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HomeMy WebLinkAbout05-17-11 1505610140 REV-1500 EX (°'_'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po sox 2sosol INHERITANCE TAX RETURN County Code Year File Number _ Harrisbum, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 0 8 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 4 8 1 4 6 0 7 7 1 2 2 9 2 0 1 0 0 9 2 2 1 9 2 2 Decedent's Last Name Suffix Decedent's First Name MI B L A C K M A N V I R G I N I A H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required QX 6. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Living Trust 1 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 t2-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number S U S A N J H A R T M A N 7 1 7 2 4 9 7 7 8 0 First line of address 1 I R V I N E Second line of address City or Post Office C A R L I S L E State ZIP Code REGISTER` _ ]ELLS USE _i5NLY ,a7 ~ - _ ~-.7 ; .~ - '- 1~- - -~ ~. ,_ _. ~-~y .. ~~ D/A'E FILED ';y-t J _._, P A 1 7 0 1 3 Correspondent's e-mail address: s u s a n h a I^ t to a n a p a• n Under penalties of ry, I deG re t I have examined this return, in m it is true, correct and plete. ra of(pr~arer otl~ than tt~Q_e I SIGNATURE PERS RESP 1 LE F FI i [; i iRUk ~C-~~ ADDRESS 2415 CLOVER DRIV SIGh1Aj,$RE OF PREPARER OTH& R 0 W schedules and statements, and to the best of my knowledge and belief, is based on all information of which preparer has any knowledge. ~~ DATE ~.~ L~ b~. ~ MECHANICSBURG PA 170 REPRESENTATIVE DATE PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: VIRGINIA H• BLACKMAN 1 4 8 1 4 6 0 7 7 RE CAPITULATION 1. Real Estate (Schedule A) ........................................ ... 1. 1 2 ~ 0 0 0 , 0 0 2. Stocks and Bonds (Schedule B) ................................... ... 2. 1 4 1 8 5 7 8. 2 8 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ....................... ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 5 8 7 ? 0 • 8 8 6. Jointly Churned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 2 3 8 7 7 0. 9 6 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ..... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 1 8 4 3 1 2 0, 1 2 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 4 5 3 0 2 . 0 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) . . ......... .. 10. 3 1 2 6 . 6 0 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 4 8 4 2 8 . 6 6 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 1 7 9 4 6 9 1. 4 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. 0 . 0 0 14. Net Value Subject to Tax (line 12 minus Line 13) .................... .. 14. 1 7 9 4 6 9 1 . 4 6 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.z)x.o _ 0. 0 0 15. D. 0 0 16. Amount of Line 14 taxable at lineal rate x .045 1 7 8 4 6 9 1. 4 6 1 s. 8 0 3 1 1. 1 2 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate x .15 1 0 0 0 0. 0 0 1 s. 1 5 0 0. 0 0 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 8 1 8 1 1. 1 2 Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 0081 DECEDENTS NAME VIRGINIA H- BLACKMAN STREET ADDRESS 8 ABBEY COURT CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) (t) 81, 811.12 2. Credits/Payments 7 7, 5 0 0 •0 0 A. Prior Payments B. Discount 4 , 0 ? 6.5 0 Total Credits (A + B) (2) 81, 5 7 6.5 0 3. Interest (3) 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. (4) 0 - 0 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2 3 4.6 2 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent Uansfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 0 3. Did decedent own an "in trust for• or payable-upon~leath bank account or security at his or her death? ......... