HomeMy WebLinkAbout09-24-15 (2) -� REV-1500 EX(02-11) 1505610143
� OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 2 1 15 00160
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
01 09 2015 01 15 1941
Decedent's Last Name Suffix Decedent's First Name MI
DANOWITZ KAROL S
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ❑ 2. Supplemental Retum ❑ 3.Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a,Future Interest Compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
0
® 8. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION§�AULD B t* CTED TO:
Name
Daytirr��Telephone NunpberL
GARY L ROTHSCHILD 717 ;540 30
r
REGISTERO0*71_1_9
y USE ONLY-7
First Line of Address
2215 FOREST HILLS DR
Second Line of Address
SUITE 35
City or Post Office State ZIP Code DATE FILED
HARRISBURG PA 17112
Correspondent's e-mail address: glrOthlaw@comcast.net
Under penalties of perjury,I declare that 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 personal representative Is based on all Information of which preparer has any knowledge.
SIGN ATUf E OF ERSO RESP NSIBLE FOR FILING RETURN DATE
Michael Allen Danowitz
ADDRESS f
121 Academy Lane, Bro mall, PA 19008
S�IGNATUPR AR TH T P ENT E p
Gary L Rothschild � AT �S
ADDRESS
The Lhvii Offices of Gary L. Rothschild
2215 Forest Hills Dr., Harrisburg, PA 17112
Side 1
1505610143 1505610143
�. v
J 1505610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A)..................................................................................... 1.
2. Stocks and Bonds(Schedule B).......................................................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)....................................................... 4.
5• Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E).............. 5. 42 , 817 . 60
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 190 , 491 . 16
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Gross Assets(total Lines 1 through 7)....................................................... 8. 233 , 308 . 76
9. Funeral Expenses and Administrative Costs(Schedule H).................................. 9.
10 , 376 . 47
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10.
10 , 445 . 39
11. Total Deductions(total Lines 9 and 10)............................................................. 11 20 , 82 1 . 8 6
..............................
12• Net Value of Estate(Line 8 minus Line 11) 12 2 1 2 , 486 . 9 0
...............................
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. 212 , 486 . 90
TAX COMPUTATION-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.
16. Amount of Line 14 taxable
at lineal rate X .045 212 , 286 . 9 0 16. 9 , 552 . 91
17. Amount of Line 14 taxable
at sibling rate X ,12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 200 . 0 0 18. 30 . 0 0
19. TAX DUE............................................................................................................ 19. 9 . 582 . 91
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Sid•2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 15 - 00160
Decedent's Complete Address:
DECEDENT'S NAME
Danowitz, Karol S.
STREET ADDRESS
325 Wesley Drive
Bethany Village
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 9,582.91
2. Credits/Payments
A. Prior Payments 91000.00
B. Discount 473.68
Total Credits(A +B) (2) 9,473.68
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is theOVERPAYMENT (4)
Check box on Page 2,Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is theTAX DUE (5) 109.23
Make Check Payable to: REGISTER OF WILLS, AGENT.
10
FA
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;........ ................................................................... P OX
b. retain the right to designate who shall use the property transferred or its income;............................... F I_x]
c. retain a reversionary interest;or....................................................................................................... F-1 Fil
d. receive the promise for life of either payments,benefits or careZ.......................................................... El Ex]
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................................................................................ I 0
3. Did decedent own an"in trust foe' or payable upon death bank account or security at his or her death?....... EX F�
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designationZ............................................................................................................... FX ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR
A�1 '
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)(1)].
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 reZrn 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 stepparent 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.
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH
INHERITANCE TAX RETURN , BANK DEPOSITS AND MISC.
RESIDENT DECEDENT PERSONAL PROPERTY
UM
NBER
ESTATE OF Danowitz, Karol S. 21 FILE E N - BER
0160
Include the proceeds of litigation and the date the proceeds were received by the estatakil property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF DESCRIPTION
NUMBER DEATH
1 PSECU savings account(See attached Exhibit A). 65.93
2 PSECU checking account with accrued interest(See attached Exhibit A). 12,291.00
3 PSECU money market account with accrued interest(See attached Exhibit A). 7,853.20
4 Toyota settlement proceeds 29.23
5 Reimbursement from Bankers Life for long term care insurance 6,269.25
6 Reimbursement from Met Life for long term care insurance 3,627.00
7 2014 Federal Income Tax Refund 3,600.00
8 PNC Estate account(See Exhibit B) 7,796.65
9 Refund of deposit from Bethany Village 470.00
10 Commonwealth of Pennsylvania State Retirement 532.64
11 Refund from personal finance magazine 142.45
12 Refund from utility forecaster 140.25
TOTAL(Also enter on Line 5, Recapitulation) 42,817.60
REVA 510 EX+(08-09)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS $
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Danowitz, Karol S. FILE NUMBER
21 - 15-00160
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE)
1 Fidelity account number Zxxx4410 payable upon 21,072.83 100% 21,072.83
death to decedent's two children in equal shares (See
attached Exhibit C).
