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HomeMy WebLinkAbout07-14-08 15056051058 REV-1500 EX ( 6-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN C°unty Code Year Fide Number PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ZI j ', (,~~ j l ~~J~ C AITC~ ~1CPC11G-IT I~ICf1C~lAT1A\I OCI AW Social Security Number Date of Death Date of Birth ---- - I171-28-0732 L~- --- - ' -_- - - - -1 OCTOBER 16, 2007 ll ~ JULY 18, 1914 - - --- _- J Decedent's Last Name Suffix Decedent's First Name MI I r -- - -- - -- -- -~ ------ _ -- - ~ ~ r ATTICKS i ELIZABETH G ~ - !- - -- J _ i_ - -- --- -- --- - -. _. --- - -~ ' - (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 j ~ REGISTER OF WILLS , FILL IN APPROPRIATE OVALS BELOW O 1. Original Return c~ 2. Supplemental Return ~_~ 3. Remainder Return (date of death prior to 12-13-82) c~ 4. Limited Estate c~ 4a. Future Interest Compromise (date c~ 5. Federal Estate Tax Return Required of death after 12-12-82) c~ 6. Decedent Died Testate c~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) c~ 9. Litigation Proceeds Received c~ 10. Spousal Poverty Credit (date of death c~ 11. Election to tax under Sec. 9113{A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number HARRY L. BRICKER, JR ~~ (717) 233-2555 I ~~ JR., ATTORNEY AT HARRY L. BRICKER, LAW ~ REGISTER- ~~ - f - - - i R OO~~AH,.LS U~6 ONL'17: - I First line of address ---__-- I ' ~r .-- 4 ' ` _. - - ----- t --i r - ----- 'I 407 NORTH FRONT STREET --- -- - --i , __~ .~ ~~~ ~~ 1 r-, - -_ -_' - - -- -_ -~_I ~ _ Second line of address ~3r; _~ --1 ~. I_ -_ _- J IIDATE FILED _ ~- r' i~.---- - City or Post Office HARRISBURG State ZIP Code L-A - ~` 17101 ------------------' Correspondent's a-mail address: HLBLAW@VERIZON.NET Under penalties of perjury, 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. SIGNAT RE OF PERSON RESPONSIBLE FO FILI~ET1 N ATE -._ ~ ._~~ ADDRESS _-_. .h,y -..... ~i---- - ------- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Name: ELIZABETH ATTICKS RECAPITULATION 1. Real estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 4. Mortgages 8 Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) ~~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~~ Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) -- - -- 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I} 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13 Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 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 0. _ ~ _ f 17. Amount of Line 14 taxable ~ i $11,121 26 at sibling rate X .12 18. Amount of Line 14 taxable $95,250.09 at collateral rate X .15 _~~- ___ 19. TAX DUE Decedent's Social Security Number 171-28-0732 1. ~ $0.00 ', 2. $0.00 3. i $0.00' -- 4. - -- ---- $0.00 - --- 5. i ~ --- $71,080.95] ----- 6. ~~ ~~ -- $7,371.26 7. ~ $80,151.44 ~ ~~ __ r 8. $158,603.65 -_- 9 ~- --- . ' $39,392.48 ~- -- 10. ~ $0.001 11. ~ ~ $39,392.481 ~ ~--- 12. $119,211.17 13. ~ $12,839.82 r-- -- --- ---~ 14. $106,371.351 15. - -- - - $0.00 16. $0.00'. 17 $1,334.551 `- - -- - -- 18. ~- - $14,287.511 - 19 $15,622.06 . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052059 15056052059 c~ REV-1500 EX Page 3 Decedent's Complete Address: Flle Number DECEDENT'S NAME ELIZABETH ATTICKS DECEDENT'S SOCIAL SECURITY NUMBER 171-28-0732 STREET ADDRESS 4837 E. TRINDLE ROAD CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount $9,000.00 --~--- $473.67 (1) $15,622.06 Total Credits { A + g + C } (2) $9.473.67 3. Interest/Penalty if applicable D. Interest ___ ,_ _ E. Penalty __ _____. Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) $0.00 (4) $0.00 (5) $6,148.39 (5A) (5B) $6,148.39 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; ^ b. retain the right to designate who shall use the property transferred or its income; ^ c. retain a reversionary interest; or ^ d. receive the promise for life of either payments, benefits or care? ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one ^ year of death without receiving adequate consideration? ^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ® ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 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. §9116(x)(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(x)(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{x)(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 EXs+ (698) SCHEDULE E ~+ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF ELIZABETH ATTICKS FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SOVEREIGN BANK: A. CHECKING ACCOUNT NO. - 2331046255 $22,679.36 B. SAVINGS ACCOUNT NO. - 2334023385 $3,619.34 C. CERTIFICATE OF DEPOSIT NO. - 2335254195 $5,029.06 D. CERTIFICATE OF DEPOSIT NO. - 2335244120 $8,382.06 2. JACKSON SIEGELBAUM GASTROENTEROLOGY -OVERPAYMENT ON MEDICAL SERVICES $6.00 3. THE BOARD OF PENSIONS OF THE PRESBYTERIAN CHURCH (U.S.A.) - 2 RETIREMENT PENSION PAYMENTS EACH IN THE AMOUNT OF $1,450.56 $2,901.12 4. THE PATRIOT NEWS -SUBSCRIBER REFUND $50.35 5. ERIE INSURANCE GROUP -PREMIUM REFUND RE: PERSONAL CATASTROPHE POLICY POLICY NO. - Q27 3050105 H $64.00 6. NEILL FUNERAL HOME, INC. -PARTIALLY PREPAID FUNERAL $4,380.00 7. HOUSEHOLD GOODS FOUND AT THE WOODS, AN ASSISTED LIVING FACILITY (RESIDED WITH HER SISTER) $245.00 8. ALL OTHER JEWELRY (COSTUME) INCLUDING BLACK ONYX RING $65.00 9. 