HomeMy WebLinkAbout04-0645 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' ,q~ ~l .~. ,4/~ // No. ~
also known as To:
Register of Wills for the
(~u m Ia~ r [an t~
County
of
in
the
Social Security No. /~'- ..~-- ~°Y~ceased'
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner~g~, who is/a-~ 18 years of age or older an the execut t-ln named
in the last will of the above decedent, dated ,,,~z~'~t~w.~' .5" ,19 7'~'
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C~t,r~t~'~/t~t~ _ County, Pennsylvania, with
last family or ~rinci~a~esidence at
(list street, number and muncipality)
Decendent, then ~ years of ~ge, died ~y , I , ~o~ ,
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows: ~
WHEREFORE, petitioner(s) respectfully rgquest(s) the probate of the last will an~codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF C,t/m ~ &--~/.~AL~ _ ns
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the ~tate according to law.
Sworn to or affirmed and subscribed t~ ~ ~/ ~.
before me this l?~.., davo~ /'~/~~- ~/' ~/"~~"~ ~
7-1- o,I- 4
Estate Of ~ [~/LIZ/NI ) NJ E. LL
· , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
200q
AND NOW ~LL L~ 17-- _A~f , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated i~ ~ ~ ~ '] ~
described therein be admitted to probate and filed of record as the last will of i,-~ ~L~x~ D .
NP_..LL
FEES
?robate, Letters, Etc $ ~¢0'0O ~~-~ ?~'"
~,-' t/j'fq' S '". ....... c~ . c)O ·
Short C[nificates( ) .......... $ z t, ~O A~ORNEV (Sup. Ct. LD. No.) ~/~
Renunciation ....... ~L'P' $
TOTAL
Filed ...................................
PHONE
RENUNCIATION
In Re Estate of /t'/'~-Z ~'/q 2.~ N~" L (_ deceased.
To the Register of Wills of d/t///,/~'~.,~/f/2~ County, Pennsylvania.
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
beissuedto ~,//'"~/ ~. ~h'l~/'~7~'C, ~,.m~,, ~~R'~
WITNESS ~ hand this /~t. day of ~"t~,~, , ,~t9 ~.
V
In Re Estate of /~'~'&~ ~' ,4/~-~ deceased.
To the Register of Wills of ~/N~G~L~/I/~ County, Pennsylvania.
The undersigned ~v~/~//fl,~ ~'. /~/~'ZL/ t~9-~R,~/' of
the above d~edent, hereby renounce(s) the fight to admi~ster the estate ~d res~tfully ~k(s) that Letters
WIT~SS ~ h~d this /~ day of ~'~ ~~
(Addr~s)
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat. , sign the same and that signed as a witness at the
request of testat in h__ presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of (Na.~.e)
19__ '"
(Address)
Regist
er ~--
(Name) ..~
(Address)
REGISTER OF WILLS OF ~/z,e/~~ COUNTY
OATH OF NON-SUBSCRIBING WITNESS
/ / '
(¢r,c..~.) a subscriber hereto, 6~aeh-) being duly qualified according to law, depose(s) and say(s) that
/',5' familiar with the signature of ~ & ~e/[ ,
$ will presented herewith and
testat~ ~ of ~e ~c +u .... ~_:u ................ ' the
that ~g believes the signature on the will is in the handwriting of
ell
to the best of ~W knowledge and belief.
Sworn to or affirmed and subscribed before ~~~-, ~~
Ime this~, 1~ ~ day of ~~* (Nam~ ~/7//~ '
] ~ V~~ (NamO
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat ., sign the same and that signed as a witness at the
request of testat~ in tx__ presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of (Name)
19.__
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF C~a4t~:~L~M.~ COUNTY
r__O. ATH OF NON-SUBSCRIBING WITNESS
-~-eeehg' a subscriber hereto, ~ being duly qualified according to law, depose(s) and say(s) that
~1~ )$ familiar with the signature of He/e~ ~. Nell ,
testat~t~ of ~ee ~f the ~,2b~:r~b~eg witno~se~ t~) the will presented herewith and
that ~ believes the signature on the will is in the handwriting of
b.
to the best of ~]~ knowledge and belief. ~~A~ ~~~
Sworn to or affirm~d~ subscribed before ~~~ ~
me this ~/~ day of ~$ ~' (Name) ~/~ ~
~ ~~~ [/~ (Address)
~ (Name~
(Address~
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
l.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanen.,t filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph. Z j'"0 4 -- ~4 5
Fee for this certificate, $2.00 ~.....~&.,[~ ~<~'~Local Registrar
P i05448GG 4=L 1, oo¢
No. ~ Date
Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Ym ' OTHER:
,,. ~lislet PA 17013 I~.) ,,~.Cou~,~ ~la~ ,~, ,,~.~ ~~ ~lisle
,,. J~ W. ~ ,,. ~ ~11~ ~et~n
~. ,uu~ oray~ ~, ~llsle. PA 17013
,,.. ~(~) ~ ,,,. July 2, 2004 I,,~llin~r ~to~ I,,,Mt. Holly Springs, PA
SI~FU~~~~SU~ I LICENSENUMSER I~E~D~Ai~8~F~IcI~ 8 ~k~t Plaza Way
;~"'~.~. ......... __,~..~. ~ . , . ~,~, ~.~. ~.,~ ~,~
~ ~ ~. / ~ . ~ONOUNCED D~D (~m, ~V, V.r) I W~ ~E ~EkERRED TO A MEaL E~Mt~'~ ~O~R?
I,.. o~- ~ -.I-. ~/,,,..~ I-. ~-~8 .o o
". ~,. ~.
I-.
till tn6
OF
HELEN D. NELL
BE IT REMEMBERED, t~ I,H~en D. N~, of R.D.~I, D~b~g, Fran~n
Town,p, York cou~y, Pen~ylva~, b~ng of sou~ ~nd, m~ory and und~n~ng,
do make, pub~h a~ dele t~ ~ and for my L~t W~ and
revo~ and ma~ng ~ a~ vo~ any and ~ W~ and T~e~ and ~ngs in
the ~e th~eof by me ~ ~y ~e h~ofore made.
ITEM I: I ~e~ t~ ~ my j~t deb~ and fun~ expe~ be p~d
soon aft~ my d~e ~ may be conve~e~.
ITEM 2: ~ the r~t, r~e and r~~ of my ~e, of w~oev~
~e a~ wh~oev~ s~ed, wh~h~ ~ be re~, p~o~ or ~, inching
prop~y ov~ w~eh I ~ve a pow~ of appoi~e~, I give, devoe a~ bequ~h
u~o my ~ba~, ~e~ F. N~, abso~y, provided he s~viv~ me for a p~od
of t~ (30)
ITEM 3: Sho~ my ~band, ~c~d F. N~, predec~e me, f~ to s~vive
me for a p~od of t~y (30) ~ys, or shou~ we ~e s~neo~ly, I then give,
devoe and bequ~h my e~e r~i~y ~e u~o my ~sue, in eq~ sh~, p~
s~p~.
