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Home My WebLink About07-12-05 1\\II.~\I..IIIlIIIIII<llkl..(....dll\111. I III 0""" J'~')'C July 11, 2005 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013-3387 Re: Estate of Mary W. Kelly, deceased No. 2005-00058 Dear Ms. Strasbaugh: Cheryl L. Baker, CP Certified Paralegal clb@jsdc.com Enclosed are the following documents to be filed for the above referenced Estate: 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. An original and two (2) copies of the Inventory. 3. Check payable to the "Register of Wills, Agent" in the amount of Six Thousand One Hundred Forty-five and 21/100 Dollars ($6,145.21) representing the additional Pennsylvania Inheritance Tax due. 4. Check payable to the "Register of Wills, Cumberland" in the amount of Thirty Dollars ($30.00) representing the filing fee for the Return and Inventory. Please time-stamp the additional copies of the Return and Inventory and return them to me in the enclosed self-addressed, stamped envelope. If you have any questions, please feel free to give me a call. t.....~ (") ~O .=-:0 ~-o(") ::D :r: r- ....- ')> m ',> 2; :0 .;',':cr>;;s:;: ;-")00 (~~ o-n -c >.J :D '''0 -l "}."> '" = e> c;.n <- c: I N Very truly yours, Ch L. Baker, CP Certified Paralegal -0 :J;.: N .. , ,""") N '" Enclosures cc: Robert B. Kelly, Co-Executor William J. Kelly, C-Executor Mary Kelly Doran Barbara Kelly 134 SIPE AVENUE HUMMELSTOWN. PA 17036 MAILING ADDRESS PO BOX 650 HERSHEY. PA 17033 TOLL FREE 1.800.942.3660 TEL. 717.533.3280 FAX 717.533.7771 www.jsdc.com COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005553 JAMES GARY L 134 SIPE AVENUE HUMMELSTOWN, PA 17036 ACN ASSESSMENT CONTROL NUMBER AMOUNT hhn__ fold 101 $6,145.21 ESTATE INFORMATION: SSN: 204-40-1097 FILE NUMBER: 2105-0058 DECEDENT NAME: KELL Y MARY DA TE OF PAYMENT: 07/12/2005 POSTMARK DATE: 07/11/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/31/2004 TOTAL AMOUNT PAID: $6,145.21 REMARKS: CHECK# NO NUMBER SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00) *' w ... ..:oO:Ul Oii!": wll.g :l:~.J 0... III II. 00: I OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 1 FILE NUMBER I- Z W C W U W C .- --- DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Kelly, Mary W. DATE OF DEATH (MM-DD-YEAR) l DATE OF BIRTH (M'M:OD:-YEAR) 12-31-2004 ! 11-13-1911 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) I II 05 0058 L COUNTY CODE YEAR NUMBER . r- SOCIAL SECURITY NUMBER I i 204-40-1097 I ! THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10 SpOusal Paver\}' Credit (date of dealh between . 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ~ 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received o D D D 2. Supplemental Return ... z w o z o II. Ul W a: a: o o I NAME i Gary L. James I FIRM NAME (If applicable) I James, Smith, Dietterick & Connelly, LLP TELEPHONE NUMBER 717-533-3280 134 Sipe Avenue Hummelstown, PA 17036 ,....., C-;I <::::> :D 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o j:: ~ ::::l l- ii: <( u W 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 0 Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (1 ) (2) (3) (4) (5) (6) (7) () &3=0 FICIA~SE [~1 ! n ::r: (") I ,~....1 .,.'"J. .~Sl ~ ~ i:,-'::~~ t~ :z; ::0 N _.j '--...) en ?' ,--, ~, -T1 (-') ,n 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) None 595,019.30 None None '. C>Q <-; Q .,., -u =< C) ~~~ :~ :) N .. 319,992.08 1,783.53 None N -.J (8) 91 6,794.91 (9) (10) 19,535.78 465.00 z o j:: ~ ::::l a. :E o U >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 (11 ) 20,000.78 (12) 896,794.13 (13) 0.00 (14) 896,794.13 '~-'------- x .00 (15) 0.00 -~-- x .045 (16) 40,355.74 x .12 (17) 0.00 x .15 (18) 0.00 (19) 40,355.74 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) 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due I ; 20. D 896,794.13 0.00 0.00 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00; Decedent's Complete Address: STREET ADDRESS 325 Wesley Drive ISTATE PA !ZIP 17055 ---~ 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 ) 40,355.74 32,500.00 1,710.53 Total Credits (A + B + C) (2) 34,210.53 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (4) 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 theTAX DUE (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBAlANCE DUE (5B) 6,145.21 6,145.21 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................. D ~ b. retain the right to designate who shall use the property transferred or its income;................................ D ~ c. retain a reversionary interest; or..............................