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Home My WebLink About08-04-15 ' pennsylvaniay 1505618403 DEPARTMENT OF REVEN tX(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 14 1133 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11 10 2014 06 15 1926 Decedent's Last Name Suffix Decedent's First Name MI KEISER RICHARD A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ❑X 1. Original Return 2. Supplemental Return EJ 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) ❑X 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 1 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) F110. Litigation Proceeds Received EJ 11. Non-Probate Transferee Return 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) EJ 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 TO: 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 Correspondent's email address: iotto(ZD_martsonlaw.com REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY ry DATE FILED MMDDYYYY C C-f n � 171 C> a-) n. M c-> r- --I O rr r'71 rT1 DR it FILED STAMP¢ ;O C:1 C7 C no -7 7 cD T1 Ti > C " ►- G7 J rn - p (n O Side 1 -r7 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�'��III �� 1505618403 1505618403 1505618411 REV-1500 EX Decedent's Social Security Number Decedent's Name: Keiser, Richard A. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 118,404 -00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 1-,613-,713. 74 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. 114 , 414 - 32 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 193,037 - 85 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 21039,569 . 91 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 63,153 -59 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 1,391 -79 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 64 ,545 -38 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1-1975,024 -53 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 1-,975,024 -53 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 .00 16. Amount of Line 14 taxable at lineal rate X .045 1,975,024 - 53 16. 88,876 -10 17. Amount of Line 14 taxable at sibling rate X.12 0 .00 17. 0 -00 18. Amount of Line 14 taxable at collateral rate X.15 0 .00 18. 0 .00 19. TAX DUE................................................................................................................ 19. 88,876 .10 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. `SIGNA�P�ERSONQESPQ S�OR FILING RETURN Terry L. Keiser '�E� 8i 2e ADDRESS 107 Kill Drive, Carlisle, PA 17013 SIGNATU E R OTHER THAN REPRESENTATIVE Ivo V. Otto ill ATFZ ADDRESS 10 East High Street, Carlisle, PA 11111111111111111111111 IN Side 2 1505618411 1505618411 REV-1500 EX Page 3 File Number 21-14-1133 Decedent's Complete Address: DECEDENT'S NAME Keiser, Richard A. STREET ADDRESS 21 Cambridge Court CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 88,876.10 2. Credits/Payments A. Prior Payments 88,000.00 B. Discount 4,443.81 Total Credits(A +B) (2) 92,443.81 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 3,567.71 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) Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................... ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. H ❑x c. retain a reversionary interest;or............................................................................................................... ❑x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receivingadequate consideration?.................................................................................................................... ❑ 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Rev-1502 EX+(12-12) SCHEDULE A pennsylvania REAL ESTATE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 All real property owned solely or as a tenant In