HomeMy WebLinkAbout11-30-10'ir
],5056041,1,25
REV'1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 0 0 2 4 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 3 9 0 9 7 9 8 4 0 2 1 3 2 0 1 0 1 0 1 2 1 9 1 0
Decedent's Last Name Suffix Decedent's First Name MI
M I T T E L S D O RF G E R T R U D E
(If Applicable} Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 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 - TH15 SECTION MUST tat GUMF'Lt I tU. ALL GUKKtJYVNUtNGC ANU GVIVtlUCIY! IHL IHR IIYI'VRmAI IVIY .l1'1VULU oc UIRGb i w ~ v.
Name Daytime Telephone Number
S TA N L E Y J A LA S K O W S K I 7 1 7 2 3 2 7 6 6 1
~,.,
Firm Name (If Applicable)
c . _
... MILLS USILY
_ ~-3
~: r--
-
~ _ _
~,` ~ -.
~ ~ ~ _
_
,~ ._
DATE FILED ~~ ~ ~~~ `~-
C A L D W E L L & K E A R N S
First line of address
3 6 3 1 N O R T H F R O N T S T R E E T
Second line of address
City or Post Office
H A R R I S Fi U R G
State
P A
ZIP Code L
1 7 1 1 0
Correspondent's a-mail address:SlBSkOWSkI _Cklegal.net
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE O PERSON RESP„pAl5(BLE FOR FILING RETURN ~ DATE _
f C
ADDRESS
SIGNATUR E HER T A REPRESENTATIVE D TE
ADDRESS
3631 NORTH FRONT STREET HARRISBURG PA 17110
PLEASE USE ORIGINAL FORM ONLY
15~56~41125
Side 1
15056041125
J
15056042126
REV-1500 EX Decedent's Social Security Number
Decedent's Name: GERTRUDE MITTELSDORF 1 3 9 0 9 7 9 8 4
RECAPITULATION
1. Real estate (Schedule A) .................................. . ..... 1. •
2. Stocks and Bonds (Schedule B) ............... . .................. 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . , ... 3. •
4. Mortgages & Notes Receivable (Schedule D) ................. . ...... 4. •
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 3 8 0 0 1 2 9 9
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . , ..... 6. 1 2 3 3 0 2 • 6 9
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....... 7. •
8. Total Gross Assets (total Lines 1-7) ..... . . .......... . ......... 8. 5 0 3 3 1 5 , 6 8
9. Funeral Ex enses & Administrative Costs Schedule H
p ( ) ................ g, 3 4 9 5 8 • 6 9
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule 1
9 9 ( ) ............ 10. 9 8 3 9 • 0 2
11. Totat Deductions (total Lines 9 & 10) ........................... 11. ~ 4 7 9 7 • 7 1
12. Net Vatue of Estate (Line 8 minus Line 11) ........................ . 12. 4 5 8 5 1 7 • 9 7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ]. 0 0 0 0 0
an election to tax has not been made (Schedule J) .................. 13. •
14. Net Vatue Subject to Tax (Line 12 minus Line 13) .................. 14. 4 5 7 5 1 7 • 9 7
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 0 0 0 15.
16. Amount of Line 14 taxable
4 5 7 5 1 7
9 7
at lineal rate X .045 . 16.
17. Amount of Line 14 taxable
d 0 d
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
2 0 5 8 8. 3 1
0. 0 0
0. 0 0
2 0 5 8 8. 3 1
Side 2
15U56042126 15056042126
J
r i EX Page 3
arlPnt's Cemnlete Address:
File Number
21 10 0242
~~CEDENT'S NAME
_GERTRUDE MITTELS_DORF _-
STREET ADDRESS
5225 WILSON LANE _-
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
7 • Tax Due (Page 2 Line 19) (1) 20, 588.31
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments 16,700.00
C. Discount 878.92
Total Credits (A + B + C) (2) 17, 578.92
3. InterestlPenalty if applicable T
D. Interest
E. Penalty
Total InterestlPenalty (Q + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
0.00
(5) 3, 009.39
(5A)
(5B) 3,009.39
Make Check Payable fo: 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 : ................................................................. ..... ^ 0
b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ D
c. retain a reversionary interest; or .......................................................................................... ...... ^
^
Q
d. receive the promise for life of either payments, benefits or care? ................................................. ......
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................. ...... ^ 0
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... ...... ^ 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................ ...... C~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
(72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, Except as noted in
72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)J. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
0.00
REV-1508 EX + (6-98)
x SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERTRUDE M{TTELSDORF 21 10 0242
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. AIG Sun America Financial -Annuity 56,259.44
Account No. A009744581 (See attached)
2. T. Rowe Price Acct. No. 7004310980-4 22,966.36
4,719.672 shares @ $4.86/share, plus accrued dividend of $28.75 (See attached)
3. United Healthcare System, Inc. -Refund 37.40
4. Asbury Communities, Inc.- Refund -Skilled nursing 4,016.66
5. The Philadelphia Contributorship -Homeowner ins. Refund 70.00
6. Asbury Communities, Inc. -Bethany Village Refund of Deposit 208,350.00
7. Pinnacle Health Emergency Dept. -Refund 45.43
8. Pinnacle Health System -Refund 25.35
9. Pinnacle Health~System -Refund 6.37
10. Continuing Cary Rx -Refund 568.20
11. Jewelry (See attached appraisal) -Total 9,589.00
12. Misc. Personal Effects, Clothing 100.00
13. Nationwide -Annuity -Acct. No. 19-9100002174 (See attached} 10,389.56
14. Nationwide -Annuity -Acct. No. 01-5698974 (See attached) 67,589.22
TOTAL (Also enter on line 5, Recapitulation) I $ 380,012.99
(If more space is needed, insert additional sheets of the same size)
S
REV-1509 EX + (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERTRUDE MITTELSDORF 21 10 0242
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS !RELATIONSHIP TO DECEDENT
A. Suzanne Jourviev
B Gail R. Steiger
c Janet Nintzel
JOINTLY•OWNED PROPERTY:
35 Richmond Hill Road
Sparta, NJ 07871
190 Peace Court
New Oxford, PA 1735p
5 East Beach Way
Lavallette, NJ 08735
Step-granddaughter
paughter
Daughter
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION pF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE,
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
7. A. 5/10/01 Hudson Savings Bank 3,672.84 50. 1,836.42
Certificate of Deposit #80006211752
2. B 7/20/94 Hudson Savings Bank 4,880.74 50. 2,440.37
Certificate of Deposit #8000616385
3. C 7/20/94 Hudson Savings Bank 4,880.74 50. 2,440.37
Certificate of Deposit #8000616383
4. C 1/11/03 Hudson Savings Bank 5,057.32 50. 2,528.66
Certificate of Deposit #8000622818
5. D 7/20/94 Hudson Savings Bank 4,877.93 50. 2,438.97
Certificate of Deposit #8000616384
6. D 1/11/03 Hudson Savings Bank 5,057.33 50. 2,528.67
Certificate of Deposit #8000622819
7. C 9/9/00 NY Community Bank Checking Account 50,272.23 50. 25,136.12
#4700005291
8. C 9/9/00 NY Community Bank Checking Account 3,060.02 50. 1,530.01
#4700005264
9. D 6/24/04 PNC Bank Checking Account #5004415003 48,235.41 50. 24,117.71
10. B/C/D 8/14/04 PNC Investments Account #63334916 43,389.65 25. 10,847.41
TOTAL (Also enter on line 6, Recapitulation) I $ 123,302.69
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
r
GERTRUDE MITTELSDORF 21 10 0242
Decedent's Name Page 1 File Number
Schedule F-1 -Jointly Owned Property
SURVIVING JOINT TENANT(S) NAME ADDRESS REIATIONSHIP TO DECEDENT
D~ Diane Gertz 225 Beaver Drive Daughter
Mechanicsburg, PA 17050
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GERTRUDE MITTELSDORF 2'1 10 0242
Decedent's Name Page 2 File Number
Schedule F-2 -Jointly-Owned Property
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % pF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTERESI
11. B/C/D 7/2p/04 PNC Investments account #25031451 81,147.91 25. 20,286.98
12. B 10/19/0 Public Service Ent. Group Inc. -stock - 600 shares, 18,114.00 50. 9,057.00
CUSIP #744573-10-6 - $29.45/sh.
