HomeMy WebLinkAbout11-15-12_J 1505610105
OFFICIAL USE ONLY
REV-1500°``°'"'`F"
PA Department of Revenue pennsytvania County Code Year file Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ~ t ' n
PO BOXZ8o6o1 RESIDENT DECEDENT 1 ~1
u~..:..w.,... on ~m oR_nfim
Social Security Number Date of Death
177-12-0463 06/11/2012
Decedent's Last Name
SHEAFFER
(H Applicable) Enter Surviving Spouse's Information Below
Spouse's Lasl Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
MMDDYYYY Date of Birth MMDDYYYY
12/07/1920
Suffix Decedent's First Name MI
JANETTE L
Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
m 1. Original Return O 2. Supplemental Retum O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date oT Death O 11. Election to Tax under Sec. 9113(A)
Between t2-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ICMFC W RHFAFFFR (301) 385-4488
First Line of Address
5008 Cedar Croft Drive
Second Line of Address
City or Post Offce
Bethesda
State ZIP Code
PA 20814
n <`-
REGISTER OF USE ONIM.~
~=
~:o z
u
n- c
~<'
= cn
r
~
' ~
o~°
"=; tV
D
DA7E FILED t'"
l
n
c, ~ <~
z
°; ~.,
r"
'r7
=_ C J
~~
correspondent's a-mail address: jWSheaf~aOl.COm
Under pe ties of perjury, I declare that I have ezaminetl this reNm, including accompanying schetlules antl statements, antl to the best of my knowledge antl belief,
it is im ct and com aration of Dreparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN UR OF F]ER$O S BLE FOR FILING RETURN DATE
t,,_ W ~ ,y A/OV ZO!
ADORES
5008 edar Croft Drive, ethesda, MD 20814
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
• PLEASE USE ORIGINAL FORM ONLY
1505610105
Side 1
1505610105
155610205
REV-1500 EX (FI) Decedent's Social Security Number
177-12-0463
Decedent's Name:
RECAPITULATION
1. Real Estate (Schedule A) ........................................... .. 1. 0.00
2. Stocks and Bonds (Schedule B) .................................... ... 2. 1,250,$47.$7
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00
4.
9 9 ( ) ........................
Mort a es and Notes Receivable Schedule D 4.
... 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 19$,$9$.04
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 0.00
7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property
7
19
000
00
(Schedule G) O Separate Billing Requested..... .
... ,
.
8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 1,468,745.91
9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 16,704.02
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 10,987.30
11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 27,691.32
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 1,441,054.59
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
13
00
5
000
an election to tax has not been made (Schedule J) ..................... ...
. ,
.
14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 1,436,054.59
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
0
00
(a)(1.2) X .0_ 15. .
16. Amount of Line 14 taxable
at lineal rate X .0 45
t6.
64,622.46
17. Amount of Line 14 taxable
0
00
at sibling rate X .12 17. .
18. Amount of Line 14 taxable
0
00
at collateral rate X .15 16. '
19. TAX DUE ...................................................... ... 19. 54,522.46
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
JANETTEL.SHEAFFER
- -- - - - --
STREETADDRE55
801 NORTH HANOVER STREET
---
~ITY STATE
CARLISLE I PA
ZIP
17013
Tax Payments and Credits:
t. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments - __ 61,200.00
B. Discount 3,220.96
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.
(,) sa,szz.as
Total Credits (A + g) (2) 64,420.96
(3) 0.00
(4)
(5) 201.50
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
t. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred .................................................................................... ...... ^
b. retain the right to designate who shall use the property transfened or its income ...................................... ...... ^
c. retain a reversionary interest ........................................................................................................................ ...... ^
d. receive the promise for life of either payments, benefts or care? ................................................................ ...... ^
2. If death attuned after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^
3. Did decedent own an "intrust for" or payable-upon-death bank account or security 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 R 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 benefidary.
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 decedents lineal becefiaades is 4.5 percent, except as noted in [!2 P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REVn5o3 EXt (a-ia)
pennsylvania SCNEp11LE B
1i1 DEPARTMENiDFREVENDE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDEM DECEDENT
ESTATE OF FILE NUMBER
JANETTE L. SHEAFFER 21-12-0705
All property jointly owned with right of survivorship must be disclosed on Schedule F.
1TEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I' 10,793.195 Shares: Columbia Acem Fund Z 309,117.10
2 300 Shares: Royal Dutch Shell PLC Class A Spon ADR 19,047.00
g 425 Shares: IShares Dow Jones Select Dividend Fund (ETF) 23,545.00
4 250 Shaees: SPDR S&P 500 Index Fund (ETF) 33,191.25
5 450 Shares: Vanguard Totat Stock Market Fund (ETF) 30,543.75
g $50,000 Face Value: Carolina First Bank S.C. Floating Rate CD 51,040.50
Rate: 4.1%; Maturity: 1112612013; CUSIP:143876DM9
7 Accrued Interest: Carolina First CD (Item 6) 85.42
g $60,000 Face Value: GE Money Bank UT Fixed Rate CD 84,469.20
Rate: 3.0°k; Maturity: 711712017; CUSIP: 36159AVM9
g Aaxued Interest: GE Money Bank CD (Item 8) 980.00
10 $145,000 Face Value: HSBC Bank VA Fixed Rate CD 144,777.43
Rate: 3.0%; Maturity: 1012812022; CUSIP: 404316612
11 Accrued Interest: HSBC Bank CD (Item 10) 161.19
12 $100,000 Face Value: Bank Hapoalim BM Fixed Rale CD 100,608.00
Rate: 4.0%; Maturity: 1011212040; CUSIP: 06251AVW7
13 Accrued Interest: Bank Hapoalim CD (Item 12) 666.67
14 $60,000 Face Value: FHLB Bond Series 4C13 61,813.80
Rate: 3.5%; Maturity: 5/15/2013; CUSIP: 31339XZR8
15 Accrued Interest: FHLB Bond (Item 14) 153.63
16 $100,000 Face Value: Federal Farrn Credit Bureau Bond 115,398.50
Rate: 5.0°k; Maturity: 2116/2016; CUSIP: 31331VCIU3
17 Accrued Interest: FFCB Bond (Item 16) 1,602.21
(Continued on Sheet 2)
TOTAL (Also enter on Line 2, Recapitulation) ; 0.00
If more space is needed, insert additional sheets of the same size
REV-i5o3 EX+ (R-ii)
pennsylvania SCNEpULE B
1i~ nEPFlRTMENinFREVENUE
INHERITANCE TAX RETURN
STOCKS & BONDS
RESIDEM DECEDENT
ESTATE OF FILE NUMBER
JANETTE L. SHEAFFER 21-12-0705
All property jointty owned with right of survivorship must be disclosed on schedule F.
1TEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I' (SHEET 2)
18 $50,000 Face Value: Federal Farm Credit Bureau Bond 58,858.00
Rate: 5.125°k; Maturity: 812512016; CUSOP: 31331V2U9
1 g Accrued Interest: FFCB Bond (Item 18) 758.16
20 $75,000 Face Value: Bank of America Corporate Step CD, FC 062811 Coupon NTS 74,172.75
Rate 5.9°k; Maturity: 1212812025
21 Accrued Interest: Bank of America Bond (Item 20) 2,040.42
22 65,940.137 Shares: Franklin Income Fund 137,814.89
NOTES
Item 1: Columbia Management Services Ltr of July 12, 2012 establishes value of holdings on
date of death (See Reference A)
Item 2,3,4,5,6,8,10,12,14,16,18,20,22: UBS Financial Services June Axount Statement
documents holdings on date of death (See Reference A)
Items 2,3,4,5,6,8,10,12,14,16,18,20,22: Computation of date of death values suppoted bt
UBS Financial Services Correspondence & computation worksheet (See Reference B)
Items 7,9,11,13,15,17,19: Accrued interest values documented im material provided by
UBS Financial Services (See Reference C)
TOTAL (Also enter on Line 2, Recapitulation) $ 1,250,847.87
If more space is needed, insert additional sheets of the same size
REVa5o8 EX+ (o8-iz)
SCHEDULE E
pennsylvania
Rif DEPARTMENT OF REVENUE CASH, BANK DEPOSITS 8e MISC.
INHERITANCE TA%RETURN PERSONAL PROPERTY
RESIDENT DECEDEM
ESTATE OF: FILE NUMBER:
JANETTEL.SHEAFFER 21-12-0705
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION Of DEATH
1. Checking Account: M8T Bank (Acct #77342674); Address: One M8T Plaza, Bufab NY 14203 42,850.15
2 Checking Account: M&T Bank (Acct # 9855106317); Address: One M&T Plaza, Buffalo NY 14203 20,000.00
3 Money Market Axount: UBS Financial Services (Acct # BA 01399 PJ) 119,290.06
Address: 77~ Wisconsin Ave; Bethesda, MD 20814
4 Retirement Benefits Due: Dauphin County PA Retirement Fund 131.84
5 Refund Due: Prepaid Room & Board (June 12-30, 2012); Church of God Home Inc, Cadisle, PA 6,360.00
6 Personal Spending Afxount: Church of God Hame Inc, Carlisle, PA 50.04
7 Security Deposit: Church of God Home Inc, Cadisle, PA 7,316.00
g Jewelry: Diamond Ring (1 kt) 2,700.00
g Jewelry: Miscellaneous costume jewelry 200.00
NOTES
Item 1: Documented in arxount statement and email confirmation from M&T Bank (Reference D)
Item 2: Documented by acceunt statement (Reference E)
Item 3: Documented by UBS Finanral Services Account Statement (Reference A; page 11)
TOTAL (Also enter on Line 5, Recapitulation) ; 198,898.04
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (OS-09)
'~ ~' Pennsylvania SCHEDULE G
DEPARTMENT OE REVENDE INTER-VIVOS TRANSFERS AND
INHERRANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JANETTE L. SHEAFFER 21-12-0705
This schedule 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
NUMBER DESCRIPTION OF PROPERTY
mauDE>HE NG1E ar rRE TRnnsrTREe, TNEm PEanansRlP TO Ox®e+r nrro
TnE On,f ar mu+srel. nTmancaw or rHEO®roa aEaE aTn>E. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
pr nwucnaE) TAXABLE
VALUE
I. 611212011: Rachel Raudenbush (Granddaughter) t,ppp,00 1,0.00 0.00
1211012011: Rachel Raudenbush (Granddaughter) 1
000
00 1
000.00 0.00
2 ,
. ,
3 1211012011: John Raudenbush Jr. (Grandson) 1,000.00 1,000.00 0.00
4 12110/2011: Brian Weber (Grandson) 1,000.00 1,000.00
5 1211012011: Mark Weber (Grandson) 1,000.00 1,000.00
5 1211012011: Leah Sheaffer (Granddaughter) 1,0.00 1,000.00
~ 1211012011: Greg Sheaffer (Grandson) 1,000.00 1,000.00
e 411412012: Susan Weber (Daughter) 5,000.00 5,000.00
9 4114/2012: Namcy Raudenbush (Daughter) 5,000.00 5,000.00
10 411412012: James Sheaffer (Son) 5,000.00 5,000.00
TOTAL (Also enter on Line 7, Recapitulation) $ 19,000.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 E%+ (1U-09)
x~~~ "~` pennsylvania
DEPARTMENT OF REVENGE
INHERITANCE TA% RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
JANETTE L. SHEAFFER 21-12-0705
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t' Internment Fees: Woodlawn Memorial Gardens, 4855 Londoderry Rd., Hanisburg, PA 17109 1,779.00
z Grave Marker (Plaque), Brachendorf Memorials, 2131 Herr St., Harrisburg, PA 17103 395.00
3 Funeral: Refreshments, Sheraton Hotel, 4650 Lindle Rd., Hartisburg, PA 171tt 1,195.18
a Funeral Services: Hetrick-Bifier Funeral Home, 3125 Walnut St., Hanrisburg, PA 17109 12,239.72
See Itemized Expenses (Statement H-1)
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) ___.
Street Address __._ _._
City __ _.___. _..._ State ___.- ZIP
Vear(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 ____ Z[P
Relationship of Claimant [o Decedent
4. Prohate Fees:
5. Accountant Fees:
6, Tax Return Preparer Fees:
7.
0.00
0.00
0.00
1,165.12
0.00
0.00
TOTAL (Also enter on Line 9, Recapitulation) ; 16,774.02
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
~~ '~ Pennsylvania
pEPARTMENT OF REVENUE
INHERRANCE TAx 0.ETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
JANETTE L. SHEAFFER 21-12-0705
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ATOM I VALUE AT DATE
1 Medication: Alert Pharmacy, 219 N. Baltimore Ave., Mt Holly Springs, PA 17065
2 Medication: Alert Pharmacy, 219 N. Baltimore Ave., Mt Holly Springs, PA 17065
3 Nursing Home: Church of God Home Inc, 801 N. Hanover Street, Carlisle, PA 17013
4 Nursing Home: Church of God Home Inc, 801 N. Hanover Street, Carlisle, PA 17013
5 Income Tax Late Penalty: PA Dept of Revenue (2011)
6 Q2 Estimated Income Tax Payment: PA Dept of Revenue
TOTAL (Also enter on Line 10, Recapitulation) ~
If more space is needed, insert additional sheets of the same size.
