HomeMy WebLinkAbout01-0169
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Albert W ciss Berg
No.
21-01-169
also known as
I Deceased
Social Security No 207108495
Petitioner(s), who is/are 18 years of age or older, apply)ies) for :
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executor
Decedent, dated September 6, 1990 and codicil(s) dates
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, ete
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
residence at 814 A Fairfield St. Mechanicbur PA 17055
(list st
Decedent, then 87
years of age, died February 2
County, Pennsylvania, with his/her last family or principal
~ -r; ({j ,
t, number and municipality)
, 19 QL, at Sinai Hospital of Baltimore, Baltimore Cit, MD
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property.........................................
(if not domiciled in PA Personal property in Pennsylvania ....................
(if not domiciled in PA Personal property in County..............................
Value of real estate in Pennsylvania ........................................... ............................................
Total ..................................... ...............................................................................
$ to be determined
$
$
$
$
Real Estate situated as follows:
Wherefor, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
I
Signature
Typed or printed name and residence
I
< --..;:;"';r~ yl
~ ~--.~ " -u.....v... -" ~-.....
Thomas Berg, 130 Parker St. Carlisle, P A 17013
RW-l
/ If-, -02 [17'- /C'
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the
Decedent, Petitioner(s) will well and truly admin~t_~~~;~~.ooo1tg to law.
Sworn to and affirmed and subscribed ~J
before me this 12th day of
FEBRUARY ~2001
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DECREE OF REGISTER
Estate of Albert Weiss Sera
Deceased
No.
21-01-169
also known as
Social Security No: 2071 08495
Date of Death: 02/02/01
AND NOW, February 13 ,~2001 ,in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary 0 of Administration
((c,t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate)
are hereby granted to Thomas Berg, 130 Parker St., Carlisle, PA 17013
in the above estate and that the instrument(s), if any, dateriSeptember 6, 1990
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters .................................... $
18.00
/? daV (/ '1;;f:';1f(e1~~:U hft-dO,A'-//j/
/ II
Short Certificates(s) ...............
75.00
Extra Pages (
) ...............
6.00
I. T.R. ......................................
JCP Fee .................................
5.00
Attorney: George F. Douglas,III, Esquire
1.0. No: 61886
Address: 27 W. High St.
Carlisle,
Inventory............................... .
Other..................................... .
PA 17013
TOTAL ............................$
104.00
Telephone: 717 243-1790
DATE FILED:
/) /?,-' (;'1-/ -~
l:':..c~-t:A:_j' "I ~..( /.';/
II
ONLY
I HEREBY CERTIFY THAT THE ATIACHED IS A TRUE COpy OF A
RECORD ON FiLE IN THE DIVISION OF VITAL RECORDS
21-01-169
5SED
;SUED:
~~VIT~i~
'6 DI
Please Type or Print in Black Indelible Ink. Assure All Copies Are Legible.
State of Maryland / Department of Health and Mental Hygiene
Certificate of Death
p if<. 6,
Reg. No.
]2 Date of Death
Month Day Year
(""-1.. ~},t4 '1./:2. "( 2 ~~'._ (
- lib City, ~ OWP, ~r locat;;n: ofDeat~ j 4c County 01 Death
1"~1--/.I{.M':I~€ <., 0r N/A
-J!.!Jnjer f"year 'lfDnder 24 H;~ [8 Date of Birth 'I "Birthplace (State or Foreign
Months Days Hours I Mln I (Month, Day. Year) Country)
------.l~iO~T 26-,-J 91J J Pennsy blQDia~
3. Time 01 Death
lent's Name (First, Middle, Last)
11 '-8-E'JIl. r
c: l ~ l..--S
~y Name (If not institution, give street and number)
~I /1-t"/~/r4',- ,-~F r;.1-L rffl1c.'YLE
~~~ ~:m;; -18 ~~M '0 ~ r Ago ~ r "" birt~:,y)
TOcM::~::~;~:rg _ --- -~~ _n~m__-_! 1o.~:";~'~'~2;~:
-- I-;~~i;~; --- - -- ~[og ~;:mw~"co""'~' _ _ _
12. Was Decedent Ever in U,S. 13. Was Decedent 01 Hispanic ori.gin? (Specify Yes or No. -[14. Ra.ce. . American .Indlan,
Armed Forces? " Yes, specify Cuban. Mexican, Puerto Rican, etc) Black. White. etc
:Never Married 20 Married 1 I2r Yes 20 No
If Yes, Give 10 Yes 2Q(No Specify. Specify T,]hl' te
Widowed 4 0 Divorced Year or Dates: L__~_
15. Decedent's Education j 16a Decedent's Usual Occupation I 16b. Kind of Businessllndustry
(Specify only highest grade completed) (Give kind of work done during most of working
--.- ---p -- - life. DO NOT use retired)
entarylSecondary (0.12) College (1.40r 5+) I
12 I Salesman Self-Employed
_Jffl;::; ~'m~ ~;:;:dIO M,~o" S"m"mo) _ _ _ _ __ ..
esidence 01 Decedent
te ~ i 1~ County-------------
~.u-~~~~~-r.~.~~~_
eel end Number
I.
Box 457
ital Status
ler's Name (First, Middle, Last)
~man Berg,
Jr.
lormant's NamelRelationship (Type, Print)
19b. Mailing Address (Street and Number or Rural Route Number, Clfy or Town, State, Zip Code)
Jmas H. Berg/Nephew
:,thod of Disposition
] Burial 20{Crematlon 3 ORemovallrom State
] Donation 5 0 Other (Specify)
130 Park.er ~seet__CilIli~le.J _l?lL_1]013
20b. Place 01 Disposition (Name of I Date I 20c Location - City~r Town, State
~cem~"ry,cr~atocy or other plB,ff) I
I 8ffi lOO OCX:lety or t'A .
i __. _, ,?-6-01 l):Iarrl?l?u~gL rA
I ~2. Name antJ Addres~ 01 Fas:ility -. --
Icrematlon ~oclety of MD, Inc.
I 299 Frederick Road Baltimore, MD
Do not enter the mode of dying, such as cardiac or respiratory arrest,
21228
Approximate
Interval Between
Onset and Death
iate Cause (Final
e or condition
Ig in death)
>l I S I S
16 /k,I'_.J
Due to (or as a consequence of):
{b
,tial/y list conditions,
leading to Immediate
Enter Undertying
(Disease or injury
lfated events
,g in death) Last
Due to (or as a consequence 01):
Due 10 (or as a consequence of):
:>ther significant conditions contributing to death but not resulting in the underlying cause given in Part I
23b. Did tobacco use contribute to the cause of death?
1 0 Ves 2% No 30 Probably 40 Unknown
24a. Was an autopsy -[24b Were autopsy findings
performed? available prior to
completion 01 cause
of death?
10Yes 2~0 I 10Yes 20No
~f;~referred to medical ~- . 26 Place of Death (Check only one) _~_ _.___ __
"bd Hospital:. _. I Other
I_~e~~_~____ 1 Inpatient 20 ERJOutpatient 3tJ D~ __...!J=l_ Nurs~ ~ome ~ ReSidence ~ OOther (Specify)
~::'~:"h 5 0 ~:"'::~t~" I 28' (~~~~ '~~7 Yeo') I 28b ~1:~ of M r" '~~~:~ 20 No 128d Do""o. how '"1"" O;;";;-ed -- ...- --
: ~~~i~~de 6 0 ~~t~~~~~r 1 28e. ~~~I~~n~~i~ii.1sp~c7~)~' i;rm~-stree;,facIOry. office I 2Bt ~~~~~J~~~~~fNUmber or Rural Route Number,
I I
:;rtifier lr:l1Certltying Physician: To the best 01 my knowledge, death occurred at the time'-d~e and pl;;;;-;-~ddue to~h;-~~~(~and--;~~~;~~stated-~~--
h9C1r only 20 Medical Examiner: On the basis 01 examination and/or investigation. in my opinion. death occurred at the time, date and place, and due to the cause(s)
:f.( ~;:' IT~C~;I; ::','~) 1(. ~ . ( 29:.~~;e:e ~;;, " 29d Date signed (Month. Day. Year)
~~ '!.I.Y,,,r So I /l/~v._/.. 2'":.)' _~'-('I
TIe and ;ddress of ~flrSOn who co pleted cause of death (Item 23a) (Type, Print) ]/..",." I~ ( , .-' ;-:---::'-' ;-;-~-::-:--
~I /k'$,.;7,.;"/ Z <It 1 t...i!>[ ,)LLj,LiJll..!..l 1-1--{'^-,'Vt:) ..r:.tcr,~:;.~~C-//~i/ir...l (,' /'
e tiled (Month, Day, Year) 32. Registrar's Signllt~re
FEB 0 6 2001 ;;.S~ :~,~..~~ ~1.
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LAST WILL AND TFSl'AMENr
I, Albert Weiss Berg, of C\.mt>erland County, Pennsylvania, being of
sound and disposing mind, meIOO:ty, and understanding, do make and declare
this as and for my last will and testament, hereby revoking any wills by
re at any tinE heretofore made.
1. I direct that my executor pay my debts and funeral expenses.
2. I devise and bequeath one-half of my estate, real and personal,
to my nephew, Thanas Berg, the son of Heman Berg, III.
3. I device and bequeath the other one-half of my estate to my
nephew, Richard Berg, also the son of Herman Berg, III.
4. In the event that my nephew, Thatas Berg, predeceases 100, or
dies in a camon disaster with Ire, I devise and bequeath his share of my
estate to his brother, Richard Berg.
5. In the event that my nephew, Richard Berg, predeceases ne, or
dies in a camon disaster with ne, I devise and bequeath his share of my
estate to my nephew, Thanas Berg, in trust nevertheless, for the issue
of my nephew, Richard Berg, per stirpes. '!be trust for each child is to
continue until that child reaches age thirty-five (35), at which tine
they are to receive their share of my estate. r:rhe trostee has the IXJWer
to invest as he sees fit.
6. I naninate, constitute, and appoint my nephew, Tharas Berg, as
my Executor. In the event he is unable to serve, I appoint my nephew,
Richard Berg, as my Executor. In the event that neither of my nephews
is able to serve as Executor, I appoint the Fa.nrers Trust Carpany of
Carlisle as my Executor.
IN ~~ WHEROOF,
day of A;-AJ't-'\ ,1990 ·
. ;' J"
I have hereunto set my hand and seal this the b
2J1z-.1 / ,I' l.?
( :.:i~7 ~.~~)
Albert Weiss Berg'
Signed, sealed, published and declared by the above named testa-
tor as and for his last will and testament, who at his request,
in his presence, in our presence, and in the presence of each
other, have hereunto subsFibed our narres as attesting witnesses:
,3:t:;;~~J~5
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
we,hr~
,
and
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 testator sign and execute the
instrument as his last will, and that he signed willingly and
that he executed it as his free and voluntary act for the pur-
poses therein contained; that each of us in the hearing and sight
of the testator signed the will as witnesses; and that to the
best of our knowledge, the Testator was at that time 18 or more
years of age, of sound mind and under no constraint or undue
influence.
Sworn to and subscribed before
me this /.; LA day Of~
1990.
~~ ~.~
Nota.l. r
NOTARIAl SEAL
JANET M. LAY, NOTARY PUBlIC
CARLISlE BORO.. CUM6E~NO COUliTY
MV COMMISSIDHfXj)lRfS JUNE'~7. 1191
. '.
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND
I, Albert Weiss Berg, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the instru-
ment 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.
{])!i-;J-Uk ~
Albert Weiss Berg
Sworn to and subscribed to
before me this In ~ day
of ~ ' 1990.
N
NOT ARtAl SEAL
JANET M. LAY, NOTARY PUBliC
CARLISLE BORO., CUMdERLANO coUtfTY
MY COMMISS!ON EX?IRES JUNE 17. ;~',u'J\
E-
----
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Albert W. Berq
Date of Death:
Feb. 2,2001
Will No.
21010169
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Feb. 14, 2001
Name
Address
See attached Notice
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Nnnp
Date:
Peb. 14, 2001
Signature~~ 1- ~eo~- .-:
Name George F. Douglas, III, Esq.
Address 27 W. High st.
Carlisle, PA 17013
Telephone ( ) 71 7 ~ 2 4 3 - 1 7 9 0
Capacity: _ Personal Representati ve
----x--Counsel for personal representative
NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND,
PENNSYLVANIA
IN RE: ESTATE OF ALBERT W BERG, DECEASED
NO. 21-01-0169
TO:
Thomas Berg
130 Parker St.
Carlisle, P A 17013
Richard Berg
P.O. Box 273
Stevenson, MD 21153-0273
Please take notice of the death of decedent and the grant of letters to the
personal representative named below. You may have a beneficial interest in
the estate under the Last Will and Testament of Albert W. Berg.
See attached copy of Will
Name of decedent: Albert W. Berg
Last known address of decedent: 814 A Fairfield St., Mechanicsburg, PA 17055
Date of Death: February 2,2001
Place of Death: Sinai Hospital of Baltimore, Baltimore City, MD
County of Grant of Original Letters: Cumberland
Decedent died Testate, and a copy of the Will is attached hereto
Name, address and phone number of all personal representatives:
Thomas Berg
130 Parker St.
Carlisle, P A 17013
717-243-3739
Name, address and phone number of counsel:
George F. Douglas, III, Esquire
27 W. High St.
Carlisle, Pa. 17013
Phone: 717-243-1790
Additional information may be obtained from the undersigned:
DOWks, D~ugl~~~las,_,
By .~~.. I } ~/ '1!...
George F. Douglas, III, Esquire
27 W. High St.
Carlisle, Pa. 17013
717 - 243-1790
Dated: February 14, 2001
to - ;:>0 CJ - I ()
"I /") I--c [II G c\
x/- (../
Internal Revenue Service
Area 3 Director
Department of the Treasury
SB/SE Compliance
Date: March 18, 2003
George F. Douglas, III
27 West High Street
Carlisle, PA 17013-0261
Person to Contact:
Kurt D. Almasy 25-02584
Contact Telephone
(412)395-5607
Dear Authorized Representative:
We are sending you the enclosed material under the provisions
of a power of attorney or other authorization you have on file with
us. For your convenience, we have listed below the name(s) of the
taxpayer(s) to whom this material relates.
If you have any questions, please contact the person whose name and
telephone number are shown above.
Sincerely yours,
x~
f?
~
(for) Valerie Lui
Area Director
Enclosures:
X Letters
_Reports
Taxpayer(s) Name: Albert Weiss Berg
606
600 Arch St., Philadelphia, Pa. 19106
Letter 937(DO) (Rev. 11-92
Internal Revenue Service
Area Director
Department of the Treasury
SB/SE Compliance
Thomas Berg
130 Parker Street
Carlisle, P A. 17013
Estate of:
Albert Weiss Berg
Decedent's Social Security Number:
207-10-8495
Date of Death: February 2, 2001
Person to Contact:
Kurt D. Almasy
Contact Telephone Number:
(412)395-5607
Estate Tax Closing Letter (This is not a bill for tax due)
Date: March 18,2003
Our computation of the Federal tax liability for the above estate is shown below. It does
not include any interest or late payment penalties that may be charged. Other penalties have been
considered in the computation of net estate tax below. You should keep a copy of this letter as a
permanent record because your attorney may need it to close the probate proceedings for the
estate. This letter is evidence that the Federal tax return for the estate has either been accepted as
filed, or has been accepted after an adjustment that you agreed to.
This is not a formal closing agreement under section 7121 of the Internal Revenue Code.
We will not reopen this case, however, unless Revenue Procedure 85-13, reproduced on the back
of this letter, applies.
If you have any questions, please contact the person whose name and telephone number
are shown above. Thank you for your cooperation.
Sincerely yours,
X~ f1.
~
(for)Valerie Lui
Area Director
Tentative Tax
1,780,769.91
Less: Aggregate gift taxes payable (for gifts made after 12-31-76)
Unified credit
Credit for State death taxes
Credit for Federal gift taxes (on gifts prior to 1-1-77)
Credit for foreign death taxes
Credit for tax on prior transfers
Total subtractions
Net estate tax
220,550.00
269,048.86
489,598.86
1,291,171.05
Generation skipping transfer taxes
Section 4980A increased estate tax
P. O. BOX 12030 PHILADELPHIA, PA 19105
Letter 627 (DO) (Rev. 6-96) 606
Shown on Return
vIIClll~e::)
Date of Death
2/ 2/2001
Agreement Secured
rxlYes r~ot~~~.
3.890.854.38
0.00
3.890.854.38
As Corrected
Name of Dec~d~~t'
Albert Weiss Ber
Name of Person With Whom Findings Were Discussed:
GeorQe F. DouQlas,III.ESQ.
1. Taxable estate shown on return or as previously adjusted
.,...,....,\J. "- v.
Lo:J lL.~ lL.C I ~^ '-^DIIII lIa L lUll
: Social Security Numbe
I 207-10-8495
2. Increase <decrease> in taxable estate
3. Taxable estate as corrected (line 1 plus (less) line 2)
4. Adjusted Taxable Gifts
5. Total
7. Aggregate gift taxes payable (after Dec. 31, 1976)
8. Subtract the amount on line 7 from the amount on line 6
9. Unified Credit against estate tax
10. Adjustment to unified credit
11. Subtract the amount on line 10 from the amount on line 9
0.00
,
O 00 i'
. ,
,
!
I
I
,
I
I
I
I
I
I
I
I
I
I
,
I
I
I
I
I
!