13. C 2/25/08 Public Service Ent. Group Inc. -stock - 600 shares, 18,114.00 50. 9,057.00
CUSIP #744573-10-6 - $29.45/sh.
14. D 2/25/08 Public Service Ent. Group Inc. -stock - 600 shares, 18,114.00 50. 9,057.00
CUSIP #744573-10-6 - $29.45/sh.
(See attachments)
SUBTOTAL SCHEDULE F-2 I 47,457.98
GRAND TOTAL SCHEDULE F-2 ~ $ 123.302.69
r
REV-1511 EX + {12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
rFRTRt lf)F MITTELSDORF
FILE NUMBER
21 10 0242
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A, FUNERAL EXPENSES:
595.00
12
1 Farner Funeral Home ,
,
2 Crest Flowers 438.70
,
3, Lodging and Travel Accommodations 459.32
4 Luncheon 49.32
.
5 Service Programs 141.41
.
6. Organist -Memorial Service 100.00
7, Bethany Village Memorial Service 68.77
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Diane Gertz
Social Security Number(s)/EIN Number of Personal Representative(s)
StroPt ~[IfIfPCC 225 Beaver Drive
2.
3.
city Mechanicsburg state PA zip 17050
Year(s) Commission Paid: 2010
Attorney Fees Caldwell & Kearns, P.C.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
(`him~nt ____
4.
5.
6.
7.
8.
9.
10
11
12
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees Federal Tax Return -Brian W. Rollin
Tax Return Preparers Fees
Travel - D. Gertz, Post office & CPA
Envelopes - D. Gertz
Postage
Appraisal -Henderson & Co. Jewelers
Labels, PackaginglMail
insured Postage to Heirs
TOTAL (Also enter on line 9, Recapitulation) $
34.958.69
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
15,200.00
5,000.00
148.50
285.00
16.80
3.17
18.88
340.00
22.36
71.46
(lf more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
r
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
GERTRUDE MITTELSDORF 21 10 0242
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Continuing Care Rx -medication - 1/6 - 1/28110 365.00
2. Continuing Care Rx -medication - 2/1 - 2/13/10 425.96
3. Cumberland County and Lower Allen Township -Per Capita Taxes 2010 9.80
4. PA State Income Tax 253.00
5. Hampden Physicians 58.43
6. Pinnacle Health 31.72
7. Hampden Physicians Assoc. 96.57
8. Bethany Village -Skilled nursing (Asbury Communities, Inc.) 8,553.11
9. Pinnacle Health Emergency 45.43
TOTAL (Also enter on line 10, Recapitulation) $ 9,839.02
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (g-00)
K
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
GERTRU DE MITTELSDORF 21 10 0242
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Gail R. Steiger Lineal
190 Peace Court One-Third (1/3)
New Oxford, PA 17350 of Residuary Estate
2. Janet Nintzel Lineal
5 East Beach Way One-Third (1/3
Lavallette, NJ 08735 of Residuary Estate
3. Diane Gertz Lineal
225 Beaver Drive One-Third (1/3
Mechanicsburg, PA 17050 of Residuary Estate
4. Grant Nintzel Lineal 1,000.00
405 Longwood Lane
Alpharete, GA 30004
5. Janele Nintzel (Hyland) Lineal 1,000.00
5 Block Court
Randolph, NJ 07869
6. Brian Gertz Lineal 1,000.00
6440 Mecantile Drive East
Frederick, MD 21703
7. Aaron Gertz Lineal 1,000.00
430 Indian Rock Circle
Elizabethtown, PA 17022
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Pleasantdale Presbyterian Church 1,000.00
471 Pleasant Valley Way
West Orange, NJ 07052
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 1, 000.00
(Ii more space is needetl, insert adtlitional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GERTRUDE MITTELSDORF 21 10 0242
Decedent's Name Page 3 File Number
Schedule J -Beneficiaries - 1
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
8. Karen Olsen Lineal 1,000.00
321 Southwell Lane
Bel Aire, MD 21014
9. Karla Romberg Lineal 1,000.00
217 Browback Church Road
Spring City, PA 19475
10. Karyl Steiger (Doss) Lineal 1,000.00
20 Lincoln Drive
Fayetteville, PA 17222
LAST WILL AND TESTAMENT
OF
GERTRUDE MITTELSDORF
I, GERTRUDE MITTELSDORF, presently of Cumberland County, Pennsylvania,
being of sound mind, memory and understanding, do make and publish this as my Last
Will and Testament hereby revoking all prior Wills and Codicils.
FfRST: I direct that all of my just debts, my funeral expenses and the
costs administering my estate be paid as soon as practicable after my death. i also direct
my Executrix to pay any and all inheritance taxes that may be assessed against any
beneficiary or beneficiaries in connection with my Will or my Estate.
