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HomeMy WebLinkAbout01-25-07 REV. 1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust(Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-9 ) THIS SECTION MUST BE COft!IPLETE!l.AU C9RR~O~ .'?_<<Xlt!FlD~~~L,_!AX !NF~~:rtON.:SI10tJLD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Dale F Shughart, Jr. Esquire c COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG. PA 17128-0601 DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) Watson, Edythe R t- Z W o w u w o DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 10/06/2006 09/08/1918 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL) W t- ",:$<Il ull:'" wl1.U ",00 ull:..J 11.'" 11. <l: ~ 1 Original Return o ~ o 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received t- Z W o z o 11. FIRM NAME (If applicable) TELEPHONE NUMBER 717/241-4311 1. Real Estate (Schedule A) 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) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) FILE NUMBER 21 06 COUNTY COOE YEAR SOCIAL SECURiTY NUMBER 00913 NUMBER 212-22-3159 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death pnor to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 10 West High Street Carlisle, PAl 70 13 (1 ) None \",-.J ~'\ (2) None (:.:~:~ --..J (3) None (4) None ~) Ul (5) 16,055.32 tJ -- , I -.,... (6) 12,285.03 N (7) None (8) 28,340.35 (9) 4,606.55 (10) 7,796.35 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (11 ) 12,402.90 (12) 15,937.45 (13) 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) (14) 15,937.45 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x ;:: <l: t- :> 11. 17. Amount of Line 14 taxable at sibling rate 9,460.45 x .12 (17) 1,135.25 :; 0 u >< 18. Amount of Line 14 taxable at collateral rate <l: 6,477.10 x .15 (18) 971.57 t- 19. Tax Due (19) 2, I 06.82 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT_ >>BE SURE TO A.NS.~E~ A.l:':~_E.S11O.!I~ QI'I~R~~~,SIf)~_A!'.D~.<:_~~K~~~_<:< Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) J~ @ ~ KJ<ty\t:J ~~.~ ~1/ ~&~. De~edent's Complete Address: STREET ADDRESS Manor Care Nursing Home 940 Walnut Bottom Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 2,106.82 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + 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 + 5A. This is the BALANCE DUE. (3) 0.00 (4) (5) 2,106.82 (5A) (5B) 2,106.82 Make Check 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;................................................................................ ~ I ~: ;:::~ :~e~;~;i:~~~s:~~~:s~:~. ~~~~~. ~~.e. .~~.e. .~.~~~~~. ~~.~.~.~~.~.r.~~~ .~~. i~~. ~~~~~~~:::'.'.'. ..............;........~::::::::::::::...... d. receive the promise for life of either payments, benefits or care? ............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................... ....... D D D ~ ~ ~ 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 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. Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and sfatemenfs. and fa the best of my knowledge and belief, it IS true, correct and complete. Declaration of preparer other than the personal represenfative is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Jill Roberts 7dI ~ - ~L<- SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 879 North Stillman Street Philadelphia, P A 19130 2.0. C>1- ADDRESS DATE ADDRESS DATE 10 West High Street Carlisle, P A 17013 //J For dates of death on or after July 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 P.S. 99116 (a) (1.1) (i)l. 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% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot 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 twenty.one 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% [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) (1 )]. 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)]. 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. . SCHEDULE E CASH, BAN K DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Watson, Edythe R FILE NUMBER 21 - 06 - 00913 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 NUMBER 1 Clothing and personal effects. DESCRIPTION VALUE AT DATE OF DEATH 0.00 2 Orrstown Bank, representative payee checking account #106003950 Principal 2,008.84 Accrued interest 0 2,008.84 3 Orrstown Bank, personal Checking Account #106003929 Principal 8,016.75 Accrued interest .15 8,016.90 4 Commonwealth ofPA, final State retirement check 171.58 5 HCR ManorCare, refund of payment for nursing care 5,858.00 TOTAL (Also enter on Line 5, Recapitulation) 16,055.32 October 24,2006 To: Dale F Shugart, Jr. 10 West High Street Carlisle Pa 17013 From: Traci Shaffer Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of Edythe R Watson IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK. CHECKING ACCOUNT Account # 106800274 16003929 106800273 106003950 106800390 Title of Account Date opened Principle Accrued Interest Edyth R Watson 01/18/06 3258.80,.45 C/O James Roberts <)uvVl (:) I-'!