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (01,-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: SCHEDULE A REAL ESTATE FILE NUMBER: VIRGINIA H- BLACKMAN 21 11 0081 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• 8 ABBEY COURT 127,000.00 CARLISLE, PA 17015 TOTAL (Also enter on Line 1, Recapitulation.) ~ s 127,000.00 If more space is needed, use additional sheets of paper of the same size. TaxDB Results Search Results for the 2010 Tax Assessment Database (Click 'Get Details' in the first column for individual listings) Page 1 of 1 DeuHa DistrictNo Parctl ID MapSutfix HouselVo Direction Street Owned C/O PropType PropDesc LivArn CurlaxdVal CurlmpYal CurTotVal CurPrcNal 40.24 8c VIRGINIA Get 40 0759- $ ABBEY BLACKMAN, H R 1313 31900 9 Details 001.-UB4- COURT ROBERT R 5100 127000 _ 1 BLACKMAN http://taxdb.ccpa.net/results.asp 5/5/2011 REV-1503 EX + (8-98) scNEOV~E s COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER VIRGINIA H• BLACKMAN 21 11 0081 All property jointly-owned with right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. VANGUARD MUN L T BOND FUND 70,799.53 [SEE DOD LETTER ATTACHED] 2• IMORGAN STANLEY SMITH BARNEY BROKERAGE ACCOUNT I 1,347,778.75 [SEE DOD LETTER ATTACHED] TOTAL (Also enter on line 2, Recapitulation) ~ S 1, 418 , 5? 8 (If more space ~ needed, insert additional sheets of the same size) ~ ~g r O A n ~ ~' '" d 3 gi N ~ 3 N A N V N ~ M O 8 O O 88 N ~t o ~ ( ff V O1 + y N (~~ ( (O N O O 8 , ~~ ~ ~ d R ~ ~ 7 C ~ m m rS~_ V J ' N ~ s' ~ ?~?~ i ~ ~ ~R 0 t~ n °~a• ~ 1 u n d u .... U1 ~~~ _ ~~~ 88 N pM r r N O ~ r Q ~I~I~I88~ O ~ pTj ' 3m ~ ~ '~ < m n~ !~ 3 C $ ~ :A F, 3 ~~ ~ ~ ~ u m~ ~~ 1 ~. m a d d g x g. A 1 n 0 Q bl~ 3 ~ 3 "" ~ b B R ~$ ~ p M ~ N ~j W Q • 1 7 w N [J}~~( M , ~ (=sue( ~ W 8 ~ ~ Q NI VWl O A P _ ~ V tJl + Ol h N J N Y M '~ ~ M ~ 3 . 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A k ~ rn~ ~ ~ w n ~ N~ ~ ~ ~ w a ~ ~ ,~ ~ ~. ~ N~ ~ ~ n w a ~ ~ N M j ~ C ~ W ~ ~ W ~' Z A~ ~ Y/ a ~~`O~• o ; ~'~~ n< anc ~~ a 3~~ a y '~m0 ° o ~ w`Pye y g~ v3 w? C Q'A ec e c , ' o ~ ~ o O~ a oai ~°i ~ -~ ~ ~'< m S y' ~ r. ~ ~ ~ ~ °t S y ~ F~Or~ ° ~ oaaw a~ `y°en ~ ~ \/ c~a ~ ~. ~~ ~rnm n•~ '< y w cco ~'~3 ~~ wa c'eaQ ~ nc' a ~ (D Q1 ~ 8ba'a ? y w=~' ~~ ono^ ~~ _ ~ ~nao~s~ `Q o c~~o n ny n - va t m ~,~, w ~~ m~d a a~~ ~ o y `, ~. `~ a < N rn 4 ~ T w y ? ~ '~ o~avo A a ~nno za c'~~n 4~ W' n g' ~ a' ° S e c a ti~ m$ a Q w ~ ~ ~ . ~ R N cwi- .~oy M ~ 4 w~mw ~~ ~~^ =' y cw ~ G A O . O ~~~~ ~c ~ w ~~ N C 4 Q a y i H i , O C ~„ 0~ _ ao_~ aw ~t~~c 30 ~ ~ ~ ~ O w , a k d~~ ~ y ~ w ~ a s A "`'~a~ . `~. o` w oo~ o~ wg~ w C c~ 1 N t' c:~ y e ° p 4 3 °~ ~~~ w a y v . o M~~ 4 ? o , w ~ ~ ~ y ~ a $w - ~ r ~ a c~ ~ ~ ~ ° ~ w N a con o o , ~ i o .. rpt ~r ~ o g~ °i y a w c o ~ y H o o ,a ~ ~ 1 N 4 i O ~ N r Vanguard' '`F VIRGINIA H BLACKMAN December 7, 2010 Page 2 of 2 Vanguard Long-Term Taz E~aeirlpt Fund Admiral Shares 800-2847245 - Voyager Services Fund number: 543 Account number: 9934229123 wccovNT vwLUe on 12io~i2olo s 70,79!.53 12/07 Admiral conversion in --~ - - - S 70,740.97 ---- 12/07 Dividend from LT TE INV Z 10.87 6,507.909 ~•~ 10.87 5.387 4VE ARE PLEASED TO CONFlRAA YOUR NEW VANGUARD ACCOUNT AND LOOK f=ORWAfiO TO S6~1/IWG YOU. VANfiUARD LONG-TERM TAJC-E7[EMPT FUND ~l1Y~w~• ~.~.-- • Do not alter or Photocopy fhb Invest-By-Md sNp, • Visit www.vanguard.oom a car to changeyour addn~.as. LJst each cherJc S ~ f ~ ~ ^ f ~ ~ ~ • ^ ~.~. ~^,C~C~C~,[~CJC7.DC~ ~f^~~f^~^•^~ ^,ooa,oaa.oo VIRGINU- H BLACF(MAN 6,507.909 6,513298 FU~lAl160tMlT NO, Male eMcks psyabN to: Ttw VsMwr+/ Orou~ - 0541 VANGUARD VOYAGER SERVICES PO >tOX 13750 PHILADELPHIA PA 19101-9897 ~n~~~~t~~~u~~~~~unu~~~~~u~~~~~~~~u~n~~~~~~~~ 05434 09934229123 302 30 -`~ 012223114 2 024888 2 - 2 26A6 [RY O1 3 1111111111111111~~~~~~rrr~~u^ REV-1.508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER VIRGINIA H• BLACKMAN 21 11 0081 Indude the proceeds of litigation and the date the proceeds were n:ceived 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 ~. M8T BANK CHECKING ACCOUNT # 1336037 46,095.11 [SEE DATE OF DEATH LETTER ATTACHED] 2• CAR 8,000.00 [SEE INFORMATION ATTACHED] 3• JEWELRY 1,871.00 [SEE ATTACHED APPRAISAL] 4• IAAA REFUND I 39.20 5• WEST SHORE ALS REFUND 65.97 6• STATE OF NEW JERSEY HEALTH BENEFITS FUND REFUND 699.60 7• PERSONAL PROPERTY 2,000.00 TOTAL (Also enter on line 