HomeMy WebLinkAbout01-29-08
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
21 07
1051
Date of Birth
184-12-3376
10/30/2007
12/16/1919
Decedent's Last Name
Suffix
Decedent's First Name
MI
Wise
Geraldine
A
(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
(8) 1. Original Retum
2. Supplemental Retum
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
4. Limited Estate
C8:>
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 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
8. Total Number of Safe Deposit Boxes
Marvin Beshore, Esquire
Finm Name (If Applicable)
Law Offices M. Beshore
REGISTER O~~ILLS USE
First line of address
130 State Street
Second line of address
P.O. Box 946
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City or Post Office
Harrisburg
State
ZIP Code
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PA
17108-0946
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this retum, 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.
F LING RETURN
DATE
DATE
A DR S
130 State Street, P. O. Box 946, Harrisburg, PA 17108-0946
PLEASE USE ORIGINAL FORM ONLY
L
15056051058
Side 1
15056051058
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15056052059
REV-1500 EX
Decedent's Name:
Geraldine
A Wise
184-12-3376
RECAPITULATION
1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . " 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested. . . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
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)................................... 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................14.
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 .0_
16. Amount of Line 14 taxable
at lineal rate X.O 45 132,333.49
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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15056052059
Side 2
Decedent's Social Security Number
136,258.89
13,379.87
149,638.76
16,382.20
923.07
17,305.27
132,333.49
132,333.49
15.
16.
5,955.01
17.
18.
5,955.01
15056052059
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
Geraldine A Wise
STREET ADDRESS
1004 Allen Street
File Number
1051
DECEDENTS SOCIAL SECURITY NUMBER
184-12-3376
CITY
New Cumberland
STATE
PA
ZIP
17070
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,955.01
0.00
0.00
297.75
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
297.75
0.00
0.00
Total Interest/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)
5,657.26
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
5,657.26
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 [iJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ D [iJ
c. retain a reversionary interest; or.......................................................................................................................... D [iJ
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [iJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D [iJ
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. ~9116 (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. ~9116 (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 zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (6-98) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Geraldine A. Wise
FILE NUMBER
21-07-1051
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
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. MetLife Investors, P.O. Box 14593, Des Moines, IA 50306-3593
Contract No. A2069953, Plan Code 258PN3 (Balance as of 5/21/2007 $10,455.02)
10,601.40
2. PNC Investments, P.O. Box 32760, Louisville, KY 40232
Account No. 87540383 (Balance as of 9/30/2007 $10,571.25)
10,571.25
3. PNC Bank, Cedar Cliff Branch, 1104 Carlisle Road, Camp Hill, PA 17011
Account No. 5002103487
19,360.99
4. Fulton Bank, P.O. Box 4887, Lancaster, PA 17604
CD No. 000-0085442 $10,000.00 + 7.32 accrued interest
10,007.32
5. New York Life Insurance Company, P.O. Box 6916, Cleveland, OH 44101
3,535.04
Policy: AN 709141 (check in 2008 $1,767.52 and check in 2009 $1,767.52 = $3,535.04)
6 New York Life Annuity, Policy No. 58123962
82,002.89
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
136,078.89
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Geraldine A. Wise
FILE NUMBER
21-07-1051
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. Audrey A. Ulsh
1004 Allen Street, New Cumberland, PA 17070
Daughter
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 DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. Mainstay High Yield Corp Bond Fund A 26,759.74 50 13,379.87
TOTAL (Also enter on line 6, Recapitulation) $ 13,379.87
(If more space is needed. insert additional sheets of the same size)
REV-1511 EX+ (12-99).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Geraldine A. Wise
FILE NUMBER
21-07-1051
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Parthemore Funeral Home & Cremation Services, Inc.
Karns Foods - Funeral Meal Expenses
9,911.12
88.97
2.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) Audrey Ann Ulsh
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 1004 Allen Street
City New Cumberland
Year(s) Commission Paid: NONE
State PA Zip 17070
2.
Attorney Fees .
Law Office of Marvin Beshore
2,000.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Audrey Ann Ulsh
Street Address 1004 Allen Street, New Cumberland, PA 17070
3,500.00
City
Relationship of Claimant to Decedent Daughter
State
.Zip
4.
