HomeMy WebLinkAbout11-03-05
.. .
REV.1500 EX (6.00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 _ 0 5
o 5 2 8
COOOY CODE
YEAR
~BER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I-
Z ELLIS , ELEANOR B 181 - 10 - 18 19
W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DlIJPUCA TE WITH THE
C
W 06 07 -2 0 05 07 17 1917 REGISTER OF 'fiLLS
() - - -
W (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I
C I
I
I
W [Xl 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of d ath prior to 12.13-82)
~ ~ en D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12.12.82) D 5. Federal Estate Tax Return equired
u a:: ~
w a- u
I 0 0 [Xl 6. Decedent Died Testate (Attach copy of Will) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) --.J2 8. Total Number of Safe Depc it Boxes
u a:: ...J
a- co
a- D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between 12.31.91 D 11. Election to tax under See. ~ 113(A) (Attach Sch 0)
<l: and 1.1.95)
f- THIS'$ECTIONMQ$T.BE.9QMP!+!:TEJ:).AL.!+.CORR!;$P9f\l[')~N9E~J:)9QNFiJ:)~~iA~T~INfQRMA.TjQN$f,lQQ~D BED RECTEDJO:
z NAME COMPLETE MAILING ADDRESS
w
0 DONN L SNYDER, ESQUIRE
z P 0 BOX 12 91
0
a- FIRM NAME (If Applicable) HARRISBURG, PA 17108 12 91
en SAUL EWING LLP -
w
a::
a:: TELEPHONE NUMBER
0
u 717 2 57 7552
1. Real Estate (Schedule A) (1) 0 00 OFFICIAL U~ .~ ONLY ... ,~:
i'
, -
2. Stocks and Bonds (Schedule B) (2) 4 , 894 2 6
'.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 0 0 ! ,
Coo
4. Mortgages & Notes Receivable (Schedule D) (4) 0 00 "', ,
-. 1
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 164 899 97 ,--1
,
Z (Schedule E) , .) I
0 , )
6. Jointly Owned Property (Schedule F) (6) 7 654 3 0 -
~ ,
D Separate Billing Requested r-..'J
;:) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0 0 0
I- (Schedule G or L) i
a.. 8. Total Gross Assets (total Lines 1 - 7) (8) 117 448 53
<( ,
() 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 23 911 3 8 i
W , I
0::: I
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1 814 2 0 I
,
11. Total Deductions (total Lines 9 & 10) (11) 2 5 , 72 5 58
12. Net Value of Estate (Line 8 minus Line 11) (12) 151 , 722 95
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 1 , 000 00
made (Schedule J) I
i
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1510 , 722 95
SEE INSTRUCTIONS FOR APPUCABLE RATES i
Z I
Amount of Line 14 taxable at the spousal tax I
0 15. I
lei: rate, or transfers under Sec. 9116 (a)(1.2) X .0_ (15) I 0 00
I- 16. Amount of Line 14 taxable at lineal rate X .0_ (16) , 0 0 0
,
:J i
a.. 17. Amount of Line 14 taxable at sibling rate 150 , 722 95 X .12 (17) 1i8 086 75
:E ,
0 I
18. Amount of Line 14 taxable at collateral rate X .15 (18) I 0 0 0
() I
g 19. Tax Due (19) 118 , 086 75
D I CHECK H!;REIFYQQA.RER!;Qt.JESTjN~.A.R!;f'I.,!NPQ~A.NQVE~A.)1MEN1l'i]
20.
:> .'>..l:ll;..$QRIS..'l"9Al'11$V\lSR.AL!-..QQI;$nPN$PNRevr;R$I$$IPI$DPRj;~l.:lE~K.MAl1H<<
STFPA42021F.1
, .
Decedent's Complete Address:
STREET ADDRESS 335 WESLEY DRIVE
CITY MECHANI CSBURG
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 17050
(1)
18,086.75
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
0.00
TotallnteresUPenalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
0.00
~8,086.75
A. Enter the interest on the tax due.
(SA)
I
I
i
~8,086.75
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT I
PLEASE ANSVVER THE FOLLOV\llNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLo6~~
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................ 0 [XJ
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . .. 0 [XJ
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [XJ
d. receive the promise for life of either payments, benefits or care? ............................... 0 [XJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . .. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 [XJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF HE RETURN.
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct nd complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PER ESPONSIBLE F FILING TURN V I~ .
[XJ
[Xl
DATE
10 fCf-o
FL 34429
ADDRESS
P.O. BOX 1291, HARRISBURG, PA
DATE
10 (
I
i
I
I
~o~ :~~e;:;::~;::Jv e-. d- 0C~,,_O lpOSed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. !l~116 (a) (1.1) (ii)].
The statute does Pc\9 I C c) 0 from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even
if the surviving Sl
For dates of dea 1'\ P D So c:':'~_.J
The tax rate imp :eased child twenty-one years of age or younger at death to or for the use of a natural parent, ~n adoptive
parent, or a step ~... ~~ --Ie. .2)).
The tax rate imp ( ) e use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !l9116(1.2) [72! P.S. !l9116(a)(1)).
The tax rate imr Ie use of the decedent's siblings is 12% [72 PS. !l9116(a)(1.3)). A sibling is defined, under SJction 9102, as an
individual who has alleaSl one parem In COflUIIUII Willi un:: uecedent, whether by blood or adoption.
