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Home My WebLink About01-11-13J REV-1500 Ex (os-os> PA Department of Revenue Bureau of Individual Taxes ~ ~ PO BOX 280601 Harrisburg, PA 17128-0601 15056051047 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death DJ(ec~edent'sJLas/`tName Suffix ! ~ L-~ L.. (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth ~~ ~~ Decedent's First Name MI ,+~ ls` ~' Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder 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 of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number +~' e ~ ~. ~ A ~ s ~~ N ! BLS' ~ ! - ~ ~! ~31~' Firm Name (If Applicable) ~ ft'1 ICI R OF WtLt'S US NL~ .' ~~~~ First line of address ~ ~ {. -.r ~. ~' ~ ~= n t F--+ ' `` .-y Second line of address ~~r~~ z~ City or Post Office ~~'~ / ~L~ Correspondent's a-mail address .y. CIJ ~'.9 ~... c..~ -r •-ri ,t ;., ~ ._3 i '" DATE tLtiE.D t.: :t "'~Y State ZIP Code P~9 l ~ ~ 3 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and [o the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT OF PERSOJNRE~p B~ F,d ®LI~`RETURN / _-// ~j/ ys7 ,IA` ~ DATE 15056051047 Side 1 15056051047 J __1~~ ~ ~ PLEASQE~USE ORItG1~~O~NLY REV-1500 EX Decedent c Name. RECAPITULATION i Real estaie (Schedule A) 2 Siocks and bonds {Schedule B. L5~5~IJ`~J~iil Decedenfs Social Securty Number s "3- Closei~~ Held Corporation Partnership : r Sol°-F' .t~~ _ ,rsi~~~~ _ :~~ ~ ~.. 4. it4ortgages & Notes Receivabie (S~-hedule D? 5 Cast~i. [3ank Deposits & Mlscei dne»uc Pr snra' ~~ ~ie ry ' ~~ a.r ',e zy9`1~`..~` 6 Jointly Qwned Prcperty (Schedule F) O Separate Blllinr Req_!e;st+;c 7 icier-Vivos Transfers & Misrellane~~us N~~n Probota Pr ~oer~ ~ ~ ^~ ~) ~ ~p ~ /~J~y SChBd Ulc ~) ~ ~'t 9 (ill',jr17 ', "=BSt _'i' ~ G. ~`-.~ ~"7 ~~~9~ U. Total Gross Assets (total L nr~ 9 Funeral Expenses & Adminis~.r~;r . . ~ t ~ ~~ e~i ~n- ' 10 Dehts of Gecedent. Mortgage i lakliitie5 k ' -. lcneriuic~ 11. Total Deductions (total ^nfS ~ 'c!. ____-_s._~-~ ,' ~ ~C~•~ ~~~ ~~ ~ ~ p~ CI.3 S".~` 12. Net Value of Estate Line 8 minus =.!~a '.'n ~- /~~~ ~~ ~~~ 13 Charitable and Governmental Bequcst~ Sec =~t'~ Tii,ts it ~i u'r. 6 an election to tax has no' been made ;SchedutF. ~` 1 14. Net Value Subject to Tax jLina t~ n~!nus Linu ' ~) ~4 /,~~~ yJ~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLJCABLE RATES 15. Amount of Line'i4 taxable at the spousal tax rate, or transfers under Sec. 9?16 i6- Amou;i of Line 1/~ taxable a? lineal r~ te> ? _D - ~ r' i' Amount of Line 14 taxabi~ /~ Q J ~ ~ ~ ~ at Sibling rate X 12 t/ • (f ~ . i8_ Amount of Line 14 ta.dble at collateral rate X _~ °~ • " i- 19. TAX DUE ZU. FiLL IN THE OVAL IF YOU ARE REQUESTING A REFIJNO OF AN OVERPAYMENT ~+ ~/ ~j' l~~ ~~~ Side 2 15056~52~48 ],5056652048 REV-1500 EX Page 3 File Number / /J3~ ~„_, ~ 8~° Decedent's Complete Address: ` V DECEDENT'S NAME ~~ ~~ ~ ,~ `~~~ STREET ADDRESS CITY Ann J7~i~ , ,/~~~~~G STATE ~~ ZI~ `~, _ ~~---~ Tax Payments and Credits: Tax Due (Page 2 Line 19) CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D Interest E. Penalty ~~ ~ i ~~ Total Credits (A+ B + C) (2) ~,~ ~ ~p ~~ Total Interest/Penalty (D + E) (3) 4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. G Fill in oval on Page 2, Line 20 to request a refund. (4) G 5. If Line 1 + Line 3 Is greater than Line 2, enter the difference. This Is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT ~~ ,~., .,~, ~,.irg;;e~,., ~, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust. for" or payable upon death bank account or security at his or her death? ........ ...... ~ ^ 4. Ditl decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... .~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does notdoes not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one 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 zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefciaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (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. LAST WILL AND TESTAMENT OF DENNIS NELL I, Dennis Nell, of Huntington Beach, California, revoke my former Wills and Codicils and declare this to be my Last Will and Testament. ARTICLE 1 PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, funeral expenses and expenses of last illness be first paid from my estate. ARTICLE II DISPOSITION OF PROPERTY A. Residuary Estate. I direct that my residuary estate be distributed to Elaine N. Keller, 722 Dogwood Terrace, Boiling Springs, Pennsylvania 17007. If such beneficiary does not survive me, my residuary estate shall be distributed to the following beneficiaries in the percentages as shown: 100.00% to James Keller, ?22 Dogwood Terrace, Boiling Springs, Pennsylvania. If this person or organization does not survive me or is not in existence, this share shall be distributed in equal shares to the other distributee(s) listed under this provision. ARTICLE III NOMINATION OF EXECUTOR I nominate Elaine Keller, of Boiling Springs, Pennsylvania, as the Executor, without bond. If such person or entity does not serve for any reason, I nominate James Keller, of Boiling Springs, Pennsylvania, to be the Executor, without bond. ~~~~T ARTICLE IV EXECUTOR POWERS My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that may be included in my estate, without order of court and without notice to anyone. ARTICLE V MISCELLANEOUS PROVISIONS A. Paragraph `Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all genders and in numbers when the context or facts so require, and any pronouns shall betaken to refer to the person or persons intended regardless of gender or number. B. Spouse. I am not currently married to anyone. C. Children. I do not have any children at the time of the signing of this Will. IN WITNESS WHEREOF, I have subscribed my name below, this. ~-3 day of Dennis Nell PROOF OF WILL On the date written below, Dennis Nell declared to us, the undersigned, that this instrument, consisting of r 3 pages, including the page signed by us as witnesses, was his/her Will and requested us to act as witnesses to it. He/She thereupon signed this Will in our presence, all of us being present at the same time. We now, at his/her request; and in his/her presence and in the presence of each other, subscribe our names as witnesses. We are acquainted with Dennis Nell. At this time he/she is over.the age. of 18 years, and to the best of our knowledge, he/she is of sound mind and is not acting under duress, menace, fraud, Page 2 of 3 misrepresentation, or undue influence. Each of us is now more than 18 years of age and a competent witness and resides at the address set forth after this name. We declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct. ~aS Executed on /~3 ~9r~ ,iRl at cyix.L«~; , /~~ .,~, r~~~~~ ,~.. f ~~~~~ Witness Signature: ~~~v`""'r`~ ~'~~ _ Witness Name: !~/i ~/~ ~-, ~' ~/~,~vIG~S' Witness Address: /Q S'O /j7gs~-s1b~^~ ~f G'/,I/~,A.v~g,S', ~iQ / ~3 Z~ Witness Witness Witness Address: -~ Page 3 of 3 REV-1504 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF L---C~^ `~ / /~ FILE NUMBER ~ ^~~ r, Schedule C-1 or G2 (including all suppo ing information) must be attached for each closelyheld corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ / ~ , ~ ~ ~ ~~~~ ~1~s -~ -~~ ~~~~~RI~S' ~Uriv.~ ~~ ~,~(irT% S TOTAL (Also enter on line 3, Recapitulation( $ (If more space is needed, insert additional sheets of the same size) ~~ ~~ ~'~ r~-~~~ HEV-r506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-Z ~ PARTNERSHIP ~ INFORMATION REPORT ESTATE OF FILE NUMBER t, Name of Partnership _~eI I ~T3CO R~t~+t'Y"-+rd a Date Business Commenced Address .- Business Reporting Year City _ -~G1L _ (t`tz~,8~}-~ (~A 9 ~„(~ 3 Q State Zip Code 2. Federal Employer LD. Number ~ .- Q ,, ---~--~-oZ ~'f~-- - 3. Type of Business _ ~F eS-~-vTdvt ~ _~~]¢~ ProducVService _ _ 4. Decedent was a ^ General Limited partner. If decedent was a limited partner, provide initial investment $_ 5, ~---- PARTNER NAME A' _~5.-L_IV.~~ e. c. D. 6. Value of the decedent's interest $ PERCENT ~ PERCENT OF INCOME I OF OWNERSHIP . 074 - _ ~-~_~~? ~LL~ --- ~ - ~. _~. _- _ f __ .-~- tSIS• OO BALANCE OF CAPITAL ACCOUNT ~. Was the Partnership indebted to the decedent? ................................. ^ Yes ~'No !f yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes (~ No It yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy __ 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was pnor to 12-31-82? ^ Yes R! No If yes, ^ Trangfer ^ Sale Percentage transferred/sold Transferee or Purchaser _ _ Consideration $~_._ Date _ _ __ __ Attach a separate sheet for additional transfers and~or sales. 