HomeMy WebLinkAbout07-18-11 (4)ESTATE OF SHIRLEY BENNETT LOTZ a/k/a
SHIRLEY ANNE BENNETT LOTZ, DECEASED.
Court of Common Pleas of Cumberland County, Pennsylvania
Orphan's Court Division
ESTATE OF SHIRLEY BENNETT LOTZ a/k/a ,
SHIRLEY ANNE BENNETT LOTZ, DECEASED.
No. 21-2010-1196
PETITION FOR ADJUDICATION/
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT to PA. O.C. Rule 6.9
This form maybe used in all cases involving the Audit of the Account of a Decedent's EstatEa. If space is
insufficient, riders maybe attached. Attach the spouse's election, if any; the papers required under items
8-79 inclusive; and any instrument pertinent to the adjudication.
INCL UDE A T TA CHMEN TS A T THE BACK OF THIS FORM
JERRY R. DUFFIE
Attorney Identification Number: 09601
Johnson, Duffie, Stewart & Weidner
P.O. Box 109
Lemoyne, PA 17043-0109
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Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Decreased
1. Name and address of Petitioner:
RICHARD S. SIMPSON II
426 South Third Street
Lemoyne, PA 17043
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
Is this the first accounting by this fiduciary? ..........................................Q Yes ^ No
If not, identify prior accountings, the accounting periods covered and lrhe date of
adjudication of the prior accounting.
2. Decedent died on November 21 2010
C~1 Letters Testamentary or ^ Letters of Administration were granted to Petitioner on
December 7, 2010. Exhibit "A"
Date of Will (if applicable): _ May 26, 2010
Date(s) of Codicil(s) (if applicable):
Was a bond required? ^ Yes D No If yes, state amount:
Are proofs of advertising of the grant of letters attached?..... fJ Yes ^ No
Exhibit "E3" and "C"
Dates of advertising of grant of letters: Cumberland Law Journal: December 31,
2010 and January 7, and January 14, 2011; The Patriot News December 2~~ and
December 31 _2010 and January 7, 2011
3. Was decedent survived by a spouse? .................... ^ Yes QNo
If yes, name the surviving spouse:
4. Has the surviving spouse filed to take an elective share? ^ Yes ^ No
5. In the case of an intestacy, state the names of the decedent's surviving children
or surviving issue of deceased children (if none, so state):
2
Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Deceased
6. Did decedent marry after execution of Will or Codicil(s)?....... ^ Yes Q No
Were any children born to decedent after execution of
Will or Codicil(s) ........^ Yes Q No
If yes, give names and dates of birth:
Name Date of Birth
7. If required by the Medical Assistance Estate Recovery
Act, 62 P.S. § 1412, was a request for a statement of
claim sent to the Department of Public Welfare? .................... C~1 Yes ^ No
Exhibit "D"
8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has
been or will be given to all parties in interest listed in item 9 below, all unpaid
creditors and all claimants listed in item 10 below. In addition, notice of any
questions requiring Adjudications as discussed in item 14 below has been or will
be given to all persons affected thereby.
A. If Notice has been given, attach a copy of the Notices as well as a list of
the names and addresses of the parties receiving such Notice.
B. If Notice is yet to be given, a copy of the Notice as well as a list of the
names and addresses of the parties receiving such Notice.
Exhibit "E:"
C. If any person entitled to Notice is not sui juris (e. g., minors or
incapacitated persons) Notice of the Audit has been or will be given to the
appropriate representative on such party's behalf as required by P'a. O.C.
Rule 5.2.
D. If any charitable interest in involved, Notice of the Audit has been or will
also be given to the Attorney General as required under Pa. O.C. Rule
5.5. In addition, the Attorney General's clearance certificate (or proof of
service of Notice and a copy of such Notice) must be submitted herewith
or at the Audit.
9. List all parties (charitable and non charitable) of whom Petitioner has notice or
knowledge, having or claiming any interest in the estate as beneficiaries under the Will
or Codicil(s) or as intestate heirs if there is a complete or partial intestacy:
3
Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Deceased
A. State each party's relationship to the decedent and the nature o1`
each party's interest(s):
NAMES RELATIONSHIP TO DECEDENT INTEREST
Dyane V. Smith Daughter 90% of Residue of Estate
PO Box 723
Bethel, CT 06801
B. Identify each party who is not sui juris (e.g., minors or incapacii:ate
persons). For each such party, give date of birth, name of each Guardian
and how each Guardian was appointed. If no Guardian has been
appointed, identify the next of the kin of such party, giving the name,
address and relationship of each.
