Loading...
HomeMy WebLinkAbout09-20-10J 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 7 9 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 8 5 3 2 5 1 6 1 0 8 0 1 2 0 1 0 0 6 2 3 1 9 1 5 Decedent's Last Name Suffix Decedent's First Name MI B L U M E L I Z A B E T H M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N / A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum 2. Supplemental Return 3. Remainder Retum (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Retum Required QX 6 Dec d Di death after 12-12-82) . e ent ed Testate (Attach Copy of Will) ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes 9 Liti ation P d R (Attach Copy of Trust) . g rocee s eceived ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND Name . CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number ev D A V I D R G E T Z E S Q U I R E 7 1 7 2~ c~ =' ~~ 4 1~ 2-.~ ~ ~~~ REGISTER O~^VI~I E ONL ~ ' -'..' First line of address !- r-r-t t\~ t`, ~ O r --~ ~~ L~ ~ 4 W I X W E N G E R & W E I D N E R ~ ~, -~' ` ~' ~ Second line of address . _~ -,-, --~ '~ ~ - _ ~ r -- ~''~ P O B O X 8 4 5 rr c-7 ~ ~~ =' C~ ~' City or Post Office H A R R I S B U R G State ZIP Code P A 1 7 1 0 8 Correspondent's a-mail address: DGETZC~WWWPALAW.COM DATE FILED 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 tr e, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI U E OF PERSO E PONSIBLE F R~ RETURN DATE ADDRESS /7 ~;~ 5261 DEERFIELD AVE• ME~HANI~SBURG PA 17050 SIGNATF PREP~REFy7DTHER AN~RE~PRESENTATIVE ~~ DATE i i WIX WENGER & WEIDN~R, PO BOX 845 HARRISBURG PA 17108 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 150561D140 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: ELIZABETH M B L U M 0 8 5 3 2 5 1 6 1 RECAPITULATION 1. Real Estate (Schedule A) ......................................... 1. .. 0 . 0 0 2. Stocks and Bonds (Schedule B) .................................... 2. .. 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. D . 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ..... .. 5. 9 0 7 6 . 3 9 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property {Schedule G) ^ Separate Billing Requested ..... .. 7. 1 6 4 9 1 3. 3 3 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 1 ~ 3 9 8 9 • 7 2 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 3 3 8 9 . 5 2 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. - 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 3 3 8 9 . 5 2 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 1 7 0 6 0 0 . 2 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 1 7 0 6 0 0 . 2 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .o _ 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 1 7 0 6 0 0. 2 0 1s. ? 6 7 7. 0 1 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 7 6 ? 7. 0 1 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0799 DECEDENT'S NAME ELIZABETH M. BLUM STREET ADDRESS 5261 DEERFIELD AVENUE CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: 1• Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 7,293.17 B. Discount 383.84 3. Interest 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. (1) 7,677.01 Total Credits (A + B) (2) 7.677.01 (3) (4) (5) 0.00 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 : ...................