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Home My WebLink About05-17-12 (2)1505610101 REV-1500 ~"°'-'°' ~ .-- PA Department of Revenue Pennsylvania Bureau of Individual Taxes «~~~ INHERITANCE TAX RETURN PO BDX a8o6ot ^• RESIDENT DECEDENT ENicN ucr.cuor. ~ ••.• ~•-•••--• ~--- -- Date of Death MMDDYYYY Social Security Number®, ~.., - ~ 1 1 1 ~ ~... Decedent's Last NameNN ~ Suffix '~ cable Enter gain usenfonnation w (If Ap Spouse's Last Name „~,. ., ~ ~ SufNx n =~ L f r_ I G n ! OFFICIAL USE ONLY County Code Year _ File Number Date of Birth MMDDYYYOY Decedent's First Name o MI ~I MI Spouse's First Name R- y ouse's Social Security Number S THIS RETURN MUST BE FILED IN DUPLICATE WITH THE p 5 ~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 3. Remainder Return (date of death ~ 1. Original Return O 2. Supplemental Return prior to 12-13-82) re Interest Compromise (date of t F O 5. Federal Estate Tax Return Required O O 4. Limited Estate u u 4a. death after 12-12-82) Total Number of Safe Deposit Boxes 8 O 7. Decedent Maintained a Living Trust . ~ 6. Decedent Died Testate (Attach Copy of Will) (Attach Copy of Trust) h nder Sec. 9113(A O 11 O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of deat between 12-31-91 and 1-1-95) ' (Attach SchaO) n oe moanTRO TO: SECTION MUST BE COMPLETED. ALL CORRESPONDENCE A navtime Tele .pfl Numbe Name ~2J` First line of address C7 ~ r - C7 ~. r *~ ~ O ~ -= i N _ -_~ ~ ~nl W ~? Correspondent's a-man aaureae. • U s trueecolrtle~cl and completeclDec a attionaof prepare other haua the personal representati9e Is basted on allntforrmation of which preparernhas ~9Ait DATE and belief, ADDRESS PLEASE USE ORIGINAL FORM ONLY L 1505610101 Side 1 1505610101 J J REV-1500 EX Decedent's Name: i 1505610105 1 . Real Estate (Schedule A) .............. ........................... .... 1. 2 . Stocks and Bonds (Schedule B) .......... .......................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ..... ................... .. . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Properly (Schedule E).... ... 5, 6. Jointly Owned Property (Schedule F) p Separate Billing Requested 6 7. .... Inter-Vivos Transfers & Miscellaneous Nan-Probate Property (Schedule G) ... . p Separate Billing Requested..... ... 7. ', 8. Total Gross Assets (total Lines 1 through 7) ..... ...................... .. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................. . . 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10, 11. Total Deductions (total Lines 9 and 10) .. ............................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ...... 13. ...................... Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not bee .. 12. n made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14~b1e at lineal rate X .0 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. '19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REpUESTING A REFUND OF AN OVERPAYMENT Decedent's Social Security Number -~- O L. Side 2 1505610105 15~i561O1O5 J [ ~ REV-1500 EX Page 3 File Number Decedent's Complete Address: Yl el sDn ADDRESS .J clrr ____ __~~(~ STATE ^~^ I ZIP `^ Z-C I Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 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. (1) 2 q3Z • ~8' Total Credits (A+ B) (2) (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Z 9 3 2_ Make check payable to: REGISTER OF WILLS, AC;ENT. 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 transferced :.................................................................................... ...... ^ b. retain the right to designate who shall use fhe property transferted or its income :...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ 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? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or secudty at his or her death? ........ ...... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a benefciary 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)]. 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 [i'2 P.S. §9116(a)(1.3)]. Asuing 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+ (11-08) r i Pennsylvania SCHEDULE A INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF 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. If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT All property jointly-owned with right of survivorship must be dlaclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (1-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCN~DULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER 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. pr more space Is neetletl, msen atltlitional sheets of the same size) REV-1505 EX+(8-Ba) Y ~ SCHEDULE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER 1. Name of Corporation State on Incorporation Address Date of Incerporation City State__ Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year 3. Type of Business ProducUService 4. TYPE TOTALNU1t$EttOF NUMBEROF$HARE$'. VALiIEA~THE . STOCK y~InglNOn•Vofirg SHARESOUTSTANDINO PAR VALUE OWNED ®Y THE Dt~EDENT DEGEOENTr9 $70CK 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 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 wrttten shareholder's agreement in effect at the time of the decedent's death? ....^ `(es ^ 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 It 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 thle 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 they decedent. E. List of officers, their salades, 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. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes If yes, Cash Surrender Value $ Net proceeds payable 9~ Owner of the policy ^ No (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 SCMEDYLE C-S PARTNERSHIP INFORMATION REPORT ESTATE OF FILE. NUMBER Name of Partnership Address City 2. Federal Employer I.D. Number 3. Type of Business ProducUService Date Business Commenced Business Reporting Year State_ Zip Code 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. 