HomeMy WebLinkAbout09-07-07
--.J
15056041125
REV-1500 EX (06-05)
PA Department of Revenue.
Bureau of Individual Taxes '. INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
2 1 0 7
o 3 6 9
Date of Birth
14512 8 8 6 8
03312 0 0 7
09041920
Decedent's Last Name Suffix
Decedent's First Name
KELLEY MS
LENORE
MI
E
(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
D 4. Limited Estate
~
D
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 D 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number'
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
D
D
D
D
1
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
D
D
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
CAR L
G .
WAS S
E S Q
717
3 2 --7 6 6 1
(/"')
Firm Name (If Applicable)
C A L D W ELL
&
KEARNS
.
REGISTEROFWILLS USE ONLY
. 1
-...:
First line of address
3 6 3 1
NORTH
FRO N T
STREET
r....)
Second line of address
N
-_J
I
._~.J
City or Post Office
State ZIP Code
DATE FILED
H A R R I S BUR G
P A
17110
Correspondent's e-mail address:cwass@caldwellkearns.com
Under penalties of pe~ury, 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.
SI N RE F fERSON ~ESPONSIBL R Fill TURN DATE
ME CHANJ: (' ~ 1=H TR r:
PA 17050
DATE
HARRI~
PLEASE USE ORIGINAL FO~~ P.I'ib-:f
PA 17110
Sill_
L
15056041125
15056041125
--1
..-J
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name LENORE E. KELLEY, MS.
RECAPITULATION
14512 886 8
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)
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested
5.
67283.98
6254.53
6.
7.
8. Total Gross Assets (total Lines 1-7)
8.
73538.51
9. Funeral Expenses & Administrative Costs (Schedule H)
9.
1
o 9 3
8. 5 3
810.61
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
. . . . . . . . 10.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . .
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)
12.
11749.14
61789.37
11. Total Deductions (total Lines 9 & 10)
. . . . . . . 11.
. . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . 14. 6 1 7 8 9 . 3 7
......... .
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.O _ o . 0 0 15. o . 0 0
16. Amount of Line 14 taxable
at lineal rate X.O o . 0 0 16. O. 0 0
17. Amount of Line 14 taxable 0 0 0 o . 0 0
at sibling rate X .12 . 17.
18. Amount of Line 14 taxable 6 1 7 8 9 . 3 7 9 2 6 8 . 4 1
at collateral rate X .15 18.
19. Tax Due . . . 19. 9 2 6 8. 4 1
.................................... . ....... .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
L
15056042126
15056042126
..-I
R~V-1500 EX, Page 3
Decedent's Complete Address:
File Number
21 07 0369
DECEDENT'S NAME
LENORE E. KELLEY, MS.
STREET ADDRESS
64 ASHBURG DRIVE ~~~~
CITY I STATE I ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
9,268.41
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
T otallnterest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
9,268.41
A Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A This is the BALANCE DUE.
(5A)
(5B)
9,268.41
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ...................................................................... D ~
b. retain the right to designate who shall use the property transferred or its income; ............................... D ~
c. retain a reversionary interest; or ................................................................................................ D ~
d. receive the promise for life of either payments, benefits or care? ....................................................... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D ~
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. D ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. 39116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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 zero (0) percent [72 P.S. 99116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 PS 39116(1.2) [72 PS 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 39116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-150B EX,+ (6-9B)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
LENORE E. KELLEY, MS.
FILE NUMBER
21 07 0369
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Bank of America - CD #91000034761683 29,506.68
(See Exhibit #1)
2. Bank of America - CD #91000064786968 26,408.73
(See Exhibit #1)
3. PNC Bank - COD #31900311419 10,030.41
(See Exhibit #2)
4. Miscellaneous household furnishings, as appraised 1,006.00
(See Exhibit #3)
5. Refund of unused renter's insurance premium 100.00
6. Refund of Security Deposit from landlord 232.16
TOTAL (Also enter on line 5, Recapitulation) $
(!f more space is needed, insert additional sheets of the same size)
67,283.98
RE~-1509 EX,+ (6-98)
'*
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LENORE E. KELLEY, MS.