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 0 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... Q ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ 0 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse i 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 0.00 REV-1502 EX+ (01-10) TE OF: pennsylvania ~ SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: ELIZABETH M. BLUM 21 10 0799 All real property owned solety or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE OF DEATH DESCRIPTION NONE TOTAL (Also enter on Line 1, Recapitulation.) ~ $ 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE FILE NUMBER ELIZABETH M. BLUM 21 10 0799 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL (Also enter on line 2, Recapitulation) ~ $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1504 EX+(6-98) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN SOLE-PROPRIETORSHIP RESIDENT DECEDENT ESTATE OF FILE NUMBER ELIZABETH M. BLUM 21 10 0799 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationlpartnershiplnterest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL (Also enter on line 3, Recapitulation) I $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1507 EX + (6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER ELIZABETH M. BLUM 21 10 0799 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH NONE 0.00 TOTAL (Also enter on line (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ELIZABETH M. BLUM 21 10 0799 Include the proceeds of litigation and the date the proceeds were received by the estate. All property IoinUy-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK CHECKING ACCOUNT #XXXX738 9,076.39 DATE OF DEATH BALANCE: $9,076.39; ACCRUED INTEREST: $0 VALUATION LETTER ATTACHED TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT TE OF: FILE NUMBER: ELIZABETH M. BLUM 21 10 0799 ff an asset was made jointty owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL STITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. A CH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. TOTAL (Also enter on Line 6, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FfLE NuMIitH ELIZABETH M. BLUM 21 10 0799 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPL~cAeIE} VALUE 1. MERRILL LYNCH ACCOUNT XXXXX-1690 164,913.33 100.00 164,913.33 TOD ACCOUNT BENEFICIARIES: GEORGE E. BLUM (45%), MARY SUE SHIER (40%), AND CHARLES H. BLUM (15%) VALUATION SHEET ATTACHED TOTAL (Also enter on Line 7 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ELIZABETH M. BLUM 21 10 0799 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. NEILL FUNERAL HOME, INC., CAMP HILL, PA 1,810.02 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Year(s) Commission Paid: ZIP 2. Attorney Fees: WIX, WENGER & WEIDNER (ESTIMATED) 1,500.00 g. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 79.