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 9. If yes, Cash Surrender Value $ Net proceeds payable 91 Owner of the policy 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 12-31-62? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferredisold 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 sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No If yes, provide a breakdown of distrtbutions received by fhe 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 addressees and estimated fair market values. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1607 EX+(1-97) e a COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REY9510 E%~(L91) SCHEDULE E CDMMDNWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE Tax RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolMyowned wNlr the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~~ ~~~ N.~ 8 C~ og ~~ ~ Z ~ Pte`, ~ ~n~ ~. ~5 ~~- ~..Z a.~~-~ TOTAL (Also enter on lint; 5, Recapitulation) $ g ~q , ~~ (If more space is needed, insert additional sheets of the same size) aEVd509 E%.fl~eq , SCHEDULE F coMMONwEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF FILE NUMBER If an asset was made joint wkhin one year of the decedent's dale of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FORJOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name offnancial instlNtbn and bank account number orsimilar identihjing number. Attach deed forjgntly-held real estate. DATE OF DEATH VA-UE OF ASSET %OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line fi, Recapitulation) I E more space aEV-isa ex. Marl COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8 MISC. NON-PROBATE PROPERTY This schedule must be completed and fled 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 wcwoe rive rvgmEaFrrvE runrvsrervee. rrvela aeunorvsrvwro oECEOCrvruaorrve onre Or ranrvsrea. nnncnacow or rrvE OEEO roa asniesrnre. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION iFnvrlicna~e TAXABLE VALUE ~e I l~ Per 1~;-r~s ~~~h-~~ ~~~ i~ I ~ - 25 Z~,g~~.(~ I I ~Z I2~ ~2 ~e~~-r ~~m~Q Q.nY1w~ 2. ~~c~ ~w~~ -~/i~~i i ~S 3I Ig I (Z ~f;$~ ,1~ w~ PtL ~ W~-~ ~~~~ ~~ ~ b`E`f.~ Q5a3 ~ ~ ~~~~ Z b TOTAL (Also enter on line 7, Recapitulation) E ~ ~"~ V ~~ , (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-06) SCHEDULE N FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip _. Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip ___ Relationship of Claimant to Decedent _ _ _ _ __ _ _ _ _ 4. Probate Fees ~~ ~ , J v 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. ~d~~ 5~ ~~,~e Zq 3 .g ~ B ' ~~!~~ C~-~- lg .lea TOTAL (Also enter on line 3, Recapitulation) $ ~j ~~] ~ . ~j~ (If more space is needed, insert additional sheets of the same size) REV-1512 EX* (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) ~ . SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~~e i ~.~ P~ ~,rs ~~~~ Z~~a ,.~. ~r ~~~ i -~ V1•e.~ Sam ~ Z5 ~/~ ~ . ~Ce,~ V l +e l ~e~r~ ~ ~ZS ~~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Z lJ~~dl- ~ ~St tf}^ r ~ . ~ V K~ U . V' TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 3't'+ ~ ~ , D (It more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE' K LIFE ESTATE, ANNUITY & TERM CERTAIN heck Box 4 on REV-1500 Cover Sheet 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 430-99, 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) DF LAFE TENANT(S) ~ ~ DATE OF fiOtTH • NEAREST Aft AT DATE OF DEATH ~ '. TERN ~ YIiRWS; . L6E 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)<~LJFEANN{NTtddT(S). DATE~BIRTH • MIE9~E6TAtlE`AT ~ DATE F1F DEATH TEFDd0F1~AR6". '. ANNtJf[Y I$ i~aYlruE ~- ^ 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) ^ Semi-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 3 1 /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) aEV_'saaEx'lao'I INHERITANCE TAX SCHEDULE L COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT IN FES DENT DECEDENTpN OR INVASION OF TRUST PRINCIPAL FILE NUMBER I. ESTATE OF (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1962. 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. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 t. 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 UninGudable 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. INVASION OF CORPUS: A. Invasion of corpus (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) P.EV-7615 E%+ v-851 INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -Aff ET$- PILE NUMBER I. Esfafe of (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 I1, 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 HeIdlPortnership $ (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) III. TOTAL (Also enter on Section II, Line C-b on Schedule L) S (If more space is needed, attach additional 8~ x 11 sheets.) REV-1646 E%+ 13-941 INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER I. Estate of (Last Namel (First Namel (Middle Initiall' II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities S (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: Total unincludable assets $ (include on Setlion 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'/i x 11 sheets.) REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCNEb11LE M FUTURE INTEREST COMPROMISE FILE NUMBER 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 NAME OF BENEFICIARY RELATIONSHIP DAl'E OF BIRTH AGE TO 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: IV. 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) ......................$ (It more space is needed, insert additional sheets of the same size) REV4619 EX ~,19i) SCHEDULE 0 CCMM~NwEALTH Cr RENNSV~VANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN inr~~~ ~n ~ ~ r~~w~r~~n~ ~~~~un~ ESTATE OF Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(Ah of the Inheritance 8 Estate Tax Act If the election applies to more than one trust or similar arrangement, a separate form must be f led for each trust. This election applies to the Trust (madt:al, residual A, B, By-pass, Unified Credit, etc.). 