Probate Fees
294.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Michael J. Ulsh
588.11
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
16,382.20
REV-1512 EX+ (12-03) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Geraldine A. Wise
FILE NUMBER
21-07-1051
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Fulton Bank, P.O. Box 4887, Lancaster, PA 17604
Check Credit No. 0000447064 (over draft protection) Line of Credit
Date of Death Balance: $373.58 Payoff amount $380.50
380.50
2.
MCHS Carlisle
188.23
3.
Heartland Pharmacy of PA, Inc.
354.34
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
923.07
REV-1513 EX+ (9-00) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Geraldine A. Wise
FILE NUMBER
21-07-1051
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 [indude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Audrey Ann Ulsh, 1004 Allen Street, New Cumberland, PA 17070 daughter 100%
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 $
(If more space is needed. insert additional sheets of the same size)
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I, GERAIDINE A WISE, of Newberry Township, York County, pennsylvania, b~ing
LAST WILL AND TESTAMENT
of
GERAIDINE A WISE
of sound and disposing mind, memory and understanding, do make, publish and declare
this as and for my Last Will and Testament, hereby revoking and making void all former
wills and codicils by me at any time heretofore made.
1. I order and direct that all my debts and funeral expenses be paid by my
Executor or Executrix, hereinafter named, as soon as conveniently may be done after my
demise.
2. I nominate, constitute and appoint my husband, JOSEPH E. WISE, to be the
Executor of this, my Last Will and Testament, if he survives me for a period of sixty (60)
days. If my husband, JOSEPH E. WISE, does not survive me by sixty (60) days, I
nominate, constitute and appoint AUDREY ANN ULSH, as Executrix hereof. In the event
that she is unable or unwilling to serve, I appoint MICHAEL J. ULSH, as Executor hereof.
3. If my husband, JOSEPH E. WISE, survives me, then I give all my property,
real, personal, and mixed to him.
4. If my husband, JOSEPH E. WISE, does not survive me, then I give all my
property, real personal and mixed to my daughter, AUDREY ANN ULSH.
5. If I am not survived by either my husband, JOSEPH E. WISE, or my daughter,
AUDREY ANN ULSH, I give all my property, real, personal and mixed in equal shares to
MICHAEL J. ULSH and MEAGAN S. ULSH. If MEAGAN S. ULSH is still a minor at that
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time, r hereby appoint MICHAEL J. ULSH, as Trustee for Meagan's interest, until she
reaches the age of 21, at which time the trust shall be terminated and distributed to her.
6. r give to my Executor, Executrix, and Trustee the following powers which are
to be construed in the broadest manner consistent with validity and their duties as
fiduciaries. r give the powers stated herein, in addition to those granted by law, and r give
them to Administrators and Trustees who succeed the fiduciaries r have appointed.
a. To retain any or all of the assets of my estate, real or personal, without
regard to any principle of diversification or risk.
b. To invest in all forms of property, including stocks, common trust funds
and mortgage investment funds, as they deem proper without regard to any principle of
diversification or risk.
c. To sell at public or private sale, to exchange or to lease, for any period
of time, any real or personal property and to give options for sale, exchanges or leases, for
such prices and upon such terms or conditions as they deem proper.
d. To allocate receipts and expenses to principal or income or partly to each
as they from time to time think proper.
e. To borrow money from any person or institution, and to mortgage or
pledge any or all real or personal property as my Executors or Trustees, in their sole
discretion shall choose, without regard for the dispositive provisions of this instrument.
f. To register securities in street name or in the name of a nominee or in
- 2 -
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such manner that title shall pass by delivery and to vote, in person or by proxy, securitites
held hereunder and in such connection to delegate discretionary powers.
g. To compromise any claim or controversy.
h. To choose the optional valuation date for federal estate tax purposes.
i. To exercise any law-given option to treat administrative expenses either
as income or as estate tax deductions, without regard to whether the expenses were paid
from principal or income.
j. To exercise any law-given option to pay death taxes in installments, the
payment of interest due on such installments to be a charge against principal.
k. To make distribution in cash or in kind, or partly in cash and in kind, and
in such manner as they may determine, and at valuation finally to be fixed by them.
7. To the extent that such requirements can be legally waived, r direct that my
Executor or Executrix shall not be required to post bond or give any security in connection
with their duties hereunder, whether in the State of Pennsylvania or any other jurisdiction.
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IN WITNESS WHEREOF, I, GERAIDINE A. WISE, have hereunto set my hand and
seal to this, my Last Will and Testament which consists of If- typewritten pages, this _
~ !l - -,-
./;!:-day of 'I(,~~f . 1992.
