HomeMy WebLinkAbout01-0208
. . -
REV-1500 EX + (6-00) OFFICIAL USE ONLY u.-
COMMONWEALTH OF PENNSYLVANIA REV-1500 /~- :J /;1- 7
DEPARTMENT OF REVENUE
DEPT. 280601 INHERITANCE TAX RETURN FilE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 0208
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Nailor, Patricia A. 164-28-0798
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
01/23/01 07/17/1935 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
3. Remainder Return
CHECK ~ 1. Original Return ~' Supplemental Return B (date of death prior to 12-13-82)
APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
(dateofdeathafler12-12,-82)
PRIATE 6. Decedent Died Testate 7. Decedent Maintained a LIving Trust 00 8. Total Number of Safe Deposit Boxes
(Attach copy of Will} (Attach a copy of Trust)
BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (dale of death between D 11. Election to lax under Sec. 9113(A)
12-31-91 and 1-1-95} (Attach SchO)
THI$~M\l$'t.jj:;PMi!Qiii~;AtMj:;QI'li'ljjij,iQllI:j~fiQQjj!l",*imAiimM!jllm!!M4nQ!)l!i!QQUiij;~p!lPi
NAME COMPLETE MAILING ADDRESS
COR- Mark E. Halbruner, Esauire 1013 Munm:l. Road, SUite 100
RE- FIRM NAME (If Applicable) I.erroyne , PA 17043
SPON
DENT Gates & Associates, P.c.
TELEPHONE NUMBER
717-731-9600
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1) None
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5) 1,000.79
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested (6) None
RECA-
PITULA- 7. Inter-Vivos Transfers & Miscellaneous
TION Non-Probate Property (Schedule G or L) (7) 122,378.44
8. Total Gross Assets (total Lines 1-7) (8) 123,379.23
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 16,146.23
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 920.29
11. Total Deductions (total Lines 9 & 10) (11) 17,066.52
12. Net Value ot Estate (Line 8 minus Line 11) (12) 106,312.71
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an ejection to tax (13) None
has not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 106,312.71
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) X.O (15)
TAX 16. Amount of Line 14 taxable at lineal rate 106,312.71 X.O 45 (16) 4,784.07
0.00 -
COMPU- 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00
TATION 18. Amount 01 Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00
19. Tax Due (19) 4,784.07
20. D Ipij~ii;jjI!Rl!iFyQjjW~Qlj~!@AI!l\fijNPQljA\'l)Q!Ii!RM~1It1
...........~~~1ii'..$Vllll:rOAmlWEl'J.l\Wq(!e$l!@jj$QNeAl1ill?Am!llllllBI$QKMi\T!'l~S,.....,....,......,.,.,
o PA15001
NTF 29755
Copyright 2000 GreatlandlNelco LP - Forms Software Only
Estate of: Patricia A. Nailor
SillIMARY OF ALlDCATICNS 'ill BENEFICIARIES
Taxable at lineal rate
Ten.y J. Renninger
Kirnberl y J. Lcpp
Nevin L. Nailor, Jr.
Am3nda Nailor
103,000.00
493.86
493.85
2,325.00
106,312.71
21-2001-0208
PA REV-1500 EX (6-00)
Decedent's Com lete Address:
STREET ADDRESS
P. O. Box 33
Page 2
CITY
New stawn
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
PA
ZIP
17072
(1)
4,784.07
4,400.00
231.58
T alai Credits (A + 8 + C)
(2)
4,631.58
3. Interest/Penalty if applicable
D. Interest
E. Penally
0.00
0.00
(3) 0.00
(4)
(5) 152.49
(5A) 0.00
(58) 152.49
TotallnteresVPenally (D + E)
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
5. 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 + SA. This is the BALANCE DUE.
Make Check Payable 10: REGISTER OF WillS, AGENT
.,.',..._._..-,..-.-,..-,...,.,-.-,.,'........,'..,...........,'........,'.....'-',._'_..._'_..:-'.-.:.....:.-,-.;.-,--;,-,;.;,-,;.,,-.;.-,-.;.-,-...-,-...-,-...-,-................,.......,'....,'..,
.,'-'...'-:-...-:-...-:-'...'-:-...-:-....'-:--,:-:-,.-.:-:,-".:.-,-.,."-.,.,,-,,.,.-,-.,.,,-,.."-':.,."-".,.....;.-':.;.:-',,.;.,,,..........,.,'....
:.":-:".:::::::,::::::::',:,','::,'::,::'::,'::,:,::',::,::":"::,:::,:,:::,,,,,::,:-::,,:,::,':':::"::,::::,:::;:"::,:,:::,:,:::,,::::,:;:,,:::,,::,::,:,::,,::,,':::::'::':"::""::':':::':'::::":::"":
::"':-:'::'::':::':-::::":';::':":::-':""'::-:"::::':'::"":::-:,":':,:,x:::',:::::,::,:::""::'::":::"':::':':':':::':':::"'::
.....,:',-,.:',-,.,.:-,.,-:-,.:-:.:-:-,.,-:.:',.,':.,.,,:",:-:",:",:::",:,.,.::",-::,.,::".,::-,,::,.--,:,.--::-.-,,:-.-_.,-:-,.,-:-,.:-:-,.,-:-,.,-:-,.:.:-,,;-,-,':',.,':',.,.:',.,':':.,':':.,.,':',
.,':'....:-:.,..'::.'.:::-'."::'.--:::',.,:,:-,-.,::--.,':'-,-':'"-,,",--:".-,-"",-..-:.-,-,:.":,:.:-:...:..,.:,:".,,:,,.,.:
.pLEASE.ANSWER...THE.FO[[OWING..QUESfiONS....By.P[ACING...AN.
1.
"X"
...-'....'-'...,'-'.-.,'-'.-..'-'.-..._'.-'.._'.-'.._'.-'.._'......_'.-'.--'......_'.......'.....-.'......_'....,..'......_'.....--'.......'......_'.-..._'.........-..-...-.,--'...,..'.-'..,.-'-.,..'
-',...-'-...."..
.......................... .............................................'..,.."..".
........................."..........-...-.."..-...-..-'--'.'--'.'--'.'--'.'--'.'--'.'"."''''''''''
............................................. ... ..' """.""
.. . . . .. ... .-...................................................-.,.-"..,..
',"",",''''''''''''''''''''''''''''',''-',','',','',',-,'".-,.".,....,-.."'.".."..."...-..,,'..'.."..
...-,.,-,.,-.........-.-...-.-...-.......-...-.-._.-...............................................................-."....,._'.-.-_._-,-,.'.
'"",, ,."...,,,....,...,..,...,..,.,,.,,. ',,'.,,',,','.',,',',',,''''''-'"'
INTHEAPPROPRiATESLoCKS
Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . .
c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? ......................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................ ....................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. 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.
Under penalties of periury, I declare that t 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 information of
which preparer has any knowledae.
SIGNATURE OF PERSO RESPON 18LE F FILING RETURN DATE
Yes No
~ I
~ B
~
D
ADDRESS
See Schedule attached
SIGNATURo/IU;~;f 7.H~ENTA~VE
ADDRESS
1013 MLnm1a Road, SUite 100, Lem::Jyne, PA 17043
DATE
~-'27-O1
00
[72 P,S !l9116 (a) (1.1) (ill
For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to orforthe use of the surviving spouse is 0% [72 P.S. !l9116 (a) (1.1) (ii)].
The statute does not F!XF!mot a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1. 2000
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to orforthe use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S, 119116(a)(1.2)].
The tax rate imposed on the net value of transfers to or/or the use of the decedent's lineal beneliciaries is 4.5%, except as noted in 72.P.S. II 91 16{1.2) [72 P.S. %9116{a){1)).
The lax rate imposed on the net value of transfers to or for the use of the decedent's Siblings is 12% [72 P.S, 891 16(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.
o PA15002
NTF 29756
CoPyri9ht 2000 GreatlandlNelco LP - Forms Software Only
Estate of: Patricia A. Nailor
21-2001-0208
The following person(s) are signing the return as representative(s) of the estate:
Terry J. Renninger
P. O. Box 33
New Kingstown, PA 17072
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Patricia A. Nailor
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include proceeds of litigation & date proceeds were received by the estate.
21-2001-0208
All DrOD. lolntlv-owned with rlaht 01 survlvorshlD must be dIsclosed on Sch. F.
VALUE AT
DATE OF DEATH
ITEM
NO.
DESCRIPTION
1 PNC Bank
Checking Acct. No. 5070024828
(see attached)
688.95
2 PNC Bank
Checking Acct. No. 50-0353-3104
(see attached)
311.84
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,000.79
7 CPA81 NTF 10908
Copyright Forms Software Only, 1997 Nelco. Inc.
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Patricia A. Nailor
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-2001-0208
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NO.
DESCRIPTION OF PROPERTY
INCLUDE NAME OF THE TRANSFEREE, THEIR
RELATIONSHIP TO DECO & DATE OF TRANSFER.
ATTACH COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF EXCLUSION
DECO'S (IF
INTEREST APPLICABLE)
TAXABLE VALUE
1 Real estate located at 37 Green
Hill Road, Mechanicsburg, Silver
Spring TcMnship, Cumberland County,
Pennsylvania, being Tax Parcel No.
38-006-0015-002B; decedent
transferred to her daughter, Terry
J. Renninger, by deed dated
11/01/2000 and recorded in the
CUmberland County Recorder of Deeds
Office on 11/22/2000. Value is
based upon the attached Appraisal.
105,000.00
100%
3,000.00
102,000.00
2 Prudential Securities
Transfer on Death AcCOlITlt;
Acct. No. 044-325845-026;
beneficiaries are decedent's
children, Kimberly J. Lapp and
Nevin L. Nailor, Jr. Following is a
list of assets carprising the
account. (see attached)
17,053.44
50 shares of 'Ibllgrade
Carrmmicatians, Inc., ccnm:m stock;
date of death high $48.375 per
share; date of death low $43.25 per
share; date of death average
$45 . 8125 per share. Date of death
value = $2,290.63
887 shares of AMStrg Ie III II1l.ltual
fund; date of death high $11.75 per
share; date of death low $11.625
per share; date of death average
$11.6875 per share. Date of death
value = $10,366.81
urs ])::w Tech10 4 Equity Unit Tnlst.
Market value = $4,099.00
Prudential M:lney Market Fund =
$297.00
'Ibtal fran continuation paqe (s)
3,325.00
7 CPA01 NTF 10910
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
122,378.44
Copyright Forms Soltware Only, 1997 NelcQ, Inc
Estate of: Patricia A. Nailor
SCHEOOLE G -- Inter-Vivos Transfers and Nan-Probate Prq:>erty
Item
No.
Description
3 1994 Pontiac Grand Am SE; being
VIN IG2NE5530RM538909; decedent
transferred vehicle to her
granddaughter, Amanda Nailor, on
01/20/2001. Value based upon
attached NAIll\. appraisal report.
4 Gift l1'ade to decedent I s daughter,
Terry J. Renninger, in 12/2000.
5 Gift l1'ade to decedent I s daughter,
Kimberly J. Lapp, in 12/2000.
6 Gift l1'ade to decedent I s san,
Nevin L. Nailor, Jr., in 12/2000.
7 Gift nacl.e to decedent I s
granddaughter, Amanda Nailor, in
12/2000.
8 Gift l1'ade to decedent I s grandson,
Corey Nailor, in 12/2000.
9 Gift l1'ade to decedent I s
granddaughter, Brandi Pechart, in
12/2000.
10 Gift nacl.e to decedent's grandson,
Jeremy Rerminger, in 12/2000.
11 Gift l1'ade to decedent I s grandson,
Dustin Renninger, in 12/2000.
Page 2
21-2001-0208
% Of
Date of Death Deed's
Value of Asset Interest Exclusion Taxable Value
5,325.00
1,000.00
1,000.00
200.00
200.00
200.00
200.00
200.00
TI.m\L. (Carry forward to main schedule) . . . . . .
100%
3,000.00
100%
1,000.00
100%
1,000.00
100%
200.00
100%
200.00
100%
200.00
100%
200.00
100%
200.00
2,325.00
1,000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,325.00
REV-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Patricia A. Nailor
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-2001-0208
Debts of decedent must be reported on Schedule I.
ITEM
NO. DESCRIPTION
A. FUNERAL EXPENSES:
AMOUNT
1 Hoffman-Roth Funeral Hare, Inc. - f1.ll1eral se:rvicejrrerchandise
(see attached)
4,964.00
2 Westminster Celretery - burial fees
(see attached)
5,303.44
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN No. of Personal Representative(s)
Street Address
Ci~ S~e
0.00
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 Teny J. Renninger
Street Address P.O. Box 33
Ci~ New Kingstcmn State PA Zip 17072
Relationship of Claimant to Decedent Dauqhter
4,500.00
1,000.79
4. Probate Fees
63.00
5. Accountant's Fees
0.00
6. Tax Return Preparer's Fees
0.00
7 Cumberland County Register of wills - filing fees
(see attached)
15.00
8 Rothman Schubert & Reed Realtors - real estate appraisal
(see attached)
300.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
16,146.23
7 CPA11 NTF10911
Copyright Forms Software Only, 1997 Nelco, Inc.
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Patricia A. Nailor
Include unreimbursed medical expenses.
ITEM
NO.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
DESCRIPTION
1 Cardiovascular SUrgical Institute - medical bill
(see attached)
2 Medicare - patient responsibility
(see attached)
3 West Shore EMS - eme:rgency transport bills
(see attached)
4 Holy Spirit Hospital - hospital bills
(see attached)
5 Pennsylvania G.1. Consultants, P.C. - medical bill
(see attached)
6 Pulrronary & Critical Care Medicine Assoc., P.C. - medical bill
(see attached)
7 Quantum Imaging & Therapeudic Associates - medical bill
(see attached)
8 Wasserott' s - medical supplies
(see attached)
9 ravid Calcagno, M.D. - medical bill
(see attached)
10 John G. Calaitges, M.D. - medical bill
(see attached)
11 Family/Internal Medicine Assoc., P.C. - medical bill
(see attached)
21-2001-0208
AMOUNT
7.41
61.36
216.76
34.35
135.71
20.73
40.97
52.95
13.82
19.67
316.56
7 CPA12 NTF 10912
Copyright Forms Software Only, 1997 NelcQ, Inc.
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
920.29
REV-1513 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Patricia A. Nailor
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Teny J. Renninger
P. O. Box 33
New Kingstown, PA 17072
2 K:imberl y J. Lcpp
R. R. # 3 Box 979
New Blocrnfield, PA 17068
3 Nevin L. Nailor, Jr.
1670 Holtz Road
Enola, PA 17025-1312
4 l\n'anda Nailor
1670 Holtz Road
Enola, PA 17025-1312
FILE NUMBER
21-2001-0208
RELATIONSHIP TO DECEDENT AMOUNT OR
Do Not List Trustee(s) SHARE OF ESTATE
D3.ughter
103,000.00
D3.ughter
493.86
San
493.85
Granddaughter
2,325.00
ENTER DOLLAR AMTS. FOR DISTRIBS. 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 TAX IS NOT BEING MADE
None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
None
7 CPA13 NTF 10913
Copyright Forms Software Only, 1997 Nelco, Inc.
TOTAL OF PART 11-- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
0.00
(If more space is needed, insert additional sheets of the same size)
'T'n~,.oI1~ ',"V ",',~I;
This is to certify that the information here given is correctly copied from an original certificate of death dlll~ filed with me as
L"cal Reg.,,,ar.' The original certificate will be forwatded to the Stare Vital Records Office for permanent filll1g,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
\l\lll\(~~\,~'orpl~...-._~
"",#-~~4'~,-
j~_.. ..!......\ ~\
!'-"~'h !;b.!
\. *'. '.,' .~) * ~
\a..-. .' /.....~l
~("A /~\\
.....Jf$>- .---<~"f"l
-.... 'MENl ~~" "",
'~~"''''''''''''''''''''''IIIIIIII!'
~.,_t\.~~~~
Local Registrar
Fee for this certiflcate, $2.00
P 8948025
Jf>.N 2 4 2001
Date
H'OS,\olJR".'2IB7
COMMONWEALTH OF PENNSYLVANIA.. DEPAATMENT Of HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
.m
'"'
+I"~~ ()E.ClO'i.""I" \~;",. "";;;,.. ~...)
1. patricia A. Nailor
.-._--_..._,-----------~-----
,..
SWI~'I.!"lJ"'B!.1l
SCC'ALSECUFl'T't"lU~BE"
O~lEOFOEft..,...c""'.o.'r, ''''1
~l"l"l"
65
UHOf:R1YEAI'I
.- "'"
lJN(lE1l 1 0/11:1
_!...Art..
8IRTHPtACE((:olylt'ld
'Slato",r","'O"Coo.Inlrvt
Sh' PA
~ppensburg
2E'ema1e ~. 164 - 2 - 0798
Pl,J.CEOIOE..,.HlCl><<~Il<'OyOt'e--.........,u<:I~""_,.,.\
ttOSPI1AL:
'-1_0 E~"'" 0
4. Ja
..GElL..9~1'l
'"
~ly)O
COU"lt'fO"~'H
RACE _..."'........IIIdi.n. llI<<~. WII~.. .'e
"-,,
<;J,\
....
Cumberland
DECEtlEHl'SUSV...l Vp.Q)QN
lol...;ra~:::.~,:::':i.:"1'
. I. Home er "".
OlECEOE...,..Sl,lAII.IHGAOOAESS(Sl'"'.C~._.ZIl>Co<Ml
P. .0. Box 33
...
_s OECEOEIlT EVER IN
V,5.ARl,lEO'OACES?
'I'o.o,.,CX
(I..",S+,
..."""'ALSTATUS.l,l.......
,.,.....l,l...'".~.
-""""
I" Divorced I.
llc.()C_....__... Silver Sorino
SURVIVING SPOUSE
1".......gI\'OI"'__1
It. New Kin stown, PA 17072
FRHEFt.SNAME(Fir'll...."""..L..'1
...
1f/f'OAMAtfT.S NAME (l yptlIP,ir"l
Terry Renninger
IoIE'1"l<<)OO4'OlSPOSt"l"lQlo4
llut'tolGl c......,io<>O RernI>YII~""'SI.'.o
~OOl""($pec.ty'
..
"""~
OECEOEI4T'S
ACTVAL
fIIESlOE"ICE
...-
""""'..-
...
17..$1". Pll
171:..Cou
~.--
17lL ___""
lotOTHEFt'SNAlolEIFirll.loIodt1lo._SuMOIN.
'"
-
~..
-'
-
C;ty-.,
..
lNf'ORMA .... $IoIo.ZIl>CodoI
P.Oo Box 33, New Kin stown PA 17072
f'l..ACeOl'OISPOSITION.N_"'C_Ofy,C""'1IIIIY lClC.fJlON.CiIVfTOo'Il.S'"..ZlI>CocIe
~an..~~. Westminster
...
Funeral Home
24. l,l.25.
27.PAfIIY': Enl."lIOdis......irojurieo...compli<:..............il;hClU...,'h.O..'h(klnol.n'.."...
List...."O....c..-""..""....
(i<-S/,,"4~,,", .hr,j""
()UElO(QflAS"'CONSfOOENCEOFj:
17",,~ /;5 _''-( -/.---~, h
OlJElO(QflAS"CQi'lSEOUE...cEOFl
...
'AppI(I.......
:inI__
:---
1~A,,.,,-'
P...,"":OIl"'lill"illc..tCondl\iono""~lOdO.!II,bul
_........ltolIinthaurwlarlyW>g_o;.en..PAFtTI
L
.<!-'t, .-;"'
1$-
?
0UE1O(Qfl AS ...CQNSEOUtNCE OF)'
WEFtE AVlOF'SY F'''IOIHQS "'''''''NEfIIOF D€A1H
~EPRJOIlIlO
COl,lpt.IE1"IONOFCAVSE H_ol e'l.- Ho/fIil;.,. 0
OFOEIQ"H7
Ace""'''' 0 P.r4n9~ 0
~ 0 ~B- _0 ~ 0 ...~ 0 COUldnolNcII'.m"ned 0
(lA1EOF INJ1JFlY
1"''''''''.OIy,'I'o1t)
l''''EOF '1-I.l1JFlY
,t4JlJIl.YIi:f~? OCSC~I<<]N~".llJA"'OCC\IAAEC-
Vao 0 NoD
..
0"
OA1EFllEOI"'on",.O,.._"
(\"-"
,.
~<\- d-GD\
,
_. 21b.
Cl:1n"""Il,C~"""""'''''''1
.C1!InIFYINGP!'l't'SICIANIPI>ysoc,.n"""~t.WM"'0N"'''''.,.I.....~..''''."'''_hl.pt''''''''''''*'dO.'h"''''e'''''_....231
10""'_.0."".l1Ow....OO.d.."'occu..e<ld...IO"'.uu..(...nd"'."".,...I.lod.
...
"'-"CEOFINJUflY.A1_.I.,m.SIf1I...IOCIOry._
...-......,.'Specdvl
"..
