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06-05-14 (2)
REV-'1500 (02-11) 1505618143 r Ex OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county cede Year File Number Bureau of Individual Taxes BEPAR MiENT OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 13 1240 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 08 2013 10 18 1920 Decedent's Last Name Suffix Decedent's First Name MI NICHOLAS FRANCES S (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1, Original Return ❑ 2. Supplemental Return ❑ 3 Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a.Future interest compromise ❑ S. Federal Estate Tax Return Required (date of death after 12-12-82) g Dededent Died Testate ❑ 7. Decedent Maim Ines}Living Trust 0_ g. Total Number of Safe Deposit Boxes (Attach Copy of Will) ❑ 9. Litigation Proceeds Received ❑ 1D.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone�1 ber :�a ETHAN K STONE ESQ 717,2,20 3129m � � C_ ERE REG�YERBILLS USE-ONVi t-° rrt i rX) i First Line of Address CO —L7 3400 TRINDLE ROAD cad o CD1 Second Line of Address rV En o DATE FILED City or Post Office State ZIP Code CAMP HILL PA 17011 Correspondent's e-mail address: EStone @EthanKStone.com Under penalties of perjury,I declare that 1 have examined this return including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPO SIBLF FOR FILING RETURN D TE j Judith D. Boyer SI DDRESS 189 Wilcox Drive, New Cumberland, PA 17070 SIGN E PR HER THAN REPRESENTATIVE DATE Ethan K Stone Esq ADDRESS Law Offices of Ethan K. Stone, LLC 3400 Trindle Road,Camp Hill, PA 17011 Side 1 1505610143 1505610143 J l7"" 1505610243 ' REV-1500 EX Decedent's Social Security Number C.Cedert's Nam NICHOLAS, FRANCES S. RECAPITULATION 1. Real Estate(Schedule A)..... ....... ........... ... .... .......... Z Stocks and Bonds(Schedule B)............_......._......... ........._..................... Z 367 , 861 . 74 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)...._.... 3. 4. Mortgages&Notes Receivable(Schedule D)......_........._ 4- 5, Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)...__...... 5. 43 , 879 . 19 6. Jointly Owned Property(Schedule F) [] Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C] Separate Billing Requested... 7, 8, Total Gross Assets(total Lines I through 7)........._............_......_.................... 411 , 740 . 93 9. Funeral Expenses and Administrative Costs(Schedule H)_........_...........___........ 9. 18 , 800 . 00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 3 , 131 . 07 11. Total Deductions(total Lines 9 and 10)......................._...___....._.................__ 11. 21 , 931 . 07 12 Not Value of Estate(Line 8 minus Line 11)......................__....-.......................-... 12. 389 , 809 . 86 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)..... .. ..... .. ... - ... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13).._............................................. 14. 389 , 809 . 86 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax rate,or transfers under Sao,9116 (a)(1.2)X.00 0 . 00 15- 16. Amount of Line 14 taxable at lineal rate X .045 389 , 809 . 86 16. 17 , 541 . 44 17. Amount of Line 14 taxable at sibling rate X .12 0 . 00 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 00 18. 19. TAX DUE..........._...._................................................................................-...... 19- 17 , 541 . 44 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21 - 13 - 1240 Decedent's Complete Address: DECEDENT'S NAME Nicholas, Frances S. STREETADDRESS Messiah Village,100 Mt. Allen Drive ZIP Mechancisburg PA 97055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 17,541.44 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund - _ 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 17,641 .44 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;..._..................................._........................................ ❑ x] b. retain the right to designate who shall use the property transferred or its income;..__.........._._..._........_ x c. retain a reversionary interest;or.................................................................................................................. x d, receive the promise for life of either payments,benefits or care?..............................__......._................._ ❑ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....__.........._....................... .....................-............._......._...._.._........_........ ❑ 0 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?.,,...... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?...,.........__..........__......._........-.................................__......................._... ❑ �] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse Is 3 percent(72 P.S.§9116(a)(1.1)(1)]. For dates of death on or after Januarryy 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S.§9116(a)(1.1)fii)]. The stafute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax reiiurn are still applicable even if the surviving spouse is the only beneficiary, For dates of death on or after July 1,2000: -The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent(72 P.S.§9116(a)(1.2)]. •The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in t72 P.S.§9116(a)(1)]. •The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent(72 P.S. 9116 a)(1.3). A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,w ether y bloo or adoption. REV-1503 EX-(6.96) SCHEDULE B COWCNWFA THOR NSYWANW STOCKS & BONDS IWERMANCE TU RENRN RESIDENT DECEDENT FILE NUMBER ESTATE OF Nicholas, Frances S. 21 - 13- 1240 All property}ointty-awned with right of survivorship must be disclosed on Schedule F. DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH First Trust NGMA Series 99- (FTGNJX)-Charles Schwab-CUSIP: 2.46 14,597.64 33733D395 Franklin Income FD CLA(FKINX)-Charles Schwab 2.30 45,275.59 CUSIP: 353496300 Nuveen PA Premium Income Muni Fund 2 (NPY) -Computershare-CUSIP: 12.0525 38,07185 67061F101 Invesco PA Value Munipal Income Trust(VPV)-Computershare-CUSIP: 12.125 41,455.38 46132K109 PPL Corporation (PPL)-Charles Schwab 30.1956 44,689.49 CUSIP: 69351T106 PPL Corporation (PPL)-Nuveen (Computershare) 30.1956 44,689.49 CUSIP: 69351T106 UGI Corporation (UGI) -Charles Schwab 38.385 76,770.00 CUSIP: 902681105 UGI Corporation (UGI)- Nuveen (Computershare) 38.385 38,385.00 CUSIP: 902681105 Hillshire Brands Co. (HSH) - Computershare 31.525 6,305.00 CUSIP:432589109 DE