.�oanz�
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
oeanarmEH.ovaeveuuE PERSONAL PROPERTY
INHEPITANCE TA%RETORN
aEsioeHroeceoEnr continued
ESTATE OF FILE NUMBER
Powers Mary Jane 21-14-1167
ITEM DESCRIPTION VALUE AT DATE
NUMBER OFDEATH
75 Verizon-Refund 29.38
i6 VerizonWireless-Refuntl 23.39
TOTAL�Also enter on Line 5.Recapitulalionl �3,648.05
Copyright(c)2012(orm software ony The LacknerGroup,Inc Fortn PA4500 Schedule E(Rev.OB-12)
R..�isos ex.�oi-io�
pennsylvania SCHEDULE F
oePnr+lMer�loFAeveNue �OINTLY-OWNED PROPERTY
INHERITANCE TPX kETUFN
RESI�ENT DECE�ENi
ESTATE OF FILE NUMBER
Powers Mary Jane 21-14-1167
x an.aa.i wn m.a.pme.�min on.y..r mm.a.�eaem�s aa.o�a.xn,n m�.�ne repon.a on xn.ama e.
SURVIVINGJOINTTENANT(5)NFME ADDRESS REL4TIONSHIPTODECE�ENT
A. Ann F. Bero 5020 Shetland Court Sister
Mechanicsburg, PA 17055
B.
C.
JOINTLV OWNED PROPERTY:
DESCRIPTION OF PROPERTY oAre or oenrH
ITEM LETfER DATE inc�uoeuarneoFritiaHcw�irvsri*u*ior+a+oeaHxncco�rvi DATEOFDEATH ECDFS uECEOENrsinrcAesr
NUMBER FORJOINT MAOE rvumeeaoasiMivamennrvwce+umsea.nnncHoeeoraa qLUEOFASSE �NTEREST
TENANT JOINT �oiurnNe�oaen�esln�e.
1 A 08/03/2015 CitizensBank4273 754,171.81 50.000°/, 77,085.97
TOTAL(Also enter on Line 6, Recapitulation) 77.085.97
(Ir more spara Is neetled.addllional pages o�ine same size)
Copyright(c)2010 farm soflware only The Lackner Gmup,Inc Fortn PA4500 Schetlule F(ftev.0140)
aa.nsm u.�ae-oa�
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
oevna�me�v�araeve�vue MISC. NON-PROBATE PROPERTY
NXERITPNLE iM RETUfiN
ResmeHtoeceoerv�
ESTATE OF FILE NUMBER
Powers MaryJane 21-14-1167
rn�:neanam�:�oewmaia�aaemnieemnea�:wenoa�yo�wa.ao�sim,o�anao�oaeem,aeonneaev-�soo�ivai.
ITEM DESCRIPTION OF PROPERTV DATE OF DEATH wor oecos Excwsioa TAXABLE
NUMBER THE�OATEOFiRANSFRE.SATTACN�AGOPYOFTHE�EEDF�ORRFALESTTE. VFWEOFASSET IMEREST �IFPPPLICABLE) VFWE
1 AmericanFuntlsCB&TCustIRA/Rollover- 57.593.02 100.000% 51.593.02
Beneficiaries: Ann F. Bero-sister/50%;Antlrew
Vovlovar-hrother/50%
2 Citizens Bank Roth IRA L7091732-Beneficiary:Ann F. 12,490.69 100.000% 12,490.69
Bero,sister, 100%
3 Forum Health Pension Plan-Pension Benetit 0.00 0.000% 0.00
Guaranty Corp.Case No.21426700; Decedent
Annuitant-first payment 8/1/73. Sister,Ann F. Bero
50%Survivor Annuitant. DecetlenYs only righls
untler the Plan were to tlesignate a beneficiary and
receive a regular monthly payment
4 LincolnFinancialGroup-IRA-Beneficiary: VirginiaS. 6,572.90 100.000% 6.572.90
Volovar-mother
5 Pacific Life Annuity VR04019477 -Beneficiaries: Ann 37Y,32P.00 700.000% 372,322.00
F. Bero,sister/30%; Antlrew Volovor, brother/30%;
Margarel Swanson sister/30%;Stephen Powers-Step
son/10%
6 AlexandraVolovar-NieceofDecetlent. Giftmade 74.000.00 100.000% 3,a00.00 17,000.00
10/6/14
7 Allen Galbraith-Fiance of Decetlent. Gik made 10,000.00 100.000% 3,000.00 7,000.00
10/6/76
8 Antlrew Bero-Nephew of Decedent. Gift matle 3,000.00 700.000% 3,000.00 0.00
10/6/74
9 AndrewVolovar-BrotherofDecedent Giftmatle 14.000.00 700.000% 3.aoo.0a 11,000.00
10/6/14
TOWI of Continuation Schetlule ee attachetl page
TOTAL(Also enter on Line 7, Recapitulation) 469,978.61
(It more space is neetlea,atlditional pages of Ne same size)
Copyrighl(c)2009 fo�m soflware only The Lackner Group, Ina Form PA-0500 Schedule G(Rev. OB-09)
ae..isia ex.loeas�
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
�EPPRTMENTOFREVENVE
wreRi.ar+oE,�aE,�aH MISC. NON-PROBATE PROPERTY
aesioeH.oecEOEH.