I
I
I
I
3,890,854.38
6. Tentative Tax
1.780,769.91
1.780.769.91
220,550.00
0.00
12. Subtract the amount on line 11 from the amount on line 8
{!~0L 1~~s t~?~l zero}
13. Credit for State death taxes 269,048.86
Tentatively allowed
S~bmjt evidence bv (date~
:4. S~btr~ct the amount on line 13 from the amount on line 12
220.550.00
1,560.219.91
220,550.00
1 ,560,219.91
15. Credit for Federal gift taxes on pre-1977 gifts
16. Credit for foreign death taxes (Statutory)
17. Credit for tax on prior transfers
18. Credit for foreign death taxes (Special Treaty)
19. Total Credits (add the amounts on lines 15, 16, 17, and 18)
I
I
I
~--
269,048.86
1,291.171.05
0.00
0.00
0.00
i
I
O.OO~
I
I
0.00 I
:
20. Net estate tax payablB
I
1 , 2 91 , 1 7 1 . 0_5 J
I
I
I
I
I
I
I
I
I
~
I
I
0.00
21. Generation-skipping transfer taxes
(Schedule R. Part 2, line 12)
22. 5e~tior. 4980A - increased estate taxes (Schedule 5)
23. Total transfer taxes
(add the amounts on lines 20, 21 and 22)
24. T0t~1 ti~fi5f~r tax previously assessed
0.00
1 ,291,171.05
1,291 ,171.05
1,291,171.05
0.00
-Q -~-Q-Q---
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~v. iv1.U; ..iuii;';,'-.. \'UJ'\ ~II\I;~U~~ -\u"';i.J;\.:UJl.:,
(difference between line 23 and line 24)
26. PC~J1ty pr~~1~~~1] J~~~~~cd
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- - ,_ _________ __ - _._ - I
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2-7. PC-~21 t i c.~--~i-C-D-ff-f:.[-fcd------__~__H
2B. ~:~ pCf;~1ti:2~ ~ I~C:ff;J~:: <dcc;r[;J~c::
______.______._______.______._.._____~_ 0 0__
0.00
difference between line 26 and line 27)
~~ ~~ IJX ~d D~~~1tic~ D~~~b1c - I~2fc~~0 ~:~~I~Uvv.
add 1 ne 25 and line 28 --
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 2&0601
HARRIst~RG, PA 17128-0601
f
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
GEORGE F DOUGLAS III ESQ
DOUGLAS ETAL
PO BOX 261
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-25-2001
BERG
02-02-2001
21 01-0169
CUMBERLAND
101
C/
REV-1547 EX AFP Cl2-00J
ALBERT
w
Amount Remitted
1P39<1~. !E
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V: iS4-j-Ex--AFP--fi"2-:oo1--NoTICE--OF-INHErfiTANcE-r-A'irA-PPR;fISEi'-ENT~--A[LOWANCE-ifR----------- -- - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BERG ALBERT W FILE NO. 21 01-0169 ACN 101 DATE 06-25-2001
TAX RETURN WAS: ( ) ACCEPTED AS fILED
( X) CHANGED
SEE ATTACHED NOTICE
NOTE: IT an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
reTlect Tigures that include the total oT ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
.00 X 045 = .00
.00 X 12 = .00
3,862,754.67 X 15 = 579,413.20
(19)= 579,413.20
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
3.816.991.76
.00
.00
210,399.05
2,983.44
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
167,619.58
.00
l1ll
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
4,030,374.25
167.619 Ki8
3,862,754.67
.00
3,862,754.67
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-27-2001 AA496524 28,771.05 546,650.00
PAYMENT MUST BE MADE BY 11-02-2001*. TOTAL TAX CREDIT 575,421.05
BALANCE OF TAX DUE 3,992.15
INTEREST AND PEN. .00
TOTAL DUE 3,992.15
* IF PAID AfTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REfUND. SEE REVERSE SIDE OF THIS FORM fOR INSTRUCTIONS.)
~
REV-1470 EX (6-88)
-~-
~ INHERITANCE TAX
~"'.~-~ EXPLANA TION
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Albert W. Berg 2101-0169
REVIEWED BY ACN
Sheila Megonnell 101
SCHEDULE ITEM EXPLANATION OF CHANGES
NO.
B, E & H Changes made to Schedules "B", "E" and "H" per letter dated 05-14-2001 from lawyer's
office.
ORIGINAL
Page 1
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
/rc'-d.oq ~- /D
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
~~
NO. 21 01 - 0 16 9
01125077
05-15-2001
REV-1545 EX AFP (09-00)
EST. OF ALBERT W BERG
S.S. NO. 207-10-8495
DATE OF DEATH 02-02-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
THOMAS H BERG
130 PARKER ST
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answer~d by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5005377774 Date 08-22-1996
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
5,966.88
50.000
2,983.44
.15
447.52
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: WRegister of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!] :;:;!:~~i~~!!!li!!!~!!!j!!!!~;!;:~~~~'!!!!I'"
TAXPAYER RESPONSE
j:ji~~!i!!gii!!~~~~~~!iil!~~:!:!~~_!!::""
'.::::::~$mf!.~~~:!:!i!
[ C~~~K ]
BLOCK
ONLY
A. 0 The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ The above asset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return
to be filed by the decedent's representative.
c. 0 The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
of perjury, I declare that the facts I have reported above are true, correct and
of my knowledge and belief.
()/7 ) 2V3<~?3<1
WO RK ( )
TELEPHONE NUMBER
HOME
E
~ " 'lIt> I
DATE
/1, -~t) 9 ~/O
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
GEORGE F DOUGLAS III
DOUGLAS ETAL
PO BOX 261
CARLISLE PA 17013-1102
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-24-2001
BERG
02-02-2001
21 01-0169
CUMBERLAND
101
sE
REV-1S47 EX AFP el2-00>
ALBERT
w
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y-=iS4j-EX-AFP-[i"2-:oo1--NOT-icE--oF-'ftiHEifiTANCE-;--AX-APPRAISEifENT~-A[i-owAijcE-ifR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BERG ALBERT W FILE NO. 21 01-0169 ACN 101 DATE 09-24-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
.00 X 045 = .00
.00 X 12 = .00
318691948.42 X 15 = 580.1492.20
(19)= 5801492.20
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (S)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
.00
11.193.75
.00
.00
.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
nO)
41000.00
.00
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your accountl
submit the upper portion
of this form with your
tax payment.
111193.75
4.000 00
7.1193.75
.00
31869.1948.42
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-27-2001 AA496524 28.,771.05 5461650.00
06-21-2001 AA496752 .00 31992.15
08-16-2001 CDOO0166 .00 1.,079.00
TOTAL TAX CREDIT 580.1492.20
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED., SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl1 YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
\./~ -'~(9f?w/O
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 780601
~HARRIS~RG, PA 17128-0601
i
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
06-25-2001
BERG
02-02-2001
21 01-0169
CUMBERLAND
101
GEORGE F DOUGLAS III ESQ
DOUGLAS ETAL
PO BOX 261
CARLISLE PA 17013
/'i
';
C
/
REY-1547 EX AFP <12-00)
ALBERT
w
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=is4-j-Ex--AFP--[iZ":ooY-No;--icE"-oF--fNHERifANCE-i:"AX-APPRA-isEMENT~--ALi-oWAifcE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BERG ALBERT W FILE NO. 21 01-0169 ACN 101 DATE 06-25-2001
TAX RETURN WAS: ( ) ACCEPTED AS FILED
SEE ATTACHED NOTICE
( X) CHANGED
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
3,816,991.76
.00
.00
210,399.05
2,983.44
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
4,030,374.25
<1Il
(12)
(13)
(14)
167.619 1i8
3,862,754.67
.00
3,862,754.67
(9)
(10)
167,619.58
.00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
.00 X 045 = .00
.00 X 12 = .00
3,862,754.67 X 15 = 579,413.20
(19)= 579,413.20
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-27-2001 AA496524 28,771.05 546,650.00
PAYMENT MUST BE MADE BY 11-02-2001*. TOTAL TAX CREDIT 575,421.05
BALANCE OF TAX DUE 3,992.15
INTEREST AND PEN. .00
TOTAL DUE 3,992.15
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (6-88)
~
i COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
INHERITANCE TAX
EXPLANA TION
OF CHANGES
REVIEWED BY
Albert W. Berg
Sheila Megonnell
FILE NUMBER
ACN
2101-0169
101
SCHEDULE
ITEM
NO.
EXPLANATION OF CHANGES
Changes made to Schedules "B", "E" and "H" per letter dated 05-14-2001 from lawyer's
office.
B, E&H
ROW
Page
\ /6-~~7'~/t:J
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REY-l'07 EX AFP (12-00>
GEORGE F DOUGLAS III ESQ
DOUGLAS ETAL
PO BOX 261
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-16-2001
BERG
02-02-2001
21 01-0169
CUMBERLAND
101
ALBERT
W
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV = 16cfj-EY-AFP--ri'2-:oo1-------...--xNifERIT-ANcE"-f"x--sTA-fEME-tif-oF-"C-couiif--.-..--------------- -- - ---
ESTATE OF BERG ALBERT W FILE NO. 21 01-0169 ACN 101 DATE 07-16-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-18-2001
P R I NC I PAL TAX DUE: .............................................................................................._...........................................................................................................................
579,413.20
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-27-2001 AA496524 28,771.05 546,650.00
06-21-2001 AA496752 .00 3,992.15
TOTAL TAX CREDIT 579,413.20
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
/L~-c2L~P-/C'
~V BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
GEORGE F DOUGLAS III
DOUGLAS ETAL
PO BOX 261
CARLISLE PA 17013
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
REV-736 EX AFP (01-02)
12-01-2003
BERG
02-02-2001
21 01-0169
CUMBERLAND
202
ALBERT W
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~
RE-V:7iE;-EX--AFpi-(oi~-02)-----.j(-NOificE--OF--DETifRMiiiATio-N-AN-D-A~SESS-HENT-----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER **
ESTATE OF BERG
ALBERT
W FILE NO.21 01-0169
ACN 202
DATE 12-01-2003
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
269~048.86
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
551~721.15
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
551 ~ 721.15
5. Pennsylvania Estate Tax Due
.00
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
.00
7. Additional Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
-IF PAID AFTER THIS DATE~ SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
/ L-- - c~-:J9- /0
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
REY-485 EX AFP el2-00l
GEORGE F DOUGLAS III
DOUGLAS ETAL
PO BOX 261
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-08-2001
BERG
02-02-2001
21 01-0169
CUMBERLAND
201
ALBERT
w
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~
iifv=4s]f-Ex--AFP--fi2:--ooj-----ii.-NCfficE--oF--oETifRMIN-ATIO-N-AN-n-AirsEsirHENT-----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF BERG
ALBERT
W FILE NO.21 01-0169
ACN 201
DATE 10-08-2001
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
269,049.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
551,721.15
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
551,721.15
5. Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
*IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DOUGLAS GEORGE F III ESQ
27 W HIGH ST
CARLISLE, PA 17013
n___n_ fold
ESTATE INFORMATION: SSN: 207-10-8495
FILE NUMBER: 21 - 2001 - 01 69
DECEDENT NAME: BERG ALBERT WEISS
DATE OF PAYMENT: 08/16/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/02/2001
NO. CD 000166
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,079.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: THOMAS BERG
C/O GEORGE F DOUGLAS III
CHECK#1029
SEAL
INITIALS: SK
RECEIVED BY:
REGIS'I'ER IF WILLS
$1,079.00
MARY C. LEWIS
REGISTER OF WILLS
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA.
ORPHANS' COURT DIVISION
NO.
FIRST AND FINAL ACCOUNT
OF THOMAS BERG, EXECUTOR OF THE LAST WILL AND TESTAMENT OF
ALBERT WEISS BERG, DECEASED, LATE OF MONROE TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA.
DATE OF DEATH: FEBRUARY 2, 2001 NO. 21-01-0169
LETTERS GRANTED: FEBRUARY 13, 2001
FIRST COMPLETE ADVERTISEMENT OF GRANT OF LETTERS:
February 17,24, and March 3,2001
TOTAL PRINCIPAL REAL
ESTATE
Stocks Currently retained by
Tucker Anthony
Amasys Corp.
Ametex Corporation Nev
Anglo Canadian Mining Corp. ANCMF
Armstrong Corp. New
Blackberry Gold Resources Inc. British
Columbia
Cordex Petroleums Ltd.
CPI Plastics Group Limited, CPI
Crack Resources Limited British
Columbia, CRACF
Creative Entertainment Technologies,
Inc.
OWl Corporation, OWIC
Elan Corp PLC American Depository
Receipt. ELN
Enermark Res. Ltd, wts expo 12/17/01,
Enerplus - 325 wts
EVOP
Exxon Mobil Corp., XOM-400 split
Fairmount Chemical Company, FMTC
Farrah Resources Ltd
Forest Laboratories Inc., FRX
Fort Minerals Limited, FKM
GlaxosmithKline PLC , GSK
Glitter Gold Mines Limited
Harsco Corp., HSC
Hershey Foods Corp., HSY
Infotechnology, Inc., ITCH
Ing Groep N.V. ADR, ING- 1209 split
DEBITS
Share
value as
# of of
Shares 02/02/01
81 $0.00
1000 $0.00
1500 $0.00
5 0.16
7500 $0.00
16 $0.00
13 $6.00
10,000 $0.00
250 $0.05
200 $0.00
1567 $50.55
1884 .12
120 .38
800 $83.70
100 $0.07
100
20,000 $65.86
5000 $0.00
800 53.21
4500 $0.00
3300 $26.55
2000 $59.81
500 $0.00
2418 $75.71
NONE
Date of Death,
02/02/01,
Mean Value
$0.00
$0.00
$0.00
1.00
$0.00
$0.00
$78.00
$0.00
11.72
$0.00
79,211.85
227.96
46.00
$33,480.00
6.50
0.00
1,317,100.00
$0.00
$42,564.00
$0.00
$87,615.00
$119,620.00
$0.00
$91,527.35
International Sunatco Industries,IF A 1667 $0.00 $0.00
Johnson & Johnson, JNJ - 200 split 400 $95.05 $19,010.00
Kaftus Inds. Ltd., KSEVQ 100 $0.01 $0.75
Killick Gold Limited, KILGF 16,000 $0.00 $0.00
Lexicon Resources Corporation, 1000 $0.00 $0.00
Lynwear Corporation Class A. LMWRA 300 $0.00 $0.00
Madison Fund Inc. 109 0.00 0.00
Matachewan Cons Mines Ltd., YMTA 12,500 $0.05 418.62
Meridian Oil NL Amern Depositary
Receipt, MEaL Y 10,000 $0.00 $0.00
Min Ore Mines Limited 1 $0.00 $0.00
Ormand Industries Incorporated 500 $0.00 $0.00
Neo Bionics Inc., NEOD 1,000 $0.00 $0.00
Pfizer, Inc., PFE 1650 $44.95 $74,167.50
Philco Resources Limited 5500 $0.00 $0.00
Pioneer Systems Incorporated 100 $0.00 $0.00
Samex Mining Corp., SMXMF 100 $0.10 $9.75
Simax Oil & Gas 50 $0.00 $0.00
St. Lucie Exploration Company, LUCE 1,000 $0.00 $0.00
Temple Mountain Industries Inc. 120 $0.00 $0.00
Templeton Develop. Markets 127.994 11.82 1,497.78
Travel By Us. TVBXF 6 .50 2.01
UBZ Corp. 100 $0.00 $0.00
Value Tradings Industries Incorporated 1000 $0.00 $0.00
Vanguard Oil Corp.. V A 4687 0.00 $0.00
Vishay Intertechnology Inc., VSH 2000 $20.78 $41,550.00
Vodafone Group PLC New 25 $34.52 $863.12
VTN Corporation, VTNC 500 $0.00 $0.00
Wal Mart Stores, Inc., SMT 1,600 55.07 $88,104.00
Watson Resources Corp. 950 $0.00 $0.00
Win Eldrich Mines Ltd. 1,900 .17 315.21
Wolf Howard B Inc., HBWFQ 500 $0.00 $0.00
TOTAL $1,997,428.12
Stocks Sold By Tucker Anthony #of shares Net Selling Price
Allied Irish Banks 564 12,286.57
Allied Irish Banks 4,800 104,056.36
Allstate Corp. 184 8,046.93
Archer Daniels Midland 249 3,160.55
A viall Inc. 25 258.09
BAE Systems Canada Inc. 1600 25,980.70
Barrick Gold Corp 640 11,010.22
Biospherics Inc. 1064 7,821.07
Black & Decker Corp. 200 7,835.43
Borg Warner Inc. 256 11,490.93
Callinan Mines Ltd. 2,500 238.99
Canada Southern Petroleum 15,966 92,658.14
Checkpoint Systems 200 2,462.15
Clearworks, corporate action adjustment 8.25
2
Coastal Caribbean Oil & Mineral
Covanta formerly Ogden
Credo Petroleum Corp.
Crompton Corp.
Devon Energy
Enermark now known as Enterplus
Fedders Corp.
Forest Labs
Glenex Industries, Inc.
Golden Triangle Industries
Griffon Corp.
Helix Tech Corp.
Intergraph Corp.
Katy Industries Inc.
Kensington Resources Ltd.
Kinark Corp.
KRL Resources Corp.
KV Pharmaceutical Class A & Class B
La Barge Inc.
Lannett Company Inc.
Levcor Int. a/k/ Pantepec
Lonmin PLC
Lonrho Africa PLC
Louis Dreyfus Natural Gas
Luxor Ind. Corp.
M&T Bank
Magellan Petroleum Australia
Magellan Petroleum Corp.
Matec Corp.
Maxco Inc. Michigan
Maxim Pharmaceuticals
May tag Corp.
Meredith Corp.
Morgan Stanley Dean Witter
Movie Star Inc.
Pan Pacific Petroleum
Proctor & Gamble
Read Rite Corp.
Rotonics Mfg. Inc.
Sears Roebuck
Selas Corp. of America
Siebert Financial Corp.
Steego Corp, exm
Texaco, Inc.
Titan Corp.
Triarc Coso Class A Del. -DWG
Trump Hotels
Tyco Int.
Vishay Int.
17,400
40
100
24
14
1,059
511
12,000
666
51
20
400
80
129
3,200
500
6,667
2,700
200
26,400
250
90
90
49
2500
648
7350
19,650
750
500
100
50
400
156
1730
57,200
40
43
465
100
1,500
256
16,355.75
677.57
837.57
235.99
838.37
19,488.80
2,254.90
858,556.17
53.69
47.59
144.59
11,000.01
738.57
797.55
1,065.20
390.82
232.57
75,277.80
346.58
21,317.31
321.13
1,161.55
5.59
1,712.78
314.08
51,896.70
6,742.09
24,885.84
3,431.32
2,798.99
753.57
1,699.65
14,018.65
10,904.26
942.52
1,562.19
2,766.82
255.07
311.13
4,545.94
4,806.03
1,204.16
99.75
614.44
76,765.84
102,772.07
4.79
15,656.13
211,150.06
9
4,000
4,184
4
300
9,130
3
Well co Enterprises Inc.
TOTAL
1,200
11.421.07
1,853,495.99
PRINCIPAL: PERSONALTY
Merrill Lynch Brokerage Account 872-12768 Cash
Morgan Stanley Dean Witter 410-017648-006
Van Kampen Tax Free Money Fund 270-07379
Charles Schwab, account 1517-7268 cash
Charles Schwab, account 1571-7268 money
market
Charles Schwab, account 1571-7291 money
mar ket
Personal Property
Miscellaneous coins
1993 Nissan Sentra XE Sedan 2d average blue
book
Allfirst Bank-passbook save. 87004935731478
Stamps sold to Larry Lee Stamps
American Express Travelers Checks
Veterans Administration burial allowance
Suburban Cable refund
Series H Savings Bond
Cash
Safe Deposit key refund
Liberty Mutual refund
Time Inc. refund
CGU homeowners ins. Refund premium
Blue Shield medical reimbursement
GE Capital Assurance, premium refund
Blue Shield refund
Blue Shield refund
Com. Of P A. Escheats
Clear, sale of stock
Liberty Mutual refund of premium
IRS, tax rebate check
Capital Blue Cross refund
IRS Refund on 706 return
TOTAL
$1,920.0C
$2,225.1E
$1,215.61
3.7:
22,349.6E
18,406.02
$500.0C
$4,503.0C
$2,700.0C
$195,552.14
$1,700.0C
$3,400.0C
$100.0C
$15.5S
$500.0C
54.6C
2.0C
330.0C
17.82
54.0C
6.6C
1,462.01
56.3E
7.54
15.5C
8.2:
45.0C
300.0C
l,584.5C
4,811.84
$263,846.9'i
INCOME REAL ESTATE
NONE
INCOME PERSONALTY - DIVIDENDS AND INTEREST.
