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Home My WebLink About10-12-07 REV.1500 EX + (6.00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 7 0 3 8 1 COUNTVCciQE ----vEA~ - - NuMsER- - I- Z W C W U W C DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) M ers Blake A DATE OF DEATH (MM.DD-Year) DATE OF BIRTH (MM.DD- Year) SOCIAL SECURITY NUMBER 2 0 8 - - 4 - 2 6 3 THIS RETURN MUSTBE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 2 0 8 - - 4 - 2 6 3 01/15/2007 03/21/1956 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) M ers Christina M. W I- ~~CJl U Q:~ wc..u J: 00 UQ:-1 c..tIJ c.. <( [X] 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attaoh copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise Idate of death after 12.12.821 D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95) D 3. Remainder Return (date of death priorto 12.13.82) D 5. Federal Estate Tax Return Required .1. 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attaoh Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS An ela F. Stevens 340 Market Street FIRM NAME (If Applicable) Cardoni & Associates LLC TELEPHONE NUMBER 570-283-5800 Kin ston P A 18704 OFFICIAL tlSE ONLY I- Z W o z o c.. CJl W Q: Q: o U 1. Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (1) (2) (3) (4) (5) ( ; 4. Mortgages & Notes Receivable (Schedule D) z o i= <( ...J ::) !::: c.. <( U w 0::: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 65,202.65 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 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) 159.50 50,372.53 X ~(15) 0.00 X _(16) 159.50 X .12 (17) 19.14 X .15 (18) (19) 19.14 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o l- e:( I- ::) c.. ~ o u X <( I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) (8) 65,362.15 8,411.43 6,418.69 (11) (12) (13) 14,830.12 50,532.03 16. Amount of Line 14 taxable at lineal rate (14) 50,532.03 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < C~~l Decedent's Complete Address: S.TREET ADDRESS 9 R an Drive CITY South Middleton Township STATE PA ZIP 17007 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 19.14 Total Credits ( A + B + C) (2) 3. I nterest/Penalty if applicable D Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 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 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 19.14 19.14 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; ........................................................................... 0 [Z] b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [Z] c. retain a reversionary interest; or ...................................................................................................... 0 [Z] d. receive the promise for life of either payments, benefits or care? ........ ......... ................................... ......... 0 [Z] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.... ........................ ............. ....... ..... ............................ ............. 0 [Z] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [Z] 0 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............. ........................ ........ ..... ......... .................. .......................... 0 [Z] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE !O-05-o'7 PA 18634 DATE/,,- '--- CJ\ .- ~. '\ PA 18704 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 PS S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)l. 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 0% [72 P.S. S9116(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. S9116(1.2) [72 P.S. s9116(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. S9116(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-1508 E~. ". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Myers Blake A FILE NUMBER 21 07 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. 0381 ITEM NUMBER 1. 2. 3. 4. 5. 6. DESCRIPTION 2002 Subaru Legacy Wagon 4D in good condition. See statement of value on Kelly Blue Book private party value on April 4, 2007 attached to this schedule VALUE AT DATE OF DEATH 9,220.00 John Hancock Funds, LLC Account #777113427; Fund Name: Regional Bank Fund A; 726.361 total shares @37.67 per share for a total account value of $27,362.02. See Statement of John Hancock Funds, LLC dated 6/22/07 attached to this schedule. John Hancock Funds LLC Account #4891605 Sovereign Investors Fund A having 481.49~ shares @$19.16 per share for a total account value of $9,225.49. See statement of John Hancock Funds attached to this schedule. John Hancock Funds, LLC Small Cap Equity Fund A, Account #4891603 having 3211.34 total shares @ $22.50 per share for a total account value of $4,765.90. See statement of John Hancock Funds, LLC attached to this schedule. Navy Federal Credit Union, Share Savings Account. See statement of Navy Federal Credit Union attached to this schedule 27,362.02 9,225.43 4,765.90 6,759.87 Navy Federal Credit Union, Checking Account. See statement of Navy Federal Credit Union attached hereto. 7,869.43 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 65202.65 .