HomeMy WebLinkAbout10-04-12 (2)1505610105
REV-1500 exl°~-"""'
PA Department of Revenue Pennsytvarda
Bureau of Individual Taxes .,,..., ~ INHERITANCE TAX RETURN
PO BOX z8o6ot
Harrisburg, PA t71z8-o6o1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth
162-22-1242 01/14/2012 07/15/1924
Decedent's Last Name
SHIELDS
OFFICIAL USE ONLY
Count' Code Year File Number
MMDDYYVV
Suffix Decedent's First Name
MARY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
M1
G
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPi.ICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
m 1. Odginal Return O 2. Supplemental Retum O 3. Remainder ReWrn (Date of Death
Pdor to 12-13.82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum 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) (Atach Copy of Trust.)
O 9. Litgalion Proceeds Received O 10. Spousal Poverty Cretlit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 antl 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENIIALTAX INFORMATION 8HDULD BE DIRECTED TO
Name Daytime Telephone Number
DAVID P, PERKINS, ESQUIRE ( 717) 532-953~7,~ !~ ~
r
-
REGISTER
S USE OM6T ~1
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First Line of Address ~ ~ `-j
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Attorney at Law C7C~~.~ , Cr Q
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Second Line of Address QC
4 James Circle - 17
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City or Post Office State ZIP Code DATE FILED N ~~~
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Shippensburg PA 17257
Correspondent's e-mail address: DPPESO@GMAIL.COM
Under penalties of perjury, I declare Nat 1 have examined this realm, including accompanying schetlules and sfetemanls, and tome hest of my knowledge and trelief,
it is true, correct and complete. Declaration of preparer other than the personal representallve is based on all infonnalion of which preperer has any knowledge.
5 AT E OF ER R PON518 F®Ft FILING RETURN / GATE
!~ lL L// - -~-tr. 4'.~/I, .%%tr 10/03/2012
ADDRESS / T
222 SHIPPENSBURG ROAD SHIPPENSBURG, PA 17257 P.O. Box 436, Newburg, PA 17240
SIGNAT RE OF SPARE/B.edHE$~i1AN PRESENTATIVE DATE
OAl V r C~ 10/03/2012
4 JAMES CIRCLE SHIPPENSBURG, PA 17257
PLEASE USE ORIGIN4L FORM ONLY
Side 1
L 1505610105 1505610105
(~
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: SHIELDS, Mary G. 162-22-1242
RECAPRULATION
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) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7.
8. Total Gross Assets (total Lines 1 through 7) ........................... .. 6.
0.00
272,216.00
0.00
0.00
5,662.79
2,275.35
280,154.14
9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. 33,935.54
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 1,816.90
11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 35,752.44
12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 244,401.70
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has no[ been made (Schedule J) .................. ...... 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ...... 14. 244,401.70
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.
16. Amount of Line 14 taxable
at lineal rate X .0 45 243,401.70 1g,
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable 1
000
00
,
.
at collateral rate X .15 16.
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205 150561D205
1505610205
10,953.08
150.00
11,103.08
O
REV-1500 EX (FI) Page 3 Flle Numher
~eceaenrs complete waaress:
DECEDENT'S NAME
MARY G. SHIELDS
_ - _ __
STREET ADDRESS
5 West Main Street
CITY _.. _ _ _.. _. _ STATE.. ,,...ZIP _
Newburg ~ PA i 17240
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments ____ 10,000.00
B. Disceunt ~ ~ ~ -~
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 tire TAX DUE.
(1)
11,103.08
Total Credits (A + B) (2) 10,000.00
(3)
(4)
1,103.08
(5)
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 transfened ................................................................................... ....... ^
b. retain the right to designate who shall use the property trensfened or its income ..................................... ....... ^
c. retain a reversionary interest ....................................................................................................................... ....... ^
d. receive the promise for life of either payments, benefits or pre? ............................................................... ....... ^
2. If death occurred after Dec. 12, 1982, did decedent tansfer property within one year of death
without receiving adequate censiderafion? ....................................................................................................... ....... ~ ^
3. Did decedent own an "in Wst lot' or payable-upon~death bank aaount or secudty at his or her death? ....... ....... ^
4. Did decedent own an individual retirement account, annuity or ofhernon-probate properly, which
contains a benefidary 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 fax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [/2 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the fax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
p2 P.S. §9116 (a) (1.1) (ii)]. The statute does rwt 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 benefidary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers trom 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 tau rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidades is 4.5 pralcent, except as noted in [/2 P.S. §9116(a)(1)].