207.08
175.35
9,954.02
109.06
11.79
530.00
10,987.30
REV-1513 EX+ (O1-10)
~ pennsylvania SCHEDULE J
DEFAFTME"' DE REVENDE BENEFICIARIES
INHERITANCE TAX RENRN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JANETTE L. SHEAFFER 21-12-0705
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal dishibutions and transfers under
Sec. 9116 (a) (11).]
1. Susan Weber, 526 Grant St., Newtown, PA 18940 Daughter 33.333%
2. Nancy Raudenbush, 3812 Copper kettle Rd., Camp Hill, PA 17011 Daughter 33.333%
3. James Sheaffer, 5008 Cedar Croft Dr., Bethesda, MD 20814 San 33.333%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LSNES IS THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX I$ NOT TAKEN:
1 NIA
B. CHARCTABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
Progress Church of God, 3424 Old Orchard Rd., Harrisburg, PA 17109
5000.00
toter nC De OT fT _ FNTFD Tl1Tel NnN_TeYenl F IITGTRTRIITIONG ON 17NF i i OF AFV-1 SOD CDVFR SHEET I S SDDD.DD
If more space is needed, use additional sheets of paper of the same size.
WILL
OF
JANETTE L. SHEAFFEB
I, JANBTTE L. SHEAPFEB, of Lower Paxton Township, Dauphin County, Pennsylvania,
3eclare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my
gravemarker and all expenses of my last illness, and any and all taxes and assessments
imposed by any governmental body as a result of my death, whether on property passing
under this will or otherwise, shall be paid from my residuary estate as soon as practi-
cable after my decease as a part of the expense of the administration of my estate.
ITEM II. I give and bequeath the sum of Five Thousand (55,000.00) Dollars to the
a
PROGRESS CHURCH OF GOD.
'API ITEM III
I give and bequeath all of my household goods, automobiles, jewelry,
and all other articles of household and personal use, equipment and ornament, together
with all insurance thereon and relating thereto, in equal shares to those of my issue,
stirpes, who survive my death by thirty (30) days.
ITEM IV. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate in equal shares to those of
my issue, per stirpes, who survive my death by thirty (30) days.
ITBM V. Should any of my issue entitled to a share of my estate not have attained
the age of twenty-three (23) years at the time for distribution to him or her, I devise
and bequeath the share of such issue to my hereinafter named trustee, IN SEPARATE
TRUSTS, to hold, manage, invest, and re-invest, the shares so received, and the accumu-
~lation of income thereon, and to use and apply from time to time such portion of income
and principal thereof as my trustee thinks proper for the comfortable support,
maintenance, health, welfare, and education of the issue or to make payment for such
1
s, without further responsibility, directly to such issue, or directly to any
taking care of such issue. Any principal or income not so applied shall be
stributed to such issue when he or she attains the age of twenty-three (23) years, or
if he or she dies prior thereto, to his or her personal representative.
ITEM VI. I appoint my son, JAMES W. SHEAFFER, trustee of the trust or trusts
created by this my last will. In addition to the other powers and authorities granted
to my trustee by Pennsylvania Law and by the preceding paragraph of this my last will,
I hereby give my trustee the following special powers and authorities:
A. To retain any or all of the assets of my estate, real or
personal (including any stock or securities of any corporate fidu-
ciaries), without any regard to any principle of diversification,
risk, or productivity;
B. To invest and re-invest in all forms of property without
restriction to investments authorized for Pennsylvania Fiduciaries,
as my trustee deems proper, without regard to any principle of
diversification, risk or productivity;
C. To sell at public or private sale, to exchange or to
lease, for any period of time, any real or personal property and to
give options for sales, exchanges, or leases, for such prices and
upon such terms or conditions as my trustee deems proper and in the
best interests of the beneficiary or beneficiaries of said trusts;
D. To allocate receipts and expenses to principal or income
or partly to each as my trustee from time to Lime deems proper in
its sole discretion;
E. To compromise any claim or controversy;
F. To exercise any option, right, or privilege granted in
insurance policies or in other investments;
2
G. My trustee may accumulate the income from this trust
during the term thereof but may, from time to time, distribute from
current income or from accumulated income or from principal such
amounts as my trustee, in its. sole discretion, deems advisable for
the education, welfare, and comfort of the trust beneficiary.
ITEM VII. All of the interests of the beneficiaries hereunder shall not be
subject to anticipation or to voluntary or involuntary alienation nor shall they be
subject to any execution or attachment.
ITEM VIII. I appoint my son, JAMES W. SHEAFFER, executor of this my last will.
ITEM IX. In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will,
I hereby give to my personal representatives the following powers and authorities
effective without court approval and until actual distribution of all property: to
compromise any claim or controversy; to make distribution in cash or in kind, or partly
in cash and partly in kind, and in such manner as my personal representatives may
determine and at valuations finally to be fixed by them; to invest in all forms of
property, including any stock or other securities in any corporate fiduciary or its
successor without restriction to investments authorized for Pennsylvania fiduciaries,
as my personal representatives deem proper, without regard to any principle of risk or
diversification; to retain any or all assets of my estate, real or personal, without
regard to any principle of risk or diversification; to sell at public or private sale,
to exchange, or to lease for any period of time, any real or personal property and to
give options for sales, exchanges, or leases, for such prices and upon such terms or
conditions as my personal representatives deem proper; and to allocate receipts and
expenses to principal or income or partly to each as my personal representatives deem
proper in their sole discretion.
3
ITEM X. I direct that my personal representatives and fiduciaries shall not be
-equired to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHERBOF, I have hereunto set my hand and seal this /6 ~' day
~f ~~ z,,~~ 1994.
NETTE L. SHEAFFER `~
The preceding instrument, consisting of this and three other typewritten pages,
each identified by the signature of the testatrix was on the date thereof signed,
and declared by JANETTE L. SHEAFFER, the testatrix therein named, as and for
last will, in the presence of us, who at her request, in her presence, and in the
presence of each other, have subscribed our names as witnesses hereto.
~~~,~
eorge A:~Vaughn, III
Bart D one
~~
4
COMMONWEALTH OF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERLAND )
The undersigned, being the testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, does hereby
acknowledge that I signed and executed the foregoing instrument as my last will,
that I signed it willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
ETTE L.^SHEAFFER '
Sworn or affirmed to and acknowledged
before me by the testatrix named above
this ~ b*" day of ~uN~ 1994.
Meq.eulyic
Notary Public trrno?"3gor.~Aa~C"`r;"~s
n,
M: Gcrnmissbn Ez(n
COMMONWEALTH OF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERLAND )
WE, GEORGE A. VAUGHN, III, and J. BART DeLONE, the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw the testatrix sign and execute
the instrument as her last will; that she signed it willingly and that she executed
it as her free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the testatrix signed the will as witnesses; and that
to the best of our knowledge, the testatrix was at that time 18 or more years of
age, of sound mind, and under no constraint or undue influence.
Sworn or affirmed to and
acknowledged before me this
/o~' day of ,TGlNe 1994.
G•
Notary 'Public t,~otariai seas publ~u~
lYnn uanc'.E~umbe~and
~mC,,;;~.~ i3ao, gyres Aug, 17,1996
Vy pornm~sscn F= P
_ _
Schedule B: Stocks & Bonds
Documentation
Contents
Reference A:
Columbia Management Services Letter of July 12, 2012
UBS Financial services Account Statement: June 2012
(Establishes investment values on date of death)
Reference B:
Computation of individual investment values on date of death
Supported by correspondence from UBS Financial Services itemizing
Average daily price on date of death
Reference C:
Calculation of accrued interest on bonds held in UBS Financial Services
Portfolio provided by UBS financial Services
,.,
- ,~
~ _ _.
July 12, 2012
James W Sheaffer
5008 Cedar Croft Dr
Bethesda MD 20814-3927
RE: Correspondence # 00695667
Janette L Sheafier
Dear Mr. Sheaffer:
ColumbiaManagement
Columbia Management SM
Investment Services Corp.
P.O. Box 8081
Boston, MA 02266-8081
We recently received your inquiry concerning the referenced accowrt.
The acoount was transferred to the estate as instructed on July 3, 2012, and confirmation has been mailed
to your separately.
1
Che value of info~anafion requested is as follows:
As of June 11, 2012:
Columbia Acorn Fund-Z (492)
• "1'he Share Balance was 10,793.195.
• The Price Per Share was $28.64.
• The Account Value was $309,117.10.
If you have any questions, please contact your financial advisor or our Client Services Department at 800-
345-661 I. Our representatives are available Monday through Friday between 8:00 a.m. and 8:00 p.m.
F,astern Cime and will be happy to assist you. Please use the reference number listed above when
inquiring about this item. You can also visit us on the Internet at www.columbiamanagementcom.
Sincerely,
Columbia Management btvestment Services Corp.
s
Securities products offered through Colwnbia Management Investment Distributors, Inc., member FINRA
f'T
~~ I: r
~ X
N
3
m
N
'n
U)
0
A
Ol
W
m
0
N
O
m
v
n
O
N
n ~ ~! C ~ O
O D m O m i
~ O sr 0 r.M1,
' !° T
n
o
~° S
o
O w
3~
y
~
(1 ~ IV C
T, N V1
O
•
~ ~
~ p ~
Q D
N
' N~
_ ° r-
n
O w O
-
J~
~ _
w 3 v »
O N
O d a
ip N n 'G o <
~_ a O o
N w ~' i ~ 0
N O O N O l
O
Z i y
A p W
N ~ ~ ~
3
N rp N
O ~
O W
O
O N l0
0
i~ ~
w ~
-
N a
~ -
~ G <
O <
O ~.i
~
[1 .a
-. o
O m ss
-~
C 01
C I
r0
N O ~ ~ - N
~O
~ 2
~ 0 N
ry ~ N j O- i
V
c O ~ _. o N ~ w
o m
o o
w a
ti
C
N
3 m I ~' Z
~
-. rip ~ < d
n N o ~ ~ O
O
' m
° N
I
N C
N
G
- N p
O v ~
u c ~
/~ ~
O
f. i ~~
N n
n
rv
~ N - °~'
N
~r O J
~
N W . O
i W y
~!
W ~ ~ ~ ~
S O
O
N p
O ~ ~
~ - O U o
m s
n
~
~
w U1
00 ~n
W J
~
C7 ~ m m
o'er ° n w ~ A
-
~
~ p _ w
a
_
N
~ m
N A
N o
O A
N
= c
m o m l"F
W
n A
c
N ~
o. d
<
o
o m w
N
1
V1
J _
iu I O U ~
01 Ol
J C O c
o ~'
m N ~ ~
~? o ~ V O ~ ~
N m O O
A O _.
~a jF Z a<O. ~n ~D
3n ,°,'n 3o ° 5^ cc
a <-
_
~ 5
o a
rn
N~ » O
N N t~ N rdp
n J
N 'O
O
~ ~ ~ O l~ N
N O N
1p ~ O. N n G
~ ]~ N
O
a V r
rn
ti O v~ J S
^ ~ m ' a
~ O
M
~
N ~ m
~ i C
N r
o G
rp C p J
~~ m
~ ] N~
~ N o ~
N W
n ro a ~ ~ C O
O v rp ~
ro
O ~
C O
C ~
n
~
~ `~ N O
O ~ C
C
~ n a
n
~ m
a 0
° a ~
m ~ ' ~
O
m
w
w ip ~ T m a
N m
V
~ O O J A
N N
W '~ O
-r
a~
o 1
A
W
p
D m in O
n ~ o z C
O m W ~
~ n ~ v
o ~
c D D ~
3 ~ A N
~ O n m ,.~
'' oOD3
m w ~ m m
D P p p n
0
w m < Q
lp N m
~ J I~
v A
R
C
M
0
W 0 ~ O
~ O ~ o
_ ~ ` A
TnD OJ
O m ~ ~
m
DDin N
~ ~ D
o n ,,, <
7J
O ~ T ~
W
~ ~ T p
P p m o
W TI A N
~ ~
N ~
V
O
m
0
0
0
0
a
N N C V m
S N N <O T
`_GNj 2 O <, ~
p ~ O (^ J
~ ~ O ~.
p N
N ~
°m ~ D
N A ~ N
~ W ~ _
D Vl ry J
~ n
N rCr^^D
~ VJ
N^^
I\ JJ
1T
V
/~
l J
O
f'1'
__ _
~ ~ 2 G1 T m ~
c
a
A
0
~
O
~
n m
N
~
Ci p
S
N .p
N
N
N
iw
ry
~u w
~
N
d
n
O
3
3
a D
jp
J
v
"'
~
µ
a -,-~.
txp
d
_
~
~
I ~
~3
~
O
' io
c m ~n
ti ~~ i _N.