17108-1291
STF PA42021F.2
11
'REV-1503 ~X + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
ELEANOR B. ELLIS
FILE NUMBER
21-050528
All property jointly-owned with the right of survivorship must be disclosed on Schedule F
ITEM VAl UE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 86 SHARES PUBLIC SERVICE ENTERPRISE GROUP INC.
$56.91 PER SHARE 4,894.26
I
1
I
I
TOTAL (Also enter on line 2, Recapitulation) $ 4,894.26
SIT PA42021 FA
(If more space is needed, insert additional sheets of the same size)
.
REV-150B EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ELEANOR B. ELLIS
FILE NUMBER
21-050528
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 Sdhedule F.
ITEM
NUMBER
1.
DSSCRIPTION
ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY CO.
VA UE AT DATE
bF DEATH
18,994.96
2.
USAA
152.78
3 .
MET LIFE
971.91
4. SOVEREIGN BANK
5. ACORDIA NORTHEAST INC.
5,495.47
80.00
1 8,808.33
516.93
145.01
418.92
9,164.79
150.87
6. GE LIFE AND ANNUITY ASSufANCE CO.
7. BETHANY TOWERS - CASH
8. BLUE CROSS - REFUND
9. BLUE CROSS - REFUND
10. MAINSTAY INVESTMENTS
11. PENN TREATY - REFUND
STFPA42021F.9
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1J4,899.97
.
REV-1509 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
ELEANOR B. ELLIS
FILE NUMBER
21-050528
If an asset was made joint within one year of the decedent's date of death,lit must be reported on Schedule G.
i
SURVIVING JOINT TENANT(S) NAME
ADDRESS
A. JEANETTE E. COALE
1615 N. FOXBORO LOOP
CRYSTAL FIVER, FL 34429
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NUMBER TENANT
DATE
MADE
JOINT
DESCRIPTION OF P OPERTY
Include name of financial instilliion and bark accolllt nunl er or similar identifying rn.mber.
Attach deed for jointly-held real estate.
1.
M&T BANK #30576016 6795
CONVENIENCE ACCOUN~
A.
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
7,654.30 100
STF PA42021 F.10
(If more space is needed, insert additional sheets of the same size)
TOTAL (Also enter on line 6, Recapitulation) $
RELATION HIP TO DECEDENT
SISTE R
DATE OF DEATH
VALUE OF
DE CEDENT'S INTEREST
7,654.30
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
I
I
I
I
I
I
I
I
I
!
7,654.30
REV-1511 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADM NISTRATlVE COSTS
ESTATE OF
ELEANOR B. ELLIS
FILE NUMBER
21-050528
Debts of decedent must be reported on Schedule I
ITEM
NUMBER
A.
1.
2.
3.
4.
5 .
6.
7.
B.
1.
2.
3.
4.
5.
6.
7.
8 .
9.
10.
11.
12.
13.
14.
15.
16.
17.
STF PA42021 F.12
DE SCRIPTION
FUNERAL EXPENSES:
MUSSELMAN FUNERAL HOME
JEANETTE E. COALE - MIse. FUNERAL EXPENSES
THE BRICKER HOUSE
PETE'S CAFE
MUSSELMAN FUNERAL HOME - DEATH CERTIFICATES
GINGRICH MEMORIAL
OPEN GRAVE - PROSPECT HILL CEMETERY
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Securijy Number(s) I EIN Number of Person I Representative(s)
Street Address
City
Year(s) Commission Paid:
State
Zip
Mom~F~ - SAUL EWING LLP
Family Exemption: (W decedent's address is not the same" claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees
Accountant's Fees
TaxRetum Preparer's Fees - SAUL EWIN3 LLP
SENTINEL - ADVERTISE GRA~T OF LETTERS
VERIZON
SAUL EWING - COPIES, POS~AGE, TELEPHONE & MILEAGE
CUMBERLAND LAW JOURNAL - ADVERTISE GRANT OF LETTERS
AIRFARE - FOR BROTHER FRJM OREGON
HARRISBURG HILTON - FOR BROTHER FROM OREGON
MAILROOM
MAILROOM
AVIS
AIRFARE - FOR SISTER
EMBASSY - FOR SISTER
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
!
I AMOUNT
8,171.80
100.00
267.12
569.22
30.00
120.00
1,065.00
8,800.00
256.00
300.00
122.51
46.72
120.00
75.00
1,072.94
754.02
162.15
58.15
168.28
1,094.39
558.08
23.911.38
REV.1512 EX + (1.97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ELEANOR BELLIS
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAE LIABILITIES, & LIENS
FILE NUMBER
21-050528
Include unreimbursed medical expenses.