2 Fidelity IRA account number xxxxx6780 payable upon 152,931.40 100% 152,931.40
death to decedent's two children in equal shares (See
attached Exhibit C).
3 Fidelity Roth IRA account number xxxxxx2989 16,475.42 100% 16,475.42
payable upon death to decedent's two children in
equal shares (See attached Exhibit C).
4 Accrued interest on IRA and Roth IRA(See attached 11.51 100% 11.51
Exhibit C).
TOTAL(Also enter on line 7, Recapitulation) 190,491.16
REV-1511 EX+(10-09)
pennsyllvanDEPARTMENT OF a REVENUE ������ppS��C��HEEDppAJEE
��H
INHERITANCE TAX N RETURN wMAIA�wTW Mme.,
RESIDENT DECEDENT 11LJ1111 1YIJ 1 IV1 (�"
ESTATE OF Danowitz, Karol S. FILE NUMBER21 - 15-00160
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Gingrich Memorials-headstone/memorial 3,060.00
2 Travel and lodging expenses associated with funeral 777.42
3 Funeral expenses and lunch after funeral 1,047.99
4 Memorial lunch 1,600.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attorney's Fees The Law Offices of Gary,L. Rothschild 3,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 175.50
Sentinel and Cumberland County Legal Journal-advertise 201.82
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
Expenses and travel costs for executor to administer estate 513.74
TOTAL(Also enter on line 9, Recapitulation) 10,376.47
pennsylvania SCHEDULE
DEPARTMENT OFDEBTS OF DECEDENT
INHERITANCE TAXAXRETURN
, MORTGAGE
RESIDENT DECEDENT LIABILITIES & LIENS
BER
ESTATE OF Danowitz, Karol S. 21 -FILE NUM- BER
0160
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Bethany Village for personal care 9,845.25
2 The Medicine Shoppe-prescriptions 443.14
3 Pinnacle Health Hospitals-medical care 50.00
4 James Norton, DPM-medical care 15.00
5 2014 Pennsylvania individual income tax liability 92.00
TOTAL(Also enter on Line 10, Recapitulation) 10,445.39
REV-1513 EX+(01.10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF Danowitz, Karol-S. FILE NUMBER
21 - 15-00160
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not ListTrustee(s)
ITAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Shoshana F. Goldberg Granddaughter 3,000.00
1422 Iroquois Place
Ann Arbor, MI 48104
2 Lauren Goldberg Granddaughter 3,000.00
1422 Iroquois Place
Ann Arbor, MI 48104
3 Zachary Goldberg Grandson 3,000.00
1422 Iroquois Place
Ann Arbor, MI 48104
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
IIS NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE 0.00
REV-1513 EX+(01-10)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE
INHERITANCE TAX RETURN BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF Danowitz, Karol S. FILE NUMBER
21 - 15-00160
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS(include outright spousal
distributions,and Froansfers
under See.9116(a)(1.2)]
4 Andrew Danowitz Grandson 3,00.00
121 Academy Lane
Broomall, PA 19008
5 Anna Danowitz Granddaughter 3,000.00
121 Academy Lane
Broomall, PA 19008
6 Harrisburg Bridge Club None 200.00
C/O Ms. Sandy Wilson
349 North 21 st St.
Camp Hill, PA 17011
7 Michael A. Danowitz Son One-half of
121 Academy Lane residuary estate
Broomall, PA 19008
8 Sharon F. Goldberg Daughter One-half of
1422 Iroquois Place residuary estate
Ann Arbor, MI 48104
Page 2 of Schedule J
LAST WILL AND TESTAMENT
OF
KAROL S. DANOWITZ
s ,
LAST WILL AND TESTAMENT OF
KAROL S. DANOWITZ
I, KAROL S. DANOWITZ of 1072-16 Lancaster Blvd. ,
Mechanicsburg, Cumberland County, Commonwealth of Pennsylvania,
17055, being of sound and disposing mind and of full age, do make,
publish and declare this as and for my Last Will and Testament,
hereby revoking any and all prior Wills or Codicils.
r.
ITEM I.