Master Blenders (DEMBF)-Nuveen (Computershare) 16.3975 16,397.50 �' TOTAL(Also enter on line 2,Recapitulation) 367,861.74 SCHEDULE B STOCKS & BONDS C MONWEALT OF PENNSYLVANIA P. continued HERITANCE TAX RETURN RESIDENT CECE�NT FILE NUMBER ESTATE OF Nicholas, Frances S. 21 - 13 - 1240 i All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER — — DEATH PPL Corporation 12 o(13 - Dividend .3675 1,087.80 Ex Date -9/13/2013 Payment Date- 10/1/2013 Hillshire Brands Co. (HSH)- Dividend .125 25.00 Ex Date-813012012 Payment Date-3127/2014 Hillshire Brands Co. (HSH)-Dividend .125 25.00 Ex Date- 11/2912012 Payment Date- 3/27/2014 Hillshire Brands Co. (HSH)-Dividend .125 25.00 Ex Date -2/27/2013 Payment Date -3/27/2014 Hillshire Brands Co. (HSH)-Dividend 125 25.00 Ex Date- 5/30/2013 Payment Date -3/27/2014 Hillshire Brands Co. (HSH) - Dividend .175 35.00 Ex Date-8/29/2013 Payment Date-3/2712014 1 Page 2 of Schedule B s pennsylvania SCHEDULE E ` DEPARTMENT OF REVENUE CASH, BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY E21 E NUMBER ESTATE OF Nicholas, Frances S. - 13 - 1240 Include 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH Santander Bank-Checking Acct#: 50415171 24,315.08 99 Old York Road, New Cumberland, PA 17070 Date of Death Balance$24,319.08 Santander Bank-Checking Acct#: 50415171 0.20 99 Old York Road, New Cumberland, PA 17070 Interest Payment Santander Money Market Fund-Acct#: 1421315910 47.42 99 Old York Road, New Cumberland, PA 17070 Date of Death Balance $47.42 Charles Schwab-Acct#: 82292963 16,687.35 22 N. 2nd Street, Harrisburg, PA 17101 Date of Death Balance$16,687.35 Pension Benefit Guaranty Corporation-Final Payment 539.04 Bethlehem Steel Corporation Pension Plan Final Social Security payment-US Treasury 2,286.10 100113WD1440344801 (Santandar) TOTAL(Also enter on Line 5, Recapitulation) 43,879,19 REV-1911 EX*110-09) pennsytvania p��p� �SCHEDULE�H ���r DEPARTMENT OF REVENUE PUINEPAL E)GIENIMS AM INHERITANCE TAX RESIDENT DECEDENT RETURN AMINSTRA� ESTATE OF Nicholas, Frances S. MLA n`��F7 r�rV1 FILE NUMBER v — ___ 21 - 13- 1240 Decedent's debts must be reported on Schedule 1. — ITEM — NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Robert W. Snyder Funeral Home $,257.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address city State Zip Year(s)Commission Paid 2. Attorney's Fees Law Offices of Ethan K. Stone, LLC 9,000.00 3, Family Exemption: (if decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Petition for Letters Testiamentary 310.00 5. Accountant's Fees 2013 Inheritance Tax Return Preparation-Waggoner, Frutiger& 300.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs Short Certificates-Cumberland County Register of Wills 24.50 See attached 908.50 TOTAL(Also enter on line 9, Recapitulation) — 18,800.00 Schedule COMMONWEALTH OF PENNSYLVANIA Funeral EVuws& INHERITANCE TAX RETURN Afthisbabe C4sts condmied DECEDENT RES*IDEW ------ ESTATE OF Nicholas, Frances S. — �—FILENUMBER 13 - 1240 Will, Inventory, Tax Return, Codicil, Inventory, JCS, Automation Fee-Cumberland 10&50 County Register of Wills RESERVES: -Costs to conclude adminstration of Estate, including preparation and 800,00 filing of fiduciary income tax returns Page 2 of Schedule H Rev-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT°BREVENUE DEBTS OF DECEDENT, MORTGAGE INHERITANCE TAX RETURN RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF Nicholas, Frances S. 21 - 13 - 1240 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER Messiah Lifeways at Messiah Village- Resident Outstanding Balance 1,808.63 Alert Pharmacy Services -Outstanding Pharmacy/Prescription Bills 1,115.44 PA Department of Revenue- State Income Tax 207.00 Check#97 TOTAL(Also enter on Line 10, Recapitulation) 3,131.07 REV-1513 EX-(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Nicholas, Frances S. FILE N UMBER 21 - 13- 1240 i HA _REI_ATIONSqIP TO RE OF ESTATE AMOUNT OF ESTATE NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) (Sss) NUMBER _ RECEIVING PROPERTY Do Not Ust Trustee(s) I I. TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under See.9116(a)(1.2)] 1 Thomas J. Boyer Grandson One-ninth of rest, 4813 Mountain Rise Drive residue and Harrisburg, PA 17110 remainder 2 Patricia B. Yentzer Granddaughter One-ninth of rest, 624 Copper Circle residue and Lewisberry, PA 17339 remainder 3 David F. Boyer Grandson One-ninth of rest, 155 Merion Lane residue and Reading, PA 19607 remainder lEnter dollar amounts for distributions shown above on lines 15 through 16 on Rev 1500 Dover sheet',as appropriate- NON-TAYABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER 0.00 REV-1513 EX.(01-10) _ pennsylvania SCHEDULE J DEPARTMENT D REVENUE INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Nicholas, Frances S. 21 - 13- 1240 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 4 Judith D. Boyer Daughter Two-Thirds of rest, 189 Wilcox Drive residue and New Cumberland, PA 17070 remainder Page 2 of Schedule J INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } SS File Number 21 -13-1240 Judith D. Boyer Personal Representative(s)of the Estate of Nicholas, Frances S. deceased,depose(s)and say(s)that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.. I verify that the statements made in this Inven- tory are true and correct. I understa that false state- Judit ments herein are made subject to the penalties of Boyer 18 Pa.C.8.§4904 relating to unworn falsification to authorities. - Attorney- (Name) Ethan K Stone Esq (Supreme CourtLD.No.) 205458 (Firm) Law Offices of Ethan K. Stone, LLC (Address) 3400 Trindle Road Camp Hill, PA 17011 (telephone) 7171220-3529 DATE OF DEATH LAST RESIDENCE Messiah Village,100 Mt.Allen Drive DECEDENT'S SOD.SEC,NO 9/812013 Mechancisburg, PA 17055 FIGURES MUST BE TOTALED Personal Property First Trust NGMA Series 99-(FTGNJX)-Charles Schwab-CUSIP: 3373301395 14,597.64 Franklin Income FD CLA(FKINX)-Charles Schwab 45.275.59 CUSIP: 353496300 Nuveen PA Premium Income Muni Fund 2(NPY)-Computershare-CUSIP: 38,07185 67061F101 Invesco PA Value Munipal Income Trust(VPV)-Computershare-CUSIP: 41,455.38 46132K109 (Attach additional sheets if necessary) Total Personal Property and Real Estate $411,740.93 INVENTORY (continued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } Ss File Number 21 - 13 -1240 DATE OF DEATH LAST RESIDENCE Messiah Village,100 Mt.Allen Drive DECEDENTS SOC SEC.NO 9/8/2013 1 Mechancisburg PA 17055 PPL Corporation (PPL) -Charles Schwab 44,689.49 CUSIP: 69351T106 PPL Corporation (PPL) - Nuveen (Computershare) 44,689.49 CUSIP: 69351T106 UGI Corporation (UGI) -Charles Schwab 76.770.00 CUSIP: 902681105 UGI Corporation (UGI) -Nuveen (Computershare) 38.385.00 CUSIP: 902681105 Hillshire Brands Co. (HSH) -Computershare 6,305.00 CUSIP: 432589109 DE Master Blenders (DEMBF) - Nuveen (Computershare) 16,397.50 PPL Corporation (PPL) -Dividend 1,087.80 Ex Date -9/13/2013 Payment Date - 10/1/2013 Hillshire Brands Co. (HSH) - Dividend 25.00 Ex Date-8/30/2012 Payment Date -3/27/2014 Hillshire Brands Co. (HSH) - Dividend 25.00 Ex Date-11/29/2012 Payment Date -3/2712014 Hillshire Brands Co. (HSH) -Dividend 25.00 Ex Date -2/27/2013 Payment Date-3/2712014 2 INVENTORY (continued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } SS File Number 21 - 13 - 1240 DATE OF DEATH LAST RESIDENCE Messiah Village,100 Mt. Allen Drive DECEDENT'S SOC.SEC.NO. 9/8/2013 Mechancisburg, PA 17055 Hillshire Brands Co. (HSH) -Dividend 25.00 Ex Date -5130/2013 Payment Date -3/2712014 Hillshire Brands Co. (HSH) -Dividend 35.00 Ex Date -8/2912013 Payment Date-3/2712014 Santander Bank-Checking Acct#: 50415171 24,319.08 99 Old York Road, New Cumberland, PA 17070 Date of Death Balance$24,319.08 Santander Bank-Checking Acct#: 50415171 0.20 99 Old York Road, New Cumberland, PA 17070 Interest Payment Santander Money Market Fund -Acct#: 1421315910 47.42 99 Old York Road, New Cumberland, PA 17070 Date of Death Balance$47.42 Charles Schwab -Acct#: 82292963 16.687.35 22 N. 2nd Street, Harrisburg, PA 17101 Date of Death Balance$16,687.35 Pension Benefit Guaranty Corporation - Final Payment 539.04 Bethlehem Steel Corporation Pension Plan Final Social Security payment- US Treasury 2,286.10 100113WD1440344801 (Santandar) Total Personal Property 411,740.93 3 O � v v v v # A D D m D G -NI 0 K O Ni C D m N O p+y, f � S On z 0 0 0 o C eD T` � nC A r X Z Z 111 T MM o 00 o m z > w A m m m o w� odO H F a a R 0 0 0 X 0 0 O O y �O 00 00 ET N r W O O O ppi�pp El �- •° r w °w V A w w V/ in N W W C n o a cn vio z 3 o A N P X o <'o wwo X .G m m Q o o cr n LO J x � 0 n m w o D .DD WY N n G Z y z A N In .-n m D z x c r cn n P X �^ 'm VI v z C A so z d z A < �a 2 O Z � .. C 0 0 3 Z r m D ? # D 111 "• n m T n to o 0 n -1 0 O T O D o=m fA C vNi Ln n Z m C m ®a _ m N cn in m d m O o kN o m mat OJ O N N n 4Yd .0.; m A W O DD KD ¢ _ z O N 6 = _ m a 0'o A In CJ < O l0 N V OV d C1 O O o W m � N o p m O O O NUVEEN lnvestrrients 'c ETHAN K STONE 3400 TRINDLE RD 1ST FLOOR FRONT CAMP HILL PA 17011 March 6, 2014 Company: NUVEEN PA PREMIUM INCOME MUNI FUND 2 Registration: FRANCES S NICHOLAS Holder Account Number: C0000027031 Document I.D.: 14051WF00356420 Our Reference: NPY/0002896222/10/ Dear Sir/Madam: Thank you for your inquiry. We appreciate the opportunity to be of service to you. As the market was closed on September 8, 2013, we have provided the account balance information for the previous business day.The account balance information as of September 6, 2013 has been provided below. Company Name: NUVEEN PA PREMIUM INCOME MUNI FUND 2 (N P Y) \ Account Number: C0000027031 31� S6.M5 a{ 1JPY a&,ne� 9A/11 Shares Held by Agent: 0 / Shares Held in Certificate Form by Holder: 3159 Total Shares: 3159 � Q Closing Price Per Share: $12.07 an a/7/,Y \ Company Name: NUVEEN PA INVESTMENT QUALITY MUNI FUND (14 o') of to f coore Co^"e r�v Account Number: C0000194395 +0 30 9308 ,��, of N Pa Shares Held by Agent: 3032.619308 Np� a, �a on Shares Held in Certificate Form by Holder: 0 q� 2,�cl wuje cab a4 .969W3. Total Shares: 3032.619308 1>.4e aE Closing Price Per Share: $12.25 Company Name: UGI CORPORATION Account Number: C0000087874 Shares Held by Agent: 0 Shares Held in Certificate Form by Holder: 1000 Total Shares: 1000 Closing Price Per Share: $38.34 Company Name: INVESCO PA VALUE MUNICIPAL INCOME TRUST Account Number: C0000024091 Shares Held by Agent: 0 Shares Held in Certificate Form by Holder: 3419 Total Shares: 3419 Closing Price Per Share: $12.18 Company Name: D E MASTER BLENDERS 1753 NV Account Number: C0000371360 Shares Held by Agent: 1000 Shares Held in Certificate Form by Holder: 0 Total Shares: 1000 Closing Price Per Share: $16.17 Attached are the form and instructions needed to transfer stock to a new account or another holder. Important: Please also note that if you are transferring certificate shares,the certificate(s) must be mailed with your transfer request. Should you have any questions, please call us at 1-800-257-8787. Our telephone representatives are available Monday through Friday during regular business days between the hours of 9 a.m. to 7 p.m. Eastern Time. Please note that any available representative can assist you. If you have Internet access, you may also obtain additional information on our products and services by visiting our website at www.nuveen.com or write to us at Nuveen Investments, P.O. Box 43071, Providence, RI 02940-3071. Sincerely, Service Representative Enclosure: Nuveen US Holder-Deceased Transfer Package.pdf N%ri 7 E E TAT Nuveen Investments ® lJ V L L V PO Box 43071 Investments Providence,RI 02940-3071 ' Telephone: 800 257 8787 www.nween.com OOD357 rfvfllrfvNuflnrlrll11111isI III 9 Jill Ifl!IIr[h III llrrril[frft FRANCES S NICHOLAS 189 WILCOX DR NEW CUMBERLND PA 17070 Account Number C0000194395 I ND Company ID NQP SSNMN Certified Yes WIM003d ,.000031_4506N00350I001069 NUveer�PA,'I tment Qu8!'ity Muhidoa7 Fund" Corporate Acfion Advice 12etaifi ForYoUri2ecords This Transaction Advice a girt record of share enti11omerd received In exchange fm your subm6sion of 3,159.000000 shares d,NPY COMMON. ' Share Transaction Advice Shares Credited I Shares Presented I Exchange Rate I 'Shares[Units Credited I CUSIP Number I Form of Share Credit I. Fractional Share COMMON 3,159.ODOD00 0.959993 3,032.619306 670972109 DRS 611/2014 Nuveen Pennsylvania Premium Income Munic:NYSE:NPY historical prices-Google Finance Search Finance Finance Nuveen Pennsylvania Premium Income Munic (NYSE:NPY) Company Summary Dail rices Se 6,2013 - Sep 9,2013 Update News yp p Historical chart Related Date Open High Low Close Volume companies Sep 9,2013 12.03 12.08 12.03 12.03 13,574 2'07 Historical prices Financials Sep 6,2013 12.05 12.11 11.99 12.07 35,072 Markets Show rows: 30 • 1 -2 of 2 rows 12.06 News Portfolios Stock screener 12.04 Google Domestic Trends Sep 6,261 i Sep 9,2013 Recent Quotes(30 days) Export chg I i NPY 12.39 — Download to spreadsheet NPM 13.96 -0.040 Google Finance Beta available in: Hong Kong-Canada-U.S.