ITEM
NUMBER DE SCRIPTION AMOUNT
1. EAST PENNSBORO AMBULANCE 50.00
2. BONNIE K. MILLER - TAX 9.80
3. BETHANY - CABLE AND HAIli DRESSER 26.00
4. VISA 1,708.40
5. GOOD HOUSEKEEPING 20.00
I
I
I
I
TOTAL (Also enter on line 10, Recapitulation) $ 1,814.20
STFPA42021F.13
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
i
I
SCHEDULE J
B ~NEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ELEANOR B. ELLIS
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distri utions, and transfers
under Sec. 9116 (a) (1.2)]
JEANETTE E. COALE
1. 1615 N. FOXBORO LOOP
CRYSTAL RIVER, FL 34429
2. EUGENE W. ELLIS
502 COVEY LANE
EUGENE, OR 97404
FILE NUMBER
21-050528
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
SISTER
BROTHER
AMOUNT OR SHARE
oF: ESTATE
1/. RESIDUE
l/L RESIDUE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHO\ N ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-15 0 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FC R WHICH AN ELECTION TO TAX IS NOT BEING MADE
STF PA42021 F.14
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONc
1. PINE STREET PRESBYTERIAN CH JRCH
THIRD AND PINE STREETS
HARRISBURG, PA 17101
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DIST IBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
1,000.00
!
I
11.000.00
Received 06L13/2005 03:36PM In 02:52 on line (12] for 3068 * Pg 3/6
06-13-'05 15:43 FEVM-BETHANY TOWERS 7177960664
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ELEANO
I
f\f
I, ELEANOR B. ELLIS,
of c~~erland, and state 0 Pennsylvania, declare this to
= the Boro~gh of LemGyne, county
i -
:..[',
;:
'lILL
OF
B. ELLIS
I::.em
I di:::ect that
be 1<Ty last ,.,ill and revoke any '....ill previously made by me.
debts and f:.:neral
-.....::-'
...
,..)
~;
-=-'<(
all ITry just
expenses, inclueJ.:ng my gra\. emarker a.'1d all expe:-.ses of rrry
"
last illness, and a.,y ~'1d all taxes and assessments imposed
by any govern~ental body as a result of n~ death, whether
....;
,",
on property passing \.:nc.er L is vlill or othez:;..;ise, shall be
. ..~
'>-..
" ,_\
\" "<
c.-'.,"'""'.
',-.1 }
~"
decease as a
par~
e>f
paid from my residuary esta c as soon as practicable afte~
expense
;1;"';.7
oN
of lilY estate.
j
:~
~~
~
Ii ,
~t \.
...
......1- c
I...~ ~ __
0r
tjle acmi~i3tratio~
Item II.
give a.~"" D queath t::::e sum of cne Thousand
(:;;1, OGO. 00) Qollars to t:--,e . E~r.; STREET PRESBYTERI.~'J C.:iURC1:
.
,
'.-
o~ 3a~~isburgJ Pe~nsy~vania.
\-'~l
It.eI7'. II I.
_ gl'.'e, cevise, Ch'1d bcqueat.h all Lite :cest,
~:-csid.ue, and remainder o~ 17::/ estate of every n.att;~e and
-~'J'~:e~e-I,;"2r- sil:.uato to be di"',,-io (~ ec~ually betT.....ee:-l r:~y si.s~€r I
E:,-,:GE:JE :rl. EL:..IS
:; Lt\l',;~<JETTE !:;. CO?L:::= of D~l.-,.~lOO =1y / GC8rg ia Jane IT:""'y" D:::-O~:-j.er r
,
i:
cj
~
~
~
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~
eaC~i S~~"'Il ve :r:v
of L::;r_gvic'."'~':, ~'l~s~ingt~Jn, ?~ovide;5. tha-:: they
or :11';
said s
deat,: uy" six y (50) Gays. Sr. ot: Li ei~'ler
predecease
my said b.::-o-::her
r' ~ C\y-
..:- -_.:.... I
or bctil or
t:1 e;r. r
:'~.c -::;:: ce deceased 'J!": -::.i-,J2 six y-fi:-:-3t. cay ':8:=-,~~Y,.,rin;- Dy deu:':::,
le<::i\,"e t.L.si.:- 311a~e :-=n.cicr -cl-: ~:= Itsrr. I-== of' :-=:: .!.', !.1y :'u3t
c~ea~:l ~)V 5~xty (50: d~~'5.
....,~.:.12 "C,:) sue> ':Jt t::e:..::: iS~ue,~ pe-=~ stir?C3r ss survi"'lc WY.
Received 06[13/2005 03:36PM
06-13-'05 15:44 FROM-BETHANY TOWERS
Item IV.
It 1.5
requir~~ent, tha~ my said
:"o::>k after oy mother and
may be necessary to care
:;':d father GUt of the fc:.nd I oequeatn to them in this my
r and provide for my said mother
n 02:52 on line [12] for 3068 * Pg 4/6
7177960664 T-165
'cst, but not my direction and
and my said brother shall
ther and expend such funds as
last will. My gifts to my aid brother and my said sister,
:.lpon such reques t.
or to tlleir issue, are not in any way, however, conditioned
PM
Item V.
I appoint ~T sister, JEAbiNETTE E. COALE, Executrix
of this my last will. ShOll d my said sister predecease lO'.e
or otherwise fail to q~ali
I appoint my brother,
my last ,-.'ill.
It.em VI.
I direct
~Da fich.lciaries shall not -
or cease to serve as my axecu~rix,
~'l. ELLIS r executor of tr-.is
my personal representatives
required to give bond for the
faithful performance of th ir duties in arlY jurisdiction.
~ave hereunto set my hand and
5e3.1
IN WIT~ESS ~~EREOF, I
,i.-f1
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f I
day .=:f ' '---,'(.I. <- .,.1.J '>.