FILE NUMBER
21 07 0369
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. Adelia M. Cartwright
2604 Warren Way
Mechanicsburg, PA 17050
Sister
B
c
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTERES
1. A. 1/10/07 PNC Bank checking account #5005027723 6,254.53 100. 6,254.53
(See Exhibit #2)
2. A. UnknoWl Bank of America safe deposit box #001470012229 0.00 50. 0.00
(See Exhibit #3)
TOTAL (Also enter on line 6, Recapitulation) $ 6,254.53
T
(If more soace is needed. insert additional sheets of the same size\
R,V. ""'~. I'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
LENORE E. KELLEY, MS.
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
FILE NUMBER
21 07 0369
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES
Myers Funeral Home, Mechanicsburg
3,396.50
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Adelia M. Cartwright
Social Security Number(s)/EIN Number of Personal Representative(s) 142-22-1599
Street Address 2604 Warren Way
City Mechanicsburg State PA Zip 17050
Year(s) Commission Paid: 2007
3,364.00
AttomeyFees Caldwell & Kearns, P.C.
Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
3,500.00
Street Address
City
State
lip
Relationship of Claimant to Decedent
Probate Fees Register of Wills, Cumberland County
256.00
Accountant's Fees
Tax Retum Preparer's Fees
Cumberland Law Journal - Legal advertising
The Sentinel, Carlisle - Legal advertising
Claude C. Wolfe & Assoc. - Appraisal of personal property
PNC Bank - Check fees
75.00
137.03
175.00
35.00
TOTAL (Also enter on line 9, Recapitulation) $
10,938.53
(If more space is needed. insert additional sheets of the same size)
REI) 1512 EX ~ (1203)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LENORE E. KELLEY, MS.
FILE NUMBER
21 07 0369
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, FIA Card Services, NA - Credit card debt balance 356.02
2. Refund of April, 2007 pension (direct deposit) 365.00
3. Good Hope Family Practice - Medical debt 6.05
4. Pinnacle Health Systems - Medical debt 83.54
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
810,61
"'''''".'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
LENORE E. KELLEY, MS.
FILE NUMBER
21 07 0369
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Martha Lynn, Lee Ann and Naomi Jean Fishman Collateral
clo Manda Lee Fishman, 1000 Highland Drive 40%-shared at discretion
Knoxville, TN 37912 of Manda Lee Fishman
2. Frances and Barbara Principe Collateral
c/o Ruth Ellen Principe, 64 Ashburg Drive, Apt. 218 30%-shared at discretion
Mechanicsburg, PA 17050 of Ruth Ellen Principe
3. Richard and Christopher Cartwright Collateral
clo Adelia Cartwright, 2604 Warren Way 30%-shared at discretion
Mechanicsburg, PA 17050 of Adelia Cartwright
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Last Will and Testament
I
II LENORE E. KELLEY
I
I'
'i I, LENORE E. KELLEY, of Mechanicsburg, Cumberland County,
IpennSYlVania, being of sound and disposing mind, memory and understanding, do hereby
make, publish and declare this as and for my Last Will and Testament, hereby revoking and
making void any and all Wills by me at any time heretofore made.
OF
ITEM 1:
I direct that all inheritance and estate taxes
becoming due by reason of my death, whether such taxes may be payable by my estate or by
any recipient of any property, shall be paid by the Executrix out of the property passing out of
the residue of this Will, as an expense and cost of administration of my estate. The Executrix
I shall have no duty or obligation to obtain reimbursement for any such tax so paid, even
hough on proceeds of insurance or other property not passing under this Will.