1. Tucker Anthony, Income to date
2. Montreal Trust
13,116.68
.57
4
3. Van Kampen
4. Selas Corp.
5. Enermark Income Fund
6. Harsco Corp.
7. Katy Ind.
8. Crompton Corp
9. Van Kampen
10. Hershey Foods
11. Enermark Income Fund
12. M& T Bank
13. Lommin P.L.
14. Van Kampen
15. Van Kampen
16. Series H Bond interest
17. Van Kampen tax free funds
18. Allied Irish Banks
19. All first Bank passbook savings interest
20. Enermar k income fund
21. Dean Witter
22. M&T Bank estate account interest
23. Total Income
2.82
67.50
470.19
792.00
9.68
1.20
2.92
560.00
318.02
162.00
31.60
2.92
16.07
15.00
1/226.17
2,437.94
84.92
315.66
526.56
537.31
20,697.73
TOTAL DEBITS:
$4,135,468.81
CREDITS
The Accountant herein credits himself with the following:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Verizon
GPU Energy bill
Charles E. Wertz, apartment rent March
Register of Wills, Ltl test.
Register of Wills, short dfs.
Roger Gratz, stamp approval
Adams Auction Sales, coin appraisal
Larry Lee Stamp appraisal
U.s. Treasury, 2000 1040
P A. Dept. of Revenue, 2000 P A 40
Waggoner, Frutiger & Daub, prep. Taxes
Sentinel, estate ad
Cumberland Law Journal, estate ad
Verizon, bill of 3/19/01
Charles E. Wertz, April 2001, apt. rent
GPU Energy
Waste Management
AT&T
Thomas Berg,Supplies reimb. to clean apt.
GPU Energy
Dept. of Anesthesia, Sinai Hasp., med. Bill
15.16
$31.38
$485.00
288.00
104.00
$20.00
$150.00
$70.00
$3,017.00
$67.00
$600.00
$87.35
$75.00
$15.08
$485.00
$20.41
$2.64
$1.59
$93.99
$14.14
9.76
5
22.
23.
American Radiology, medical bill
Register of Wills, filing
inventory / appraise
Roger Glover/ commission on sale of car
Reserved for filing final account
Verizon
Pennsylvania Inheritance Tax
Register of Wills/ additional P A
inheri tance tax
Cremation Society of P A,
Pottsville Joint Veterans Honor Guard,
funeral
Greenawalt & Co, reserved for fiduciary
ret.
Thomas Berg, Executors fee
Douglas, Douglas & Douglas, attorney fee
IRS, 706 tax
American Radiology
Register of Wills, additional inheritance
tax
Register of Wills, additional probate fees
Register of Wills, filing supplemental
inventory
Register of Wills, additional probate fees
M& T Bank, bank charges
Tucker Anthony foreign taxes paid
Douglas, Douglas & Douglas, reimb. Sh.ctf
Army War College, Salvation Army,
Barnitz U.M. Church, personal property
Total Credits
500.00
$2,014,547.98
8.16
24.
25.
26.
27.
28.
34.00
200.00
$400.00
4.54
546,650.00
29.
30.
3,992.15
$155.00
$100.00
31.
32.
33.
34.
35.
36.
$5,000.00
78,750.00
78,750.00
1,291,171.00
38.32
37.
38.
1,079.00
32.00
39.
40.
41.
42.
43.
15.00
$1,547.00
12.92
432.54
23.85
44.
RECAPITULATION
TOTAL DEBITS
TOTAL CREDITS
BALANCE FOR DISTRIBUTION
$4,135,468.81
$2,014,547.98
$2,120/920.83
b............ '''-
~~?--:;~.~
/ -;;>
Thomas Berg
(SEAL)
6
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Thomas Berg being duly sworn according to law, deposes and says that he is
the Executor of the Estate of Albert Weiss Berg, deceased, and that the averments of
the within First and Final Account are true and correct to the best of affiant's
knowledge, information a~,,~,:l~~::f:_,,-,:~:L .,.... '.
'"""""""'7'~~ (SEAL)
Thomas Berg
Sworn to and subscribed
before me this \ day of f~ , 2002
~~ ~ Notary
Notanal Seal
Anne M Cox, Notary Public
Carlisle Borough, Cumberland Countv,......
MV commiSSIOn expIres July 14, 200~
7
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA.
ORPHANS' COURT DIVISION
NO.
STATEMENT OF PROPOSED DISTRIBUTION
OF THOMAS BERG, EXECUTOR OF THE LAST WILL AND TESTAMENT OF ALBERT
WEISS BERG, DECEASED, LATE OF LOWER FRANKFORD TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA
I, the accountant herein, propose to distribute the said estate in accordance with
the Last Will and Testament of ALBERT WEISS BERG as follows:
AMOUNT TO BE DISTRIBUTED $2,120,920.83
ITEM 2. I DEVISE AND BEQUEATH ONE-HALF OF MY ESTATE, REAL AND
PERSONAL, TO MY NEPHEW, THOMAS BERG, THE SON OF HERMAN BERG, III.
ITEM 3. I DEVISE AND BEQUEATH THE OTHER ONE-HALF OF MY ESTATE TO MY
NEPHEW, RICHARD BERG, ALSO THE SON OF HERMAN BERG, III:
THOMAS BERG, ONE HALF $1/060/460.41
Amasys Corp. 023113103 40.5 $0.00 $0.00
Ametex Corporation Nev 031114101 500 $0.00 $0.00
Anglo Canadian Mining Corporation 750 $0.00 $0.00
Armstrong Corp. 2.5 0.16 .50
Blackberry Gold Resources Inc. British
Columbia 3/750 $0.00 $0.00
Cordex Petroleums Ltd. 8 $0.00 $0.00
CPI Plastics Group Limited 6.5 $6.00 $39.00
Crack Resources Limited British
Columbia 5/000 $0.00 $0.00
Creative Entertainment Technologies,
Inc. 125 $0.05 5.86
OWl Corporation 233356104 100 $0.00 $0.00
Elan Corp PLC American Depository
Receipt 783.5 $50.55 $39/605.93
Enermark Res. Ltd, wts/ expo 12/17/01 942 .12 113.98
EVOP 60 .38 23.00
Exxon Mobil Corp. 30231G102 400 $83.70 $16/740.00
Fairmount Chemical Company 305477101 50 $0.07 $3.25
Forest Laboratories Inc. 345838106 10/000 $65.86 658/550.00
Fort Minerals Limited 2/500 $0.00 $0.00
GlaxosmithKline PLC 400 $53.21 21/282.00
Glitter Gold Mines Limited 2250 $0.00 $0.00
Harsco Corp. 415864107 1/650 $26.55 $43/807.50
8
Hershey Foods Corp. 427866108 1000 $59.81 $59,810.00
Infotechnology, Inc. 456798107 250 $0.00 $0.00
Ing Groep N.V. ADR 456837103 1209 $75.71 $45,763.67
International Sunatco Industries Limited 833.5 $0.00 $0.00
Johnson & Johnson 478160104 200 $95.05 $9,505.00
Kaftus Inds. Ltd. 482910106 50 $0.01 $0.37
Killick Gold Limited 8,000 $0.00 $0.00
Lexicon Resources Corporation 500 $0.00 $0.00
Lynwear Corporation Class A 551675101 150 $0.00 $0.00
Matachewan Cons Mines Ltd. 576471106 6,250 $0.05 209.31
Meridian Oil NL Amern Depositary 589775204
Receipt 5,000 $0.00 $0.00
Min Ore Mines Liited .5 $0.00 $0.00
Ormand Industries Incorporated 686679101 250 $0.00 $0.00
N eo Bionics Inc. 500 $0.00 $0.00
Pfizer, Inc. 717081103 825 $44.95 $37,083.75
Philco Resources Limited 2,750 $0.00 $0.00
Pioneer Systems Incorporated 50 $0.00 $0.00
Samex Mining Corp. 795912104 50 $0.10 4.87
Simax Oil & Gas 25 $0.00 $0.00
S1. Lucie Exploration Company Limited 792112104 500 $0.00 $0.00
Temple Mountain Industries Inc. 60 $0.00 $0.00
Templeton Develop markets 63.997 11.70 748.89
Travel By Us 3 1.00
UBZ Corp. 50 $0.00 $0.00
Ungava Copper Corp Ltd Merger 12.5 $0.00 $0.00
Value Tradings Industries Incorporated 500 $0.00 $0.00
Vanguard Oil Corp. 2,343.5 0.00 $0.00
Vishay Intertechnology Inc. 928298108 1000 $20.78 $20,775.00
Vodafone Group PLC New 92857T107 12.5 $34.52 $431.56
VTN Corporation 918346107 250 $0.00 $0.00
Wal Mart Stores, Inc. 800 $44,052.00
Watson Resources Corp. 425 $0.00 $0.00
Win Eldrich Mines Ltd. 972635106 950 0.17 157.63
Wolf Howard B Inc. 250 $0.00 $0.00
SUB TOTAL STOCKS $998,714.07
CASH 61,746.34
Total $1,060,460.41
9
TO RICHARD BERG, ONE HALF $1,060,460.42
Amasys Corp. 023113103 40.5 $0.00 $0.00
Ametex Corporation Nev 031114101 500 $0.00 $0.00
Anglo Canadian Mining Corporation 750 $0.00 $0.00
Armstrong Corp. 2.5 0.16 .50
Blackberry Gold Resources Inc. British
Columbia 3,750 $0.00 $0.00
Cordex Petroleums Ltd. 8 $0.00 $0.00
CPI Plastics Group Limited 6.5 $6.00 $39.00
Crack Resources Limited British
Columbia 5,000 $0.00 $0.00
Creative Entertainment Technologies,
Inc. 125 $0.05 $5.86
DWI Corporation 233356104 100 $0.00 $0.00
Elan Corp PLC American Depository
Receipt 783.5 $50.55 $39,605.93
Enermark Res. Ltd, wts, expo 12/17/01 942 .12 113.98
EVOP 60 .38 23.00
Exxon Mobil Corp. 30231G102 400 $83.70 $16,740.00
Fairmount Chemical Company 305477101 50 $0.07 $3.25
Forest Laboratories Inc. 345838106 10,000 $65.86 658,550.00
Fort Minerals Limited 2,500 $0.00 $0.00
GlaxosmithKline PLC 400 $53.21 21,282.00
Glitter Gold Mines Limited 2250 $0.00 $0.00
Harsco Corp. 415864107 1,650 $26.55 $43,807.50
Hershey Foods Corp. 427866108 1000 $59.81 $59,810.00
Infotechnology, Inc. 456798107 250 $0.00 $0.00
Ing Groep N.V. ADR 456837103 1209 $75.71 $45,763.67
International Sunatco Industries Limited 833.5 $0.00 $0.00
Johnson & Johnson 478160104 200 $95.05 $9,505.00
Kaftus Inds. Ltd. 482910106 50 $0.01 $0.3 7
Killick Gold Limited 8,000 $0.00 $0.00
Lexicon Resources Corporation 500 $0.00 $0.00
Lynwear Corporation Class A 551675101 150 $0.00 $0.00
Matachewan Cons Mines Ltd. 576471106 6,250 $0.05 209.31
Meridian Oil NL Amern Depositary 589775204
Receipt 5,000 $0.00 $0.00
Min Ore Mines Liited .5 $0.00 $0.00
Ormand Industries Incorporated 686679101 250 $0.00 $0.00
N eo Bionics Inc. 500 $0.00 $0.00
Pfizer, Inc. 717081103 825 $44.95 $37,083.75
Philco Resources Limited 2,750 $0.00 $0.00
Pioneer Systems Incorporated 50 $0.00 $0.00
Samex Mining Corp. 795912104 50 $0.10 4.87
Sima x Oil & Gas 25 $0.00 $0.00
St. Lucie Exploration Company Limited 792112104 500 $0.00 $0.00
10
Temple Mountain Industries Inc.
Templeton Develop markets
Travel By Us
UBZ Corp.
Ungava Copper Corp Ltd Merger
Value Tradings Industries Incorporated
Vanguard Oil Corp.
Vishay Intertechnology Inc.
Vodafone Group PLC New
VTN Corporation
Wal Mart Stores, Inc.
Watson Resources Corp.
Win Eldrich Mines Ltd.
Sub Total Stocks
Cash
Miscellaneous Coins
Total
TOTAL AMOUNT DISTRIBUTED
928298108
92857T107
918346107
972635106
r---=L~ ~
".._:,.~"..."..".. .~
, -- '" -- ----~
~
THOMAS BERG
11
60
63.997
3
50
12.5
500
2,343.5
1000
12.5
250
800
425
950
$0.00
11.70
$0.00
$0.00
$0.00
0.00
$20.78
$34.52
$0.00
$0.00
0.17
(SEAL)
$0.00
748.89
1.00
$0.00
$0.00
$0.00
$0.00
$20,775.00
$431.56
$0.00
$44,052.00
$0.00
157.61
$998,714.05
57,243.37
4503.00
$1,060,460.42
$2,120,920.83
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
THOMAS BERG, being duly sworn according to law, deposes and says that he
is the Executor of the Estate of ALBERT WEISS BERG, and that the averments of the
within Statement of Proposed Distribution are true and correct to the best of affiant's
knowledge, information and belief.
c;;:=;~~ (SEAL)
THOMAS BERG
Sworn to and subscribed
before me this' "p\ day of f ~ , 2002.
~Notary
NotarIal Seal
Anne M. Cox, Notary Public
Carlisle Borough, Cumberland County
My commiSSion expires July 14, 2QOS--.J
12
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/10/2005
DOUGLAS GEORGE FIll ESQ
1 IRVINE ROW
CARLISLE, PA 17013
RE: Estate of BERG ALBERT WEISS
File Number: 2001-00169
Dear Sir/Madam:
It has corne to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 2/02/2005
Your prompt attention to this matter will be appreciated.
Thank You.
A:~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
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STATUS REPORT UNDER RULE 6.12
A\ ~T ~~St::eRCo
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Name of Decedent:
Date of Death:
Will No.
1.(
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No \/ w.L aJ\..L loo.\-t\:\ ~oo('" ~s+4:a.. C\OC)h''\. \ L1-r
Of\ -,o~.
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: 1M Aou3
3. If the answer to No.1 is Yes, state the following:
a. Did the pers9flal representative file a final
account with the Court? Yes ~ No .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~ F. ~4-:6
Da te: \ - \ ~ - 0 '3>
Signat.ure
~CD Cge- F ~(.\'-''i Lc.- S UI:
Name (Pla.ase type or\print) ,\"
?- I lu. -H-\i' ST C,,- r( l )1 e. t1\
Address I l'lcl3
(l \'1) ~'+- "3> l '\ <1 D
Te 1. No.
Capacity:
Personal Representative
~unsel for personal
representative
(MAH:rmf/AM3)
l'-Tame of Decedent:
STATUS REPORT UNDER RULE 6.12
~ (112fT WI2l~S 6e-r&r
:2- / '2-/ V>D I
I
Date of Death:
V\Till No.:
:2-( - 0 I - 0 J ~ ti
Admin. No.:
Pursucult to Rule 6.12 of the Supreme Court Olphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State ~ther administration of the estate is complete:
Yes K1 No 0
2. lfthe answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did theyersonal representative file a final account with the Court?
YesX No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes 0 No 0
Date:
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
:d may be attached to this .re;ort. ~. . .... _
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Address
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Telephone No.
Capacity: n Personal ReDresentative
QCounsel for ~personal representative
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REV.1SllllEX(6-aI~ I
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COMMONWEALTH OF
PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPI 280601
HARRISBURG, PA 17128-0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECElJENT'S NAME (lAST, FIRST, AND MIDDlE INITIAl)
er Albert Weiss
DATE Of DEATH (MM-OO- YEAR) DATE Of BIRTH (_YEAR)
2/2/01 10/26/1913
(IF APPlICABlE) SURVMNG SPOIJSE'S NAME (lAST, FIRST, AND MIDDlE INITIAl)
[ill. Original Return
o 4. Limited Estate
Q9 6. Decedenl Died Testate _..,d"'J
o 9. Litigation Proceeds Received
o 2. Supplemental ReIum
040. Future tntenlstCompromise I""'d.......12.12"')
o 7.lJecedentMainlainedaLiYingTrust_..,dTMIJ
o 10. Spousal Poverty Credit {dale ot.....llIlwtIen 12-31..(11 n M-&5)
OFFICIAL USE ONLY
ILP - ~ (J1- 10
FILE NUMBER
2...L-~.L JL-LLL_
COUNTY CODE YEAR MJUBeR
SOCIAL SECURITY NUMBER
207 - 10 - 8495
lI\IS RETURH MUST BE FlLED IN DUPUCAlE WITlt THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainde<ReIum(dolod"""""""12-1>8>)
~ 5. FedeIaI Estate Tax Return Required
~ 8. TotaI_ 01 Safe Deposit Boxes
o It EIeclionklIaxIM1derSec. 9113(Ali_Sd\Oi
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NAME
George F. Douglas, III, Esquire
RRM NAME 111_)
uouglas, Douglas & Dou las
TElEPtiONE NUMBER
COMPLETE MAIlING ADIlRfSS
27 W. High St.
P.O. Box 261
Carlisle, PA 17013
1. Real Estate (Schedule A)
2. SloCks and Bonds (Schedule B)
3. C10seIy Held CoIporation, Par\neIShip or SoIe-Proprietorship
4. Mortgages & Notes ReceIYabIe (Scl1edlle D)
5. Cash, Bank Deposi1s & MisceIIa.-.. Personal Property
(Schedule E)
6. .l9inIlY Owned Property (Scl1edlle F)
o Sepanlte BDling Requested
7. Inter-Vivos T_ & MiscaIIa.-JS _ property
(Schedt.le G or L)
8. T.... Gross Assets (total Liles 1-7)
9. FII1Of8I Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent MoI1gage Liabilities, & Liens (Schedule I)
11. T.... DedutIIons (total Unes 9 & 10)
(1)
~) 3,788,980.43
(3)
(4)
~) ?In.n~l ?~
(6) 2,983.44
----
OFFICIAL USE ONLY
(8)
4,002,015.10
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12. Net Value of Estate (Une 8 minus Una 11)
(7)
(9) .165,872.58
(10)
13. Charitable and Govemmental BequestslSec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Sub/ecl to Tax (line 12 minus Una 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. An1<MrtofUne 141axab1e althe spoosaI tax
!ate, or _ uode< Sec. 9116 (aXt2)
16. Amooot of Line 14 taxable .1 lineal !ale
17. Amount of Line 14 taxable at sibling rale
18. Amoool 01 Una 14 taxable at _1e!aI!a1e
19. Tax Due
20.0
(11)
(12)
165,872.58
3,836,142.52
(14)
3,836,142.52
x.o_ (15)
x.O_ (lG)
x .12 (17)
x .15 (18) 575,421
(19) 575,42.1
3,836,142.52
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>ecedent's Conm1ete Address:
S1REET ADDRESS
814A Fairfield St., Mechanicsburg, PA 17055
Mechanicsburg
I STATE PA
rZlP
17055
CI1Y
"ax Payments and Credits:
Tax Due (Page 1 line 19)
CredifslPayments
A. Spousal Poverty Credit
B. Prior PaymenIs
C. Discounl
(1)
575,421.00
.?R 771
ToIalCredits(A+B+C)
(2)
28,771.00
IntereslIPenaIt W appflCBble
D. Interest
E. Penally
TOCaIInleresIIPenaIt ( D + E ) (3)
IfUne 218 greaterlhan Une 1 + line 3, eoter1he dilferIlnce. ThIs is 1he OVERPAYMENT.