SECONQ: I specifically devise the sum of ONE THOU`~AND DOLLARS
($1,000) to each of the following beneficiaries:
~ . my grandson, GRANT i'JlivTZEL, if he survives me;
2. my granddaughter, JANELE NINTZEL, if she survives me;
3. my grandson, BRIAN GERTZ, if he survives me;
4. my grandson, AARON GERTZ, if he survives me;
5. my granddaughter, KAREN OLSEN, if she survives me;
6. my granddaughter, KARLA ROMBERG, if she survives me;
7. my granddaughter, KARYL STELGER, if she survivE~s me;
8. my church, PLEASANTDALE PRESBYTERIAN CHIJRCH,
Located in West Orange, New Jersey, to be used by it as it deems appropriate.
THIRD: I incorporate into this Will by reference a document, in my
handwriting, titled "Identification of Bequest of Tangible Personal Property", which
document is annexed to this Will. It is my express intent to dispose of such tangible
personal property as I direct in the above referenced document.
FOURTH: I give, devise and bequeath the rest, residue and remainder of
my estate, both real and personal, of every nature and wherever situate, of which I may die
seized or possessed, to my children, JANET NINTZEL, DIANE GE=RTZ, and GAIL
STELGER, in equal shares. if any of my said children shall predElcease me, their
respective share shall be given to their surviving issue in equal shares, per' stirpes.
FIFTH:
(a) If a beneficiary under the age of twenty-one (21) becomes absolutely
entitled to any property under the foregoing provisions, such property shall immediately
vest in such beneficiary. However, the distributing fiduciary in hislher discretion may
distribute the property at any time if that fiduciary feels the funds will be properly expended
directly to the beneficiary or to a parent or any other person or entity on behalf of the
beneficiary, or to a custodian for the beneficiary under a Uniform Transfers to Minors Act,
or to the Trustee named in this Will. If the property is distributed to the Trustee, the
Trustee shall hold the property as a separate trust for the benefit of the beneficiary and
shall pay to or apply for his or her benefit al{the net income and so much of the principal at
any time and from time to time as the Trustee with sole discretion believes advisable to
provide adequately for the beneficiary's health, maintenance, education ar~d support in
reasonable comfort.
2
(b} All funds not paid to or applied for the beneficiary in accordance with
~ Paragraph FIFTH (a) above, shall be paid to the beneficiary at age twenty-one (21} or to
the beneficiary's personal representative in the event of the beneficiary's death prior to age
twenty-one (21). Upon obtaining a receipt from the person to whom distribution is made,
the Trustee shall be relieved of any further obligations with respect. to the property
distributed.
SIXTH: I nominate, constitute and appoint my daughters, DIANE
GERTZ and JANET NINTZEL, to be and act as co-Executrixes, or the survivor ofthem and
then in that event individually, of this my Last Will and Testament. In the event of
renunciation, death, resignation or inability to act for any reason whatsoever of both of my
daughters, DIANE GERTZ and JANET NINTZEL, as co-Executrixes, I nominate, constitute
and appoint my daughter, GAIL STELGER, as Executrix of this rriy Last Will and
Testament.
I hereby direct that no Executrix appointed hereunder shall be required to furnish
any bond or other security in any jurisdiction for the faithful performance of their duties.
I hereby direct that the Executrix of my estate shall receive no greater than a total of
five percent (5%) of the value of my gross estate for Pennsylvania Inheritance Tax
purposes, and the co-Executrixes as named herein shat! divide this amount equally, for
services rendered by them in that capacity to my estate.
SEVENTH: 1 nominate, constitute and appoint my daughters, DIANE
GERTZ and JANET NINTZEL, to be and act as co-Trustees, or the survivor of them and
then in that event individually, of this my Last Will and Testament. In the event of
renunciation, death, resignation or inability to act for any reason whatsoever of both of my
3
daughters, DIANE GERTZ and JANET NINTZEL, as co-Trustees, 1 nominate, constitute
and appoint my daughter, GAIL STELGER, as Trustee of this my Last Will and Testament.
1 hereby direct that no Trustee appointed hereunder shall be required to furnish any
bond or other security in any jurisdiction for the faithful performance of their duties.
EIGHTH: l authorize and empower my Executrix, in addition to all powers
conferred by law and without the necessity of court order, to sell, convey, mortgage,
leases, invest, reinvest, exchange, manage, control or otherwise deal with any and all
property, real or personal, comprising my estate; to adjust, compromise and settle any
claim or demands in favor of or against my estate upon such terms as is deemed
advisable; and to make distribution under this Will in kind or in money, or partly in kind or in
money.
NINTH: 1 authorize and empower my Trustee, in addition to all powers
conferred by law, to sell, exchange, mortgage, lease, bargain, sell, convey or otherwise
deal with the property with which she is so entrusted, without regard to ar~y limitation upon
investments by fiduciaries which may be imposed by any law, and witriout the need for
authorization by any Court in this or any other jurisdiction. It is my intent by this Paragraph
NINTH to authorize my Trustee to deal with the corpus and the income of such trusts as
though she were the absolute owner and to authorize her to make payments for the benefit
of beneficiaries whenever she in her sole discretion shat{ deem them necessary for the
purposes hereinbefore stated; whenever the accumulated income shall be insufficient for
such purposes, then she shall have the full power to invade the corpus to whatever extent
may be necessary.
TENTH: I forgive, release and discharge each of my daughters, JANET
NINTZEL, DIANE GERTZ and GAIL STELGER, of all indebtedness and interest thereon
which may be owing to me at the time of my death, whether or not. evidenced by a
promissory note or other instrument.
ELEVENTH: Throughout this Will, the masculine shall include the feminine
and the singular shall include the plural, and vice versa, unless the context of the Will
indicates otherwise.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
„ , 7
fJ day of ~-c~=~,~-~-z~~~z-.-- , 2004 .
.. ~~ ;.'
~~ ~,
GERTRUDE MITTELSDORF
The foregoing instrument, consisting of this and four (4) preceding typewritten
pages, was on the date thereof signed, published and declared by GERTRUDE
MITTELSDORF, the Testatrix therein named, as her Last Will and Testament, in the
presence of us, who at her request and in the presence of each other, have subscribed our
names as witnesses.
.,,.. ~.
l^~"` .