10 Was there a written partnership agreement in effect at the time of the decedent's death? ...... ^ Yes ~ No If yes, provide a copy of the agreement. tt. Was the decedent's partnership interest sold? ... ... .................... ^ Yes jlJ No If yes, provide a copy of the agreement of sale, etc. t 2. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes P1 No if yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ... ............................... . ^ Yes Cp No If yes, explain -- 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ~ No Ii yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • • - rr ~ r A. Detailed calculations used in the valuation of the decedent's partnership interest. 8. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a fist showing the complete addresses and estimated fair market value/s. If real estate appraisals have been secured, attach copies. 0. Any other information relating to the valuation of the decedent's partnership interest. ~'~ ~~ ~:: ~~ ~ ~~ PROPERTIES PARTNERSHIPS 25521 COMMERCENTRE DRIVE LAKE FOREST, CA 92630 PH: (949) 910-0705 FAX: (714) 639-0763 ggnncar ~+ att.net October 22, 2009 William 5. Daniels, Atty-at-Law 1 West High Street, #205 Carlisle, PA 17013 RED Estate of Dennis P. Nell Dear Mr. Daniels: It was a pleasure talking with you this morning. I am enclosing several documents for you pertaining to the above referenced account. If the Executrix decides to sell the units, she needs to find a buyer. If it is someone from the enclosed list, he/she will be able to re-register them for her. If she decides to keep them and re-register them, she can use the enclosed transfer documents and list of appli- cable requirements. Per your request, as of 9/19/09, the book value for Dennis P Nell's 20 units in DEL TACO RESTAURANT PROPERTIES II is $75.75 per unit or $1515.00. Should you need anything else, please don't hesitate to ask. Sincerely, Ginny Gancar Investor Relations Encls. Schedule K-1 2 Q O g (Fot"ttl 1065) For calendaryear 2009, or tax Department of the Treasury yearbeginning JAN 01 20n09 Internal Revenue Service and ending DEC 31 2U' 9 Partner's Share of Income, Deductions, Credits, @tC. ~Seebackofformandseparateinstructions. 33-0064245 3 Partnership's name, address, c ,state, andZlP code DEL TACO RESTAURANT PROPERTIES II INVESTOR SERVICES 25-521 COMMERCENTRE DRIVE LAKE FOREST, CA 92630 271 ncome 17 0 No. OGDEN, UTAH D ^ Check'rf this Ls a pubilkay traded partnership (PTP) S Net short-term capital gain (loss) E Partner s identRying number 9a Net long-term capital gain (loss) 17 ARernative minimum tax (AMT) Rems 160-36-3786 F Partner's name, address, cRy, slate, and ZIP code 9b Colle Ibles (2 ~°) gain ss) DENNIS P. NELL 722 DOGWOOD TERRACE 9c Unrecapturedsection1250gain BOILING SPRINGS PA 17007 expenses G ~ General artner or LLC D member-manager ~ P Limited artner or dher LLC member t ~ F H ®Domestic partner ^ Foreign partner r I What type of entity is this partners INDIVIDUAL J Partner's share of profd, loss, and capital (See instrudbns): Beginning Ending 12 ProtR 0.0741 % 0 - 0000 ~° 13 toss 0.0741 °~, G.0000 °~ ca Ral 0.0741 °f, 0 .0000 % K Partner's share of IiabllRles at year end: Nonrecourse .............. $ Qual~ed nonrecourse financing .. Recourse .. .. .. ........ .. $ . . $ 14 L Partner's capital account analysis: 342 0 tae Innin ca i[al ac oust $ 2 , 4 81 'See attached stalemerr[ for additional Irtonnation. 9 9 P c ....... Capdal contdbuted during the year ... $ 0 Cunent year increase (decrease) ... $ 2 8 9 WRhdrawals & distributions .......$ ( 2 , 7 7 0 ) ?~ Endirrg capital account ......... $ 0 0 Tax basis ^ GAAP ^ Section 704 (b) book v ~ ^ Other (explain) N Did the partner cordnbule property wlfh a hulit-in gain or loss? ,°~ ^ Yes ~ No it Wes", attach statement (see instructions) For Privacy Ad and Paperwork Reduction Act Notice, see Instructions for Form 1065. Cat. No. 113948 PRT #6623 UNITS: Schedule K-1 (Form 1065)2009 671 Schedule K-1 2047 (Form 1065) For calendar year 2~~r t~ 1 Department of the Treasury year beginning , 2007 Internal Revenue Service DEC 31 dJ 7 2 and ending Partner's Share of Income, Deductions, CredltS, etC. ~ See back o(form and separate Instructions 20 A Partnership's empbyer idertitticatlon number 4 Guaranteed paymerts 33-0064245 B Partnership's name, address, cAy, state, and ZIP code 5 Interest income DEL TACO RESTAURANT PROPERTIES II 2 INVESTOR SERVICES 5a ordinarydNidends ---- 25521 COMMERCENTRE DRIVE LAKE FOREST, CA 92630 6b pualifieddividends C IRS Center where pannership filed return 7 Royalties OLDEN, UTAH 8 Net short-term capital gain (loss) D ~ -1 Ctreck p this is a pubilicfy tratled partnership (PTP) 9a Not long-term capAal geln (1055) 17 AAemairJe minimum tax (Atv1T) Aems A <1> ~,~~~-y, li.~~ - Q~~~ ~" ~ ~ ~,~~ ~~, ~ 9b Collectibles (28%) gain (loss) E Panner's idenl AY ing number 16 0 - 3 6 - 3 7 8 6 9c Unrecaptured section 1250 gain - --- F Partner's name, address, cdy, state, and ZIP code DENN I S P . NELL t0 Net section 1231 gain (toss) to Tax-exempt income and 18612 VALLARTA DRIVE nondeductible expenses ` HUNTINGTON BCH CA 92646 tt other income (loss) p 1 -- I G u General panner or LLC ~i LimAed partner or other LLC member-manager member H ~~ Domesllc partner ~ Foralgn partner 19 Dlstrlbutlons 12 Section 179 deduction A 387 -~ I what type or enihy is this panner? INDIVIDUAL ~ _ _ 13 Other deductions J P n ' h f f ner s s a are o pro A, loss, and captlaG 20 Other iNormallon 6eglnning Ending - ~ _._ _ _... _.,. ProtA VARIOUS °~° 0.074100 °~° A 2 doss VARIOUS % 0.0 74100 ~° ca Aal VARIOUS °~° _ _ 0.074100 °~, 14 Self-employment earnings (loss) K Partner's share of liabiltties at year end i ~ Nonrecourse $ _ Qualdied nonrecourse financing $ Recourse . . . $ 'See attachetl slatemeM for adddional iNormatlon. L Partner's capAal account analysis: 2 548 Beginning capAal account . .. , $ r -' ~ Capdal contributetl during the year . $ 0 0 a Current year increase (decrease) ... $ 3 5 3 ~ WAhd rawals 8 tlisiribulions $ ( 3 8 7 ) v, Ending capAal account .. $ 2 , 5 13 5 Tax basis ~ GAAP ^ Section 704(b) book LL r~ Other ex lain) or Nnvacy Act and Paponvork Reduction Act Notice, see Instructions for Form 1065. Cat. No. t 139aR Schedule K•1 (Form 1065) 2007 PRT n6623 UNITS: 20.0000 r-t r•--, DEL TACO RESTAURANT PROPERTIES II BALANCE SHEETS December 31, 2008 2007 CURRENT ASSETS: Cash Receivable from Del Taco LLC Deposits "Total cun-~t assets $ 160,340 43,520 1,727 205,587 $ 170,340 45,631 1,534 217,505 PROPERTY AND EQUIPMENT: Land and improvements Buildings and improvements Machinery aild equipment. Less--accumulated depreciation 1, 806,006 1,238,879 898,950 3,943,835 2,051,344 1, 892,491 $ 2,098,078 1, 806,006 1,238,879 898,950 3,943,835 2,015,948 1,927,887 $ 2,145,392 LIABILITIES AND PARTNERS' EQUITY CURRENT LIABILITIES: Payable to limited partners $ 35,651 Accounts payable 14,655 Total current liabilities 50,306 PARTNERS' EQUITY AT DECENLBER 31, 2008 AND 2007: Limited part<ieis; 27,006 units outstanding at December 31, 2008 2,076,346 and December 31, 2007 General partner-Del Taco LLC (28,574) 2,047,772 $ 35,481 13,994 49,475 2,124,009 (28,092) 2,095,917 $ 2,098,078 $ 2,145,392 See accompanying notes to financial statements. 11 DEL TACO RESTAURANT PROPERTIES if INVESTOR NEWSLETTER FORM 10-Q ENCLOSURE Enclosed with this newsletter is a copy of the Partnership's Securities and Exchange Commission Form 10-Q for the year ended June 30, 2009. We suggest that you review this report as it contains detailed information on the activity of the partnership. SUMMARY OF _D_ISTRIBUTIONS TO LIMITED. PARTNERS FROM 1985 TO 2009 Return As A Percentage For Annual Distribution Less Than A Fuil Percentage Year Per Unit Year Return 1985 (1) $ 8.52 3.408% -- 1986 11.06 -- 4.424 1987 13.95 -- 5.580 1988 16.70 -- 6.680 1989 16.61 -- 6.644 1990 17.46 -- 6.984 1991 14.89 -- 5.956 1992 15.59 -- 6.236 1993 16.93 -- 6.772 1994 (2) 48.34 -- 19.336 1995 14.52 -- 5.808 1996 13.99 - 5.596 1997 15.06 -- 6.024 1998 15.73 -- 6.292 1999 16.36 -- 6.544 2000 17.57 -- 7.028 2001 19.28 -- 7.712 2002 19.61 - . 