Checl< bOx on Page 1 line 20 to request . refund (4)
If l.i1e 1 + l.i1e 3 is greater Ihan line 2, enter 1he diIferenoe. ThIs is 1he TAX DUE. (5)
A. Enter 1he Inleresl 00 1he tax due. (SA)
B. Enter 1he IoIaI 01 line 5 + SA. ThIs is 1he BAl..ANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
o
546,650.00
o
546,650.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did de<:edenl make a Inlnsfer and: Yes No
a. retain 1he use or Income of 1he property ball.lened;.:..........................__................................................... 0 iii
b. retain 1he right to designate who shall use 1he property 1ransIerTed or lis Income; ............................................ 0 !Xl
c. retain a ~ InIerest; or.......................................................................................................................... 0 g
d. recaiYe 1he pIlll1ise lor lie of either payments, benefits or care? ...................................................................,.. 0 g
2. If dealh occurred ofIer Decembet" 12, 1982. did decedent bansfer propef1y r.iIhin ooe year 01 dealh
without ~ adequate collsidetalion? .............................................................................................................. 0 . g
3. Did decedent own on 'in trust for" or payable upon dealh bank account or securily .1 his or her dea1h? .............. 0 I;J
4. Did decedenI own on IncivIduaI RetiremenlAoolunt. omulty. or other noo-proba1e property wllicll
c:onIaIns . benelicIaIy designation? .....................................................................................................................:.. 0 IKJ
: THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
;....-olpoc;.y.I_.....I__...._IncIud"o1g.............;.~_and-..m.lI1lllo...beslolmy~lI1llbelel.IIs....._II1ll"""""'"
_ol__........penonaIlopo....iloli..Is_IXl..lrIonnoIionol__hos..,~
elATURE Of PERSON RESPONSIBlE FOR FlUNG RETURN DATE
lRESS
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-130 Parker St., Carlisle, PA 17013
llATURE Of PREPARER OTHER THAN REPRESENTATIVE
George F. Douglas, III, Esq.
DATIl 101
JRESS
27 W.High St., Carlisle, PA 17013
dates of dealh 00 or. .fter ~ 1. 1994 and before January 1. 1995. 1he tax rate imposed 00 1he net value oI1nlnsIers to or lor 1he use ollhe suMiIng spouse is 3%
P.S. fi9116 (a) (1.1) Q)~
dates of death 00 Of after January 1. 1995. lhe tax rate imposed 00 !he net value ol1nlnsfers" or lor 1he use 01 !he surviving spouse is O'JI> (72 P.S. 59116 (a) (1.1) (i)~
sIab.Ce does not .~ . tensfer to . SUI'IMrIJ spouse from tax, and Ile sIaIulory reqtiremenIs lor cisdosure 01 assets and filing a tax mIIm are still applicable ewn W
survMng spouse is !he cdy beneficiary.
daIas of dealh 00 or ofIer -MY 1, 2000:
lax mtelmposed 00 !he net value oItmnsIars from e deceased child -.ty-one years of age or younger at dea1h to or lor !he use 01 a naIIr.Il parent. an adopIi'I9 parent.
sleppal9l4 of !he cIlIldlsO% (72 P.S. ~9116(a){12)J.
tax mte imposed on lhe net value oIlnlnsfers to or lor lhe use oIlhe decedent's ineal beneficiaries is 4.5%. exoept as noted in 72 P.S. 59116(1':2) ~2 P .s.s9116(a){111. -
tax mte imposed- on !he nel value 01 transfers to Of lor !he use oIlhe de<:edenfs siblings is 12% (72 P.S. 59116(a){1.3)). A sIbf"'9 is defined,- under Section 9102, as an
>1ualwro lias at least ooe parenlln common vriIh lhe deteden~ wheIher by blood or adoption. -
~_1500E),.l'-91)
'*
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETLRN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Albert Weiss Berg
21-01-0168
All property jolnUy-owned wflh right of IUlYlvorshlp must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
See attached lists of stocks with supporting documents
3,788,980.43
TOTAL (Also enter on line 2, Recapitulation) $3. 78!L OJ'" I"
(" more space is needed, insert additional sheets 01 the same size)
No.
Stock Namo
Charles Sctlwab Brokerage Account 1517.7268
Chartes Schwab Brokerage Account 1517-7291
Acadia Uranium Mines Umited
Allied Irish Banks (AIB)
Amalta Oils & Minerals, Lid alkJa Paracorp Ltd.
American Vision Centen; I~.
Ametex Corporation Nav
Anglo Canadian Mining Corporation
Anglo Company Umited
Ascot Metals Corporation limited
Atlantic Coast Copper Corporation limited T/A has 0
Atlanta Mines Ltd..
BAE SytotemS Canada Inc,
Barrick Gold Corp
BiospherJcs Incorporated
Black & Decker Corp.
Blackbeny Gold Resources Inc. British Columbia
Cabre Exploration Ltd. (Rights)
Callinan Mines Ltd. Nkla Consolidated Callinan
Campbe\I Resourees Inc.
Canada Southern Petroleum limited voting shares
Canadian Nisto Mines Limited
CanaelSn prospect ltd ESCHEATED
Carsl Mining Co. Lid
Carr Consolidated Bisqull
Cartier Quebec Exploration Lid Merger
OK Witco Corporation
ClearWorks.net Inc.
Coastal Caribbean Oil and Minerals Ltd. Bennuda.
Combined Metal Mines eJk/a CME Resources
Con~Key Mines Limited
CPt Plastics Group limited
Conro-Development Corporation Limited
CoosoIidatet1 BeIIekeno Mines Umited
Cordex Petroleums LId.
Covanta Energy Corp formerly Ogden
Cove Uranium Mines Limited
Crack. Resources Limited British Columbia
Creative Entertainment TechnolOgies, Inc.
Credo Petroleum Corporation
Crompton Corp
Crowpat Minterals Limited
David James Industrial Ud. N.V.aIkIa Intertech
Delta Minerals Corporation
Devon-LElduc Oils Lis ESCHEATED
Derogan Asbestos Corp lid
Duvex Oils & Mines Limited
OWl Corporation
Dynacore Enterprises Llimited
Elan Corp PLC American Depository Receipt
Enennark Income Fund Units
Enermark Income Fund WTS expire 12117101
Fainnount Chemical Company
Farwest Mining Lilmiled
Fanah Resources \Jmited
Filter Dynamics Inlemational, Inc.
Forest LabOratories Inc.
Fort Minerals limited
Frobex Limited
Fundy Exploration Limited
GlaxosmilhKline PLC
Glenn Explorations LId Merger
Glitter Gold Mines limited
Golden Triangle Industries Inc. New
Golden Triangle Royalty & Olllne.
Griffon Corp.
Gulf Lead Mines Umited
H.G. Young Mines Limited
Quantity
527,941.21
37,626.33
1000
5364
1000
500
1000
1500
200
1100
857
1,020
1600
840
1064
200
4000
1884
2,500
3
13966
500
50
500
10,000
12,000
24
3
1800
6,000
16,000
13
10,000
432
16
40
16,500
10,000
250
1000
24
2000
3156
250
200
500
100
200
320
1561
6123
1884
100
2030
100
100
32000
5000
0.03
.1000
800
4000
4500
51
8444
20
4,000
4,000
per share value
$1.00
$1.00
$0.00
$23.91
$1.05
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$16.76
$15.33
$6.16
$45.15
$0.00
$0.00
$0.10
$0.55
$5.88
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2.75
$1.44
$0.00
$0.00
$6.00
$0.00
$0.00
$0.00
$16.10
$0.00
$0.00
$0.07
$6.62
$11.20
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$50.61
$2.95
$0.12
$0.05
$0.00
$0.00
$0.00
$65.60
$0.00
$0.00
$0.00
$53.05
$0.00
$0.00
$2.00
$0.00
$7.40
$0.00
$0.00
Total
$527,941.27
$37,626.33
$0.00
$128,253.24
$1,050.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$26,816.00
$9,811.20
$6,550.25
$9,030.00
$0.00
$0.00
$255.00
$1.65
$82,050.25
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.25
$2,588.40
$0.00
$0.00
$78.00
$0.00
$0.00
$0.00
$668.00
$0.00
$0.00
$17.50
$6,620.00
$268.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$79,399.89
$18,062.85
$227.96
$5.00
$0.00
$0.00
$0.00
$2,099,200.00
$0.00
$0.00
$0.00
$42,440.00
$0.00
$0.00
$102.00
$0.00
$148.00
$0.00
$0.00
, ,
Harsco Corp.
Hershey Foods Corp.
Hugh.Pam Porcupine Mines Umited (Exchanged tor Enennark
Hydra Capital Corp. (Hydra Explorations lid)
Instrument Systems Corporation
Inttlrgraph Corp.
International Sunatco Industries Limited
KV Pharmaceutical Co. aass A
KV Pharmaceutical Co. ClliSS B
Katy Illdustries Incorporated
Kensington Resources Limited
Killick Gold Limited
Kinar\\. Corporation
Kirkland Minerals Corporation limited
Kirkland Townsite Gold Mines limited
Kontikl Lead & Zinc Mines lid aIkIa Advanced Pultrusion
KRL Res Corp
La Barge Incorporated
Lannett Company Incorporated
l6'lCOl' In\ema\iooallnc. aIkIa Pantepec
Lexicon Resources Corporation
lock Thread Corporation
lonmln PLC
lonmo Africa PLC
Louis Dreyfus Natural Gas Corp.
luxor Industrial COrporatiOn
lynwear CoTporation Class A
M&T Bank Corp.
Madison Fund Inc.
Magellan Petroleum Corp.
Mantaur Goldfields Corp.
Mauve! Mines Ud
Matachewan Consolidated Mines, Limited
Maxco Inc. MichIgan
Maxim Pharmaceuticals, Inc.
Maytag Corp
Meridian au NL Amem Depositary Receipt
Min Ore MII'I&S Lilted
Mlro Mines Limited
Mount Wright IronMlnes Company Umiled
Movie- Star Incorporated
Neo Bionics Inc.
New Hanicanna Minas Umiled
Nawnorth Gold Mines Umited
Noel Industries ESCHEATED
Northwest Ve-ntures LId Merger
Numac Oil & Gas ltd.
Obaska Lake- Mines Ud M&rg&r
Opemisca ExpIor&rs Umited
Optical Radiation Corporation
ORE..Qcean Research EqulpJFerranti
Ormand Industries Incorporated
Pallaum Minerals Umlted
Pan PacifIC Pe-troleum Registered Foreign
Pen\roo Industries, Inc.
Philco ReSOllrces Limited
Pioneer Systems Incorporated
Pole- Star Mines Limited
QED Exploration, Inc.
Quanto Explorations Limited
Read Rite Corp.
RocKy PetrOleums Limited
RSC Industries, Inc. aIkIa Matec
Rotonics Manufacturing Inc.
Santa Fe Resources lne.
Selas Corporatioo of America
Siebert Financial Corp.
SiITlltX Oil & Gas
St. luc\e Exploration Company Limited
Stardust Inc. alkJa Sanmark-Sntrdust,lnc.
3300
2000
13,000
60
200
80
1667
1350
1350
129
100
16,000
500
4,000
4,000
11000
6,667
200
6600
250
1000
1,000
90
90
49
1,250
300
648
109
2650
2
500
12,500
500
100
50
10,000
1
2000
0.5
1730
1000
22,500
2,000
300
4000
100
4000
500
100
200
500
20
57,200
500
5500
100
200
4,000
3,000
43
16
500
299
65
1500
258
50
1,000
2,130
$.26.42
$59.61
$0.00
$0.00
$0,00
$7.69
$0,00
$29,40
$29.40
$7,99
$0,70
$0,00
$0,91
$0,14
$0,00
$0,00
$0,06
$2,66
$0,63
$2,25
$0.00
$0.00
$15.45
$0,20
$34,55
$0.41
$0,00
$67.02
$0,00
$1,05
$0,00
$0.00
$0,00
$7,88
$7,69
$34.73
$0,00
$0,00
$0.00
$0,00
$0.60
$0,00
$0.00
$0.00
$0,00
$0.00
$0.00
$0,00
$0.00
$0.00
$0,00
$0.00
$0,18
$0.04
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.31
$0.00
$5.00
$0.78
$0.00
$3.75
$6.25
$0.00
$0.00
$0.00
$87,186.00
$119,620.00
$0.00
$0.00
$0.00
$615.04
$0.00
$39,690.00
$39,690.00
$1,030.71
$10.00
$0,00
$455.00
$560.00
$0.00
$0.00
$420.02
$536.00
$5,500.00
$562.50
$0.00
$0.00
$1,390.50
$18.27
$1,692.95
$512.50
$0,00
$43,428.96
$0.00
$2,714.29
$0.00
$0.00
$0.00
$3,937.50
$768.15
$1,736.50
$0.00
$0.00
$0.00
$0.00
$1,038.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$3.68
$2,516.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$400.42
$0.00
$2,500.00
$233.22
$0.00
$5,625.00
$1,600.00
$0.00
$0.00
$0.00
, .
Steego Corporation
Tax Cofp. 01 America
Temple Mountain 1ndusb1es Inc.
T",""", Cola Cclponltion
ToItec oa & Gas Inc. aNa Taraga Gas & 01\
T~ra Oils UmIIed
Triarc CornpanIe$ toe., Class A Delaware alWa OWG Gorp
Trump HOIefs and Casino Resorts Inc.
UBZ eo.p.
Ungava Copper Corp LId M_
UnIbfaz. CorporaIlon
U_ ~ MIneo Umi1ed
V.... T_ _lncorporaled
Ventures, UmIted ESCHEATEO
Vlco Exp/otlltions Umlted
VlShay lnlef'l8chnobgy Inc.
VTN Corpooation
W._ CllplIaI Managamenllnc.
Watson IntemationaI Resoun::es Ud.
Watson Rescutcea Corp. aAIIa cede. Inc.
W.1l<o ErIarp.... lncorporaled
W..- _ Oi & Gas Company UmlIed
WJn..EIdrich M"1n8S UmIIed
_OOs&Mine$Umlted
Wolf Howard B Inc.
;'Merna Lynch BrokBraQ8 Accounl 872.12768 Cash
Morgan Star1tey Dean WItter 410-017648-006
Van Kampen Tax Free Money Fund 270-07379
3.
4.500
120
2,649
500
1,000
4184
.
100
25
100
200
1000
.
1,000
11061
500
60
2,000
950
1200
62
1,900
l,GOO
500
1960
2225.16
1215.61
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$24.90
$2.89
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$20.05
$0.00
$0.00
$0.00
$0.00
$9.90
$0.00
$0.00
$0.00
$0.00
$1.00
$1.00
$1.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$104,181.60
$11.56
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$222.174.05
$0.00
$0.00
$0.00
$0.00
$11...0.00
$0.00
$0.00
$0.00
$0.00
$1,960.00
$2,225.16
$1,215.61
$3.788,980.43
. .
REV-t5lJll~+(t-&1}
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21-01-0169
Albert Weiss Berg
IncIOOe 1he proceeds 01 litigation and 1he date 1he proceeds wen! received by 1he estate. AI JlR>POfIY jolntly_ with the right of survivorship must be disclosed on Schedule F.
ITEM YALUEAT DATE
NUMBER DESCRIPTION OF DEATH
t
Personal PropofIy
MlsceIIaneous coins
1993 NIssan SentIa XE Sedan 2d ....rage blue book
AllilSt BanI<-passl>Oo'< save. 87004935731478
SIamps aoId to Lany Lee Stamps
_ E>cpIess TraveIen CI1ecb
VatefanS M,II"lstJ_, burial aJIowanco
Suburban ~ '"""'"
_ H &Mngs Bond
Per"lS)'fvania EscheaIa
cremation SocIely 01 PA. p<epared ........
500
4503
2500
195,552.14
1700
3400
100
15.59
500
15.50
1265
$1.00
$1.00
$1.00
$1.00
$1.00
$1.00
$1.00
$1.00
$1.00
$1.00
$1.00
.
$500.00
$4,503.00
$2,500.00
$195,552.14
$1,700.00
$3,400.00
$100.00
$15.59
$500.00
$15.50
$1,265.00
$210,051.23
TOTAL (Also enter on line 5, Recapittllation) $
(If more space is needed, insert additional sheets of the same size)
"""""""'71'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAl( RETURN
SIOENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Albert Weiss Berg
FILE NUMBER
21-01-0169
Wan assai was made jolnlwtlllln oneyearofthe '*-._ of_. klllUlt lie _118d on Schedule G.
SURVIVlNG JOINT TENANT(S) NME
IJlORESS
RELATIONSHIP TO DECEDENT
A.
Thomas Berg
130 Parker St., Carlisle, PA 17013
Nephew
B.
C.
JOINTLY.{)WNED PROPERTY:
lETTER DATE DESCRPllON OF PROPERTY "OF DATE Of DEATH
ITEM fOR JOINT MACE IncIude.....or__IIldblr1kexountnumlieror_klenIIfylngllUlTl>er._ DATE Of DEATH DEWS VALlJE OF
NlMlER TENANT JOINT deedforjlinly_..._ VAl..l.E OF ASSET mEREST DECEOEIIT'S mEREST
1. A. PNC Bank Account No. 500537774 5,966.88 .50 2,983.44
.,-'
.
TOTAL (Also enter on line 6, Recapitulation) $ 2,983.44
-
(W more space is needed, insert additional sheets of the same size)
REV-1511'EX+ (1t-9!:l)
, ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Albert
Weiss Berg
Debts of decedent must be reported on Schedule 1.
FILE NUMBER
21-01-0169
ESTATE OF
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Cremation Society of PA
Additional payment due at death on funeral bill
Pottsville Joint Veterans Honor Guard,funera1
1,265.00
155.00
100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 Personal Representative(s)
Thomas Berg
Social Security Number(s)/EIN Number of Personal Represeota\ive(s}
130 Parker St.
Street Address
City
Carlisle,
State~Zip 17013
$78,750.00
Year(s) Commission Paid:
2001
2. Attorney Fees
3.