C. State why a Petition for Guardian/Trustee Ad Litem has or has ino~t been
filed for this Audit (see Pa. O.C. Rule 12.4).
D. If distribution is to be made to the personal representative of a deceased
party, state date of death, date and place of grant of Letters anti type of
Letters granted.
10. Other than the claim for the family exemption, list names of all known claimants
and the amount of their claims and state whether each claim is admitted.
Name and Addresses of Each Claimant Amount of Claim
Claim Admitted?
Will Claim Be
Paid in Full?
^ Yes ^ `des
^ No ^N~o
If the estate is insolvent, attach a schedule setting forth the order of preference I,~nder
20 Pa.C.S. § 3392 and the proposed payments.
11. Was family exemption claimed? ................................. ^ Yes Q No
Was family exemption allowed? ................................. ^ Yes Q No
Family exemption claimant's name and relationship:
Name:
Relationship:-
12. The amount of Pennsylvania Transfer Inheritance Tax and additional
Pennsylvania Estate Tax paid, the date(s) of payment(s), and the interest(s)
upon which paid, are as follows:
4
•
Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Deceased
Date Payment Interest
February 17 2011 $ 13.000.00
May 6, 2011 $ 887 73
13. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent under
power of attorney) or surety on the bond of a fiduciary?........ ^ Yes Q No
If yes, provide the name of the estate, indicate whether an account hals been filed
and confirmed absolutely and all awards performed, or, in the alternative, how the
decedent's estate will be discharged for the decedent's fiduciary administration of the
estate.
14. A. Describe in detail any questions requiring adjudication and state the
position of the Petitioner(s) as to each question: See attachment
B. Has notice of the question requiring adjudication been given to the parties
identified in Paragraph 9 above? .............................. Q Yes ^ No
15. If Petitioner has knowledge that a share has been assigned, renounced,
disclaimed or attached, provide a copy of the assignment, renunciation,
disclaimer or attachment, together with any relevant supporting documentation.
16. Had the decedent been adjudicated an incapacitated person? ^ Yes Q No
If yes, attach a copy of the Order if available: otherwise state the Court, term,
number, date, and name of Hearing Judge.
17. A. List or attach a separate list of additional receipts and disbursements
since the closing date of the Account.
B. Has notice of the additional receipts and disbursements been given to the
parties identified in Paragraph 9 above? ..................... ^ Yes ^ No
18. If a reserve is requested, state amount and purpose.
Amount: $350.00
Purpose: Expenses incurred in preparation of Accounting and potential claims against the Estate _
If a reserve is requested for counsel fees, has notice of
the amount of fees to be paid from the reserve been given
to the parties in interest? ..............................................^ Yes ^ No
If so, attach a copy of the notice.
5
Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Deceased
19. Is the Court being asked to direct the
filing of a Schedule of Distribution ........................................... ^ Yes Q No
As to real estate only? ........................................................^ Yes Q No
Wherefore, your Petitioner asks that distribution be awarded to the parties
entitled and suggests that the distributive shares of income and principal (residua
shares being stated in proportions, not amounts) are as follows: ry
A. Income:
Proposed Distributee(s)
AmounbProportion
Duane V. Smith
Remaining 90% of Residue of Estate
B. Principal:
Proposed Distributee(s)
AmounbProportion
Dyane V. Smith
Remaining 90% of Residue of Estate
Submitted by:
U ,~ ~
Richard S. Simpson, II, Petitioner
6
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Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Deceased
Verification of Petitioner
(Verification must be signed by at least one petitioner)
The undersigned hereby verifies that the facts set forth in the foregoing Petition
for Adjudication/Statement Proposed Distribution which are within the personal
acknowledge of the Petitioner are true, and as to facts based on the information of
others, the Petitioner, after diligent inquiry, believes them to be true; and that ant false
statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 (relatin to
9
unsworn falsification to authorities).
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ichard S. Simpson, II, Petitioner
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for
Adjudication/Statement of Proposed Distribution is a true and accurate re roduction of
p
the form Petition authorized by the Supreme Court, and that no changes to they form
have been made beyond the responses herein.