"/
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GERAIDINE A WISE
Signed, sealed, published and declared by the above-named, GERAIDINE A. WISE,
as her Last Will and Testament in the presence of us, who at her request, in her presence
and in the presence of each other have hereunto subscribed our names as witnesses.
~~
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Witness
of 'III a~A ~
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of 4// &:}c0~rf(d
jVaw ~/aPLc/ IN-
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ACKNOWLEDGMENT
COMMONWEALTII OF PENNSYLVANIA
COUNlY OF (' ~~
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)
I, GERAIDINE A. WISE, Testatrix, whose name is signed to the attached or
foregoing instrument, having been du1y qualified according to law, do hereby acknowledge
that I signed and executed this instrument as my Last Will; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
_ -<,It <<a-d~ ;.f! t;OA'A' ~
GERALDINE A. WISE
Sworn or affirmed to and ift10wledged before me, by GERALDINE A. WISE, the
Testatrix, this ~ #1 day of '~. '1992.
-----
Notary Public
AFFIDAVIT
COMMONWEALTII OF PENNSYLVANIA )
I/J )ss.
COUNlYOF y~ )
We, ftlaMJ~" &~l)re..... and f+fltntl.~I'I"'.e '&har~ the witnesses whose
names are signed to the attached and foregoing instrument, being du1y qualified according
to law, do depose and say that we were present and saw the Testatrix sign and execute the
instrument as her Last Will; that she signed willingly and that she executed it as her free
and voluntary act for the purpose therein expressed; that each of us in the hearing and
sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge,
the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Sworn or affirmed to and subscribed to before me by these witnesses, this
day of . 1992.
~11d-
, ~~e
Notary Public
- 5 -
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNIY OF DAUPHIN
On this, the '7% day of J}U8U sT
. 1992, before me KATHLEEN C.
WRIGHf, the undersigned officer, personally appeared MARVIN BESHORE, ESQUIRE,
know to me or satisfactorily proven to be a member of the bar of the highest court of
Pennsylvania, and certified that he was personally present when the foregoing
acknowledgment and affidavit(s) were signed by the Testatrix and witnesses.
In witness whereof, I hereunto set my hand and official seals.
~ (
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Notary Public
Notarial Seal
~ c. Wright, Nolary PubIIo
My~==994
I~ of
- 6 -
Met Life Investors USA
P.O. Box 14593
Des Moines IA 50306-3593
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December 18,2007
MR. MARVIN BESHORE
ATTORNEY AT LAW
130 STATE STREET
PO BOX 946
HARRISBURG, PA 17108
RE: METUFE INVESTORS USA INSURANCE COMPANY CONTRACT A2069953
OWNER Geraldine Wise
Dear Mr. Beshore:
Thank you for your recent request regarding the above referenced contract. Our records indicate the
account value on the date of death as follows:
Date of Death: October 30, 2007
Account Value: $10,601.40
Cost Basis: $9,997.85
Gain/Interest: $603.55
Value as of January 1, 2007
Account Value: $10,331.39
Gain/lnterest Accumulated January 1, 2007 to October 30, 2007: $270.01
If you have any questions, please contact our Customer Service Center at (800) 284-4536 Monday
through Friday between 8:30 a.m. and 6:30 p.m., ET.
Sincerely,
Ashlee Reed
Sr. Annuity Representative - Post Issue Processing
Met Life Annuity Operations and Services
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Tht Thinking BehInd The Money
December 12,2007
Marvin Beshore
130 State St
PO Box 946
Harrisburg. PA 17108
RE: Geraldine A Wise (Deceased)
SSN: ]84-12~3376
000: 10-30-2007
Dear Mr. Beshore:
In response to your request for Date ofOeath balances for the customer noted above, our
records show the following:
Checking A.ccount
Account # 5002103487
Established 06-28-1999
GERALDINE A WISE
DOD balance: $19,360.99 Don interest bearing
The decedent maintained Investment Account # 87540383. For further information, you
roay all the Brokerage Department at 1-800-762-61 ] 1.
Please note that this office onJy provides date of death balances for deposit accounts
(!RAs, CDs, Checking and Savings accounts). We do Dot process any financial
transactions or provide statelI1ents. 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,
~ (!~d0
Colleen Crowder
1-800-762-1775
P7-PFSC-04-F
500 First Ave
Pittsburgh, PA 15219
Member FDIC
Page 1 ofl
Fulton Bank
LISTENING.
