HomeMy WebLinkAbout01-0871
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
E~Meof Bertha G. Shultz
also known as
No.
:1J-()J- Y1/
, Deceased
Social Security No. 204-01-0283
Robert B. Shultz
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
. \-
. \
[!] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or named in the Ia~ Will of
the Decedent, dated 12/14/73 and codici~s) dated 08/08/91
Primary Executor Ray B. Shultz
predeceased Bertha G. Shultz
State relevant circumstances, e.g., renunciation, death of executor, 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:
D B. Grant of Letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with hislher last family
Upper Allen
or principal residence at Messiah Village, 100 Mt. Allen Dr., I:;cwep.-A-~~ Township
(li~ ~reet, number, and municipality)
,~OOl, at Messiah Villa~e, Mechanicsburg, PA
(Location)
Decedent, then ~years of age, died 09/17
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
625,000.00
$
S
$
$
situated as follows:
Wherefore, Petitioner(s) respectfully request{s) the probate of the la~ Will and Codici~s) presented with this Petition and the grant of
letters in the a ro riate form to the undersi ned:
S' nature
T
Robert B. Shultz
120 N. File s Rd., Dillsbur , PA
17019
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form softwar. only CPSystems, Inc.
17- 9.~ 6
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumber land
The Petitioner(s) above-named swear(s) or 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.
Sworn to or affirmed and subscribed ~~ ~~
Robert B. Shultz
before me this ~y of
September @{ 2001
No. 21-2001-871
Estate of Bertha G. Shultz
Deceased
Social Security No: 204-01-0283 Date of Death: 09/17/01
AND NOW,
September 5~f:H
2001
, ~, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters [ID Testamentary D Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Robert B. Shultz
in the above estate and that the instrument{s) dated
12/14/73 08/08/91
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters. . . . . . . . . $ 410.00
Short Certificate(s). 5 . $ 15.00
Renunciation. S
Affidavits ( $
Extra Pages ( 1 ) . $ 3.00
Codicil. . . . . . . . . . S 10.50
JCP Fee. S 5.00
Inventory. $
Other . . $
Attorney:
Jan M. Wiley, Esquire
1.0. No:
06298
The Wiley Group
One S. Baltimore St.
Address:
Dillsburg, PA
17019
,
Telephone: 717/432 - 9666
,,~
":1
'.( w"..... ~ ."
TOTAL. ...... s 443.50
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc.
MAILill LE'I"I'ERS 'IO AT'IORNEY
Form RW-1 (1991)
21-2001-871
REGISTER OF WILLS OF CUMbe.r \a.nd COUNTY
OATH OF NON-SUBSCRIBING WITNESS
_1)()PD+h\j A. Shu\+'2. AOd, :ran ~- W'\\~LJ\ ~l.L\re. ,
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
...:J-he..~ a.. re. familiar with the signature of ~~ .-+-ha ~. S hu. H:.~__,
~
testatr\ 1- of (eft' af the 511Bserieiftg witftCS5eS t6) the ~ presented herewith and
codicil
that -=l::.h <. 'f . nature on the will is in the handwriting of
h ~. Snu \-1-2-
to the best of -=th~.:, r knowledge and belief.
\..,D 19
(Name)
Ba l+'&tnDr~ 51. I Di \~A 11019
(Address)
O~.80~ REV 9/8()
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 ttling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
p
7691071
~ I(~~L/l ~(t~
Local Registrar
Fee for this certificate, $2.00
No.
~rA.UtLA~ I~ ~oo (
Date
21-2001-871
Hl0; ;4JRe. 2187
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
iYPEJPRINT
IN
PERIoUI<ENT
BlACKINK
2.
Female
STAlE FILE NUMBER
SOC'Al SECURITY NLlWBER
3. 204 - 01-
DAlE Of IlEATH ,Me,.",. [la,. _,
September 17, 2001
SEll
85 YIS
UNDER 1 DAY
HaoA ! WInul..
PUCE OF DEIifH fC_. ""'y I1l'8 -. "'" _,""..... 00'-' _I
:="Y10
S.
COUNTY OF OERH
..
Cumberland
Ie.
White
DECEDENT'S USUAl OCCUPATION
(~~~'::::zl,:T
Homemaker
I..
!'RHER'S NAME tFoI" lolodl1l8, UIl)
DECEDENT'S
100 Mt. Allen Drive ~~NCE
Mechanicsburg. Pennsylvania 1705 See~1IOl'oI
17e. SIaIe
Pennsylvania
O;d
-
Ifwe in .
Cumberland --"1 17...0 :;"'-::'::::0/
MOTHER'S _,FoI" _. MI-.s..o_l
WAAlTAl swus.__
Ne__._.
~ ISileclIyI
I.. Widowed
17c.(j 'Me. __in Upper Allen
SUfMIIlHG SPOUSE
(1_.__-
-
~
fil
~
a
~
~
..
z
1711.
~
...
INFORMANT'S NAME (TypeIP""lI
Charles Lehman
Robert B. Shultz
Carlisle, Pa. 17013
f',J
1--
PART .: 0Ul8r llgflollC'" __ conlIoIluIiroQ 10 _ft. buI
lIOI_ongin_~__..f'IIoIITf
--.J
}
~
l/)
! :
DUE 10 (OR AS A CONSEOUE NCE Of):
DUE TO (OR AS A CONSEOUENCE Of)'
walE .wlOPSY FINIllNGS
-.uaE PfIIOA 10
COUPlETlOH ~ CAUSE
OF OERH?
IolANNER OF OEIifH
OIifE Of INJURY
jMonth. Oa~. -l
TIME Of INJURY
INJURY Iif WORK' DESCRIBE HOW INJURYOCCIIRflEO
Neon-
Y.. 0
NoD
......81
-
~
.&
o
o
-
Pending In_igaUon
o
o
o PlACE OF INJURY. AI_.,...... ........""'...,.__
building. 81<. ISpecM
:lOa.