197 :1.
?3:ie 2
(7" A ,
/'..' .. /) Ct_ -1 .
. ..-t..!' c~-<- <-<C'-t.-' /."5 K-C( LJ.
Elednor B. Ellis
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Received 06L13/2005 03:36PM in 02:52 on line [12] for 3068 * Pg 5/6
06-13-'05 15:44 FROM-BEl'HANY TOWERS 7177960664 T-165 P05
~1e preceding instr ent, consisting of this and tW8
other type<rritten pages, ach identified by the signat~re
of t:-le testatrix was on signed, published,
and declared by Eleanor B. Ellis, the testatrix therein named,
a3 and for her last will, in the presence of as, who at her
req1.Lest, in her presence r nd in the presence of each otr:er,
have subscribed aur nanes as vii tnesses hereto.
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'.'_' .COMMON">'lEALTH OF PENNSYLVANIA )
;' ~ '
"!.ill:
J~, . COUNTY OF CUMBERLANU )
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Received 06[13/2005 03:36PM in 02:52 on line [12] for 3068 * Pg 6/6
06-13-'05 15:45 FROM-BETHANY TOWERS 7177960664 T-165
P06
55. :
to
I, ELEANOR B. ELLIS, th
the attached or foregoing i
testatrix whose name is signed
having been duly qualified
owledgethat I signed ~~d Oxecuted
that I signed it willingly;
ru.d voluntary act for the purposes
according to 1a<,.], do here:by ac
the inst:::-ument as my last ,,,ill,
and that I signed it as my
therein expressec.
<I'
p- ,
A"-. ..~ ._~_ .~~_J___~ ~- .''r.....-..
/....,
/~~;; .
....~.
'~-L_;Z~/~.:
S\'lor:l or affirmed to and
ack.owledged before me by
Elear:or B. Ellis, t}'1e testat:::-i
t:::is -..:,;- L day 0:: f. :'_~._ '.,~:_,L~ ..__
~ l r~! -tj. l'
Notary ?ublic
\",
CO!'1.."!ONWEA:.1'H OF PEt~SYLV ANIl'> )
( 5S.:
COUN'IY OF CUMBERLA...~D )
WE, S&~UEL L. N~DE3 and GEORGE A. VAUGHN, III, the witnesses whose
names aye signed to the attac~e' or =oregoing instrument, being
duly q~alifiec according to law, do depose and say that we were
prese':-lt ana. sa.,,',? t!-lC testa"trix s' gl~ and execute t:te instru.rr..cnt
cxecu~ed it as her =~ee
a:c; her last will; that :;he sigl': Q it \villingly ~~d that she
for the p~rposes therein
;"1earing and sigr..t of t:rle testatrix
t:l.at to the best of our knowledge,
expressea; that each of us in
si,g:;ec1 t:1C will as ','litnesses;
the testatrix ,,]as at tha:. ti:ne
or more years 0= age, of so~nd
:.:ndve inflllCIlCG.
rcine and under no const~ai!"'.l~
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11
G. David Bias
Legg Mason Wood Walker, Inc.
07/22/2005 3:18 PM
Ele ~nor BEllis
Date 0' Death Values
June 7. 2005
Holdinas
Price
Per Share
i
Date 011
Death Value, I
I
$ 118,808.331
,
1.) GE Life & Annuity Assurance Company
Policy # T06064172
2.)
Allmerica I
Policy # MN00409415 \
86.00 Shs. Public Service Entrrprise Group Inc.
I
$ 18,994.96 \
3.)
56.91
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$ 4,894.261.
$ 142,697.551 f
Totals
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The foregoing information was prepared~ fm sources believed to be reliable but is not
guaranteed as to accuracy. It should be refully reviewed and compared with your
Legg Mason monthly statements. Any qu stions should be referred to your Investment
Executive or the Branch Manager.
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STATEMENT
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:,::::91 11.!.~f.l7
00874 62 29 _:tI:1
9aoo Fredericksburg Road
San Antonio. Texas 78288
Visit us at usaacorn
591 110
TO CHANGE A POLICY OR ORDER ONE
1-800-531-8111
FOR BILLING QUESTIONS, CALL
1-800-531-6095
TO REPORT A CLAIM, CALL
1-800-S:H -8222
--'!- -
EST OF ELEANOR BELLIS
C/O JEANETTE E COALE
1615 N FORBORO LOOP
CRYSTAL RIVER FL 34429-7687
'MONT _ VACTJVITV_
I!Al.ANCE ON LAST STATEMENT
REFUND CHECK ISSUED
CIC AUTO POLICY 7101 7 lNACYIVE: AUTo
POLICY CANCELLATION CREDIT
$
.00
152.76
07-20-2005
06-16-2005
152.76CR
ACCOUNT BALANCE AS OF 07-20-2005
$
.00
';t:ffEC1IVE DATE
- - -:PAYMt;KT PLAN 'OPTIONS
- - - 8ALANCE: - --REGUl:-AR-;PlAN-":EXTEN EcLpLAN:
04-01-2005 CIC AUTO POLICY 7101 7
$
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$
$
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$
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TOTALS
$
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s
.00
YOUR REfUND CHECK IS ATTACHED.
