HomeMy WebLinkAbout06-12-06
~
15056041046
REV-1500 EX (05-04)
PA Department 01 Revenue tiC,
Bu'eau of Individual Taxes .'.'.'.. ... ,~
Dep! 280601 . ~).~
Harrisburg. PA 17128-0601 ~.. ~J$.:1t
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
dl
Db
L"\ C S \
s
Date of Birth
2 0 9 1. 1. 5S; eg
0//02.006
1130/CJ30
Decedenfs Last Name Suffix
Decedent's First Name
MI
P f) 5/0 R I( 0 V I C If
,g rE P II!:: N
J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
PRsrO"RJ<..o Vier(
Spouse's First Name
MI
fY){)KY
ELLEN
B
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Onginal Return
.. 6 Decedent Died Testate
N Y~l\ac~~~ J'~r;1k L)
c:::> 9 Litigation Proceeds Received
c::::> 2. Supplemental Return c:::> 3. Remainder Return (date of death
prior to 12.13-82)
c:::> 4a. Future Inlerest Compromise (dale of c::::> 5. Federal Eslale Tax Return Required
death after 12-12-82)
c::::> 7. Decedent Maintained a liVing Trust ~ 8 Total Number of Safe DepOSit Boxes
(Attach Copy of Trust)
c::::> 10 Spousal Poverty Credit (date of death c::::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
c:::> 4. l.lmlted Estate
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
()1ffRY
Ei-L~N
Pit S TO R. KG VI ell
7/.1
'1.37
1 ,5- / 6
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
First line of address
~/9
P/1wNEE
/)(2
VE
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
.
(Y) EC H/}/V I CS/3()I2G:
PH
I 7 {) ,~- G~ 2. ,S - i 1
r'<)
Correspondent's e-mail address:
Under penalties of perjury. ! declare tl1alll1ave examined tillS return. including accompanying schedules and statements. and to the hest of my knowledge ann ()e!if,f
It i:;; true. correct and complete_ Declaration of pre parer other than the ent8tive is based on aU informatIon of wrltch prep<=lrer hAS any knowledrle
/ /)
. _ fVc c'3k
PI1
DAlE
6 - /t) - 0 (-;
J7[.s-c::)
DJ\ TE
f\[)ORESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041046
15056041046
.-J
.-\. .).
....J
15056042047
REV-1500 EX
Decedents Social Secur'ty Number
Decedents Nan",
S'T.f~ /'11 f- /../
J
fide /)j//l
I ~TCI\.J),-/I/(CH
;LC 9 :2. 2--.. ,;;-:J-es
RECAPITULA nON
Real estate (Schedule A)
1.
NC71'JE..
2. Stocks and Bonds (Schedule 8)
2
IV {..IN E.
7
rV i) iV c.
NoN E.
//0'0.
/;<q1/6-.
tv .0",) [ .
I 3 CO 8 / 3- .
/Bi3!J.
7
':;-0 .
:3 Ciosely Held Corporation, PartnerslllP or SOle-Proprietorship (Schedule C)
3.
4. Mortgages & Notes Receivable (Sctledule OJ.
4
5 Cash. E3ank Deposits & Miscellaneous Personal Property (Schedule E)
5
6 JOintly Owned Property ,Schedule F I <::::) Separate Billing Requested. .
'7 inter-VIvos Transfers & Miscellaneous Non-Probate Property
(Sched~Jie (3) c::> Separate BII!ing Requested
6.
'3. Total Gross Assets Itotal Lines 1-7)
8.
c: Funera: Exoenses & Admlr11strntive Costs (Schedu!e HI
9
F' DeUs of Decedenc, Mortgage Liabilities. & Liens (Schedule i)
10
11 Total Deductions (total L,nes 9 & 10)
11
//.:712.
/ I / 87 3.
N,:'^lf..
II Ig 13.
12 Net Value of Estate (Line 8 minus l.ine11) .
Il Chanta~)le and Governmental Bequests/See 9113 Trusts for v;/hich
2f'; etectron to tax has ;.)()t been rnade (Schedule J)
12
13.
; '" Net Value Subject to Tax (LTe 12 minus Li'le 13;
lit
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
1 b AnlGLt'i( Dt Une ...! 4 taxable
at the spc,isa: t8:< rate. CJT
tL~i~:.~fers Lndc'f See 91"', C
(3 -)( ~1.> >:: 0
f:\:vount of Unf:- 1 [axahif:
("-It ljnea~ fEttc X 0
/ I / 9 ? 3 . 15 o.
tv' t' (Ij " 16 CJ
~ . .
N " N f; . 1 ! 0 .
A; (t /VI::. . 16 0 .
19 0 .