5, Recapitulation) (i 5 8 , 7 7 0 (If more space is needed, insert additanal sheets of the same size) Page 1 of 2 Susan Hartman From: "JESSICA REESE" <JLREESE@mtb.com> To: <susanhartman~pa.net> Sent: Friday, January 28, 2011 9:56 AM Subject: Fwd: Re: prod -Date of Death Request Jessica L. Reese Relationship Banker II Carlisle High Street Office M & T Bunk 717-2-10-~5=i5 »> DATE OF DEATH REQUESTS 1/27/2011 10:16 AM »> Per you request, please find below the date of death values for Virginia Blackman, SS#148-14- 6077>. ACCOUNT NUMBER BALANCE ACCRUED INTEREST TOTAL 1336037 46094.84 .27 46095.11 This customer also has a safe deposit box at the Spring Garden branch the box number is 116 it was opened October 9, 1996. Let me know if there's anything else you need :-) Thanks, Tammy Spencer Records Management /DOD Unit M&T Bank- "Understanding what's important." »> <JLREESE(a~mtb.com> 1/20/2011 1:52 PM »> Account Information Date of death: 12/29/2010 Account Number: 1336037 Product Type: Deposit Account .~;1 ,~['*rt'iut.Y~ 'a`te ~ t'~f ~`~_il d~i~i~.3~~ri'T ~ _~,.'_k. r?ui2 1` 3:11 ~b4 ."mil: + ?~4.,+~. ~ _ 4;~ ~r~+E~I' ~'+'~''~i„"~ stir ~ ~a~~nsa H. Backman ~ceaszd_ One Thousand Eight Hundred Se~~enty One Dollars and Zero Cents) ($1,871.00) -is A~rraisa~ C.A. -irector The report must be read in its entirety. The Appraisal Summary ONL Y is not the appraisal report. 615 APFraisa~ Services Page 5 of 2 1 REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: VIRGINIA H• BLACKMAN 21 11 0081 SCHEDULE F JOINTLY-OWNED PROPERTY Han asset was made jointty owned within one year of the decedent's date of death, it must be reported on Schedule G. 2415 CLOVER DRIVE MECHANICSBURG, PA 17055 RELATIONSHIP TO DECEDENT ADDRESS SURVIVING JOINT TENANT(S) NAME(S) a.MICHAEL H• BLA s. c. JOINTLY-OWNED PROPERTY: ON 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 % OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENTS INTERESI ~. A. 03/99 PUBLIC SERVICE GROUP 10,693.75 50• 5,346.88 339.916 SHARES a 31.46 2• A• 03/99 AT&T 57,408.56 50- 28,704.28 1958 SHARES a 29.32 3• A• 03/99 VERIZON 38,052.84 50• 19,026.42 1068 SHARES a3 35.63 4• A• 03/99 NORFOLK SOUTHERN 169,884.00 50• 84,942.00 2700 SHARES a 62.92 5• A• 03/99 COMCAST 4,787.02 50• 2,393.51 217 SHARES a 22.06 6• A• 03/99 FRONTIER 2,467.84 50• 1,233.92 256 SHARES a 9.64 7• A• 03/99 U•S• TREASURY BONDS 100,000.00 50• 50,000.00 [SEE DOD INFORMATION ATTACHED] 8• A• 08/98 PNC SAVINGS ACCOUNT X5000882464 64,621.95 50• 32,310.98 [SEE DOD INFORMATION ATTACHED] 9• A• 09/09 NCFCU - SAVINGS ACCOUNT 5.00 50• 2.50 [SEE DOD LETTER ATTACHED] 10• A• 09/09 NCFCU - CHECKING ACCOUNT 3,289.19 50• 1,644.60 [SEE DOD LETTER ATTACHED] TOTAL (Also enter on Line 6, Recapitulation) I s 2 3 8, 7 7 0. 9 6 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent VIRGINIA H. BLACKMAN 21 11 0081 Decedent's Name Page 1 File Number Schedule F-2 -Jointly-Owned Properly 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 % OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 11• A• 09/09 NCFCU - MONEY MARKET ACCOUNT 26,331.74 50• 13,165.87 [SEE DOD LETTER ATTACHED] SUBTOTAL SCHEDULE F-2 ~ 13 ,16 5.8 7 GRAND TOTAL SCHEDULE F-2 ~ i 238, 770.96 Public Service Enterprise Group Incorporated (PEG) Historical Stock Prices & Data - N... Page 2 of 3 Download This File in Excel Format Date Open High Low Closall.ast Volume v Buy stocks y~,,~,,,~ for S j~ 7~'ioR ao a~vs ® zwrz.zz srcwrtaz uz alMapf Popular Sediona: Careers ~ Flash puotes ~ Stock Ticker ~ Nasdaq Loo I ETFs ~ Company News I Stock Charts ~ SEC Filings I Get Free Annual Reports Popular Tags: stock quote ~ currency converter ~ credk cards ~ online investing i crosswords ~ stock research ~ cuo ~ agar hour trading I mutual funds Privacy Statement ~ Copyright I Disclaimer i Trademarks ~ List of Companies I Help ~ Contact Us ~ SRe Map ~ ~I Feedback Too Stock for 2011 - GTSO Desperate Search For Rare Earth Minerals Solved. Rare Opportunity. www RareEannExponers com Ton 12 Stocks to Buv Now Panel of nation's leading analysts just announced their favorite picks www ro(rsmckAOarysts oom Free Pennv Stock Picks Get Up To 600% Gains in Days. Free Email Sign Up. 