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Estate of Theod~o~reW. Stellw~,a_Jr.,
Deceased
Social Security No. 147-32-61685
Date of Death: September 19,' 2009
Pennsylvania Inheritance Tax ~teturn
(Form 1500)
Prepared sy:
MacElree I~,'
Harvey
Louis N. tell, Esquire
MacElree Harvey, Ltd.
17 West Miner Street
Post Oftios Box 660
West Cheater, PA 19381-0660
Telephone: (610) 840-0300
Facsimile: (610) 429-4486
Email: Itet~macelree. com
EXHIBIT A
.,-„I REV-1500 EX (os-os) 15 D 5 6 D 4115 8
PA Department of Revenue OFFICIAL USE ONLY
Buroau of Individual Taxes County Code Yar Filb Numbsr
Po sox 2eo6ot INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
'147-32-6885 09192009 06201941
Decedent's Last Name Suffix Decedent's First Name
STELLWAG, JR• THEODORE
(lf Applicable) Enter Surviving Spouse's Information Below
Spouse's Laat Name Suffix Spouse's First Name
STELLWAG ANN
Spouse's Social Security Number
195-32-0933
FILL IN APPROPRIATE BOXES BELOW
^ 1. Original Retum
^ 4. Limited Estate
^ 6. Decedent Died Testate
(Attach Copy of Wilq
^ 9. Litigation Proceeds Received
THIS RETURN MU8T BE FILED IN DUPLICATE WRH TH~
REGISTER OF WILLS
^ 2. Supplemental Return
^
4a. Future Interest Compromise (date of
^ 7. death after 12-12-82)
Decedent Maintained a Living Trust
(Attach Copy of Trust)
^
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-93)
^ 3. Remainder Retum
prior to 12-13-82)
^ 5. Federal Estate Tax
~ 8. Total Number of
^ 11. Election to tax ui
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST ~ COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION
Name Daytime Telephone I
LOUIS N• TETI, ESQUIRE 610-84D-D
Firm Name (If Applicable) RE(iMTER
MACELREE HARVEY, LTD•
First line of address
17 WEST MINER STREET
Second line of address
P•0• BOX 660
City or Post Office State ZIP Code
WEST CHESTER PA 19381-0660
Correspondents a-mail address: L T E T I W M A C E L R E E• C O M
DATE
Under penalties of perjury, I dsGaro that I have examined this return, including accompanying schedule and statements, and to the bat of
it is true, correct and complete. Declaration of preparor other than the personal ropreaentative is based on all information of which preparor has sny
SIGNATIX?E OF PERSON R SPON I E FOR ILI R RN /7 _ ~ DA
ANN 0 • STELLWAG (•(•~~
MI
W
MI
0
late of deatn
eturn Required
e Deposit Boxes
r Sec. 9113(A)
SE DIRECTED TO:
d ~"r
.
i
I EON Vi
: j
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. n, . _ ~..~
a
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knowledge and belief,
~o//D/!O
~rvua J ~ ~Lr~ r~ rt IYLW LUIIOLICLAIVL, r'A Jr (U (U
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
LOUIS N • TETI '~' - ~~ /o /o
ADDRESS
PO BOX 66D WEST CHESTER, PA 19381~f0~6-Q
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041158 6M48473.000 15D56041158 J
REV-1500 EX
15056042159
Decedent's Social Number
147-32-6~ 5
RECAPITULATION
1. Real estate (Schedule A) 1. II 0 • 0 0
2. Stocks and Bonds (Schedule B) ........................ 2. ~, 6 7 3 5.7 6
3. Closely Held Corporation, Partnership or Solo-Proprietorship (Schedule C) • 3. D . 0 0
4. Mortgages 8 Notes Receivable (Schedule D)........ .... .... . 4. ~!~ 0 • D D
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. ..... 5. ill 112 5.7 7
6. Jointly Owned Property (Sd~edule F) ~ Separate Billing Requested .. . 6. ~
0 • 0 0
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested 7.
5 6 ? 6 2 4.2 6
8. Total Gross Assels (total Lines 1-7). . 8.
9. Funeral Expenses & Administrative Costs (Schedule H) . 9. ~ 2 9 0 2 3 • 7 2
10.
Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I). .. ~i
10. ',
I
202.97
11. Total Deductions (total Lines 9 8 10) . .. 11. 2 9 2 2 6.6 9
12. Nat Valua of Estab (Line 8 minus Line 11) . .. .. 12. 5 4 6 2 5 9.10
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~~
an election to tax has not been made (Schedule J) . ........ ....... 13. ~ 0 • 0 0
14. Net Valua SubJsct to Tax (Line 12 minus Line 13) .. 14. ~ 4 L. a ~ 9 _ 1. n
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable ~
at the spousal tax rate, or I
transfers u-~~eerr Sec. 9116
(a>(1.z>x.oLL 440469.33 15. I 0 • DO
16. Amount of Line 14 taxable ~
at lineal rate X .Oils 0.0 D
16• ~
0.0 0
17. Amount of Line 14 taxable
at sibling rate X .12 D• 0 0 17• ', 0• D D
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18• 0. 0 0
19. TAX DUE 19. i 0 • D 0
I
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN O'VEtiPAYMENT
Side 2
15056042159 8M48482.000 1505604219
REV 1500 EX Pape 3
Flk Number
Decedents Com late Address:
DECEDENT'S NAME
STREET ADDRESS
CRY STATE ZIP
Tax Payments and Credits:
1. Tax Due (Pape 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit D • 0 0
B. Prior Payments 0.0 0
C. Discount 0.0 0
3. InteresUPenalty if applicable
D. Interest 0 . D 0
E. Penalty 0.0 0
(1> II 0 00
I~
Total Crodkt (A + B + C) (2) ~ D • D D
I
TotallnteresUPenaMy(D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line ZO 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) I D•00
(a) II ^ . 0 0
(5A)
(5B)
Make Check Payable to: RKo'~S7ER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRWTE
1. Did decedent make a transfer and: Yes
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 I'rfe of either payments, benefds 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 "in trust for" or payable upon death bank account or security at his or her death? .
4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? 0
IF THE ANSVIfER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 u e 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 souse fa zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does pot exempt a transfer to a surviving spouse from tax, and the statutory requirements fort disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only benefiaary.
For dates of death on or after Juy 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 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)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) perlcent, 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. J39116(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 ar adoption.
8M1871 7.000
REV-1503 EX+ (ggg)
SCHEDULE B
CC~AAMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS
INHERITANCE TAX RETURN
RESIDEM DECEDENT
FILE NUMBER
ThQOdore W. Stellwag,~T~.
REV-1508 EX+ (698)
SCHEDULE E
COM~AONINEALTH OF PENNSVwANIA ('~~, BANK DEPOSITS, ~ MISC.
INHERITANCE TAX RETURN
RE31DEPf1'oECEOEKr PERSONAL PROPERTY
ESTATE CIF FILE
ThQOdore W. 3t®llwaa, Jr.