____........................................................-................. D ~ d. receive the promise for life of either payments, benefits or care?........................................................... D L!J 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....... ............. ........ ....... ...................................... ................ n ...... ............... U 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.............. ... ........... .n............................ n................ ...... ...... n.................... D ~ 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, 1 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 Robert elly ~ l!J DATE 1532 McCormick Drive Mechanicsburg, PA 17055 7// / rOO Y- /DATE TURN ADDRESS 5225 Wilson Lane, Apt. 3108 Mechanicsburg, PA 17055 7 - // - ;?oJ-l...... ADDRESS DATE 134 Sipe Avenue Hummelstown, PA 17036 7-/( -)~<~ For dates of .de h on qr after July 1, 1994 and before January 1, 1995, the tax rate imposed on the surviving s I ~ is 3o/~ [72 P.S. 99116 (a) (1.1) (i)]. Th e For dates of dea~or after January 1, 1995, the tax rate imposed on the net value of transfers to [72 P.S. 99116 (a) (1.1) (ii)]. The statutedoes not exempt a transfer to a surviving spouse from tax, ~ '"Pet of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficial) For dates of death on or after July 1, 2000: f.\~ D ;;) 5() UD The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or . natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficial J, ~U..s \ 99116 1.2) [72 P.S. 99116 (a) (1 )]. the loCo 0 . tru 14 I 0 ' (\'0 )% ;ure The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% If:.! P.S. 99116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1503 EX+ (6-98) *' SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kelly, Mary W. FILE NUMBER 21-05-0058 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 19 shares of Agere Systems PFD A common stock - 1.6 30.40 valued per public listing 2 479 shares of Agere Systems PFD B common stock - 1.61 771.19 valued per public listing 3 502 shares of AT&T common stock - valued per public 19.15 9.613.30 listing 4 151 shares of Avaya Inc common stock - valued per 17.25 2.604.75 public listing 5 1,944 shares of BellSouth Corp common stock - 27.9 54.237.60 valued per public listing 6 2,382.394 shares of BlackRock High Yield Bond - 19.797.69 Class A - Account No. 123-0009548504 - valued per statement dated 12/31/04 7 811 shares of Com cast Corp common stock - valued 33.18 26.908.98 per public listing 8 2,750 shares of Exelon Corp common stock - valued 44.3 121.825.00 per public listing 9 3,295.512 shares of Exxon Mobil Corp common stock - 51.2 168.730.21 valued per public listing 10 1,812 shares of Lucent Technologies Inc common 3.76 6.813.12 stock - valued per public listing 11 766 shares of Qwest Communications International 4.42 3.385.72 Inc common stock - valued per public listing Total of Continuation Schedule( ) See attached page TOTAL (Also enter on Line 2, Recapitulation) 595.019.30 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule 8 (Rev. 6-98) Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kelly, Mary W. FILE NUMBER 21-05-0058 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 12 3,631 shares of SBC Communications Inc common 25.78 93.607.18 stock - valued per public listing 13 1,867.238 shares of Vanguard Growth & Income Fund 30.61 57.156.16 Investor Shares - held in Account No. 09867089375 - valued per letter dated 2/14/05 14 1,080 shares of Vodafone Group PLC common stock - 27.35 29.538.00 valued per public listing TOTAL (Also enter on Line 2, Recapitulation) 595.019.30 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleS (Rev. 6-98) Rev-1508 EX+ (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kelly, Mary W. FILE NUMBER 21-05-0058 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bethany Village - patient account refund 227.000.00 2 First Citizens Bank Certificate of Deposit No. 001210259891 - valued per letter dated 30.412.51 2/9/05 3 First Citizens Bank Certificate of Deposit No. 001210259891, accrued interest - 54.89 valued per letter dated 2/9/05 4 PNC Bank Checking Account No. 8573387405 - valued per letter dated 1/26/05 2.768.21 5 PNC Bank Checking Account No. 8573387405, accrued interest - valued per letter 0.20 dated 1/26/05 6 PNC Bank Savings Account No. 8887896085 - valued per letter dated 1/26/05 56.434.96 7 PNC Bank Savings Account No. 8887896085, accrued interest - valued per letter 28.12 dated 1/26/05 8 2,293.19 shares of Vanguard Admiral Treasury Money Market Fund - held in 2.293.19 Account No. 