-China-U.K. Information is provided "as is" and solelyfor informational purposes, not for trading purposes or advice,and may be delayed. To see all exchange delays, please see disclaimer. 0)2014 Google-Google Home-Blog-Help-Report a Problem-Privacy Policy-Terms of Service M ez r\ Pr'%c 2 q/Gl13 - low hash (;Z"\ = 4 /a.0So s /fl e $ 12.0.3 = #o-oss http:/Av .google.condfinancet histaical?cid=13257141Rstartdate Sep+6%2C+2013&enddate=Sep+9%2C+2013&nur 30&ei=WDmLU7Bbd5OSBaq MgZAL 1/1 6/1/2014 Irnesco Pennsylvania Value Mncpl Incm Tr:NYSE:VPV historical prices-Google Finance Search Finance sign €n Finance Invesco Pennsylvania Value Mncpl Incm Tr (NYSE:VPV) Company Summary Dail rites Se 6,2013 - Se 9,2013 U date News yp p p p Historical chart Related Date Open High Low Close Volume companies Sep 9,2013 12.14 12.30 12.01 12.04 85,813 z.ta Historical prices Financials Sep 6,2013 12.03 12.19 12.00 12.18 51,414 Markets Show rows: 30 • 1 -2 of 2 rows 12.13 . News Portfolios Stock screener 12.09 Google Domestic Trends Sep 6,2013 Sep 9,2013 Recent Quotes (30 days) Export chg l r VPV 13.83 -0.050 Download to spreadsheet NQP 13.91 -0.080 NQU 13.92 -0.020 NPY 12.39 — NPM 13.96 -0.040 Google Finance Beta available in:Hong Kong-Canada-U.S.-China-U.K. Information is provided"as is"and solely for informational purposes, not for trading purposes or advice,and may be delayed. To see all exchange delays, please see disclaimer. ©2014 Google-Google Home-Blog-Help-Report a Problem-Privacy Policy-Terms of Service Meca.n C-e. 01 /( /r3 . tm a 4X2.00 # /oz i Ia , Ias IAC�re $ 1-1 "C' http:/A . ..google.comifinancethistorical?cid=708030&startdate=Sep+6%2C+2013&enddate=Sep+9a/o2C+2013&num=30&ei=KkWLU6CJMYPtkAX-7oGg Bg 1/1 6/112014 PPL Corporation:NYSE:PPL historical prices-Google Finance Search Finance C sigh in Finance PPL Corporation (NYSE:PPL) Add to portfolio Company Summary Daily prices Sep - ep rices S 6,2013 S 9,2013 Update News � Historical chart Option chain Date Open High Low Close Volume Related 30.27 . companies Sep 9,2013 30.10 30.31 30.02 30.27 4,663,545 Historical prices Sep 6,2013 30.09 30.41 30.04 30.07 4,494,292 Financials Markets Show rows: 30 1 1 -2 of 2 rows 30.20 News Portfolios 30.14 Stock screener Google Domestic Trends Sep 6,2013 Sep 9,2013 Recent Quotes(30 days) Export chg I% Download to spreadsheet PPL 35.09 +0.310 VPV 13.83 -0.050 NQP 13.91 -0.080 NQU 13.92 -0.020 NPY 12.39 — NPM 13.96 -0.040 Google Finance Beta available in: Hong Kong-Canada-U.S.-China-U.K. Information is provided "as is" and solelyfor informational purposes, not for trading purposes or advice,and may be delayed. To see all exchange delays, please see disclaimer, 02014 Google-Google Home-Blog-Help-Report a Problem-Privacy Policy-Terms of Service Me%(\ 9 /(0/t3 - too 36. 0 = 30.a�S /)3 r.;sti + 30. y� 3d . I45 Js4 we 30. 09 http:/An .google.coMfinance/historical?cid=26948&startdate Sep+6%2C+2013&enddate=Sep+9/a2C+2013&nur 30&ei=dWLU4DVN42rkg W7hoEY 1/1 6/112014 UGI Corp:NYSE:UGI historical prices-Google Finance Search Finance TI-1( ,S; r' 1 Finance UGI Corp (NYSE:UGI) A dtoportolio L J Company Summary Update S 2013 6 prices S Daily pep , - Sep 9,2013 News � Historical chart Option chain Date Open High Low Close Volume Related companies Sep 9,2013 38.37 38.42 38.08 38.29 631,059 38.34 Historical prices Sep 6,2013 38.61 38.75 38.29 38.34 561,514 Financials Markets Show rows: 30 • 1 -2 of 2 rows 38.32 News Portfolios 38.31 Stock screener Google Domestic Trends Sep 6,2013 Sep 9,2013 Recent Quotes 130 days) Export chg I% UGI 48.67 +0.250 Download to spreadsheet PPL 35.09 +0310 vPv 13.83 -0.050 NQP 13.91 -0.080 NQU 13.92 -0.020 NPY 12.39 — NPM 13.96 4040 Google Finance Beta available in: Hong Kong-Canada-U.S.-China-U.K. Information is provided "as is" and solely for informational purposes,not for trading purposes or advice,and may be delayed. To see all exchange delays, please see disclaimer. ©2014 Google-Google Home-Blog-Help-Report a Problem-Privacy Policy-Terms of Service Mean Price CI AP /111 - low � 38. 015 = � 38 . Sa /(.0 /t3 — h;S�n 3�r �' _L / = 38 . 385 /5koce 9 / ,1/13 _ low 3bc) C t /q / t 3 - ;Sti 38.42 http:/Au ..google.conVfinancet historical?cid=612596&startdate=Sep+6°/2C+2013&enddate=Sep+9"/o2C+2013&num 30&ei=mEq LU4imKsOPk4LXNj4DgCQ 1/1 6/112014 Hillshire Brands Co:NYSE:HSH historical prices-Google Finance Search Finance Sign €n Finance Hillshire Brands Co (NYSE:HSH) Add to portfolio Company Summary Dail rices Sep 6,2013 - Se 2013 U d News yp p 9, p ate Historical chart Option chain Date Open High Low Close Volume Related 31.59 companies Sep 9,2013 31.41 32.03 31.41 31.59 797,404 Historical prices Sep 6,2013 31.54 31.74 31.19 31.41 965,031 Financials Show rows: 30 1 -2 of 2 rows 31.53 Markets ........... News Portfolios 31'47 Stock screener Google Domestic Sep 6,2013 sep9,2o13 Trends Recent Quotes (30 days) Export `hg l° Download to spreadsheet HSH 53.28 +0.520 UGI 48.67 +0.250 PPL 35.09 +0.31 VPV 13.83 -0.050 NQP 13.91 -0.080 NQU 13.92 -0.020 NPY 12.39 — NPM 13.96 -0.040 Google Finance Beta available in: Hong Kong-Canada-U.S.-China-U.K. Information is provided "as is" and solely-for informational purposes,not for trading purposes or advice,and may be delayed. To see all exchange delays, please see disclaimer. 02014 Google-Google Home-Blog-Help-Report a Problem-Privacy Policy-Terms of Service M e� Pr%ce- °► /� �� a - nr5h µ 3 . 74 — ,i sa5-A1 u4 low - � http:/Aw google.corrAmncelhistorical?cid=30793&startdate=Sep+6%2C+2013&enddat a=Sep+9%2C+2013&nurr r=30&ei=sEytU7DVCMOPk4XNj4DgCO 1/1 6/112014 D.E.MASTER BLENDERS:OTCMKTS:DEMBF historical prices-Google Finance Search Finance sign in Finance D.E. MASTER BLENDERS (0TCMKTS:DEMBF) Add to portfolio Company Summary Daily prices Sep 6,2013 - Sep 9,2013 Update News � Historical chart Related companies Date Open High Low Close Volume Historical prices Sep 9,2013 16.43 16.48 16.41 16.47 22,974 16.47 Markets Sep 6,2013 16.32 16.38 16.32 16.35 55,118 News Show rows: 30 1 -2 of 2 rows 16.43 Portfolios Stock screener Google Domestic 16.39 Trends Recent Quotes (30 days) Sep 6,2013 Sep 9,2013 chg l% Export DEMBF 16.86 0.00 DE 0.00 — Download to spreadsheet HSH 53.28 +0.520 UGI 48.67 +0.250 PPL 35.09 +0310 VPV 13.83 -0.050 NQP 13.91 -0.080 NQU 13.92 -0.020 NPY 12.39 — NPM 13.96 -0.040 Google Finance Beta available in: Hong Kong-Canada-U.S.-China-U.K. Information is provided "as is"and solelyfor informational purposes,not for trading purposes or advice,and may be delayed. To see all exchange delays, please see disclaimer. ©2014 Google-Google Home-Blog-Help-Report a Problem-Privacy Policy-Terms of Service HL0.n pr,;•e 0(/!o / i3 - Id-j �t 1L. _ A I6•3s t"5lil- i(o. 38 1(o . 