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 tmst 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 arrangement. PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF H. MAC NELSON I, H. Mac Nelson, of Newville, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declaze this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my ~,~ ~~ f `\ estate as soon after my death as conveniently may be done. I direct that my remains be cremated and spread in the woods at 191 LeFever Road, Newville, Cumberland County, Pennsylvania. ' SECOND I give and bequeath certain articles of my tangible and personal property in accordance with a hand written list made by me during my lifetime and attached hereto. In the absence of such a list or designation on said list, said articles of my tangible persoral property shall be added to the residue of my estate. THIRD I hereby make the following additional specific bequests: (A) All of my investments in American Securities Fund and my Sovereign Bank certificates of deposit to my children, Kristin Nelson, Aaron Nelson, Blake Nelson and Kelly Perkins in equal shazes. Should any of my children predecease me, I direct that the deceased child's shaze be distributed in equal shazes to my remaining then- living children. (B) To each foster child who I am sponsoring at the time of my death through Latin Child Care of Assemblies of God Church and/or through World Vision - an amount equal to the monthly sponsorship rate for that respective child multiplied by the number of months remaining from the date of my death until the date of 1:hat child's 18~' birthday. FOURTH I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved wife, Kathleen A. Nelson, absolutely and in fee simple if she survives me by thirty (30) days and she is not institutionalized in a health care facility or nursing home, or receiving benefits through the PDA Waiver Program or any other public benefits program. FIFTH In the event that my wife, Kathleen A. Nelson, fails to survive me by thirty (30) days or in the event she shall be institutionalized in a health caze facility or nursing home, or receiving .y `~ benefits through the PDA Waiver Program or any other public benefits program, I hereby give, .ti .J~, devise and bequeath my estate to my children, Kristin Nelson, Aaron Nelson, Blake Nelson u and Kelly Perkins, equally, share and shaze alike, per capita. ~~ ~ SIXTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. SEVENTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in his or her absolute discretion: (A) To retain in the form received, or to sell either at :public or private sale any real or personal property; (B) To exercise any options to subscribe for stocks, bonds, or other investments; (C) To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; 2 (D) To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his or her sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; (E) To make settlements and compromises on such terms as my personal representative in his or her sole discretion may deem wise without the necessity of obtaining any court approval thereof; ~` (F) To make distribution hereunder either in cash or kind, as my personal ~ representative in his or her discretion may deem wise. EIGHTH R~ ?'y I do hereby nominate, constitute and appoint my daughter, Kelly Perluns, to act as Executrix of this my Last Wili and Testament. Provided, however, that if she is unwilling or unable to act as Executrix, I direct the duties of Executor to be performed by my son, Aaron Nelson. NINTH I direct that no personal representative, guardian, trustee or other fiduciazy appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, H. Mac Nelson, have hereunto set my hand and seal to this m}~ Last Will and Testament, consisting of four (4) typewritten pages, the first two (2) of which bear my signature in the margin for identification, this 2"d day of March, 2009. _ .~~. H. Mac Nelson, Testator Signed, sealed, published and declared by the above-named H:. Mac Nelson, Testator, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto, in the presence of said Testator and of each other. t.../:~= ~ ~ ' ({.;-'~ ADDRESS %' ' ' ^ ^'~-1,,=/_.%.'~~/,~'~ ~ ADDRESS ,' ~_ ~ ~-~. . ~ .. ~~~~ a-- 7, ~t ~ ----~~ ~' l COMMONWEALTH OF PENNSYLVANIA COUNTY OF C,. GCr~ ~CJ!"/~~?L~` We, H. Mac Nelson, /~%ur~ u , ~~,~~5~?~l~~C and ~~r,~~c~ GG~:;I~rI`" ,the Testator and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly and that he executed as his free .and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses and that to the best of their knowledge the Testator was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. H. Mac Nelson, Testator .- .. ~9l%%'-~~ (~ ~. r'n l' i ~f <{ ,Witness Subscribed, sworn to and acknowledged before me by H. Mac Nelson, the Testator, and subscribed to and sworn or affirmed to before me by ~?F./ LG! ~//S{?OiiS'~: and T;;i„c; %/ ;, ,~j- f ` ,witnesses, this 2nd day of Marcxi, 2009. ,7/,. nor~aut aE~~ siuuE ~uaeouse - No ary Public No1Cry iubliC CARROt~ iWP, I~taRY COUMY MY Caunmbtlon Expin~ Mat 29, 2014 4 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. gee for this certificate, $6.00 .This is to certify [ha[ the informationhere given is correctly copied from an original Certificate of Death duly filed with me asLocal Registraz. The original certificate will be forwarded to .the State Vital Records Office for permanent filing. P 17 9 7 9 6 7 0 ~9~.~l~t~~b~lr~w~ ~9v ~~ 2at~ Certification Number Loca112egistrar Date Issued ' x+RF1A mv+]gom COMMOMWEIILTX OF PENNSYLVANIA.-0EPARTMENT OF HEALTN•WTAL RECORDS ' ~PEIWIP I~BIf adrx en CERTIFICATE QF DEATH rse. InMrugtlq]u anal exemoNs qn nvenet y~ 3 h I.N•udGeMxFM.nYI6.W4 MM1d x.8ul ]. BaW SemNh Nnbr I.Md4MIgtlN M. WA 201L 9893= November 17 24 172 , . - H Mac Nelson Male., ] Np ryY &em11 Wr+ nqr+ Aom dwm ]:Wdam aMMMdwM ' Olbn I Fp I 82 u.q. ~ xon r.sr December Newvi lle PA ^~~ !