HomeMy WebLinkAbout07-31-15 (2) J 1505618601 <w<earaom
�en�syNanie
�"�la>ia��1v1
R EV-1500 �FlC�AL USE ONLY
e�ma�wma�mauai*a.es coum�Coae rear vaerv�mee,
eo eox zeoso� INHERITANCE TAX RETURN
Ha,nse�,e,Pa niae-oso� RESIDENT DECEDENT 21 �� �'S�
ENTER DECEDENT INFORMATION BELOW
Social Securiry Number Date ot Death Mmoovwv Date ot Bltl� Mmoovrrv
10312014 08131934
Decedenl's Last Name SuHix Decetlenfs Firsl Name MI
FISCHER JACOB R
(It Applicable) Enler Surviving Spous¢'s Information Below
Spouse's Las�Name Suftix Spouse's Firsl Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APP0.0PRIATE OVALS BEIOW
� 1. Original ReWm � 2. Sopplemen�al ReWrn � 3. Remaintler ReWm(tlateMtlealh
prior�0 12-0&82j
� 4. AgriculNreExemption(EateM � 5. PuWrelnteres�Gompmmise(tla�eo� � 6. FetlerelEsla�eTaxReWmRequtretl
aealh on or etler)4-2012) daeth af�er 12-02-82)
� �. �ecetlenl Died Twtate � 8. Decetlen�Main�ainee a LiWng Trust � 9. Tolal Number oi Safe Deposil Boxes
(Attac�copy of wIIJ (AVach copy oi ImsL)
� 10.Litiga�ion Pmceetls Receivetl � 1 t. Non-Probate Trenaferee fteturn � 12. DeterraVElection of Spousal Trusts
(Schetlole F antl G Pssets Only)
� 13.Business Assets � 14. Spouse is Sole Benefciary
(No trust imoNetl)
CORRESPONOENT� THIS SEQION MUST BE LOMPLETED.ALl CORRESPONOENCE RH�CONFIOENTIRL TR%INFORMRTIOH SMOUL�BE DIRECTEO T0:
Name DaNime Telephone Number
WAGGONER, FRUTIGER & DAUB 717-506-1222
Flrsl Line ofAtltlress
5006 EAST TRINDLE ROAD
Secontl Line of Atltlress
SUITE 200
Ci�y or Posl ORice Slate ZIP Cotle
MECHANICSBURG PA 17050
CorrespontlenYs email atlEresa:
REGISTE,.ROF WILLS US�ILY � m
REGISiEROFWILLSWEONLY G � T �J
�ATE FILEO MMODVVI'Y � � C � o
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PLEASE USE ORIGINAL FORM ONLY ' �
Sitle 1
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII J �
L 15056186�1 15056186�1
J 1505618619
REV4500IX(TP)
Decetlenfs Social5ecuriry Number
oe�0ea�rsHemaJACOB R FISCHER
RECAPITULATION
1. RealEslate(SchetluleA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. �. Q�
z. sro�ks a�a eo�as�su,eawe e�. . . . . . . . . . . . . . . . . . . . . . . . . . z. 125521. 71
3. Gosely Held Corporotion, Parinershi0 or Sole�Pmprielorship (Schetlule G). . . . 3. �. ��
4. Mortgages and Notes Receivable(Sc�edule D). . . . . . . . . . . . . . . . . . 0. Q. QQ
5. �M1, Bank Deposits and Miscelleneaus Personal Pmperty (Sc�eJule E). . . . . 5. �2484 48
s. domny owoee Pro�ny�s�ned�ie F� � Separate Billing Requestetl. . . . . .6. �'I9. 'I'I
l. In�erVivos Transters&Miscellaneous Noo-ProEate Property
(SchetluleG) � Separa�eBillingRequ¢sted. . . . . .�. �4Q6HZ. E�
a. rotai crms aas=m(mtai unes i mmuqn �). . . . . . . . . . . . . . . . . . . a. 282807. 91
9. Funerel Eqienses antl AdminisVative Costs(Schedule H). . . . . . . . . . . . . 9� �3��. ��
10. Debis of Decetlenl,Morlgage LiaEilities and Liens(Schetlule I) . . . . . . . . . 10. ���62. 00
it rotai o.auctims(rotal Lines s ane to). . . . . . . . . . . . . . . . . . . . . i t. 18533. 00
12 Net Veiue ot Esm[e(Line 8 minus Line i t). . . . . . . . . . . . . . . . . . . 12. 264274. 9�
13. CharitableantlGovemmentalBeques�s/Sec.9113TmsLsfwwM1icli
an eleRion�o�ax has not been matle(Schedule J) . . . . . . . . . . . . . . . 13. 0. ��
14. Net Value Su0)Mto Taz(Cine 12 minus Line 13). . . . . . . . . . . . . . . 14. Q6QQ]Q. 9�
TA%CALCULATION-SEE INSTRUCTIONS FORAPPLICABLE RATES
15. Amoun�of Line 14�a�a01e
at tM1e spousal W rete,or
Vansfers vntler Sec.9116
(a�(12�X.0_ �. �0 15. Q. ��
is. nmo�moru�eia4��ae 264274 91 is 11gg2, 37
a�lineal ra�e X.0-
19. Amounlof Line id ta�oble
a�sibling rale %.12 0. �Q 1]. �. ��
�8� Amount o�Line 14 tarable
al collateral rate X.15 Q. �� 18. Q. 0�
ie. Tnxoue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . is. 11892. 37
20. FILL IN THE BOX IF YOU ME REWESTING A REFUNO OF RN OVERPAYMENT ❑
Untlx penahles o!perjury,I JecHre t�at I�aua eramined t�ls reW m.IncluUing accompanying xM1etlules antl sblemence,antl�o Ore Eesl o�my knwvlaEge antl baliel,
i� Is llve,mrred antl complele. �eclaration o!preparer otM1er t�an Ne pemon rea0onal�k(or filling t�e retum Is beseE on al�Inlormatlon of w01c� pre0arer las
enykn wletlge.