7.844 2003 19.63 -- 7.852 2004 22.21 -- 8.884 2005 22.65 -- 9.060 2006 21.03 -- 8.412 2007 18.89 -- 7.556 2008 17.61 -- 7.044 2009 (3) 7.84 6.272°f° -- $ 442.03 9.680% 170.265% (1) Partial year, from Februa ry 15, 1985 through December 31, 1985 . (2) Includes $18.41 from the sale of the South Gate property paid on September 1, 1994 and $13.24 from the sale of the Fallbrook property paid on December 12, 1994. (3) Partial year, from January 1, 2009 to June 30, 2009. COMPENSATION PAID BY THE PARTNERSHIP TO DEL TACO INC. GENERAL PARTNER In July 2009, the General Partner received a distribution of $1,049 for the quarter ended June 30, 2009 relating to its one percent interest in the Registrant. RYr11Jp NIIMRPR FIIR RARTAICRRNID IWL(1RMATInIJ• !9601 9~OJ17n5 Investor Entry ------ Legal Registration --_________,__________._______ { .D #: ~~ 6623 23-Ownership Type { 1 1-Cust-Name1 DENNIS P. NELL 1 INDIVIDUAL ( 2;Name2 24-Foreign No ( { 3-Trust Acct # 25-W9 Rcvd No { { 4-Alpha Sort NELL DENNIS P. 26-Withldg No ( 1 5-Tax Id 160-36-3786 6-2nd SSN { ~________._._. Mail Address ---------------- --------- Legal Reg Addr ----- ( 7-Label Name DENNIS P. NELL { 27- 722 DOGWOOD TERR I { &Salutation Dear ( ( 1 9-Addr 1 722 DOGWOOD TERRACE -- Payee-Check Addr --- ( Subscription -Investments 10:05:49 2 OCT 2001 I I (Fund SSN # Units Amount Dep Date Admit Status Exit Date ( I- - ---- -___----- --------- ----- - ---------- ----- IDTP2 0103 20.0000 5000 07/19/85 07/19/85 Active 1 ~ 20 000^ 5000 ( { I I 1 I F2-Subscription Detail F3-Investor Detail F4-Escrow Checks F5-Commission F6-Original Rep F7-Activity FB-Cert List Page 1 -End Of List Cinny Gancar Del Taco Investor Relations Ph: 949-9I0-0705 . PART II Item 5. Market for the Partnership's Common Equity, Related Security Holder Matters and Issuer Purchases of Equity Securities The Partnership sold 27,006 ($6,751,500) limited partnership units during the public offering period ended December 31, 1985 and currently has 968 limited partners of record. There is no public market for the trading of the units. Distributions made by the Partnership to the limited partners during the past three fiscal years are described in Note 6 to the Notes to the Financial Statements contained under Item 8. Item 6. Selected Financial Data The selected financial data presented as bf and for the years ended December 31, 2008, 2007, 2006, 2005, and 2004, has been derived from the audited financial statements and should be read in conjunction with the financial statements and related notes and Item 7, Management°s Discussion and Analysis of Financial Condition and Results of Operations. Years ended December 31, 2008 2007 2006 2005 2004 Rental revenues $ 547,191 $ 584,595 $ 631,571 $ 690,925 $ 665,398 General and administrative expense 75,327 76,924 73,986 73,237 71,316 Depreciation expense 35,396 38,057 54,180 54,180 54,180 h~terest and other income 5,885 5,156 4,584 4,471 3,418 Net income 442,353 474,770 507,989 567,979 543,320 Net income per limited partnership unit 1 G.22 17.40 18.62 20.82 19.92 Cash distributions per limited partnership unit 17.98 19.34 21.58 22.60 21.84 Total assets 2,098,078 2,145,392 2,206,089 2,276,807 2,330,405 Long-term obligations - _ _ _ _ Item 7. Management's Discussion and Analysis of b5nanciai'Condition and Results of Operations Management's discussion and analysis of financial condition, results of operations, liquidity and capital resources, and off balance sheet arrangements and contractual obligations contained within this report on Form 10-K is more clearly understood when read in conjunction with the notes to the financial statements. The notes to the financial statements elaborate on certain terms that are used throughout this discussion and provide information about the Partnership and the basis of presentation used in this report on Form 10-K. 4 REV-t j06 EX+ (9-00) i' Q.,~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEDU~E a-s PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER 1. Name of Partnership ~2F u £- R i ~ ~~ ~t p ~ Date Business Commenced Address ~, ~~, ~ n~j t~~~,~__,(~~ Business Reporting Year city ___~~ L l to r.l-~r,_ _~____~'/~ ~t` ~~ $' 3 f 3 //-~ state _ zip code 2. Federal Employer LD. Number -3 3 - oQ a I~ ~~ 3. Type of Business "~r~~~.n _~~, L ProducVService _ ~ M ~, 1 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. 6. Value of the decedent's interest $ _~~_ n(~~ 7. Was the Partnership indebted to the deceden/t?~...~.- ............................. ^ Yes f~l No If yes, provide amount of indebtedness $ 8 Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes Ii yes, Cash Surrender Value $ __ _ Net proceeds payable $- Owner of the policy __ 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ~d No If yes, ^ Transfer ^ Sale Percentage transferred/sold_`_ ___ Transferee or Purchaser Consideration $ Date ______ Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... ^ Yes ~ No It yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ....................................... ^ Yes ~ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ............... .. ^ Yes C~ No it yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ........... . ........................ ^ Yes C,YNo tf yes, explain / 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for eac~nterest. ~ • •~ ~ ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. 8. Complete copies of financial statements or Federal Partnersnip Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market valuels. If real estate appraisals have been secured, attach copies. ~ No D. Any other Information relating to the valuation of the decedent's partnership interest. ~~~-- F EQu~T~ES, INC. (71a1 s37-zo6z FAX (714) 637-4056 135 Sou~rli CHAPARRAL COURT, SInTE 200 ANAHEIM HILLS, CA 92808 ("'~j-~ c, ~ C'Z/~/~v'.t ~i/- ~ ~-7 November 2, 2009 ~ ~" %rf~~'~"' ~..,... ~~~~. ... William S. Daniels `~ Humer & Daniels r ~, ..., One West High Street '~"~~''"~ Carlisle, Pennsylvania 17013 ~ ~ °~-~ ~~'~`~ Re: Estate of Dennis P. Nell, deed Fredricks Fund I Estimate of Fair Market Value Dear Mr. Daniels: Thank you for your letter of October 21, and the enclosures. Pursuant to your request, we have set forth below our estimate of the fair market value of the limited partnership interest owned by Dennis P. Nell as of his date of death on September 19, 2009: 9/19/2009 F,stimated PartnershiU % Interest # Units _a V . u~,- Fredricks Fund I 0.6671 % 40 $ 74,000 Please note that the estimate oi'value is based on our review of the most recent sales of comparable interests in similar partnerships and our experience as General Partner in facilitating sales of partial interests in our partnerships. Please also note that our estimate of value is not to be construed as a representation or assurance that the interest can be sold at the estimated value or at any other price within a particular time period. The ultimate determination of the value of the interest will be determined by what a third party purchaser is witling to pay. Further, you should be aware that a higher price might be realized in the event that the partnership properties were sold and the partnership is liquidated. William S. Daniels November 2, 2009 Page ? In order to assist our investors with their investment needs, the General Partner, in the past, has purchased the partnership units of those investors requesting a sale of their units. While this is not a guarantee that the General Partner will do so in the future, it is likely that we would be in a position to assist the Executor in the sale of the Estate's units. However, we will require the appropriate court documentation in order to move forward with a sale, as well as the execution of our form Assignment. If and when the Estate is in a position to proceed with the sale, please provide us with the court documentation and we will prepare our Assignment for execution. I trust this information will be adequate for your purposes at this time. However, if you have any questions regarding the partnership or we may be of further assistance, please do not hesitate to give us a call. Sincerely, ` ,~5~ ~ ~~ Ester Di Maio Partnership Administration 225 65119 Schedule K-1 ~ n n o L _I Final K-1 n Amended K-1 FMB Nn 1 fi45-009A (form 1 D65) For calentlaryear20o9, cr tax ~ V w `~ Department of the Treasury year beginning Faf'i<: Kt'! Partner's Share of Current Year Income, Deductions, Credits, and Other Items Internal Revenue Service entling Partner's Share of Income, Deductions, 1 Ordinary business income (loss) 0 . 15 Cretlits CiredltS, etC. 2 Net rental real estate income (loss) - See se crate instructions. 7 , 0 3 5 . t 6 Foreign transactions 3 Other net rental income (loss) s~'?art.l.