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Download This Fiie in Excel Format Popuiar Sections: careens Dab Opan High Low CtoaelLaat Volume I Flash puotes I Stock Ticker I Nasdaq t00 I ETFS I Company News i Stock Charts i SEC Filings I Get Free Annual Reports Popular Tags: stock quote I currency converter I crodk cards I online investing I crosswords I stock rosearch I taco I after hours trading I mutual funds Privacy Statement I Copyright I Disclaimer I Trademarks I List of Companies Help Contact Us I Site Map I ~I Feedback M ~I~~ Y lLTRAOE iRE ipp 60 DAYS ~~SOC~OTRADE~ rarurrsrcrires~ o0tiona ituaYs Too Stock for 2011 - GTSO Desperate Search For Rare Earth Minerals Solved. Rare Opportunity. www RareEannEzponers wm Dividend Paving Stocks Learn About The Income Potential & Dividends of Dividend Weighted ETFs wvnv Ntsdomrme cortvDrvtnt 600Y. Penny Stock Gains Alerts on stocks that move. Huge Returns. Free Sign Up! wwe c~adiatorStocks tom eS Aei w C,«sgk S+1 L1 aC14~ ~ 3 ~, 05z t8'~ ~,O(~r8 http:/;~w~r~w.nasdaq.com/aspic/historical quotes.asnx?symbol=T&svmhnl=V7Xrwmhnl=N ~;~ ~i?nt t 35~~ ~t~~~l~~~~~°~~~R~~i~'~~d~t-~~t~g~cs~~s~aF-~~~-k~DAQ.c... ~ ~ ~~ egister Sign In Help ? New User Preview Mail cal Toolbar Yahoo! Mail - R w ~~~~~~~, ~ ~ N ~ ~ ~ ~ Search...... ~ ....~ x~~ _-.~.,P .,o. ~ Web Search Dow 10.08% Nasdaq i 0.07% HOME INVESTING NEWS & OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER --~ CaET QUOTES Finance Search Fri, Feb 11, 2011. 10:34AM EST - US Markets close in 5 hra and 28 mins Norfolk Southern Corp. (NSC) At 10 18AM EST 63.43 t os9 rosri i ~~OFRE NSC IS UP Nsc Historical Prices Get Historical Priees for: I C'~, Set Date Range Daily Start Date: Dec 28 2010 Eg. Jan 1, 2010 Weekly End Date: Dec 31 2010 Monthly Dividends Only Get Prices First ~ Previous I Next ~ Last Prices Date Open High Low Close Volume Adj Close' Dec 31, 2010 62.62 63.01 62.60 62.82 1,132, 300 62.42 Dec 30, 2010 62.77 63.03 62.51 62.74 1,178,200 62.34 Dec 29, 2010 62.81 63.13 62.72 62.74 1,156,700 62.34 Dec 28, 2010 62.88 62.95 62.38 62.71 1,024,100 62.31 ' Close price adjusted for dividends and splits. ,"~ First ~ Previous ~ Next ~ Last a°''~ thinkorswim by ~' •.,..rr.r. ~~ Download to Spreadsheet Currency in USD- Copyright ®2011 Yahoos Inc All rights reserved. Privacy Policy -About Our Ads -Terms of Service - Copyrght/IP Policy -Send Feedback - Yahoos News NelWOrk puoba delayed, except where indicated othervnse. Delay ernes are t 5 mins for NASDAQ NYSE and Amex. 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Intematbnal historical than data. deity updates, rand summary. fund performance. dmdend data and Momingater Index data provitled by Marmngstar, Inc k-11ic~,:•b~it-lit'Nie~ ~ - ~R~~~~hn.~.~sa~}rlr.~~i~nmu~.~l~r~~~r~v~dti+~.i.~>~1~+~~ib~~jf tllv9,~~"t.l ~/7OVX ~/1 1 /fit 1 /.7 Comcast Corporation (CMCSA) Historical Stock Prices & Data - NASDAQ.com Page 2 of 3 Popular Sections: Careers Download This File in Excel Format i Flash puotes I Stock Low CloseA.ast Volume Ticker I Nasdaq 100 I ETFS Company News Stock Charts I SEC Filings Get Free Annual Reports Popular Tags: stock quote i eurroncy converter crodR cards I online investing i crosswords I stock rosearch i csco I aRerhourstrading I mutual funds Privacy Statement I Copyright I Disclaimer i Trademarks i List of Companies I Help ~, Contact Us I Site Map I •i Feedback er Buy Blocks ~` TRADE ftt~ iDi sq Tf ~~ ae ~~,.~ [{IqN i[clpiTRT NC YLx[k't Q Municipal Bond Search Search for twnds by state, maturity 8 credit, RBC Wealth Management www Racaonasearcn.com Commodity Charts Receive Free Commodity Charts, Ouotes & News. Sign up Online Now! www Uod-Waltlock crrrvcnans Comoanv Information Get the most comprehensive company information available. Free Trial waw noovers coM Qg Adf M Goo$Ir fVAS~tt*i~ f y~ 789, 02 httn•!/~[~~cn: n•ic~,an rnm/acres/hictnrii~ol mtiit.