common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is Jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate-21 Cambridge Court-Real estate located at 21 Cambridge Court,Carlisle 118,404.00 Borough,Cumberland County, PA, known as Parcel No.04-20-1794-026 and being described in that certain Deed dated 07/19/1999 and being recorded on 07/19/1999 in Cumberland County Deed Book 204, Page 119,and being conveyed to Richard A. Keiser, Decedent herein. Value is assessed value of$119,600.00 x common level ratio of 0.99. See attached. TOTAL(Also enter on Line 1, Recapitulation) 118,404.00 (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 A(Rev. 12-12) Rev-1503 EX+(08-12) SCHEDULE B pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 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 1 01853W105 7,733 shares of AllianceBernstein Amers Govt-CL A 8.55 66,117.15 Accrued dividend on Item 1 through date of death 37.47 2 142339100 16,000 shares of Carlisle Companies Inc-Com 88.92995 1,422,879.20 3 172967424 4 shares of Citigroup Inc 53.7175 214.87 Accrued dividend on Item 3 through date of death 0.04 4 345370860 189 shares of Ford Motor Co Del-Com Par$0.01 14.0750265 2,660.18 Accrued dividend on Item 4 through date of death 23.63 5 693517106 3,000 shares of PPL Corp-Com 36.58 109,740.00 6 US Savings Bonds,Series EE-See attached 11,041.20 7 US Savings Bonds,Series HH-See attached 1,000.00 TOTAL(Also enter on Line 2, Recapitulation) 1,613,713.74 (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 B(Rev.08-12) Rev-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2004 Buick Lasabre-Proceeds from the sale of decedent's vehicle 5,000.00 2 2008 Buick Lucerne-Proceeds from the sale of decedent's vehicle 9,500.00 3 Carlisle Companies-Dividend earned prior to date of death,deposited after date of death 4,000.00 4 M&T Bank Checking Account#456845-Date of death value,see attached 5,145.54 Accrued interest on Item 4 through date of death 0.04 5 Miscellaneous cash deposit 1.00 6 PA Department of Treasury, Unclaimed Property-Santander dividend checks uncashed 72.50 during decedent's lifetime 7 PPL Corporation -Dividend earned prior to date of death,deposited after date of death 2,235.00 8 TIAA-CREF-Annuity distribution deposited after date of death 292.10 9 TIAA-CREF-Annuity distribution deposited after date of death 114.64 10 Wells Fargo CD Account#247402084008483-Date of death value,see attached 31,107.34 Accrued interest on Item 10 through date of death 44.53 11 Wells Fargo CD Account#24740284008485-Date of death value,see attached 28,910.07 Accrued interest on Item 11 through date of death 41.38 12 Wells Fargo Checking Account#1004014021106-Date of death value,see attached 14,692.34 Accrued interest on Item 12 through date of death 0.05 Total of Continuation Schedules See attached pages TOTAL(Also enter on Line 5, Recapitulation) 114,414.32 (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) Rev-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT continued ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 13 Wells Fargo Savings Account#3000222071047-Date of death value,see attached 2,933.29 Accrued interest on Item 13 through date of death 0.01 14 Wells Fargo Savings Account#5970586748-Date of death value,see attached 2,511.56 Accrued interest on Item 14 through date of death 0.06 15 Miscellaneous property and household items 5,000.00 16 Capital Blue Cross-Insurance premium, refund 220.05 17 Citigroup-Dividend accrued prior to death, posted to account after death 0.04 18 Citigroup-Dividend accrued prior to death, posted to account after death 0.04 19 Comcast-Refund of equipment leasing fees 260.00 20 Coventry Care Link-Refund of long-term care insurance policy 797.14 21 Ford Motor Company-Dividend accrued prior to death,posted to account after death 23.60 22 Pennsylvania National