<< Information About the Partnership A Partnership's employer identification number 4 Guaranteed payments 33-0021790 B partnership's name, address, city, state, and ZIP code 5 interest income 86. FREDRICKS FUND I 6a Ordinary dividends 135 SOUTH CHAPARRAL COURT, SUITE 2 00 17 Alternative min tax (AMT) items ANAHEIM HILLS, CA 92808 6b Qualifieddividentls -1. C IRS Center where partnership filed return OGDEN, UT 7 Royalties 18 Tax-exempt income and D C] Check if this is a publicly traded partnership (PTP) 8 Net short-term capital gain (loss) nondeductible expenses 9a Net long-term capital gain (loss) Pam'<~i information About the Partner ................... E Partner's identifying number 160-36-3786 96 Collectibles (28%) gain {loss) 19 Distributions 9,006. state, and ZIP code address city F Partner's name 9c Unrecaptured sec 125D gain , , , ESTATE OF DENNIS P NELL, DEC' D 20 O therinformation ELAINE N KELLER, EXECUTOR 10 Net section 1231 gain (loss) 86 722 DOGWOOD TERRACE * STMT BAILING SPRINGS, PA 17007 t1 0therincome(ioss) G general partner or LLC ~ Limited partner or other LLC member-manager member H 0 Domestic partner ~ Foreign partner l What type of entity is this partner? INDIVIDUAL 12 Section 179 deduction and capital: foss J Partner's share of profit 13 Other deductions , , Beginning Ending * 1 , 15 1 . Profit 0.6671000% 0.6671000% Loss 0.6671000°~, 0.6671000% Ca ital 0 . 6 6 710 0 0 % 0.6 6 710 0 0 °J° 14 Self-employment earnings (loss) K Partner's share of liabilities at year end: 0 Nonrecourse $ ................................................ $ 6 6 , 2 35 . Qualified nonrecourse financing "See attached statement for additional information. ....................... Recourse ..........__ ................ ................... $ 0 . L Partner's capital account analysis: Beginning capital account ....................._._.... $ -45, 329 Capital contributed during the year .................. $ 12 1 , 2 4 2 • Cu« ent year increase (decrease} ..................._.. $ 5 , 9 7 0 . Withdrawals&distributions.. ..._ .............._,.. $( 9,006.) Ending capital account $ 7 2, 8 7 7. ... _ .... .............. _........... 0 Tax basis ~ GAAP 0 Section 704(h) haok Other (explain) M Did the partner contribute property with abuilt-in gain or loss? Yes ~ No If "Yes". attach statement (see instructiops) _ _ ~ ¢ 0 LL iz'-oa-'gg LHA For Paperwork Retluction Act Notice, see Instructions for Farm 1065. Schedule K-1 (Farm 1065) 2009 225 FRE'DRICKS FUND I 33-0021790 SCHEDULE K-1 OTHER DEDUCTIONS, BOX 13, CODE W DESCRIPTION PARTNER FILING INSTRUCTIONS AMOUNT SECTION 754 DEPRECIATION - SEE IRS SCH. K-1 INSTRUCTIONS RENTAL REAL ESTATE 1,151. TOTAL TO SCHEDULE K-1, BOX 13, CODE W 1,151. SCHEDULE K-1 UNRELATED BUSINESS TAXABLE INCOME, BOX 20, CODE V DESCRIPTION PARTNER FILING INSTRUCTIONS GROSS REVENUES FROM DEBT-FINANCED PROPERTY FOR UBTI PURPOSES UNRELATED BUSINESS TAXABLE INCOME TOTAL TO SCHEDULE K-1, BOX 20, CODE V AMOUNT 16,224. 4,662. 20,886. PARTNER NUMBER 225 LLB F Schedule K-1(Fgrm tOfi5) 2009 Page 2 This list Identifies the codes used en Schedule K-1 for all partners and provides summarized reporting information for partners who file Form 1040. For detailetl reporting and filing information, see the separate Partner's Instructlons for Schedule K-1 and the Instructions for your Income tax return. 1. Ordinary business Income (toss). Determine whether the income (loss) Is passive or nonpassive and enter on your return as follows. Report on Passive loss See the Partners Instructions Passive Income Schedule E, line 28, column (g) Nonpassive loss Schetlule E, Ilse 2B, column (h) Nonpaaslve income Schedule E, line 28, column Q) 2. Net rental real estate Income (loss) See the Partners Instructions 3. Other net rental Income (loss) Nat income SchetluVe E, Ilse 2B, column (g) Net loss See the Partners Instructions 4, Guaranteetl payments Sohetlule E, line 28, column b7 5. Interest income Form 1040, line 8s Be. Ordinary tlivitlends Forth 1040, line 9a 6b. Qualifietl tlivitlends Forth 1040, line 9b 7. Reyaltles Schetlule E, line 4 8. Net short-term capital gain (loss) Scnetlule D, line 5, column (fl 9a, Net long-tens capital gain (loss) Schetlule D, line 12, column (fl 9b. Collectibles (28%) gain (loss) 28% Rate Gain Worksheet, Ilse 4 (Schetlula 0 Instructlons) 9c. Unrecaptured section 125D gain See the Partners Instructlons 10, Net section 1231 gain (loss} See the Partners Instructlons 11. Other income (loss) Gods A Other portfolio Income (TOSS) See the Partners Instructions B involuntary conversions See the Partners Instructions C Sec. 1256 contracts 8 stredtlles Form 6781, line 1 D Mining exploration costs recapture See Pub. 535 E Cancellation of debt Forth 1040, line 21 or Forth 982 F Other income (loss) See the Partners Instructlons 12. Section 179 detluctlon See the Partners Instructions 13. Other deductions A Cash conMhutions (50%J B Cash contributions (30%) C Noncash contributions (50°k) D Noncash conVlbutions (30%) See the Partners Instructions E Capital gain property to a 50% oryanization (30%) F Capital gain property (20%J G Contnbutlons (100%) H Investment interest expense Form 4952, I1ne 1 I Deductions - royalty inwme Schedule E, line 18 J SecBon 59(e)(2) expenditures Sea the Partners lnstructSons K Detluctlons -portfolio (2% floor) Schetlule A, line 23 L Deductions -portfolio (other) Schetlule A, line 28 M Amounts paid for metlical insurance Schedule A, line 1 or Form 2040, line 29 N Educational assistance benefits See the Partners InstNCtions 0 Dependent care benefits Form 2441, line 14 P Preproductlve period ospenses See the Partners Instructions O Commercial rcvlWiization tletluction From rental real estate activities See Form 8582 Instructlons R Pensions entl IRAs See the Partners InstNCtione S Reforestation expense deduction See the Partners Instructions T Oomesdc production activities informaton Sea Form 8903 Instructions u qualifletl protluctien activitles Inwme Fops 8903, Iine7 V Employers Farts W-2 wages Form 8903, Ifne 15 W Other tleductions See the Partners InsWCtlons 14. Self-employment comings (loss) Note . if you nave a section 179 tletlucoon or any partner-level tletluctions, see the PaRners Instructlons before completing Sched ule SE. A Net earnings (loss) from seer-employment Schedule SE, Section A or B 8 Gross farming or fishing income Sea the Partners Instructions C Gmss non-farm income Sea the Partners Instmcdons 15. Credits A Low-income housing credit (section 42(j)(5)) from pre-2008 buildings B Low-Income housing credit (other) horn pro-2008 builtlings C Low-Income housing credit (section 42Q)(5)) from post-2007 buildings D Low-income housing cretlit (other) from post-2007 builtlings E qualified rehabilitation expenditures (rents) real estate) F Other rental real estate credits G Other rental credits H Untlistdbutetl capital gains cretlit I Alcohol and celtuloslc bie(uel fuels credit See the Partners InsWCtons See the Partners Instmctions Forth 8586, line 11 Forth 8586, line 11 See the Partners InsW coons Forth 1040, Ilse 70; chock box a Forth 6478, line 7 911282 12-OB-09 Coda Report on J Work opportunity credit Form 5884, Ilse 3 K DlsaHletl access cretllt Sea the Partners Instructions L Empowartnent zone end renewal community employment credit form 8844, line 3 M Credit for increasing reseazch activities See Cha Partners Instructions N Credit for employer social security and Medicare taxes Form 8846, Ilse 5 O Hackup wftnholtlin9 Form 1040, line 61 P Other Gredlts See the Partners InsWCtlons 16. Foretgn tmnsactlons A Name of country or U.S. possession B Gross income from all sources Fonn 1116, Part I C Gross income sourced at partner level Foreign gross income seurcetl at partnership level D Pesslve category 1 E General category to Form 1116 Part I F Other , 1 Deductions allocatetl and apportlonetl at partner level G Interest expense Form 1116, Part I H Other Form 1116, Part I Deductions allocatetl entl apportionetl et partnership level to foreign source income I Passive category J General category Form 1116, Part I K Other ONer fniormation L Total fnrelgn taxes paid Fonn 1116, Part II M Total foreign taxes accrued Forth 1116, Part II N Reduction in taxes available br credit Forth 1116, Ilse i2 0 Foreign heeling gross receipts Forth 8873 P Extratertitodal Inwme exclusion Form 6873 O Other foreign trensactlans See the Partners Instructlons 17. Altema8ve minimum taz (AMT} Items A Post-1966 depreciation atliustment B Atljustetl gain or lass See the Partners C Depletion (other then oil $ gas) Instructions and D OII, gas, $ geothermal -gross income the Instructions for E Oit, gas, $ geothemaal- tletluctions Forth 6251 F Other AMTitems 18. Tax-exempt income and nondeductlble expenses A Tax-exempt Interest income Forth 1040, line 8b B Other taz-exempt income See the Partners InsWCtlons C Nondeductible expenses See the Partners Insbvetions 19. Dlatributions A Cash entl marketable securities B Distribution subject to section 737 See the Partners Instructlons C Other property 20. Other iniortnatlon A Investment Income Form 4952, line 4a H Investment expenses Farts 4952, line 5 C Fuel tax cretlit Infortnatlon Forth 4136 D Oualifietl rehabilitaton ezpentlitures (other than rental real estate) See the Partners Instructlons E Basis of energy property See the Partner's Instructions F Recapture Of low-income housing credit (secton 42()15)) fom18611, line B G Recapture of low-income Housing credit (other) Forth 8611, line 8 H Recapture of investment cretlit See Forth 4255 I Recapture of Omar cretllts See Ne Partners Instructions J Look-back interest -completed long-term contracts See Form 8697 K Look-back interest -income forecast methotl See Form 8866 L Dispositions of property with section 179 deductions M Recapture of section 179 deduction N Interest expense for corporate partners O Section 453(1)(3) infortnetion P SecBOn 453A(c) information O Section 1260(b) information R Interest allocable to protluctien See the Partners expenditures Instructions S CCF nonqualifiad withdrawals T Depletion Information -oil end gas U Amortization of reforestaticn costs V Unrelated business taxable Income W Prewntdbaaom gain Q09S) x Section 108(1) Information V OMer inkrtnaUon 225 LJL 651107 Schedule K-1 Z D U 7 C] final K-1 0 Amended K-1 OMB No. 1545-0099 (Form 1065) Forcxlandaryear2007, or tae I Department of the Treasury year boglnnmp pat~t,111. Partner's Share of Current Year Income, Deductions Credits and Other Items Internal Revenue Service enCing Partner's Share of Income, Deductions, 1 Ordinary business income (loss) 0 . 