J
m W
~
° ~
N d
n
In
~
3
S fD
M °'
`~
~
n '
fll
['
UI
~~
~n
m
~
'~ d
n
ID
VI
~ a
p
f1
N
D ~
;~
I !~
I
ID
O (S
-
C ~ in
~ N
O
' ~
N ~
d
~D ~
N
Q~
_
0 l0
0
O T
~
J
N ~
J ITl
m
N
Q
T
O
N
O
A
O V
o
U1
a o
UI
O
W W
W
W
0 n
N
W
0
O
O
W
N
O
W
N
0
R~
0
!~
f.i
O
A
0
~ N
J
O
0 0
N
V v
~ ~
J
S
8
0
A
N
A
0
W
W
0
a
K
~ d
('D
N
IJ
N
O
v
N
N
W
O
O
O
O
0
v
O
O
O
O
a
O
O
O
O
0
0
n
n
R,
N
m
n
S
v
m
7
m
D
n
T
a
0
v
m
O W
lp V
Ul V
~ ! O ~
O O OJ
I
O O J
W O V
r., 0 0
0 o I a
p I
G
C
2 ~
7
.r
a
m
d
'u O
d
0
7
T S ~°' g'.
- ` .c. ~ n
~n' p ~
d ~ N ~ d W
O d~ C d W
~ ~ 2 ~ ~
~ O O ~ ~ N
o c io ~ n n
n a
~ p ~ S ~
c a O o
v one
~ Q
°c 3 ~ ~ °~ o
••. N W N C
•+ ~ N O ~ ~
0 ^ N O U ^
N v .r n' ~ d
~ d p N
d ~ 3 ~_ N N
~ ~ ~ ~
U 4 3 N ~
N ~ d ~ ~ ry
M m
~ ~ C
~ ~-
3 ~~ ~
3 -° ~ u
O O
^, T
W
O
a /++ r ^
J
~ o ~ V
c Q
~
O ~
_ _ ~
~ ~
-• _
` i--r `° NO
vii ~ p C
H w
N
~ ^, N
a
~
w ("~ 7
w (~ ~
~ ~ ~
~ ~
`~ D
n
O
N N 2
N C
lD N ~ ~,
w O
J
O
3
w
~ ~
o ,
c n
m
~
v ~
o~ _ DD
c `~
o O
3 3
n n
C C
~ ~
r
J
C d
D D
Z
O
~ m
~o r
v=
D
m
A
0
J O
m C
O -~ T
O m 7
O d
W I n
O
O ~ d
W n.a
A ~
N
~ O 1
:~
.,
-~ ~~~~~
o ~. o
a a
K n ~
< ~ C D ~ S
a ~ N N ~.
O. ~ M N N
.. ~
O
A
W
m
0
O
0
0
Qv ~ ~ Q
d
' 1
~
w w ~
VI Vi A J
0~1 O Owl O ~
~ ° ~ ~ o
N -N+ to Ol
V N l!~ V W
n z
O ~
N
~• n
~ N
S
d -~
d
N
{R M
o
O '
O ~ ~
~ '. V N
~ ~
~ ~ ~
N 4A
v
Y J
~ W O
w V Vl
~
~ i m
^
L J
N W N
A O A w
0
h
c
v
ti
0
~ c ~
~ ~ s
c Q ~
s. ~
~ ~
S Q
Q N
N d
Q.
7
_ ' ~
n ~ Q_
J
~ I
N
~ i
'a ~ a~ ~' o x o ~ !1
aaaos~",° ~• ~
'8 ~. o
~ N N m
X N% O 2 r~ ¢ G1
a C'• i0 F'" ~ j~ ~ `V R
~ a a ~ z, a i--~•+ ~
~
N
N {~
o
N 3m w3 4.r d
q ~ ~ a "
~
° ' Q
, N
,~
,..
<, f
X
S .
J
N
~ ~ i' 3 ~•
~
3 N ~
~
~ ~ 1 „ 3 N °
o S a o' _..~ m ~
° o » ~
m 3 N
~
~ N m Cn
x
.
m $
N ~~~~0»
r~_ Q N N d J
K T o 1° 0. C C7 O
N~ 3°~° o~ Q O
o a ~- o ~ ~. .°. 3 ~ ONl
N ~ s~n~o.ao
~ -3 (~ V
., n N_ N N ~ G
~ ~
~
N 2 N ~
^'
-o ..~NOm
~
° c 2 3 °^
N
$
~ O
o~ m
~ i r,, W
{ v° g N 3
o r
~ N 3 H C C N D d O1
0 oN °'oao
~ a~~
n O
a N
A
~
~c
01
o ~ m ~
Ot
~
o
°~"
~ V
o
~. ~
a~p
~
7 N J
S C O
m ~ ~
n
~ a v
~ Q
m o a
~ '~^ °.
-_ ~
N
N
r
J
O l0 V1
V J ~p lD
~ P ~ w
O P l
O
O ~ O
o o N ~
i
•
N
N
A '
~
A io
O ~ ~ U
61 ! J N Vl
~D n rn n w V
0
N
N
a
0
N
w
d
J
N
d
H
O
O
O
0
O
O
O
O
0
O
O
o ~ p
a ~
~ O j'
~ ~ ~
~ ~'
O
~ a
7
m ~
N N
J
O
N
A
to N
O ~
N lp
~ b
V
~ J
In V
J J
t> w
n
s
d
C
m
W
w
N
W
0
5' n
m ~
v
m ~
~~
.t ~
N
N
O
v
n
C
d
N
A
O
0
O j'
w n -.
as
t0 ~
~ d
~ N
N ~
3 ~
m ~
~ ~
,« ~
N
lD
Q
m
J
d
Q
N
!D
O
m
a
N
N
V
N
~ ~
~ ~ ~
o
O ~ A
rn o
A w
A o n m
N ` J O
" ~ a
~~ a
.
Sago. ~
N,
w~°n
~ ("~
~ n
a
~ ~ ti
~ ry ~•
N N 7 ~•
nn
N C
T
Q S~ C
/~I
I
v e S Cn
^
v
S y o
O
r
~
~ ~
wo V
o
v N
N C ~
'° ~
°' A
d ~'
' N
m
~~
g
v a
~gc i
~ ~ ~
mD
o °m'
^1 n ~
N
V
~ J
m _
n A
N
.
o
n
+~ .~.
$
g
Q
~ did
i ~ ~ ~
• c3~ A
j ~-u.m
,
N V
l
y ~
~ P
> o ~ ~
N G1
r
O
m
3
N
N
V
N
A
N
A
V
W
O
3
O
O
O
O
O
O
N
O
O
d
n
O
C
d
C
N
A
N
N
O
w
W
N
w
A
y~•
F-~
0
~-h
~J
C
m
N ~
N
W
m
O
a
m
.n
4
O
HF~
l
c
~o
7 N
~ O
N ~
N ~
N
7
N
7
D
O
C
r'+
D D
C c
N i=!
d
3
g..
`° `n
D z
o
w m
~_
D
A
~
'm ~
=
8
~
N
o N
m S
N ¢ ~
iri
&
~ ~ ~
~ ~
a _
a o ~
m ~
~ ~
~ ~
m ~
O ~
a o
N n
jp
q W
o
N ~ 0
m C
~ ~ ~ T
~ O =J
N O m y
~ I n
N
~ o
.
a ~ ~ ~~
O ~ w ~' D
%~ m ci a
N v
~. A G
~ O
.
O
w d l0 p 1
T ~ ~ ,
~ 0 3 ~ ~ ° `~~° °i ° o ~ ~ m rp ~ oN m ~ m ~~ ~y
o v ~ N. r. m m ? w ~- < of w. ~ m ~p ~ N ~
9 F 3 C .. - m ID ~ ~ to C~ M y.~y d
~ ~ p V ~~ ~ O ~' ~ N emu. N N ~ ~. W C~ W /D
a n ~ ~ °,. N °Q ~ o ~ ^,. ~ m m ~ ~ v w m ~ ~ ~ O
Q ~ ~ ~ ~ 2 N~ ~ ~~ a CD v v '^ ~ m m
!~ I- f a0 ~~~ O F~ a N ~ V I~~ ~ N O
' y ~ w m ~. CD N ,w. ro l7 I~~ ~ ~
m ~ v~ 3 3 ~ ~~ a 7
~. -o C7 0 ~ o a ~ D n i-- • l0
~ ~ ~ ~ ~ n
~~
3 O ~ ~ N ~
I ~~ 3 o Pi' w ° j
~ F O ~ ~ ~ N r+
~r J
T ~ `~ ~ O
~, .. m ~, _^ ~V
~ w o F-~
~ m o ~
> > s
a
a ~
o ». ~ ~ w e,a tsa v
m ~ ~ A vt
O ~ ~ N O
~ ~n O W A O a
v m
p' O kA ~ ~ ~ m ~ ~ D
o A A W~ W o -'^ 0 0
C G
J
r .~
D J J
N Q N
~ .
O 1
O
8 .
O
D D
w, z
A O
N W
~ m
O l0 r-
N 2
of m
o D
m
o ~
g:
n
o
rn
n
0
°o
n
0
v
0
a
w
D
0
gl
0
0
0
0
w
i o
J <
O
~ i
O '1 T
O S J
O m 01
'O W = n
b ~ ~ =
~ N
A I W Ll d
A ~
s. ~~~
r
°m
m
N
°w
m
d
N
0
N
o
3' z ~' ~OCOO 'rv oo !1 y~ v "
.
j. ~i ~ ~T ~~ t p w ~ - 3 ~ O
~ ON.~ ~nGV n
~ ~ roo DD
m
~ ~ ~ ~
~ ~ c o ° o
~ ~ ~
a n
`" om a8c a y
~
~;
,o ~~
~ x
z
~e ooh ~
o d 3o m ~
., A ~
0 5' v
~ X p z
X q,,
q
K »~ S o D
a
~
w p » ~
` d
~ m
3 v nm
;~ a~~ ~
m
o, c
as
'
¢~
o d v
o c o ~ ~ ~
ma xa
~, a R
S_ o
A
O Z ~ ~ ~ ~ N
C
J 3
~ f'
~ P u ~ d
` n a m m
`c „ ~
D c m~ o
m `m-r n
as c v
w
s~;~ ns
s~ a o
o
a ~ T a
-~ 3~
x ~ ~
~ 3
8 ~ 0 0
e
3 ~ 'm .`:
'Dn o .o
~ n h
~
,, ur
0
m
o;~s ~3~~
a -`° ~~ mm
n
_~ ~ ~ ~ ~
c n3
m
~
m J
-•• ip
Z
,
m°a .. o ° ~.
~
e o rg in
A
Vt
~
Pim
:
-~
~. o ~ c
.
~
~
~ ~ a
a ro
J
.-.
~ ~
s »
N " o
~
3 ~ ° o
~ ~ o v p
~ ~ ~ c °- 4
a
~ ~ q
~
O
~~
m J
=
0 3 ~
m
~
d A
o
` N a
;~
~
c
< 31D„ w ~ m
~
~ C ~ S iD ~ C e
p
'~
c
,p w ~
y
~
3
,~Z
w~ S
~
Pe
~° zap
~~
a
_
l
_ a~
o
N ~ ~ ~ ~ ~p N
m~
- ~ T N
lD
O n 2 2 O
~ rT ~D ~ N
_ m 3
a
~
~° m~
m`
w o ~ ~ ~
L°
I w o
». 3
p O a - m O A
~ J
l
~ O~ d~ ~ J
J
~ 3 ~ ¢ w
Q, - p
~ µ J O
~
2 d O O C_
O
6
~ ~ N d O m O „R
m n
' ~» u ~
on
a
m
o z
s=
~P
~Dc
m
a
~ ~ m
m o °
n
0
v
~~
7
~a
w~
C ~
7
b N
~7
~ C
7
a
w a
o m
3 c
3 r..
~ ~
R
x
c
W
m
Di
2 '~ ~ ~ N d
a m ° °
' S S
~ a
µ~c ~
n a
s 3
~ a $ j
a ry
o Q a ~
.. m ^ S
_ -. p y
o a' ~ N
.
n Q ~
ry ~
~ N
~
»_
~~
~~~
N D
voa
~' ~ a
o a n
S
'
Q
a ~ m
o ~ ^ ~
Q~nS
o=_
' -~
7
]
O ip e01
C Q 3
~ w o
3 ~
r~ o ~
v v
~~
sa
o ~
a
"
n o
v
~
0
i '-^ v m
o
'° ti c
~ ~ ~ rv
o n
a~ c a
z
D
v
D
n
!l
ti
A'
N
v
v
0
ro
~.
~°
_~
ri~
Y~
o~
m
O
Q
i~
s
~o
:~
O ~ O
%~~~ O
~»v
o' ~
a~~. ~
='s cn
o n n
i c
O ~
~ ~
s~
0 0
3 ~
03
~~
a
o ~
c o'
~ ~.
M~
.°. ''^
m ~
a
a N.
0
a
6
o°~
~°
3 3
~~
o ~
~`
~ ~
tD O
N ~
O ~
N ~
N
7
d
fD
~_
D
n
O
C
rt
O O
c C
,~.n w
C a
3 3
~'"'
CD D
- z
o ?~
~ -ml
~ r
0
2
D
m
A
0
J O
~ i
O y ~
O m
O y
W n
O N DI
ci c
A G
p ~ O
I
Di
8,
O,
SI
O
~~i
O~ I
N
S
o'
8
O
0.
m
O
p
8
W
O
~,
8
S'
o.
v
m
m
o_
N,
-., m
-~An z n n ' -~ -a m -~ < m ~ N ~., ~ ~ -~
A~
mnD
D
D
n n
D
S
D a o ~U m O O D v `~ D - a 3 O D a n O
N
n N
m~
D
Q ~ ~ r
~
W N Q ~ Q 'v iq N
N V v V O O ^ "Q
-1 ~ ~
p ~- * ~ N
O
Oi N
O
V~
W
p ~ m
_ C z
W O
J Z A
~^.