NOW YOU CAN CHOOSE THE PAYMENT PLAN THAT FITS YO R NEEDS AT NO EXTRA COST. WE NO LONGER ASSESS A
SERVICE CHARGE WHEN YOU PAY YOUR P&C INSURANCE B LL ON THE EXTENDED PAYMENT PLAN. SEE THE REVERSE sloe
OF THIS ~ILl fOR MORE INFORMATION ABOUT AVAIlABL PAYMENT PLAN OPTIONS. OR VISIT USAA.OOM.
DM4462
REFUND CHECK
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cancelled. If .'1QIU\llft;:~' .~~nce",ing Ihis document od.i\\l(' "\ \
Insurance cot6~~1'A'. ..... "de~olenl 'n...ra..... Agent: ..... '.,
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insured's Name: E.
OR EO-IS
oate
01/10105
PoliCY !'lumber
HOP 1465942
Account !'lumber
371001421 3--001-00001
Amount
80.
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2140380
31-0-4004
N;COUt-rr NUMaE~
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01/10/05
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AGEI-!CY NUM&ER
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1615 N fOXBORO LOOP
CRYSTAL RiVER FL 34429
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MAINSTAY
-INVESTMENTS-
ELEANOR B ELUS
335 WESLEY DR # 128
MECHANICSBURG PA 17055-3539
'UlIII.IIJ11. Il' r. r. .1.1...11111. I. ..1I.1.ln,,1 .1.1111.11111
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Transaction Confirmation
Sta'-M 0... eIII&/2lIlI!i
.. Client Senrices
p.... hI 1
1-800-MAfNST A Y (62l1-f782)
MaInStay lnvnune~
P.O. Box 8401
Boston, MA 02268-8. 1
www.rMinstayfuud.. o.
SAMUEl G lUCH ,
NYUFE SECURITIES 1Nt. 'i
ADO'l COPYTO: NY UFt !
3401 NORTH AlONT ST 1ST ftODR
HARRISBURG PA 1711o-1~
.. On the Web
... Ylliar Iaoveft...t
ProfeQioHl
The financial markllts tend to move in cycles. That'. wtr.j asset alloclltion and diversification can
be so important in helping to meet Ion -tenn goals. Contact your investment professional to
determine if changes are needed. inc ding.. possible increan in large-cap growth t:x.posure.
Making additional invtstments is 98S; t than liver, becauu you have established banking information . i
on your account. You can call 1-800- AINSTAY anytime to purchue additional shares lInd thu money iSI
automatically drawn from your bank 11 count OR log On to WVIIW.mainstayfunds.com to make a purchau1
Investmem Accounts
MainStay Higb Yield Corpofate Bond B
Aceaunt Owner(s.
ElEANOR BELLIS
Fund Transaction Detail
T..... Coltfina
.... DaM TRUlliiICtia. Dascriplio.
Begi..ing lkIuoe
OIVl~ TRANSR;R TO 1010029511
hd... Ba',_ ~ ., H/16tU5
011(16105
fund No. 43
Account No,
Daftar .....nr Sll.,. stla.n lIlis 't~fa' ShRIi
efT,._aiotI ~ Trl~DG 0wM4
$19,1".19 ~..II_f77
$0,00 $0.00 3.018.077 I O.tlXl
$.... I ....
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On selling your shares, you may pay a sa es charge. For the charge and other fees, see the ptospe~tus.
a
iii
IMPORTANT INFORMATION om PROCEDURES FOR OPENING A Nav ACCOUNT
To help the Il'ovemm~ntfightthe funding of te OOSIn Ilnd money laundering activities. Fedelllllaw requires all financial
institutions to obtain, lrerRy. and record inform tion that idcntitie. each person who opens In account.
What this means for you: When you open an ccounr. WI: wiIIllsk for your name, address. dabl of birth. tax infol'mlltion
number and other infonmnion that will allow u to identifyyol.l. We may 8lso askto see your driver', license or other
identifying documents.
------
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Mt.ioTSllIly funds arB distrIbute a by NYUFE Oistri uta" llC. l69lICkaW<<lM Ava., P8r8ippany. NC'NJeracy01054.
for account selVin inquiries or complaints. write to MlIinSley love ments, P.O. Box 84tH, Bosron MA 02266 or c81l1-800-MAINSTAY (G24-678Fl. option 12.
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Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of Eleanor B. Ellis
No. 21-05-0528
also known as
Date of Death
June 7, 2005
, Deceased
Social Security No.
181-10-181
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory inc ude all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decede t, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's dea hi and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memo andum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understa d that
false statements her in are made sub' to the penalties of 18. Pa. C.S. Section 4904 relating to unsworn falsific tion to
authorities.
Name of D
Attorney:
I.D. No.: 06858
Address: 2 North Second Street, 7th Floor
Harrisburg, PA 17101
Telephone: (717) 257-7524
10-
\. Dated:
Description
Value
REAL ESTATE:
None
PERSONAL ESTATE: ; I
See Schedule "B" Attached
See Schedule "E" Attached
H i ,_OJ
See Schedule "F" Attached
f",-..