15 Credits Credits, etc. 2 Net rental real estate income (loss) - See separate instruetlons. 8 995. 16 Foreign transactions 30ther net rental income (loss) Para 1 Information About the Partnership ~A Partnership's employer identification number 4 Guaranteed payments 33-0021790 ., f B Partnership's name, address, city, state, and ZIP Code 5lnterest income I 107. ~ FREDRICKS FUND I 6a Ordinary dividends 2 6 0 0 E NUTWOOD AVE 10TH FLOOR 17 Alternative min tax (AMT) Items FULLERTON, CA 92831-3114 6b Qualified dividends 9, C IRS Center where partnership filed return OLDEN, UT 7Royalties 18 Tax-exempt income and D 0 Check if This is a publicly traded partnership (PTP) BNet short-term capital pain (loss) nondeductible expenses 9a Net long-farm capital gain (foss) Part N Information About the Partner E Partner's identifying number j j 160-36-3786 ,___ 9b Collectibles (28%) gain (loss) 9cUnrecapturedsect250gain 19 Distributions 8 339 F Partner's name, address, city, state, and ZIP code 20 Other information i, 10 Net section 1231 gain (loss) 1 0 7 . DENNIS P NELL * STMT 18612 VALLARTA DRIVE 110therincomeposs) ~ HUNTINGTON BEACH CA 92646 G [~ General partner or LLC 0 Limited partner or other LLC j member-manager member N 0 Domestic partner ~ foreign partner 12 Section 179 deduction I 1 What type o1 entity is this partner? INDIVIDUAL 130ther deductions ~ J Partner's share ofprofit, loss and capital ~ Beginning Ending Profit 0._6671000°i° 0.6671000°~° ~ Loss 0. 6 6 710 0 0 °r° 0. 6 6 710 0 0 °i° 14 Selt-employment earnings (loss) __ Capital 0.6671000°~° 0.6671000°~° 0. K Partner's share of liabilities at year end: Nonrecourse .__ __... ._._...._._..__..._.., $ "Seeattacnedstatementtoradditionallnformation. I Qualified nonrecourse financing _ . _ _ _ _ ,. $ 6 8 , 5 9 6 . ~I Recourse _ . _ __ __ $ 0 . L Partner's capital account analysis: Beginning capital account _ _.. $ -4 6 , 4 6 6 . Capital contributed during the year _ _. _.., ,_ $ Current year increase (decrease) _ ._ _. $ 9 , 102. witndrawals8distributions __ _. ___._. $( 8, 339.) Ending capital account _ _____. ._ _ $ -45, 703. Tax basis ~] GAAP 0 Section 704(b) book ~~ Other (explain) l O .~ ~ ~ o " JWA For Paperwork Reduction Act Notice, see Instrucllons for Form 1D65. ;nzsi rz-aro7 Schedule K-1 (Form 1065) 2007 . 232 REVd508 EX. ry971 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF r ~1--. r SCHEDULE E CASH, BANK DEPOSITS, $ MISC. PERSONAL PROPERTY FILE NUMBER t7 . ~ Include the proceeds of litigation and the tlate the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH z r ~o~~~ ~j=~ ~~~~~ ~~- ~.~~ ~rs~ i~~, ~X /-~//,i/~C7/~ /`~ ~~ c ~ ~~ ~ .~~ mod/ j,~ ~ ~~' ~~ ~~ ~~-~ s'~ ~z i~ ~~~z~~a ~, ~ TOTAL (Also enter on line 5, Recapitulation) $ ~j '7" j ~/ ~,~~ (If more space is needed, insect additional sheets of the same size) Free Checking Account Statement PNC Bank rte- -~~ .~.~. ~~! DENNIS P NELL DECD ELAINE ~ KELLER REP PAYEE 722 DOGfV00D TER BOILING SPRINGS PA 17007-9627 ~'N~~A~IlC Primary account number: 50-0569-9984 Page 1 of 1 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to PNC Bank Online Banking at pnc.com. 'a For customer service call 1-866-PNC-4000 Monday - Friday: 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espan"ol, 1-866-HOLA-PNC Moving? Please contact us at 1-866-PNC-4000 We value your relationship with PNC. For questions about your account, please call 1-866-PNC-4000. ® Write to: Customer Service __~._,_ P_Q Box 609.... _ __ Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaired clients only There is an additional $15 fee for Telephone Customer Service Representative-assisted outgoing wire transfers. This fee is not charged for Performance Select Checking and PNC Complete Accounts. Free Checking Account Summary Dennis P Nell Decd Account number: 50-0569-9984 Elaine N Keller Rep Payee Overdraft Protection Provided By: Cormact PNC to establish Overdraft Protection Balance Summary ,.,, „ ,5,,. Beginning Deposits and Checks and other Ending balance other additions deduMions balance r x"`x.4,461.01 .00 4,461.01 .00 Average monthly ~ Charges balance and fees 2,112.50 .00 Activity Detail Online and Elegy fc Banking Deductions There was 1 Online or Electronic Banking 1 ~ , Date ~ Amoun Description A~q ~MQ,G1S c-e.~e,~,5~~, 09 n ~ 1, Deduction totaling$1,820.OQ. /29 1,820.00 ; x t~P~e~n4~„$Reversal, v US Treastar~ 303 XXXXX3'786A : _.:. <, Other Deduetlons There were 2 Other Deductions totaling Date Amovnt Description $2,641.01. 10/23 .00 Outstanding Item Close 10/23 2,641.01 Debit Memo Reference No 521516584 Daily Balan "1 ~ Date 'F'~ 8alanCe Date Balance 09/29 2,641.01 10/23 .00 ~_.~.. ~jji..~__ \\ t FORM953R-1005 7 - t Z -?.id B PNCBANK Dennis P. Nell Fstate November 13, 2009 Dear Mrs. Keller: ~w, . . ~~«.- - ~~ . .This was anon-interest bearing account. The account number was 5005699$4. If you need any additional information, please call me at 717-432-$959. Very truly yours, ~.~~~~~ ~~..t,---~ Deborah Irvin Dillsburg Branch Manager A memberof the PNC Financial Services Group www. pncbank.com Social Security. Administration Retirement, Survivors, and Disability Insurance 0515 Important Information Mid-Atlantic Program Service Center ` - .+ 300 Spring Garden Street Philadelphia, Pennsylvania 19123 Date: April 22, 2010 ~, Claim Number: 160-36-3786A --- '~nl'~i~luiilli~'il"ull'~ilu'r~'I~lu~'li~~lnli~~iirlli~ 000001614 Ot MB 0.382 T009,MAD,0416,PC2,I,PH, ELA II~JE KELLER " ~"• FOR THE ESTATE OF `~s DENNIS P NELL DECD 722 DOGWOOD TERRACE BOILING SPRINGS,PA 17007-9627 a We are writing to give you new information about the retirement benefits which DENNIS P NELL receives on this Social Security record. What We Will Pay You will soon receive a check for $1,820.00 because we owed money to DENNIS P NELL. Do You Think We Are Wrong? y If you disagree with this decision, you have the right to appeal. We will review your case and consider any new facts you have. A person who did not make the first decision will decide your case. We will correct any mistakes. We will review those parts of the decision which you believe are wrong and will look at any new facts you have. We may also review those parts which you believe are correct and may make 'them unfavorable or less favorable to you. ' • You have 60 days to ask for an appeal. • The 60 days start the day after you get this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period. • You must have a good reason for waiting more than 60 days to ask for an appeal. • You have to ask for an appeal in writing. We will ask you to sign a form SSA-561-U2, called "Request for C SEE NEXT PAGE 0515 160-36-3786A Page 2 Reconsideration". Contact one of our offices if you want help. If You Have Any Questions We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about,,Social Security. If you have any specific questions, you may call us toll free at 1-800-772-1213, or call your local Social Security office at 1-717-243-0085. We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at: SOCIAL SECURITY 200 S SPRING GARDEN ST CARLISLE PA 17013 If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office. V Elaine Garrison-Daniels Assistant Regional Commissioner Processing Center Operations C Ly ~ Ao~HIN ISTRATIV r. Clr FILES -. .. _ 1440 ROSFCRhNS Avei~uE, M ;NHATTAN BEacrl, CA 90266 • TE.310.64s.5400 TES 800.854.9E4o FEDERAL CREDIT UIVfIOYJ w~ti,w.kinecta.org•infot/all:inectz.org Account Number: 872050 SO1 Savings Ownership: Dennis Nell Joint: N/A Beneficiary: Estate of Dennis Nell Date of Death: 9/19/09 Balance as of 9/01/09 $3,362.37 Interest Accrued: $1.66 Balance on date of death: $3,364.03 Alicia Alva Account Services Representative, Senior Name Title I ' ~, ~ , -, 10/27/09 ,, Signature Date ~, ACHIFiIS°P.ATIVE OFFICES ,':_~ i. .' ~,,..,~ ,;" 'i 1440 RosFce,.N; Avea~e, MnNHa7rnrd 6e.ecN, CA 90266 • TES 310.64x.5400 Te! 800.854.9846 F[ULkAI CREDIT VNIC'iN www.kinecta.org•info~akinecta.org Account Number: Ownership: 3oint: Beneficiary: Date of Death: Balance as of 9/19!09 Interest Accrued: Balance on date of death, including interest: $72050 S06 Checking Plus Dennis Nell N/A Estate of Dennis Nell 9/ 19/09 $161,544.55 X6.20 $161,550.75 Alicia Alva Account Services Representative, Senior Name Title '~_ ~"+ : -,•,. 