HomeMy WebLinkAbout09-23-05 (3)
REV.l500 EX . (6-00)
*'
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENrs NAME (LAST. FIRST. AND MIDDLE INITIAL)
King, Eugene C.
DATE OF DEATH (MM-DD-YEAR)
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12-31-2004
(IF APPUCABLE) SURVIVING SPOUSE'S NAME I LAST. FIRST AND MIDDLE INITIAL)
07-09-1930
DATE OF BIRTH (MM-DD-YEAR)
FILE NUMBER
II 2005
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
NUMBER
0068
171-24-5517
THIS RETURN MUST BE FILED IN DUPUCATE WrTH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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o 1. Original Return
o 4. Limited Estate
[!J 6. Decedent Died Testate (Attach
copy of Will)
o 9. Litigation Proceeds Received
o
o
o
o
2. Suppiemental Return
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal Poverty Credit (date of death between
. 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach 5th 0)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
11. Total Deductions (total Lines 9 & 10)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
12. Net Value of Estate (Line 8 minus Line 11)
Copyright 2002 form software only The Lackner Group, Inc.
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAlUNG ADDRESS
James D. Bogar
FIRM NAME (If applicable)
Bogar & Hipp Law Offices
TELEPHONE NUMBER
717-737-8761
One West Main Street
Shiremanstown, PA 17011
1. Real Estate (Schedule A)
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(1)
(2)
(3)
(4)
(5)
(6)
(7)
None
OFFICIAL USE ONLY
76,845.66
None
None
6,272.11
None
None
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(8)
.8.3,117.77>,
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(9)
(10)
22,002.49
13,664.43
(11)
35,666.92
47,450.85
0.00
(12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
47,450.85
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20.0
0.00
0.00
0.00
7,117.63
7,117.63
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
Z or transfers under Sec. 9116(a)(1.2)
0
i= 16. Amount of Line 14 taxable at lineal rate 0.00 x .045 (16)
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a. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
u 18. Amount of Line 14 taxable at collateral rate 47,450.85 .15 (18)
)( x
~ 19. Tax Due
(19)
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH<<
Form REV-1500 EX (Rev. 6-00:
,~~
Decedent's Complete Address:
STREET ADDRESS
30 Honeysuckle Drive
CITY Mechanicsburg
STATE P A
ZIP 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditS/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
7,117.63
6,412.50
337.50
Total Credits (A + B + C)
(2)
6,750.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total InteresVPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3)
(4)
(5) 367.63
(SA)
(5B) 367.63
Make Check Payable to: REGISTER OF WILLS, AGENT
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
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;.............................................................._................. ~ ~
~: ~:::~ ~~e~~~i~~~~s:~~;~s;~~.~~~~~.~~.~..~~.~..~.:~~~_:.~~~~.~~.~.~~~.~:.~~~_~~~~:~~::::::::::::::::::..........................:::: :
d. receive the promise for life of either payments, benefits or care? ............................................................. x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .............................................................................................-...................... 0
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DATE
56 Bayberry Drive
Mechanicsburg, PA 17050
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5845 St. George Avenue
Westerville, OH 43082
ADDRESS
ADORESS
One West Main Street
Shiremanstown, PA 17011
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For dates of death on or er Iy 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 . . 99116 (a) (1.1) (i)].
For dates Df 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%
[72 P.S. 99116 (a) (1.1) (Ii)]. The statute does not exemDt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure
of assets and filing a tax retum 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 twenty-one years of age or younger at death to or for the use of a
nalural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (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%, except as noted in 72 P .S.
99116 1.2)[72 P.S. 99116 (a)(l)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .S. 99116 (a) (1.3)J. 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.
ReII-485 EX; (9-00)
'*'
SAFE DEPOSIT BOX
INVENTORY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX is LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
DATE OF DEATH
12/31/2004
(CITY) (STATE)
PA
(CITY) (STATE)
Shiremanstown PA
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING
. a. (NAME) (RELATIONSHIP)
James D. Eogar, Esquire None
(STREET NAME) (CITY)
One West Main Street Shire~anstown.
b. (NAME) (RELATIONSHIP)
Jeffrey A_ King Nephew
(STREET NAME) (CITY)
56 Eayberry Drive Mechanicsburg
c. (NAME) (RELATIONSHIP)
Roger F. Trostle Nephew
(STREET NAME) (CITY)
5845 St. George Ave. Westerville
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
(NAME)
Citizen's Eank
(STREET NAME)
2 West Main Street
I NAME OF PERSON MAKING LAST ENTRY
Je p..lM
DATE OF CONTRACT TO R T BOX NUMBER OF BOX
\;z. LJIRl, ~W-l.- LS"-z...