Douglas, Douglas & Douglas, 27 W. High St.,Car1is1e,PA
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
78,750.00
Claimant
None
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees Register of Wills, Cumberland County, PA
392.00
5.
Accountant's Fees Es t ima t ed -Greenawal t & Company
1,000.00
6. Tax Return Preparer's Fees
7. See attached List for additional costs
TOTAL (Also enter on line 9, Recapitulation) $ 165,872.58
(If more space is needed, insert additional sheets of the same size)
Payee
GPU Energy bin
Charles E. Wertz, apartment rent March
Roger Gretz, stamp approval
Adams Auction Sales, coin appraisal
Larry Las Stamp appraisal
U.S. Treasury, 2000 1040
PA. Dept. of Revenue, 2000 PA 40
Waggoner, Frutiger & Daub, prep. Taxes
Sentinel, estate ad
Cumberland Law Journal, estate ad
Verizon, bill of 3/19/01
Charles E. Wertz, April 2001, apt. rent
GPU Energy
Waste Management
AT&T
Thomas Berg,Supplles relmb.to clean apt.
GPU Energy
Reserved for filing inventory
Reserved for filing final account
$31.38
$485.00
$20.00
$150.00
$70.00
$3,017.00
$67.00
$600.00
$87.35
$75.00
$15.08
$485.00
$20.41
$2.64
$1.59
$93.99
$14.14
$25.00
$200.00
REV_1513EX+(1_97J.
. .
. ,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DEC DENT
SCHEDULE J
BENEFICIARIES
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
r. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Thomas Berg nephew 1/2
130 Parker St.
Carlisle, PA 17013
Richard Berg nephew 1/2
P.O. Box 273
Stevenson, Maryland
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
-
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
Albert Weiss Berg
FILE NUMBER
21-01-0169
ESTATE OF
(If more space IS needed,lnsert additional sheets of the same size)
LARRY LEE STAMPS
322 S. FRONT ST. 717-763-7605
WORMLEYSBlJRG, PA 1~
4607
Date 4 ~1 "71'''''
60-8310313
46..
Pay to the
Order of.
?~~.b- R-D.~ ~~~
I $1>7<.l11~
~ M...._ '\0\_,. 'u....J qB~_ \-.. ~..:.....J n .. ""'?I-"~ - Dollars tD =.=:--=
!l allfirst
AIl6rst Bank
Harrisbutg. PA 17101
For 1>'<""., __...J J-............ ___ ~-~. ......,I~^_A. ...
':03 BOOB 31.': 51. 71; 5 5 31;"" lobO 7
......-
~8AFETYElWEOFIII3t.
III allflrst
Allfirst Financial Center N.A.
P.O. Box 900
Millsboro, DE 19966
February 28, 2001
Pbone (302) 934-2909
Fax (302) 934-2955
Thomas Berg
130 Parker Street
Carlisle, P A 17013
Re: egjat!LPiAleiir1JJerg
Social Securitv: 207-10-8495
Date of Death: Februarv 02,2001
Dear Sir or Madam:
Per your inquiry dated February 16,2001, please be advised that at the time of death, the above-named decedent
had on deposit with this bank the following:
1.
Type of Account
Passbook Savings
Account Number
87004935731478
OWllership (Names of)
Albert Berg
Thomas H. Berg, POA
Richard A. Berg, POA
Opelling Date
11/24/87
Balance 011 Date of Death
$194,947.06
Accrued Interest
$ 605.08
Total
- $Jii5;552. iT -- - - -- -- -- - --
This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,
Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement.
For further account information, closures and/or reimbursement of funds refer to be/ow branch:
CAMP HILL OFFICE
3045 MARKET STREET
CAMP HILL, P A 17011
717-255-2279
. Sf~Y'
~e
Assistant III
Cis Services, (302) 934-2909
FEB 26 2001
0PNCBAN<
Decedent Reporting
Firstside Center
500 First Avenue, 4th Floor
Pittsburgh, PA 15219-3128
/SCP
February 21,2001
Douglas Douglas & Douglas
27 West High Street
PO Box 261
Carlisle, PA 17013
RE: Estate of Albert W. Berg, Deceased
SSN: 207-10-8495
DOD: 02/02/2001
Dear Sir or Madam:
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#5005377774 Established 08/22/1996
ALBERT BERG
THOMAS H BERG
DOD Balance: $5,966.44 + $0.44 accrued interest
For Loan information please contact the Consumer Loan Center: 1-800-878-0027
RCA: #4003048014335310
Page 1 of2
A member of The PNC Financial Services Group
PNC Bank NA Pittsburgh Pennsylvania 15265
0PNCBAN<
Our office only provides date of death balances for IRA's, CD's, Checking and
Savings accounts. We do NO Financial Transactions or Statement Orders. For
Further information please call1-800-4-BANKER or your local PNC Branch and
ask to speak with a Financial Services Representative.
Sincer~~~
~ ---';;jjr ~ .
Erica A. Bishop
1-800-762-1775
Page 2 of2
A member of The PNC Financial Services Group
PNC Bank NA Pittsburgh Pennsylvania 15265
J'~DAMS
.....UCTION
SALES SERVICE
Mervin W. Adams
Steven E. Adams
AU-000002
AU-OO 1705
~ Phone (717) 692-3076
~
February 27, 2001
Attorney Douglas, Douglas &
27 W. High Street
Carlisle, P A 17013
Re: Albert Berg Estate
TO WHOM IT MAY CO
The following three a
Berg Estate of Box 45
208 Maple Street · Millersburg. PA 17061
-Page 1 - Albert Berg Estate - Coin Appraisal-
57 - 1986-S - Statue of Liberty - Ellis Island Commemoratives - Proof
Dollars - 57 @ $ 5.00 each -------------------------------------------------______.$ 285.00
33 - 1986-S - Statue of Liberty - ProofHalfDol1ars - 33 @ $ 3.00 each ---------------99.06
PEACE SILVER DOLLAR ROLLS
Roll #P-l - 22 pes - 1922 - Good to Fine--------------------------------------------------ll0.00
Roll #P-2 _ 18 pes.- 1922 _ XF+ ----~---------------------------------------------------.144.00
Roll #P-3 - 20 pes.- 1923 - VF! ';!~l.t.~~~~'c':""f:_--------------------------.140.00
Roll #P-4 - 4 - pes. 1923 - Goo' . " . 0 ,::+------------------------------20.00
Roll #P-5 - 10 pes.- 1924 - XF+',,~",/;,~. ...'.:;~y.~-------------------------------80.00
Roll #P-6 - 5 pes.- 1925 - XF+~..;...,.l;( ..:,.~.'-."""""'~f----------------------------_40.00
# 2 5 6 ...;~:~t "?~_\-':~. :t_'t/t3,\~>'~-:,:-}~\1'~-~>:);;;,_/-_
Roll P-7 - 1924 - 5- 2 - 2 ~.i:;t~~;"'\~~.r;.'t,..~~~----------------------------24.00
~~~ :;~~ ~ ~~~~~ ~ii : ~iki~t;~~~I~~C~~~~~~~~~~~~~~~~~~~~~~~~:~~
Roll #P-I0 - 3 - 1924, 2-261i~~i~~~ry~~~~;~i~------------------------30.00
>frz;; i>'.:..'.~;'t.r~2i~r:l~itJ~~1$0
IKE DOLLARS .,.
MORGAN SIL
, ~,'" '"
',', '>';(:.;--<-~::-,'~->-
---------------------3.00
1971 - 72 - 78 - Clad-
,,- /)
~,~J;:-,L _',,'-,_ __ '
,"""~~-..._..._r-----...~~~~~1:i""'~. '"
,.",
1934-A series Ten
otherwise
,:,i;i-~~~~~\;:~i+-{).;f/.-
.. .. ". " "", -, ,'...... <'
er ce~e~~:~ (;:\~~.;,~I,~ i
---------..7""~..~-7;t'''':---~7-........-t.'t'''?,~-~-_;-
· ------------12.00
PAPER BILL
_-';;~yt?t~<-:'jr _',__'A~.,__., " -; ",..'.. .,'...... ,';> t,;!:",_
~~~O~~.~.~~~::~~~-------------------------------:-~:~~~~~:i~;~~~.______14 00
~;:!>::":';~;;;;;t;\>{P"j;i~,<.,,'.., ,:: ....... .;': -';;:.:f~~'t1J;:."/f3:~~,~:;;-st:;,'< ,"',,__ _ .
1884 -.1i,i~I.,,'::' ,.~~~;."!f"7"------------------------.......7"""'" 00 >io~'~~:l".~~";;;,;.~d2:..12.00
1885 - XF -----________________n______________________________________--------------------------12.00
1886 - AU --------------------------------------------------------------------------------------14.00
2 - 1889 - XF - 2 @ $ 11.00----------------------__________________________________----------22.00
1890 - XF ----------------______________n___________________________-------------"-------------12. 00
2 - 1896 - AU - 2 @ $ 13.00 ----------------------------------------------------__________---26.00
1904-0 - Unc. __n___________________________________________________________-------------------15.00
1904-0 - XF -------------------------------_________________n___________-----------------------12.00
10 - 1921 - Morgan - Hi AU & Unc. - 10 @ $ 10.00 each -----------------------------.100.00
, .
-Page 2 - Albert Berg Estate - Coin Appraisal
MORGAN SILVER DOLLARS (CON'T.)
Roll #M-Z - One roll Mixed Dates - F & VF - No Key Dates ------------------------$ 140.00
Roll #M-3 - One roll Mixed Dates - F & VF - lOOStly F - No Key Dates--------------.140.oo
Roll #M-4 - One roll Mixed Dates - F & VF - mostly F - No Key Dates--------------.140.00
Roll # M-5 - One roll Mixed Dates - G & VF - No Key Dates-------------------------.IOO.OO
Roll #M-6 - 1/2 roll Mixed Dates - About G - G & VF- VF - No Key Dates -----------50.00
In 2x2s Dollar Coin Holders
3 - 1878-S - VF - 3 @$ 10.00*
1878 - 2nd. Reverse - 7 Tail F
1879 - VF & 1879-0 - F - 0
1896-S - XF Dull in
1921 - Morgan - XF ----------
1921-S - Morgan - Hi VF---;
------------------------------30.00
------------------------------10.00
---------------------------.9.00
. --------------------------.9.00
FRANKLIN HALF DOL.
Roll #1 - One roll Mixe
Rolls #2, 3, 4, &5 - 4 r
Roll #6 - One roll - . .
Roll #7 - 4 pes. - 51-
--------------------27.00
h--------------.108.oo
----------------30.00
-----------------.5.50
BARBER HALF
.00---.160.00
--------21.00
WALKlN:!;l .
~~~:;;),,~:k';t;tk:;~'PZ; >. .~ .' '
Roll #WL-l - One roll (7 pes.) 1-1941,3-1945,2-1945-0
Roll #WL-2 thru #16 - 15 rolls - Mixed Dates - Cire. - 15 @ $ 32.00-----------------480.00
Roll #WL - 17 - 1 roll (I9 pes.) - P.D&S - Cire. -------------------------------------------32.00
Roll WL- 18 - 1 roll (19 pes.) Mixed w/weak & unreadable Dates ----------------------27.00
KENNEDY HALF DOLLARS
7 - rolls - 1964 - All Upper Grades - 7 @$ 30.00 eaeh------------------------------.210.00
1 roll (9 pes;) 1964 - All Upper Grades -----------------------------------------------------13.50
-Page 3 - Albert Berg Esate - Coin Appraisal-
QUARTER DOLLAR ROLLS
18 rolls - Wash. - All Silver - All Upper Grades - 18 @ $ 30.00 ea -----------------$ 540.00
12 rolls - Wash. - All Silver - Cire. Low Grades - 12 @ $ 27.00-----------------------.324.00
Rolls #BQ#1 thru 10 - 10 rolls - Barber - Cire. - Low Grades - 10 @$ 28.00-------.280.00
Roll #BQ# II - I roll (25 pes.) Cire. - Low Grades ----------------------------------------16.25
Roll SL#1 - I roll Standing Liberty Quarters - Weak & Unreadable Dates -------------25.00
Roll SL#2 - I roll (29 [pes.) Standing Liberty Quarters Weak and
Unreadable Date~ft;----------------------------------------____________17.50
ti;,~ .
'J',.,
DIMES
5 rolls Barber Dimes - Cire.
I roll (43 pes.) Barber Dimes
I roll (44 pes.) Roosevlet D:
I roll (8 pes.) Mercury D'
NICKELS
ff'. --------------------.2.50
------------------.1.75
--------$ 4,503.00
Mervin W. Adams
~elley Iillue Book Used Car Values
Page 1 of2
-~.==
Used Car Values
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OCustoltlBuihlTlllsVetllde oGetTturd P~
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il Deater Near You 0 Flflilllce Your Vetllde
~
Click on the image above to visit this advertiser
Blue Book Trade-In Report
Pennsylvania. February 7. 2001
1993 Nissan Sentra XE Sedan 20
Engine: 4 Cylinder Gas
Trans: Automatic
Drive: Front Wheel Drive
Mileage: 72,000
W<lYSto 13uy a l)sed Ci'lr
WgJ'.~.IQ.6.YYng.N~w..(;gr
,List V9ur Ci'lrForSglgQoline
Financinq Quote
In~Yrgn~gQY9.te
Warranty Quote
Pgrt~&'A~~e~~9rie~
pgyrnent "Ci'll~,y!ator
Equipment
Air Conditioning
Power Steering
Tilt Wheel
AM/FM Stereo
Consumer Rated Condition:
Fair
"Fair" condition means that the vehicle probably has some mechanical or
cosmetic defects, but is still in safe running condition. The paint, body and/or
interior need work to be performed by a professional in order to be sold. The
tires need to be replaced. There may be some repairable rust damage. The
value of cars in this category may vary widely. A clean titl~ hi~torY is assumed.
Even after significant reconditioning this vehicle may not qualify for the Blue
Book Suggested Retail value.
Trade-In Value
$1,760
Trade-in value represents what you might expect to receive from a dealer for
this consumer owned vehicle. Keep in mind that the dealer must then absorb
the cost of making the vehicle ready for sale, advertising, sales commissions,
arranging financing and insurance and standing behind the vehicle for any
mechanical or safety problems.
Copyright @ 2001 by Kelley Blue Book Ca., All Rights Reserved. Jan-Feb 2001 Edition. The Information
In this report was printed from the Kelley Blue Book Web site (www.kbb.com) and is intended for the
personal use of the customer only and may not be sold or transmitted to another party. We assume no
responsibility for errors or omissions.
http://www.kbb.com/kblki.dlllkw.kc.ur?kbb;834462&;t&39&9;NI;F6&
02107/2001
~eJley Blue Book Used Car Values
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used Car Values
New Car Pricing
Motorcyd....
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Buy a used c.... i
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---I Blue Book Retail Report
Financing i
Insuran<e , Pennsylvania' February 7, 2001
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1993 Nissan Sentra XE Sedan 20
Engine: 4 Cylinder Gas
Trans: Automatic
Drive: Front Wheel Drive
Mileage: 72,000
Wa,Ys toJ\\!ya,!JsedCa,r
wa,YsTo~\!ya,Ney(c::a,r
ListYoJJLc::ar.[orSa,LeQnUne
Flnancing.Q\!ote
Lns\!J"anceQ\!ot5l
WclHa,[ltyQ\!ote
Parts & Accessories
pa,yment Ca,IqJJa,toI
Equipment
Tilt Wheel
AM/FM Stereo
Air Conditioning
Power Steering
Retail Value
$4,760
S\!ggested retail represents the price a dealership might ask for this make and
model vehicle. This represents a fully reconditioned vehicle in excellent
condition with a clean titlenist.Qry. This retail price is not a trade-in or private-
party value, but rather assumes that a dealer has absorbed the cost of making
the vehicle ready for sale, reconditioning, advertising, sales commissions,
arranging for financing and insurance and standing behind the vehicle for any
mechanical or safety problems. Many late model vehicles at this price have
passed an inspection program or carry a warranty. Actual dealer selling price
may vary from this price.
Copyright @ 2001 by Kelley Blue Book Co., All Rights Reserved. Jan-Feb 2001 Edition. The information
in this report was printed from the Kelley Blue Book Web site (www.kbb.com) and Is intended for the
personal use of the customer only and may not be sold or transmitted to another party. We assume no
responsibility for errors or omissions.
http://www.kbb.com/kblki.dlllkw.kc.ur?kbb;265305&;r&40&9;NI;F6&
02/07/2001
Statement Period: December 1, 2000 through December 31, 2000
Last Statement: November 30, 2000
I
I
I Brokerage Account of
ALBERT BERG
PO BOX 457
MECHANICSBURG PA 17055-0457
Please call us if you have a new address.
Account Number:
1517-7268
I Customer Service and Account Information
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Customer Service and Trading:
Call your Schwab Signature Gold team
1 (800) 979-8229
TeleBroker$:
1 (800) 272-4922
Local Office:
22A NORTH SECOND ST.
HARRISBURG, PA 17101
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111111111111111111111111111111111111111111111111111111111III
"9678050400"
Charles Schwab
it'jh:. ""' ~ ~ ' ..i~'~'7~,;;i... '~~0.;",,}!' t~,~m.-: _ 1 ~ "- "y ~{': :,. ,.,.' ~ 1 ~"".~ :~o:,,',i~ 1.. " ,!'? "'{ r_" ,'-'" H ...:.f:< ''< ~:v:..". ".-;,."'"
':"~">\; ,+'t,~1:o'~ ,',_' 1.~;,:&~4- 1; Ji1;:~;:4@:,~.")",.;i!\~{.~ ., ,,""'~Ji" i'X',1.1<'~I'7~.,4:$:' ~',';:i'~, ' ",:y~'-Y7l1C~~\.,;t..~ m. ;,AJ~~t;<\''''..A.~
~;'!t'! " ..I,. ,", .: ,'~/j"~ 1;W.~ ".' l A:: >1' >],J."!M 0 ~: ',;""" ~.S.,' 19~ ~~'~~r..jr~~'{'h.);" ;'"f..b;>~I1~~IJ~~'^'<\ ,~. ~', .....~1'>',,'Z<~"'."!01~~::. ""'
Account of ALBERT BERG
Statement Period: December 1, 2000 through December 31, 2000
Account Number: 1517-7268
. ,
I Transaction Detail (continued)
Cash Activity (continued)
Trans Process
Date Date Transaction Description
Fees and Charges
12/08 12/08 ADR Mgmt Fee MAGELLAN PETE AUST ADR F
Total Fees and Charges
Expense Credit
$ 29.40
$ 29.40
$ 29.40 $ 795.56 I
Subtractions Additions
from Account to Account
$ 30.67 $ 795.56
I Total Cash Activity
Grand Total Transaction Detail
I Money Funds Detail
Settle Date
Transaction
Money Market Funds (Sweep) Activity
SCHWAB MONEY MARKET FUND Activity
Opening Shares of SCHWAB MONEY MARKET FUND were 21,341.9200
12/04 Purchased
12/05 Purchased
12/08 Purchased
12/11 Purchased
12/12 Purchased
12/13 Purchased
EB03501-00861874816
~ Printed 011 Rccyded Pa~f
Quantity
15.3300
12.4500
148.5000
154.3500
176
64
Unit Price
Purchase/Debit
Sale/Credit
$1
1
1
1
1
1
$15.33
12.45
148.50
154.35
176.00
64.00
CS 4428 17/99)
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Statement Period: December 1,2000 through December 31, 2000
Last Statement: November 30, 2000
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EB03501-Cl0861974819
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II
I Brokerage Account of
ALBERT BERG
ACCT # 2
PO BOX 457
MECHANICSBURG PA 17055-0457
Please call us if you have a new address.