1993 OLDSMOBILE CUTLASS CIERA (NOT IN WORKING ORDER) $500.00 10. RING CONSISTING OF ONE LARGE DIAMOND AND TWO RUBIES SET IN YELLOW GOLD $3,750.00 11. M&T INVESTMENT GROUP - 50 PRORATED QUARTERLY FIXED INCOME FROM THE J. NEDRA SCHILLING FOUNDATION $987.44 12. NATIONWIDE -CANCELLATION OF TENANT POLICY (CHECK WAS IN THE AMOUNT OF $6.00 AND DIVIDED BETWEEN THE DECEDENT AND HER SISTER) $3.00 13. $97.00 IN CASH -FUNDS ON DEPOSIT AT THE WOODS $97.00 14. INTEREST ON ESTATE CHECKING ACCOUNT (AS OF 06/19/08) $10.52 15. MASS MUTUAL FINANCIAL GROUP -INCOME DIVIDEND: ACCOUNT NO. - 177796 00 $40.76 ACCOUNT NO. - 177796 02 (2 PAYMENTS) $78.89 AMOUNT OF CONTINUATION PAGE FOR SCHEDULE E $1$,192.05 TOTAL (Also enter on line 5, Recapitulation) $71,080.95 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CONTINUATION PAGE SCHEDULE E ESTATE OF ELIZABETH ATTICKS FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. AMERICAN BIBLE SOCIETY -QUARTERLY GIFT ANNUITY PAYMENT $30.00 2. C.A.R.E. GIFT -ANNUITY FUND - REISSUANCE OF CHECK FOR INCOME DISTRIBUTION FOR PERIOD ENDING 12/31/07 $120.00 3. AF&L INSURANCE COMPANY -POLICY NO. - 16187 -UNEARNED PREMIUM $805.14 4. ALLIANZ -NON-QUALIFIED ANNUITY ACCOUNT NO. - 3423668 ESTABLISHED - 07/19!1994; BENEFICIARY UNKNOWN (ESTATE IS BENEFICIARY) $17,236.91 70TAL1 $18,192.05 • REV-1509 E•X i (8-98) }~ t1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ELIZABETH ATTICKS SCHEDULEF JOINTLY-OWNED PROPERTY FILE NUMBER 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. LEAH MAY ATTICKS c/o JAN L. BROWN, ESQ. SISTER 845 SIR THOMAS COURT, HARRISBURG, PA 17109 B C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY IncYude name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET ~ OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 08/28/64 M&T BANK -CHECKING ACCOUNT NO. - 11464364 $2,532.52 50.0°!° $1,266.26 2. A. 08!28/64 M&T BANK -CHECKING ACCOUNT NO. - 11477164 $12,210.00 50.0% $6,105.00 TOTAL (Also enter on line 6, Recapitulation) $7,371.26 (If more space is needed, insert additional sheets of the same size) ~ REV-151 ~ EX~* (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ELIZABETH ATTICKS SCHEDULE G INTER VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY FILE NUMBER 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. REGATTA SUNLIFE FINANCIAL -NON-QUALIFIED ANNUITY $36,530.99 100.0% NONE $36,530.99 ACCOUNT NO. - 50-39-059000-69344, ESTABLISHED - 09/10/1990 BENEFICIARY -ESTATE OF JOYCE 1. MILLER, DECEASED (DATE OF DEATH FOR MS. MILLER IS MARCH 25, 2008 -SEE DEATH CERTIFICATE ATTACHED) 2. AMERICAN FUNDS -NON-QUALIFIED MUTUAL FUND $5,475.49 100.0% CHARITY $0.00 ACCOUNT NO. - 81632805, ESTABLISHED - 09/22/06 PA/TOD, BENEFICIARY -MARKET SQUARE PRESBYTERIAN CHURCH CORPORATION 3. AMERICAN FUNDS -NON-QUALIFIED MUTUAL FUND $43,620.45 100.0% NONE $43,620.45 ACCOUNT NO. - 81470231, ESTABLISHED - 07!27/06 PA/TOD, BENEFICIARY -ESTATE OF JOYCE {. MILLER, DECEASED (DATE OF DEATH FOR MS. MILLER IS MARCH 25, 2008 -SEE DEATH CERTIFICATE ATTACHED) TOTAL (Also enter on line 7, Recapitulation)I $80,151.44 (If more space is needed, insert additional sheets of the same size} .REV-1511 EX.~ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF ELIZABETH ATTICKS FILE NUMBER Debts of decedent must be reported on Schedule I ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. NEILL FUNERAL HOME, INC. -PARTIALLY PREPAID FUNERAL $4,380.00 2. NEILL FUNERAL HOME, INC. -FUNERAL $522.24 B 1 2. 3. 4. 5 6 7. 8. 9. 10. 11. 12. 13. 14. 15. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) HARRY L. BRICKER, JR. Street Address 407 NORTH FRONT STREET City HARRISBURG State PA Zip 17101 Year(s) Commission Paid: NONE Attorney Fees HARRY L. BRICKER, JR., ESQ. 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 Probate Fees REGISTER OF WILLS, CUMBERLAND COUNTY Accountant's Fees Tax Return Preparer's Fees CUMBERLAND LAW JOURNAL -ADVERTISE ESTATE THE SENTINEL -LEGAL -ADVERTISE ESTATE INTERNISTS OF CENTRAL PA -MEDICAL SERVICES (2 PAYMENTS) ASSOCIATED CARDIOLOGISTS -MEDICAL SERVICES (2 PAYMENTS) KALEANA LEESE -CAREGIVER SERVICES THROUGH GRISWOLD SPECIAL CARE DORIS SAMPSON -CAREGIVER SERVICES THROUGH GRISWOLD SPECIAL CARE SUZANNE KEENER -CAREGIVER SERVICES THROUGH GRISWOLD SPECIAL CARE GRISWOLD SPECIAL SERVICES -CAREGIVER SERVICE FACILITY EAST PENNSBORO AMBULANCE SERVICE, INC. -MEDICAL SERVICES AMOUNT OF CONTINUATION PAGE FOR SCHEDULE H $3,965.09 $7, 930.18 $157.00 $75.00 $118.72 $104.80 $51.36 $128.53 $48.37 $150.50 $89.25 $44.00 $21,627.44 TOTAL (Also enter on line 9, Recapitulation) I $39,392.48 (If more space is needed, insert additional sheets of the same size) CONTINUATION PAGE COMMONWEALTH OF PENNSYLVANIA SCHEDULE H I INHERITANCE TAX RETURN RESIpEN7 DECEDENT ESTATE OF ELIZABETH ATTICKS FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. VERIZON -PHONE SERVICE (2 PAYMENTS) $110.86 2. VASCULAR ASSOCIATES -MEDICAL SERVICES $3.43 3. QUANTUM IMAGING & THERAPEUTIC ASSOCIATES -MEDICAL SERVICES $7.74 4. MOBILE X-RAY IMAGING, INC. -MEDICAL SERVICES $7.87 5. MESSIAH VILLAGE -MEDICAL SERVICES (EMERGENCY CALL MONITORING) $310.65 6. SUSQUEHANNA TOWNSHIP EMS, INC. -MEDICAL SERVICES $46.00 7. MSHMC PHYSICIANS GROUP -MEDICAL SERVICES $31.69 8. PINNACLE HEALTH EMERG. -MEDICAL SERVICES (2 PAYMENTS) $14.53 9. HERSHEY KIDNEY SPECIALISTS, INC. -MEDICAL SERVICES $24.45 10. PINNACLE HEALTH HOSPITALS -MEDICAL SERVICES $198.43 11. RETURN FEES FROM WACHOVIA BANK $50.00 12. BOARD OF PENSIONS -REIMBURSE PENSION CHECKS FOR 1112007 AND 12/2007 $2,901.12 13. VITAL RECORDS - 4 DEATH CERTIFICATES $36.00 14. BANK OF AMERICA -FINAL CREDIT CARD STATEMENT $23.51 15. FIA CARD SERVICES -FINAL CREDIT CARD STATEMENT $501.72 16. THE WOODS -FINAL STATEMENT OF 12/31/07 (PAID HALF OF STATEMENT) $271.43 17. AMERICAN BIBLE SOCIETY -RETURN OF ANNUITY PAYMENT $30.00 18. REGISTER OF WILLS - 5 SHORT CERTIFICATES $20.00 19. MORROW FARRAR JEWELERS -APPRAISAL OF TWO RINGS $150.00 20. ENSMINGER AUCTIONEERS -CLEANING OUT OF APARTMENT AT THE WOODS $1,115.51 21. HARRY L. BRICKER, JR., ESQ. -ATTORNEY FEES DUE PRIOR TO DECEDENT'S DEATH $1,562.50 22. REGISTER OF WILLS -FILING FEE FOR PENNSYLVANIA INHERITANCE TAX RETURN AND INVENTORY $30.00 23. PREPARATION OF ACCOUNTING FOR SUBMISSION TO COURT $500.00 24. ADDITIONAL PROBATE FEE $45.00 25. FILING FEE RE: ACCOUNTING AND RECORDATION OF RELEASES ($100.00 FOR THE FILING FEE PLUS $80.00 FOR THE ADVERTISING FEE; $25.00 FOR THE RECORDING OF 5 RELEASES) $205.00 26. UNITED STATES TREASURY -ESTATE FEDERAL TAX RETURN FOR 2007 $81.00 27. PENNSYLVANIA DEPARTMENT OF REVENUE -ESTATE STATE TAX RETURN FOR 2007 $49.00 28. PENNSYLVANIA DEPARTMENT OF REVENUE -INDIVIDUAL STATE TAX RETURN FOR 2007 $1,000.00 29. UNITED STATES TREASURY -INDIVIDUAL FEDERAL TAX RETURN FOR 2007 $11,300.00 30. SF & COMPANY -PREPARATION OF ESTATE AND