continued
ESTATE OF FILE NUMBER
Powers Mary Jane 27-14-1167
ITEM �ESCRIPTION OF PROPERTY DATE OF DEATH w ov oeco�s �cwsor+ TA%ABLE
NUMBER THE��ATEOFTMNSERSATTPCHTPLOPVEOFTHE�EEOF�ORREAl�ESTATDE. VAWEOFASSET IMEREST (IFPPPLICPBLEj VAWE
10 Caroline Bero-Niece of Decetlent Gik made 10/6/14 3,000.00 100.000% 3,U00.00 0.00
71 ChristopherJ. Bero-Brother-in-IawofDecedent. Gift 10,000.00 iQ0.000% 3,000.00 7,000.00
made 70/6/74
72 FrenkVolovar-Brotherof0ecedent. Gikmatle 5,000.00 700.000% �,000.00 2,000.00
7016/14
13 Jason Swanson-Nephew of Decedent.Gik made 70.000.00 100.000% 3,oao.oa 7,000.00
10/6A4
14 John Volovar-Nephew of Decetlent. Gik made 14.000.00 100.000% 3,Oo0.00 11,000.00
10/6/14
75 MargaretSwanson-SisterofDecedent.Gikmade 14.000.00 100.000% 3,000.00 17,000.00
10/6R4
i6 Staphen Powers -Step-son of Decetlent.Gik made 74,000.00 700.000% 3,000.00 7'I,000.00
10/6/ib
17 Virginia Volavar-Mather of Decedent. Gift made 70,000.00 100.000% 3,000.00 7,000.00
10/6/i4
78 WilliamNear-FrientlofDecedent. Giftmatlel0/6/14 5,000.00 100.OU0% 3,000.00 2,000.00
TOTAL(Also enter on Line 7,Recapituladon� 469,978.61
Copyright(c)2009 form sofiware only The Ladner Gmup,Ina Portn PA-1500 Schedule G(Rev.OB-09)
aev-mn es.�ae-u�
pennsylvania SCHEDULE H
oernarmen�orAevenue FUNERAL EXPENSES AND
�""ER""""""`REORN qDMINISTRATIVE COSTS
aesioe�+roeceoEr�.
ESTATE OF FILE NUMBER
Powers MaryJane 21-14-1167
Decedent's debts must be reportetl on Schedule I.
ITEM DESCRIPTION AMOUNT
p, FUNERALE%PENSES:
See continuation schedule(s)altachetl 9.8�8�2�
B. ADMINISTRATIVE COSTS:
1. PersonalRepresen[ative'sCommissions
Name o(Personal Represenlative(s)
SireetAtltlress
Ciry State _ Zio
Year(s)Commission Paid Waivetl
p, Attorney's Fees 31,709.19
See continuation schedule(s) atWched
3, Famity Exemption: Qf tlecetlenPs adtlress Is no�lhe same as claimanPs,attach explana�ion)
Claimant
SlreetAtltl�ess
City State _ Zio
Relationshio of Claimant to Decetlent
4. ProCate Fees 435.50
See continuation schedule(s)attachetl
5. AccountanPSFees
6. Tax ReWrn PreOarer's Fees
]. Other Administralive Cos(s 76,576.08
See continuation schedule�s) attached
TOTAL(Also enter on line 9, Recapitulation) 58,538.97
Copyrigh�(W 2013 torm sokware onlyThe Lackner Group,Ina Farm PA-1500 Schedule H(Rev.0843)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Powers Mary Jane 21-14-1167
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex eo nses
7 Bloams by Vickrey-Funeral flowers 328.55
2 Caddyshack-Funeralluncheon Z.000.00
3 Father Eric Vogt-Burial service at St. Mary's 50.00
4 Geoh-BurialFlowers 84�80
5 Gunners-Luncheon following burial 519.05
6 Neill Funeral Home-Funeral expenses 4.910.80
7 Oliver TKorb 8 Sons-Grave marker 975.00
8 Our Lady Lourdes-Donation,(uneral expense �5o���
9 St. Marys Catholic CemeWry-Funeral eapense 600.00
70 SWtion Inn -Dinner,evening priorto 6urial servlce 200.00
H-A 9,878.20
Attornev Fees
17 Martson Law Offices-Estimated attorneys'f¢es 31,709.19
H-B2 31,709.'19
Prohate Fees
72 CumberlandCountyRegisterofWills-Probatefee 435.50
Copy�igM(c)2002 fotm software only The Lackner Gmup, Ina Porm PA4500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Powers Mary Jane 21-14-1167
ITEM
NUMBER DESCRIPTION AMOUNT
H-84 435.50
Other Administretive Gost<_
73 AM-Titlefortrensferafvehicle 53.00
74 Advancetl Chem-Dry-Carpet cleaning in preparation for sale oT real estate 320.64
15 Ann F.Bero-Reimbursement for supplies purchased 780.91
16 BE Shank Contractors-Costa to replace roof in preparalion for sale of real estate 3.975.00
17 Boyer&Ritter-Preparetion of 2074 presonal income tax retums 360.00
18 CitizensBank-Servicecharge,esWtecheckingaccount 2�4�
19 Ci[izens Bank-Service charge,estate checking accounl 2.00