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) $ 3.389.52 If more space is needed, use additional sheets of paper of the same size REV-1512 EX+(12-OS) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER ELIZABETH M. BLUM 21 10 0799 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on Line 10, Recapitulation) ~ $ If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: ELIZABETH M. BLUM NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. MARY SUE B. SHIER 204 MILL BRIDGE LANE PHOENIXVILLE, PA 19460 2. CHARLES H. BLUM 3613 UNDERWOOD ST. CHEVY CHASE, MD 20815 3. GEORGE EDWARD GLUM 5261 DEERFIELD AVE. MECHANICSBURG, PA 17050 FILE NUMBER: 21 10 07~ RELATIONSHIP TO DECEDEN Do Not list Trustee(s) Lineal Lineal Lineal AMOUNT OR SHARE OF ESTATE 67,860.95 26,632.63 76,106.62 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. DJL/January 16, 1991/2583 ~~~~ ;-'ill ~.n~ ~P~tcZ11iP1T.~ ~;~ ~: ..r~ _ ~i ~=; . ~-~ ~~ :i ~..~ fl OF :~:-.~ ELIZABETH BLUM _-_~ `~'~ --'- I, ELIZABETH BLUM, of the Township of Lower Allen, Cumberland County, Commonwealth of Pennsylvania declare this to be my Last Will and revoke ;:ny Will previously made by me. Item I. I direct that as soon as practicable after my death, and before embalming, my body be placed in the hands of the Humanity Gifts Registry of the State of Pennsylvania by my nearest of kin or the Executor of my estate, for delivery to the Milton S. Hershey Medical Center in Pennsylvania, for studies in the promotion of scientific medicine and ultimate cremation with others, and burial of the ashes with others, in the burial plot of the Humanity Gifts Registry. Item II. I give and bequeath my automobiles, household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto my husband, GEORGE BLUM, if he survives me by thirty (30) days. Should my husband, George Blum, not be living on the thirty-first (31st) day after my death, I give and bequeath the same to my beloved children; MARY SUE B. SHIER, CHARLES BLUM and GEORGE EDWARD BLUM, to be divided between them by my Executor or successor with due regard for their personal preferences in as nearly equal shares as practical, if living on the thirty-first (31st) day following my death, otherwise to their children per stirpes by representation. Item III. I devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate, to my husband, GEORGE BLUM if he survives me by thirty (30) days. Item IV. Should my husband, GEORGE BLUM, fail to survive me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate, to my beloved children; MARY SUE B. SHIER, CHARLES BLUM and GEORGE EDWARD DJL/January 16, 1991/2583 BLUM, share and share alike, in fee simple, if living on the thirty-first (31st) day following my death, otherwise to their children per stirpes by representation. Item V. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. Item VI. I appoint my beloved husband, GEORGE BLUM, Executor of this my Last Will and Testament. In the event that my husband, George Blum, should predecease me or in the event that he should be unable or fail to qualify as Executor, then I hereby appoint my son, GEORGE EDWARD BLUM, Executor of this my Last Will and Testament. In the event that my son, George Edward Blum, should predecease me or in the event that he should be unable or fail to qualify