Account Number:
1517-7291
I Customer Service and Account Information
Customer Service and Trading:
Call your Schwab Signature Gold team
1 (800) 979-8229
TeleBroker@:
1 (800) 272-4922
Local Office:
22A NORTH SECOND ST.
HARRISBURG, PA 17101
Visit Our Web Site:
schwab. com
~~~-
CS 442B 17/99)
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Account of ALBERT BERG
- --
Statement Period: December 1, 2000 through December 31, 2000
Account Number: 1517-1291
I Investment Detail
Description
Cash and Money Market Funds (Sweep)
CASH
SCHWAB MONEY MARKET FUND
Total Market Value of Cash and Money Market Funds (SweIlP)
Stocks
CREDO PETROLEUM CORP NEW
DEVON ENERGY CORP NEW
LANNETIINC
LUXOR INDUSTRIAL CORP F
MATACHEWAN CONS MINES F
CL A SPL
MATEC CORPORATION NEW
ROTONICS MFG INC
ST LUCIE EXPL L TO F
TEXACO INCORPORATED
Total Market Value of Stocks
Unpriced Securities
WIN ELDRICH MINES L TO F
Quote Quantity Latest Total
Symbol Long/Short Price Market Value
$ 0.70
SWMXX 18,358.4200 L $1 18.358.42
$ 18,359.12
CRED 100 L $ 5.2500 $ 525.00
DVN 14 L 60.9700 853.58
LANN 17,600 L 0.6875 12,100.00
LXRRF 1,250 L 0.1850 231.25
MWCAF 12,500 L 0.0200 250.00
MXC 750 L 6.1250 4,593.75
RMI 166 L 0.7500 124.50
STUEF 1,000 L 0.0300 30.00
TX 9 L 62.1250 559.13
$19,267.21
WIDMF 1,900 L N/A N/A
I Total Account Value (excl. unpriced securities) $ 37,626.331
I Transaction Detail
Cash Activity
Trans Process
Date Date Transaction Description
Investment Income Activity (including Money Market Fund dividends reinvested)
12/08 12/08 Cash Dividend T.EXACO INCORPORATED
12/29 12/29 Cash Dividend DEVON ENERGY CORP NEW
Debit
Income
$4.05
0.70
EB03501-00861974822
iW.\.... .
Charles Schwab
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Account of ALBERT BERG
Statement Period: December 1,2000 through December 31, 2000
Account Number: 1517-7291
I
I Investment Income Summary
Description
Money Funds Dividends
Cash Dividends
I Total Investment Income
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MORGAN STANLEY DEAN WITTER
4th & Walnut Streets
P.O. Box 12053
Harrisburg, P A 17108
800-676-0673 717-255-6666
March 13, 2001
George F. DOuglas III
Douglas, Douglas & Douglas
27 W High Street
PO Box 261
Carlisle, PA 17013
Re: Estate of Albert W. Berg
Account # 410-017648
Dear Mr. Douglas:
Attached is copy of the Date of Death Value you requested for Albert W. Berg.
You will see, the money market information is listed at the top and the securities listed
down below. If you require any other information, please feel free to contact me at
(717) 255-6681.
Sincerely,
~YL~ t iLl1t----
Amy ~yer
Sales Assistant to
Tamara L. Jennings
Estate of Albert Berg
Account # 410-017648-006
Money Market Balance
As of 02I02I01
Description
Kensington Res
Read-Rite Corp
Barrick Gold Corp
Trump Hotels & Casion Resorts
Creative Entertainment Tech
BAE Systems Canada Inc
Black & Decker Corp
CDA So Pete LId Vtg Stk
Elan PLC Adr
Helix Technology Corporation
Intergraph CP
Kinark CP
Lexicon Resources Corp
Maytag Corp
/ Ogden Corp
Vishay Intertechnology Inc
GlaxosmRhkline PLC Ads
Total Value of Securities
$2,225.16
Close
0.700
9.312
15.330
2.890
0.070
16.760
45.150
5.875
50.67
27.984
7.688
0.910
0.020
34.730
16.700
20.050
53.050
Value
70.00 v
400.42../
1839.60
11.56/
17.50..-"
26816.00 v
9030.00/
188oo.0OV
79399.89 ,/
11193.60
615.04
455.00'/
20.00
1736.50/
668.00v'
4290.70 v'
42440.00 V
197803.81
MAR () 1 20m
Private Client Group
~M8rrill Lynch
214 Senate Avenue
Suite 501
P.O. Box 0810
Camp Hill. PennsylvanIa 17001-0810
717 975 4600
800 937 0735
February 27, 2001
Douglas, Douglas, & Douglas
Attn.: George Douglas, III
27 West High Street
Carlisle, PA 17013
RE: ESTATE OF ALBERT W. BERG
ACCOUNT #872-12768
Mr. Douglas,
As per your request, the value of the above referenced estate account, as of
February 2, 2001 is enclosed. I have also enclosed a copy of his December
statement. There are 3 securities highlighted that have no available figures.
We have not yet received any of the necessary paperwork or instructions on
opening an estate account. Also the stale check that you forwarded is being
researched.
Please contact Gwyn or myself with any questions.
s:;rreIY,
~-~JtZ
Todd Boop
Financial Consultant
Certified Financial Manager
TB/gw
Historical Pricing Inquiry Page 1 of 1
Historical Pricing Inquiry , .,
coeBF - COASTAL CARIBBEAN OILSltMINL/ Cusip: 190432203 'C-.
'Oatle High Price Low Price Close Price Volume ',' f . 'of -",,<,,'{
,C-',/
02/02/2001 1. 500 1.219 1.438 22800
"
KT.. KATY INOS INC !2-1 Y -? ~ 'J 1030.11
Cusip: 486026107 ' .
Datl~ High Price Low Price Close Price Volume
02/02/2001 7.990 7.750 7.990 8000
)"J., 51 b .,-
LO. LOUIS DREYFUS NAT GAS CORP V Cusip: 546011107 v
Oat.:!' High Price Low Price Close Price Volume
02/02/2001 34.660 33.710 34.550 138500
LOMNY - LONMIN PUB LTO CO /' Cuslp: 54336Q104 V
Oat., High Price Low Price Close Price Volume
, _ J ; I:H ;;.;
02/U2/200l .000 .000 15.450 0 1,))< ,
RMI - ROTONICS MFG INC Cusip: 778903104 v'
Oat':!' High Price Low Price Close Price Volume ? :2 '.>~)
02/U2/2001 .780 .760 .780 500
SIEB, - SIEBERT FINL CORP Cusip: 826176109 !l,oO ,\.J
Oat,:!, High Price V Low Price Close Price Volume ~. '-- . / '1,1"
02/U2/2001 6.375 6.156 6.250 15300
TRY - TRIARC COS INC High Price / Cusip: 895927101
DatE' Low Price Close Price Volume ,~ "'f ~/i '1 '--"'r
02/U2/2001 25.090 24.650 24.900 6600
The information has been obtained from sources we believe to be reliable but we do not guarantee its accuracy. Past
performance is not indicative of future performance.
.../HPITable.asp?SearchType= 1 &StartDate=200 1 0202&EndDate=200 I 0202&Adjusted=A&Frequency=2/26/0 1
Histori~aI Pri~ing Inquiry
Page I of I
Historical Pricing Inquiry
275;25 - FAIRMOUNT CHEM INC ../
Dat,e High Price
02/23/2001 .000
Low Price
.000
Close Price
.050
Cusip: 305477101
Volume
o
10 0 ,xc,~
5 eM -./
434B6 --> Historical Pricing data not available for this symbol.
43653 - LANNETT INC
Datl3'
02/23/2001
~
High Price
.000
Cuslp:
516012101
Volume
o
;.....
s
v
Low Price
.000
Close Price
.625
ud
83322 - WOLF HOWARD B INC --> Historical Pricing data not available for this date range.
91655 - PAN PACiFIC PETROLEUM NL
DatI! Price In AUD
02/23/2001 .085
Price In USD
.044
~ 72 "0 -(
,If+ :
2;"1 (,.2D
./
/, I.
U^".lI'\
!f\~"\(( "\
\ '11,,0 ,x..
\t>i q8Q (J?
, '.,.",.~ U. I Q
The information has been obtained from sources we believe to be reliable but we do not guarantee its accuracy. Past .
performance is not indicative of future performance.
.../HPITabIe.asp?SearchType=3&StartDate=200 1 0223&EndDate=200 1 0223&Adjusted=A&Frequency=2/26/0 1
MR ALBERT BERG
PO BOX 457
MECHANICSBURG PA 17055-0457
ACCOUNT # Fie 'II' PAGE # T.I!:L.I!:PHONli: #'
872 12768 8172 1 717-975-4600
8S UR .Lv
207-10-8495
.!;iTATli:Mlill'l' P.I!:R.LUD
09/30/00 TO 12/29/00
}o'lNANC.LAL CONSULTANT
TODD A BOQP
INV.e;STOR
CREDIT LINE
Ulo'.I.o'H.'::J:: SJ:i.:RVHRi YUUR ACCUUNT TYPE
214 SENATE AVE, STE 501
CAMP HILL PA 17011 CASH
*****
ACCOUNT SUMMARY
*****
UPKNlN~ ~ALANC.l!: CLUSlNG HALANcli:
$1960.00CR $1960.00CR
.L.N V.I!:S'l"M.I!;,N'!'S
$58081
MUNgY. ACCOUNTS PK.lC.t!:!J POKTrULIU
$.00 $60,041.00
*****
TAX INFORMATION SUMMARY
*****
V1!:SCR1P'l'!UN
Y!ffil{ TO DA'l'J::
'I'M!.::; ~n'A'l'.t:l'Ilt;NT
REPORTABLE DIVIDENDS
FOREIGN SECURITY DIVIDENDS
$9.68CR
$.00
$226.64CR**
$27.68CR**
**YOU SHOULD NOT USE THIS MONTHLY STATEMENT FOR TAX PURPOSES IF YOUR ACCOUNT IS
SUBJECT TO IRS REPORTING. A TAX REPORTING STATEMENT WILL BE SENT IN JANUARY.
LJA'l'l:!:
*****
DAILY ACCOUNT ACTIVITY
*****
TRANSACTl.UN
Vl!:1:)CIUP'l'!UN
PRlcli:
AMUUNT
OPENING BALANCE
$1960.00CR
$9.68CR
09 30
10 30 *Dividend
11 24 Check
12 29
f,JUANTI'l'Y
540
1800
100
129
15
90
90
8800
299
256
50
1789
500
57200
KATY INDUSTRIES
HOLDING 129.0000
MONTHLY AMT ISSUED
$9.68
$1960.00CR
CLOSING BALANCE
*****
CURRENT PORTFOLIO
*****
INV.I!:~'l'M.I!:N'l' D.I!:::;CKlPTlUN
cURl{li:NT MAKKKl' CURl{. .l!:f:j'l' .
PRICE VALUE YIELD INCOME
CQASTL C 0 AND M NTRF RT
COASTL COIL MIN LTD COM
FAIRMOUNT CHEMICAL
KATY INDUSTRIES
LOUIS DREYFUS NAT GAS
LONRHO AFRICA PLC SP ADR
**LONMIN PUB LTD CO SPNADR
LANNETT CO INC DEL $.001
ROTONICS MANUFACTURING
SIEBERT FINCL CORP
SIMAX OIL&GAS INC ONT
TRIARC COS INC DEL CL A
HOWARD B WOLF INC
PAN PACIFIC PETROLEUM NL
AUD PAR ORDINARY
TOTALS FOR PRICED INVESTMENTS
$18560
$3 -
$774 5.00
$687 V
$9
$1248 >(1.99
$6050 V
$224 V
$1056.....3.87
$43383V
$2791 V
UNAVAILABLE
1. 031
.030
6.000
45.812
.100
13.875
.687
.750
4.125
UNAVAILABLE
24.250
UNAVAILABLE
.048
$39 .,...../
$25
$41
$58081
$105
IMPUR'l'AN1' NEWS ABUUT YUUR INDIVIDUAL INV.I!:S'l'OR ACCUUNT l~M) ANNUAL FEE.
SEE ENCLOSED NEWSLETTER FOR DETAILS.
Delaware
END OF STATEMENT
DECEMBER 2000
DUPLICATE MERRILL LYNCH STATEMENT.
STATEMENT RECEIVED BY MAIL IS YOUR OFFICIAL RECORD.
Edwar,d ~ ones
4829 East Trindle Road
Mechanicsburg, PA 17050
(717) 763-7669
Mark R. Snyder
Investment Representative
MAX Q 1 2001
EdwardJones
February 27, 2001
George F. Douglas, Esq
27 West High Street
Carlisle, Pa. 17013-0261
Re: Albert W. Berg
Dear George:
Per your request, we are writing to provide valuation information for the
attached list of securities belonging to the person listed above, now
deceased.
The values listed are as of February 2, 2001, the day that Albert W. Berg
passed away. The values were obtained from an outside historical pricing
service and while we believe that they are reliable, we do not guarantee
their accuracy. Please let us know if you need any other information
or assistance.
Si~h:kY ~ t_ ~
~1rk R. - snJrlh
Investment Representative
~.
Edwa.rd.Jones
4829 East Trind1e Road
Mechanicsburg, PA 17050
(717) 763-7669
Mark R. Snyder
Investment Representative
Albert V. Berg Account number 270-07379
Date of Death Values for Securities held at Edward Jones
SYMBOL
DESCRIPTION
VALUE
DATE PER SHARE
CSPLF
CANADA SOUTHN PETE
02/02/2001 $5.8750
02/02/2001 $7.6875
02/02/2001 $1.0469
MAXM
MAXIM PHARMACEUTICAL
MPET
MAGELLAN PETE CORP
EdwardJones
NO. TOTAL
OF SHARES VALUE
100 $587.50
100 $768. 75v
2,650 $2,774.28 (
MARK R SNYDER
EdwardJones
February 23, 2001
Historical Quote
Symbol DescriptionjT ype Date Value
CSPLF CANADA SOUTHN PETE L Tn L TO VTG SH
Adjusted Closing Price 02/02/2001 $5,8750
MAXM MAXIM PHARMACEUTICALS INC COM
Adjusted Closing Price 02/02/2001 $7.6875
MPET MAGELLAN PETE CORP COM
Adjusted Closing Price 02/02/2001 $1.0469
-
Page '1 This information is for tax and estate purposes only and while believed accurate, is not guaranteed. 1here is no warranty
that any trades were or would have been executed at these prices on the dates given.
n
~=~TUCKER ANTHONY
MID ATLANTIC DIVISION
95 Alexander Spring Road
Carlisle, PA 17013
Phone 7I7.2'P.3055
March 26, 2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Date of Death Values for Albert W. Berg
Dear George,
Listed below are the dates of death value for the above-mentioned estate:
Company High Low Close
Allied Irish Banks 24.25 23.80 23.91
BAE Systems 16.86 16.60 16.76
Barrick Gold Cpo 15.50 15.24 15.33
Biospherics Inc. 6.875 6.15625 6.15625
Black & Decker Corp. 45.25 44.51 45.15
Campbell Res. Inc. .55 .49 .55
CDA Southern Pete Ltd. 5.875 5.75 5.875
Coastal Caribbn 0 & M 1.50 1.218 1.437
Covanta Energy Cpo 16.99 16.62 16.70
Crompton Corp. 11.37 11.10 11.11
Elan Corp. PLC ADR 51.20 49.90 50.67
Forest Labs Inc. 66.54 65.17 65.60
Glaxo Smith Kline ADR 53.75 52.66 53.05
Golden Triangle Ind. 1.375 1.125 1.375
Griffon Corp. 7.42 7.23 7.40
Harsco Corp. 26.86 26.24 26.42
Helix Techno. Corp. 29.4375 27.625 27.984375
Hershey Foods 60.25 59.40 59.81
IntI. Sunatco Ind. Ltd. 8.375 7.6875 7.6875
K V Pharm. Co. B 29.63 29.35 29.40
K V Pharm. Co. A 29.75 29.15 29.40
Katy Indus. Inc. 7.99 7.55 7.99
Kinark Corp. 1.00 .91 .91
La Barge Inc. 2.75 , 2.60 2.68
Lannett Co. Inc. No quotes for 21212001 2/6/01 .937
Levcor IntI. Inc. 1.75 1.75 1.75
Lonmin PLC Sp. ADR 16.25 15.25 15.50
Louis Dreyfus N/G Cpo
M & T Bank
Maxco Inc. Mich.
Maytag Corp.
Movie Star Inc.
Read Rite Corp.
Rotonics Mfg. Inc.
Selas Corp. of America
Siebert Finl Corp.
Triarc Cos A
Trump Hotels & Resorts
Vishay Intertech
Wellco Enterprises Inc.
34.66 33.71 34.55
67.98 66.90 67.02
8.00 7.8125 7.875
35.45 34.60 34.73
.85 .84 .84
9.90625 9.15625 9.3125
.78 .76 .78
3.37 3.35 3.37
6.375 6.15625 6.25
25.09 24.65 24.90
3.05 2.85 2.89
21.55 20.00 20.05
No trades 2/2/01 10.00 on 2/1101 10.24 on 2/5/01
If I can be of further assistance, please let me know.
Sincerely,
George A. Sneed
Senior Vice President
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/10/2005
DOUGLAS GEORGE F III ESQ
1 IRVINE ROW
CARLISLE, PA 17013
RE: Estate of BERG ALBERT WEISS
File Number: 2001-00169
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12). in ~the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 2/02/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STR3tSBAUGH
REGISTER OF WILLS
cc:
File
Personal Representative(s)
Judge
2';;!~
---' ':'Y' ,
~,~.c; --.:
[-i"--
!'!.. ,
'--' ~ .
'...-"
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
*Ikn \NQ.l~S 6Q.(~
:z-I "2.. / U>D I
Z-l - () ( - 0' \D 1 Admin. No.:
Date of Death:
Will No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Comi Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State ~ther administration of the estate is complete:
Yes,Kl No 0
2. lithe answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lithe answer to No.1 is Yes, state the following:
a. Did the)'ersonal representative file a final account with the Court?
Yes)& No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
ininterest?Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report. ~
Date:~l-()S- .q__.;;Ji!f
"signa
G<2<!)~ro ~ f hcNriLL
Name
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Telephone No.