C ~
y'
lp d C
~ d
~
~p
N .
~
W Z
o ~' p D o m O
in w Ll .~ y w N rr A »
~ S A A %~ v ~ ~ ~ N
ou, o< O
o w * ~ 3 n p n .~ N n N
n
npm~ A
mm~°
A ~ n °' ~ -i E ~ °o S o rp
Dm
c D
p o
c m m ~ v O ? ~ m < rt
N
° n
io ~ m ? ~ n ° ~ M ~ ~ .~. w y f. m .~. w
,~. ~~
y~ f. T O D T~ n d N J ~. O ~. O ~ '~.
-1
u .~ -1 N
~ ~ J ~ A N W .T N
a O
A Rl
N ~ O C N n ~ 17 C d O 2
_ _ S ~
a~ o N a .. p °- uni ~ -~ n . m C p ~
~ \
N ~ ~^
n ~-y
o
~~ m
io ]~ i0
w A
~
i+: N
O
~ 1p N °w N a o ~ o o N N
o c
° o ° 3
!? -~ u+ ~
N
,~ w
o m
~ ~
o w
N ~
~
7 G ~ N
~ ~ ~
D!
Z a -1 ~ N l0
~
~o
1p
o
C
(D
° ' ~
w ~ c.
~
~ O
p VI
o Vl
o IV
u, Z
v 3
~ l~
(1
0
0
0
0 o
°~ m
x
o
rt o s c
ro in a
» i'o
io y c° d 7
0 v u~ ^ mm~ lfl
o °0 3 in io m s~ m ~
0 0 '~ w
- 3 ~ `~ ~ ~~a
~ "
y
0
0 0
o c
i!!. m a
~ w
w Vi
m m
io ~ _~ ~ d
~ Ol J OJ ~. N ~ N
d
J
• ry
J
N
A
m ~ Q
_n p
i i
v ~ C
D D
1 0 V
01 Ol
A M
l0 N
~~ 3
N ~ n
P n n
o O a c
~' N A O~ ,~.. 0 0
o
O O
O -
~ d v
tl'~ ~
O V
V w
~ w .on
- O
> J ~,.
rf
O
O O
O
~N ~
]
C d
a 3 ~
'
pVj VNi A ~ ~
V
p1 Ol
p W
~p N
N V
N A O~ ~ ~ l1
v o v
Vt _.
O ~
V w
W w o
- °~ D
D
O O ~ Z
O
o O
O
G' ~ O rt~
--VI
w
0 0 1^, ~ ~ . m m
o
c` io r
m
w
~ ~
~ ~
_
yo m m N m
J
O ~
o ~
l0 m~
w ~ D
O V1 O T
A
O
O C
7
N n
VI
V1 V
'. Ol
~ J
M
W
W
W
lD A ? ~
V OWi N W ~
N T O~ o b m
O O ~ ~ ~'J
A ~
~A O
~ ~ ~ r d
] ~
w
VI J ~y C N VI t0 N Q
0 0 ~ o
"
` p N N A O d
0 0 _
- ~ ~p a ~ G
o ~ w ~x
W
0
a ~
o
o A a c w m
A
VI W
J ~
O v N Vi l0 N ~ ~ Vi ~ .n
C N
W ~
N W
A
~~ O 2 J
~ O
~
i O
~
w
~ O
l0 N
O
l0
j 3 O m d
J
~ ~~ . vNi o m w °' :. o n ~.
N
~ ~= Ra ~ c~a
~ -
~ . 2
6
~
'y
--I
-1 _
2iD A ~,
lN0 0
i l
V) 1)
n D A ~,
N n D w
~~ m
vi ~ ~ ` m
W ~ ~
~ w V °O z
w
O O
~- ~i z
~ ti
~ i
p o
n,
'
_~ D
~, I
j C
n
~, a~
r-
~ ~n
w ~~ C
o Ol
I
1
1 ~
c`.
w
0
I
p
i
i O
W U
O O
OJ i O
~ O
m o
O o
o
W.'.
°
N_ I
O
W
O
0
«,
~'
U
N
n
J
iu
w
w
A
0
a ~a
~ .
1
_
>
w
~ ~ ~l
d
~ k
V
~
o m
ri
Iv
iD ~ n D w
µ ~ A T
N ~"; C W D
O w O o ~
° W O
c~ X m O O
IV o z
v m 3 O
ro
~ D A
N N C A
iu ~ N n
W ~ O W
i. ai \n
0
I o l\
W
m
N
;~
N
O
O
0
0
to
w
,n
N
A
0
w
m
W
v
vi
N
w
-i
N n D X D D
~~ r",ya~ ~ E' 6' 6' wvAsom~c
¢m ~; u ~ A~ m m D p 2
0
r,=°v3 ~ 2 gjornmo°~
~ NN ~
~~'m 1 ~ D m~ 0° C
~ ~ A o
N n~ w m ?~ `m^ ~ ~ m
~ m 0 n ] 1 ~ O
D
mD3 C ~ ~ ~. ~ N ~ ~
;~ R a 'r; 01 n, n~ o N
N
n 3 0. 0 b ~ 1O ~ N
oa .~.a ~ C~ °o O
o d 0 j N
n~^ N
u'
03' o
a`~ o
d i N O
i ~ rF
m n ~ ~ N
_ d o
~,
vav
0
c ~
m ~ m
~vo
~ 5a
w 0 S A S W -'
O ~ N V U
7~ 030. u' °
8 O
~~ _~ O O
w O O» p O
Teo 8 °
.o ~ o
`m ~ o
3 ~ 3
N N C
N ~_ r
~ ` O
°~ S
o
°
~~
a
„
0. j o
,
G ~ O
w a ~ O O
°
n o N o
-O ~ ~ N O
_ .. Q a O O
~ ~
d
a S
3°
3 3.
C
~ ~ 3 3 0
~ 3
~n m m
a o
J
.~!.' ° .°. a
o
o'
0
0
~
° w
o
-
m ~ °
~ < a ~ A
~ ~
~o ~ g o
~ o
a
m
c
0
o;
o `°
^ ~p
O
A
-~ J
w
a O O
C
o
a c'
Ion y
m n D n m=
D N n D m D~
v A~ O m n
A l C m A W W t
m
vWi A O m m O Z
° ~ Z ~ o ~
` ~ e
c ~ A N ~ ° D
~ N ~ NO ~ <
< D D
~' ~' N C
6 -- ® o v'
w ~
o
0 0
° 0 0
~ O N
O
N
o I
a
ti
O
A
O
O
0
A
0
N
0
N
N
N
N
T
~
~. ~
~ ~
N ~
/1 O C
N ~
d
1 -I n
on ~
~
-«
a
.r
N
~ 3
~
~
rt
D
~,
u 0 ~ n
n
O
3 - ON
r+ „~~
O.
m =.
c
a
~~
;~
xn
A
an
~~
~~
<<
:~
3 3
m m
D Z
O
~ m
~ r
~ _
D
rn
A
w~
~ a
~m
wo
o;
o 'm
!!~ n
a
o~
w
0
~ ~
O -i T.
O = ~
o m w
~ ? n
O
O F
~ a
A G
~ O~'
~ ~ 1
I
~ ~ -I -I O
L w O_ ry O D ~O
.`' iD N d d r
- v v z
', ~ °o `m m io i~ ~
z z
n m ~ ~ X
~ ~ YJ Q
to m ~
m J m
g
W
0
ui ^' ~ ~'
vl io 0
u w m
A ~ A ca
o ~ ~ ti
N N Ol
W J VI
J w O 1
N N N N
lJ ~ VI A
U 10 IO O
o in ~n
0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
~n ~i yr In
vi A O
N N O O
w w o 0
0 0
m m o 0
m w o 0
N N N
m m m
0 0 0
N A N vl
lJ A VI W
O O J W
~ N A W
N V In
W -~ tT
O A tP
O W N (T
l0 lP W Ol
10 A N J
a
N
A
w
~ ~
0
o Z
s c
mr°o
-~
°m m
s~
w N ~
~ ~
<'
3
»n
w~
o ~ °» o ~ ~ o 0 o D c n D T
O
m ~ O~ ~ .
~. mo
r
W a
+~
W B
a
W W
P
NF n W .~ S N C ,
ID N W lA ~ p m
N w~~ W Y
q _n ~~ d ~ u
+ n ~~ o
~
_
a"
~a"»
c ~
3
2 Z
"';
,N„o
z
°" °-~„ n m a N.~„
~• O ~ O N N ~ i0 N
c o q
p y
J ~ ~ ~ D
~ m m°O ~ ~i c
o
s a =
~ 3 0 H 2 ~ N
O
~ O S w
J
~ n N A p O
a
' ~ v'
O
m 0 ~ N
o• O ~
3 j ~ n» N m
A m
f0 o p
p
q w
b
- o
o < 01
l
O
o ~ a ~ w
- o n ~
~~ ofs
~o
a n
~ p n
°
m m
a o
3 ~ -
~
m y o
-
'°n
m%o ~C
d v a
2a
C <
~^ 2 m
~ M
r
Vl
N j O~ O O
an w o 0
a
ti ~z
ID 2 S o
~
~ 2 O O '
a ~ 8 O I
G S
~ m?
p ~~
% m
3
~ ~
c
° ~
~~
I'o a * w
w
co
w ~ p ~ ~ m ~
~ n 11
"iii ~ a o. m 8 m '~
m 0» 3 n Q C
n='~ n o~~
i ~ ~ c m
o- ,', °. B n ~9a,
o:m'" ~ N.~ ~.
c`a
ADS n~C ~~
..], o~q
~= m ~. 'm
~ c < o _ T
~ W ~ J J d
j~L m O ".S
O n ~
Vic. a .
j C J iN N d~
C n 7 N a C
YO N '~ »
tFl~ dT3 3v3~
N C j ~ ?
~~ Bo =o~
d J ] C n d C
~ N m ~^ <
O O. 2 u IdY 6 ~'
N % ~D 2
p ry ~
I, , ~ n
~ ~ ~ N p
j n_ c.
h ~ - m d
1 ~~ v m n
a
J m - " ~ ~
n rv S Q O M
N s o n
°m °- o m o °
,a m
°al]o ~ ~
w
W
w
ly
in
m
O
3~
:~
~d
~ ~
N O
N ~
O ~
N ~
61
7
N
fD
fD
7
.+
D
n
n
7
r+
n~
9c
u w
^~
x' n
~o
D D
0 O
n .e
> >
C m
3 3
~"
.l
w D
D Z
o
~ m
w~
W N_
D
m
A
l C
_ J ~
Ol -
O
~
O O
N
N J
M
N
W UI
V1 W C
0
0 ~
] w
V O N C
W N b ry
~
O O !^
O
w 3 ~ 0
W CO
m O j W ~
w °~' GH. °o rn
ono ~ `-~- n w = ~
O n
o
a
x N
m
w
~n o
o Ltd
~
a~ ~ <
~ O~'
~ v
o,
a v '~
v w a
Q Q w
~ `°
~ `° a
n
> > ~
N
W N i
tT ~ CO ~
S
iD 3
N S
!p
m o
N m
O
O
°
m
°
w
O z n v n n
~ N Z
v '. C A C S
~ v c
n' A
v ~ O v W
o
c~ A ~ q' ~ Z Z w O
O A
m w - W
W
W
O
~ m O
w
O -
~ o C
~ ~ ~i N n A
N y 4 0 ~ ~ ao
N < ~
0 N N
- 0
~
a
N ~
O
- N
m
~ A
~
a0i
g
o o~
' o ~i
B ~
o f
v~l Ni
v °~ ~
I O ~
of ~ o O
W I P
~ O
V
~ tii
- m
O
v O
p~j ~ N
,~ ~ J
8 N n
~ N \
W
8i m W N
0
ro
D' n J
O m{ Z
O I
°
' n ' C1
-
~ U I v
I
' i~
°
'I I
D m
O i
S
' O
~
J
o
I
8
i
ol I
w~
l
~
op
8 41 -~ W
~ U~
~ W
W N
W
u' m
J
W
O ~,
~'
C
~
a n
~
~ /
'r
~
~
~ nF
o ~
N ~
m
Na
~ ~
A
O
N
o >
V ~ N N N UI
W
K
3 v _o 0 o a o
m m < <_. ~ s
N _a N N ~ N l0 N
~ > > >
"' a a a ; ri a
m
a ~
N
n -~n A ~
Z S C
m Lt a-i ~ v D A
- C m r D
Z v~~ v
~ A O p O ~
~ ° v, ~ n z'
D ~O ~^ l0 2 z i
~ m ^~
o - ~ °m m ~
v m
O ti O ~
~ o o ~ -
n
D ~ Z n
n ~ o
O ~ X D
C u,
~ ~ C p
Z
N V O Z
O -~ D I
~Lr A
o ~O v v
m z -_ D
O O O
O O
r.i Z Z
A
0
vNi °o
'
M
W ~ N N J
vOi vNi ~ omo A
A O O N O W
0
.~J
C7 .ci ~` m [ ~
~ O O u
d m a '.. w
?' N "i '1
O ~
i
~ O i
v
~ ~ ~
e--r v
.
