Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
08-02-11 (2)
],5056],0],05 REV-1500 ~ {02-11' `~' OFFICIAL USE ONLY PA Department of Revenue pennsytvama DEPARTMENT DF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~' ~ ~ /~~~ ~~ Harrisburg, PA i~i28-o6oi RESIDENT DECEDENT V ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 S'C~ - Z Ze ~- (,o C.~ ~ ~ ~ ~ - U J~ - ~. ~ I 1 C"~ 1 ~- 13 - 1 c1 2 2 Decedent's Last Name Suffix DE;cedent's First Name MI (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 ® 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number First Line of Address Second Line of Address ~~~ ~~ P t Off State ZIP Code ;:~.-, REGISTER S USE O~Y ~~ Cep ,~ ~ ~ ~ ~~ i' m ..~ , w ~ DATE FILED ~' City or os ice Correspondent's a-mail address: ©\ S ~ ~ 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 al! information of which preparer has any knowledge. SIGN TURE DER U'~u~..-~.SPC~~SiE FpR~FILIN RETURTN ! ~ V c . D ~ E~ Z 1\VV, ~ 1 ~ ADDRE.S { J SIGNATURE OF PREPARER OTHE THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 .~ i'j 4~.:~; -~ ;-'n ~ J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: RECAPITULATION .,..- 1. Real Estate (Schedule A) ............................................. 1. ~ ~- 2. Stocks and Bonds (Schedule B) ....................................... 2. ~ 3~ 3 ~ `~~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. -- ~ -- 4. Mortgages and Notes Receivable(ScheduleD)..•••••.••-•••••••••••••••• 4• ~ v 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. $ G1 ~ 1 Z-S ~ °` 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. --- ~ -`-'" b t P 7. y Inter-Vivos Transfers 8~ Miscellaneous Non-Pro a e rope (Schedule G) O Separate Billing Requested........ 7. _ . ~ ~ ~ ~ () "~~ , ~ ~,,,, 8. Total Gross Assets (total Lines 1 through 7) ............ • • • • . • • • • • • • ~• • • • • 8. ~~ ~ ~ ~ ~. ~ CI~ • ~ S 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~ ~ , , ~ 3 O = ~ ~--~ 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. ~ ~° ~ ~ ~ ~ Z c) , 11. Total Deductions (total Lines 9 and 10) ................................. 11. ~ (`"?J t , ~' t ; 3 ~- 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. $ ~ ~ ~ ~~ 3 , t 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 `"- ~ j an election to tax has not been made (Schedule J) ........................ . 14. 1 e Sub'ect to Tax Line 12 minus Line 13) ........................ Net Va u ) ( 14. rt 7 ~ ~ ~ ~ J~ 3 ~ _ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. Amount of Line 14 taxable ~ at lineal rate X .0 ~~ ~ ~ ~ ~ ~ ~ ~j . 4 ~ 16. ~ ~•• ~ ~~ ~ . 1 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .........................................................19. 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 ,J me Numper Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments ~' ~ f B~iscount ~ ~, h~ 0 •`-i~~ X S ~~ 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ~ 2, Z ~3- S~ Z._ (4) 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 ...................................................................................... i .... ^ ncome ........................................ b. retain the right to designate who shall use the property transferred or its .... ^ c. retain a reversionary interest .......................................................................................................................... .... ^ d. receive the promise for life of either payments, benefits or care? .................................................................. .... 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................................... th? h d .... ^ ^ .......... er ea 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or .... Did decedent own an individual retirement account, annuity or other non-probate property, which 4 . 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)J. 