20 Citizens Bank-Service charge,estate checking account 2.00
21 Citizens Bank-Servica charge,estate che<king account Z�O�
22 Citizens Bank-Service charge,estate checking account 2.00
23 Commonweal[hofPennsylvania-Cartitle 86.00
24 Dennis McGlaughlin-Service fees to repair fence,clean steps and paint lights to prepare for 200.00
sala of real estate
25 George Weaver Moving Company-Fumiture removal, pending sale of real estate 1.859.96
26 Hamptlem Township-Sewer/trash service pentling sale of real esGte 160.75
Copyright(c)2002�orm software only The Lackner Gmup,Ina Form PA-0500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Powere Mary Jane 21-14-1167 _
ITEM DESCRIPTION AMOUNT
NUMBER
27 Hampdem Township-Sewer/trash service pentling sale of real estate 760.75
28 Lowes-CosttoreplacemicrowavepentlingsaleofrealesWte 376.57
29 Michael Langan,Treasurer-2074 CountyRwp. real estate taxes pending sale of real esWte d09.88
30 PA Department of Revenue-2014 PA40 Wx due 230.00
31 PAWC-Water service pentling sale of real estate 18.05
32 PAWC-Water service pending sale o(real esfate 18.05
33 PAWC-Water service pending sale of real estate 16.01
34 PAWC-Water service pentling sale of real esWte 16.05
35 PAWC-Water service pentling sale of real estate 15.03
36 PAWC-Water service pending sale of real estate(fnal) �����
37 PPL-Service pending sale of real estate 32.9�
38 PPL-Servicependingsaleofrealestate 38���
39 PPL-Service pentling sale of real estate 35.21
40 PPL-Service pentling sale of real estate 28�87
41 PPL-Servicepentlingsaleofrealestate 79�13
42 PPL-Service pending sale o(real estate 28.08
43 PPL-Service pending sale of real esWte(final) »�68
Copyrig�t(c)2002 torm software only The Lackner Gmup.Ina Form PA-0500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Powers MaryJane 21-14-1167
ITEM AMOUNT
NUMBER DESCRIPTION
44 Realtorcommission-2244GIeImCourt-Commissionpaitlatserilement 4.312.50
45 Realty Tasn(er Tax-2244 Gleim Court-Paitl at settlement 7,725.00
46 Saidi,Sullivan&Rogers-Tax certification fee paid at settlement 70.00
47 Schweitrer Constmction -Fees to gmund gas line in preparetion for sale of real estate 125.00
48 The Sentinel ZZZ'40
49 UGI-Service pending sale of real esGte 41.00
50 UGI-Service pentling sale of real estate 41�00
51 UGI-Service pentling sale of real estate 41���
52 UGI-Service pendin9 sale of real esWte 41.00
53 UGI-Service pending sale af real estate 41�00
54 UGI-Service pending sale of real esfate 4�.U0
55 UGI-Service pendin9 sale of real estate(final) 85.31
56 Verizon-Service pending sale of real estate 52.��
57 Verizon Wireless 23.39
58 WCHOA-HOA fee pentling tlistribution of real esfate 63.00
59 WCHOA-HOAfeepentlingdistributionofrealesUte 63.00
60 WCHOA-HOA fee pending distnbution of real estate 63.00
Copyright(c)2002 form soflware only The Lackner Group,Inc Portn VA-0500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Powers MaryJane 2�-�4-��s�
ITEM
NUMBER DESCRIPTION AMOUNT
67 WCHOA-HOA fee pentling distribution of real esWte 63.00
62 WCHOA-HOA fee pentling distribution of real estate 63.00
63 Wes�eld Insurance-Homeowners insurance pending sale of real estate 245.OU
64 Whelan Crossing Homeowners Association-2244 Gleim Court-HOA Resale Certification 50.00
paid at settlement
H-67 16.576.08
Copyright(c)2002 form software only The Lackner Group.Inc. Form PAd500 Schedule H(Rev.&98)
flav-054 E%��4-031
SCHEDULE I
pennsylvania DEBTS OF DECEDENT,
oErnArmer+roFReveHue MORTGAGE LIABILITIES AND LIENS
NHERITPNLF TM RETUftN
RESIOENT DECEOENT
ESTATE OF FILE NUMBER
Powers MaryJane 21-14-1167
x.porc a.ms�nc�n.a ey m.ee�saem prior�o a..m m.�rem.m.a unn.m.nn.a.�.o�a.,�q mn�mne��reimom..a m.am.�..a.�....