~~ Orb.Y ^'NmYa w• ^RYawY ^a• EP•ir T9. .xmwaroef :wYwxwadw•d•aYgNt, XO ^vr tq wb b,enmmga,.a•>awms, M. a w e. W wnud: W y w. fa.eYd4M xnY. mP, d4M rum mY. •w can ~# p 11 lI pp . te y y t Cumberland South MidEleto •me•n w4Ra, ml ~1'J'Q (QI U `/ iTOxaeXwnlRel MdMew nnRd ewb W Is wr abfsrt ew t4 oee]xenYeftr]oaM1 tY.*n aM X7•d41••^WwTt ta.~ ]aeflwYM. +s analp Epeu•Ip.b, F•^•q•n•ga IaaawNY xadarrorxMm] us. ,nYe roan ENmeMmyt s•Lwuen to-+a cPNeM1 l++es.l Married Kathleen McMillan Dair Farmer Ariculture ^r. IIJw 12 o •aere • ]E.gebe.aweq NwwrFY•rtdv+n.X,Y4.Mwx1 be N'•<°'e'• PA ~ ganeenl uaeln WP•et Penn ahnrn T•P. In ®vw 35 Creek Road Apt. 1 . . enr ReegNa ne,sYe Tw~RV] Cumberland +n].^ ~••~^ P 17241 • ]]e ~, ~+eeq tFFMw•xr.lwmmm•;u Ren Ira L. Nelson ta]IN4r.xma~Ye Mw••~.ar..~.Mn Viola M. ?orney. N. ]eo.wre N•v (]wwtPem as lmangbegMqnNlw lsXriaY+gn nM yma/ Kathleen Nelson 35 Creek Rd. A t. 1 Newville PA 17241 xt•IlMadgw4Rln ®Casrlb ^qm]m ne.oaNL4P•e•IYM,MY,Yur) x+e wrdmR•xalwY•drmMn Nwn•4yvoNxpNYI f+e. xoreen l~Mlm.n M4MYe^! Mt H ll S s PA ^aa ^wlee•Ibmsb. .w. crMalwlbleYenAweaNM f e ^ 11/18/2011 . o y l _pbsng Hollinger Crematory 7ii77 r e nb pa.. r4MeaNesgYtcNd•n [ a, wwge•!dF4m.sNay+pr•a •xNF•RM! amuYNax.bm as Ymewnw4.aFaa Egger Funeral Home Inc. ~ ,.-. Lr;, ti+~,.~^. -- FD 13895.L. 15 Bi S rin AVe. N cmp•442sgtlw MNraeRPq ase. ion ~Nnurewex•. ambM•n•. Mmp•eeMw.IgyWueab•el aa.uwY Nrgw asc oad spore M•n •v. wA (INFWIYMMYYN MdMNb / 1 ~ 11. 1 I 1 o1)oaNOM. ^ r.n F{ . . iM•dWM .R•b 0.•e IMIR hY nN x1 xe. WYCWR FIMMIfome M[RwM OM •GenMntl WmWn? . 4NMMnry4MM8'N44•e• ro Pi•qua•e.en. ~ o ~ / I 1 1 1 ^ Y. U9EOF gFATH N••Ibb Nbs rq ) kpubiMNMVel Py11: EaaDIA]elewp'M•WlNuhgPmryM1aYn'Ab1'%F/uINMMaM. CO agT•r•r Mi4elmNa RrAUtWYc1n•I. GuIb4M Ym21 PM X:EMrdar h1M•eW gFabbnMquub PMNPNI xe. Ltl iMV/. CmxMY•MIM ^YS RafAIY , rr:8•MeIIKnr•N4hrIpMMa MIMTblxgtll••IdiM WPII/a4 mwmv.Pi llm ^LHaam rNPnure C,~ Iq~Ire•••a ..d muY •+umlP~nB Ai 1 I lJ ]anFrw. ^Yl n•a•^I•len obwlr ~, • Gu to la• ~}YUm•a 1 ^PrglM tem. ol4M l YmbaJ 211 XA /I II t' ^X Y reee MYNIx N M b ' . . e. ,~" YM•iYR e. OW bIw Y• d) EM •• WGFKYMJ fJV9F. IUwayyytlYHYMe b I N MPN N• M dEMN ^ Np Pe se Eg4rq•A baproll•• Mnbi•.w1F6Jrl IAHi. • a , PWbin••MWnFV dr: 4W aN ^ I.TNmmRP••NNM aDMymr e. • 9YW en.149w 91 Wxa MIFMY Rm1'A 11 AWnn 0.M ~ a'G gadlWnV IYISi.4Y.H•'1 92i.0eYtlY Ww l+yry ~arnsl. RPImdbP•/Xme.Fbm.fieeN.FanY. Oea 9ee~a~M.l.°pdrll P•AVnM RrebN•PMbp IIM d L~~..I ^xmMe. a c•a bebP _ / ^K°°'+ ^xT<^a lnYtl¢N'n tee. tYYdrp] ]b. bi•nwan ]wNtiu•dMwntNurv lS:•A1 ]xa~:q••^dld+rv lM•N, bYremm. a•1 ^vr ^vr tiY1A DVU ONa ^OMrlQtwebr ^PeunWr^P••Hn ^&Ma], ^GNb •X4C••m•we M. (Mp~$]wwy' ]L.CMV1ei•ai•h.•I axp lad6rt4r 1 _ /a / / 1 / / ( ( }~ A ClMflrq MqM+•{mrba•nM9ardaMw4numrggWU4•puwe•uaum s•m.WeYnxT 1 // // l V/ (l. ll WW (( ToMatld mYh•NN44M ••meN•I4•url•)MmnrrY•M ~ • M•u•Na•M•rw]iw MYNelumMb•N•pu•uY9dM NalYlMbbu•de•eJ •~ SE.CM E1~e .~4]n'•. r1 Sx LanMNUr$r %' \ A Q ' io••bpdmlb••YN4arg4eunen+MaRY14 MP•M bIE L•btlu•u•lyEm•mrr M•E ^ ~ / • ~O O Y } ( ~ ( / 1 WYNFVdMICUm• gnbmwNeFMiYa M/waM•NIFNa.n MYrgba~aM Uwmenwnm•.eM.wp••.erleeu•nm.uiM•I vemwwrn.wl. ^ ]I. Nw•re mPx.m xloi pownl ??'~TMV$1 . ~ •I • ~/ 1 D ]s nµor~y.,•M ap~rf~~ - I ~l I I I :] I i I O I ~ oMnwl ar.Y®n (y, Q (d~ .• /l ~ V! ~~ f'7-I" 61 - / v..... 1! doe+wmPemmwe. ~~ ~~ COMMONWEALTH OF PENNSYLV~"O° COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate o:E Wills and Granting Letters of Administration .in and for CUMBERLAND County, do hereby certify that on the 5th day of December, Two Thousand and Eleven, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of H MAC NELSON late of WEST f'ENNSBORO TOWNSH/P (First Midtl/e, Lesf/ a/k/a HARRY M NELSON in said county, deceased, to KELLYA PERKINS and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this St;h day of December Two Thousand and Eleven. File No. 2011-01300 PA File No. 21- 11- 1300 Date of Death 11/17/2011 S . S . # 172-24-9893 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL SIRS°~ spy R OFVEN[7~EESERVICE Y CINCINNATI OH 45999-0023 H MAC NELSON ESTATE KELLY A PERKINS EX 3307 ELK DR BURLINGTON, NC 27215 Date of this notice: 12-07-2011 Employer Identification Number: 45-6626003 Form: SS-4 Number of this notice: CP 575 B For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT TFlE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 45-6626003. This EIN will identify your estate or trust. If' you are not the applicant, please contact the individual who is handling the estate or trust for you. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as sY.own above. Any variation may r_ause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1041 04/15/2012 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top cf this notice. If you need help in determining your annual accounting period (tax year), see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your ear classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-~1, 2004-1 Z.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 6632, Entity Classification Election. See Form 8832 and its instructions for additional information. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. (IRS USE ONLY) 575B 12-07-2011 NELS B 9999999999 SS-4 IMPORTANT REMINDERS: * Keep a copy of this notice in your permanent records. This notice ie issued only one time and the IRS will not be able to generate a duplicate copy for you. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at thc: phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Thank you for your cooperation. Keep this part for your records. CP 575 B (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address. CP 575 B 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 12-07-2011 ( ) - EMPLOYER IDENTIFICATION NUMBER: 45-6626003 FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE H MAC NELSOZ;f ESTATE CINCINNATI OH 45999-0023 KELLY A PERR:INS EX ~~~u ~~~~~~~~~u ~i~n)~~u ~~u ~~~u m~~~u ~~~~~~n) 3307 ELK DR BURLINGTON. NC 27215 American Funds Year-to-date Quarterly Statement March 30, 2012 Page 2 of 3 Primary account number: 86632812 Trade deb Description Dollar amount Sham pdtt Sharoc trenwated Sham balance 01/01/12 Beginning balance $0.00 $35.16 0.000 03/08/12 Transfer From ********624 $8,889.18 $39.28 226.303 226.303 03/08/12 Fundslink Redemption -$8,889.18 $39.28 -226.303 0.000 03/30/12 Ending balance $0.00 $39.47 0.000 Tmde date Description Dollar amount Sharo prior Shares trenearded Sharc bslantt 01/01/12 Beginning balance $0.00 $35.39 0.000 03/08/12 Transfer From ********624 $9,753.50 $38.67 252.224 252.224 03/08/12 Fundslink Redemption -$9,753.50 $38.67 -252.224 0.000 03/30/12 Ending balance $0.00 $39.36 0.000 Tmda data Dasmption DoIWr amount Shem price Sharec tmnwd¢d Sham balantt 01/01/12 Beginning balance $0.00 $32.12 0.000 03/08/12 Transfer From ********624 $9,044.78 $35.30 256.226 256.226 03/08/12 Fundslink Redemption -$9,044.78 $35.30 -256.226 0.000 03/30/12 Ending balance $0.00 $35.57 0.000 Tnds dah Desedption Dollar amourd Sham pritt Shares trarwcted Sham balance 01!01/12 Beginning balance $0.00 $28.40 0.000 03/08/12 Transfer From ********624 $9,523.98 $30.03 317.149 317.149 03/08/12 Fundslink Redemption -$9,523.98 $30.03 -317.149 0.000 03/30/12 Ending balance $0.00 $30.42 0.000 Year-to-date transaction history Year-to-date transaction history Year-to-date transaction history N r N N r r N G Z w 4 N O U Q Z Q F- C a 0 U m 0 0 Leo C ~ m Y 3 °_ '~ £ 0 a '~ r 2 m x m m N N ~?~ O ~ ~ N ~ N ~ N N N ~ W aZ ~ N ~ N ~ 4 `~ w.-UZ Qtnr4 .n rL 7 W = S>~ yC a K, r 4 ~r ?~~ U =ov O N 2 LL' ~ F. O r I J zi Z U 4w] a~ Wro cL~q~ ~NQ ~O ydr O Z J Q Q r 0 U ~a Q r a O W N N H x N w v Q, W P W a m s? ~, a ~. ~..~.,..~~a ~ ~_~. " G RJ U~ rv W i j• N W r W a N r r O r N r ~,n w m N m z F D ~ ~ ~ '^; ~ s~'d a ~, i3 • m ~ ~ , ~~ ~.{ J n3 „~ ~ > ~ . ,. . = sd ~ ~ d` A ~aS 0 ~ ,F~ '`~ .,, ''~ M •.. ~ ~ , -. „~ .. ~. ~,, ~~ @...: p ~ ' s ~ z o ,, ", m ~. , O s, Z -h I "~ g, . . .. u. ~_ ..,, . , y v T ~._~ ~ v ~ „* ~ _ '~ * ,, c ,, * p ~~ ' -,'~ ~:. ,~ - z .- W v ~17~ z ~'~, ~, ~~,~ a - ~ ;. i :. m s . ~ ~ .. _. rno.vw ew .. ,., re~T 0 >~Q y, 9 3 ?- ,-~ ~ _ e -s ,.n ," ,- G Oy ~ rt. ~ ~rl O ~ /JI ~S 1~ j ~,5 .A, Y µ rfvA un cr' ~, ra .... ~, ~; r t=~ ,. a e~ e yin ca ~~~ om c~C Y tj'S ~~~ ~ ~ w c w O m ~ ~ F 't 3 M y',i~'F , • Page 1 of 3 01/05/12 NC 0005200396911 618-01-01-00 33401 0 C 001 Ol 50 002 EST OF HARRY MAC NELSON EXC KELLY A PERKINS 3307 ELK DR BURLINGTON NC 27215-9781 Your account statement For 01/05/2012 Contact us (800) BANK-BBT or BBT.com o (800) 226-5228 Hetp protect your identity and Qedit rating everyday with BB&T Identity Protection. Identity theft is one of the fastest growing crimes in the world. Add Identity Protection to your existing checking account or open a new checking account with BBB:T Identity Protection, and enjoy the peace of mind that comes with knowing you are protected. Leam more about the benefits of BB&T Identity Protection by visiting your local financial center, calling 800-BANK BBT (1-800-226-5228) or go to B BT. com/i dprote ct f on. BB&T Member FDIC ^ ELITE GOLD-MM 0005200396911 Account summary Your Drevious balance as of 12/07/2011 $0.00 Checks - 0.00 Other withdrawals, debits and service charges - 25.00 Deposits, credits and interest + 34.00 Your new balance as of 07/05/2012 = $9.00 Interest summary Interest paid this statement period $0.00 2011 interest paid year-to-date $0.00 Interest rate 0.02% Checks DATE CHECK # AMOUNT(S) 12/23 1001- Total checks = $ 0.00 - indicates an electronically converted check. See "Other withdrawals, debits and servicE~ charges' Other withdrawals, debits and service charges DATE DESCRIPTION AMOUNT(S) 12/23 CONVERTED CHECK -ARC CHECK PYMT CHASE 010011001 25.00 Total other withdrawals, debits and service charges = $25.00 Deposits, credits and Interest DATE DESCRIPTION AMOUNT(S) 12/20 DEPOSIT 34.00 Total deposits, credits and Interest = $34.00 Effective March 1, 2012, BB&T will charge a $5 BB&T Check Card replacement fee. . PAGE 1 OF 3 ~,1:?F Page 1 of 3 02/03/12 NC 0005200396911 618-01-01-00 33401 0 C 001 O1 50 002 EST OF HARRY MAC NELSON EXC KELLY A PERKINS 3307 ELK DR BURLINGTON NC 27215-9781 Your account statement For 02/03/2012 Contact us BBT.com a (800) BANK-BBT or o (soo)zz6-szza File your taxes with TurboTax. And save time with BB&T OnLine® Log into BB&T Online and choose the TurboTax tab to start your free Federal return. Portions of your return will be pre-filled. Or visit http://bbt.com/turbotax to learn more. ^ ELITE GOLD-MM 0005200396911 Account summary Your previous balance as of 01/05/2012 $9.00 Checks - 3,809.72 Other withdrawals, debits and service charges - 443.32 Deposits, credits and Interest +26,817.83 Your new balance as of 02/03/2012 = $22,573.79 Checks DATE CHECK # AMOUNT(S) 01/30 1002 2.929.66 01/23 1003- Interest summary Interest paid this statement period $0.21 2012 interest paid year-to~ date $0.21 Interest rate 0.02% Annual percentage yield (APY) earned 0.02'Yo DATE CHECK # 01/24 1004 50.00 01/31 1005 608.00 DATE CHECK # AMOUNT(S) C11/27 1006 75.00 CI7/24 1007 147.06 Total checks = $3,809.72 indicates an electronically converted check. See "Other withdrawals, debits and service charges" Other withdrawals, debits and service charges DATE DESCRIPTION AMOUNT(S) 01/23 CONVERTED CHECK -ARC CHECK PYMT CHASE 010031003 443.32 Total other withdrawals, debits and servfcecharges = $443.32 Deposits, credits and Interest DATE .DESCRIPTION AMOUNT(S) Total deposits, credits and Interest = $26,817.83 .PAGE 1 OF 3 0005390 '~ Page 1 of 2 03/05/12 NC 0005200396911 618-01-01-00 33401 0 C 001 01 50 002 EST OF HARRY MAC NELSON EXC KELLY A PERKINS 3307 ELK DR BURLINGTON NC 27215-9781 Your account statement For 03/05/2012 Contact us BBT.com (800) BANK-BBT or e (800)226-5228 File your taxes with TurboTax. And save time with BB&T OnLine® Log in to BB&T Online and choose the TurboTax tab to start your free Federal