09867089375 - valued per letter dated 2/14/05 9 Miscellaneous personal property - valued per Executors 1.000.00 TOTAL (Also enter on Line 5, Recapitulation) 319.992.08 (If more space is needed, additional pages of the same size) Copyright (cl 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) . SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kelly, Mary W. FILE NUMBER 21-05-0058 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Robert B. Kelly 1532 McCormick Drive Mechanicsburg, PA 17055 Son B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH LETTER DATE ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 4/14/2004 PSECU Checking Shares Account - 574.43 100.000% 574.43 valued per letter dated 2/11/05 2 A 4/14/2004 PSECU Regular Shares Account - valued 1.209.10 100.000% 1.209.10 per letter dated 2/11/05 TOTAL (Also enter on Line 6, Recapitulation) 1.783.53 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduJeF (Rev. 6-98) REV.1151 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kelly, Mary W. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-05-0058 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 10,451.78 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 8,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 706.00 See continuation schedule(s) attached 5. Accountant's Fees 5. Tax Return Preparer's Fees 7. Other Administrative Costs 378.00 TOTAL (Also enter on line 9, Recapitulation) 19,535.78 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 5-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Kelly, Mary W. FilE NUMBER 21-05-0058 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Barbara Kelly - reimbursement for funeral travel expenses 488.00 2 Farrell's Florist - flowers for funeral 530.00 3 Kinko's - funeral programs 70.00 4 lamb Tavern - funeral luncheon 690.13 5 lehman's Restaurant - family funeral dinner 453.65 6 Mainline Memorials - gravestone engraving 130.00 7 Ruffenach Funeral Home - funeral services 8.090.00 Subtotal 10.451.78 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H-84 PROBATE FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Kelly, Mary W. FILE NUMBER 21-05-0058 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Register of Wills, Cumberland County - probate fee 456.00 2 Register of Wills, Cumberland County - reservation for additional probate fee 250.00 Subtotal 706.00 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule H-B4 (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kelly, Mary W. FILE NUMBER 21-05-0058 ITEM NUMBER DESCRIPTION AMOUNT 1 James, Smith, Dietterick & Connelly, LLP - reservation for estate administration closing costs 250.00 2 Register of Wills, Cumberland County - fee for short certificates 80.00 3 Register of Wills, Cumberland County - filing fee for Return & Inventory 30.00 4 Vital Records - additional death certificates 18.00 Subtotal 378.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleH-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Kelly, Mary W. FILE NUMBER 21-05-0058 ESTATE OF Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 PA Department of Revenue - 2004 individual income tax VALUE AT DATE OF DEATH 306.00 2 U.S. Treasury - 2004 individual income tax 159.00 TOTAL (Also enter on Line 10, Recapitulation) 465.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV 1513 EX+ (9-00) *' . . SCHEDULE .J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kelly, Mary W. 21-05-0058 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee/sl I. TAXABLE DISTRIBUTIONS [include outright sfrousal distributions, and ransfers under Sec. 9116(a)(1.2)] See attached schedule Total 896,794.13 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduJeJ (Rev. 6-98) It. to SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Mary W. Kelly 204-40-1097 12/31/2004 Item Name and Address of Person(s) Number Receiving Property 1 Mary Kelly Doran 319 South Lawnrence Court Philadelphia, PA 19106 Relationship Daughter Share of Estate (Words) Amount of Estate ($$$) 221,198.53 2 Richard A. Doran 715 South Marvine Street Philadelphia, PA 19147 3 Barbara Kelly 2401 Hermosa Avenue Hermosa Beach, CA 90254 4 Sheila A. Kelly Kaplan 1 Irving Place Apt. P7H New York, NY 10003 5 Robert B. Kelly 1532 McCormick Drive Mechanicsburg, PA 17055 6 Robert B. Kelly III 1532 McCormick Drive Mechanicsburg, PA 17055 7 William J. Kelly 5225 Wilson Lane Apt. 3108 Mechanicsburg, PA 17055 Grandson 4,000.00 Daughter 221,198.53 Granddaughter 4,000.00 Son 221,198.54 Grandson 4,000.00 Son 221,198.53 Total 896,794.13 1 , " Register of Wills, Cumberland County, Pennsylvania INVENTORY Mary