The fax rate imposed on the net value of Uansfers 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.
REVa50j EXi (8-II)
sir
~ ~- pennsytvania
DEPBRlMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEp11LE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
SHIELDS MARY G. 21-12-0099
REV-1508 EX+ (oR-u)
pennsylvania SCNEp11LE E
DEPAflTMENTOFREVENUE CASHF BANK DEPOSTiS @C MISC.
INRERITAUCE TAx RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER;
SHIELDS, MARY G 21-12-0099
Include the proceeds of litigation and the date Me proceeds were received by ttre estate.
All property jointly owned with AgM of survivorship must be disclosed on Schedule F.
REV-1510 EX+ (0a-09J
~ pennsylvania SCHEDULE G
DEPARTMENT OF flEVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TA%RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE
FILE NUM8E0.
SHEILDS, MARY G. 21-12-0099
This schedule must be completed and filed if the ansvrer to any of questions 1 through 4 on page [hrE~e of the REV-SSDD is yes.
REM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NPNF aTHE TRANSFEREE, iXEi0. REIATIONSNIP IO DECEDENT AND
TEIE DALE OF TRANSFER. AITACNACDPY OF THE DEER FDR REAE ESTATE.
DATE OF DEATH
VALUE OF ASSET
960E DECD'S
INTEREST
EXCLUSION
pFAVVUrARU:)
TAXABLE
VALUE
1. 2000 Ford Taurus automoblie transferted to Joann E. Sprecher -
1,921.00 100 1,921.00 D.01
daughter l0/17/2017
2 Individual Retirement Account -Citizens Bank acct # 6100795586
2,275.35 700 2,275.3:
beneficiaries -children: Dale B. Hebedig,Joann E. Sprecher,A. Wayne
Heberlig,Nelson H. Hebedig,Ronald L. Hebedig,M, Darlene Davidson
TOTAL (Also enter on Line 7, Recapitulation) ; ~ 2,275.35
If mare space is needed, use additional sheets of paper of the same size.
0.EV-ISlt EX+ (30-09)
B. ADMINISTRATNE COSTS:
1. Personal Representative Commissions: 5,603.08
Name(s) of Personal Representative(s) " Dale 8. Heberlig -
street Address 222 Shipoensburg Road
- _---- - _
City _Shippensbur~___ ____ _-_____ Btate PA_zIP '17257_
Year(s) Commission Paid: 2012
~ Pennsylvania SCHEDULE H
DEPARTMENT OF REVENDE FUNERAL EXPENSES AND
INMERRANCE TA%RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SHIELDS, MARY G. 21-12-0099
Decedent's debts mart be reported on Scbeduk 7.
ITEM
NUM8E0. DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Fogelsanger-Bricker Funeral Home cremation & monument engraving 1,813.67
112 West King Street Shippensburg, PA 17257 -portion not paid by life insurance
2. Attorney Fees: 14,007.70
3. Family Exemption: (If decedent's address Is not the same as claimant's, attach explanation.) 3,500.00
salmon[ Joann E._$precher___ _ _
street Address 5 West Main Street
City Newbu~ _ __-- ___..._ - _-_ _ _ State PA ZIP 17240
Relationship of Claimant to Decedent Daughter-_.
4. I Probate Fees:
5~ ~ Aaauntant Fees:
6. Tax Retum Preparer Fees:
7 Legal Advertising - $ 75.00 Cumbedand Law Journal and $210.78 The Sentinel newspapE:r
a VitalChek -Death certificates
~. ' Pesonal Representative Commission Joann E. Sprecher
P.O. Box 436, 5 West Main SUeet Newburg, PA 17240
e. Mern11 Lynch commissions and transaction fees -stack liquidation
f o. tvlerdll Lynch -annual account fee
424.50
285.78
73.00
5,603.08
2,559.73
65.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 33,935.54
[f more space is neetled, use additional sheets of paper of the same size:.