JI{BEOF PERS(�I RESPoy$IBLE F FOp, 1 Jf' ,I�I� a RENY �I C f, DATE
�at-II.µ,LU...ei OM ��'v•NS/ r
AD�RESg�
3609 FRANKLIN AVENUE, MECHANICSBURG, PA 17050
� SIGN4TU OFPftEP E�/.p�y E PERSONRESPONSIBLEFORFILINGTHERETURN DATE
l � � � 7"._�b-/ �.,
ADDRESS
5006 E TRINDLE ROAD, MECHANICSBURG, PA 17050
L iiiiiiiiiiiiiiiii��4����1����l�iibiiiiiiiiiiiiiiiiii S�dez
1505618619 J
ewasae s.000
REV-1500E%�TP) Pe9e3 FINNumEe� 2�'�4-��.5�
Decedent's Complete Address:
DECEDEM'S NAME
ESTATE OF JACOB R FISCHER
sm�.nooRess
3604 FRANKLIN AVENUE
CITY STAIE LP
MECHANICSBURG PA 17050
Tau Payments and Credits:
i. ra.�oa(aaeezu�eisi lil 11gg2,
2. CretlitslPaymen�s
A.Prior Paymen�s O.
8.Discount �.
(3eelnsVUGlons.) To�slCretli�s(A+B) (2) Q.
3. In�erest
(3) Q.
4. I(Line 2 is grea�er than Line 1 �Line 3,enter[�e Aitterence.This is�he OVERPqYMENT.
illl in oval on Pege Y,Line]0 to repuest e rNund (4) p.
5. If Line 1 + Line 3 is greater t�an Line 2,enter the aiHerence.This is iM1a TAX pUE. (5) ��$9Q,
Make check payable to: REGISTER OF W ILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRWTE BLACK5
1. Diddeceden�makeabansferand Ves No
a. re�ain Ihe use or income of the Ompertyhansferretl . . . . . . . . . . . . . . . . . . . . . . . . .� �
b. re�ain�he righl to tlesignate who shall use�he proOeM1Ybansterretl w its income . . . . . . . . . . .� ❑
c. retain a reversionary iMerwt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑ �
4. receive tM1e promise for life of ei[�er paymenis,ben�ls or�are? , , , , , , , , , , , , , , , , , , ,� �
2. If tleat�occurretl after Dec. 12, 1982,tlitl tlecetlen�vansfer property within one yea�ot deaN
wiNoul receiving atlequate consitleretion4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑ ��yry
3. Ditl tlecetlent own an 'in�ms�for'or payable-upon-tleaN bank account or securiry a�his w hx death?. .❑ Lry
4. �id Gecedent own an indivitlual�e�iremenl account,annuity,or other nonpoEate popetly,whicM1
contains a�eneficiarydesi9naHm? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .� ❑
IF THE ANSWER TO ANY OF THE ABOVE QUE3TION5 15 YES, YOU MUST GqAPLETE SGHEDU�E G ANO FILE IT AS PART OF TME RETURN.
Fp tlates of deatM1 on or aker Joly 1,1994,anJ before Jan. 1, 1995,the tax rale imposetl on the ne�value oi lransfers to or for the use of tM1e smviving spouse
is 3 percent�]2 P$.§9116(a)(1 d)(i)].
For dates ot death on or after Jan. 1, 1995, the taz rate imposetl on �M1e ne� value of transfers m or lor the use of �pe surviving spouse is 0 Oercent
[]2 P.S.§9116(a)(1.1)(ii)].TTe staWte tloes not exem0�a ironsfer to a svrvWinq spouse from tax, antl the s�a�utory requirements for tlisdwure of azsels antl
filinq a Wx reWm are s�ill applicable even ifNe surviving spouse is Ne only Eenefidary.
Fa tla�es ot tlealh on o�afler Jvy 1.Y000:
• The tax rate imposetl on the net value o([rans(ers from a deceaseC child 21 years of age or younger at tleaN �o or for lM1e use of a naWral parant, an
atloptive parent or a s[ap-paren[oi ihe child is 0 percent�I2 P.S.§9116(a)(12)].
• TM1e tv rate Imposetl on I�e nH value ol irerekrs to or hr �M1e use ol tM1e tlecetlenfs Ilneel benefmianas Is 4.5 pervant, excep� as noletl in P� P5.§9t1B(a)(ip.
• The taz ra�e imposetl on the net value ot lransfers to or fw�he use of��e tlecetlenfs siGlings is 12 percent�l2 P.S.§9116(a)�1.3)].A siblinq is tlefineQ
un0er Sec�ion 9102,as an indivitlual who has at leasl one parent in common with�he decedenl,whelher Oy blootl or atlop0on.
aw�sn z.000
REV-1W3E%�(&1Y) �
pennsylvania SCHEDULE B
�EPARTMENTOFREVENUE
INHERfTANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDEM
ESTATE OF FILE NUMBER
JACOB R FISCHER 21-19-1150
All property�olnlly ownetl wl[�rlpht of auMvorahip must be Chclased on ScheCule F.