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. (NAME)
JRt~ ~.~~
(STREET ADDR;~~) ( \j
(CITY) 5'tg ~a,.Id~(j' ~E)
(STATE)
PA
(STATE)
PA
(STATE)
OH
(STATE)
PA
b. (NAME)
(STREET ADDRESS)
(CITY)
(STATE)
-1~t>~
WAS A WILL IN THE BOX? 0 YES LJ NO
If yes,
a. Date of will:
b. Name and address of personal representative, if named in the will
(NAME)
(STREET NAME)
(CITY)
(STATE)
c. Name and address of attomey, If any
(NAME)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
17050
(ZIP CODE)
17011
(ZIP CODE)
17011
(ZIP CODE)
17050
(ZIP CODE)
43082
(ZIP CODE)
17055
(ZIP CODE)
(ZIP CODE)
(ZIP CODE)
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING Copy OF A -""
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INvENTORY:/// ~...........L I
(~r!/ A-JI ~net~CWa,Lta:
P'}INT tjA~J.ND CHE~PROPRIATE BOX~LOW:
Jeffrey A. King & Roger F. Trostle
CHECK APPROPRIATE BOX:
CQ-
.KJ{Executor(trix) 0 Administrator{trix)
D Estate Representative 0 Joint owner of safe deposit box
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
ITEM
NO.
:,
SAFE DEPOSIT BOX INVENTORY Page
INSTRUCTIONS
of
Cash: Report total only.
Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by name of company, certificate number. date of certificate, name in which stock is registered, and
number of shares and class of stock.
Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book,
name of bank and branch, and balance.
Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
All other contents.
ITEM DESCRIPTION
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SIGNA~ . 11 tfdlb.
(//i"r/urt/-r ,-
PRINT NAME {, \J
James D. Bogar, Esquire
PRINT TITLE
NOTE: A
,
DATE
Attorney
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additional 8'/2" X 11/1 sheetl.~\ if nA~A~J:.~rv nr I14::.A rfll"Ii...~+.a.~ ",f ...J..ie ................... ""'. $...........
Roy-1503 EX. (5-8S)
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
King, Eugene C.
FILE NUMBER
21-2005-0068
All property j04ntly-owned with right o' lurvlvorshlp must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Citizens Investment Services Corp. - Date of Death 71.163.06
Value of Account $71,163.06
2 123 shares of Manulife Financial Corporation - 46.20 5.682.60
Common Stock
TOTAL (Also enter on Line 2, Recapitulation) 76.845.66
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 tonm software only The Lackner Group, Inc.
Fonm PA-1500 Schedule B (Rev. 6-98)
~~ Citizens
Investment Services
I200 Hancock Street
Quincy, MA 02I69
April 21, 2005
James Bogar
1 West Main Street
Shiremanstown, P A 17011
Re: Statement Request, Eugene King
Dear Mr. Bogar:
Per your request, enclosed is a copy of the December 2004 statement for account number
L7C 209791 (formerly account number 65719724).
We appreciate the opportunity to serve your financial needs. Should you have any
questions, please contact us at 800-942-8300, Monday through Friday, between 8:00 a.m.
and 5:00 p.m.
Sincerely,
Brian Hokeness
Service Quality Specialist
Enclosure
Cc: Tina Giambanco
017-01 15205Pbk
Securities and Investment Advisory Services offered through CCO Investment Services Corp. Member NASD, SIPC. One Citizens Plaza, ProvidBnce, RI 02903. (800) 942-8300.
Insurance products offered through CCO Investment Services Corp. In Massachusetts. insurance is offered through Citizens Financial Services Insurance Agency.
In New York, Insurance is offered through Citizens Insuranca Agency of New York Inc.
CCO Investment Services Corp.. Citizens Financial Services Insurance A ency and Citizens insurance A en of New York Inc. are affiliates of Citizens Bank of Rhode Island.
Products are: -NOT FDIC INSURED - NOT BANK GUARANTEED - NOT A DEPOSIT - MAY LOSE VALUE - NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY
.' CITIZENS
~.. INVESTMENT SERVICES CORP.