(Attach Additional Sheets if necessary)
116538.1 8/9/05
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15:43 FROM-BETHANY TOWERS 7177960664 T-165
P03
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vJILL
OF
ELEANOR B. ELLIS
I, ELEANOR B. ELLIS, of the Borough of Lemoyne, county
of c~~berland, and state of Pennsylvania, declare this to
be ~y last will and revoke any will previously made by me.
I::em I.
I direct that all ~y just debts and funeral
expenses, including my gravemarker and all expenses of IITy
last illness, and &"y &~d all taxes and assessments imposed
by any governmental body as a result of my death, whether
on property passing under this will or otherwise, shall be
paid from my residuary estate as soon as practicable after
rr~~.T decease as a part of t1:e expense of the administration
of T;;Y estate.
It.ern. II.
give ~~d bequeath ~,e sum of One Thousand
($1,000.00) Qollars to the PIN2 STREET PRESBYTERIfu~ CHURCH
at ~3r~i5~urg, Pennsylvania.
It.e!:', II I.
I give, devise, and bequeath all the rest,
~csi~uc, an~ remainder of ~J estate of every nature and
.~.,.he~e-\;-2.:- Sl. c~atG to be di ~JiciGd equally bet'1'\;ee:1 rr~y sist.er,
:EN~~ETTE s. COALS of Dw~wocdy, GC8rgia, anc ~y brother,
EUGE:JE :rl. EL:..IS of LOr'.;.gvicv?, Vlas~ingtQn, provided that they
eaC~l s:~~vive :r:y deat;, b-y sixty (50) days. Should either
il.Tj- sa~ci ~J~o-::h.e;:- or :ny" said sister, or ~ct:'J. of the."I1, predecease
r:le J~ be deceased .~ ::he six--:y-fi:-:-.3L cay fol2..o\..ving t:1y deu-tl:,
1 ief~--;Jr-= t!~si::- 3~ci.~e ::ndcr th.:.s Itcrr.. I':::::;:: of 1..:r-:i~=; my last
~...r.:.12. -;:.:1 3U:::;' ':.J-= tl--..eir is.sU8, oe::- stirpes, as survive rny
c~eat~'J D~ 3~X~Y (50) days.
Received 06[13/2005 03:36PM in 02:52 on line [12J for 3068 * Pg 4/6
06-13-'05 15:44 FROM-BETHANY TOWERS 7177960664 T-165 P04
Item IV.
It is my re~est, but not my direction and
requirement, that my said sister and ffiY said brother shall
look after my mother and father and expend such Iunds as
may be necessary to care for and provide for my said mother
:nd father CU"C. of the h:nds I bequeath to them in this my
last will. My gifts to my said brother and ny said sister,
or to their issue, are not in any way, however, conditioned
tlpOn such requ.es t .
Item V.
I appoint ~T sister, JEk~~BTTE E. COALE, Executrix
of this my last will. Should ~ said sister predecease me
or othenlise fail to qualify or cease to serve as my executrix,
I appoint my brother, EUGENE W. ELLIS, executor of this
my last \dll.
It.em VI.
I direct th<lt my personal representatives
ana fiduciaries shall not be requirec. to give bond for the
faithful performance of their duties i:1 a...,y j'..:.risdiction.
IN WITNESS ~~~REOF, I have hereunto set my ~and and
sea.l ::n.-!.s
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Eleanor B. Ellis
Page 2 of J }~Ug20
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06-13-'05 15:44 FROM-BETHANY TOWERS 7177960664 T-165 P05
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~1e preceding instrument, consisting of this and tW8
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ether typevrritten pages, each identified by the signat~re
of the testatrix was on the date thereof signed, published,
r_;~
and declared by Eleanor B. Ellis, the testatrix therein named,
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as and for her last will, in the presence of us, who at her
request, in her presence, and in the presence of each other,
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have subscribed ~ur names as witnesses hereto.
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06-13-'05 15:45 FROM-BETHANY TOWERS 7177960664 T-165 P06
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. - ( 55
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5&lli! COUNT'[ OF Cli?1BERi.A1:olD )
i~~ I, BLEANOR B. ELLIS, the testatrix whose name is signed
~%;:~~ '::0 the attaC:'1ed or foregoing instrument, having been duly qualified
~~->,:,~ ~
_ .,_" according to la,,] , do hereby acknowledge that I signed and Oxecuted
.:..,
the inst:::-ament as :ny last will, that I signed it willingly;
a~d that I signed it as my free and voluntary act for the purposes
therein expressed.
J:r
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Swo~~ cr affirmed to and
aCY.Jlowledsed before me by
E:eanor n. Ellis, the testatrix
t:-;is . '- day Qf ~.~ ~:__:.._,'.rr~._L~:'_ ):/
:.T~-: 1
Notary ?'..1b.lic
t'~~ .'. '~,--
....,.;.~. --
COH~"!OtJ'"v;EA:.. TIr OF PEJ:~SYLVl-.NIA )
( 58.:
CCUN'IY OF Cl7MBERLA..l--JD )
WE, S&~l7EL L. .~~DES and GEORGE A. VAUGH~J, III, the witnesses whose
names are sisne~ to the attached or =oregoing instrument, being
duly ~lalifie~ according to law, do depose and say that we were
presc:1.:: 2i"16o sav," ::.l-le testatrix sign and execute the instr'Ufficnt
as her la,:t v;ill; tLat she signed it willingly and that she
cxecu::ed it 2'J ),er- free and voluntary act for the purposes t:herein
expressed; c::;at each of us in the hearing and sight of the testatrix
sigr-:ed t:w ".,ill as ','Ii tnesses i and t:.at to the best of our knowledge,
~he tcstatriz was at that time 18 or more years 0= ase, 0= sound
rei:Lei an.;:). undey no const::caint or 1JTIdue infl~eIlce ~
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R!;CV .1503 EX. , (1-97) (I)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ELEANOR B. ELLIS 21-050528
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VAL E AT DATE
NUMBER DESCRIPTION o DEATH
1- 86 SHARES PUBLIC SERVICE ENTERPRISE GROUP INC.