REV-1510 EX+ (8.88)
COMMOrMIEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENTDECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
Theodore W. 3tellwaq, Jr.
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
NUMBE DESCRIPII N OF PROPERTY
MCLICETFEIIMiE0FT1£TRM{9FEREE,TI~RREUTIONMPTOOECEDBdrMD
TIED~lE0F1R~laFBRATTIpiA00PIOFTIEOE®FORREALEBTATE
DATE OF DEATH
VALUE OF ASSET
°~OFDECD'S
INTEREST
EXCLUSION
FaF~ucAe~E
TAXABLE
VALUE
~• Integrity Bank - IRA acct
$1029169 124,903.17 100.0000 0.00 ' 124,903.17
Beneficiary: Ann O. 3tellwaq
(surviving spouse)
2 Charles Schwab - Roth IRA acct
X85543193 23,464.69 100.0000 0.00 I 23,464.69
Beneficiary: Ann O. 3tellwaq i
(surviving spouse)
See attached valuation
Interest accrued to 9/19/2009 77.00 100.0000 77.00
3 Charles Schwab - IRA sect
I
$84715370 56,974.15 100.0000 0.00 ~', 56,974.15
Beneficiary: Ann O. 3tellwaq
(surviving spouse)
$ee attached valuation
Interest accrued to 9/19/2009 205.73 100.0000 I 205.73
4 PNC Bank - IRA CD acct
$55010201102 117,544.39 100.0000 0.00 ' 117,544.39
Beneficiary: Ann O. 3tellwaq ~i
(surviving spouse)
Interest accrued to 9/19/2009 1,381.66 100.0000 '~ 1,381.68
~
5
Belco Community Credit Union - I
IRA CD acct X131790-38624 26,310.11 100.0000 0.00 !~ 26,310.11
Beneficiary: Ann O. Stellwag
(surviving spouse)
Interest accrued to 9/19/2009 432.59 100.0000 I 432.59
6 Americhoice Federal Credit
~
Union - IRA CD acct $44142-80 90,763.26 100.0000 0.00 ', 90,763.26
Beneficiary: Ann O. 3tellwaq ',
(surviving spouse) ',
Interest accrued to 9/19/2009 1,826.38 100.0000 ', 1,826.38
7 Citizens Bank - IRA CD acct
~k6246521938 121,722.63 100.0000 0.00 121,722.63
Beneficiary: Ann O. 3tellwaq '
(surviving spouse) ',
Interest accrued to 9/19/2009 2,018.48 100.0000 2,018.48
See Exhibit "6"
TOTAL (Also enter on line 7, Recapitulation) 13 567 , 624.26
(Ir more apace is needed, inseA addNbnal sheets of the same size)
3W48AF 1.000 '.
_- - -- --- L_-..
REV-1517 EX+ (1406)
CO~MAONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Theodore W. StellwaQ. Jr.
Debts of decedent must be reported on Schedule I.
ffEM
NUMBER gESCRIP1lON AMOUNT
A. FUNERAL EXPENSES:
~ Malpezzi E'uneral Home 14,919.84
2 Gingrich Memorials 3 375.00
B.
1
ADNpNISTRATNE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
2.
3.
City State Zip
Year(s) Commission Paid:
Attorney Fees (estimated through 5/31/10)
Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7.
1 Bank of New York Mellon -waiver of probate surety
bond fee
2 EstateVal - valuation of securities
10,500.00
212.33
1.55
Total from continuation schedules 15.00
See Exhibit "7"
TOTAL (Also enter on line 9, Recapitulation) S ' 29 023.72
7W46AG tooo (If more space is needed, insert additional sheets of the same size)
_... _ __. _ __ __._._. _.-__- _r
Estate of: Theodore W. 3tellwag, Jr.
Schedule H Part 7 (Page 2)
3 Cumberland County Register of Wills
Filing fee/PA Inheritance Tax Return
15.00
Total (Carry forward to main schedule) I 15.00
REV-1512 EX « (12-08)
Pennsylvania
~EPARTbENf OF REVENUE
NfRITANCE TAX RETURN
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES 81 LIENS
ESTATE OF FILE NUMBER
Theodore W. 3tellwag, Jr.
i
BW46AH 2.000 ~~ mvw spaces ~s neroeasu, mavn awmvnai sneers yr Inv Same SIZe. ~.
REV-1513 EX+ (11-OB)
Pennsylvania
DEPATZnYFM OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTA
SCHEDULE J
BENEFICIARIES
IMBER ~~ AND ~~ ~ PERSON(S) RECEMNG PROPERTY
I TAXABLE DISTRIBUTIONS [include outripM spousal distributions, and transfers under
Sec. 2116 (a) (1.2).j
1. Ann O. Stellwag
1803 St. Clair Rd.
New Cumberland, PA 17070
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Surviving Spouse
10~p7 of residue of
esltate and all
tafngible personal
property
ENTER DOLLAR AMOUNTS FOR DISTRIBUT10N5 SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROP IATE.
I[ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN ',
1.
I,
B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS
L
See Exhibit "8"
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEP. ~ S ' 0.00
If more space is needed, insert add'Rional sheets of the same size.
8W46AI 2.000 '~~
-7 'I
EXHIBIT B
H105.Rp5 RF_V f01/07)
__ T r~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is Illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P .5838470
Certification Number
MIOSW IEY 11/AY{
IYIE / PIrR N
r
This is to certify Chit the information here given is
correctly copied frorih an original Certificate of Death
duly filed with me ~s Local Registrar. The original
certificate will b0 ;forwarded to the State Vital
Records Office for permanent filing.
~~ a
oval Registr ~ Date Issued
cow~owweniTa of PEwr+sr~vaw- . o~a,-nTrmNr of ~-~rH . vmu aECOROs
CERTIFICATE OF DEATH:
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EXHIBIT C
LNT; 441134_1; 700177.OU678; lae 07/20/09; 07/21/09; can 08/13/09
WILL
OF
THEODORE W. STELLWAG, JR
I, Theodore W. Stellwag, Jr., of the Borough of New Cumberland, County of
Cumberland, Pennsylvania, declare this to be my last Will, and I hereby revoke all prior Wills and
Codicils, and writings in the nature thereof, heretofore made by me. ~I
FIRST: PAYMENT OF EXPENSES: I direct that the expenses of my last
illness and funeral be paid from my estate as soon as practicable after my death.
I
SECOND: TAXES:
A. All estate, inheritance, succession or other death takes, except
generation-skipping transfer taxes, imposed or payable by reason of my death, and due ~t my death
or incurred during the administration of my estate, and interest and penalties thereon, ~f any, with
respect to all property comprising my gross estate for death tax purposes, whether ~r not such
property passes under this Will, shall be paid out of the principal of my residuary est~te. 1n the
absolute discretion of my Executor, such taxes may be paid immediately or may be pdstponed on
future or remainder interests until the time possession thereof accrues to the
B. My Executor may join with my wife, Ann O. Stel}v~ag, or her
personal representative, in a joint income tax return covering any period of time prior t~ my death,
or in a gift tax return on gifts made by my wife prior to my death; and in connection therewith may
determine what taxes, interest and penalties are proper; and may pay the same even Ithough not
attributable in whole or in part to income or gifts from my property and without requiring said wife
Page l of 10 Pages
LNT; 441134_1; 700177.00678; lae 07!20/09; 07/21/09; can 08/13/09
or her personal representative to indemnify my estate against liability to it for tax attributable to her.