One Citizens Plaza
Providence. RI 02903
(800) 942-8300
YOUR 8ROKERAGE ACCOUNT STATEMENT
NDv.mber 30, 2004 to
Dec.mber 31. 2004
12811 4005318 001 008137 CFY
EUGENE C KING
30 HONEYSUCKLE DRIVE
MECHANICSBURG PA 17050
YOUR ACCOUNT
65719724
EUGENE C KING
YOUR REPRESENTATIVE
TINA GJAMBANCO
REP ID: PF76
--..,..---...,......,..-----
If you have any questions or concerns with regard to this account, please call1-BOO-942-8300.
Total value of your account on Dec 31, 2004
Cash account
$71.163.06
$71,163.06
Asset allocation
November 30, 2004
$32,317.48
Fixed income
Taxable fixed income
Equiti.s
Total assets
TDtal valu. Df your """Dunt
$32,317.48
$32,597.94
December 31, 2004
$32.597.94
$38,565.12
$71,183.06
$71,163.08
$37,475.73
$69,793.21
$69,793.21
EQuities 53.7
Equities 54.
FiXed income 45.81%
FMd income 46.30%
Summary of your income
TlllUIbl.in""me
Dividends
Capital gain distributions
TDtal taxabl.incom.
TD~~I~'='.~!_!"_~!.!!.'~estmentsl1"ve ....m.d
This period
$319.31
$2.54
$321.85
$321.85
Year-to~date
$1,159.19
$2.54
$1,161.73
$1.161.73
12811400531802562204612600001/00002
Account carril!td with FIS8IV Securtttes. Inc.. a member of tne NYSE. NASO and otner principaj exchan~s. SIPC.
PAGE 10F 4
YOUR BROKERAGE ACCOUNT STATEMENT
November 30, 2004 to
December 31, 2004
JJ.' CITIZENS
~... INVESTMENT SERVICES CORP.
YOUR ACCOUNT
65719724
EUGENE eKING
Your investments cash account
QuantitY 0
Priceon
12J31104
($) e
Fixed Income taxable
Mutual fUnds
DREYFUS PREMIER UMITED TERM INCOME FUND CLASS R PLTIX
EATON VANCE GOVT OBUGATlONS FUND CLASS B EMGOX
EATON VANCE STRATEGIC INCOME FUND CLASS A ETSIX
Total mutual fUnds
Total blXlIble fixed income
Total fixed income
18.995
1,689.272
2.383.79
11.3900
7.6400
8.1700
One Citizens Plaza
Providence, RI 02903
(800) 942-8300
Valueon
12I3l104
($)
EsL Est.
annual yield
incom":$) (%)
216.35
12.906.03
19,475.56
32,597.94
32.597.94
32,597.94
Equities
Mutual fUnds
DREYFUS DISCIPUNED STOCK FUND DDSlX
DREYFUS PREMIER TECHNOLOGY GROWTH FUND CLASS B
DTGBX
EATON VANCE LARGE CAP VALUE FUND CLASS A EHSlX
EATON VANCE UTIUTlES FUND CLASS A EVTMX
Total mutual fUnds
Total equities
183.82
1.137
31.9300
21.9100
1,243.531
1,193.059
16.8800
9.7900
5,869.37
24.91
20,990.80
11,680.04
38,565.12
38,565.12
Value of your cash account
71.163.06
Total value of your account
$71,163.06
Activities in your account cash account
Amounaddedto
(deductedrom)
Date ActivitY Details QuantitY 0 Pnce($) e youraccount($)
12/01/04 DIVIDEND EATON VANCE STRATEGIC INCOME FUND CLASS A 115.25
INC DIV 11130/04 ll/30/04
12/02/04 DIVIDEND DREYFUS PREMIER UMITED TERM INCOME FUND 0.60
CLASS R INC DIV 11130104 11/30/04
12/02/04 DISBURSEMENT SETL CHK ACCNT 6201166681 (115.25)
12/03/04 DISBURSEMENT SETL CHK ACCNT 6201166681 (0.60)
12/10/04 DIVIDEND EATON VANCE UTIWT1ES FUND CLASS A INC DIV 31.26
12/08/04 12/09/04
12/10/04 DIVIDEND EATON VANCE LARGE CAP VALUE FUND CLASS A 59.27
INC DIV R12/08/04
12/10/04 RECEIVED EATON VANCE LARGE CAP VALUE FUND CLASS A 3.605
INCOME REINVST@ 16.44 12/09/04
12/10/04 REINVEST DIV EATON VANCE LARGE CAP VALUE FUND CLASS A (59.27)
INC DIV R12/08/04
12/13/04 DISBURSEMENT SETL CHK ACCNT 6201166681 (31.26)
12/16/04 DIVIDEND EATON VANCE GOVT OBUGATlONS FUND CLASS B 67.15
INC DIV R12/15/04
12/16/04 DIVIDEND DREYFUS DISCIPUNED STOCK FUND INC DIV 45.78
R12/13104
PAGE 2 OF 4
.' CITIZENS
~.. INVESTMENT SERVICES CORP.