Mutual Casualty Insurance Company-Refund from homeowner's 11.00 policy for Carlisle property 23 US Department of Treasury-Refund from decedent's 20141040 return 784.00 24 Westfield Insurance-Refund of auto insurance premium 232.00 25 Westfield Insurance-Refund of auto insurance premium 109.00 26 Westfield Insurance-Refund of auto insurance premium 376.00 Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12) Rev-1510 EX+(08.09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSOF FER. ATTACH THEIRNSFEREE COPRELATIONSHIP OF THE DEED FOR REAL ESTATE. VALUE OF ASSET EDENT AND INTEREST (IF APPLICABLE) VALUE 1 Allstate Life Insurance Company-Annuity contract 42,598.39 100.000% 42,598.39 #GA16174341,Terry L. Keiser(son) beneficiary 100%, see attached 2 American General Life Insurance Company-Annuity 81,171.09 100.000% 81,171.09 contract#VP231648,Terry L. Keiser(son)beneficiary 100%,see attached 3 American General Life Insurance Company-Annuity 45,799.72 100.000% 45,799.72 contract#VV235470,Terry L. Keiser(son)beneficiary 100%,see attached 4 MetLife-Annuity contract#A2051791 BSG,Terry L. 23,468.65 100.000% 23,468.65 Keiser(son)beneficiary 100%,see attached TOTAL(Also enter on Line 7, Recapitulation) 193,037.85 (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) REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DEC D NTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 2,479.46 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid Waived 2. Attorney's Fees Martson Law Offices 52,611.02 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 905.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 225.00 7. Other Administrative Costs 6,932.61 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 63,153.59 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hoffman-Roth Funeral Home&Crematory, Inc.-Funeral expenses 1,006.26 2 Westminster Cemetery-Base for grave marker 282.20 3 Westminster Cemetery-Burial expense 1,191.00 H-A 2,479.46 Other Administrative Costs 4 Borough of Carlisle-Water and sewer for Carlisle property, pending disposition of real 74.82 estate 5 Borough of Carlisle-Water and sewer for Carlisle property, pending disposition of real 79.35 estate 6 Cambridge Condominium Association-Maintenance fees for Carlisle property, pending 650.00 disposition of real estate 7 Cambridge Condominium Association-Maintenance fees for Carlisle property, pending 650.00 disposition of real estate 8 Cambridge Condominium Association-Maintenance fees for Carlisle property, pending 1,300.00 disposition of real estate 9 CenturyLink-Phone bill for Carlisle property, pending disposition of real estate 37.05 10 CenturyLink-Phone bill for Carlisle property, pending disposition of real estate 37.05 11 CenturyLink-Phone bill for Carlisle property, pending disposition of real estate 38.13 12 CenturyLink-Phone bill for Carlisle property, pending disposition of real estate 38.13 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 ITEM NUMBER DESCRIPTION AMOUNT 13 CenturyLink-Phone bill for Carlisle property, pending disposition of real estate 38.13 14 CenturyLink-Phone bill for Carlisle property, pending disposition of real estate 38.17 15 CenturyLink-Phone bill for Carlisle property, pending disposition of real estate 38.17 16 Charles Holtry,Tax Collector-County/Municipal real estate tax, pending disposition of 657.89 Carlisle property 17 Cumberland County Recorder of Deeds-Deed recording fee for Carlisle property 80.00 18 Deluxe Checks-Order of checks for estate checking account 25.20 19 EstateVal-fee for date of death valuation report 2.00 20 EstateVal-fee for date of death valuation report 10.00 21 LandEx-Lien search and deed copies 0.57 22 Legal Advertising-Cumberland Law Journal 75.00 23 Legal Advertising-The Sentinel 201.16 24 PA Department of Revenue-Tax due on 2014 PA40 return 