ITEM II:
I have three living sisters, none of whom are
in need of any direct financial assistance from me. Therefore, it is my wish to honor, and to
how my love and respect for my three sisters, not by making gifts directly to them for their
ersona) use, but to direct any remaining monies which I may have into the hands of my three
isters so that each of those sisters, in their separate and unique discretion, may distribute the
odest financial gifts which I may make to their children, my nieces and nephews.
ccordingly, I direct my Executrix to liquidate into the form of cash all assets which I may
assess at the time of my death and, 1 then give and bequeath all of those cash assets as
allows:
i 11\.....-
"--"(
A) Forty (40%) percent thereof, I gIve and bequeath to my sister,
Manda Lee Fishman for the purpose of making discretionary distribution of
those funds among her three daughters: Martha Lynn, Lee Ann, and Naomi
Jean;
B) I give and bequeath thirty (30%) percent thereof to my sister, Ruth
Ellen Principe for the purpose of making discretionary distribution of those
funds among her two daughters: Frances and Barbara; and,
C) Thirty (30%) percent thereof I gIve and bequeath to my sister,
Adelia M. Cartwright for the purpose of making discretionary distribution of
those funds among her two sons: Richard and Christopher.
ITEM Ill:
In the event any of my three aforementioned
sisters should predecease me, then I direct that the percentage gift of my estate assets, as
provided above, shall be directly distributed, in equal shares, to those children of the deceased
sister who shall then be living.
ITEM IV:
I hereby nominate, constitute and appoint my
, sister, Adelia M. Cmiwright, Executrix of this my Last Will and Testament. No bond shall
be required of my Executrix in Pennsylvania or any other jurisdiction.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will
nd Testament, consisting of this and the preceding one (l) page, at the end of each page of
hich I have also set my initials for greater security and better identification this ;1f day
~~L
,2006.
/1
i~~
2
(SEAL)
I
The foregoing instrument, consisting of this and one (1) preceding typewritten page,
was on the date thereof signed, published, and declared by Lenore E. Kelley, the Testatrix
therein named, as her Last Will and Testament, in the presence of us, who at her request and
\', (\i I, C
J;~LL\L.t\ }-
( '~/LJJ.L~
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r, have subscribed our names as witnesses.
7\.f l 2- G '{"Q 'Q. Y'-. '--\ ~ R-~ ~
residing at \-\"h~qQ,..~_, i?~ If I I ~
d 7V 0 {V'Lflo ~r-.fS L.iJ u..- (-
residing at 1-lP-r(l'llou1 CiA I I II --C
The Testatrix and the witnesses whose names are subscribed to the foregoing
instrument, being first duly sworn and qualified according to law, do hereby acknowledge and
declare to the undersigned authority that the Testatrix signed and executed the instrument as
hers last Will in the presence of the witnesses, that she signed willingly or willingly directed
another to sign for her, that she executed it as her free and voluntary act for the purposes
therein expressed, that each of the witnesses, in the presence and hearing of the Testatrix,
signed the Will as witnesses, and that to the best of their knowledge, the Testatrix was at that
time eighteen years of age or older, of sound mind and under no constraint or undue
influence. //1
'//.'~~
Witn
\"\ \ ) I j.. f"\ ('
A )-i.j\"J'VV\ Ij" \,,-\ t.-)C, . 0----
- WitQe_$s
03879
Sworn to, subscribed and acknowledged before me by the above named Testatrix and
itnesses this Z %1h day of (J.JJ.quof , 2006.
/-J-h.-U n. :0, K-uJ (SEAL)
T{ Notary Public or
Attorney-at-Law
NOTARIAL SEAL
HOllY S. KIRK, Notary Public
Susquehanna Twp., Dauphin County
My Commission Expires Feb. 15, 2007
3
Bank of America ~
~
Legal Order Processing
May 4, 2007
Caldwell & Kearns, P.C.