~ Kelley Blue Book - Private Party Pricing Report - Suham, Legacy Page I of 3 _~~(USEDCARS":_~~_ Home> Used Cars> Wagon> Subaru > Legacy> 2002 > LWagon 4D > Equipment '. Prir Kelley Blue Book THE TRUSTED RESOURCE. tbb.com acJvertlsen1ent Quick Dealer Price Quote Search Used Car listings lis 2002 Subaru legacy l Wagon 40 Trade-In Value Private Party Value Suggested Retail Value Photo Gallery Review Specifications Compare Vehicles ,:cet Shopping Tools Free CARFAX Record Check Auto Loan from 6.65% APR Compare Insurance Rates Payment Calculator Extended Warranty Quote Print For Sale Sign BUY A USED CAR on Blue Book Classifiedsm Subaru Legacy 30 Miles or less ZIP Code 18704 To View Ads, Click SElL YOUR USED CAR on Blue Book Classifieds'M Reach millions of shoppers on kbb.com, Cars.com, and other popular sites. find out more, Click BLUE BOOK PRIVATE PARTY VALUE Condition Value Excellent $9,925 Good $9,220 More Photos Fair $8,330 NEXT STEPS: Search local listings Sell Your Wagon Vehicle Highlights Mileage: 67,000 Engine: 4-Cyl. 2.5 Liter Transmission: Automatic Drivetrain: AWD Selected Equipment Change Equipment http://www.kbb.com/K BB/UsedCars/PricingReport.aspx?V ehicleClass= U sedCar&Manufac... 4/4/2007 John Hancock Funds, llC 1 John Hancock Way, Suite 1000 Boston, Massachusetts 02217-1000 (800) 225-5291 www.jhancock.com/fu nds ~ -. r~-- ~' (Q r=:~ ~n.',. ,I "::::;' --...:. 1'::':''; r- ; I,' i 0 .S" l~ Ll:;-; 0 ~ ~,-"" ~; , , r--------.'>-----~= I; I~i I JUL 2 1007l ' l, J "L U7It()QD MUTUAL FUNDS John Hancock Signature Services, Inc. June 22, 2007 Angela F Stevens Attorney at Law Cardoni & Associates LLC 340 Market St Kingston P A 18704-5498 Reference: 914796 Account Numbers: 4891603,4891605,777113427 Dear Ms. Stevens: Thank you for contacting John Hancock. I am writing in response to your letter regarding the John Hancock mutual fund accounts listed above registered to the late Blake A. Myers. I have enclosed a copy of your letter. Please refer to the following table for the account values on January 15,2007, the date of Mr. Myers' death. Please remember that the share prices fluctuate daily. Fund Name Account Total Net Asset Value Account Value Number Shares Regional Bank Fund A 777113427 726.361 $37.67 $27,362.02 Sovereign Investors 4891605 481.494 $19.16 $9,225.43 Fund A Small Cap Equity Fund 4891603 211.348 $22.55 $4,765.90 A Total $41,353.35 Please note that because Mr. Myers' death occurred on a non-business day, the above amounts were calculated using the preceding business day's closing prices. Additionally, the shares in account numbers 4891603 and 4891605 were initially purchased on June 11, 1992, and the shares in account number 777113427 were initially purchased on May 28, 1993. Please note that we have forwarded a copy of your letter to John Hancock Life Insurance Company (JHLICO) in case Mr. Myers had any policies or contracts with them. You may contact muco at 1-800-732-5543. John Hancock Funds. LLC. 601 Congress Street Boston. MA 02210-2805. Member NASD . Sovereign Asset Management LLC 09/27/2007 09:59 FAX 7032557963 DECEDENT ACCOUNTS NAVY (I) FEDERAL CREDIT UNION I4J 0011003 PO Box 3000 . Merrifield VA . 22118-3000 In reply refer 10 accou,1 no. :FAX [)hone: 1-800-883-3323 Ext 47503 703-255-7503 Fax: 703-255-7963 To: ~p (t~ };ax: 5-70J0- S900 From: Patncia Wilson~ecedent Account 09 /1- 7 /0 - I 3 Date: Phone: Pages: F.e: /. CC; / __l/Urgent _ For Review _Please Comment _Please Reply _Please -Recycle 09/27/2007 09:59 FAX 7032557963 DECEDENT ACCOUNTS f4J 002/003 2114883 6 March 2007 :)ear Mrs. Myers: lvirs. Christina Myers :~ Orchard Ave West Nanticoke, PA 18634 ')n behalf of Navy Federal's staff and memoership, I wish to extend our heartfelt sympathy to :rou and your family on the loss of your husband in January. We have completed settlement of his accounts and I hope that the following infonnation is of aEsistance to you. <)n J 5 January 2007, your husband's share savings account reflected a balance of $6,759.87, with dollar for dollar insurance coverage up to a maxinmm 0[$2,000.00. The enclosed flier [ncludes detailed information regarding the complimentary Life Savings Insurance coverage that we provide as a benefit to our members. Transactions on the account since the date of death resulted in a balance of $5,374.76 as of28 February. Your husband's checking account had a balance of$7,869.43 on 15 January. The funds in a Ghecking account do not earn Life Savings Insurance. His Defense Finance and Accounting Service (DF AS) direct deposit of $1 ,890.99 was received and credited to the checking account on 31 January. The funds have been deducted for return to the paying agency. In view of these tram;actions, and dividends credited since the date of death, the checking balance as of2 March was $7,876.63. For the purpose of disbursement, the funds in the checking account have heen transferred to the share savings. We also credited dividends of$.21 to the shares on 2 March. After the transactions, the share savings balance was $13,251.60. Although no joint owner was designated on your husband's accounts, you are entitled to his combined balance as Claiming Successor based on the Affidavit provided. In addition, as payee of the Life Savings Insurance provided on the share savings account, you are entitled to the insurance proceeds. Our checks are enclosed. The check for the insurance proceeds includes dividends of$14.95 for a total insurance benefit of$2,014.95. Your hushand's Visa account was not covered