- ( A l::v. JII'i1 "'y) R-1:wc,z-r<; Edythe R Watson 12/01/05 8016.75 .15 C/O Dale Shugart Jr Edythe R Watson Jill Roberts C/O Dale Shugart Jr Edythe R Watson Rep Payee Dale Shugart Jr Edythe R Watson 05/10/06...t. 18,102.20 James RobertsC)l{\N\P j ~... P--i/vJ(JIL/7) C/O Dale Shugart Jr 01/18/06 12/01/05 3205.64 2008.84 SA VINGS ACCOUNT Account # Title of Account Date opened Principle CERTIFICATE OF DEPOSIT Account # Title of Account Date Opened Principle .45 .00 2.50 Accrued Interest Accrued Interest " '. SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Watson, Edythe R FILE NUMBER 21 - 06 - 00913 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A James S. Roberts c/o Jill Roberts Brother 879 Stillman Street Philadelphia, P A 19130 B Jill Roberts 879 Stillman Street Niece Philadelphia, PA 19130 C .lames A. (alkla Jimmy) Robel1s 159-34 Riverside Drive West Nephew Apt C, New York, NY 10032 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF ITEM LETTER DATE Include name of financial institution and bank account number DATE OF DEATH DATE OF DEATH NUMBER FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real DECO'S VALUE OF TENANT JOINT estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST A 02/28/2003 On-stown Bank Checking Account #106800390 * 18,104.70 50% 9,052.35 2 B 01/20/2001 Onstown Bank checking account # 1 06800273 * 3,206.09 50% 1,603.05 3 C 01117/2003 Onstown Bank, checking account #106800274 * 3,259.25 50% 1,629.63 *Explanation of origin of joint accounts attached. TOTAL (Also enter on line 6, Recapitulation) 12,285.03 SCHEDULE "F" ATTACHMENT Explanation of Joint Account Sometime, many years ago, Decedent, Edythe R. Watson, opened a Merrill-Lynch Investment Account, #2AT-35120, jointly, by survivorship, with her brother, James S. Roberts. A statement confirming the existence of this Account in 2003 is attached. Also attached is 2005 Tax Year Reporting Statement and final closure statement. Also, sometime, many years ago, Decedent, Edythe R. Watson, opened two brokerage accounts at Alliance-Bernstein, jointly, by survivorship, one for her niece, Jill Roberts, #630006126 and one for her nephew, James A. (a/k/a Jimmy) Roberts, #6300021991. Confirmation of the existence of these Accounts in 2001 and 2003, respectively, are attached. Also attached are statements confirming the closure of these accounts in 2005 and 2006, respectively. In September, 2005, Estate Attorney, Dale F. Shughart, Jr., assumed responsibilities as Agent for the Decedent under General Durable Power of Attorney. The Decedent was a skilled care resident at ManorCare Nursing Home in Carlisle, who had become incapacitated due to progressive dementia. Attorney Shughart assumed responsibility for her finances, finding very few records prior to 2005. Those attached to this Schedule are the only ones in existence of which Dale F. Shughart, Jr. is aware. In late 2005, early 2006, Attorney Shughart liquidated the three brokerage accounts and used the proceeds to open joint checking accounts, by right of survivorship, at Orrstown Bank to the Account numbers referenced on Schedule "FII. Copies of the jointly issued checks and first bank statements confirming the deposits are attached. The Decedent's other assets having been depleted, these funds were used, proportionate to each other, on a monthly basis from March 2006 until Decedent's death to help pay the cost of the Decedent's nursing care. No funds were distributed to anyone but the Decedent prior to her death. The balances remaining in the three Accounts were disbursed to the surviving joint tenants after the Decedent's death. 00005318 <....III;}. 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Vd 31SnHV:> :> J.N3WUIVdV .133HJ.S 3~a1H "M 61.1. SOHM.lr S.1H380~ S S3WVr ONV NOSJ.VM 3H.lA03 80E'O ~d lJ. vt...WOO 9€:9LlW Ol", .11~IO-E ...D.1nV..................... 111'"'1'1'1"'11 '1"1'1"'1"1'11"'11"11'""'111"'111"'1 ~ ~ - - ~ - - ~ Merrill Lynch January, 2006 Enclosed is your Merrill Lynch Annual Tax Reporting Statement for 2005. The Consolidated Tax Reporting Statement provides a summary of 2005 reportable activity in your account, as well as a detailed, chronological breakdown of transactions grouped under the appropriate category: Dividends and Distributions, Interest Income, Original Issue Discount (010), Proceeds from Broker and Barter Exchange Transactions and Miscellaneous Income. Often, distributions made by Mutual Funds, Real Estate Investment Trusts (REITs), and Unit Investment Trusts structured as Regulated Investment Companies need to be reclassified as a different type of distribution after year-end financial information becomes available to the funds (i.e., nondividend distributions, qualified dividends or long-term capital gain distributions). Since this information may not be available to Merrill Lynch until after January 31, 2006, it may be necessary to send you updated information via an amended tax reporting statement, or alternatively, the issuer may provide a special communication or annual report. Over the last two years, Mutual Funds and REITS have made improvements to provide this information in a more timely manner. However, providing timely reclassified income information remains a challenge for many Mutual Funds and REITS. Merrill Lynch will provide you with any updated information via an amended tax reporting statement as soon as the information is available. Since we anticipate receiving amended information from Mutual Funds and REITS after January 31st, we strongly discourage any client holding Mutual Funds and/or REITS from