One Citizens Plaza
Providence, RI 02903
(800) 942-8300
YOUR 8ROKERAGE ACCOUNT STATEMENT
November 30, 2004 to
December 31, 2004
YOUR ACCOUNT
65719724
EUGENE eKING
-----..-- -......- -~_..
Activities in your account cash account contd
Amouneddedto
(deductedrom)
Date Activity Details Quantity 0 Price($) e youraccount($)
12/16104 RECEIVED DREYFUS DISCIPUNED STOCK FUND INCOME 1.44
REINVST@ 31.79.12/14104
12/16104 RECEIVED EATON VANCE GOVT OBUGATIONS FUND CLASS B 8.778
INCOME RElNVST@ 7.65 12/15/04
12/16104 REINVEST DIV EATON VANCE GOVT OBUGATJONS FUND CLASS B (67.15)
INC DIV R12/15/04
12/16104 REINVEST DIV DREYFUS DISCIPUNED STOCK FUND INC DIV (45.78)
Rl2/13104
12/27/04 CAPITAL GAINS DREYFUS PREMIER UMITED TERM INCOME FUND 2.54
CLASS R 20%LCG 12/2:l/04 12/22/04
12/3Y04 DISBURSEMENT sm CHK ACCNT 6201166681 (2.54)
---'"
About your statement
In this 5taremen~ "you" and :tout" mean the account holder. "FSr m~an$ AseN Securities.
Inc.. the catrflns: fftm fbt)OUr btOketage 4CCOunt.
If you wish to cnange your addr8$S or direct a complaint, please call CItizens Investment
Services COrp. en 800.942.8300.
AlMMdtMlnfannatfonln tN. ~
The pnces and vaNes shown am the estimated t'IllJre5 on the statement date. Some
secunttes. such as bonds and S8CUritias that trade InfreQueMy. may not be priced. FSI
recewes seanit)' prtees and tax status from an iOl;lependent SDUrCa. While FSI consideB this
source to be reliable. the prices Jt pnMdes are 81'!:Il'tIXimate and are not necessarily the
prices me securities would receiw it they WltnJ sold. W. Ie IMftlcut_1ytrue of bond prI-..
T3I fanns will be pmo.Aded as required by the IRS.
Total oIw oIJOW' account
The total vajue of your account is the total value of your cash account. checking account.
margin account, snort account or other account.
The totJj value at your account doesn't: Include:
. any unprieed securrti8$
- any inwsunents you h~d outside )'OUr brokerage account
Because the total vajue of your account may not Indude the value of all your itM!5tments. it
is meant to be a gtnn Iolideline only.
AaMt.....aon
This shows you how your ill'AlStments are aJlocatecl amonl nve possible classes: cash and
equivalents. ftxed income, eQuities. options and omer. The tbced Income Class is divided into
taxable and rKm.~ investments. The 'otl1er' class includes investments that don't flt into
tnese categories. like limited partnerships and unit investment trusts.
Your statement Indudes an asset allocation pie chart 'When:
- Your assets an! allocated to mora than one c!ass ..
. .All of the asset classes have a positive \l8.lue.
Because the asset allocation may not inclUde the value of aU of )'tlur investments, the
percentages in the table and me pie chart are meant to be a guide only.
SUmmary of your IncotI*
This summary snows how much taxable and non.taxable income your inve5tments earned
during the statement period and for the year-to-date. It also shows you aU charges and other
dedUctions for me staterrent peri~ and the year-to-date,
The income ftlOJre5 are estimates for federal income taX PlJl1'OS8S and may vary from the
ftaures an the annual tax torm (all IRS FOO1'I$ 1099) FSI sends to you atter the snd of the
year. The income fte,Jres shown in the summary don't take into account any state or local
-..
Items in this statement listed as t8X8ble may not apply to offshom accounts. Please call your
representative with any questions.
Your ImraatInents
12811 400531802562304612800002/00002
1l1is section lists a!I of the irNeStments you held at the end of the statement pet'iod by type
of account and asset class. You'll find a description of eeen investment. its symbot, quantity,
prh:a and value. as well as an estimate of its annual income and estimated average annual
yield. It you have any questions regan::ling tnese calculations please contact FSt.