INDIVIDUAL FEDERAL AND STATE INCOME TAX RETURNS FOR 2007 $1,000.00 TOTAL ~ $21,627.44 .REV-1513 6X + (9-00)) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF ELIZABETH ATTICKS FILE NUMBER 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. LEAH MAY ATTICKS, Go JAN L. BROWN, ESQ. SISTER $3,750.00 -RING 845 SIR THOMAS COURT, HARRISBURG, PA 17109 CONSISTING OF LARGE DIAMOND TWO RUBIES SET IN YELLOW GOLD 2. ESTATE OF JOYCE I. MILLER, DECEASED, Go GEORGE B. HANDELSMAN, ESQ. FRIEND $500.00 -1993 2143 ARDMORE BOULEVARD, PITTSBURGH, PA 15221-4852 OLDSMOBILE (DATE OF DEATH FORMS. MILLER IS MARCH 25, 2008) CIERA (NOT IN WORKING ORDER) 3. ESTATE OF JOYCE I. MILLER, DECEASED, Go GEORGE B. HANDELSMAN, ESQ. FRIEND $14,598.65 2143 ARDMORE BOULEVARD, PITTSBURGH, PA 15221-4852 (DATE OF DEATH FOR MS. MILLER IS MARCH 25, 2008) 4. ESTATE OF JOYCE I. MILLER, DECEASED, Go GEORGE B. HANDELSMAN, ESQ. FRIEND TWO ANNUITIES 2143 ARDMORE BOULEVARD, PITTSBURGH, PA 15221-4852 LISTED ON SCH. (DATE OF DEATH FOR MS. MILLER IS MARCH 25, 2008) G TOTALING (DOD VALUES) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1 500 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 1. J. NEDRA SCHILLING FOUNDATION $65.00 -ALL OTHER MANUFACTURERS & TRADERS TRUST COMPANY, 213 MARKET STREET, HARRISBURG, PA 17101 JEWELRY (COSTUME) INCLUDING BLACK ONYX RING 2. MARKET SQUARE PRESBYTERIAN CHURCH 20 S. SECOND STREET, HARRISBURG, PA 17101 $7,299.33 3. MARKET SQUARE PRESBYTERIAN CHURCH CORPORATION AMERICAN FUNDS 20 S. SECOND STREET, HARRISBURG, PA 17101 NON-QUALIFIED MUTUAL FUND LISTED ON SCH. G $5,475.49 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $12,839.82 (If more space is needed, insert additional sheets of the same size) ~i Sov+ereign Bank HARRY L BRICKER, JR ATTORNEY AT LAW 407 North Front Street Harrisburg pa 17101 December 6, 2007 Ref: ESTATE OF ELIZABETH G ATTICKS Dear Sir: Elizabeth G Atticks has 4 accounts with Sovereign Bank. She does not have any safe deposit with the bank. There are no beneficiaries or POD recipients on these accounts. Checking a/c 2331046255 Opened on 11/02/1998 Balance 22,693.47 DOD balance 22,679.36 Savings a/c 2334023385 Opened on 01/17/1975 Balance 3,619.34 DOD balance - 3,619.34 CD a/c 2335254195 Opened on 10/04/1997 Balance 5,046.24 DOD balance 5,029.06 CD alc 2335244120 Opened on 05/05/1997 Balance 8,412.42 DOD balance 8,382.06 Enclosed are 4 checks payable to Estate of Elizabeth G Atticks, Deceased. If you need more information please call at 717 737 2323 Thankyou. Beulha Sigamony Community Banking Assist Manager .., . ~- - - ,. . --~~ Jackson 5iegelbaum Gastroenterology ' Wachovia Bank; ~tA 3-50/310 18864 423 N. 21st Street, Suite 100 HARRISBURG Camp Hill, PA 17011 PENNSYLVANIA Check Date: 11/1'5/07 -Pay to the order of.• ELIZABETH ATTICKS $ 6.00 ..Six And 00/100 Dollars.«~........,,.....*......~...,.*.*...*............*.,.«.....,.,.#*»,.*..~..#~..««.*..,., ELIZABETH ATTICKS 824 LISBURN RD, APT 615 CAMP HILL, PA 17011 REFUND _ ti________~ ._ .~_- - ~__ _ ,._ -- ~~'0 ~8864i~' ~:0 3 L000503~: 96 20 39 5 280~~' From: Jackson Gastroenterology,' Ltd. Date: 11/1S/07 423 N. 21 st'Street, Suite 1.00 Check-°Number' 18864 Camp Hill, PA 1701`1 - Amount: 6.00 Memo: _ ~ ~ . REFUND Y I _4 .; _._' The Board. of Pensions of the Presbyterian Church (U.S.A.) 2000 Market Street (~ ~ ~ Philadelphia, PA 19103-3298 1-800-773-7752 MEMBER NAME : MEMBER LD. NUMBER CHECK NUMBER: ISSUE DATE ELIZABETH G ATTICKS 1009785 30095287 11 /01 /2007 RETIREMENT PENSION PAYMENT ~ $1,785.66 FED WITHHOLDNG I $161.10 MEDICARE SUPPLEMENT $174.00 $1,450.56 • `~ The Board of Pensions of the'Presbyterian'Church (U.S'.A.) No, 30095287 sz-zz 2000 Market Street 31 V WV Philadelphia, PA 19'103-3298 PEI~tSION ~~~g~~ t ~ `>' ~ eA~~ 3 ~~~N~ ' 1-800-773-7752 , ACCOUNT ~ :<. .' ,' ~'~'-~ 1009785 11/01/200T $1,450.56 .: <<:: :::r~~,"Y` ~~'~`~,,,.~` '.~ . One thousand four hundred fifty and 56/L00 Dollars . Wachoviaf3enkof.Relawar® ls].A. wlmington, DE 19803 ` ELIZABETH G ATTICKS THE ORDER THE: WOODS Authorized Signature of 824 tISBURN RD APT 615 M ` void aFrEA so Days CA P HILL, PA 1.7011. ii'30095287ii' ~:03L100225~: 20 799 500499 7 5ii' The Board of Pensions of the Presbyterian Church (U.S.A.) -2000 Market Street Philadelphia, PA 19103-3298 1-800-773-7752 MEMBER NAME : ELIZABETH G ATTICKS MEMBER LD: NUMBER : 1009785 CHECK NUMBER : 30097537 ISSUE DATE : 12/01 /2007 RETIREMENT PENSION PAYMENT FED WITHHOLDNG MEDICARE SUPPLEMENT $1,785.66 $161,10 $174,00 $1,450.56 The"Board of Pensions of the`Presbyterian Church (U.S.A.) No, 30097537 sz-zz 2000 Market Street 31t O lllp Philadelphia, PA .19103-3298 PE[VSION E~~~t ~ ,< ~.~-I~ 9. AMpt1N'~r *; 1-800-773-7752 ACCOUNT 1009785 12/01 /2007 $1,450:56 `,~~"~` ` „ `~``'~°~'~` One thousand four hundred fifty and 561100 Dollars Wachovia Bank of Delaware, N:A. ' wlminpron, DE 19803 ELIZABETH G ATTICKS - PAY TO THE V1100QS THE ORDER Authorized Signature T of 824 LISBURN RD APT 6t5 CAMP HILL, PA .17011 volo nFretaso aavs ~' u'30097537ii' ~:03LL00225~: 207995004997511' THE PATRIOT-NEWS PO Box 2265 Harrisburg, PA 17105 Check Date: 10/11/2007 Vendor Number: 9999999999 Check No. 0900015734 Invoice Number IOVf1IrP r)ato v....,.ti.._ rn ,. r~~ rid Insurance Group 100 Erie Ins. PI. Erie, PA 16530 ~, NOTICE OF PREMIUM REFUND DATE MO. DAY YR. 11 23 07 DP164G 1101 REFUND AMOUNT $64. ~Q POLICYNUMBER~Q27 3050105 H AGENT NO. AA7034 AGENT'S NAME JAMES B. MURDOCH REASON 1 REF. NO. X920178 CHECK NO. 24920178 ESTATE OF ELIZABETH G ATTICKS C/0 HARRY L. BRICKER JR 407 N FRONT STREET HARRISBURG PA 17101 AA7034 NON-NEGOTIABL-E VGID78i? DAYS AFTER DAT~~ POSITIVE PAY PROTECTEQ i -~ Eri~`Insurance I ~ Group 100 Erie Ins: PI. Erie;~PA 76530 PAY ESTATE OF ELIZABETH G ATTICKS TD C/0 HARRY L. BRICKER JR Banr, of America Cu;t.irnerConnection 64-1278 ~ Bank'of America, N.Aj 611 Atlanta, Dekalb County, Georgia r DATE CHECK N0. 249210178 MO. DAYIVR. ~ i 11~23~07 ~ R i' U x THE 40'7 N FRONT STREET $64.