filing their tax return early. Please discuss your specific situation with your tax advisor. Merrill Lynch extracts the realized gain and loss information as reflected on your monthly statement. Unfortunately, the gain and loss information will not reflect any subsequent income reclassifications related to retum of capital. As a result, gains and losses for these securities may be overstated or understated and may need to be adjusted. Information about certain transactions not included in this statement may be reported in separate statements from Merrill Lynch or other sources. Investors in Real Estate Mortgage Investment Conduits (REMICs) and certain other Collateralized Debt Obligations (COOs) will receive separate statements covering the tax reporting requirements of these investments, by March 15, 2006. Clients who will be receiving a REMIC/CDO Tax Reporting Statement will be advised of this with a message printed at the end of their reportable transactions in the enclosed statement. Investors who hold Limited Partnership interests in their Merrill Lynch accounts should receive separate statements (Schedules K-1) directly from the partnership regarding their income and deductions from partnership activities. Investors in certain Unit Investment Trusts (Defined Asset Funds) that are registered as grantor trusts will receive separate statements from Merrill Lynch. If you traded commodities or other regulated futures contracts, these transactions should be reported on a separate Tax Reporting Statement. Statement Enhancements This year's statement includes changes designed to clarify important information. First, to make it easier to identify qualified dividends, the dividend detail section has been modified to reflect the qualified dividend alongside its associated dividend. Second, in order to assist you in determining any difference between the reportable gross proCeeds and the available gain/loss information, we have expanded the gain and loss section to include totals for sales proceeds, cost basis and net gains or losses. We have also included the total reportable gross proceeds and any difference between that amount and the sales proceeds total of the available gain/loss transactions. TurboTax@ Effective February 1, 2006 you will have the ability to download your Form 1099 tax information directly from Merrill Lynch into TurboTax@, TurboTax@ for the Webs.., or one of the several TurboTax@ desktop software products. New this year, you will also be able to download your tax information into text files for importation into Microsoft Excel@ and other software. Enrollment into the free Merrill Lynch Online service will be necessary. For more information on these services and Intuit's 15% discount to Merrill Lynch clients for TurboTax@forthe WebsM, please visit the Tax Education and Planning Center on Merrill Lynch OnLine (MLOL). Unlimited Advantage Fee The Unlimited Advantage fee is generally charged in lieu of paying fees for various non-transaction services and traditional brokerage costs at the time of each service or eligible trade. A Big Four accounting firm has advised Merrill Lynch that it is reasonable to allocate a portion of the annual fee to the non-transaction services. They have also advised that it is reasonable to treat the remaining portion of the annual fee as attributable to transactions. It may then be characterized as a capital cost that can be allocated among your eligible tax lots as an adjustment to the original cost basis. For more information, please refer to the Unlimited Advantage Cost Basis Allocation Brochure and your Unlimited Advantage Cost Basis Allocation Worksheet, which are available through your Financial Advisor. Qualified Dividend Income Qualified dividend distributions to individuals will be eligible for the maximum capital gains tax rate of 15% (5% in some cases). The term "qualified dividends" includes dividends paid by most domestic corporations as well as dividends paid by qualified foreign corporations (e.g., foreign corporations whose securities are readily tradable on an established securities market in the United States). Dividends paid on ADRs that meet the "readily tradable" test will generally be treated as qualified dividends. In order to treat dividends from Mutual Funds or REITs as qualified, the Mutual Fund or REIT must reclassify their dividend income to qualified status. Since this information may not be available until after January 31, 2006, Merrill Lynch may be required to send you an amended tax reporting statement reflecting updated information. An amount shown on Line 1b of Form 1099-DIV as a qualified dividend indicates that the dividend is qualified at the issuer level. You must determine whether the shareholder level tests (e.g., the holding period requirement) are met, in order to treat the dividend as qualified on your income tax return. Mutual Funds are required to apply the holding period tests at the fund level when determining the character of dividend distributions they pass through to their shareholders. In addition, it is our belief that those investors will also have to satisfy the holding period requirements in order to treat the dividends as qualified. In certain cases, the holding period may not be met until after the end of the tax year. Please consult