(a) I direct that all my just debts and funeral expenses
be paid by my Executors or successors as soon after my decease as
may be conveniently done.
(b) I direct that I be cremated and that my Executors
decide where to keep or place the ashes.
ITEM II.
I give any pets I own to my son, MICHAEL ALLEN DANOWITZ.
ITEM III.
(a) I leave the sum of Three Thousand Dollars
($3 , 000. 00) to each of my living grandchildren.
(b) I leave the sum of Two Hundred Dollars ($200. 00) to
the Harrisburg Bridge Club of which I am currently a member.
ITEM IV.
(a) I give the rest of my Estate, of whatever nature,
real, personal or mixed of whatever kind and wherever situate which
I now own or may hereafter acquire, to my beloved children, SHARON
F. GOLDBERG and MICHAEL ALLEN DANOWITZ, in equal shares.
(b) In the event either or, both of my children shall
predecease me, or not survive me by thirty (30) days, I give that
deceased child's share to that child's issue, per stirpes .
(c) In the event either child shall have predeceased me,
or not survive me by thirty (30) days, leaving no issue, I direct
that his or her share shall be paid over and augment the share of
the surviving child.
ITEM V.
In the event any of my children shall be incapable of
receiving his/her share of my estate directly because of minority
or other incapacity, I direct that his/her share of my estate shall
remain in Trust during such incapacity for the following uses and
purposes:
(a) To use for necessities, with "necessities" being
described in the most liberal way, including but not limited to
food, clothing, shelter, education, entertainment, etc.
(b) To distribute and pay over to any such beneficiary,
the corpus of the trust when the beneficiary becomes 18 years old
or pursuant to the provisions of this Will.
2
ITEM VI.
I expressly direct that all principal and income of any
Estate or Trust created hereunder shall be free and clear of the
debts, contracts and engagements of those beneficially interested
therein, and from anticipation, assignment, alienation,
attachments, executions or sequestrations, by any process, legal or
equitable, and shall be paid over directly to the persons entitled
thereto hereunder upon their own proper receipt in writing only.
ITEM VII.
In addition to powers elsewhere granted herein or by law,
my Trustee(s) , at their sole discretion and without leave of Court
may:
(a) Invest principal and accumulated income in any
secured, interest-bearing account;
(b) Allocate any property received or charge
incurred including Trustee's compensation to principal or income or
partly to each, without regard to the usual rules of trust
accounting;
(c) Distribute principal and/or interest of the Trust to
or for such beneficiary as shall or may be absolutely necessary for
the education, comfort, maintenance and/or support of such
beneficiary.
3
(d) If, in the judgment of my said Trustee, it shall
become uneconomical or otherwise inappropriate to set up or
continue any Trust hereunder, my said Trustee may distribute the
principal and accumulated income of such Trust directly to the
beneficiary or to deposit such principal and accumulated income in
a federally insured savings account for the beneficiary with or
without restrictions as my Trustee may deem appropriate.
11.1 I-N
ITEM VIII. P--U
In addition to the powers elsewhere granted herein, or by
law, my Executors and/or their successors, at their sole discretion
and without leave of Court may:
(a) Compromise any claims by or against my Estate,
without consent of any beneficiary;
(b) Make distributions hereunder either in cash or
in kind at valuations to be determined by my Executors or their
successors; and
(c) Sell property for such prices on such terns,
and at public or private sale as he may deem proper and grant
options for the purchase of property.
ITEM IX.
(a) I appoint my children, SHARON F. GOLDBERG and
MICHAEL ALLEN DANOWITZ, or the survivor of them, to be the
4
Executors of this, my Last Will and Testament.
(b) Should any trust be necessary for any beneficiary,
I nominate the surviving parent of that beneficiary.
(c) Any successor fiduciary shall have the same powers,
rights, duties, discretion and immunities which I have conferred
upon the original fiduciary.
(d) No fiduciary hereunder shall be required to enter
security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this day of March, 2004.
1ROL S. )ANOWITZ
SIGNED, SEALED, PUBLISHED and DECLARED by the above-named
Testatrix, KAROL S. DANOWITZ, as and for her Last Will and
Testament, in the presence of us, who at her request, in her
presence and in the presence of each other, have hereunto
subscribed our names as witnesses.
Address Jo
Address
5
ACKNOWLEDGEMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA:
SS
COUNTY OF DAUPHIN
WE, KAROL S. DANOWITZ, the Testatrix and witnesses,
respectively whose names are signed to the attached instrument
dated the day of March, 2004 , being duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and
executed the instrument as her Last Will and Testament and that she
signed willingly, and that she executed it as her free and
voluntary act for the purposes therein expressed, and that each of
the witnesses, in the presence and hearing of the Testatrix, signed
the Will as witness and that to the best of his or her knowledge,
the Testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
ROL S. DANOWITZ
Witness
94':�u& v2jf&-aza-
witness
Subscribed, sworn to and acknowledged before me by KAROL S.