10!27109 `; , , Signature Date A Dr!Ihlls Ta ATIVE OFfICEs 1440 Ros=_cac.~is Ave!~~E, i 1An!:+a7Ta!u BEACH, CA 90266 • Tee 310.643.5400 TF~ 800.854.984G www.kinecta.org • fnfoCa~kinecYa.org Account Number: 872050 S 10 Money Market Checking Ownership: Dennis Nell Joint: NIA Beneficiary: Estate of Dennis Nell Date of Death: 9/19109 Balance as of 9/01/09 $179.92 Interest Accrued: $0.0037 Balance on date of death: $179.9237 Alicia Alva Account Services Representative, Senior Name Title i`!, r ~ ;~ , ~ ;~ ~ ' ; . , 10/27/04 _.~- ~; .~ _ Signature Date AUMINISTR ATIVE OFFICES i ,m ~. u 1440 ROSECRA13S P.VENUE. ("IAN HATTAN BEACH, CF1 91260 TEL 31x.643.$400 TEL 8~~.$54.9$46 FEDERAL CREDIT UNION vdwwl:.inecta.org•info@kineda.org Account Number: 872050 S 16 Money Market Savings Ownership: Dennis Nell Joint: N/A Beneficiary: Estate of Dennis Nell Date of Death: 9119/09 Balance as of 9!01/09 $78,713.37 Interest Accrued: $14.73 Balance on date of death: $78,728.10 Alicia Alva Account Services Representative, Senior Name Tit]e ~: ~~..~ ~,t.i~ ~,~;~ _~ . f 10/27(09 1 _ Signature Date Strong Capital Mgmt Distribution Fund c/o BNY Mellon PO Box 859250 Braintree, MA 02134 13091 SH STR1P001 DENNIS P NELL U/A DTD 08/31198 722 DOGWOOD TER 801LING SPRINGS, PA 17007-9627 Date of Check: Account Number: Reference #: U.S. Securities d Exchange~rtfission Fair Fund Distribution Check May 13, 2011 9782030 9857/80 In the MoKer o/Strong Capital Manageme Inc., eta!, Admin. Proc. No. 3.11498 The enclosed dseck is a distribution payment from the Faw Fund established by the SEC M con with the Strong Capital Madagement settled admiNstratne pratedksg identified above. TAa payment is made purwant to the PWn of Dktrthutlon approved by the SEC on September 14, 2009 htK "Plan'). the Plan desaitses bow the Fak Fund, established fa Investors Inured as a rewlt of market timing In 24 Strong mutual funds from 1998 through 3007 Is being dhtributed. Your account has been fdenti8ed as an account that Mvested on behaN of investors ellgWk fa dktdbutian under the Plan. If this is not an account invested on behafl of other Mvestas, please call the Administrator at Me number set forth below fa Infarmatlbn appkabk to you account To read the Plan, Statement to Eligible Investors, or to team more about the distributon process, please refer to the iniamational website at wwwstrongsenlement.com a contxt the Settkmmi Adminknator at 1-8(10-555-7718 between tfie hour of 8 OOam and S:OOpm Ei. Wease be sure to have the above-referenced Information avalW6le. The Plan (avNWbk at www.suongsettlementcom) requires you to further distribute this money to yotu affected llhirtwte Sharehdders M accordance wNh the PWn and wIN you legat contractual, and fiduciary oblgations. The allaation formulas necnsary to make distributions to your utimate shareholders are available at http:/(wwwstrongsettlemtnt.com/brokerdownbads (password MSVrsGh$f34). CAUTION: Before you deposit or otherwise negotiate thb chedt, It is very Important that you understand the Impllations that may arise M comsedion wRh this payrrsent. To thh end. prior to depositing or otherwise negotiating this chedw please reWew the Statement to Eligible Investors and consult you tors adviser. Further, tfie receipt and ashng of this dsede shah be deemed to be en agreement by you that you will further distribute the proceeds M a manner consistem with the Plan. You are required to provide SUong's Independent Dlstrlbutbn Consulnnt with daumenation sufflcknt to show how the distnbution to ultimate shareholders B arced au. Pkase provide sucA documentation to: BNY Mellon/Strong Funds, PO Bo: 859250, 6rainUee, MA 02184 K you have further questlons about the distrbution process, please contact the Setdement Adminhtntor at 1-80D-SSS•7)18. Pkue be sue to have the above reference information anlabk. It you are not the hpkler of the account identified on the front of Me dtedt, If your account Is not an account that Invested on behaH of other investors, or N you believe that you ue receMng this payment in error, please ImmedWtely contact [he Adminlstrata o1 the Wan at the toll-bee number identified Delow. Please note that tMs diedc must be cashed rriWn the number of day} indicted at tfie bottom of this chede. after whirls h will be voided. If you do not accept tAis distributon payment, the Independent Dlstributlan Cantuhant is required to isaify the SEC staff. Advisory Groaa Taxes Distribution Looses Feea Amount Withheld Amount ~ $40.20 $34.72 S74.92 50.00 574.92 gin R ll'000699~7~I1' i:p43301627t: L02886i80t,111• __ - - -- ._ OPPENHEIMER SECURITIES LITIGATION CLAIMS ADMINISTRATOR PO BOX 4199 PORTLAI~NI~DIII,IIOIIR I9~'7'2II~0I8I-4I~199 u~~ f 1f~W ~Y ~1 I~ UI ~1 ql~ 1~ ~~ ~ ~1 ~I~ ~ ~ll '410009515185' 000 0008808 00000000 001 001 08808 INS: 0 0 RPSS TR IRA FBO DENNIS P NELL 722 DOGWOOD TER BOILING SPRINGS PA 17007-9627 Website: www.OppenheimerCoreSettlement.com Email: info~OppenheimerCoreSettlement.com Phone: 877-845-3575 ' CLAIM NUMBER: 320162447 CHEGK NUMBER: 046163 CHECK AMOUNT: $52.41 CHECK DATE: DECEMBER 14, 2012 r - Dear AuthorizedCiaimar~t __--._.. _ _ __ ... _., .._ __ The attached check representsyour prorata share of the Net Settlement Fund in the class action entitled 1'n re Oppenheimer Core Bond Fund. Your Gaim was calculated in accordance with the court-approved Plan of Allocation, as a result of the Gaim you submitted, or the Record of Funds Transactions submitted on your behalf in connection with this settlement. Please see the enGosed Release to Accompany Check for further details. If you have any questions, please contact the Claims Administrator at Oppenheimer Securities Litigation, Claims Administrator, PO Box 2838, Portland, OR 97208 or the telephone number or email address noted above. KOW1 vO.OB 12.107013 /l1 L7VCaW000 ItK ` > i+ r. c d,~ )r~"~fi'~?~ri r '>> a BOILING SPRINGS PA 17007 9627, ~ , w ~ G , ~,. ~ ,,gyp "~ ~ '.; • v1° -0• i'~ ~~ Yv v ,.j~ i T1 i ~i r i ~ i Sri Kv.+ ~ y Y! b ;~ ~ A~L+t% t r+ ,- d rJ ~°. >~ i'~;,vrx ~4,rh~"; 4~ Ap ~. a~ h~ N, >, -~ ~`" l~: ~is~i "„'~~ Ii~J ~w vl.' y~,3~dCs J A'.d~ty!{'{K`s-~ i one it For peposi~ nl ~'~n x~^ ~ ~~~ .~ Y ,. Y^^v9 ~`~"~'Yyf ~`R~' ve`-.1F!'1' c 3*'t~ T ~ 11F#'~C.~{'r S rtiV ~iA 'V}%' ~ ' >~ ~ ~~ . ~, w, ter ~ ~ r ,, 1., ~, , ~, ~ ~ ~k=~~wa,' ~r~y~ ~ ,~~,~,~ .~.~1,« ,~ Authtrtizati Slgn`ature. ,+ F s g n t~ uYx .x. ~.~ ~ +'i ~~YR' s ~ I '~~ ~ i' ~ N#` ~ Y~! 'r ~ ~.d:'+~ °'+~F r ~; ... ~LL ( z wk sa . r , a ~ ref ~ : z '~ 1 Y~~r i~ n 'r :,'~ 3n 1 -0 ~~` 91+ 0'3. "C , _ ~ ., te'."~ r^N~ s ^.~1, tix ~ u r ~ ~ '~ .~ ~T1 +r.*m .FFr ~ ~ 9 4n°,v1 .~ ~ ~W II'D46 L6311' ~:0 2 1000089: 497058 2 24911' RELEASE TO ACCOMPANY CHECK You have received the enclosed check from the Claims Administrator in In re: Core Bond Fund, Case No. 09-cv-1186-JLK-KMT (District of Colorado) (the "Class Action"), because you have been identified as a member of the Class certified for the purposes of settlement only by the United States District Court for the District of Colorado. By cashing the enclosed check, you provide an additional release to all "Released Defendant Parties" from all "Released Claims." This Release is an "additional release" because the September 30, 2011 Judgment in In re: Core Bond Fund entered by the Court independently orders that you have released the Released Claims against the Released Defendant Parties. "Released Claim(s)" means all claims, demands, rights, actions, suits, or causes of action of every nature and description, whether known or unknown (including Unknown Claims, as defined herein), whether the claims arise under federal, state, statutory, regulatory, common, foreign or other law, whether foreseen or unforeseen, and whether asserted individually, directly, representatively, derivatively, or in arty other capacity, that the Releasing Plaintiff Parties: (1) asserted in the Complaint or the Action as against the Released Defendant Parties; (2) have asserted, could have asserted, or could assert in the future, in any forum against the Released Defendant