'''IlONOIJ''ICltf(l AND CI.1l11'-"1"I0 I"HYSICIAN {PI>yso:..n boO~ ~'''''''''nc'''9 a.a'~ at><! c",,"v>nQ1O c'u" 0' d""'\
10'''. _ o. "'y~"."ol"'lI". dCOlh""Cu"ed .1_ '1m.. d.'" .~d "I.u. .nd d...IO 'h.C'U..(.)'nd "'."~O'.. 01.'''''..
'lIU,O)CA.. UAM1NERN;ORONEFt
On.".b..l.ol...",ln.lIonl"dlorln"ullg.lIon,I""'yoplnion,dull\oeeunedlllhellm.,d"e..I1<lpl.c..lndduelolll.cau..(.)It1d
m."".....I.I..:!,.
".
:13. ~0'51Fl~""'5s.G""1..,p.E"t<O..~~. ~tu..~Q
Id., I ,d. 1,01
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
"'-'~"
"""-',' -~""'i'"
'" !....!," '''',
~~" < . .................. ~~i.;..
/' ........1 .. ......\~,4',:"*
,'....., ).... -"', -:. 'n
;~ >~Illl'"' .~, ,,':.(l \\
(" . .! : ~.}I - .. .. - '.
l '~"I ;:<:;11.
.~ . ~ ~,' r'
.~ ,'~... \
, .,
\ .".
J ..\
" \)
" ':"'"
Register of Wills of CUMBERLAND County, pennsyl'
Certificate of Grant of Letters
~ "
No. 2001-00208
ESTATE OF NAILOR
lLA.:i'l',
PA No.
PATRICIA A
r 11"<:::),i', iYl.lULJLt.,;)
21-01-0208
'~? 11,1'
Late of
SILVER SPRING TOWNSHIP
L:UM,tj.r.;KLAl'lU l,;UU.N'l' X I
,
WHEREAS, on the 22nd
dated November 14th 2000
was admitted to probate as the last will of NAILOR PATRICIA A
(La::;'!', t'l.K::;'!', Ml.UULIO)
Deceased
Social Security No. 164-28-0798
day of February
20Q1. an instrur.
late of SILVER SPRING TOWNSHIP
23rd day of January 2001 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to TERRY J RENNINGER
,
CUMBERLAND County, who died on the
who has duly qualified as Executor(rix)
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 22nd day of February 2001.
1Jll}L'lJ', X.:iUU;J ',(ii", (< t{"' ,?k':"--:-l-.::..,) L... 1/,
J 'Keg1s~er or w111S 7~
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
I, PATRICIA A. NAILOR, now of 37 Green Hill Road, Silver
Spring Township, Cumberland County, Pennsylvania, do publish and
declare this to be my Last will and Testament, hereby revoking
all other prior wills and codicils made by me.
FIRST: Family Backqround and Appointment of Executor.
(A) Family and Backqround Information. I am not married.
I have three children, TERRY J. RENNINGER, NEVIN L. NAILOR, JR.
and KIMBERLY J. LOPP, and throughout this Will, they will be
referred to as "my children". The word "issue" will refer to my
children and my other descendants.
(B) Appointment of Executor. I appoint as my Executrix and
Successor Executor (all hereinafter referred to as Executor or
Executors) under this Will, the following named persons to serve
without bond and without being required to account to any court:
Executor: My daughter, TERRY J. RENNINGER.
Successor Executor: My son-in-law, G. SCOTT RENNINGER.
SECOND: Funeral and Last Illness Expenses; Taxes.
(A) Expenses of Funeral and Last Illness. I direct my
Executor to pay my funeral expenses and the expenses of my last
illness from my estate.
(B) Taxes. I direct my Executor to pay any and all estate,
inheritance, succession, legacy, transfer and other death taxes
or duties, by whatever name called, including any and all
interest and penalties thereon, imposed under the laws of any
jurisdiction by reason of my death, upon or with respect to any
and all property included in my gross estate for the purpose of
such taxes, whether such property passes under or outside of this
Will, out of my residuary estate, without being prorated or
apportioned among or charged against the respective devisees,
legatees, beneficiaries, transferees or other recipients of any
such property or charged against any property passing or which
may have passed to any of them. The Executor shall not be
entitled to reimbursement for any portion of any such taxes from
any such person.
i~~
~\t'LJY\.
11)01
<, I
,
~_.
__ ~_ "vr~" T'e ",_, .~'___
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE :&
THIRD: Tangible Personal Property. Except for those items
excluded below and those items enumerated in the Letter of
Instruction, I bequeath all my cash on hand and all my tangible
personal property, including but not limited to clothing,
jewelry, furniture, household furnishings, household goods,
personal effects, motor vehicles and all other similar articles
which I own, and the insurance thereon, to my issue, per stirpes,
to be divided among them as they may select in as nearly equal
shares as is practical. Tangible personal property shall not
include: (1) any and all property used by me in any business, (2)
cash on deposit in banks, (3) stock or securities, (4) any type
of evidence of indebtedness and (5) any life, health or accident
insurance policies.
If there is any disagreement as to distribution, I direct my
Executor to make such distribution, and the decision of my
Executor shall be final and binding. Any items not selected or
any items which my Executor considers unsuitable for my
beneficiaries may be distributed or sold in the sole discretion
of my Executor, and if sold, the net proceeds therefrom shall be
added to the residue of my estate. Any such article allocated to
a minor may, as my Executor deems advisable, either be delivered
to the minor or to any person to safeguard on behalf of the
minor.
Notwithstanding any other provisions in this Article THIRD,
I may leave a separate, dated and unsigned Letter of Instruction,
which I shall place with this Will, containing directions as to
the ultimate disposition of certain of the property bequeathed
under this ArtiCle THIRD, and such Letter of Instruction shall
determine the distribution of such items.
FOURTH: Residuary Estate.
(A) I give, devise and bequeath all the rest, residue and
remainder of my estate, of every kind and character, real,
personal and mixed, tangible and intangible, and wherever
situated, inCluding any lapsed or renounced legacies, devises or
residuary bequests and any property over which I may have a power
of appointment, in equal shares to my children, NEVIN L. NAILOR,
JR. and KIMBERLY J. LOPP, provided that the share of any
predeceased child shall be distributed to hiS/her then-living
issue in equal shares, per stirpes.
nL
)v.~
'Mctr
....~'If..1;:li..l.7!li.ll'.:..,."."""':Jo..h'f.~..,.-. . ~ .._....,.~.-......~,.,._~,._
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE 3
(B) I have intentionally omitted my daughter, TERRY J.
RENNINGER, and her issue from this bequest of my residuary
estate.
(C) Prior to final distribution of my estate, the Executor,
in his discretion, may make partial distributions to one or more
beneficiaries or trusts. As a consequence, the executorship and
any trusts created under this will may exist contemporaneously.
A distribution may be made subject to any indebtedness or
liability of my estate.
FIFTH: Powers of Executor. In addition to such powers and
duties as may have been granted elsewhere in this will or by law,
but subject to any limitations stated elsewhere in this Will, the
Executor shall have and exercise exclusive management and control
of the estate and shall be vested with the fOllowing specific
powers and discretion:
(A) In the management, care and disposition of the estate,
the Executor shall have the power to do all things and to execute
such instruments, deeds or other documents as may be deemed
necessary or proper, including the following powers, all of which
may be exercised without order of or. report to any court:
(1) To sell, exchange or otherwise dispose of any
property at any time held or acquired hereunder, at public
or private sale, for cash or on terms, without
advertisement, including the right to lease for any term
notwithstanding the period of the estate, and to grant
options, including any option for a period beyond the
duration of the estate.
(2) To invest all monies in such stocks, bonds,
securities, mortgages, notes, choses in action, real estate
or improvements thereon, and any other property as the
Executor may deem best, without regard to any law now or
hereafter enforced limiting investments of fiduciaries.
(3) To retain for investment any property deposited
with the Executor hereunder.
(4) To vote in person or by proxy any corporate stock
or other security and to agree to or take any other action
in regard to any reorganization, merger, consolidation,
~
JtAA
~
.
~~~..j;"" ". ;'I:"..:~:~..""~.r.,,,...-.~,~.. _
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE 4
liquidation, bankruptcy or other procedure or proceedings
affecting any stock, bond, note or other security.
(5)
and other
desirable
services.
To use attorneys, real estate brokers, accountants
agents if such employment is deemed necessary or
and to pay reasonable compensation for their
(6) To compromise, settle or adjust any claim or
demand by or against the estate and to agree to any
rescission or modification of any contract or agreement
affecting the estate.
(7) To renew any indebtedness, as well as to borrow
money, and to secure the same by mortgaging, pledging or
conveying any property of the estate.
(8) To retain and carryon any business in which the
estate may acquire an interest, to acquire additional
interest in any such business, to agree to the liquidation
in kind of any corporation in which the estate may have an
interest and to carryon the business thereof, to join with
other owners in adopting any form of management for any
business or property in which the estate may have an
interest, to become or remain a partner, general or limited,
in regard to any such business or property and to hold the
stock or other securities as an investment, and to employ
agents and confer on them authority to manage and operate
the business, property or corporation, without liability for
the acts of such agent or for any loss, liability or
indebtedness of such business if the management is selected
or retained with reasonable care.
(9) To register any stock, bond or other security in
the name of a nominee, without the addition of words
indicating that such security is held in a fiduciary
capacity, but accurate records shall be maintained showing
that such security is an estate asset, and the Executor
shall be responsible for the acts of such nominee.
(B) In making distributions from the estate to or for the
benefit of any minor or other person under a legal disability,
the Executor need not require the appointment of a guardian but
shall be authorized to payor deliver the same to the custodian
M-
~
J1/)4-J~
-'~Y7"'~~~,.w,~_.... .' _ '~~~':l"::."'~""""'"",_
~.~T"!f"~~"""'-:'~~'--'''''''~:_''-''''''~''''-''-'_"""~,,,'='''''''''''''_'''''''''''''~''''''''''''''''U'''-~..............._
-
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE 5
of such person, to payor deliver the same to such person without
the intervention of a guardian, to payor deliver the same to a
legal guardian of such person if one has already been appointed,
or to use the same for the benefit of such person.
(e) In the disbursement of the estate and any division into
separate trusts or shares, the Executor shall be authorized to
make the distribution and division in money or in kind, or both,
regardless of the basis for income tax purposes of any property
distributed or divided in kind, and the distribution and division
made and the values established by the Executor shall be binding
and conclusive on all persons taking hereunder. The Executor may
in making such distribution or division allot undivided interests
in the same property to several trusts or shares.
(D) The Executor shall be authorized to lend or borrow,
including the right to lend to or borrow from any trusts which I
may have established during life or by will at an adequate rate
of interest and with adequate security, and upon such terms and
conditions as the Executor shall deem fair and equitable.
(E) The Executor shall be authorized to sell or purchase at
the fair market value as determined by the Executor, any property
to or from any trust created by me during life or by will, even
though the same person or corporation may be acting as Executor
of my estate or as trustee of any of my other trusts.
(F) The Executor shall have discretion to determine whether
items should be charged or credited to income or principal or
allocated between income and principal as the Executor may deem
equitable and fair under all the circumstances, including the
power to amortize or fail to amortize any part or all of any
premium or discount, to treat any part or all of the profit
resulting from the maturity or sale of any asset, whether
purchased at a premium or at a discount, as income or principal
or apportion the same between income and principal, to apportion
the sales price of any asset between income and principal, to
treat any dividend or other distribution of any investment as
income or principal, or apportion the same between income and
principal, to charge any expense against income or principal or
apportion the same, and to provide or fail to provide a
reasonable reserve against depreciation or obsolescence on any
assets subject to depreciation or obsolescence, all as the
Executor may reasonably deem equitable and just under all the
j fl ~
)0~
1IVJkii
~:~
'"'-:7~:~l.~~~~,g",,;;..:>riz;,~~~s.~?~~~~'~~'f.:~,~:'$of~-~~""--~'-..-~.._--
.~;'~~~'!,g:~~~~~4:~~:-kl:~ot''''_''i~..<.._ -. -......, -,,"',-,~ -~- -
!t....:.'..
-~
i
;~
~t
-~. - '..~--"'-"''''-''-~--_.., '."
LAST WILL AND TESTAMENT
OF
PATRICIAA. NAILOR
PAGE 6
circumstances. If the Executor does not exercise the above
discretionary power, the cash or accrual allocation shall be in
accordance with Chapter B1 of Title 20 of the pennsylvania
Consolidated Statutes, or the corresponding provisions of
subsequent state law.
SIXTH: Riqhts and Liabilities of Executor.
(A) No bond or other security shall be required of the
Executor.
(B) This instrument always shall be construed in favor of
the validity of any act or omission by the Executor, and the
Executor shall not be liable for any act or omission except in
the case of gross negligence, bad faith or fraud. Specifically,
in assessing the propriety of any investment, the overall
performance of the entire estate shall be taken into account.
(C) The Executor shall be entitled to receive reasonable
compensation for services actually rendered to my estate in an
amount the Executor normally and customarily charges for
performing similar services during the time in which the Executor
performs the services.
SEVENTH: Tax Elections.
(A) In determining the estate, inheritance and income tax
liability relating to the estate, the Executor's decision as to
all available tax elections shall be conclusive on all concerned.
In accordance with Internal Revenue Code ~2632(a) and without
regard to whether a federal estate tax return is actually filed,
the Executor shall allocate so much of the federal Generation
Skipping Transfer (GST) exemption amount as will fully exempt any
generation skipping transfer which may occur under this will.
(B) The Executor may, in the Executor's discretion,
determine the date as of which my gross estate shall be valued
for the purpose of determining the applicable tax payable by
reason of my death.
(C) The Executor may, in the Executor's discretion, decide
whether all or any part of certain deductions shall be taken as
income tax deductions (even though they may equal or exceed the
taxable income of my estate and whether or not claimed or of
f~1
Rsv\\
rv1211
'::rJ'"~~~~~';;..~~~~Bm\:~M8~0I,w.~"~-~"r~~.p;'-~'-"",,",,""'-'-"-"""'-'--~_T_______..'~n --'
.~... ""T ,".,~~.~_~.. ~, __"'-''''----.''O''C'.
-" ..,...-.-.--..... -~--_._.~~.....-..._...__.-
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE 7
benefit on my estate's income tax return) or as estate tax
deductions when a choice is available; and in the event that all
or any part of such deductions are taken as income tax
deductions, no adjustment of income and principal accounts in my
estate shall be made as a result of such decisions.
EIGHTH: Spendthrift Provision. No beneficiary shall have
the power to anticipate, encumber or transfer his interest in the
estate in any manner other than by the valid exercise of a power
of appointment. No part of the estate shall be liable for or
charged with any debts, contracts, liabilities or torts of a
beneficiary or subject to seizure or other process by any
creditor of a beneficiary.
NINTH: Definitions and General Provisions.
(A) Survival. Any beneficiary who dies within sixty (60)
days after my death shall be considered not to have survived me.
(B) Captions. The captions set forth in this Will at the
beginning of the various articles hereof are for convenience of
reference only and shall not be deemed to define or limit the
provisions hereof or to affect in any way their construction and
application.
(C) Code. Unless otherwise stated, all references in this
Will to section and chapter numbers are to those of the Internal
Revenue Code of 1986, as amended, or the corresponding provisions
of any subsequent federal tax laws applicable to my estate.
(0)
genders.
includes
Other terms.
and the use of
the other.
The use of any gender includes the other
either the singular or the plural
~ :
!U--
.<"
~'1);;-.,
J;{;Jlfj
c
~~
!~
';'.'
'..;....
}:
=~
._;;.~t~~~~~%~~~.."..~~~~~~~~~~~~:~';:;'M~...._~~~----;>--,.-_=r_."...."..-..-..---'-"---'
-
LAST WILL AND TESTAMENT
OF
PATRICIA~. NAILOR
PAGE e
IN WITNESS WHEREOF, I, PATRICIA A. NAILOR, the Testatrix,
have to this my Last will and Testament, typewritten on eight (8)
pages, including the Acknowledgment and Affidavit, set my hand
and seal this 14th day of November, 2000.
f~f~/~/~
PATRICIA A. NAILOR
Signed, sealed, published and declared by the above-named
Testatrix, as and for her Last will and Testament, in the
presence of us, who have hereunto subscribed our names at her
request, as witnesses hereto, in the presence of the said
Testatrix, and in the presence of each other. Each of us further
declares that he believes the Testatrix to be of sound mind and
memory. The preceding instrument consists of this and eight (8)
other consecutively numbered typewritten pages including the
Acknowledgment and Affidavit.
~ t J~.-(L~\i)'Jl} residing at f'\"~.c..h)LL....\~n::J5w,t~) p~
II l\. " _ \' .0
1\ \ "'h-ect:tklL. !T(...\,fI.'T 0 \ CJ.
(print na )
1"t~e~Miding" Mec fr,^""Sb9 , f-4
(prine ~). ..... ..
-~
':i:"~~~:
'~...' .~:af~~"'~~"r~~~~"""'-"""-"~~''''''''''''-'<''''-'''''''-'-~.'---'-'' --
2
I',
o
Jl"'~~ ~_
-"l;.,~'~'ao,.,~,-,T~"''''"'_'~''~_''''~'.'',.r,."_",..."'......~......'""". ~..,~....._., '."" -t: _,"
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
55:
COUNTY OF CUMBERLAND
The Testatrix and the witnesses whose names are signed and
subscribed to the attached or foregoing instrument, being first
duly sworn and qualified according to law, do hereby acknowledge,
depose and say to the undersigned authority, that the Testatrix
signed and executed the instrument as her Last will in the
presence of the witnesses; that she signed it willingly or
willingly directed another to sign it for her; that she executed
it as her free and voluntary act for the purposes therein
expressed; that each of the witnesses were present and saw the
Testatrix sign and execute the instrument as her Last Will; that
each sUbscribing witness in the hearing and sight of the
Testatrix signed the will as witnesses; and that to the best of
their knowledge the Testatrix was at that time eighteen years of
age or older, of sound mind and under no constraint or undue
influence.
~ ~
~.,. ~
/6' ~.-~ ~~~
Testatrix
On this, the 1<.1 tJr day of .0 6'l~ ,2000, before me,
a Notary Public, the undersigned officer, personally appeared
MARK E. HALBRUNER. known to me or satisfactorily proven to be a
member of the bar of the highest court of Pennsylvania, and
certified that he was personally present when the foregoing
acknowledgment and affidavit were signed by the Testatrix and
witnesses.
IN WITNESS WHEREOF, I
seal.
hereunto set my hand and official
$m~)
Notary Public
My Commission Expires:
Notarial Seal
Ten L. Walker, Notary Public
Lemoyne Bora. Cumbenand County
My Commission Expires Jan, 20, 2003
Member, Pennsylvania Assoclatloo ot Notanes
PA REV-1500
SCHEDULE E
CASH, BANK DEPOSITS &
MISCELLANEOUS PERSONAL
PROPERTY
APR-12-2001 08:41
PNCBANK ClF DEPARTMENT
412 705 0057 P.01/01
0. PNCBAN<
Decedent Reporting
Firstside Center
P7-PFSC-4-F
500 First Avenue
Pittsburgh, PA 15219-3128
/SCP
April II, 2001
Traci L. Sepkovic
1013 MumrnaRoad, Suite 100
Lemoyne, P A 17043
RE: Estate of Patricia A. Nailor, Deceased
SSN; 164-28-0798
DOD: 1/23/2001
Dear Ms. Sepkovic:
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#5070024828
Established 08/07/1993
PATRICIA A NAILOR
DOD Balance: $688.95 (non-interest bearing)
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.
Sincerely,
GiAcJuJA- JCuJm
Rachelle Sciullo
1-800-762-1775
A member of Th~ PNC Financial Scrvit;cS Group
F'NC Rank NA Pittsburgh PcnnwlV:lnia Ttl265
TOTAL P.01
, '
,. . ' ,
~ ~ ,I -.... '- ';- ~ '=:. z
. ' i. e~ ~C{1 it; c
- '<> '"
1--" - ;:::-<:. ..... . '"
Q :::,-.1:: <u m
<><l - :D
",0 ~2. :;:Q " '-' -~ ~ '"
b; -- <;
- - .......
m
~ ~ ~ '1
~ ~ ~~ ~ ~ ~ 't'l " t ~,
c & --;
Q- ~ C\ :( '< <..:: :D
f::V", ~ '" 1i " )>
"i' " ::.- ,.. ~ z
:::-0 , :.:. it> c ~ en I
{1 ~ ~ t4 )> I
CI1 OJ ~ f1 ()
, -, - i" "- --;
:::,. - ~ is
'" 0 z
?\- ~ ,. I- '~ ? ),... '"
I' m
-..... fl, ?\- en
;t: ~ ~' . ()
:D
...r: f'i', ~ 'C
, "; <r --<
~ '" -- ~
't ~ ; '\'"
>-- "
~ ~
,
~ ~, "'" ~
"0 " ...... ~ i,
--- ~' ~8 <u Vc
'--l lA '" m.
