HomeMy WebLinkAbout09-24-12 (2)1505610149
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REV-1500 EX(°,-'°'
pennsytvania
PA Departmentof Revenue `"{1°"""''`°"
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280801
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year File Number
20 10 1164
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1,95 28 8228 09 12 2010 D6 10 1936
Decedent's Last Name
Ertel
Suffix Decedent's Frst Name
Shirley
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's Frst Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
R~~~~T€R ~F 1NILLS
FILL IN APPROPRIATE OVALS BELOW
[~ 1. Original Return ~ 2. Supplemental Return Q 3. Remainder Return (date of death
prior to 12-13-82)
D 4. Limited Estate O 4a. Future Interest Compromise (date of D 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)
0 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
MI
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CORRESPONDENT -This section must be completed. All Correspondence and Confidential Tax Information Should be Directed to:
Name Daytime Telephone Number
Elyse E• Rogers, Esquire 717 612 5801
Frst line of address
635 North 12th Street, Suite 400
Second line of address
City or Post Office State ZIP Code
Lemoyne PA 17043
Correspondent's a-mail address: erO~erS@SSr-attorrleyS.COm
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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, correctand complete. Declaration of the preparer otherthan personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PE RSONRESPONSlBLE FOR FILINGRETURN DATE
ADDRESS 2966 Maple Road
_ Camp-kiill, PA 17011 i 1
SIGN/jT EOFPREP,A~REROT ERTHANREPRESENTATIVE DATE
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ADDRESS 1635 North 1 re t
Lemoyne, PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610149
REGISTE~F WILLS USE ~1yI;}:Y
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1505610149
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Rev-1500 EX
Decedent's Name: Shirley M. Ertel
Decedent's Social Security Number
195 28 8228
RECAPITULATION
1. Real estate (Schedule A) ......................................... 1. 0 ' 0 0
2. Stocks and Bonds (Schedule B) .................................... 2. 0 ' 0 0
3. Closel Held Co oration, Partnershi or Sole-Pro rietorshi Schedule C
Y rP P P P ( ) ......
3. 0 • 0 0
4.
9 9 ( .........................
Mort a es and Notes Receivable Schedule D) 4. 0 ' 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ....... 5. 8 , 5 7 2 • 5 8
6. Jointly Owned Property (Schedule F) D Separate Billing Requested ...... 6. 0 ' 0 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested ...... 7. 9 9, 0 8 2. 9 3
8. Total Gross Assets (total Lines 1 through 7) ............................ 8. 10 7 , 6 5 5 •51
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) ............................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ....................... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... 14.
1,061.99
0.00
1,061.99
106, 593 •52
0.00
106,593.52
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 0 • 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 10 6 5 9 3 5 2
~ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable 0 0 0
at collateral rate X .15 18.
19. TAX DUE .................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610249 1505610249
1505610249
0.00
4 , 796 • 71
0.00
0.00
4,796.71
O
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Rev-1500 DC Page 3
Decedent's Complete Address:
Fle Number
20 10 1164
DECEDENTS NAME
Shirley M. Ertel
STREET ADDRESS
200 North 30th Street
CITY
Camp Hill STATE
PA ZI P
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
0.00
Total Credits (A + B) (2)
(1> 4,796.71
0.00
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.
(3)
0.00
(4)
(5)
4,796.71
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 : .................. • .................. Q
b. retain the right to designate who shall use the property transferred or its income : ................ Q
c. retain a reversionary interest; or ..... • .. • .. • ............ • ............ • ............. Q
d. receive the promise for life of either payments, benefits or care? . • • ... • • • • • • • • • • • • . • . • • • • • • Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year
of death without receiving adequate consideration? ....................................... Q
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .. Q
4. Did decedent own an individual retirement account, annuity, or other non-probate property,
which contains a beneficiary designation? .............................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [72 P.S. Sect. 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. Sect. 9116(a)(1.1)(ii)]. The statue 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. Sect. 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. Sect. 9116(1.2) [72 P.S. Sect. 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. Sect. 9116(a)(1.3)]. A sibling
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-1508 EX+(8-98)
COMMONWEALTH OF PENNSYLVANIA
INH ERITANCE TAX RETURN
RESIDENTDECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Shirley M. Ertel 20 10 1164
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
REV -1510 EX+ (OS-09)
r~ Pennsylvania
I](.NAR I'fie?V-T Q?~ Rr:4':>.Ni t~
INH ERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Shirley M. Ertel 20 10 1164
This sc hedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUM DESCRIPTION OF PROPERTY
INCLUDE NAME OFTRANSFEREE, RELATIONSHIPTO DECEDENT&
DATE OFTRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
EXCLUSION
(IFAPPLICABLE)
TAXABLE
VALUE
1 AXA Equitable IRA Policy 081-938-958 99,082.93 100 99,082.93
Beneficiary: Decedent's daughter, Christel L.