~c r[crw`)c~ mh~I-TR.cvmh~l-V7R.o.~ml..~1-T~i ~/ 7 ~~t I i~nt t ~~.Ob Date Open High I~~t~~~~eomiP~~~b~t~~~~r~~~~~~~~4~4~~~f~~o~~~~'~~~~~"'~'A~~S>;U ,~i~d~'~ ~~.~~~~a ~,,.~. ~~ ._~,a~,~~.~~~~.~~w,.~~~.~..w~.~.~~~,~.~ .~ , ,a.. ~.~.~~..._._ Download This File in Excel Format Popular Sections: Careers j Flash Guotes j Stock Low CIOpILast Volume Ticker !Nasdaq 700 j ETFS j Company News ! Stock Charts i SEC Filings j Get Free Annual Reports Popular Tags: stock quote j currency converter j credit eardn j online inventing j crosswords j stock rosearch i cseo j after hours trading j mutual funds Privacy Statement ! Copyright j Dixlaimer j Trademarks j list of Companies j Help j ContaM Us j Site Map j d Feedback M ~~ TRADE iR8 FOR 80 OAYS [f1W[ 5[CWTaf ll[ Too Stock for 2011 - GTSO Desperate Search For Rare EaRh Minerals Solved. Rare Opportunity. www RareEannExponers com Too 12 Stocks to Buv Now Panel of nation's leading analysts just announced their favorfte picks www rop5tookAnaystsmm 600Y. Pennv Stock Gains Alerts on stocks that move. Huge Returns. Free Sign Up! www claoialorSlocks corn ~ Adn M G°°gk j~~L167.SL ,~v`~G a,~~'„:r~?~~d; r,a"-~~„ ~~°t'~~~Cd,~,`t~>?tr•;~~Qt7Rt~~~~~dY`b~~l~-~1~~'?~k~4~A.~,;;1~k1O:)~,~:~'~?~juu ~~'~N~1t n .., Date Open High 7D S17T (S~p4rnbw 20104 Le9~Y Treasury Directs ~.~~.~ -eoa.7zx ae„ ~ ~eeo-e~e~ ~ouisw. n» u.3., MICHAEL H BLACKMAN OR VIRGINIA H BLACKMAN 2415 CLOVER DR _ NECHANICSBtJR6 PA 17055-5726 ~~9 Mumb~r 0310030: TREASURY RETAIL SECURITIES STFE P.O. BOX 56? PITISBURC3H FA 15230-0567 PHONE: (800) 722 2678 - - _- - - - - - 1 766-7546 or 71 243-8810 Papmenta meda by di>recx deposit to: - PNC BANK _- ~----~ - - .. .,. ntial -- -Routia~l't~aeibe>~-031312738-- - - - - Name on Account MICHAEL H BLACKMAN SAVINGS Amount Nnmber: ConSdential - - _.._ No withho ACCOUNT HOI.DING3 n2s2arn3 ~ 3/~i NOTE F 11 ~3/31/11 1~, n2a2a~c1 i 1/~ NOTE K 11 _ K/3~/11 1~, l12s2r1CZ7 ~ b/i NOTE N 12 a7/31/12 la, n2us,~n 3 1/>t NOTE ~ 13 N/31/13 1~, l12i2rxC2 2 b/i NOTE ~ 14 ~7/31/U 1~,~~~ bl lb,bbb 03/3LK !l.Mblfi ~.7rti - a'~/3L11 M eM Inert 1~,237.b~ sl la,~a~ a~3•/K ».siMb3 b.za3 12/31/1• I t -~_ n ~e{ 2ii.2i ~1 1~,~~~ ~7/3L~7 ~l.~337~i ~.K 11/31/11 Inter{ Z31.2i 01 10,~bb N/b2/~i l1.~1374 3.12! ~2/2Vi1 Intahs} lii.2i ~1 1~,~~~ a7/31/~~ ~l.7aZ~4{ 2.fi! ~L31/il ~tserat 131.2E IF YOU HAVE pUE3TIONB CONCERNMK3 TH18 3TATEIIN:M, PLEASE CONTACT YOUR TREASURY RETML SECURtT1E8 SR'E AND PROVIDE YOUR ACCOUNT NU~ER ~, L'_', ~. ~ into V~, _~,u~~ ~h,~ %J L~'t ~~, ~~ l.tftDiNG ~liE WAY February 25, 2011 Susan J Hartman Esq. Duncan & Hartman P.C. t Irvine Raw Gtirlisle, PA 17013 RE: Virginia H Blackman SSN: 148-14-6077 DOD: 12-29-2010 llear Ms. Hartman: In response to your request for Date of Death (DOD) balances for the customer noted above, uur records show the following: Savings account Account # 5000$82=164 Established: 08-23-1!398 MICHAEL H BLACKl~LAN VTRUIiV']A H $LACKl~L4N DOD balance: $ 64,612.69 ~- 9.26 accrued interest Interest paid 01-01-20i 0 thru 12-29-2.010 ~ 26 i . ~3 ~C~TD Please note that this office provides date of death balances far deposit accounts (IRAs, C"Us, ~'hecking and Savings). R'e do aot process any financial tranyactioos or provide statements. tf you need a.;sistapce with any of these items, please call 1-888-PNC-BANIt (1-888-?62-2~b5) or step by your kcal PNC Bank branch off ice. Sir_cerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intended,t~r the use of the individual or entity to which it is au'dressed :,md mcn~ crintain inf~rmc7tiun that is privileged canJidential and e.rempt frvm disclosure 2~rder upptie;zble lcru'. IJ~the reader of thin ,nessuge is not the intended recipient ear the errrplvs~ee or u~e-lt rrspa~.cibte far delivering this message to the intended recipient, you ure hereby notiJiad that urty dissemi~lution. dis~7ibution or copying of this communications is strictly prohibited Ij you hcnne receiti~ed this cammunicativn in error. please note me immediately by reply or by telephuhe at 8U0- %d'-1 ~ i~ and immediately ciestrny this faxed document. Psge 1 of 1 Y'vur Comtnuttih' Credit Union F.Q. Rox (;ti$. lv~v; Cumberland, t'A 17070-06ti~ l'hnne. {?17j 7?