ITEM VALUE AT DATE
NUMBER pESCWPIION OF�EATH
�- AMERIPRISE BROKERAGE/ AMERIPRISE ONE ACCOUNT #00097569257 133
DOD VALOATION STATEMENT ATTACHED - ITEM 2 AS PER AMERIPRISE 12�296.91
2. AMERIPAISE COLUMBIA GLOBAL BOND FUND CLASS A
accrp oionszao�nooz o0o vxsonmma saxxeMeer nrrncxco - xren s 16,278.29
3. AMEffiPRISE WLUMBIA MOLTI-ADVISOR SMALL CAP VALOE FUND CLA55 A
ACCTk 010131�9306002 pOD VAL�ATION STATEMEPT ATTACNED - ITEM 6 12� 056.86
9. AMERIPRISE COLUMBIA LARGE CORE QUANTITATIVE FOND CLASS A
ACCTM 01013309313002 DOD VALOATIOB STATEMEPT ATTACHED - STEM "! 16� 854.36
5. AMERIPRISE COLUMBIA DIVERSIFIED EQUITY INCOME FUND CLASS A
ACCTM O1D13803'Ifi9002 D00 VALpATI06 STATEMEPT ATTALNEO - ITEM B Q0� 3']'z.l]
6. AMERIPRISE COLOMBIA GLOBAL EQOITY VALOE FOND CLASS A
ACCTk 013�9929828002 O0� VALOATION STATEMEPT ATTACNEO - ITEM s 37, 163.01
7. AMERIPRISE WLOMBIA INCOME BVILDER FOND CLA55 A
ACCTM 02�15609922002 �00 VALOATION STATEMEPT ATTACHEO - ITEM 1D ZO�SSO.61
TOTAL �AIsoenteronLine2,RecapiWla�ion) S 125�521.71
awassc�.000 If more space is needed.insetl a4tliYonal shee[s olihe ume size
REV.Is�a u.lae-tll
pennsylvania SCHEDULE E
oea.w�movne�nue CASH, BANK DEPOSITS & MISC.
n�ioEMOEce�rpir��R" PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
JACOB R FISCHER 21-19-1150
Inclutlel�eD�aeetlsofli�igationanJOreaareNepmreNswererecei NDy�M1euWle.
All ro e olntl onneE wiM ri M of auMvpshl mue[be tllacloaetl m ScheEula F.
REM VALUE AT DATE
NUMeER DESCRIPrION OF DEATM
1. �. SANTANDER BANR, N.A. MONEY MARKET ACCOONT # 2313726912569059803
DOD BALANCE PER BANR 358.63
2. AMERIPRISE CERTIFICATE COMPANY CERTIFICATE OF DEPOSIT
ACCOUNT A 00805069799001
DOD BALANCE PEA HANR —ITEM 3 AS PER AMERIPRISE ll� 929.65
3. AARP — NOVEMBER 2019 HEALTH INSORANCE REFUND 169.75
9 . AMERICAN EXPRESS — AEFUND 26.95
TOTAL(Alsoen�eronlineS,ReraqWlaUon) { 12� 989 .98
aw�sPn L000 If more soace Is neatled,use aeailbnal sneels of paoBr otiM ume sae.
aEv-iso9 ew�oi-io7
pennpsylvania SCHEDULE F
���E�^++�ET�aET�a� JOINTLYAWNEDPROPERTY
r+Fsio�ncereoer+r
ESTATE OF: FILE NUMBER:
JACOB R FISCHER 21-19-1150
If en asset beceme�dntly owned wltM1in one year of the tlecetlent's Aate af tleM,X must be repatatl on Schetlule G.
SUFVIVINGJOINTTENAM(5)NAME�S) PDpRE55 REL4TI011SHIPTODECEDENT
A. JACQUELINE FISCHER 3609 FRANKLIN AVENOE DAOGHTER
MECHANICSBURC>� PA 17050
B.
C.
JOINTLV OWNED PROPERTY:
ITEM DA� �ESCRIpTONOFPROPERTV %OF pAlEOF�EAT1
MADE siu .a ��OFOEFTH DECE�EMS VPLUEOF
NUMBER JOINT VqLUE OFPSSET INIEPEST DECECEN151MEREST
1. A. CITIZENS BANK CHECKING ACCOUNT 238.21 50.00 119. 11
TOTAL(Also¢nter on Line 6.RecapiWlation) f 119.11
awasne�.000 If more s0ace is neetletl,use ad0i�ional shrets of paperof�he same size.
REV45t0 E%a(OB-09) SCHEDULE G
pennsylvania
oEcaarn�EHrocaEVErvuE INTER-VIVOS TRANSFERS AND
NHeRirauee*naeaeniaH MISC. NON-PROBATE PROPERTY
RESIDEMOECEDEM
ESTATE OF FILE NUMBER
JACOB R FISCHER 21-19-1150
This scM1etlule mus�be wmpleteE antl filetl if tM1e answer to any of questions 1 NrouBh 0 on paBe Nrce of�M1e REV-1500 is yes.