REV-1512 EX+ (]2-08)
SCHEDULE I
Pennsylvania
DEPARTMENT OF flEVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENr DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
SHIELDS MARY G. 21-12-0099
Report debts incurred by the gecedent prior to death that remained unpaiq at the date Df death, including unreimbursed medcal expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTIDN OF DEATH
]. Dr. Darryl Guistewite-medical bill 127.80
Z Dr Darryl Guisrivite-medical bill 86.40
3. West Shore EMS 134.75
3. Century Link -telephone 44.46
a. Faye[feville Volunteer Fire- non-emergency ambulance transport 274.00
5. Presbyterian Homes, Inc nursing home care Green Ridge Village Newville, PA 1,149.49
TOTAL (Also enter on Line 10, F;ecapitulaticn) ~ # 1,816.90
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (D1-10)
Pennsylvania SCHEDULE 7
DEPARTMENT OF REVENUE BENEFICIARIES
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SHIELDS. MARY G. _ 21-12-0099
NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include ouMght spousal distributions and transfers under
Sec. 9116 (a) (1.2).1
1. SHIRLEY M. HEBERLIG DAUGHTER-IN-LAW $1,000.00
222 Shippensburg Road Shippensburg, PA 17257
2. DALE B. HEBERLIG SON 1 /6 of residuary
222 Shippensburg Road Shippensburg, PA 17257
3. JOANN E. SPRECHER DAUGHTER 1/6 of residuary
P.O. Box 436, 5 West Main Street Newburg, PA 17240
4. A.WAYNE HEBERLIG SON 1/B of residuary
247 Potatce Point Road Newburg, PA 17240
5. NELSON H. HEBERLIG SON 1/6 of residuary
100 Shady Road Newburg, PA 17240
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 LOVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECr10N 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON TAk~LE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~
If more space is Rpelled, use additional sheets of paper of the same s!e.
REV-1513 EX+ (O1-10)
pennsy[~ania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX 0.ETURN
RESIDENT DECEDENT
E5fATE OF: RLE NUMBER:
SHIELDS, MARY G. CONTINUATION 21-12-0099
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRiBUT10N5 []Irclude outright spousal dis[dbu[ions and transfers under
Sec 9116 (a) (1.2).]
1.
6. RONALD L. HEBERLIG SON 1 /6 of residuary
P.O. Box 432 Newburg, PA 17240
7, M. DARLENE DAVIDSON DAUGHTER 1/6 of residuary
11000 Thomwood Road Shippensburg, PA 17257
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 10 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBURONS UNDER SECiTON 9113 FOR WHICH AN ELECRON TO TAK IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRTBUflONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBMONS ON LINE 13 OF REV-1500 (.LOVER SHEET. $
If more space is needed, us{ (NQiUonal sheets of paper of Me same size.
LAST WILL AND TESTAMENT
OF MARY G. SHIELDS
...
(1+'
N
V~
~~~
I, Mary G. Shields, of 5 West Main Street, Borough oi~Newbuig,
Cumberland County, Pennsylvania, being of sound mind, memory and disposition,
do hereby make, publish and declare this my Last Will ;and Testament, hereby
revoking and making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts
and funeral expenses as soon as may be convenient after my decease.
SECOND. I give and bequeath the sum of ONE THOUSAND DOLLARS
($1,000.00) to my daughter-in-law, SHIRLEY M. HEBERI;IG, provided that she
survives me. In the event Shirley M. Heberlig predeceases me, I then give and
bequeath the sum of one thousand dollars ($1,000.00) to h.er children, Sherry L.
Piper and Bryan D. Heberllg, to be divided into equal shares.