ITEM 4: I appoi~ the Commo~h N~o~ ~nk ~ gu~n ov~ any
prop~y w~ch p~s~ ~h~ u~ t~ W~ or oth~e to a ~nor a~ ~h
r~pe~ to w~eh I ~ ~ho~zed to appoi~ a g~n and have not oth~e
spe~fi~y done so, prov~ed t~ t~ appoi~e~ of a gu~n s~ not
sup~ede the ~g~ of any f~~y in ~ ~~on to ~b~e a s~e wh~e
possible to the ~nor or to anoth~ for the ~nor's benef~. Such g~n s~
~ve the pow~ to ~e p~n~p~, ~ w~ ~ income, f~om ~e to ~e, for the
~nor's suppo~ a~ ~e~on, (ine~g eo~ege edue~on, both g~d~e ana
und~g~e) ~ho~ r~d to ~ or h~ p~e~'s ably to provue for such
suppo~ a~ ~uc~on, or to make ~e~ for thee p~pos~, ~ho~ f~h~ r~pon-
sib~y to the minor's p~e~ or to any p~on ~ ~e of the ~nor.
~ITNESS:
ITEM 5: I direct my Executor to pay all inheritance, estate, succession
and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer
of any property passing hereunder or otherwise passing by reason of my demise, may
be subject and to charge such taxes against my residuary estate, it being my
intention that none of the aforesaid taxes, either federal or state, on any property
required to be included in my gross estate, under the provisions of any state or
federal law now in force or hereafter enacted, shall be prorated among the pe~ons
interested in my Estate to whom such property is or may be transferred or to whom
any benefit accrues.
ITEM 6: I appoint my husband, Richard F. N~l, as Executor of this my
Last Will and Testament. Should my h~sband predecease me, fail to qualify, cease
to act or renounce probate, I then appoint my three ch~en, William E. Nell,
Kathryn E. Nell and Mary B. Nell, as Co-Executors of this my Last Will and Testament.
ITEM 7: I direct that my Executor, guardian, or the~ successors sha~l
not be required to give bond for the faithful performance of th~ duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~-~ day
of. ~ ~ 1975.
HELEN D. NELL -
The preceding instrument, consisting of th~s and one other typew~en
page, was on the day and date thereof signed, sealed, published and declared by
HELEN D. NELL, the Testatrix herein named, 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
eaok~other, have subscribed our names as witnesses hereto.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Dew_edent: Helen D. Nell
Date of Death: July 1, 2004
Will No. Admin. No. 21-04-0645
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
July 26, 2004:
Name Address
Mary N. Phillips 1004 Drayer Court, Carlisle, PA 17013
Kathryn E. Obrecht 1640 South Garner Road, Milford, MI 48380
William E. Nell 10710 Rosehaven, Fairfax, VA 22030
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: July 26, 2004
CHARLES E. SHIELDS, III
~ 6 Clouser Road
~5~ Mechanicsburg, PA 17055
~ . Telephone: (717) 766-0209
. r~ Counsel for Personal Representative
REV-1162 EX(11-96)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601 PEN N SYLVAN IA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004419
PHILLIPS MARY N
1004 DRAYER COURT
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold
101 $11,400.00
ESTATE INFORMATION: SSN: 198-22-9073
FILE NUMBER: 21 04-0645
DECEDENT NAME: NELL HELEN D
DATE OF PAYMENT: 09/23/2004
POSTMARK DATE: 09/23/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 07/01/2004
TOTAL AMOUNT PAID: $11,400.00
REMARKS:
CHECK# 4
INITIALS: CCP
SEAL RECEIVED BY' GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Helen D. Nell
Date of Death: 07-01-04
Will No.
Admin. No. 71-04-064'i
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: within 6 IlOnths
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~g~96
Signat.ure
..:Ie
,-,_Date :,,01-20-05,
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Charles E. Shields, III, Esquire
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
"-,/
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(717 ) 766-0209
Tel, No,
Capacity:
Personal Representative
X
Counsel for personal
representative
J
(MAH: rmf/ AM3)
'COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
___nn_ fold
ESTATE INFORMATION: SSN: 198-22-9073
FILE NUMBER: 2104-0645
DECEDENT NAME: NELL HELEN 0
DATE OF PAYMENT: 04/01/2005
POSTMARK DATE: 04/01/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 07/01/2004
NO. CD 005147
ACN
ASSESSM ENT
CONTROL
NUMBER
AMOUNT
101 I $15,122.94
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$15,122.94
REMARKS: CHARLES E SHIELDS III
CHECK# 9
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
~ ",,(::j ~~ . ... ~'\s \)\Ul i
REV-1500 EX (6-00)' , ~.)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
"t; ~\ S ~~~\~ ~'(~\, ~~,~
REV-1500
OFFICIAL USE ONLY
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INHERITANCE TAX RETURN
RES.IDENT DECEDENT
FILE NUMBER
:2L-2!L
COUNTY CODE YEAR
NUMBER
006lf5
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
!VELL) HELEN 1>.
DATE OF DEATH (MM-DD-YEAR)
07- tN - -7oolf
SOCIAL SECURITY NUMBER
/7f3 -22
9073
DATE OF BIRTH (MM-DO-YEAR)
~7 :... /" - 2- PO ~
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
II/A
~ 1. Original Return
o 4. Limited Estate
IZI 6. Decedent Died Testate (Attach copy of Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AttachcopyafTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-1l2)
o 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME eH,f~'-/FS E; S/{/EL/)S.1lC
FIRM NAME (If Applicable) AJ/;4
TELEPHONE NUMBER 1 / 7 _ 7~~ - 0209
COMPLETE MAILING ADDRESS
~ CLpllSE;(~.
/JfE~rt/lAl/CS$uIf6,. //1 /7t'J5"S""
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1) -t!J -
(2) 1- 378'. 59 S. /2.
(3) CJ
(4) C>
(5) ~ 173,)4'73.J~
(6) -(;) -
'f
(7) fo 1; IS6. tfl
~ (8)
(9) /'.39/.J>'i
(10) Jl/o/,2.7
.
OFFICIAL USE ONLY
...,
--,
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or l)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an eiection to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
-:-;
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( "1
en
,.
4:,/7. 225",/9
...,
(11)
(12)
(13)
~~.. q9.3J~
~ fQ02. 732.02
-
o
~(gO.2J 732,()Z
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax - 0- x.oL -0 -
rate, or transfers under Sec. 9116 (a)(1.2) (15) ~~7
16. Amount of Line 14 taxable at lineal rate 1 (PO~J 732.02- x .0 ':f.S:. (16) IZz.9'1
I
17. Amount of Line 14 taxable at sibling rate -0 x .12 (17) t!:>
- 0 x .15 (18) 0
18. Amount of Line 14 taxable at collateral rate
19. Tax Due (19) 1- ;;. 7 J "2 Z. qq
,
20.0
CrlECK rlERE F feU ~RE ~ECUESTING':; REFUND )F .IN OVERPl\YMENT
REV-l!i03EJ\+(j.97)
SCHEDULE B
STOCKS & BONDS
i COMtNWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF NELL, I!ELE1V ]).
FilE NUMBER
;21 -CJ '1-6 'IS-
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. /},lJjJG'N/lGI/11€R "f &., !/IIe. S"/ot:/< /$,e0/<E'/f'/!-6E /paer
#; /I-()q - ()O:J. " 970 - 127
~ /l1Jj/,I-/!J//PGE ~1t//#4~Y L/q b'/p,4"FY /!1/}r?kEr FUND
1$. rille!) )J1/)/tJ,f ~ CPI'JfIJlt?A! s'?Pt:k
/ [" I ,. 9.
176171Zre..s nI IS. 7, ID 14. ~
~
ave. IS:~ x 17 s1, =
~. V'lsrEPN {!p;e,a SfI/I-.IZE5"
~i till. '7 ~ 4~. ~ 11.3'1
, Shuns /0 11./1
lJ. EArlJN Y/Jlf/C!E /AX- /J14-Al/f6CD GLLJ/V 7/f S.