your tax advisor in determining the holding period for your specific investments and whether you meet the requirements for qualified dividend treatment. The aforementioned comments reflect Merrill Lynch's understanding of IRS reporting rules and regulations. Please keep in mind that this notice deals only with federal income tax laws and regulations and does not address state or local issues. Merrill Lynch is neither a tax advisor nor a tax return preparer. This notice is not a substitute for professional advice. You should consult your tax advisor for information about the consequences of your personal investment strategies and their implications for your particular tax situation. Customer Service Trained client service representatives are available to answer questions pertaining to the information provided on your Consolidated Tax Reporting Statement. A special telephone number will be available for your tax reporting questions through April 15, 2006, 24 hours a day, 7 days a week. Please call 1-800-637-6326 if you have any questions. If an error is identified and corrections are required on reportable transactions, Merrill Lynch will adjust the information provided to the IRS. Merrill Lynch will issue a new statement highlighting any corrections that have been made. If you need to change information concerning the name, address or taxpayer identification number of your Merrill Lynch account, you should contact your Financial Advisor or Client Associate. Please be advised that Merrill Lynch client service representatives will only discuss with your tax preparer limited and specific information regarding your tax statements. Additionally, if your account is protected by a Telephonic Password, Merrill Lynch client service representatives will need your verbal authorization to discuss any information with your tax preparer. 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CJ 00 08 lD 01 tv 0- t1) ;;;: g- f" c I III 0 -< c ""' I\.) G;- !JI (J) I\.) ~ 0 0 Ql <Jl :J () 0) s ~ 0 00 -., III -...j d 0 W :::T .9 "-...j C") w $ i\:> Cil J-' I\) IT1 ~ I\.) ::0 0 ::0 0 (j) r r ORRSTOWNBANK A Tradition of Excellence Date 3/31/06 Primary Account Enclosures Page 1 706002141 111.111111111,,1 "111,,11.1,,1.1 Edythe R Watson James S Roberts C/O Dale F Shughart Jr 35 E High St Carlisle PA 17013 WE PUT THE LOW IN LOANS! ASK ABOUT OUR SPECIAL LOW RATE HOME EQUITY LINE TODAY! CALL 1-888-0RRSTOWN ABOUT THIS LIMITED TIME OFFERl S A V I N G SAC C 0 U N T S Account Title Edythe R Watson James S Roberts C/O Dale F Shughart Jr Prime Statement Savings Account Number Previous Balance 2 Deposits/Credits Checks/Debits Service Charge Interest Paid Ending Balance 706002141 .00 56,374.83 .00 .00 169.52 56,544.35 Statement Dates 2/28/06 thru Days In The Statement Period Average Ledger Average Collected Interest Earned Annual Percentage Yield Earned 2006 Interest Paid o 4/02/06 34 53,468.55 49,657.93 169.52 3.84% 169.52 Date 2/28 3/22 4/02 Description Savings Deposit Savings Deposit Interest Deposit Reference 004087370 003092130 Amount 51,807.83 4,567.00 169.52 Balance 51,807.83 56,374.83 56,544.35 ..... ... .'~ ...~,..--.-I k'~ "~":I"j'" I . .- . ( Ill"-' ~. - - .~-JJ' ..' " O~?2~~~ ~ Teller #/Transaction # Time/Date Amount Account # OOliltOi.l9 [fEP 060B12:12PMD2-28-06 $51,807.83 #?06002J. 4..1. BR-36A .,- Please be Sure to enter this transaction in your records.." .........~~;.O..;,.-'-'O~~ I: 5 0 :l 0 III 5 0 0 0 I: ? 0 r; 00 2 1 1.. ~ II; I u1 60-15036 313 '!.:(IM (filII I; ~.IIH TOTAL 1I~1 Ollif 1< SIDI I !II 1..1 >111111 JlU.J II~, 11 t!C, <.. A~Jj 1:1 f IIVll' DEPOSET [If SURE: lACH I JTM I.':. l'ROPEIIl Y fNDORSU) All UfMC, ARf ACCFI'HlJ SURII:n lU OIH: RUlr~, AHD R[C\Ht,TlOW; M'I'tH 1-. f: \ 1 1(1 nil" A((OIINT ~ Merrill Lynch o S!j~8~ Syracuse, N.Y. 13202 5D-937 2T3 Office Disbursement Account 4804 Deer Lake Drive East Jacksonville, FL 32246 Date I 02/23/2006 ITypea To The Order Of EDYTHE WATSON AND JAMES S ROBERTS JTWROS C/O DALE F SHUGART. JR 35 E HIGH ST STE 203 CARLISLE PA 17013 II' c:.~ CJ B 7 20 J 20 9 I:' r:Ci 2 t ~Jg 3 r;:gr:t:[i .B~. 702 Merrill Lynch. Pierce, Fenner & Smith Inc. Check Number 00872-02209 Amount I PAY 'llif . " $51807.83 !J~ ....__-M-rrI'jJI LYllch c I'O'Bo,<4,~247 J:lcksol\vi lie. FL J2231-32/17 EDYTHE WATSON AND JAMES S ROBERTS JTWROS C/O DALE F SHUGART,.IR 35 F HIG" ST STE 203 CARLISLE PA 17013 403 I ",III It ,III '" ,It 11,,11 " ,11,11" " 1,1, " 1,1,1,1, "11,11,, ,I ORRSTOWNBANK A Tradition of Excellence <tJ'1 t ~~, CeM.5iJ A) 3'ctM25. 5~~ mk VCL,vV Teller #/Transaction # Time/Date Amount Account # ,";.., ':'I-.j !;:~/~",': ~.!~_: ", j::' ~\:i r j V< ~; ;" ; .; {:i i.J L.! ;; ':' I I BR-36A em1B Please be sure to enter this tmnsJcti6r'/jn: yob:tth~~d):'~{~:..: ,.., ,',\ "j 'L~_u_.~__... w. _ _,_" ._. "._ _ _ COLR9761 7673 0001 90SR 07060317 P^GE 00001 or 00001 00000403 ']:'[C1I~rll"~:I:t"~tI:,,~.:w,~..~~i.~i~':1I.:'.'f11~(l"I:I']II~1'.I'I'n.:.~1I1',I[":['I~:'I~..::t'.'I'/11:1~11~[~:"'~I' 'I ~ Merrill Lynch CHASE 0 6040 Tllrbell Road Syrl'lclIse, N. Y. 13206 511-9.11:'" 21Y'. Qfl'ice .::.::':<.'.:i ". ...::......:g~.' ~'~~:.~t~4;ActO~f.~lt.:...:..:. ':>J;lcksollville;FL 3223J~,;j24 7 Mc~willhYll~h, l)ielk~,r.