27.00 25 PA Department of Transportation-Registration renewal for Buick Lucerne, pending 36.00 disposition of vehicle 26 Phyllis Myers-Reimbursement for mailing costs for forwarding decedent's mail to Executor 6.00 27 PPL Electric Utilities-Electricity for Carlisle property, pending disposition of real estate 36.35 28 PPL Electric Utilities-Electricity for Carlisle property, pending disposition of real estate 113.18 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 ITEM NUMBER DESCRIPTION AMOUNT 29 PPL Electric Utilities-Electricity for Carlisle property, pending disposition of real estate 128.74 30 PPL Electric Utilities-Electricity for Carlisle property, pending disposition of real estate 117.53 31 PPL Electric Utilities-Electricity for Carlisle property,pending disposition of real estate 140.60 32 PPL Electric Utilities-Electricity for Carlisle property, pending disposition of real estate 67.01 33 PPL Electric Utilities-Electricity for Carlisle property, pending disposition of real estate 36.54 34 Register of Wills-Fees for 4 short certificates 20.00 35 Register of Wills-Fee for 1 short certificate 5.00 36 Register of Wills-Additional probate fees 350.00 37 Register of Wills-Fee for 1 short certificate 5.00 38 Terry L. Keiser-Reimbursement for office supplies for estate record keeping purposes 70.43 (printer ink,fax documents, binder clips,printer paper,post-it notes,file folders,certified mail delivery fees) 39 Terry L. Keiser-Reimbursement for costs incurred when traveling to Florida to sort through 1,092.19 and gather decedent's files and miscellaneous personal property 40 TIAA-CREF-Return of annuity distributions deposited after date of death 406.74 41 Tuckey Mechanical Services-Airconditioning and Heat pump maintenance service fees for 66.50 Carlisle property, pending disposition of real estate 42 United States Postal Service-Certified mail delivery expense for Safe Deposit Box Inventory 6.48 Notice sent to the PA Department of Revenue Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 ITEM NUMBER DESCRIPTION AMOUNT 43 VitalCheck-Ordered 5 death certificates for decedent's predeceased spouse,Joyce E. 63.00 Keiser 44 VitalCheck-Ordered 4 death certificates for decedent 51.50 45 Wire transfer fee-To receive proceeds from sale of 2008 Buick Lucerne 16.00 1-1-137 6,932.61 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 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 Best Benefits-Healthcare discount program,account payable 19.95 2 Borough of Carlisle-Water and sewer for Carlisle property,account payable 74.82 3 Capital Blue Cross-Insurance premium,account payable 220.05 4 Capital One Card Services -Paid balance remaining on GM card,account payable 301.48 5 Centuryl-ink-Phone bill for Carlisle property,account payable 37.05 6 Charles Holtry,Tax Collector-Payment of past due real estate taxes for Carlisle property 738.44 TOTAL(Also enter on Line 10, Recapitulation) 1,391.79 (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+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Keiser, Richard A. 21-14-1133 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT Do Not is sees (Words) ($$$) ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Terry L. Keiser Son Sole beneficiary 1,975,024.53 107 Hill Drive Carlisle, PA 17013 Total 1,975,024.53 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) 0 LAST WILL AND TESTAMENT OF RICHARD A. KEISER I, RICHARD A. KEISER, a legal resident of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. THIRD: I devise and bequeath the residue of my estate, of every nature and wherever situate, to my wife, JOYCE E. KEISER, provided she shall survive me by thirty (30) days. Should my wife, JOYCE E. KEISER, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the residue of my estate, to my son, TERRY L. KEISER. Should my