Capacity: n Personal Representative
Q-Counsel for .personal representative
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SECURITIES ACCOUNT
FOR THE PERIOD:
~ar 1 - Mar 31, 2001
THOMAS BERG EX
TUCKER ANTHONY
BERG ALW 02/01
Page
9 of 15
\CCOUNT ACTIVITY
::AMPBELL RES INC
::OA SOUTHN PETE LTO
:LEARVIORKS. NET EXM
)V11 CORP
"NERMARK I NC FO UT S
~TS ENERMRK INCM FD
'OREST LABS 1 NC
;R ] FFON CORP
iARSCO CORP
iERSHEY FOODS CP
~ V PHARMACEUT CD B
~ V PHARMACEUT CO A
.A BARGE I NC
.OUIS DREYFUS N/G CP
. YNNVlEAR CORP CLA
1& T BANK CORP
lAD I SON FUND I NC
IAXCO INC MICH
IERIDIAN OIL NL ADR
IEO BIONICS INC
'ISHAY INTERTECH
'AN PACIFIC PETE REG FGN
REC~IVE FROM MERRILL LYNCH
NGLO CON MINING CRP
NGLO ENERG LTO/AEXM FGN
10875
12/17/2001
ACCOUNT NUMBER:
DSH- 013396- 21
I CONTINUED)
DATE TRANSACTION
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/08 Received
03/09 Received
03/09 Rece i ved
03/09 Received
QUANTITY
PRICE/COMMENTS
3
10,666
3
200
6,123
1,884
32.000
20
3.300
2.000
1.350
1.350
200
34
300
648
109
500
10,000
1.000
10.867
57.200
1.500
200
AMOUNT DEBITED
AMOUNT CREDITED
176BB 000
76BB 000
76BB 000
76BB 000
76BB ODD
76BB 000
76BB 000
7666 ODD
7666 000
766B 000
76BB 000
76BB 000
766B 000
766B 000
766B 000
76BB 000
76BB 000
76BB 000
76BB 000
76BB 000
76BB 000
52BB 000
79BB 000
79BB 000
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SECURITIES ACCOUNT
TUCKER ANTHONY
BERG ALW 02/01
=OR THE PERIOD:
lor 1 - Mar 31. 2001
THOMAS BERG EX
ACCOUNT NUMBER:
DSH- 013396- 21
Page
15 of 15
,CCOUNT ACTIVITY
( CONTINUED)
DATE TRANSACTION
QUANTITY
PRICE/COMMENTS
AMOUNT DEBITED
AMOUNT CREDITED
)!V ON
200 BLACK & DECKER CORP
03/30 Dividend
Income
S24.00/89AB 101
$67.50 89AB 101
)IV ON
1.500 SELAS CORP OF AMER
03/30 Dividend
Income
NCOME EARNED ON MUNICIPAL BONDS CAN BE FREE OF FEDERAL. STATE. AND LOCAL TAXES. CONTACT YOUR INVESTMENT EXECUTIVE
-ODAY TO DISCUSS WHICH MUNICIPAL BONOS MAY BE RIGHT FOR YOUR INVESTMENT AND INCOME REQUIREMENTS.
Mal
:; --~TUCKER ANTHONY
r-1 I 0 1', I L A r>. r ,C 0 I V I ::3 ION
95 Alexandu Spring Road
Carlisle, PA 17013
Phone 717.241.3055
April 19, 2001
Douglas, Douglas & Douglas
27 W_ High Street
Carlisle, P A 17013
RE: Albert R. Berg Estate
Dear George,
The securities listed below had no value on Mr. Berg's date of death.
3,156 shares David James Industries (Netherlands Antilles)J
If I can be of further assistance, please let me know.
Si~__
George A. Sneed
Senior Vice President
- .
1\1II
c=TUCKER ANTHONY
~18 A-LANT C DIVISION
95 Alexander Spring Road
Carlisle, PA 17013
Pht>ne 717.241.3055
April 2, 2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Estate of Albert W. Berg
Dear George,
The securities listed below were worthless on Albert W. Berg's date of death:
500 Caral Mining Company V"' .,,/
500 Derogan Asbestos Corporation Limited
2 quarters of one share Mount W~ht Iron Mines (Now Mantaur Pete Corp.) V
500 Massval Mines Limited ./
500 Toltec Oil & Gas Inc. .../
If I can be of further assistance, please let me know.
c~
George A. Sneed
Senior Vice President
,
.
~TUCKER ANTHONY
"1ID-A~LAr--.TIC: DIVISION
95 Alexander Spring Road
Carlisle, PA 17013
Phon~ 717.241.3055
March 28, 2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Estate of Albert W. Berg
Dear George,
The securities listed below were worthless on Mr. Berg's date of death.
100
62
100
200
Duvex Oils & Mines Limited v'
Convoy Capital Corp. (was Western Allenbee)
Numac Oil & Gas LTD. ./'
Pole Star Mines Limited"'/
/
If 1 can be of further assistance, please let me know.
Sincerely,
G
Senior Vice President
, ,
-=TUCKER ANTHONY
'v'ID ATL","JTIC DIVISION
March 27, 2001
95 Alexander Spring Road
Carlisle, PA [70I3
Phone 717.241.3055
Douglas, Douglas & Douglas
27 W, High Street
Carlisle, PA 17013
RE: Estate of Albert W. Berg
Dear George,
The securities listed below were worthless on Mr. Berg's date of death:
2,000
4,000
1,020
16,000
2,000
6,000
1,000
11 ,000
1,000
4,000
Newnorth Gold Mines Limite~
Obaska Lake Mines Limited/
Atlanta Mines LTD. ./ /
Con Key Mines Limited
Crowpat Minerals Limited'/ .
Combined Metal Mines Limited ,j
Carnreco Inc, ( was Windfall Oils & Mines Limited),;'
Kontike Lead & Zinc Mines Limited ../
Lock Tread Corp. V /
Kirkland Townsite Gold Mines Limited (now KT Mining LID)
If I can be of further assistance, please let me know.
Sin~r~ ' -------.,.
//
( ~/.. /~.
George A. Sneed
Senior Vice President
,
. .
III
2TUCKER ANTHONY
MID ATLANTIC OIV ,=,ION
95 Alexander Spring Road
Carlisle. PA 17013
Phone 717.241.3055
March 26, 2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Estate of Albert W. Berg
Dear George,
The securities listed below were worthless on Mr. Berg's death.
4,000 QED Exploration, Inc. Transfer unknown /" /
8,867 Golden Tri Royalty & Oil Company did not return phone calls,
100 FDI Inc. (Filter Dynamics) had .50 merger in 1983
If I can be of further assistance, please let me know.
Sin~~.
&~
George A. Sneed
Senior Vice President
III
TUCKER ANTHONY
MID ATLANTIC DIVISION
95 Alexander Spring Road
Carlisle, PA 17013
Phont: 717.241.3055
March 21,2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Albert W. Berg Estate
Dear George,
The securities listed below were worthless on Mr. Berg's date of death:
16,500 shares
3,156 shares
1,884 wts
1,000 shares
200 shares
500 shares
500 shares
Cove Uranium Mines Limited ../
Netherland Antilles
Cabre Exploration Ltd. Expired 1992 V'
Amalta Oils Now ParaCorp Ltd. Ceased trading J'
Anglo Energy Limited Status unknown
Vieo Expls L TD Charter Cancelled ,/
AM Vision Ctrs Cash merger 1991.,./
If I can be of further assistance, please let me know.
Sinca. el,;~_____
La;
George A. Sneed
Senior Vice President
~.
. .
MAR 19 2001
-TUCKER ANTHONY
....1 I D AT '- ANT CD.", S ,ON
95 Alexander Spring Road
Carlisle. PA 17013
Phone 71/.241.3055
March 15,2001
Douglas, Douglas and Douglas
27 W. High Street
Carlisle, PA 17013
RE: Estate Albert Berg
Dear George,
The following securities were worthless before Mr. Berg's death for the following
reasons:
Trans-Era Oils Limited
Ocean Research Equipment Inc.
.../
Charter cancelled 3/16/1976
Completely liquidated 8/30/1982 V"
If I can be of further assistance, please let me know.
Sincerely,
a/~-----/
George A. Sneed
Senior Vice President
III
~ TUCKER ANTHONY
HID A1LANTIC DIVISION
March 14,2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Albert Berg Estate
Dear George,
The following securities were worthless before Mr. Berg's death.
Frobex Limited
New Harrirana Mines Limited
Ascot Metals Corp. Limited
Acadia Uranium Mines Limited
Canadian Nistro Mines Limited
Como Development Corp. Limited
Fundy Exploration Limited
Delta Minerals Corp.
Gulf Lead Mines Limited
Consolidated Bellekeno Mine Ltd.
H. G. Young Mined Limited
Miro Mines Limited
New Harrirana Mines Limited
Quonto Explorations Limited
Charter cancelled 11/8/1977 ./
Charter cancelled 8/13/1976.....),)~l
Charter cancelled 7/17/1972 v
Charter cancelled 3/16/1976 v'
Charter cancelled 311611976 v,
Charter cancelled 8/2511973/
Charter cancelled 3/16/1976v'
Charter cancelled 1011211974 V
Charter cancelled 3116/1976../
Charter cancelled 3/16/1976'/./
Charter cancelled 11/111982
/
Charter cancelled 3/16/1976 v t
Charter cancelled 8/1311974- 7, ,'-
Charter cancelled 7/2611972 ,/'
If I can be of further assistance, please let me know.
Sincerely,
a?~."
George A. Sneed
Senior Vice President
95 Alexander Spring Road
Carlisle, PA 17013
Phone 7J7.24-1.3055
, ,
~TUCKER ANTHONY
MID ATLANTIC DIVISION
March 14,2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Estate Albert Berg
Dear George,
95 Alexander Spring Road
Carlisle. PA 17013
Phone 717.24-1.3055
The following securities were worthless on Mr. Berg's date of death for various reasons
that are listed below:
Dynacore Enterprises Limited
Farwest Mining Limited
Watson IntI. Resources Ltd.
Consolidated East Crest Oil Co.
Carr-Consolidated Biscuit Co.
Tax Corporation of America
Kin-Ark Corp.
Declared Dissolved for failure to file 5/20/1980 .'
Declared Dissolved for failure to file 3/17/1975'
Declared Dissolved for failure to file 8/2211986 v
Completely Liquidated 11111972 v
Bankrupt 2/18/1955 v
No stock equity v
Common Stock purchased RTS declared for v
common redeemed 1/211990
If I can be of further assistance, please let me know.
Sincerely,
~
Senior Vice President
-
. .
G
I I
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TAX FREE MONEY FUND
P.O. BOX 219319
KANSAS CITY MO 64121-9319
ALBERT BERG
PO BOX 457
MECHANICSBURG PA 17055-0457
DIVIDEND
STATEMENT
1",1"","'""',1"',1,1'",.1,,',',',',,,1,1,1,',,,1,1,,"
Transaction
1/31
1131
REMITTANCE SLIP
TO MAKE A CHANGE: If the address
or dealer name is. incorrect or missing,
please print the correct information here.
DEALER INFORMATION
1386 PENDING
01<}~~t~1 KA M PEN
FUNDS
1-800-421-5666
TOO 1-800-421-2TDO
VAN KAMPEN FUNDS
NO DEALER INFORMATION ON ACCOUNT
PLEASE PROVIDE
SELLING FIRM/ADDRESS:
REGISTERED REP:
PENDING MO 64153
IDENT.
NO. OR SOC. SEC. NO.
ON FILE
Account No. I ~k Ugt I
I Total Shares Owned
1,215.610
2.820 1,218.430
2.820- 1,215.610
Dollar Amount I Share Price
Of Transaction
2.82
2.82-
VAN KAMPEN
P.O. BOX 2193]9
KANSAS CITY MO
64121-9319
1.00
1.00
IDENT. NO. OR SOC. SEC. NO.
ON FILE
I ~Ung880'1 ACC46; ~3'8 I (;~ ~gt I
To Invest By Mail:
For purchases into this accDunt,
return this stub and your check
in the enclosed envelope.
AMOUNT OF CHECK
',"",'"',.,11..1,1."1",1.",",,,,"',',,,1,,1'
0000 92090610 000004631381 0000088
($ 25 .00 minimuml
FORM H002 REV 9/98
LAST WILL AND T.ES'l'AMENl'
I, Albert Weiss Berg, of Ct.lnberland County, Pennsylvania, being of
sound and disposing min:i, mem::>:ty, and understanding, do make and declare
this as and for my last will and testanent, hereby revoking any wills by
me at any time heretofore made.
1. I direct that my executor pay my debts and funeral expenses.
2. I devise and bequeath one-half of my estate, real and personal,
to my nephew, Thanas Berg, the son of Henran Berg, III.
3. I device and bequeath the other one-half of my estate to my
nephew, Richard Berg, also the son of Henran Berg, III.
4. In the event that my nephew, Thanas Berg, predeceases me, or
dies in a u..all,....11 disaster with me, I devise and bequeath his share of my
estate to his brother, Richard Berg.
5. In the event that my nephew, Richard Berg, predeceases me, or
dies in a camon disaster with me, I devise and bequeath his share of my
estate to my nephew, Thanas Berg, in trust nevertheless, for the issue
of my nephew, Richard Berg, per stixpes. '!be trust for each child is to
continue until that child reaches age thirty-five (35), at which time
they are to receive their share of my estate. '!be trustee has the power
to invest as he sees fit.
6. I naninate, constitute, and aw:>int my nephew, Thanas Berg, as
my Executor. In the event he is unable to serve, I ilH?Oint my nephew,
Richard Bel:g, as my Executor. In the event that neither of my nephews
is able to serve as Executor, I appoint the Fanners Trust Carpany of
Carlisle as my Executor.
. /,7"
IN ~ WHEREnF, I have hereunto set my hand and s.eaI this the '"
day of~' ,1990. (li1:<dW~)
Albert Weiss Berg
Signed, sealed, published and declared by the above named testa-
tor as and for his last will and testament, who at his request,
in his presence, in our presence, and in the presence of each
other, have. hereunto subt-ibed our names as attesting witnesses:
>fJ,~5 > .'
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
)
~,~
/
witnesses whose names are signed to the attached or foregoing
we,h~~
and
,
the
instrument, being duly qualified according to law, do depose and
say that we were present and saw testator sign and execute the
instrument as his last will, and that he signed willingly and
that he executed it as his free and voluntary act for the pur-
poses therein contained; that each of us in the hearing and sight
of the testator signed the will as witnesses; and that to the
best of our knowledge, the Testator was at that time 18 or more
years of age, of sound mind and under no constraint or undue
influence.
me this
(,v,
subscribed before
day Of~
Sworn to and
1990.
~~ Yn.~
Nota
IIOTAlIW. SEAl
JANET M. LAY. NOTARY PUBliC
CARLISlE 1lORO.. CUMilE{llAND roum
MY COMMISSIOIHX~RES 'JUNEF. 1191
,
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND
)
I, Albert Weiss Berg, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the instru-
ment 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.
{]J2tj-~ ~
Albert Weiss Berg
Sworn to and subscribed to
before me this /" tJ, day
of ~ ' 1990.
N
NOTAIlIAl SEAl.
JANET M. LAY. "OTAIIY PIlBlIC
CAAUSLE BORO.. CUMdERLANO COUlITV
MY COMMISSION EX?IRES JUNE 17. 1@<)1
-~-
r
REV-1500EX(6-00i
w
...,
,,:$.,
,,"'''
w""
,,00
,,"''''
..Ill
..
'"
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
0-1.~~_
NUMBER
100 --a2e/l-/()
REV-1500
~,
)h-
c.:.--
OFFICIAL USE ONLY
FILE NUMBER
2- 1 - 0 1
COUNTY CODE YEAR
I-
Z
W
C
W
U
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl)
pEttee ~\ tiER-I We.'l.S
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
2-/~/OI IQ/2../,/1113
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (tolal Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
SOCIAL SECURITY NUMBER
2cr7 I 0
e'f-9~
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (AtlachcopyotW~I)
D 9. Litigation Proceeds Received
~ Supplemental Return
D 4a. Future Interest Compromise (dale or death after 12-12-82)
D 7. Decedent Maintained a Living Trust (AtlachcopyoITrust)
D 10. Spousal Poverty Credit (date or death between 12"31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-1J.-82)
~ 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
...,
z
w - l:::buco \.a..'>
0 lD.-
z -r.
0
..
., ouc.lA5 i t;.l..A ~
w
'"
'"
0
" I, "10
z
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<(
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12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
COMPLETE MAILING ADDRESS
2-'1 \..u. K '''\''' ST
~. o. 00'1-.4-10 I
~r\l,>le.. YA. I~O\3
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
IJ, 1'1'3.75
(6)
(7)
(8)
Il, 1"13.75'""
(9)
(10)
+000.00
i
(11)
(12)
(13)
If:.. 000.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
-
7/13.7.:J
.
15. Amount of Line 14 taxable at the spousal lax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
I. Ii'?>. is'
-
x.O_ (15)
x .0 (16)
x .12 (17)
x .15 (18) I ,07 If. C>O
(19) / 67 q.OO
.
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
/
,
,
STREET ADDRESS '8" I't-A FI"M-fldd- rr.
"^~~\C.\t:,U r- '1.-PA
CITY I STATE p~ I ZIP ~L05S-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Poor Payments
C. Discount
(1) .
Tolal Credits (A+ 8 + C) (2)
3. interesVPenalty if applicable
D. Interest
E. Penaity
TolallnlerestJPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
10,"1..00
,
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
1.0"'4.00
A. Enter the interest on the tax due. (SA)
8. Enter the tolal of Line 5 + 5A. This is the BALANCE DUE. (58) ~ , 0" '1 . 00
Make CheckPayable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. relain the lighl 10 designate who shall use the property transferred or its income; ............................................ 0
C. retain a reversionary interest; or........................................................................................................................... 0
d. receive the promise for me of either payments, benefits or care? ...................................................................... 0
2. If death occumed after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..................... ................. ..................................... ................................... 0
3. Did decedenl own an "in trust for" or payable upon death bank accounl or security at his or her death? .............. 0
4. Did decedent own an Individuai RetirementAccount, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................... ......................................................... 0
No
0'
G--
Q--
@--
g..--
[J..
G:}
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare thai r have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Daclaralioo of preparer other than the pel'SQl\al representative is based 00 all informatioo of which preparer has any kIlOwIedge.
SIGNATURE OF PERSON SPONSIBLE FOR FiliNG RETURN
ADDRESS
\,013
., \., 2-'1', \ 1'10
DATE
,),/ \AI. ~'\~ ':)1- .
SiGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1985, the tax rate imposed on the net value of transfers 10 or for the use of the sUfViving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, Ihe lax rale imposed on the net value of transfers to or for the use of the sUfViving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does nol exemnt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the surviving spouse is the only benefictary,
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 0% [72 P.S. ~9116(a)(1.2)].
The lax rate imposed on the net value oftransfe" to orlor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)].
The lax rate imposed on the net value of transfers \0 or for Ihe use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent. whether by blood or adoption.