7
In the Court of Common Pleas of Cumberland County County, Penns Ivania
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Orphans' Court Division
File No. 21-10-01196
Estate of Shirley Bennett LOTZ, Deceased ____
Late of Township of Upper Allen
First and Partial Account
Richard S Simpson II, Executor
Date of Death: 11/21/2010
Date of Executor's Appointment: 12/07/2010
Date of First Complete Advertisement: 12/31/2010
Accounting for the period: 11/21/2010 to 06/17l'2011
Purpose of Account: Richard S Simpson II, Executor, offers this Account to acquaint iritE:rested
parties with the transactions that have occurred during the Administration.
It is important that the Account be carefully examined. Requests for additional informai;ion or questions
or objections can be discussed with:
JERRY R. DUFFIE
JOHNSON, DUFFIE, STEWART & WEIDNER
301 MARKET ST.
PO BOX 109
LEMOYNE, PA 17043-0109 -
(717) 761-4540
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SUMMARY OF ACCOUNT
Estate of Shirley Bennett LOTZ, Deceased
For the period of November 21 ~ 2010 through line 17, 2011
PRINCIPAL
Receipts: This Account
Net Gain (or Loss) on Sales 371,257.25
or Other Dispositions
74.58
Less Disbursements: 371,331.83
Debts of Decedent
Funeral Expenses 6,594.67
Administration Expenses 0.00
Federal, State & Local Taxes 9,286.40
Commissions 13,882.73
Fees 9,000.00
Family Exemption 9,225.00
0.00
47,988.80
Balance Before Distributions - -
323,343.03
Transfer to (from) Principal
Distributions to Beneficiaries 0.00
_ 31,895.00
Principal Balance on Hand
291,448.03
For Information:
Investments Made
Changes in Holdings
I C ME
Receipts This Account
Net Gain (or Loss) on Sales 6,021.67
or Other Dispositions
0.00
-----
Less Disbursements 6,021.67
0.00
Balance Before Distributions --
6,021.67
Transfer to (from) Income
Distributions to Beneficiaries 0.00
0.00
Income Balance on Hand '"'""-
6,021.67
For Information:
Investments Made
Changes in Holdings
COMBINED BALANCE ON HAND
Signature 297,469.70
-
Verification
SCHEDULE A
RECEIPTS OF PRINCIPAL
Assets Listed in Inventory
(Valued as of Date of Death)
Cash
Ameriprise Annuity Account No. 00066763806 8 021 30,990.27
(IRA)
Ameriprise Annuity Account No. 93002115662 3 004 15,415.73
Ameriprise Annuity Account No. 93002407024 3 004 - 38,753,.33
Beneficiary: Estate
Ameriprise Annuity Account No. 93003403326 4 004 - 27,516$.38
Beneficiary: Estate
Ameriprise Annuity Account No. 93004115967 2 004 - 47,0:59.41
Beneficiary: Estate
Ameriprise Annuity Account No. 93107812969 5 004 100,843.39
(IRA) -IRA Annuity Account
Beneficiary: Estate
Ameriprise Annuity Accounts
Sovereign Bank Checking Account No. 1051070287 13,8:13.08
Hartford Annuity 382.20
Social Security -Payment of benefits 1,096.00
Kay LLC d/b/a Home Instead Senior Care -- Refund 1,167.52
Pinnacle Health System Refund 50.00
Allstate Insurance Refund -Refund on Renters 52
00
Insurance .
ReimbursementlRefund of Retainer Check from Law 2
990.00
Offices of Pratz and Wallace LLC ,
Home Shopping Network (HSN) Refund on Account 163
7'4
5780-9795-3235-0956 .
Allstate Insurance Refund -Refund on Automobile 51
00
Insurance .
Freedom Blue Premium Refund 13:?.60
Holy Spirit Hospital -Refund on Account 7;1.00
2010 Federal Individual Income Tax Return 95FI.00
Reimbursement from The Law Offices of Pratz and 7;1
00
Wallace - Error in billing .
Ameriprise Annuity Account No. 93002407024 3 004 - 291
23
Beneficiary: Estate .
Total Cash --
Fiduciary
Acquisition
Value
281, 705.88
SCHEDULE A
RECEIPTS OF PRINCIPAL
Continued
Fiduciary
Acquisition
Pe
l P Value
rsona
rongrt~
1995 Oldsmobile Ciera SL Sedan 4D -Kelly Blue Book
2
675
00
valuation is attached ,
.