son, TERRY L. KEISER, fail to survive me, I devise and bequeath the residue of my estate to my daughter-in-law, ANNE L. KEISER. Should both my son and daughter-in-law fail to survive me, I devise and bequeath the residue of my estate to my niece, TRACY LYNN BOUTELLE. FOURTH: I nominate, constitute and appoint my wife, JOYCE E. KEISER, Executrix of this, my Last Will and Testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of the said JOYCE E. KEISER, I nominate, constitute and appoint my son, TERRY L. KEISER, Executor of this, my Last Will and Testament. I hereby relieve my Executrix or her successor from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by law so to do. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of one typewritten page, which bears my signature, this /$�!'` day of 1992 . CZl, rti ti Lt • Q.E _ —(SEAL) Richard A. eiser Signed, sealed, published and declared by the above- named Testator, Richard A. Keiser, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, Richard A. Keiser, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Richard A. Keiser, the Testator, this / '"�'` day of 19.,.9 (SEAL) Testator Picbard A. iser (SEAL) Notary Pu c NOTARIAL SEAL. AFFIDAVIT SHOLEY P. Ak+LERS, NOTARY PUBLIC CA.RLa:si.E 3():E�.. C!1P«i3Ea�l.ANJ bUt3NT ?iti COMMONWEALTH OF PENNSYLVANIA ) ° Y -i'`3y+4oS:4tR wPi'tE,,DULY 14, 193. •1 SS. COUNTY OF CUMBERLAND ) We, Edward L. Schorpp and the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that Richard A. Keiser signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed and subscribed to before me by Edward L. Schorpp and witnesses, this day of �T�,�✓�.. , 1992 . —(SEAL) i.tn �s E7d�ard L. Schorpp — SEAL Witnes JA (SEAL) Notary Publi 8111HLEY A. CAR USLE 3CRO.. CUM.-ERLAND COUNTY. PA MY CONIMISSI^U JULY 14, 1993 Property Mapper Cumberland County, PA Taxable21 CAMBRIDGE COURT PIN:04-20-1194-026 D—dbook:00204 001 IQ Land Use Code,10/ :clean: Green Status. BuMcnq Assessed Value .. 00000 Sa e Date:Sun M 18 1999 „ , PM Year Built:1904 VA a rA Copyright 2011 Esri.All rights reserved.Mon Nov 24 2014 11:05:46 AM. 21 CAMBRIDGE COURT PIN:04-20-1794-026 Deedbook: 00204-00119 Owner: KEISER,RICHARD A Land Use Code: 107 Property Type: R Acreage: Square Feet: 1668 Taxable Status:T Clean&Green Status: Land Assessed Value$: Building Assessed Value$: 119600 Total Assessed Value$: 119600 Sale Price$: 100000 Sale Date: Sun Jul 18 1999 08:00:00 PM Year Built: 1984 Municipality: CARLISLE BORO 3RD WRD Height in Stories: 1 Type of Dwelling:CONDO Primary Exterior: Brick Basement Percentage: Air Conditioning: HP Total Rooms:6 Bedrooms: 2 Full Bath: 2 Half Bath: SCH e:19uC U A, IT�rr� l r � 70 3 o Taal Parcel#04-20-1794-026 THIS DEED MADE this +y{'A day of July,1999, BETWEEN Ray L.Wolfe and Dorothy R.Wolfe,husband and wife,of 41 Ladnor Lane, Carlisle,Cumberland County,Pennsylvania, "GRANTORS", AND Richard A.Keiser,single man,of 543 Summit Drive,Carlisle,Cumberland County,Pennsylvania, "GRANTEE", WITNESSETH,that in consideration of the sum of One and 40/100{51.00} Dollar,in hand paid,the receipt whereof is hereby acknowledged,that said GRANTORS do hereby grant and convey in fee simple to said GRANTEE,his heirs and assigns, ALL THAT CERTAIN Unit in the property known,name and identified in the Declaration referred to below as"Cambridge Condominium",located in the Borough of Carlisle,Cumberland County,Pennsylvania,which has heretofore been submitted to the provisions of the Pennsylvania Uniform Condominium Act,68 Pa.C.S.A.3101 r,grdy by the recording in the Office of the Recorder of Deeds for Cumberland County of a Declaration dated June 15,1983,and recorded on April 24,1984 in Miscellaneous Book 294,Page 964,being and designated in such Declaration as Unit Pio.A4 together and including the detached garage,which said Unit and detached