"
~ 'p/. f7~ "huH'S ~ .;zo. //f
)( '.s},.::
e.
LtJ()/Jf/s SA y~s HIGH /N~d/E .B
~
J;;2/ ~33. Jf/o .5/,p~s @ << 6K
JltlfEE# jJ/f Dlf' W /JtVA/1
~ ~t7P JhllreS h/ j~ '1'1 h, j~3h
PtlTAllf1f/ E~U/7Y /Ne.ontE B
If, 3S7J. 07'1 Sh41t5 (iJ jS:~1
PU7I11A/J1 GEt'1{6t: J='tlNLJ 13
3, 4>77. 35~ Jt. t7j) j,~. 10
P t{ 7/111f/1/ G/low TH ~ j/f/~Q/t!: B
~
I, 494': Lf~/ 5/,. @ 17. 79
( SGE f/ itlU If (II) AI /.. E Tra<. rn t7 /J1
;;. -r/}fO/Y€ j) ).
~p;OE/II#e/IJB<
r.
,t
a~. /'/.'13 X ~ ()OO sJ.,~
G.
.;:::.
N.
I.
,;,
EIJ/t/,f~j) :$#8 ~,e/).KE,e/f6~ /le(2T" A/o_ d7o-0?/'Il/-I-~
I, If7/'tJ4.< S~.5. of ~rq ,4bbb11.5 4:rh~~j-t:'d (LAFFX) ~
~ (3. 1f pr Jf;4/r:.
(SeE (!~t1Uf77()A/ H..f) ,o~#E .4Ie5SA6E /!/1P7k; #T77k!H'G!>)
C S~E (!P/lll/ltJtln-7i{)A} SHeET) TOTAL (AlsO enteron line 2, Recapitulation)
(If more space IS needed. insert additional sheets of the same size)
~
3,37S: 99
;
I, 3 36. 32-
1- b f, .3tf
.,
9.2, "7..3.. 73
~
5~ /8f.3'
;
~
/ if, 'f 3(}. 00
'.il
~ 7,. 9{)'/. ,(,
;
'5, 5':17.30
~
02t:.; 657- 27
1-
d.Oj,z 7{), 9~
$ 37~J 575. /Z
seliE}), ;8/ &AI/~.
FST OF .t1L€tL/../I~t~ j)~
3_. ~A/a /#li~__.$.T/JtE;1/rs.
($GF /7&/JI/zG:J) Mf.<<A!7lttJ4/
_L-LC~~+._;;!!- q'l- tfs-
:K
::?? /62,/9
.. ....._-.. ... . ....-./..... ... ..... -...
S7A-a=:-/R'e;if(L /!/:72ttYIe;:i))..
OPpENHEIME~
Oppenheimer & Co. Inc.
1015 Mumma Road
Wormleysburg, PA 17043
800-722-2294
Member of All Principal Exchanges
August 6, 2004
Mr. Charles E. Shields, 111
Attorney-At-Law
6 Clouser Road
Mechanicsburg, PA 17055
Re: Estate of Helen D. Nell
DOD: July1, 2004
Dear Charles:
As per your faxed request on August 3, 2004, please find attached the list of positions in her accounts
along with high & low prices for stocks and the market close price for mutual funds. If you have any
questions, please do not hesitate to call me at 763-8200.
Sincerely,
~\~ ~~
Marc Moonin, CFP
Vice President - Investments
lvlM/dh
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Date 8/3/2004 Time 2:33:34 PM Phoned ~
From Karen Wilson Please Call Back D
Company Edward Jones Returned Your Call B
Phone 731-1672 Will Call Back
Was Here to See You D
FAX Urgent D
Taken By slk
Message Re: Helen Nell
They require a death cert. and probate document
regarding her holdings: She had 1,471.042 shares of Lord Abbotts Affiliated (LAFFX) valued at
$13.78 per share on 7/1/04
" If/I. ()Lf:lv 05haAtV
1-/3.1;
-, AJ/ ,ltc, 96
AJG/10/2UU4/TUE lU:~~ AM
P. 002
ESTATE OF HELEN D. NELL
(DOD VALUATION July 1,2004)
The information provided in this report is believed to be reliable,
but its accuracy cannot be guaral'1teed.
A mean price is calculated as an.average of the high and low on
the valuation date when available. If these prices are not available, such
as on weekends or holidays, the mean price is the inve.tSely weighted
average of the high and low on the nearest trading dates before and
after, when these prices are available within one week of the valuation
date. If acroal trades are not available) the nearest bid and ask prices are
substituted. Note that securities traded on the T orooto Exchange are in
Ot'Q~t1j::tn dollars.
If an equity is ex-dividend for a cash distribution on or before the
valuation date but is of record after the valuation date, the dividend is
included in the valuation report and is added to the securitys value.
This is reported as an adjusted value on the report. If the date of death
is on or after the record date and the dividend is payable after that date,
the accrued dividend is listed separately on the report and added to the
portfolio IS total value. .
Prices for which daily updates are not available are priced
according to a Corporate Pricing Cycle. These pricing dates occur on
the last business day of the week, and. the last business day of the
month, unless the end of the weekupdate falls within three business
days or less, of the end-of-month update.
Prepared: 10 August 2004
AUG/10/2004/TUE 10:58 AM
Date of Death., 01/01/2004
valuation Date, 07/01/2004
Processing Datel 08/10/2004
Sharee
or lI&r
security
ne8cript.:i.0I1
1)
162.83 KOlIet JlAlUte'1' (IW01)
01/01/2004
1)
57.3'4 ArLAC !XC (001055102)
COH
X.W York Stock IxchaDge
a7/01/2004 .
. 3)
21.524 BP PLC (055622104)
IIl'OBSOUD lIDJ.
Ife" York stock !Icc~n9'8
07/01/2004
4)
94.02 DIIDO~D IlfC (253651103)
COJI
Rev York Stook Bxahaage
01/01/JOU
.5)
55.181 I5TB~ CORP (458140100)
COlt
IIlASXlAQ - Induetrial
07/01/2004.
6)
24.'67 KeLLOQQ CO (487836108)
COJl
Hew York Stook Exchange
07/01/2004
7)
150.414 IWC rIlL BVes QIOUJ IRC (69341510.51
COM
Bew York St.oek Ixcl:uuJ.ge
01/01/2004
8)
39.'7 PRaDIYTtAL rIHL INC (7~~3201D2)
COlI
Rew York Stock BKchange
07/01/3006
9)
89.382 RPK ISTL tiC (7.9685103)
COM
xew York Stook Exchange
07/01/2004
10)
100.623 SBC COHNDJIClTIOJlS IBC (78387'103)
COM
New Yerk Steek ExehaDg8
07/01/2004
11)
101.79 WlKDYS IITL IlIC (950590109)
COM
Hew York Stook Bxohaage
07/01/2004
Totd v..h.:
Total Aoonal.