-00 z ORS ER ~RISBURG PA 17101 3 i i CODE REASON POLICY NUMBER AGENT cHeclc' 1^ Q27 30501'05 H A.A7034 Premium Refund Due to Code 1 •'POlicy Cancelled Code 2 • Policy Expired Code 3 • Premium Reduction Code 4 • Overpayment 5. ,~~ re.aure. ~ n EXACTLY '~'~**~~64 DOLLARS AND 00 CENTS• ':, REF. NO. ~ < X920178 i R T AUTHORIZED SIGNATURE. _ ': u. ll'24920L7811' ~:06LLi12788~: 329 999 65L4u' NEILL Funeral Home Inc. October 29, 2007 Leah May Atticks 4837 E. Trindle Rd. Mechanicsburg, PA 17055 Basic Professional Services of Funeral Director & Staff Refrigeration Transferring Remains to Funeral Home Service Vehicle/Hearse Verde Marble Urn Cemetery Crematory Medical Examiner Fee Certified Death Certificates Patriot News Obituary Total Amount of Services Rendered Direct Cremation Discount Preneed Discount Forethought Payment Remaining Balance Due 3501 Derry Street Harrisburg, PA - 17111-1817 tel 717 564-2633 fax 717 561-9918 Stephen J. Wilsbach, Supervisor 3401 Market Street Camp Hill, PA - 17011-4428 tel 717 737-8726 fax 717 737-1859 Rebecca J. Donahue, Supervisor $2330.00 400.00 495.00 395.00 495.00 125.00 265.00 25.00 60.00 312.24 $4902.24 - 1625.00 - 853.10 - 1901.90 $ 522.24 • ~ .- ~ - ~. ~~,~.•~- ENSM~NGER AUCTIONEERS i=uitgn $ank 007354 Since 1836 Capital l7ivision .~~~ 3557 Elmerton Avenue Harrisbu~g'P,4 ~7tot Harrisburg,. PA 17109-1132 60-142/313 ~nTE 3/3/2008 PAY TO THE ORDER OF EStat@ Of EIIZdbetll AttICkS - ~ *`J~~0.00 Five Hundred and 00/100*******~****~*********~*****~**********~~******~*******~*~ oo~~a,Rs Estate of Elizabeth Atticks ~ 6adaM~ly~f iur c/o Harry. L. Bricker, ]r. Esquire _ ~ ^®o,,,,,~,a,~~` 407 N. Front St. ~~ ~~F Harrisburg, PA 17101 ~ „~ ~~ Memo. ~ naun~ 4 -i^007354n^ ~:03,~301422r 3622 63~,35u^ '` !,. ~ i ~ ~ KH~I~~IdT.i'f3i~132~1i'1131R'iT'YY1'94ri rr~»~ ~ r ~ MORROW FARRAR JEWELER S NAME/OWNER: Estate of Elizabeth G. Atticks C/o: Harry L. Bricker Jr. Attorney at Law 407 North Front Street Harrisburg, PA 17101 DATE OF APPRAISAL: March 3, 2008 APPRAISER: Jill Morrow, Graduate Gemologist (GIA} PURPOSE OF APPRAISAL: The reason for this appraisal is to grade and estimate the value of this jewelry for fair market value. Because the grading was done in the mounting, all grades and measurements are estimated to the extent the mounting allows using GIA standards and measurements. ITEM DESCRIPTION: This three stone diamond and synthetic ruby ring is stamped 14KT gold. It has a yellow gold shank and a white gold top. There is a center Old European Cut diamond with a synthetic ruby on either side. They are in four prong v-flair settings. The ring is a size 7 %2. ITEM EVALUATION: This Old European Cut diamond is an average 7.01 mm in diameter and 4.62 mm in depth and weighs an estimated 1.38 CT. It is VS2 (Very Slightly Included 2) in clarity and L in color. There is a large culet and slight fluorescence. The girdle is unpolished, thin to thick and there are two large chips in it. The two vermeil flame fusion synthetic rubies are an average 7.1 mm in diameter each. They have a depth of 4.4 mm and weigh approximately 1.59 CT each. The ring weighs 3.3 DWT. MARKET LEVEL: This three stone ring could be purchased on the secondary market; i.e., those dealers, and jewelers who specialize in used, estate, and antique jewelry. FAIR MARKET VALUE: $3,750.00 3750 MARKET STREET • CAMP HILL, PA 17011 • www.morrowfarrar.com • 717-737-5808 Page 2-Estate of Elizabeth G. Atticks ITEM DESCRIPTION: This black onyx ring is lOKT yellow gold. The ring is a size 7. ITEM EVALUATION: The black onyx is oval and measures 12 mm x 16 mm in diameter. The stone is scratched and abraded. The ring weighs 2.1 DWT. MARKET LEVEL: This ring would be purchased for gold value only. FAIR MARKET VALUE: $40.00 Gold price at $982.00 on March 3, 24D8 DISCLOSURE: I have no financial interest in this ring nor do I anticipate any. The fee for this appraisal was not contingent upon value and reflects our normal and customary fee schedule. Jill`Morrow, GG (GIA) AM-ISA Member Appraisers Association of America Accredited Member- International Society of Appraisers Q M&T Investment Group Trust Operationsi One M 8 T Plaza:- 8th Floor Buffalo NY 14203 2/4/08 134 ESTATE OF ELIZABETH ATTICK SCHILLING,J NEDRA CRAT FBO E ATTICK 2002677 OFFICER 0236 JOSEPH A. MACRI ESTATE OF ELIZABETH ATTICK No. 227774985 2/4/08 ^X INCOIME ~ PR~NCIPAL $987.44 50 PRORATED QUARTERLY FIXED INCOME TRSCHK:TRC-+K1 DETACH & RETAIN FOR YOUR RECORDS 499158243815499157 NEW 04/04 8135070134 ~r~ r ~ s .. n ~ ,. `" YIPdL1ZG3~F~irtri.T. , ~~ _ •~ TA E~.WATERMARk,., * No. 227774985 .23_97 (~ M&T Investment Group _ , 02u ~- 2002677 \ Date 2/4/08.._. PAY NINE HUNDRED EIGHTY-SEVEN AND:44/100 - U.S. +DOLLARS $ 9'87.44 TWO SIGNATURES 12Eg1lIRED FOR'AMOUNTS OF 519,000 ANDOVER TO THE. :ESTATE OF ELIZABETH ATTICK 7 ~' ORDER _ _ '~ OF ~' : -' DRAWER:'MB.T E3ANK ' :Issued by lntegrated'Rayment'Systems-Inc ,Englewood, Colorado TH IZED NATURES _ JPMoryan Chase E3ank, N.A., Denver, Colorado MANUFACTURERS AND TRADERS TRUST C6MPANY~ ~~ ~. n'342523n^ ~:L0200097'9~: 680D2277749853n^ e(I IIII IIII 01302 LEAH MAY & ELIZABETH ATTICKS 824 LISBURN Rd APT 615 CAMP HILL PA 17011-7101 N O M O f0 O m 0 0 s ~_ ;~ l~ aaa~ 1~ iilii~ ;~ Policy Number: 5837MP989264 Refund Amount: $ 'Y"6 . o0 Check. Number:. 5813so5s Check Issued: 01-24-2008 This refund was issued for the following reason(s): CANCELLATION CREDIT REFUND. If you have-any questions, please contact your Nationwide representative. Agent Name: RP ENGLE Agent Phone Number: 717-545-2639 Agent Number: 0007990 Detach Stub Before Cashing And Keep For Your Record .NAT ~ ~ ~.~_ ~ -- - - z ~ 1~1Ui3Y1EG1{LiETt"iiC~'M~II iNtl )riCIFS~~~3~.~1Lt ~ ~~. 1 K .i ~t w~RasBURe~ ~A `~t`~i `' ~~ 5 I~~r~`~n~~d~~ ~ ~ CEle~k,~ Nc~ ,.. •.~ 5 .,~ ~~ 9~ ~ r~ ~ `/ . « gip! o ~Nlmber: ,~8 ' ~,:'..'~ ~a.~V: ~ .. ^Z!~ F ;,n ~,.,y~J _ . is PAY "'SIX,AND.00/i00 DOLLARS*+~.+„~+ + ,,' + +,~;,,+++w,;*+++*++,,,+.w•++.:++++++++++++++++,.+*+++«.„,* EXACTLY: rt I~III~LI!>-I II~~I~~l~~~l~lll~ ~'~ 1~ ~.. ~~1~ " ~~ ~ ~~~ ._~ ._ 1`;L is~`~,~ , A~"T I L(CS ~~ Pa ~ X824 ~..,:~~BC~RN~~1)''` ~ ~~»" ~ ~,~~ ,^~ $>~c~:6.00 ,.To The ~ T Order L - ~~~~~ ~,' Of. 1 1 ~ _ ~ t h e _ r p e I t I '' ~ • ; ~ ~ ~ ; ` z ,.. Y;. X ~; .,.: .., .... Ind ~.