garage,being part of said Unit is more folly described in said Declaration,together with a proportionate undivided interest in the Common Elements(as defined in said Declaration)of 6.25%. BEING the same property which John H.Billman,by deed dated May 25,1984 and recorded in the Office of the Recorder of Deeds in and for Cumberland County in Deed Book L-30,Page 880,granted and conveyed unto Ray L.Wolfe and Dorothy R. Wolfe,husband and wife,grantors herein. AND the said GRANTORS hereby warrant specialty the property herein conveyed. iW 204 FAu tiS SCN.ievtCi✓ 14 sm IN WITNESS WHEREOF,the said GRANTORS do hereby set their hands and seats the day and year first above written. Witness: Ray .W01fe Dorothy R.W fe COMMONWEALTH OF PENNSYLVANIA :ss. COUNTY OF CUMBERLAND On this,the /14 day of July,1999,before me,the undersigned officer, personally appeared Ray 1.•Wolfe and Dorothy R.Wolfe(mown to me(or satisfactorily proven)to be the persons whose names are subscribed to the within instrument,and acknowledged the foregoing deed to be their act and deed and described the same and to be recorded as such. WITNESS my hand and official seal the day and year first above written. • Notal Bsel Wlds M.se�s�,NotuY Public Notary Public hlppro E. G--11111Ww W Cnq S ....<•.'j,�;i'. My CIZZ-llon Expires Apr.16.2002 Sr S ,i/ •;ice. �h;�:... OU 204 PACE 120 • s I hereby certify that the p ise residence and complete post office address of the within named GRANTEE is / �i�IBIPr�eOlrf+[„�SY.ar�iFJ Ag ,1999. Attorney for Grantee ��I�+z!�jgc�ij•y'a:.,;"�,i.,+�f1.iM� ".C? 'i t -.Wi-%fin;he rrcording of I",e:Or r~p p i _i ,y .�t •a ' '�';i.��`rii. Fw;ids _ n 13/1 ry yr CO rn a Z4 gi 9 j'1 g.1 Yn V V frR A as > Bd5 204 PACE 121 f'J Estate Valuation Date of Death: 11/10/2014 Estate of: Richard A. Keiser Estate Valuation Date: 11/10/2014 Account: 10887.1 Processing Date: 07/30/2015 Report Type: Date of Death Number of Securities: 6 File ID: 10887.1.Keiser 2 Shares Security Mean and/or Div and int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 16000 CARLISLE COS INC (142339100; CSL) COM New York Stock Exchange 11/10/2014 89.38990 88.47000 H/L 88.929950 1,422,879.20 2) 3000 PPL CORP (69351T106; PPL) COM New York Stock Exchange 11/10/2014 36.80000 36.36000 H/L 36.580000 109,740.00 N/A 4) 189 FORD MTR CO DEL (345370860; F) COM PAR $0.01 New York Stock Exchange 11/10/2014 14.20000 13.95000 H/L 14.075000 2,660.18 Div: 0.125 Ex: 10/29/2014 Rec: 10/31/2014 Pay: 12/01/2014 23.63 5) 4 CITIGROUP INC (172967424; C) COM NEW New York Stock Exchange 11/10/2014 53.89000 53.54320 H/L 53.716600 214.87 Div: 0.01 Ex: 10/30/2014 Rec: 11/03/2014 Pay: 11/26/2014 0.04 6) 7733 AB GLOBAL BD FD INC (01853W105; ANAGX) CL A Mutual Fund (as quoted by NASDAQ) 11/10/2014 8.55000 Mkt 8.550000 66,117.15 Daily div. accrual as of 11/10/2014 37.47 Total Value: $1,601,611.40 Total Accrual: $61.14 Total: $1,601,672.54 SCN v [A b, Page 1 This report was produced with Estateval, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 8.0.2) Inventory Report Active Inventory Print Date: 12/31/2014 Bonds: File P icing Date: 11/2014 Issue Next Interest Final Maturity No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note 1 EE $1,000 M7857925EE 02/1985 $500.00 $1,761.20 $2,261.20 4.00% 5.18% 02/2015 02/2015 2 EE 1,000 M9112346EE 06/1985 500.00 1,716.80 2,216.80 4.00% 5.20% 12/2014 06/2015 3 EE 1,000 M10348168EE 10/1985 500.00 1,716.80 2,216.80 4.00% 5.20% 04/2015 10/2015 4 EE 1,000 M013224615EE 01/1986 500.001 1,673.201 2,173.201 4.00% 5.22% 01/2015 01/2016 5 EE 1,000 M14565522EE 05/1986 1 500.001 1,673.201 2,173.201 4.00% 5.22% 05/2015 05/2016 Inventor Totals: BondsPrice Interest Value 5 $2,500.00 $8,541.20 $11,041.20 t� +1"4 • Cl-bond was Cashed In • EX-bond was EXchanged for an HH bond • MA-bond is MAtured and not earning interest • NE-bond is Not yet