Tot.al: '29,162.19
B~t.te va1uatioD
lIigh/AJlk
.1.00000
U .13000
53.58000
52.79000
21.UOOO
U.85000
53.00000
66.94000
15.22000
24.66000
35.53000
Low/Bid
1.00000
4.0.51200 B/L
52..95000 B/L
51.88000 BIL
26.69000 BIL
40.J8aOO I/L
52.00000 BlL
45.86000 R/L
14.88000 B/L
H.01000 BIt
34.60000 H/L
P. 003
Betat. of. ULJIlI n. JlBLL
AOOOUDt. 62045297
aopon Typel Date of tleath
Hu.b.~ of S.cu~!tje.: 11
rU. %tl. _ILL, JIILDI
Kee u.Ajo:: Div &zl4 Illt Sec:udty
Adju.t.meat.. Ac:cxua1. Value
1.000000
162.83
'o.a::llOOO
2,342.88
53.:noooo
1;146.58
52.335000
4,920.54
27.0'5000
1,494.74
41.tl9000
1,013.40
52.500000
7,896.74
ti.400000
1,831.41
15.050000
1.345.20
n.235000
2,08.60
35.065000
3,569.27
$28,162.19
$0.00
page 1
This repor~ was produced wttb BJltataVal, a pro4uot ot B.t.ate Val~io~ , prioiDf'9yBt..., :rae. If you hA~ ~.e1ona.
please Qontaat:. nt> SYJlt... at (8UI 313-6300 or _.89p8y"Coa. (Aen8ic= 7.0.4)
SeliE/) E 7 (h/Jf/;tI.ted
I
i PST/l-Tc; cf:
I
H€I.EN D. NELL
ZI-() l./ - 6qs:
~
/30, SI
~ /3 'f. /)0
/7. ! Pro-raful. paynu4 from 1=hnsion paylLlole aJ III d.o.d.
If. i (lash .fJtr cSa~'th/lt7J/'! };O)( ;/lV'erlft;~
: (see (]&py pf rftti cIe,IJPS,t . ~x /11J/~/P7 a/l-dc/d/ ~h1I-
i ed' by .P'#~ 6744,f" ~ar)
l *" .:r/J';;/'/I/a/;~/I41 AI~~.' Ikt/2 ~ 4U/,p:/ ~. ~ dd~ ~$It
~~j/Mb7 ~J}? /~clu/e:r 4.,/ :zKm/? R /'t!-@/y//ce ~
i,? ;:J/f't! fe/it: (Jf 4efJPf,f. ~ ~ri2,f"lRe ~/1 #/1 ~:r H/LS"
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i~{;A/(rtl F 4/c'/(.. kvIW /y/'e~c;eR~/4er.
STATE FARM FIRE AND CASUALTY COMPANY
One State Farm Dr.
-Concordville, P A 19339-0001
0266 H-6278-F382 F H
ACKNOWLEDGMENT OF
CANCELLATION REQUEST
NELL, HELEN D, ESTATE OF,
1004 DRAYER CT
CARLISLE PA 17013-3511
Renters Policy
POLICY NuMsER: 38-L V -4559-3
DATE CANCELED: JUL 01 2004
11,,111,,1111.,,1 I 1,111,11.. i 11,,1.1"1111"111111,..1..1.1.,11
RETURN PREMIUM: $27.05
To: [RJ INSURED 0 MORTGAGEE 0 OTHER
Dear Policyholder,
As requested, this policy has been canceled effective 12:01 a.m. (or the time which is required by state law) as of the Date
Canceled shown above. We thank you for giving us the opportunity to provide this insurance.
J . ,'~ \,.. ."
....
Location:
207 TODD CIR
CARLISLE PA
Agent: MIKE SHOPE
Telephone: (717) 241-3029
524.127 04'01.2002 (o1f1223a)
DATE PROCESSED
JUL 07 2004
IN PAYMENT OF RETURNPREM. 25g.:.00
.' ", ',. ", " -. .
',.':' ......_. ,', .. ,'0<,_
."' . '..' ".' .
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.. BANK OF AMERICA, N.i .
ClistOMER CONNECTION"
ATLANTADEKALBCNTY, GA
'Ii!~t\il~~;~:~~~~M~~~~;
513661365.
POLlCY NUMBER 38-LW455g:..a
:'9
I~.~. PAY TO THE
~ ORDER OF
"~.e
~'"
~~
~~.
tn'lll-.
~
i . ,,'i"f6
H-6278-F382 F H
NELL, HELEN D, ESTATE OF,
1004 DRAYER CT
CARLISLE PA 17013-35L1
$ '"******27.05
TWENTY SEVEN OOLLAASAND 05 CENTS
) ~l"",~~~~'iA
1.':.I.l~.'~....'...mftfjr:A~:t::-'!.It.I:ft1=~IIJ"'!1.:'~I.I.."'-"""'tlI(C't.~..:&UI:&.\t.Ill-I.-....IM
PRESIDENT
.AI /. 11.~~ -..
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%_.:_Ii:l:tI~I. ~SUfiER:
2(n
II- ~ :\ 50 b b .. ~ b 5"- i: 0 b . .. . 2 78 a I: :\ 2 Ll '1.... ~ 5 ~ 0 II-
SUSQUEHANNA
ALLEY
FEDERAL CREDIT UNION
August 25, 2004
Charles E. Shields, III
Attorney-at-Law
6 Clouser Road
Mechanicsburg, PA 17055
Re: Helen D. Nell, Deceased
SSN: 198-22-9073
Dear Mr. Shields:
The above referenced decedent has a share savings account, no. 308-00, at
this credit union with a date of death value of $1566.44. Of this amount
$1566.42 is principal and $.02 is accrued interest. The account has been
open since June 3, 1969. There are no joint owners.
Mrs. Nell does not have a safety deposit box with us.
Sincerely,
',,--- ",,,-,,;-;,-;:/' --;/Li" ,
/"7"'\ /~ / - "
.", /"~--< c-;-.~
Larry L. Stoner
President/CEO
~'/~','
.' '.
( ~
,~
3850 HARTZDALE DRIVE · CAMP HILL, PA 17011-7809
LOCAL: (717) 737-4152 TOLL FREE: (800) 948-1454 FAX: (717) 737-0589
~~'
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'lITED CHURCH OF CHRIST HOMES
REMITTANCE ADVICE
014423
ME:MO INVOICE DATE INVOICE NUMBER AMOUNT DISCOUNT NET
RESIDENT REFUND 06/23/2004 101387 1,250.93 1,250.93
SARAH TODD HOME
HELEN NELL
cUpD0 /U)'Tlj1j1.CO .
'.. STATE FARM FIRE AND CASUALTY COMPANY
.._.~ One State Farm Dr.
> . Concordville, P A 19339-0001
0266 H-6278-F382 F H
ACKNOWLEDGMENT OF
CANCELLATION REQUEST
(;-1 V
NELL, HELEN D, ESTATE OF,
1004 DRAYER CT
CARLISLE PA 17013-3511
Renters Policy
1...III...IIIIIII..IIIIIIII.II..I.IIIIIII...IIII'II.IIII.lnll
POLICY NUMBER: 38-L V-4559-3
DATE CANCELED: JUL 01 2004
RETURN PREMIUM: $27.05
To: [:RJ INSURED 0 MORTGAGEE 0 OTHER
~tL fJU~ Z-KTk!.
Dear Policyholder,
As requested, this policy has been canceled effective 12:01 a.m. (or the time which is required by state law) as of the Date
Canceled shown above. We thank you for giving us the opportunity to provide this insurance.
:..t
Location:
207 TODD CIR
CARLISLE PA
Agent: MIKE SHOPE
Telephone: (717) 241-3029
524-12704-01-2002 (o1f1223a)
DATE PROCESSED
JUL 07 2004
1111111 ~I~ 1111/11111111111111 11I1
JDAP 11 EY .003752 1
----
~
Vendor /I U000460686
Vendor Name: HELEN NELL
==
----
----
-
Check Date: 08/06/2004 Check No. 0010548038
Voucher 10 I Invoice Number I PO Number , Invoice Date I Gross Amount I Discount I Paid Amount
U0460686 717-249-1803-896 08/02/2004 19.29 0.00 19.29
FINAL CREDIT
~{ {( chf()-j~ f-~d
fs~k V/~
CUS tomer Refunds Total Gross Amount Total Discounts Total Paid Amount
$19.29 $0.00 $19.29
==
~
----
----
-
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-
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==
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.......