THIRD: CARE OF PETS: In the event my wife, Ann O.
survive me, I have left a memorandum outlining our intentions with respect to the
dog, Powder Puff, and any other pet(s) I may own at the time of my death. I direct my
review this memorandum, and to the best of his ability, follow the directions
memorandum regarding the care and maintenance of any such pet(s) during their li
Executor is authorized and directed to pay any reasonable amounts necessary to
directions regarding Powder Puff s or any other pet(s)' care and maintenance, as
memorandum.
does not
of our pet
xecutor to
led in the
le(s). My
y out the
red in said
FOURTH: TANGIBLE PERSONAL PROPERTY: I give all of my
tangible personal property (exclusive of cash, securities, choses in action, and all oth'~r tangible
evidences of intangible personal property) together with all insurance on such property, ~° my wife,
Ann O. Stellwag, if she survives me. In the event Ann O. Stellwag does not survive me, I may
leave a memorandum to be found among my personal papers, stating my wishes with
disposition of certain articles of my tangible personal property. This
interpreted as an expression of my wishes and shall not create any trust or obligation,
offered for probate as part of this Will. I request, but do. not direct, that my
property be distributed in accordance with said memorandum. In the event such a
cannot be found, or to the extent any of my tangible personal property is not
-ect to the
shall be
shall it be
personal
norandum
of in said
memorandum, then I give all of such tangible personal property to my son, Patrick 'J'F Stellwag,
1241 Claremont Road, Carlisle, Pennsylvania 17015, if he survives me. In the event }he does not
survive me, then all such remaining tangible personal property shall be distributed by rr~y Executor
Page 2 of 10 Pages
LNT; 441134_1; 700177.00678; lae 07/20/09; 07/21/09; can 08/13/09
to those persons whom he believes should receive such property, either from a sentimental point of
view or otherwise. Any items not so distributed by my Executor shall be sold, and tl~e proceeds
therefrom shall pass as part of the residue of my estate. My Executor shall represent the
any minor in any division of my tangible personal property. My Executor shall
expense of settling my estate, all costs of delivering such tangible personal property;
the costs of packaging, delivery and insurance. My Executor may distribute any item
a minor, or a person with whom he or she resides, and will be fully discharged thereby,
FIFTH: SPECIFIC BEQUESTS: In the event my wife, Ann
predeceases me, then I make the following specific bequests:
interest of
as an
including
directly to
Stellwag,
A. I give the sum of Ten Thousand ($10,000.00) Doll~rs to my
grandson, Stephen P. Irvine. In the event Stephen P. Irvine predeceases me, then th~s gift shall
lapse and shall pass as part of the residue of my estate. III
B. I give the sum of Ten Thousand ($10,000.00) Dollprs to my
grandson, Seth J. Stellwag, c/o 1241 Claremont Road, Carlisle, Pennsylvania 170 5. In the
event Seth J. Stellwag predeceases me, then this gift shall lapse and shall pass as part of the
residue of my estate.
C. I give the sum of Ten Thousand ($10,000.00) Dol~ars to my
wife's niece, Juliann M. Schell, 4632 Laurel Ridge Drive, Harrisburg, Pennsylvanian 17110. In
the event Juliann M. Schell predeceases me, then this gift shall lapse and shall pas as part of
the residue of my estate.
D. I give the sum of One Thousand ($1,000.00) Dollars to The
Foundation for the Preservation of Historic St. Lawrence Chapel, 212 Slate Street,
Page 3 of l0 Pages
LNT; 441134_1; 700177.00678; lae 07/20/09; 07/21/09; can 08/13/09
Harrisburg, Pennsylvania 17101, or to its successors and assigns.
E. I give the sum of Five Thousand ($5,000.00) Dollars t~ my step-
granddaughter, Amanda M. Rohrer. In the event Amanda M. Rohrer predecease$ me, then
this gift shall lapse and shall pass as part of the residue of my estate.
F. I give the sum of One Thousand ($1,000.00) Dollars ~o each of
the grandchildren of my friends, Mary and Nick Hober (the "Hober grandchildren'h). Those
grandchildren are William N. Moore and Nicole E. Moore, both of 1014 Shunpike Rbad, Cape
May, New Jersey 08204, and Alezis L. McDuell and Ryan C. McDuell, both of 1721 New
England Road, Cape May, New Jersey 08204. If any one or more of such Hober
predecease me, then such deceased person's gift shall lapse and shall pass as part of 1
of my estate.
I note here that my wife, Ann O. Stellwag, has also included a
Bequest" provision in her Will which is identical to this provision. I hereby
aforementioned beneficiaries and charitable organizations as outlined in this Article
each be entitled to receive a single bequest in the amounts specified, and not a bequest
idchildren
ie residue
"Specific
n that the
1'H shall
prom each
of our estates.
SIXTH: RESIDUE: I give the residue of my estate, real and personal, to my
wife, Ann O. Stelhvag, if she survives me. In the event Ann O. Stellwag does not survive me, then
I give the residue of my estate, outright, to my son, Patrick J. Stellwag, or if he is then (deceased,
then to my wife's niece, Juliann M. Schell, or, if she is then deceased, then in equal shajres to my
grandsons, Stephen P. Irvine and Seth J. Stellwag, subject, however, to the provisions !of Article
EIGHTH of this Will. If either or both of them predeceases me, then such deceased grandson's
Page 4 of 10 Pages
LIVT; 441134_1; 700177.00678; lae 07/20/09; 07/21/09; can 08/13/09
contingent share(s) shall be distributed to The Foundation for the Preservation of )(Iistoric St.
Lawrence Chapel, 212 State Street, Harrisburg, Pennsylvania 1 ~ 101, or to its suc~Cessors and
assigns.
SEVENTH: POWERS OF APPOINTMENT: No provision of thus Will shall
exercise any power of appointment that I may have.
EIGHTH:
Except as otherwise provided herein, if any beneficiary becomes entitled to an outright distribution
of income or principal and is (a) under twenty-two (22) years of age or (b) in my E~Cecutor's or
Trustee's opinion, disabled by illness or other cause and unable to properly manage the
A. As much of such income or principal as my Trustee ma~ from time
to time think desirable for the health, education, maintenance or support of that beneficiary shall be
paid to him or her or shall be applied for his or her benefit; and,
B. The balance of such income and principal shall bel held as a
separate trust for the beneficiary and, subject to my Trustee's power to pay to, or to a~ply for the
benefit of the beneficiary, both income and principal of such trust shall, together v~ith any net
income therefrom, be kept invested and paid, as the case may be, to the beneficiary Iwhen he or
she reaches twenty-two (22) years of age or becomes, in my Trustee's opinion, free ojf disability.