December 6, 2007
Marvin Beshore
130 State Street
P.O. Box 946
Harrisburg, Pennsylvania 17108
Dear Mr. Beshore:
RE: Geraldine A. Wise, deceased October 30, 2007
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
Check Credit # 0000447064, open 12/20/1988, date of death principal
balance owing $373.58, in her name only. (over draft protection)
(corresponding checking account closed 7/19/2004)
CD # 000-0085442, open 2/22/1996, rollover 2/22/2005, matures 2/22/2008
date of death balance $10,000.00 plus accrued interest $7.32; paying 3.34%,
in her name only. Interest paid year to' date of death $278.58.
If you should have any further questions, please do not hesitate to contact me at (717)
291-2437.
Very truly yours,
~~~
Credit Inquiry Processor
CONFIDENTIAL
This information is fum!~hed ri3 a matter of bw;;'ness courtesy
In _answer to your inqlliry, and is for 'jour confidential us.:,! only.
~IO reS"'f1nsl'hiljh ',..~ ""^' I... .,. , '.
, "',,' . ",;,tY I" aSStln;cQ [I'j W!S D~1nl( or allY of its officers.
Any opinion herein eXl)re<:<::;>r "',' - s'lbi"I't t.o i"hal1~<> \"I"'IOU~ '-n"l'ce
foi _..........l1 ... "1"" ....c:. If:i~ 't t", t ~ H,,}t .
......_......~-
.-.-. . .~
FbltonBank
POBox 4887
Lancaster, PA 17604
125 VEARSANOSTlLL LISTEN I N G.
fultonbank.com
1-800-FULTON-4
** J0.38~d l~101 **
, .. ~ .
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.
NEW YORK LIFE INSURANCE COMPANY
NEW YORK LIFE INSURANCE COMPANY AND ANNUITY CORPORA nON
(A DELA WARE CORPORATION)
PO BOX 6916, CLEVELAND OH 44101, (800) 695-9873
The Company You Keep
January 16, 2008
AUDREY A ULSH
1004 ALLEN 5T
NEW CUMBERLAND PA 17070
Policy: AN 709 141 Geraldine A Wise
Dear Ms. Ulsh:
We are pleased to infonn you that we have adjusted om records to continue payments to you from the above
annuity, beginning with a check of$1767.52 representing payment due August 11,2008 and continuing annually
until August 11,2009.
Please keep this letter with yom records for future reference.
Should you have any questions, please feel free to contact me at (800)695-9873.
Sincerely,
Theresa A. Hakkio
Customer Service Representative
Ext. 8824
CC: James D Day LUTCF, V39
l0.d
l6L.09f:C: 01
~~ L.C::ll 800C: C:C: N~f
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II
December 5, 2007
New York Life Insurance and
Annuity Corporation
(A Delaware Corporation)
P.O. Box 922
New York, NY 10159-0922
1-800-598-2019
www.newyorklife.com
Audrey A. Ulsh
1004 Allen Street.
Cumberland, P A 17070
Annuitant: Geraldine Wise
Policy Number: 58 123962
Dear Ms. Ulsh
1 am pleased to reply to your request for tax information on the above annuity.
Since Form 712 is not applicable for a contract other than life insurance, the following information about your LifeStages Variable
Annuity should be of assistance to you:
Policy Number:
Issue Date of Annuity:
Date of Death:
Cash Value:
58123962
May 24,1999
October 30, 2007
$82,002.89
This Deferred Retirement Annuity was issued to the decedent to provide for life income payments to commence at a future date.
If you should have any questions or wish to discuss this matter, please contact your Registered Representative or call our
customer service representatives at 1-800-598-2019. For online policy information, service and forms, please visit our
Virtual Service Center at www.newyorklife.com/vsc. Thank you for making New York Life The Company You Keep@.
cc: Registered Representative James Day, V39
Variable products are offered through properly licensed registered representatives
.~
MAINSTAY
MainStay Shareholder Services
December 5, 2007
P.O. Box 8401
Boston, MA 02266-8401
1-800-MAINSTAY (1-800-624-6782)
www.mainstayfunds.com
-INVESTMENTS -
AUDREY A ULSH
1004 ALLEN ST
NEW CUMBERLND PA 17070-1525
REFERENCE: 03428449
MAINSTAY HIGH YIELD CORP BOND FUND A
ACCOUNT NUMBER 55055212
GERALDINE A WISE
AUDREY A ULSH JT WROS
Dear Ms. Ulsh:
I am contacting you concerning your above referenced MainStay
joint tenant account.