as Executor, then I hereby appoint my son, CHARLES HENRY BLUM, as Executor of this my Last Will and Testament. In the event that my son, Charles Henry Blum, should predecease me or in the event that he should be unable or fail to qualify as Executor, then I hereby appoint MARY SUE B. SHIER Executrix of this my Last Will and Testament. I do further authorize and direct that my said Executor or Executrix shall have full and complete power and authority to .manage, le;~se, control, pledge, mortgage, sell, convey, exchange, invest, reinvest or otherwise dispose of or otherwise alienate all or any portion of my estate as to them, in their discretion shall seem fit and proper, all without the intervention of any court or other agency, and without limitation by reason of the enumeration herein of any specifically authorized powers and authorities. Item VII. I direct that my Executor or Executrix or his or her successor shall not be required to give bond for the faithful performance of his or her duties in any jurisdiction. DJL/January 16, 1991/2583 IN WITNESS WHEREOF, I, ELIZABETH BLUM, Testatrix, have hereunto set my hand and seal this ~ day of '~ , !a. z ~ , 1991. ~~ i t`~ ~ f L." Elizabeth Blum DJL/January 16, 1991/2583 Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in the presence of us, who, at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses. ~~ ~ ~a ,.s .w rn ,+~ ~'"= ,J ~. _' ~, DJL/January 16, 1991/2583 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA :ss: COUNTY OF CUMBERLAND I, ELIZABETH BLUM, Testatrix, whose name is signed to the 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 I signed it as my free and voluntary act for the purposes therein expressed. ~~ / ~ ~ Elizabeth Blum ~J Sworn or affirmed to and acknowledged before me, by ELIZABETH BLUM, the Testatrix, this ~~;9.~{.day of ~' _~kr~-~w_.-..~,~- , 1991. Notary Public DIANNE LENI~3, P~JTAk~ Y!il~I.i+r. ~.EM~3yN£ aGpD. LUM3ERLA'dD C~J . ~If CC~'lISSio'! €kPI~ES DEC. 21, 99; DJL/January 16, 1991/2583 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA :ss: COUNTY OF CUMBERLAND ~~;a v i ~~ .~ : ~- v; A ~z ~ and ~~^;• . ~: 7~" r~ "t'~ e' the witnesses We, ~~ 0 whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were. present and saw the Testatrix sign and. execute the foregoing instrument as her Last Will and Testament; that she 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 sign of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time at least 18 years of age, of sound mind and under no constraint or undue influence. ,- ~~'~ ~. ~` ~- .. Sworn to or affirmed to and subscribed to before me by ~~,,,~.:.'°~ _ `~r.,_,w, and c_ Y`t~°,~„~~: '~~~.~',~_, witnesses, this `~ ~~day of ~=.,.Jw•:~.a,.,.~ , 1991. Notary Public N07ARIAL SEA+_ 6iIANNE LENIG, NOTARY P!!BLiC LEMUYNE BORv. CUMBkRLAN~ C,. NY COMMISSION EXPIRES OcC~2!,__"?~~~ --.__ Rug 19 10 11:47a Ed Blum _ Secure Message:Date of Death Request. 