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(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. Total Credits (A + B) (2) (3) r«v-i~uv ~n Sri) reye ~ Decedent's Complete Address: REV-1502 EX+ (11-08) ~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF , ~) ~ n , ~ FILE NUMBER 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 ~1~ ~/ TOTAL (Also enter on Line 1, Recapitulation.) I $ If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS ~,,~. ~ FILE NUMBER J ~~ ~~ ~ ~~~11<<~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 ~~~ ~ ~C`~ r`~~ ~ e ~'1,~ VALUt AI UAI t OF DEATH TOTAL (Also enter on line 2, Recapitulation) $ ~ 3 ~ ~ ~~', ~ 3c (If more space is needed, insert additional sheets of the same size) _ ,P~ ~ 11VVE5~`MEl\TS July 14, 2011 Anthony Fernandez anthony.femandezCa~onc.com RE: 09?-7'(18531 William J. Mitti {lndividua!) Dear Anthony: The value of the above-referenced account on June 5, 24'11 is enclosed: If you have any questions, please contact our Estate Resolution Desk at 8Q0-fi22-7086, Sincerely, PNC lnvestrrients, LtC. Estate Resolution Desk KSJ The summaries, prices, quotes and/or statistics contained herein have been obtained frorr~ sources believed to be reliable but are not necessarily complete and cannot be guaranteed. They are provided for informational purposes only. Past perfom~ance does not guarantee future results. PNC tnaestrrsertts ~!C Member t~f The Pt~C Financial Services Group i ~G'~? past Ni~'.i, Sira_eE Q': -1'E F ~-?5- . Cievetard Che 4~ i .4-34J4 =,avn~r.or-ic.ccm important lRVestntents Fn#nrmation: Brokerage and insurapce products are: t~tot FDIC Insured • Not Bank Guaranteed • fi~lay Lose Yatue , ~::~~ -ii:}:: ~-~~ =~ ~t:e s1.i~ Sp.-.!}.'.:?J ?~f.' [ir'i:a^G }=,, ~';;~ Iii __"*i`.fiii~ i- ~iY~jo' Fi~~+; r~:t' ~'~;. L~.i !,i:±i . ~. ~~ ~'~.~`.,.,- .. 'iil+;., .,._ ::Y:-::~:L c ~ ~j':::i C: i'` f4^ :is5:i: :f'1.`... ~~',?: ~ ..... c .::c`?^i'. !I',~.e i`~_:l,•w ~C~lii, ,• Pl\I~ 1NVESTME~ITS ra;:;-.~. ~ ; ir,K~, ~::,~i sir):: ~ , +• ~ ~ 1 rY • q• sm '~. :... ~ ~ ,y .,~ '0..e ~ 1 ~ J.,tl. (y' ` .'~~ .t 3 ~ +P ~Ara:~.• , 4.'Ga 4. ~.:. "S' ). ~t• Y ~I•` ' _ . ~w:~.t~3: *~E~-in ~ ' •~~: 1 .t~3.:n `t ' 1 ~'°~~,< a ~: ~~..+_~::.... ~1.. L :'..~i1~ ~/v 20,263.410 Federated Prime Cash Obti atians Fund IC ' PCCXX $ 1.00_ $ 20,263.41 2,000.000 Altria Grou Inc MO $ 27.60 _ $ , 55,240.00 ~_ ..-- ___ 1 384 000 ~ Kraft Foods I nc CI A KFT $ 34.10 47,194.40 $ _ --..._. ..__...._.~ . ~ 4,000.000: Lehman Bros Hldgs Corp # LEHMQ $ 0.05 , $ ..._ ._ 200.00 ____ __ _ 2,Ot?Q.QOQ Phitip_ Morris Intl Inc Com i PM $ 68.99 $ 137,980.00 s t 1,000.0005 PNC Finl Svcs Group PNC $ 59.34 $ 59,340AA __..-__~_ 000 p00 2 De Cv ADR Telefonos De Me~aco Sab TMX $ 17.01 $ 34,020.00 _ __ ____.___.__ . , 177.195: 6 _ Putnam Convertible Securities CIA PCONX $ 20.96 $ 129,474.01 _ __ , 14,122.498 Franklin New Jerse Tax Free Income A FRNJX $ 11.79 $ 166,504.25 _T____.__ 004.802 12 A Trus# Clas s Putnam Diversified Encome PD1NX $ 8.18 $ 98,199.28 . , 14,104.372 _ _ _ _ Putnam Income Fund Class A~~ _____ ____`_ _ .... . ~ PINCX $ 6.94 $ 97,884.34 6,393.862 Putnam US Government Income PGSIX $ 14.40 $ 92,071.61 _ ~ $ 938,331.30 ~--.__..----..._ .~. ~ Grand Total Market Value + Accrued Interest < ~_~_ _ $ 938,331.30 ~ _^_ KSJ The summaries, prices, quotes andlor statistics contained herein have been obtained from sources believed to be reliable but are not necessariiy complete and cannot be guaranteed. They are provided for informational purposes only. Past performance does not guarantee future result. ~'NC lnveskmertts LLC t+!ember of The PAIC Fina~caal Services Group ':9iii) East Nir~il? Street ;~7-Yiri3-"t,-1 C~;:':~Fl.3nc~ Q~lio [:.~? ?;:-340-a tmpartant investmenks !rtormatian: Brokerage and Insurance products are: -iaY F~SEC Insured • Not Bank Guaranteed • E~fay Lase Value ! ,:....`, .,~::..i,........~,~air..:....u<•-,.,~.,:._..... .<s~f~•>..:~.c~'t;~<•-~itii,it,_~~ir~:ent_ L.t..;..:i:r;r.._ '-V...:_~~,::~;,; .. ~ i :...p;,. ~ i .:.+i~ :;r '~ ~ :';~ i~, r,~i':~^;i"f` ~-...,':'ICK~~: , ~.;. -... :'), i:;;":I jr~c.i,.:~`i~.