~,..... ~,,,. ~ ,. IIII 111 II111111 Il1I II111 111 II111 ~I~IIIIu~l II1~ IIII "~ •' ': Fe„~~E BANKS,~NE Qe>eire JP~1JfOR[3kN C~iA ~~ANK,'~EFRBOFN T ,~®o ae~- D~ARBOFiN, MICMGAN dU'' ¢eo o~~,^ .~~., c .. s. :~ . ;>v~-•• , r .F ._n ar . ~ ~ t or o a._. e LEAH MAY & ELIZABETH ATTICKS `824 LISBURN Rd APT 615 CAMP HILL PA 17011-7101 I~'S8L38056~~' ~:0724L2927~: ~L5826~~' MassMutual Massachusetts Mutual Life Insurance Company 1~1 ul Springfield'MA 01.111-0001 - r(- FINANCIAA GROUP" CKI 15(0306) ELIZABETH G`ATTICKS - 'i .THE WOODSY AT CEDAR RUI3 824 LISBURN-ROAD #615 CAMP 'HILL, PA 17011-7101 _ 'j , ! ,1 j ,~ N IF THERE IS ANY CHANGE TO THE ABOVcE'.NAME AND ADDRESS PLEASE COMPLETE ALL INFORMATIO BELOW AND RETURN TO: - MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY CLAIM AND MATURITY SETTLEMENTS M356 Y295 STATE S'~ - ~- SPRINGFIELII'MA Ollll-0001 PZ.EASE TYPE 'OR PRINT CLEARLY. ~ -PAYEE NUM$ER1'7779b 00 EFFECTIVE DATE-UF CHANGE: NEW .NAME: NEW ADDRESS: CITY: , STATE: ZIP: THIS ADDRESS CHANGE IS: ^ PERMANENT ^ TEMPORARY --A"MONTHS OR LESS - _ MONTHS LEGAU RESIDENCE- (STATE) DIRECT DEPOSIT INFORMATION: , CHANIGE IS FOR CORRESPONDENCE ONLY. CONTINUE. TO SEND CHECKS ~TO MY BANK. ~ ' ^ MAIL CHECKS TO MY HOME ADDRESS. DISCONTINUE'SENDING CHECKS TO MY BANK. I WOULD".LIKE TO STARTlCHANGE I DIRECT DEPOSIT OF 1VIY CHECKS. PLEASE SEND ME THE PROPER FORMS. . , PEILSONAL.SIGNATURE OF PAI'EF.' FOR INFORMATION REGARDING YOUR ACCOUNT, CONTACT OUR DIRECT ACCESS SERVICE AT 1-800-272-2216. ~ ~" __ _.._ _ __ _ ___ __.__ _.____ _. ____ ___.__ ._.___ . ___ _ _ .. _ __ __.___ ._______ __.._I '_ _ __ u Massachusetts Mutual Life Insurance Company IIIIIIIIIIIIIIIII'IININIIIIIIIIIII =00428553 MassM tual Springfield MA 01111-0001- I Do Not Cash Be ore Amount o Check Bank o America, NA. F'INANCI:at cscdv° f L Q ~ ~ Q -- Q ~ ~'~>?k~k~c~K?K~~#~,'76` "" F7artford,.CT PAYEE NUMBER Invalid After 270 Days 51.44 177795 00 II9 EUI'ZABETH G ATTICKS THE WOODS AT CEDAR 'RUN '~' Pay To 824 :LISBURN ROAD #615 ~ The - CAMP -HILL , PA 17011-7101 President and CEO Order Of I ~~~ INCOME DIVIDENb: l t,28 TY'easurer C~CII S (0306} I THIS OOGUMENT HAS AN EMBEDDED WATERMARK (HOLD TO LIGHT Tp VIEWIAND \/Iu161_E SECUNITV FIOERS. TO IN51_IRE AUTHEN TICiI'`/, BOTH 1=f_ATURESMUST 6E PRESEf•1Y i~'4 2657~53ii' ~:0 i L900445~: 0009603 2~i' ~~SSI- )fu~A, Massactinsetts Mutua] Life Insurance Company rr- 1V1 [LL Springfield MA, 011:11-0001 F INANCIAt fiA0'UP" ~ - - - - i CKllS(0306) __ ELIZABETH G ATTICKS THE WOODS AT CEDAR RUN 824 LISBURN ROAD #615 CAMP HILL:, PA 17011-7101 I IF THERE'IS ANY' CHANGE TO' THE ABOVE_NAME AND" ADDRESS PLEASE COMPLETE ALL INFORMATION BELOW AND RETURN TO: MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY =~' CLAIM AND MATURITY SETTLEMENTS M356 - 1295 STATE ST _ ___ SPRiNGFIELn MA. Of111-0001:...._. PLEASE TYPE OR PRINK' CLEARLY. _ 1 PAYEE NUMBER:177796 02 THIS ADDRESS CHANGE IS: ^ PERMANENT EFFECTIVE DATE OF CHANGE: ^ TEMPORARY - 4 MONTH& OR LESS - _ MONTHS NEW NAME: LEGAL RESIDENCE.>(STATE) 'DIRECT DEPOSIT INFORMATION: NEW ADDRESS: _ ^ CHANGE ,IS FOR CORRESPONDENCE ONLY. CONTINUE TO SEND CHECKS TO"MY BANK. ^ MAIL CHECKS" TO MY HOME ADDRESS. DISCONTINUE SENDING CHECKS TO MY BANK. CITY: ^ I WOtiLD LIKE TO START/CHANGE. STATE• ZIP: DIRECT DEPOSIT OF MY CHECKS. i .. PLEASE SEND ME THE PROPER FORMS.. PERSONAL SIGNATURE OF PAYEF. FOR ~TFORMATION'REGARDING YOUR ACCOUNT, CONTACT OUR DIRECT ACCESS SERVICE AT 1-800-272-2216. ~ i./_ ,1~ /~assll /Tu}~~„1 Massachusetts Mutual Life-.Insurance Company (- j~/j jVl l.llQ1 Springfield MA 01111-0001: Do Not Cash Before FINANCIA I GROUP" 0~1-0],-D7 PAYEE MiMBER 177796 02 0028 ii ELIZABETH G ATTICKS ~!~ f THE WOODS AT CEDAR RUN ~\.~J,/ Pay To 824 LISBURN ROAD #-615 The CAMP HILL, PA 17011-7101 ~ President and. CEO/I ,'. Order Of I a~~ Treasurer I I - CK175 (0306) THIS DOCUMENT HAS AN EMBEDDED. WATERMARK~HOIffTp LIGHT:TO VIL"W) AND VISIB6E SECUHITV FIBERS. TO INSURE. AUTHENTICITY, BO7N FEATURES MIDST DE PRESEPIT n'4 2584 27u' ~:0 L L900445~: 0009603 2ii' ~'MassMutual Massachusetts Mutual Life Insurance Company and affiliates, Springfield, MA 01111-0001 www.massmutual.com HARRY L BRICKER JR ADMINISTRATOR OF THE ESTATE OF ELIZABETH G ATTICKS 407 NORTH FRONT ST HARRISBURG PA 17101 Settlement Option: ONE SUM PAYMENT Statement of Proceeds Date: 11 /30/07 Policy No.: MM 5599039 Policyholder: ELIZABETH G ATTICKS Agency: Payee No.: 177796-02 Date of 1st Payment: Frequency: Anniversary Date: Amount of Proceeds $ Amount of Installment $ Interest $ Income Dividend $ Installment Due $ 39.52 Less Federal Tax Withheld $ Deduct Installment $ Less State Tax Withheld $ Less Federal Tax Withheld $ Net Income $ Less State Tax Withheld $ Total $ 39.52 Comments: * Interest has been figured from 10/16/2007 to 12/0312007. If interest is $10.00 or more, shortly after the 1st of the year we will inform you of the amount of interest which we will report to the Internal Revenue Service. Cash Withdrawal As you recently requested, we are enclosing our check covering this withdrawal. The figures shown on the form give the current status of this account. Amount of Withdrawal $ Earned Interest to Date $ Check Enclosed $ New Account Balance $ Future Interest Payments $ P>~rraennntmTnnterest Rate 0.00°l0 q 0 0.00 M1311 (0102) ~ Mass'Mutual Massachusetts Mutual Life Insurance Company ( ti Springfield MA 011:11-0001 F1NAN'CIAL G''ROUP" MAILING ADDRESS _~ CK440 HARIdY L BRICKER JR ADMINISTRATOR OF THE ESTATE OF - ELIZABETH G ATTICKS _ 407 NORTH FRONT ST HARRISBURG PA :17101 j ` - ~ 1 , __ SEPTEM6ER INSTALLMENTTHAT WAS OWED .BEFORE DATE OE DEATH. - . ... J VENDOR NUMBER: OVINCSET Chuck#:1046114 - November 30,2.007 DOCUMENT VENDOR ~~ PO INVOICE AMOUNT DISCOUNT NET AMOUNT. NUMBER INVOICE NO. NUMBER DATE 1907944734 C3280A3524 1777.9602 11/30/2007 39.52 0.00 39.52 _ TOTALS 39.:52 ~I 0.00 39.52 ~' ~ _ iviassachusetts Mutual Life Insurance Company MassMutual 104 6114 s rhz field MA 01111-0001. '" p g FINANCIAL G AOUP Uan,( of.Amerrcd, N.A. - Hnrfford, CT ' ~~* THIRTY-NINE USI) and 52/.100 *** - ~ - i ' ~ / Amouut.bfCheck: ************39.52* _ _ .