J , ~'~•
.~...-~.: ~-.~.~,,~a...~..~ z..~ ~. ~ ,~ {-{' ~-~~-~Re s i d i n at _~ ,::~, ~ ~ ; ~~ _ ~.~:~~ <~ _~ ~°
,~ ^ ~ ~~- ~
i `' ~'~
is
.~, C.~ ~ c;-~-~: Residing at .~ =~ ~ .~ ~ ~~ , ~Y~- ~`~,~ -~`~~ ~ .~ s
~~~-~~-~-..~~-~ Resid in at f ~<< y ~~--~.
~,. g --
5
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~ (~ ~ PN ~ ~
~ ss:
I, GERTRUDE MITTELSDORF, whose name is signed to the attached foregoing
instrument, have been duly qualified according to law, and do hereby acknowledge that I
signed and executed such instrument as my Last Will and Testament; that I signed the
same willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
GERTRUDE MITTEL.SDORF C'
Subscribed, sworn to, affirmed and acknowledged before me, a Notary Public, by
GERTRUDE MITTELSDORF, this a~~~ day of ,/~~ -~~m~~e , 2004.
~~~'~~-
NOTARY P lIC
My Commission Expires:
CCWIMONV1fEALTH OF PEAiNSYLVANIA
NOTARIAL SEAL
NANCY L. BFIESKl, Notary Public
Susquehanna Township, Da~hln County
f4ly Conuniasbn Expires Manrh 16, 2008
. r.:,_.~,.._.,~._.._. ~..
6
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~ ~ v ~~~a~I
ss:
__~
/~ 1 ~,
W E , ter: ~-~:~ rz%~f~t..c'~.-.~_...; ~ ~ " ~ ~~ ~~~-J~--~~ ~~-' ti~ -:;. ~ ~ ~~ a n d
-- 1 ~~
~~.~-~~~-~.. ,the witnesses whose names are signed to the attached foregoing
instrument, being duly qualified according to law, do depose and say that we were present
and saw the Testatrix sign such instrument willingly and execute it as her free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of
such Testatrix signed such Last Will as witnesses thereto; and that to the best of our
knowledge, such Testatrix was at that time eighteen (18) or more years of age, of sound
mind and under no constraints or undue influence.
Subscribed, sworn to, affirmed and acknowledged before me by"~_ G; ,j-~~
_ f J~ .{
.= x ~~ ~- ~. ;, -~~. and,~.,~ ~.--~~.- ~.., witnesses, this da of
~_ Y
r
WITNESSES:
.._,~
~) ' ~ t
+. n ~ y~~..1 ~ ~/ y
..1 ~~;
;~-
-- -•~ ~ -~
n '
~ -- - s
~ ~.. ~ -c-~,.
NOTARY UBLIC
My Commission ~Lt~ciWEAL-"H GF ~'Ei~hf`aYLVANIA
NOTARIAL SEAL
04-888/81574 NANCY L BRESKI, (Votary public
Susquehanna Township, Dauphin County
!V!~ Co~ssbn Expi~sa (~Aatch 18, 2008
EXHIBIT A
S
June 17, 2010
Caldwell & Kearns
Attorneys At Law
3631 N Front St
Harrisburg PA 17110-1533
~,~~ [~)'1'1~1Y'ih~ Firt~d ~1n-ruil~ Atlnrinistr•atit-n
the r~tirenunrt specialist I'.U li~>:~ ~)O(Y(~
~,m~n~illy. "I'~ 79105-90Oh
Re: Annuity Contract A0097544981
Contract Owner Gertrude Mittelsdorf, Deceased
Dear Mr. Stanley Laskowski:
Listed below is the relevant death benefit information for the above-referenced annuity contract.
Contract Number A0097544981 __
Ty e of Annuity Contract: (Sin le Premium) Non-Qualified Tax Deferred Annuity
Date of Issue: 10/31/1997 ___
Contract Owner's Name(s): Gertrude Mittelsdorf __
Accumulated Value as of $56,259.44
Date of Death on 02/13/10: _
Accumulated Value as of $56,634.28
05/06/10: _
Accrued Interest as of $33,034.28
05/06/ 10:
Mr. Laskowski, we appreciate the opportunity to assist you. Should you have any quesl:ions,
please contact our Client Care Center at 1-888-333-2349.
Sincerely,
/~~
~v~
Lam'
Shatori Wilson
Annuity Claims Department
tiun 1nr~ric;i ~~nnuii~. ,uui Life :1,>ur;u~c~~ (un~4i~ur~ Iir,t Sui~Amcrica Life In;uranr~ (~um~~an~ tiun:~m~~riai Life In>ueui~_e (~~,m~ru~~
~;ciininu~r;i~~,i ;~,~ l I~~~ ~ ~n~it+l '~;itnnril Lii~ (n~ur;uuc <~~>m~rtt~~ ~+1 Onr,~li~~ ~~~imini<trat~~r f~~r J~~lu~ :11ci~~n life In;urni~_~ (nm~rui~
July 20, 2010
Stanley J A Laskowski
Caldwell & Kearns PC
Attorneys at Law
3631 North Front Street
Harrisburg PA 17110
Subject: Account Balance
Short-Term Bond Fund Account 7004310980-4
Dear Mr. Laskowski:
\N`RV+' iROVJ~ FNICE ~'OtJ~
~ , ,,!J:r
i! t ~a;i ;;~r:~
I am writing in response to the letter we received from Diane Gertz regarding the mutual fund
account shown above registered to the late Gertrude C. Mittelsdorf.
The balance of the account as of February 12, 2010, was $22,937.61. The account had a
balance of 4,719.672 shares. The net asset value of the T. Rowe Price Short-Terms Bond Fund
was $4.86. The accrued dividends were $28.75. This amount is not included in the account
balance, and the dividends were paid in cash on February 26, '2010.
Please note that we are providing the balance of the account as of February 12, 2010, because
February 13, 2010, was not a business day.
I hope this information is helpful. If you have any questions regarding this correspondence,
please call a telephone services representative at 1-800-225-5132. Representatives are available
1Vlonday through Friday from 8 a.m. to 10 p.m. ET and Saturday from 8:30 a.m. to :5 p.m. ET.
Sincerely,
I
Jeannette Romero
Senior Account Services Representative
Correspondence Number: 01799784
I~ ~~-~i~
INVEST V~ITH CONFIDENCE
l
Gr~mrni#Eae ~ct~r+~x~u
643 Eagle Rock Ave
West Orange, NJ 07052
973-731-3155
973-731-1508 (fax)
ESTATE OF GERTRUDE MITTELSDORF
C/O DIANE GERTZ 225 BEAVER DR.