'-'" --- -.t V' C) z
-..c "
'"
t -r: r; ~8 "-" m
~ '-'! ~ ~
-J;, --, -.L =>
"
g
~
I m
m
\ ~ S. '"
~
~
I \ m
~ .
L;: cJ; ~ , ~::::: ilJ ~- ~ v. c: ..
Q., k~ V ~~ ~t::
'- ~ 'bR; '-C O~ 01. :, $
...0 --0 --c.-.;;' " I'---r: S--I:. '- ~Q ~Q ~ .
I .. ~' "
~ -.... "'''<) \ -.c, ~Vf-' ~~8 ~ ~,~ \ 1
f\'- '-C 9---.:1 Q
, ' ,,' ,""..' " ' ' --'-
" ' ,
, \.... ,
PA REV-1500
SCHEDULE G
INTER-VIVOS TRANSFERS and
MISCELLANEOUS NON-PROBATE
PROPERTY
LAW OFFICES OF
GATES &- ASSOCIATES, P.C.
1013 MUMMA ROAD' SUITE 100' LEMOYNE, PENNSYLVANIA 17043
(717) 731-9600' FAX: (717) 731-9627
LOWELL R. GATES
Also Admitted to Massachusetts Bar
MARK E. HALBRUNER
Also Admitted 10 New Jersey Bar
CRAIG A. HATCH
CORY J. SNOOK
ALBERT N. PETERLlN
Also Admitted to Maryland Bar
BRANCH OFFICE:
3 WEST MONUMENT SQUARE, SU1TE 304
LEWI5TOWN, PA 17044
(717) 248-6909
WEB SITE:
www.GatesLawFirm.com
June 27, 2001
Pennsylvania Department of Revenue
Bureau ofIndividual Taxes
Inheritance Tax Division
Department 280601
Harrisburg, P A 17128-0601
RE: Estate of Patricia A. Nailor
Estate File No.: 21-2001-0208
Date of Death: January 23,2001
Social Security No.: 164-28-0798
Dear Examiner:
On November 28, 2000, decedent instructed her daughter, Terry J. Renninger, to
withdraw $8,000,00 from decedent's PNC Bank checking account. Of the $8,000.00 withdrawn,
$4,000.00 was used to establish a separate PNC Bank checking account in Terry J. Renninger's
name for the purposes of paying her mother's increasing medical bills and expenses. The
balance remaining in that account on decedent's date of death was $311.84 (see attached check
register for detail of medical bills paid). The other $4,000.00 was gifted as follows: $1,000.00 to
each of decedent's three children, and $200.00 to each of decedent's five grandchildren in
December 2000 as shown on Schedule G.
Please contact my office if you need any additional information.
7i'7:tc! ~-
Mark E. Halbruner
MER/tis
Qualified Account Statement
l"~(: Jtlllk
0PNCBAN<
Primary account number~ 50-1002-4828
Page 1 of 2
For the period 1112212000 to 1212012000
"
PATRICIA A tAILOR
BOX 33
NEW KINGSTOWN PA 17072-0033
Nurnbe:r.if. enclosures: 7
tt For 24-hour customer service or
cunent fates: Can 1.888.PNC-BANK
C:!SI Write to: Customer Service
PO Box 609
Pill,burgh PA 15230-9738
~ Visit us at www.pncbank.com
<-.:Z.
[I TOO termina/:1-800-531-1648
fot be'~fU\'1 m'l'::Iul:.l dienh o1'lh'
l.iIIih)ILalll AC:GOUlli In'om.aCion
---
--
~~-- - .-""'....
lilt' illl"orm;iliolJ slale,l ht'lo\\" .lllll'wls ft.'Helin information in 0111' C011S\ll11t'r F1I1ltls AvailahiJily l)ulicy ("Polky"). All other
illlollll;llioll ill our Pulicy rUlllillllt\~ 10 apply to rOllr aCCOlmt. 1'le;lsc nnicw this information and rt'laill it with )'mn'r('conls.
I.Jk( lin' :"..:on'lllher l, 2000:
Ltr~(. DoU4lr Deposits
II yntlr 101al dqlO:-ib of local anclnon-Iocal check!O. ('xchulillg checks drawn 011 PNC ll<mk, c~u,h, wire nansfers, tHrecl deposils, Iht'
tHill.l' 5\00 uLnlY ckl'o:sil, .UH\ items lisle(l as "Nf"xt Da~.lt(,llIs" in onr Fuuds .-\railahilil)' Policy, on <lilY Ollt' husillt'ss (by, ("pial 01
c'~cl'l'd S;"'"IO,OOO. Ihe limds from thos(' deposits "ill be <l\'ailahle as follows:
~...
..
. \. Lot.-al Checks: The rt.~maillillg fmllls frulI1local chccks, if any. will bl' ~l\'aibhl(' the sC'cOlul hUSllll'SS day ~fl('r th\' husiut'ss ~by
of' dt'po~il for ,,11 pili poses.
n. Non.lul'al Ch~cks: -111(' n'l1l~tillil1g funds from lIoll-Jocal checks, if ~lIY, will be ~\\!ailahk Ih(' fourth busiuess (lay aflt'1 Ih('
hll~illl.'!'is day of llqw"it [or .\t1 pUq)05\'S.
If \011 woultl1ikt~ a cupy of utlr FUlHls .\rai1ability polic)' or han" any qllt'stiollS ahouI ii, please Slop hy your local PNC Balik of(ic('
'" ,,,II 1-1l88-PNC-B.\NK.
Qualified
Budget Checking Account Summary
Ac.collnt nllmber: 50-7002-4828 Account link <<I number: 0164280798
Patricia A Nailor
Pk..:;,z ::l<:,-= t:,c A~t;'.,.ii.y Gd.:.;: $o:;:t..i;VI' rVI
additional information.
!bl""ce Summary
Beginning
balance
\l
Deposits and Checks and oUler Ending
other addilions deductions balance
j'19.00 8,651,.17 1,()02.l).:J
Average monthly Charges
balance and fees
2,296.7J ~.()()
Bank card/POS Account Information Teller
transactions 3ssi slance call Ii transactions
() () 3
PNC Bank MAC Other MAC A TM Other ATM
ATM transactions transactions transactions
() 0 0
,'i,~IO~'..~ I
Transaction Summary
Checks paldl
wilhdrawals
Total A TM
transactions
o
Qualified Account Statement
0PNCBAN<
11' For 24-hour customer sel'Vice:
Call: 1-888-PNC-BANK
For tll. p.rlod 11/22/2000 to 12/2012000
PATRICIA A NAILOR
Primary account number: 50-7002-4828
Pagp. 2 of 2
Ac:c:uunl numher~ 511-7nI124:i28 . 4.'olllinued
Activity Detail
Deposits alld Other Additiolls
Amount Description
lOtiJI(} Direct D..:'1)\Isi1 - Sc-'C St'(
ll.") TIC';JS-ury 303 H13:.?40779BtJ SSA
~t07 .00 l)epn~i' Rt''1enonu' N4.I. 0'-.!9l'}~)'23-to
:l:lli,OO Direct DqlOsit - SPl~ See
llS Tn>;lsUl)" :lO:l It)t?~079:ir\
Dd~e
I.: (I'
L! I~
12 20
There were 3 Deposits and Other Additions
total;ng $749.00.
Checks
Ch",o:;~
!\llmtJ1>r
:U:!li
:n~i
.112~
;_;.!II
Amtlun1
THU
Itl'1,ii
~1;-i31
:l:t~IO
Date
paid
11':!2
11/2.\
l} /22
12/0.1
Check
number
Calli! Refercnet
Amount paid oumber
137.1H' 12/20 \l2i~:IW;:!1
2j.30 11/20 02~11'c:.lli'" I
(11.:J~ l:.V'~1 li:,:/...;;-,;3<:
Reference
number
:133()
\)2ilt',t,!'">2:;
{)'!'l~~lli,)7
1I'l7It:l;.;!
11215:, I ~l 72
:1~)32 *
1:;.':::
Dal<!
Amount
Descriptron
\\'i1I"b.,w,,1 Rcfe&nce No. ll':!97'l3007
\\'ith(ll';lwal 1'("1 O.-IOO()(J.IIOl 0132
Selvin"CJMI'1;{t'
C.mn'lIed Cht"t"k Return Fee
There were 7 checks listed totaling
$652.17.
There were 4 Other Deductions totaling
$8.004.00.
~ Gap in check sequence
Other Deductions
11 ':.!;i
II .~~
12 ~Il
12 .!(l
~.OOO.IXI
.1.()(HUHI
:l.00
1.00
D;,le
Daily Balance Detail
11'1"
II '~I
Balance
;i,iJlj.11
<'i,~l,U,lii
Date
12/().1
12/):1
Balance
11l5.77
922.77
Balance
:'t\O.~q
1,00:1.11.1
Datt!!
12/19
12.'20
Date
11.'~~
12,'01
Balance
!H:t.l.7
(d9.lii
Save Time and Money This Holiday Season With Your PNC Bank Check Card
:'\1'l'f110 pid.. up some laSI Illillllle lhing"s, , . gifts, ranls. wl";lpping paper or decorations? Don't (ah' time to nm to lh(' .\TM fur
(.1',11. Dou't \IH~ YUU) crt~dil cud ancl pOly all Ih~ll itHt"'rt~~1. San" yuursc..'lf somc.~ lime and muner by using your PZ\'"C ltmk Check
(:,u1l. J\I~I P1TS("1I1 your PNC llank Check Canl anywhere yc.m M~(' the \'ha(R) logo and )'our pUHhasC' will he <<.kduCI('d rig-hi from
\'0111 dwckillg ~ICCUll111. JWiI ~igB and gut
;'~~~iiJ;:;,
Check.ing Account Statement
P:\C U,llIk
0PNCBAI'IK
Primary account number: SO-03!i3 :1 ! ._1
Page 1 of 2
For tile perlocl1112312000 to 12/2212000
Nt.lmber of enclosures; 0
"
TERRY J RENNINGER
37 GREEN HILL RD
NEW KINGSTOWN PA 17072
e For 24-hour customer service (
current rates: Call1-8S8-PNC E>~)\"T
S Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
S Visit LIS at www.pncbank.com
11 TOO terminal:1~800-!)31.164a
For hr-:llu\g' mlp:lll('d dk'n'!> QrtJ,-
!mportRnt Ac'Coul;t Infnrmatiet:
-
-
The iufofln,ltioll Sl.lh'll bdow .ullel1<ls Ct~n.lir- illfonn"tillll in our Consunwr FmHb Av.\il"hitity PUllCY rfPoliq:"), .-\1\ t
illform.t1iOIl ill our Polky cuntinues 10 apply 10 roor a('TOlllIl. l)kast' n>\'iC'w this information anel retain it wilh yom I
l-Jll..'ni\'", ~on'mh{'r 1. 2000:
d
large" Donar- Depn~its
II \'PIIl' IOlalllq}Usil~ (,1' local awl llUn-local dl('I'ks, exc1ucliIlJ{ checks drawn 011 PNC Bank, cash, wire lransfrl's, din'(' I
illilj,ll SIOO of any dt'po~il, awl il....llls Iisll'fl as "Nexl Dity Ih~ms" in our Funds Availahility Policr. 011 an)' ulle bttsincs:< ,; ,
cxft'cd $:")0,000, Ih,,' fuods from those tlC"posirs will b.... a"aibhk as follO\\"S:
\'1" 1,(
"(,ILl O.
,\. L(lt.-al Checks: The r€'mainiug funds from lucal ch('cks, if any. will h(' availahlc the secOIlc} husitl<'sS lbr a[lC'r the }" i
,,( dt.'(lllsil for all plII pos,,'s.
B. Nun-local Checks: The rcmaillil1g funcls from nOI1~local checks, iran)', ,,,-ill he a,'ai)ab1c lhe founh businC'ss llay all," :1 t'
hn~ill(,ss lby or ckpnsil for ,tll p\IJpOSl~S.
Il you wuuld likt' a copy vf our fUllels .,\,.aibbilil\. policy or h~l\'c an)' questiolls about if, please stop hy )'our IOfidl)NC ); \;tk ( tJI
01 cllll-888.PNC-BANK.
.
-
Checking Account Summary
Account number: 50-0353-3104 Accot.lnt link~ tlulnber. 0198540978
Terry J Renninger
B..lance Summary
Beginning
balance
.00
DepOSIts and Checks and other Ending
other additions deductions balance
4,000.(1) 5.15.33 :3,-l54.ti7
Average monthly Charqes
balance and fees
3,6:.W.77 1-1.99
Bank cardlPO~; Account Information Teller
transaCltOn:i assistance calls transactions
I' 0
PNC Bank M,I.\C Other MAC ATM Other ATM
ATM transactions transactIons lransactions
II 0 0
Please see {he ActivitV Detail ;i~~i;~-
additional information,
Transaction Summary
Checks paidl
wi Ihdrawal s
Total ATM
transactions
()
8hecking Account Statement
0PNCBAN<
'tr For 24-hour customer service:
Call: 1-888-PNC-BANK
For tho ....iod 11/28/2000 to 12/2212000
TERRY J RENNINGER
Primary account numbel: 50-0353~3104
Ac.Tt1unt number: .511-n:l;3.3104 - ~ontinucd
Page 2 of 2
Activity Detail
Deposits and Other Additions
II -2~
Amount DescriptIon
.I,nOO.no Deposil Rl'f('"t'l~n(:c No. 029i230Oti
There was 1 Deposit or Other Addition
totaling $4,000_00.
D,.,Ie
Checks
Cl1e6.
numb'?,
AmolJnt
Date
paid
12/01';
R.ference
number
;l;lO.:lI
\r.?21 1$18~,
Dale
L! "117
Amount
Description
There is 1 check. listed totaling $530.34.
There was 1 Other Deduction totaling
$14.99.
Other Deductions
l.UI~' Clll....(-k l'rillling Fee
Daily Balance Detail
D<lte Balance
II:!.'! -1,000.00
Date
J2..'OG
Balance
3,..J&9.liG
Dale
12/07
Balance
3,-154.67
Save Time and Money This Holiday Season With Your PNC Bank Check Card
~('(''' 10 pick lip SOUU' last mimltt~ IhillgS.. . gifts, canis, wrappinR paper or cll'corations? DOIl't take lime rl! run tolhC' .\TM for
cl....I1. DOll'l liSt' YUUI neclil c..rd .1Illl pay alllllal inlerest. Sa\'e }'utlrsrlf SOllie lime and money b). using YOU! PNC Hank Chl'f"k
(:~ll'd. JlISI pn'S('IH ~'ollr I'NC B;mk Check Canl anp\'hCH' rOll Sl"l" rhe ViSa(R) lugo awl rour purchasl' will he dt~dllffe.11 ight from
YClUJ dh'rkillg" (l("(,"Ol1JlI. JII.SI sign and go!
UNIFORM RESIDENTIAL APPRAISAL REPORT GATES
Properly Description File No. 01-05R
i !'r:Q~Addres~lrQreent!i11 RL_________ __gity~~ha~icsburlL__ _ __ __ _ _Staj.~J'a'___~p_Q9~L179~~._ ___
L~g~1 DescdQ!i"-"-Jl~_(LQ~34~Il!Jl.~,-d~!e<l..11!1100 fr:Qrn_m-"-th.!r!o.!l~ugt1ter__ Co]!njl'. _ClJmIl~rta~_____ ____
" !\ssesso(s Parcel No._3!OQ5:Q015:Q02B __ __ __ ____._____ T-,,~ ~~~r 20QU~,~ Te.!'""j;_1,~9.0~e~@I!\ssessl1l,,-"~ $ __ _lJ
'ElQ[rowe'-___. _ __ ___ _CiJrr.e"-10wn~r.J~fIl'.J. Renninger. _ ___Qccllp~nLL!UQv!n~r_TII"-",,"1ITy~,,,!n~
! ErllP.!!1Lrights ~pr'!.i!'edm E.e~~i.I1lPiil!'~'!.s~-"-lcL _F'roj~~ lYl>'L[Jj>!J~_D(;QI1<l,,-mjn~'!1 LfjUQi\I!\ ,,-nlYL!:l~Aj__ ____JMo".
~ighborho,,-d.Q[!,IQj~~ N-""-,L~Iv~fuldngJ\YP_____ _ ______M~pB~l!lllcL __ __ __ __(;"'1S_4!J:rllct 011L_____ __
~ale.!'ri~ l_________P~t~LSjll~ _ ____ _1)"!criJ>lIon-,,nQ ~a'!!OlJIlll>flo"""h~'lLesl",,-n~iQ!1s to b"-P~idJIl'sall~____ ______ ___
!,endel!G1i"'1t MarkJ:lal~ne,- _ _ _ __ _ _ . ___ .P-<l<l!~~"-lQl3.Mul1lm_a Rd, I,ertlO\'fl.!,J'I\17Q4L__ _ ___ __ _ _ __ __ _ _ _____
\V, Annraiser William F. Rothman IFAS Address 308 East Penn Drive Enola Pa,17025
'.l Location _ Urban ~ Suburban X Rurai Predomlnsnt SI~~le family houslrl!l Pres.nt Isnd use % Land uee ch~e
.5 BUilt up I- Over 75% JS. 25-75% _ Under 25% ~cupancy ~W001 ty7.1 One family __. ~Q [j(]Notlikely ULikely
,;~ Growth rate I- Repid X Stable _ Slow .x Owner ___ 55 Low _10 2-4 family __ _ D In process
't'" Property value I--- Increasing X Stable - Declining _ Tenant 200 Hioh 50 Multi-family ___ To: -------
. Demand/supply I--- Shortage X In balance _ Over supply _ Vacant (0-5%) ----"redol1lL~f1!__ Commercial _ __. .______
Marketinntime UndBf3mos. X 3-llmos, Over 6 mos. Vacant 'over 5% 125 35 arm 10%
,- Note: Race and the racial composition of the neighborhood sre not appraisal factors.
, Neighborhood boundaries and characteristics: TheJlr~a.isjllstnorthlJflJS ROllle..8..1, so-"tl1.llfI!OlJI!~.VI'e..rI!viII~~,-w!st.ofHa'!'~e..n_T\V~nLeast of
Midllle..~_T\y",-!h~lII'eals_allolll12rn"es_l'I8~ olliarri~urg_~ !laJe_Cllpil!'19f 1'enn.sylv~nitl,___.. __. _ __ _ __ ____ _ ____ _ _ _____
Factors that affeel the marketability of the properties in the neighborhood (proximity to employment and amenities, employment slability, appeal to market, etc.):
_The area Is convenient t9 sl<<>Jlll!n\L. highwayJlccess-,-a.nd e!"I'iQl'l1l.m.e..nt.ce..n~~.Ji1!' CUmll~~nll.. ValillYJllllJc:a~oi1a'-~,!,p'-e~i!.IClCat!d .Ill!.t e..a~ <:Iflh~___
.!.llbj~L_._ _____ ___ ______________ ___ ____
).,- ----------"---
Markel conditions in the subject neighborhood (including support for the above conclusions relaled to lhe trend of property values, demand/supply, and marketing time
- - such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc,):
! . Th.llQ~~rali mark,lll.i!.llrll\Vi~g..icl\VJy_\Vith !ppr~iatlo.n .rates in the two (2%) area for 1I1e'-a~t teI1.Y!a.rs~JI1eJElI19.th_oftir11~fro'!' lIs~ngJo~ontra~ !1a!.a.v!ra.g!d
.
.. 90!lllY!..si.ncereco!~!.hllvel1..eeni<eplc1!l7L_ __ _ __ ______ ___ _____ _______._ __ _ ____________________
" Project Informstlon for PUDs (If applicable) - -Is the deveioper/builder in control of the Home Owner's Association (HOA)? UYes llUNo
: Approximate total number of units in the subject project~___ Approximate total number of units for ssle in the subject project nf!'_ _ ___
.1' Describe common elements and recreational facilities; n/a
~:::~:~n~~~~~~1,4~:aq..i-:'--=--=---=--_-_-=~--=--co~;rL~t Dve-'WN'';- ~:':eOgraPhY i:~~::====~ _===-.
SpecificzOnlngClaSsificatio:~and~descriPtionA'<L________ .__ __ Shape ~~~Ie........_____
Zoning compliance II] Legal Legal nonconf~ing (Grandfalhered use) OWegaiITNo zoning Drainage Jlood _.__ _
Hinhest & besl use as im-;;oved: X Present use I iOtheruse1exnlain\ View excelie..n~L_______
Utilities P,!!!1Iic Other Dff...lte Improvements Type P~lic P!i'!.!!le Landscaping !ver!~ _____
Electricity ~ __.__________._ Street rnacadal11......____..!. _ Driveway surface _m.~~a.m____________
Gas I- __ _______ Curb/gutter ~on_e..______ ____ _ _ Apparenleasements nll.ne noted ~x~lllIlily __
Water I- weli Sidewalk 11.0~e_.__._______ ___ ~ I- FEMASpec;alFlaodHazardArea UYes illNo
Sanitary sewer I- .!.<'pti~ _____ Street lights Il.o~!_________ I- I- FEMA Zone .Q ___ Map Date ~/11ll3.__ __
Stonn sewer AIIev none FEMA Man No. 420370-oo05B
Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning use, etc,): .J1one ll.Ql.ed..:.the rll.edi1()is!_
f~om US Route!1i!.Jlvidllf1.L___________~___~__ . ________
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION_
No. of Units ___.___1 Foundstion Jliclc.L__.__ Slab Area Sq. Ft. ___JJQO Roof ___
No, of Stories ____._1 Exterior Walls l1rIalu.mlnlJl11...... Crawl Space % Finished 15 Ceiling _.!