- _ _ _ _ . Invalid after 270 days 51-44 119 Date: November3D2007 - AccountlVo. 177796D2 ray To HARRY L' BRICKER JR PresiAenr The ADMINISTRATOR)OF THE ESTATE OF order of ELIZABETH G ATTICKS 407 NORTH FRONT ST ~~/ HARRISBURG PA 17101 cxa4o Trensurer THIS DOCUMENT HAS API EM6EDDED WATERMARK (FIOLD TO LIGHT TO VIED/) AND V1SII3LE SECURIT`! F16ER5. TO INSURE AUTHENTICITY. L3GTH FEATURES MUST fE PFIE ;ENT. 11' X046 L 1411' ~:0 ~ L900445~: 00000009607611' I~-~11 ~~-_ AMERICAN BIB LE SOCIETY Pay Thirty and 00/100 Dollars To the Order Of ': D to ' Acr3o:unt MISS ELkZABETH G ATTICKS 12/03/07 $30:00 824 LfSBUflN ROAD APT. 61b CAMP HILL, PA 1 701 1-71 0 11'0080 7 58 3 L X11' ~:0 i X00 ~ 2 34~: L8 04 2 411' __ .......... . ___ ®I~fS®~®®~5 ®~i13®®~I~i[~~L~~it3~iLeJ[~SI~®C~3®®[~5~1>~~r~r~tesr~rr~r~r~ee~e~~ ---------..~.~...s..=..~~.~a x-123 1 Tp Mellon„Trust of New England, N.A. Check' No.: 80758311 Ruttibrtzed S(gnature Not VsOd After Six Months ~~~,rm,~.~.s..s,.~,...-,.sue------ ........................... _ ..__ _ __ __ ..a.~.s~.l....,------- J~~! AMERICAN BIBLE SOCIETY Defgch and Retain this Statement For Your Records Mellon Trust of New England, N.A. Account Numt~er and Name Transaction Explanation 10001229000 ABS-GA SURPLUS-IMA QUARTERLY GIFT ANNUITY PAYMENT Check No.: 80758311 >., Date Amount 12/03/07 ~,~ Batch Transaction No. Portfolio Amount Account Administrator ZY 20 6147 PRINCIPAL $30.00 398 RICHARD D OLNEY THIS PORTION IS NON-NEGOTI~4~~E 1382 of 1564 AMBIBLE STATE STREET I SSA. GLOBAL ADVISORS February 27, 2008 52-014285 Harry L. Bricker, Jr., Esquire 407 North Front Street Harrisburg, PA 17101-1296 RE: CARE Gift Annuity Fund -Elizabeth G. Atticks Dear Mr. Bricker: Please find enclosed a check for $120.00 payable to the Estate of Elizabeth G. Atticks representing a reissue of the 12/31/06 payment from the CARE Gift Annuity Fund. The original payment dated 12/31/06 and the subsequent reissue in July 2007 were not cashed by Ms. Atticks. Therefore, these checks were deemed staledated and not good for payment. If you have any questions, please call me at (617) 664-3605. Sincerely, (,Y~/~~ . Joanne T. Pipkm Principal Charitable Asset Management Enclosure ®~1082M c 52-014285 AZ ~' CHARITABLE ASSETMANAG~EMENT - C.A.R.E. GENERAL GIFT ANNUITY Fl PAYMENT OF: $120.00 ' PAID: ESTATE OF ELIZABETH ATTICKS REISSUE OF 12/31/06 PAYMENT ESTATE OF ELIZABETH ATTICKS '008 4 care sM DETACH ALONG DOTTED LINE AND RETAIN TOP PORTION FOR YOUR RECORDS i u^000 138 7 204ii^ i::0 1 10000 28~: 9900 005 ii~^ i~'00 5 58 50 Iii' ~: 2 3 L 3 7269 1~: 84 3 L00 ~ 74 Iii' REF03 Ref: 161.87 Check No..558507 Amt: $`805,14 Dear Sir/Madam,:. We 'have received your request for~an unearned premium refund on the above policy. Please accept our condolences. Attached is our refund check representing the return o~ al'1 unearned;p'remiums paid. If 'you have ariy questions, please contact us'at (800) 659-9206. Sincerely, CUSTOMER SERVICE DEPARTMENT 1VI&TBailli 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Harry L Bricker Jr Attorney At Law 407 North Front Street Harrisburg, Pennsylvania 17101-1296 Re; Estate of: Elizabeth G Atticks Social Security: 171-28-0732 Date of Death: October 16, 2007 Phone (888) 502-4349 Fax (302) 9342955 November 28, 2007 Dear Sir or Madam: Per your inquiry dated November 19, 2007, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total 2. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 11464364 Elizabeth GAtticks, Leah MayAtticks 08/28/64 Closed 11/1S/07 $2,532.52 $ 0.31 $2,532.83 Checking Account 11477164 Elizabeth G Atticks, Leah May Atticks 08/28/64 $12,210.00 $ 0.21 $12,210.21 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the South Charles Street Office # 410-545-2155. Sincerely, !. U ~C' ~~ Nancy Clagett Records Management Elizabeth Atticks Account Summary 1. Regatta Sun Life-Non-Qualified Annuity Acct. #50-39-059000-69344- Registration-Elizabeth G. Atticks-Established-9/10/90-DOD Value-$36530.99- Beneficiary-Joyce Miller. 2. Mass Mutual-Payee No(s}.: 177796-00, 177796-01, 177796-02-Registration- Elizabeth Atticks-Life Income Option Accounts-Established-10-20-79-One Payment Due the Estate-$39.37-Submitted packet on 11 /27/07 with death certificate and short certificate providod by Mr. Bricker. 3. Mass Mutual-Policies #7506246 & #2366675-Registration-Elizabeth Atticks- Life Insurance Policies-#2366675-Established 1/18/55-DOD Estimated Death Benefit-$6797.00-Beneficiary-Joyce I. Miller-#7506246-Established- 10/1/88-DOD Estimated Death Benefit-$5100-Beneficiary-Market Square Presbyterian Church Corporation. 4. American Funds Non-Qualified Mutual Funds Acct. #81632805-Registration- Elizabeth G. Atticks PA/TOD Market Square Presbyterian Church- Established 9/22!06-DOD Value-$5475.49-Beneficiary-Market Square Presbyterian Church Corporation. 5. American Funds Non-Qualified Mutual Funds Acct.#81470231-Registration- Elizabeth G. Atticks PA/TOD Joyce I. Miller-Established-7/27/06-DOD Value- $43620.45-Beneficiary-Joyce I. Miller. 6. Allianz Non-Qualified Annuity Acct.#3423668-Registration-Elizabeth G. Atticks-Established-7118/94-DOD Value-Not Available, they were unable to calculate-10/18107 Value-(Closest to DOD they could give)-$17236.91- 11/15/07 Values for 10/30f07-Annuitization Value-$21189.42 and Surrender Value-$17236.91-Beneficiary-Unknown. e 1(~A.Ri~tl~~: tt is ittegat t€~ d~r~ticate this ~op~ h~ g~hotosta~ or ~fio~ograph. ~ ~ee for this certificate, $6.00 P ~~489894 Certification Number X7U67ASAEV H14DW TreEirreHrtr7 ~Enea77E7+r eucxwc ~:. This is to certify that the information here. given i. correctly copied from an original Certificate of Deatl duly filed with me asLocal Registrar. The origina certificate will be forwarded to the State Vita Records Office for pernaanen~ Bing. a. ~a~ / ! Local Registrar Date Issued. 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Tara . y a e i t M orMw oa.. • C•NMe pmbra I Tehbedd~ay lriatldpe, dealreootared tfwbharuele)rd mirttrrebrd-----------------,.