~1-77+)~ • 1-SO()-71b-~~~3 • Fax: {717) 71~-'99fi • WeL~: ~°~~'w.ncfcut?nli~e.i>r lvia;-ch 1?, 201 I ~i1I1CaI1 ~~ 1.4~rbnan, P.(~. (9tte h-viite Row C'ar1_i.sle, PA 17013 RE: Estate of Virginia ~. ~31ackti7an Date of Death: 12/29/2(11() Dear. Ms, Hartman., Pursuant to }-otu' letter dated k'ebrtlary 10, ?01.1., i~1 regards to Estate t}~ Vir~?inia H. J3lackmati the int~zn~atiati is :~.s follows: Account Ntunber: Orvxter(s j ot~ Account Date acct opened: Date ~f Ueath Balances Dividends as of UOX~: Divi.den.ds as of YTU: 90393 ]~•Tirh~iel ~. Blacktnan,Ovvner Virginia H. $1ack3nan, Joint OLVner (19/1 S/09 ~1 (Sac-ings) $ S.ij(} ~3 (Money Market:) $26,177.18 S4 (C'hecking) $ 3,?89.19 $ 154.y6 $ I ~7.Q7 It you need an5~tlur~ additional, pertaining to this matter, please do nat hesitate tc~ contact me directly. Si~c;~t~v; ~,, ~,~~~' ~~ ~ B~irhra~J_ Wright BratlCh I~-Tana` er .laiew Cumberland Federal Credit Union REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER VIRGINIA H• BLACKMAN 21 11 0081 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. EWING BROTHERS FUNERAL HOME 12,080.64 2• DEATH CERTIFICATES 36.00 3• GRAVE MARKER- Ginrich Memorials 2,258.00 B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. AttomeyFees: DUNCAN & HARTMAN, PC 28,000.00 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant SVeet Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 1,152.50 5 Accountant fees: 6. Tax Retum Preparer Fees: 7. CUMBERLAND LAW JOURNAL - LEGAL NOTICE 75.00 8• THE SENTINEL - LEGAL AD 176.92 9• REGISTER OF WILLS - FILING FEE 15.00 10• REGISTER OF WILLS - 2 SHORT CERTIFICATES 8.00 11• HELD IN RESERVE 1,500.00 TOTAL (Also enter on Line 9, Recapitulation) I S 4 5 , 3 0 2.0 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER VIRGINIA H• BLACKMAN 21 11 0081 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. MET ED 133.65 2• MET ED 228.81 3• MET ED 217.28 4• USAA - VEHICLE & HOMEOWNER'S INSURANCE 751.27 5• ROBERT CAIRNS - TAX COLLECTOR - 2011 REAL ESTATE TAX 275.68 6• IBIS - JEWELRY APPRAISAL 240.00 7• U•S• TREASURY - 2010 TAX DUE 896.00 8• PA DEPARTMENT OF REVENUE - 2010 TAX DUE 36.00 9• BANK FEES 83.50 10• RECORDER OF DEEDS 63.00 11• MET ED 201.41 TOTAL (Also enter on Une 10, Recapitulation) I S 3 ,12 6 •6 0 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: VIRGINIA H• BLACKMAN 21 11 0081 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY IJo Not List Trusteets) OF ESTATE i TAXABLE DISTRIBUTIONS [Indude outrtrgght spousal distributions and transfers under Sec 91'f6 (a) (1 2) ) 1. 2. 3. 4• 5• I1. MICHAEL H• BLACKMAN 2415 CLOVER DRIVE MECHANICSBURG, PA 17055 MARINA NOVALIE 1404 BRADLEY DRIVE CARLISLE, PA 17D13 MICHAEL H• BLACKMAN 2415 CLOVER DRIVE MECHANICSBURG, PA 17055 ROBERT R• BLACKMAN 1352 CORNWALL PLACE NORFOLK, VA 23508 AMY BLACKMAN MANOFF 9 HIGH RIDGE ROAD RANDOLPH, NJ 07869-4567 Lineal Collateral Lineal Lineal (Lineal 100,000.00 REAL ESTATE PERSONAL EFFECT 10,000•DO 150% RESIDUE 125% RESIDUE 125% RESIDUE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I S 0.00 If more space is needed, use additional sheets of paper of the same size. LAST WILL 8t TESTAMENT OF I, VIRGINIA H. BLACKMAN, of 8 Abbey Court, Carlisle, South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give and bequeath Ten Thousand ($10,000.00) Dollars to Marina Novalic. FIFTH. I give, devise and bequeath my home located at 8 Abbey Court, Carlisle, Pennsylvania, and all of its contents, unto my son, Michael H. Blackman. If Michael H. Blackman predeceases me, then to my son, Robert R. Blackman, Jr. and my granddaughter, Amy Blackman Manoff, in equal shares. SIXTH. I give and bequeath unto my son, Michael H. Blackman, the sum of One Hundred Thousand ($100,000.00) Dollars, in cash or in kind from my Wayne Hummer Investments Account # 050-075 1 7-1-4. If Michael H. Blackman predeceases me, then to my