$56.91 PER SHARE 4,894.26
I
TOTAL (Also enter on line 2. RecapitulatIOn) $ !4, 894 _ 2 G
:Jli- f"'-....,.:F--t
(If more space IS needed. Insert additional sheets of the same size)
REV-150B E;.('+ (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ELEANOR B. ELLIS
FILE NUMBER
21-050528
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 Sc edule F.
ITEM VALWE AT DATE
NUMBER DESCRIPTION C F DEATH
1. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY CO. 8,994.96
2 . USAA 152.78
3. MET LIFE 971.91
4. SOVEREIGN BANK 5,495.47
5. ACORDIA NORTHEAST INC. 80.00
6. GE LIFE AND ANNUITY ASSURANCE CO. 1 8,808.33
7. BETHANY TOWERS - CASH 516.93
8. BLUE CROSS - REFUND 145.01
9. BLUE CROSS - REFUND 418.92
10. MAINSTAY INVESTMENTS 9,164.79
II. PENN TREATY - REFUND 150.87
TOTAL (Also enter on line 5. Recapitulation) $
(If more space IS needed. Insert additional sheets of the same size)
IG4,899.(:n
:-ill !-J.:.,-';.c: LH "_'
G. David Bias
legg Mason Wood Walker, Inc.
07/22/2005 3:18 PM
Eleanor BEllis
Date of Death Values
June 7, 2005
Holdinqs
Price
Per Share
Date of
Death Value
1.)
GE life & Annuity Assurance Company
Policy # T06064172
$ 118,808.33
2.)
Allmerica
Policy # M N00409415
$ 18,994.96
3.)
86.00
Shs. Public Service Enterprise Group Inc.
56.91
$ 4,894.26
Totals
$ 142,697.55
The foregoing information was prepared from sources believed to be reliable but is not
guaranteed as to accuracy. It should be carefully reviewed and compared with your
Legg Mason monthly statements. Any questions should be referred to your Investment
Executive or the Branch Manager.
STATEMENT
591
USAA
NUMBER
00874 62 29
.'
~
~-o::::
USM"
9800 Fr-edericksburg Road
San Antonio. Texas 78288
Visit us at usaacorn
581 , 10
TO CHANGE A POLICY OR ORDER ONE
1-800-531-8111
FOR BILLING QUESTIONS. CALL
1-800-531-6095
TO REPORT A CLAIM. CALL
1-800-531-8222
EST OF ELEANOR BELLIS
C/O JEANETTE E COALE
1615 N FOXBORO LOOP
CRYSTAL RIVER FL 34429-7687
...
MONTHLY ACfTVITY
13ALANCE ON LAST STATEMENT
REFUND CHECK ISSUED
CIe AUTO POLICY 7101 7 INACTIVE: AUTO
POLICY CANCEllATION CREDIT
$
.00
152.76
07-20-2005
06-16-2005
152.76CR
ACCOUNT BALANCE AS OF 07-20-2005
$
.00
BALANCE
EffECTIVE DAn:
04-Q1-2005 eIC AUTO POLICY 7101 7 INACTIVE: AUTO
$
.00
$
.00
$
.00
TOTALS
$
.00
$
.00
s
.00
YOUR REFUND CHECK IS ATTACHED.
NOW YOU CAN CHOOSE THE PAYMENT PLAN THAT FITS YOUR NEEDS AT NO EXTRA COST. WE NO LONGER ASSESS A
SERVICE CHARGE WHEN YOU PAY YOUR P&C INSURANCE BILL ON THE EXTENDED PAYMENT PLAN. SEE THE REVERSE SIDE
OF THIS aILL r-OR MORE INfORMATION ABOUT AVAILABLE PAYMENT PLAN OPTIONS, OR VISIT USAA.OOM.
DN4462
REFUND o-lECK /I 12132499
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Received 07/29/2005 01:50PM in 02:40 on line [4) for 3069 * Pg 6/7
~12:25 F~X 3527954649 Raymond James & ASS.
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07/29/05
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WESTFIELD
GROUP'"
.'
('\
Y
(}9' /~re. your Westfield Group draft. We appreciate havingth~ opportu-
C\ ~ \A.?nit to setve you. The panel below indicates the reason for t!1e draft
'V i\" our Independent Insurance Agent, indicated belgw, can show you
t ~ther fine insurance products. Call.t~em or stop by for 'moteinforma..
tlon.,: ";:';}.... :
,.,,'
/
'JUL 13, 2Otl5
Reason:
CANCELLATION OTHER
Insured's Name: ELEANOR ELLIS
Date
07110/05
Policy Number
HOP 1465942
Account Number
377001421~1~001
Amount
8Q.