Type (Det./Att_) ~~ Roof Surface a1s___ Basement full _ Ceiling __ Walls ____._
Design (Style) !an~~~_ Gutters & Dwnspts, alu!"______. Sump Pump i1"---_____ Walls _________ _ Floor ____
Existing/Proposed existi~lL__ Window Type dou~j1.lJIl9.~ Dampness no Floor ~11l:'!~_ None_ __ __ _
Ag. (v,,",) 26 8torm/80",.n. thenna! no Settlem.nt no. Outsida Enlly ~l!!____ __ Unknown _ _
,EffectlveAnelVrs.\ -15-20----- Manufactured House no-"-----' Infeotatlon no- - ..--
_BQQM~ ,--_EQY~L_ _Livi[l9._ Dinin.!L ~!~h~1!. D!l.!L. Famill'."-m~;Jl.!c.Bm., Bedrool1l.s ~!!liL Laun<ID-.. ._OtheL_ Area ~_
Bjlsel11.!nj __.____ _____ ____ _~___________.._ 1,300
Level L_ 1 .__L_ __ L _ 1__ ___1__.____ __..3_ 2 1,336
!"evel~_L____ ----- ----,-i----~--- ---- ---- -- ---- --1-----
Finished area abovA nrade contains: 6Rooms' 3Bedroom's\' 2,0 Bathls" 1 335Snuare Feet of Gross Livinn Area
, INTERIOR Matertals/Condilion HEATING KiTCHEN EQUI~ ATTtC _ AMENITIES _ CAR STORAGE:
Floors \VilV.Pll'l'-...~ Type HI'! ___. Refrigerator _ None _ Fireplace(s) # ____..1 _ None [j(]
Walls l!.anell.good Fuei QiI___ Range/Oven X Stairs X Patio ye..s ____ _ Garage
Trim/Finish ~!.fal'------_ Condition ok Disposal _ Drop Stair _ Deck Attached
Bath Floor \V.~lai-,----__ COOLtNG Dishwssher _ Scuttle _ Porch ___ _ Detached ._____
Bath Wainscot~~~~_lLOQQ_ Central no Fan/Hood X Floor _ Fence __ _ Built-In
Doors woodl fair Other Microwsve _ Heated _ Pool Carport
----~- ~nndillon WasherlO~.r C'-i---~ .
Additional features (special energy efficient Items. etc.): !tIere is a seco.nAlL'!PlaC8 in theJ')\V~rle~eL _______________
# of cars
,~ .--. -" -_._-------------~ --- _._-----_._----~--_._.._-- -.-------..---------,------..----------.-
Condition of the improvements, depreciation (physical, functional and externai), repairs needed, quality of construction, remodeling/additions, etc.
!h!SullJElCt "-8!d!.r~modellngan<l the_ owDer stated thalthel' \Ver.'L'!Pla~Jl !.idinjJ,-"arpelaD~.lhe_rotlt. Jhe ove~a~~l1ditiQn-'-..fair. ______ ___ _ _
Adverse environmental conditions (such as, but not limited to, hazardous wastes, toxic substances, etc.) present in the improvements, on the site
or in the immediate vicinity of the subject property: !l_O~~_JIQ!~ ~_v!~~aUn~~~tiQn~ _____ _________'_______._".__ _ _____ _ _,____~ _. _. ___
r~C'Formf06:93
Day Onn Forms forVVindowa, 1997 1800-GET-DAY1 PAGE 1 OF 2
ROTHMAN. SHUBERT & REED REALTORS
Fannin Man Form 1004 6-93
=
GATES
File No. 01-05R
.. 40,000 Comments on Cost Approach (such as, source of cost estimate
site value, square foot calculation and for HUD, VA and FmHA,
the estimated remaining economic life of the property):
he cost data was compiled usingMa-'sh~"-and Swift guides and ___
represent typical frame construction...
Valuation Section
~~. ~~~::~~~ ~~;R~~~~TION COST:NEW~FIMPROV~~ENTS
~ Dwelling____1,~36 Sq. Ft. @ ._...55.0Q = $__ 73,480
Bsmt.__ ___1,300 Sq. Ft. @ = n - 0
Garage/Carport . .__ Sq. Ft. @
. Total Estimated Cost New. .
Physical
=
Functional
= $ 73,480
Extemal
Less
. , Depreciation 01 101 0 = $
H
-A Depreciated Value of Improvements = $
~ "As-is" Value of Site Improvements. . .. :: $
~ INDICATED VALUE BY COST APPROACH.. ... .... :;;
18,370._
55,110
12,500
107610
'1 ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3
,'. Address 37 Green Hill Rd. 143 Middlesex Rd. 900 Greenbriar Dr. 32 Millers Gap Rd.
,-~ ~~~j~s~~r:~~ject " 2 miles .---- 2 miles -.---4.;;lles- -..-
.~ ~al~~ PriCL..__ L _ $ 122,000 $ 129,700'111-,''';, $ 110,000
~ Pri~Gros~.l.iv,I\~~ L___ 0.00 $.. n 108.93 -.. $ 90l $_7818'L,~l!<I,t:~il
',; Data andlor Central Penn MLS CPMLS CPMLS
'~ Verification Source Marge Berkheimer JackGaughen_ Kewith Sealover Jack Qaugh.en__ JilTl Slraubc21 Pisc _____
.~ ~~~~~o~j;~:~~~~TS - n_ c~n~SCRIPTIQN +{-)IAdj"'lme"' ~~SCRIPTION +{,)IAdj"'~t ~~~CRIF'TIQN_ +{-)!Mi"'lme"'
:'~ gQn""ssio~L ._ buye~s costsn.. 4,000 none _______
ii Date of Salemme 10113100 119DOM 11/13/00 22DOM ______ 8/30100 131DOM
'~ LQ~~On~___= Rural same ____ superior ..,5,QOO same_____
.1 Leas~holdIFee~m"e._ 99___ _ _ fee fee _ _n__ _______ fee
~ ~itL___ ____ ,000_or 1.45 acres 1/2 acre _______ 5,000 3/4 acrewooded____________ 1.55 acres
I View ____ -,,,,,Uennt average______ average _ average ______
'j l:l~~ign an~ !\ilpeal. rancher same same same _______ _
.,~ Q~~ih'of Co-"slruction average____ _m same 0 same same__ _ ______ ______
" I\g~____ 26______ 28 m______ 27 _ __ ___ 25 +1-
gondition___ air ____ good -7,500 good -10,000 good
Above Grade _ Total IBdrmsl Ba.th. S TotallBdrm. sl Bath.s . n. T~tal IBdrm. sl Bat.h..s . - .- T~t~'1Bdrms.,;;J.... ~Bath... s
Room Count _____6 _ 3L .2.0 6 3 __.to 1,000 6 3__ 1.0 1,000 61 3L. 2.0 0
GrQ~~ LivillQf.l'!l~ .1,336Sq,Ft, _ J,120~q, Ft 4,0001,442~g,FL _. . -2,500 ._l~04~_<LEL ____cMOO
Basement & Finished 1,300 full unfinished full finished .2,000 full unf
RoolTl~~lQw_Gi~~e
F~n<;tionaLli~litl'...._ ()()(j_
l:lea!ing/gQQling._ HVilno___
IO~YEffici~nlJte", ____
G~r~ge/C:~jl<lrt_ _QIle_
Porch, Patio, Decl<, yes
_, Fireplace(s), etc. .., 1
I f~~, F'QQLetc~""_ -..--.---
.5,000
good_
oU FHA! ca
good
.-2,000 elee BBlno ea___
_.,..w __., ___~__~_
--- gOl)(j---
_ u __2,000 Illec BBI ca
2 car attached
fireplace
inground pool
4,000 2 car attached_
fireplace
sun room deck
4,000
4,000 2 car att.
.4,000
. ___ _,2,500
N~I.Adj(tQ!~ll- G-III-_ L______11,500 [J+~ill $ --~23,000 G]]J- ~=""jO,500
, Adjusted Sales Price -9.4 % Net -18 % Net .10 % Net
" of Com arable 25.8 % Grs 110 500 22 % Grs 106 700 10 % Grs 99 500
j Comments on Seles Comperison (including the subject property's competibility to the neighborhood, etc.):.,!.1I three ..,Ies arOl_in the same!ownship.
an~ SChool systern,,',lIthe_ ..,Ies~re silTlilarsiz~ similar age, an~ condition., The resultant range in value is $ 99500_To_ $11 0,50o..Ba~_Cll1 thefor~olng
a v~ue()f~1Q5,1l00Lis chosen as a Final Vaiue Estimate for the Sales Comparison Method. .. _ __ _ __ _ __ __ _ _________
~ ITEM
Date, Price, and Data
Source. for prior sales
within ear of a raisal
Analysis of any current agreement of sale, option, or listing of the subject property and analysis of any prior sales of subject and comparables
within one year of the date of appraisaI:Mark~A.pJlro""hi~nonnally the best gauge to d~tllrmin.ern~rk.lltvaluel _ Cost Approaehi~illlst used 1n new ___
construction.
---------..--.---. ".- _.__._._~--_._----_._-_._._-_..._..__._---
INDICATED VALUE BY SALES COMPARISON APPROACH.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ _ __10MQQ
DICA E VALUE BY INC If A licable Estimated Market Rent nla /Mo. x Gross Rent Multi lIer nla = nla
Th~ appraisel is made .~'es ~. _ subject to repai.., alterations, inspections or conditions listed below __ subject to completion per plans and specifications.
Conditions of Appraisal: Thllrll aren() conditio.".. ~ac~on thisapJll'aisal__. .. ____.... .. .__.n__ .__ .______..____ n'
SUBJECT
ransfer from mother t
aughter
COMPARABLE NO.
COMPARABLE NO.2
COMPARABLE NO.3
nla
nla
nla
#1 Final Reconciliation:~.l>~~Com2arison method is used in most cases to be determine marketvalull-,,~()stApproach is use.ful in m.ea~uti"g neworn.ll\Vll'-_
jlroperties or for i(ll;urance 2u'l'oses,____
The purpose of this appraisal is to estimate the market value of the real properly that Is the subject of this report, besed on the above conditions and the certifICation, contingent
and limiting conditions, and market vaiue definition that are statad in the attached Freddie Mac Form 439/Fannie Mae Form 1004B (Revised ).
I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED. OF THE REAL PROPERTY THAT IS THE SUBJECT OF THIS REPORT. AS OF 2/176/01
(WHICH IS THE DA)' E OF INSPECTION AND THE EFFECTIVE DATE OF THIS REPORT) TO BE $ . . _ _ _._____::.,105,000 - - -. -.-
APPRAISER: I I . ~- -- SUPERVISORY APPRAISER (ONLY IF REQUIR!'Cl):
,~S,gnature _ .\ _ C -:-- L qf'f.L . _ _ ___ S'gnature________ _ _ __ __ UD'd o Did Not
'1 Name .Willaim1=. Rothman, lFAS . Name _________.___ Inspect Property
.iI Date R~port Signed _ Date Report Signed __ _ ________ ______ __________.._
':i State Certification # GA 000303 L State Pa State Certification #_______.______ __.. _n_n_ _ ~tatll
re 18 ae orm 6-
ay ne orms or n ows.1 9 180
annle ae otm 1
Statement of Limiting Conditions
GATES
File #: 01-05R
DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market
under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not
affected by undo stimulus. Implicit in this definition is the consumation of a sale as of a specified date and the passing of title
from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well infonned or
well advised, and each acting in what he considers his own best interest; (3) a reasonable time is allowed tor exposure in the open
market; (4) payment is made in tenns of cash in U.S. dollars or in terms offinanciaJ arrangements comparable thereto; and (5) the
price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions'"
granted by anyone associated with the sale.
'" Adjustments to the com parables must be made for special or creative financing or sales concessions. No adjustments are
necessary for those costs which are normally paid by sellers as a result of tradition or law in the market area; these costs are
readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments
can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is
not already involved in the propeny or transaction. Any adjustment should not be calculated on a mechanical dollar cost of
the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing
or concessions based on the appraiser's judgement.
STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report is subject to
the following conditions:
1. The appraiser will not be responsible for matters of legal nature that affect either the property being appraised or the title to it.
The appraiser assumes that the title is good and marketable and, therefore, wHl not render any opinions about the title. The
property is appraised on the basis of it being under responsible ownership.
2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements and the
sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's detennination
of its size.
3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other
data sources) and has noted in the appraisal report whether the subject site is located in an identified Special Flood Hazard Area.
Because the appraiser is not a surveyor, he or she makes no guarantee, express or implied~ regarding the determination.
4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless
specific arrangements to do so have been made beforehand.
5. The appraiser has estimated the value of the land in the cost approach at its highest and best use and the improvements at their
contributory value. These separate valuations of the land and improvements must not be used in conjunction with any other
appraisal and are invalid if they are so used.
6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreciation, the presence of
hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware
of during the normal research involved in perfonning the appraisal. Unless otherwise stated in the appraisal report, the appraiser
has no knowledge of any hidden or unapparent conditions of the property or adverse environmental conditions (including the
presense of hazardous waste, toxic substances, etc.) that would make the property more or less valuable, and has assumed that
there are no such conditions and makes no guarantees or warranties, express or implied, regarding the condition of the property.
The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be
required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards,
the appraisal report must not be considered as an environmental assessment of the property.
7. The appraiser obtained the information, estimates, and opinions that were expressed In the appraisal report from sources that he
or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the
accuracy of such items that were furnished by other parties.
S. The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of
Professional Appraisal Practice.
9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory
completion, repairs, or alterations on the assumption that completion of the improvements will be performed in a workmanlike
manner.
10. The appraiser must provide his or her prior written consent before the lender/client specified in the appraisal report can
distribute the appraisal report (including conclusions about the property value, the appraiser's identity and professional
designations, and references to any professional appraisal organizations or the firm with which the appraiser is associated) to
anyone other than the borrower; the mortgagee or its successors and assigns; the mortgage insurer; consultants; professional
appraisal organizations; any state or federally approved tlnancial institutionj or any department agency, or instrumentality of the
United States or any state or the District of Columbia; except that the lender/client may distribute the property description section
of the report only to data conection or reporting service(s) without having to obtain the appraiser's prior written consent. The
appraiser's written consent and approval must also be obtained before the appraisal can be conveyed by anyone to the public
through advertising, public relations, news, sales, or other media.
Freddie Mac Fonn 439 6.93
Page 1 of2
FlUlPie Mae Fonn 100486.93
nay Olle Forms for Window~. 1997 I 800~(jET.DA Y I
SUBJECT PHOTOGRAPH ADDENDUM
Borrower I Client
Property Address 37 Green Hill Rd.
Cily~han~sbu~
Lender Marl< Halbruner
County
Cumbe~and
State Pa.
Day One Fonns for Windows, 1995 -1800-GET-DAYl
GATES
01-05R
-- .-
Zip Code 17055
FRONT OF
SUBJECT PROPERTY
REAR OF
SUBJECT PROPERTY
STREET SCENE
COMPARABLES PHOTOGRAPH ADDENDUM
Borrower I Client _ ____'n_ '__
Property Address ~~7~Green Hill Rd.
City Mechanicsburg ~
Lender Marl< Halbruner
Cumberland
State Pa.
County
,:.:."-;j;~~~;;:;:.:,~ .>
,-...,~'f.r~:~-,.., "
Day One Fonns for Windows, 1995 ~ I gOO-GET~DA YI
GATES
01-05R
Zip Code 17055
COMPARABLE SALE # \
143 Middlesex Rd.
Date of Sale:
Sale Price
Sq.Ft.
$/Sq. Ft.
10113100 119DOM
122,000
1,120
108.93
COMPARABLE SALE # 2
900 Greenbriar Dr.
Date of Sale :
Sale Price
Sq.Ft.
$1 Sq. Ft.
11/13/00 2200M
129,700
1,442
90
COMPARABLE SALE # 3
32 Millers Gap Rd.
Date of Sale :
Sale Price
Sq.Ft.
$/Sq. Ft.
8130100 131 DOM
110,000
1,404
78
. .
-
-
'F~oAJ ,
-t
N
If ,,'*
J.-t(. 75Il C/I..
"rf "&4'" . .. M&1-
fA) ( !Pt..
IUA 'WA'fft
3"
I;~' lb
-
~
~
~
...
,.;."
.("ft
, ....-"
'\ /!J.
. ..
!... . \ ~: .
" , "\0=
-'~".
,
'!-
..
\!
'I ..,.
"'.
':t,
..
\
''. .~- .,l:
"S'" .
t
11:.
,
.
!
f
.'
tl~MOl
1IHS/IINlO.L
-
,- ,~
:I
-",I,'"
.......
...
~-
~
,
--
-""
'-'.'
.. -,
~:'! 'X
!,-,' ~
. '':.
..
_-fcO .-
,,'"
"
~..!i.1~
.-
:--
- ....
~
',-
~
l
, IIA
.. ,
;;a '
,;; .
'''l
\.
'~,....,.
..
,.\
.~".
.... . '1 "" .:........;.. ,,: ;" '\
..':".r~', :- _"-'" ",:. i
; i. ' '.. '. .' .
t ~ "';c. J' ~ "
r " w- r ,..;'
~f) .:
L,'~ '. I,
i;.... .. C'I ?;.:....
_ -..~, - c ~,...i..
'....,... '.. '~..
... .-:i' \
'l~'~':#" ,
~ j\~ 1'~'};'
.: y ~ ....-
.:};~ :..~i~" ...':'
. : ''t\!.'' ..,
~, ..:.., ',;~1-':
...~ l a.J!.
..:'--'.0::1"- ."~
Jt-~*,~~;~./~:.~2j.~~
~
-~
~ .~... _.tr. ... ......
~... . '.
. .~~
~'''. . :
i'(..'lt
... .c, ~ . ~
'.: '
- '. ~
,". ..
. \ "
,
..
-
;...-
"
,
i
~..
i'
#
,
-/
.
. en rvl
AREA MAP
a:'1
.Mannsville.Mckee
."
,U~l
0"'
. Rutherford
F
"''i.
. Wenksville
o 1997 Delorme
TAX PARCEL NO. 38060015002B
SaVERSpmNGTOWNSIDP
- - - ~:.:'i~
'. ;-~:~C'~., .~"'., 'n~ ...:i:JS
i,Ul/Pf:t'"., ~ {'\ ~
. 'i.J.....I\~i.\d../ vOJr;TY-c,
DEED '00 NOU 22 APlll 3~@ [P)"Yf
TillS DEED is made the 14th day of November, in the year two thousand (2000).
BETWEEN PATRICIA A. NAILOR, now of 37 Green Hill Road, Silver Spring Township,
Cumberland County, Pennsylvania, party of the first part, GRANTOR,
AND
TERRY J. RENNINGER, married woman, now of37 Green Hill Road, Silver Spring Township,
Cumberland County, Pennsylvania, party of the second part, GRANTEE.
WITNESSEm, that said party of the first part, for and in consideration of the sum of ONE AND
00/100 DOLLAR ($1.00), lawful money of the United States of America, well and truly paid by the
said party of the second part to the said party of the first part, at or before the sealing and delivery
of these presents, the receipt whereof is hereby acknowledged, has hereby granted, bargained, sold,
aliened, enfeoff ed, released, conveyed and confirmed, and by these presents does grant, bargain, sell,
alien, enfeoff, release, convey and confirm unto the said party of the second part, her heirs, successors
and assigns,
ALL THAT CERTAIN piece or parcel of land situated in the Township of Silver Spring, County
of Cumberland and Commonwealth of Pennsylvania, more particularly bounded and described as
follows, to wit:
BEGINNING at a point in the center of Green Hill Road (T -505), said point being located and
referenced at a distance of 1,600.00 feet measured along the center line of said Green Hill Road in
a northeastwardly direction from its point of intersection with the centerline of Bemheisel Bridge
Road (T-574); thence along the centerline of said Green Hill Road, North 62 degrees 34 minutes
East, a distance of two hundred (200) feet to a point in the same at the line oflands now or formerly
of Mervin Raudabaugh; thence along said line oflands now or formerly of Mervin Raudabaugh the
following two (2) courses and distances: (I) South 16 degrees 40 minutes 27 seconds East, a distance
of one hundred two and fifteen hundredths (102.15) feet to a point; and (2) South 13 degrees 19
minutes 03 seconds East, a distance of two hundred seventeen and ninety-six one-hundredths
(217.96) feet to a point on the same; thence along the line of remaining lands now or formerly of
Albert 1. Deitch the following two (2) courses and distances: (1) South 62 degrees 34 minutes West,
a distance of two hundred (200) feet to a point; and (2) North 14 degrees 23 minutes 19 seconds
West, a distance of three hundred twenty (320) feet to a point in the center of Green Hill Road (T-
505), the point and place of BEGINNING.