Eligible for payment • NI -bond has Not yet been Issued • P5-bond is a Series I or EE,was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old •* bond is a Series I or EE,was issued in or after January 1990 and may be tax exempt if used for post-secondary education • () bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date F:\FILES\Clients\10887 Keiser\1 0887.1.us.savings.bonds.ee.sbw Page 1 of 1 Inventory Report Active Inventory Print Date: 12/31/2014 Bonds: File P icing Date: 11/2014 Issue Interest Next Interest Final Maturity No. Series Denom Serial Number Date Price [Deferred] Value Rate Yield Date Date Note 1 1 HH I $1,000 M5873681HH 06/1996 $1,000.00 $0.00 $1,000.00 1.50% 12/2014 06/2016 Invento Totals: Bonds Deferred Interest Price Interest Value 1 $0.00 $1,000.001 $0.00 $1,000.00 CZ • CI-bond was Cashed In • EX-bond was EXchanged for an HH bond • MA-bond is MAtured and not earning interest • NE-bond is Not yet Eligible for payment • NI -bond has Not yet been Issued • P5-bond is a Series I or EE,was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old •* bond is a Series I or EE,was issued in or after January 1990 and may be tax exempt if used for post-secondary education • Q bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date F:\FILES\Clients\10887 Keiser\1 0887.1.us.savings.bonds.hh.sbw Page 1 of 1 M&TBank 499 Mitchell Road,Millsboro,DE 19966 Records Management Phone 888-5024349 F ax (302)934-2955 December S,2014 Martson Deardorff Williams Otto Gilroy & Faller Martson Law Offices 10 East High Street Carlisle, PA 17013 Re: Estate of Richard A. Keiser Social Security: 213-28-0761 Date of Death:November 10 2014 Dear Sir or Madam: Per your inquiry on December 02,2014,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: I. Type of Account Checking Account Account Number 456845 Ownership(Names o) Richard A.Keiser Opening Date 0910111967 Balance on Date of Death $ 5,145.54 Accrued Interest $ .04 Total $3'-)?4 5 5 8 2. Type of Account Safe Deposit Box Box Number/Location 180/Stonehedge Ownership(Names of) Richard A.Keiser Opening Date 05/22/2002 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the Nigh Street Carlisle at 717-240-4+36. This letter does 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, Valarie Mercer Records Management e7 L4 Customer Correspondence MAC P6102-o3A P.O.Box 6995 Portland,OR 97228-6995 Date of Death Balance Request Response Form Decedent: Richard A.Keiser Case number: 90005501 Date of death: Monday,November to,2014 Completed by: Volletta Wiley Requested by: Dena S.Brumbaugh Contact number: (540)562-9031 Mail: Martson Law Offices Date: December 9,2014 to East High Street Carlisle,PA 17013 Principal balance Interest paid Accrued Date of death Account title Affiliation Account type Account number as of date of death year to date of interest balance death Richard A.Keiser Sole Owner Checking xxxxxx8971 $0.00 $0.00 $0.00 $0.00 Opened on 07/17/2012 Richard A.Keiser Joint Owner Checking xv000cxxx11o6 $14,692.34 $0.90 $0.05 $14,692.39 Z-My" 17„ Joyce E.Keiser Joint Owner Terry L.Keiser Power of Attorney Opened on 1.0/13/1994 Richard A.Keiser Sole Owner Savings xxxxxx6748 $2,511.56 $1.67 $o.o6 $2,511.62 14 Opened on 07/17/2012 Richard A.Keiser Sole Owner Savings xxxxxxxxx1047 $2,933.29 $0.20 $0.01 $2,93330 -TI-e-r, 13 Opened on o8/20/2010 Richard A.Keiser Sole Owner Certificate of deposit mxx 8483 $31,107.34 $582.58 $44.53 $31,151.87 =- jd Opened on 08/20/2010 Richard A.Keiser Sole Owner Certificate of deposit xxKKKxxxxxx8485 $28,910.07 $541.43 $41.38 $28,95145 Opened on o8/20/2010 Notes:Balances provided are for the last business day prior to the date of death,if the date of death falls on a holiday or weekend. Money Market Checking and Money Market Access accounts pay dividends only. �- Comments: . crosoihLrz There was no Safe Deposit Box found. 