------„-----_--^ ~ ~~ harnutreq rd artlrybe vM~+lPrr+wn Hoer patortmn7 a.m rid orayYe b aue d aedh) n tluebho NH rdewrrrddeL m ra l h b - = ~ a7. u«rtr Hurts ~ at d . D.r Mrm, arn r~) C r,r p ,r rr ee,aret atxunedd ente,t ------- '--- ---- Toherldtly btealM a drd e r ic ie MlN3 ~ , 7 ~ 7 A (Yl -( ~ 7- ~ooG :a« anr r . ur On h err d arraetrbrt rind! a 8ratlpelbn, b air W~ti deee reu,.d d h due, dar, end parr, eM due b h erree)e) rd mrarrr ewd_ ^ 8~t. .nor Addms a Pweat wM Ctre a Dt~71rrn47) TM ~ nib l f 23 i ve ~} Sla l i ~ ~ r r i v. . ~ : s. ~i r v 5 l D syt~e...nd Haar ~ ore. n e. ~ ~0~1~0~3{Jr~ ore. or. rued 1-+~at, dx f~ ,3~^p'jg~06 S~i2Soi..'Fl. ~tkts. SV-~~t20\ V Drpasuon Pxml No. ©d/ g a o~9 ~, ) LAST WILL AND TESTAMENT ,~, c~ o a x OF w ir: ; r - ;~ o ~ ~. ~ ~' :_~ ELIZABETH G. ATTICKS ~v3~ m `~~ a. ~ ~~ ~ ~, I, ELIZABETH G. ATTICKS, an adult individual, of the Township of Liver AIIeN ~:; c , ~ . ~ ca County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all W ills or testamentarywritings by me at any time heretofore made. FIRST: I direct that all my debts, funeral expenses and inheritance taxes be paid by my personal representative, hereinafter named, as soon after my death as may be practicable. SECOND: I direct that my body be interred at the family cemetery plot owned by me at the Rolling Green Cemetery, Lower Allen Township, Cumberland County, Pennsylvania. THIRD: I hereby give and bequeath my ring consisting of one large diamond ;~ and two rubies set in yellow gold to my sister, LEAH MAY ATTICKS, who presently resides at The Woods at Cedar Run, 824 Lisburn Road, Camp Hill, Pennsylvania 17011, providing ~ she is living at my death. If the said LEAH MAY ATTICKS predeceases me or is not living d at my death, I give and bequeath said ring to my friend, JOYCE I. MILLER, who presently `~ resides at 5700 Bunker Hill Street, Park Lane Apartments, #807, Pittsburgh, Pennsylvania ~:~'~ 15206, providing she is living at my death. If the said JOYCE I. MILLER predeceases me or is not living at my death, I give and bequeath said ring to the J. NEDRA SCHILLING FOUNDATION. FOURTH: I hereby give and bequeath all of my other jewelry to the J. NEDRA SCHILLING FOUNDATION. FIFTH: I give and bequeath my silverware, furniture, pictures and household furnishings to my sister, LEAH MAY ATTICKS, providing she is living at my death. If the said LEAH MAY ATTICKS predeceases me or is not living at my death, I give and bequeath said silverware, furniture, pictures and household furnishings to my friend, JOYCE I. MILLER, providing she is living at my death. If the said JOYCE 1. MILLER predeceases me or is not living at my death, I give and bequeath said silverware, furniture, pictures and household furnishings to the MARKET SQUARE PRESBYTERIAN CHURCH, presently situate at 20 South 2nd Street, Harrisburg, Pennsylvania 17101. SIXTH: I hereby give and bequeath my automobile to my friend, JOYCE I. MILLER, providing she is living at my death. If the said JOYCE I. MILLER predeceases me or is not living at my death, I give and bequeath said automobile to the MARKET SQUARE PRESBYTERIAN CHURCH. SEVENTH: I give, devise and bequeath all the rest, residue and remainder of my Estate, be it real, personal and mixed, of whatever nature and wheresoever the same may be situate, per capita and not per stirpes, as follows: A. Two-thirds (2/3}thereof to myfriend, JOYCE I. MILLER, providing she is living at my death. B. One-third (1/3) thereof to the MARKET SQUARE PRESBYTERIAN , CHURCH. i C. Should the said JOYCE I. MILLER not be living at my death, I give, devise and bequeath her share to the MARKET SQUARE PRESBYTERIAN CHURCH. EIGHTH: I hereby nominate, constitute and appoint SOVERIGN BANK of :~- Harrisburg, Pennsylvania, and HARRY L. BRICKER, JR., of Harrisburg, Pennsylvania, to ;~ serve as Co-Executors of this, my Last Will and Testament. Should either fail to qualify or u cease to act as Co-Executor of this, my Last Wili and Testament, I hereby nominate, constitute, and appoint the other as sole Executor. I further direct that the personal representatives shall serve without bond. Said personal representatives shall have the power to discharge all the debts, liens and encumbrances upon my Estate, as well as any taxes thereon, to pay for the cost of the final disposition of my remains and final illness, if any, to receive any and all commissions and other compensation for services rendered by me during my lifetime, and to perform any and all fiduciary duties authorized by statute. Further, I direct my personal representatives to preserve my Estate and any instructions pertaining to the distribution of the same from any attachment or anticipation while in the hands of my personal representatives, it being my express intent that all legacies sha11 be free from any attachment or anticipation while in the hands of the accountant for my Estate. 2 • !~ A NINTH: I hereby direct that all taxes attributable to the passing of any assets by means of this W ill or otherwise, or that maybe assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from the residuary of my estate as a part of the expense of the administratiori'of my estate. IN WITNESS WHEREOF, I, ELIZABETH G. ATTICKS, have signed, sealed, published and declared this to be my Last Will and Testament, consisting of this and three (3) additional pages in the margin of each of which I have also set my hand for greater security and better identification this ~fday of ~~r l-~ , 2005. .~ .,.. /~ ELIZ~ 1G. A`fTICKS ` The preceding instrument, consisting of this and three (3) other typewritten pages, each identified by the signature of the Testatrix, was on the day and date hereof signed, sealed, published and declared by ELIZABETH G. ATTICKS, Testatrix herein - ~ named as and for her Last W ill, in the presence of us, who at her request, in her presence v and in the presence of each other have hereunto subscribed our names as witnesses hereto. We further certify that at the time of the execution hereof, the said ELIZABETH G. ATTICKS was of sound and disposing mind, memory and understanding. ,, _ / }, t 1f ti. .,^. ~,. . ~ of 4 c '"1 ~ . ~. ~ Z.s~.