DANOWITZ, the Testatrix, and subscXibed and sworn to before me by
the above, her witnesses, this 77i�i day of March, 2004 .
Notary Public
COMMONWEAL H OF PENNSYLVANIA
Notarial Seal
Aimee L.Paukovits,Notary Public
City of Harrisburg,Dauphin CO.
MY Commission Expires Apr.17,2
PSECO
03/04/2015
Michael A. Danowitz
Estate of Karol Danowitz
121 Academy Lane
Broomall, Pa 19009
Re: KAROL S DANOWITZ, Deceased.
PSECU Reference#7350208130833
Dear Mr.Danowitz:
The above referenced person has an account with PSECU which wasopened on November 27. 1981.
The Share accounts were individually held by KAROL S DANOWITZ.
The following.are the Date of Death Balances for KAROL S DANOWITZ's account with PSECU:
Account Date of Death Balances Interest—January 1-9th
Savings (Sl) $ 65.93 S 0;00
Checkin- (S4) $12,290.79 $0.21
Mloney'Mark-et (S1) S 7,852.62 $0.58
The account has been closed per your:mquest.
If you have any:cluestions,please contact our department toll-free at(800)237-7323,press 6.extension
3120 or email accountservices(i'7i)secu.co
Sincerely,
Dana Willard
Member Service Representative
PSECU
P. OB(,)X 67013 1�iARRISBURG, PA 17106-70113 $00.237,7328 ,:,psecu.com
THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORI UNITY LENDER.
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EXHIBIT "B"
AftFidelftv
February 25,2015
MICI]AEL A.DANOWITZ
121 ACADEMY IN
BROOMALL.PA 19008-1925
Dear Michael A Danovvitz:
As recItiesteri,pleasc find the Date of Death Account Valuation.for the Estate of Karol S Danowitz.
Estate Valuation
Account Number: 243364410 Individual TOD. Value Date: 0110912015
Share
Symbol Security Description Qty Value Price
D DOMINION RESOURCES INC VA NEW 100 $7,694.85 $76.95
-NI NISOURCE INC 100 $4,24825 $42.48
Total Securities: $11,943.10
Cash/Money Markets: $9,12933 $1.00
Total Value: $21,072.83
Estate Valuation
Account Number: 34543678.0 IRA Value,Date: 01109/2.016
Share
,Symbol Security Description oty value Price
AAPL APPLE INC 3.6.615 $4,090:99 $111.73
WTR AQUAAMERICA INC 136.025 $3,631.88 $26.70
AT ATLANTIC POWER CORP COM NPV ISIN 197.136 $526.34 $2,67
BMY BRISTOL MYERS SQUIBB 108.361 $6,556-37 $60.51
CVx CHEVRON CORP NEW 12:835 $1,398,32 $108:95
CSCO CISCO SYS INC COM ISIN#US17276R1023 146.54 $4,067,95 $2736
DUK DUKE ENERGY CORP NEWCOM NEW[SIN 110.791 $9,396.60 $84.80
EPD ENTERPRISE PRODUCTS PPTNS LP 213,333 $7,287.99 $34A6
XOM EXXON MOBIL CORP 26.41 $2,43111 $92.08
STIAX FEDERATED STRATEGIC INCOME CLASS A 1754.535 $15,77127 $8,99
FSICX FIDELITY STRATEGIC INCOME 401.391 $4,290.85 $1{1.69
GEL GENESIS ENERGY L P UNIT L P INT 183.231 $71587.60 $41.41
INTC INTEL CORP 208,237 $7:653,76 $36.76
JAFIX JANUS FLEXIBLE BOND FUND CLASS T 397.523 t4,221.70 $10.62
LINE LINN ENERGY LLC UNITREPSTG LTD 270.715 $3,013.04 $11,13
',Brokeragc Services provided b;Fidelity Brokerage Serviccs I.I.0 Member NYSE,SIPC
Clearing,cust(vJy and scrilenwnt services by National Financial Services I.A.C.Member NYSE,S111C.