1 agP; ~, . i1eIP ~ F.orget. me on this computer I~i1 M&T Bank undetsteneinE wha _'s i anportanC _ . ......,....:. , Reply Secured Message From: NATAI.IE PETERS <npeters@mtb.com> To: ED.BWM@ERA.COM ,. .. Date: August 16, 2010 12:27:58 PM EDT ::- Subject: Date of Death Request Morning Edward, Per you request, please find below the date of death values for Eli~.beth Blum, social security#085- 32-5161. ~: 1. Account #879738, Balance $9076.39 + accrued interest $0.00 = $9076.39 Total Also, the Social Security was not returned yet so Pm going to hold off a little longer on closing out the old account. _ _ . _ _. _. _. . _ .. _ _ ._. . Let me imow if there's anything else you need :-) Sincerely, Natalie 4, 1. Natalie Peters .. ... ~ t: , _ ~ . . Assistant Manager-M&T l~adk ~ i Registered Representative- M&T Securities Hampden Branch , . .. , , . • , ~~.. .. _ 717-766-0507 (ph) ,.. 717-766-1793 (fax). _ ~.. ~ ~: "Understanding What's Important" npeters@mtb.coin .°' :' Repiy i- ® 2000-2008,Gisco Systems Inc. All rights reserved. :... ~. ?..: _. .,.. ,T ________.._ __a ~e,,;,,.,~~ni„mF.riw~Local Settings\Temporary Internet Files\Conte... 8/19/2010 .ti r Aug 11 2918 16:41:41 1866Z3Z8113 -> !~1err i 11 Lynch Page 883 u y ~ N M N t- ~, m ~ Q ~ _ ~ x ~ _ N 4 d1 ~ c rn ~ 7 6 ~y C1 ~ ,~ ~ - ~ ~ .~ ~ ~ ~Q~ GY '.~^ .4 `~' ~ a ~ r C ~ w ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ x Z C N C }- ~ ~ ~ ~ l~ to W :.7 40.9, N t10 ~ N ~ ~ p w 7 W CC ~ O r r 1A tfi w w ~ W •o C> (Q J J ~ ~ z ~ ~~ ~~ ~$ ~g ~~ a O ~ ~ c~ u_ D w U .. FQ- ~ ~,"~ •` N ~ ts"i O W ', c; 4~ o _ ~ i U ~ ~ ~ ~ ~ ~ ~',.\ ~ b~_3 xo ~ w ~ ~ O W ~~ ~_ ~~LL/ aL Z~ Q O C7 O ~cw Ca d~C70 ~ LLAy:C?U ~L~ W 40 p~~OC2 ~ ~ ~ o ~-'~©o duo o G7 W YO6 ~~¢oo c~.=•~oo O~0 ~ ~ ~ q ~ $ ~ © ~ W ~ ~ `,i Y ?t ~ o Q ~ V1 c1 O ~ O O O ,ea d 6 arr.o'd r~ ~ r, .s~~r~ ...r w r~ p~ t/~ [] oD~co C,?~c7~ ~ G~aoo WCf o GGQ24w ~O y " +r~ W .... ~,, a ~ ~ ~ ~ s ~ ~.~~+° ~~o ~ y o g g -- ~ ~ ~ p c .__ "~ ~ ~ '~ » ~ lV ~ Q e-' N v ch q' tLY ~~ ~ 7 U ~ n ' Q. t:' Aug 11 2818 16:41:57 18662328113 -> ' 'Merrill Lynch Page 884 ~ ~ ~ ~' Q rn a ~ ~ ~ ~ ~ ~ ~ ~ ~ ri co ~ vi v- N F ~ ~ , ~ ~ c c m N - N p ~ r7 ~ ~ ~ ~w ~ ;~ al QQQT. ~ N qv ~ ~ N (7 N cq N o N N "Q` w O ~' J J J .J J E ~~ zi ~~ '~~ 5z~~5z~~ i~ ~ zz z m oq ~~ "bo 0o c`5 Z5 `c~ $ o0 '~ o» u~ti M'o~o_ u`~~ ~~ ~~ r~ usu~ N Ql r~ c~ ~~ NN ~~ ~~ NN ~ $~~ gg "~~ M~~~ ~gv ~~ `^ ~ ~ D) O V QU G? cn itl ~ W M 4 w ~ ~ 00 [T M ~^' Cyy p r p h !~ N ~_ ~ ~ N `V ~ Ci N N QD tC) N N N fV 0 OO~ `c~ . ~ $ ~ ~ fi ~ ~ ~ w co o ~ ~ O ~ 4!S o A. ,.I', M1 ~ .d ~' '^ ca ",~ OGb`. ~ ago _ 4 x w eq a n ~ .... „~ Gd a I)~°O° ~~' a os W~ ~n~~ ~ '~a~ ~~ ~~~ F ~~ C ~ VU7!/?q C.a © qC7 /ON~G~ b ~Nq q Q W~C~CS ~ aNo 0 o Jyoo ~~ oo ~ r~o' `"X~©o ~-~oo o~~`oo a~~ ~yo© ~r~~ ~WroN n ~-~a~; ~v,r~N Ur~N ~~~rrn ~ r 3r N `d,'vi ~ ~ °z~oc~ ~~~©o ~f~©e~ ~~l`~c~o ~n~ ~v5~'oo ~c'S 5 8~ao P. ~ O I 4A p a ~ ~ ~ ~C'i cA 04 ~ T N ~ N ~- t~9 .r C a O Aug it 2818 16:4Z:Z1 186623Ze113 -> .~' ; 3 R y ~ N $; ado , a~ ~ ~ w ~ ~'v eNw' o w ~ ~ N r ~ O © n' ~ a `° a c N N q q -. ~ Q ccc777 m p Ci ¢ Q m p '~ ~ ~ ~ •u „i N o 6 ~ ~ ~ ~ ~ E Merrill Lynch N OD ~+` 1'~ R ai c tTS O ~ I`~ p @ lV rn ti ~ ~ ~ im ~ ~ ~' _ _~ ~ ~ ~ ~ ~ i..i ~ ~,i ~i cti of 4 ~ ~ ~ J c- ~ v SG w d ~ N L a x a°~' 1 ~~I rs r 07 ~ 0 N ~ N ~ ~ ~ ~ ~ N r. ~ Q ~ ~ ~ ~ '~ Sri `~ '"- ~ ~ ~ ~ ~ 4 n ~ ~ c~ ~~ ~ ~~ ~ ~¢ ~ c4io`;c ~ 'ri wL pro ~o o ~~ p vZ~p ~ O V o ~c7~o,."