The following table shows information for your MainStay Class A
High Yield Corporate Bond Fund account as of October 30, 2007:
Net Asset Value
(NAV)
$ 6.38
Share Balance
Account Value
4,194.316
$ 26 759.74
The value of your account can be determined by multiplying the
total number of shares by the NAV.
We appreciate the opportunity to service your financial needs.
If you have any questions, please contact MainStay Shareholder
Services by calling 1-800-MAINSTAY, option 2. A Representative
MainStay Shareholder Services is a division of NYLlM Service Company LLC, a Registered
Transfer Agent and affiliate of New York Life Investment Management LLC. Securities distributed
by NYLlFE Distributors LLC, 169 Lackawanna Ave., Parsippany, NJ 07054.
.-
..
will be happy to assist you any business day between 8 A.M. and
6 P. M., ET.
Sincerely,
~~~
Bryan McCarthy
Correspondent
CC: JAMES D DAY
Parthemore Funeral Home & Cremation Services, Inc.
P.O. Box 431
1303 Bridge Street
New Cumberland, P A 17070-0431
(717) 774-7721
Mrs. Audrey A. Ulsh
1004 Allen Street
New Cumberland, P A 17070
Statement
For the service of Geraldine A. Wise
DATE
11/26/2007
AMOUNT DUE AMOUNT ENC.
$0.00
DATE TRANSACTION AMOUNT BALANCE
09/30/2007 Balance forward 0.00
10/30/2007 INV #1321. Due 11/29/2007. 9,911.12 9,911.12
10/31/2007 PMT #7043. Warren E. Ulsh -1,767.00 8,144.12
11/21/2007 PMT #972. Estate, Audrey Ulsh -8,144.12 0.00
\
!J 'r:-JJ- Jf.-J- .
CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS AMOUNT DUE
DUE DUE DUE PAST DUE
0.00 0.00 0.00 0.00 0.00 $0.00
Please don't hesitate to call our office if we may be of assistance. Thank you.
'A/est Shore Plaza
OPEI'J 7 Days
A Week
7cIr"'n - lOprn
KARNS CARES WITH 1 FOR THE SCHOOLS
TOM MALESIC STORE MANAGER 763-0165
GARY BARNA MEAT MANAGER 763-0173
)04 02 02816057 10/30/07
36 HEINZ KETCHUP
HANOVER CHO- ONI
1.48 Ib @ $O.59/1b
PRODUCE $0.87
32 RF ELBOW MAC $tb~
10#CHOPPED CHUCK ;A ;-00 $:H-:-96~
7;37pm 456
$2.19 F
$2.49 F
F
F
F
SUBTOTAL
TOTAL
$:lli-:-S& ~ 9,.55"
~
GIFT CARD
)/30/07 /t~: 38
:~H,/ fQ{3?84
:0 # i%41D02
\LANC~( $' \ !O: 00
i \ GJfT CARD
l/30/07"-.19: 38
JTH # \ 00023802
:Q # \J'
:0 # 21241002
\LANCE $ 11. 70
$25.00
-JU3':'10"
CHANGE
$@"W
,/ _.../
I OF ITEMS: 5
FOR SCHOOLS: $38. 30
REG2
'vVest Shc)(e PI02,(,:1
C;PEN 7 Dovs
/~.. \/\/ oS'€! k
''/clI'n - lOprn
KARNS CARES WITH 1 FOR THE SCHOOl.S
TOM MAl.ESIC STORE MANAGER "763-0165
GARY BARNA MEAT MANAGm 163 - tH 73
0004 06 06584043 11/02/07
15MARTN WHEAT RL
15MARTN WHEAT HL
15 MARTN SCLD RL
15 MARTN SCLD RL
15 MARTN SeLD RL
15 MARTN SCLD RL
15 MARTN SCLD RL
15 MARTN SCLD RL
5#CHEESE SLICES
SWISS CHS SLICED
20% OFF CHEESE
SWISS CHS SLICED
20% OFF CHEESE