~ J~ f ~~y~ yo ~ ~ . ~r~-f ~~~'' ~~ ~~i'al -. of ~IJ . iii ~ t 7 << ~ %~ . . ~-~. . •. . COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN I, ELIZABETH G. ATTICKS, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that f signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and ac nolntledged before me by ELIZABETH G. ATTICKS, the Testatrix, this .'.~ ..day of ~' ~..~1',:c:/~{...i _ , 2005. /i r. ~ .~. Noja Public `, .. My'dommission expires: ~~ ' ?;~~`~~` (SEAL) / ~® NOTARIAL SEAL AGNES G. NICHICI, NOTARY PUBLIC CITY OF HARRISBURG, DAUPHIN COUNTY MY COMMISSION FxPlRES JUlyE 19, 2006 COMMONWEALTH OF PENNSYLVANIA ) SS: p COUNTY OF DAUPHfN ) ,1 We and f~l ~ the witnessesm are signed to th ttached orforegoing instrument, being du{y qualified acco dtrrg to law, do depose and say that we were present and saw ELIZABETH ?~~ G. ATTICKS, Testatrix, sign and execute the instrument as her Last Will and Testament; ' that ELIZABETH G. ATTICKS signed willingly, and that she executed it as her free and voluntary act for the purposes 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 to and subscribed before me this . ~~;t_.day of ~~- r _~:~ ./rG:.-, , 2005. J~( _~ ~% - Not ry Public , My`commission expires: <~'' jl ~fj' ~~~'' (SEAL) NOTARIAL SEAL AGNES G. NICHICI, NOTARY PUBLIC CITY OF HARRISBURG, DAUPHIN COUNTY MY COMMISSION E;PIRES JUNE 19, 2006 FI~RRY L. BRICKER, ,dR. ATTORNEY AT LAW 407 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17101-1296 E-MAIL - HLBLAW~VERIZON.NET July 10, 2008 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Elizabeth G. Atticks, Deceased Date of Death -October 16, 2007 Socia! Security No. - 171-28-0732 File No. - 2007-01050 PA File No. - 21-07-1050 Tax I.D. No. - 30-6150671 Gentlemen: AREA CODE 717 233-2555 FAX 233-8555 ~~ o °' --~ C~ c~ -t ~- - C' T i ~ - _ - ~ ~. ~ .. - ;i -, ~ _ _ , , -~ ~ We are enclosing the following documents concerning the above captioned estate: 1. Six (6) completed {nventories. 2. Six (6) completed Pennsylvania Inheritance Tax Returns. 3. A check payable to the Register of Will, Agent in the amount of $6,148.39 for payment of the Pennsylvania inheritance tax. 4. A check payable to the Register of Wills in the amount of $45.00 for the additional probate fee. 5. A check payable to the Register of Wills in the amount of $30.00 which is, as we understand, the filing fee for the Inventory and Pennsylvania Inheritance Tax Return. We will appreciate you clocking all of the documents in and returning four (4) Inventories and four (4) Returns to this office using the enclosed self-addressed, stamped envelope. Certainly, if you have any questions, please feel free to call. Very truly yours, ~ ~~ ~~ ~, sr C,` _~ ---'~ Harry L. Bricker,~r. HLB, Jr./bld Enclosures • •-,_ Register of Wills CUMBERLAND County, Pennsylvania INVENTORY Estate of ELIZABETH ATTICKS No. Z I '~~ ~ ~ V ~~ also known as Deceased Date of Death OCTOBER 16, 2007 Social Security No. 171-28-0732 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate end all of the real estate in the Commonwealth of Pennsylvania of said, Decedent that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and th Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Attorney HARRY L. BRICKER, JR., ATTORNEY AT LAW I.D. No.: 07049 Address 407 NORTH FRONT STREET HARRISBURG, PA 17101 Telephone: (717) 233-2555 h !. -~ w ~,-,_ ,_,~ Dated Description 1. SOVEREIGN BANK: A. CHECKING ACCOUNT NO. - 2331046255 B. SAVINGS ACCOUNT NO. - 2334023385 C. CERTIFICATE OF DEPOSIT NO. - 2335254195 D. CERTIFICATE OF DEPOSIT NO. - 2335244120 2. JACKSON SIEGELBAUM GASTROENTEROLOGY -OVERPAYMENT ON MEDICAL SERVICES 3. THE BOARD OF PENSIONS OF THE PRESBYTERIAN CHURCH (U.S.A.) - 2 RETIREMENT PENSION PAYMENTS EACH IN THE AMOUNT OF $1,450.56 4. THE PATRIOT NEWS -SUBSCRIBER REFUND 5. ERIE INSURANCE GROUP -PREMIUM REFUND RE: PERSONAL CATASTROPHE POLICY POLICY NO. - 027 3050105 H 6. NEILL FUNERAL HOME, INC. -PARTIALLY PREPAID FUNERAL 7. HOUSEHOLD GOODS FOUND AT THE WOODS, AN ASSISTED LIVING FACILITY (RESIDED WITH HER SISTER) 8. ALL OTHER JEWELRY (COSTUME) INCLUDING BLACK ONYX RING 9. 1993 OLDSMOBILE CUTLASS CIERA (NOT IN WORKING ORDER) 10. RING CONSISTING OF ONE LARGE DIAMOND AND TWO RUBIES SET IN YELLOW GOLD 11. M&T INVESTMENT GROUP - 50 PRORATED QUARTERLY FIXED INCOME FROM THE J. NEDRA SCHILLING FOUNDATION Total from Continuation Page(s) (Attach additional sheets if necessary) Value $22,679.36 $3,619.34 $5,029.06 $8,382.06 $6.00 f~.m C..'J ~.- 0 ~' 901 $2 12 .i .~ ~ , . , _ -I~ CJ ~° $50.35 r- irn _,~ J : .&° ~;~ -z ~-, - ; $64.00 _J _' ~, ~.' X4,380.00 ~J t\J _ - =' r ? -~ r ., ~ _ -`$245.00 -_.! $65.00 $500.00 $3,750.00 $987.44 $18,422.22 Total: $71, 080.95 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. _~ Register of Wills CUMBERLAND County, Pennsylvania INVENTORY CONTINUATION PAGE Estate of ELIZABETH ATTICKS No. Description Value 12 . NATIONWIDE -CANCELLATION OF TENANT POLICY $3.00 (CHECK WAS IN THE AMOUNT OF $6.00 AND DIVIDED BETWEEN DECEDENT AND HER SISTER) 13 . $97.00 IN CASH -FUNDS ON DEPOSIT AT THE WOODS $97.00 14 . INTEREST ON CHECKING ACCOUNT (AS OF 06/19108) $10.52 15 . MASS MUTUAL FINANCIAL GROUP -INCOME DIVIDEND: ACCOUNT NO. - 177796 00 $40.76 ACCOUNT NO. - 177796 02 (2 PAYMENTS) $78,89 16. AMERICAN BIBLE SOCIETY -QUARTERLY GIFT ANNUITY PAYMENT $30.00 17. C.A.R.E. GIFT -ANNUITY FUND - REISSUANCE OF CHECK FOR INCOME DISTRIBUTION FOR PERIOD ENDING 12131/07 $120.00 18. AF&L INSURANCE COMPANY -POLICY NO. - 16187 -UNEARNED PREMIUM $805.14 19. ALLIANZ -NON-QUALIFIED ANNUITY ACCOUNT NO. - 3423668 ESTABLISHED - 07/19/1994; BENEFICIARY UNKNOWN (ESTATE IS BENEFICIARY) $17,236.91 Total: $18,422.22 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. C''3 <t ._ ~_ o.._ - i ' [lam ` j ``;. ~ ~ ~ + ~! ~ (-~'- ' " ©. C J r` ~a U c~ ~~ if c. s c~ ,. N ^ Y O 00 0 ? 0 Oo 0 dfM7^ S {~}o tl~ J • ~ O O ~ ~ 2 ~~ M r o ~~ ~~ " '^ u f ~~ o N N O W H N O 2 N 7 q 0 N Q L o U ~ w ~ ~' W3~a O C to ch N U~~> ~ N ° V Y ~ Y W LL Z ~ O T ~ m~FW o ~~a J~oa ~ ~ ~ ~ • ~ a a '~ ~ i = C Af ~ U O U a 2 O