by Loan Protection Insurance or a Payment Protection Plan. His outstanding Visa balance was paid by a transfer of$I,399.94 from his share savings account on 20 Febmary. His accounts are now closed and the fmal statement will be forwarded at a later date. 09/27/2007 09:59 FAX 7032557963 DECEDENT ACCOUNTS Access Number 2114883 rage 2 of2 y [lU You are eligible for membership in Navy Federal. If you wish to establish an account in your name, please complete and sign the enclosed application and return it to our office in the envelope provided. You may return the enclosed checks for crediting to the new account. Otherwise, a minimum remittance of$5.00 should accompany your application to complete your initial share purchase. Should you have any questions, please call me toll-free at 1-800-883-3323, extension 48116, l::...;:tween 8:00 a.m. and 4:30 p.m, Monday through Friday. You may also reach me by fax at 1-703-255-7963. Sincerely, TP:rt E.nclosures: NFCU 97 NFCU 97 A Insurance FI i er Check No. 2600526247 Check No. 0801045400 R.,;tum Envelope Bryne Torres I4J 003/003 REV-1510 EX, + (6-98) '* SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 07 0381 ESTATE OF Myers Blake A This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPlICABLEI VALUE 1. M& T Bank Safe Deposit Box #4046 POD to decedent's sister, 159.50 100. 159.50 Anita Lanious contained 25 U.S. Silver Dollars See appraisal of Ochman's Coins & Jewelry dated 9/25/07 and attached to this schedule. TOTAL (Also enter on line 7 Recapitulation) $ 159.50 (If more space is needed, insert additional sheets of the same size) ~ REV-485 EX (05-04) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue Social Security or Death Certificate Number Date of Death 48500041046 PLEASE USE ORIGINAL FORM ONLY County Code Year File Number eRa? 1A ~3?D Decedent's Last Name 0/ /!)Ao 01 Suffix J1u o '7 u O~? I First Name MI Y) e f/ / 7 ()O '7 STATE: ZIP CODE: STATE: ZIP CODE c. () G~ A1ml/7/5" tilt I; k 1 n:3') l{)n PA InDY RELATIONSHIP I/~ _ ~'/; . fh;;JUf1: U W/ a(7) il -i z1 {,o -r 0 , ()A CITY/" 7 " 11 S(ATE ZI CODE L~_ ~ "O(F~r9{l61 RELATIONSHIP: STATE ZIP CODE STREET ADDRESS CITY STATE: ZIP CODE NAME (L{ ~L 8uJ\Ll NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED Q~ p~ STATE ZIP CODE IDtAS /L{ u efS \ ( IV "2- r1{ tcld Ltloyt-T STATm- JI~LDFj b_ NAME STREET ADDRESS CITY STATE ZIP CODE NAME AND TITLE OF EMPLOYEE TAKING THE I VENTORY WAS A WILL IN THE BOX? 0 YES Si\ NO If yes, a. Date of will: b. Name and address of personal representative, if named in the will NAME STREET ADDRESS CITY STATE: ZIP CODE C. Name and address of attorney, if any NAME STREET ADDRESS: CITY: STATE ZIP CODE: L 48500041046 48500041046 --.J REV-485 EX SAFE DEPOSIT BOX INVENTORY ------ ~-- -------- - ----- -- -- -------- --- - - INSTRUCTIONS Page___ / of / (1) Cash: Report totell only (2) 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. (3) Obligations of U.S. Government: Number of items, date of issue, face value. names in which registered and type of ownership, ie., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) 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. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents, (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT 280601 HARRISBURG, PA 17128.0601 ITEM NO. ITEM DESCRIPTION ~/k' 4L1 c1). Fl 17 c; 16/07 . NOTE: Attach additio al 8'1," x 11" sheet(s) if necessary or use duplicates of this page of form. The Department IS authorized by law, 42 use ~405 (c)(2)(C)(i) to require disclosure of SOCial Securrty numbers In connection with administering state tax laws. The Department uses the Social Security number to Identify the decedent and personal representatives of the estate The Commonwealth may also use the Information in exchange of tax information agreements wit~edera~Jclc~xlng~uthorltl~I_he~ta~la\'J prohlbltsthe ComfTlCJrlwealths persCJrln~t..fr.om dlsclo~ng confidenliallax information except.fclr~clal purposes__.~___ o Executor(trix) Administralor(trix) o Estate Representative 0 JOint owner of safe depOSIt box -:d-J ---- OCHM~N'S Coins and Jewelry 18 CHURCH STREET · DALLAS, PA 18612 (570) 675-5872 DATE 7~ Driver's License D.O.B. Phone No. I I Quantity * We do not purchase from Minors. * Driver's License required to sell items. * We cooperate with the Luzerne County Sheriff's Office. * I certify that the above items are mine to sell ::P~ ----- OCHM~N'S Coins and Jewelry 18 CHURCH STREET · DALLAS, PA 18612 (570) 675-5872 DATE 7.... - ,) ~~- c . Driver's License D.O.B. Phone No. I ~'-~~ r~( Quantity . We do not purchase from Minors, . Driver's License required to sell items. . We cooperate with the Luzerne County Sheriff's Office. . I certify that the above items are mine to sell REV-1511 E~ + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF Myers Blake A Debts of decedent must be reported on Schedule I. 21 07 0381 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ronan Funeral Home 4,936.10 B. ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2 Attorney Fees Cardoni & Associates, LLC 3,071.56 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 Cumerland County Register of Wills $143.00- open Estate; 174.00 $15.00- Petition to Discharge Executrix; $16.00-short certificates 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. The Sentinel- legal advertising 129.77 8. Cumberland Law Journal- legal publication 75.00 9. Ochman's Coins & Jewelry- appraisal of 25 U.S. Silver Dollars 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 8 411 .43 (If more space is needed, insert additional sheets of the same size) REV-1512 EJ< + (6-98) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Myers Blake A FILE NUMBER 21 07 0381 Include unreimbursed medical expenses. ITEM NUMBER . VALUE AT DATE OF DEATH 2. 3. 4. 5. 6. 7. 8. DESCRIPTION Verizon Wireless Account #619608570-00001 due and owing prior to decedent's death. See statement of Verizon Wireless dated 12/6/2006 attached to this schedule 50.42 Pepco Electric Service Account #2284126030 due and owing at decedent's death. See statement of Pepco Electric Service dated 2/21/07 attached to this schedule 183.25 Met-ED Account #100069048302 due and owing at decedent's death, including terminatior of service fee. See statement of Met-Ed dated January 22, 2007 53.95 AT&T customer 10 #301468-32820896716 due and owing at decedent's death. See statement of AT&T dated October 29- November 28, 2006. 45.49 Washington Gas Account #2653270039 due and owing at decedent's death. See statement of Washington Gas dated 3/20/07 attached to this schedule. 460.24 Shipley Energy Customer Account #385382 due and owing at decedent's date of death dated 12/7/06. See statement of Shipley Energy attached to this schedule. 467.43 Deausen Enterprises, Inc. debt of decedent associated with decedent's apartment prior to death, 11505 Monongahela Drive, Rockville, MD. See statement of Deausen Enterprises, Inc.dated 4/27/07 Navy Federal Credit Union Visa account balance on date of death. See statement of Navy Federal Credit Union attached hereto. 3,757.97 1,399.94 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6418.69 ~ verizon~ We never stop wc:lmngf6r ~ P.O. BOX 17120 TUCSON, AI. 85731-7120 [,nvoice Number ! 1250201189 i 10003770 01 AV 0.293 "AUTO T1 2 2206 20852-244905 1 3 E WABL0606 '"1,111".,..1"1.1"""..',1,,,,',1..11.1,.11," ,'.','.'..1 BLAKE A MYERS 11505 MONONGAHELA DR ROCKVILlE, MD 20852-2449 Quick Bill Summary Nov 07 - Dee 06 PreVious Balance (see back for details) Payment - Thank You Balance Forward $1m.98 -$103.98 $.00 Save Time and Money It's never been easier to enroll in Auto Bill Pay. See back of Payment Coupon below for details. Account Charges and Credits Monthly /!>I:;ress Charges Usage Charges Voice Data Verizon Wireless' Surcharges and Other Charges & Credits Taxes, Governmental Surcharges & Fees Total Current Charges $1.00 $43.98 ~-: ~ ": V(d?6nWtwrtS"$l'4eW$:"~JL~ $.00 $.00 $3.18 $2.26 $5OA2 Total Amount Due by January 01,2007 $50.42 - --- - - ------ ------------------------ --- -.- ------ -. -----.---- --.- - --- -- --- - -. - _.- - - - - -- - --- ----.-- --- - -- ------ - --- --- -.------------ --- - ----- ~e'{zQow;reIess We never stop WOr#(ing for you!" Bill Date Account Number Invoice Number VE December 06, 2006 619608570-00001 1250201189 BlAKE A MYERS 11505 MONONGAHELA DR ROCKVlLLE, MD 20852-2449 Make check payable to Verizoo Wireless Please return this remit slip with payment Total Amount Due by January 01, 2007 ---------------~--- $50.42 $00.00 PO BOX 17464 BAlTIMORE, MD 21297-1464 I" 1.1... II.. ,., 1.1. .1.. .1...11.' ,,1.11...'.. 1.1 "II o Check here and fill out the back of this slip if your billing address has changed or you are adding or changing your email address. 1250201189010619608570000010000050420000050426 i) 0 f" ..0~ .~ ,s-" ~e'i2RDWireless We never stop working for you.- Invoice Number Account Number Date Due Page Summary for Blake Myers: 301-801-0171 Your Calling Plan Charges Monthly Access Charges Current Calling Plan 12/07 - 01/06 1XT Messaging - 200 12/07 - 01/06 39.99 3.99 $43.98 America's Choice II 450 Any Unlim N&W and Unlim IN Calling $39.99 2yr 0205 $39.99 monthly access charge 450 monthly general allowance minutes $.45 per minute after allowance NatlIN Calling-Unllm Unlimited IN Calling minutes Venzoo Wireless' SUrcharges Fed Universal Service Charge Regulatory Charge Administrative Charge Montgom. County Une Surcharge .73 .05 .40 2.00 $3.18 Unlimited Night & Weekend Mlns TXT Messaging - 200 $3.99 monthly access charge 200 monthly 1XT Message allowance $.10 per message after allowance Taxes, Governmental Surcharges and Fees MD State Sales Tax Total Current Charges for 301-801-0171 Usage Charges 2.26 $2.26 $49A2 Voice Calling Plan Promotional IN Calling Total Vofce Data -m Messaging Total Data Total Usage Charges Allowance Used Billable minutes 450 385 minutes 275 minutes unlimited 912 Cost $.00 messages I 200 I 16 I -- - $.00 $.00 View your bill and call details online lor FREE log inlo My Account at www.verizonwireless.com. Orrjer \,"'~""ve'i7O::Wjreless . We never stop wo ng for yo~ Invoice Number :-~ -~:::.. _=_"""";,.o-~",,, Account Number Date Due Page Need-to-Know Information - - Umiting Notations on Payments Pursuant to our Customer Agreement, we won't honor limiting notations you make on or with a payment - - - - -- -- ~ Important Infonnation Regarding Electronic Fund Transfers When you send a check to pay your bill, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account Qr to process this transaction as a check. If you wish to be exduded from the process, please call 