Yw 0 NelO
"MEDICAL EXAMlNERlCOROMER
On ,he basi. o. ..amin.Uon and/or "'''._liIation. in my opinton, de.th occ:u"cd at the Um_, date, ~nd plac.. and du.to the c.u..(.) and
manner.. .t.'ed.. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . ....................................
Jle
REGIST. R'S SIGNATURE AND NUMBER
JJ I ; 1..:21 II d..l
Could noI " d.,.rmllled
~
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a... a....
ClRTIFIEIl .Crecll. oniy onel
-CERTIFY1NG PHYSICIAN (PhySIC""" cefl~ cause ~ deall'l wnen .Jl'\OIher JJhYSaC.an has pronouncea dealh ana COfn~oo Item 23)
To'" _, 0'''', ........... ..11> __ _ID... oeuMlI) end ........... .. .110'.... . . . . . . . . .
a.
.PAONOUNCIHG AND CERTifYING PHYSICIAN (Phys.cwo buCI1 iJfonotKiGl(l{I *<ilh ,,)od Cet'IAyJ09 10 (;~uS6j' of c::Ie..lh\
To lhe M.t 0'." kno~.. _atb occUlred a. .......... d.'., and pIKe, and d~ to the cau..(a) and manne' .. a.aled .
J4-S'eIlClT~P7-6f?1€- 19 .:AcJn
,
~-
,
.... '
,-
LAST WILL ANl TESTW;.ENT OF BEP.THA G. SHULTZ
I, Bertha G. Shultz, of the Borough of Ca~p Hill, CQmerlana County,
?ennsylvania} declare this instrument to be my last \dll Hnd test.arr:.ent,
1n manner and form following:
1. I hereby expressly revoke all wills and codicils heretofore
made by me.
2. I hereby direct my. executor to pay all my just debts, funeral
and administrative expenses out of my estate, as soon as practicable
after 11JY death.
3. Should my husbarrl, Ray B. Shultz, survive me for a period of
thirty days, I give, devise and bequeath the balance of my estate to
Eny B", Shult:tJ.
4. Should my husband, Ray B. Shultz, predecease me or die on or
before the thirtieth day following my death, I devise and bequeath the
balance of my estate to my issue in equal shares, ;?er stirpes., to be
theirs absolutely and forever; provided, tha.t the share of any child of
mine who has died leaving no issue shall be divided 8.11l0ng my sUl-viving
children in equal shares, per stir~es.
5. Should both my husba-qd, Ray B. Shultz, am my issue and their
issue, predecease me or die on or before the thirtieth day following
my death, I ciev.lse and bequeath the balapce of my estate as follows:
a. I give the sum of One Thousand ($1,000.00) Dollars to the
church of which I am a member at the time of my death.
b. I give and devise the remainder to the Masonic Shrine
Hospital for Crippled Children in Philadelphia, Pennsyl-
vania.
6. I nominate and appoint Cumberland County National Bank and
Trust Company, Camp Hill Branch, guardian of any property ",hien passes
to a minor a.oo 'Kith respect to which I am authorized to appoint a
guardian and have not otherwise specifically done so. Such guardi8_n
s~a.ll have the power in its discretion to use principal as well as
incol.':1e from time to time for the support, \ielfare arrl education of such
- 1 -
~
.-
I
~
'"
minor and no Court Order shall be necessarJ for such expenditure.
7. I nominate and appoint ::ny husband, Bay B. Shultz as executor
of this my last will ani testament; arrl as substitute executor, I nomi-
nate and appoint, 1n order of preference, first, Robert B. Shultz, of
R.. D. 3, Dillsburg, Pennsylvan5.a, and secondly, my brotller, Fussell W.
Lehman, of Carlisle, Pennsylvania.
IN vlITNESS \-JHEREOF, I hereunto set my ham and seal this /~."at)day
of /Jl.L c!L--t-t-(,I-e~
, 1973.
~Eu(.~':s~Lff--- (SEAL)
Bertha G. hultz /
Signed, sealed, published and declared by the above named testator,
Bertha. G. Shultz, as am for her last will and testament, in our presence,
who, in her presence, at her request, and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
(l)~~gd-<-e_;:t;-..~ ..-__~j4fi[~ A
.0.' -. ~City-r State
(2);@PCI/.2L!f m-1!)~Of aU? )4liL fid ~__
Ci State
... 2 ....
~ ~
Aug.8 1991
Let it be known that on 8/8/91, I Bert.ha,~G. Shultz,
gifted $10,000 to Jack R. Shultz, my son.
This amount then will be deducted from his
share of my Will.
Upon the event of my death, he will give 1/3 of
this amount to my other two sons, Robert and Richard.
Signed ,j//fd>/ J~~
Signed (~tul fl ~
Witneis' ejlJJ.~ f.I-;y~ ..tA/1
21-2001-871
E..
-
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Bertha G. Shultz
Date of Death: September 17, 2001
Estate Number: 21-01-0871
To the Register:
I certify that notice of beneficial interest 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
October 2, 2001 :
Name
Robert B. Shultz
Jack R. Shultz
Susan Whitmer
Richard M. Shultz
Sally Shultz Follett
Address
120 N. Fileys Road, Dillsburg, PA 17019
1501 Baltimore Road, Dillsburg, PA 17019
613 Beinhower Rd., Etters, P A 17319
523 Harding Street, New Cumberland, P A 17070
261 44th Avenue, N.E., St. Petersburg, FL 33703
Notice has now been given to all persons entitled th
under Rule 5.6 (a) except N/A.
Date: October 2, 2001
_~w~
Name: JAN M. WILEY, ESQUIRE
Address: One S. Baltimore St.
Dillsburg, P A 17019
Telephone: (717) 432-9666
Capacity: Counsel for personal Rep.
.
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of
Shultz, Bertha G.
, Deceased
No. 21 - 01 - 00871
Date of Death 9/17/2001
Social Security No. 204-01-0283
also known as
Robert B. Shultz
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located 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 the Decedent owned no real estate outside of the Commonwealth of Pennsylvania eXc6pt that
which appears in a memorandum at the end of this Inventory. IMle verify that the statements made in this Inventory are true
and correct. IlWe understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
1.0. No.:
06298
Personal Representative
Signature: tfobl.d"" f!J s:all~
Robert B. Shultz
Signature:
Attorney:
Jal1 M. Wiley, Esq.