MECHANICSBURG, PA. 17050 Date 4-20-10
Item Description
Value
PLATINUIv1 LADIES DIAMOND RING SET WITH ONEROUND DIAMOND
APPROX..50 CTS. SI2 CLARITY, J COLOR AND TWO STRAIGHT BAGUETTE
PROX..10 TW. 420.00
14 K WHITE GOLD DIAMOND INSERT RING SET WITH 10 DIAMOND
BAGUETTES APPROX..36 CTS. AND TEN SINGLE CUT DIAMONDS
APPR X..40 CTS. TW. 80.00
i
J
ti
Appraiser
This estate jewelry appraisal was prepared by
Henderson & Co. Jewelers, Inc.
Windsor Park Shopping Center
Mechanicsburg, PA 17050
(717) 766-7771
for:
Estate of
Gertrude Mittelsdorf
Diane Gertz, Executrix
This appraisal was prepared April 20, 2010.
The following metal prices are from the date of death, February 13, 2010
The price of gold was approximately $1,089.00 per ounce and silver was $15.49.
The following equipment was used in preparing this jewelry appraisal:
Binocular Microscope
Dial Gauge
Table Gauge
E{ectronic Sca{e
Color Master Stones
Refractometer
Polariscope
Touchstone & Acids
The appraiser was David A. Henderson, Gemo{ogist of t e Gemolog c ~ titute:of
-~
America, no. 3561240. " -- --,
G.I.A. grading terminology was used in preparing this jewelry ap raisal
This appraisal was prepared for estate purposes only. The values given represent a fair
price that the items could be expected to bring in a reasonable time period if sale was
necessary to settle the estate. This is based on prices obtained far similar items in our
area at the time this appraisal was prepared, or recent auction prices for similar items.
The condition of the gems and their mountings was factored in when arriving at these
values.
This jewelry appraisal does not represent an offer to buy nor does Henderson & Co.
Jewelers have a stake in these items.
Items for Diane Gertz
Item 1 OPAL EARRINGS
Please note: One prong is broken on one earring. This is a pair of opal drop earrings for pierced ears. The
mountings are approximately 14 karat yellow gold. Each is set with a single round opal.
Total weight of earrings is 1.7 dwt. / 2.7 gr.
Opals: Two round genuine opals
Diameter: 4.5 mm
Body Color: milky translucent
Play of Color: predominantly green and blue pin fire
ESTATE VALUE..........$82.00
Item 2 MULTI-OPAL RING
One lady's fashion ring in 14 karat (stamped) yellow gold. There are four opals in this ring. The mounting
is of cast- construction. Total weight of mounting with gems is 4.9 dwt. / 7.6 gr.
Opals: Two oval 8 mm x 6 mm
Two round 3 mm
Body Color: slightly milky white
Play of Color: blue green and red
ESTATE VALUE..........$600.00
Item 3 OPAL CRESENT PIN
This 314 circ{e brooch was cast in approximately 14 karat yellow gold. There are- 9 round opals of
graduated sizes prong set in the brooch. Brooch is 1 ~/z inch across and weighs 4.2 dwt. / 6.5 gr.
Opals: Nine genuine opals as follows
1-4.5 mm, 2-4 mm, 2-3.5 mm, 2-3 mm, 2-2.5 mm
Body Color: slightly milky white
Play of Color: green, blue, yellow, red
ESTATE VALUE........,.$470.00
Item G3 TWO-TONE FAMILY RING
There are six simulated birthstones in this 10 karat (stamped) family ring. The stones are held by four
prong settings in white gold and the shank of the ring is yellow gold. Total weight of the ring with stones
is 3.idwt./4.8gr,
ESTATE VALUE..........$60.00 (scrap value)
Item G4 HINGED BANGLE BRACELET
One hollow, hinged bangle in i4 karat yellow gold. The bracelet is 10.55 mm wide with a concave top.
The outer surface is Florentine finished and engraved. The bracelet is secured with a sliding safety and
clasp. Condition of bracelet is good. Total weight of bangle is 9.9 dwt. / 15.4 gr.
ESTATE VALUE..........$500.00
Item GS FLORAL BROOCH WITH DIAMONDS
This 3 D," filigree look" brooch was cast in 18 karat yellow gold. There are five round diamonds held by
prongs in the center of the brooch. Measurements of the brooch are 2 inch diameter x 7/16 inch thick.
Total weight of the brooch is 7.6 dwt. 11.9 gr.
Diamonds: Five Single Cut Genuine Diamonds
Diameter: 2 mm to 2.4 mm
Weight:.03 to .05 ct. ea., approx. ,20 carat t.w.
Clarity: SI2
Color: H-I
ESTATE VALUE..........$500.00
Item G6 CHARM BRACELET WITH SEVEN CHARMS
This traditional double link charm bracelet alternates one smooth link then one rope link. Length of
bracelet is 7 7/2 inches and 10 mm wide. The links are solid and heavy. Six charms are soldered on the
bracelet. Both charms and bracelet are 14 karat yellow gold. Three of the charms are set with simulated
birthstones. Total weight of bracelet and charms is 29 dwt. 45.2 gr.
ESTATE VALUE..........$1,102.00 (scrap value)
ITEM FOR JANELE
Item J1 ACANTHUS LEAF RING
This ring was cast in 14 karat yellow gold. It is a tapered band type ring measuring 13 mm wide at the
top and 7.8 mm at the back. Total weight of ring is 5.1 dwt. / 7.9 gr.
ESTATE VALUE........,,$350.00
ITEM FOR SUZIE
Item S1 BASE METAL BROOCH
One bar pin style brooch in base metal with a glass simulated sapphire.
ESTATE VALUE..........NO VALUE
ITEM FOR 7ANET NINTZEL
Item N 1 BI-COLOR LOCKET ON GOLD CHAIN
A round diamond is burnished into the center of this rose and white gold hinged locket. The locket was
well made but it condition is only fair A puzzle rope suspends the pendant at present time. The chain is
26 inches long and 1.5 mm wide. Total weight of locket and chain is 7.5 dwt. / 11.7 gr.
Diamond: One round irregular cut genuine diamond
Diameter: 2.5 mm
Weight:.06 carat (approx.)
Clarity: SI
Color: H
ESTATE VALUE...........$350.00
OTHER ITEMS
Item M1 OPEN-WORK HOOP EARRINGS
One pair of hoop earrings of cast construction. The earrings are made of 14 karat white gold with
stationary posts and nuts for pierced ears. The hoops are oval and measure 1 inch x 3la inch and weigh
5.4 dwt. / 8.4 gr.