....
Sprint@
Monthly statement: August 1, 2004
1 of
4
Customer service
1-800-829-8009
Internet address
sprint.comnoca'
Customer number
717-249-1803-896
Summary of Current Charges
Total
Monthly Service Charges
Partial Month Charges
-1.67
-16.57
Taxes and Surcharges
-1.05
Previous charges
Payment July 30 - Thank you!
Balance
27.13
-27.13
.00
II "
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NNNNNNNN 4
.......
....
Sprint@
Customer service
1-800-829-8009
Internet address
sprint.comlloc81
Customer number
717-249-1803-896
Do not send payment.
Credit will be applied to your next bill.
We appreciate your business.
I." 11111I111" 11I.11,11111111,11.11,,1111111111,1111.,1,11,11
AUTOCR**C-014
---
!!!!!!!!!!
+ 017147
HELEN NELL
1004 DRAYER CT
CARLISLE PA 17013-3511
Sprint
PO Box 740463
Cincinnati OH
45274-0463
---
-
==
-
!!!!!!!!!!
1.1,,1,1,1'1.1.11 ",1,1,,11111111,,1,11111111,,1,1,1
12 71724918038967 00000000001929 000019291 0427306
~Jl:J:,f'~':'?o:',jl"
1'f:::!'N'l~""Y"'''.
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.;- &1prmt@
Monthly statement: August 1, 2004
30f 4
Customer service
1-800-829-8009
Internet address
sprint.com/loca'
Customer number
717-249-1803-896
Sprint local Services
Detaitofcharges~'AUgust 1 - AUdUst 31
Monthly Service Charges
This section provides a summary of your monthly recurring charges,
including calling plans, local toll charges and calling features.
Calling Plans
Selective exchange plan
o minutes in plan
.0 minutes used
-1.67
Partial Month Charges
This section contains pro-rated charges due to starting or stopping a
service during the previous billing month. These are one-time charges
and will not appear on future bills.
Interstate acceSs surcharge -2.95 1
Partial month service
July 6 - August 1
Local phone service -13.621
Partial month service
July 6 - August 1
Taxes and Surcharges
This section includes federal. state, and local taxes and surcharges.
For an explanation of the charges appearing in this section call
1-800-938-1172 or visit sprint. com/taxes.
Wireless portability surcharge
Federal tax
State tax
-.37 1
-.56 1
-.12 1
t - see paoe 2 for Aynbtn:lltinn
IV1EMO : INVOICE DAT'E
iNVOICE NUMBc:R i AMOUNT
OISCOUi~T
014570
NET \
,
7ED CHURCH CF CHRIST HOMES
REMrTT.-\NCE .A.DVICE
lliSlDENT REFUND
3ARAH TODD HOME
~ELEN D_ NELL
D7/09/2004 101387-1
178.71
178_71
,
,
/'
Statement
United Church of Christ Homes
Sarah A. Todd Memorial Home
1000 West South Street
Carlisle, PA 17013
Statement Date: 07/09/2004
Mary Phillips
1004 Drayer Ct.
Carlisle{ PA 17013
Due Date: 07/24/2004
Re: Helen D Nell
Account Nr: 101387
--------------------------------------------------------------------------------
Date
Description
Days
Quant
Rate
Charges
Payments
Balance
--------------------------------------------------------------------------------
BALANCE FORWARD 5,595.54 5,595.54
BALANCE FORWARD 1,290.00 6,885.54
06/18/04 PAYMENT 1{290.00 5,595.54
06/18/04 PAYMENT 5{595.54 .00
06/03/04 Beauty & Barber 1. 00 13.00 13.00 13.00
06/10/04 Beauty & Barber 1. 00 13.00 13.00 26.00
06/17/04 Beauty & Barber 1. 00 13.00 13.00 39.00
06/24/04 Beauty & Barber 1. 00 11.70 11.70 50.70
06/24/04 Beauty & Barber 1. 00 13.00 13.00 63.70
06/30/04 Apartment - Type A 30 43.00 -1,290.00 -1,226.30
06/30/04 Incontinence Suppli 1. 00 84.50 84.50 -1,141.80
06/30/04 Apartment - Type A 20 43.00 860.00 -281.80
06/30/04 Medical Supplies 1. 00 83.59 83.59 -198.21
06/30/04 Personal Laundry 5e 1. 00 19.50 19.50 -178.71
NOTE:
Please remit by 07/24/2004 the Last amount printed on the stmt. Please
include Acct # from statement on MEMO LINE of your check. Payments
after 06/30/2004 do not reflect on statement. NOTE: A $10.00 fee wil
be CHARGED for RETURNED Checks.
CiCT-Cf~,- 2C1l).) 19: 14
F''tICEA: i~
4"1:: ?l:.~=: 34::,;:::
F. :=1LC11
o PNCBAN<
October 6.2004
Charles E. Shields, m
6 Clouser RD
Mech?illicsburg, P A 17055
RE: Estate of Helen D. Nell, (Deceased)
SSN: ! 98-22-9073
DOD: 07/0 l/2004
Dear Mr. Shields
In response to your request for Date of Demh b31ances for the: customer l1oteda1:!ove, Ollr
records show the following:
Checking A\:count
Account # 5070 L03243
EstablIshed 08/04/1988
HELEN D NELL
DOD balance: $143.539.31 -$8. i 9 aCCIlJed interest
Savings Account
Account # 5003918012
Established 04/01/2002
HELEN D NELL
DOD balance: $14,538.10 + 52.43 accrued mterest
The decedent. maintained investment account 62045297. For further informauon you may
contact the brokerage department at 1.800.762-6111
Please note that tlm office only provides date of death balances for deposit accounts
(mAs. CDs, Checking and Savmgs accounts). We du not protess any fiD3locia)
transactions or provide stlltemenr~. If you need assistance wIth any of these items,
please call 1.888.PNC-BA l\i'K , 1.888.762-2265} or stop by your local PNC Bank branch
office.
Smccreiy,_
. r'--,
'~'3' . ..v'(f~ <.....-:.i .\iJ)l n
c '\ ;.' ~ . 1/,
'- . .......J G~"';'-.,..._
Jessica SC1JelJer .
1-800-/62 [';:'5
P7.PFSC-04-F
'Of) tits! Ave.
,'>llfSbur~lll'A i .~; 19
\lel~,bcr FDIC
-
Safe Deposit Box Inventory
~~B=
0PNCBAN<
Safe Deposit Box Number
<6;
Drilled - Date
_/_/-
Rental Paid To I
Lessee )JV/~N I
D )J c--- i J
Address Ie; cI d
.;;< (/ ?r- ei ;:i.. c / C> . CJ4-J1- ); 's.)-e.