Signature:
Address:
I S. Baltimore St.
Dillsburg, P A 170 I 9
Address: 120 N. Fileys Rd.
Dillsburg, PAl 7019
Telephone:
('1\1) l\~a- q~ulp
Telephone: (1\.,') lull-Oei-51
Dated: -:June 512.00'2.
Personal Property
AT&T Stock
1,857.12
AT&T Stock (Book Shares)
928.56
BP Amoco Stock:
16,124.48
Verizon Stock:
39,840.00
Consumer Financial Preferred Stock (redemption):
272.74
Dominion Resources Stock:
6,566.16
Duq. Lt. Prefen-ed Stock (redemption):
5,169.67
DQE Stock:
6,135.00
IBM Stock share certificates:
9,334.00
IBM Stock (book shares):
28,002.00
Lucent Technology Stock:
754.80
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$661,450.68
,
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of
Shultz, Bertha G.
No. 21 - 01 - 00871
Date of Death 9/17/2001
Social Security No. 204-01-0283
also known as
I Deceased
1,074.06
MetLife Stock- Book Shares:
PNC Stock:
Exelon Stock:
USX (Marathon) Stock:
Redemption of Series H Bonds:
Redemption of Series E/EE Bonds:
PENNS YL VANIA INSURED MUNI INC TR SER 88 (twelve units @ 147.67):
PA Ins L T Tax-Exempt Inv (7,665.333 shares @ 11.54 per share plus Accrued Dividends of
$199.74):
Wellington Fund Inv (2,652.900 shares @ 27.11 per share):
Preme Money Market Fund (The Vanguard Group) - (34,171.420 shares @ $1.00 per share) plus
Accrued Dividends 01'$54.24):
lntennediate-Tenn Tax Exempt Fund (The Vanguard Group)-5,463.114 shares @ $13.66 per
share plus Accured Dividends of $159.35):
Dreyfus Family of Funds Premier PA Muni Bond Fund CL A (4,586.790 shares @ $16.01 per
share) :
Dean Witter Select Equity Trust (40439 shares @0.89790 per share):
PNC Bank Account #5140058135:
Nuveen P A Municipal Bond Fund R (redemption):
VanKampen Municipal Income Class A (redemption):
Nuveen Insured Quality Municipal Fund, Inc. (redemption):
Counby Meadows (refund):
The Patriot News (refund):
Erie Insurance Group (refund):
Homestead Senior Care (refund):
Verizon (refund):
State and Federal Income Tax (refunds):
2
13,518.48
5,424.00
3,880.80
7,500.00
12,909.59
1,772.04
88,657.68
71,920.12
34,225.66
74,785.49
73,434.51
36,273.79
4,844.55
45,165.20
52,800.52
14,527.50
763.92
40.50
67.00
720.74
308.00
1,852.00
-. Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of Shultz, Beltha G.
No. 21 - 01 - 00871
Date of Death 9/17/2001
Social Security No. 204-01-0283
also known as
I Deceased
$661,450.68
Total Personal Property
3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WILEY JAN M
1 S BALTIMORE STREET
DILLSBURG, PA 17019
-------- fold
ESTATE INFORMATION: SSN: 204-01-0283
FILE NUMBER: 21 - 2001 - 0871
DECEDENT NAME: SHUL TZ BERTHA G
DA TE OF PAYMENT: 12/07/2001
POSTMARK DATE: 1 2/06/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 09/17/2001
NO. CD 000610
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $25,051.50
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JAN M WILEY ESQUIRE
CHECK#18
SEAL
INITIALS: PB
RECEIVED BY:
REGISTER OF WILLS
$25,051.50
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WILEY JAN M
1 S BALTIMORE STREET
DILLSBURG, PA 17019
---.---. fold
ESTATE INFORMATION: SSN: 204-01-0283
FILE NUMBER: 2101-0871
DECEDENT NAME: SHUL TZ BERTHA G
DA TE OF PAYMENT: 06/06/2002
POSTMARK DATE: 06/05/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 09/17/2001
NO. CD 001256
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $668.04
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JAN M WILEY ESQUIRE
CHECK# 5163
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$668.04
MARY C. LEWIS
REGISTER OF WILLS
/?-9-6
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-22-2002
SHULTZ
09-17-2001
21 01-0871
CUMBERLAND
101
JAN M WILEY ESQ
THE WILEY GROUP
1 S BALTIMORE ST
DILLSBURG
.(r~ dUL
..~ :"; d
p''''. l70 19
*'
REV-1547 EX AFP COl-a!)
BERTHA
G
Allount Rellitted
) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
159,291.46
.00
.00
502.159.22
.00
.00
(8)
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 ~
REY=is'4-j-ix-AFP--fol-:02j--No'ficir-ciF-i-NHiifiTAifci-TAi-APPRAisiitENT~--Ai:.i-ciwANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHULTZ BERTHA G FILE NO. 21 01-0871 ACN 101 DATE 07-22-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
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
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subiect to Tax
NOTE: If an assessment was issued previoUSly, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
TAX CREDITS:
58,604.13
2.001.26
(11)
(12)
(13)
(14)
(9)
(10)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYll8nt.
661,450.68
60.601; 39
600,845.29
.00
600,845.29
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00 X 00 =
600,845.29 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
.00
27,038.04
.00
.00
27,038.04
. "'. ....... . ".......... . l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-06-2001 CDOO0610 1,318.50 25,051.50
06-05-2002 CDOO1256 .00 668.04
TOTAL TAX CREDIT 27,038.04
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 REFUND. SEE REV~RSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
STATUS REPORT UNDER RULE 6.12
(Y;
Name of Decedent: &r-tha.. ~. Sh LLl tL.
Date of Death: q -1'" -J-otJ 1
Will No. :2-\ - 0 \ - 00'2; '1l
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with
respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes v-- No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No ~
b. The separate Orphans' Court No. (if any) for the personal representative's account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes V"" No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts
may be filed with the Clerk of the Orphans' Court may be attached to this report.