SWISS CHS SLICED
20% OFF CHEESE
BERKS IlL HAM
HONEY TRKY BRST
16RF HALF & HALF
. COUPON ($5 OFF ENT
ITEM SUBTOTfI.L
STORE COUPON TOTAL
KARNS COUPON TOTAL
SUBTOTAL
TOT.II,L
GIFT CARD
11/02/07 08:53
AUTH # 00001175
SEQ #
LID # 21241006
l:l:51dlli'IW
$2.79 F
$2. 79 F
$2.59 F
$2.59 F
$2.59 F
$2 59 F
$2.59 F
$2,59 F
$12.45 F
$<1. 28 F
$0.86- F
i:3 95 F
$0. 79- r'
$4.01 F
$0. 80- F
$12 D F
$7.54 F
$1. 39 F
$5.00<iC
$66,57
$5.00...$
$2A.5-'S
$59-:"ti7.~
$59,42 )
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$11 .70
:; f S,S-
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'/7
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
CarlisleJ PA 17~13
Rece~pt Date:
Rece+pt Time:
Recelpt No. :
11/16/2007
15:38:34
1050629
WISE GERALDINE A
2007-01051
LAW OFFICES OF MARVIN BESHORE
AJW
------------------------ Receipt Distribution -------------___________
Fee/Tax Description Payment Amount Payee Name
Estate File No. :
Paid By Remarks:
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 20182
Check# 20183
Total Received.........
210.00
15.00
24.00
10.00
5.00
----------------
$234.00
$30.00
$264.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
Fulton Bank
1057 0514 OP
29 1
*** BILLING STATEMENT ***
LISTENING.
CLOSING PAYMENT DUE
DATE DATE
11-03-07 11-18-07
PAYMENT
DUE: 15.00
GERALDINE A WISE
1004 ALLEN ST
NEW CUMBERLND PA 17070-1525
ENTER AMOUNT PAID
ACCOUNT NUMBER
OPN-0000447064
I: 5 .5 I'"' 5 L, :101:
0000 L, L, 70 b L, /I-
PLEASE RETURN THE TOP SECTION OF THIS STATEMENT WITH YOUR PAYMENT. RETAIN THIS
SECTION FOR YOUR RECORDS.
LINE OF CREDIT ACCOUNT: OPN-0000447064
PAGE 1 OF 2
LINE AMOUNT CURRENT BALANCE
5,000.00 373.58
AVAILABLE
CREDIT
4,626.42
PAYMENT
DUE DATE
11-18-07
MINIMUM
PAYMENT
15.00
NAME
INTEREST PAID THIS YEAR
LAST PAYMENT
ACCOUNT/PAYMENT
GERALDINE A WISE
55.55
30.18
INFORMATION
LAST PAYMENT DATE
10-23-07
BALANCE SUMMARY
STATEMENT PERIOD 10-04-07 THROUGH
BEGINNING BALANCE
+ ADVANCES
- PAYMENTS RECEIVED
+ INSURANCE PREMIUMS(S}
RECEIVED THROUGH 11-03-07
***FINANCE CHARGE***
ENDING BALANCE
11-03-07
403.76
.00
30.18
.00
3.97
377.55
BILLING SUMMARY
PRINCIPAL DUE +
FINANCE CHARGE DUE +
TOTAL AMOUNT DUE IS =
11.03
3.97
15.00
TRANSACTION ACTIVITY SINCE YOUR LAST STATEMENT
POSTING EFFECTIVE
DATE DATE ACTIVITY DESCRIPTION AMOUNT
10-04-07 BEGINNING PRINCIPAL
10-23-07 10-23-07 REGULAR PAYMENT 30.18
TO PRINCIPAL 26.19
TO **FINANCE CHARGE** 3.99
11-03-07 ENDING PRINCIPAL
BALANCE
399.77
373.58
373.58
52- " Paid
NOV 2 "7 ZOOt
DIRECT FULTON BANK
INQUIRIES TO: ONE PENN SQ
LANCASTER PA 17602-2853
FULT()I~ BANK
031301422
TELEPHONE:
717-581-3000
FUlton Bank
1057 0514 OP
30 ~-
*** BILLING STATEMENT ***
LISTENING.