DESCW�EON OF PROP�ERtt
��M OFTEOFDEATH oOFDECDS E%CLUSION TA%AgLE
rvuMeE VALUEOFPSSET INIEREST �nwuc.aF VpLUE
�. AMERIPRISE BROKEAAGE/ oAMEAIPRISE
ONE ACCOONT 8 OOD37798372 133
IRA —ITEM 1 AS PER AMEAIPRISE 1.00 100 1.00
2. AMEAIPRISE CERTIFICATE OF DEPOSI
ACCTB 03309753958 001 IRA—ITEM 9 � 2,768.99 100 2, 768.99
3. RVS FIXEO ANNOITY
ACCT# 93006333536D09 — ITEM 11 ' 33, 799.67 100 33,799.67
9. AMERIPRISE HROKERAGE ACCOUNT IAA
ACCT# 99250068832 — ITEM 12 # 81, "l19.21 lOD 81,719.21
5. PRUDENTIAL FINANCIAL
ACCCT# 218298B01 ` 3, 660.27 100 3, 660.27
6. TAANSAMERICA LIFE INS COMPANY
NON QUALIFIED ANNOITY
POLICY# 26160702 " 22,733.97 100 22,733.97
* PAYABLE TO LIVING, LAWFUL
CHILDREN IN EQOAL SHARES 1008
TOT/1L(Also en�er on line 7,Recapkulalion)8 199� 682.61
n more soaca�is neeeee,use am�no�ai sneets of peper m me aema sme.
awasu i.000
REV-05fl EX��C8�131
pennsylvania SCHEDULE H
oEo�rr.Eirror��Nue FUNERALEXPENSESAND
wew.,wcEru�ae,uw, ADMINISTRATNE COSTS
aEeou.rocc�oercr �
ESTATE OF FILE NUMBER
JACOB A FISCNER 21-19-1150
�ecetlen['a tleba must be reporhJ on ScM1etlule I.
ITEM
Nl1MBER pESCRIP�ION AMOUNT
A. FUNERALEXPENSES:
1. PARTHEMORE FUNERAL HOME 6 CAEMATION SERVICES, INC 3� 905.00
B. ADMINISTRATIVE COSTS:
1. PersonalRepresentativeCommissions'.
Name(s)ol Personal Represen�aGve(s)
Street Address
City S�ate ZIP
Veans)Commisslon PaiQ.
2. AtlomeyPees.
3. Famity Exemption'. Qf Aecetlenfs atltlress is no��he same as GaimanCs,al�ach e�lanationJ
Claimant
StreetAtltlress
Ciry State ZIP
Relationship of Claimant�o Decetlent
4. ProbateFees: 216.00
5. AcwuntantFees:
fi. TmReWrnPreOarerFees: 3� 750.00
�.
TOTAL(Also en�er on Line 9,Refapimla�ion) $ 7�371.00
awaswe�qoo If more space Is neetletl,use aJOitimal shee�s of paper of�he same siu.
RE0.15R E%�(12-1])
pennsylvania SCHEDULE I
oEaunmervroraEVENUE DEBTSOFDECEDENT,
wHeRi.arvcErw�aE.uau MORTGAGE LIABILITIES & LIENS
REsicenrtoecEOEnr
ESTATE OF FILE NUMBER
JACOB R FISCNER 21-19-1150
Report tlebta Incunetl Ey tM1e tleca0ent prlor to tleaN Nat remalnetl unpeitl at the tlate of EeatM1,inclutling unrelmbunetl metlical expansee.
��`m VP1VE AT DATE
r�umeea DESCRIPTION OF DEATH
1, FINAL BSLL FROM VISITING ANGELS 207.00
2. BALANCE �OE ON DECENDENT'S 2019 FEDERAL INCOME TAX RETURN 10, 932.00
3. BALANCE DUE ON DECENDENT'S 2019 PENNSYMVANIA INCOME TAX RETORN 523.00
TOTAL(Also en�er on�ine 10,Rewpitula�ion) S 11, 162.0�
awaswN i 000 If more space is needed insetl atldilional shee�s of t�e same size.
���,�„��.`°, ,°, SCHEDULE J
pennsylvania
oEPu+rmervrorReveHue BENEFICIARIES
iNHERITANCE TA%RETURN
RESIpEMpECE�ENT I
ESTATE OF: FIIE NlIM9ER:
JACOB R FISCHER 21-19-1150
RELATIONSHIPTODECEDENT AMOUNTORSHARE
NUMBER NAMEPIJDPDDRESSOFPERSON(5)RECEIVINGPROPERTV DONotLlstTruslee�a) OFESTPTE
I TA%ABLE��STRIBUTIONS pnclutle ouingM1i spousel tllAnbNlona enU Venclam untler
Sec. 9116(e)(12)_�
1. � JACQOELINE M. FISCHER �AOGHTER 1/2
3609 FRANKLIN AVENOE
MECHANICSBURG, PA 17050
2. MARY E HETTINGER DAOGHTER 1/2
109 5 AIVER STAEET
WORMLEYS60RG, PA 17093
ENiER DOLLAR AMIXINi$FOR DISlRIB1fIlONS SHONM ABOVE ON LINES 15 T1ROlIGH 1 B OF REV4500 COVER SHEET,HS APPROPRIHTE.
II NOMTA%ABLEDISTRIBUTIDNS
A.SPOUSAL DISIRIBUTI0N5 UNDER SECTION 911]FOR WHICM AN ELECTION TO TA%IS NOT TPKEN'.
i
B.CMARRABLEAN�GOVERNMENTALOISTRIBUTIONS'.
1
TOTAL OF PART II-ENTER TOTAL NON-TPXABLE DISTRIBUTIONSON LME 13 OF REV4500 COVER SHEET. f
awasni i o0o If more space is neetleQ use atltlitional s�eets oi paper of the same size.