1-866-544-0401. - - - ~ - - - ~ -- ~ - California - Questions About Your Bill? Call Customer SelVice at 1-800-922-0204. Send written OlSputeS to: Verizon Wireless, Customer SelVice, P.O. Box 96082, Bellewe, WA 98009. If you are disputing a dlarge because you contend it was not authorized, and we need time to investigate the complaint, you are not required to pay the disputed amount while our investigation is pending. If you have a complaint you cannot resolve with us, write the California Public Utilities Commission at Consumer Affairs Branch, 505 Van Ness Ave., San Francisco,CA 94102, or at WWW.qlUc.ca:gov..OrcalI1-8oo-.649-7570 or TIS 1-800-229-6846. - - - - tJew Mexico - Questions About Your Bill? Call Customer SelVice at 1-800-922-0204 or by dialing "611 from your wireless phone. If you are unable to resolve any service problem or billing dispute with Verizon Wireless, you amy contact the New Mexico Public Regulation Commission's Consumer RelatiQns Division at 1-800-663-9782 for assistance. l.Tiene preguntas sabre su factura? Dame a Servicioal Cliente aI1-800-922-0204 Q mar!jue "611 desde su teh~fono inalfunbrico. Si no puede resolver su problema de selVicio ()SU disputa con Verizon Wireless, puede contactar a la Division de Relaciones -del Consumidor de la Comision de RegulacionPUblica de Nuevo Mexico, aI1-800-663-9782 paraasistencia. Returned Payments In the event your check for payment of your wireless bill isretumed by your bank for insufficient or uncollected funds, Verizon Wireless may resubmit your check electronically to your bank for payment from your dlecking account <> ... '" <> o <> <> 6 "- "- '" <> <> <> .. "0 ~ o o Important Information About Mexican Mobile Telephone Numbers Effective November, 2006, when making calls or sending text messages to Mexican mobile telephone numbers, you must add a "1" after the country code "52" (e.g. 011 +52+"'" + area code + telephone number). This dialing change was mandated by the Mexican govemment You'll enjoy the same global connections to Mexico that make it easy to keep in touch. For more infonnation, please visit www.verizonwireless.comlinternational and select 'International long Distance'. U> <> .. >- 0. o U U> o '" '" .. Wony Free Guarantee Updat~ Beginning November 16, Verizon Wireless expanded its industry-leading Worry Free Guarantee. My Account customers will get additional Worry free Guarantee benefits: Receive Back Up Protection for your stored phone numbers. Get a new phone every year at a promotional price with an Annual Upgrade. And if you're using more minutes than your calling plan includes, we'll let you know about some other options that may save you money. log in or Register for My Account today! See verizonwireless.comlmyaccount for details. Coming Soon! Verizon Wireless will be opening a store in Prince Frederick, Maryland in eal1y January! The store will be located in the Mal1<et Square Shopping Center located at 304 Market Square Drive, Prince Frederick, MD 20678. Soon you WIll be able to stop by our new store to see the latest handsets, accessories, and wireless data products! ill pepc~::[ CompooJ Page I of 2 Account No: 2284 1260 30 Bill Issue Date: Mar 20, 2007 ~LAKE MYERS ; ORCHARD AVE -lANTICOKE PA 18634-1115 Service Period: .Ian 26, 2007 to Feb 22,2007 Service Address: 11505 MONONGAHELA DR NOTICE OF INTENT TO DISCONNECT ELECTRIC SERVICE NOT PAYABLE AT AREA BANKS vlar 20, 2007 )ear Customer: Jur records indicate your account is overdue. You must pay $183.63 by April 4, 2007 to prevent disconnection of your electric service on or Ifter April 5,2007. i\ccounts disconnected will be required to pay the total amount owed plus a reconnection fee of $35.00 and a deposit of two twelfths the mnual usage. You can pay with a check or major credit card by calling BillMatrix, Inc at 1-800-960-1242. You can also Imke in-person payments by :heck, money order, or cash at ACE or Global Express locations which are conveniently located in or around Washington. BillMalrix, ACE, 3nd Global Express charge a small fee for this convenience. Pepeo offers other payment options. Please visit us at www.pepco.com to learn more. The Stllte of Maryland offers the Electric Universal Service Program which is available to assist low income customcrs in paying Ulcir electric bills. To qualify for this program tJlC monthly household income cannot b.; more Ul311 $1,633.00 for a single member household. The maximum household income increases by approximately $566.00 for each additional household member ($2,200.00 for 2; $2,766.00 for 3; etc.). If you believe you can qualify for this program, please call the Office of Home Energy Programs for your county: Montgomery County residents call 240-777-4450; Prince George's County residents call 301-909-6300. AMOUNT DUE NOW $183.63 SEE REVERSE SIDE OF THE NOTICE FOR PAYMENT LOCATIONS AND OTHER IMPORTANT CONTACT INFORMATION ervice Address: ~-'"-OO5T5~----PLEASE-DEtACH "HEFrfAND RETURN THlS'PAR:rWiTH"YOURPA YMENTOR oPA YONLlNEATWWW.PEPCO.CO."M------ Please make your payment payable to Pepco Write your Account No. 2284 1260 3001\ your payment 11505 MONONGAHELA DR I. ..111..1..11.. ..11..1..1.. .11.. .11.. .11.1.1.11.....11.1...11 ********** AUTO**MlXED AAlX~ 200 BLAKE MYERS 3 ORCHARD AVE NANTICOKE PA 18634-1115 AMOllNT$Dor--J no PAID L L .l----1 DO NOT