If any beneficiary dies before that time, the balance of his or her share shall be paid ~o his or her
estate.
Any funds to be applied under this Article either shall be applied directly by my
Trustee or shall be paid to a parent or guardian of the beneficiary or to an}~ person or
organization taking care of the beneficiary, and my Trustee shall have no further responsibility
Page 5 of 10 Pages
LNT; 441134_1; 700177.00678; lae 07/20/09; 07121/09; can 08/13/09
for any funds so applied or paid.
NINTH: SURVIVAL CLAUSE: If any beneficiary shall die withil~ thirty (30)
days of the date of my death, any devise or bequest given or appointed to or for the
beneficiary shall lapse, and this Will shall be interpreted as if such beneficiary had x
me.
TENTH: PROTECTIVE PROVISION: All principal and income
actual distribution to the beneficiary, be free of debts, contracts, alienations and antici
beneficiary, and the same shall not be liable to any levy, attachment, execution or
while in the possession of the Executor or Trustee.
ELEVENTH: NON-ACCRUAL OF INCOME: Income from any
herein or any share thereof shall not be apportioned between successive beneficiaries.
of such
shall, until
of any
created
income
not actually paid to a beneficiary before termination of his or her interest shall be treated ~s though it
had accrued and become payable thereafter; likewise, no credit or accrual shall be ma~e for taxes,
commissions or other charges theretofore made against income. ',
TWELFTH: POWERS: In addition to the powers above provided fo~, and those
given by law, my Executor or Trustee, without any order of Court and in their sole discrq'tion, may:
A. Retain any and all property received for as long as such retention
appears advisable;
B. Invest and reinvest in stocks, shares and obligations of c~rporati
of unincorporated associations or trusts and of investment companies or in any ot)~er kind of
personal or real property, notwithstanding the fact that any or all of the investments maade are of a
character or size which, but for this expressed authority, would not be consideredl', proper for
Page 6 of 10 Pages
-- _ _ _
LNT; 441134_1; 700177.00678; lae 07/20/09; 07/21/09; can 08/13/09
executors or trustees;
C. Retain the services of a qualified investment advisor(s) fi}om time to
time as the Executor or Trustee deems necessary, and also to obtain the services of a qualified
.lawyer and/or accountant to assist with the legal and accounting requirements of s~rving in a
fiduciary position;
D. Keep reasonable amounts of cash in the bank uninvested if deemed
advisable for the protection of principal; !,
i
E. Repair, alter, improve or lease, for any period of time, any property,
and give options for leases; ~,
F. Sell for cash or on deferred payments at public or p~ivate sale,
exchange, or convey any portion of my estate, real or personal, at the time or price and o~l the terms
and conditions which my Executor or Trustee may deem best; ',
G. Borrow money from any person, including the Executor or Trustee,
hereinafter named, and mortgage or pledge any property; I'
H. Compromise claims; I~,
I. Make distributions in cash or in kind, or partly in each;
J. Exercise all powers in the management of my estatewhich any
individual could exercise in the management of similar property owned by that indivijdual in his
own right, and upon such terms and conditions as may seem best to my Executor or Trustee, and to
execute and deliver any and all instruments, and to do all acts which my Executor or Trustee may
deem necessary and proper to carry out the purposes of this Will;
K. At any time merge any trust hereunder with any other tryst held by
Page 7 of 10 Pages
__
~_r
LNT; 441134_1; 700177.00678; lae 07/20/09; 07/21/09; can 08/13/09
my Executor or Trustee, whether created by me or by any other person by Will or deed, if the
teens of the trust are then substantially similar and held for the primary benefit df the same
person or persons; I!
L. Change the situs for administrative and accounting purposes of any
or all trusts created hereunder to any jurisdiction, without the necessity of court appro~al; and,
M. Disclaim any power or interest in property, without coin approval,
with such property to include, but not be limited to, all or a portion of survivorship rights in
multiple-party accounts, tangible personal property or real property; rights under) retirement
plans, annuities, individual retirement accounts, endowment insurance policies and ~ertain out-
of-state lottery proceeds; and inter vivos gifts. I~,
i
These authorities shall extend to all property at any time held by my E~ecutor and
shall continue in full force until the actual distribution of all such property. ~ll powers,
authorities, and discretion granted by this Will shall be in addition to those granted ~y law and
shall be exercisable without leave of court.
THIRTEENTH:
R
appoint my wife, Ann O. Stellwag, as Executrix of this my Will. Should Ann C~. Stellwag
predecease me, or for any reason be unable or unwilling to act or continue to act, then I ~ppoint my
friend, Louis N. Teti, Esquire, 17 West Miner Street, West Chester, Pennsylvanian 19381, as
alternate Executor in her place and stead. Should he predecease me or for any reason' a unable or
unwilling to act or continue to act, then I appoint my son, Patrick J. Stellwag, as alternate Executor
in his place and stead. Should he predecease me or for any reason be unable or unwilling to act or
continue to act, I appoint my wife's niece, Juliann M. Schell, as alternate Executrix in his place and
Page 8 of 10 Pages
TrT _
LNT; 441134_1; 700177.00678; lae 07/20/09; 07/21!09; can 08/13/09
stead. I appoint Louis N. Teti, Esquire, as Trustee of any trusts created herein. Should Louis N.
i
Teti, Esquire, predecease me or for any reason be unable or unwilling to act or continu~ to act, then
I appoint Juliann M. Schell as alternate Trustee in his place and stead. Should Julian>h M. Schell
predecease me or for any reason be unable or unwilling to act or continue to act, th~n I appoint
Patrick J. Stellwag in her place and stead. Should Patrick J. Stellwag predecease m~ or for any
reason be unable or unwilling to act or continue to act, then I appoint my friend, James )~. Tarman,
Esquire, in his place and stead. No Executor or Trustee nor any duly appointed succe~sor shall be
required to give bond or furnish sureties in any jurisdiction. III,
~I
FOURTEENTH: COMPENSATION OF FIDUCIARIES: An~ person(s)
serving as a fiduciary under this Will shall be entitled to reasonable compensation fo~ his or her
services as a fiduciary, provided such compensation does not exceed the maximu~rl amounts
allowed by law.
FIFTEENTH: GENDER AND NUMBER: Wherever any words are used
I
herein in the masculine gender, they shall be construed as though they were also ~lsed in the
feminine gender or neuter gender in all cases where they would so apply, and whereve# any words
are used herein in the singular form, they shall be construed as though they were also I, used in the
plural form in all cases where they would so apply.
SIXTEENTH: SAVING CLAUSE: Should any provision contained herein be
determined by opinion of counsel or by decree of court to be illegal, unenforceable or to ~esult in the
loss of substantial inheritance or income tax benefits to my estate, such provision shall be
considered null and void, and the remainder of this Will shall be in full force and efffect and my
estate shall be administered accordingly and without reference to any such provision
Page 9 of l 0 Pages
LNT; 441134_1; 700177.00678; lae 07/20/09; 07/21/09; can 08/13/09
IN WITNESS WHEREOF, I have hereunto set my hand and seal this~~ ~' day
of C.C-(.c~~rc.[/~ , 2009.