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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18I 1. Original Return 0 2. Supplemental Return
o 4. Limited Estate 0 4a. Future Interest Compromise (date of death
after 12-12-82)
18I 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
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AME COMPLETE MAILING ADDRESS
Jan M. Wiky, Esq.
DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
Shultz, Bertha G.
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DATE OF DEATH (MM.DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
OFFICIAL USE ONLY
(7 q-
FILE NUMBER
21 01
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00871
NUMBER
09/17/200 I
12/05/1 915
204-01-0283
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13-82)
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I
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
I S. Baltimore St.
Dillsburg, P A 17019
(1 ) None:':-
(2) 159,291.46
(3) None
(4) None
(5) 502,159.22
(6) None
(7) None
(8)
(9) 58,604,13
(10) 2,001.26
OFFICIAL USEDNLY
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661,450.68
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
(11 )
60,605.39
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IRM NAME (If applicable)
The Wiley Group
ELEPHONE NUMBER
(12)
600,845.29
32- 9LJu~
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
600,845.29
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 600,845.29 .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
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0<( x .15 (18)
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19. Tax Due (19)
____n'" .
.............................
..............."...,........
..................................,.......................
............................
....,.......,..............
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11 . Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
27,038.04
27,038.04
20. 0 ~;1:tllj~i~~;lSl~".,!..':~;;f:~~..1IJ~~lIN~~i/1\'~lljl~
Copyright 2000 form software only The Lackner Group, Inc.
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Form REV-1t.00 EX (Rev. 6-00)
......................................
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Dp,.,=edent's Complete Address:
STREET ADDRESS
100 Mt. Allen Drive
I ZIP 17055
I STATE PA
CITY
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
25,051.50
1,318.50
Total Credits (A + B + C)
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
27,038.04
26,370.00
(3) 0.00
(4)
(5) 668.04
(SA)
(5B) 668.04
Total Interest/Penalty (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 th~ total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. 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?.......................................................................................................................
Yes
n
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D
No
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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 perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
120 N. Fil~s Rd.
Dillsburg, P A 17019
ADDRESS
ADDRESS
1 S. Baltimore Street
Dillsburg, Pa 17019
b I s-1 () d....
, DAT~
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 39116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P .S. 39116 (a) (1,1) (ii)], The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary,
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P .S, 39116 (a) (1,2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 39116
1.2) [72 P.S. 39116 (a) (1 )],
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 39116 (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.
~
LAST WILL AN}) TESTAMENT OF BERTHA G. SHULTZ
I, Bertha G. Shultz, of ule Borough of Camp Hill, Cumerlarxi COllDty,
Pennsylvania, declare this instrument to be my last will an:1 testament,
in manner and fom following:
1. I hereby expressly revoke all wills and codicils heretofore. .
made by me.
2. I hereby direct my executor to psy all my just debts, funeral
and administrative expenses out of my estate, as soon as practicable
after m.v death.
3. Should J'J'JY husbaw, Ray B. Shultz,. survive me for a. period of
thirty days, I give, devise and bequeath the balance of my estate to
Hay E. Shultz.
4. Should my h.usbaIJi, Ray B. Shultz, predecease me or die on or
. before the thirtieth day follo.ring my death, I devise and beq'.lea.th the
balance of my estate to my issue in equal shares, per stirpes, to be
.'"
theirs absolutely a.nd forever, prOVided, that the share of any child of
mine who has died leaVing no issue shall be divided among my surviving
children in equal sha.res, per stirpes.
5. Should both my husbandt Ray B. Shu11:.IO, a.IXi my issue and their
issue, predeceaslil me or die on or before the thirtieth day following
. my deatht I devllJe and bequealth the balance of my estate as f'ollo....s:
>8.. ! give the sum of One Thousa:nd ($1,000.00) Dollars to the
church of .lhich 1 alIl a member at the time of my death.
-,.. b. I give and devise the remainder to the Masonic Shrine
Hospital for Crippleri Children in Philadelphia, Pel111syl-
vania.
6. I nominate am appoint Cumberland County National Bank a.nd
Trust Compa.~, Camp HiU Branch, guardian of a.ny propex:ty which passes
to a minor am 'With respect to Wich I am authorized to appoint a
guardian and have not othe:rwise specifically done so. Such. guardian
shaLl have the power in its discretion to Use principal as well as
income from time to time for the support, welfare a.nd education of such
-1-
minor and no Court:. Order shall be necessa.r-j for such ~"'{penditure.
7. I nominate and appoint my husba.nd, Hay B. Shul h an executor
of this my last \("1-11 and testament; and as substitute exec'l1tor, I nomi-
nate and appoint, in order of preference, firat, Robert E. Shultz, of
R. D. 3, Di11sburg, Pennsylvania, and secondly, my b:l:'othe:r, Russell Y.
Lehman, of Carlisle, ~onnsylvania.
IN wITNESS WHElUOClF, I hereunto set.. my ham and seu this /~.z7t?day
of J,Jl.LrU.f,<-'-~ ,1973.
&taZJJIJ J./t ;:ifr- (SEAL)
Bertha G. ~hultz .'
Signed, sealed, publlsned alP declared by the above named testator, .
Sertha G. Shult.t, 606 am for hel' last. will and testament, in our prElsence,
who, in her ?rssence, at her request, and in the presence of each other,
have hereunto subscribed our names as attesti.ng witnesses.
(l) ~g"d~~ ~ ##.. A
, . City . 'State
(2)A!bfJ-7/"22)Ll."p or cl"'Ci:7 )hf' ./6.
Ci' . State
....
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- 2-
Aug.8. 1991
Let it be known that on 8/8/91, I Bertha-..:G>. Shultz,
gifted $10,000 tb Jaok K. Shultz, my son.
This amount then will be deducted from his
share of my Will.
Upon the event of my death, he will give 1/3 of
this amount to my other two sons, Robert and Richard.
Si~n.d ;{< ".dn J. . AL.t/-:i:.