~ ~
~ °
C7 M
~ N ~ J ~
N N
2
~•
N C
O
1
' ~
•
~Ji N (l
!D
f"f ; ~ ~ '. Ll '. n ti "o n '. n
~ ~ d 2 ~ '
a ~
C k
m n'. 3
m '
m ~
e
a ,
'
m
~' N
l0
o e '
' ,
m
O
N ~'
..
. m
yi c ~ n
Jc 0
~
~
~
C
Q ~
~
N ~
M ~
~ ~
Q~
~ ~
~
r'h
-
r~
~
u D
z ~ ~
~ . ~ p
c
v ', ~
a ,~.
n .
K
a'
~ W
J ~
C
O m
~ O ~ ~ ~ o ° ~ ~ o ' D D
N A i
o ~ n n
~ A iC io '. o ~, io in iv ~ i~ V ~ n n
V O ~ W : w ~, A ~ N ~ p
t
0 ~ ]
~
N pJJ
p
A'
O
' O p
O
O
O .pp
.
00
~^ ~
~~
A 0 0
3 3
m
N
p
$ m m
8
W ~
00 ~
O ~
V
n~ D
-
2
p
O
W
~n
:
N
O
U m
C rr
x~~
~
a? o a ~, a '. a °~ ~ m
~D r
~ 2
m
D
N ~
O
N
VI
V
~
N
O
W
~
l~
V
J
OJ
~n N j N T in
~ V
p
OC GJ i0
N io
~ ' O
' N
~ N
A ~
N '
A
N
~ Lp
!O v
~-~
J p1
W w
W m
W . in
~ O a
N ~
lI~ ~ w
~ V p
W w o
~ .~A
N
J
A
N
'
-
3
W ~O
y ~o N
O N
V N
W
U~
C O1 p
p p
~
W Ol
W .
O W l0
Ol ~
J
J 3 d
p o o ', o ',°o O °o ',°o wa
W
O
O
~ Z
O ~ T
A
w
'
~ ~
~ 2
V N W W ', lp ~
V N ', A a j Oo n =~
N
O S W
1A W
W ~ O N
QI O
l0 J
J O~ m N
a
pVj S ~ w
' '
o OWG vNi : W ~! o. .
~ ~
. .
~
e
w v
i
i
l
v
m
O
N
0
W
jl,
N
A n
ro w
N
O
now
v ~ ~
o r
V
~ iv D
~ w 3
o a
~ A
o O
lT A
~ N ~
W
n~
O o
c
O o
Z
L
y
N N
N
ro
N
I VI
W
A n
m w
N
O
n n i
L r
N ~ W
O ~
w m O
W U Z
0
X ~ o
>c ?
N
~ ~
N m
0
m
0
N
0
O
0
O
i o
~i
U
of
w
O
O
0
0
J
A
O
0
°o
~ ° ~ o ~ ~
N
~
N g
~
~ ~
3 _.
~ o'
~.,
a
A
~
v' D
R
<'
a
••
"
~
a
m
N `~ '~ j N Q'
N Q /
~ ~
m o ~{
' (
S o
O y N
S ~
ma
a _.
O m
D ~ a 2
N A Q ~ N
o D ~
N Z O
Z F ~
z
< S
z
O Z p c` ° o
o O .'_~ ~ N
m ~
O p.
~ O
f n
,n
. i~
a
`~°
~
~
~ o
~ n
~i
~ c s m_ :
o
m
i _
N ~
d
m ~ ~
Z
° u a
X
A
m m
_ N
~
z
<
o
3
m ~
~
~
'. }i
O O
O 3 D
.
o r ~
a O
v ~
n
x
I =
w 4
~' c
J
W
A 3
w
N
w
m
N
Vl
O
0
0
'-'R
.~ ~ N
o ~ °
~ o
~^~ 3
3'
m
3
~ n ~.
n
J
W ~
? H ~ C
7
W Vi O d
.'.
~n
'~ C
w 'D
n
W
O
r
v
n
D
O
Z
o~
D N
O r0
i W C U1
w }. A
O ~ A
~ s 0 O
N rY
~ F W
a
~ x
° a a
v
~a m
~ ~.
a m
N
M
° 'm'
m ~
n »
o'
O n
0
m
°
U
A
C
n
O_
O
0
O
3
m
Z
3 lv~i A
C lp
ti O1
b
o D
<
~ n
?
_
P_ y
w ~- ~
.
m a r
d ~/
V -
n
+
r
N p <
o ,e 'G c .Z7
(~
~ ]
~ p r+
3 ~
N O
3 N
0 ~
O N ~
o fit
~ (
3 N
N ~
~ O ~
~ o - ~
N 3
w ~- !D
I
,+
-
m ~ D
.
~
O
C
r+
Ca
i~ O
~ ~'
~D o
A
n
O
~ D
A
~ v
~ m C C
~ ~
J V
o
' ~ ~
C d
~
~ 3 ~
~
0
o
N
N
W
N
y D
O Z
-1
O 0
N
N w
U m
~ r
~
o v ~
~ _
m
!l D
o
~ m
A
W
n
O
C
O
z
N
C
I I~
_O
J ~
m C
N ~ T
O S ~
o m d
o = ^
o ~ _'
a ~ a
A yGy.~
p ~ O
ro v
O
A
W
0
W
O
N
v
m
0
N
2 2 p n P 1
.~• r d Grow
d ? i
v_. ~ ~ o O
~~ O
N ~ O
d
1°_ 3 r~
n
~ N O
o v °~
N y ~
N N
ry O
N b O
0
N
N O
H M N
V V V
N N N
0
U
O
0
O
N
4.
0
I
I,~
0
iPo
N
N
~ l
o ~n
0
8
o'o
OIL
wII
~n -~
m
V J
j N
N i~
J
N
~,~~ ~ r °~a°~~
C l ~
S ~~ ~ ~ d~ d~~ A
w
n
o
3
~
Ngm;2 .~'
~
o
-.. ~ ~ ~ o n ~ n p ~ H.
n N~ = ~ N ~ o ~ a
ao N
~tig ;s 3 ~
o„~D
,~d ¢
G ,,
iO~
-~ d m @ ~°~m
ev
Uq
o~
o ~ $ ~ ° (/~
~
~
H ^ n s ~ o
7 ~
~
T
i~ ~ ~
iu ~
F
3 O
O '',a d q
q
a.o?mm~ O
n
`
» ~ "
'°
% Cn ~ c
J
N ._..
p
p~ ~`~cnD ~
Cn ~ tG
u O ~ .r d O
d
G p ? K ~
I 3 <_ _ o
o ~
m ~ ? abo m` D
I
~ 3. o o ~ n~ 0
O rD 7 O
m n O v S a'
~D ~ ~ n = j d D (1
n d -1 O d
o~
m
~
0
rte' ~ o
~,n
U
n
N
_
o _ ~
° Fr
~
0'03'^ ~ z
°
m
oza a °
'm
3 w a o m W
D _
w ~ ~ 3 ~ y
F
N
w A D o~ c 5~ o
~
r3
~ ~
~ C
yi
3
~
~
o ~ ,~ D
N ,o a o
o m
o
0
D j' p ^ j'
'0 3p
°
~ k
a ~ o
-
3 D
1
~ 2 C ~.a m
- ~ 3 n
0
J O ~
` ~ ? ~
~O
o O '
~;~~_
a
°
µ
,N
~
'c^_.n
~
o ! m ~ x ~ ~ 3
Qa ~
i j ~ p o
art ~
ll i ~~~o.~a
.
~
n
I 3 ~
~
~ ~ K #
J
I ~ o ~ o~~
~ n'$~'»~. g.
O
O ~
-~ n d
= ~ S,~ ~ 6
~o vi ° .a.. Q: ° ~ c 6
a ~
~
'
~
a
~Qa
os&°°.°
o m ~ s 3'u
n .°i. v o
n 3 m
~
o ~ c m
Pa nwn~
i 3 N
.m ~ ~ o o s
~
ao
o
»
,
C
~
i N m m ~,'^i
'~ M
3 m °'
°
~
~
m
~ ~
~ ~
c ~: N.
O
P
m ~ O 3
M W ~ 2 n
~ s° v
3
z
I~ ~g3
o a
a3`c'
a
~ C' ~ .~+
3~n 3
~. .o
,a
3
~
_
~
I Li
-
_ 3 'mo
~ °. ..
~ a
N N N N
t0 J Ol N V~
O O O O
O ~ ~ O d
_ _ _ M
a
o D
~ ~
C
a ~
d ,+
n
o, ~
2. <
S
3
0
3 0
a
V ~ ~ ~
W
O O ~ ~
m m
~ ~ d $
O O ~ 2
_ _ n
O
a
c c o
m m
~ ~
w m a'
D D p
z z
x ~
C C
N
n n
0 4
0 0
~ ti
n n
n n
O O
~ ~
D
m
0
m
N
w
m N n
ao A o
~ ~ Abp »
w A ~ ~'
G
c
J
fD O
N ~
O
N n
61
N
N
D
n
O
e'F
D D
C C
w
c d
m
w D
D Z
O
W m
~ ~
m
.~
O_
v ~
m ~
Q ~ _T
o m ~
d
~ ? n
o ~ &'
Ll 6
N A G
~ O
~ ~ 1
N O 00 Ol A N O OC O1 VI A W N N
T
~
m
>
~
3
fp
T
C
O. QJ
d
~
ac
~
n
N
t+
~
N
\
N
~
-- T
T
n
W
0
N
Ql T
T
~
W
0
N
Ol T
S
~
W
0
N
V W
d
o
F
3
_
y
O
F+
N
NN
A
O S
VI
m
n
N
D
~
O
N
00
N
N Gl
T
~
O
°~'
~
\
V
\
N
O C"1
d
~
~
7
~
y
7
~
N
~"~
N
~
N
O
~ G
d
~
W
G
O
a
~
d
JC
.fie
N
x
m ~
~
v
A
V~
~
T
C
a y1
7
m
~
vii
~
n
`_~
N
x
T~
O. ~
O
~
d
s
N D
A
o
7
N
T
3
z
c
3
m
A
N °.
A
A
v
W
d ~
7 ~ ~ N
~ w r
.~ C ~ 1/1
3 o"i obi ~
N ~~ ~ d
M ? ~ ~
N N
~ V
N ~
N ~
= b
O+
W
V1
S
d
A
A
V vV+
O pN
O
O S
pO
O O
S 8
O
O tAi~
S O
O
O
O
O
(n
O
W
to
7
C
N
O
t0
to
00
~
V
r
V
iV-`
Ol
~
W
0~o
In
o
W
N
W
p~
S
O
00
~
~
OAi
In
~
~
0~1
In
O
N
W
H+
m
V
~
In
W
N
OVi
l/i
~
?
O
W
?
l0
W
O1
A :+
IBC
W
V V
A V1
W N
N 01
t+ p~
O A~A
A 00
A V1
N W
O W
W N
W F+
~O O
~D G
d
pp
N
A ~...
V
N pp
lA
00 W
tO
OD p0
h`
W 01
O
W V
V
V A
Q1
t0 O
A
O lA
A
W I-+
l0
I+ In
A
N O
A
VV ~-+
N
V C
IE
~O to O O O p
O W O O In to O O O
~' W:'ntern;~ :Date Of Death Valuation -Request # 5982538
From: marilyn.berry <marilyn.berry@ubs.com>
To: jwsheaf ywsheaf@aol.com>
Cc: oeter.hicks <peter.hicks@ubs.com>
Subject: i=W: Internal :Date Of Death Valuation -Request # 5982538
Dale: Thu, Jul 5, 2012 9:44 am
Ilttachments: f3A01399.x1s (65K)
Page 1 of 1
'~- ... i "'" ~ ~ rc; ; .II no6liny in
tunr'ue 7h~~aiter's ucwunt on June 11 10'I.~ as you
„, ,.._, I . ~i.~ I;uow
Best regards,
Marilyn A. Berry
Registered Client Service Associate
UBS Financial Services Inc
Phone:301-718-4785
Fax:301-718-5099
From: Nemuri, Krishma
Sent: Thursday, July 05, 2012 9:37 AM
To: Berry, Marilyn
Cc: DL-Pricing Group
Subject: Internal :Date Of Death Valuation -Request # 5982538
Hi.
Please find attached prices Lor securities in the mentioned request
No[e:
The prices have been provided for securities that are currently reflecting in our
systems. if there has been any trading activity/ Asset transfer post Date of Death
(DoDi, kindly reopen the case and email the spreadsheet containing the securities to
We ene pricing department only provides end of the day prices for securities.
We do not provide cost basis information. For COS'[' BASIS TNFORMATION you will need to
contact Lhe PMIS DEPARTMENT,
Thanks & Regards,
Kri shma.N
Please visit our website at
for important disclosures and rnformatron about our email ~
policies. For your protection, please do not transmit orders
oz instructions by e-mail or include account numbers, Social
Security numbers, credit card numbers, passwords, or other
persona]. informatLon.
http://mail. aol. com/36478-211 /aol-6/en-us/mail/PrintMessaPe.asnx
_7/R/2(11 7
~
I O "O U _. C_
N U y ~ O O 9 O a O .~ O ~~ ~ O ~u u u u _-
~ O N C) N UJ N~ N O N d N N C
p ~ C •
E E
E
°
+
'
' E
E O O
m
of
U Q
¢ '
U m .