20u.8
AGENCY NUMBER
ACCOUNT NUMBER
POliCY NUMBER
DME
DRAfT NUMElH
37-0-4004
3770014213-001-00001
HOP 1465942
07/10/05
2740380
~
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Bank One, A
AMOUNT
'80.00
.,
AT ,lGHT
PAY TO THE
~DfR Of
ACORDIA NORTHEAST INC
OR. ELEANOR ELLIS
CIO JEANETTE COALE
1615 N fOXBORO lOOP
CRYSTAL RIVER FL 34429
u. ? 7 l, 0 l a 0 II- I: 0 l. l. ~ ~ 5 l, l. :1 I:
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MAINSTAY
-INVESTMENTS-
Transaction Confirmatill>n
S&a~ 0.18 81f16/2II05
.. Client Senrices
P~hl,
DOOO3Il
... On the Web
~ Y,vr IlIYes1lM.t
l'nlfe'l'.ioul
1-800-MAlNST A V (62<1-1182)
MainStay InvlI$unenti
P.O. Box 8401
Boston, MA 02265-S4tl
www.maiRStayfundu 0"
SAMUEl Ii ZUCU
NYUFE SfCURlTlES INC_
ADOOL COpy TO: NY UF[
3401 NORTH mONT ST 1ST! OOR
flARRlSBURG PA 171lo-14lU
ELEANOR 8 ElLIS
335 WESLEY DR # 121$
M~CHANICSBURG PA 11055-3539
1...111.. .111,", I. III! .1." 11..1.1..,11.1,. II ,,1.1111...1.."
The financilll marKuts tend to mOVe in cycles- That's why asset alloclltion and diversificlltion can
be so important in helping to meet long-term goals. Contact your investment professional to
determine if changes are needed, including II possible increaslf in larlle-cap growth 8llposlJre_
Making additional investments is easillt than liver, becau~e you have established banking information
on your account You can caUl-BOO-MAINSTAY anytime to purchase additional shares Bnd thll money is
lIutomatically drawn from your bank account OR log 011 to wwwJTlainstayfunds.com to make a purchase.
Investment Accounts
MainStav High Yield Corporate Bond 8
ACCQCJ!1t OW1tel1:d
ELEANOR BELlIS
Fund Transaction Detail
fund No. 43
AccoQnt No. 54! 04563
T..~. eo.ram
D..te D...., TraJI~ilCli"lI ou.,riplio.
Bogi..ing 8;1laAce
08/16105 TRANSFfR TO 1010029511
&di.9 BaI.IICl1 ll$ '" 0If16/l1S
Dallal' AnIoa... SlIaNl n...,1'S IllUi 1. I $IIanI"
.fTraft$X1iq Price Tril/t$"ll;tioa aw-d
$(9.1".79 3 aU_in
SO. DO $0.00 3.018.077 OlXXl
sua .....
0lV161OS
On selling your shares, you may pay a sales charge. For the charge and other fees. see the prospel;tus_
a
a
IMPORTANT INmRMA TION ABOIJT PROCEDURES FOR OPENING A NEW ACCOUNT
To hclp the llovemmenr fight the fundlllg of terrorism lIod money laundering actIVities, Federellaw requires all financial
institutions to obtain, verify, !\nd record information that identifies each person wtIo opens an account.
What this means for you: When you open an account we will ask for your nllme, addr~s. date of birth. tax infonnation
number 8nd other info nT1lltio n that will allow us to identify YOll. We may elso ask to see your dr;"er'~ license Of other
identifying documllnls.
~-a-)
M~",Sll!Y fund. arB dia1TlbUlej Dy NVUFf O."nbulu"ltC. lt39l.'lulwaona Avo. P.'Slpp'ny. NowJeflcym~.
Fur account $ervice inquiries or complaints. write to MllmSlliY Investments. PO. Box 8401, BaSiOn MA 02166 or ca\lI-800-MAINSTAY {1i24-6782, option n.
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ZOO!EJ
R~V-1509 E~\ (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ELEANOR B. ELLIS
SCHEDULE F
JOINTLY-OWNED PROPERTY
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
A. JEANETTE E. COALE
B.
c.
JOINTLY.OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NUMBER TENANT
DATE
MADE
JOINT
1.
A.
sTrp;....:~ ~:~'.I 'i~:
ADDRESS
1615 N. FOXBORO LOOP
CRYSTAL RIVER, FL 34429
DESCRIPTION OF PROPERTY
IrdLde name of finardallnstltulon am bari< accomt number or Similar IdentifYing number
Attach deed for jOintly-held real estate
M&T BANK #30576016-6795
CONVENIENCE ACCOUNT
FILE NUMBER
21-050528
DATE OF DEATH
VALUE OF ASSET
7,654.30
%OF
DECO'S
INTEREST
TOTAL (Also enter on line 6. Recapitulation) $
(If more space IS needed Insert additional sheets of the same size)
RELATIONS IP TO DECEDENT
SISTER
DATE OF DEATH
VALUE OF
DE EDENTS INTEREcST
100
7,654.30
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0_00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0_['0
0.00
0.00
0.00
0.00
o . I) 0
o. (1
17,654.30