Ertel
TOTAL (Also enter on Line 7, Recapitulation) ~ 99,082.93
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
~~, Pennsylvania SCHEDULE H
FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shirley M. Ertel 20 10 1164
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 1, 000.00
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:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7 Saidis, Sullivan & Rogers, out of pocket expenses 31.99
8 Register of Wills, filing fees 30.00
TOTAL (Also enter on Line 9, Recapitulation) I 1,061.99
If more space is needed, use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
r~ pennsylvania SCHEDULE J
INHERITANCETAXRETURN BENEFICIARIES
RESIDENTDECEDENT
ESTATE OF: FILE NUMBER:
Shirley M. Ertel 20 10 1164
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NuMBE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees OF ESTATE
z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2).]
Christel L. Ertel Daughter 106,593.52
2966 Maple Road
Camp Hill, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15THROUG H 180E REV-1500 COVER SH EET, AS APPROPRIATE.
zz NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET.
If more space is needed, use additional sheets of paper of the same size.
LAST V~'ILL AND TESTAME~'T
I. Shirle~~ M. E1-tel. of Cumberland County, Pelu~sylvailia_ revoke m~~ prior
wills and declare this to be m}~ will:
GIFTS
I. Personal and HoL~~sehold Effects: I give all m~~ articles of~personal or
household use, including automobiles, together with all insurance relating; thereto, to n1}~
ol~l}~ child, Clv~istel L. Ertel (Stewartj, who so survives me.
I may leave a memorandum setting forth suggestions as to the distribution
of cerl:ain items and; while the memorandum is not to be legall}~ bindii3g, I hope the
suggestions in it will be carried out.
IL Residuary Estate; I give the residue of m~~ estate, real and personal:
To my daughter; Christel L. Ertel; if she survives n1e and if not, to
my grandchild Grace Martha Ertel Stewart
III. Powers of A~pointlnent: No provision of this will shall exercise any
pov+~er of appointment I ma~~ have.
ADMINISTRATIVE PROVISIONS
V. Minor Beneficiaries: An}~ property passing under this will to a person
under twenty-one years of age shall be paid to a custodian for the minor selected and
appoinied by my executor under the Pennsylvania Uniform Transfers to Minors Act.
VI. Protective Provision: No interest in income or principal shall be
assignable by, or available to anyone having a claim against, a beneficiary before actual
pa}~ment to the benerciary.
VII. Death Taxes: All federal; state and ether death taxes payable because of
n~}~ death on the property forming n~}~ gross estate for tax purposes; whether or not it
passes under this will. shall be paid out of the principal of my probate estate so that the
burden thereof falls on m>> residuar}~ estate. and none of those taxes shall be charged
against any benerciar}> or any outside fund. This provision shall not appl}~ to generation-
skipping transfer taxes.
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VIII. Management Provisions: 1 authorize n1y executor:
A. To retails and to invest in all forms of~ real and personal property,
without being confined to investments authorized by a statutory
list;
B. To compromise claims and to abandon any property which, in my
executor's opinion. is of little or no value;
C. To sell at public or private sale, to exchange or to lease for any
period of tinge; any real or personal property, and to hive options
for sales or leases:.
D. To join in any merger, reorganization, voting-trust plan or other
conce~l-ted action of security holders, and to delegate discretionary
duties with respect thereto;
E. To borrow and to pledge property as security for repayment of an}~
funds borrowed;
F. To partition. subdivide or improve real estate and to enter into
agreements concerning the partition, subdivision, improvement.
zoning or management of any real estate in which my estate has an
interest and to impose. or extinguish restrictions on any such real
estate;
G. To employ and to rely upon advice given by investment counsel, to
delegate discretionary authority to make changes in investments to
investment counsel, and to pay investment counsel reasonable
compensation in addition to any fees otherwise payable to my
executor;
H. To employ a custodian, to hold property unregistered or in the
Hanle of a nominee [including the nominee of any institution
employed as custodian], and to pay reasonable compensation to the
custodian in addition to an}r fees otherwise payable to nay executor ;
and
To distribute in cash or in kind.
These authorities shall be in addition to those granted by lain and shall be exercisable
without couT~t authorization.