Lady's 18K Yellow Gold Diamond Engagement Rin
-
g
Appraised by Joseph James Jewelers 5,250.00
Personal Property appraised by Chuck Bricker - 970
00
Appraisal by Chuck Bricker, Auctioneer AU094-L „
Total Personal Property --
Stocks/Listed 8,895.00
Ameriprise Annuity Account No. 00066763806 8 021 10
208
89
(IRA) -Trans Short Term Bond - C Trans America ,
.
Funds
Beneficiary: Estate
1,040.1920 shares Ameriprise Mutual Fund Account No
.
01013191525 7 002 -Transfer on Death Account to
7,832.65
Estate
1,597.2310 shares Columbia Inflation Protected Securities Fund 16
914
68
B -Transfer on Death Account to Estate ,
.
961.8890 shares Intl Prtct Services Secs B _Ameriprise Mutual 6
867
89
Fund Account No. 01013480119 9 002 -Transfer on ,
.
Death Account to Estate
Total Stocks /Listed --
All Other Proms 41, 824.11
Ameriprise Certificate of Deposit Account
00804836762 0 001 - Transfer on Death Account to 8,64(1.22
Estate
524.0000 CNL Lifestyle Properties -Ticker: CNLIDI ~ Real 5
24(1
00
Estate Share ,
.
500.0000 Corporate Property Associates -Ticker: WP15DI ~ 5
350
00
Real Estate Share ,
.
757.2000 Inland American -Ticker: INAMDI ~ Real Estate Share
6
080
32
Amerprise Account No. 00064103922 021 ,
.
5,091.3900 Ameriprise Mutual Fund Account No. 01133915297 4
002 - Transfer on Death Account to Estate 5,091.39
SCHEDULE A
RECEIPTS OF PRINCIPAL
Continued
Fiduciary
Acquisition
Value
Ameriprise Certificate of Deposit Account 8 207.12
00804724475 4 001 - Transfer on Death Account to
Estate
Total All Other Property 38,615.05
Total Receipts 371,040.04
~ ~bc aunt Principal Rr~r-e~i
12/16/2010 10.0750 shares Ameriprise Mutual Fund Account No. ~t7_78
01013191525 7 002 -Transfer on Death Account to
Estate
12/16/2010 4.3130 shares Columbia Inflation Protected Securities Fund 44.29
B -Transfer on Death Account to Estate
05/28/2011 11.8480 Inland American -Ticker: INAMDI ~ Real Estate Share (15.14
Amerprise Account No. 00064103922 021
Total Subsequent Principal Receipts 217.21
Total Adjustments and Subsequent Receipts 217.21
Total Receipts of Principal 371,257.25
SCHEDULE B
GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS -PRINCIPAL
~~ Loss
12/27/2010 1,601.5440 Columbia Inflation Protected Securities Fund B -
Transfer on Death Account to Estate
Net Proceeds 16,608.01
Fiduciary Acquisition Value -16,958.97 -350.96
12/27/2010 961.8890 Infl Prtct Services Secs B ~ Ameriprise Mutual Fund
Account No. 01013480119 9 002 -Transfer on Death
Account to Estate
Net Proceeds 7,281.50
Fiduciary Acquisition Value -6,867.89 413.61
12/31/2010 1,050.2670 Ameriprise Mutual Fund Account No. 01013191525 7
002 - Transfer on Death Account to Estate
Net Proceeds 8,181.58
Fiduciary Acquisition Value -7,910.43 271.15
04/15/2011 500.0000 Corporate Property Associates -Ticker: WP15D1
Real Estate Share
Net Proceeds 4,836.00
Fiduciary Acquisition Value -5,350.00 -514.00
05/20/2011 524.0000 CNL Lifestyle Properties -Ticker: CNLIDI ~ Real
Estate Share
Net Proceeds 5,494.78
Fiduciary Acquisition Value -5,240.00 254.'78
TOTAL GAINS AND LOSSES/PRINCIPAL
939.:54
LESS LOSS -864.96
NET GAIN OR LOSS -
74 ;>8
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Alert Pharm acy
01 /18/2011
1113.18
Allstate Insu rance ~ Final Payment on Account
04/09/2011
51.00
Bon Ton Cre di Card Accou t No 2116 0410 1033 1511
01/19/2011 Turned over to HSBC for Payment 55.61
~~~
04/09/2011 Final payment 1!9.80
Messiah Villa ae
11/25/2010 Payment for November -Check Clearing after Date of
Death 4,16;1.00
01/24/2011 Home Care Assistant Fees (Final) 68.00
Messiah Villa ge Home Health Care
11/25/2010 Payment for November ~ Check Clearing after Date of
Death 339.25
PA De~rtment of Transt~ortation
02/01/2011 Duplicate title for Automobile
22.,50
113.18
51.00
55.61