ESTA7E OF IACOB R FISCHER
FILE NUMBER 21-14-1150
THE FOLLOWING DOCUMENTATION IS INCLUDED
1. LASTWILLANDTESTAMENT
2. AMERIPRISEFINANCIALACCOUNTSUMMARY
3. PRUDENTIAI.FINANCIALSTATEMENT
4. TRANSAMERICA LIFE INSURANCE COMPANY STATEMENT
5. AARPHEALTHINSURANCEREFUND
6. AMERICAN EXPRE55 REFUND
LAST WILL AND TESTAMENT
OI'
IACOB R. FISCHER
I,JACOB R.FISCHER, of Mechanicsburg, Cumbedand County, Pennsylvania,bei�g
of sou�d and disposing mind and memory, do make, publish, and declaze [his instrument to be
my Last Will and Testament, in the manner and form following:
FIRST: I hereby expressly revoke all Wills, Codicils and testamentazy writings of
whatsoever kind and nature heretofore made by me.
SECOnD: 1 hereby direct my hereinafter named Executnx to pay all my just debts,
expenses of administration, funera] expenses, and inheritance tax out of my estate, as soon xs is
pructicable after my decease.
TffiRD: I give, devise and bequeath all my propeay,real, personal, and mixed, of
which I may die seized or possessed, or over which I may have the power of testamentary
dispositio�, of whatsoever kind and wheresoever situate, to my two daughters, JACQUELINE M.
FTSCHER and MARY E. HETTINGER, per stirpes.
FOURTII: In addition to those provisions authonzed by law my Exewttix shall have
the following powers:
1. Comnromise -To compromise all claims and controversies.
1-
2. Sell.ExchanRe or Lease -To sell at public or private sale, m exchnnge or to lease
for any penod of time any real or personal propeny for such terms as deemed proper; and to give
options for such sales, exchanges or]eases.
3. Distribution- To make distribution in Idnd or cash, to postpone distribution by
agreemen[ with a beneficiary and to distribute articles of tangible personalty to a minor or�o any
person to hold for a minor.
4. Investments-To accept in kiod, retain, invest in and reinvest in any form of
property, without being limited to legal investments and without regard to any principa] of
diversification, risk or productiviry; to exeroise all rights of ownership in respect ro such
investment aod to hold investments in the name of a nominee.
5. Residence - To purchase,invest in or retnin rea] estate to bc used as a residcnce
for a beneficiary to whom income or principa] may be paid.
6. Life Insuraoce-To continue io force any life i�surance owned by me on the 7ife of
ano[her and to exercise any settlement optioos provided in any such policies, to purchase life
insucance and ann�iry contracrs for the benefit of a beneficiary to whom income or priocipal is
payable.
7. ContinuinQ Business - To conduct alone or with others, any business in which 1
am engaged or in which I have an fnterest at my death with all the provisions of any owner with
respw[thereto,including the power to delegate discretionary duties to others, to change the
-2-
eamings and invest othec property of my estate in the business, and to orga�ize a pannership or
coipora[ion to cazry on the business.
8. Borrowine - To boirow money to secure the]oan by a pledge or mongage, and to
execute any accompanying bond, note or other evidence of iodebtedness auffionzing the
confession of judgment.
9. Common Trust Fund - To invest in a common trust fund, whenever the same is
legally provided by the laws ot the Commonwealth of Pennsylvania.
10. Administrative Expenses - To employ attomeys, accovntants, engineers and such
other persons, professionals or others, as may be necessary for the proper administration of thc
estate and to pay their compensation.
1]. Business Mereer Etc - To assent to,join in, or vote in favor of any merger,
reorganizatioq reeapitalization, voting trust pla� or�imilar action and ro delegate discretionary
duties with respectthereto.
FIFTH: No fid�ciary acti�g hereunder shall be required ro post bond or enter
secndty in any jurisdiction.
SIXTH: I hereby nominate and appoini, my daughter, JACQUELINE M.
PISCHP.R, Exec�trix of this my L.ast Will aod Testnmeot with full power and authoiity to sell,
transfer and convey a�y or all of my pioperty, real, personal and mixed, which in her discietion
she may deem necessary in order to pay my debts and ifabilities or to effect distri6ution of my
-3-
estate io accordance wrth this my Last Will and Testament. If Jacqueline M. Fischcr is unable to
perForm her d�ties as Executrix, [hen I appoint my daughter, Mary E. Hettinger, Con[ingent
Execu[nx
� IN WITNESS �'VIIBREOF, I have hereunto set my hand and sea] this�day
of May, 2006.
_ `�� �� �"J�(SEAL)
ACOB R. FISCHER
SIGNED� SEALEll, PiJ13LISI�ED AND llECLARED by the above-named Testator
JACOB - R•FISCHER, as and for his Last Wi71 and Testament, in the presence of�s, who at his
request, in his presence and in thc piesence of each other, all being present at the same [ime, have
hereunto set our hands as wifiesses.
- 'l''��� residingat L�'Moy^e� /g
residing at
residing at �
-q_
COMMON6ygqLTH OF PENNSYLVANL�. )
) ss:
COUNTY OF DAUPHIIJ �
We, JACOB R. FISCI-IER, and Brad Stiffler
Diane E. Grissinger and eonar .in ner '
, thc 1'estator and the
witnesses, respectively, whose names aze sigoed to the attached or foregoing instrument, being
first duly swom, do hereby declare to the u�dersigned authority that the Testator signed and
execoted the instrument as his Last Will and that he had signed willingly (or willingly directed
another to sign for him), and that he executed it as his free and voluntary act for the puiposes
therein expressed, and that each of the witnesses, in Ihe presence and hearing of the 1'estator
signed the Wiil as wimess and to Ihe best of our knowledge the Testator was at that timc eighteen
years of age or older, of sound mind, and under no constraint or u�due influence.