11.0,13ox 770061.Cinchimiti,0H 45277-0034
0,%Fidelftv
0 S r AV aswrs Aw
MDU M D U RES GROUP INC 107.617 $2,54998 $23,70
PFE PFIZER INC 61.546 $2,003.94 $32.56
PDVDX PIMCO DIVERSIFIED INCOME FUND..CL D 286.325 $3,052.20 $10.66
PTTDX PIMCO TOTAL RETURN CLASS D 41.132 $442.56 $10.76
000M QUALCOMM INC 36.448 $2,706.45 $74.26
SORL SEADRILL LIMITED SHSISIN 4BMG7945EI057 108.404 $1,093.27 $10.09
SRE SEMPRA ENERGY 83,836 $9,295,62 $110.88
SO SOUTHERN CO 120.031 $6,000.89 $50.00
TRP TRANSCANADA CORPORATION COM NPV ISIN 55.427 $2,616.98 $4712
VBINX VANGUARD BALANCED INDEX INVESTOR 196.898 $5,841.95 $29.67
VHDYX VANGUARD HIGH DIVID YLD INDEX FD INV 328,511 $8,915.77 $27.14
VWINX VANGUARDIWELLESLEY INCOME INVESTOR., 268.315 $6;893,00 $25-69
VET VERMILION ENERGY INCCOM ISIN :107.51 $4,657.86 $43.33
WIN WINDSTREAM HLDGS INCUSD0.0001 277.515 $2,282.57 $8.23
XEL XCEL ENERGY INC COM 252,618 $9,170.02 $36.30
FAIRPOINT COMMUNICIATIONS INC NO STKHLDR EQTY 2.346 $0.00 $0.00
SUN CAL ENERGY INC COM 125 $0.00 $0.00
Total Securities: $149,450.43
Cash I Money Markets: $3,480.97 $1,00
Total Value: $152,931.40
Interest in the amount of$3.75 from the Videlity Strategic Income fund is not included in(lie above amount,
Estate Valuation
Account Number: 327432989 Roth IRA Value Date: 01109/2015
Share:
Symbol Security Description Qty Value Price
SPHIX FIDELITY HIGH INCOME 633.873 $5,635.15 $8.89
VBMFX VANGUARD BOND INDEX TOTAL MKT INVESTOR 414,139 $4,543.09 $10.96
VFIIX VANGUARD GNMA INVESTOR CL 580.547 $6129112 $10.83
Total Securities: $16,471.36
Cash/Money Markets: $4.06 $1.00
Total Value: $16,475.42
Interest in the amount of$7.76 from the Fidelity High Income fundis not included in the above amount.
All values included represent the Fair Market Value(FMV)of assets held in the account as of the owner's date of
death.The report does not include Limited Partnerships,Options, Precious Metals or Worthless Security positions
field in the account as of the date of death nor any accrued dividends not distributed prior to the date of death. Values
for any accounts that only hold those asset types are therefore,not included.
Fidelity does not Nvarranty the accuracy of this infortwition for any particular purpose nor does Fidelity provide legal
or tax advice. Consult with an attorney or wx professional regarding any specific legal or tax situation.
FOR TRUST ACCOUNTS: Please note that if the account on the valuation is'a trust registration reporting,
under-a social security number(SSN),then the cost basis of]00%of the account will automatically be stepped
up. If the trust has anctriployer identification number(BIN),a separate request must be submitted, The letter
inust include the following three items:
1. A statement that the trust qua li fics under the IRS regulation to receive a step up
2. The percentage of the trust that should be stepped up
3. The signature of a currently acting trustee
' Broke rage Services provided by Fidelity Brokerage Services LII Member NYSE,SIPC
Clearing.custody and settlement services by Nation Financial Services LLC Member NYSU'..S111c,
11.0,13os 770061,Cincinnati,01-145277-0034
yVi"",ES row E Mrs.
The request to update cost basis should be sent directly to:
:Fidelity Investments
ATIN:Cost Basis
100 Crosby Pkwy,Mailzone KC.1 K-PR
Covington,KY 4.1015
We hope this information is helpful. If you have any questions regarding this matter or need instructions on how to
transfer the ownership of the accounts not yet tranSfCrred,please call us at 800-544-0003. Fidelity Inheritor Services
Representatives are available Monday through Friday,from 8:00 A.M.to 6:30 P.M.Eastern time,or you may visit
our website at Nvww.fideliLy.com and search under"change account registration"for additional information.
Sincerely,
Fidelity Investments
Our,file number: W062354-17FEB 15
3 BrAcnige Services provided by Fidelity Brokerage Services LLC Member NYSE-.,SIPC
Clearin,9-custody and sculement services by Natio6l Finaficiil Services,LII. Member NYSE,S111V
11.0,Box 7700011,Cincinnati,01145277-0034