=' <.i"; ~::'1': REV-1504 EX+ (1-97) .. -~ COMMONWEALTH OF PENNSYLVANIA ~t~~l-IFRITANC:F TAX RETURN SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR ESTATE OF ~ ~~ \ ~ ` FILE NUMBER ~~ ~. `` ~ ~ ~,,, ~ `mil ~C Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~J \o/ ~~ TOTAL (Also enter on line 3, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ (6-98) SCHEDULE C-1 :,~, ~~ CLOSELY-HELD CORPORATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ~\~ ESTATE OF ` 1 ~ ~ ++ ~` V" 1. Name of Corporation Address City 2. Federal Employer I.D. Number 3. Type of Business 4. STOCK TYPE Voting/Non-Voting TOTAL NUMBER OF SHARES. OUTSTANDING PAR VALUE NUMBER OF SHARES OWNED BY THE DECEDENT VALUE OF THE DECEDENT'S STOCK Common $ Preferred ~ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? ................................. ^ Yes ^ No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................................... ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ f1~.,ncr of tho nnlirtv ~....~. -' ---- r----~ _.. 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ..................................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? .................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ No ' If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • ~• ~ • ~ ~ A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. FILE NUMBER State on Incorporation Date of Incorporation State Zip Code Total Number of Shareholders Business Reporting Year Product/Senrice (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-Z PARTNERSHIP INFORMATION REPORT ~,\~ ESTATE OF .-'~ ~~~ `~~ ~ ~ FILE NUMBER 1. Name of Partnership Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Product/Service 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. PERCENT PERCENT BALANCE OF PARTNER NAME OF INCOME OF OWNERSHIP CAIPITAtL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ....................................... ^ Yes ^ No If yes, provide a copy of the agreement of sate, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • •- ~ • ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX+ (1-97) , :;~'~ SCHEDULE D .:~ .._ COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES itvHFRITANCE TAX RETURN RECEIVABLE ~~~ ESTATE OF \ ,~ ~ -~ FILE NUMBER V~ t,t1~M ~ ~'~` All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. ~j TOTAL (Also enter on line 4, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: r`,t ~ 1 Indude the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointly owned with right of survivorship must be disclosed on Schedule F. TEEM NUMBER DESCRIPTION ~. ~~~ ~ ~~ a~~ ~~~ ~..-.. VALUE AT DATE OF DEATH 1 ~~~.c~ TOTAL (Also enter on Line 5, Recapitulation) $ I ~ ~ '~~• ~~~ i Pennsylvania SCHEDULE F - DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: ~ - FILE NUMBER: l~ JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR IOINT 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 DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. TOTAL (Also enter on Line 6, Recapitulation) I $ 0 ___ If an asset became iiointly owned wrthin one year of tt~e decedents date of death, it must be reported on Schedule G. REV-1510 EX ~ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF - FILE NUMBER . t ~~<~~ ~~ `1 ~ ,~, This schedule must be completed antl filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~~~ 3 '~ r•-~ ~ S °~ ~ ~cc~r~ ~~ ~°- ~ L ~ ~-~. ~G !~ .~ G. ,n .~ TOTAL (Also enter on line 7, Recapitulation) $ ~ S C)~ ~ , ~ ~, (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ___ ESTATE OF ~ FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. ~ ~ ~~ c>~ ~:. ~ `CIS.-C. ~~ '~t~ eMc~tt. ~ ~-az ~v ~ ~.~ ~ S tv V' ~ i~`~... S~ g. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ~~ ~ S Street-A-dd~ress ~ ~~ ~ ~~,,~.~, ~ ~ ... ~ ~ e---~- City Y~~ J'~ i-~ -~~'C--~`"` - State ~`~~ Zip ~3~ g ~ Year(s) Commission Paid: ~ ~ 1" ~C ~- - ~p.