Theodore W. Stellwag, Jr.
SIGNED, SEALED, PUBLISHED and DECLARED by the above na ed Testator
as and for his last Will, in the presence of us, who at his request, in his presence and in the presence
of each other, all being present at the same time, have hereunto subscribed our names a witnesses.
of
of
Page 10 of l0 Pages
EXHIBIT D
Estate Valuation
Date of Death: 09/19/2009
Valuation Date: 09/19/2009
Processing Date: 12/08/2009
Shares Security
or Par Description
High/Ask Low/Bid
Estate of: Theodore W. Stellwag, Jr., Deceased
Account: PSE&G stock holdings
Report Type: Date of Death
Number of Securities: 1
File ID: STELLWAG, Theodore - PSE&G Stock
Mean and/or Div ar~d Int Security
Adjustments Accruals Valve
1) 210 PUBLIC SVC ENTERPRISE GROUP (744573106)
COM
New York Stock Exchange
09/18/2009 32.10000 31.64000 H/L ~,
09/21/2009 31.98000 31.25000 H/L
31.742500 I 6,665.93
Div: 0.3325 Ex: 09/04/2009 Rec: 09/09/2009 Pay: 09/30/2009 69.83
Total Value: IIII $6,665.93
Total Accrual: I $69.83
Total: $6,735.76
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If ~ou have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.0),
EXHIBIT E
Jan. ~. LUIU I:L1rm rN~ ~HIVIt 41Z-IU7-L14!
+~FNC
BEADING THE WAY
January 8, 2010
Louis N Teti, Esq.
Macelree Harvey LTD
l 7 W Miner St
P O Box 660
West Chester, PA 1938]-0660
RE: Theodore W Stellwag
SSN: i47-32-6885
DOD: 09-19-2009
No. 4~ IU r. 1
Dear Mr. Teti:
In response to your request for Date of Death (DOD) balances for the customer noted ab~ve, our
records show the following:
Checking Account ',
Account # 5112016237 Established: ~9-19-2005
THEODORE W STELLWAG JR
DOD balance: ~ 59.30 non interest bearing ',
IRA Aeconnt '
Account # 55010201102 Established: ~9-17-2005
THEODORE W STELLWAG JR
DOD balance: $ 117,544.39 + 1,381.68accrued interest
Interest paid Ol-O1-2009 thru 09-'19-2009 $1,986.80 YTD
For beneficiary information, please call 1-888-?62-4727. '~
Please note that this office provides date of death balances for deposit accounts (IR~iis, CDs, Che king and
Savings). We do not process arty financial transactions or provide statements. If you need sistaoce with
any of these items, please call 1-888-PNC-HANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank, N.A.
Member FDIC
Page 1 of 1
-,,
Fr'oln:AMERICH0ICE FED. CREDIT UNION 717 697 3713 05/20/2010 15:23
asosao i
~oo~ n:ozo~ z
STATEMENT OF ACCOUNTS AND OBLIGATIONS
HELD BY
THEODORE W. STELLWAG, JR.
Re: Estate of Theodore W. Stellwag, Jr.
Date of Death: September 19, 2009
Our File No.: 700177.02012
Institution: Americhoice Federal Credit Unlon
Checking Account:
Account number:
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement and checks cleared:
Balance as of date of death:
Accrued interest as of date of death:
Qther Account•
Account number:
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement
Balance as of date of death:
Interest Rate
Accrued interest as of date of death:
Other Account:
Account number:
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement:
Balance as of date of death:
Accrued interest as of date of death:
Additional information or comments:
#524 P.002/002
i
~~ ~ c ~ C v e /~[ / S 1 /~y,a~
3 - ---.'T~ ~ o .._ .
`~ C ~ (0 3 . a'• Co
$ ! 8 ,~ tp 3 ~ -('~ o nn ~~ ~: L( ~l~o
The above information is true and correct as of~Gwws~- c~~1 ~G~! o
'' (Date)
n i
(Sipnaturo) (Title)
Print name~d'~ +~ ~ ~ ~ . rtes ~e.,_.
Phone number: t'1 S4 (
FronI:AMERICH0ICE FED. CREDIT UNION 717 697 3713 05/20/2010 15:23 #524 P.001/002
_~;\1ERICHOICE I-'EDER.-~L (:REDI'I" UNION
2175 BU;~1B1..E BE1=; HUL.LUVG' RO:~D
I~fECH.-~NICSBt~RG, P<~ 17055
71 7-GJ7-3474 PIIONE
71 7-697-371 3 F:1~
FACSIMILE TRANSMITTAL SHEET
rO:
Donald P Bristol, Estates Paralegal
I~1acLlree Han*e.~~, I .td.
1~ ~~~ >`U~IH1~.R:
61 U-429-44t3G
1'11O)Tli Nl+TlHlilt:
r•1u )~t:
BUIIIllC R ~CRg1:I\'eS
17:1'1'1::
OS/2U/2UIU
IU l':V. NU. OI' 1'AGIiti 1N(;l.lr1711~G (:(~\'t~.li:
2
k1::
SIaICIIICIIC Uf tlccountS and Obligations
N'1' F(7R Iili~'l1iVC` PLI?.\tili ('U;\I1iL•'N'1' 17.1:.1ti1•: ltl{t'1.1' I'].1..\til5 R1~.C
Original ro follow ~-ia US i~•4ai1
AmeriChuice t~~CU
Bonnie Seagl^aves
Uperationls Specialist
2175 Bumble Bee Hollov Rd_
~•4cchanicsburg, Ply 17055
Phone (717) 5)1-1282
Fax (717) 697-3713
Email: taves("iilame~-icht)ice.ur~*
This message is intended ody for the use of the individual or entity to ttdtich it is at4irrascd and may rnntain information that is privileged,
cottfidattial sod ettearpt frasn discloeurc under applicable law. If the reader of this message is trot the intrndetl recipient, you arr. heRehy notified drat
any dissemination, distribution or copying of this communication is strictly pm}ubited. I( you have received this commtmiratiorb in error, rlranr
notify us immediateh br• tekphonc and rMUm the original menc~e to u9 at the obove address tea the U.S. Postal Service. Thank roy'.
Feb. S. 1010 3:43PM Citizens Bank
asosas ~
700177.02012
STATEMENT OF ACCOUNTS AND OBLIGATIONS
HELD BY
THEODORE W. STELLWAG, JR.
Re:
Date of Death:
Our File No.:
Institution:
C ckin count:
Account number.
Date opened:
Estate of Theodore W. Stellwag, Jr.
September 19, 2009
700177.02012
Citizens Bank
Names on account:
Date additional names added or deleted:
Date of last statement and checks cleared:
Balance as cf date of death:
Accrued interest as of date of death:
Other Account:
Account number.