CONTAINING one and four hundred forty-six one-thousandths (1.446) acres ofland.
(
BEING Lot No. I as shown on a certain "Final Subdivision Plan of a Tract of Land for Albert
Deitch" made June 24, 1976, by William B. Whittock, Professional Engineer, and recorded in the
Office ofthe Recorder of Deeds in and for Cumberland County, Pennsylvania, in Plan Book 30, Page
58.
. BEING the same premises which Nevin L. Nailor and Patricia A. Nailor, by their deed dated March
14, 1988, and recorded on May 20, 1988, in the Cumberland County Recorder of Deeds Office in
Deed Book 1-33, Page 886, granted and conveyed unto Patricia A. Nailor, Grantorherein.
THIS IS A TRANSFER FROM MOTHER TO DAUGHTER AND IS THEREFORE
EXCLUDED FROM THE PAYMENT OF REAL TYTRANSFER TAX. 72 P.S. ~8102-C.3(6).
TOGETHER with ail and singular the buildings and improvements, ways, streets, alleys, driveways,
passages, waters, watercourses, rights, liberties, privileges, hereditaments and appurtenances,
whatsoever unto the hereby granted premises belonging, or in any wise appertaining, and the
reversions and remainders, rents, issues and profits thereof; and all the estate, right, title, interest,
property, claim and demand whatsoever of the said Grantor, as well at law as in equity, of, in and to
the same.
TO HAVE AND TO HOLD the said lot or piece of ground above-described, with ail and singular
the buildings and improvements thereon erected, hereditaments and premises hereby granted, or
mentioned and intended so to be, with the appurtenances, unto the said Grantee, her heirs and assigns,
to and for the only proper use and behoof of the said Grantee, her heirs and assigns forever.
AND the said Grantor, for herself, her heirs, executors and administrators, does covenant, promise
and agree, to and with the said Grantee, her heirs and assigns, by these presents, that they, the said
Grantor and her heirs, all and singular the hereditaments and premises hereby granted or mentioned
and intended so to be, with the appurtenances, unto the said Grantee, her heirs and assigns, against
them, the said Grantor and her heirs, and against ail and every person and persons whomsoever
lawfully claiming or to claim the same or any part thereof, by, from or under him, her, them or any
of them, shall and will, subject as aforesaid, SPECIALLY WARRANT AND FOREVER
DEFEND.
IN WITNESS WHEREOF, the said party of the first part has hereunto set her hand and seal, the
day and year first written above.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF
.~~5"lh..t. ~~~
'\ -
~
If. ! //~..- -'-J
;:1io1'f, Iv.... . . . __; / .~--_.
~/.. ,
~. ~ r ~~ "'""~d-
.~ 3\ ['3- L .
PATRICIA A. NAILOR
COMM"ONWEAL TH OF PENNSYLVANIA
COUNTY OF a IJMBeI2L.QND SS:
On this, the It{ t:I. day of CVl ~ , 2000, before me, a Notary Public, the
undersigned officer, personally appeared MARK E. HALBRUNER, known to me (or satisfactorily
proven) to be a member of the bar of the highest court of said State and a subscribing witness to the
within instrument, and certified that he was personally present when PATRICIA A. NAILOR and
the above witnesses, whose names are subscribed to the within instrument, executed the same, and
that said persons acknowledged that they executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~(lliW
Notary Public
My Commission Expires:
Notanal Seal
Ten L. Walker. Notary Public
Lemoyne Bora. Cumberland County
My Commission Expires Jan. 20. 2003
Member, Pennsylvania AssOCIatIon at Notanes
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
RECORDED in the Office for Recording of Deeds, etc., in and for said County, in Deed Book
No. , Page
WITNESS my hand and official seal this _ day of
,2000.
Recorder of Deeds
CERTIFICATE OF RESIDENCE
I hereby certifY that the present residence of the Grantee herein is as follows:
Terry J. Renninger
37 Green Hill Road
Silver Spring Twp., Cumberland Co., Pa.
RETURN DEED TO:
Terry J. Renninger
P.O. Box 33
New Kingstown, P A 17072
f?/La1i( Ie 1-.~
Attorne~Ag~tfurGranree
~ Prudential
-
Prudentiel Securities Incorporated
3 Lemoyne Drive. Lemoyne. PA 17043
Mail: P.O. Box 7
Camp Hill. PA 17001-9852
Tel 717 761-7344 800 468-8685
Fax 717 975-8426
i '. .
"'lie;
'-'...',".
March 15,2001
.(-\...,
'4;p
"
Gates & Associates, P.C.
1013 Mumma Road Suite 100
Lemoyne, PA 17043
<?::','..
RE: Estate of Patricia A. Nailor
Social Security Number: 164-28-0798
.
Dear Ms. Sepkovic:
Enclosed is the information you requested on the one account Patricia Nailor has with us.
I have also enclosed a copy of the transfer on death program agreement that Ms. Nailor
signed on November 13, 2000. Please send us an original death certificate.
If you have any further questions please do not hesitate to can Rob Durham or myself
Sin~elY,
J)2LUu f1ULI!t/
Barbara Charles
bient Service Assistant for Robert Durham
Historical Quotes
Page 1 of 1
'b;EIoO!FlNANCE.
Finance Home. Yahoo! . Help
~it,;?::-rj 4"J-f ,,,l]' 111z?l1' v .~" <1slow<Ol<;'
~ ~, ;; '\ : "l'f \,'"J n " /,
~~.',w ~ '.. ~ 1'" \, ,<' t.. '
~.))'" - '
,'''.' 'Cl~~' ~
. ,
More Info: .Ql!!lli: I Q!m1/ News I Insider
Historical Quotes
NYSE:CSP
Month Day Year
Start Date: l:J~ E.::J ~
End Date: l~~ L23 j I.~:U
@ Daily
o Weekly
o Monthly
o Dividends
Date Open High Low Close Volume Adj. Close*
23-Jan-0 1 11.625 11.75 11.625 11.6875 66,300 11.5211
Download Spreadsheet Format
.....*adjllst<:dforcli'l~~9satl~sj)lits,l'l1e~~,s~~f~g:......
Questions or Comments?
Copyright @2001 Yahoo! All Rights Reserved.
See our 1mDortant Disclaimers and Legal Information.
Historical chart data and daily updates provided by ComllIoditySyJ.tems,Il1c.lcSlL
Data and information is provided for informational purposes only, and is not intended for trading
purposes. Neither Yahoo nor any of its data or content providers (such as C31) shall be liable for any
errors or delays in the content, or for any actions taken in reliance thereon.
http://chart.yahoo.com/t'?a=O 1 &b=23&c=0 1 &d=O 1 &e=23&f=0 1 &g=d&s=csp&y=O&z=csp 3/26/2001
Historical Quotes Page I of I
~IFlNANCE. Finance Home - Yahoo! .1:M:1
=;r:x=~~::I.
!
::. H&R BLOCK
f .
More Info: .Q\!Q1l; 1.C!!Ml1 News I Protile I Research I Sill:: I ~ I ~
Historical Quotes
Nasdaq:TLGD
Month Day Year
Start Date: LJar:JII ~~J I~~j
End Date: l~~.::Jli I~_~l 1?~J
Ii, DaiI
. y
o WeekIy
o Monthly
C Dividends
Date Open ffigh Low Close Volume Adj. Close*
23-Joo-Ol 45 48375 43.25 47.25 524,800 47.25
Download Spreadsheet Format
..*~djllst~~forl1i\,i~:n~lIIl~spI~t~,p:!!<~~~~J:49:.
Questions or Comments?
Copyright <92001 Yahoo! All Rights Reserved.
See our Imoortant Disclaimers and Legal Information.
Historical chart data and daily updates provided by Comw.o4ifY.$yste.Wi!.lnc.lCSI).
Data and information is provided for informational purposes only, and is not intended for trading
purposes. Neither Yahoo nor any of its data or content providers (such as CSI) shall be liable for any
errors or delays in the content, or for any actions taken in reliance thereon.
http://chart. yahoo.com/t?a=O 1 &b=23&c=0 I&d=O I &e=23&f=O I &g=d&s~~TLGD&y=O&z= 3/26/200 I
...__......._ ............1....""'001
Balances
Name: 1044-325845 MS PATRICIA A NAILOR.:l
Contact: IBuslness -697-2399 .:I
Re~itime I B.1~ceD.4 N."Ba1anc...' <-List I ~ ,
Max Available for Withdrawal
Uncleared Checks
PQstedCh~c;t<1>
Option Level
Cash Account
Trade Date
Settlement Date
Equity
Short Market Value
Short Account
Trade Date
Short Market Value
Mark to Market
372.53
372.53
372.53
372.53
372.53
372.53
0.00
0.00
o
75.53CR
75.53CR
17,201.09
0.00
0.00
0.00
0.00
,...,yt::.L u, L
As of: 01/23/01
Account #: 044-325845-026
Type:ID
UserID: M044052
Performance
Performance thru December
PollarJ,yeigt!t~<!
Time Weighted
Margin Account
Trade Date
Available SMA
SMA
Equity
Mi:lnlJn_C<lJI
Margin Agreement
Dividend Information
Dividend Accumulation Type 4
-17.555%
-15.298%
0.00
0.00
0.00
0.00
NO
NO
0.00
Escrow Information
Escrow Balance 0.00
General Information
Long Market Value 17,125.56
Net Worth 17,201.09
Free Credit -75.53
Money Market FundS 297.00
pending Money Market 0.00 *
Cash Buying Power w/o
Borrowing
Cash Maximum Buying Power
Margin Buying Power w/o
Borrowing
Margin Maximum Buying
Power
Margin Day Trade Buying
Power
Period
12/29/00
1999's
Annualized
Dollar Weighted Performance
Performance Includes Annuities
-17.555% No
Not Calculated N/ A
0.000% N/A
http://branchserver.prusec.com/patnztn:f/balance.asp
1/24/2001
. . ......._............ .............. .....'-.;J
rdYt::" VI"
Posted Checks
COMMAND
Cash
Margin
Dividend
0.00
0.00
0.00
0.00
Margin Calls
Federal
House/Maintenance
NYSE
Equity Deficiency
0.00
0.00
0.00
0.00
This representation of your account history is not the official record of your account. It is for
informational purposes only and has been prepared to assist you with your investment
planning. Your Prudential Securities Client Statement is the official record of your account.
Therefore, if there are any discrepancies between this information and your Client Statement,
your should rely on the Client Statement and call your local Branch Manager with any
questions.
http://branchserver.prusec.com{path2053{balance.asp
1{24{2001
,~_''''''''''''' ..,..,......,......
r Qyt:= ~ VI ~
Realtime Positions
As of: 01/24/01 9:59 AM
Price, Market Value and Cost Basis Information As Of: 01/23/01
Name: 1044-325845 MS PATRICIA A NAILOR..:J Account #: 044-325845-026
Contact: IBuslness -697-2399 ..:1 Type: ID
Start Of Day I DetaU I N_ R'I! Position. '<=Li.t I ~ I UserID: M044052
Equities and Options
TYP QTY 1 SYMBOLI
OPEN CUSIP
1 SO TLGD
DESCRIPTION
TOLLGRADE COMUC INC
PRICE AVG TOTAL
COST COST
47-1/4 102.205 $5,110.25
MARKET GAIN/
VALUE LOSS
$2,363.00 $ -2,747.25 ~ACK~
RATING
Closed End Mutual Funds
TYP QTY 1 SYMBOLI
OPEN CUSIP
1 887 C5P
DESCRIPTION
AM STRTG IC III
PRICE
11.688
AVG TOTAL
COST COST
11.264 $9,991.81
MARKET GAINI
VALUE LOSS RATING
$10,367.00 $375.19 ~8_UY
Equity Unit Trust
TYP QTY 1 SYMBOLI
OPEN CUSIP
1 510 R VDWTC-4
DESCRIPTION
UTS DOW TECHI0 4
PRICE AVG
COST
8.036 9.796
TOTAL MARKET GAIN 1
COST VALUE LOSS
$4,996.41 $4,099,00 $ -897.41
Money Market Funds
TYP QTY SYMBOLI
CUSIP
1 197 PBMlQ(
DESCRIPTION
PRU MONEYMART ASSETS
PRICE
MARKET
VALUE
1.000 $297.00
Order T~cket
This representation of your account history is not the official record of your account. It is for informational purposes only
and has been prepared to assist you with your investment planning. Your Prudential Securities Client Statement is the
official record of your account. Therefore, jf there are any discrepancies between this information and your Client
Statement, your should rely on the Client Statement and call your local Branch Manager with any questions.
http://branchserver. prusec.com/funcRTIME/apsnlist.asp
1/24/2001
."'......H"'II.n.. I V~I'-IVII.;;J
I'dye L UI L
Realtime Positions
As of: 01/24/01 9:59 AM
Price, Market Value and Cost Basis Information As Of: 01/23/01
Name: 1044-325845 MS PATRICIA A NAILOR.:1 Account #: 044-325845-026
Contact: IBuslness -697-2399 ~ Type: 10
Start Of Day I D.taU IN... RT Position. I <2Li.t I ~ I UserID: M044052
Equities and Options
TYP QTY 1 SYMBOLI
OPEN CUSIP
1 50 TLGD
DESCRIPTION
TOLL GRADE COMUC INC
AVG TOTAL MARKET GAINI
PRICE COST COST VALUE LOSS RATING
47-1/4 102.205 $5,110.25 $2,363.00 $ -2,747.25 ~!;K5
Closed End Mutual Funds
TYP QTY 1 SYMBOLI
OPEN CUSIP
B87 C5P
1
DESCRIPTION
AM 5TRTG IC III
PRICE AVG
COST
11.688 11.264
TOTAL MARKET GAINI
COST VALUE LOSS
$9,991.81 $10,367.00 $375.19
RATING
liBUX
Equity Unit Trust
TYP QTY 1 SYMBOLI
OPEN CUSIP
1 510 R VDWTC-4
DESCRIPTION
UTS DOW TECHI0 4
PRICE
8.036
AVG TOTAL MARKET GAINI
COST COST VALUE LOSS
9.796 $4,996.41 $4,099.00 $ -897.41
Money Market Funds
TYP QTY SYMBOLI
CUSIP
1 297 PBMXX
DESCRIPTION
PRU MONEYMART ASSETS
PRICE
MARKET
VALUE
1.000 $297.00
Order Ticket
This representation of your account history is not the official record of your account. It is for informational purposes only
and has been prepared to assist you with your investment planning. Your Prudential Securities Client Statement is the
official record of your account. Therefore, if there are any discrepancies between this information and your Client
Statement, your should rely on the Client Statement and call your local Branch Manager with any questions.
http://branchserver.prusec.com/funcRTIME/apsnlist.asp
1/24/2001
NADA Appraisal Guides - Get a Value - Official Used Car Guide - Domestic6
Page 1 of2
~~.f.
....~ 0.1_
www.nadaguides.com
Appraisal Report
Official Used Car Guide - Domestic
Consumer Edition
March 26. 2001
PONTIAC
1994
GRAND AM-Quad 4 - Front Wheel Drive
Body Style: Sedan 4 Door SE
Model Number: NE5
Weight: 2.793
Average Trade-In: $3.525
Average Retail: $4.925
Reported Mileage: 68,000
Add $400
Totals
Total Average Trade-In: $3.925
Total Average Retail: $5.325
l:ree..F.inllnce...Quotes
Free Insurance Quotes
Fre"tl.J~m01LChe.c.!I
~ree"",ar~arl~Cl~otes
Click below on the first character of the Manufacturer's Name.
[SICIDIEIE!1IMIQIEISJ
[ Domestic Car I Imported Car I Tru<;ks ]
You have receivlldlofthe? .freEl d<li~val~esforClfficiaIU~e~C<lr<3uide- [)orn~tic ..
Average Trade-In - An Average Trade-In vehicle should be clean and without glaring defects.
Tires and glass should be in good cond~ion. The paint should match and have a good finish.
The interior should have wear in relation to the age of the vehicle. Carpet and seat upholstery
should be clean and all power options should work. The mileage should be ~in the
acceptable range for the model year. The "Average Trade-In" value is a national average
calculated from the Official Used Car Guide's nine regions. The "Average Trade-In" value for
your vehicle could be higher or lower than the national average due to your local market
condnions.
Average Retail Value - An average retail vehicle should be clean and wnhout glaring defects.
Tires and glass should be in good condnion. The paint should match and have a good finish.
The interior should have wear in relation to the age of the vehicle. Carpet and seat upholstery
should be clean. and all power options should work. The mileage should be ~hin the
acceptable range for the model year.
An Average Retail vehicle on a dealer lot may include a limned warranty or guarantee. and
possibly a current safety and/or emission inspection (where applicable).
(0) Vehicles wnh low mileage that are in exceptionally good condnion and/or include a
manufacturer certification can be worth a signilicantly higher value than the Average Retail
price shown.
The web Trade-In, Retail Vehicle. and Optional Equipment values. as well as the Acceptable
Mileage Ranges. are based on the Quarterly ednion of the N.A.D.A. Official Used Car
Guide @.
...N alues_Manuf.asp?UserID=05146348D6E&DID=36976&Type=DM&GCode=UC&wSec= 3/26/200 1
PA REV-1500
SCHEDULE H
FUNERAL EXPENSES and
ADMINISTRATIVE COSTS
Hoffman-Roth Funeral Home, Inc.
219 North Hanover Street
Carlisle, PA 17013
(717)243-4511
February 9, 2001
Terry Renninger
P.O. Box 33
New Kingstown, P A 17072
The Funeral Service for Patricia A. Nailor
13422-25
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact US if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
J. Profeuioo.al Services
Graveside Service. . . . . . . . . . . .
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Winthrop Casket . . . . . . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
52690.00
52690.00
51825.00
54515.00
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERT AIN PAYMENTS TO
OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Certified Copies of Death Certificate .
FJowers. . . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
CONTRACT PRICE .
TOTAL AMOUNT DUE
This statement is net and payable In full within 30 days of receipt.
520.00
5159.00
5179.00
54694.00
54694.00
rhlJ
. \ .0\
:; )
,^,c y. /)
cpt 1'7 0
>\.0
~ r\~ q
RSR ~praisers
analysts
February 20, 2001
Mr. Mark Halbruner
1013 Mumma Rd.
Lemoyne, PA 17043
Re: Uniform Residential Appraisal
INVOICE
Residential Appraisal:
37 Greenhill Road
Mechanicsburg, PA 17055
Cumberland County
Our File # 01-05R
Total Due:
$300.00
$300.00
Appraisal Fee:
Please Include Our File # On Remittance, Payable To:
RSR Appraisers & Analysts
308 East Penn Drive
Enola, PA 17025
Tax ID. # 23-2468209
Thank You!
NOTE: A late fee of 1.5% per month will be added to any invoice not paid within fifteen
(15) days. (Annual percentage of 18%).
308 East Penn Drive' Enola, PA 17025. Phone (717) 763-1212' Fax (717) 763-1656
PA REV-1500
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES
and LIENS
PROVIDER CHARGES PAYMENTS
DATE NAME EXPLANATION OF ACTIVITY PATIENT NAME AND DEBITS AND CREDITS
-'" . ,
CHAHlit::s A......t;AHINU VI" Inl.:) .:)11"\1C.1'i1L..1" ,.\1..... I."" ...v....:.:......... ......; .... . .__.
f~0700 JLP
010801
012501
012501
012501
CPT: 93970- .28 DUPLEX OF EXT. VEINS,S ESTATE OF P
HEALTHSOUT 451.8
MEDICARE (EC) FILED
IlEDICARE PAVllENT
IlEDICARE ADJUSTMENT
APPLIED TO CO.PAY $7.41
305.00
-29.83
-287.88
/()\
'dV
~~ ~' ~ \O~
Y r\,U:S-'" ~\
0'- ~ "\.
T: 02/18/01 PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CAlLING OUR OFFICE
INS PENDING PATIENT 8AL TOTAL 8AL CURRENT 8AL PAST DUE
25888-1-1
NEW BAtANCF
PAY lHiSAlIOUN,
7.41
7.41
7.41
(717) 875.0800
BALANCE SHOWN IS PATIENT DUE.
IF YOU HAD INSURANCE AND WE
SU8MITTED, THIS IS YOUR RESP..
PLEASE REMIT PAYMENT PROMPTLY.
7.41
SEND INQUIRIES TO:
CARDIOVASCULAR SURGICAL INST.