CLOSING PAYMENT DUE
DATE DATE
11-03-07 11-18-07
PAYMENT
DUE: 15.00
GERALDINE A WISE
1004 ALLEN ST
NEW CUMBERLND PA 17070-1525
ENTER AMOUNT PAID
ACCOUNT NUMBER
OPN-0000447064
.: 5 ~ 5 7 II' 5... :I 0.:
0000 ... ... 70 b ... II-
--------------------------------------------------------------------------------------------------------
LINE OF CREDIT
ACCOUNT: OPN-0000447064
PAGE 2 OF
2
FINANCE CHARGE SUMMARY
THE DAILY PERIODIC RATES USED TO COMPUTE YOUR FINANCE CHARGE IS BASED ON A 365 DAY
YEAR APPLIED OVER 31 DAYS THIS PERIOD.
FROM
10-04-07
THE PERIODIC
THROUGH
11-03-07
RATE SUMMARY
RATE APPLIED TO YOUR ACCOUNT MAY VARY.
*** ANNUAL *** DAILY
***PERCENTAGE RATE*** PERIODIC RATE
12.0000 .0003287671
AVERAGE
DAILY BALANCE
389.63
52..1 P,~lhl
NDV 2 7 20m
FULTON
0..':11301 ~ri"
DIRECT FULTON BANK
INQUIRIES TO: ONE PENN SQ
LANCASTER PA 17602-2853
TELEPHONE:
717-581-3000
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MCHS Carlisle
940 Walnut Bottom Road
Carlisle, PA 17015
(717) 249-0085
STATEMENT
Patient: Wise, Geraldine (27175)
Location: -
Statement Date: 11/1/2007
Audrey Ulsh
1004 Allen Street
New Cumberlnd, PA 17070
PLEASE DETACH AND RETURN WITH YOUR PAYMENT
Amount Due $188.23
Amount Enclosed $
MCHS Carlisle
940 Walnut Bottom Road
Carlisle, PA 17015
(717) 249-0085
Patient: Wise, Geraldine (27175)
Location: -
Statement Date: 11/1/2007
Date Description Units Unit Amount Amount
BALANCE FORWARD $6,511.70
10/9/2007 Payment - #965 ($6,511.70)
10/1/2007 Room & Board Charges Oct 1-29 2007 29 $197.42 $5,725.18
10/1/2007 ** Room & Board Charges Oct 1-31 2007 ** ($6,120.00)
10/1/2007 INTERMIT INCONT -DL Y FEE 29 $4.09 $118.61
10/1/2007 NTRTNL/ENTRL SERV GRP 1 87 $0.50 $43.50
10/12/2007 ST BEDSIDE SWAL EVAL IP Coinsurance 1 $20.90 $20.90
10/15/2007 ST BEDSIDE SWAL EVAL IP Coinsurance 1 $20.90 $20.90
10/22/2007 ST SWALLOWING TREAT IP Coinsurance 1 $15.14 $15.14
10/1/2007 OXYGEN CONCEN RENT DL Y 23 $6.00 $138.00
10/1/2007 OXYGEN 23 $8.00 $184.00
10/27/2007 OXYGEN CONCEN RENT DLY 3 $6.00 $18.00
10/27/2007 OXYGEN 3 $8.00 $24.00
BALANCE DUE $188.23
In order to prevent collection letters we would greatly appreciate your payment be made by the 12th of the month.
Heartland 7
CHECK CARD USING FOR PAYMENT
I{'~,'.' I 0 .0
'::.~> > MASTERCARD .. DISCOVER
CARD NUMBER
tz;j SL
AMOUNT
'.
. PHARMACY OF PENNSYLVANIA, LLC
7010 SNOWDRIFT RD
ALLENTOWN,PA18106
800-270-6351 EXT 6050
FACILITY: 53720 CARLISLE
PAY PLAN: PPPA PRIVATE PAY EASTERN PENNSYLVANIA
SIGNATURE SIG. CODE EXP. DATE
33978
STATEMENT DATE PAY THIS AMOUNT CUSTOMER 10
MAIL
10/31/2007 $354.34 63234
SHOW AMOUNT $
PAGE NO. 1 of 1 PAID HERE
~ RETURN SERVICE REQUESTED
)1
652863
111,1111/ 1111'1,111111111111111,1,111/ 1,1,1111111/ 1/ 1'1111/111
GERALDINE WISE
1004 ALLENT 8T
NEW CUMBERLAND, PA 17070-1525
111111.11/ 1111111,1111/ 11111,11111111111/ 11111,1111,111,11,,11
HEARTLAND PHARMACY OF PENNSYLVANIA
PO BOX 72413
CLEVELAND, OH 44192-0002
O Please check box if above address Is incorrect
or insurance information has changed, and
indicate change(s) on reverse side.