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement
Balance as of date of death:
Interest Rate
Accrued interest as of date of death:
Other Account:
Account number_
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement:
Balance as of date of death:
Accrued interest as of date of death:
Additional information or comments;
foZl O7o~8~~0
-~- ~-
No.0881 P, Z
0
T'~~ ~ ] I S c ELc.r,.~~ ~7C..
Ot r5 2oi~
ZIR38
~-. zoo
O~ !b
2Z.• ~ 3
s
2-Olg<~g
The above information is true and correct as of ~2 ~ ~ ~ ~
co ~y
ignature) ~
Print name: OW ~} ,~ U ~2~ crne
Phone number: ~ ! ~ ~ ~ Z y ^ -i. 3 ~ G
Feb. 5. lUIU 3:43PM Citizens Bank
citizens Bank
50 E Uwchlan Ave
Exton, PA19341
Ph: 610-524-3370
Fx: 610-5243375
Fax
To:
No.0881 P. 1
From: ~~„ _ n
Fax: ~ ~ O - ?~ -- ~(l'l g'-~ Pages: 2~
Phone:
Date;
zlslr ~
Re: CC:
.------------r.
EXHIBIT F
460549_1
700177.02012
STATEMENT OF ACCOUNTS AND OBLIGATIONS
HELD BY
THEODORE W. STELLWAG, JR.
Re: Estate of Theodore W. Stellwag, Jr.
Date of Death: September 19, 2009
Our File No.: 700177.02012
Institution: Integrity Bank
Checking Account:
Account number:
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement and checks cleared:
Balance as of date of death:
Accrued interest as of date of death:
Other Account:
Account number:
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement
Balance as of date of death:
Interest Rate
Accrued interest as of date of death:
Other Account:
Account number:
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement:
Balance as of date of death:
Accrued interest as of date of death:
Additional information or comments:
IZ~i4 jo~x ',
~Theoac~e '1.J S~e11
N/A
1i 1-g~o8 '~
. qb a%
N/~1 ',
i
~,
a
The above information is true and correct as of
(Date)
By: ~~~~ _ r~rc
(Signature) (Title)
Print name: ~5ee R~~~t
Phone number: 'tn-qa--Ssoc-
T T,T
MacElree Harvey, Ltd.
Attorneys at Law
i~ West Miner Street
Post Office Box 660
West Chester, PAi938i-o66o
MacElree I'~
Harvey
4~
December 16, 2009 ~~ -'
Integrity Bank
440 Bridge Street
New Cumberland, PA 170
Re: Estate of Theodor
Social Security No
Date of Death: Sel
Our File No. 7001 ~
Ladies and Gentlemen:
~'-^ ~~
w~~ ~ w ~ ~~
i
Grr/'~
~.,
Our office re, _ _ _..__ _.._ ~..........,.,,..,,..~.. ~~~a«. ~~
We are in the process of assembling information concerning th decedent's
estate, so that we may prepare the Pennsylvania Inheritance Tax return. As an xhibit to the
tax return, we need to receive information from you concerning the balance o any and all
accounts or obligations held by the decedent, either individually or jointly, as o his date of
death, Seatember 19, 2009.
Enclosed is a death certificate, an Authorization to Release ACCOW t Information
signed by the decedent's surviving spouse, and a Statement of Accounts and Obl gations form
for your completion. Please return the death certificate with your response. Kindl forward the
requested information to us at the above address.
If you have any questions regarding this matter, please do not hesit~te to contact
me. Thank you for your assistance and cooperation.
Very truly yours,
Louis . T ti
LNT:dpb
Enclosures
450777_1
cc: Mrs. Ann O. Stellwag (w/o enc.)
AUTHORIZATION TO RELEASE ACCOUNT INFORMATION
Re: Estate of Theodore W. Stellwag, Jr., Deceased
Date of Death: September 19, 2009
Institution: Integrity Bank
Ladies and Gentlemen:
Please be advised that I am the Executrix of the above-captioned estate
I hereby authorize you to release information regarding the decedent's
attorney for the estate, Louis N. Teti, Esquire, at 17 West Miner Street, P.
Chester, PA 19381-0660.
Thank you for your kind attention and cooperation.
Ann O. Stellwag, Executrix
450228
accou t(s) to the
O. Bo 660, West
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pan, 8. 2010 L 22PM PNC BANK 412-705-2747
~~~
.LEADNiG THE WAY
January 8, 2010
Louis N Teti, Esq.
Macelree Harvey LTD
17 W Miner St
P O Box 660
West Chester, PA 19381-0660
RE: Theodore W Stellwag
SSN: 147-32-6885
DOD: 09-19-2009
Dear Mr. Teti:
r.
No, 4570 P, 1
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Chectcing Account
Account # 5112016237
THEODORE W STELLWAG JR
DOD balance: $ 59.30 non interest bearing
IRA Account
Account # 55010201102
THEODORE W STELLWAG JR
DOD balance: $117,544.39 + 1,381.68accrued interest
Interest paid O 1-01-2009 thru 09-19-2009 $1,986.80 YTD
For beneficiary information, please call 1-888-762-4727.
Established: 09-19-2005
Established: 09-17-2005
Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Chlecking and
Savings). We do oot procesar a~ financial traaautiona or provide statement. If you aced ~assistnace with
any of these items, please call 1-888-PNC-HANK (1-888-762-2265) or stop by your local PNC Hack branch
office.
Sincerely,
National Financial Services Center
P'NC Bank, N.A.
Member FDIC
Page 1 of 1
DECEDENT ESTATE INFORMATION
1. Name(s) in which the account was held: Theodore W Stellwag,Jr !i
Ann O Stellwag
2. Account number: 131790
3. Balance as of date of death: S1 8 S4 $2,319.17
Balance Accrued Dividends YTD Dividends O~ened
Regular Savings: S1 $68.17 $0.12 $0.42 5/30/1984
Christmas Club:
Whatver Club:
Checking: S4 $2,251.00 $0.00 $0.00 I 5/30/1984
Money Market: ',
Certificates: Balance Accrued Dividends Certficate Number 1(~D Dividends
IRA ACCOUNT: $26,310.11 $432.59 38624 ICI $1,273.49
I
$ $ III
4. Date the account was initiated:
5. Name(s) in which Safe Deposit Box was held: '
6. Date the box was initially rented:
7. Branch address at which the box is located: ~
8. Loan Information: Balance Accrued Interest F~er Diem Int
A. Unsecured Loans:
B. Secured Loans:
C. Mort a L
g ge oans:
$ $
$
$ $ $
$ $ $
9. Miscellaneous: We will submit a Death Notice to our IRA Process on Mr. Sellwa .The will be sen in forms
to the beneficiaries listed on the IRA application to be completed and return to our process. Once they hia a the forms
back, they then will notify us as to how the IRA is to be distributed
MacElree Harvey, Ltd
Attorneys at Law
17 West Miner Street
PO Box 660
West Chester, Pa. 19381-0660
January 6, 2010
RE: Estate of Theodore W Stellwag Jr.,
ELC~
COMMUNITY CREDIT UNION
SAN 0 ~ ZOtiU
Attention: Louis N. Teti ',
Here is the information you requested on the account information at time of death on the abo a decedent.