10 06-01-'15 16:03 FROM- MT Carlisle High Str 7172404518 T-968 P0002/0002 F-606 Allstate* You're in good hands. June 1, 2015 Shawnee Smith M&T Securities 1 W. High Street Carlisle, PA 17013 Re: Richard A. Keiser Contract No: GA16174341 Dear Ms.Smith: We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date(usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. 1 can, however, provide the following information for estate purposes: Date of Death: November 10,2014 Annuity Value as of Date of Death: $42,598.39"' Cost Basis: $30,000.00 Named Beneficiary Terry L.. Keiser *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions,please contact us at 1-877-499-6418. Sincerely, Valarie Melton Sr.Claim Examiner Allstate Life Insurance Company Life and Annuity Claims P.O. Box 94212,Palatine, IL 60094-4212 Phone 877-499-6418 l=ax 866-635-4523 American General Life Insurance Company The United States Life Insurance Company in the City of New York January 14, 2015 DENA BRUMBAUGH 10 EAST HIGH ST CARLISLE PA 17013 Re: Annuity Contract VP231648 Dear Ms. Brumbaugh: Thank you for your recent inquiry regarding the above referenced annuity contract. We would like to take this opportunity to respond to your request. The accumulated value of this contract as of 11/10/2014, the date of death, is $81,171.09. Ms. Brumbaugh, we appreciate the opportunity to assist you. Should you have any questions, please contact our Client Care Center at 1-800-424-4990. Sincerely, Ca Cassandra Russell Annuity Claims Department Annuity Service Center• P.O. Box 871 •Amarillo, TX 79105-0871 Administrator for Renaissance Life& Health Insurance Company of America - Administrator for John Alden Life Insurance Company LH-AGL/USL American General Life Insurance Company The United States Life Insurance Company in the City of New York January 14, 2015 DENA BRUMBAUGH 10 EAST HIGH ST CARLISLE PA 17013 Re: Annuity Contract VV235470 Dear Ms. Brumbaugh: Thank you for your recent inquiry regarding the above referenced annuity contract. We would like to take this opportunity to respond to your request. The accumulated value of this contract as of 11/10/2014, the date of death, is $45,799.72. Ms. Brumbaugh, we appreciate the opportunity to assist you. Should you have any questions, please contact our Client Care Center at 1-800-424-4990. Sincerely, Cassandra Russell Annuity Claims Department Annuity Service Center• P.O.Box 871 •Amarillo, TX 79105-0871 Administrator for Renaissance Life&Health Insurance Company of America • Administrator for John Alden Life Insurance Company LH-AGL/USL Annuity Operations . `e' ife Metropolitan Life Insurance Company MetLife Insurance Company USA New England Life Insurance Company First MetLife Investors Insurance Company Contract Number: A20511918SG I ContractOwner(s): RICHARD A KEISER January 22,2015 Dear Mr. Terry Keiser, We wish to say again that we at MetLife are sorry for your loss and understand that what you're going through can be a difficult experience. I hope to keep your inconvenience to a minimum. Why we're contacting you We're responding to-your request for contract-values.-- What ontract-values:What you need to know The values for contract A2051791 BSG are below: Contract Values Date of death value Date of death November 10, 2014 Value ofthe contract at the close of the New York Date of death value $23,468.65 Stock Exchange on the owner's date of death Current contract value $23,891.09 Contract value Value of the contract at the close of the New Account type Traditional IRA York`Stock Exchange Account type Type of annuity What you need to do There is no action required by you. You may keep this notice for future reference. METLIFE P.O. BOX 14593 DES MOINES IA 50306-4593 ESTATE OF RICHARD A KEISER ATTN TERRY KEISER 107 HILL DR CARLISLE PA 17013 0015-001 Page 1 of 2