Parties that are based upon, arise out of, or relate in any way to the facts, matters, transactions, allegations, claims, losses, damages, disclosures, filings, or statements set forth in the Complaint or at issue in the Action; or (3) have asserted, could have asserted, or could assert in the future relating to the prosecution, defense, or settlement of the Action as against the Released Defendant Parties. Released Claim(s) does not include: (1) claims to enforce the Settlement or (2) the rights of the Core Bond Fund in any derivative claim filed or asserted against the Released Defendant Parties prior to the date of this Stipulation. "Released Defendant Parties" means (1) any and all of the Defendants and/or their current or former attorneys, auditors, officers, directors, employees, partners, subsidiaries, affiliates, related companies, parents, insurers, heirs, executors, representatives, predecessors, successors, assigns, trustees, or other individual or entity in which any Defendant has a controlling interest; and (2) broker-dealers or financial advisers of any Class Member. For the avoidance of doubt, OIF and the Core Bond Fund are included in the definition of Released Defendant Parties. "Released Plaintiff Parties" means any and all of the Lead Plaintiff, Class Members, Lead Counsel, and their respective partners, employees, attorneys, heirs, executors, administrators, trustees, successors, predecessors, and assigns. "Releasing Plaintiff Parties" means: (i) Lead Plaintiff; (ii) all Class Members; (iii) the Lead Plaintiff's and each Class Member's present or past heirs, executors, administrators, successors, assigns, and predecessors; and (iv) any person or entity who claims by, through, or on behalf of the Lead Plaintiff or any Class Member. "Unknown Claims" means (i) any and all Released Claims that any of the Releasing Plaintiff Parties does not know or suspect to exist in his, her, or its favor at the time of the release of the Released Defendant Parties which, if known by him, her or it might have affected his, her, or its settlement with and release of the Released Defendant Parties, or might have affected his, her, or its decision(s) with respect to the Settlement (including the decision not to object or exclude himself, herself, or itself from the Settlement), and (ii) any Released Defendants' Claims that any Defendant does not know to exist in his, her, or its favor at the time of the release of the Released Plaintiff Parties, which, if known by him, her or it might have affected his, her, or its settlement with and release of the Released Plaintiff Parties, or might have affected his, her, or its decision(s) with respect to the Settlement, Moreover, with respect to any and all Released Claims and any and all Released Defendants' Claims, upon the Effective Date, the Releasing Plaintiff Parties and Defendants, respectively, shall be deemed to have, ahd by operation of the Final Judgment shall have, fully, finally, and expressly waived any and all provisions, rights, and benefits conferred by any law of any state or territory of the United States, or principle of common law, that is similar, comparable, or equivalent to California Civil Code § 1542, which provides: A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR. The Releasing Plaintiff Parties, or any one of them, may hereafter discover facts other than or different than those which he, she or it knows or believes to be true, tiut each of the Releasing Plaintiff Parties hereby expressly waives and fully, finally, and forever settles and releases, upon the Effective Date, any known or unknown, suspected or unsuspected, contingent ornon-contingent Released Claim. Likewise, the Defendants, or any one of them, may hereafter discover facts other than or different than those which he, she or it knows or believes to be true, but each of the Defendants hereby expressly waives and fully, finally, and forever settles and releases, upon the Effective Date, any known or unknown; suspected or unsuspected, contingent or non- contingent Released Defendants' Claim. The Parties acknowledge that the inclusion of "Unknown Claims" in the definition of Released Claims and Released Defendants' Claims was separately bargained for and was a key element of the Settlement. K3501 v.03 17.26.2012 REV~1510 EX ~ (1~9I; SCHEDULE G INTER-VIVOS TRANSFERS & COMNDHERITANCEDTAXERETURNANIA MISC. NON•PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCWDETHENAMEOFTHETRANSFEREE,THEIRRELATICNSHIPTC~ECEDENTANDTHE~ATEOFTRANSFER. ATracHacoPr oFmEOEEO FOR REU ESraTE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IFAPnICae~E TAXABLE VALUE _3. ~/~1/~G~ ~r ,,~/~ f ~~ !"Gi9~1/ ~--~/l/Yj~ S ~ -~~G°r~~~~~ 7~~ ~ ~ ~ . 3~~ c ~~ ~ ~ `~ t ~ /G~ ~ . ~ /z~-/2 9~/ ~C Flo ~ `~~ ~ ~~ ~s;.~~~ o~~~~Y~~i~~.~ ~t~/1 S' ~'z~~~ I 7a~ ~ ~ ~ y~~ ~ ~~ ~`~~7 L/~O3 ~~~ ~ 1 ~ (If more space is TOTAL (Also enter on line 7, Recapitulation) $ / ~ 2'L- (.hr ~~ / r insert additional sheets of the same size) ;~, ~~ ry REV-516 EX+(12-03) !' REQUEST FOR WAIVER OR IF YOU ARE REQUESTING A WAIVER COMMONWEALTH OF PENNSYLVANIA NOTICE OF TRANSFER BUREAU OFENDN OUALE AXES (FOR STOCKS, BONDS, SECURITIES OR PLEASE CHECK THIS BLOCK DEPT. 280601 SECURITY ACCOUNTS HELD IN BENEFICIARY FORM HARRISBURG, PA 17128-0601 DECEDENT NAME: (LAST) (FIRST) (MIDDLE INITIAL) INFORMATION Nell Dennis p SOCIAL SECURITY NUMBER OF DECEDENT: DATE OF DEATH OF DECEDENT: (MM-DD-YYYY) 160-36-3786 09/19/2009 ADDRESS OF DECEDENT: CITY STATE ZIP CODE COUNTY 722 Dogwood Terrace Boiling Springs PA 17007 Cumberland NAME OF CORPORATION, FINANCIAL INSTITUTION, BROKER OR SIMILAR ENTITY CORPORATION, American Funds FINANCIAL INSTITUTION ADDRESS OF FIRM CITY STATE ZIP CODE OR BROKER 8332 WOODFIELD CROSSING BLVD. INDIANNAPOLIS IN 46240 INFORMATION TELEPHONE NUMBER EXTENSION (IF ANY ) (800)421-0180 TYPE OF ACCOUNT: CAPITAL STOCK REGIST RED BOND A SECU R ASSET A SECUR ACCOUNT ACCOUNT ^ E ~ ~ INFORMATION ATTACH INVENTORY ACCOUNT BALANCE (INCLUDE ACCRUED INTEREST UNTIL DATE OF DEATH) IDENTIFYING NUMBER OF ASSET aFSecuRlTV ACCOUNT LISTING ALL 550,278.31 ___ 62630990 ASSETS AND DATE OF - ' DEATH VALUES ACCOUNT TITLE AS IT APPEARS ON STOCK. BOND, SECURITY /SECURITY ACCOUNT ORIGINAL PURCHASE DATE OFASSET __ CB&T CUST. IRA DENNIS P. NELL DECD 0 812 9/1 9 94 BENEFICIARY NAME (Last) (First) (Middle Initial) INFORMATION Keller Elaine N OFFICIAL USE ONLY ADDRESS PERCENT TAXABLE 722 Dogwood Terrace CITY STATE ZIP CODE TAX RATE Boiling Springs PA 17007 RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER Sister 160-36-3686 __. BENEFICIARY NAME (Last) (First) (Middle Initial) INFORMATION OFF1ClAL USE ONLY ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER BENEFICIARY NAME (Last) (First) (Middle Initial) INFORMATION OFFICIAL USE ONLY ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER SIGNATURE O PREPARER DAYTIME TELEPHONE NUMBER Instructions for filing this notice are on the rpyerse side. o ~ N O Z J 4 N,,,aLLQ~ ~~,a~w~. cs~rmr~w ~~~~~Q =YQ~OK y 1-2)yF- LLK ~~OXUZUi~ vpl+~~-u~W OD C44NQ~-r 7 U ~ N ~- C 4~ 7 y Z 7 r ~ ~ 6~ O Q N N ~ ~ U r G 42 g ~ ~~ r rS, ~ U W ~ '~- J~OZ 2~0~ d a cr~j c9 ~ NwaZ d z~o:~ .4 Q C ~. [4 ~' s C Q. °cO ~ v ° ~O_ ~ U ~. 7 q_ a ~~ 0 a ~ ~ ~ ~ o , ~ ~ N d O, ~ , ~ Q ~ ~r .~ 4Y1 ~ ~ ' d ~ ~ d ~ ~ ~ ~ O ~ .~ ~ ~ N 411 0 '~ O 0- ~~ U v w 4 o N tc o 4O rn ~ `~~ O~Z u~OX`x ~ N ~ Q ~ppa.0 mr ~ ~ ~ ~ I ,d. ~ ~ O, ~ ~ ~ O ' v~ o ~ `O. ~ ~ , 'G ca o ~0. 7 N Efl C 7 O ~' 77 ~ N IU ~ m C' U~ ~ N N N lt- v -- U U a~ G ~ J C ~ 7~ ~ ~ U 7 t~j y j ~ ~ ~ ~ G p !- r. O, ~ ' r :yi 0 r- d ~ ~ ' N d ~i ~ to '~ d ~: (6 f p ~ c I i p.. N o o ~ 1 N N '.:J ~ d ? ~} N G ~ ~ '..% L1 S ~ N N G C ~ .. ~ V pX. Q 0 ~ ~ U a 1!1 N N ®, ra ' i'._' FEDC-RAL CREDIT UNION AoMin~isrr.ATIVF OFFICES 1440 Roscce~NS A~~eniue, MNn~Nr,.rrF.ni Bcncn, CA 90266 • TF~. 310.6435400 ___! 