Inventory
(1)~li-l2 - ()/u~ bU/<f ()/J) (
(i) J kv~.~~ Hu'7-Q CUf-A.:'--u)
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Drilled in the presence of the contents verified _/ _/ _
by
INVENTORY FOR THE ESTATE OF HELEN D. NELL - PERSONALTY
* Queen Bed & Frame
* Dresser
* 2 Bedside tables
* 1 Small drop leaf Kitchen table
6 kitchen chairs
Small desk & chair
* Grandmother clock (kit)
Sofa
2 Living Room chairs
1 Coffee/butler table
Stacking end tables
1 Phone table
1 Computer table
1 Old computer &
old printer
* I Maple blanket chest
Singer Sewing table &
Electric machine
Sewing storage talbe
* 1 Wash stand
Magazine rack
1 End table with 3 small drawers
$200,00
$200,00
$ 35.00
Old Zenith TV console
VCR
Miscellaneous Household
Ironing board
Dishes
Pots/pans
Silverware
Pictures
1 Eastern Star ring
Pearl necklace
Costume jewelry
2 Table lights
2 Floor lamps
$175.00
$200,00
$420.00
$100.00
$ 60,00
$ 50.00
$ 40.00
$ 20.00
$ 15.00
$100.00
$250.00
$100.00
$ 50.00
$ 75.00
$ 6.00
$ 65.00
$ 45.00
15.00
$200,00
$100.00
$100.00
$ 5.00
$ 50.00
'l: 1/1/1/1
REV-1510 EJ( + (1-97)
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
CO'IMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF t1I ELL.) .II €L E tV 1J.
FILE NUMBER
21- 0 '1- ''-IS-
. 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
1.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OFTHE TRANSfEREE, THEIR RB..All0NSHlP TO DECEDENT AND 11HE DATE OFTRANSfER.
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
tJjJ;JENNEI/J'I~t< tJ; t!.tJ" /Alt. .:r,e~ /I(!,e,/)I(A/T
#: /I-!1- 09t9tJ5/9- /Z7
/l-1Jj/;f/ll~G~ ~/?/d/~/lV u.? /IIt'AleY 4/.tI~KG7
FuAlD
t5. j,..PP/J1IS S.ll YLG'S #16# //IIC/JJ'1fG" B
.:l,lf73. ~7~ SJ"rHS ~ j 4, J,f
C. j-Jk7"1II1f-1J1 NI6H Y/E'LD T/lttST /3
;;., 55"9. 6~ 'I Shllh'oS r;j) '7,. tf.2
[Su)9J/OTA-L FO~ :r~A-.:: ~ 33, ~7"/; ptJ ]
(SeE' J/Ht.t1,1'7jPA/ LErrE7l F/2tJh1
t?P fiG /I HEImS< $ &7. #-r7/f erl~j) /l:1
S tIlGl)t/t.€ ~J.
,4.
:2.
-r;e/lJllc54-/IIEIt/C/I~ .t./,t:t;;- //J!.5ulf, ~,
/l-A"lVtf/r)' /J'"#.. 0.2t?t/PI30~S'#t;
(~€€ J/Ai/(A-1i~N ~rrd A/7/f-eflE"..D)
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
EXCLUSION
IF APPLICABLE)
-0-
TAXABLE VALUE
~ Ibolo ~
I, ~81. ~S- - 0- I, Cllfl. ZS;-
"/> /OO~ -o~ ~/~ S7~.7?
/ /, .576. ~
t ~
~~ 01'.57 /pofb -0- dC1 olto. S7
(If more space IS needed, Insert addition a' sheets of the same size)
~
3~ OJ-Z.3/
JI>P/o
1
'7, /5,.9/
~
.3 if" O!2.31
TOTAL (Also enter on line 7, Recapitulation) $ 6 1, f S 6. 9 I
iI~~~~
Transamerica Life Insurance Company
4333 Edgewood Road NE
PO Box 3183
Cedar Rapids, Iowa 52406-3183
August 6, 2004
Charles Shields
Attorney At Law
6 Clouser Rd
Mechanicsburg PA 17055
RE: Annuity Number(s) 0200PB04546
Dear Beneficiary(ies) :
We have received notification, Helen D Nell, annuitant of the above
listed non-qualified tax deferred annuity is deceased. Our office
wishes to extend sincere condolences for your loss.
Our records indicate the following annuity information:
Annuitant:
Owner:
Primary Beneficiary (ies) :
Annuity Policy Date:
Full Value as of 08/06/2004:
Taxable Portion:
Full Value as of 07/01/2004:
Helen D Nell
Helen 0 Nell
All Children Equal Shares
November 08, 2001
$34,225.74
$ 4,225.74
$34,082.31
The attached document reflects the options available to the primary
beneficiary(ies) listed above.
The full value as of the date of death is for tax purposes only and is
not a guaranteed death benefit amount.
The attached document contains general tax information based on
Transamerica Life Insurance Company's interpretation and should not be
relied upon for your personal tax planning. If you have questions
concerning the direct tax consequences when selecting an option, you
may wish to consult a tax advisor.
Member of the _mON. Group
,Ary additional questions regarding this annuity can be directed to the
Annuity Service Center at 1-800-553-5957. A Transamerica Life
Insurance Company representative will gladly assist you with any
questions you may have regarding this annuity and help you meet your
financial goals.
Sincerely,
~~~~\-\~\~
Dannel Osthoff
Transamerica Life Insurance Company
Claims
Enclosure(s) :
Annuity Claimants Statement
Postage Paid Return Envelope
Death Option Packet
Affidavit Concerning Children
REV.1511EX. (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
~ESIDENT DECEDENT
ESTATE OF IV ELL' -. P€LEN)).
,I
FILE NUMBER
;2/-0'-/- 645"
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
1.
-- /J11i/E~Z/ rv.JIEML h'pAlE t?F mE(!IIAA/ICSBttJe6
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) /J1 A-~ Y N. -PH ILl-! PS
Social Security Number(s) I EIN Number of Personal Representative(s) AI or /N',4.1./cA I8l€
Street Address IOtJ9 DItAYE/t C-r:
City t! ,If 1'l.L../ S ~ e
Slate
'pA
17Pl3
Zip
Year(s) Commission Paid:
/I' Or /f/J ~ L./ qUit G
2.
3.
AtlomeyFees eh'AIt!LES E. S/l/F~S 1lL
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant /1/ t' .iY E
Street Address
Slate
Zip
4.
City
Relationship of Claimant to Decedent
Prob te Fees .1 .' I I SL ...l "I,,.t cart;f;(ates
a ~" 't"j''1c:L1 . ~- or ....11 ..
5. Accountanfs Fees
6.
TaxRetumPreparer'sFees - JO'fce Go.rd11 tr, of H $~ Eloc.I<. of- 1),llsb\'\'~,
{,or ptt.pQ.y/)h'OVI Df clo~o~ IOlfO, r'1f. Lto ) a....d f.,.r ptep. /);
IOc'(I, Pi+ 1..(1, 1<-15 ,de..
/tallerfisi"!3 ."\ ClA..W\bu-la.ncl Lc..w JOlu"t1al
It clve.-rt;s ;nd 111 Cll.rli.sle ~nTinel Ntwspa.rer-
If dd,'/!'IJnal Short cert;~(Q.tes
11";';';1//1'// flrohcd-e /us
t=;It"J ,f ;:7rsf 1Ht/l h;u~/ /fed-:
r/;;~f,1 .2'/1 h~ rjm /1C~ ~ ;(elurh "
;(e/lltbHI!I?I/1&HI- '/? tJh/lrks E Sh,'e/d5 zzz: ~A()/;~/~ ~e,.t ~
7.
'3'.
9.
/1,
II.
/2.
J3.
AMOUNT
~
;; ~ 75: lf2
lAlli-lyE))
f
/3, ~SV. 00
A/()JtJ~
.,., 0 t.f. 00
~
3 7S'. 00
"7 ~.()()
q S; 27
1-
. '.:10.00
'"f J /.,S. {)O
,.