REV-JS03 EX + (1.s1)
'*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
t\ll? e. 'r T \..U e..l S, S. ~ 'C: lL b
FILE NUMBER
2.-\ - 0 I
0/ l., '(
All property jolntly-owned with right of sUlVivo..hlp must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
\-Ita. II 'Yo- C'orJ>o r c.....'t. <.lV'\ . '+-00 Sh4 re ~ ~ ,.l 7. 'l8q..:"S-
1 ,:IOse.)
1.A\<;,~"'i::> Or-, 0('".0'('\....\ ,\"~",""R;",
VALUE AT DATE
OF DEATH
II, ,q:.."1~
TOTAL (Also enter on line 2, Recapitulation) $ I \ . \ 'i ~. "1 S"
AEV-1S11 ~X+ (12-99) _
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
AI bur kiars5 8ER..C::.
FILE NUMBER
2../ -0 I -0 I fa '1
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative{s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Ci1y State _ Zip
Relationship of Claimant to D8{;edent
4. Probate Fees
~r...e.('Ic;. """""- \ + 00. t&f11lM~e~ Q .....
5. Accountant's Fees .. 1006
n-\ ..r-''1rt\<Jl ......;."....1\. NQ..U.I~.)-t> jIA":u"'" \ S 't DOO. ()O
6. TaxRelurnPreparer'sFees 5000. b.S;:~L('"e('lc.~ o~ 't-ooo.
7.
TOTAL (Also enler on line 9, Recapitulation) $ I.{Ooo.OO
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
95 Alexander Spring Road
Carlisle, PA 17013
Phon~ 717.241.3055
March 26, 2001
Douglas, Douglas & Douglas
27 W. High Street
Carlisle, PA 17013
RE: Date of Death Values for Albert W. Berg
Dear George,
Listed below are the dates of death value for the above-mentioned estate:
Company High Low Close
Allied Irish Banks 24.25 23.80 23.91
BAE Systems 16.86 16.60 16.76
Barrick Gold Cpo 15.50 15.24 15.33
Biospherics Inc. 6.875 6.15625 6.15625
Black & Decker Corp. 45.25 44.51 45.15
Campbell Res. Inc. .55 .49 .55
CDA Southern Pete Ltd. 5.875 5.75 5.875
Coastal Caribbn 0 & M 1.50 1.218 1.437
Covanta Energy Cpo 16.99 16.62 16.70
Crompton Corp. 11.37 11.10 11.11
Elan Corp. PLC ADR 51.20 49.90 50.67
Forest Labs Inc. 66.54 65.17 65.60
Glaxo Smith Kline ADR 53.75 52.66 53.05
Golden Triangle Ind. 1.375 1.125 1.375
Griffon Corp. 7.42 7.23 7.40
Harsco Corp. 26.86 26.24 26.42
X Helix Techno. Corp. 29.4375 27.625 27.984375
Hershey Foods 60.25 59.40 59.81
IntI. Sunatco Ind. Ltd. 8.375 7.6875 7.6875
K V Pharrn. Co. B 29.63 29.35 29.40
K V Pharrn. Co. A 29.75 29.15 29.40
Katy Indus. Inc. 7.99 7.55 7.99
Kinark Corp. 1.00 .91 .91
La Barge Inc. 2.75 , 2.60 2.68
Lannett Co. Inc. No quotes for 2/212001 2/6/01 .937
Levcor IntI. Inc. 1.75 1.75 1.75
Lonmin PLC Sp. ADR 16.25 15.25 15.50
, - .
f/
DOUGLAS LAW OFFICE
43 W. South St.
P.O. BOX 267
CARLISLE, PENNSYLVANIA 17013-0261
WILLIAM P. DOUGLAS, ESQ.
CERTIFIED AS A CIVIL TRIAL ADVOCATE BY
THE NATIONAL BOARD OF TRIAL ADVOCACY
May 13, 2009
Register of Wills
Cumberland County Court House
1 Court House Sq.
Carlisle, PA 17013
Dear Sir:
7I7 243-1790
FAX: 717-243-8955
EMAIL: douglaslau~a.earthlink.net
I have enclosed the original and two copies of the Supplemental
Inheritance Tax return for the Estate of Albert W. Berg along with the inheritance
tax due of $627.76 and the filing fee of $15.00.
Thank you.
Sincerely,
~,...~ ,
~~t
WPD:a
Enclosure
~_
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COMMONWEALTH OF
~~
•
REV 15 0 0 OFFICIAL USE ONLY
PENNSYLVANIA
DEPAR
F
REVENUE
D PT26
~ INHERITANCE TAX RETURN FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT ~ ~ E -Q~ ~ Rte- -~- -
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
W Berg, Albert W. 207 - 10 - 8495
~ DATE OF DEATH (MM-DD-YEAR)
02/02/2001 DATE OF BIRTH (MM-0D-YEAR)
10/26/1913 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
U REGISTER OF WILLS
WQ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
F ^ 1.Original Retum ®2. Supplemental Retum ^ 3. Remainder Retum taste or seam pdar b iz-i38z-
w a ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise taste or deam after tatz~z) ^ 5. Federal Estate Taz Retum Required
~ a m ^ 6. Decedent Died Testate tnmd, copy or wdQ ^ 7. Decedent Maintained a Living Trust tattacn copy otTnst) 8. Total Number of Safe Deposit Boxes
a ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (acre or deatl~ behveen t2atat and taas- _
^ 11. Election to tax under Sec. 9113(A) tnrod, Sch of
z
o
o
NAME
William P. Douglas,
Esquire
COMPLETE MAILING ADDRESS
a FIRM NAMEtnapp~wael 43 W. S outh St., Carlisle, PA 17013
~ ice
p TELEPHONE NUMBER
U
1. Real Estate (Schedule A) (1) OFFI~j,~-L USE ONLY
2. Stocks and Bonds (Sctredule B)
(2) t-
~ ~~
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) -' `~ ~
~r
4. Mortgages b Notes Receivable (Schedule D)
(4) -,: ~
. ~ r--
> ~
.
5. Cash, Bank Deposits b Miscellaneous Personal Property (5) 4 , 185 . 10 ::.
- ~
: ~7
~-~ ~
~ 3T
Z (Schedule E) .
, ~ -ri
~ 6. Jointly Owned Property (Schedule F) (6) { ~ c
^ Separate Billing Requested t.,,a
iYJ
~ 7. Inter-Yrvos Transfers & Miscellaneous Non-Probate Property (7)
a
Q
V
W
Z
0
Q
F-
a
0
U
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Sr~redule H) (9)
10. Debts of Decedent, Mortgage Liab~ifies, 8 Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 ~ 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemrrrental BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Une 13)
(11)
(12)
(13)
(t4) 4,185.10
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(12)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
4,185.20
18. Amount of Une 14 taxable at collateral rate
(6) _ 4,185.10
x .0 _ (15)
x .0 _ (16)
x .12 (17)
x .15 (18)
$627.76
19. Tax Due (ts) _ $627 76
H
20. ^ ..
Decedent's Complete Address:
~i SIKtt1AUUKtJJ R14A Fairfield St., Mechanicsburg, PA 17055
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payrnents
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits { A + B + C) (2)
Interest/Penalty 'If applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
i. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the.TAX DUE.
A Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
ZIP 17055
627.76
(5B) 627.76
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ......................................................................................... . ^ ^
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 I'tfe of either payments, benefits or care? ..................................................................... . ^ ^
2. tf death occurred after December 12,1982, did decedent transfer properly within one year of death
without receiving adequate consideration? ............................................................................................................. . ^ ^
3. Did decedent own an "in trust for' or payable upon death bank acx;ount or security at his or her death? ............. . ^ ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly 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.
nder penalties of perjury. I declare that I have examined This return, indudirg accomparryirg schedules and statements. aM to the best of my krwwledge and belief. % is true. correct and complete.
edaration of preparer oti>er than the personal repn~entative is based on all information of whidi preparer has any knowledge.
Ili P ~ RE~ NSjBLE FOR FILING RETURN DATE
~~ ~-x€~~.a~ Thomas H. Berg, Executor f„~Qy /~ ~oa9
DDRESS 130 Parker St., Carlisle, PA 17013
IGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
DDRESS
x 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 3°h
2 P.S. §9116 (a) (1.1) (i)].
x 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 OY° ]72 P.S. §9116 (a) (1.1) (ii)].
to 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
e surviving spouse is the only benefiaary.
rr dates of death on or after July 1, 2000:
to 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,
a stepparent of the child is 0% [72 P.S. §9116(a)(1.2}].
~e tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1}].
ie tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a){1.3)]. A sibling is defined, under Section 9102, as an
iividual who has at least one parent in common with the decedent, whether by blood or adoption.
REV~150B Q"~ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
PERSONAL PROPERTY
Albert W. Berg
FILE NUMBER 21-01-016 9
Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
~, _ OF DEATH
Commonwealth of Pennsylvania, Escheats
check
(This was for North American Galvanizing & Coatings, I
stock) We were not aware this existed until Albert
Berg's name appeared on Escheats list. -Please abate
the interest because we did not know of this account.
Copy of check attached.
TOTAL (Also enter on line 5 Recapitulation) 13
(If more space Is needed, insert addlUonal sheets of the same size)
$4,185.10
4,185.10
Pet~ns~ ]vania T~e~~luy -Bureau of Li,;claime~~ropet ~y ~ ~~ ~~~~~°
Pale _ vi~ ~
:`
Commonwealth of Pennsylvania ~ ~~
Treasury Department
Bureau o. Unclaimed Property
Property ID's: 7833784
Property /Holder I
a) Original Owner's Name
BERG, ALBERT
(C) Holder Reporting Funds
North American Galvanizing & Coatings In
(F} Type of Funds Reported
Misc. Stock
s}
PROPERTY DESCRIPTION
Propertyld: 7833784
3) Original Owner's Address as Reported
Po Box 457
Mechanicsburg, PA 17055-0457
CLAIMANT INFORMATION
NAME OF CLAIMANT(S): Thomas Herman Bero
SOCIAL SECURITY NUMBER: 161342376
CURRENT MAILING ADDRESS: 130 Parker Street
CITY: Carlisle
PHONE NUMBER: (~71) 7)2 - 43-3 739
)) Last Transaction Date
12/31 /2001
(G) Certificate, Policy or Check Number
Cusip: 65686Y109
DATE OF BIRTH: 04/11/1945
STATE: PA ZIP: 17013
EMAIL ADDRESS: tomberga~Juno com
I certify that I am legally entitled to try to claim the property, as stated below, that has been reported and delivered to the Treasury
Department, Bureau of Unclaimed Property.
I further hereby certify that the information provided, herein, is true and correct subject to the penalfies of 18 C.S.§4904, relating to
unsworn falsification to authorities.
SIGNATURE OF CLAIMANT (IN INK): _- s'ery,,,„t ~ /!~
Date: ti 7 f ~
SIGNATURE OF ADDITIONAL CLAIMANT (IN tNK):
Date:
State law limits the fee a third party can charge an owner for the recovery of unclaimed property to 15 percent of the
property value. Please contact the Bureau of Unclaimed Property at 1-800-222-2046 with any additional questions.
"" If You Paid A Fee To Claim Your Property, Please Complete The Following*~
The Pennsylvania Treasury Department does not charge a fee to claim or recover unclaimed property. Third parties who
assist with the recovery of unclaimed property are subject to requirements set forth under section 1301.11 of
Pennsylvania's Unclaimed Property Act. They must disclose the nature and value of the property as welt as where it is
being held. (Pennsylvania Treasury Department). The fee a third part can charge to assist with the recovery of property
cannot exceed 15% of the total value of the property.
Was/Is a third party involved in providing this claim form to you/the claimant or assisting with the claim in any way?
Yes~No
Name, address and phone number of third party
Did the third party charge or inform you/the claimant of a fee, or receive payment, for any service or assistance in
connection with the claim? If so, please state the amount of such fee/payment.
Yes No ~ Please specify amount of fee/payment.
Please note that the above information concerning third parties must be submitted in aft cases where a third party is
HOLD DOCVIIAEtVT TO LIGHT TO 1)ERIFY. 1NA'FERNtAtiECS
0000 03 012709 000019 ez-22
01350284 08'3410
CDC FUND DEPT PREP DATE VOUCHER WgRRANT
31 57 14178598
- ID
WACHOVIA BANK cHecK`N1ir~neER '
_~ PHILAQELPHIA, PA fly o~f~
~~ ~ vn >n ~~,~ z ~~".
_ VERIFICATION AVAILABLE "POSITIVE PAY"PR07"ECTED ~ ~`°`` ~`°""~'''°"°'' `" Oi/ao/zoos
_ -PAY . ~~ GATF
ONLY~F R CfSCTS..
TO THE ORDER OF ;
VOID AFTER 180 DAYS
BERG ALBERT ESTATE OF *****•****
THOMAS BERG EXEC 4 ~ 18rj . 1
130 PARKER STREET
CARLISLE PA 17013 °'
o
o
___ o
,~_~,~~
-- -- __
TREASURER OF PENNSYLVANIA
°~ L 4 L 78 598°' ~;0 3 L L00 2 2 5~: 20 799 5000860 2u'
Commonwealth of Pennsylvania 000019 57 14178598
Remittance Advice
Acct. Purchase Order Invoice Invoice Payment
Control Number Number Date Number Amount
WE ARE PRESENTING THIS CHECK FOR YOUR UNCLAIMED PROPERTY, CLAIM #100165816
0 0 01 /22/2009 100165816 $4,185.10
Total Payment Amount - $4,185.10
.BUREAU OF INDIVIDUAL TAXES COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITA1~CE TAX DIVISIDN
DEPT. 260601
HARRISBURG, PA 17128-0601 NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER REV-736 E% AFP (01-02)
DATE 12-01-2003
ESTATE OF BERG ALBERT W
DATE OF DEATH 02-02-2001
FILE NUMBER 21 01-0169
COUNTY CUMBERLAND
GEORGE F DOUGLAS III ACN 202
DOUGLAS ETAL
PO BOX 261 Amount Remitted
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NDTE: To insure proper credit to your account, submit the upper portion of this fora with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR FILES -~
--------- -------------------------------------------------------------------------------------------
REV-736 EX AFP (01-02) ~(* NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~(~(
ESTATE OF BERG
ALBERT W FILE N0.21 01-0169 ACN 202 DATE 12-01-2003
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
2. Pennsylvania Inheritance Tax Assessed 551,721.15
(Excluding Discount and/or Interest)
3. Inheritance Tax Assessed by Other States .00
or Territories of the United States
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
7. Additional Pennsylvania Estate Tax Due
TAX CREDITS:
269,048.86
551.721.15
.00
.DO
.00
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
*IF PAID AFTER THIS DATE, SEE REVERSE SIDE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .DO
TOTAL DUE .00
(IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
,•
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF NILLS, AGENT.
REFUND (CR): A refund of a tax credit may be requested by completing an ^Application for Refund of Pennsylvania
Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills,
any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering:
1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the assessment of tax as shown on this notice may object within
sixty (60l days of receipt of this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter determined at audit of the personal representative, OR
--appeal to the Orphans' Ccurt
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601,
Phone (717) 787-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing
letter becomes delinquent at the expiration of one (1) month from the date the final notice of the increase
in Federal Estate Tax is received.
Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum
calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear
interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA
Department of Revenue. The applicahle interest rates for 1982 through 2002 era:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20% .000548 1992 9% .000247
1983 16% .000438 1993-1994 7% .000192
1984 11% .000301 1995-1998 9% ..000247
1985 13% .000356 1999 7% .000192
1986 10% .000274 2000 8% .000219
1987 9% .000247 2001 9% .000247
1988-1991 11% .000301 2002 6% .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUlIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 01 1228
DOUGLAS GEORGE F III
354 ALEXANDER SPRING ROAD
CARLISLE, PA 17015
fold
ESTATE INFORMATION: ssN: 207-io-s49s
FILE NUMBER: 2101-0169
DECEDENT NAME: BERG ALBERT WEISS
DATE OF PAYMENT: 05/ 14/2009
POSTMARK DATE: 05/ 14/2009
couNTY: CUMBERLAND
DATE OF DEATH: 02/02/2001
REMARKS:
CHECK# 16228
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 5627.76
REV-1162 EX(11-961
TOTAL AMOUNT PAID:
INITIALS: JN
RECEIVED BY:
REGISTER OF WILLS
5627.76
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
~-.••: -.---,t~T.,I,~E ,.O.F INHERITANCE TAX
APpRA~I-Sf1r1ENT', ~,~rLLOWANCE OR DISALLOWANCE
BUREAU OF INDIVIDUAL TAXES ~-°
INHERITANCE TAX DIVISION {i_`.QrJ+9~i~D,~o~'IO;f~S AND ASSESSMENT OF TAX
PO BOX 280601
HARRISBURG PA 17128-0601
L~ I tJ JEf 1 Q ~ 1 1
RP LERK Q~~
Q !-~f S ~~J~T
WILLIAM P DOUGLAS ESQ~~~~~~~) ~C1•' ~A.
DOUGLAS LAW OFFICE
43 W SOUTH ST
CARLISLE PA 17013
tl) . DO
t2) .00
C3) .00
t4) .00
C5) 4 , 185.10
t6) .00
C7) .00
CUT ALONG THIS LINE ~ --RETAIN-LOWER-PORTION FOR YOUR RECORDS ~
------------------------ ---------------------------------------------
REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: BERG ALBERT WFILE N0.:21 01-0169 ACN: 101 DATE: 09-06-2010
TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED 0N: SUPPLEMENTAL RETURN NO. 02
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest tSchedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
Pennsylvania ~
DEPARTMENT OF REVENUE
r
REV-1547 EX AFP t12-09)
NOTE: To ensure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
t8) 4,185.10
t9) .00
tlo) .00
11. Total Deductions (11) .0 0
C12) 4, 185.10
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0
Tax
t t
b
t
S (14) 3, 874,133.52
14. jec
o
u
e
Net Value of Esta
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date .
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .0 0 X 0 0 = .0 0
16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 x 0 4 5 = .0 0
17. Amount of Line 14 at Sibling rate (17) _0 0 X 12 = .0 0
18. Amount of Line 14 taxable at Collateral/Class B rate C18) 3, 874 , 133.62 X 15 = 581 , 119.96
19 Principal Tax Due C19)= 581,119.9b
.
rex raFnTrc~
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
04-27-2001 AA496524 28,771.05 54b,b50.00
06-21-2001 AA496752 .00 3,992.15
08-16-2001 CD000166 .00 1,079.00
05-14-2009 CD011228 .00 627.76
BALANCE OF UNPAID INTEREST/PENALTY AS OF 05-15-2009
DATE 09-06-2010
ESTATE OF BERG ALBERT W
DATE OF DEATH 02-02-2001
FILE NUMBER 21 01-0169
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 11-05-2010
(See reverse side under Objections
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TOTAL TAX PAYMENT 581,119.96
BALANCE OF TAX DUE .00
INTEREST AND PEN. 284.59
TOTAL DUE 284.59
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
~~~