.IctIvttINln yew M>COUnt
This section lists uansactiOns in your account during the statement period by type 01
account. You'll tlnd a deserlption of!actl transaction along with the Cluantity, price and
amount added or deducted from your account.
...1Iy.......
FSI receiws lllfTluneratlon on a cems per snare baSis for directing on::lers in equity securities
anQIor ~ to particular broker/dea1ers, market centerS, or exchanges far execution. This
remuneration is considered eoml*'Sation for FSI. The source and amount of any
remun8f3tion FSI receives in connection witn your transaction will be disclosed upon your
request. FSJ executes any transactions in your account on behalf of your brokerage firm. For
more information, Cllnse contact your brokerage firm.
--
FSI acted as agent in any transaction marked as 'dividend reinvestment'. For more
Information. PMaM contact FSI in writing.
You can \l1eW an FSI Statement of Anandal COndition in P8f$0n at its omces, or ask FSI to
mail you a copy.
AS8fV Securities. Inc.. One Commerce SQuare, 2005 Market Street. Philadelphia, PA
19103.3212 (2lS) 838-3000.
Thls address may also be used it you have a complaint that you wtsn to direct to the
elearinll'lrm. " you wIM to chanCe your addNA,pl........ the &ddr...anellOI' phone
IIIIInlMr on tile front orw. sbltement.
About your account
PSI CUb-=count
You must pay for aU PUtehases in a cash account in full on or before the settlement date.
You can pay for Clurchases by depositing cast! into your account, selling other investments or
by drawing down other accounts.
LD.t: securltl..
AsetV Securities does not replace certificates. Aset\' Securities replaces only uanster and
ship non-recltipts for up to one yeer. FlseN Securitles will also replace stock certificates in
transit to Fiserv Securities, if Faserv Securities is in nan-receipt. All ottler losses are at tt1e
c1ient"s expense.
PAGE 30F 4
YOUR 8ROl<ERAGE ACCOUNT STATEMENT
November 30, 2004 to
December 31, 2004
11..' CITIZENS
~.. INVESTMENT SERVICES CORP.
One Citizens Plaza
Providence, RI 02903
(800) 942-8300
YOUR ACCOUNT
65719724
EUGENE eKING
Upon your request. Fiserv Securities, Inc. will provide you with the name of the market center or exchange to which a specific equity security or option
security order was routed for execution. The specific order must have been processed within the past six (6) months from the date of your request. Pleae
contact your Broker Dealer directly to request this infonmation or visit www.Fiservsecurties.com for FiserVs overall order routing infonmation
PAGE 4 OF 4
~~ ceo Investment
Services Corp_
r 200 Hancock Street
Quincy, MA 02r69
March 18, 2005
James D. Bogar
1 West Main St.
Shiremanstown, PA 17011
RE: Account Number: 65719724
Registration: Eugene C. King
Dear Attorney Bogar:
Weare writing with regard to your recent request for the above referenced account. Please extend our
condolences to the family of Eugene C. King.
We are providing a summary ofiVIr. King's account in the table below as of the close of business on
December 31, 2004.
~';:;?t~!ff:B:"'~~~i~t:illl:~1k'l,~N:'uMo~~~sli~"'-Sli:iielli~L~1t~~Q1tn't_~
Dreyfus Premier Technology 1.137 $21.91 $24.91
Growth Fund Class B
Dreyfus Disciplined Stock Fund 183.820 $31.93 $5,869.37
Dreyfus Premier Limited Term 18.995 $11.39 $216.35
Income Fund Class R
Eaton Vance Govt Obligations Fund 1,689.272 $7.64 $12,906.04
Class B
Eaton Vance Large Cap Value Fund 1,243.531 $16.88 $20,990.80
Class A
Eaton Vance Utilities Fund Class A 1,193.059 $9.79 $11,680.05
Eaton Vance Strategic Income Fund 2,383.790 $8.17 $19,475.56
Class A
Should you have any questions, please call CCO Invstment Services Corp Customer Service at
1-800-942-8300. We are available Monday through Friday, 8:00 a.m to 5:00 p.m We will be happy to
assist you.
~~R~
Qanice Russo
CCO investment Operation Specialist
001-0722030PS
Securities and Investment Advisory Services offered through CCO Investment Services Corp. Member NASD, SIPC. One Citizens Plaza, Providence, RI 02903. (800) 942-8300.
Insurance products offered through CCO Investment Services Corp. In Massachusetts, insurance is offered through Citizens Financial Services Insurance Agency.
In New York, insurance is offered through Citizens Insu.rance Agency of New York Inc.