.I 0 tJ
Signed .iul R oltk
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Witnes"s Plo/{"Ilo oflJp.I. ~A/J
......
;;;..
"fREV.485 EX >(9.88)
,.
SAFE DEPOSIT BOX
INVENTORY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCI TAX DIVISION
DEPT. :2l106Ol
HARRIS8URG. PA 17128-0601 Plea.e Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIALINSTITUTJON WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBIlR
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DATE OF DEATH
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, DECEDENT'S NAME (LAST, FIRST, MIDDLE)
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. ADDRESS OF DECEDENT (STREET) (CITY) .
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DATE OF CONTRACT TO RENT BOX NUMBER OF BOX
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NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. ~AME)
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. NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY
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WAS A WILL IN THE BOX? ~s DNO If yes, a. Date of will:
b. Name and addre.. of penonal repres.ntatlve, if named In the will
(NAME) :"\. ,.,.-.,
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(STREET ADDRESS)
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c. Name and addr... of attorney, If any _J ....
(NAME)
(ZIP CODE)
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Page of
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are
to be designated by name of company, certificate number, date of certificate, name in which stock is registered,
and number of shares and class of stock.
(3) Obligations of U. S. Government: Number of items, date of issue, face value, names. in which registered
and type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in
book, name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as
fully as possible.
(8) All other contents.
ITEM
NO.
ITEM DESCRIPTION
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Signature '. '-, '" ' i/-~ Date
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Print Name and Title I h
\) - ': 'C ' 'J /i -- '1
t) t: L.(.--. .. rv_:;"T \.j :~') r-:)~\ ~C'lC (\\.0
NOTE: Attach additional 8'12" x 11" sheet(s) if necessary or use dupliciates of this page of form.
*'
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21 - 01 - 0087 1
ESTATE OF
Shultz, Bertha G.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
- ---
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE
NUMBER OF DEATH
AT&T Stock 17.52 1,857. 12
AT&T Stock (Book Shares) 17.52 928.56
HP Amoco Stuck: 49.16 16,124.48
Verizon Stock: 49.80 39,840.00
Consumer Financial PrefelTed Stock (redemption): 272.74
Dominion Resources Stock: 60.24 6,566.16
Duq. Lt. PrdeITed Stock (redemption): 5,169.67
DQE Stuck: 20.45 6,135.00
IBM Stuck share cel1ificates: 93.34 9,334.00
IBM Stock (book shares): 93.34 28,002.00
Lucent Technology Stock: 5.55 754.80
MetLife Stuck- Book Shares: 27.54 1,074.06
PNC Stock: 57.04 13,518.48
Exelon Stock: 54.24 5,424.00
USX (Marathon) Stol.:k: 30.80 3,880.80
I
Redemption of Series H Bonds: 7,500.00
Redemption of Series E/EE Bonds: 12,909.59
I
I
I
--
TOTAL (Also enter on line 2, Recapitulation) 159,291.46
Estate of Bertha G. Shultz
Assets
# shares Price per Sh Estimated Value Date of Price or Value Liquidation Value Tax Withheld
-
$4,676.48 9/17/01 $0.00*
106 $17.52 $1,857.12 9/17/01 $1,551.59 3/25/02
53 $17.52 $928.56 9/17/01 $873.70 11/28/01
328 $49.16 $16,124.48 9/17/01 $14,352.64 12/13/01
800 $49.80 $39,840.00 9/17/01 $36,552.20 3/25/02
100 Pref. $272.74 1/17/02
109 $60.24 $6,566.16 9/17/01 $6,321.35 3/25/02
200 Pref $5,169.67 3/25/02
300 $20.45 $6,135.00 9/17/01 $6,058.15 3/25/02
100 $93.34 $9,334.00 . 9/17/01 $9,827.10 3/25/02
300 $93.34 $28,002.00 9/17/01 $25,344.04 3/25/02 $11,141.96**
136 $5.55 $754.80 9/17/01 $710.53 3/25/02
39 $27.54 $1,074.06 11 /9/0 1 $1,137.88 12/13/01
237 $57.04 $13,518.48 9/17/01 $13,003.99 . 3/25/02
100 $54.24 $5,424.00 9/17/01 $5,208.17 3/25/02
126 $30.80 $3,880.80 9/17/01 $3,418.16 3/25/02
P'age: '1 Document Name: untitled
DATE: 10/11/01
TIME: 11: 39 : 29
PNC BANK
U.S. SAVINGS BOND REDEMPTION INQUIRY
PROGRAM: TELOCBl
PLEASE ENTER:
BOND TyPE........: E
BOND DENOMINATION:
BOND ISSUE DATE..:
REDEMPTION DATE..:
REDEMPTION INFORMATION:
REDEMPTION AMOUNT:
INTEREST EARNED..:
MESSAGE......... .:
RUNNING TOTALS:
NUMBER OF BONDS..:
REDEMPTION AMOUNT:
INTEREST EARNED..:
CLEAR=EXIT PROGRAM
75.00
09/65
10/01
478.56
422.31
39
12,909.59
11,672.09
ENTER=COMPUTE REDEMPTION
PF3=CLEAR RUNNING TOTALS
Date: 10/11/2001 Time: 11:42:34 AM
1310a2934
3-4
310
, " ,,',', . . . . . AlJ'I'HORlZEO SfGNA11JRE
IOC",",:,,,:";;'!':;~.i~~i~i,';.~;,"";I~\~~"""IU'_~I~""","',"""'II~,.i\~C."=.~:~~~.".""",, ,",,,,,,,.,,,
r!:0 j ~0000"'01: . ~ .08 2g ~"'"' 000 j
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shultz, Bertha G.
I FILE NUMBER
21 - 0 I - 00871
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorshIp must be disclosed on schedule F.