Also to inform you that Mr. Stellwag has an IRA which the funds aze currently in an IRA Ce ificate of
Deposit, we will send a Death Notice to our IRA processor. They will be sending out forms o the
beneficiazies listed his IRA application, once they complete the paper work and return it too r processor.
they then will in return give us distribution instructions, but until we get that information the IRA cannot
be closed.
We apologize for not getting this information out to you in a timelier manner.
If you have any questions or concerns please contact me at 717-720-6414.
Sincerely,
i
I Finance Dep eiit '
Enclosure (s)
Fr'orn:AMERICH0ICE FED. CREDIT UNION 717 697 3713 05/20/2010 15:23 #524 P.002/002
46054~J 1
-
ozo~2
~oo~n
STATEMENT OF ACCOUNTS AND OBLIGATIONS
HELD BY
THEODORE W. STELLWAG, JR.
Re: Estate of Theodore W. Stellwag, Jr.
Date of Death: September 19, 2009
Our File No.: 700177.02012 ',
Institution: Americhoice Federal Credit Union !,
i
Checking Account: _ II
Account number: __ ____ _~_
Date opened: _
Names on account: 'i
_ _ _ __ _ _ ___ _
Date additional names added or deleted: _._.
_~
Date of last statement and checks cleared:
Balance as of date of death:
Accrued interest as of date of death: ~I
Other Account:
Account number: `-/~! / ~/_.~_- ~ /
` --`;/fait ~ s
Date opened:
- .•~. ~-
Names on account: ~`",c, F. „~?~ .
Date additional names added or deleted: __
Date of last statement : 3 _._~t z.c~
Balance as of date of death: ~ ~ c•c~
Interest Rate _ _ __
Accrued interest as of date of death:
Other Account: ',
Account number: ~ ~/ ~~ Z - ~t~ =.~/=i~
Date opened: % r -- i. ~_ _ _- Z oc• S=
Names on account: T~ ~ ~ ~/ „v e /,t/ 5~~ 1/
Date additional names added or deleted: _ __ i
_
Date of last statement: 3 i ~a r o _ _
Balance as of date of death: ~ `~ C '7 (0 3 . a (o
Accrued interest as of date of death: ~ (~,~tQ . 3 g -C'ro.v. Uc>> ~•: ~I ~~~
Additional information or comments: ~I
The above information is true and correct as of `~XEw~-~•.s~.- r~1 ~,~cl o
(Date
(~ ~
By: ~_ 1C_. ~ [~p.re.rr~a~'~s
(Signature) (Title)
Print name~dr~ +. ; e- ,rZ . ro-s t-
Phone number: ('1 64 ~ ~-
From:AMERICH0ICE FED. CREDIT UNION 717 697 3713
05/2D/2010 15:23 #524 P.001/002
.'~I11ERiCHOICE PEDER.-~L CREDI'T' L'NION
2]75 BUMBLE BEJ/ HULLU~) RO:~D
MECH:~NICSBURG, PA 17055
71 7-G97-3474 PiIONE
717-G97-371 3 F.1~
PACSIMILE TRANSMITTAL SHEET ',
'I't ):
Donald P Bristol, Estates Paralegal
rc)~1P.\NY:
A4acI itee Hait~ey, i .td.
G 10-429-4~3G
rlu)r`l~ ~Un1arR~
rlu)~t:
liorulie K Sea}n~ves
l~:\'1'h:
05/20/2010
TU1':\1. NU. t)~~ 1'':1(;1{~ l;~(a.lil)ING la)\'I~.R:
2
u r•.:
Statement of Accounts and Obligations
UR<:liN"1' 1-C.1R RIi\'lli~' PLI~..\til: CO1\I\1L•'Iv'1' I'I.li.\til~: llltil'l.l' 1'LL.\Sli RI{C1'q:Lli
Original co follow ~*ia US :~Zail
AmeriChoice i-CU
Bonnie Seagraves
Operations Specialist
2175 Bumble Bee 1-iollo~x~ Rd_
~lcchanicsburg, P:~ 17055
Phone (717) 591-1282
Fax (717) 697-3713
Email: s . ave~ ameridtuice.ort_*
I
This measagr is intended only for the use of the individual or entity to avhich it is attdretaerl and may ctmmin information tl}at is ptivt7eged,
cocddental and exempt from disclostae wider applicable leas. ]f the reader of this messalte is not the intended recipient, you are he~ehy notified that
any dissemisation, diaaibtrtioa or coptinY of this conununicotion u strictly prohibited. 1f you haa•e received tha commamicaribr~ in error, rlraxe
.,,,city us inrmcdiately by telephone and return the origiml message to ars at the obove address a•ia the U.S.1?octal Service. 'Thank ypuj
T _-
Feb, h. 1UlU 3:43PM Citizens Bank No. 0881 P,
4sosas ~
~oo~n-a2o~z
Re:
Date of Death:
Our File No.:
Institution:
Checking Account:
Account number.
Date opened:
STATEMENT OF ACCOUNTS AND OBLIGATIONS
HELD BY
THEODORE W. STELLWAC3, JR.
Estate of Theodore W. Stellwag, Jr.
September 19, 2009
700177.02012
Citizens Bank
Names on account:
Date additional names added or deleted:
Date of last statement and checks cleared:
Balance as of date of death:
Accrued interest as of date of death:
Other Account:
Account number.
Date opened:
Names on account:
Date additional names added or deleted:
Date of fast statement
Balance as of date of death:
Interest Rate
Accrued interest as of date of death:
er ccount:
Account number
Date opened:
Names on account:
Date additional names added or deleted:
Date of last statement:
Balance as of date of death:
Accrued interest as of date of death:
Additional information r c mments:
Z o 70 ~lg~o
0
7~~ ) I S ~EU.c,~~ ~K..
Ot t~ yolo
r
d
2. 2.00 '~
TK as ~ Sr~.c.+ - ~
O~ Ib
2Z.• ~ 3
s
,O ~ g . LPg
The above information is true and correct as of ~Z as ~ ~ ~
(D te)
ipnaturQ) ~tle)
Print name: O W ~ ,~-~ U,2~
Phone number: ~ ~ ~ ~ ~ Z y .- ~ 3 -~
_ _ __
_ ~ .