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF�EATH
1 Citizens Bank Home Equity 7866-Payoff amount,see attached 56,682.47
2 Ciry Cards-Account payable 6.99
3 PA Department of Revenue-2014 PA40 ES paymenl 150.00
4 PAWC-Accountpayable,warerservice 38.49
5 UGI-Accountpayable 41��a
6 US Treasury-20141040ES payment � 270.00
7 Verizan -Account payable SZ.��
8 WCHOA-Accauntpayable 63.00
TOTAL(Also enter on Line 10,Recapitulation) 57,304.66
Qf more space Is nreticd,aEdllional pages of Ine same size7
Copyrighl(c)2012 fo�m software onty The Lackne�Gmup,Inc Form PA-0500 Schetlule I(Rev. 12-12)
aw-isu ex.�o�.�o�
pennsylvania SCHEDULE J
OEGPRTMEMOFREVENVE
���ER�,AN�E...aE,�Rx BENEFICIARIES
ESTATE OF FILE NUMBER
Powers, Ma Jane 21-14-7167
NAMEANDAD�RESSOF RELATIONSHIPTO SHAREOFESTATE AMOUNTOFESTATE
NUMBER PERSONf51REGEIVINGPROPERTV DECEDENT (yyo�ds) (S8$)
TAXABLEDISTRIBUTIONS �inclutleoutrightspousal
1. Eisiributions,andirensfers
untler Sec.9716 a 12
1 Andrew Bero Nephew Schedule G-8
5020 Shetland Court
Mechanicsburg, PA 77050
2 Ann F. Bero Sister Schetlule F-1, 386,957.18
5020 Shetland CouR Schedule G
Mechanicsburg,PA t7050 -t,2,5;antl 100%
of resitlue
3 Caroline Bero Niece Schedule G-10
5020 Shetland Court
Mechanicsburg, PA 17050
4 Christopher J.Bero Brother-in-Law Schetlule G-11 7.000.00
5020 Shetland Court
Mechanicsburg, PA 77050
5 Allen Galbraith Friend Schedule G-7 7,000.00
2244 Gleim Court
Enola, PA 17025
See conlinuation schedule attached Continuation 323,994.81
Total 724,957.99
Enter tlollar amoun[s fo�tlistributions shown above on lines 15�hmu h 18 on Rev 1500 cove�sheet,as a ro �iale.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL OISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOV ERNMENTAL OISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXAOLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyrigh[(c)20ID form software onty T�e Lackner Gmup,Ina Portn PA-0500 Schetlule J(Rev.01-10)
SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Mary Jane Powers 71/2912014 164d63080
Item Name and Address of Person�s) Share of Estate Amount of Estate
Number Receiving Property Relatfonship (Words) ($$$)
6 William Near Friend Schetlule G-19 2.000.00
527 Ward
Niles,OH 44446
7 Stephen Powers Stepchild Schedule G-5,16 42,232.20
4797 Watertord Circle
Stow, OH 44224
e Jason Swanson Nephew Schedule G-13 7.000.00
856 Brantlycamp Road
Kersey, PA 15846
9 MargaretSwanson Sister ScheduleG-5,15 104,696.60
850 Brentlycamp Road
Kersey, PA 75846
10 AlexandraPearson Niece ScheduleG-6 71.000.00
2t Hillcrest Drive
Middletown,PA 77057
71 Andrew Volovar Brother Schedule G-1,5,9 730,493.11
27 Hillcrest Drive
Middletown, PA 17057
12 Frank Volovar Bro[her Schedule G-12 2.000.00
737 Hall Avenue
Saint Marys, PA 15857
13 JohnVolovar Nephew SchetluleG-74 77,000.00
387 Dickens Drive
Lancaster, PA 17603
14 Virginia Volovar Mather Schedule G�,'17 13.572.90
737 Hall Avenue
SaintMarys, PA 75857
1
SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Mary Jane Powers 71/2912014 164-46-3080
Item Name and Address of Person�s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
Total 323 994.8�
2
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of
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L ��tar� I,�i�z Pu.vers,a resident ol�hr�Illage o(Conlund.Counry��t Tmnibull, and Sme ol Ohio.
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I I I-41 _ I_�c_dr�isc unJ haqumih�ell ni mv reul und pasoiml prupert},whemsu.vnslwutcd.��iiivh I may
„ � ichld� I muy be cnti�l vl a� Iht ume ot my demh, lo my sis¢�. Ann f-. Ucm, o� �o her Ilncal
Jc.�xnJems on�,i per srirpes basis If vhe do s no�sucvive me by thirty(30J calendnr days. I reyucxl ih:LL no
.ippn�l.rnicnt h�� muJc uf m� houxehold gonds and lurnishings and my personal dll:cu.
Ill_11=. Ai. I:�ecwnz,hallhmethefolio�cingliduciarypo�cers,whlchurembemnstmed'mthehmndest
in_�nner mnxiNinnl�ciih the.�ullJity ol this VVill anJ wilh thdr duue��s�lduciudes.�Il�e pu�rew+Wmd hcre
.nut'ancnd:J m Fe o�cluslct Pu�shall he in aJdltiuu m those f�.runted hy I;nc�.ind.hull ulso parlain lo�m
�idininiv�mmrs ur Ihis[rzs who vuccenJ the Gducia�ics' I haa appnint�l In Item a-These powea are'
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ull u��u ary documenG punuant lu such optiuns or contncts.