return. Portions of your return will be pre-filled. Or visit http://bbt.com/turbotax to learn more. Turbo Tax is a product of Intuit ^ ELITE GOLD-MM 0005200396911 Account summary Interest summary Your previous balance as of 02/03/2012 $22,573.79 Interest paid this statement~riod $0.27 Checks -12,939.75 2012 interest paid year-to-date $0.48 Other withdrawals, debits and service charges - 30.00 Interest rate 0.02% D~osits, credits and interest +0.27 Annual percentage yield (APY) earned 0.02% Your new balance as of 03/05/2012 = $9,604.31 Checks DATE CHECK # AMOUNT(S) DATE CHECK # AMOUNT(S) DP,TE CHECK # AMOUNT(S) 02/15 1008_ 2,868.00_ 02/13 1010 2,500.00 02/27 1012 2,500.00 02/14 1009 2,500.00 02/29 1011 2,500.00 __ 02/16 1013 71.75 Total checks = $12,939.75 Other withdrawals, debits and service charges DATE DESCRIPTION AMOUNT(S) 03/05 MAINTENANCE EEE 30.00 Total other withdrawals, debits and service charges = $30.00 Deposits, credits and Interest DATE DESCRIPTION AMOUNT(S) 03/05 INTEREST PAYMENT _ _ 027 Total deposits, credits and interest = $0,27 04633 • PAGE 1 OF 2 j ~ •' Pagel of 2 04/04/12 NC 0005200396911 616-01-01-00 33401 0 C 001 01 50 002 EST OF HARRY MAC NELSON EXC KELLY A PERKINS 3307 ELK DR BURLINGTON NC 27215-9781 Your account statement For 04/04/2012 Contact us BBT.com (800) BANK-BBT or ® ~ (800) 226-5228 Turn ordinary spending into extraordinary rewards. Using your BB&T credit card is even more rewarding with BB& T Rewards. iJow, your everyday purchases can earn points toward valuable merchandise, gift cards and travel. To learn more, contact a Relationship Banker or visit BBTRewards.com today! Credit cards are subject to credit approval. Credit cards are issued by BB&T Financial, FSB, a subsidiary of BB&T Corporation. Member FDIC. Copyright O 2012, Branch Banking and Trust Company. All Rights Reserved. ^ ELITE GOLD-MM 0005200396911 Account summary Your rep vious balance as of 03/05/2012 $9,604.31 Checks - 277.30 _ Other withdrawals, debits and service charges - 0.00 Deposits, credits and interest + 37,212.08 Your new balance as of 04/04/2012 = $46,539.09 Checks DATE CHECK # AMOUNT(S) 04/02 1015 277.30 Total checks Deposits, credits and Interest _ $ 277.30 Interest summary Interest paid this statemerlt period $0.64 2012 interest paid year-to date $1.12 Interest rate 0.02% Annual Percentage yield (APY) earned 0.02% DATE DESCRIPTION - AMOUNT(S) 03/12 REDEMPTION AMERICAN FUNDS XXXXXXXXXXX281Z 8,889.18 03/12 REDEMPTION AMERICAN FUNDS XXXXXXXXXXX2812 9,044.78 03/12 REDEMPTION AMERICAN FUNDS XXXXXXXXXXX2812 9,523.98 03/12 REDEMPTION AMERICAN FUNDS XXXXXXXXXXX2812 9,753.50 04/04 INTEREST PAYMENT _ 0.64 Total deposits, credits and interest = $37,212.08 ~~~ .PAGE 1 OF 2 Name Date Amount Check # Description Chase Credit Card 12/21/2011 25.00; 1001 Minimum Payment Egger Funeral Home 1/18/2012 2929.66 1002 Funeral Expenses Chase Credit Card 1/18/2012' , 443.32 1003 Payment in Full Carlisle Regional Hospital 1/18/2012 50.00 1004 Balance of bill Latin American Child Care 1/20/2012 608.00 ~ 1005 Sponsor to 18/1 Cumberland Law Journal 1/20/2012 '_ 75.00 1006 Advertising Kelly Perkins, EXE 1/23/2012 , 147.06 1007 Reimbursement Adv World Vision, Inc. 2/2/2012 2868.00 1008 Sponsor to 18/2 Aaron Nelson 2/2/2012 2500.00 1009 Distribution Kelly Perkins, EXE 2/2/2012 2500.00 1010 Distribution Blake Nelson 2/2/2012 2500.00, 1011 Distribution Kristin Nelson i 2/2/2012 2500.OO~i 1012 Distribution Valley Times Star 2/11/2012 71.75 1013 Advertising Void -Amer Funds Trsfr 3/2/2012 Void 1014 Trsfr Annuity Kelly Perkins, EXE 4/2/2012 277.30 1015 Estate Expense ~(~o,,;,,paa c~(9~QQd S~~p~~Z Z°13Z.-1~ 10110 ~4~-'~c, Rewards" Menayeyouraccountonline: Cus[omerService Atltlhfonalcontact www.chase.coMCretlitcerds 1-900-293-1211 inbrma9on on back ACCOUNT SUMMARY Account Number: 1006 0438 0021 2806 Previous Balance $635.07 Payment, Credits -$635.07 Purohases +$459.66 Cash Advances Balance Transfers ~~ \ 1~ $0.00 $0.00 Fees Charged $0.00 1 Interest Charged 1 2, 121 I ~ +$9.50 New Balance $463.16 OpeninyCbsing Dale Credit Access Une Available Credit Cash Access Una Available for Cash 1az7/1 i - 1 v2s/t 1 $14,400 $13,936 $2,680 $z,s6o PAYMENT INFORMATION New Balance $463.16 Payment Due Dete 12/23/11 Minimum Payment Due $26.00 late Peymsnt Wsrning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee of up to $35.00 and your APR's will be subject to increase to a maximum Penalty APR of 29.99°/ . Mirtimum Payment Warning: If you make only the minimum payment each period, you will pay more in interest and it will take you longer to pay off your balance. For example: If you would like information about credit counseling services, call 1-666-797-2685. If you make no You will pay off the And you will end up addiQonal charges balance shown on paying en estimated using this card and this statement in total of... each month you about... PaY... Only the minimum 22 months $526 payment AARP REWARDS SUMMARY Previous balance q 541 To redeem points or ask questions please call: Points eemed on non-trevel purohases 313 1-600-283-1211. You can also redeem your Points earned from travel purohases qq3 points online at www.chase.com/aarp. Remaining prints balance 5,297 297 Reward points that will expire March 2014 With your AARP Visa card you earn 9 points for every $1 you spend on eligible travel purchases and 1 point for every $t you spend on all other purohasea. Use your AARP Visa card for all your purchases and watch your rewards add upl Redeem your rewards at www.chase.coMearp, or call our dedicated AARP service team at 1-800-283-1211. ACCOUNT ACTIVITY Date of Transaction Merohant Name or Transaction Description $ Amount 11170 Payment Thankyou Electronic Chk ~ -635.07 ta26 CROSSROADS RESTAURANT CARLISLE PA 10.49 1 826 SAYLOR'S MARKET NEWVILLE PA ~ 20.67 1 a28 SUPER 8 CARLISLE CARLISLE PA ~ 71.26 1 829 BONANZA STEAKHOUSE 717 CARLISLE PA 14.92 1a30 CROSSROADS RESTAURANT CARLISLE PA 47.48 11/01 SAYLOR'S MARKET NEWVILLE PA i0,g5 11/03 SAYLOR'S MARKET