Attn: Carl G. Wass
3631 North Front Street
Harrisburg, P A 17110-1533
RE: Lenore E. Kelley, Deceased {Date of Death March 31, 2007}
Date of Death Values
Dear Mr. Wass:
Below find financial information requested on accounts held in the name of the above- captioned
decedent as of the date of death:
Account Number 91000034761683 CD 3.94% Mat: 10/26/07
Date of Death Balance: $29,484.40
Accrued Interest: $22.28
Status: Open
Title: Lenore E. Kelley
Account Number: 91000064786968 CD 2.72% Mat: 06/04/07
Date of Death Balance: $26,351.78
Accrued Interest: $56.95
Status: Open
Title: Lenore E. Kelley
Safe Deposit Box Number: 001470012229
Banking Center Name: Regency
9550 Regency Square Blvd.
Banking Center Address: Jacksonville, FL 32225-8148
For more information, contact: Customer Service Manager at 904-724-4445
Name(s} on Safe Deposit Box: Adelia M. Cartwright or Lenore E. Kelley
Exhibit 1
Banl{ of America. FL6-00l-02-11
PO Box 407090, Fort Lauderdale, FL 33340
l{{!cycled Paper
Bank of America __
~
~
Legal Order Processing'
Carl G. Wass
May 4, 2007
Page 2
If you have any questions concerning the information provided, please do not hesitate to contact
me. For questions not related to "date of death" values, please direct your inquiries to Bank of
America, Tampa Service Request Unit, FL1-002-01-31, P.O. Box 25118, Tampa, FL 33633-
0900.
Sincerely,
'"
Betsy A. Vasquez
Legal Order Processing
954.473.7733
404.532.3128 fax
Bank of America, FL6-00l-02-11
PO Box 407090, Fort Lauderdale, FL 33340
lkcydcd Paper
o PNCBAT\K
April 26, 2007
Carl G. Wass
3631 North Front Street
Harrisburg, PA 17110-1533
RE: Estate of Lenore E. Kelley, deceased
SSN: 145-12-8868
DOD: 3/31/2007
Dear Mr. Wass:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Certificate of Deposit
Account #31900311419
Established 03/06/2007
LENORE E KELLEY
DOD balance: $10,000.00;- $30,41 accrued interest
Checking Account
Acconnt #5005027723
Established 01/1 0/2007
LENORE E KELLEY
ADEDLlA M CARTWRIGHT
DOD balance: $6,253,99;- $.54 a.ccrued interest
please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not process any financial
transactions or provide statement... If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~otlVJJ..t- ~
Rachelle Wells
J -800-762-1775
P7-PFSC-04-F
SOD first Ave.
Pittsburgh PA 15219
Member FDIC
TOTRL P. 01
Exhibit 2
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET' CAMP HILL, PA 17011
717 -737 -0734
Appraisal for the Estate of Lenore E. Kelley
64 Ashburg Drive, Mechanicsburg, P A 17050
LIVING ROOM
Breakfront
Misc. contents of breakfront
TV
Pair of occasional chairs
Coffee table
Green velvet chair
Maroon velvet chair
2 Half tables
Wing back chair
Table lamps
Misc. pictures
Misc. knick-knacks
Pair of sterling silver candlesticks
Metal table
Misc. contents of living room
BEDROOM
3-Piece bedroom suite
Pair of table lamps
Quilt rack
Broyhill chest of drawers
Dresser
Misc. pictures
Reproduction clock
Alarm clock
Misc. contents of bedroom
Exhibit 3
April 26, 2007
95.00
25.00
30.00
5.00
1.00
1.00
30.00
190.00
5.00
8.00
50.00
25.00
60.00
6.00
25.00
50.00
5.00
3.00
85.00
75.00
25.00
25.00
1.00
25.00
CLAUDE C. WOLFE & ASSOCIATES
AUCTIONEERS & APPRAISERS
FAMILY OWNED SINCE 1910
2009 LINCOLN STREET. CAMP HILL, PA 17011
717-737-0734
Kelley appraisal
Page 2 of 2
KITCHEN
5-Drawer server - painted black
Stool
Coffee maker
Toaster
Breakfast table and two chairs
Misc. pictures
Table lamp
Rush seated chair
T rash can
Linens
Electrolux canister vacuum cleaner - old
Walker with hand brakes
Shopping cart
Misc. contents of kitchen
BATH
Small table
Trash container
2-Door cabinet
Misc. pictures
45.00
1.00
2.00
1.00
25.00
10.00
2.00
5.00
1.00
1.00
3.00
25.00
5.00
20.00
2.00
1.00
2.00
5.00
APPRAISAL TOTAL $ 1,006.00
This Fair Market Value appraisal is true and correct to the best of my ability as an
auctioneer and appraiser with 35 years experience.