~llll~F4~ Smilh rllc. Dale I OJ/ I 7/2006 . - .. . . Che~kNlImbef 53210-89062 .... Bn1l1ch I 872 Alllottnf' I PAY $4,567.00* Nol valid after 180 days To The Order Of EDYTHEi.W ATSONAN.U ..... '.. ."JAMESSROBERtS.lTWRO$ .. C/O DALE F SHUGART,.lR 35 E IHGH ST STE203 CARLISLE PA 17013 ~ ~-duJ '. ,'. .' , .' i ,". ,EXPL.A19ATION OF APPITlO.NAL SECURITY FEATURES INPICAT;EP ON.REVER~E SIP". i. II- 5 :\ 2 l. 0 B gOb 211- I: 0 2 l. :\ 0 g :\ 7 g I: b 0 l. a b 70 :l g II- AlLlANGEBERNSTEIN P.O. BUX 786003 SAN ANTONIO, TX 78278-6003 EDYTHE R WATSON & JILL ROBERTS JT TEN 119 WEST RI DGE STREET CARLISLE PA 17013-3822 000617 1."11111.111."."11,,11...11.1111,,,1.1111,11,1,,1.1,,,1.1,1 learn more about how AllianceBernstein works to build and preserve investor wealth. Visit www.alliancebernstein.cum. Mutual Fund Activity ~ AtLIANCEBERNSTEIN@ Investment Research and Management Confirmation Statement Date 12/16/05 Page 1 of 1 Fund Name AllianceBernstein U S Government A Trade Confirm Date Date Transaction Description Total Shares Owned 09/20 09/20 10/20 10/20 11/1811/18 12/16 12/16 12/16 12/16 Beginning Balance as of 09/20/05 INCOME REINVEST INCOME REINVEST INCOME REINVEST SHARES REDEEMED INCOME DIV CASH Ending Balance as of 12/16/05 Fund/Account Number 46/6300006126 Dollar Amount $2985 $32.34 $36.33 $9,913.56 $28 59 OPPENHEIMER & CO. INC 1015 MUMMA RD WORMLEYSBURG PA 17043-1118 Dealer No. 8239 Branch A09 Advisor No. 128 Advisor Name MICHAEL G CROUSE Ticker ABUSX Share Price Shares this Transaction $7 010 $6.940 $6.900 $6.920 4.258 4.660 5.265 1,432 596 0.000 1,418.413 1,422.671 1,427.331 1,432.596 0.000 o 000 0.000 m m L{) ... (") L{) 'AlliANCE US GOVT BOND FD - Cl A P.O. BOX 786003 SAN ANTONIO TX 78278-6003 CUMUlA TIVE STATEMENT' 09/20/2001 Alliance Capital ~ The Investment Professional's Choice REP. 128 MICHAEL G CROUSE IDENT. NO. OR SOC. SEC. NO. 212-22-3159 1",111",111"".,11,,11,.,11,1.,1..,1,1,,1,11.1,,1.1,,,1,1,1 EDYTHE R WATSON & JILL ROBERTS JT TEN 119 WEST RIDGE STREET CARLISLE PA 17013-3822 FAHNESTOCK AND COMPANY 1015 MUMMA RD WORMLEYSBURG PA 17043-1118 ~ o WATSOEDYTR FUND NO. ACCOUNT NO. 46 6300006126 TOTAL SHARES OWNED 1/20 2/20 3/20 4/20 5/20 6/20 7/20 8/20 9/20 TRANSACTION BEGINNING BALANCE 1/20 INCOME DIV CASH 2/20 INCOME DIV CASH 3/20 INCOME DIV CASH 4/20 INCOME DIV CASH 5/20 INCOME DIV CASH 6/20 INCOME DIV CASH 7/20 INCOME DIV CASH 8/20 INCOME DIV CASH 9/20 INCOME DIV CASH DOllAR AMOUNT SHARES THIS OF TRANSACTION SHARE PRICE TRANSACTION ---------~.~.. 34.60 53.63 53.76 53.63 53.70 53.63 53.70 53.63 53.66 _.-.-__-._. _ u 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 THE FUND'S DIVIDEND DISTRIBUTION RATE IS 6.66% BASED UPON A DIVIDEND OF $.04050 PER SHARE FOR THE PERIOD AUGUST 21 - SEPTEMBER 20. THE SEPTEMBER 20, 2001 NET ASSET VALUE O~WN I3Al\fl<TDa~e 1/31/06 '1 11. ..., J. ~rlmary Account Enclosures Edythe R Watson % Dale F Shughart Jr 35 E High St Carlisle PA 17013 Carriage Club Image 106003929 (Continued) Page 2 106003929 4 Check No 101 102 missing --- CHECK SUMMARY Amount Reference 450.00 005094750 125.24 001013810 check numbers Date 1/06 1/20 * Denotes Date 1/30 Check No 103 Amount Reference 100.02 003020880 Account Title ******************************************************************************* Edythe R Watson Dale Shughart Jr Rep Payee % Dale F Shughart Jr Number of Enclosures Statement Dates 1/01/06 thru Days In The Statement Period Average Ledger Average Collected Carriage Club Image Account Number Previous Balance Deposits/Credits Checks/Debi ts Service Fee Interest Paid Current Balance 106003950 .00 .00 .00 .00 .00 .00 o 1/31/06 31 .00 .00 :::::::*:::::************:;::::*:*::::::**********Pz*****~t1i7*7:.o****~*:~::~*);n(~i~~ Jl11 Roberts t,r v~ I I \/\.} I'~. I c,/f c/o Dale F Shughart Jr Money Market Account Account Number Previous Balance 1 Deposits/Credits Checks/Debits Service Fee Interest Paid Current Balance 106800273 .00 9,979.10 .00 .00 2.46 9,981.56 Check Safekeeping Statement Dates 1/18/06 thru Days In The Statement Period Average Ledger Average Collected Interest Earned Annual Percentage Yield Earned 2006 Interest Paid 1/31/06 14 9,979.10 6,450.85 2.46 1.00% 2.46 CHECK REPLACEMENT CONFIRMATION I ALLlANCEBERNSTEIN U S GOVERNMENT A EDYTHE R WATSON & JILL ROBERTS CIO DALE F SHUGHART JR 35 E HIGH ST STE 203 CARLISLE PA 17013-3052 ALPHA CODE: ACCOUNT NO. 6300006126 ALLIANCE GLOBAL INVESTOR SERVICES, INC. PLEASE REFER TO ABOVE ACCOUNT t>:/UMBER IN ALL CORRESPONDENCE AND MAIL TO: P.O. BOX 786003 SAN ANTONIO, TX 78278-6003 THIS IS A REPLACEMENT CHECK. A STOP PAYMENT HAS BEEN PLACED ON THE ORIGINAL CHECK. SHOULD YOU RECEIVE OR LOCATE THE ORIGINAL CHECK, PLEASE DO NOT ATTE'MPT TO CASH OR DEPbslT IT, BUT INSTEADQESTROY IT. j;.:lti n llg e N7 {';i REPLACEMENT CHECK DATA ORIGINAL CHECK DATA CHECK TYPE: REDEMPTION CHECK NUMBER 226708 ACCOUNT NUMBER 6300006126 CHECK DATE 01/06/2006 CHECK NUMBER 1652499 BANK ACCOUNT NUMBER 09903-266-6 CHECK DATE 12/16/2005 BANK ACCOUNT NUMBER 09903-226-0 J Detach this confirmation and retain for your records before cashing or depositing check. J 111100' 2.d21; 708 'I~ CHECK REPLACEMENT CONFIRMATION I ALLlANCEBERNSTEIN U S GOVERNMENT A EDYTHE R WATSON & JILL ROBERTS C/O DALE F SHUGHART JR 35 E HIGH ST STE 203 CARLISLE PA 17013-3052 ALPHA CODE: ACCOUNT NO. 6300006126 ALLIANCE GLOBAL INVESTOR SERVICES, INC. PLEASE REFER TO ABOVE ACCOUNT NUMBER IN ALL CORRESPONDENCE AND MAIL TO: P.O. BOX 786003 SAN ANTONIO, TX 78278-6003 THIS IS A REPLACEMENT CHECK. A STOP PAYMENT HAS BEEN PLACED ON THE ORIGINAL CHECK. SHOULD YOU RECEIVE OR LOCATE THE ORIGINAL CHECK, PLEASE DO NOT ATTEMPT TO CASH OR DEPOSIT IT, BUT INSTEAD DESTROY IT. '- ORIGINAL CHECK DATA REPLACEMENT CHECK DATA CHECK TYPE: REPLACEMENT CHECK NUMBER 226800 ACCOUNT NUMBER 6300006126 CHECK DATE 01/0612006 CHECK NUMBER 226185 BANK ACCOUNT NUMBER 09903-266.6 CHECK DATE 12/16/2005 BANK ACCOUNT NUMBER 09903-266-6 J Detach this confirmation and f,etain for your records before cashing or depositing?