NEWVILLE PA 26.68 11/05 BOB EVANS REST M0212 MECHANICSBURG PA 15.67 11/06 CROSSROADS RESTAURANT CARLISLE PA 77.74 11/07 SAYLOR'S MARKET NEWVILLE PA 20.73 11/07 CUMBERLAND GOLF CLUB INC CARLISLE PA 15.00 11/10 LOWES #01710' CARLISLE PA 31.77 11/14 CUMBERLAND GOLF CLUB INC CARLISLE PA 20.00 11/20 DAYS INN CARLISLE PA 76.90 OD00002 FIa33338 C 0 000 N Z 28 11/11/28 Pager 1 b 2 OOOOB rnn DC 20280 32910000060532029801 7C OW] INS15133 15 Big Spring Avenue NEWVILLE, PENNSYLVANIA 17241 F. CHARLES EDGER, Supervisor 717-77b-3414 FRANK C. EDGER, Funeral Direcror November 30, 2011 Funeral bill for H. Mac Nelson Date of service December 4, 2011 Cremation with Memorial service $2,260.00 10 Death Certificates $6.00 a piece $60.00 Valley Times Star Obituary $50.00 Sentinel Obituary $311.08 Patriot News Obituary $498.58 Total $3,179.66 -minus former employee deduction $250.00 Total $2,929.66 /C, _ ~ ~ eat z Uv~ ay ~ ~~g ~ ~z RewalC~s" ~ Manage your accountonllne: CuatomerService Atldalonalcontect www.chase.wlNCretlitcartls 1-600-29&1211 inrormatlal on back L ACCOUNT SUMMARY Account Number: 4406 0439 0021 26013 Previous Balance ^ ~ ~ " ~ V~ $469.76 Payment Credits ( ~ -$26.00 Purchases Cash Advances , 3 1 ~ $0.00 $0.00 $0.00 Balance 1'ransfere Fees Charged ry ~y \ I\g `~ I/ b $0.00 ~.~ Interest Charged +$6.16 New Balance $443.32 Opening/Closing Date Credit Access Une Available Credit Cash Access Line Available for Cash 71/27/11 - 12/26/11 $74,400 $13,956 $2,660 $2,880 PAYMENT INFORMATION New Balance $443.32 Payment Due Date 01!23/12 Minimum Payment Uue $25.00 Late Psyment Wnrning: if we do not receive your minimum payment by the date listed abcvo, you may havo to pay a tale fee of up to $35.00 and your P.aR'3 will be subjoct to increase to a maximum Penalty APR of 29.99%. Minimum Payment Warning: If ya1 make only the minimum payment each pedud, you wit! pay more in interest and ii will takes you longer to pay off your balances- For examples. If you make no -~~- You will pay off the And you will end up additlcnal charges balance shown on paying an estimated using this card and this snltement In total of... each month you about. _. pay... _ Only the minimum 20 months Y501 payment - - ~ If you would like information about crodit counseling services, call 1-866-797-2885. AARP REWARDS SUMMARY ~ Previous balance 5,287 To redeem points or ask questions please call: Points earned on non-travel purchases 0 1-800-283-1211. You can also redeem your Points earned from travel pumhases 0 points online at www.chase.coMaarp. Remaining points balance 5,297 297 Reward points that will expire March 2014 With your AARP Visa card you earn 3 poims for every $7 yoq spentl on eligible travel purchases and 1 point br every $t you spend on all other purchases. Uae your AARP Vise card for all your purohases emi watch your rewanls add upl Redeem your rewards at www.chase.coMaarp, or call our dedicated AARP service team et 1-800-283.1211. TOTAL INTEREST FOR THIS PERIOD $5.76 I Total fees charged in 2011 ' $0,00 Total interest charged in 2011 $14.46 Year-to-date totals reNect ell charges minus any refunds applied to your account. 0000002 FIS33335 C 4 000 N Z 26 11/1226 Page 1 of 2 00008 MA OC 04511 36010000000530451101 ~ 7{ 00071NS15130INS1610B " P°n',n x~ ~ ,' ~,..,v m°.^" p , IR°0.l ." C^.._.,_. _. THE GENERAL COUNCIL OF THE Assemblies of God 1445 N. BOONVIL.LE AVE. SPRINGFIELD, MO 65802-1894 RECEIPT INQUIRIES: Mantlay - Fritlay 9:00 A.M. - 4:00 P.M., CST 1-B11-840-4800 1-41]-862-2]81, EXT. 8840 GIVING ONLINE'. www.contributions.ag.org DATE FRAME NO. 01/31/12 031-01528 AGWM 1528 Instructions: 001410 0007410055 For your convenience, we have listed your previous designation(s) and amounts. Please fill in your desired contribution(s) in the ASSEMBLIES OF GOD CHURCH TO RECEIVE AG TOTAL GIVING CREDIT IF DIFFERENT FROM ADDRESS SHOWN. CHURCH ADDRESS "AMOUNT" column and make additional DONOR ID p offerings on the reverse side of this form. g 3 910 6 2 0 0 CHECK PAYABLE TO: THE ASSEMBLIES OF GOO. CHURCH TO CREDIT ESTATE OF HARRY MAC NELSON EXC KELLY A PERKINS 3307 ELK DR BURLINGTON NC 27215 GC USE ONLV DISTRICT FILL IN NEIN 21 ®oFFERING®TOTALS AS OF 02/01/12 AM 60000 682755 4 LACC-HAITI CHILDCARE __-SiO~ ___-__ - - - --- - -.- ~- - - T ~ - _ _._ . -- -- - i - __ -- - I fAiEDR CARD ODNATION Visa ^ MasterCard ^ Discover ^ AmEx ^ Please bill my credit card Monthly ^ One time ^ TOTAL CDNTIIIBUTIONS ~ CASH AND/OR , 6 ~ 8 ~ ~ GREOIT CAR a arcodes were at3ded for faster processing Expiration Date ___/___, Phone#--_____ Signature Amount $ THE GENERAL COUNCIL OF THE Assemblies of God 1445 N. BOONVILLE AVE. SPRINGFIELD, M065802-1694 RECEIPT INOUIFIIES: Monday -Friday 9:00 A. M. - 4:00 P.M., CST 1-BT1-890-4800 1411-862-2]81, E%T. 8840 GIVING ONLINE: www.contributions.ag.org Thank yov /or your continued support to Me woHd m/nlatrlea o/ the Assembllea o/ Gotl. Our preyere are that ea a result of your sowing, you will have /he joy o/ reaping bounhPolly. We take serloualy Me reaponslbilityotbeing goodstewarda a/these Iuntls, and we wvet yourproyere end cont/nued aupport as we endeavor urWer God to carry ou! the Great Camm/aslon. DOUG CLAY, General Treasurer DATE FRAME NO BATCH DONOR ID# 01/31/12 031-01528 136 8391062 00 RECEIPT NO. DIST. CHURCH TO CREDIT 001410 21 0007410055 ESTATE OF HARRY MAC NELSON EXC KELLY A PERKINS 3307 ELK DR BURLINGTON NC 27215 VO GOODS OR SERVICES WERE EXCHANGED IN CONSIDERATION FOR THIS CONTRIBUTION. CEEP THIS RECEIPT FOR INCOME TAX PURPOSES. mr~mnT r+ „r. r~,T. r,.~ /... r, ., ,, .. RETURN TOP PORTION WITH YOUR NEXT OFFERING CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax: (717)249-2883 February 17, 2012 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. T0. Kelly Perkins, Executrix RE.• Harry MacNelson Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: February 3, February 10, and February 17, 2012 ~~ oo~ Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director i ne ~ennnei vww.cumberlinl:.com :ARIR(E SIiPPENSBIAG PERRI'COLNtt I~CLLI R'CRrUlYO ------.. 