33978'T7VOWK5SMOO 1724
STATEMENT
PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
1I1/1~1 W I111II111I1 ,,"m II IWIII 1"1 m 11111 11111 "111111. 1m 11111"
;3978 MAIL 'T7VOWK5SM001724
PRIMARY PHYSICIAN NAME . .
INVOICE DATE
DR GUISTWITE, DARRYL, MD 10/31/2007 106429
. DATE RXNO. DESCRIPTION' Nbc Ncf QUANTITY :'..AMOUNT>
'9/2512007 PAYMENT Statement: 94242 Check: 967 .: 632.79CR
'9!?? /2007 PAYMENT Statement: 62094 Check: 967 96.56CR
7j2.91?'P()7 2645832 PRILOSEC OTC 20 MG TABLET 37000",045~,..02 28 EA 35.36 OTC
?;?912607 2645835 MUCINEX 600 MG TAB ER 63824~0008~50 60 EA 36.80 OTC
i/?9j2()97 2645855 NAMENDA 10 MG TABLET 00456,..32,1(}--(,3 60 EA 43.87 C RX
7/29j2097 2645861 BUSPIRONE HCL 15 MG TABLET 58177-0309-08 60 EA 12.09 C RX
7/29/2007 2645.8(,9 LORAZEPAM 1 MG TABLET 00781+1404"':05 30 EA 3.71 C RX
7/29/2007 2645~72 MAPAP PM CAPLET 00904~7651-51 50 EA 8.08 OTC
7/29/2007 2645877 NYSTOP 100,000 UNITS/GM POImER 00574.,..2008~15 15 GM 6.99 C RX
7/30/2007 2653366 ACETAM!NOPHEN 325MGTABLET 00182-8447-00 30 EA 6.06 OTe
10(02/2007 2805249 ~IARFARINSODIUM 2.5MG TAB 00555-0832-05 15 EA 2.67 C RX
10(04/2007 2667798 ZYPREXA 2.5 MG TABLET 00002-4112-33 30 EA 55.10 C RX
10(04/2007 2694333 FLORASTOR 250MG CAPSULE 66825-0002-01 50 EA 41 .70 OTC
10/12/2007 2645846 ARICEPT 10 MG TABLET 62856-0246-41 15 EA 23.64 C RX
10(13/2007 2834048 SPIRONOLACTONE 25 MG TABLET 00378-2146-05 15 EA 1.98 C RX
10/17/2007 2841229 AZITHROMYCIN 250 MG TABLET 00781-1496~31 6 EA 11.14 C RX
10/20/2007 2645867 ~JELCHOL 625 MG TABLET 65597-0701-18 60 EA 30.60 C RX
10/20/2007 2678625 FUROSEMIDE 80 MG TABLET 007B'I~1446-05 60 EA 6.11 C RX
10(22/2007 2645853 LEVOTHYROXINE 50 MCG TABLET 00378-1803-10 30 EA 2.82 C RX
10/28/2007 2645846 ARICEPT 10 MG TABLET 62856-0246-41 15 EA 23.64 C RX
10(28/2007 2834048 SPIRONOLACTONE 25 MG TABLET 00378-2146-05 15 EA 1.98 C RX
ESSAGES
Finance charges are calculated @ monthly periodic rate of 1.5% (or a minimum
of $1.00 per month) for a total annual rate of 18%. The charges listed
on this invoice do not reflect any balance billed to your insurance.
"111,.1 1.......II"I::t~.Ih.....
1- 729.35 I- 0.00 I. 0.00 1+ 0.00
PAYMENTS
CREDITS
FINANCE
CURRENT CHARGES
TOTAL DUE
EVIOUS BALANCE
729.35
1+
354,34
)~
0.00
354.34
DUE DATE:
11/30/2007
DAYS OUTSTANDING
1 - 30
31 - 60
61 - 90
91 - 120
121 +
AGED BALANCE
AMOUNT DUE:
$354.34
0.00
0.00
0.00
0.00
0.00
7010 SNOWDRIFT RD
ALLENTOWN, PA 18106
AMOUNT ENCLOSED:
800-270-6351 EXT 6050