500.II54.9346 wwva.kinecta.org • info'~a~kinectaor~ Account Number: 872050 SI I Money Market IRA Ownership: Dennis Nell Joint: N/A Beneficiary: James M Keller, Elaine N Keller Date of Death: 9/19/09 Balance as of 9/01/09 $459,103.98 Interest Accrued: $10.04 Balance on date of death: $47.53 Alicia Alva Account Services Representative, Senior Name Title r, Signature 10/27/09 Date REV-516 EX+(12-03) $ REQUEST FOR WAIVER OR IF YOU ARE REQUESTING A WAIVER COMMONWEALTH OF PENNSYLVANIA NOTICE OF TRANSFER BUREAU DAFENDN DUAL TAXES (FOR STOCKS, BONDS, SECURITIES OR PLEASE CHECK THIS BLOCK DEPT. 280601 SECURITY ACCOUNTS HELD IN BENEFICIARY FORM) HARRISBURG, PA 17148-0601 DECEDENT NAME: (LAST) (FIRST) (MIDDLE INITIAL) INFORMATION Nell Dennis P SOCIAL SECURITY NUMBER OF DECEDENT._,_ DATE OF DEATH OF DECEDENT: (MM-DD-4444) 160-36-3786 09/19/2009 ADDRESS OF DECEDENT: CITY STATE ZIP CODE COUNTY 722 Dogwood Terrace Boiling Springs PA 17007 Cumberland NAME OF CORPORATION, FINANCIAL INSTITUTION, BROKER OR SIMILAR ENTITY CORPORATION, American Funds FINANCIAL INSTITUTION ADDRESS OF FIRM CITY STATE ZIP CODE oR 8332 WOODFIELD CROSSING BLVD. INDIANNAPOLIS IN 46240 BROKER INFORMATION TELEPHONE NUMBER EXTENSION (IF ANY ) (800)421-0180 TYPE OF ACCOUNT: CAPITAL STOCK REGISTERED BONA A SECU RITY ASSET A SECURITY ACCOUNT ACCOUNT ~ ~ ~ ^ INFORMATION ATTACH INVENTORY ACCOUNT BALANCE (INCLUDE ACCRUED INTER EST UNTIL DATE OF DEATH) IDENTIFYING NUMBER OF ASSET __ OF SECURITY 439 884.14 60962730 ACCOUNT LISTING ALL , ASSETS AND DATE OF DEATN vaLUes ACCOUNT TITLE AS IT APPEARS ON STOCK, BOND, SECURITY /SECURITY ACCOUNT ORIGINAL PURCHASE DATE OF ASSET _.. _. _.. DENNIS NELL DECD PA/TOD ELAINE KELLER 10/05/1998 BENEFICIARY NAME (Last) (First) (Middle Initial) INFORMATION Keller Elaine N OFFICIAL USE ONLY ADDRESS PERCENT TAXABLE 722 Dogwood Terrace CITY STATE ZIP CODE TAX RATE Boiling Springs PA 17007 RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER _ __ Sister ____ 160-36-3686 __ __ BENEFICIARY NAME (Last) (First) (Middle Initial) INFORMATION OFFICIAL USE ONLY ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER BENEFICIARY NAME (Last) (First) (Middle Initial) INFORMATION OFFICIAL USE ONLY ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE .- RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER c~'~ ~1.'`~-~.~.~L~.~ (~ ~~~ a s~ - 3 sz ~ SIGNATURE OF PR PARER DAYTIME TELEPHONE NUMBER Instructions for filing this notice are on the reverse side. REV-516 EX+(12-03) .a REQUEST FOR WAIVER OR IF YOU ARE REQUESTING A WAIVER COMMONWEALTH OF PENNSYLVANIA NOTICE OF TRANSFER BUREAU OFENDIVIDUALE AXES (FOR STOCKS, BONDS, SECURITIES OR PLEASE CHECK THIS BLOCK DEPT. 2811601 SECURITY ACCOUNTS HELD IN BENEFICIARY FORM) HARRISBURG, PA 17128-0601 DECEDENT NAME: (LAST) (FIRST) (MIDDLE INITIAL) INFORMATION Nell Dennis P SOCIAL SECURITY NUMBER OF DECEDENT:. _ DATE OF DEATH OF DECEDENT:. (MM-DD-YYYY) 160-36-3786 ~I 09/19/2009 _. ADDRESS OF DECEDENT: CITY STATE ZIP CODE COUNTY 722 Dogwood Terrace Boiling Springs PA 17007 Cumberland NAME OF CORPORATION, FINANCIAL INSTITUTION, BROKER OR SIMILAR ENTITY CORPORATION, Franklin Templeton FINANCIAL INSTITUTION gDDRESS OF FIRM CITY STATE ZIP CODE OR Attn FAST; 3344 Quality Drive Rancho Cordova CA 95679 BROKER INFORMATION TELEPHONE NUMBER _ _ _ _ EXTENSION (IF ANY) _ (800) 223-2141 RED BOND A SECU STOCK REGIST TYPE OF ACCOUNT: CAPITAL ASSET A SECUR ACCOUNT R ACCOUNT ^ E ~ ~ X INFORMATION ACCOUNT BALANCE (INCLUDE ACCRUED INTEREST UNTIL DATE OF DEATH) IDENTIFYING NUMBER OF ASSET ATTACH INVENTORY OF SECURITY 46 304 188 ~2,~-1291176591fl ACCOUNT LI6TINC ALL . , ASSETS AND DATE OF DEATH VALUES ACCOUNT TITLE AS IT APPEARS ON STOCK, BOND, SECURITY /SECURITY ACCOUNT ORIGINAL PURCHASE DATE OF ASSET Account #12911765910 DENNIS HELL T/O/D 06/06/2008 BENEFICIARY NAME (Last) (First) (Middle Initial) OFFICIAL USE ONLY INFORMATION Keller Elaine N ADDRESS PERCENT TAXABLE 722 Dogwood Terrace CITY STATE ZIP CODE TAX RATE Boiling Springs PA 17007 RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER Sister 160-36-3686 BENEFICIARY NAME (Last) (First) (Middle Initial) OFFICIAL USE ONLY INFORMATION ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER BENEFICIARY NAME (Last] (First) (Middle Initial) OFFICIAL USE ONLY INFORMATION ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER -. ~~_~u-~ ~~~-, ~~I~~ DSO -JSz~ SIGNATURE OF PREPARER DAYTIME TELEPHONE NUMBER Instructions for Tiling this notice are on the reverse side. REV-516 EX+(12-03) REQUEST FOR WAIVER OR IF YOU ARE REQUESTING A WAIVER COMMONWEALTH OF PENN3YLVANUI NOTICE OF TRANSFER BUREAU OnFENDIOV DUAL TAXES (FOR STOCKS, BONDS, SECURITIES OR PLEASE CHECK THIS BLOCK DEPT. 280601 SECURITY ACCOUNTS HELD IN BENEFICIARY FORM) HARRISBURG, PA 17128-0601 DECEDENT NAME: (LAST) (FIRST) (MIDDLE INITIAL) INFORMATION Nell Dennis P SOCIAL SECURITY NUMBER OF DECEDENT: _, DATE OF DEATH OF_DECEDENT.,(MM-DD-YYYY) 160-36-3786 09/19!2009 _._._.. ADDRESS OF OECEDENT: CITY STATE ZIP CODE COUNTY 722 Dogwood Terrace Boiling Springs PA 17007 Cumberland NAME OF CORPORATION, FINANCIAL INSTITUTION, BROKER OR SIMILAR ENTITY CORPORATION, Oppenheimer Funds FINANCIAL INSTITUTION ADDRESS OF FIRM CITY STATE ZIP CODE OR 10200 E. Girard Bldg. D Denver CO 80231 BROKER INFORMATION TELEPHONE NUMBER _ EXTENSIOtJ (IF ANY) , (800)525-7048 _ _ TYPE OF ACCOUNT: CAPITAL STOCK REGISTERED BOND A SECU RITY ASSET A SECURITY ACCOUNT ACCOUNT ^ ^ ~ ^ INFORMATION ATTACH INVENTORY ACCOUNT BALANCE (INCLUDE ACCRUED INTER EST UNTIL DATE OF DEATH) IDENTIFYING NUMBER OF ASSET ___ __ of secuRm 89 299.14 7407400315~Fo3 ACCOUNT LISTING ALL ASSETS ANO DATE OF DEATH VALUES ACCOUNT TITLE AS IT APPEARS ON STOCK, BOND, SECURITY I SECURITY ACCOUNT ORIGINAL PURCHASE DATE OF ASSET DENNIS P. HELL TOD -SUBJECT TO STA TOD RULES PA 04/08/2008 BENEFICIARY NAME (Last) (First) (Middle Initial) OFF1CfAL USE ONLY INFORMATION Keller Elaine N ADDRESS PERCENT TAXABLE 722 Dogwood Terrace CITY STATE ZIP CODE TAX RATE Boiling Springs PA 17007 RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER __ __ ___ Sister 160-36-3686 _. BENEFICIARY NAME (Last) (First) (Middle Initial) OFFICIAL USE ONLY INFORMATION ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER _ __ BENEFICIARY NAME (Last) (First) (Middle Initial) INFORMATION OFFICIAL USE ONLY ADDRESS PERCENT TAXABLE CITY STATE ZIP CODE TAX RATE RELATIONSHIP TO DECEDENT BENEFICIARY'S SOCIAL SECURITY NUMBER SIGNATURE OF PREPARER ~ DAYTIME TELEPHONE NUMBER Instructions for filing this notice are on the reverse side. REV-1511 EX+ (12-99) ~~ ~ ~> SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF~~/ ~ ~ FILE NUMBER ~y 2 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A t FUNERAL EXPENSES: i/ /~~g lr ~KO~,,,,~,/ ~~.,~,L ~,~ C~ ~7`~ / B. ADMINISTRATIVE ~iOSTS: 1. Personal Representative's Commissions Name of Personal Representative(s)- ~ Q --^ Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees ~~~~~ ~ ~~~~z~s ~ ~ ~'~~ ~~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) / -~ ~ -- Claimant ~` /f Street Address City State Zip a. 5. 6. 7. ~~ ~, ~ )~ ~/ r ~~~ Relationship of Claimant to Decedent Probatefees ~" ~~s~^ ~_~/~/S' Accountant's Fees ~,qG',~.~ f / *7'X .SL~Z/iC_2 -'f7-r~-°'~,a /r /.,~Li,,G~+-.~.~ 7`''/`'.1,x, / Tax Return Preparer's Fees r //~f~KC.zc%r,/ 7 / ^~`/xt.~'r wi/¢G/~Y~eiZ-d' ~JC~/~ . ~i~4.r~ f/,f°J ~trry L2//.c L~'~ C.. w~j-j O...Dr//!j .L C~ ""'"/ "' 111-Arlf-/ /~~C ~wlc ~ C~ ~ G~dr~i-~Zj- 9g o~. G° r i ~~r G~ ~3~r ~~ ~il~ Y`~ iGz~~, ~-~ ~.v f~/~~-~ r...~~,s- .,mot. ~ TOTAL (Also enter on line 9, Recapitulation) $ ~/ ~ ~(-' (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT] INHERITANCETAXRETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF ~' J~~ ~ ~ L ,~, „/~ ~ ~ FILE NUMB~~~ Report deb/ts incurred by the decedent prior to d~eath/IYw'h/i/cthl"r/emained unpaid as of the date of death, including unreimbursed'/m'ed~fical expeCns%s. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH l ~-v ~G f ~r ~ ~~ ~ ~~~ ~~ i ~. ~ ~ ~ r r~'~r~- ~~ ~~~~ n~,s~ i ~S _ z,G~' J G ~~, l //~~~' ~~ ~~ 4 /y C ~ ~~ TOTAL (Also enter on line 10, Recapitulation) $ ,'~~~ / ~rs/ / (If more space is needed, insert additional sheets of the same size) e~ssiah v~ ~~A~~ 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 ELAINE N KELLER 722 DOGWOOD TERRACE BOILING SPRINGS, PA 17007 _ ~~ Form PBal1 QUESTIONS? CALL: 717 697-4666 RESIDENT # UNIT ` ~ STMT;'DATE' 10804 272 D 08/31/2009 RESIDENT S Mr. DENNIS P. NELL y TOTAL AMOUNT-DUE' $10,273.25 DATE RUE : 09/30/2009 DATE'' DE$CRIPT!ON .: `RATE':( Units' CHARGES CREDITS EALANCE '' (CAMPUS) 19.00 4.00 76.00 1,403.00 08/22/09 (CAMPUS) HOME CARE ASSIST. - WKND ~"..19.00 4.00 ..•76.00 .`.~ 1,479.00 08/31/09 RM/ BRD -NURSING -SEMI-PVT 271.00 31.00 8,401.00 9,880.00 08/31/09 FORTIFIED ICE CREAM 1.15 25.00 28.75 9,908.75 08/31/09 FORTIFIED ICE CREAM 1.15 53.00 60.95 9,969.70 08/31/09 FRUIT BEVERAGE 1.95 19.00 37.05 10,006.75 08/31/09 FRUIT BEVERAGE ~ 1.95 54.00 105.30 10,112.05 08/31/09 PREVAIL PROTECTIVE UNDERWEAR 1.30 24.00 161.20 10,273.25 ~13~2. ~~ ~~ ~ ~ 2 ~ ~~ ~ Q09 f , ~ ~ • ~ RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOT OUNT DUE 10804 10,273.25 0.00 0.00 0.00 0.00 $10,273.25 RESIDENT NAME Mr. DENNIS P. NELL ~°rmYtl-°' A 1 % finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF ~ ~~ ~ C~~ ~ /~ ~ FILE NUM~O~ ~ ~~~~ 6 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~ ~~ 'i ~~~~ T~ , ~oi~~~ ~~~~N~ s ~~ i~-~~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART Il -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) ~a. ~ `~~tk , i t l`t ~ .. ,~ ; ~~... ~, ~~~~ ~ ~~~