Feb, 5. 1010 3:43PM Citizens Bank
Citiaens Bank
50 E Uwchlan Ave
Exton, PA19341
Ph: 610-g24-3370
Fx: 610-5243375
Fax
To:
No. 0881
From: ~~~
Fax: ~ ~ O - ~~ ._ (,r~~ Pages: 2i
~~~- ~~~~~~~w~r~ ~~~~
Phone:
Date: Z/ ~~
Re: CC:
EXHIBIT G
8 Market Plaza Way
Mechanicsburg, PA 17055
(7]7)697-4696
Michael J Malpezzi, Owner, FD Jeremy J. Shartzer, FD _ _ Kyle C. Knipe, FD
October 9, 2009
Mrs. Ann O. Stellwag
1803 St. Clair Road
New Cumberland, PA 17070
The Funeral Service for Jr. Theodore W. Stellwag
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT},
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
i. PROFESSIONAL SERVICES
Services of Funeral Director/Staff , $4275.00
3. AUTOMOTIVE EQUIPMENT
Limousine . $335.00
FUNERAL HOME SERVICE CHARGES 54610.00
SELECTED MERCIANDISE:
Solid Cherry Casket $4865.00
Burial Vault $2780.00
Register Package . $115.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED 512370.00
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO
OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Opening Grave. $950.00
Cemetery Equipment . $160.00
Certified Death Certificates , $120.00
Newspaper Notices - Patriot_ _ $536.84
Father Ogden _ $150.00
Father Rozman, $200.00
Msgr. Overbaugh . $125.00
Organist. $125.40
Soloist/Cantor , _ $125.00
Flowers. $250.00
City of I-Iarrisburg Parking Permit , . $108.00
Custodian $35.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES . $2884.84
CONTRACT PRICE 515254.84
HISTORY
09/19/2009 Compassionate Discount -TRADITIONAL SERVICE , $-335.00
TOTAL AMOUNT DUE 514919.84
r. y::
~, r 1 (_ -
-
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MEM~RI~II..S Since 1921 Drawing < Drawing Sent to' Cost. Approved
5243 Simpson Ferry Road, Mechanicsburg, PA 17050 Found By Foulxf: Ordered
(717) 766-5622 • Fax (717).766-8007 Vendor t ' ~ ` , ::,~:.~'~ Ack #
unuw.gingrichmemorials.com Grave Position Verified Cremation
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SOLD TO: ~~"~ ~ `~,t "C" ¢ : ~ t ~ ~.:E ~t. ~ -, Date` of Order {.1 ~~ ~ . i :g ~ ~.:, ,r ~~~
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Phone -..~. ; ~" y ~ `-` Cell ,~~~ rr ~~- ` ~ ° Center Over ,T. Graves Sec. /Lot #
Email Approx. Date of Completion:
Lettering
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Type ~ _ Material i' . ; :
Additional Lettering:.
Size ` ; X } .:~ X Finish' ~ ~ ~ ,:
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^ Base
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Size -~ X X -~x 'Finish.
Description
Location on Cemetery
^ Vase ^ Rhoto ^ Other
Agreement: A 50% deposit is required to commencement of work. ' COSTS:
Agree to pay stated balance upon erection regardless of labor. troubles or shipments or any other good reasons. This order or .; MerrtOflal $ -
contract cannot be canceNed by customer uriess agreed by both parties. The artitie herein mentioned shah remainthe property of
James R. Gingrich Memorials un67 paid in full and they reserve. the right to remove the same is not paid as stated.' Ft)undatlOn $ ' - ":-
I agree to carefuly proohead all rternes and dates: for accuracy.and accept fuB respons[bility for any errort3 or omissiorrs..THERE Cemetery Fe~S $
WILL BE AN ADD1110NAL CHARGE FOp AHY IEITERING ADDED TO THIS MEMORIAL AFTER ERECTED OH THE
$ ',
I further agree to pay the balance stated for the work. pertormed under this contras wkhin thirty (30) days of receipt of life final
invoice and further agree Mtat interest sl~l accrue at the rare of one and one-haH.percent (1Yz~) per montli on the unpaid balance $
owed to James R. Gingridt Memorfala not paid within flirty (3oj .days of the invoice date. In additlon thereto, I agree if h beoanes
necessary for James R. Gingrich to,insUttde legal proceeding to cored arty funds due from me for my account bekg past due thirty $ '
(30) days, to pay all: court costs aril attorneys fees incun'ed try James R. Gingrich Memorials to coNecl the same.
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TOTAL
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$ . - ~ ::
Dealer 6 ~ ; ;
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DEPOSIT
Customer Balance Due
(I further agree that the above names, spelling, and dates are correct) Upon COmpletrdrt
EXHIBIT H
WEST SHORE EMS -BLS
205 GRANDVIEW AVE
SUITE 211 -
CAMP HILL, PA 17011 ~~~
Phone #: (S00) 367-0512 Federal Tax ID: 23-2463002 a~ ~_ ~ %"~-'~' ~'
PATIENT NAME: THEODORE STELLWAG Jf PATIENT NUMBER:
CALL NUMBER:
INSURANCE: MEDICARE B 147326885A DATE OF CALL:
HIGHMARK ZAL100937376001A TIME OF CALL:
CALLER:
193123W FROM:
TO:
THEODORE STELLWAG Jr
1803 ST CLAIR RD REASON(S)
NEW CUMBERLAND, PA 17070 FOR
TRANSPORT
~~ ~~~~
83551 WCS
193123W W 1
08/20/2009
07:20 PM
HOLY SPIRIT HOSPITJ4L
HOLY SPIRIT HOSPIT,~4L
MANORCARE HEALTF}I SERVICES
~i
,.
CANCER ~`~~ _ _
~ i
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE A OUNT
Stretcher One Way Transport A0999 1.0 96.06 gg.06
Transport Van Mileage A0999 1.0 3.74 3.74
OXYGEN ADMINSTRATION A0422 1.0 65.01 65.01
t 164.81
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
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DETACH-ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE ` 164.81
;LENT NAME: STELLWAG, THEODORE W CALL NUMBER 193123W AMOUNT s
"[ENT NUMBER: 83551 BILLING DATE: 09/17/2009 ENCLOSED
THIS ACCOUNT IS PAST DUE! Send your payment now or contact ~- - Vlsa-
our office to make payment arrangements. I ` •" ° ' `
' k. i,i ANDI ----
MASTER LARD
ACCEP~fED
WEST SHORE EMS -BLS 205 GRANDVIEW AVE CAMP HILL, PA 1701'
II
ri
AMERICAN HOME MEDICAL EQUlP. CH
2300 A OLD GETTYSBURG ROAD
CAMP HILL PA 17011
(717) 737-5584
Today's Date
Order Date
Invoice #
3111 To Ship To I
Item Description I Qty ~ Rate ~ q-mount ~
c~,
I have been given the product informatio a ve described product. I have been made
aware of and and tand p er use and precautions with use, ',
(CUSTOMER SIGNATURE)
The above item(s) do not require a physician's order to dispense and I have chosen to purchas~
the above without obtaining an order from my physician. 1 have informed American Home Medical
Equipment Company at the time of purchase that 1 elect to have no insurance involvement.
LG~T ~~~-~'~'
(CUS OMER SIGNATURE) ',
SEATLIFT CHAIRS-1 understand that my factory ordered seatlift chair requires a 25°~ non-refun able
deposit. I have chosen the following fabric color for my chair:
1 have been made aware that tF my insurance company agrees to cover this chair they will pay #heir
percentage of the lifting mechanism ONLY.
(CUSTOMER SIGNATURE)
edit Card:
th#
Cash:
Check #:
Subtotal )(o
Tax ~ ~
NON REFUNDABLE DEPOS/T ON ALL SPEC/AL ORDERS
Total ?,~: ~~