SEND CASH BY MAIL NOT PAY AllLE AT AREA BANKS NOTICE OF INn':NT TO DISCONNECT 222841260300000183630000183630404070000183630002284126030 ~ ~t-Ed A FustEnergy ~ January 22, 2007 I ACll~mber: 10 00 69 0483 0 2 I Page 1 of 3 M70 Bill for: BLJ\KE A MYERS 456 CRISWELL DR BOILING SPRINGS PA 17007 Billing Period: Bill Based On: Jan 12 to Jan 17,2007 for 6 days Actual Meter Reading Final Bill Prorated Bill Residential Your previous bill was Total payments/adjustments Balance at billing on January 22, 2007 Current Basic Charges Met-Ed - Consumption ue e Met-Ed A~Corrpan~ Return this part with a check or money order Payable to Met-Ed Account Number: 100069048302 I.. .111111111111111111...11.111' 111111111.1111.1.1..1111..11.1 ~~****~AUTO**SCH 5-DIGIT 17007 00016014 01 AV 0.293 P2 BLAKE A MYERS 456 CRISWEll DR BOILING SPRINGS PA 17007-9606 Amount Paid I Please Pay I $53.95 Due By MET-ED PO BOX 3687 AKRON OH 44309-3687 1.1..1.'111..11.1'1111.'111.11..1,..,. .1.1'1111. .1.1. 111,1111 I February 12, 2007 0210006904830200000000000000000000000013590000053952 ~, r..ccount Number: 10 00 69 0483 0 2 BLAKE A MYERS Invoice Number: 95451451114 Page3-~:- M70 When contacting an Electric Generation Supplier, please provide the customer numbers below, Call Met-Ed at 1-800-545-7741 with questions on these charges. Met-Ed Basic Charges Customer Number: 0804534201 0002328601 - Residential- ME_RS_01D Customer Charge Generation Charges Transmission Charges Distribution Charges Transition Charges State Tax Surcharge 141 141 141 141 KWH KWH KWH KWH x 0.046060 x 0.001720 x 0.030290 x 0.007670 0.09 0.09 0.18 Total State Tax Surcharge Total Met-Ed Charges 1.::-:&,;~~:~;;~',':r1':i~j-Wi.~.,t>:~~fJ17JJg.'fXt_t?1~'n~ "-~';"< ." .,,;>f;lVI~ter R~il~t09 lo.torm~tl9n ::" Residential Meter Number Present KWH Reading (Actual) Previous KWH Reading (Actual) Kilowatt Hours Used S33919343 25,747 25,606 141 Usage Comparison 350 300 250 200 150 100 50 o N N N N N N N N N N N A-Actual E-Estirnate C-Customer N-No Usage Average Daily Use (KWH) Average Daily Temperature Days in Billing Period Last 2 Months Use (KWH) Average Monthly Use (KWH) Jan 07 51 41 6 352 176 1~:,,)J,{~ft;r);~;<i;;'t+4\'tj:j':;if;.;0t9'Y' ,'J\'M(:issageJ\bpl.llf;lO<<;;Ogr';" '0;' Generation prices and charges are set by the electric generation supplier you have chosen. The Public Utility Commission regulates distribution prices and services. The Federal Energy Regulatory Commission regulates transmission prices and services. 1.33 6.49 0.24 4.27 1.08 0.18 $ 13.59 I I -~-~ -.~ --.- Your AT&T~Statement Octuber 29 - November 28, 2006 \"000 ~q,<{, rl.\'\ #07040896716015# 4079.3.106.254201 AT 0.308 1..1.111.,.1..1" 1.1.11111..1,1,1.11.11111.1,.11..1.1.1,1.11.1 BLAKE MYERS 11505 MONONGAHELA DR ROCKVILLE MD 20852-2449 #BWNCJFM 111111111111.11111 II 1111111 111111,1'11'11".11I11111"'111'11111,,11I11/ Summary of charges Previous balance........ ................... ............................. .45.49 Payment received Nov 16 - Thank you ......................... -45.49 AT&T Local Services ............... ................... ..p 3.......... .33.54 AT&T Internet Access Services. ..... ............. ...p 4. ........ ..11.95 Total amount due $45.49 Date due December 23,2006 Your savings and benefits Never Mail Another Check to Pay Your AT&T Bill. For the ultimate convenience, enroll in AT&T Automatic Bill Payment (ABP) and have your future payments automatically deducted from your enclosed check. To enroll, check the box and sign on the line on the back of the remittance coupon, and return with your payment. Or sign up for online billing to review and pay your bill each month by logging onto your AT&T Online Billing account at http://www.att.com/remitdoc Detach and return with payment Please write your customer 10 on your check or money order made payable to AT&T. Do not send cash. Do not staple this portion to your payment. Thank you. Total amount due Date due $45.49 December 23, 2006 Amount enclosed: $1 1.111111..,.1.1.1.111..1.1 I ..1 1111,111.11.. I .1'1111111,1. I .,11 AT&T PO BOX 8212 AURORA IL 60572-8212 /111, II 111111111,11I111" 11111,11111,11,111.1111111,111,11I111,1111,1.11 D n w"- r:W :~ at&t Customer ID: 301 468-3282 0896716 Page 1 of 4 Customer Service: 1 800 288-2747 Text Phone (TTY): 1 800833-3232 Internet Address: www.att.com Extra! Extra! For collect calls just dial down the center 1 800 C-A-L -L -A- T - T. ('[I;)~rL Benefit news Sign up for AT&T Online Billing and you won't get another paper bill! To sign up just visit www.att.com/online Why more customers are choosing online billing! Simply visit www.customerservice.att.c om to manage or set up your online account. ~ at&t BLAKE MYERS Oct 29 - Nov 28, 2006 Customer ID: 301 468-3282 Moving? It's hassle free with AT&T. Check the box, print your new address on back. Save your check! Visit W'NW. att. com/remitdoc 07040896716011120100000004549000000454900000045494 custo->>1~ervice: 1 800 288-2747 Text Pl1ooe-(TTY): 1 800833-3232 Int~rnet Address: www.att.com Oct 29-;;: 006 Customer 10: 301 468-3282 Page 3 of 4 AT &T Local Services Oct 29 - Nov 28, 2006 Charges for 301 468-3282: Basic service and calls .......................... ......... ..... ............. ......... .... ........... .... ... ..........28. 