son, Robert R. Blackman, Jr. and my granddaughter, Amy Blackman Manoff, in equal shazes. SEVENTH. I give, devise and bequeath all the rest, residue and remainder of my estate to be divided as follows; 50 % unto my son, Michael H. Blackman; 25 % unto my son, Robert R. Blackman, Jr.; and the remaining 25 % unto my granddaughter, Amy Blackman Manoff. In the event that Michael H. Blackman or Robert R. Blackman fails to survive me by thirty (30) days, then his portion of the residue of my estate shall pass to Amy Blackman Manoff. In the event Amy Blackman Manoff fails to survive me by thirty (30) days, then her shaze shall pass to her children. EIGHTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. NINTH. I hereby nominate, constitute and appoint my son, MICHAEL H. BLACKMAN, as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation }k; or inability to act for any reason whatsoever of Michael H. Blackman, I nominate, constitute and appoint my Attorney, Susan J. Hartman, of Duncan & Hartman, P.C. as Executrix of this my Last Will and Testament, with the condition that her commission for acting as Attorney and Executrix be limited to eight (8 %) percent. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he may be called upon to act insofaz as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. TENTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two typewritten pages this ~ day of Mazch, 2006. .L~ l.J+- -Pl . rl_ ~ ~i~ ~ ~2..~ ` ~ A~ 1. tL. V. Virginia .Blackman Signed, sealed, published and declazed by the above named Testatrix Virginia H. Blackman, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. -D. AA A COMMONWEALTH OF PENNSYL VANIA . . SS. COUNTY OF CUMBERLAND _ I, Virginia H. Blackman, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Virginia H. Blackman Sworn or affirmed to and acknowledged before me, by Virginia H. Blackman, this ~~ day of March, 2006. Notary Pu ' NOTARIALRIAL S~F.AL Kathy L. Mummert, Notary Public f~cn~ugh of Carlisio, Cumberland Co., PA t~iy ~i(1n;ii:I:iS~::I1 ri'.:' t'~$ /dug. 11, 2J07 COMMONWEALTH OF PENNSYL VANIA COUNTY OF CUMBERLAND SS. We, ~,~1~ ~ ~CIC~Q Y~ and ~-t~ ~ Ae~mS the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Virginia H. Blackman sign and execute the instrument as her Last Will; that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~, Sworn or affirmed to and subscribed by Svsar~ ~ ('~uC~a r1 and Spun ~ t~C.~ rYt S ,witnesses, this ~ c~ day of March, 2006. Not lic ~ NOTARIAL SEAL I<athy L. Mummert, Notary Public ~Bcrough of Carlisle, Cumberland Co., PA L ~~y Commission Expires Aug. 11, 2007 REV~BS t=X (05-04) 4 8 5 0 0 0 4 ], 0 4 6 SAFE DEPOSIT BOX INVENTORY PA OeperUrlerlt d Revenue Sodal Security or Death CertNfcaAe Number Date of Death rLEASB UIiE ORIGINAL FORM ONLY ,5.9'50 ~i3 E / Caurny Cade Year' Fib Number , , .Z / ~ 9/o?oia Decedent's Last Name , ~ ( v~o/U , Suftbc ,LJ jaCKrr.gn First Name MI ©ADDRESS OF DECEDENT STREET: ` V I `~ ~ h ~ q H e L CITY: STATE: ZIP CODE: NAME AND ADDRESS OF PERSON REQUESTING THE OPENMVO OF THE g O ~E D NAME: O 6 BO , I „ . ~ n . E S fT X MrcHget ~/sccKrn STREET ADDRESS: b. NAME: -Sk Sa., T 2-~A - ~- ri ra STREET ADDRESS: 12nc Trvr,. f2o~ c. NAME: STREET ADDRESS: NAME ANO amoca: ne ~......... _ . . CITI- RELATI STATE: Zip CODE: i i ~_ ZIP CODE: RELATIONSHIP: CITY: STATE: Zlp CODE: NAME: --_"~ .••~ ~ • • v ~ n+n nnERE THE SAFE DEPOSIT BOX M LOCATEn STREET ADDRESS: S C i t h CITY: ATE: NAME of PE ING LAST ENTRY ~ ` /r DATE AND TIME OF LJ1ST ENTRY DATE OF CONTRACT TO RENT BOX NUMBER OF BOX ~ - / - _ ~/ ~ TITLE UNDER WMICN BOX IS REQUESTED NAME AND ADDRESS OF PE S Yi { . _ ~i Qi_ i~. RSON( I NAVINO ACCESS TO BOX ~. NAME: -110, hu t P, roc Kwtan b. NAME: STREET ADDRESS: -----__ t~/,j C~~ ~ c ~ S r STREET ADDRESS: CITY: STATE: ZIP CODE: -~-" CITY: NAME AND TITLE OF EMPLOYE TAKpiG THE d 1cTinw .1.1 Fynely t/~ WAS A WILL IN THE BOX9 ^ YES ~ NO K yes, a. Dab of wNk b. Name and address of personal reprseenyq~ N named M tl» vvM "---- NAME: STREET ADOItES3: CITY: e. Name and address or +~eorrNx M ~ NAME: STREETADDRESS~ CITY ~„~, 46500041046 ZIP CODE; , STATE: ZIP CODE: STATE: Zlp CODE: STATE: ZIP CODE: 44500043046 J R~'~85 ~ SAFE DEPOSIT BOX INVENTOR INSTRUCTIONS Y Pe9° ~ ~-~ NO. (~) Cash: Report total only. (zl 3~ d List in detaN every common or ~~~ oertillcate, wa ~panY. certificate number, dale of Trent or other rights found in box. Stocks are to be deslgrrated (3) Obligagone of U.3. t;ovem certlflcate, name in which stock sa registered, and num by f.e., jdntly held. ^renr Number of items. date of issue. tats vakre, n ~ of shares and ~ d clock. payable on death, etc. amen in which registered and type of ~. (4) Bonds: Designate by name. amount, (S) Bank and Savi serial number, or other designation. (Bearer Bonds) ngs and Loan Passbooks: State and branch, and balance. name of depoailpr, number of book. leaf date (6) Jewelry, Coins. 3tam aPpearirp in book. name of bank (n Deeds, Mo [~• Manuscripts, ate: List and describe as fogy as p~b~. n~l~ . Currant Inwrance Polklea or ot~ aWdMgs of Indebtedneq: L(st and describe as lu (tl) All other co (g) Return compNgd form to: _ ~ ~ PossiWs' INHERfTAN E TAx HARRISBURG 2tgapl PA 17t2g.pg01 ~ _ ITEM DESCRpTpN L 1 CEIC !ckl~~~ _ ,wp C ~^+~~ r r1AT THE AOOyE RECD M °~~ T'o TME sEST os Mr grpy~~,~ ~ ?~l ~s'...~~, ~: ~+-rrr a ~' n ~ ~ ""° ~AOwtuTE sox ow: V t' ~''f .u 4 T ~ii rt 1~ a~ ~* ~vanoPawrF sox - NOTE: ARtsch additlony A'/:' x 11' a ~ ~ ~'"'0"'" ^ ~:x ~•~.- a ,.w E~y at +T u.s.c. Bros ~ ~s b rsq„1s ~nry of soad s ~°~ ~ PPE o1 fom1, ~ ~• ~ a aec.d.r „d rep,eMr,~ of he eafala. t>tia auhoriya, lh. rir raw he ~Ammor>Mea~,a ~ 'nrea8- aw ale ore rn nb,mi1~~ ~ ~r aNS. Th, DepNrwt ueNa he re~Adersial me inlbrn~ ~ d Isr Ywbrrrrim apeenrrw REV-485 EX SAFE DEPOSIT BOX INVENTORY Page ~ °` `~ INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stodt is registered, and number of shares and class of stock. (3) ObIlgaHons of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (t3) Jewelry, Coins, Stamps, Manuscript, etc: List and describe as fully as possible. (T) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other conbnb. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280801 HARRISBURG, PA 17128-0801 ITEM NO. ITEM DESCRIPTK)N __ _ _ __ - __ - _ _ -. --_ _ -_._ _ _ __ _ -- _ --- __ --- __ __ __ PLC _ ~a±~ l_. _ w.; ~tb_>L ~ ~ ~ i s ,.~' __r~~------ ----_ - -- __ - - - ---- -- - - --- ___ --- _ _ -- - _ -- - - -- __ __ -- _ _ - - -- -_._ -- _en _ rt±----X(1Q-21S__ tn_X_[;4~f. o., ,~~,__ _ ~ ~ -~° ,~ ~c ~z - ! `~~--- _ -- -- - -- - --- _-- y _ -- - - - _ - ea( C ro ~ s , - -----~~n ___ __ - -- - __ ---- ---- - - _..--- - -- - -- -. __ - -- _ - _ - - °?G - t2t~1 ~ ~ t~C._c; --~ c,r f t t. -- bcv ~„.~ :z~4- ~ >!~ n c _ _ _ - -- _ __ ___ --- _ - -- -~7- _ _- ----- ------- ------ --- ----- --- - _ _ --- ~n_- _ fLuc_~_ (~•t_ -- ~ ~ toc </t_,_ r, -blc_ _ _ - _ - _- _ -- - - -- _ - ---- - _ ~ old c to n~ckl~c~ct_wi_*l. Var~~.~s ~~! ~~c~~41-~'_~c ~iarMS, I CERTIiY UNDER PENALTY Oi PERJURY THAT THE ABOVE RECORD IS CORRECT ANO COMPLETE TO THE 9EST OF MY KNOYtIlEO(;E ANO B PERSON RECENIHII'i COPY Of ELIEF. StGNAT ~ SAFE DE SR NTQ St ~ ~ // / L ,7 PRINT NAME O Qha y PRIN~fITLE ~' ~~tr/ PRINT ANp CHECIf E90Xe L ~`~G~4Ct ~7 B~kC)CiY-'W^ ~ GATE CHECK APPROPRUITE BOx ' ! j V r [ < I r~ `Ji ~ ~~ ~' ~ i- j ~QA~ ~ -/ 0 - !/ ~ E~ecLlaryvia) ~ Admirnstraloritru- Espt" Reprasenta0v~ ~ Jant owner d sak dsposrt poi NOTE: Attach additional 8'/~" x 11" sheet(s) it necessary a use dupNcatas of this pegs of form , The Department rs authonzed by taw. s2 U S C ¢WS (cN2NC1(i-. ro tequve d~sdosure of Socal Secwity ambers ~ connec0on ,~ atirntmstetirg state tax laws. The Departrrtertt uses the Social Sea,nty number to ~Qenhfy the decedent and personal represenfahves of the estate The C . ornrrtOnweallh may also use the infortnabpn in ext~angs of tax ~nformabon agreernenfs wtlh Federal and Ip(;al taxi aurhan6es. The state taw bits the Cornmornvealtft's net from di oonfwenrial tax mkXmaOOn ex for offiaal