'1..30.//70
1Il
IS: Ob
;;t 37. 2CJ
TOTAL (Also enter on line 9, Recapitulation) $ 1(" 3'1' ,. 89
(If more space IS needed, insert additional sheets of the same size)
",,~ft!'"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX- RETURN
RESIDENT OECEDENT
ESTATE OF
AlE LL/ h"€L€/V
DEBTS OF DECEDENT
I
MORTGAGE LIABILITIES) & LIENS
)).
FILE NUMBER
Include unreimbursed medical expenses.
iTEM I
NUMBER I
1.
DESCRIPTION
2.
51'/lI#r /h't'#E SE.-eJl/C!;
(J./I/l-A' /fIERle/! - ,4/E.DIC//VES
,;zl-~ C/ 6q~
I
AMOUNT
Jl"
.,;;?: /.3
7 77'./,/
REV.1513 EX. (1.97)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF NEL-L/ #€LFN 2>.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I . TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. I'h/f.ey j/. ,IJ/I/t.l.IPS
iool/- ])12,4yE/? t!7;" {!A-/2LISL..€5 /-/A 17p/3
~. KI'fP/RYN E. ~15/(GCflr
16'1~ S. ~,pA!h'~ RJ>. rrJ/l.;::-tJl<J> / /YJI '-f t 3j-~
/
3. tf)1lL/JII-/J1.FE: AlELL.
/07/tJ /(t'.5E#AYEN, F/I//tFA~ J/"f 2Z030
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
'DAti 6 H-rE7e
])AU6Ht4::-,e
SoN
;2/-t/!/- 6Qs-
AMOUNT OR SHARE
OF ESTATE
Y3
Y3
Y.3
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(if more space is needed, insert additional sheets of the same size)
IDust lIill ann Q[-e5htm~nt
Of
HELEN V. NELL
BE IT REMEMI1EREV, :that. 1, Hele.n V. Nell, 06 R. v . # 1, V.<..u6 bWl..g, F lLanklin
TOWfUJup, YOlLk County, Pe.nfUylvarUa., bung 06 .6ound mind, memolLY and. undeJ/..6t:ancUng,
do make, pubwh and deci..aJte. :th..t.6 a.6 and 601L my La.6:t Will and Tu:tame.nt, heJLe.by
lte.voUYIfI and mating nu.U and void any and aU W..i.m and Tut:ame.n:t.6 and <<VU.:t.i.ng.6 in
:the. na:twr..e. :theJLe.06 by me. lLt any time. he.!tet060lte. made..
ITEM 1: I cWr.ee:t :thlLt aU my jU.6:t de.bu and 6uneJLa.l e.Xpe.fUU be. pa...td a.6
.6oon a6:te!t my dem..i..6e a.6 may be c.onve.n..i.e.nt.
ITEM 2: AU :the. Itu:t, lte..6idue. and ltema...tndeJL 06 my utlLte., 06 wh.a.UoeveJL
natuJl..e. and wheJLuoeve.!t .6U:u.lLte.d, whethe.!t li be. Ite.al, peJL.6onal Olr.. m..txed, inc.luding
pltopvz;ty oveJL whic.h I have. a POWeJL 06 appointme.nt, I give., de.v..i..6e. and be.que.lLth
unto my hU.6band, R..tc.ha.Jr..d F. Nell, ab.6olutely, pltovide.d he. .6wwivu me. 601t a pe.Jt..[od
On :th..t!t:ty ( 30 I day.6.
ITEM 3: Should my hU.6band, Ri..c.ha.Jr..d F. Nell, plte.de.ce.a.6e. me., 6a...tl:to .6Wl..vlve.
me. nOIL a pe!t..i.od 06 :thUt.:ty (30) day.6, olt .6hould we. die. .6..tmui;tane.oU.6ly, 1 :the.n give.,
de.v1.6e. and be.queath my e.n:t..i.!te. lte..6idua./ty utlLte. unto my ..t.6.6ue., in e.qual .6haJr.u, pe.!t
.6:tUtpu .
ITEM 4: I appoint :the. Commonwe.a.Uh National Bank a..6 gua./tcU..a.n ove.!t any
pJtope!t:ty whic.h pa.6.6 e..6 e.UheJL undeJL :th..t.6 Will olr.. o:theJLwiA e. :to a m..tnolr.. and w.U:h
lLe..6pe.C.:t :to whic.h I a.m a.u:thouxe.d :to appoint a gUaJl.d..[a.n and have. no:t o:theJLwiA e.
.6pe.u6..[c.ally done. .60, pltov-ide.d:that :th..t.6 appo.tn.tme.nt 06 a gua./tdian .6haU no:t
.6upvu.ede :the ught 06 any 6..tdu.c...i.aJLy in W cU6c.JLeUon :to fu:tJUbute. a .6haJr.e. whe!te.
pO.6.6ibie. :to :the. m..tnolt olt :to ano:theJL 60lt :the. m..tnolt'.6 be.ne6U. Suc.h gUa./tcU..a.n .6haU
have :the powe.!t :to U.6 e. pJUnupal, a..6 we1i. a..6 income., 61t.am:t..i.me.:to :t..i.me., 601t :the.
m..tnolt'.6 .6Uppo!t:t and education, (inc.lud..[ng c.oUege. e.duc.atA..on, bo:th gMdua.:te. and
undeJLglr..adua.:te.) w.U:hout Ir..e.ga./td :to hiA Olt heJL paJr.ent'.6 abiLUy :to pltov..[de. 601t .6uc.h
.6Uppo!t:t and e.duc.ation, Olt:to make. payme.nt 60lt :thu e. pWl..po.6 u, wUhout 6wr..:the.!t Itupon-
.6ibiLUy to :the. minolt'.6 paJr.e.nt Olr.. :to any pe.!t.6on mUng c.a./te. 06 :the. minolr...
WITNESS:
l
)
(\
A/I
'J J"t'0)/
f /' ' .'
/ I 'k- /
(StAL)
;' .'
\ .J
~'.- .
'-. t._. "t-,,-,
'i'.-\..-\
l 1 (I-
..----.J /-..--./
"il(
,.."- / ('
'{;~-II
!
t
.'\
,
r
i
ITEM 5: I d..t!te.c.:t my Exe.c.u:tolL :to pay aU inheJtlianc.e, utlLte., .6uc.c.e.6.6ion
and le.gac.y taXe.6 06 wh.a.UoeveJt natwLe. and IU..nd, :to whic.h my E.6:tlLte.olL :the. :tJtafU6eJt
06 any plLoPeJL:tY pa.6.6ing heJLeunde!t Oft o:the.!tw.We. pa.6.6ing by lLe.a.6on 06 my dem1.6e, may
be .6ubje.c.:t and :to c.haltge. .6uc.h taXe..6 agaifU:t my lLuidualty utlLte., il being my
in.:te.ntion :that none. 06 :the a60ltuaid :taxe.6, Uthe.!t 6e.deJtal Oft .6tlLte., on any pltopeJL:ty
./te.quilte.d :to be inc.lude.d .in my gftO.6.6 e.6:ta:te., undeJt :the. pltov.i4iofU 06 any -6:tate OIL
6e.de.Jtal law now in 6olLee. OIL heJtea6:teJt e.nac.:te.d, .6halt be pftoJta:te.d among :the pe.Jt.60fU
.inteJte..6:te.d in my E-6:tlLte :to whom .6ueh plLopeJL:ty ..t.6 oJc. may be. :tJta11.6 6 eJt!te.d Oft :to whom
any be.ne.6il ac.c.4Ue.6.