3�7S/st.vr 9/9 / 13 R/9/ 13 • d lt�,N8 http:/Aw .google.conYfinancethistorical?cid=593286296574166&startdate=Sep+6°/2C+2013&enddate=Sep+9^/2C+2013&nur 30&ei=plCLU4COJcyZkgXP4... 111 6/1/2014 Positions for XXXX-2441 Print Accounts >Positions:for)0=-2441 as of 06/01/14 01:52 PM Group By:FNone Price Change Day Change2 %of Symbol Description(Full I Short) Quantity Price ($1%) Marked Value ($1%) Rating 3 Reinvest?4 Accounts 33733D395 FIRST TR GNMA SER'UNIT SER 5,934 $2.306 0.00 6 � 99 MONTHLY CASH $13,648.20 0.00 -- N/A 2.96% FKINX FRANKLIN INCM FD CL A 19,685.039 $2.54 0.00 $50,000.00 0.00 ""' No No 10.85% HSH HILLSHIRE BRANDS CO 200 $53.286 +0,52 $10,656.006 +104.00 ED 2.31% VPV INVESCO PAVALUE MUNI 3,419 $13.836 -0.05 6 INCOME TRUST $47,284.77 -170.95 -- No 10.26% NQP NUVEEN PAINVI-QLTYMUN 3,032 $13.916 -0.08 $42,175.126 -242,56 -- No 9.15% PPL PPL CORPORATION 2,960 $35.096 +0,31 $103,866.406 +917,60 0 No 22.53% - UGI U G I CORPORATION NEW 3,000 $48.676 +0.25 $146,010.006 �. +750.00 n No 31.67% Cash&Money Market' $47,326.89 0.00 -- — 10.27% Account Total $460,967.38 +1,817.64 Prices and Market Values are real-tine and based on NASDAQ Last Sale or a consolidated market quote unless otherwise indicated. Quotes from the Toronto Stock Exchange and TSX Venture Exchange are delayed for professional users.Nun-professional users nay see a nix of real time oral delayed quotes. For Mutual funds,tyre NAV is a daily calculation occurring after market close.This process may take 2-d-4 hours before a final NAV is made available to the public. 1.The Account Day Change($)and I%)are based on the difference between[tie sort)of the current market value of all positions plus the current cash balances less the Previous closing values for positions and cash balances.The Account Day Change will be available until one hour prior to the next r arket open. 2.The Position Day Change value is calculated as:Rice Change x the sharesR)onds/unLs/contracts held in the account currently.R asperities no change in quantity from the prior day and will be available until one hour prior to the next market open. 3.Ratings are specific to each type of security.Equities display Schwab Equity Ratings'S,Ergs&Closed End Funds display a link to Morningstar ratings,Mutual Funds display Morningstar ratings,and Fixed Inccrro display S&Pfolluwed by buody'a ratings. 4,Mutual funds display Dvidend Rcinvsstrrnnt instructions followed by Capital Gain Reinvestment instructions. 5,The%of Account Assets for each position is calculated using all the long positions w ith values and all cash or cash investment sco ts. 6-The value reported may not reflect the current price. 7.The Cash or Total Cash value reflects the aggregate amount of your bank accounds),money market funds,url opt at Infra-day cash,credit or debit balances for fine accounts) displayed insured Bank Napa ork accounts are held at the[FDIC insured]depository usl utlon(s)referenced on the Balance detail page,your account statements,and disclosed in your account documents.Securities products(including un-swept or intraday cash,not credit or debit balances and mi rvtrkst funds)offered by Charles Schwab&Co-ins(member SIFC) are not deposits or obligations of the[FDiCinsared]depository imusufion(s),are subject to investment risk,are not FDIC-lnsured,may lose value,and are not bank guaranteed SIfC does not cover balances held at Sweep Banks in the Insured Bank Netw ork feature. For each Lund with at least a three-year history,tviDmingstar calculates a ksorningstor RatlngTm based on a fvio ningstar Risk-Adjusted Return=measure That accounts for variation In a fund's irritably put fomtanco(including the effects of sales changes,loads and redemption fees),placing more orrphasis on dow nw and variations and row at consistent performance.(Each share class Is counted as a fraction of one fund w ithin this scale and)also separately,w hlch may cause slight variations in the distribution percentages-)The top W%of the funds in an Investment category receive 5 stars.22.51%receive 4 stars,35%receive 3 stars:the next 22.5%receive 2 stars,and the bottom 10%,receive 1 star.The Overall Morningstar Rating is a ve eighted average of the funds three-,five-,and 10-year(if applicable)ll ngstar rating metrics. 2'f.re"L• https://client.schvrab.com/Areas/Accounts/Positions/PositionsPrird.aspx?domain=clierd.schv b.com&ls=N 1/2 Santander, Mini-statement FRANCES S NICHOLAS Account number:231372691 0050415171 A list of recent transactions on your account -BALANCE SUMMARY Type Amount($( Available 0.06 Ledger 0.06 PENDING ACTIVITY Date Details - Deposit($) Withdrawal($) 02/07/2014 Interest credit from 01/06/2014 to 02/05/2014 0.06 - POSTED ACTIVITY Date Details Deposit($) Withdrawal($) Balance($) 01/14/2014 Withdrawal -26,606.26 0.00 01/07/2014 Interest credit from 0.23 26,606.26 12/09/2013 Interest credit from 0.22 26,606.03 11/07/2013 Interest credit from 0.23 26,605.81 10/07/2013 Interest credit from 0.20 26,605.58 10/01/2013 Xxus treasury 303 xxrr ret 2,286.10 26 .38 09/09/2013 Interest credit from 0.20 24,319.28 09/06/2013 Check 000000001735 -275.00 24,319.08 09/05/2013 Check 000000001734 -164.29 24,594.08 09/05/2013 Unitedhealthcare premium -197.75 24,758.37 Revision Date 10/17/2013 Mini-statement FRANCES S NICHOLAS Account number:231372691 1421315910 A list of recent transactions on your account BALANCE SUMMARY Type Amount($) Available 0.00 Ledger 0.00 PENDING ACTIVITY Date Details Deposit($) Withdrawal($) POSTED ACTIVITY Date Details Deposit($) Withdrawal($) Balance($) 01/19/2014 Withdrawal -47.42 0.00 08/07/2013 Interest credit from 0.01 47.4 07/08/2013 Interest credit from 0.01 47.41 06/07/2013 Interest credit from 0.01 47.40 05/07/2013 Interest credit from - 0.01 47.39 04/08/2013 Interest credit from 0.01 47.38 03/07/2013 Interest credit from 0.01 47.37 02/07/2013 Interest credit from 0.01 47.36 01/07/2013 Interest credit from 0.01 47.35 12/07/2012 Interest credit from 0.01 47.34 Revision Date 10/17/2013 N O O 3 N O 0 n m x c n . m o a � o c nn n C 2 =e) CL ,v-. N m 7 Z z m o 00 O 1 D S l J m i D 1 prJ+ m F n o w 2. m m °m o-o N K Q O O O ° 9 o N w m C O 07 W 6 c d w V \ \ \ °o m A w w p N V r N 7 O Q 0) O ° tea, wwo X o m m �D ioo X ,m v, x V O V � 0 9i � ¢v < o � A n D c n Op N N z ,vv m ti D .N w ° n D 2 D N U) X '� 03 oa m U) O . o0 l0 N 3 (0 z 'm < �� 0 63 c o a m 2 ff1 T D C # ID m w m 3 O O A wJ D N c y C m z