THIRD. I give, devise and bequeath all of the rest, residue, and remainder
of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my
beloved children, in equal shares, as follows:
A. ONE-SIXTH SHARE to my son, DALE B. HEBER.LIG.
B. ONE-SIXTH SHARE to my daughter, JOANN E. SPRECHER.
C. ONE-SIXTH SHARE to my son, A. WAYNE HEB:ERLIG.
D. ONE-SIXTH SHARE to my son, NELSON H. HEBERLIG.
E. ONE-SIXTH SHARE to my son, RONALD L. HEBERLIG.
F. ONE-SIXTH SHARE to my daughter, M. DARLENE DAVIDSON.
FOURTH. In the event any of my children should predecease me or is not
living on the thirtieth (30`h) day following my death, leaving issue who survive me,
I then give, devise and bequeath said deceased child's share to his or her issue who
survive me, on a per stirpes distribution basis.
1.
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SIXTH. I direct that all taxes that may be assessed in consequence of my
death of whatever nature and by whatever jurisdiction imposed, shall be paid from
my residuary estate as a part of the expense of the administration of my estate.
SEVENTH. I nominate, constitute and appoint my son, Dale B. Heberlig,
and my daughter, JoAnn E.Sprecher, or the survivor thereof;, to be the Executors of
this my Last Will and Testament.
EIGHTH. I direct that my personal representatives shall not be required
to give bond for the faithful perfor.,iancc cf their duties in ~r~y jurisdiction.
IN WITNESS WHEREOF, I, MARY G. SHIELDS, have hereunto set my
hand and seal to this my Last Will and Testament, written on two (2) pages, the
first page signed for identification only, this ~:f s-r' day of February, 2009.
~~
(SE )
This instrument was by the Testatrix, on the date hereof, signed, published and
declared by her to be her Last Will and Testament, in our presence, who at her
request and in the presence of c;:~;;h otl,ei, we uelieving h:,r to be of sound arc'
disposing mind and memory, have hereunto subscribed our n~unes as witnesses.
~~~ ~. c~~
~i :- ~,.~
COMMONWEALTH OF PENNSYLVANIA
:§
COUNTY OF CUMBERLAND
I, Mary G. Shields, the person whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my Last Will; that I signed it
evillingly; and that I signed it as !r!v free and volLntary act f'or the purposes therein
expressed.
Sworn or affirmed to and acknowledged
before me by Mary G. Shields, the Testatrix,
this ~ day of February, 2009.
~~. ~~,~
(' 4GF~ I rt{ ~
f ~i driaai~
:%Victori ~ ~ .r~ ~FyFI(lSl~~
`~hlpP~ ~ , ~ ~~~
!'~MtiH6Teii-Fe=~~ ~--aUO~of No Bf~g
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Vicbria N. Perkins, Notary public
Shippenaburg Boro Cumberland Corurty
MyCanmission Expires Oct. 15, 2010
Member, Penna~~~~ oeiatlan of NotarlBE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, David P. Perkins and Francis H. Norton, the witnesses whose names
are signed to the foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw Mary G. Shields, the Testatrix, sign
and execute the instrument as her Last Will an d Testament; that she signed
willingly and that she executed it as her free and voluntary act for the purposes
therein e;:pTessed; .that each of us in the hearing and sinht of the Testatrix, signed
the will as witnesses; and that to the best of our knowledge the Testatrix was at the
time eighteen (18) or more years of age and of sound mind and under no constraint
or undue influence.
~~a.,a ~j,,v~~
S:vorn or reffirmed to and subscribed before
me by David P. Perkins and Francis H. Norton,
witnesses, this ~ ~ ~~ day of February 2009.