ITEM 6: I appoint my hcuband, Ric.haJr.d f. Nell, M Exe.c.u:tolL 06 tlli my
LMt Wilt and Te..6:tame.nt. Should my hcuband pJc.e.de.c.e.a.6e. me, 6ail:to quaU6Y, c.e.a.6e.
:to ac.:t alL fte.nounc.e. pltobate., I :the.n appoint my :thltee. c.W.dJr.e.n, WiU..[am E. Nell,
KlLthltyn E. Nell and Malty B. Nell, M Co-EXe.C.u:tOM 06 :th..t.6 my La.6:t Will and Te.6:tame.nt.
ITEM 7: I d..t!te.c.:t :that my Exec.u:tolt, gualLdian, Oft :the...i.Jt .6UC.C.e..6.60M .6haU
not be. ftequ..i.Jc.e.d to give bond 60ft the 6alih6ul peJtnolLmanc.e. On :the...i.Jt du:t..i.u in any
j utU...6 dIc.tia n .
1 N WITNESS WHEREOF, 1 have heJteunto .6 e:t my hand and .6 eat :tlli -5,-1+"1 day
06
f\j.~ d
1975.
,J /'1 yP",,)~ .,. 'J ./
'-". ' I ? "
~l{ . . ({>t~ ,j f J [[:.( .'
HELEN V. LL
(SEALl
The. pfte.c.e.d..tng ifU:tJtument, c.ol1.6..t.6ting 06 :tfuA and one. o:theJt :type.WlUt..te.n
page., t.UW on the day and dlLte. :theJte.06 -6..tgne.d, .6eate.d, publlihe.d and de.c.la!te.d by
HELEN V. NELL, :the. Te.6:tlLtJt..tx heJtun name.d, M and noJc. heJt LMt WUi.. and Tutame.nt,
in :the. plte.6e.nc.e. 06 cu, who, lLt he.!t Jc.e.quu:t, in heJt plLue.nc.e. and in :the. plLue.nc.e. On
e.ai(.h otheJt, have. .6ub.6wbe.d DUlL name..6 a.6 w.U:ne..6.6e.6 he.!teto.
-"-'"
OF C_") {' rl / _
~~.y\),-~'-'''''.J'' -
"-.f' . ~ f "
'~i--"-'
\ ii
L_ i _..,~-,..\....,'1
f2
(~..
, -i
1 \
~-
I -'_. .
1\
, I!
i- " \ ~ ,!\
OF "\\
~)\ i
......~._..J), _, 1..' ,~,
,- ~
.',; \ -',
Safe Deposit Box Inventory
"
o 'PNCBAN<
~e
. DILLSBURG
Safe Deposit Box Number I
<6;
Dnlled - Dale
_/_/-
Rental Paid To I
I
i
Lessee JJc-/~/V I
D )Je--i)
Address Todd CJ4-P- J)'sje,
dO ~ C//LC/c>.
Inventory
~/-JJ-I2 _O/U~bu/~'Li/h(
(i) J hcJ~ Hu"7J1 (U~;---uJ
6S~~ 0
(!jj'?i>~ r(, '. "~Ll~~)
5 ') a~ CL\;t:1f- - - cr
r J -.crJJ~.A2;.-
~4o ' J' J
e ~'!. (/~
'iJ. /~ 7c~ Cd- p)
~ 5~f~~
.~ "~1<- ~M ~1
.~~~~
~.. K (';f.k--&i<-<VL
-!+~~~r0 .
PAle ~~ .~ L-~'1~~ir,-
/ - (r'
, 0-1 ,r 1- cC~~w~ )
~.L~
Drilled in the presence of the contents verified _/ _/ _
by
~I' ,J
Signature
I at.
Place one copy with tents in sea envelope.
File One copy wit ease agreement in Branch Office file,
Sealed envelope with contents placed in Safe Deposit Box Number
-..k-~h_
'/~
,
'._/
Safe Deposit Box Inventory
~~~LSBURG
0PNCBAN<
Safe Oeposit Box Number
Orilled - Oate
_1_1-
Rental Paid To
Lessee
Address
Inventory
@
ff) { jtj
, Gvr!1 < r"0 Qr-C
~
Drilled in the presence of the contents verified _I _I _
y
'l/z/'}-l'J t' n-
,'-./
Signature
Place one copy wi contents in seal envelope.
File One copy with lease agreement in Branch Office file.
Sealed envelope with contents placed in Safe Deposit Box Number
06-20-2005
NElL
07-01-2004
21 04-0645
CUMBERLAND
101
APPEAL DATE: 08-19-2005
( See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _
REY:is47-Ex-AFP-coi:osj-NOTIcE-OF-INHERITANCE-TAX-APPRAIsEMENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
HELEN D FILE NO. 21 04-0645 ACN 101
BUREAU OF INDIVIOU"':- 'i"XES
INHERITANCE TAX DIVISION ' ,
PO BOX Z80601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERIT"NCE TAX
APPRAISEIlENT, ALLOIIANCE OR DIS"LLOII"NCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
JlCl i 7
i: 5L.
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
r:'_ ;
r;-i
C' 'T"
It.:;-,:\
0"1...., '.r\".~..
h,'nr":'
CHARLES ~,j~RIELDS
6 CLOUSER RD
MECHANICS BURG
'III ~,
PA 17055
ESTATE OF
NELL
*'
REV-lS~7 EXAFP (06-05)
HELEN
D
TAX RETURH WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 06-20-2005
I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
reflect ~i9ures that include the total a~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Llh8 14 at Spousal ~at. (IS)
16. ~unt of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling ,..te (17l
18. AIIaunt of Line 14 taxable at Collateral/Class Brat. USl
19. Principel Tax aue
CDS.
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schadul. A)
2. Stocks and Bonds (Schedule BJ
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank o.posits/Kisc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule GJ
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(71
.00
378.595.12
.00
.00
173.473.15
.00
67,156.91
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/A~. Costs/Klsc. Expenses (Schedule H)
10. Debts/Hortgage Llabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Gover~tal Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Est.t. Subject to Tax
(9)
(10)
16,391.89
101.27
(11)
(12)
(13)
(14)
NOTE:
.00 X
602,732.02 X
.00 X
.00 X
00 =
045 =
12 =
15 =
DATE
09-23-2004
04-01-2005
ANOUNT PAID
11,400.00
15,122.94
NUIlBER
CD004419
CD005147
INTEREST/PEN PAID (-)
600.00
.00
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your .ccount,
sub.it the upper portion
of this for. with your
tax P8Yllent.
619,225.18
16.493 16
602,732.02
.00
602,732.02
(19)=
.00
27,122.94
.00
.00
27,122.94
27,122.94
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YDU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FOHN FOR INSTRUCTIONS.)
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Helen D. Nell
Date of Death:
July 1, 2004
Will No.
Admin. No.
? 1 -04-064.')
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 'f No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No )( .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and
approvals of formal,~ormal accounts may be filed with the
~:::,o: ~t1PhaD( ourt and may e;:;;; ts~
5l.gnat-ure
Charles E. Shields, III
Name (Please type or print)
6 Clouser Road, lv'Jechanicsburg, PA 17055
Address
(717 ) 766-0209
Tel. No.
Capacity:
Personal Representative
Counsel for personal
representative
(MAH:rmf/AM3)
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