~ ~ ~~~ ~~.. ~ f^ ~-~~'~ c~~ > S 2. Attorney Fees --' ~ -- 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4 5 6 7 City State _ Relationship of Claimant to Decedent Probate Fees ~ ~ V c~~ c„~e..- c: ~ c, G ~-~ Accountant's Fees ~-- ~ "'"- Tax Return Preparer's Fees __ ~ -- AMOUNT `3, ~. t~ ~; ~- $ ~ --~ S C; , .~ ~ ~ ~~~~ ~~ ~ ~~ I. ~~ ~. :~~~4 ~~ ~ ~.~ ~ . ~~ TOTAL (Also enter on line 9, Recapitulation) I $ ~ ~ ~ ~ ~ ~; T Zip (If more space is needed, insert additional sheets of the same size) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF t - ~ ,', ` A~ ~ , ~ ~ FILE NUMBER V~1 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 1. ~--- ~~ TOTAL (Also enter on Line 10, Recapitulation} I $ ~ ~ ~ ~ , ~ ~ 0 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN ESTATE OF j~ ~ FILE NUMBER `1 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. ~ V ~. ~3~s-~. 2 ~~ ~ ~°3~' ~~ ~~ ~. • 02^3 ~~ 2~ ~ 'p ~~ ~ ~~ ~. c. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~w~~ ~ ~~ ~A ear rt r-ITrn T/'1TA 1 41/1A1 TA V A DI ~ n1eTDIQI ITII'~AIC I'1AI I IAIC i Z (1G RG\/_i C(1(1 f'(1\/FR CI-IFFY I ~ '`- ~~ ^' (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) SCHEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4 on REV-1500 Cover Sheet ESTATE OF ~ FILE NUMBER ~~ ~ -~~ This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH • NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table ................................................ . Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ NAME(S) OF LIFE ANNUITANT(S) DATE'OF BIRTH • NEAREST AGE AT DATE Of DEATH TERM AF YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ............................................$ 2. Check appropriate block below and enter corresponding (number) ......................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other { ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see instructions) ................................................. . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX + (3-04) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L REMAINDER PREPAYMENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER I. ESTATE ~~~~ ~r t I _ (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. I REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on B. Name(s) of Life Tenant(s) or Annuitant(s) (Date) Date of Birth Age on date Term of years income of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. .$ 2. Stocks and Bonds ......................... .$ 3. Closely Held Stock/Partnership .............. .$ 4. Mortgages and Notes ...................... .$ _ 5. Cash/Misc. Personal Property ............... .$ 6. Total from Schedule L-1 ..................... .................................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................... .$ 2. Unpaid Bequests .......................... .$ _ 3. Value of Unincludable Assets ................ .$ 4. Total from Schedule L-2 ......................................................$ E. Total Value of trust assets (Line C-6 minus Line D-4) .................................$ F. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ . G. Taxable Remainder value (Line E x Line F) .........................................$ (Also enter on Line 7, Recapitulation) III. (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed ............................................................$ D. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ . E. Taxable value of corpus consumed (Line C x Line D) .................................