~ O ~ urQ o ~ o ~ ~ n~Z ~'~~~ ~~~ q~~ oa ~ ag ~ ~ ~ a ~ N O timed cr ~w ~ a d Oho v)4w~o ~.~. Op7 co c~,,..."ac7 o.w ~e ~ ~ ~ ~ ~ ~ ~ ~ ~ p~ ~ ~ N 4 I ~ ~ h r ~ fy ~ O S 'al• rte.. ~ ~' ~ ~ N N N sr w Page 885 n n o; o; •+ ~ VF bT O (O Cr7 d~ ~a ~~~ 1" FQ 1- Aug it 2818 16;42:38 18662328113 IM r t0 w •• ? ~ ~ ~ o 0 -> Merr'i11 Lynch ~ ~3 a ,~ ~ „ ~ c ~' .,a., ~ c ;~ ~ ~ .~ ~_ ~ ... °~ "tl ~. ~~7 ~ ,~ s `o w a ~ ~ ~ -~~ - o ~ e ~, ~ ~~ '}o c~ c 7 l9 Aj ~ ~ h y ~ ~ co E ~_ ~ ~ ~ ~ C ~ ~ ~ ,~ ~ LL 4 l6 C ~ ~ N ~~~ ~.~ _ a ~° ~`~ c .Q ~ ~ ~. ~ ~ ~ c o g ~ ~ '~ ~ ~ ~, ~~a ~~ ~ ~~ .', s ~ ~ ~ ~ A 6 f0 a ~ ~ ~ V s5~~~`~~,~ ~ "~ p b "~~{ M ~ C C ~V C ~ A ~ ~~`~ ~ ~ ~ ~ J ~ ~ o~, ~~ ~~ ~ O ~ G O. fD ~ W ~ ~ 'Ci ro m .» ~ ~ m {~ y+` o ~ ~ .~ ~ ,Sy ~ 4 ~ ~ ~ g ~ ro e, ~ ~' ~ ~ ~ ~ ~ ~ ~ R ~ - ~ ~ . Page 886 e 0 L C J ~ ~ ~~ e u ,SR a w ~ ~° u u A •G ~ ~~ y ~ v '~ ~ ~' $ d? ~~ ~~ ~~ N ~ .n ,~ '` ~~ ~~ C N G ~ c JA Aug 11 2818 16:42:54 1866Z3Z8113 -> t1~ 6_/ Merrill Lynch Page B87 TO BCs CoM~+l.~7'~,D 8Y AC~'OUPti' Dwlv£RA (Check Onn? ew'rQtJ dasignuton and Ag~asment Q Add1tJon of 70p Ht;neAcfvy ^ Cts•ng. ln'f10D A.o~6<iwrl.• Q t7wmoveJ aETOD H.n.Bei..y )f chnnging~ ndding to rem "_ ' ' ' ' -"` ' enrfieiarke. Acrouy pwnar and ry'ide: M k ~~-~ ~~~'_ ~,( ~ • ~i.,.U ~- Account Plumber; ~[~~ .. S ~ ~ 4 QeneQci~ De,11~.~atienw ._ N•ms of Ytneficitsr },i. .. ~. AdAret+ar nexnrur tteh~ipnaptp ~s pvne,~. SON atTit/ -ssamagr '' ~'~st ~. ~ 'i c ~• •. I '~'~ '3'~faf 'D~,or~w S oVle•df.- m«~ b . d /17 ~ r C: tN~ - _ ,~ ~. Chatrl a 1•~_ lu ~ ` ~ o Sati7 ~K •; •7 0 ~' caot,~ cl~,« anh ~„ ~-,~~ a. _. .... ... . . . t. s. ., •Ugtl: T)+c total of sU per<entat;a mtlsl ctjunt IAA 96 if ihe'DerctlitoR'~ coltiiril is lel2blehK, egasl.Detceritalca+:wUl be aaaumul,. THIS QUi~STION MUST 8£ CaMPi.E'TEI71F: pv[oTtE TriAN:ONE B~N~FICiARY 15 N,A,MED ABOVE. tf any ®oneYeiarp ltst•d alw~e i• not li.~ing sc elte Dc~eh of i.~e,teea~ne Qvni61. A+•t 9af•E{elieyTy 9rc~htw~:i ill th,t fanda.itt~xtiUe+apd 4a)fi4f in the Aetnunt ehsW lchcdt ody one box.) _ ~ - ~ ;:_ ; .:._ _... _ ,~ t1aa~s to any suewiraxg 9en<1Relr* lea in u : acid based upua the euevivittN Aenefieisrii~a abavc at+ted pet•centages f ea parograph i t ). txS P•es to t3~e e•tnt~ pf the deeomt Own.-. ~ .. ......_ tf neiche: bax is chedtett, v+• trrro•nwg^ of cb. funds, secwdtSn sit.1 kiets deeignoted Eor s d troeased ben~~.ry shat flnsa to the sate o! the Anne Owrtnc. The M),P!}&5'ft~snsfer On Dt'at}ti Actaunl dace not rro~ide (or cpnc),stgent or aucccsso> Ber~tUriw. My ntternpt l4 nilet ur tunep4 thla Agttemtnt tt- pro- _._ v)de fur cond.ng•nt of succe•so~ Pt;ne(tcid;lee shoU render tttls entire AQr•eancnf nWl snd'vol~. Actaunt tH•ner hereby sgree~ ta. the terttf• elf the MLpMttiS'ii];antte~ OR Desth A~in7flanc+pd ~nowledgra rtacLpe of w mpl of Aar Agrcem~nt. _ \ . 1 I` ~'~\ .'~, _ _ . __ ~~ ~~ s ', .. l~fgC'y _ Continued mn next pose .. r _ .. ,M ~. _ ._ .._ _.... ,.....,.~.v......~~ ....................v_,.. M._............._.~_..