m 3 r C -I C ryW fV r Vl VI W 7 M C� m F.I ° n � c y V1 CO 't7 m VL/ 0' w m KD �y c C- o O V O O ° A vl PD A N W O � Ul N_ O O O �Qihi PBGC/Benefits Admin& Payment Dept PBGC P.O. Box 151750 -•- Alexandria VA 22315-1750 201E April 15, 2014 PBGC Case Number: 19660300 Plan Name: PENSION PLAN OF BETHLEHEM STEEL CORPORATION JUDITH D BOYER 189 WILCOX DR NEW CUMBERLAND PA 170703073 Dear JUDITH BOYER: This is to advise you that based on information our records nd information we received from you, PBGC has determined that you are ue $539.04 th we owed FRANCES NICHOLAS under the above named plan. If th ear other beneficiaries, we will communicate separately with them. Important To Understand: When a deceased payee does not have a contingent annuitant (someone who is due continuing benefits after the payee's death), and a PBGC Designation of Beneficiary is not on file, PBGC pays any money owed the payee at the time of his or her death, in the following order: a Spouse of the deceased payee • Children of the deceased payee • Grandchildren of the deceased payee O Surviving parent(s) of the deceased payee • Estate (if open) Next of kin Based on the information that we have been provided, FRANCES NICHOLAS was not married at the time of death and you are the designated beneficiary of FRANCES NICHOLAS. The term designated beneficiary is the person named as FRANCES NICHOLAS beneficiary for amounts owed to the deceased participant at the time of death. PBGC will pay the money owed to FRANCES NICHOLAS to you, JUDITH BOYER. Please complete the enclosed application and return it to us in the envelope provided. Your Responsibility: PBGC used the information in our files and provided by you and/or other individuals to determine that you are a beneficiary of the deceased payee. If you know about any other potential beneficiaries as listed above and have not told PBGC, please contact us immediately. Consequences: If you willfully withhold information about other potential beneficiaries and PBGC subsequently determines you were not due all or part of the payment, you will have to repay PBGC. In addition, you may face criminal penalties. Payment may be not rolled into an IRA To apply for your payment: Please complete the enclosed PBGC Form 721T - Tax Election for Payment Not Eligible for Rollover, and return it to us with the proof Pension Benefit Guaranty Corporation U.S. Government Agency document(s) requested above in the envelope provided. Your signature on this form is a certification that the information on which we based our determination is correct. Please read the enclosed Special Tax Notice Regarding Non-Periodic PBGC Payments. You may want to contact the IRS or your tax consultant for information and guidance on inherited IRAs. If you have any questions or need assistance, please call our Customer Contact Center at 1 (800) 400-7242, Monday through Friday, 8:00 a.m. —7:00 p. ET. If you use a TTY/ASCII, call 1 (800) 877-8339, and ask the relay operator to call our telephone number. Or, you may write to: PBGC/Benefits Administration and Payment Department, P.Q. Box 151750, Alexandria, VA 22315-1750. Please include your Social Security number, PBGC case number, 19660300, and a daytime telephone number. Please keep this letter in your records for future reference. Sincerely, C4 L Charnetta Lane FBA Pension Benefit Analyst Field Benefit Administration Enclosures: Privacy Act Notice (Short Form) Postage Paid Envelope 6 X 9 Form 721T - Tax Election for Payment Not Eligible for Rollover Pension Benefit Guaranty Corporation U.S. Government Agency Financial Summary Statement Period 09/10/13 10/09/13 FRANCES 5 NICHOLAS JVOYD BOYER ATTY BE Deposit Accounts Account Number Average Daily Balance Current Balance PREMIER MONEY MARKET-STANDARD 1421315910 $47.42 $47,42 Total Deposits $26,65100 PREMIER CHECKING Statement Period 09/10/13- IW9/13 FRANCES S NICHOLAS Account#50415771 JUD Y D BOYER A TT Y IFF Balances 9"N Deposits/Credits +$2,286,30 Avera2! Interest 990299MM= 2, Earned this Period W20 Paid Last Year $3.01 The interest earned and the interest paid may differ depending on when interest is credited to your account. Account Activity JJ 9-70 Beginneng 43 9.28 PREMIER MONEY.MAR'KET-STANDARD -nt Per icd 09/10113 1 0/0W1 3 Staterric FRANCES S NICHOLAS Account# 1421315910 JUDYD BOYER A rTY/Ar Balances EgWr - V- I Timn 1 Deposits/Credits 1$000 Avera?e Dai1X Balance $47,42 Em Account Activity Date Description Additions Subtractions Balance Begmmng $47,42 Page 2 of 4 AAL 50415171 Robert W.Snyder Funeral Home STATEMENT OF FUNERAL GOODS AND SERVICES 327 Easton Road PO Box 83 SELECTED Riegelsville,PA 18077 Charges. are for only those items that are selected or are 610-749-2421 required. If we are required by law to use any items, we Amy L.Snyder,Owner explain the reasons In writing below. fi�ES Q/g- an(3 1q zQ r 3 Funeral service for Date of death Date of service ITEMIZED PRICE LIST ADDITIONAL MERCHANDISE CHARGES Basic services of funeral home and staff...........$2,100.00 Casket..............................................$ 1]SID XU ransfer of remains o funeral home.....................200. Outer burial container................... (2951 OU Embalmin ...................................................................400.00 Cremation urn..........................t.. Autopsy embalming....................................................600.00 Clothing.... f .. 10 , 00 Other pre aratl ...........................275.0 Register book.................................. isitation first hour ..................................................250,00 Prayer cards.................................... Additional hour/hours................................ Memorial folders............................ Funeralservice.....................I.....................................250.00 Crucifix...,.......................................... earse................................. .......................................200 Other................................................ Cl (Service car . ..............................................................150 TOTAL MERCHANDISE CHARGES$ ................................................................................................... TOTAL CHARGES........................................$ 3• STS00 CASH ADVANCES Opening and sing of grave...... $ c31, 3 ADDITIONAL SELECTIONS Cemetery a Sun., Holiday..... (5, Direct cremation....................................................