¢
m Q F E
>
¢ ~
E
¢ °
Q m ~ m
~ ~ ~ o
~" m
ml m
~ m
a~ a~
a~ ¢ m
a
N p
N p
C
d C
N ~
~ 3
~ 3 3
!> O
O D
p
N
~ N O
O N
U N O
O '
N
N C
p°
~
'p 'O
. V~
~ . U _ N d N Q N d D, ~
N
L N 'i_ N U N U N U N U (0 N N
O 0) OI ~ p C O p~ O O O O 3
~ O O m °I D)
0
c
O p
O O N
C
N°
"O ~ -
C UJ
1
L
=
Q
N N C IO
U U
f0
U
(O V p
10 .'
. .
a
.
p)V iy N mt ~L ~N LN
m Lv
OI LO O
N O O
L
'
L
~
L
-o
L Y
t S
L
- OI V N r/i
Z m m °
` o o~ o a o
O o~O om om rn
Z m Z m Z m Z m Z m Z m Q Q Q
\ S > > > ~ ~ \
~
ICI
J M m N ~p N , a ~
t+
O M n
O
~
O O
N
~
V
T n
O N ~
Q " ~ r ~ O O W ~ M A
~O
m in
0 0
m m ~n
0
o
0
o
0
a
°
°
°
°
0 0
o °v a o ~ o m
~ ~
ml M N
N ~ m O
(~ ~ ~ ~ ~ ^O O O O) N M r
t° tp
O
U
3 ~
N O O
N
I
O) o
B J ~ N M r
l0 (O
O
N N 0 0
4> t
_ ~ ro m r
~
O M
.;
O O
0
Y
O
C E a ° ~ m
.
~ j° m m o v
M
Q 1
O N N O
O ° ~ ~ N O O O O O
o d N
o M °
~
o r
~O m
° m m ~ 0 0 0
~ ~ OI th U] M [V
r t[I ~ N V N O
tE ~- U ° ~ ~ ~ o o m ~ M ai
0
O N O
° Z N ~ O ~ o O uy
O
~ (
O
M N N i o ° ° °o c r
U u o o O
w w m ~ o o °
M M °~
E
~ v
~ m ~ (~ ~ o
N
Y O p ~ ~ ~ F.
K
~ Y Z Y U y N
N ,. z m W o m m ~ ~ ¢ ~ ~ LL
~ r 7 U F- O U m > W W
~ C
O W S W I-
~ F
U Y
Z ~ 4 N 2 W
r ..~ _ ~ 0., p
O N
m J N O = ~
ID - i LL i° U Q ti Q m Z
y J J~
~~ Z ¢J¢ ~ W d Z ~ j Q
L cr~ m 2 w O ~ 2 m w 0
V ~
D O D Q g Z ¢
LL
W O
LL K m ¢ 2
` N l
l !/) l1 U ~ m 2 ~
M
W ~
~ K
~
~ o ~i a z ~ a ~
v .. y
"1 N LL ~ "'05
~~
> ~`~ W
0
a`
~'
~ M
~~o
o
~
~
~
~
~ ~ o~
(+~ d cis U M M V M M M ~ ~ M N N m ..
~
~
~
M
~ N ~
0 M M M ~ (`
') O V V ~~
O r '
m
O w
(~
l6
~
iii d
~W: ?nternal: Ristorical Price - Request # 6045082 Page 1 of 1
From: marilyn.berry anarilyn.berry@ubs.com>
To: jwsheaf <jwsheaf@aol.com>
Cc: peter. hicks <petechicks@ubs.com>
Subject: FW: Internal: Historical Price- Request#6045082
Date: Tue, Jul 10, 2012 9:21 am
Attachments: BA01399.x1s (54K)
Good morning, M.r. Sheaf fe r,
kere'd the cas_ basis 1-or the Bank of America Step CD £or June 11, 2012,
Ft me kr >w i= you need any additional information. P m sorry the
~cf -;ru m: oae -looked this holding.
Have a nice day,
Best re.~a rds,
Marilyn A. Be r:y
Pegist:erad Client Service Associate
08S Financial Gerviccs Inc
Phone; 3'il--!].F-9785
_a~. iG 1-718-5099
----Origina]. Message---
From: sinha, Pratima
Sent: Tuesday, July I0, 2012 7;91 AM
To: Berry, Marilyn
Cc: Di;-Pricing Group
Subject: Internal: Historical Price - Request #k 604508?
lli.
P tease find attacY~ed prices £or security in the mentioned request
Note:
We tae pr`'cirg department only provides end of the day prices for
S'PCL1Z l.L1ES.
We do not provide cost basis info nnation. PMIS department will be able
to ass_st you on COST BASIS INFORMATION.
?hanks F, Regards,
P ratima,
Please vis it our website at
I do ur e mai
o]rcicti. Eor our not trap -
ial
Securityunumbersbyc Peditlc~rdinPludeea cdcounbonumbers, So~ers
d numbers, passwords, or other
personal :nformation.
http://mail.aol.com/36478-211/aol-6/en-us/mail/PrintMessage.aspx 7/10/2012
L
U
C
l~E
m
Q7
.~
4
L
Q
V' N
Q O
~ N
4 0
~~
N r,
r o
N n.
~ t";
r
~
~ o
<O i'3
Q 1J
~'
t +1A
V
~ to
1 N
,
N
W N 3
a ~
a {~~
o
'p n s»
~
'O `
01 O u'
~
M ~
d ~,
O r r(~
m d n
0 r~
0 w
~ ei
Z ~f
U 1.
a o ~~:
C O a
_F N ~
E m ~
7
U Q m
o
~ ~
~ o
av
u
N '-
3 a
o ~'
D ~
~ O
~ U
L
IT L
L "
O ~
Z m
rv ~
> m
Q m
vl o
o m
U m
of
J
SI
d
E c
O
MI
O
U
0
0
0
v
E
0
0
C
N
O
E
y
w
Y
U
a
N
U
(~D
r
m
Z
H
a
K
O
U
U
w
Q
Y
Z
m
W
W
O
O
5
Accrued• Interest Calculator
http://apps.firua.org/Calcs/ 1 /Accruedlnterest
I~C~I~'Ct+.K.l ~-
Accrued Interest Calculator
Interest on a bond accrues between regularly scheduled payments. Td find out how much interest is owed on a given bond,
use the calculator below. Select the appropriate bond type to figure accrued interest for corporate and municipal bonds or
government bonds. Interest for corporate and municipal bonds is calculated using a 360-day year. Interest For government
bonds is calculated using a 365-day year.
ZTLM 3
Inputs `
1
CArzoCt,v,~ Ra~,T t3'+Htc z. Ca
Bond Type $~
Corporate and Municipal Bonds (360 days)
Investment Amount
~___. "~
~1 $50,000,00
Annual Interest Rate e
V ~4
1
,
.
Days In Holding Period
C_.._._._______.
3$ 15
Calculate-. Reset
Results
Accrued interest Analysis
`* Summary
', Accrued Interest
0.171
I Value of Accrued Interest
$85.42
Note: If a band is in default, there is no accrued interest
Calcqqul`a~iionyMet}hotlps antl Accuracy Audited By:
f)I\l ~a\d ~~
~II! c'i ice.
Your use of this Calculator signifies your agreement to the ~Tbrms and Conditions.
loft
7/24/2012 3:30 PM
Accrued Interest Calculator
http://apps.finra. ory~Caks/ 1 /Accruedlnterest
Accrued Interest Calculator
Interest on a bontl accrues between regularly scheduled payments. To find out haw much interest is owed on a given bond, use the calculator
below. Select the appropriate bontl type to figure accrued interest for corporate and municipal bonds or government bontls. Interest for corporate
and municipal bonds is calculatetl using a 360-day year Interest folr government bonds is calculated using a 365-day year
Inputs C=TCWI a
~~. MUiJ~Y CSa„K
Bond Type el ~Corporata and Municipal Bonds (360 days)'.
r__. _ __ __ __
InvestmentAmount ed $80,000.00
Annual Interest Rate
iB I3.0 % __-___
Days In Holding Period '~'-""""-"""_""'
dk 147
Calculate Reset
Results
Accruetl Interest Analysts
'. "~ Summary
Accrued lnterest~ ~ 1.TT5
i Value or Accrued Interest §BBO
aO
r
Note. tt a bontl is in delault there is .
no accruetl interest.
cemmarmn memoas ens nm~~ecy mm~ee ey.
l 1 1. t
Your use of this Calculator signifies your agreement to the Terms and Conditions-
w
loft
7/24/2012 3:32 PM
Accruee' inferest Calculator
http://apps.fins,org/Calcs/ l/Accruedlnterest
Accrued Interest Calculator
Interest on a band accrues between regularly schetluled payments. To fintl out how much interest is owed on a given bontl, use the calculator
below. Select the appropriate band type (o figure accrued interest for corporate and municipal bonds or government bonds. Interest for corporate
and municipal bonds is calculated using a 360-tlay year. Interest(~forTrgovernment bontls is calculated using a 365-day year.
Inputs ~.1~~ I ~~
I-I ~,3C. (;q,.~K
Bond Type ^ =.3 Corporate and Municipal Bonds (360 days)
Investment Amount - -
d9 $145,000.00.--_
Annual Interest Rate.
~:y r3.0 %
Days In Holtling Period - -
Ji I4
Calculate Reset. '.
Results
Accruetl Interest Analysts
'~. "Summary
Accruetl Interest
0.117
Value of Accruetl Interest
$169.17
Note: If a bontl is in tlefaulf there is no accruatl interest
~,
_ _.
cxrcumuan uenmas ana aw~~ecy auoueo ey
~'i ill. )} ~' ~~.
,.. ~ t ,
Your use of this Calculator signifies your agreement to th e Tonns and Conditiorxs.
1 of 1
~_ 7/24/2012 3:32 PM
Accrued Interest Calculator
Accrued Interest Calculator
http://apps.Snra.org/Calcs/ 1 /AceFuedLrterest
Interest on a bond accrues between regularly scheduled payments. To find out haw much interest is owed on a given band,
use the calculator below. Select the appropriate band type to figure accrued interest for corporate and municipal bonds or
government bonds. Interest for corporate and municipal bands is calculated using a 360-day year. Interest for government
bonds is calculated using a 365-day year.
~I' ~ cam. 13~
Inputs
Bond Type '
~ Corporate and Municipal Bonds (360 days)
Investment Amount tiP $100,000 00
Annual Interest Rate #$ I 4 0 % -~
Days In Holding Period ~ 60
Calculate Reset
Results
Accrued interest Analysis
~' Summary
Accrued Interest '
', 0.687
Value of Accrued Interest
$888,67
Note: If a bond is in default, there is no accrued interest.
Celc[ul77e,~ l))ionyyMyyet~qft//otlTTe eppntl Fccurecy Aotlitetl By.
A d1..~47 Cy l.".1~
~rlt I AKyFr
Your use of this Calculator signifies your agreement to the Ternis and Conditions.
lofl
7/24/2012 3:29 PM
Accnae:'; Interest Calculator
r
http://apps.fins.org/Calcs/1/Accruedlnterest
Accrued Interest Calculator
Interest on a bond accrues between regularly scheduled payments. To find out how much interest is owed on a given hood, use the calculator
below. Select the appropriate bond type to figure accrued interest for corporate and municipal bonds or government bonds. Interest for corporate
antl municipal bonds is calculated using a 360-day year. Intere/st for government bonds is calculetetl using a 365-tlay year
Inputs C~-~ IS~
Bond Type #~ Government Bonds 365 days)
-._~
Investment Amount 18 ', $60,000.00
~.-_____
Annual Interest Rate .~ ' 3 5 % -
Uays In Holding Period ' - ------
ag G7_-_-
II`` Calculate Reset
Results
Accmedlnteresr Analysts
Summary
Accrued Interest
0.261
Value of Accruetl Interest
$156.63
Note. It a bontl is in tletault, there is no eccruetl interest. -
Celculallan McI~o05 end Accuracy qu011e0 By'.
E[t(tl:I'Et~'
b ii? .r? J
Your uae of this Calculator signifes your agreement to the Tcn
ns ^nd fonddions
loft
7/24/2012 3:31 PM
Accrued'Interest CalctdaWr
http://apps.finra.org/Catcs/ I /Accruedlnterest
Accrued Interest Calculator
Interest on a bond accrues between regularly scheduled payments. To find out how much interest is owed on a given bond,
use the calculator below. Select the appropriate bond type to figure accrued interest for corporate and municipal bonds or
government bonds. Interest for corporate and municipal bonds is calculated using a 360-day year. Interest for government
bonds is calculated using a 365-day year.
Inputs `=~M ~~~
Bond Type
Investment Amount
Annual Interest Rate
Days In Holding Period
Results
Accrued Interest Analysis
'"Summary
Accrued Interest
Value of Accrued Interest
I Nate: It a bond is in default, there is no accruetl interest.