Imo. Business Interests: In dealing with the stock of an}~ close corporation, any
partnership or an}~ other business interest forming a paz-t of n1y estate, I authorize my
executor:
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A. To disregard any principle of investment diversification and to
retain an}~ paz-t or all of such interest as lone, as nay executor
considers it advisable to do so;
B. To sell any part oz' all of'such interest at such tune or time's for
such prices. to such persons (including persons who are fiduciaries
or beneficiaries hereunder) and on such terms and conditions as my
executor may thinlti advisable;
C. To do an>~thing that may seem advisable with respect to the
operation or liquidation of any such business or any change in the.
purpose; nature or structure of any such business;
D. To delegate authority to any director.. stocl~7older, manager, agent,
partner or employee, and to approve payment from the business of
adequate compensation to any such person;
E. To cause the business to borrow money froze the banking
department of any corporate executor, regardless of any rule of law
with respect to conflict of interest; and
F. To make additional investments in any such business, if such
action seems in the best interest of the beneficiaries hereunder.
The fact that any executor of this will ma}~ be interested in any such business as director,
stocldlolder, manger, agent. paz-tner, employee or creditor shall not constitute an adverse
or conflicting interest, and the acts of such executor shall be judged as if he or she had no
interest in the business. No executor shall be liable to anyone for an}thing done. or not
done by an}~ other executor or by any beneficiary; except for willful or gross negligence.
In short, I intend that in making decisions hereunder, my executor shall have the same
fi°eedon~ of action that I would have if living.
~. Debts and Funeral Expenses: My debts anal the expenses of my last
illness, funeral and burial shall be paid out of my estate.
XI. Eaeculor: I appoint my daughter. Christel L. Ertel, executor of this will,
and I direct that:
A. Lf n7y daughter, Cl~~istel L. Ertel, for any reason fails to qualify or
ceases to act as executor, I appoint Gary 1~1. Stewart; executor in
her place;.
B. M~~ executor may at any time be written instrument appoint a
corporation with fiduciary powers as a co-executor and may enter
into a binding agreement with it regarding its compensation;
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C. The words "m~~ executor" shall refer to all those from time to time
acting as such; and
D. No executor shall be required to give bond.
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In our presence the above-named testatrix signed this and declared it to be his will. and
now at his request, in his presence; and in the presence of each other, we sign as
witnesses:
e
Witness Address ~ ~ ~ ~ ~
V~~itness Address
STATE CAF PENI~SYL~IANIA
SS
1
I, Shirley- M. Ertel, having bee17 dul}= qualified according to law,
acknowledbe that I signed the foregoing instrument as my will, and that I signed it as my
free and vollu~tary act for the purposes therein expressed,
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We, having beef duly qualified according to law.. depose and say that we
were present and saw Shirley M. Ertel sign the foregoing. instrument as his will; that he
signed it as his free and voluntar}~ act for the purposes therein expressed; that each of us
in his sight and hearing and at his request signed the will as witnesses; and that to the best
of our lalowledge he was at that time i 8 or more years of age, of sound mind and under
no constraint or undue influence.
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Subscribed, sv~rorn to or
affirmed, a~zd acl~lowledged
before n1e by the above-flamed
testatrix and b}~ the witnesses
whose names appear opposite,
ol~~tljt/ d~ , ?010.
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Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Michelle A. Sine, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires Nov. 18, 2012
t+e4ember, Pennsylvania Asso^..iation of Notaries
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PRt)PERTY DESCRIPTION
'pco a Holder nforma#ion _ ;_ ro ert _' ~ 7884'(24 °.
(A) Original Owner's Name (f3) Original Owner's Address as Reported
ERTEL DONALD L H C 31 BARBOURS WILLiAMSPORT PA 17701-6806
ERTEL SH)RLEY M H C 31 BARBOURS WILLIAMSPORT PA 17701-6806
(C) Holder Reportng Funds (D) Last Transaction Date
PRUDENTIAL MUTUAL FUND SERVICES LLC 12/06!2002
(E) Holder Address and Contact (F}Type of Funds Reported
100 MULBERRY STREET GATEWAY CENTER 3 -10TH FL DIVIDENDS
NEWARK NJ 07102 (G) Certificate, Policy or Check Number
MICKI MAGEE 1
(973)367-35$6 (H) Amount Reported $55.89
Pra e ; ' ' older°lnforffna#ran - - - Pro e 1D 7884'192 .