ESTATE VALUE...........$450.00
ITEMS FOR KARYL DOSS
Item D1 HOOP EARRINGS
This pair of faceted hoop earrings is 14 karat yellow gold. The hollow hoops are 1 inch diameter. The
posts are hinged and clip shut. Total weight of ear hoops is 1.8 dwt. / 2.8 gr.
ESTATE VALUE..........$165.00
Item D2 LADY'S QUARTZ PENDANT WATCH
This watch was on a base metal chain at time of examination. The watch is a yellow plated base metal
quartz Waltham.
ESTATE VALUE..........$45.00
ITEMS FOR GAIL STELGER
Item Gi STERLING CROSS WITH MOTHER OF PEARL AND MARCASITE
A sixteen inch long 1.1 mm wide box chain 'rn sterling- silver was on this cross at time of examination. The
cross measures 1 ~/2 inch x 1 inch with its articulated bail. The cross has m.o.p. inserts in the front with
two round marcasites (pyrite) at each end and four in the center,
ESTATE VALUE..........$15.00
Item GZ THREE STONE DIAMOND NECKLACE
Three round diamonds in bezels are spaced 1 ~/2 inch apart at the center of this long and short chain. The
17 inch long chain is 14 karat yellow gold. Total weight of chain with bezels and diamonds is 1.6 dwt. /
2.1 gr.
Diamonds: Three Round Brilliant Cut Genuine Diamonds
Diameter: 3.5 mm
Weight: approximately .16 carat each, .48 ct. t.w.
Clarity: Iz
Color: J
ESTATE VALUE..........$350.00
ITEMS FOR KAREN OLSEN
Item 01 CAMEO BROOCH/PENDANT
This item is a traditional shell cameo in an ornate bezel with booth pin stem and catch and a fold down
pendant loop. The mounting is 14 karat yellow gold except for the stone seat which is made from a
yellow gold filled wire. Over-al! measurements of the pendant are 1 3/8 inch x 1 3/16 inch.
Cameo: One Oval Shell Cameo of medium carving quality.
Dimensions: 30 mm x 22 mm
Color: orange brown and light beige
ESTATE VALUE..........$125.00
Item 02 CAMEO EARRINGS
These earrings consist of a pair of oval shell cameos in bezels with a rope edge. Posts and nuts for
pierced ears complete the earrings. The mountings are 14 karat yellow gold.
Cameos: Two oval shell cameos
Dimensions: 9 mm x 7 mm
Color: orangy brown and beige
ESTATE VALUE..........$45.00
Item 03 STATION NECKLACE WITH PEARLS AND BARS
There are 14 cultured pearls in this 14 karat yellow gold station necklace. The pearls alternate with 9 mm
long bars on a cable link chain. The necklace is 24 inches long. Total weight of chain with pearls is 5.5
dwt. / 8.5 gr.
Pearls: Fourteen Akoya (saltwater cultured) Pearls
Diameter; 5 mm
Shape; rounded
Color: cream
Surface: spotted
Nacre: thin
ESTATE VALUE..........$125.00
Item K2 DOUBLE STRAND PEARL NECKLACE
Please note; this necklace should be restrung. The old silk is stretched and weak from age. Two knotted
strands of cultured pearls with an ornate clasp make up this necklace. The pearls are uniform and the
clasp is 14 karat white gold. There is a round diamond in the center of the flower shaped clasp. There are
also six small round opals between the petals. All stones are prong set. Without the clasp the strands are
about 17 ~/4 inch and 18 inch,
Pearls: One hundred and nine Akoya (salt water cultured pearls)
Diameter: 6.5-7 mm
Shape: round to near round
Color: white to light cream
Luster: good
Surface: light spotting
Nacre: thin to medium
Diamond: One Round Brilliant Cut Genuine Diamond
Diameter: 2.8 mm
VIleight:.08 carat
Clarity: SI
Color: H
Opals: Six Round Cabochon Cut Genuine Opals
Diameter: 2.5 mm
Body Color: crystal
Play of Color: intense green, blue, yellow and red.
ESTATE VALUE..........$1,600.00
Item 2B GOLD CHAIN WITH BEAD STATIONS
One 29 ~/z inch long link chain with bead stations spaced 1 ~/4 inch apart around it. The chain alternates
one rope link and one flat bright finish link. The beads are 7 mm with a frosted finish. Total weight of
necklace is 13.3 dwt. / 20.8 gr. The necklace is 14 karat yellow gold.
ESTATE VALUE.........$680.00
Item B3 CACIQUE STYLE PENDANT ON CHAIN
At time of examination this pendant was on a sterling silver rope chain. The chain is 16 ~/2 inches long
and 1.62 mm wide. The pendant consists of a fluted and frosted rectangle of quartz crystal. A white gold
art deco frame surrounds the quartz and a small setting plate with diamond is riveted into the center of
the crystal. An articulated bail suspends the pendant. The pendant measures 1 ~/z inch (with bail) x 3/a
inch.
Diamond: One single Cut Genuine Diamond
Diameter: 1.5 mm
Weight:.015 carat
Clarity: SI2
Color: I-J
ESTATE VALUE..........$135.00
ITEMS FOR KARLA ROMBERG
Item K1 GOLD CROSS ON CHAIN
This 14 karat yellow gold cross measures 1 3/4 inch x 3/4 inch without its bail, the thickness is .69 mm.
The cross was suspended from a box chain at time of examination. The chain is 18 3/4 inches long and
.92 mm wide. Total weight of chain with cross is 2.9 dwt. / 4.6 gr.
ESTATE VALUE..........$110.00
Item 4 BUTTERCUP DIAMOND EAR STUDS
This is a pair of round diamond earrings in 14 karat white gold buttercup style ear stud mountings. The
heavy weight mountings have posts and nuts for pierced ears. Total weight of mountings and diamonds
is 1 dwt. / 1.6 gr.
Diamonds: Two Round Brilliant cut Genuine Diamonds
Diameter: 3.4 mm
Weight: approximately .40 carat total weight
Clarity: I~
Color: I
ESTATE VALUE..........$350.00
Item 5 FILIGREE BRACELET WITH DIAMONDS AND SYNTHETIC SAPPHIRE
This white gold bracelet is stamped 14 karat. A synthetic blue sapphire is bezel set in the center of this
filigree style link bracelet. There are also two round diamonds bead set in bracelet. Total weight of
mounting and stones is 5.1 dwt. / 8 gr.