$ (Also enter on Line 7, Recapitulation) INVASION OF CORPUS: A. Invasion of corpus _ PEV-16d5 EX+ I~-a$I INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -ASSETS- FILE NUMBER Estate of ~ ~ ~,1 ~r^ ~ ~ , (Last Name) (First Name) (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) Total value of real estate (include on Section II, Line C-1 on Schedule L) $ B. Stocks and Bonds (please list) Total value of stocks and bonds (include on Section II, Line C-2 on Schedule L) $ C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership (include on Section II, Line C-3 on Schedule L) $ D. Mortgages and Notes (please list) Total value of Mortgages and Notes (include on Section II, Line C-4 on Schedule L) $ E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property (include on Section II, Line C-5 on Schedule L) S III. TOTAL (Also enter on Section II, Line C-b on Schedule L) $ (If more space is needed, attach additional 8'/z x 1 1 sheets.) REV-1646 EX+ (s-e4, INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN FILE NUMBER RESIDENT DECEDENT -CREDITS- `~, , ~` I. Estate of ~J~ ~ ~~~ C'''~'~ (Last Name) (First Name) II. Item No. Description A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: 'Middle Initial) Amount Total unincludable assets $ (include on Section II, Line D-3 on Schedule L) III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ (If more space is needed, attach additional 8'/z x 11 sheets.) rv~ REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet ~~~ ESTATE OF /- FILE NUMBER ~~t\~°~ ~ ~ti~ l This Schedule is appropriate only for estates of decedents dying after December 12,1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: NI Summary of Compromise Offer: 1. Amount of Future Interest .........................................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ......$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% ......................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ...........................$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$ (If more space is needed, insert additional sheets of the same size) REV-1648 EX (11-99) .,r ~ ~ . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) i~ FILE NUMf3tM ESTATE OF -\' This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1 . Taxable Assets total from line 8 (cover sheet) ............................................ 1 . 2. Insurance Proceeds on Life of Decedent ................................................ 2. ................................................................ 3. Retirement Benefits 3. 4. Joint Assets with Spouse ............................................................ 4. 5. PA Lottery Winnings ............................................................... 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6b. << 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................................................ 6. 7. Total Gross Assets {Add lines 1 thru 6) ................................................. 7. 8. Total Actual Liabilities .............................................................. 8. 9. Net Value of Estate(Subtractline8fromline7) ..............•.••••••••••••••••••••••••••• 9• If line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part II. Income: 1. TAX YEAR: 19 Spouse ........... a 1a. . b. Decedent .......... 1 b. c. Joint ............. 1 c. d. Tax Exempt Income .. 1d. e Other Income not listed above ........ 1 e. f. Total ............. 1 f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) _ 4b. Average Joint Exemption Income .................................................... . If line 4(b) is greater than $40,000 -STOP. The estate is not. eligible to claim the credit. If not, continue to 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less 2. Multiply by credit percentage (see instructions) 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet . .............................. . 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ........................................................... . 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .Include this figure in the calculation of total credits on line 18 of the cover sheet...... . 2a. 2c. 2d. 2e. 2f. + (3f) 3a. 3b. 3c. 3d. 3e. 3f. (= 3) Part ~ 1. III. ~ ' 2. 3. 4. 