~~~~: J ROBERTS C/O DALE FSHUGHARTJR 35 E HIGH ST STE 203 CARLISLE PA 17013-3052 . llliooa.2{;800Ij~ " -";-',: ,: , . . - . ~:O~,.~{Jtlo 0...2$-: Allla nc~BernSle In PO Box 786003 , San Antonio, TX 78278-6003 1.800221 5672 ALUANCEBERNSTEIN Investments EDYTHE R WATSON & JIMMY ROBERTS JT TEN C/O DALE F SHUGHART JR 35 E HIGH ST STE 203 CARLISLE PA 17013-3052 Page 1 of 3 Account Statement Period January 01. 2006. March 31. 2006 003057 111.111",111."."11..11...11.11,,,,1.1,"1,1,1.111.11,11.,,1 OPPENHEIMER & CO. INC 1015 MUMMA RO WORMLEYSBURG PA 17043 111B AdvIsor Naill!!: MMICHAEL G CROUSE Advisllr Nil. 12B DIlalm/B239 Branch Nil.: AD9 News Corporate Name Change On February 24-. 2006. Alliance Capital changed its corporate name to AllianceBernstein. We feel that the new name better reflects the shared mission and values that form the foundation of our firm. and recognizes the success of the combination of Alliance and Bernstein over the past five years. Of course. what will not change are the principles at the heart of everything we do--our focus on the client, our dedication to research and our pursuit of investment excellence. We hope that you like our new look. New Statement Enhancement To help you better understand the costs associated with your AllianceBernstein investments. we are now including the maximum sales commission paid during the first year of ownership for Class A share purchases. This information can be found in the Hypothetical Expense Summary section of your statement. Account Fund Name Fund/Account Number Shares NAV Value Beginning Portfolio Balance $9,988.60 Summary ALLlANCEBERNSTElN U S GOVERNMENT A 4616300021991 o 000 $6 780 $000 Ending Portfolio Balance $0.00 Earnings Interest' Tax.Exempt Short.Term long.Term Year Summary Fund Name Oividends Dividends Cap Gain Cap Gain To Date ALLlANCEBERNSTEIN U S GOVERNMENT A $66 79 $0.00 $0.00 $0.00 $66. 79 Total Earnings $66.79 $0.00 $0.00 $0.00 $66.79 Mutual Fund AlllANCEBERNSTEIN U S GOVERNMENT A Fund Symbol: ABUSX Activity FUND/ACCOUNT NUMBER 46/6300021991 Confirm Trade Dollar Amount Share Shares This Total (J) a Date Date Transaction of Transaction Price Transaction Shares '<t (J:j '" Of) 01-20 0120 Income Reinvest $28.86 $6.95 4.153 1,443.433 02-16 02-16 Shares Redeemed $9,916.38 $6.87 1 ,443 .433 0.000 02.16 02.16 Income Oiv Cash $37.93 $0.00 0.000 0.000 03.31 03-31 $0.00 $6.78 0.000 0.000 Your Payment Option Dividends Cap. Gains REINVEST REINVEST Ale. ~S7100" 000516100409169 09169.CNSAlCO UNVMAT___._.ALS.,, __000606922 AlllANCEBERNSTEIN U S GOVERNMENT A . P.O. BOX 786003 SAN ANTONIO TX 78278-6003 ~~~~~~~~-f ~ALLIANCEBERNSTEIN'" 06/20/2003 Investment Refi'ill'ch tlnd Iv/tlntlgement REP. 128 MMICHAEL G CROUSE 1,"/11",111"""111111,,,11,1,,1,..1,1,,1,11,1.,1.111'1.1.1 EDYTHE R WATSON & JIMMY ROBERTS JT TEN 119 WEST RIDGE STREET CARLISLE PA 17013-3822 FAHNESTOCK AND COMPANY 1015 MUMMA RD WORMLEYSBURG PA 17043-1118 q u 1/17 2/20 3/20 4/17 5/20 6/20 TRANSACTION BEGINNING BALANCE 1/17 INCOME DIV CASH 2/20 INCOME DIV CASH 3/20 INCOME DIV CASH 4/17 INCOME DIV CASH 5/20 INCOME DIV CASH 6/20 INCOME DIV CASH DOLLAR AMOUNT SHARES THIS OF TRANSACTION SHARE PRICE TRANSACTION ACCOUNT NO. 6300021991 TOTAL SHARES OWNED 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 1,328.010 23.80 36.89 36.96 36.89 36.90 36.95 THE FUND'S DIVIDEND DISTRIBUTION RATE IS 4.42% BASED UPON A DIVIDEND OF $.02780 PER SHARE FOR THE PERIOD MAY 21 - JUNE 22. THE JUNE 20, 2003 NET ASSET VALUE PER SHARE IS $7.54. ORRSTOWNBANK A Tradition oj Excellence Date 2/28/06 Primary Account Enclosures Page 3 106003929 4 Edythe R Watson % Dale F Shughart Jr 35 E High St Carlisle PA 17013 Money Market Account Account Number Previous Balance Deposits/Credits Checks/Debits Service Fee Interest Paid Current Balance 106800273 9,981.56 .00 .00 .00 7.65 9,989.21 Check Safekeeping Statement Dates 2/01/06 thru Days In The Statement Period Average Ledger Average Collected Interest Earned Annual Percentage Yield Earned 2006 Interest Paid 2/28/06 28 9,981.56 9,981.56 7.65 1.00% 10.11 Activity In Date Order Date Description 2/28 Interest Deposit Trace No Amount 7.65 Balance 9,989.21 ******************************************************************************* Account Title Edythe R Watson c/o Dale F Shughart Jr ..,.".-. J {, jh. c.l, ! ('<, () .:' ~ J.-. ~111" / ..:. ~.:t.'. '( I"t. Money Market Account Account Number Previous Balance 1 Deposits/Credits Checks/Debits Service Fee Interest Paid Current Balance 106800274 .00 10,041. 79 .00 5.00 .27 10,037.06 Check Safekeeping Statement Dates 2/01/06 thru Days In The Statement Period Average Ledger Average Collected Interest Earned Annual Percentage Yield Earned 2006 Interest Paid 2/28/06 28 2,151.81 376.49 .27 0.94% .27 Activity In Date Order Date Description 2/23 Deposit 2/28 Interest Deposit 2/28 Total Service Fee Trace No 004068380 Amount 10,041. 