~ .., .. ..r _q... •. _.. t. Aug 11 2818 16:43:21 18662328113 -> Merrill Lynch Page 688 IS TRANSFER ON DEATH AGRE$MBNT MUST BT? Tu0";:~RTTEb AND MAY NOT BE EX>6Gt1TBD [SY AN NT T]~R A O 13R OF ORNEY. atu of Ateo t Own^r ^turc aF Account (arner~~, bale; ~Q • ~Cl ~ 7/S~~ Date: SpOUaa1 CiOiUet11 ~Mrltu:l~°~: ,,,~ The Spowal Ct:nuet S.ceiron must ire compkted lY A[.L of the Grllo+ri>,g cVndetion^ ^re met; ~~~~ (a) the Acctruat Owner has A Itrertg sryouu; (b) the Account Owtur and the spouse rrsidtd it+: Arirooe. Colifornu, Idaho, iauialona, N.w.aJ^, h7ew Mexiso,'i'exaa, Washington yr ~aeomrin, at any tune during the marriage; snd {c) either. (i) the rpouse u net an Account Owner: (1} Qg ehr spouse is na[ fire sole Beneficiary of tha asseu xaf the Arcptap4 Speux! consent wry {~ rarokcd by proyidl„g MkpC•8r$ ^ .rrinan rsroc.clan, rn order for this rtvoratWn of spousal consent to Oe effertire. it moat be dtllvercd to M[.PF&5 prior to ehe Account Ownar'a death. M4pF&S reserver ehr right to odd to tht !bt of sales abWe kn the event soy Other slate shall adopt a ryskeen of com- munityor maritai Fropcrq. ,.~.-./..-..J.~..w. 9lgnatur'e ofof Spquse .~~V Dale r',une of s1'ottsr (pdnred) Adtiresx of 9peuxe '~•~~~~ -- AIOTARIZATTON State of ,. ,_ aunty of on ,,,,,,,,,,~ O ~I q~G Jr- Aefare me, ~- ~ ~ peraonauy appeared, ~a~~..- ^ persaoaily known to me ~ Old - . ~pcom~ ro the on the basis of satistkctory evidence [U ye tpc persorrwhose name la sttbsCribcd to the within instrunntat and at]utowlydged rq me char he/she catccutert thv name in hia/[tcr authorized copaciry, and ri~tar by higher signsture an the instntmenk Ute person or entity upon tvhieh the person scrod, czecutwd thr instrusttent. WiTIlESS toy hand grad oflycial seal. (5i stare a notary) V Comgaonweallb of P Iv~ia ~~ i .,,, 1Merri~l Lryntsb 02001 MerriA tynel, pierce, Keener & &mleh Iea4rFor^taJ. , ~ rM~ p+1•sa^ialntr Printed in Che U.S.A. Member, Securities investor Protealen Corpor^tlon (SpXCa P^ge d ~ Code ~04[O_1101 George Edward Blum 5261 Deerfield Ave. Mechanicsburg, PA 17050 SECTION 1 SERVICES AND MERCHANDISE FUNERAL DIRECTOR AND STAFF SERVICES Minimum Professional Service CARE AND PREPARATION OF REMAINS Embalming Other Preparation {Casket, dress, cosmetic ) Refrigeration USE OF FACILITIES 8 RELATED STAFF CHARGES Visitation $ Funeral Ceremony _ Memorial Service _ Graveside Service TRANSPORTATION Transferring Remains to Funeral Home $ 495.00 Funeral Vehicle -Hearse LimousinelFamily Vehice $ Servlce/Flower Vehice Transfer to Anatomical Donation $ 395.00 MERCHANDISE Casket Outer Burial Container $ Alternative Container $ Um Clothing $ OTHER GOODS AND SERVICES Cremation Fee Memorial Package Flowers prayer Ards TOTAL SECTION I $ 1,660.00 Services for Elizabeth Blum Service Contract: 741101000194 Date of Service August 3, 2010 SECTION II CHARGES MADE ON YOUR BEHALF $ 370.00 Cemetery Obituary Notice Certified Copies of Death Certificate Clergy Honorarium $400 Organist Honorarium Other /Coroner TOTAL SECTION II SECTION III OTHER Dignity Allowance Trust Allwance Insurance Allowance TOTAL SECTION III SECTION N TAX TOTAL SECTION IV $120.02 $ 30.00 $ $ 150.02 $ - $ - TOTAL CHARGES $ 1,810.02 Less Payment $ (1,810.02) less Trust Balance Due $ - -~~~~~'.