5. REV-t649 EX + (t-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ ,,\\ ~ ~` SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) _\ ~ I ~~ FILE NUMBER Do not complete this schedule unless the estate is making the election to tax assets unaer ~ecuvn ~ ~ ~~~~~ ~~ ~~~G ~~~~~~~~-~~~~~ ~ ~~~~~ ~ ~~ ~ ~~-• If the election applies to more than one trust or similar arrangement, a separate form must be filed for eT~u t umarital, residual A, B, B -ass, Unified Credit, etc. . This election applies to the If a trust or similar arrangement meets the requirements of Section 9113(A), and. a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0, The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 A trust or similar arran ement. VALUE Part A Total I $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) electron to taxis being made. VALUE Part B Total I (If more space is needed, insert additional sheets of the same size) Total Banking Statement PNC Bank For the period 45I1'8/ZO~ 1 to 06/17/2011 A 005482 WILLIAM J NITTI 1630 KING ST FANWOOD NJ 07023-1541 Pl~1CBAl"~IK Primary account number: 81-0917-1918 Page 1 of 5 Number of enc{osures: 0 For 24-hour banking, and transaction or interest rate information, sign on to PNC Bank Online Banlong at pnc.oom. 'a For customer service call 1-888-PNC-BANK Monday - Friday: 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espaiiol, 1-866-HOLA-PNC fAlfiovs>tg1! Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 .,,,~~ ' ~ V isit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaired clients only Relationship Q~rerview /~ ~~~ Bank ARtCOUn~"S Description Account Number Interest Checking 81-0917-1918 Premium Monep Market 80-0907-5144 Retirement Account{s) Total of 1 Total Deposits ~~~~~~ G ~' Pell~formance Checking interest Chmlong Account Summary Account number: 81-0917-1918 Overdraft Protection Provided By: XjCKXXX5144 To learn more, visit us online at pnc.oom/overdraftsolutions Balance Suzy Beginning Deposits and Checks and other Ending ba~aace o:~-v_r addi>ions d~usaicas ~lar~ce 4,540 90 3,558.84 240 ~0 7,858.84 Average monthly Charges balance and fees 6,234.34 •~ 7,85 8 1,017 ~ ~ ~ ~ ~ 53,913.25 ~~~ ~ ~,~ William J Nitti ~' Transaction Su~rarl/ Checks paid/ Check Card POS Check Car+dlBankcard withdrawals signed transactions POS PIN transactions 2 0 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 p 0 Interest Suzy Annual Perrenta~e Yield Earned ~APYE} 0.01% Number of days Average collected Irrtenzst Paid in icterest period balance forAPYE this period 30 6,234.34 .05 As of 06/17, a total of $1.54 in interest was paid this year. Total Banlring Statement For 24hour infiormation, sign on to PNC Bank Online Banking on pnc.com. _ _ en nen'7_r;l dd _ rnntinII6a PNCBAl~1K For tl~s period 05/19/20'11 to 00117f2011 WILLIAM J NITTI Primary account number: $1-0917-1918 Page3of5 Retirement Accounts winiam J Nitti Interest Original or Current Description Maturity date value l~estment rate renewal value number 4,gg ~ 4$,119.61 45,037.36 115 Months Fixed Rate 0411/2014 -.~ 75400027588 t) _ ~. ______..+,.~.~ ,/ 45.OSfi.36 ,f ^v~ w..^a..~ ~.~_ ~~a~'¢~ __ ~ ~ RECEIPT FOR PAYMENT GLENDA FARMER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 NITTI WILLIAM J Receipt Date: 6/15/2011 Receipt Time: 08:36:29 Receipt No.: 1065942 Estate File No.: 2011-00676 Paid By Remarks: LOIS NITTI-VERLEN DB ----------------------- Receipt Distribution ------ - ------- -------- --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 660.00 00 15 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN WILL SHORT CERTIFICATE . 8.00 50 23 CUMBERLAND COUNTY BUREAU OF RECEIPTS GENERAL & CNTR FUN M.D JCS FEE AUTOMATION FEE . 5.00 00 20 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN COMMISSION TO TAKE . -_-~ Check# 537145 1 =:_ -- $ 731.50 'v ...