19.80
4,233.00
339.25
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
22.50
years credit Car d Acco nt No 5121 0719 7237 9139
01 /18/2011
44L2.85
Social Security 442.85
01/25/2011 Return of benefits
1,096.00
1,096.00
Uhaul - Mechanic sburg
12/13/2010 Payment for Decedent's Storage Unit of Personal
Property 121.85
121.85
West Shore EMS
03/02/2011 Final Invoice
99.63
99.63
Total Debts of Decedent
6,594.67
Administration Ex enses
Chuck Bricker Au ctioneer
01/24/2011 Appraisal of Decedent's personal property
120.00
120.00
Cumberland Coun y Register of Wills Office
11/21/2010 Filing Fee
12/06/2010
Probate Fees 10„00
12/20/2010
Additional Short Certificates for Ameri
rise Ac
t 194.50
05/04/2011 p
coun
s
Filing Fees for Inheritance Tax Return and I 24.00
nventory 30.00
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
05/09/2011
06/15/2011
Duane Smith
01 /07/2011
Additional Probate Fees
Filing Fees for Formal Account (Estimate)
Reimbursement for expenses associated with 7;11.65
gathering Decedent's personal property and Uhaul
storage
225.00
3:50.00
Joseah James Jewelers
01/07/2011 Appraisal of Decedent's Diamond Ring 150.00
Messiah Village
01/19/2011 Resident Account No. 90913 ~ Final Balance Due 4,569.20
Nancy~nd Jim Rickard
01/25/2011 Moving Expenses of Decedent's personal property to 520.00
Storage Unit
Neill Funeral Homes Inc
01/21/2011 Remaining Balance
1,043.28
Sovereign Barzk
12/20/2010 Bank Service Fees for Date of Death Letter on
20.0(1
Accounts
833.50
751.65
150.00
4,569.20
520.00
1, 043.28
20.00
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
Sovereign Bank Checking Accoun No 1051070287
01/07/2011 Bank Service Fees
02/09/2011 Bank Service Fees
03/09/2011 Bank Service Fees
The Cumberland La Journal
12/17/2010 Notice of Estate Administration
The Patriot News Co
03/01 /2011
V ri n
01 /18/2011
Vital Records
12/27/2010
Wiedeman & Dou y P C
03/03/2011
Notice of Estate Administration
Additional Death Certificates
Accountants performing Audit of Agent Records
Total Miscellaneous Administrative Expenses
Federal_ State and I nr~~ Taxes
12.00
112.00
1' 2.00
75.00
18!x.75
48.02
90.0()
36.00
75.00
189.75
48.02
90.00
840.00
840.00
9,286.40
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
Register of Wills Agent
02/20/2011 Inheritance Tax Prepayment 13,000.00
05/09/2011 882.'73
13,882.73
Total Taxes 13,882.73
Commissions
Richard Sim son
06/05/2011 Executor Commission 9,000.00
9,000.00
Total Commissions 9,000.00
Fees
Johnson Duffie
06/05/2011 Attorneys Fees 9,OOCI.00
9,000.00
Wiedeman & Dou y P C
04/11/2011 Preparation of 2010 Personal Income Tax Returns 225.Op
225.00
Total Fees 9,225.00
TOTAL DISBURSEMENTS OF PRINCIPAL 47,988.80
SCHEDULE D
DISTRIBUTIONS OF PRINCIPAL
05/18/2011 Mary Louise Sheffer 1,000.00
05/25/2011 Susan Fulginiti 1,000.00
06/05/2011 Lisa Starner 1,000.00
3,000.00
Dyane V Smith
11/21/2010 Lady's 18K Yellow Gold Diamond Engagement Ring - 5,250.00
Appraised by Joseph James Jewelers
11/21/2010 Personal Property appraised by Chuck Bricker 97(1.00
01/01/2011 1995 Oldsmobile Ciera SL Sedan 4D 2,676.00
8,895.00
Grant Foundation HoQital Albert S hweitzer Haiti
06/05/2011 Grant Foundation 10,000.00
10,000.00
Presbytery of Carlisle ~ Presbyterian Church (U S q
05/26/2011 Presbytery of Carlisle, Presbyterian Church, USA 10,000.,00
10,000.00
TOTAL DISTRIBUTIONS TO BENEFICIARIES 31,895.00
PRINCIPAL BALANCE ON HAND
# Units Description
~b
Ameriprise Trust #2677 7656 5 021
Annuity 930024070243004
Annuity 930034033264004
Annuity 930041159672004
Annuity No. 930021156623004
M T Bank Estate Account
Total Cash
ASSEfS
Ameriprise Annuity Account No. 00066763806 8 021 (IRA)
769.0480 Inland American
Total Assets
Current Valuie Fiduciary
06/17/2011 Acquisition
nr ac Alntnrdl v..~..,.