79 .27 5.00- Balance 10,041. 79 10,042.06 10,037.06 '-7! /1 ' 1/ 1/ () (-; / r I r if' f\ Ii V V \J-~ J-J-e " ) /J / A/~ i. . it)/} //) {:/./vC:l 1P 5./ \/ V r~ [..uzx.t ;~~) I REDEMPTION CONFIRMATION 2006 ALLlANCEBERNSTEIN U S GOVERNMENT A EDYTHE R WATSON & JIMMY ROBERTS JT TEN C/O DALE F SHUGHART JR 35 E HIGH ST STE 203 CARLISLE PA 17013-3052 OPPENHEIMER & CO. INC 1015 MUMMA RD WORMLEYSBURG PA 17043-1118 128 MMICHAEL G CROU ACCOUNT NO. 6300021991 WA TSOEDYTR ALLIANCE GLOBAL INVESTOR SERVICES, INC. PLEASE REFER TO ABOVE ACCOUNT NUMBER IN ALL CORRESPONDENCE AND MAIL TO: P.O. BOX 786003 SAN ANTONIO, TX 78278-6003 CONFIRM TRANSACTION SHARE SHARES T!1IS TOTAL DATE TRANSACTION DOLLAR AMOUNT PRICE TRANSACTION SHARES OWNED BEGINNING BALANCE 1,439.280 INCOME REINVEST 28.86 6.950 4.153 1,443.433 SHARES REDE;EMED 9,916.38 6.8701,443.433 .000 INCOME DIV CASH 37.93 .000 1/20 2/16 2/16 1/20 2/16 2/16 AuIANCI1BERNSTEI Investment Researcb and )vlana9'O'fUnt ./ . \ 6 I 3M RB INCOME DIVIDENDS CERTIFICATE SHARES HELD BY YOU SHARES YOU NOW OWN + SHARES U~~E5~~DAGENT TOTAl SHARES OWNED 13-3302819 REINVESTMENT REINVESTMENT .000 ~ Deta<::h!his confirmation and .r~~ain f()fyc>ur records beforl:l,<::C3.~rying or depositing check. .. ~_. - J ,:~\, X;\8-";::\!\~~I~~~.. ..~~{;~~~~,*~~~i~~'*,*;;,~*i,i'.i ' '~E}>YTHEAVV}\]$(DN &*** . JIMMy ROBERTS JT TEN C/QDALE FSHUGHART J,R 3$"1; HIGH ST STE203 ' CARLISLE PA 17013-3052 ,.:,7~: ... '-;'::_~:}:.-'~;.i..:> .:: "").-";: ,3lt!~ffr),~,;~(1;;~f'~;;~;!;~ : '-".'".- ~ ....,.~<.. -';-.:.';;':".-;-' "',r.. :-,' ',''.'f ~(J; ;..... (.:-;~ .'...'.....,.,',',;; .,.,= '-",..-.'"..-;, -; :':.:'--"" e:~):':~. , <.~~:~~~:;:,;,(; . .-'....'--.-., .', u.o.'.' ;1,.. '.r..... ?........H. B..........~. r.I..I-i... ,':u~;;i'6b;db:B;.8'1:<~~[r.~).' 2.'lNg':':/6k-i \,{ y"', , '>. q ,...._., ....,;._,.~...:..._,i..::iiii. ~~.i..:;,I:.,~;~j.L;,{..,:::~~L.,~,,~_.,';'ji,~i2.~',~L'~~;;:';i.,:.::;.i.i"~J"""i"j.".(~:..:.::;::..~~.~~~~i:I;,==;~L~~".(.,~' ..';i.....' .' . . - ,. '.'- ,,,'C""';.. CHECK.REPLACEMENT CONFIRMATION ALLIANCE MORTG SEe INC FD - CL B EDYTHE R WATSON & JIMMY ROBERTS JT TEN C/O DALE F SHUGHART JR 35 E HlpH ST STE 203 CARLISLE PA 17013-3052 ALPHA CODE: WATSOEDYTR ACCOUNT NO. 6300021991 ALLIANCE GLOBAL INVESTOR SERVICES, INC. PLEASE REFER TO ABOVE ACCOUNT NUMBER IN ALL CORRESPONDENCE AND MAIL TO: P.O. BOX 786003 SAN ANTONIO, TX 78278-6003 THIS IS A REPLACEMENT CHECK. A STOP PAYMENT HAS BEEN PLACED ON THE ORIGINAL CHECK. SHOULD YOU RECEIVE OR LOCATE THE ORIGINAL C;HECK, PLEASE DO.NOT ATTEMPT TO CASH OR DEPOSIT IT, BUT INSTEAD DESTROY IT. A l~" T I Ai ''f\\.T Ji"'''''r~ .d:.-.. ..~:~;~.~~ja.,K ,f'i.Jl-~ ~~~.,.,~,~."~: , ."" ,'Ii<"~ "R' N' '1i'I/P'['tI'... 'TI Ii!"~ '~, '- . ,.~ ~ .,;,,1 .L ~,J! .~ ,., ".11. ' 'SItf 1""11 J,(' r t ~.1t(.. e j\-~ t R\ ps 1'> /t. rf," t., ri 1." J /1,1'a n x Ire <l<n (;,.... i- f" ....l..".." ~f.. Fl. l,.- 1I.r-t::4. 'i._;J"". ~~.. {..(,f.. 11'-. U::: .1'1 "h;"~ , ~,.;) ORIGINAL CHECK DATA REPLACEMENT CHECK DATA CHECK TYPE: R-lfPLACEMENT CHECK NUM,BER 228178 ( ACCOUNT NUMBER " 6300021991 CHECK DATE 02/16/2006 CHECK NUMBER 180617 BANK ACCOUNT NUMBER 09903-266,6 CHECK DATE : 08/27/2002 BANK ACCOUNT NUMBER 09903-266-6 J Detach this confirmation and retain for your records before cashing or depositing check. J CHECK REPLACEMENT CONFIRMATION .. EDYTHE R WATSON & JIMMY ROBERTS JT TEN C/O DALE F SHUGHART JR 35 E HIGH ST STE 203. CARLISLE PA 17013-3052 I ALLIANCE BERNSTEIN U S GOVERNMENT A ALPHACODE:'!r.. ;, WATSOEDYTR ACCOUNT NO. 6300021991 ALLIANCE GLOBAL INVESTOR SERVICES, INC. PLEASE REFER TO ABOVE ACCOUNT NUMBER IN ALL CORRESPONDENCE AND MAIL TO: P.O. BOX 786003 SAN ANTONIO, TX 78278-6003 1;HIS IS A REPLACEMENT CHECK. A STOP PAYMENT HAS BEEN PLACED ON THE ORIGINAL CHECK. SHOULD YOU RECEIVE OR LOCATE THE ORIGINAL CHECK, PLEASE DO NOT ATTEMPT TO CASH OR DEPOSIT IT, BUT INSTEAD DESTROY IT. ,::;;:I]r,ll\,:r\r~~~]::~ l....I{.l\,..rs"';p..W'l 'In 'o/"f~_ ...."ll{ l\r~ i ,,~! '\ !i1 *"'" ~ ;,.,.,! ..~.;..... , "it>. .'''it f-:.:: . .J~... ...1!.....,j} ...:.,...,!., ..~ ./l'2 '/..:' t~3~-~' tf"l i(;~f)t ~Rt'Je({.r}"ii~./(:~; " '1 !\. <! v, {Ii r /J ,-1.n ,.o} g' ."{:,, "'N _,. :s.~,,, lr 1:4.1 _L ,,_ ~ J ...(!:'jt,. " :S','.... !.. C. REPLACEMENT CHECK DATA ORIGINAL CHECK DATA CHECK TYPE: DIVIDEND CHECK NUMBER 228171 ACCOUNT NUMBER 6300021991 CHECK DATE 02116/2006 CHECK NUMBER 8382483 BANK ACCOUNT NUMBER 09903.266.6 CHECK DATE 02120/2004 BANK ACCOUNT NUMBER 09903.229.4 ~ . Oetachtl1isGonfirmati9-n an? retai9fo.r your records before?q~hing or depo~itingcheck. ~ . , ,.;,'-..-. ~."':", lEbYTHE:~'W~T8()N' &. *** JIMMY RO~ERTS.jT.T~N". C/O DALE F SIiVGHARTJR . 3S EHIGH 8T STE~()3 CARLISLE PA 17013"3052, " .- . ,. ';~i;"/ :i.< , ~?~!~;~{1Y,. ;",:.:-,'--::,,; .~: '.- "'j.-:,,' . ~ '~.~. J - w ~,~., .:.. ~ ~', r'~~ ~~' ~-'~~S... .~. .;:~ :.,..~ ~:;.~'~,~: :.,.; ~\;~ ~.:~..~ ,~~~ ;..I'I.1-I~ _...n; ~ ~lool.l~ ~~~~'~:1~ 1'~~.:~'~ ~I_ :'~I ;.. ~ .;r~~'..~_ ~'. .-~';":;~..,;.;.~'~~~:'~'~-.~ ~~, r.~~.~; ~.~.~~~~. t~~__'-.,..~ ~I Mil ~ ~'I"~~ I~~~'~~':~'I-'~ ~ ~~I_ ~'..'~:..~',~'~ ~'.~~ ~ j.;:';' , . . . . -, ;,; :'-'- ,'.. . : ..-.,.,:. . < 1I.0qd;9~a,I7.I\t 1:0, ..OrJbd2a,l:d9;~b.3j . 2b':~; '-' :-:','" 1. ::.r,;:,' 'i~.