U ��anueu�en��.:po��enncces<nrymthecllacti�endmini>Irii,�nofievlpmpun.lndudwe,�clihout
lunilwg mc grncrehn ol ihi,pu��cr
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�.iduJing P�nod�csmndlne'ntiond thc icrm ol ihc Iru�l orc�t�tc upon��hatcctt tcnns he
Ilnds prupee unJ w eseeure!rascc eontulning eovenunts. !neWdl�ig wvenanls nl mmocal:
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,iwh �,r In aumwon uhh nth.rc and'.o pl:n:�ud,ubJlvda,m� m:d prnpert•..
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nupiv�ioy I`v��parn hald hv him.
I I. Ib pm.anmprnmise,ed�lust seule.conipuund.rencea.orahondon claims held by nry fiduciu7'-on
ohataccr�cnns hc Jecros�adclmhlc ��ithout prior murt outho�ip�.
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ron�li Ivmnding�hc lacl ihm d'utnh W i��c shw'es mu}.:�s n result�hereof bc compu+ed dilRmntly_
I I�� linura �he propu�iy hetihc hulJs us IiJuciary ugainst thu ri>As und iu 1he�moun[s ha i� his
d6cn�Ioa liuds cxpeJlrni.
IC. I n ontcr�,nm v�ns'sctloos wltli mhcr liduclur'ies,includlny axecumrs or tmstees o[the esmtes vnd
ru�i In vhmli m�� hrncllciurius inu)' huce un �n�ercsl,and indudiny hunsclt:�s tiduciaN lar othu�
:m,ua und iru��i�. �o p�� !unucl C heael F reasun�6le corcipeiuetion for hls:he�sen�ice.
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Regislrniion' 11arylancPowcrS
Se<urity COSIPNumDer NumDerof p�iceperShare To�nl
Shnre�
FRANKLIN
IRCO�IflC1ASSA FKIVX 7,857236 52.45 59,45023
PRANKI.IIJ '
STRATEOIC pRSTR 802.44d 51036 $8.3I3.32
MCOMECLASSA
IEMPLCTON
GLOIlALBOND T�mX 627632 813.T1 $8,291.W
CLASS A
To�slAccaunlVeWcaeofNovember29,Z014 � . � 526,059.57
IfyauheveenyquesiionsplwsecalluseiL800-942-83oqoption7,Mwdey�hmuyhFrideyFrom8:30e.m.toS:aO -
y.m.,ET. Wc will be Aappy ro a65is1 you.
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l�sininc Rivere .
Overn�ians Specialist
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Aris Wealth Services,Inc.
POItTFOLio APPRAISAL
Mary Jnne Powers,Personnl Assetr
FYdeliiyAccount#6I3-636100
November28, 2074
4Wf 'Canl Merket Fe�.
Oete Security Q�n��Y Cmt Coet P;�m Valne Asotts
CASBA�DEQUNALEM'$
FidcGryMwdcipel 0.02 �.02 0.0
MnneyMeke�
p1I,7[;p�,p(7Np5-bOFIP.STIC FIXCD
IrtcmrEiazeTertnHontl
p8-22-14 Metmpoli�e�WCR'� 300114 10B6 3.165.95 1093 3,]46.80 40
'to�NRemmBmdFe�
0210-06 PIMCOToislAsmrn/ ]4I965 10.63 ],865.19 11.03 8,18387 �00
AJmiv
11.150.94 IIp906A 14J
UvaonsbainedBonE �
124g-12 1PMorgenStrekg�c - 134.436 118B 1,59693 lll4 1:5]92A 19
InM111EQPr0YN111�IE9
MmegodPutwcs
09-08�10 AQR!NmegedFUNr<s � 233]40 9.73 2�6].91 L.16 3,601.84 32
$Irp�py
High-Yieltl
02-22A8 }LrtfoN��oetingRa� 229.989 6]6 2,OI4b2 8.89 2,040.00 ]5
06-IS-09 MamsNyHig6YielE � 68.005 104i . ]09.92 I�49 BOS.58 t0
Oppmwnities —
Z�q„N 2,y4B.59 3.5
1'/,i4033 18.49938 ]2.9
�i V IUAL FONDS-1NTL LQllRY
� Em:�gv�gEqmry
a6-IS-09 ��dEmerging" ❑9.991 i929 �313.]3 1966 1,3590B 2.9
�.Aarkea
IvcemazioiWBqv�n
04-1]-0d Eikiity➢iversi6eG � 90.T/1 2i90 2,532.69 3G94 3,33130 41
IpkI0BN01181
G1obelPqufry 25�� 17
06-��-a8 A�ncm}Yndv�ew � �59s>4 26.81 4]Y1.5] 39.40 6,
Perspcttivc
06-15-CB remoicwnwoaa � I69]30 1293 _�_69559 1921 ].093.9� e]
By93.16 I3,J80.11 t64
t3 819.58 I9,0]0.50 29.A
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Olobel9ooU
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5,593.57 6,U�489 74
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PORTFOT.TO AYPRAISAL
Mary lane Powers,PersoealAssets
PidedtyAccount fF 6T3-636100
Novembu 28,2014
IIni[ Tahl Morkct PU.