CCO Investment Services Corp.. Citizens Financial Services Insurance A ency and Citizens Insurance A en of New York Inc. are affiliates of Citizens Bank of Rhode Isiand.
Products are: -NOT FDIC INSURED - NOT BANK GUARANTEED - NOT A DEPOSIT - MAY LOSE VALUE - NOT iNSURED BY ANY FEDERAL GOVERNMENT AGENCY
eRBS
Rov.1508 EX. (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
King, Eugene C.
FILE NUMBER
21-2005-0068
Include the proceeds of litigation and the date the proceeds were received by the estal8.
AU property Jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Cash
VALUE AT DATE
OF DEATH
447.53
2 Central Lincoln-Mercury - Lease Refund
48.75
3 Central Penn Auto - Refund
42.00
4 Citizens Bank, Checking Account No. 6201166681 - Date of Death Balance
$1,232.85, accrued interest $0.00
1,232.85
5 Cruisin' Inc. - Refund
1,394.46
6 Ford Motor Credit - Refund from Leased Vehicle
520.67
7 Hearst Corporation - Refund
33.25
8 Mid Atlantic Insurance - Refund
15.37
9 National Financial Services - Credit
276.24
10 Penn Treaty - Long Term Care Insurance Proceeds
54.09
11 Service Master - Refund
121.90
12 Personal Property - Value as per attached appraisal
2,085.00
TOTAL (Also enter on Line 5, Recapitulation)
6,272.11
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
t: CITIZENS BANK
525 William Penn Place
Suite 153-2510
Pittsburgh, PA 15219
March 21, 2005
JAMES D BOGNAR
ONE WEST MAIN STREET
SHIREMANSTOWN, PA 17011
Estate of EUGENE C KING
Date of Death: Dec 31, 2004
SSN: 171-24-5517
Dear Sir:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his /her date of death.
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884.
Sincerely,
Cr;:,~,~tr1~
Operations Services
z~ ,'.
+:: CITIZENS BANK
Account Number
Account Title
Date Opened
Account Type
Principal Balance as ofDOD
Interest from Last Posting to DOD
Account Balance as ofDOD
YTD Interest to DOD
6201166681
EUGENE C KING
12/16/02
Checking
$1232.85
$ .00
$1232.85
$22.93
To: James D. Bogar, Attomey
One West Main Street
Shiremanstown, PA 17011
From: William G. Rowe, Appraiser
211 Old Stone House Rd.
Carlisle, PA 17013
Re: Personal Property Appraisal
Eugene C. King Estate
30 Honeysuckle Drive
Mechanicsburg. PA 17055
Date: January 17, 2005
LINDEN HALL ANTIQUES
211 OLD STONE HOUSE ROAD
CARLISLE, PA 17013
717-249-1978
LIVING ROOM
Sofa
Wall hangings
Lamps
Knick knacks
Chairs (3)
Lamp stand
Small T.V.
Small display cabinet
Snack table set
Radio
Magazine racks (2)
OFFICE
Desk/chair
Older model T.V. & VCR
Mirror
Recliner .
Computer desk
Computer
Lamps
Lamp stand
Wall hangings
Humidifier
KITCHEN
Pots/pans
Microwave
Small appliances
Dishes
Miscellaneous household
King Appraisal .
$110.00
$50.00
$15.00
$60.00
$45.00
$15.00
$10.00
$45.00
$15.00
$5.00
$15.00
$85.00
$20.00
$15.00
$45.00
$110.00
$150.00
$10.00
$10.00
$10.00
$5.00
$10.00
$15.00
$10.00
$15.00
$10.00
1
01/1712005
DINING ROOM
Table/4 chairs
Music center/stand
Server
Cabinet
Small TV.
Mirror
BEDROOM
Bedroom set, complete
Lamps
Clock radio
Housewares
BEDROOM - STORAGE
Luggage
Bedding
Lamp
Housewares
GARAGE
Lawn chairs
NOTE: All major appliances stay with the house.
King Appraisal
TOTAL
.~ "
$125.00
$100.00
$30.00
$20.00
$15.00
$25.00
$750.00
$25.00
$10.00
$10.00
$25.00
$15.00
$10.00
$10.00
$10.00
$2,085.00
William G. Rowe
- -
-/?~
2
01/1712005
REV-1151 ex. (12-911)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
King, Eugene C.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-2005-0068
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 7,658.58
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Jeffrey A. King Roger F. Trostle
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 56 Bayberry Drive
City Mechanicsburg State PA Zip 17050
-
Year(s) Commission paid 4,150.00
2. Attorney's Fees Bogar & Hipp Law Offices 5,557.50
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 114.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 4,522.41
TOTAL (Also enter on line 9, Recapitulation) 22,002.49
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rey.1502 EX... (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYL.VANIA
INHERITANCE TAX FtETURN
FtESIDENT DECEDENT
ESTATE OF
King, Eugene C.