<t;~' ,<:'.'-'h:i.:":' ;- ..,. ,~ SCHEDULE H RJNERAL EXPENSES & ADMIMSmA11VECOSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Watson, Edythe R FILE NUMBER 21 - 06 - 00913 ITEM NUMBER A. B. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1,027.00 2,500.00 90.00 500.00 8.00 75.00 406.55 4,606.55 FUNERAL EXPENSES: Auer Memorial Home & Cremation Service, cremation and interment 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State _ Zip 2. Attorney's Fees Dale F. Shughart, Jr. (estimate) 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State Zip 4. City Relationship of Claimant to Decedent Probate Fees Recorder of Deeds (paid $50, owe $40) 5. Accountant's Fees 6. Tax Retum Preparer's Fees Mentzer & Co (estimate) 7. 1 Other Administrative Costs Register of Wills, Short Certificates 2 Cumberland Law Journal, advertise Letters Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) , '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Watson, Edythe R 3 The Sentinel, advertise Letters 4 Postmaster, certified mail 5 Reserve for final accounting Schedule H FlIleraI Expenses & Aanini&bati1le CosIs continued FILE NUMBER 21 - 06 - 009 13 Page 2 of Schedule H 151.55 5.00 250.00 ESTATE OF . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Watson, Edythe R SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 - 06 - 00913 Include unreimbursed medical expenses. ITEM NUMBER I 2 DESCRIPTION Checks written before death on On'stown Bank Representative Payee Account 106003950 #107 ManorCare Nrusing Home Carlisle 372, Checks written before Death on Orrstown Bank Personal Checking Account 106003929 #134 Dale F. Shughatt, Jr., fees 150.00 # 135 ManorCare Carlisle 372, 6,604.00 nursmg care # 136 Heattland Health Care Services, medicine 38.35 TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 1,004.00 6,792.35 7,796.35 REV-1513 EX+ (i-OO) '. SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Watson, Edythe R FILE NUMBER 21 - 06 - 00913 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Us! Trustee(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Jill Roberts 879 Stillman Street Philadelphia, P A 19130 Niece One-quarter 2 James A. Roberts 159-34 Riverside Drive West Apartment 2C New York, NY 10032 Nephew One-quarter 3 Brenda Ann Leacock 419 Butler Street Brooklyn, New York 11217 Niece One-quarter 4 Bruce Nunery 20 Toler Place Newark, NJ 07114 : Nephew One-quarter 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 . . I, EDYTHE R. WATSON, also known as EDITH C. WATSON, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my last will and testament and revoke any will previously made by me. I. I direct my personal representative to convert into cash and sell at either public or private sale all of my tangible personal property, and to add the proceeds thereof to my residuary estate. II. I direct my personal representative to pay all inheritance, transfer, succession and estate taxes which may become payable by reason of my death, whether with respect to property passing under this will, jointly owned property or otherwise, out of my residuary estate. III. I devise and bequeath all of my net residuary estate as follows: A. One-half to be divided equally between my niece, JILL ROBERTS, and my nephew, JAMES ALBERT ROBERTS, and if either be deceased, to her or his surviving issue, per stirpes, and if no surviving issue then all to the surviving one of the two of them. B. One-half to be divided equally between my niece, BRENDA JACKSON, and my nephew, BRUCE NUNERY, if living, and if -! )" " ) . -, 'l'-r~' I ....\ j~ / I , .; ,1.....__. C'-. \ ~-~J I \1 \ \ f' \. \/ ,I\} j\ '.I . either be deceased, to her or his surviving issue, per stirpes, and if no issue, then to the survivor of the two of them. IV. Any share of my estate which shall become distributable to a minor may be held in a savings account, certificate of deposit or similar security, in a federally insured banking or savings institution in the name of the minor and marked not to be withdrawn until the minor attains the age of 18 years. V. 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. VI. I appoint my nlece, JILL ROBERTS, executrix of this my last will. Should she fail to qualify or cease to act as executrix, I appoint my nephew, JAMES ALBERT ROBERTS, alternate executor of this my last will. VII. I direct that my executrix or her successor shall not be required to give bond for the faithful performance of their duties ln any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this 7d. day of/.~9/tA-'-Y , 1993../, , i c' 'j Jl:-.+.,~_u. , /~. I:: '/"-.- .. ., 1 ., /,., ('l' ,..c",,::-:'c.cJ FC."-.. ! l C./ C ',,--.,,v-... . .'__..' . , EDYTHE R. WATSON .-...-:>~ f ;" . i . d::::.,' /:!cZ.<<.::Yc j., .~ " // a/k/a EDITH C. r'. I' I) l I/}/ .......1\. / I} . '::''- r' c\.i--.1....()-,.,_ " WATSON The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, EDYTHE R. WATSON, a/k/a EDITH C. WATSON, was on the day and date .. thereof signed, published and declared by EDYTHE R. WATSON, a/k/a EDITH C. WATSON, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our na~es a~ witn se~ hereto. /"'... ---#.. ) ",> //tY"....~P-rr , c/._.K ~L. <... ~rJ1 "0t/~A: \ <<~~ ['J . "-- . . /'/ /15 ~6 fi~4bt-;elh./~~/::/ , 9' L C m'7~..J-1 : /.tld . -1L /b-n . - - / -f' :J-"-- , 'f' If