�COB -R F1SCI���� ��
��/�"
Witness
Wimess
Witness
Subscribed, swom m, and acknowledged before me by JACOB R.�SCHER, the
Tes[ator and subscribed and swom to before me by �� Hrad Stiffler
Diane E. Grissinger and Leonard Tintner �' /%
day of May, 2006. , �'�tnesses, this �t7
� `-� ' "� (Seal)
Notary Public
My commission expires: 3�T��/
CO MONWEALTH OF PENNSYLVqNUI
NOTARIqL SEAL
DENISE L. FOS'fER, Nofa
Ciry of Harrisburg, D;uphin Caun{y
Uj Y fort,rtission fxpires Mareh 5, 2009
2015-07-27 14:28 Ameriprise Financial 7177613686 » 717 506 1223 P 2/6
Ameriprise �
Financia!
Account Summary for the Estata Settlement of Jacob R Fischer, Client ID 15076100
i)Type ot imeahnend Amenprise 8mkeagelAmenprise ONE Account
Product Name:Amenprise Bmkerage Account
i Total Awourrt Value(ae of Oate o/Death�:5.52
` AceountNomber,000377983�2 133
AccouM Regiatretlon:Ameriprise Tmst Compeny GO Jawb R Fisc�orAs Custd For The Jawb R Fischer Ira.
BanaNciary Designation:
PRIMARY BENEFICIARY
LIVING, LAWFUL 9HIL�REN W EQUAL SHARE5100.00%
Xow the eccount(s)proceeas wlll be SetHed;
We wi0 t2nsfer assets in this accouM to an accounl for the bene(ciary(ies).
Important Details aba�t ihb accounC
This accounf holtls Oosi�ions heW oulsitle of Ame�ipnse.You must conlecl the wmer tlirectty Por saNemenf of tpese pOsitions-
2)rype o(Investment:Amenprisa BrokeregelAmenptlse ONE Account
ProCuct Name:Amefpnse ONE FlnenUal Accoun�
�- Tota!AaounWalue(as of Oate of Dealh�:$12,246.41
pccount Number:0004756925�133
Account Registrotbn:Jacob R Fischer Tod
8rneficiary Dasignetion:
PRIMAftV BENEFICIARV
41VING, LAWFUL CHILDREN W E�UAL SHARES 10000%
How the account�a)procceda will ne seMed:
We wi0 Vansfer assats in ihls account lo an acmunl for ihe Denef6ary(ies).
ImportaM�etalls aboul this account:
Account Restnpad For Ameriprise ONE Accounts,fealures are suspentletl un�i4we have receivetl all requestetl tlocuments to
ra-register ihe accouni If ihe dalmant would like ro contiouelhe feaNres antl open a new ONE aaount,please complete tbe
Additionel Acrount Features Fortn(i50Z8). Failw¢to complete Nis form will resup in iha removal of�eatures when Ihe accounl
ownership Is�e-registeretl.
3)Type of invasiment Cenificale �
GmEUM Name:Cehlfcal2
Total Aeeount Value(es of Dele ot Dea[h�:$t 1,92B&5
�Account Number.00805084794 001
Account Regfstm0on:Jemb R Fischer Tod
2015-07-27 14:29 Ameriprise FinanciaL 7177613686 » 717 506 1223 P 3/6
5eneficlery Desi9natiun:
PRIMARV BENEFICIARV
UVING,LAWFUL CHILDREN IN EQUAL SHARES 100.00Yo
How lhe awoun$s)pmceeds wlll be sattletl:
W e will Vansfer assets in this account to an account for[he Deneflciary(ies).
Important Datails about this account:
Due b producf IimHa�ions�his account cannot be settle0 until all reqNrements are receviaG trom all claimants nemetl on�he
account.
4)Type of ImactmenL Certifcate
Produd Name:Certificate
/Total Acwulrt Value(ac of Dete of Death�:$2,7GB.99
`Account Number:03304]53958 001
Account Reglstretion:Ameripnse Tmsf Company CIO JacoE R Fiwher As Cusitl Por The Jawb R flscher Ira
Beneficiary Desig^ation:
PRIMARV BENEFlCIARY
LIVING, LAWFUL CHIIDREN W EQUAL SHARES 100.00%
How Me account�s)proceetls will be settled:
We will Vansfer assets in Ihis acwont to an account tor ihe benef<iary(ies).
Important Oetailc about lhis account:
Due b protluct limitalions this accounl Cannot be senled until all requrzements are recevietl from ail claimants nemed on the
accouN.
5)Type of Investmenk Mutual Funtl
Product Neme:MuWal Pond
Tolal Account Value(as of Date ot Death):$16,2�829
G Account Numbar.01011524074 002
Account Re9�stretion:daco�R Fischer Totl
eaneficiary DeclgnaYon:
PRIMARY BENEFICIARY
LIVING,LAWFUL CHILDREN M E�UAL SHAftES 100.00°h
How Me accouM(s)proceeds will be s¢ttled:
We will transfer assets in 1Ms acrsnnt to en ecmun�br the beneficiary(ies).