{A) Original Owners Name {B) Original Owners Address as Reported
ERTEL SHIRLEY M H C 31 BARBOURS WILLIAMSPORT PA 17701-6806
ERTEL DONALD L H C 31 BARBOURS WILLiAMSPORT PA 17701-6806
(C) Hofder Reporting Funds (D) Last Transaction Date
PRUDENTIAL MUTUAL FUND SERVICES LLC 12/1312002
(E) Hofder Address and Contact (F) Type ofi Funds Reported
100 MULBERRY STREET GATEWAY CENTER 3 -10TH FL DIVIDENDS
NEWARK NJ 0710?_ (G) Certificate. Policy or Check Number
MICKI MAGEE 1
(973)367-3586 (H) Amount Reported 95.62
Frv ert 1 _Nolder, tnfc~rmation Proper ;1D ` 87198 2 _ __ ,
(A) Original Owner's Name {S) Original Owners Address as Reported
ERTEL SHIRLEY M 111 CEMETERY RD WILLIAMSPORT PA 17701-6806
ERTEL DONALD L 111 CEMETERY RD WILLIAMSPORT PA 17701-6806
(C) Holder Reporting Funds {D) Last Transaction Date
PRUDENTIAL MUTUAL FUND SERVICES LLC 09/30/2dQ3
(E) Holder Address and Contact (F) Type of Funds Reported
100 MULBERRY STREET GATEWAY CENTER 3 -10TH FL DIVIDENDS
NEWARK NJ 07102 (G) Certificate, Policy or Check Number
MICK1 MAGEE 1
(973)367-3586 (H) Amount Reported 1,528.33
RETURN CLAIM FORM AND DOCUMENTATION TO: 100693655
Bureau of Unclaimed Property J P.O. Box 1837 ~ Harrisburg, PA 17105-1837 ~ 1.800.222.2046 page 5 8/27/2012
www.patreasury.gov '~-~,.
on
_ _ -e: ~~~-ms's Name
__- _~ DONALD L
- - _i_ SHIRLEY M
-c ~ r Reporting Funds
~RJDENTEAL MUTUAL FUND SERVICES LLC
'_ =;,!der Address and Contact
100 MULBERRY STREET GATEWAY CENTER 3 -1 OTH FL
NEWARK NJ 07102
MICKI MAGEE
(973)367-3586
Pro - e > ID '>87'I°9$'13
{B) Original Owners Address as Reported
H C 31 BARBOURS WILLIAMSPORT PA 17701-6806
H C 31 BARBOURS WiLLIAMSPORT PA 17701-6806
(D) Last Transaction Date
03/31 /2003
(F}Type of Funds Reported
DIVIDENDS
{G}Certificate, Policy or Check Number
1
{H}Amount Reported
170.8
Pro ert ~ 'Holder n ormation ~ - Pt~a e =ID . 1427966
(A) Original Owner's Name (B) Original Owner's Address as Reported
L DONALD 111 CEMETERY RD WILLIAMSPORT PA 17701-0000
(C) Holder Reporting Funds
PIONEER NATURAL RESOURCES COMPANY {D) Last Transaction Date
04/13/2004
(E) Holder Address and Contact {F}Type of Funds Reported
CONTINENTAL STOCK TRNSFER & TRUST 17 BATTI DIVIDENDS
CIO
NEVV YORK NY 10004 (G}Certificate, Policy or Check >`!umher
NTHONY ANTONIO 282007083
A
{212)509-4000 {H) Amount Reported 136.02
Props Holder information ;- - =- _ -:Props 1D 'i0237967
(A) Original Oti~mer's Name (B) Original O~a~ner's Address as Reported
L DONALD 111 CEMETERY RD WILLIAMSPORT PA 17701-0000
(C) Holder Reporting Funds
PIONEER NATURAL RESOURCES COMPANY (D) Last Transaction Date
04/13/2004
~E) Holder Address and Contact {r=)T;~~e of Funcis ~~~port•u
C/O CONTINENTAL STOCK TRNSFER & TRUST 1 7 BATTI UNDERLYING
NEW YORK NY 10004 (G) Certificate, Policy or Check Number
ANTHONY ANTONIO PXD00054740
(212)509-4000 (H) Amount Reported 5,785.87
Total Shares Claimed 0.0000 Total Cash Claimed 8,572.58
RETURN CLAIM FORM AND DOCUMENTATION TO: 100683655
Bureau of Unclaimed Pro~e'~',' ?.~. =~x 1837 ~ Harrisburg, PA 17105-1$37 ~ 1.$00.2222046 Page 6 8/27/2012
www.patreasury.gov