3307 ELK DRNE BURLINGTON, NC 27215 919.699-7960 LETTERS U Check # U Credit Card ~~®~®~® Acct #: ~~ ~~ I ID E>~. Date: m m Nama on credit card Signawre Publieatlon Insertions Rate Net Amount Gross Amount 3 THE SENTINEI- -LEGAL 3 LGL $138.08 TOTAL AD CHARGE ;138.06 3 MOBILE SITE MOB2 $2.00 3 PROOF OF PUBLICATION (11 PRF $7.00 PREVIOUSLY PAID ($147.06) \~/s ~ ~/ J ~f"' ~~ ~I/(..\\~~\V\V 1nV~-/~ \ v ~ v l ~~,~ _ I .. :, PurenaseOrder Est.HarryNelson $0.00 ~ $0.00 Thank you for advertising with The Sentinel! Deadline for in-column legal ads is 4:00 p.m. two business days prior to date of insertion. For questions, call (717) 240-7130. THE SENTINEL Go LEE NEWSPAPERS PO BOX 540 WATERLOO IA 50704-0540 KELLY PERKINS 3307 ELK DRIVE BURLINGTON, NC 27215 Neese make checks payable to: THE SENTINEL I 405490 1 of 1 BILL DATE SALESPERSON 01/13/12 wolfs .START DATE STOP DATE 12130/11 01/13/12 10 PUBLIC NOTICES THE SENTINEL clo LEE NEWSPAPERS PO BOX 540 WATERLOO IA 50704-0540 Ad Number 9°"'° Billing Date 01/13/12 Amount Due $ .00 e0°~a THE SENTINEL c/o LEE NEWSPAPERS PO BOX 742548 CINCINNATI OH 45274-2548 ~t~u~r~t~ut~t~~ut~r~n~u~r~R~r~n~n~)n~u~u~~u~t~ut~~ 21540200000004054900000000000000000000000000000002 World Visun° CC~n~iL ~~~~.m~~riiri<< February 9, 2012 Ms. Kelly Perkins Executor 3307 Elk Drive Burlington, NC 27215-9781 Re: Estate of Harry Mac Nelson Dear Kelly: P.O. Box 9716 Federal Way, WA 98063-9716 1.800.426.5753 gikplan ning@worl dvi si o n.o rg www.worldvision.org/mylega<y World Vision gratefully acknowledges receipt of check numb r 1008 o February 8, 2012, in the amount of $2,868.00 from the estate of your father, rry Nelson. In accordance with your father's will, we are pleased to designate these funds toward his 2 sponsored children: Jingkhie Tomicos in the Philippines and Alex Rene Changa in Ecuador until they reach the age of 18. Please note that no goods or services were provided in exchange fir this contribution unless otherwise noted herein. World Vision has exclusive legal control of the contributed assets. We are so grateful for your father's faithful support of the ministry of World Vision! Please know that)ingkhie and Alex will be blessed for years to come thanks to your father's compassion and generosity. It was a pleasure working with you on this bequest! If I can be of further assistance, please call me toll-free at 1.800.723.5888. Sincerely, ~~ ~,~~~ `/~ o~~ vvvvw~~~' `-Tit, Melissa Stubblefield Program Coordinator Gift Planning Operations k W ik Phnnm(.OONOR FILESW W ehon. Harry Mad301bO1.09.Beyuen Reaaip, IeaerNehon, Ham.EOc And do not forget to do good and to share with oehers, for with such sacrifces Cod is pleased. -Hebrews 13:16 (f~IIV) ~fdvertising Statement KELLY PERKINS 3307 ELK DRIVE BURLINGTON, NC 27215 The News-Chronicle Co. 22 East King Street P.O. Box 100 Shippensburg, PA 17257 Phone: (717) 532-4101 133 Customer : 01108'720-000 Phone : (919)699-7960 • Date : 01 /31 /'12 Page : 1 Date Reference # Type Description Runs Lines Inches Total 01/18/12 01600028-001 i 2X2 ESTATE NOTICE Letters Tes ;i 16 4.00 71.75 M1 A ~ ~~~3 ~)r~ ~, \~~\ ti~ Remarks PLEASE RETURN A COPY WITH PAYMENT Sub Total: 71.75 Discounts: 0.00 Total Due: 71.75 Current 71.75 1-30 0.00 31-60 0.00 61-90 0.00 91+ 0.00 RECEIPT_FOR_PAYMENT GLENDA EARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle. PA 17613 ~ NELSON H MAC Estate File No.: ~\ 2011-01300 Paid By Remarks: KELLY PERKINS HEA ------------------------ Receipt Distribution Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCS FEE AUTOMATION FEE Cash Total Received......... CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN Z jU ~~` ~-- '. ~ ~ r. G G O ^i LiJ h G L11 4~ Cfi C' CD ~~ G t A J PJ C..I O W ! G ~ :- oa e ~:~ u+ r w sr- '~ ~ J w ¢ ¢ W 4'r } i1 3: it O ' W Q ~_ ~~ Z Z. W CC T~ '"' "s ~ '~ W u F1 ~a X. S :~ ~ J +~ Z ... x o a: J i- c.u .-~ x x w~ z ~ a¢;-~w -a X ~- J 3 'S 3 ~: 3 2 W Ca :x: U'~ J U'i O Z t~ ~ ti ~ Q \ r:: ~ R U t- S W h O J C ~! Yv: l'.i .g iC W H tC F-- p ~ 6 y nl t, o.1 .l:o i-W m LA BREA PETITE 2.49 B MISSION 5.49 B HF SKIM FFFF MILIT 3.99 B MR POSTAGE STAMPS NP 9.00 MR POSTAGE STAMP FEE NP .50 MR POSTAGE STAMPS NP 9.00 MR NEWSPAPERTAMP FEE NP 1.25 T xxxx 6.75% NC SALES TAX •25 xxxx 2% NC SALES TAX .24 xxxx BALANCE DUE 35.21 VF DISCOVER 35.21 xxxxxxxxxxxxxxxxtxxxxxxlxxxxxxxxxxxxxx DISCOVER $$$$$$535.21 ACCOUNT M xxxxxxxxxxxxxxxxxxxx6398 REF A 01479 EFT SEO N 3027 CARD WAS SWIPED AT PINPAD xxxxxxxxxxxxxzxxxxxxxxxzxxxxxxxxxxxxxx Payment Amount Payee Name 135.00 15.00 16.00 23.50 5.00 ---------------- $194.50 $194.50 ~~~ ~~ ~~ 2727 S. CHURCH RORB - BURLINGI~ON, NC STURE A 0345 - PHONE # 336-58 -1414 IF YOU RRE NOT COMPLETELY SFlTISFIEO WITH YOUR VISIT TODRY PLERSE CRLL STORE MANAGER: DON B YOUR CRSHIER : EVITR P MR POSTRGE STRMPS NP 8.80 MR POSTRGE STRPP FEE NP 50 -~w^ BRLRNCE DUE 9.30 OF DISCOVER 9.30 ^*it f~~x x*iE*.*~itr•*fr *irxx*x~t~~f*+f~k~t+x;~>x~r DISCOUER SSSSS8889,30 RCCOUNT >< ~~*..+xx.."'""'""*'*6398 1016 58-112/581 2~3z. ~8 enulcn er~w~ma wvo>lwsr coravu+r (_, JJ~1.WUINNK BB~i B~9f,.~o/mn ~ ~ ` J x:053 LO i 121:000 5 200 3969 L ia'0 LO L6 ~,~.~a~. EST OF HARRY MAC NELSON EXC KELLY A PERKINS 3387 ELK DR Z BURLINGTON, NC 2721&9787s rry„~ p '' ~ ~: fj'~}/ l l ~ r r l ,' ..`` 4 ~•Y. t~ ryrye~, : ~ i Y~,S ~c~ ,~;, ~ 's~ ~} A+ ~~c, ~~ k~~'~. da,.C ~~_.~. ~~~ ~., a~~a ~~ ~~ ~: ~~ ~a i~ 4~ ~~ ~'~ Habitat r fot Humanlty® ~~ ~ ~~-- 1 t ~ ' ~-1'1~ ~~ S ~: ~~ ~ Q 9 -~gc~v ~= ~ ~,~ -;~ r ~~ ~ ', cz ~; ~ ~ ~- cr ~ U I~j(~ n3nauoi ssvU-lsnid vsn ',\1.1 ' Y3A3tlOi SSYD-15NH VSn nm _. ~~~isn M~ M~+ tl3A3YM SM1?6tli]VYn ~ + ~3tlOf ~V IJ I)illitl5fl ~1 //~~ tl3/~3tlOtl S5V1> LSLIJMf1 ` j '.n3nm san lSUt9 vsn i~ BA3Mm -SV I J I Sll~f tl5n M3A3tlOfSN]J IsLii VSn /~ 4Ntlm ssaUisnu VSn - ~( Y3A3tlOf SSalJistlH Kn //V/.~_]~/'AV/1 ~~ Y 1n3nm<5~}IStlH VSf1 tl3A3tlOi 55vl}-15tlH VSn 1~ .'A3tlq.:~OIJ fSGfiMS~l tl3~3tlOi S5VU-1Sxli vSn ~ ~~ ~ '~ ~ ~ C~ ~ ~ ~ ~ ,~ dd- Q:) aNd1b38W0~ (y ~~, C~- ~ ~nl~a' , Q !r~,~0;)~~