-----, Total Recei ed 731.50 / $ k ~ ,._ \~ ~~ ~/ ~ c A Family Tradition Of Caring ~ ~~ re111at1011 ~ehV1CeS, InC. H~M~CJRE Fu e & C PART Mrs. Laura Lanig 6/6/2011 103 Yellow Breech Drive Camp Hill, PA 17011 For the Service of William 7. Nitti 1303 Bridge Street We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way P:O. Box 431 we can. Please feel free to contact us if you have any questions in regard to this statement. The following is an itemized statement of the services, facilities, automotive equipment and merchandise that you selected New Cumberland, PA 17070 when making the funeral arrangements. {717) 774-7721 {Fax) 774-554b Terms Due Date Account # u,wvv.parthemore.com Net 30 7/6/2011 2011037.8 Description Amount SERVICES & MERCHANDISE _~~- ..._ 2,505.00 Immediate Burial ~ 1,099.00 20 Gauge Steel Casket, Brown Gilbert W. Parthemore, Total Services and Merchandise 3,604.00 Founder Gilbert J. Parthemore, Supervisor Stephen K. Parthemore, CFSP Bruce R. Parthemore, Pre-Need Coordinator, CPC Professional Memberships: NFDA • PFDA DCFDA • CCFDA ,~~~ G ~~ EN LE The Rule You linox; Tl:e People )'ou Trust CASH ADVANCE ITEMS 12 Certified Copies of Death Certificate Clergy Honorarium Flowers, Casket Spray Total Cash Advances Immediate Pay Discount -Thank you! Total Paym@t'1t5~CPet~1tS Balance Due 72.00 150.00 212A0 434.00 -72.08 ~,, ~~ , ~~ _ _:., $3,965.92 $-3,965:92 $0.00 . - ~ ~ . Q - c ~- 3 ~ m ,~ ~ ~ _ ~ . _; o ~ o ~ -a- a o -n, ~ t _ < ~ ~: _~,~ o c ~ p _ ~ I'. _ - { . ,~ ~ - -n a - n ., m - ~, ~ o .. ~ ~ - . sn . a ~-. -n ~ . .: _ n - L7 - - ~ ~m - - - s , ~ - - - ~ _ - - - . X a o ~_o ~ a.n.D o.. n_ ~ - ~- _ ~, _ r z :~ . _ m - - -~ ~ ''~ - - . t'9 - _ - - - = ~ . - - . - ,~. _ . _ < ~ _ _ '~7 D fi gym ~ -m.~ ~~ ~` ~ ~- ~ '_ . n. - ' ' ~~ .. ~ 3 N to - ~ _ 4 ' `c ~; ' - m _ z ~ .~ ~.- ~ - '~ t _ - i.- ~ : - - ice - - , v = , _p ~ y T . r' _ _ ~, ~ cn- m - ° - -`~' - ~ t; Z ~~ Q- . _ ZO . to . ~ ~ ~ r - o ~ _ ~ `'` c~ - -~ A. ~- _ _ . _ - ;" - - _ - io ~ :~ c ~~~ m r• • ~~ ~ ~ ~~ ~.._ ~. y \1 ~ _ _ - 7v r ° .~ ° o . .m .. - ~, C ~ - ~ _D ~ 7 ~- m m m m. ~ . N m . _ ~o - ,.~ ~ ~ D m -~ o - _- - ~ `~ a Z ° to : ~ , m J ~ m ..,. a ~ ~ ~ =~ ~`, _ i Office of Catholic Cemeteries Dioeese of Harrisburg PO Box 3651 Harrisburg, Pennsylvania 17105 Phone (717) 657-4804 SALES ~~IV7`itt4 DATE CEMETERY _ A/N P/N_ CEMETERY#_ AIR NAME PHONE ( ) ADDRESS CITY STATE ZIP CODE Interment Spaces ....... C~ $ 1. Price ................. $ _ - ~. Down Pa ment......... - . Bronze Nlemor~als....... @ $ y Size _-_.---_ Granite F6undation...... @ $ 3. Unpaid -Balance{1=2)_ ... Burial Vaults ......... • - @ $ 4. Finance Charge ........ . -.. Crypt Spaces ..:....... @ ~- $ _ 5. Deferred Payment (3+4) . , Niche Spaces .......... @ - $ 6. Total Price (1+4) ........ - Other = _ $ 7. Approx. Monthly Payment _ __ _ _ . Section Lot Grave(s) 8. Number of Payments .... - Building Side Crypt or Niche 9. First Monthly Payment Due Selection must be made within 30 days or cemetery will make choice. 10. Annual Percentage Rate The payment is due on the date stated above and the remaining payments on the same day of each succeeding month. Buyer may prepay in advance the full amount due without penalty and will be entitled to a:-p~rs~~e~- -fund` f the unearned finance charge- Upon default in the payment of any installment due hereunder for a period in ess of one hundred twen (1 ) ys, Seller may, at its option, void this agreement and retain all payments made b Buyer as liquidat d damages. Bu er hereby acknowledges receipt of an exact executed copy of this agr ement at the time of~ x son hereof. Y ~- Before any burial is permitted in this lot, or any memorial placed on this lot, the pr ,of e gray n emorial mu be paid in full. The Purchaser(s) agree(s) to abide by all rules and regulations of the ceme now in force as well as an es~ and regulations which may hereafter be adopted. Said rules and regulations may en upon re u e Seller s office. U on fulfillment of the conditions of this agreement and receipt of al! the above described payments, Seiler agrees and P binds itself to convey to the Buyer, by its cemetery easement, for interment purposes only, the above mentioned number o sites. YOU, THE PURCHASER, MAY CANCEL THIS TRANSACTION SY WRITTEN NOTICE AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. BY (Authorized Representative) NOTICE: See other side for additional information. (Purchaser's Signature) (Co-purchaser's Signature) ~ ~ ~ ~ ~ ..:, .. ~~ ant T Rate Cha 206.00 5 Balances 5,206.00 ; ~ Dane , w° 8aiance B/F .