131,833.66 131,833.66
38,782.56 38,782.56
27,568.38 27,568.38
47,059.41 47,059.41
15,415.73 15,415.73
14,403.94 14,403.94
275,063.66 275,063.68
10,208.89
6,175.46
16,384.35
c i ~,uos.dts 1y'1,445.03
SCHEDULE E
PRINCIPAL INVESTMENTS MADE
# ni
12/16/2010 10.0750 Ameriprise Mutual Fund Account No. 01013191525 7 002
12/16/2010 4.3130 Columbia Inflation Protected Securities Fund B
05/28/2011 11.8480 Inland American
Tota I
Cost
77.78
44.29
95.14
217.21
SCHEDULE F
CHANGES IN PRINCIPAL HOLDINGS
# unit
^^~ ^~~'°mobile Ciera SL Sedan 4D
2,675.00
1112112010 Inventoried -2,675.00
0110112011 Distributed
0.00
Ameriorise Annui~,y Account No OOna~7~~ROC 8 021 (IRA_l
10,208.89
11/2112010 Inventoried
10,208.89
~rise M
Ameri utual Fund Accou nt No 01013191525 7 002
, 7,832.65
11 /2112010 1,040.1920 Inventoried 77 78
1211612010 10.0750 dividend reinvestment -7,910.43
12/31/2010 -1,050.2670 Sold
0.00
0.0000
CNL Lifestyle Pro e~,rties
5,240.00
11/21 /2010 524.0000 Inventoried -5,240.00
0512012011 -524.0000 Sold
0.00
0.0000
Columbia Inflati on Protectp~ S ecurities Fund B
16,914.68
11/21/2010 1,597.2310 Inventoried 44.29
12116/2010 4.3130 dividend reinvestment
-16,958.97
12/27/2010 -1,601.5440 Sold
0.00
0.0000
Coruora Pro~.erty Associa es
500.0000 Inventoried 5.350.00
11/21/2010 -5,350.00
04/15/2011 -500.0000 Sold
0.00
0.0000
SCHEDULE F
CHANGES IN PRINCIPAL HOLDINGS
Continued
~~ Cost
Infl Prtct Services Secs B ~ Am eriprise Mutual Fund Account No 01013480119 9 002
11/21/2010 961.8890 Inventoried 6,867.89
12/27/2010 -961.8890 Sold -6,867.89
0.0000 0.00
Inland American
11 /21 /2010 757.2000 Inventoried 6,080.32
05/28/2011 11.8480 dividend reinvestment 95.14
769.0480 6,175.46
Ladv's 18K Yellow Gold Diamo nd Engagement Ring
11 /21 /2010 Inventoried 5,250.00
11 /21 /2010 Distributed -5,250.00
0.00
Personal Pro e~rtv apuraised b y Chuck Bricker
11/21/2010 Inventoried 970.00
11/21/2010 Distributed -970.00
0.00
16,384.35 Total 16,384.35
SCHEDULE G
RECEIPTS OF INCOME
Corporate roperty gssoriat es
04/26/2011
Ticker: WP15DI ~ Real Estate Share
90.95
Inland Am ricar~ 90.95
03/23/2011
04/15/2011 Ticker: INAMDI -Real Estate Share
05/15/2011 Ticker: INAMDI ~ Real Estate Share 32'04
06/16/2011 Ticker: INAMDI ~ Real Estate Share 32'04
Ticker: INAMDI ~ Real Estate Share 32.04G
32.04•
128.16
TOTAL DIVIDEND INCOME
219.11
Amerinrisa Annuity Acco ant No Interes Bank
93007'1 ~ ~aa~
004_
11 /29/2010
11 /30/2010
05/26/2011 13.26
06/01 /2011 1.65
296.30
32.14
A ri ri Annuity Acco„
nt No
9~nn~~,07024 3 004 343.35
11 /27/2010
05/26/2011
06/14/2011 32.89
623.24
99.89
Ameri~rise An 756.02
nuity A o n__i; Noi_930o~an33
11 /29/2010
23.71
SCHEDULE G
RECEIPTS OF INCOME
Continued
05/26/2011 532.83
06/14/2011 57.48
614.02
Ameriprise Annuity Account No 930041159 7 2 OOA
11 /27/2010 45.53
11 /29/2010 40.47
05/26/2011 864.00
06/14/2011 98 12'
1,048.12
Ameriprise Certificate of Deposit Account 00804724475 4 001