FILE NUMBER
21-2005-0068
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cocklin Funeral Home - Funeral
7.458.25
2
St. John's Church - Funeral Luncheon
200.33
Subtotal
7,658.58
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev'1502 EX. (H8)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COJoIIMONWEAl.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DeCEDENT
ESTATE OF
King, Eugene C.
FILE NUMBER
21-2005-0068
ITEM
NUMBER
AMOUNT
DESCRIPTION
15
16
1
Cingular Wireless - Bill-Final
33.32
2
Comcast - Cable Bill-Final
2.82
3
Cumberland Law Journal. Estate Notice
75.00
4
Jeffrey A. King - Rent
800.00
5
Jeffrey A. King - Rent
800.00
6
Jeffrey A. King - Rent
800.00
7
Linden Hall Antiques - Personal Property Appraisal
85.00
8
Nationwide Insurance
21.00
9
Patriot News - Bill-Final
28.30
10
Patriot News - Legal Notice
100.95
11
PP&L - Electric Bill-Final
269.20
12
RESERVES: - Costs to conclude administration of Estate including filing fee for
Pa. Inheritance Tax Return and Inventory; preparation of Fiduciary Income Tax
Returns
850.00
13
Robert Farber - 2004 Federal and State Personal Income Tax Returns
100.00
14
Silver Spring Township Authority. Sewer Bill-Final
138.84
United Water - Bill-Final
20.28
Verizon - Telephone Bill-Final
301.30
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6.98)
Rev.1502 EX. (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DeCEDENT
ESTATE OF
King, Eugene C.
FILE NUMBER
21-2005-0068
ITEM
NUMBER
DESCRIPTION
AMOUNT
17
Waste Management - Bill-Final
96.40
Subtotal
4.522.41
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev.1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYL,VANIA
INHERITANCE TAX RETURN
RESIOENT OECEDENT
ESTATE OF
King, Eugene C.
FILE NUMBER
21-2005-0068
Include unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Andrews & Patel - Final Bill 5.47
2 Bon-Ton - Credit Card-Final 89.33
3 Boscov's - Credit Card Bill-Final 734.23
4 Cabellas - Credit Card Bill-Final 2,304.81
5 Capital One Bank - Credit Card-Final 160.47
6 Central Pennsylvania Hemotology - Final Bill 39.01
7 CitiCards - Credit Card Bill-Final 940.66
8 Citizens Bank, Checking Account No. 6201166681 - Outstanding Checks not cleared 690.35
as of date of death
9 Danbury Mint - Merchandise ordered prior to date of death 103.50
10 Discover Financial Services, Inc. - Credit Card Payoff 1.500.00
11 Family Internal Medicine - Bill-Final 86.26
12 George K. Shahinian, M.D. - Bill-Final 52.81
13 James D. Bogar - Invoice for Preparation of Power of Attorney and Declaration 185.00
14 MBNA America - Credit Card-Final Payment 2,316.51
15 Moffett Pease and Lim - Bill-Final 26.94
16 Pa. Gastroenterology Consultants - Bill-Final 61.50
Total of Continuation Schedule(s)
See attached page
TOTAL (Also enter on Line 10, Recapitulation)
13,664.43
(If more space is needed, additional pages of the same size)
Copyright (e) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
Reva1512 EX+ (WI)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
continued
COMMONWEAl.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
ESTATE OF
King, Eugene C.