Diamonds: Two Single Cut Round Genuine Diamonds
Diameter: 2 mm
Weight:.06 carat total weight
Clarity: I1
Color: I-J
ESTATE VALUE.........$550.00
ITEMS FOR BETH NINTZEL
Item 1B FILIGREE BRACELET WITH SIMULATED SAPPHIRES
This white gold bracelet is 10 karat (stamped) with a wide decorative link in the center. Three marquise
cut blue, simulated sapphires accent the center three links. The mounting is in good condition but the
stones are badly abraded and chipped. Total weight of mounting and stones is 4.9 dwt. / 7.6 gr.
ESTATE VALUE.........$330.00
.~
,~~,: ?t~=t? F~'~: 14 ?1??18162 GERTE
- ~ ~ iVatic~nrn-ide
F~ndsro
~~k~
Orr y'ac~r' Side °
P.O. fox .5354
CinClnnatl, OH 4507-5354
I7TA~,NE C GE~,TZ
?2~ ~3E~1'VER. ~~
MEGHANZCSBURG, FA 17050
Reference id: K3I00~
Re: Nationwide Funds
Account Na. l,~-910~OO~.I7~4
PAGE ~2l82
Dear Mrs. hertz
Thank you for your recent correspondence regazd~ng the Natzo~.wide Funds accounts for
C.~ertrude M~ttelsdorf.
Thzs letter is in xefexezxce to your recent zequest for a Vexifzcation of Deposit. Tlie
infurrrlatsox~ is as follows:
D~.~e Account Value Total Shares 1~AV
2/l. x/2010 x0,3$9.56 968.272 $1.0.73
Should you have any queStX~7l~s, please fees ft'ee to contact Nationwide Funds between the
wee]cd3~r hours of $'00 a.m. arYd 7:0(} p.nx. Easten~ Stanc~drd Time at 1,800-$~-$-()~~Zt~,
and a Sharcholdex Services Repxesezitative v~ill be ava~iable to assist you. We appreciate
your bttsi.x~ess ~nci thF ~ppoz-twaity to service your ac~oL~,nt.
Sincerely,
Nati.t:~t~t~~irle Funds ..
c~~ c' i~
- / r``
Brian Schmitz,
Account Resolution Specialist
. $~ s F ~~~~~ ,'re Sii,<' ~lCk~k'~r1°.3t)1.,. :~,'~.'.M11^.~1 '~ ~~.'.;,:'(~'S
i ~
.-
Un Your ~idery
November 4, 2010
Diane ~. hertz
225 Beaver Dr.
Mechanicsburg, PA 17050
RE: Nationwide Annuity Gcntract Number:
IV~tionwide Financial
P.O. Bax 182021
Columbus, OH 43218-2a~1
www. natienwide.com
d 1-5G9$g74, Estate of Gertrude Mittelsdorf
Dear Diane C. Gertz:
We appreciate your inquiry.
please accept our condolences for your loss, This cornm~,nication is providing the requested
information for the above referenced immediate annuity contract.
Please accept this letter as confirmation the value of annuity contract number 0'I-~~98974 as of
February 13, 2D10; was 567,5$9.2.
(Vote; This value is Nationwide Life Insurance company's interpretation of tl~e valuatier;i requited for
federal estate taxes as defined in Section 2~.203'l-S of tMe Internal Revenue bode. Nationwide does
not recommend use of this value for arry othsr purpose.
We're here if you need us..
PleasA contort ~s-at 1-500-4~2-7126, Mar.day through Friday: 8:00 a.m, to G:00 p.rr7. Eastern standard
Time should you have any additior}al questions or corrcern~.
Best regards,
Income Products Cervice Center
Nationwide Financial
GERTZ FpGE a2~~2
AG
HL1DS(~N ICY
September 29, 2010
5 n v i N <; s r> n ~~ is
l~~r»k ors Better l%~lltr~es•
-~ '; ski
~`eur St~<<~~.:y j A. Las: ^~j~.
In reference to your letter, here is the correct opening date with the date of death balance for account # 8000621752.
Open date - 5/10/01 Date of death balance $3,672.84
If you have any questions please contact me at the number below.
Thank yau,
Mary Lamberti
Hudson City Savings Bank
Platform Clerk
18. I~,:~c~~_r. R~?ch _~~~~~.~L°r: • P.~~sr.i.:~~~_~, Al O; 1)h~-] ;<~ % . <~; 3??~,."-I-U~
H DSON ITS
LJ July 15, 2010
S A V I N G S B A N K
Bank on Better Values"'
Dear Stanley j. A. Laskowski
In reference to your letter, here are the date of death balances and all accounts maintained by Gertrude Mittiesdorf.
Acct. # 8000615900 - CD -Opened on 09/27/93 -held jointly with Diane Gertz Closed on 7/01/08
Acct. # 8000615901 - CD -Opened on 09/27/93 -held jointly with Janet Nintzel Closed on 07/01/08
Acct. # 8000622818 - CD -Opened on 1111/03 -held jointly with Janet Nintzel Closed on 06/08/10
D.O.D. Bal. $5,057.32
Acct. # 8000622819 - CD -Opened on 1/11/03 -held jointly with Diane Gertz Closed on 06/08/10
D.O.D. Bal. $5,057.33
Acct. # 8000624016 -Opened on 4/19/06 - CD held individually Closed on 11/25/08
Acct. # 8000624017 -Opened on 4/19/06 - CD held individually Closed on 11/25/08
Acct. # 8000624018 -Opened on 4/19/06 - CD held individually Closed on 11/25/08
Acct. # 8000616383 -Opened on 7/20/94 - CD P.O.D. Janet Nintzel Closed on 06/08/10 -D.O.D. Bal. $4,880.74
Acct. # 8000616384 -Opened on 7/20/94 - CD P.O.D. Diane Gertz Closed on 06/08/10 -D.O.D. Bal. $4,877.93
Acct. # 8000616385 -Opened on 7/20/94 - CD P.O.D. Gail Steiger Closed on 06/08/10 - D.O.D.BaI. $4,880.74
Acct. # 8000621752 -Opened on 5/10/10 - CD P.O.D. Suzanne Jouravlev -Account Active - D.O.D Bal. $3,672.84
If you have any questions please contact me at the number below.