W. Kelly No. 2005-00058 12/31/2004 Estate of also known as Date of Death Mary Walsh Kelly , Deceased Social Security No. 204-40-1097 Robert B. Kelly Wiliam J. Kelly 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 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 are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Signature: Personal Re rese I.D. No.: _ Gary, L. James 76084 Signature: Attorney: Robert B. Kb--~ ~ellY James, Smith, Dietterick & Connelly, Firm: LLP Signature: Address: 134 Sipe Avenue Hummelstown, PA 17036 Telephone: 717-533-3280 Address: 1532 McCormick Drive Mechanicsburg, PA 17055 Telephone: 717 -796-1657 Dated: 7 - / / - ~Cl6 6- Personal Property Cas h............................................................................................... M isce Ilaneous Pro perty ................................................................ Stocks/Listed................................................................................. Stocks/C lose Iy He Id...................................................................... Bonds............................................................................................ . Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... C) 322,95~~1~ 1 ,00P.'.Pi p '-.. ':-..-- g:l 595,01~~v.; ;x? :.JC)(} C) -'Ti ~;; ~~;~.~ -; r--.., c::;, = 4"-"1 c........ c:::: r- =:0 ,--F1 ~!j p,~: ~~:; t.':J 1'1'1 CJ ..;~~ -"j (") i-.-'- rTl 1./:'> (:;.? N --0 :x ,~ N -.J Total Personal Property......................................... 918,978.47 Total Real Property.. ..................... ........ ................. Total Personal and Real Property......................... 918,978.471 Total Out-of-State Real Property.......................... . Register of Wills, Cumberland County, Pennsylvania INVENTORY , Deceased No. 2005-00058 Date of Death 12/31/2004 Social Security No. 204-40-1097 Estate of Mary W. Kelly also known as Mary Walsh Kelly Cash Bethany Village - patient account refund 227.000.00 First Citizens Bank Certificate of Deposit No. 001210259891 - valued per letter dated 2/9/05 30.412.51 First Citizens Bank Certificate of Deposit No. 001210259891, accrued interest- valued per letter dated 2/9/05 54.89 Penn Mutual Life Insurance Policy No. 1712987 - beneficiary is Estate 3.967.09 PNC Bank Checking Account No. 8573387405 - valued per letter dated 1/26/05 2.768.21 PNC Bank Checking Account No. 8573387405, accrued interest - valued per letter dated 1/26/05 0.20 PNC Bank Savings Account No. 8887896085 - valued per letter dated 1/26/05 56.434.96 PNC Bank Savings Account No. 8887896085, accrued interest - valued per letter dated 1/26/05 28.12 2.293.1900 shares Vanguard Admiral Treasury Money Market Fund - held in Account No. 09867089375 - valued per letter dated 2/14/05 2.293.19 Total Cash 322.959.17 Personal Property Miscellaneous personal property - valued per Executors 1.000.00 Total Personal Property 1.000.00 Stock I Listed 19.0000 shares Agere Systems PFD A common stock - valued per public listing 30.40 (Attach additional sheets if necessary) Total Personal Property and Real Estate 918.978.47 ~ Register of Wills, Cumberland County, Pennsylvania INVENTORY , Deceased No. 2005-00058 Date of Death 12/31/2004 Social Security No. 204-40-1097 Estate of Mary W. Kelly also known as Mary Walsh Kelly 479.0000 shares Agere Systems PFD B common stock - valued per public listing 771.19 502.0000 shares AT&T common stock - valued per public listing 9.613.30 151.0000 shares Avaya Inc common stock - valued per public listing 2.604.75 1.944.0000 shares BellSouth Corp common stock - valued per public listing 54.237.60 2.382.3940 shares BlackRock High Yield Bond - Class A - Account No. 123-0009548504- valued per statement dated 12/31/04 19.797.69 811.0000 shares Comcast Corp common stock - valued per public listing 26.908.98 2.750.0000 shares Exelon Corp common stock - valued per public listing 121.825.00 3.295.5120 shares Exxon Mobil Corp common stock - valued per public listing 168.730.21 1.812.0000 shares Lucent Technologies Inc common stock - valued per public listing 6.813.12 766.0000 shares Qwest Communications Internationallnc common stock - valued per public listing 3.385.72 3.631.0000 shares SBC Communications Inc common stock - valued per public listing 93.607.18 1.867.2380 shares Vanguard Growth & Income Fund Investor Shares - held in Account No. 09867089375 - valued per letter dated 2/14/05 57.156.16 1.080.0000 shares Vodafone Group PLC common stock - valued per public listing 29.538.00 Total Stock / Listed 595.019.30 2 .,. cr~ LW .,. . ~ :~~~; LL.. . 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