�mportant Datails about this eccount
N/A
6)Type of investmenC Mutual Fund
2015-07-27 14:29 Ameriprise Financial 7177613686 » 717 506 1223 P 4/b
7
Ameriprise n
Financial
Pratluct Nama: MUWaI fund
j Total Account Value�es of Date of Death�:812.056.86
` AccountNwnber.07013109306002
Account Regirtration:Jacob R Fischer Totl
eeneflslary DesiBnatlon:
PRIMARY BENEFICIARY
LNING,LAWfUL CHILDREN IN EWAI SHARES 100.00%
How the accounl(s)proceetls wlil ba aettleC:
We will lransfer assets in this eccoun�to an acwunt for the bene�iaary(ies).
ImportaM DeUils abaut this account:
NIA
l)Type ot inveatment:Muwal iund
Product Name: Mutual Fund
Total Accoum Value(as of�ete of Death):$16,85436
�Accrount Number:01�13t09313 OW
Account Registratian:Jacob R FischerTotl
BeneNciary Oesi9�ation:
PRIMARY BENEFlCIARY
LNING,LAWFUL CHILDREN IN EQUAL SHARES 100.00%
How the accounlls)Proceatls will be settled:
We will lrensfer asseLs in this account to an eccount fw the benefciary(ies).
importent De[ails about Mis account
N/A
8)Type of InvestmenL Mutual Fu�tl
ProEuct Name: MUWaI Pontl
/ Total Account Value(es W Date of�enth�:$20.3]21]
\ AccountNumber.Ot013883"/69002
AccounfReglsttatlon:Jamb R FlscharTotl
Beneficiary Dosi9�tion:
PRIMARY BENEFICIARY .
LIVING LAWFUL CHILDREN IN EQUAL SMARES 100.00°k
How the ettounqs)proceeds will be settled:
We will transfer assets in this accouN to an account for Ihe benefidary(ies).
2015-07-27 14:29 Ameriprise Financial 7177613686 » 717 506 1223 P 5/6
Important Uatail5 abou[this account
N/A
9)Type of imestmeirt:Mutual Fund
Protluct Name:Mutual Funtl
Tofal Account Value(as ol�ate of Oeath):$3�,163.01
G Accoun[Number:0137AA246280q2
Account RegiaVation:Jacob R Fischer TOC
Beneficiary UesiBnation:
PRIMARV BENEFICIARV
LIVMG, LAWFUL GHILDREN W E�UALSNARES iD0A0Wo
How the account(s)proceeds wlll be sattled:
We will transfer assets in this accouN to an account for the benefciary(ies).
Importent Oetalls about this account:
N/A
10)Type of investment.Mutual Fund
Product Name:Mutual Funtl
/ TMaI Accounl Value(as of Da[e of Death):$10,550.61
` AccountNumber:02015609422002
Account Regiatratlon:Jacob R Fischer Tod
Bene£ciary Oesignatien:
PRIMARV BENEFICIARY
LIVING,LAWFUI CHILDREN IN EOUAL SHARES 1000�%
How the account(s)proceeAs wlll be settled:
We will trensFer asse4s in Nis account[o an sccount for�he benefciary(ies).
Important�etails about Mia acmunl:
N!A
11)Type of Investment: De�ertetl Annutty-Successor annuitant possible
ProCuct Name:�eferreG Mwity-Successor annuilan[poesible
/ Tatal AccouM Value(as of Oata of Death):$33)99.6��
` AccountNumber:93008333536004
Account Reglstrallon:Jawb R Fisc�er
Be�x9clary�eslgnation:
PRIMARV BENEFICIARV
LIVING, LAWFUL CHILDREN IN EQUAL SHARES t00.00%
2015-07-27 14:30 Ameriprise Financial 7177613686 » 717 506 1223 P 6/6
Ameriprise �
' Financial
Now the account(s)proceeAs will be settletl:
We vnll disinbute pmceeds to Ihe benafdary.
Important�etalls about this account
N/A
72J Type o1 inventmant:Omers
Prod4ct Nama:Mnuity Heltl In Bmkerage
/ Total Awount Value(as o/Data of DeaM):$81]1921
�Account NumDec 99250068832
Accow[Regishatlon:Jawb Fischer
Beneficiary Deaignatlon:
LIVING LAWFUL CHILDREN
Bene Percentaga100%
How the acwunt(a)proceeds will ba seMed:
We will distnbute pmceeds ta fhe benefidery.
Important Oetails abqut ihls eccount.
N/A
�n Prudential
��rNae�u.�,�a.��r c�p�r ornme;�.
ein,n<;ai secudry Noga,,,
PA.Box"/960
��'�`�'�'PA11J6 Prudential Financial Security program
. Annual Statement
.lanuary 1, 2014 through December 31, 2014
.7ACOB R FISCHER
3604 FRANRLIN AVENUE
MECHANICSBURG PA 17050
PLAN NUMHER 218248B01
OWNER NAME JACOB R FISCHER
To obtain the most up-to-date information about your plans,
please call the Service Center at :
1-888-778-2888
Our representatives are available to assist you
Monday throucjh Thursday (B a.m. - 7 p,m. ) and
Fciday (8 a.m, - 6 p,m, EST) .
Please review your statement and contact us within 30 days, if you find
any information that you believe to be inaccurate.
Your Plan Activity �
Beginning Value January 1 , 2014
� Ending Value December 31 , 2014 $3 ,434.48
$3 660 27
Portfolio Detail as of December 31 , 2014
prudential Gibraltar Fund (SIP Shares)
Current number of shares 234.4830
Unit Price
$15.60997000
Am�ities are issued by the Pvdmual Luvnnce Camp.ny ofqmmca e�W Puco Life 4uwance Cwnpaoy(in New Yo�ic by P�ufu life Wvrence
�O'^P�Y o�T�'lersry),m by PNdmtial Mnuiau Life qswrence Cmparation Amuitia ue diaaibu�ed by Prudmual qmw�pes Dictr�bu�ors,
Inc.All are Prudrntial Finanaial,Irc.compydes,and eech is colely rerym�sible fw i¢own f anciel cmMiGon antl contracwal obligauom.