Member: Certified Appraisers Guild of America
w,'i.{~~~
W. K. Dusty Chapman, CAGA
BankofAmerica. ~"
Safe Deposit Box Inventory
Certificate Of Contents
Banking Center Name: Cost Center: State:
Regency 0109196 FL
Primary Owner: Social Security Number:
Lenore E Kelley 145-12-8868
Co-Owner: Social Security Number:
Adelia M Cartwright 142-22-1599
Last Known Address:
3502 Lenczyk Dr VV
City: State: Zip:
Jacksonville FL 32277-
Other Names Listed on Account:
none
Safe Deposit #: Safe Deposit Box Agreement Date Drilled/Opened: Drilling Fee (if applicable):
1222-9 Expiration Date: nal 1 08/20/2007 $ na
.
1. The safe deposit box numberindicated above was accessed due to:
D Surrender of Box [8J Death of Renter
D Will Search Order from Court D Court Order Appointing Guardian
D Other Court Order D Court Order Appointing Bankruptcy Trustee
D Subpoena D Letters Testamentary or Letter of Administration
D Search Warrant tor the estate ot the deceased renter
2. When the box was opened by 0 forced entry or 1ZI key, we examined it: (check one) and
[gI found it empty 0 removed nothing 0 removed the items listed below (attach separate sheet, if necessary)
Description of Item
na
(continued on reverse)
00-14-5247NSBW 03-2006
Safe Deposit Box Inventory Certificate of Contents
Page 2 of 2
3. The safe deposit box contents were:
o Released to a Personal Representative presenting Letters of Administration/Letters Testamentary
o Released to a foreign (out of state) Personal Representative presenting Letters of Administration/Letters Testamentary
o Sealed in a package and placed, using dual control, in the designated Bank of America vault
o Delivered by Bank of America to a court having probate jurisdiction in the county or city where the banking center is
located
o Released to a person (Burial plot or information regarding burial instructions only)
o Released to a beneficiary (life insurance policy only) (except Arkansas & Illinois)
o Other:
4. The contents have been sealed in a package and placed under dual control in the designated Bank of
America vault.
Note: Iowa state statutes require dual control associates must both be bank officers.
As an authorized representative of Bank of America, I acknowledge that the information contained on this Safe
Deposit Box Inventory Certificate of Contents is true and corre ,and the items descr'berrlif#2\were removed from
the safe deposit box in my presence. .
Bank As~oci te (witnes
, v'P I Boo/)
State of Florida
Date:
08/20/2007
County of Duval
I Homer Leonard ' a duly qualified Notary Public in the state indicated, do hereby
certify that the Bank of America safe deposit box number 1222-9 leased to Lenore E Kellevl Adelia JA.
Cartwriqht was opened today in the presence of the above Bank of America associate ~o ersonally
came before me this day and acknowledged the execution of the foregoing instrument.
The contents are correct as stated.
Notary Public
Serial Number (if any) =:D 'j) L/ h r;q~ Z
My Commission Expires qr~c( () 9
"'a~ .."
.... '"
Ii ~
HOMEf1 LEONARD
Nolary' F'ublic. Slate of Florida
My GOlTirn expires Aug. 24. 2009
No.DD 465562
CUSTOMER RECEIPT (to be obtained on original only)
In consideration of the return to me of all the articles listed on this Safe Deposit Box Inventory Certificate of
Contents, I hereby; (a) acknowledge receipt in good condition of all said articles; (b) acknowledge that said articles
constitute the entire contents left by me in the described safe deposit box; (c) consent to, ratify, and approve all acts
of said Bank, its officers and employees with respect to said articles and safe deposit box; and (d) release said Bank, its
officers and employees from any and all claims, rights, and causes of action which I now have or shall hereafter have relating
to or arising out of 'Said acts of said Bank, its officers or employees.
Signature: Primary Identification:
00-14-5247NSBW 03-2006