423 NORTH 21ST STREET
CAIIP HILL PA 17011
IR8 II: 23.2432843
{~~~
. I
WEST SHORE
EMERGENCY MEDICAL SERVICES
503 North 21st Street. Camp Hill. PA 17011-2204
(717) 761-1038' 1-800-367-0512 (PA Only)
FEDERAL 10 # 23-2463002
INVOICE
INVOICE #: ('''054356E )
DATE: C
11/'27 10(~
BILL TO:
PATRICIA NAILOR
PO BOX 3:3
NEW KINGSTOWN, PA 17072
DOB: 07/17/35 SSN: 164-'2'='-079::::
PATIENT: NAILOR, PATRICIA
PO BOX :33
NEW KINGSTOWN, F'A 17072
POLICY NAME:
INS. #:
INS. #:
ACCOUNT#: 5:::'='51
TRIP#: 9054351.:,E
DATE OF SERVICE: 11/27/00
PATIENT PICKED UP: :37 GREENHILL DR
PATIENT TAKEN TO: HOLY SPIRIT HOSPITAL
DESCRIPTION OF ILLNESS/INJURY:
7:36.09 DYSPNEA
7:::0.79 Generalized Weakness
7:::7.01 Nausea I Vomiting
DESCRIPTION UNIT COST QTY. AMOUNT DUE
Ambulance Base Charge - ALS 624.70 1 624.70
AmbLl1 ance Mi 1 eage Charg- ALS 5.7~ 12 6'7.00
CARDIAC MON ITOR 6:::.80 1 6:3.80
EKG ELECTRODES 4.0:;: 1 4.02
ANGIOCATH (14-24) 4.7~ 1 4.75
PRN ADAPTOR 1. 7: 1 1. 72
3CC SYRINGE 1.41.: 2 2 ~r-::'
. .'-
OP SITE 4.47 1 4.47
NEBULI ZER 3.64 1 :3.64
PROVENTIL 1.52 .., 4.5(:,
.~
BRETHINE 1MG 2 8.20
SOLU-MEDROL 1'-'~ MG VIAL 1 4.02
.0::..._1
5CC/10CC SYRINGE 1 3.92
~\
I ~,\)\
~~~ / ~ \05
01.., c;'!1
\\ 1 \,
COMMENTS: *** Medicare has paid their portion of SUBTOTAL :304.72
*** balance is the CO-PAY and lor DEDUCT ABLE amoun
*** req\..\ ires we bi 11 to you. YOLlr prompt payment CREDIT ?:~::3 . 19
THANK YOU TOTAL 71.53
,,. M .., d ~,
~_"""-o'~ ,a8\8r\....<ara Eln ~
, ~~_:
Visa Ace;eptcd
~
WFSf SHORE
L "'LN.( ;1::'\( 'Y \1!.T:t<. .\1. SI-.l<I,:I<. '1-.":'
INVOICE
INVOICE #: (9055:340A )
503 Nonh 21st Street. Camp Hill, PA 17011-2204
(717) 761-1038. 1-800-367-0512 (PA Only)
FEDERAL 10 . 23-2C63002
DATE: (
12/10/0C)
BILL TO:
P?\TRICH\ NAILOR
PO BOX :33
NElA! I< I NGSTOWN, PA 17072
DOB = 07/17/:35 SSN' 164-2E:-0'79:::
PATIENT: NAILOR, PATRICIA
PO BOX 33
NEW KINGSTOWN, PA 17072
POLICY NAME:
INS.#:
INS.#:
ACCOUNT#: 5:::::351
TRIP#: 'i"1055~:40A
DATE OF SERVICE: 12/10/00
PATIENT PICKED UP: REHAB-SnLLED NURSING FACILITY
PATIENT TAKEN TO: HOLY SPIRIT HOSPITAL
DESCRIPTION OF ILLNESS/INJURY:
786.(J9 DYSPNEA
7E:6.50 CHEST PAIN
DESCRIPTION UNIT COST QTY. AMOUNT DUE
Ambulance Base Rate - ALS 594. 9~ 1 594 . 9~1
lOGTT TUBING 7.5~ 1 7..5:=:
GLOVES 16.3~ 1 16.38
(.\NG I DCA TH (14-24) 4.7c 1 4.. 7~5
EKG ELECTRODES 4.0::; 1 4.02
CARDIAC MONITOR 68.8< 1 68.80
NEBUU ZER 3.1:.,1. 1 3.64
NORM(.\L SALl NE 1 (JaOCI: :3.8!= 1 3..85
OP SITE 4.4" 1 4.47
PROVENTIL 1.5::; .-, :3.04
.-
Ambulance Mi 1 eage Charg- ALS 6 34.50
O>:ygen Admi n i str,~t ion 1 45.86
0\
~ ~.~ pC\
tP 1;'1..
,1\-
COMMENTS: *** Medicare has paid their portion 0 SUBTOTAL 7'71.84
*** b,~ I anee is the CO-PAY and/or DEDUCT ABLE amOLl
*** r"'eqlJ ires we bi 11 to you. Your prompt paymen CREDIT 720.02
THANK YOU TOTAL 71.82
.-
.:---.
~.~
WEST SHORE
LMERGENCY MEDICAL SERVICES
503 North 21st Street -Camp Hill. PA 17011.2204
(717) 761-1038' (-800-367-0512 (PAOnly)
FEDERAL ID . 23-2463002
INVOICE
INVOICE #: (';>05661\.I\.R )
DATE: (
12/26/(0)
BILL TO:
PATRICIA NAILOR
PO BOX 3:3
NEW KINGSTOWN, PA 1.7072
DOB: 07/17/35 SSN: 164-28-0798
PATIENT: NAILOR, PATRICIA
PO BOX :,;:3
NEW KINGSTOWN, PA 17072
POLICY NAME:
INS. #:
INS.#:
ACCOUNT#: 58:=:51
TRIP#: 9056644R
DATE OF SERVICE: 12/26/00
PATIENT PICKED UP: HOL Y SP I R IT HOSP IT AL
PATIENT TAKEN TO: WEST SHORE HEALTH AND REHAB
DESCRIPTION OF ILLNESSIINJURY:
496 C.O.P.D"
DESCRIPTION UNIT COST OTY. AMOUNT DUE
Ambulance Base Charge - BLS 292.25 1 292..25
Mileage Charge - BLS 5.7~ 1 5.75
O"ygen Adm in i strL.t; on 45.8l: 1 45..86
c\
,.
~~~ .~~ ~\\$
t~ ~ 1~
~" ~.
COMMENTS: """ Med i care has paid t.heir portion 0 SUBTOTAL 343..:36
""" balance is the CO-PAY and/L1r DEDUCT ABLE c'amOUI
""" requires we bi 11 to YOLl. YOLlr prorr,pt. payment CREDIT 305.07
THANK YOU TOTAL 38.7';'
,~ ..
~~
~~
WEST SHORE
L\lI:R( :10.\;('1' \IH)(( 'AI SERVICES
50'l Nonh 21st Street. Camp Hill. PA 17011-2204
(717) 761-1038.1-800-367-0512 (PA Only)
feDERAL 10 , 23-2413002
INVOICE
INVOICE #: (
.::~. (/:::i':~ :"
",.' .".
"':':':.'i
)
DATE: (
1::2i03/UtJ
DUb ~
PATIENT:
07,'17/35 ss.~~ 164-28-('7~:~
NAILDR7 FA"I-RICIA
PC} .80 X 3:3
NE'~ J~IN05-fOW~11 FA 17u7~'
BILL TO:
Ff; TF:; I C I p., ;--~(.:: LOP
F'[: ::0): '.;'..:'
rJEW kINGS1"OWN1 PA 17072
I
POLICY NAME:
INS. #:
INS.#:
DATE OF SERVICE:
l~.'/O:'=::/OU
ACCOUNT#:
~~5E';:<) :t
TRIP#:
'.~;'O~54 796{-1
PATIENT PICKED UP:
PATIENT TAKEN TO:
HO~lE/F:ES I DE~lCE
HULl' SF-IFI] HOSPITAl.
DESCRIPTION OF ILLNESS/INJURY:
4~;;::. C~O.F'.D.
4')2.e E.t"iFHYSEI"'j,::::j
DESCRIPTION UNIT COST an: AMOUNT DUE
t=lmbu i .~nC:E'.; f.;.:~1<;;e F:..-3tf? _. PIL.~;j ;:i'?4 . 9c I ,;:,';>"-1 . '::"C;"
1 (IGT"r TUB I \'.J(3 i :-;;;,. 1 ..~. ....,
. "_I,::,
BF':ETH I NE 1 1"Ie; 4 . 1 ( 1 4 . 10
P,NGIOe:,TH , 1 '1-24 ) 4 . :r 1 .1 ;' ::)
EKG ELECl PDUES . 0:-: :t 4 . ()....::
CPIRD IP1C ;'!Uj"J I TiJI::;' ":):: :=i'. 1 ,:;:,i:;: . e':)
ND,::::J1PiL. ~:.;Fil._. JNE lOO,)C.:C :=~ ,-,I- I .,~, ;.::::,'5
. ':'". - .
(JP S r lE 4 .<j 1 4 .-.~.?
I CC SYF:INGE , 4( 1 I 4(,:,
, .
F'F;I]I,,':E:i\.IT I!._ 1 ::1 ..;;: . 04
. .
NEBUL I ?F.J.; 1 .3 '::.~.
{~mbu , <:ijjC~ 1'1. I (:2C;;1<;;::'::> 1_.;""'-0.:.1;-'-'"3'- ALS '~: ".C. \_.' (~J
, .
L~~::~ 'y ';l \.:'f". :,di'!; I , ~:.tr:3t 1 on 1 4r- . :=;(:.
~ ,ul ~\)t
~~\
~~ ~~
~ J
~)i \~,.
COMMENTS: ii--;i--~ I"'h:?d i h_'-iS pa-i d thei SUBTOTAL 7"_:
c:~\r'~'? r por't 1 Dn 0 .' '.'. .
ii--?".,:j. ba 1 2,nc.f? i s thE' ClJ-'F'~\ y and IOI~ [IE DUCT (O,BLE aHiOUt CREDIT
*~'~-;j. rC:.'q:..l I t"'€-;'.:i !/JI:;? !J 1 1 1 tC) '-,.'DU . YOI_lr prompt p.:;",ym.;3~n ;"C;;'7 ./, .
THANK YOU TOTAL :,4
,-
~.. ........-..
5
o
~
:>.,
:.J
:::
(l)
01
~
~
1/
~
"l
~
~
W
M
iil
'"l
w
11
....
~
~
Q,
I-f
i
-'
:J
J
1/
3
.J
n
'"l
.J
~
,
11 ~ II
;~
)
)
)
)
~
i
,
~
~
C::>C::>"l'C::>C::>'I'C::>C::>"l'CC'I'C
CC"l'l'-C'l'l'-C::>'l'l'-C"I<l'-
. . . . . . . . . . . . .
Clt\lt\lt\lt\lt\lt\lt\lt\lt\lt\LOlt\
"'...."I"I<...."I'l'...."I'I'...."I
I I I r I I I I
~ ~ ~ ~
!3 !3 !3 !3
4.l
ID~ e-. ~ e-.
o ~ 0 ~
~o. ~Q, ~o. ~Q, ~
~ ~ ~~. ~ ~ ~ ~ ~
o 000
~~tl~~ti~~tl~~tl~
....><~~><!@~><~~><~~
t:F:luOF:lUl::q~Ul:\F:lt.H~
~~~~~~~~~~~~~
.....l-fl-fl-fl-fl-fl-feil-fl-fl-fl-fl-f
~~~~~~~~~~~~~
~~~tI1~~tI1~~tI1~~tI1
....c::>'""fjc'""fjc'"'fjc'""fj
~~~:t~~:t~~:t~~:t
-o-{:,-t:..
\ - ....
-:r- ~~ ~
'='" ;:>> s::or.
~ i:J
~
c::;;;;--
gs
gs
gs
gs
0\
C
IQ
<xl
r-
0\
C
IQ
<xl
l'-
0\
C
Cl\
C
.
IQ
<xl
l'-
.
IQ
<xl
l'-
O~t"'iOririO",",,,,",O""ri
CCCCCCCCCCCC
""""""""""""
<xlo\o\o\o\o\Co\o\lQCC
cccccc....cc............
""""""""""""
t-i........l""if"ir-tr-tr-tf"-i1""'fI""iM
....cc....cc....cc....cc
~
"J
~
~
tI1
,
tI1
~
~
><~
~o
lll~
~~
Q,E-i
..
~
Qj
~~
~C
~...
o
e-.
~
.....
III
II::
I
I~'
~;
I'"
u
"I<
'l'
.
It\
....
...
~
i
,~ n
~,~'-;/I
(~(Q) '-' 'D
-~ ....,....aClCl",,.......\G "'I
CIC1 In'''In~N'''CI\''' ,..
" . . .- .' . . . .
....... OIll.....""\OItICOCl\ CI\
.; C1.... ~ "',,"N"'''''''''P'''IG\ N
z " ","<<I <<ntuo...-l
. :::>
1 NN 0 . . .. . ':i; ""." ;;
........ '~ <<I~ IIl<l'~ "" ,
>
..J
~Qi I-
J:i;! 0.
cC.?i 'E E
...~. C Cl
u~~ llI: ...
... '" 0. <
1nQ: ~ 0.
J<<, w
0.1- ~ ~ >
C1< J ~ < III
NO. 61 IIIWWWWIIIIII " 0. >
~ .C1.... a: llI:lt:lt:llI:Q:llI:Q: <
CI CIC1 '-' <<<<<<< III :
"'Q:" ffi uuuuU(.J(.J !Z CJl
...-ICtl')N .M........................... 6 < ==
..JCICI ~ 'Cll:ll:ll:lCll:ll:l III 0
..." 111111111111111111111 ~ ..J >
<NN ~ ~:'" EE:E:E:EEE 0.
Z....C1 ~<' III .. u.
f2 UClooo'Qca ... 0 I- '
1i~~~ z~
~ ZCI\CI\CI\CI\CI\CI\CI\ :J~
i<<lVolc ... <EEEE:E:EE > I- 0 0;'
::8'E III ..J 0"';;:\'," I- Z :2 ,
jlH N < ... III '" L
," "' =
CI\ w '~ III U '''' ..J CI E 0 0
El , :::> CI ,- ,-(;k,;:,-:, ... CI III i =
Q I- '
~ w CI CJl Zo.""? ,.:>,-,-' III I- :> .;
1ft '-' :;) 0"'0. .... < '" "
~ a. ~
N Oo.Z "'0. CJl I- w>
, ,s~ ...... 0..,'" N Z CJl "' >
,.. 1il -;,~ >'I-l/lo... '" C "'~
.'h w'C
,.. i!: 1110..%0 III a.. 0. In 0. l/l ~-
GO ~ Q:l/lW:OIll III In III ... a. 0
."
I 0.0....:01-0 1ft III : .; ~
.... :1-1- :E: CI llI: I- - <
<:E< > CI " L
~ <0.>,<0.< CI Q: 0. l:l 'R~
, o..u' , CI :;) , Q: . ~
UllI: UIIlU C ... < 0-
~ >
w...... III .... > (.!) . "
l:l:l:ll:lCl l/l III III 0'"
"
" '" 1111-111111111<111 (.!) 3 It: llI: g
w ,.. EO:E:E:Eo.o. , III C < l/l
3 '-' ! Z (.J ;;;
~ ... "
. 0. CI ... l:l
: N c:u~ooa"""'" : III Cl
l. ,!Xl CI ClCiOCC::U:I ... III III
S: w ""'" E l/l
:::> ~ f"'tNG\~O\COCO i Q: CJl <
.. ~ ........NNNCCI ... CI III
..
Z '" ""'" ... : CI\ ..J
0 ~ NNNNN........ l- E 0.
1;; ....................OCl
w rFf
"
0
AcCOtJntNumO'" 16011090
PaOentName:NAILOR .PATRICIA
Service Start 11/27/00 Service End,
Statement Date: 0 3/02/0 1 lOst Statement 0""
PagaNo, J.
12/01/00
12/06/00
QUESTIONS? Please Call:
1-877-254-9239
Contact:
ACCOUNT BAlANCE ESTlMATEO INSURANCE QUE TOTAl PATlENT CAEOIT
31.63 .00
~
I TRANS DATE OESCRIPTlON AMOUNT
PREVIOUS BALANCE 6.522.33
12/06/00 MED CIA HOSP-IP M90 MEDICARE UP 2.614.47-
01/08/01 PA BS PYMT M90 MEDICARE UP 15.63-
01/08/01 PBS CIA HOSP M90 MEDICARE UP 92.46-
01/10/01 MEDI PYMT-HOSP IP M90 MEDICARE UP 3,894.78-
01/10/01 MEDI CIA HOSP-IP M90 MEDICARE UP 2,417.33-
01/10/01 MED CIA HOSP-IP M90 MEDICARE UP 2.614.47
02/12/01 OTHER PATIENT NON CO M90 MEDICARE liP 10.50-
\\ ~O t
r~UJ 1i \ 0
C}~~ 1,l- \0 ~
I
141 I R HO SG 1 000047137 I ACCOUNT BALANCE I 31.63
THIS IS NOW YOUR RESPONSIBILITV. PLEASE PAY PROMPTLY.
M90 MEDICARE I/P .00
PLEASE DISREGARD THIS STATEMENT IF YOU HAVE PAID.
Until your insurance has paid. the PLEASE PAY THIS AMOUNT repr$sents the balance we estimate you owe.
A" balance un aid b our insurance will be due from ou... Thank au.
Accou"'Numller: 16077729
P''''ntName,NAILOR ,PATRICIA
SeN'ce Stalt 1 2/11/0 0 S...~e End,
Statement Dale: 0 3/2 3/0 1 last Statement Date:
Page No. ...
12/26/00
01104/01
QUESTIONS? Please Call:
717-763-2141
Contact:
ACCOUNT BALANCE
ESTIMATED INSURANCE DUE
TOTAL PATIENT CREDITS
18.91
.00
TRANS DATE DESCR1P'TlON AMOUNT
PREVIOUS BALANCE 30,299.45
01/04/01 MED CIA HOSP-IP M90 MEDICARE liP 26,404.31-
01/08/01 OTHER PATIENT NON CO M90 MEDICARE liP 27.00-
01123/01 MEDI PYMT-HOSP IP M90 MEDICARE liP 3,894.78-
01123/01 MEDI CIA HOSP-IP M90 MEDICARE liP 26,190.67-
01/23/01 MED CIA HOSP-IP M90 MEDICARE liP 26,404.31
02105/01 PA BS PY"T M90 MEDICARE liP 75.63-
02/05/01 PBS CIA HOSP M90 MEDICARE liP 92.46-
11I1 I R HO SG 1 000035655 ACCOUNT BALANCE
PAYMENT IS DUE UPON RECEIPT OF THIS STATEMENT.
M90 MEDICARE I/P .00 Z89 COM SEC MED A
PLEASE DISREGARD THIS STATEMENT IF YOU HAVE PAID.
18.91
.00
... Of .
Until your insurance has paid, the PLEASE PAY THIS AMOUNt represents the balance we estimate you owe
Any balance unpaid by your insurance will be due from you... Thank you.
"
PENNSYLVANIA G.I. CONSULTANTS PC
899 POPLAR CHURCH ROAD
CAMP HILL PA 17011
(71 7) 763-0430
n.'n.!d
:.... 'ilL. "3~
PATRICIA NAILOR
C/O TERRY RENNINGER
PO BOX 33
NEW KINGSTOWN PA 17072
03/16/2001
'fJ#f.,}',.."
12/U/00
12/12/00
12/13/00
12/14/00
12/16/00
12/17/00
HOSPITAL CONSULTATION
EGD
HOSPITAL DAILY VISIT
HOSPITAL DAILY VISIT
HOSPITAL DAILY VISIT
HOSPITAL DAILY VISIT
98.34
152.76
53.97
69.10
34.55
269.85
78.67
122.21
43.18
55.28
27.64
215.88
c) 01
}l " ]1\
{)~ C~ I
, Ch{ ~.'\\
. \'
678.57
542.86
135.71
135.71
** STATEMENT DUE UPON RECEIPT * THANK YOU **
.00
135.7J.
.00
.00
.00
Pulmonary and Critical Care Medicine Associates, P.C.
1631 N. FRONT STREET
o Z HARRISBURG, PA 17102
PHONE: (717) 234-2561
..
ROBERT C. GILROY. M.D.
WILLIAM M. ANDERSON, III. M.D.
FRANKLIN J. MYERS. III. M.D.
RICHARD G. EVANS, D.O.
I
L
STATEMENT DATE
I
03/14/01
ACCOUNT NUMBER
PATRICIA NAILCoR
00 SOX 33
New KINGSTOWN PA 17072
~
32043 (1)
DATE DESCRIPTION CHARGE CREDIT
2/13/00
. 1/0'2/01
1/02101
1/29/01
2/15/00
1/05/01
1/05/01
, 1/29/01
~A?RICIA NAILOR (32043.0)
EVEL 3 SUBSEQvEN~ HOSPITA 130.00
Ins Pmt-~ MEDICARE
Ad~uc;t.met.,t.
R&j~ct-P JNI?EG AMERICAN INS CO
55.28
60.90
0.00
EVEL 3 SUBSEQUENT HDSPI-A 65.00
Ins ?~c-M MEDICARe
Adjust.ment.