ITEM
NUMBER
I
DESCRIPTION
VALUE AT DATE
OF DEATH
1,772.04
PENNSYL VANIA INSURED MUNI INC TR SER 88 (twelve units @ 147.67):
2
P A Ins LT Tax-Exempt Inv (7,665.333 shares @ 11.54 per share plus Accrued Dividends of$199.74):
88,657.68
3
Wellington Fund Inv (2,652.900 shares @ 27.11 per share):
71,920.12
4
Preme Money Market Fund (The Vanguard Group) - (34,171.420 shares @ $1.00 per share) plus Accrued
Dividends 01'$54.24):
34,225.66
5
IntellIlediate- Tenn Tax Exempt Fund (The Vanguard Group)-5,463.114 shares @ $13.66 per share plus
Accured Dividends of $159.35):
74,785.49
6
Dreyfus Family of Funds Premier PA MWli Bond FWld CL A (4,586.790 shares @ $16.01 per share):
73,434.51
7
Dean Witter Seb:t Equity Trust (40439 shares @0.89790pershare):
36,273.79
8
PNC Bank Accuunt #5140058135:
4,844.55
9
Nuvcen P A Municipal Bond Fund R (redemption):
45,165.20
10
VanKampen Municipal Income Class A (redemption):
52,800.52
II
Nuveen Insun:d Quality Municipal Fund, Inc. (redemption):
14,527.50
12
Country Meadows (refund):
763.92
13
The Patriot News (rd'und):
40.50
14
Erie Insurance Croup (refund):
67.00
15
Homeskad Senior Care (refund):
720.74
16
V erizun (refund):
308.00
17
State and Federal Income Tax (refunds):
1,852.00
TOTAL (Also enter on Line 5, Recapitulation)
502,159.22
'lHb HANK OF NEW YORK
NEW YORK'S FIRST BANK - FOUNDED 1784 BY ALEXANDER HAMILTON
November 5, 2001
Jan M. Wiley, Esquire
The Wiley Group
1 South Baltimore Street
Dillsburg PA 17019
VA-1\ ~
RE: PENNSYL VANIA INSURED MUNI INC TR SER 88
AlC: 02206417
N/O: BERTHA G SHULTZ
C/O ROBERT B SHULTZ
Dear: Mr. Wiley
Thank you for your recent correspondence concerning the referenced Unit Investment Trust.
Please be advised there is a certificate fo:ralVelve unitS}hich was issued and remains
outstanding. This account is owned and registered in the name of Bertha G. Schultz the account
opened August 4, 1989.
The per unit value of the referenced fund was as follows:
Trade Date
09/17/2001
Fund & Series
086/088
Bid Price
147.67
Accrued Interest
1.90000
We trust this information proves helpful. If you have questions or require further assistance,
please call our Customer Service Deparbnent at (800) 856-8487. We look forward to being of
service.
William Carroll
Unit Investment Trust Division
Customer Service Department
P.O. BOX 988, NEW YORK. NEW YORK 10268 - 0988
a~B~
Firstside Center
500 First Avenue, 4th Floor
Pittsburgh, PA 15219-3128
ISCP
November 1,2001
The Wiley Group
. Attorneys At Law
Wiley, Lenox, Colgan &
Marzzacco P .C.
t South Baltimore Street
DilIsburg PA 17019
RE: Estate of Bertha G Shultz, Deceased
SSN: 204-01-0283
DOD: 09/17/2001
Dear Ms. Wiley:
Please find the date of death balances you have requested listed below.
CHECKING ACCOUNT
#5140058135
Established 12/22/1994
BERTHA G SHULTZ
ROBERT B SHULTZ
DOD Balance: $4,843.81 + $0.74 accrued interest
Our office only provides date of death balances for IRA's, CD's, Checking ud
Savings accounts. We do NO FiDancial Traasadions or Statement Orden. For
Further information please caD lw800-4-BANKER or your local PNC Branch and
ask to speak with a Finaneial Services Representative.
S~lY, .__
Marian ~~o.<.(j
1-800-762-1775
A member of1la~ PNC Finandal Services Group
One PNC Plaza 249 Fifth AVt'nu(: Pittsburgh Pennsylvania 1 &222 2707
TOTAL P.01
t.g~~Hwell.. Look ahead. LEAVE YOUR MARK~
. .
.--..d..___'
<__l'......_.... .
NUVEEN
December 7, 2001
PAGE 1
Investments
Mutual Fund Confirmation
Customer Service: 800 257-8787
For Access to Prices, Yield and Dividend Information
24 Hours A Day: 800 682-2934
ESTATE OF BERTHA G SHULTZ
ROBERT B SHULTZ
120 N FILEYS RD
DILLSBURG, PA 17019.9506
NUVEENINVESTMENTS
333 W WACKER DR
CHICAGO, IL 60606
In a period rapidly changing international events an uncertain economic news, only one thing seems
clear - no one can predict the future. However, we can try to prepare for it. .
Now might be a good time to talk to your financial advisor about your goals, and how a careful combination
of Nuveen investments might help position you to achieve them.
DATE TRANSACTION DOLLAR AMOUNT PRICE
NUVEEN PENNSYLVANIA MUNI BOND FUND R - ACCOUNT # 99602772634
SHARES
TOTAL SHARES OWNED
The purchase of additional Class R shares is subject to certain eligibility requirements as indicated
in the Investor Guide.
Balance Forward
12/07 Redemption by Check as of 12/06/01
$45,165.20
$10.19
4,432.306.
4,432.306
0.000
Dividends
OR~Ordinary) Capital Gains Taxes
Fund Name Purchases Redemptions TF{ ax-Free) L T{Long- Term) Withheld
PA Municipal Bond R $0.00 $45,165.20 OR $0.00 LT $0.00 $0.00
TF $0.00
Total $0.00 $45,165.20 OR $0.00 LT $0.00 $0.00
TF $0.00
I ~II~ 111~ 1~11111~ 1IIIt I~~ Il~ ~~ 111/11111111111111
* 0 1 000 a 9 0 0 0 ~
CONTINUED ON NEXT PAGE
UVEEN
ax-Free Exchange-Traded Funds
iquidation Statement
Refer questions on this confirmation to 800 257-8787.