1.602
$1,602.21
Calculation Melhotls antl Accuracy Autlitetl By:
C3 fZt~3ftf E~' o
t~Pl ~ u=ts'
Your use of this Calculator signifies your agreement to the Terms and Conditions.
~~ ; I Government Bonds (365 days)
!1f $100,000.00 ~`.
6$ 5.0
r 16fi `~`_____.
Calculate Reset
loft
- 7/24/2012 3:30 PM
Accnted• Interest Calculator
http://apps.fins.org/Celts/ I/Accruedlnterest
Accrued Interest Calculator
Interest on a bond accrues between regularly scheduletl payments. To fintl out how much interest is owed on a given bond, use the calculaer
oelow. Select iha appropriate bond type to figure accrued interest for corporate antl municipal bonds or government bonds. Interest for corporate
antl municipal bonds is calculatetl using a 360-day year. Interest//-Tf~orgovernment bonds is calculated using a 365-day year.
Inputs l.1-~~~ (C'j,
Bond Type ~ -"«" °r ~~ ro
a-t• Government Bonds (3G5 days) '.
Investment Amount
c0 x$50000.00_____
Annual Interest Rate
E4 5.13 % _.._.___
Days In Holding Period ~~---
i,¢ 107 -_.-
Calculate Reset
Results
Accruetl Interest Analysts
'~SUmmary
Accrued Interest
1.516
Value of Accrued Interest ~ -
i Note: If a hontl is in tletaulf (har
i E758.76
e
s no accruetl interest.
Celculel
lon
M
al
tlotls an0gccu~ecy qutllletl By:
r
(
y
{
f.J 4'ytl )Ill , ~~.
` n t 't, .1
Your use of this Calculator signifies your agreement to th T
e
eens and Conditiau.
l of 1
7/24/2012 3:31 PM
Accrued lnterest Calculator
r
http://apps.finra.org/Calcs/ 1 /Accruedlnterest
Accrued Interest Calculator
Interest on a hontl accrues between regularly schetluletl payments. To fintl out how much interest is owed on a given bond, use the calculator
below. Select the appropriate band type to figure accruatl interest for corporate antl municipal bontls or government bontls. Interest for corporate
and municipal bonds is calculated using a 360-day year. Interest for government bonds is calculated using a 365-day year.
Inputs ~~T~'t^'I Z1~
Band Type ai ~ _ _ _
Cor rate and Municipal Bonds (360 days)
Irnastmen( Amount r -
9,y r75,000.G0 _-_.-.~_-._
Annusl lnterest Rate
E1 ~5.9
Days In Holtling Period
4$ ~iG6 _._____
\ Calculate' 'Reset
Results
Accruetl Interest Analysis
' `i' Summary
Accruetl lnterest
2.721
Value of Accrued Interest
' $2,040.41
Note'. m a bontl is in tlefault, there is no accruatl interest
f
cemmenon raeinaes ena nccurecv numiea ey
I311t )Ki,It
rn n
Vour use of this Calculator signifies your agreement to the Teens and Conditions.
loft
~~~~-/z
7/24/2012 3:32 PM
Schedule E: Cash, Bank Deposits & Misc Property
Documentation
Contents
Reference D:
M&T Bank Account (# 77342674) Statement (Line Item 1)
Reference E:
M&T Bank Account (#9855106317)Statement (line Item 2)
Account established in anticipation of death to provide liquidity
by transfer of funds from Account #77342674
i1000UNT N0. ACCOUNT TYPE
~73~~26741, RELATIONSHIP CHECKING WITH INTEREST
JANETTE L SHEAFFER
5008 CEDAR CROFT DR
BETHESDA MD 20814
OD 0 06129M NM I17
18821
INTEREST EARNED FOR STATEMENT PERIOD 0.33
INTEREST PAID YEAR TO GATE 2.73
ACCOUNT SUMMARY
STATEMENT PERIOD PAGE
MAY.24-JUN.22,2012 1 OF 2
COLONIAL PARK
BEGINNING
BALANCE DEPOSITS &
OTHER ADDITIONS
CHECKS PAID OT HER
SUBTRACTIONS CURRENT
INTEREST PD ENDING
BALANCE
N0. AMOUNT N0. AMOUNT N0. AMOUNT
53,683.41 4 9,166.54 2 20,207.08 0 0.00 0.33 42,643.20
~f CfIIINT GCTTVTTV
POSTING
DATE
TRANSACTION DESCRIPTION DEPOSITS~INTEREST
&OTHER ADDITIONS CHECKS $ OTHER
SUBTRACTIONS pAILY
BALANCE
i
05-24-12 BEGINNING BALANCE 353,683.41
05-24-12 CHECK NUMBER 0338 20,000.00 33,683.41
05-31-12 US TREASURY 312 TAX REF 5,155.45
05-31-12 DAUPHIN COUNTY R PAYROLL 512.D0 39,350.86
06-01-12 US TREASURY 312 XXCIV SERV 2,477.09
06-01-12 SEC tl, k. S 1~
05_TREASURV 303
_k_Y-. _
XXSOC
_
` ~ ___ __„__,7,~~?._QO_
~ „___.~_~_,.._._.-,- ._.__. _._..92.. B44.4S.__.
_,
,
_
d
06-15-12 ~L)
`C,~/'~
CHECK NUMBER 0339 207.08 42,642.87
06-22-12 INTEREST PAYMENT 0.33 42,643.20
ENDING BALANCE 542,643.20
CHECKS PAID SUMMARY
338 05-24-12 20,000.00 339 06-15-12 207.08
ANNUAL PERCENTAGE YIELD EARNED = D.00
SAVE YOUR CASH FOR WHEN YOU REALLY NEED ZT. INSTEAD OF CARRYING EXTRA CASH OR
FUMBLING WITH CHANGE, USE YOUR M&T CHECK CARD FOR ALL YOUR EVERYDAY PURCHASES -
IT'S SAFER AND FASTER!
WHETHER IT'S A BURGER AT LUNCH, GAS, GROCERIES, EVEN MOVIE RENTALS OR A CUP OF
COFFEE - NO PURCHASE IS T00 SMALL FOR YOUR CARD!
LnUUN ~G/U%I
Gmail - FW: prod. -Date of Death Request
~..~rl:`'7 f ~
FW: prod -Date of Death Request
1 message
Lau, Kelvin < KLAU2@mtb.com>
To: "jim.sheaffer@gmaiLcom" <jim.sheaffer@gmaiLcom>
-----Original Message-----
From: Mercer, Valarie On Behalf Of DATE OF DEATH REQUESTS
Sent: Friday, June 29, 2012 12:28 PM
To: Lau, Kelvin
Subject: RE: prod -Date of Death Request
Per your request, please find the Date of Death Values I
Account Number Balance Accrued Interest Total
1. 77342674 42849.95 .20 42850.15
Let me know if there's anything else you need :-)
Thanks
V Mercer
-----Original Message-----
From: Lau, Kelvin
Sent: Monday, June 25, 2012 2:28 PM
To: DATE OF DEATH REQUESTS
Cc: Lau, Kelvin
Subject: prod -Date of Death Request
Accountlnformation
Date of death: 06/11/2012
Account Number: 77342674
Product Type: Deposit Account
Request Details
Deliver to: Requestor
Page 1 of 2
Jim Sheaffer<jim.sheaffer@gmail.com>
Tue, Jul 17, 2012 at 10:35 AM
https://mail. google. com/mail/?ui=2&ik=ab4f029f53&view=pt&search=inbox&th=13 8955... 7/ 17/2012
. ~~~
ncCOUNT ND~ 1 ACCOUNT TYPE
E ___ 90551063171 MVCHOICE PREMIUM CHECKING
JAMES W SHEAFFER
5008 CEDAR CROFT DR
BETHESDA MD 20814
INTEREST EARNED FOR STATEMENT PERIOD
INTEREST PAID VEAR TO DATE 0.72
00 0 D6544M NM 017
64270
0.72
n rrnn~iT cnuunnv
R~ r~-~.,ccs L
STATEMENT PERIOD PAGE
MAY.24-JUN.22,2012 1 OF 1
CABIN JOHN
BEGINNING DEPOSITS 8 OTHER CURRENT ENDING
BALANCE OTHER ADDITIONS CHECKS PAID SUBTRACTIONS INTEREST PD BALANCE
N0. AMOUNT N0. AMOUNT N0. AMOUNT
0.00 1 20,000.00 4 15,469.18 0 0.00 0.72 4,531.54
n rrniiuT nrrr„rT..
POSTING
DATE
TRANSACTION DESCRIPTION DEPOSITS,INTEREST
8 OTHER ADDITIONS CHECKS 8 OTHER
SUBTRACTIONS DAILY
BALANCE
05-24-12 BEGINNING BALANCE 30
00
05 24-12 DEPOSIT __.__-_~ ! ~. ` E1~., 'kl,. (, V(! 1 1 L _ .~4,_244....ILQ._ _.-.-______.___ .
.______24..11OO.DO
Ob-18-12 CHECK NUMBER 0103 11,965.00 8,035.00
06-19-12 CHECK NUMBER 0101 1,779.00
06-19-12 CHECK NUMBER 0104 1,195.18 5,060.82
06-20-12 CHECK NUMBER 0102 530.00 4,530.82
06-22-12 INTEREST PAYMENT 0.72 4,531.54
ENDING BALANCE 54,531.54
CHECKS PAID SUMMARY
101 06-19-12 1,779 .00 102 06-20-12 530.00 103 06-18-12 11,965.00
104 06-19-12 1,145 .18
ANNUAL PERCENTAGE YIELD EARNED = 0.04
SAVE YOUR CASH FOR WHEN YOU REALLY NEED IT. INSTEAD OF CARRYING EKTRA CASH OR
FUMBLING WITH CHANGE, USE YOUR M8T CHECK CARD FOR ALL YOUR EVERYDAY PURCHASES -
IT'S SAFER AND FASTER!
NHETHER IT'S A BURGER AT LUNCH, GAS, GROCERIES, EVEN MOVIE RENTALS OR A CUP OF
COFFEE - NO PURCHASE IS TOO SMALL FOR YOUR CARD!
i coati faro i~
~-~ M 1
"* ACTIVITY FOR
~ SHEAFFER, JANETTE -SHEAJA - -802662
', 05/09/12 Payment-Thank You 216.29- .00 216 .29-
OS/12/12 7869022 30 FUROSEMIDE 20MG O1 .33 .00 .33c
',05/12/12 7869029 31 LEVOTHYROXINE 50 Ol 1.19 .00 1 . 19c
05/12/12 7869030 61 METOPROLOL 25 MG O1 .64 .00 .64c
05/12/12 7869031 30 MIRTAZAPINE 15 MG O1 ,78 .00 .78C
05/12/12 7869034 60 ~ SENNA LAXATIVE 8. O1 * 2.99 .00 2. 99
j05/12/12 7947736 14 BEE-ZEE TABLET O1 * 3.49 00 3 49
05/12/12 7869037 60 VITAMIN D 1,000 U O1 * 3.91 .
.00 .
3. 91
OS/12/12 7948963 31 SERTRALINE 100MG O1 .75 .00 . 75c
05/13/12 7951510 40 IODOSORB GEL O1 * 59.77- .00 59. 77-
',OS/13/12 7951510 40 IODOSORB GEL O1 * 62 .38 00 62 38
05/14/12 7951825 10 NOVOLOG 100U/ML V 01 24.75 .
.00 .
24. 75c
05/15/12 8206937 1 DRESSING CHG PERI O1 2.29- .00 2. 29-
05/15/12 8206942 1 VISTA IV OATH EXT O1 14.02- .00 14. 02-
',OS/15/12 8206935 3 IV ..PUMP #901608 Z Ol. 34. 68 .00 34. 68
'OS/15/12 8206936 2 ZYNO SOLN SET 800 ~ OL~s. 17.97 .00 17. 97
05/15/12 8206937 1 DRESSING CHG PERI O1 4;55 .00 4. 55
.05/15/12 8206942 1 VISTA IV CATHEXT r O1' 18,48 .00 18. 48
~, 05/16/12 7952377 8000 DEXTROSE 5$-1/2 NS 01 2:32 .00 2. 32c
'OS/17/12 8206936 1 ZYNO SOLN. SET 800 O1 B. 11- .OD 8. 11-
05/17/12 8206936 2 ZYNO SOLN 9ET 800 01 77.97 .00 17. 97
105/17/12 7952706 2000 NSS 0.9$•SOLN O1 .54 .00 . 54c
,05/18/12 8206935 3 IV PUMP #9.013.76. Z.. _ . 0.1. 34.68 .00 34. 68
', 05/20/12
' 7951867 10 NOVOLOG 100U/ML.V O1- 24,.75 .00 24. 75c
'.05/22/12
1 2046587 10 FENTANYL 25 MCG/H `01 12.61 .00 12. 61c
05/29/12 2046668 10 FENTANYL 12 MCG/H O1 21.51 .00 21. 51c
~~~~~d~l'L ~Of ~~~ ~.ec~t"
...----. __.._._-- -- I
-- - - - ~
.00
__ 194.08 _ 13.00
LEGEND NON-LEGEND I rorn~TAx]
`--- -,- -_._ _ FOR MONTH FOR MONTH AMOUNT DUE
'revious Balance Charges this month Finanee Char a TOTAL CWAROES TotarPaym.nt s crealta
216.29 r 291.2 7 + .00 507'.56 300.48 207.08
FOR ALL PHARMACY RELATED INQUIRES PLEASE CALL Alert Pharmacy Services, Inc aLt-800-266-9954
S~alemenl Terminology on reverse
I-t~, Z
** ACTIVITY FOR SHEAFFER, JANETTE
05/15/12 8211131 1 IV START NURSING O1
06/04/12 7951825 10 NOVOLOG 100U/ML V O1
06/13/12 Payment-Thank You
S' ~
~~~{~z.k ~ 1Uf
~f~~i2
AVE. MT HOLLY SPGS, PA 17065
-SHEAJA - -802662
150.60
24.75
207.08-
00 150.0"0
00 24.75c
00 207.08-
---
_~ ___-_
175.35
LEGEND Torai T~
-- __ ___ FOR MONTH
~revious Balance Charges ehis month ~ Finance Char e - TOTAL CHARGES Total Payment 8 Qredtts AMOIyNT DUE
207.08 { 175.35 I .00 382.43 207.08 - 175.35
FOR ALL PHARMACY RELATED INQUIRES PLEASE CALL Alert Pharmacy Services, Inc at 1-800-266-9954
_._ - Slalement Terminology on reverse
Comments
__ __.
$9,540.00 $414.02
I rr rti 3
$0.00
Date p~scrip~ii
_ _- L _ j.._ _s.::
Balance Forward
05/01/12 - 05/01/12 Wash & Set
05/01/12 - 05/01/12 LlXL Briefs
05/01/12 - 05/20/12 Protein Powder
05/01/12 - 05/20/12 Resource 2.01 (2 oz)
05/02/12 - 05/02/12 Escort Fee $2.50/15 mins.