Dam $�� Qum�ty C�f Cost P�ee �nlue Aaaetl
M VftIAL I�'UND$-DOMESIIC LQUITY
T�t6`al Ailocetlon
03-45-10 IvyAssc[Shv.kgy '� 52540 23.18 1,218.00 3142 1,650.81 2.0
Ofi15-09 LeuNoldCmc =- 199.699 14.45 2,i68.08 1838 5$65.94 4a
Innsmmt
3,766.16 <.91655 60
Commoditiu
09A6d4 P7MC0 " 60691 Illl 696.05 8,80 ]09.90 0,9
Coim+mEi@cPLOS
Sinttgy
Long/SM1art
02-10.06 DiamondHili � V4.630 I8.69 � 3�29.9fi 2363 4.t2fi9 5.]
LwP/$Lon
� ... . .. _. .. . _ _ _.'___. . . .
� Lmge Cep Blend
� 06-01-OA JPMoiganUSLuge � 16Z192 L9.59 3}]4.99 � 3156 . 5,271.60 6.5
. L§pCorcPlm ..
LuBe GP GroeM ~... � .. � _ . . . -
Dn-13-04 i.RnwePnaGmwth / 100.125 45.98 3611.90 5712 6,017.95 9H
SNcI[
Large Gp Ve�ue
OG27-13 AmencenHeacmLerge '� 251.566 18.99 4,9'l6.85 30.It ],5]4.65 9.]
Gp VeNe
0a-13-o4 AmencmFunds '� 36.]66 30]A I.lIl75 4325 1,590.13 2.a
wazn�ron Mu�uN
' S,88B60 9,16Q.]8 ❑R
Sm�l Cap Growth
0546-OS AayxVNuePlus� 1082A6 ]0.96 I,18fi,85 1730 1,89335 23
$ma�f Gp Velva
1b20-/2 T.RowcPflw9me11'� 12248 39.13 A99.� 4BA5 59031 0.9
Cep VaNc .
22,35333 3A6J996 42.5
TOTALPORTFOLW 62,"J50.45 � B1,539.18 100.0
2
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T� Citizens Bank OneCitizensDrive
a'��ers�de,ei az9is
December 23, 2014
To whom it may concern:
On November 29`"the date of death value for Mary lane Powers'joint checking acmunt,with Citizens
Bank ending in 4273,was 5154,171.81.
Sincerely, ((/�/�1/" ,('/"V'V
�' V V �
Nikki L. Perrotta
Licensed Banker
NMLS IDtt962416
Camp Hill Office
186-0125
4101 Carlisle Pike
Camp Hill, PA ll011
717.731.4845
CE RBS
i
_. .. • , . . . ' Yd:rPONdla _ . ..� . .
1^✓1�2014 .
�
AMERICAN
FUND5'
From GpNal Grap
MARY J POWERS $51 ,593.02
Total Port4olio Val�e as of 7128/2014
_..._._----__'�_.____.._._---_'_'—___—_'__ —A«ounlValue
7A322t52 CB&T CUST IRA/ROLLOVER $51 ,593.02
MARYJANEPOWERS
as of 11/2B/2014
Current
ClassAShares NAV Shares Valua
EumPac'rfic Growlh Fu�d(AEPGX) $49.76 115.727 $5,758.58
Fundamentallnvestors(ANCFx1 355.99 51.932 $2.9o�_6�
The lncome Fund of A+varica 1AMECX) 322.11 1,U17 881 $22,505.35
ThelnvestmentCompanyofAmeria E4152 313.970 873,036.03
(AIvSX)
NewPerspe<tiveFund(ANWPX) 539.61 76959 $3,04835
Washington Mutual Invesmrs Fund Sa3.37 100.001 $1,337.04
(AWSHX7
� Tocal Account Value
$51 ,593.02
� .i,. !� . �., �
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AMERICAN
FUNDS" aoe�zzeo
fmmCaprlGnuo NorlolkVA2 3 501-4 290
DENISE/DOUGLAS CLELAN/CLELAN Decem ber 29, 2014
CEfERAA�VISOR NETWORKS LLC
210 GRANDVIE4V AVE STE 101
CAMPHILLPA 17011-1769
Re: Accountk74322152 �
CB&T CUST IRA/ROLLOVER
MARYJANE POWERS
�ear DeniS¢ClBlan:
Wa recently recaivedyourinquiry reqarding the 6alance oflhe eccount referenced below.