02/08/2011 26.70
26.70
Ameriprise Certificate of Deposit Account 008048367610 001
11 /29/2010 7 57
06/01 /2011 45.54
53.11
Ameriprise IRA Brokerage Account No 00066763806 8 021
11 /25/2010
12/27/2010
Ameriprise Mutual Fund Account No 01013480119 9 002
01 /07/2011
riprise Mutual Fund Account No 01133 15297.4 002
0.83
0. X67
1.50
9.112
9.62
01 /31 /2011 0 02
0.02
SCHEDULE G
RECEIPTS OF INCOME
Continued
Ameriprise Trust Com ag_nv c/o Richard Sim son, Executor for Estate
05/26/2011
2,948.50
2,948.50
rg.Rgn Bank Checking Account No 1051070287
12/09/2010
12/09/2010
12/09/2010
03/07/2011
0.58
0.8 i'
0.10
0.05
1.60
TOTAL BANK INTEREST
5,802.56
TOTAL RECEIPTS OF INCOME 6,021.67
INCOME BALANCE ON HAND
# Units Description
~b
Ameriprise Trust #2677 7656 5 021
Annuity 930024070243004
Annuity 930034033264004
Annuity 930041159672004
Annuity No. 930021156623004
M T Bank Estate Account
Total Cash
Current Value Fiduciary
06/17/2011 Acquisition
or as NntPrl Va1~~o
2,950.O~D 2,950.00
756.02 756.02
614.O:t 614.02
1.048.1:Z 1, 048.12
343.35 343.35
310.1Ei 310.16
6,021.67 6,021.67
6,021.67 6,021.67
COMBINED BALANCE ON HAND
# Units Description
~h
Ameriprise Trust #2677 7656 5 021
Annuity 930024070243004
Annuity 930034033264004
Annuity 930041159672004
Annuity No. 930021156623004
M T Bank Estate Account
Total Cash
ASSP.tS
Ameriprise Annuity Account No. 00066763806 8 021 (IRA)
769.0480 Inland American
Current Valuie Fiduciary
06/17/2011 Acquisition
134,783.66 134,783.66
39,538.5'8 39,538.58
28,182.40 28,182.40
48,107.53 48,107.53
15,759.08 15,759.08
14,714.10 14,714.10
281,085.35 281,085.35
10,208.89
6,175.46
Total Assets 16,384.35
281,085.35 297,469.70
In the Court of Common Pleas of Cumberland County County, Pennsylvania
Orphans' Court Division
File No. 21-10-01196
Estate of Shirley Bennett LOTZ, Deceased
Signature
Richard S Simpson II, Executor
In the Court of Common Pleas of Cumberland County County, Pennsylvania
Orphans' Court Division
File No. 21-10-01196
Estate of Shirley Bennett LOTZ, Deceased
Verification
Richard S Simpson II, Executor under the Last Will and Testament of Shirley Bennett LOT'Z,
Deceased, hereby declares under oath that he/she has fully and faithfully discharged the duties of
his/her office; that the foregoing Account is true and correct and fully discloses all significant
transactions occurring during the accounting period; that all known claims against the Estate have
been paid in full; that, to his/her knowledge, there are no claims now outstanding against the
Estate; that all taxes presently due from the Estate have been paid; and that the grant of letters
Testamentary and the first complete advertisement thereof occurred more than four monl:hs before
the foregoing Account.
This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to uns~rorn
falsification to authorities.
Dated:
~~ - ?~--
Richard SSimpson II, Executor