FILE NUMBER
21-2005-0068
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17 Pennsylvania Department of Revenue - 2004 Personal Income Tax 43.00
18 Quantum Imaging - Final Bill 51.31
19 SI Swimsuit Products - Bill-Final 29.91
20 Vascular Associates - Bill-Final 18.96
21 West Shore Anesthesia - Final Bill 5.11
22 West Shore EMS - Ambulance Bill n.90
23 West Shore Pathology. Bill-Final 152.36
24 Wolf Furniture - Bill-Final 3.989.03
TOTAL (Also enter on Line 10, Recapitulation)
13.664.43
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX. (9-00)
*'
SCHEDULE .J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
King, Eugene C. 21-2005-0068
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trusteelsl
I. TAXABLE DISTRIBUTIONS [include outright sgousal
distributions, and ransfers
under Sec. 9116(a)(1.2)]
1 Gregory A. Deardorff Nephew l/11th of Rest,
1039 Dishman Loop Residue and
Oviedo, FL 32765 Remainder
2 Lon Earl Deardorff Nephew l/l1th of Rest,
14 West Marble Street Residue and
Mechanicsburg, PA 17055 Remainder
3 Jeffrey A. King Nephew l/11th of Rest,
56 Bayberry Drive Residue and
Mechanicsburg, PA 17050 Remainder
4 Wendy L. Lambert Niece l/l1th of Rest,
4196 Nantucket Drive Residue and
Mechanicsburg, PA 17050 Remainder
5 Roger F. Trostle Nephew l/l1th of Rest,
5845 St. George Avenue Residue and
Westerville,OH 43082 Remainder
See continuation schedule attached Continuation
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
COPYright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
SCHEDULE .J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Eugene C. King 171-24-5517 12/31/2004
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Kimberly Y. Weaver Niece l/11th of Rest,
1210 Ridge Road Residue and
Dillsburg, PA 17019 Remainder
7 Dirk E. Wiley Grand Nephew l/l1th of Rest,
345 Mountainview Road Residue and
Shermans Dale, PA 17090 Remainder
8 Tamara Jo Slike Niece l/11th of Rest,
6171 Haymarket Residue and
Mechanicsburg, PA 17050 Remainder
9 Joyce E. Boyer Niece l/l1th of Rest,
13 Brookview Circle Residue and
Elizabethtown, PA 17022 Remainder
10 Brian S. Trostle Nephew l/l1th of Rest,
216 Lindy Avenue Residue and
York Springs, PA 17372 Remainder
11 Dennis C. Trostle Nephew l/l1th of Rest,
1161 Ivory Road Residue and
Frewsburg, NY 14738 Remainder
1
J
LAST WILL AND TESTAMENT
OF
EUGENE C. KING
I, EUGENE C. KING, of 200 Cockley's Drive, Mechanics-
burg, Cumberland County, Pennsylvania, 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 devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
~ncluding any property over which I hold power of appointment and
~ogether with any insurance policies thereon, unto my wife, JEAN
E. KING.
~
1
~\.
SECOND: If my wife, JEAN E. KING, predeceases me, I
and bequeath all the rest, residue and remainder of my
of whatever nature and wherever situate, including any
property over which I hold power of appointment and together with
any insurance policies thereon, as follows:
(A) I give and devise my wife's china
Moreland Grape Design (entire set), to my wife's
0:
TROSTLE and TAMARA TROSTLE, his wife.
(B) I devise and bequeath all the rest, residue and
remainder of my estate, in equal shares, to the following named
!individuals or should they predecease me, t6 their issue per
stirpes by representation: my wife's niece, JOYCE E. BOYER; my
wife's nephew, ROGER F. TROSTLE; my wife's nephew, DENNIS F.
TROSTLE; my wife's nephew, BRIAN TROSTLE; my nephew, LON EARL
DEARDORFF; my grand-nephew, DIRK E. WILEY; my nephew, GREGORY A.
DEARDORFF; my niece, TAMARA JO SLIKE; my niece, KIMBERLY Y.
WEAVER; my nephew, JEFFREY A. KING; my niece, WENDY L. POTOCKI.
THIRD: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
j
milk glass, West
nephew, ROGER F.
--
\
.( ,
-~ '--.:J'
._'-/
"
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
extinguish restrictions on real estate.
(e) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
and other tax laws, including, but not necessarily being
to, personal income, gift and estate or inheritance tax
Federal
_ ? ,limited
. '\
~ laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(1) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
2
. .
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FOURTH: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
FIFTH: I nominate and appoint my wife, JEAN E. KING,
Executrix of this, my Last will and Testament. In the event of
the death, resignation or inability to serve for any reason
whatsoever of the said JEAN E. KING, I nominate and appoint ROGER
F. TROSTLE and JEFFREY A. KING, Co-Executors of this, my Last
will and Testament. I direct that my Executrix or Executor, as
the case may be, and their successors, shall not be required to
post security or a bond for the performance of their duties in
any jurisdiction.
IN WITNESS WHEREOF, I have
to this, my Last will and
1994.
Signed, sealed, published and declared by the above-
named Testator as and for his Last Will and Testament in our
presence, who, at his request, in his presence and in the presence
of each other, have hereunto subscribed our names as attesting
witnesses.
Address
f'.-. -+ J:!' 1
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Address
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