$1,650.00 Completing Inscription................... I $s- 00 immediate burial.....................................................1,800.00 other ce tory....I.......................... Forwarding remains to another FH......................2,050.00 Flowers. .0 X .SIP.. ....... lsD •�X) Receiving remains from another FH.......................700.00 .................................................I.......... Memorial service in funeral home..........................300.00 Obituaries... f?Y Lam.................. Graveside service........................................................100.00 GJ�7C .. ....��}��... ......... 175,QC) Clergy...... `u... . ....T ... { ...... C (9D• �� DISCLOSURES Other................. . ...... ....... ................. If you selected a funeral which required embalming, such as a funeral with a viewing,you may have to pay �YRf1S �!R^..u{°S•St.� „Pi...... f qLi . 00 for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such TOTAL CASH ADVANCE..............$ 2, 75 ` as a direct cremation or Immediate burial. if we charge 14 5m- '-c�&K.$- for embalming,we will explain why below. 24 {{�� SUMMARY OF CHARGES f6r •tt l�)E'ml pe.,/.t9 6 1. ALTERNATIVE SELECTION.........$ 2. TOTAL MERCHANDISE.............. If any law,cemetery, or crematory requirements have 3. TOTAL CASH ADVANCES.......... required the purchase of any of the items listed,the law or requirement is ex lained below. IJ q I TOTAL CHARGES.........................$ J S� Cefv v 9palair7°IMPhT - SL14f6 69(- dd ( Ste- oo I/we the undersigned, acknowledge that the forgoing statement had been read to me/us and I/we hereby acknowledge receipt of completed copy. A oved by Date For uneral Ko me use RECEIPT FOR PAYMENT ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 11/20/2013 Cumberland County - Register Of Wills Receipt Time: 12 : 10 :13 One Courthouse Square Receipt No. : 1076287 Carlisle, PA 17613 NICHOLAS FRANCES S Estate File No. : 2013-01240 Paid By Remarks: JUDITH BOYER DMB ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN CODICIL 15. 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20. 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 .00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 .50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 5633 $418 . 50 Total Received. . . . . . . . . 5418 .50 RECEIPT FOR PAYMENT LISA M. GRAYSON, ESQ. Receipt Date : 2/05/2014 Cumberland County - Register Of Wills Receipt Time : 15 : 04 : 37 One Courthouse Square Receipt No. : 1076925 Carlisle, PA 17613 NICHOLAS FRANCES S Estate File No. : 2013-01240 Paid By Remarks : ETHAN K STONE WZ ----------------- Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 20 . 00 CUMBERLAND COUNTY GENERAL FUN PHOTOCOPIES 4 . 50 CUMBERLAND COUNTY GENERAL FUN Check# 1046 $24 . 50 Total Received. . . . . . . . . $24 . 50 WAGGONER, FRUTIGER & DAUB, LLP CERTIFIED PUBLIC ACCOUNTANTS 5006 EAST TRINDLE ROAD SUITE 200 MECHANICSBURG, PA 17050 CLIENT: RCB-NICFR APRIL 12 , 2014 FRANCES S. NICHOLAS ESTATE 189 WILCOX DRIVE NEW CUMBERLAND, PA 17070 PROFESSIONAL SERVICES RENDERED IN THE PREPARATION OF YOUR 2013 INDIVIDUAL INCOME TAX RETURNS, INCLUDING: FORM 1040 , U.S. INDIVIDUAL INCOME TAX RETURN SCHEDULE B, INTEREST AND ORDINARY DIVIDENDS SCHEDULE D, CAPITAL GAINS AND LOSSES FORM 8879 , E-FILE SIGNATURE AUTHORIZATION FORM 8949 LT E, SALES AND OTHER DISP OF CAPITAL ASSETS PPIN, PRACTITIONER PIN TWO-YEAR COMPARISON WORKSHEET PA 40 , INDIVIDUAL INCOME TAX RETURN PA SCHEDULE A/B-TAXPAYER, INT INCOME/DIVIDEND INCOME PA SCHEDULE W-2S/MC, WAGE SUMMARY, MISC INCOME PA 8453 , DECLARATION FOR ELECTRONIC FILING PA REV-1630 , UNDERPAYMENT OF ESTIMATED TAX PA SCH D, SALE, EXCHANGE OR DISPOSITION OF PROPERTY PA V, PAYMENT VOUCHER TAX PREPARATION FEE $ 300 . 00 !• pennsylvania DEPARTMENT OF PUBLIC WELFARE February 18, 2014 ETHAN K STONE ESQUIRE 3400 TRINDLE RD CAMP HILL PA 17011 Re: Frances Nicholas SSN: ###-##- Dear Attorney Stone: Pursuant to your letter dated February 14, 2014, the Department's, Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. Thank you for your cooperation in this matter. If you have any questions, please contact me. Sincerely Znz-e- 0. ]✓d Vince A. Porter Recovery Section Manager (717)772-6604 Bureau of Program Integrity I Division of Third Party Liability I Recovery Section PO Box 8486 1 Harrisburg, Pennsylvania 17105-8486 JUN-05-2014 THU 08;29 AM ALERT PHARMACY SERVICES FAX N0. 17174864410 P. 02 ALERT PHARMACY SERV. INC. A FINANCE CHARGE OF 1.50 H PER MONTH 219 NORTH BALTIMORE AVE. (AN ANNUAL PERCENTAGE RATE OF 18.00 OR A MT HOLLY SPGS, PA 17065 MINIMUM SERVICE CHAKCE OF $ 1.00 WILL DE CHARGED ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE IF YOU RECEIVE A NEW INSURANCE CARD FOR YOUR PRESCRIPTIONS AE SURE TO SUPPLY US WITH A COPY. 05/31/201.4 PMT DUE. .06/24/14 NICHOLAS, FRANCES S NYCHF 30 DAYS. 16.24 JUDITH BOYE'R GRP-7W 60 DAYS. 16.00 189 WILCOX DR PAGE 1 90 DAYS. 1066.72 NEW CUMBERLAND PA 17070 ALERT PHARMACY SERV. :J!NC.2I9 NORTH BALTIMORE AVE. MT HOLLY SPGS, PA 1-7065 800-266-9954 ** THIS AMOUNT PAST' DUE ** .00 1098 . 96 .00 16. 48 1115. 44 .00 1115.44 YM E S S I 151 I .,., .. �• __._ . Form PB-0t ens- at 100 MT.ALLEN DRIVE,MECHANICSBURG,PA 17055 RESIDENT# UNIT I STMT. DATE 50901 001 D 11/30/2013 RESIDENT(S) JUDITH BOYER Mrs. FRANCES S.NICHOLAS 189 WILCOX DRIVE NEW CUMBERLAND,PA 17070 TOTAL AMOUNT DUE $1808.63 DATE DUE 12/31/2013 _ - . - -- DATE DESCRIPTION RATE Days!- CHARGES CREDITS BALANCE Units Balance Forward 1,808.63 s V 'ii ' L ��.Il �,� I ' -� lh'SACCOL41Tw I �,� ; PLEASE u RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 : OVER 120 TOTAL AMOUNT DUE 50901 0.00 0.00 1,808.63 0.00 0.00 $1,808.63 RESIDENT NAME Mrs. FRANCES S.NICHOLAS N/A P&01 Please make check payable to Messiah Lifeways at Messiah Village. A 1%fmance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank You! 611/2014 Check Image Details Print Accounts >History&Statements Account Number : 8471-2441 Check Number: 97 Posting Date : 04/18/2014 Front JUDITH D BOYER If / /' ESTATE OF FRANCES S.NICHOLAS" LL C/IClYLC$$CFIWAU - I 097 !" '1S9 WILCOX Dfl _i _ II. sz isms NEWCUMSERLAND PA 17070-30]3 I, f J Pay-to lhe, i- ' �imD- /u�nr.Gtr ,� 1Jn�cfjrw,_- `/e-o Donars L8 *ine.,kaN rwm mn Q i Schwab One r„ _ AMYakM'IOZe6 Ir --.For, .1:03 3 300 157.1: 76Lv53 13358 - -20097 Back n !IE' ��.G�Y.F_J tt Is l I . Y 1 r � I (1113-7984) https://client.schw b.conVPrintPopup.aspx?domain=client.schw b.com&ls=N 1/1 I, FRANCES S . NICHOLAS, of the 'Township of Forks ,. ,. County of Northampton, and Commonwealth of Pennsylvania, being