~). ~:~
! ~ t fns //! ~l G~ / ?21J/
COMMONWEALT%-i OF PcNIVSYLVANIA
Notarial Seal
Victoria N. Pedtin=, Notary Public
Shippensburg 13oro. Cumberland County
My Commissi,n cxrtras Oct 75, 2010
Member, Pem,e.%.., .:.~ ,~r::afan of NOtadea
Estimate
~~~
Frotscher Automotive
30 Pine tree Lane
Newburg Pa 17240
71723-0098
froaulo(~embergmail.com
Bitl To:
Joann Sprecher
5 W Main St
Newburg Pa
Code Description
2000 Ford Taurus LX -94000 Miles, V6
Estimate of current value at current condition
F~timate No:
11
Date
5/17/2012
QtyMours Rate Amount
1.00 $0.00 $0.00'
1.00 $1,921.00 $1,921.00'
• Indicacesaon-taxable item
Subtotal $1,921.00
Tax (6.00%)
Total
$0.00
$1,821.00
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Oct B3 ZB1Z 19:28:23 1717773943b
P.C7. Box 204d
Lakewood, NJ 08701
-> 717 532 9537 Merrill Lynch Page BB9
Merrill lynch
Wealth fNana~etnerlt
HriN of An+ence Coroorenan
Merrill Lynch
Ofrce Servingg Your Account
t 106 I(ENNEBEC OR
CHAMBER58URG PA 77201.2809
(711) 263-4070
MARY G SHIELDS
PO 80X 435
NEWBURG PA 17240-0435
MARY G SHIELDS OCSD
PO 8pX 435
NEW8t1RG PA 177.40
Account Number: 697-72306
TRADE CONFIRMATION Uate: June 13, 20,2
We confirm Ure foflowirrg transaction(s) sUAJect to the agreement below.
SOLD EXXON MOBIL CORP COM
trade Date 06/13/12
Settle Date 06/16/12
MI_ Symlx+! XUM
Serurity # 257D4
CudiPN 30231 G102
F'A A` 6961
5EE ABOVE FOR TRANSACTION DETAILS
SOLD EXXON MOBfL CORP COM
Treda Dote 06/13/12
Settle Dare 06/16/12
ML Symbnf XOM
Security 257D4
CUSIP N 30231G70'L
~+M 6961
SEE ABOVE FOR TRANSACTION DETAILS
Merrill Lyndl Weulth Management makes available product and services offered Dy Merrill Lynch, Pierce, Fenner & 5mlth
Inrorpnraia[I (MLPF85) and other SubgltllarlQS 0( Bunk Or AmeriGl CMpOratiOn. MLPF&5 la a regLtefed Dro4;ervdreler, member
Securities Investor Protection Corporation (SIPC) end a wholly owned subsidiary of Bank d Amedca Corporation. Investment
protluns:
Are Nnt FDIC Insured Are Nnt Bank Guaran[eetl Ma Lose Value
Account Number: 697-12306 Date: 08/13/2012 Page 1 of 3
EXECUTED 100% AGENCY. UNSOLICITED ORDER, ML ACTED AS AGENT,
EXECUTED 100% AGENCY. UNSOLICITED ORDER. ML ACTED AS AGENT.
Oct B3 ZB1Z 19:ZB:SB 17177734436 -> 717 53Z 9537 tlerrill Lynch Page BBS
,~; Merrill Lynch
D~~ Wenlth Mnnagament
aenk ,N Nnorka Car(wratbn
TRADE DETAILS fcon(inued)
SOLD EXXON MOBIL CORP COM
Trade Oa(e 06/13/12
Settla Dale 06/18/12
ML .Symbol XOM
Security,Y 25704
Cua~ J 302316102
FA ti 6961
SEE AEtOVE fqR TRANSACTION DETAILS
Paymarn for securities a other irrvestmem instruments purchased, antl tlNNery of securities or other invesbnenl instmments gold,
are dun nor later than SETiLE1JENT DATE unless otherwise (ndicalad by a D TE DUF.. Please presme this conllrmaNon fnr income
mx purppoos9es. IT aubmiuing a check, money order or rorregpondsnce, please write your accoum number and forward to "Merrill
Lynch Olbca Serving Vour Account", shown et the top of Uce page above your attount number. If ymi have moved or plan to move,
notify your Finaxinl Adufsor of your new addrKS.
Account Number: G97~12306 UeCe: 0 611 3/201 2 f ago 2 of 3
EXECUTED 10096 AGENCY. UNSOLICITED ORDER. ML ACTEp AS AGENT.