- 0 , 799.73 00 865 -4 5,005.73 1,140.73 06/Ol/ 11 -06/05/ 1 i CN Private Studio 06/01/11 - 06/30J11 N Private Studio 3 1 . , 246.22 246.22 1,386.95 1 412.95 06/21/ 11 Pharmacy Bldg. 4 1 26.00 26.00 , (16/29/11 Domestic Phone Service ~~ ~.' Over 90 Days Anwunt Due i-30 Days 31-b0-.Days G1-90 Days: Current - 341.00 .00 .00 - .- ~,~4~.2 ~~ , ~ -.. .00 1,071.95 -Thank ya, for choosing counay Meadows of west shore 4! Statement'Date; 07/01/2011' Please include the top Portion of this bill vwth your payment by the 15th using the enclosed envelope. Make your diedc payable to Country.. Meadows Associates. William Nitti -Account #:..87384 Mead living C`h~ ~5~o e Meadows wing . 4837 East Tnndle Road Mechanicsburg, PA 17050 ~._._ ~._~ ~, i, vv -Ii,LL,~~i~i J. T~TITT'I, residing at 127 Gales Drive, Apt. #1, New Providence, New Jersey 0 7 974, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, in manner and form following, hereby revoking any and all former Wills and Codicils by me made. FIRST: I order and direct that all of my lawful debts, funeral and testamentary expenses be paid as soon as convenient after my decease. SECOND: I give, devise and bequeath all the 1-est, residue and remainder of my estate, real, personal and mixed, or whatever kind and character and wherever situate, whereof I may die seized or possessed, hereinafter referred to as my residuary estate, to my wife, FRIEDA NITTI. THIRD: lii the event my said wife predeceases me, then and in that event, I give devise and bequeath the rest, residue and remainder of my estate to my children, LUCY SKRABLJT, LINDA WHALEN, LAURA LANIGAN and LOIS VERLEN, equally, share and share alike. FOURTH: I nominate, constitute and appoint my wife, FRIEDA NITTI, as Executrix of this any Last Will and Testament, to serve without bond or surety. FLF'r~.~-I: s~ the e :~~nt n~~ ~a1;I ~_ -~ • - ~ - hereby nominate my daughter, LOIS VERLi~~.N, as1Substitute,Executr ct, thdii, arld iil thr~c :vent, I ix, to serve without bond or other surety. SIXTH: It is my wish and I do order and. direct that my Executrix, Substitute Executrix shall not be required to give bond or other surety in this or in any other jurisdiction wherein proceedings may be required to be taken in connection with this my Last Will and Testament. IN WITNESS WHEREOF, I, the said WILLIAM J. NITTI, have hereunto set my hand and seal this 28`x' day of May, Two Thousand Four. ~%l/ WII-LIAM J. N TI, Testator I, WILLIAM J. NITTI, the testator, sign my name this 28`'' day of May, 2004, and being first duly sworn do hereb declare to the undersix~~,:.e ty gn and execute this instrument as y ,, d authori that I si my Lrist ;?-'ill; that I sig~~ it ~x-, -~1 algid +i.,~t r ,,~ ,.}~ ~. Y 'llil. ~~ ------ .~ ~ ~:_y, ~. _. _ ..,-.c~:,.,, it ~, r,~v fr;~e arr~ v^,?,inr:~>~. ~„* ~' rtr f'~~ _~ • We, ~RANDI OSORIO and JOSEPH NITTI, the witnesses, sign our names to this instrument, and, being duly sworn, do hereby declare to the undersigned authority that the testator signed and executed this instrument as his Last Will and that he signed it willingly; that each of us, in ll~c hrescnce ~llld hCar1n1~7 OT the testat0l', hel'eby s1g11S this W111 aS W1t11eSS t0 the S1iTlllllg tllel'e01~ '~ by the testator; and that to the best of our lulowledge the testator is 18 years ol~ age or older, of sound mind and under no constraint or undue influence. I OSORIO Witness JO"~~PH Witness STATE OF NEW JERSEY } } SS. COUNTY OF ESSEX } 145 Ea le Roclc Avenue _ _ _ Address Roseland, New Jersey 07068 14S,..Ea l~ e Rock Avenue Address Roseland, New Jersey 07068 Subscribed, sworn to and acknowledged before me by WILLIAM .I. NITTI, the testator, and subscribed and sworn to before me by RANDI OSORIO and JOSEPH NITTI, the witnesses, this 28`x' day of May, 2004. LUKE ~ NITTI, ESQ. ' An Attorney at Law of New Jersey PAGE TWO OF TWO