Reject-P jNI~E) AM~RICAN INS CO
TOTAL FOR PATRI IA
27.64
30."5
0.00
NAILOR
01
,
~~' '. i \,J--
~. ('V:1"
I
.HL..
o.}/151.01
-$per: BR
Statement
Page: ~
IRS #
251792806
QUANTUM IMAG&THERA ASSOC (HOLYSP
POBOX 2226
YORK, PA 17405-2226
Tel: 8005297621
NAILOR, PATRICIA
C/O TERRY RENNINGER
PO BOX 33
NEPi KINGSTOWN,PA 17072
Acct: 20847071-1 /MC 164280798
Pat : NAILOR, PATRICIA 07/17/35
Tel: 717/697-2399
Insl: MEDICARE 164280798A
Date
Diag Ref C.P.T Qt Procedure
PIc Prv Arnt
Bal
-------------------------------------------------------------------------------~
11/03/00/ 496 4115 7101026 1 CHEST 1 V ER JA 36.00 1.8:
12/22/00 4115 MCCK MEDICARE CHECK ER JA -7.31
102482666
12/22/00 4115 MCDS MEDICARE WRITE-OFF ER JA -26.86
11/27/00/ 786.094115 7101026 1 CHEST 1 V ER RA 36.00 1. 8:
01/08/01 4115 MCCK MEDICARE CHECK ER RA -7.31
102511820
01/08/01 4115 MCDS MEDICARE WRITE-OFF ER RA -26.86
12/11/00./ 786.054106 7858526 1 PULMONARY PERFUSION Pi/V IH BG 216.00 10.8E
01/18/01 4106 MCCK MEDICARE CHECK IH BG -43.50
102546644
01/18/01 4106 MCDS MEDICARE WRITE-OFF IH BG -161. 62
12/11/00./ 496 4249 7101026 1 CHEST 1 V IH SPi 36.00 1.83
01/18/01 4249 MCCK MEDICARE CHECK IH SPi -7.31
102546644
01/18/01 4249 MCDS MEDICARE WRITE-OFF IH SPi -26.86
12/03/00./ 496 8475 7101026 1 CHEST 1 V ER XU 36.00 1.83
01/18/01 8475 MCCK MEDICARE CHECK ER XU -7.31
102546644
01/18/01 8475 MCDS MEDICARE WRITE-OFF ER XU -26.86
12/12/00~ 729.5 A335 9397026 1 EXTREMITY VEINS BILAT D IH BU 275.00 7.41
01/23/01. A335 MCCK MEDICARE CHECK IH BU -29.63
102556524
01/23/01. A335 MCDS MEDICARE MUTE-OFF IH BU -237.96
12/14/00~ 285.9 5021 7427026 1 BARIUM ENEMA SINGLE CON IH SPi 143.00 6.98
01./24/01. 5021 MCCK MEDICARE CHECK IH SPi -27.91
102564923
01/24/01. 5021 MCDS MEDICARE WRITE-OFF IH SPi -108.11
12/17/00~ 562.108215 7400026 1 ABDOMEN 1 V IH HO 36.00 1.83
01/24/01. 8215 MCCK MEDICARE CHECK IH HO -7.31
102564923
01/24/01 8215 MCDS MEDICARE WRITE-OFF IH HO -26.86
12/18/00./ 792.1 821.5 7425026 1 SMALL BOWEL & SERIAL FI IH GD 98.00 4.72
02/02/01 8215 MCCK MEDICARE CHECK IH GD -18.90
102585723
02/02/01 8215 MCDS MEDICARE WRITE-OFF IH GD -74.38
Referral Physician: PETERS, DAVID DO
---------
t.t/O\
~~tO' ~ i \t,
O~:~q .\*
Regular Balance: $
39.14
03/15/01
'-'Per: BR
Statement
Page: 1
IRS #
251792806
QUANTUM IMAG & THERA ASSOC(HS)
POBOX 2226
YORK, PA 17405-2226
Tel: 8005297621
Acct: 50902609-1 /MC 164280798
Pat: NAILOR, PATRICIA 07/17/35
Tel: 717/697-2399
NAILOR, PATRICIA
PO BOX 33
NEW KINGSTOWN,PA 17072
Ins1: MEDICARE 164280798A
Date
Diag Ref C. P. T Qt Procedure
Plc Pry Amt
Bal
--------------------------------------------------------------------------------
12/08/00/496 4112 7101026 1 CHEST IV IH HL 36.00 1.83
02/02/01 4112 MCCK MEDICARE CHECK IH HL -7.31
102589049
02/02/01 4112 MCDS MEDICARE WRITE-OFF IH HL -26.86
Referral Physician: DO, SI V MD
1"D\
h10 1 ~t ~ \\~
t~~f1
Regular Balance: $
1.83
'.
r:"l
:J
6
'"
:f
.J
..
z
a ~
a:
o ;1
~- '"
.!ij!)td}e
xQ..'S''''
iO~
c!~sg
pre~
lS:i Ie -
;:,.... N
-J" .
rEll;
~'s
-,0,...,
a::a.:e
r
(\/
,...
o
,...
-
CD
<J
C
el
'-z
::10
lIl_
CI-
.....0:
>o~
'-
ell-
~z
CW
0-
<JI-
41,:(
000.
a:
o
-'
-
.:(
z
<(~
...
(,)x
-0
0: a;
I-
<(0
Q.Q.
<(
a.
z
o
I-
00
(!l
z
-
>t:
;r
W
Z
~
~
0
N 0
,...
0 m
,... z
a:: - ...
0 ..
-' <( GlW
- Q. <Ja::
<( c.:(
Z Z elO
0 ,-x
<(~ I- ::11-
m Ul..J
- (!l cet
Ux z -w
... >oX
-0 >0::
a::lXl '-0
I-
etO ;r elW
o.Q. UJ EI-
Z --
'-z
a.:;;)
( "0 '\
cS -
z ~
rJ ... -J ~:!':
...
- ~
i ... ~ .~
...
...
g
S
Q
,~
~ ~
'"
~
~ a
'_ a::
~ ...
'- t:
z
:)
'"
'"
:<:
.-
uj
<J ...
z -
g i
::;
~ c!
...
a: a::
~ ~
E ~ ~
~ CJ .~
~
w
=>
-J
III ...
z lD
a: 9
~ g
II:
W
'"
~
ll. ~
-
5 i :;
~ ill: I
~
o
If
~. i
ijl i ::'
1!:! ~:, III
g ~ gill
.'"
;
~ ~ Q
~ ~
~ ~
o
,I
r
\
~
-
.~
~
=~
cr.. ~~
..;~
:;;~
_ -:Y
... -
\ ..-. \J'
~~ CS":
,1 ~
~""'!:..-
~
.u
=
o
~
-
=>
~
~
~
3
III
Q
-H'
b
a.-
1
~
r~
.n
"'~
~'"
~=
~~
-0
~ -
",5
=.-
~~
"''''
~~
- ~
~~
'-'co
.. '"
o~
,-,m
i
>t
~
~""
=~
=~
...~
...&'
m ._
~ .n
~ .~
:;:<::>
0:> .~;;
Q
w
...
...
z
..
'. P..t i ~nt II: n..i I pa-00
Est Patr'icic; Nailor'
C/O T er'l'''V Rerm i nge-r
New Kingston PA
......BILL FOR SERVICES"""
Date: 03/28/01
17072 B1Il II: 079914
--- ------ - - ------ --- - - ------ -- --- ------- --- -- --------- -- -- - - --- - - - - - - - - -_. - --- -- -. - ---- --
Tc,":.al Pl"~\l~ e~.l_:-
Today's Charges:
Today's P..vments,
Today'~ Ad.jments:
Total Payments ;
E.E..51-
100.00
0.00
0.00
BE..IB
ClIrr: 13.82 91-120: 0.00
31-E.0: 0.00 121+: 0.00
E.1-90: 19.t.7
PendiNI at Carr i er'.: 0.00
- - - --- ,.----- - -----... --- ------- --_.- --- -----
Date
tPl?.cE of g.......vcP lPt"'oc CdeIP....ocedm..e Description
INew P..tient B..I:
I 33.49
!Ne.t Appointment
I
--- -" - - - -------- ------- --- -- ---- -------- -- --------- - -- --- - -------- --- - --- -- - - _._-
Cha'-ge
12/12/00 Ilnp..tient
I
J
I
J
12/13/00 Ilnpatient
I
I
I
I
J
I
I
I
I
HospiJ99231
I
I
I
I
Hospil99231
I
I
J
I
J
I
I
I
OX Code I Oia9nosis D~scription
I Hospi t..I-V i s it Tocused-Bri ef-lS M I
IPlan P.waent:MCR-10297 I
IAdj:Medico~. W~iteof'
IPlan ~'oyment: 102555965 I
IPayment:pt f..1l11y c..lled I
IHospitol-Visit-Fo~used-Brief-15 MI
IPlon P..yllPnt :MCR-102'l7 I
IAdj:Medica,-e Writeoff I
I Plan Payment: 102555%5 I
I
I
,
I
I
I
I
I
I
b\
~r
~~"J/ ~\\1
c,~\.".~ IJ.-
Total:
I OX Code ~ Dia~nosi~ Desclipticn
1. 451.111Deep Venou> Thrombosls 14.
2. I 15.
3. 1&.
Date of first symptom:
Date first consulted fDr this condition:
Was Illness 0" injury employment "elated~: no
**1**1**
"*I**/*~
Auto r'ehted~:
Emergency~:
Insurance Release: Sign here to authori~e
the physician to release any
information to the insurance COMpany
that is needed to process this clair
50.00
0.00
15.45---
27.64-
0.00
50.00
0.00
15. 45--
27.&4.-
13.32
no
nc.
As~-igr1mer,t of in$liranCe~ I herebv
assign my insurance benefits
to be paid to the undersigned
phy~ician. I all financially
responsible for non-cQvered
ser'vices.
Dat:e:
Patient or authDrlzed persons signature
Policyholder siQnat~re
David C..lcagno
B00 Pcplar Church
Camp Hi 11
M (l
Road
PA
17011
Ph~ne: 717-7&3-0510
Date:
Date
Employer 1.0. No.: 25-1728&&8
Social Security #~
.. Pat i fnt *': ?';et 11 pa -00
....BILL FOR SER~'JCESH'
Date 03/2-13/01
Est Patr'icia Nailor
C/O Ter'l"'y Renr>'inQe:-'
New I".:ingstorl l='A
1707:':
P" ~! #: 07,)};:'B
T~t-~~ Pn.:... r;2;~.:
<;1.51-
TQdav~ ~ ~h~~~~s: ~22~Z0
Today's Paym~nts:
Today' 5 AdJments:
T,.:otal Payments
10.00
1/1.1'10
1t:'5.33
CIJrr: 13~ 82 91-1;~0: 0~00
31-5 0 ~ O. 0~1 121+: 0.00
61--90: 19.67
I PendIng at Car"')-"ier; 0.00
~N@~! P&tip~t B~l:
33_49
_________~___.~_____ ________________r____ .____.._
INoxt Appointmeot
!
P",te
tPl.;,(":e of Sr.....;::e- JPr;Jc. Cde-}P~~oce-dl.I:-.e De-~cr"iption
Chan~e
--.---.-------------------------------------..-------------------.-----------.------..
12/11/00 IInpatient
I
H,}~pi 199253
J
I
I
I
DX Code I Diagnosis Descriptiun
1. 451. lllDeep
,
,
Vpnous Thrombosis
-,
".
3.
'Hospital Consult-Oetalled
IAdj,Medicare Writeoff
IPlan Payment:102501343
IP~yment'pt family callert
!
I
I
I
I
I
I
1
I
I
I
I
I
J
125.1210
26~ bi..~-
78.61-
0.1110
o ,\) \
~ ~'" J1 ~\\'\
'~r\~1\ ~\
\,; \ \"\:
Total:
19. (,.7
I DX Code I Diagno!is D~5cription
'4.
15.
16.
Date of first symptoA'
Date first consulted fer this conjiti~n:
Was Illness or injury e.ploy.ent reJated~: no
**/*'*1**
**I,*"*/lF-iP-
Auto related?:
Emei'"Qioncy? :
no
no
lnsurance Reled~e: Slgn here to authorize
the physician to release any
information to the insurance company
that is needed to p~~cess this claim
Assignment of insurance: I hEreby
assign my insurance benefit~
to be paid to the urdersiQ~ed
phy~ician. r am financially
responsible for non-covered
sel~V ices.
Date:
Patient or authorized persons signature
John G Calaitges M D
800 Poplar Ch~rch Road
Ca.p Hill PA 17011
PhDne, 717-7&:5--051111
Policyholder signature
Dats-
Date,
Employ.,- 1. D. ND.: 251728&(,8
Social Security #:
FAMILY/INTERNAL MEDICINE ASSOC. ,P.C.
6 MARKET PLAZA WAY
MECHANICSBURG, PA 17055
Tel: 717/766-0228
STATEMENT
patient: NAILOR, PATIUCIA
Tax I.D. 232488934
NAILOR,PATIUCIA
BOX 33
NEW KINGSTON, 'PA 17072
STATEMENT DATE PAGE
04/11/01 1
ACCOUNT NUMBER
1000931 - 1 / NO
AM;=~~D $ I"~. n
Place Codes:
IH=In Patient
OH=Out Patient ER=Emergency Room
-. I I
DATE ICD9 CD PL* DESCRIPTION AMOUNT
Balance forward last statement 0.00
1.1/28/00 491.20 IH 99222 ADMISSION - MEDIUM (AM) 130.00
12/18/00 MCCK MEDICARE CHECK -89.12
12/1S/00 MCDS MEDICARE DISALLOWANCE -lS.60 ;I..l-'i'
11/29/00 -
11/30/00 491.20 IH 99232 VISIT - MEDIUM (IV) 120.00
12/18/00 MCCK MEDICARE CHECK -S6.35 )
12/18/00 MCDS MEDICARE DISALLOWANCE 51..1 f -12.06 IJ.1.Si
12/01/00 491.20 IH 99238 HOSPITAL DISCHARGE DAY 70.00
12/1S/00 MCCK MEDICARE CHECK -51.46
12/18/00 MCDS MEDICARE DISALLOWANCE -5.67 0.&7
12/04/00 491.20 IH 99222 ADMISSION - MEDIUM (AM) 130.00 '2.~J
01/02/01 MCCK MEDICARE CHECK -89.12
01/02/01 MCDS MEDICARE DISALLOWANCE -18.60
12/05/00 491. 20 IH 99232 VISIT - MEDIUM (IV) 60.00 =----
01/02/01 MCCK MEDICARE CHECK -43.18
01/02/01 MCDS MEDICARE DISALLOWANCE ..f(f11 -6.03 /1)-7<;
12/06/00 491.20 IH 99238 HOSPITAL DISCHARGE DAY 70.00
01/02/01 MCCK MEDICARE CHECK -51. 46
01/02/01 MCDS MEDICARE DISALLOWANCB -5.67 /7,.0
12/07/00 491.20 SNF 99254 INITIAL INPATIENT CONSULT 145. 00
01/02/01 MCCK MEDICARE CHECK 10\ -110.43
01/02/01 MCDS MEDICARE DISALLOWANCE ,,10 -6.96
12/11/00 491.20 IH 99222 ADMISSION - MEDIUM (AM) 130.00
01/08/01 MCCK MEDICARE CHECK ~ ~i' -89.12
01/08/01 MCDS MEDICARE DISALLOWANCE )' -18.60
12/12/00 - t"t 840.00
12/25/00 491.20 IH 99232 VISIT - MEDIUM (IV) .fill
01/08/01 MCCK MEDICARE CHECK 10- -604.46
01/0S/01 MCDS MEDICARE DISALLOWANCE -84.42
Continued on page 2
Ref. Phy: DBLAFUENTE, CARLOS F MD
CURRENT AMOUNT PAST DUE AMOUNT PLEASB PAY /c,a. .3'
$ 0.00 $ 316.56 THIS AMOUNT $ 316.56
WE MUST HBAR FROM YOU REGARDING
YOUR OVERDUE ACCOUNT.
r h ~.../-U_"'_...../_. //
/.i,A...J_ /:1 /'Jo. ,. _ _ --'
~ ~,1 ~O! ~
~fVO fJi- *~ r.\o
etl, \b~'~
WlMILY/INTERNAL MEDICINE ASSOC. ,P.C. STATEMENT
6 MARKET PLAZA WAY
MECHANICSBURG, PA 17055 Patient: NAILOR,PATRICIA
Tax I.D. 232488934
Tel: 717/766-0228
NAILOR, PATRICIA
BOX 33
NEW KINGSTON, PA 17072
STATEMENT DATE PAGE
05/01/01 1
ACCOUNT NUMBER
1000931 - 1 / MO
INDICATE t (
AMOUNT PAID $ ('5~ .
Place Codes:
IH=In Patient
OH=Out Patient ER=Emergency Room
DATE ICD9 CD PL*I DESCRIPTION II AMOUNT I
Balance forward last statement 153.20
--~-
.. . .~-
. . ' .. ~ -,-,~
()\ *' '
j f)../ ~ )
'"$ / \)
Q ~ Ct\f-a--
\ \>-(~ 1{)
11. \~,?
CURRENT AMOUNT PAST DUE AMOUNT I PLEASE PAY 11 153.20 I
$ 0.00 $ 153.20
THIS AMOUNT $
THANK YOU FOR YOUR PAYMENT.
Register of Wills CumberlandCounty I Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
Patricia A. Nailor
No.
~/-OI-2~~
also known as.
, Deceased
Social Security No. 164-28-0798
Terry 1. Renninger,
Petitionef(S). who is/lMe 18 veara of .age D1 oI4e1. apP'yfiesJ tor:
(COMPLETE "A" OR "B" BELOW:)
~
A. Probate and Grant of Letters and aver that Petitioner{sl is/are the execut~ named in the Last Will of the
Decedent. dated November 14, 2000 and codicil(s) dated N/A
SUIte felevllOt dr~cea. e.g., renunciation, death 01 exeeutor, etc.
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 incompetent:
[J
B. Grant of Leners of Administration
(c.t.... d.b.n.c.t...: pendente lite; durante absentia; dUI...te rrinoritet&)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(it any) and heirs:
I Name Relationship Residence I
~~... IN :) Attach additlonalsheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 37 Green Hill Road, Silver Spring Township, Cumberland County, Pennsylvania 17072
t1ist aueel, number .,d mun~cipafitvl West Shore Health and Rehabilitation Center,
Decedent, then 65 years of age, died January 23 , 2O~. at East Pennsboro Twsp., Cumberland County, P A
(LoclltionJ
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property .............................. $
(If not domiciled in PAl Personal property in Pennsylvania. - . . . . . . . . . . . . . . . . . , . . $
(If not domiciled in PAl Personal property in County . . . . . . . . . . . . . . . . . . . . . . . . . . $
Value of real estate in Pennsylvania ............................................... $
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Real Estate situated as follows: NI A
5,000.00
U.UU
0.00
0.00
5,000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil{sl presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Signature
Typed or printed name and residence
Te
P. O. Box 33, New Kin stown PA 17072
RW-7
.-. --'
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 administer the estate according to law.
before me this
41'~
Sworn to and affirmed and subscribed
day of .
JL.12.A~ 200.1-
1
'7J.)ad ~'. (~ ~. C~d. Jtf~t;,Lf
~L~)
Terry 1. Re lifer
Estate of
Patricia A. Nailor
DECREE OF REGISTER
21-01-208
Deceased
No.
also known as
Date of Death: January 23, 2001
Social Security No: 164-28-0798
AND NOW, FEBRUARY 22 , 20 ~ in consideration of the Petition
,
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 129 Testamentary 0 of Administration
(c.I.a.; d.b.r\.C.I.; pendente lite; durante abHfttia; duu..... rninoritatel
are hereby granted to' Terry 1. Renninger
in the above estate and that the instrument(s), if any, dated November 14, 2000
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters.......................... .
Short Certificate(s)......?..
Renunciation................. .
Affidavit ( ).................
Extra Pages ( 8 )............
CodiciL............ ........ .....
JCP Fee........................
Inventory & Tax Forms...
Other.. ..........................
$ 25.00
~;? ~ ~. ell ~~~ O~~~..,
Register of Wills
$ 9 . 00
$
$
$ 24.00
$
$ 5.00
$
$
Attorney: Mark E. Ha1bruner, Esquire
1.0. No: 66737
Address: Gates & Assoc., P.C., 1013 Mumma Rd., Ste. 100
Lemoyne, P A 17043
Telephone: 717-731-9600
DATE FILED: FEBRUARY 22, 2001
TOTAL............~... $ 63.00
RW-7a
MAILED LETTERS TO ATTORNEY FEBRUARY 22, 2001
1105.805 REV 9186
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
)1.~ ~. ~e.u..~~~~
Local Registrar
Fee for this certificate, $2.00
p
6948028
JAN 2 4 2001
Date
H10S.143 R.-w. 2..'87
COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
=tIN'T
lENT
INK
N....ME OF DeCEDENT (F,rst, M~.. La.,
SEX
STAll J''lf !lfUMeER
SOCIAl. SECURITY NUMBER
.c'';l,\
I. Patricia A. Nailor
....GE(laslBirtf'ld8y)
,. 164 - 28
65
UNDER' 'tEAR
Mond'II OeY'
UNDER 1 DAY
Hours ! MInut"
BIRTHP\.ACE (C"y af'Id
3UIteO'FcretgnCounrryt
Shippensbut~
y",
..