Oct B3 ZB12 19:Z9:B8
P.O. Box 2044
Lakewood. NJ 08701
17177739936 -> 717 532 9537 Merrill Lynch Page BB6
MARY G SHIELDS
PO BOX 435
NEWBURG PA 17240-0435
~~ Merril{ lynch
9~3~ waelNr M.na~.atene
ganN of America Comoratlan
Merrill lynch
U~ce Serving Your Accaunt
1108 KENNEBEC DR
CHAMRERSBUI2G PA 17201.2807
(717) 263-A070
MARY G SHIELDS fJCSD
PO BOX 435
NEWBURG PA 17240
Account Number: 687-12306
TRADE CONFIRMATION Da[e: March 22, 2012
We confirm the following transaction(s) subject to the agrz~ement below.
SOLO EXXON MOkill CORP COM
Trade 17ete 03lL2/12
Settfe i7ate 03/27/12
ML 5ymbo! XOM_~_
Security NN 257D4
CUSi ,M 302316102
FA p` 6961
SEE ABOVE FOR TRANSACTION DETAILS
SOLD EXXON NIOBI! CORP COM
Trade Date 03/22/12
Se4tfe Oete 03!27/12
ML Symbol XOM
Security ~' 25704
Cusi~s 302316102
FA B 6961
SEE ABOVE FOR TRANSACTION DETAILS
Payment for secuHllas or other ImrastnaaM insVuments purchased, end delivery of socvraies or otlwr imresunant Instrwnams sold,
aro due not later then SETTLEMENT DATE uMess otherwise indicated Try a DATE DUE. Please preaervo this confirmation for income
tas (w s. 8 suhttdtt'tng a check money ceder or correspmdenea please wrke your accoum number and Forward to "Merrill
Lynch Olflee Serving YWr Account", shown al the top of the page above your account number. If you have moved or plgn ra nwve,
notfly your Finenclgl Advisor of your new address.
Morrin l.ynrh Wealth Manegemem makes available w'alucis and services offnred l)y M¢I'flll Lyncn, PlarCa, I=sonar F 5m1Ih
Incorporalstl (MLPF&S) and other subsldiarlgs M Hank o! AmerlW Corporation. ML F8:5 is a rcgiscered a'oker•deatar, metntxir
Securities Investor Praleaion Coryoredon (SIPC) anU a wrwlly owned subsidiary ut E1anK or An~oriw Corporation. Invasmtent
Ixociucts:
!ke Not FDIC Insured FVr. Not Hank ctunranteed 4A Lose Value
Account Number: 697.123D6 Data' 03/2 2120 7 2 Paye 1 Of 2
E%ECUTED 100`X+ AGENCY. UNSOLICITED ORDER. ML ACTED AS AGENT.
EXECUTED 100`% AGENCY, uNSO11CITED ORDER. M4 ACTED AS AGEN'T'.
Oct B3 2812 19:29:38 17177734436 -> 717 532 9537 Merrill Lynch Page 887
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Dote: 03/2Z/20t2 pDge 2 of 2
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March 6, 2012
David P Perkins, Esquire
Attorney At Law
4 James Circle
Shippensburg PA 17257-2165
Estate of Mary G Shields
Date of Death: Jan 14, 2012
SSN: 162-22-1242
Dear Sir/Madam:
One Citizens Drive
ROP112
Riverside, RI 02915
In accordance with your request, the attached information sheets have been provided in the above
decedent's name as of his/her date of death.
For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For
all other inquiries, please ca11877-579-2667 option 2.
Sincerely,
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Kristen B. Correia
Decedent Account Processing
REF#:527373
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Account Number 6100795586
Account Title M G Shield:>
Date O ened 3/29/1980
Account T e Checkin
Princi al Balance as of DOD $3652.12
Interest from Last Postin to DOD $ .Ol
Account Balance as of DOD $3652.13
YTD Interest to DOD $ .07
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Account Number 6140698987
Account Title _ Mary G Shields
Date ened 6/16/1995
Account T e Time Deposits (IFLA)
_
Princi al Balance as of DOD _
$2275.31
Interest from Last Postin to DOD $ .04
Account Balance as of DOD $2275.35
YTD Interest to DOI? $ .20