�� �T�rrs�E�ucn � s�9�a,�,�<m�ua�,�eo��P:
4i33 Fdeewood Roed NE
� LIFE INSURANCE COMPANV Siqnawre�evRapids,IA 52q99
SlgnaWre
17/10/2014 05569a015w0]
JACQUELINE M FISCHER
3604 FRANKLIN AVE
MECHANICSBURG, PA 1 70 5 0-221 4
Annuity Policy Number: 26160702
Dear JACQUELINE M FISCHER:
We have received notification of the death of Jaco6 Fischer. We eutentl our sincere condolences to you for your
loss. Our records reflect the following information regarUing lhis annuity policy:
Annuitant Name: Jacob R Fischer
Owner Name: Jacob R Fisc�er
Claimant Name: JACQUELINE M FISCHER
Portion of claim: 50%
� Annuity Value: $22,733.47 as of 10/31/2014
Annuity Type: Non Qualifietl
Please complete and reWm the endoseA forms in oider to initiate a death claim on this annuiry policy. The
following information is being provided to assist you in completing ihe forms antl submitting the appropriate
documentation.
General Information
The financial pmfessional of recorU will remain on this annuity unless we are notified of a change in writing.
Please be advised aulomatic operations such as Systematic Payouts and Automatic Payments have been
stopped.
Please suhnk the(olbwing tlxuments upon seleciion of an option:
• An original certifietl death ceAificate for Jacob Fischer indicating the manner of death. '
. The completed Annuity Claimant's SGtement..
If you have a copy of the original annuity policy, please retum d with the above requiretl documents.
28
/'1 TnniGnm
� A
UnitedHealthrare Insurance Company
� PO Box �05133 =
Atlanta, GA 30304 =
DATE: 12/102014
D1IIvIBERSFIIPq: 029281D26-1 �
CHECKNUMBER: 382787 =
xa'wAamim+aoimsa+-o. CFiECKAMOUNf' 5169.75 �
ESTATE OFJACOB R FISCHER
3604 FRANKLIN AVE
MECHANICSBURG PA 17050-2214
THIS REFUND IS FOR Tf�AMOUNT RECEIVED WITH YOUR ENROLLMENT FORM BECAUSE
COVF..RAGE WAS NOT ISSUED. IF YOU HAVE ANY QUESTIONS, PLEASE CALL TOLL FREE
1-800-523-5800.
�eSupplemental and Porsonal Health
I Plans m�,.d�UriudHealthcan �'.
Inau*anm Compazry i
Plaua dahch ch«k and<ssh or daposit prompUy.
ageT oT
dH elnsu?anceCompany. . ....__ _ . , .. . .. .... _. . .. . . ...
�'�ox���i�o�� JPMorgan-Chase Bank, N.A. � � � .� 50 93�
anta. aia
syrecuse,tiv 00382787 '
�. .. . DATE:12H0/14
Plenae Preaen�Pmmptly for Pcyment
•»"„"^•16995 ;
'One HundreE Si<Ty Nine Dollars and SevenTy Flve Centssaaasuannarr�nr��ra+�.+r+s.r..aa.+vaa+.....a.�..nar..aa+»a..aa�r a.
PAY ESTATE OF JACOB R FISCHER a
TO THE 3604 FRANKLIN AVE .o ' `
MECHANICSBURG,PA19o50-ssta "`✓l. �
ORDER OF .
nurHoa¢Eo sicNnrur+E �.
� � � �
�flIFYTHENUlHEMILITYOFTHISMULTI-TONE ECIIflITV00CUMENi. CHELKBACKGflOUNOPHEPLMFNGESCOLOPG1iqDWLLYFflOMTOPTOBOTTOM
:. :.I•--�s � -` V :' � p"' ^' —�%4 -t'^ j
amEAlrnri '['R f4��; � America Ekples THS @ pe y!n ,. � "` , ��•�• ••,�•�
oseess T o 1.$ � ted5 Comp�y ' ' 'r
�,AT�H 34pIW� h�dAS'�ESSMC]4011'/ txEckoare �ccOti�.n';+un�apn �io1 . .
' .- - 5E$VIC�'S 3n <o�K nz �sa]v . � � - � , �inv.e�< " ' s ; �cxecew�Mem : 3a isse ..
enw�a��sv comtimv ,� " . �.-. ' . -� � '� ` • .... ' � . O�H1645b. � _
iaoe >x<
bm moaf.,y f .• . .
��_�
eav �� 7MenryS�xAnd 45/(00 USDollars 8
TO THE ORDLR OF
&
� C}�CE:/�tvfQ�T �
�TF�ESTATE�OF � , " s
J R FISC}IER """'"526.45
3604 FRANKLI7V pVE vm.irxoicw.amieomy. ..
MECHAMCSBURG PA 170502214 � � �
. . �Yv I^� I � '
.. ... �o.�a«, .. .
�i• 76216�. 50i�• �:0 7 24 13 298�: 7 �63942� 76�i'
r�o.oo s,s, �
PROCESSED DATE CHECK NO. RnTE ACCOUNT HATCH I SEQIJHNCE
12R2R014 ]6216450 ���ooa zream�epu
REFERENCE GROSS DISCOUNT NETqMOUNT
S]6.45
I
TOTALS szb as