05/02/12 - 05/02112 Transportation 0-10 miles
05/10/12 - 05/10/12 Wash Cream
05/10/12 - 05/10/12 Adult Wipes Refills
05/10/12 - 05/10/12 Escort Fee $2.50/15 mins.
05/10/12 - 05/10!12 Transportation 0-10 miles
05/14/12 - 05/14/12 Payment Check # 200
05/14/12 - 05/14/12 M/R Briefs
05/14/12 - 05/14/12 Wash & Set
05/14/12 - 05/14/12 Adult Wipes Refills
05/23/12 - 05/23/12 M/R Briefs
05/24/12 - 05/24/12 Transportation 0-10 miles
05/28/12 - 05/28/12 Adult Wipe Tubs
05/28/12 - 05/28/12 Adult Wipes, Refills
05/31/12- 05/31/12 Laundry ~.
05/31/12 - 05/31/12 Telephone Basic Charges
05/31/12- 05/31/12 Wash Cream
05/31/12 - 05/31/12 Escort Fee $2.50/15 mins.
05/31/12 - 05/31/12 Transportation,0-10 miles
06/01 /12 - 06!30/12 Room & Board
TOTAL BALANCE DUE:
$0.00 $0 00 ' $9 954.02
$10,140. 79 $10,140. 79
1 $13 .15 $13. 15 $10,153. 94
1 $27 .40 $27. 40 $10,181. 34
40 $0 .35 $14. 00 $10,195. 34
160 $0 .45 $72. 00 $10,267. 34
7 $2 .50 $17. 50 $10,284. 84
1 $22 .00 $22. 00 $10,306. 84
1 $5 .36 $5. 36 $10,312. 20
1 $2 .88 $2. 88 $10,315. 08
8 $2 .50 $20. 00 $10,335. 08
1 $22 .00 $22. 00 $10,357. 08
$10,140.79 $216. 29
1 $23 .77 $23. 77 $240. 06
1 $13 .15 $13. 15 $253. 21
1 $2 .88 $2. 88 $256. 09
1 $23 .77 $23. 77 $279. 86
1 $22 .00 $22. 00 $301. 86
1 $4 .07 $4. 07 $305. 93
1 $2 .88 $2. 88 $308. 81
1 $34 .75 $34. 75 $343. 56
1 $30 .60 $30. 60 $374. 16
1 $5 .36 $5. 36 r)~ $379. 52
5
1 $2
$22 .50
.00 $12.
$22. 50
00 1
` I .V
~~'~ 0 t $392.
$414. 02
02
30 $318 .00 $9,540. 00 $9,954. 02
$9,954.02
FACILITY NAME RESIDENT NAME ACCOUNT NUMBER
CHURCH OF GOD HOME, INC JANETTE SHEAFFER 802662
~TTCacr. '-1
---
• RESIDENT STATEMENT FROM
CHURCH OF GOD HOME, INC
801 N HANOVER STREET
CARLISLE, PA 17013 ,
717-249-5322
Statement Date Due Date
06130/2012 Upon Receipt
566
ACCOUNT NUMBER
802662
AMOUNT PAID $
JANETTE SHEAFFER
clo JAMES SHEAFFER
5008 CEDAR CROFT DRIVE
BETHESDA, MD 20814
Please make check payable to CHURCH OF GOD HOME, INC
Remit To:
CHURCH OF GOD HOME, INC
801 N HANOVER STREET
CARLISLE, PA 17013
Please detach and return this portion with your remittance to the address above.
Comments . ~ • i • ' ' ' ' ' -
• ~ ~ ~
--- -- -
- ! 00
$0 $(13,566 94)
- _.
$0.00
$(13 566.94) $0 00 $0 .00 .
Description
I ~
~ li EJaYs
Rate
~ ~
gh~+r9e41 ° I Rayme~ts ~Salan4e
~I
I
~~
'
~
Date i ~
_ II units
iL ~~
_ j
' lCretlffl ._.~.
~.
_
-- ------- - __.,L:.._.~ .. ,
-
$9,954.02 $9,954.02
Balance Forward
(1)
$7,316.00 7,316.00)
$( $2,638.02
07108109 - 07/08109
Security Deposit Skilled
1
$23 77
$23 77 $2,661.79
06/02/12 - 06102112 M/R Briefs
1
88
$2
$2.88 $2,664.67
06/02/12 - 06!02/12 Adult Wipes Refills
1 .
15
$13
$13.15 $2,677.82
06/05/12 - 06/05/12 Wash & Set
24 .
45
$0
$10.80 $2,688.62
(U9 ,O6
06/05/12 - 06/10/12 Resource 2.01 (2 oz) . 50
$12 $2,701.12
06/07/12 - 06/07/12
Escort Fee $2.50/15 minx. 5 $2.50 .
00
$22 ~
,.a. ~~s $2,723.12
~'
06107112 - 06/07/12 Transportation 0-10 miles 1 $22.00
4 .
74
$12 u,
~ $2,735.86
06/11/12-06/11/12 Laundry 1
1 $12.7
22
$11 .
$11.22 $2,747.08
06/11/12 - 06111112
Telephone Basic Charges
20 .
00)
$(318
$(6,360.00) $(8,612.92)
06/11/12 - 06/30/12 Room & Board (
) . $8,854.02 $(13,566.94)
06/13112 - 06113/12 Payment Check # 201
• TGTAL BALANCE DUE:
$(13,566.94)
Cam. r~~~ ~l~l~~fi
1~~t~..~S t~eeor~eA o~- Sd-"~~ E.
FACILITY NAME RESIDENT NAME
CHURCH OF GOD HOME INC JANETTE SHEAFFER
ACCOUNT NUMBER
802662
S~~
pennsylvania ~
DEPARTMENT OF REVENUE
uLRencoElnOrnonA~~rASh"s PERSONAL INCOME TAX ~~~.,,a<<,oo~~x«,a„n
HARRISBORG I'A 77128-0471
POR"~~BU431 BILLING NOTICE
115400374366
DLN:
OTI
-2-0463
F
NUM: 177
SE
SOCIAL
TAX YEAR: 2011 840.79
PREASSESSMENT AMOUNT
A2
2012: B
BALANCE(S) DUE FOR YOUR ACCOUNT AS OF AUG
AX UNDERPAYMENT PENALTY
E
D
ESTIMAT A LAN
JANETTE L SHEAFFER P
00
O
W
0
~-+ BALANCE INCLUDES 00
5008 CEDAR CROFT DR
MD 20814 0
-3927 EST7 PN LTY 11.79
~0 11.79
.00
B ETH ESDA .
LEGAL ,00
INTEREST .00
USE TAX 929 00 929.00 ~
PIT TAX/RFD 9
2011 BALANCE DUE SIDE OF NOTICE)
PLUS OTHER TAX YEAR(S) LIABILITIES (SEE REVERS
TOTAL DUE NOW*- (PLEASE PAY THIS AMOUNT
USING THE ENCLOSED COUPON) 11.79
S
U
E ORPASSADJUSM HDN BY THE DEPARTMENTREPORTED ORIGINAL OR
E
~
N
2011
Y OU R
ON T URN
R
T
X
ADJUSTED AMOUNTS
lA. GROSS COMPENSATION ..........................
1'B. SCNEDU LE 'JE EXF EIJSES ........................
1C. COMPENSATION ........ .............. .~~~~~~~~
2. INTEREST (SCHEDULE A) .......................
3. DIVIDENDS (SCHEDULE B) ......................
q, NET INCOME OR LOSS ..........................
5. TA%AB LE SALE - GAIN OR LOSS .................
SA. CAPITAL GAIN EXCLUSION ......................
6. RENTS, ROYALTIES, PATENTS, COPYRIGHTS.......
7, ESTATES AND TRUSTS (SCHEDULE J) .............
8., GAMBLING AND LOTTERY WINNINGS ...............
9. GROSS TAXABLE INCOME (ADD LINES 1C,2-5,6-8).
10. OTHER OEDUCTIO NS(MEDICAL. HEALTH, TUITION).N
11. NET PA TA%ABLE INCOME(LINE 9 MINUS LINE 10).
12. TAX LIABILITY (MULTIPLY LINE 11 BY .03070)..
13. TAX WITHHELD (FROM W2'S) ....................
14. CREDIT FROM PREVIOUS TAX YEAR ...............
15816 ESTIMATED TAX & EXTENSION PAYMENTS..........
17. TAX WITHHELD AS REPORTED ON NRK-1...........
18, TOTAL CREDITS (ADD LINES 14-17) .............
19B. NUMBER OF DEPENDENTS ........................
21. TAX FO R6IVENESS CREDIT ......................
22. RESIDENT CREDIT (SCHEDULE G) ................
23. CREDITS (SCHEDULE OC) .......................
2q. TOTAL CREDITS (ADD LINES 13.18.21'23 )...~~~
25. USE TA%
26. TA% DUE (LINES 12 PLUS 25 MINUS Z4)......~~~
27. PENALT]ES AND INTEREST ......................
29. OVERPAYMENT .................................
....................
30. REFUNDED........
32~36.TOTALT DONAOT IONST(LINES 32~36)TED TAX......~~
0
O
0
34,317
24.847
0
8,823
0
0
0
0
67,987
0
67,987
2,087
0
0
1,158
0
1,158
0
0
0
0
1,158
0
929
0
O
0
THE REASON(S) FOR THIS NOTICE ARE AS FOLLOWS:
~NA fN DA L1PTAXPAY ERS WHOIEX PECTT TO RECEIVE ATS LEAST SB~OOOTO FY PARTAXABLET INCOM E~SWHICHI ISLNOTRSOUBJ ECT
FILE A DECLARATION OF PENNSY LVAN]A ESTIMATED TAX AND MAKE INSTALWHICH
IO EMPLOYER WITHHOLDING.
i'AYM ENTS DURING THE TAX YEAR. ThIIS INFORMATION IS LISTED IN THE TAX INSTRUCTION BOOKLE
O FCTAXAPREPAI DEISA LESSRM HANA90 PERCENTNO FNTHEP ACTUAL ~AXESHOW NTON THE ANNOALERETURN.W IFNTHEE AMOUNT
OFEESI'IMAT EDATAX ES.~~NT ERESTT IOF FIGU REDX SEPARATELYT FO RREACHNINS~ALMMENTP DU EI DATE~SIFF pUUNDERPTHATNT
ONI REVENUETS WEB SIDT EO ATNWWW RREV ENU EA STATOMPAEUS OR YOUBCAN ORDER THE3EO RMHFROMVTHE3 DEPA RTMENTABLE
24-HOUR AUTOMATED FORMS ORDERING MESSAGE SERVICE BY CALLING 1-800-362-2050.
ANY UNPA]D BALANCES WILL REDUCE OR ELIMINATE ANY FUTURE REFUND. YOU WILL BE
ASSES SEDO NOOURWI LL THEN HAVE THES RIGPM TOEAPPEALO TOTTHE DEPARTM ENT~AY THE AMOUNT DUE,
39 PERC ENTSO FNTH EBAMOUNTADU6 MAYH BE IMPO SEDION ANYN LIABI~ITMANOTEPAI OJ PRIOR TOO REFERRAL TOEA UP TO
COLLECTION AGENCY OR CONTRACT COUNSEL.
*The "Total Due Now" may not reflect payments remitted to the department within 15 days prior to the
't•• ~ date of this notice. Please compare the date of this notice with your banking records before
contacting the department.
SEE REVERSE SIDE FOR MORE INFORMATION