99 Custom calling features......................................... ............................................ .......... O. 00 Taxes and surcharges ........................... ........... .............. ......... ...... ............ .......... ........4. 55 Total A T& T Local Services...................................................................................$33.54 If you have questions concerning your AT&T Services or bill, please visit http://Iocalhelp.att.net for more information. Basic service and calls' - --.- q....-... -. -. -. ---. .- -- 1 2 3 4 5 6 Date Nov 28 - Dee 27 Nov 28 - Dec 27 Nov 28 - Dee 27 Nov 28 - Dee 27 Nov 28 - Dee 27 Nov 28 - Dee 27 Amount .00 .00 18.95 .59 6.50 2.95 Description Local number portability service charge Directory listing - standard Call Plan Unlimited Plus Universal connectivity charge Subscriber line charge Local connectivity charge The Local connectivity charge is a monthly per line charge implemented to recover increased connectivity costs associated with providing local service in your state. For an explanation of this charge, please call 1 888 301-0390. $28.99 Custom calling features Date Description Amount 7 Nov 28 - Dec 27 Call block - 900/976 Taxes~nd~u!Eharge~_ _ _ _~__ "~____'___ ~_'_________'_' ._..__"-_______ Description Federal tax MD PSC Franchise Tax 2.04% State 911 Charge Local 911 charge Telephone Tax MD Universal Service Fee Amount .89 .46 .25 .75 2.00 .20 $4.55 Important information about your local service Federal regulation requires AT&T to inform our valued customers that basic local service will not be disconnected for the non-payment of non-regulated service charges (e.g. Wireless, Worldnet@, voicemail.insidewiremaintenanceplan).To avoid collection activity, please remember to pay all charges by the due date. ~ at&t ........... .~.- .00 $.00 For more information concerning your AT&T Local Taxes and Surcharges, please visit http://localhelp.att.n et Continues on back ~ IU.,JU IIVV 1 I c:. UOJ qc:.~ UUUVUU.:::::q~t> ~)~ c:,,-i,_ 'il-- .. _ c..-' ACCOUNT INFORMATION Service Address: 11505 Monongahela Dr Mailed 03/26/07 Account Number 2653270039 Meter ID No. 886644 Rate Class RESIDENTIAL HEAT/COOL Level 1 Next Meter Reading Date Days in This Billing Period 8 Gas Use Current Reading Previous Reading CCF of Gas Used Unmetered Gas Light (CCF) + Total CCF of Gas Used Conversion Factor X Total Therms (TH) Used Reading Date 9797 03/23/07 9786 03/15/07 11 11 1.035 11.4 - - - - - - - - ~ - Method READ BY CO. READ BY CO. GAS USAGE DETAIL TOTAL THERMS USED 11.4 DISTRIBUTION SERVICE DISTRIBUTION CHARGE 11.4 TH @ $.3912 4.46 SYSTEM CHARGE 2.72 NATURAL GAS SUPPLY SERVICE PGC @ $1.0241 11.67 STATE & LOCAL MONT CTY SUR @ $.0437902 0.50 TOTAL GAS CHARGES $ 19.35 CHARGES PREVIOUS BILL AMOUNT PAYMENTS RECEIVED BALANCE FORWARD CHARGES THIS PERIOD GAS USAGE TOTAL THIS PERIOD TOTAL DUE 460.24 75.00 460.24 19.35 19.35 $ 479.59 TO AVOID LATE PAYMENT CHARGES, FULL PAYMENT MUST BE RECEIVED BY THE DUE DATE. '1/21jt ;;:----- 1/19-59 \JiJf'v JI-1W FINAL BILL 'l:.r of) ff?8 1 fl PAYMENT OF THIS FINAL BILL CLOSES YOUR ACCOUNT. A ~ LI' 9 LATE CHARGES WILL ACCRUE ON ANY UNPAID BALANCE'-.--() . 5 rf) /A"l T - 125/./ f!!!5 Fa: ~ C![ 61f 2 ,3 ~L f>Ata Important customer information is on the back of this bill. Please detach this stub and return with payment. Make check payable to WASHINGTON GAS or pay online at www.washingtongas.com. Washington Area Fuel Fund Check box and include donation with payment. (If you have previously pledged a donation, do not check box.) Donation Amount $ o Mailing Address or Name Change? Please check box and complete form on back. ~~~ Wasnngton 101 Constitution Avenue, NW Washington, DC 20080 Gas 202-624-6049.703-750-1000 ADDRESS SERVICE REQUESTED o 0000002495 ........*AUTO.. MIXED AADC 350 11111111111.11.11111111111..111.1.1 I ...11.1"1"111..11"11111 BLAKE MYERS C/O CHRISTINIA MYERS 3 ORCHARD AVE W NANTICOKE PA 18634 Account No. Due Date Amount Due Amount Paid 2653270039 $ 479.59 I $1h16fl 1,1'11..."..111'111,1.'1.'1,1.1',11111'1.1'",1",1'1,1.'11,' Washington Gas PO Box 830036 Baltimore, MD 21283-0036 ~ lfJ6~ Irt60g / /" r; 2653270039004795900479594 hie.. IcuT" ENERGYI , , GU~LM~5~~;~4:298 00000 46 7 438 d t) Y-tL -- Customer Number: 385382 Invoice Number: 48298 Invoice Date: 12/07/06 - BLAKE MYERS 456 CRISWELL DR BOILING SPRINGS, PA. 17007 Please pay: $467.43 PAYMENT DUE DATE: 12/22/06 Amount Enclosed $ Please Enter Your Email Address: I~~~~~~~W~~~~~~~~W~~~QOO~~ through 5/31/07 Since 6/01/06 167.0 Product: HS FUEL Total Amount Due $467.43 ee service calls on your heating and cooling systems and if we can't fix it _ ~'II replace it. How'sthat for protection! Say goodbye to discomfort and 110 to peace of mind. Sign up for the Lifetime Protection Plan! Shipley Energy Co. PO BOX 5006 YORK, FA 17405-5006 www.ShipleyEnergy.com (800) 839-1849 717-766-4722 Trk. Drvr. 248 327 ~ # 711082 Customer# 385382 ~ --------------- j/Mi' i Deausen Enterprises, Inc. Property Management Division 13975 Connecticut Ave Suite 311 Silver Spring MD 20906 Tel No. :30]-871-2084 Fax No. : 30]-871-7913 Apri] 27, 2007 Christina Myers 3 Orchard Avenue W. Nanticoke, PA ]8634 Re: Blake A. Myers 11505 Monongahela Dr. Rockville, MD 20852 Outstanding Accounts: 1. Tenant's unpaid rents during abandonment as per letter. March'07 rent --- $ ],690.00 Apri]'07 rent ----- $ ],690.00 Sub-Total _______________________$ 3,380.00 Less: Security Deposit ---------------($ ] ,800.00) Pet Deposit ______________________($ 400.00) Total Amount Due Rent -------------------------$ ],180.00 2. Basement Carpet Cleaning ________________$ 840.00 Yard Cleaning, Mowing, Trim Plants, House Cleaning (Appliances, Bathroom, 4. State Farm Insurance Claim; Deductible paid by Owner (see statement) -----$ ] ,000.00 5. Dump abandoned Trash, Appliances ---$ 489.52 6. Unpaid Utilities (Gas & Water) __________$ 248.45 TOTAL AMOUNT DUE ---------------------- $ 3,757.97 If you have questions or clarification, please feel free to contact us. Thank you for your cooperation and understanding in this regard. Sincerely, C~ Dani]o C. Miranda cc: File, Owner-Penala d:S9 FAX 7032557963 DECEDENT ACCOUNTS ~J UO";::I vt).j 2114883 6 March 2007 ':)n behalf of Navy Federal's staff and memBership, I wish to extend our heartfelt sympathy to :{ou and your family on the loss of your husband in January. We have completed settlement of his accounts and I hope that the following infonnation is of assistance to you. Iv1rs. Christina Myers ] Orchard Ave West Nanticoke, PA 18634 :)ear Mrs. Myers: ':In 15 January 2007, your husband's share savings account reflected a balance of$6,759.87, with dollar for dollar insurance coverage up to a maximum of$2,000.00. The enclosed flier includes detailed information regarding the complimentary Life Savings Insurance coverage that we provide as a benefit to our members. Transactions on the account since the date of death resulted in a balance of$5,374.76 as of28 February. Your husband's checking account had a balance of$7,869.43 on 15 January. The funds in a ;;hecking account do not earn Life Savings Insurance. His Defense Finance and Accounting Service (OF AS) direct deposit of$I,890.99 was received and credited to the checking account on 3 I January. The funds have been deducted for return to the paying agency. In view of these tran<;actions, and dividends credited since the date of death, the checking balance as of2 March was $7,876.63. For the purpose of disbursement, the funds in the checking account have heen transferred to the share savings. We also credited dividends of$.21 to the shares on 2 March. After the transactions, the share savings balance was $13,251.60. Although no joint owner was designated on your husband's accounts, you are entitled to his combined balance as Claiming Successor based on the Affidavit provided. In addition, as payee of the Life Savings Insurance provided on the share savings account, you are entitled to the insurance proceeds. Our checks are enclosed. The check for the insurance proceeds includes dividends of$14.95 tal insurance benefit of$2,014.95. Your hushand's Visa account was not covered by Loan Protection Insurance or a Payment Protection Plan. His outstanding Visa balance was paid by a transfer of $1 ,399.94 from his share savings account on 20 February. His accounts are now closed and the fmal statement will be forwarded at a later date. . . . ":.""""* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Mvers Blake A 21 07 0181 RELA TIONSHIP 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. Christina M. Myers Spouse 50,372.53 3 Orchard Avenue, Tilbury Terrace Nanticoke, PA 18634 2. Anita Lanius Sibling 159.50 296 Heisers Lane Carlisle, PA 187015 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) CARDONI &ASSOCIATESr; ATTORNEYS AT LAW Attn: Jackie Cumberland County Register of Wills One Courthouse Square Carlisle, P A 17013-3387 October 11, 2007 "- -~ ~: ESTATE OF BLAKE A. MYERS ESTATE NO: 21-07-0381 OUR FILE NO. : 6167.0002 Dear Jackie: In response to our telephone conversation of earlier today, enclosed please find a check in the amount of $30.00 which represents the filing fees required to file the Inheritance Tax Return and Inventory with regard to the Estate of Blake A. Myers that was previously forwarded to you. i.'V you should have any questions or comments with regard to the processing of this Petitiqfi~ please do not hesitate to contact me. Thank you. --- -....~- .,.'\} --- :-c" Very truly yours, ,WaflHu krM~ ~:;;;J1KONSCHNIK FOR ANGELA F. STEVENS /sk Enclosures 155098_I.DOC :l40 MARKET ST., KI,\GSTON, P\ t8704-5498. V: 570.28:L5800 F: 570.283.5900 , :1 H S P /{ I C I'; S l. S C /{ \ \ l () \. P \ I H 'i ():l . \ 'i 7 () :1 -I 2 . II () () . \\ \\ \\ (' a [' d () n i . (' () m 1\)7 \ () R l II C I': 1)\ /{ S T 11\ Z LET () \, 1 '\ 1 H 2 () 1 . \. 'i 7 () . 'i () I . ~) :1 () () HARRY V. CARDONI . NORMAN D. NAMEY . NEIL F. MACDONALD. .JAMES V. PYRAH . LAUREN E. DOBROWALSKI LAWRENCE A. DURKIN. MICHAEL R. KOSTELANSKY . .JOSEPH C. ZOLA . RYAN C. BLAZURE . ANGELA F. STEVENS OF COUNSEL: HOWARD A. BERMAN ... ,J o ... i.J .t i.J i.J Ul ~ I Ul JJ r o o ... - - - - - - ~::: ~n ~. ~ --' >..... ~~ crJ), ;'?; ~ CFJ" ~.~~ 0... f:: -< L"::; V ---. rJ]~o :; >'~ ..- --';.....jz ::-, r- r:r:J )-~- ~, - - - C::::O> OOZSC:\ )> r~Z ::ornr\JJ.. COU>rn U>o ::oC- rC ';;~ m::o z" -01 on; )>0 0 -"'c 0 c3U> C -"'rn z CfU> -\ v.>o -< v.>c ::0 ~J> rn ::0 G> rT\ en. t ~ rn ::0 o -n - - - - - ~ :~ ~~~;\ po.. ~ ~~ ::'l} '0 (~j ~,., (,0.) ;u D- 0(51 <"m 0>> ~ O.f,l~" o c:'.C:q g,:C) :: ~ -". ~: .1) ,.) ,ra. ;, :_j CJ _~ \/'". ,=>,:) a b '-.j UNITfo <)), 'VA fj, -n Ii .l;.'" ,,>0