of sound mind, memory, and understanding, do make, publish, and declare this to be my Last Will and Testament, hereby revoking all wills and codicils at any time heretofore made by me. FIRST: I direct my Executrix hereinafter named to pay all my just debts and funeral expenses as soon as is. con- veniently possible after my decease, including tt�i cinstatla-m , co C,> � tion of a suitable marker (or an inscription the @cfya�'at my � c ` m +v m rn;. CZ) - kn_ grave if one is needed, just as if they were debts 06 my —1 '7 estate. `> ° V" �. >. v ry r- rn u O CO �. SECOND: Any condominium or other residence wfiPch I n may own at the time of my death and which may have been owned jointly prior thereto by my .husband, Thomas E. Nicholas , and me, shall be sold and the proceeds thereof distributed in equal shares to my daughter, Judith D. Boyer, or to her issue per stirpes , and my husband' s daughter, Dawn Taylor, or to her issue per stirpes . THIRD: I give, bequeath, and devise one-third (1/3) of the residue of .my estate, both real and personal, per stirpes to the issue of my daughter, Judith D. Boyer. FOURTH: All the rest of the residue and remainder of my estate, both real and personal, I give, bequeath, and devise to my daughter, Judith D. Boyer, or to her issue per stirpes. Frances S . Nicholas FIFTH: In order to avoid court proceedings for t _e appointment of guardians for minor beneficiaries , I . appo�:it my daughter, Judith D. . Boyer, or if she does not survive, then her husband, Samuel Boyer, as Trustee of any property or pro- ceeds which passes as a result of my death, either under this Will or otherwise to a beneficiary under the age of eighteen (18) years , and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so ; the said Trustee shall use from time to time so much of it and the income thereof as said Trustee thinks advisable for the beneficiary' s support, education, and welfare (by paying bills directly or by paying amounts to any person taking care of the beneficiary) , shall deposit in a savings account, or invest , .any surplus until it is needed, and shall pay the remaining balance to the beneficiary when he or she reaches the age of eighteen (18) years, or to the beneficiary' s heirs under the Pennsylvania Intestate Law in case of death prior to his" attaining the age of eighteen (18) years. SIXTH: In addition to powers granted by law, my Executrix and said Trustee shall have the following powers exercisable at her discretion without court approval with re- spect to both principal and accumulated income and such powers shall continue until distribution is actually made: A. To sell at public or private sale, to ex- change, or to lease for any period of time, any real or personal property, to give options for sales or leases , and to execute and deliver deeds or other necessary instruments therefor. B. To compromise claims or controversies . C . To make distribution in cash or kind or partly each. "Frances S . Nicholas D. To accept in kind, retain, and invest in any form of property without being limited in any jurisdiction to what are known as legal investments for fiduciaries , .including stock in any corporation which may become a fiduciary in my estate or in any Trust created -by this Will , and including any Com= mon Trust Fund of a corporate fiduciary. E. To allocate receipts and expenses to prin- cipal or income or partly to each. F. To exercise any option, right or .privilege. granted in insurance policies or in other invest- ments . G. To accumulate income and, from time to time, to distribute from current income or from accumulated income amounts for the - purposes 'set forth elsewhere herein. SEVENTH: If my husband, Thomas E. Nicholas , shall. die simultaneously with me or under such circumstances as to render it difficult or impossible to determine who predeceased the other, I hereby declare that I shall be deemed to have survived my said husband and that this Will and all of its provisions shall be construed upon that assumption and basis . EIGHTH: All estate, inheritance, and other taxes imposed because of my death with respect to the property in- cluded in my gross estate for tax purposes shall be charged against my general estate just as if such taxes were my debts . All such taxes on present or future interests shall be paid at such time or times as my Executrix thinks proper, regardless of whether such taxes are then due. NINTH: I appoint my daughter, Judith D. Boyer, Executrix. If she does not qualify or ceases to act, I appoint Frances S . Nicholas in her place my personal' attorney, David H. <Miller, Esquire, of Easton, Pennsylvania, Executor. No bond shall be required of the Executrix or the Trustee appointed herein, nor of her successors . Executed on October 25, 1982. t i,•_zri•vC ,-z :r . . . . Lc 2 a-�' (SEAL) Frances S. Nicholas In our presence the above-named Testatrix signed this and de- clared it to be her Will, and now at her request, in her pres- ence, and in the presen of each other, we sign as witnesses . 1—/}��'U/'�%��•. /� , r/�` Residence �,-. 2i.-••,, ;. ;^`l �...'� ,✓;.:..Z_f . Residence I, PRANCES S. NICHOLAS, of the Township of Forks, County of Northampton, and Commonwealth of Pennsylvania, being of sound .mind, memory, and understanding, do make, publish, and declare this to be the sole Codicil to my Last Will and Testament dated October 25, 1982. ITEM ONE: On March 21, 1983, my husband, Thomas E. Nicholas, and I executed a written agreement which was joined in by ,my daughter, Judith D. Boyer, and my husband' s daughter, Dawn Taylor, which Agreement provided for the ownership, use, and disposition of certain real property in Hillsborough County, Florida. I hereby direct that said Agreement shall remain in full force and effect and shall not be changed, modified, nor affected in any way by the provisions of my aforesaid Last Will and Testament, nor by the provisions of this Codicil. ITEM TWO: In all other respects , I here12.7 M %ati a-, 00 -0 M C-) i cam. confirm, and republish my Last Will and Testament --aalcrd rQ r- ;W� M �>- C,4� 71 acs October 25, 1982 , together with this sole Codicil � as wand 402:5� my Last Will and Testament. Fn C:) > Executed on March 24, 1983. (SEAL) �2 ces -S. Nicholas In our presence the above-named Testatrix signed this and de- clared this to be the sole Codicil to her Will dated October 25, 19,82, and now at her request, in her presence, and in the presence of each other sign as witnesses. Residence Residence