The ta61e 6elow reflecta the share balence,pershare net assetvalue(NAV�, and total value ofihe account onthe date
requested:
Accounti174342752
Data Pund name Share balante NAV pei ahere Total veWe
11/28/14 WASHMGTONMUiUALINVE5TOR5FUNP-A 100.001 $43.37 $ 4,337.04
11/28/14 THEINVESTMENTCOMPANVOFAMERICA-P. 313.970 41.52 13,036.03
11/29(14 THEINCOMEFUNDOFAMERICA-A 1,017,881 22,11 22,505.35
11/26/14 NEVJPERSPECiiVEFUND-A 76,959 39.67 3,048.35
11/28/14 FUNDAMENTALINVESTORS-G. 51.932 55.99 2,407.67
11/28/1A El1ROPACIFlCGROVJTHFUND-A 115,727 49J6 5,758.58
Yotalvalue $51,593.02
Please note ihet dosed funds within an eccount may affect our abllityto provlde an accurate account value on the date
rsqueeted.
Mutual fund share prices vary with(he fluctuations of financial market share prices.You cen find current and historical
prices,aa weli as other details for all Ameri pn Funds on our website or on many f nancial websites,
Ifyou have any questions,please wntaQ us at(S00)421-0180.You wn reach ona ofour servica representatHes
Mortday through Friday between 8 a.m.and 8 p,m� Eastem tima,You may also obtain accou nt infortnation by visking
� ourwebsiteatw�vw.americanfunds,com,
Weappreciarotheopportunityto6eapaftofyourdient'simestmentprogram. �
Cordially,
Ameriean F�nds
; �as�rzma. _. �� , , .� . uiewPrnHdtaemerdaries �. . _• ,
�� �. � .
�
AMERICAN
FUNDS'
From CapiuiGl6�
Beneficiaries
Im� 9eneN ' rv D t If P
AcwunWame Value AccountType
74322152C6&TNSTIRA/ROLLOVER 550,145.09 Retirement
MARY JANE POWERS value as of
10/30/2014
Beneficiarylnformation HowtoupdatelRAaccountbenefciaryinfortnation
Primary . 1 CompletethelRABeneficiaryChangeForm
Deslgnation date: 12/09/200d �� 2 Have your client sign and retum theform m an Amedcan Funds service �
ANDREVJ G VOLOVAR 50% ' center. �
ANN F BERO 50% �'�. IRA Benefi<iary Change Fo�m
� �. i.'e'___- _ ..
� ConfingenE ��
_--- DOWNLOAD(PDF)
Natprovided � � '
II ' - r
Copvri4ht c�2014.4merican Funds Distri bumrs,Ina All Rlghcs Resarved.
�».a,�.,,.,,.�,ma...a.«�„�,�.,mia.n,�emi�.,.n...�e,..ia�n.,.��..:..e,.e..:d:e.M_ ,.�
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���. ��: �:� , � ��a� �� �, ,
I/13/2015
Luty Sowhe
Emoil
PP:Accoun[Numbar:L7C091732 4 /� ;r /�
Reginrfl[ion: CiGuns Bank � .
Ro��IRA ✓� '
FDOD1eryJanoPowus - �
Dzar M�.Sowrers:
I nm wri[ing witA reppiN m tAe corzespondenee recmtly rocaived in our oflice regarAing�he above refereiIDed eccount
On bchalFof our flrm,pleese exund our sincerest condolen�es m the family of Mery lane Powers.
In neeordance wilh your rtquest,I vn providing a summvy of Ms.Powcrs account in ihe table bclow rs of Ihe close of
business on Vovember 29.2014. .
Security CUBIPNomber Vumberof p��ceperSh�re Totul
SEaru
BA�K DEPOSIT
SNCEPPROCRAM QCCOQ 0.71 TI00 TOJI
FRANKLIN
INCOMECLASSA FKINX 1,369.147 5245 53,754.41
fRANKLM
S7'RATLGIC pR$TX 291.797 SIOd6 53,023.02
INCOME CLASS A
TGMPLLTON
GLOBALBOND �mX 462.767 51311 S6,II3.15
CLAS$A
Total Accwnt VaWe az ofNovemtier 29,2014 51�,490.69.. .
O10•0618130ps
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�Lincoln
Financial Groupm
P.O. 8oz 7576
Fort Wayne, IN 46801J876
lanuary 2, 2015
ANN BERO
5020 SHETLAND CT
MECHANICSBURG PA 17050
RE Mary lane Powers' 401K Linmin Alliance Small Account IRA with Holy Spirit Health System
Dear Ms. Bero:
Thank you for choosing the Lincoln Alliance product as part of your retirement portfolio.
We recently received a request m mnfirm the 6alance in Ms. Powers' acmunt as of November 29, 2014.
Our records indicate that as of close of market that day, the vested account balance was$6,620.55.
If you have further ques[ions please call our customer mntact center at 1-800-2343500 between the
hours of 8:OOam-S:OOpm ET Monday through Friday.
Sincerely,
Izamar Guzman
Customer Service Representa[ive
Client and Administrative Services
Lincoln Financial Group
Heyir�eicdRc4�'���� l�'eoI-�ndae�urmesduvebmedD-C IrrFlnnna�lU�.�ribuion, lna, A�okenJeolee I . ceproduasie.medbeThe
].Inrolrz No�ional Lefe lnsvrance ComPam'. Gnroln Finanaol Group rs the mar'ketirrR name f r Lenmin.Abhwrnl Corpormion onAes��Im�ex.