,.. .........,ratayer~PN#fflIJlir
Acriotint~umbel'
EST BERTHA G SHULTZ
ROBERT B SHULTZ EXEC
120 N FILEYS RD
DILLSBURG PA 17019-9506
25-6794659
Payable Date
12929133127
01/08/02
14,550.00
Amount Payable
Taxes Withheld
0.00
Check Amount
22.50
14,527.50
070125672
Amount Reinvested
Check Number
NlNEEN INSURED QUALITY MUNICIPAL FUND INC
NQI
Price! Shares This Gross Fees Withheld Fees Withheld Net Sha
Rate Transaction Amount Processing Brokerage Amount Balant
14.55 11"000 14,550.00 2.50 20.00 14,527.50 0.00'
Certificate Shares
Book Shares
0.000
0.000
M 0102/00649
Total
0.000
Please detach and retain this statem
National Financial Services LLC
NO. 302633384
VOUCHER
12/21 VAN KAMPEN MUNICIPAL INCOME CLASS A
12/21 DEBIT BALANCE
SLD
52,860.52
60.00-
ACCOUNT NO. E660069201
DETACH THIS PORTION BEFORE CASHING CHECK
The Chase Manhattan Bank
Unit Investment Trust
P.O. Box 660083
Dallasl&tb1?gF4>,O~DO 1
o CHASE
BERTHA G SHULTZ
ATT: THE WILEY GROUP
% IAN M. WILEY
1 SOUTH BAL TLMORE STREET
DILLSBURG PA 17019
RE: ACCOUNT VERIFICATION
Registered As: BERTHA G SHULTZ
(Dean Wi-\k.r- Selec+ f-qw +-~ Tt-u 5+)
Dear Ms. Wiley:
Thank you for your inquiry regarding for account verifications. We appreciate the
opportunity to be of assistance.
4043Q sn-Ai'e,S
As of September 10, 2001 the per unit value of the Utility Stock Series 4 was>1111.~~ttii';'^
and there were no accrued interest on this date. The date of death was Septemeber 11,
2001 which falls on a weekend, in which the market is closed. This account is held as a
single holder in the name of Bertha G. Shultz.
If you have any further questions or need additional assistance, please call our customer
service representatives at 1-800-428-8890. We are available to help you Monday through
Friday from 9:00 A.M. to 6:00 P.M., Eastern Time. Please have the reference number
listed below available at the time of your call.
Sincerely,
BREE PRUITT
Customer Services Representative
200110040301
40~3q y. o. gQ10
4f3l..c I :;?"l ~. I g
Dreyfus Family of Funds
P. O. Box 9268
Boston, MA 02205-8502
October 11, 2001
JAN M WILEY
THE WILEY GROUP
ATTORNEYS AT LAW
1 SOUTH BALTIMORE STREET
DILLSBURG PA 17019
REFERENCE: 01103788 - 20011011105421
DREYFUS PREMIER PA MUNI BOND FUND CL A
FUND:0000058-ACCOUNT:01001323045
Dear Ms. Wiley:
We received recent correspondence regarding the above
referenced account, a copy of which is enclosed. We wish to
confirm that the account is currently an individual account
registered to Bertha G Shultz. The account was opened on
June 18, 1990. As of September 17, 2001, the account had
4,586.790 shares with a net asset value of $16.01 per share.
The total dollar balance on that date was :~i4~.a.c The
balance was calculated by multiplying the total number of
shares by the price (net asset value) per share. Please
keep in mind that the balance may change daily because of
changing market and economic conditions. Also, past
performance is not a guarantee of future results.
In addition, the account must be liquidated or transferred
to a new or existing Dreyfus account since we are unable to
retain an account registered to a deceased shareholder.
Therefore, please provide us with the following:
. A letter of instruction from the executor of the estate
- It is essential to include the account number and
specific instructions. The executor must sign indicating
his position. The signature must be Signature
Guaranteed*.
* The Transfer Agent has adopted standards and procedures
pursuant to which Signature Guarantees in proper Form
generally will be accepted from domestic banks, brokers,
dealers, credit unions, national securities exchanges,
registered securities associations, clearing agencies and
savings associations, as well as from participants in the
New York Stock Exchange Medallion Signature Program (MSP) ,
the Securities Transfer Agents Medallion Program (STAMP) and
the Stock Exchanges Medallion Program (SEMP) . Notarization
by a Notary Public is not an acceptable guarantee.
. Please include in the letter of instruction, the request
to update the address of record in order that 2001 tax
information can be forwarded to the correct address.
. Certified copy of Letters of Appointment - The
certification must appear on the document itself and
state that the copy is a true and complete copy of the
original and is still in full force and effect as of the
current date. The certification must be signed by the
Judge or clerk of the court and dated within 6 months of
the date the transaction takes place.
. Affidavit of Domicile - The enclosed form must be
completed in its entirety and notarized.
. Form W-9 - In order to ensure correct tax reporting
under the estate's taxpayer identification number, the
enclosed Form W-9 must be completed in its entirety.
Please include the taxpayer identification number in the
space provided, and sign the certification section. The
Dreyfus account number must also be provided on the
Form.
. New Account Application - In the event the assets are to
be transferred to a new Dreyfus account, the enclosed
application must be completed to reflect the
registration of the new account. If providing bank
information for any of our privileges or the Either/Or
CheckWriting privilege is to be established, the form
must bear a Signature Guarantee*.
In lieu of the above, we will accept a Signature Guaranteed*
letter of instruction from the dealer of record, Bisys BD
Service Inc. The request must be on official firm
letterhead and be signed by an authorized signatory.
As soon as we receive the required documentation in good
order, we will promptly process the request. Enclosed for
your convenience is a self-addressed envelope.
If you have any questions, please call a Dreyfus Service
Representative toll-free at 1-800-645-6561 or contact the
financial advisor at Bisys BD Service Inc.
Sincerely,
~d.6~
Kerry A Bozek
Institutional Client Services
Enclosure(s) :
Account Application
Affidavit of Domicile
Self Addressed Envelope
Form W-9
THEVanguaJd:jROUP~
ATTN JAN M WILEY
THE WILEY GROUP
1 SOUTH BALTIMORE ST
DILLSBURG PA 17019
October 24, 2001
PA Ins LT Tax-Exempt Inv
Wellington Fund Inv
Prime Money Market Fund 09862827503
Inter-Term Tax-Exempt 09883565682
BERTHA G SHULTZ
Dear Mr. Wiley:
Thank you for contacting Vanguard.