COUNTY OF DEA'H
..
Currberland
DECEDENT'S USUAL OCCUP~tON
(~'IlIOftI~=:O~=~=:
~ DECEDENT EVER IN
u.s. ARMEOFOACES?
_0 ...G!:
MARITAL STATUS. MIIfried
Ne'4t M....... Widowed,
-~"vl
14. Di vorced IS.
17..[]C.....__.. Silver Sorinq
-
17.. State PA.
'7ll,
No, dKedMllhoed
17.. wlCt*'............af
MOTHER'S NAME IFirsl. Moddht. MatMn SurNrNI
DId
-
twin-
_,
PA 17072
cityl'bonl.
II.
INFQAMAN . ( Me.
_ P.O. Box 33, New Kin stown
PLACE OF OtSPOSlTION. Heme Of Cemetery. CremMOry
<<~~K. Westminster
PART II: on.... signifICant concMionI c:onmbuting 10 6t.th, but
r1Qt resuftlng in the underfVtng ce-... g;v.n in PART ,
I :
L
WERE AUlOPSY FINDtNGS
_1lA8lE PR10A 10
COMPLETION OF CAUse
OF OERH?
DUE TO(OA /IS "CONSEOUENCE OF):
MANNER OF DEATH
OATE OF INJURY
(Monlh. Day, _at')
TIME OF INJURY
INJURY IJ WORK?
DESCRIBE HOW INJURY OCCURRED.
Hatur"
f1-..
o
o
Homicide
...E-
_0
NoD
""""'"
Could not be delermlNtd
o
o
o pV:Ce OF INJURY. AI home, la'~~;'et. lactorr, otftce
buitdIng, MC.15peedv)
'00.
.... 0 ...0
Accidenl
Pending tnYesl.llon
M. :JOe.
o
~~ d-.C5D\
,
a.. 21b,
eERTlFlER ,Check only onel
"CERTIFYING PHYSICIAN (Ph~.." Cf!fkfylnQ cause d death ~ atIOIher pI'Ivscoan f\as pronounced death ano completed Item 231
To the ~tot",yllnowledge, d.athocc\lM'll'd ~totheu\l..(s)andmann.'a.atatad"",...,..",.,.,.,...,...,.",.,.."
,.,
'PRONOUNCING AND CERTIFYING PHYStC1AN IPhysJc<an DOIh pl'0f>0ul"ICIflQ death,and cerldy""9 10 cauw of deartll
To the ~ 01 my Ilno.....l.dQfI. d.ath occurred at the dfne. dat.. a"d place, and due '0 the cause(a) and m.""., a. a'eted,. . .., . .... . , , , .
.UEDICAL EXAMINER/CORONER
On Ihll! b..i~ 0' eumlnatlon and/o' InvesUgaUon, in my opinion, death occuffed ., the tlm., dat., and place, and due to the eause(a) and
manne' a. statltd.. .,..,.. . . . ....... "......, ......,.,...... "............,...........
11a,
REGISTRAR'S SIGNATURE ANO NU~ ~. ". t'"'. ..... t\..&- \
~ ""' ,'----dt\.\.u\'o k:1J \ Id; 1101
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
I, PATRICIA A. NAILOR, now of 37 Green Hill Road, Silver
Spring Township, Cumberland County, Pennsylvania, do publish and
declare this to be my Last will and Testament, hereby revoking
all other prior wills and codicils made by me.
FIRST: Family Background and Appointment of Executor.
(A) Family and Background Information. I am not married.
I have three children, TERRY J. RENNINGER, NEVIN L. NAILOR, JR.
and KIMBERLY J. LOPP, and throughout this will, they will be
referred to as "my children". The word "issue" will refer to my
children and my other descendants.
(B) Appointment of Executor. I appoint as my Executrix and
Successor Executor (all hereinafter referred to as Executor or
Executors) under this Will, the following named persons to serve
without bond and without being required to account to any court:
Executor: My daughter, TERRY J. RENNINGER.
Successor Executor: My son-in-law, G. SCOTT RENNINGER.
SECOND: Funeral and Last Illness Expenses; Taxes.
(A) Expenses of Funeral and Last Illness. I direct my
Executor to pay my funeral expenses and the expenses of my last
illness from my estate.
(B) Taxes. I direct my Executor to pay any and all estate,
inheritance, succession, legacy, transfer and other death taxes
or duties, by whatever name called, inCluding any and all
interest and penalties thereon, imposed under the laws of any
jurisdiction by reason of my death, upon or with respect to any
and all property included in my gross estate for the purpose of
such taxes, whether such property passes under or outside of this
Will, out of my residuary estate, without being prorated or
apportioned among or charged against the respective devisees,
legatees, beneficiaries, transferees or other recipients of any
such property or charged against any property passing or which
may have passed to any of them. The Executor shall not be
entitled to reimbursement for any portion of any such taxes from
any such person.
j@~
-\L'lh
'IY..]q' 1__.
/ . _ __1.
.' <:" ~{
J
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE 3
(B) I have intentionally omitted my daughter, TERRY J.
RENNINGER, and her issue from this bequest of my residuary
estate.
(C) Prior to final distribution of my estate, the Executor,
in his discretion, may make partial distributions to one or more
beneficiaries or trusts. As a consequence, the executorship and
any trusts created under this Will may exist contemporaneously.
A distribution may be made subject to any indebtedness or
liability of my estate.
FIFTH: Powers of Executor. In addition to such powers and
duties as may have been granted elsewhere in this Will or by law,
but subject to any limitations stated elsewhere in this Will, the
Executor shall have and exercise exclusive management and control
of the estate and shall be vested with the following specific
powers and discretion:
(A) In the management, care and disposition of the estate,
the Executor shall have the power to do all things and to execute
such instruments, deeds or other documents as may be deemed
necessary or proper, including the fOllowing powers, all of which
may be exercised without order of or. report to any court:
(1) To sell, exchange or otherwise dispose of any
property at any time held or acquired hereunder, at public
or private sale, for cash or on terms, without
advertisement, including the right to lease for any term
notwithstanding the period of the estate, and to grant
options, including any option for a period beyond the
duration of the estate.
(2) To invest all monies in such stocks, bonds,
securities, mortgages, notes, choses in action, real estate
or improvements thereon, and any other property as the
Executor may deem best, without regard to any law now or
hereafter enforced limiting investments of fiduciaries.
(3) To retain for investment any property deposited
with the Executor hereunder.
(4) To vote in person or by proxy any corporate stock
or other security and to agree to or take any other action
in regard to any reorganization, merger, consolidation,
-#L
.~
'1/'1 /\~. '/ '". ...
~
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE 6
circumstances. If the Executor does not exercise the above
discretionary power, the cash or accrual allocation shall be in
accordance with Chapter 81 of Title 20 of the Pennsylvania
Consolidated Statutes, or the corresponding provisions of
subsequent state law.
SIXTH: Rights and Liabilities of Executor.
(A) No bond or other security shall be required of the
Executor.
(B) This instrument always shall be construed in favor of
the validity of any act or omission by the Executor, and the
Executor shall not be liable for any act or omission except in
the case of gross negligence, bad faith or fraud. Specifically,
in assessing the propriety of any investment, the overall
performance of the entire estate shall be taken into account.
(C) The Executor shall be entitled to receive reasonable
compensation for services actually rendered to my estate in an
amount the Executor normally and customarily charges for
performing similar services during the time in which the Executor
performs the services.
SEVENTH: Tax Elections.
(A) In determining the estate, inheritance and income tax
liability relating to the estate, the Executor's decision as to
all available tax elections shall be conclusive on all concerned.
In accordance with Internal Revenue Code ~2632(a) and without
regard to whether a federal estate tax return is actually filed,
the Executor shall allocate so much of the federal Generation
Skipping Transfer (GST) exemption amount as will fully exempt any
generation skipping transfer which may occur under this Will.
(B) The Executor may, in the Executor's discretion,
determine the date as of which my gross estate shall be valued
for the purpose of determining the applicable tax payable by
reason of my death.
(C) The Executor may, in the Executor's discretion, decide
whether all or any part of certain deductions shall be taken as
income tax deductions (even though they may equal or exceed the
taxable income of my estate and whether or not claimed or of
(fit
~
tVj[1cf.
LAST WILL AND TESTAMENT
OF
PATRICIA A. NAILOR
PAGE 7
benefit on my estate's income tax return) or as estate tax
deductions when a choice is available; and in the event that all
or any part of such deductions are taken as income tax
deductions, no adjustment of income and principal accounts in my
estate shall be made as a result of such decisions.
EIGHTH: Spendthrift Provision. No beneficiary shall have
the power to anticipate, encumber or transfer his interest in the
estate in any manner other than by the valid exercise of a power
of appointment. No part of the estate shall be liable for or
charged with any debts, contracts, liabilities or torts of a
beneficiary or subject to seizure or other process by any
creditor of a beneficiary.
NINTH: Definitions and General Provisions.
(A) Survival. Any beneficiary who dies within sixty (60)
days after my death shall be considered not to have survived me.
(B) CaPtions. The captions set forth in this will at the
beginning of the various articles hereof are for convenience of
reference only and shall not be deemed to define or limit the
provisions hereof or to affect in any way their construction and
application.
(C) Code. unless otherwise stated, all references in this
will to section and chapter numbers are to those of the Internal
Revenue Code of 1986, as amended, or the corresponding provisions
of any subsequent federal tax laws applicable to my estate.
(D) Other terms. The use of any gender includes the other
genders, and the use of either the singular or the plural
includes the other.
-UL
JoL~
111 (1J
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
The Testatrix and the witnesses whose names are signed and
subscribed to the attached or foregoing instrument, being first
duly sworn and qualified according to law, do hereby acknowledge,
depose and say to the undersigned authority, that the Testatrix
signed and executed the instrument as her Last will in the
presence of the witnesses; that she signed it willingly or
willingly directed another to sign it for her; that she executed
it as her free and vOluntary act for the purposes therein
expressed; that each of the witnesses were present and saw the
Testatrix sign and execute the instrument as her Last will; that
each subscribing witness in the hearing and sight of the
Testatrix signed' the will as witnesses; and that to the best of
their knowledge the Testatrix was at that time eighteen years of
age or older, of sound mind and under no constraint or undue
influence.
On this, the /4tlt day of iJ tJ'1~ , 2000, before me,
a Notary Public, the undersigned officer, personally appeared
MARK E. HALBRUNER, known to me or satisfactorily proven to be a
member of the bar of the highest court of Pennsylvania, and
certified that he was personally present when the foregoing
acknowledgment and affidavit were signed by the Testatrix and
witnesses.
IN WITNESS WHEREOF, I
seal.
hereunto set my hand
~~
Notary Public
My Commission Expires:
and official
Notarial Seal
Teri L. Walker, Notary Public
Lemoyne Boro, Cumberland County
My Commission Expires Jan. 20, 2003
Member, Pennsylvania ASSOCiation ot Notaries
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Patricia A. Nailor
Date of Death: January 23, 2001
File No.: 21-01-0208
To the Register:
I certifY that notice of 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
March 9, 2001.
Name
Address
Terry J. Renninger
P. O. Box 33
New Kingstown, P A 17072
Nevin L. Nailor, Jr.
1670 Holtz Road
Enola, PA 17025-1312
Kimberly J. Lapp
R. R. # 2 Box 979
New Bloomfield, P A 17068
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
Dated: March q ,2001
~~.~
Mark E. Halbruner, Esquire._
Counsel for Personal Represe)llative
Gates & Associates, P.C.
1013 Mumma Road, Suite 100
Lemoyne, P A 17043 -->'
(717) 731-9600
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
TIDS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM TIDS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be determined wholly or partly by the decedent's Will.
If the decedent died without a Will, whether you will receive any money or property will be determined by
the intestacy laws of Pennsylvania.
IN RE:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ESTATE OF PATRICIA A. NAILOR,
DECEASED
NO. 21-01-0208
TO: Terry 1. Renninger
P. O. Box 33
New Kingston, P A 17072
Nevin L. Nailor, Jr.
1670 Holtz Road
Enola, PA 17025-1312
Kimberly 1. Lapp
R. R. # 2 Box 979
New Bloomfield, P A 17068
Please take notice of the death of decedent and the grant of letters to the personal representative( s)
named below.
The Decedent, Patricia A. Nailor, died on the 23M day of January, 2001, at West Shore Health &
Rehabilitation in East Pennsboro Township, Cumberland County, Pennsylv~.C.
The Decedent died testate (with a Will).
The personal representative of the Decedent is:
Terry 1. Renninger
P. O. Box 33
New Kingston, P A 17072
(717) 697-2399
If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of
Cumberland County, located at 1 Courthouse Square, Carlisle, Pennsylvania 17013.
A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the
charges for duplication.
Dated: March 3-. 2001
~1c:~
Mark E. Halbruner, Esquire
Counsel for Personal Representative
Gates & Associates, P.C.
1013 Mumma Road, Suite 100
Lemoyne, PA 17043
(717) 731-9600
.
r
\'
\
\
\
\
\
\
\
,
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
j.... ~
Co
;fl
~
~
~
~
-=r
c-l
cD
';
~
\
'Z
:::>
~
:ii(
.....
o
.....
<i
~
ro-'(1:
z~<&~
~~'Z5
(/)0%
(/)0
"'-
~
i-
"""0-
Ul..-
'4,U1
S~(.)
2Ul U1
~o (t.
~2 .-l
~'8 4
Q%. <:)
0. 4. ..-
t:u.
~u.
,!O
~
.c.
~
~ en
~ ~
~~~ \
~m;l ~
\I..~:) ...
oa:9 ';:
-.r.u..'2. .c.
~o~ ~
~~:...~
i~o~~
Q~~~(/)
~~'l'il
afu:) \1.1 4
OOlDO-.r.
2
~
u.
~
~
~
'l\.....
t.B
u.l
\-"
4
....
u
'fA
~
.6
U)
u.l
'4
~
l
~
%
.....
ul
t'"
....
i~
o
Qt"-
4.....
o
0:.4
40..
s:.
'& ...
i't
,..
~i
~.'1
::;.c- ~,'~'~ ,:.,,~'.." .
- .
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
\
~\
;d\
~\
'5\
cm\
'm\
-\
$'
a::
o ':S..
~ UJ
o
o
~
.
~
.
9
"'-
0.
'Z
6
~
i
o
I-
Ja:.
.W
.... \-"
IJ tn
, .,.....
~ct;t5
o4.~
\1.11:-
Z
w
~
a:
~
Q)
0-
b
\
,
\ ,..
.:t ~ .,
..0 c.;
..... Ib
i 4. .
is) <t
.... !
L)
- cg ,......
~ ~a:. ..... 0 i .... h
oa ~~ 0 0 % ';
~ 0 0.. 0 0
\ 01 0 i- t\) ~
R & ~ ......
m1t: ~- ......
moD \1.10 U1 -.r.t'J
~5 ~o t ~~ ;...
~ t\\ ~o
Z ~ \ &.... ~- 0-
~o ::> 0....
- Ul..... oi ~.:t
~~tu '5 '5 .c. ~u '5
~ \1.1
<(Z ~ \1.1 6 ~
t;\\I.I ~ 0
,\~ 1'0 ~ \0 0
p11 II- Z
'f:s
"""
4
~
~
..
~
01.0
wt"-
"""
4-
~~
~~
u[
~
~
~
Vi
'it
'!
%
...
\
I t,-;;'t'? - ;;
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
<;1-
C/
April 24, 2001
Telephone
(717) 787-3930
FAX (717) 772-0412
Law Offices of
Adler & Adler
125 Locust St.
P.O.Box11933
Harrisburg, Pa.17108-1933
Re: Estate of Stanley D. Adler
File Number 2101-0145
Dear Mr Adler:
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before October 17,2001. Because
Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional
extension(s) will be granted that would exceed the maximum time permitted.
Sincerely,
/) I.i! //.///1. /;~
(" / Iii I ( /1 Ii. /1..
!' " / i. t/ //"!'/ 1" I
l,,-.:'~ ,j:~,::'" ,,' /''-' ~_ ,.,;~,.--'Y:'~-/~' J--Ltt~/v./
, I/J' /'~I ;.>...... V
.{' I'e~y D. Hollenbush, Supervisor
- DOcument Processing Unit
Inheritance Tax Division
"/6-~/.;2,~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
MARK E HAL BRUNER ESQ
GATES 8 ASSOCIATES
1013 MUMMA RD STE 10.0
LEMOYNE P4~7043
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-13-2001
NAILOR
01-23-2001
21 01-0208
CUMBERLAND
101
'*
REY-1547 EX AFP U2-DD)
PATRICIA
A
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=is'4j-EX-AFP-fi'2-=oOY-NO'TicE--OF-YNHEiiiT"NCE-'TAX-APPRAisEiiENT~--ALi-ow"NCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF NAILOR PATRICIA A FILE NO. 21 01-0208 ACN 101 DATE 08-13-2001
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:
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
106,312.71 X 045 = 4,784.07
.00 X 12 = .00
.00 X 15 = .00
(19)= 4,784.07
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
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
1,000.79
.00
122,378.44
(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)
UO)
16,146.23
920.29
(11)
(2)
(3)
(4)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
123,379.23
17.066 52
106,312.71
.00
106,312.71
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-06-2001 AA478246 231.58 4,400.00
06-27-2001 AA496781 .00 152.49
TOTAL TAX CREDIT 4,784.07
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 $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A '"CREDIT'" (CR), YOU MAY BE DUE
A D~~IINn ~~~ D~U~D~~ ~Tn~ n~ THT~ ~nDM ~nD TN~TDII~TTnN~_ 1
v
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY
UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No.:
Patricia A. Nailor
January 23, 2001
21-01-0208
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
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete: N/A
3. If the answer to No.1 is yes, state the following:
A. Did the personal representative file a fmal account with the court? No
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: None
C. Did the personal representative state an account informally to the parties in
interest? No
D. Copies of receipts, releases" joinders and approvals offormal or informal
accounts may be filed with the Clerk of Orphans' Court and may be attached to
this report.
. L
t;J;~[', ~
Mark E. Halbruner, Esqmre
PA LD. # 66737
GATES & ASSOCIATES, P.c.
1013 Mumma Road, Suite 100
Lemoyne, PA 17043
(717) 731-9600
----'
Date: September 19,2001
Capacity: Counsel for Personal Representative
LAW OFFICES OF
GATES &- ASSOCIATES, P.C.
LOWELL R. GATES
Also Admitted to Massachusetts Bar
MARK E. HAlBRUNER
Also Admitted to New Jersey Bar
CRAIG A. HATCH
CORY J. SNOOK
ALBERT N. PETERLlN
Also Admitted to Maryland Bar
1013 MUMMA ROAD. SUITE 100. LEMOYNE, PENNSYLVANIA 17043
(717) 731-9600 . FAX: (717) 731-9627
BRANCH OFFICE:
3 WEST MONUMENT SQUARE, SUITE 304
lEWISTOWN, PA 17044
(717) 248-6909
WEB SITE:
www.GatesLawFirm.com
June 27,2001
Cumberland County Courthouse
Office of the Register of Wills
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Patricia A. Nailor
Estate No. 21-2001-0208
Dear Sir or Madam:
Enclosed for filing are the Pennsylvania Inheritance Tax Return (in duplicate) and
Inventory for the above-referenced estate. Also enclosed are a check in the amount of $25.00 as
the filing fees for the Return and Inventory, and a check in the amount of $152.49 as payment of
the balance of inheritance tax owed. Please time-stamp the two (2) additional photocopies of
each document and return them to our office in the enclosed envelope.
Please contact our office if you need any additional information. Thank you for your
assistance in this matter.
Sincerely,
ttauAhluv1c
Traci L. Sepkovic
Paralegal
Enclosures
cc: Terry J. Renninger, Executrix
Register of Wills Cumberland County, Pennsylvania
G
INVENTORY
Estate of Patricia A. Nailor
No. 21-2001-0208
also known as
Date of Death January 23, 2001
, Deceased
Social Security No. 164-28-0798
Terry J. Renninger,
Persona' Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include ail
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. l!We verify that the statements made in this Inventory are true and correct. l!We understand that
false statements herein ara made subject to the penalties of 18 Pa. C.S. Section 4904 releting to unsworn faleificetion to
authorities.
Name of
Attorney:
Mark E. Halbruner, Esquire
66737
Personal Representative:
?J~J () ii/J2IllJ/YT'fA J
Terry I Renninger
1.0. No.:
Address:
Gates & Associates, P.C., 1013 Mumma Road,
Suite 100, Lemoyne, PA 17043
717-731-9600
Dated
Telephone:
Description
Value
PNC Bank CheckingAcct. No. 5070024828
$688.95
PNC Bank Checking Acct. No. 5003533104
311.84
Total: $1,000.79
(Attach Additional Sheets if necesliary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the election of the persona' representative, include
the value of each item. but such figures should not be extended into the total of the Inventory.
RW-8