Thank you
Mary Lamberti
Hudson City Savings Ba k
Platform Clerk
187 EAGLE Rocx AvEVUE • RosELA,~TD, NJ 07068-1397 • 973.226.7405
s
•r~rrr: ~~a~rir~c r•rr rrr~rrtr~ rrtrrr: ~s~itir~~ ~ c~~: rr•r~t~~-~r~ ~r~~~rrsr;r~ ryr~tc:
L)+tre+zx L:ru^r; Sanr+y^s Hang . i.'aat~~a Savrr~ farad ~ ~;+c,~rvnd ~ow~ty ~~,nrnxr., tsar r Rorscv~,! Sa»»,rys f~~ret' ~- Ci,7t2'l~r. Str7>'k` t:,xrvn-.~^.~!1~ Is~ani
~•~ tY+vrr.+n rx Cr N~+ Ya'is ~c~'rn~rr.+yr.'Y ~~ad ~ ,tte~r>r~+ r'G!+C'
June 21, 2010
Caldwell & Kearns
3631 North Front St.
Harrisburg, Pa. 17110-1533
ATTN: Stanley Laskowski
RE: Estate of Mittlesdorf, Gertrude
Dear Mr. Laskowski:
In reply to your letter dated June 14th, we are providing the following information to your
request:
1. Savings accounts #'s 4700005264 and 4700005291 were opened on September 9,
2000 in the names of Gertrude Mittlesdorf and Janet Nintzel.
2. On February 13, 2010 the balance in account #4700005264 was $3,060.02. The
balance in account #4700005291 was $50,272.23.
3. The amount of interest posted to account #4700005264 on January 31 was in the
amount of $66.10. The amount posted to savings 4700005291 was in the amount of
$207.92.
4. The amount of interest posted to savings 4700005264 since January 31 is in the
amount of $49.49. The amount posted to savings #4700005291 is in the amount of
$813.01.
5. There is no record of any safe deposit boxes in the name of Gertrude Mittlesdorf.
6. There are no other accounts in the name of Gertrude Mittlesdorf..
If you have any further questions or concerns feel free to contact me at any time.
Very truly yours,
GEN STATE COMMUNITY BANK
Della A. Z ,
Vice Presi nt/Branch Manager
Roseland ffice
1 Sl Eagle Rock Avenue • Roseland • New Jersey • 0706&-1321
(973) 364-1993 • (973) 364-9585 Fax • www.myGSCB.com
t~Prvc
311]y ~, ~0~
Srtanle~' J. A. LaskowSkt. Esc}.
Ca.1d'Well ~ .earns
3631 ~T Front St
Hamsburg, PA 17110-153 3
RE: Gertrtade ~ Mittelsdorf
SSN: 139-49-7984
DDI7~: 02-13-2x10
Dean Mr. Laslec-wski:
In response to your request for Date of Deatb (DC~I~} balances for the customer noted above,_ our
records show the following:
~~1!~C~IIl liCCOt1t1~
Account # 5004415003 ~;stab~isbed: 06-04-200~~
GERT~.UI7E MITT`ELSDORF ~
DIATV.E ~ER.TZ ~
Tom` C-T) balance: ~ df~? , _77 -}- 1 ,7Q Y~ ~~P~ y,~t~r~et
Interest paid 01-01-2010 thru 02-I3-2010 ~ 1.04 ~
f
i
Investment Aee~unt
The decedent maintained Investment Account 2501451 ~: 6334916. For fiu~ier in~armation, you
may call file Fsroxerage i~epax-t~me~it at i -~uu- ~6>-~ t :i i .
Please note that this o~'ice provides date of death balances for deposit accounts (IRAs, ~TJs, Checl:ir~g and
Savings}. We do not process an3, financial fransacEion.~ or provide statements.. If you need assistance with
an~r of these it.~ms5 please call 1-8~S-PNC-BAND (J -~$$-762-225} ar stop by your local PNC Banlt branch
office .
Sincerely,
?vational Financial Services tenter
PNC Bank, N' .~~. i
Mernb~ FMC
I
i
i
T
YS~;, 1 OI 1
~17•~I~~,%~~~T'T~~~1~IT
Mciric~si -Ildlft, ., r,d 51f'(.
Caldwell & Kearns, Attorneys At Law
Attention: Stanley .1. A. Lasl:owsl<i
3631 North Front Street
Harrisburg, PA 1 7 1 10-1533
RE: Estate of Gertrude Mittelsdorf
Date of Death: February l 3, 2010
Dear Atty. Laskowski:
,f my 9, 2010
The Date of Death Value for securities held by Gertrude Mittelsdorf, Diane Gerta, Gail Steiger and Janet Nitzel in
Account 2503-1451 opened as joint tenants with rights of survivorship on 7/20/04 is as follows:
1257.560 shares Blackrock FD5 Municipal Money Market Port a $1.00 per share
381.447 shares Federated Equity Kaufmann A Shares ~ $4.50 per share
385.11 1 shares Growth Fund of America F-1 @ $26.11 per share
42.322 shares JP Morgan Emerging Markets Sel @ $19.65 per share
4765.758 shares Oppenheimer PA Municipal Fund Class A ~ $10.66 per share
85.780 shares T Rowe Price Mid Cap Value ~ $20.02 per share
766.332 shares Templeton Foreign fund Class A ~ $6.09 per share
424.357 shares American Funds Washington Mutual Class F 1 ~ $23.80 per share
The Date of Death Value held by same persons in PNCI Account 6333-4916 opened as JTWROS on 8/18/04 is as fo1]ows:
457.542 shares American funds US Government Securities @ $14.11 per share
516.772 shares American Funds American High Inc TR Class B @ $10.49 per share
465.030 shares Bond Fund of America Class B @ $11.91 per share
562.945 shares American Funds Capital Inc Builder Class B @ $46.14 per share
Please feel free to contact nee if I can be of further service.
Sincerely
~~
1~ ` ~'
,~%~/L., ter.. _;c:-'
Charles E. Little, CFP, VP
Financial Advisor
CEL/djp
7~e i~rfoimatiort co~atni~ied~ereiit (ras 6ec>•t o6t~i~itedfr~~rn sources eve Ge~ie~ue to Ge reEinbfe but cfo ~iot~u~raritee it to 6e accurate, correct,
co~iapCete or ti~nae(y, aiad~s~aC~rlot Gc respoasi6Ce for tie resuCts oFitai~riedfrona it's use.
f'i`J~ invE~~sfr~~ent.e E_G_~'
'~en~b~~r of 1'hf F'i`dC F irrar~c:iat Services Group
r,5~ ; ,,,
~` ~ linpo~t~.r«irne ~orlnForm tion: ~ r_~ - *r ~ ~ t.
,_ _.
- ~ ~-,, „-~~~ `t ~~
,_