We received the certified court document naming Robert B. Shultz as the executor of Bertha
G. Shultz's estate, and his authorization to release information to you concerning Ms.
Shultz's accounts.
As of September 17, 2001, the number of shares, the price per share, the value of each
account, and the accrued dividends (if applicable) were as follows:
Fund & Dates Opened Shares Price Value Accrued
Dividends
PAIns L T Tax-Exempt Inv 7,665.333 $11.54 $88,457.94 $199.74
10-28-1992
Wellington Fund Inv 2,652.900 $27.11 $71,920.12 N/A
08-04-1989
Prime Money Market Fund 34,171.420 $1.00 $34,171.42 $54.24
02-18-1997
Intermediate-Term Tax 5,463.114 $13.66 $74,626.14 $159.35
Exempt Fund 12-09-1992
The accounts were registered in Bertha G. Shultz's name alone with Robert B. Shultz as
her attorney-in-fact.
Post Office Box 2600, Valley Forge, Pennsylvania 19482~2,6oo
6ro-669-rooo . www.vanguard.com
, .
To transfer the accounts, we need Mr. Shultz to complete the enclosed transfer form. This
form will provide the new registration information and certify the taxpayer identification
number for the new accounts. This form will also let Mr. Shultz choose options for the new
accounts.
Mr. Shultz must sign the form in section #3. If the accounts will not be transferred to Bertha
G. Shultz's estate, Mr. Shultz's signature must be guaranteed. All new account owners must
sign the form in section #9.
. A signature guarantee verifies a signature. Most commercial banks, savings
banks, credit unions, trust companies, or member firms of a U.S. stock
exchange offer this service. A Notary Public cannot provide a signature
guarantee.
. For a signature guarantee to be valid, it must appear in the following format:
"Signature(s) Guaranteed"
By (Signature & Title)
Institution's Name
Since the account registration is changing, we are unable to carry over the Checkwriting
option to the new Prime Money Market Fund account.
If the new owner wants to establish the Checkwriting option on the new account he or she
will need to complete section #8 of the transfer form.
When we receive the requested items, we will transfer the account. The new account owner
will receive a statement confirming the new account number and new registration under
separate cover. Please use the enclosed, coded, postage-paid envelope to help us match your
reply with this letter file.
.. I, ~
If you have any questions or need further assistance, please contact a member of our
Transition Specialist Team at 1-888-237-9045. A dedicated Transition Specialist will be
pleased to assist you.
Sincerely,
Client Services Department
rac
Enclosure(s): Vanguard Change-of-Ownership
Business Reply Envelope
50041961
I.
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shultz, Bertha G.
I FILE NUMBER
21 - 01 - 00871
ITEM I
NUMBER
A. FUNERAL EXPENSES:
1 I Myers Funeral Home:
B.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
7,269.00
2
Jack & Dorothy Shultz (clothing for decedent's funeral, & food for service):
335.76
3
James Gingrich Memorials:
75.00
ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Robert B. Shultz
I Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 120 N. Fileys Rd.
City Dillsburg
Year(s) Commission paid 2002
25,000.00
State
PA
Zip 17019
2.
Attorney's Fees
The Wiley Group -- Jan M. Wiley, Esq.
25,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
4.
City
Relationship of Claimant to Decedent
Probate Fees Regiskr of wills:
Register ufWills (add'l short certificates):
443.50
63.00
State
Zip
5.
I Accountant's Fees
I
6.
Tax Return Preparer's Fees David 1. Lenox, Esq.
125.00
7. Other Administrative Costs
Cumberland Law Joumal (advertise):
75.00
I The Sentind (advertise):
103.55
10.00
2 Notal)' Fee:
l. Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
104.32
58,604.13
.
'I "
~
~
Schedule H
Funeral Expenses &
Adninistrative Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
21 - 01 - 00871
Shultz, Bertha G.
Filing Fee:
3
4
5
6
7
Postmaster (postage):
25.00
21.08
5.00
27.44
25.80
Bank service charge:
Check printing fee:
Seaboard Surety Co. (certificate replacement):
Page 2 of Schedule H
. '. .
.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
\ FILE NUMBER
21 - 01 - 00871
ESTATE OF
Shultz, BeItha G.
Include unreimbursed medical expenses.
ITEM
NUMBER
1 Burick & Azizkhall (last illncss)
DESCRIPTION
AMOUNT
16.74
2
Quantum Imuging (lust illness):
5.94
3
Verizon:
50.14
4
Physicians of Rehab (last illness):
26.74
5
Patient Account Services (last Illness) (Dr. Inners):
54.06
6
Messiah Village:
1,486.00
7
Apria Phul11wcy:
20.65
8
Motlitt, h:ase, & Lim Assoc. (last illness):
43.02
9
Associated Cardiologists (last illncss):
2.05
10
Phannerica (last illncss);
133.64
II
Pinnack I-kalth Hospitals:
162.28
TOTAL (Also enter on Line 10, Recapitulation)
2,001.26
. '. .
SCHEDULE J
BEN EFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Shultz, Bertha G.
I FILE NUMBER
21 - 01 - 0087 I
NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
~TAXABLE DISTRIBUTIONS (include outright spousal distributions)
I Robert B. Shultz
120 N. F ikys Rd., Dillsburg, P A 17019
RELATIONSHIP TO
DECEDENT
Son
2 Jack R Shultz
150 I Baltimore Rd., Dillsburg, P A 17019
Son
3 Susan Whitmer
613 Beiuhower Rd., Etters, P A 17319
4 I Richard M. Shultz
Granddaughter
Grandson
5 Sally Shultz F olld!
Granddaughter
Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15oo COVER SHEET
AMOUNT OR SHARE
OF ESTATE
one-third
one-third
one-ninth
one-ninth
one-ninth