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Page� of=
�A�CIFIC �.1F� Variable Annuity Interim Statemenl
p.o. aox za�s om,na uasa�oszs�s
9tetementPeriotl 10:0712014- ll128/2014
Preparod Far
OOUGLAS R CLELAN Yaur Cliant
GETERA ADVISOPNETWORKSLLC MARYJANEPOWERS
270 GRANDVIEW AVE STE 101 2244 GLEIM C7
CAMP HILL PA 1 7 011-1 7 69 ENOLA PA 17D25�1495
Customer 5arvice(tall irae)
Comrect Owners (800) 722-4448
Regls�eretl Repreaemativas(800) 722-2333
AEon - Fd, fi a.m. -5 p.m. Paciilc tima
Pacific Value
Contract Informatlon Hlghlights
Cont�aclNum6er VB0401B471 Portloliuoptlmization
Owner MARYJANEPOWEFS
Joini Owner none
Annuita�t MARYJANEPOWERS
Jo1nlAnnWlanl none
p�m� Type NomQualilied
Issue 0ate o4/�1fp004
Summary Values
�
Year-to-Date Contrsct Summary Historlcal Contract Summary
COMractVelueonl2l3V�013 $302,235.38 CurreotVeluell/2Bl2014 $312,322.00
Total Paymen�s $0.00 Lest Quatter Value 09/30/2074 $306,054.65
Total Wfthdrawels $o.Do 9urrender Veiue on 09BO/2o14 $300,OSa.65
Surrender Value on 11I28/2014 $312,322,00 Va�ue 12 Months Prfo�11l2912013 $2s9,248.07
Gontrecl Vslua on 11�29/2014 $372,822.00 Total Wifhd�ewels13inc�e 04l01200a $1B9 z$0.00
Investor Information
For more Informalion regartling your coniract, Padflc Llie, or your conlrecYs Accumulatad Un�t�alue (Dalty Unit Value),pleese vlsit
www.P2GficLife,com. If you Iden[Iry an ertor on a statement orconfirmation,notlry us In wri[ng within 30 days hom recalpt of the
stetemen!of CoNirmation o�'1 whlcp Ihe errar occUfled.
Impottant: We ha�e 6een notitiee that en owneriannUitant on thls coNract has passed awey. I� is critical th3:the deslgnated
feClplents of any henefits feYlew thelr opllons immadletely. Cedaln benefit opilone may he bdeited if aCtlon Is not Iaken in a tlmely
manner. Please contact our customer seMce erea for additional Intormatlon.
When�he end ctihe slatemant periotl is a nom6uslne95 day,[he unit values are as of the naxt husiness tlay.
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Page 5 oF 5
� PACIFIC LIFE Variable Annuity Quarteriy Statement
P.O, BOM P378�Oma�a,NE H9109-2978
5tatementPerlod 10101l2019• 12/31/2�13
GoqtreCl NumdOr VR�AOt0471
Owner MAl2YJANEPOWERS Conlracttlwners(800)722-A448
AnnWtant �UARY JANE POWER6 Regletered RepreaentaliVea(8001�22•2333
Beneficlary besiqnation
The following is Ihe current beneflrAary dealgrtatlon for this PaclOc l.l(e 0nnu�ty centrecL See yaur contrect and pmspecNa tor tlelalls
ebout daefn beneR antl beneflclery provlslons, ICs Important to revlew your 6ena11elery deslgnatlon to ansure Ihal It Is�p-tu•dete es
dealh bena(a pmceed5 wlll be dlahlbUteO beeed on tne Information pn flle and In ecwrdance Wlth the guidelinea set!oqh In y0u(
contrsct.
li y4u hava 9ny questlona ahom your current 6enallclary dedgnaGon,plaase contaclyour RegWPored kepresentalive.If you wnuld
Ilke to�pdele yaur banaficiary dB8lgnaLop,you roBY 9CC988 e0tl pAnl�he Annulry Conlrect Changa Requeat fwm onlina al our
wabsite, F���=�n.,,�,ix.<mann�o�`�nt nsclBcllfe.com.The Compleled end signed Porm may be relurfiad lo ua by mell ol'lax.
iype 9eneflolery Name PaYcenle0a
PRIMARY ANN F e�{y0 30.00%
PRIMARY ANDREW G VOLOVAR 30-004�0
PRIMARY MARGARET'SWANSON 34�d�g
PRIMARY STEPHENPOWERS 10,00%
�� Citizens Bank o�e����=P�=o���e
Rivcrsidc,FI02915
December 23, 2014
To whom it may concern:
On November 29'"the date of death principle balance for Mary Jane Powers'home equity loan,with
Ci[izens Bank ending in 7866, was$56.682.41.
Sincerely,
I "�/"—°"" ��_,1����� V v�, v '
Nikki L. Perrotta
Licensed Banker
NMLS IDri962416
Camp Hill Office
186-0125
4101 Carlisle Pike
Camp Hill, PA 17011
717.731.4848
CE RBS
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