"7 Arr<ount Of Line 14 taxa[)!(-;
ai. Sibln,] rate X 12
A~Tl0tYli or L t:1{; 1 ,: t8xab,:e
3; {~c.;i;~ter,:il r2re .x i 5
19 TAX DUE
20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c::>
Side 2
L
15056042047
15056042047
--.J
RE\i- -: 5JG ex PdUU j
File Number
Decedent's Complete Address:
DECEDENT'S N.AMi:
.5 T .t::.-P II I::.. !'v
S-:"i:(EET ADDRESS
u, P/iSTc\!2.(<C:J t//Cl-i
7/1
/"It v...,' v.f'z. J) /2 ; !./ E
r:TV
v'
/l1e CHit IV ( C s' a ,,( (J C;
STATE
Pri
ZIP
/70,:5>- c:
Tax Payments and Credits:
1 Tax Due (Page 2 Lrne 19)
2. Credils;Payments
A. Spousal Poverty Credit
8 Pncr Payments
C Discount
(')
J';:! _~=_
-.:, -
-- ",'--' .-
..- i.~
Total Credits ( A + B + C i
121
3 'nteresUPerlaity If appiicable
D Interest
E. Penaltv
-c
- c -
'1.
TotallnterestiPenalty ( D + EO
if Line 2 IS <)feate' than Line 1 + Line 3, enter the difference. This is U',e OVERPAYMENT.
Fill in avalon Page 2, Line 20 to request a refund.
le)i
c'
-,.._'----------~--".~-.._-,-~-----_._-- -~
14;
_.- ~-~
if Lme 1 - Lire 3s greatw than Line 2. enter the (j,fference. This IS the TAX DUE.
15:
---e..-
A Enter the Interest on the tax due
/5/J...}
..-.t:.-
B. Enle' 'he tot21 of Line 5 .. 5A ThiS IS the BALANCE DUE.
;53:
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACiNG AN "X" IN THE APPROPRIATE BLOCKS
eJ:rJ deceoont make a tr21lsfer and
c retain the use or income of the prooeny transferred
re,aln the to deSignate who shai! use the, properl\: transferrec or itS inCOllle
'crain a re,'ers!onary 'ntems!. or
receive the promise tor I'fe of eithor oayme'lts benefits or care?
Geath occ!lTerJ after December 12, 1982. die! decedent tmnsfer
<:'es
X
K
g
X
WiUtl one '/f.:2r of dE3t~1
Did decedent C:Vifl an "Ill trust for' or payable upon damn Dank aCOGunt or
at hiS CJ r',er (Jee;t" .
'X
x..
1NithCJut
adequate cons!cerJt!on?
"-j. Did decedent crNF1 3:1 ~ndivjduaj Retirement I\ccount. a:H"~u;ty; or other non-probate Dropeny \vt!icn
(entail:s a benefiCiary des:g:iation')
x.
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUI
For dates of death on or after July 1, 1994 and before January 1, 1995. the laX 'ale imposed on the net value of transfers to 0' for the use cf !'Ie sr
is three (3) percent [72 PS S9116 fa) (11)
For dates of death on or after January 1 1995. the tax rate Imposed on the net value of transfers to or for tne use of the surViving SDouses zero pE
[72 PS S9116 (a) (1.1) (Ii)]. The statute does not exempt a transfer to a surviVing spouse from tax. and the statutory requirements for disclosure of asset
filing a tax return are sUi 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 pare,
adoptive parent or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's Ilneat beneficiaries is four ana one-half (4.5) percent. exceot as no
72 PS S9116(1.2) [72 PS. s9116(a)(1)].
The tax rate Imposed on the net value of transfers to or for the use of the deced8nts siblings IS twelve (12) percent [72 PS s9116(a)( 13)] A slollng is defined
Secilon 9102, as an Indivldua! who has at least one parent in cornman with the decedent, whether by olood or adoption
QF.f-'s<:a ~:.(. (1-;7;
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANiA
iNHERITANCE TAX RETURN
RESiDENT DECEDENT
ESTATE OF
~re PH-!:.~ N
FilE NUMBER
~
V'
PI!c..5TC:) ~ KL' V I G H
ITEM
NUMBER
Include the pror,eeds of litigation and the date the proceeds were received by the estate. All property jointfy-owned with the right of survivorship must be disclosed on Schedule F.
I
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
, ,. - -r-H NC ;:Or ':\c'.;,. A' ,"t 1-
/Y) ,5. C I L,,~1 L_.....J/ "- LJ:' ", I -;- r C r....:.--.c...- "-v
?R.c ('E P-. T Y
I. /t!)~.
1
TOTAL (Also enter on line 5, Recapitulation) $ I, IO()
!Ir~..___ _ __._:_ ___..4_...l :_.........-i........J..i;~:,...........I^h........+.........+"h.....'"''''............ro;-,-.....\
SCHEDULE F
JOINTLY-OWNED PROPERTY
c:: r,M/,~.!t';',.r~~:~J"'-H C'F PENNS'"Vj...NL~
i .:~>: R~:r,/;;,t,;
~~':;;:';;""::'7:=~-:~~J..l~ii=-,J[:'.1:2tL'_
ESTATE OF ----
_.___~_~ /l;'l.fe" N J~
FILE NUMBER
I
~
- - - .E't"TE-R--r- --:;:.:r-;: d~T"-'---._-~"_.._--'------
'lei: ! CCG,;:'il;' I/~D'C I',~, .',~ " " ,>" "DESCRIPC-IONOFPRCPERTY I - ----,
'1/81-1 I --'1 _ , ", "lli ~e,c..~'"~~lc_.:'6.',,c,~rd,ancdl'f1S111L:r()parrcbankaccOJn'nLmberorslmlla'lcenl,tln(',"~be' '\tlach f ,'Te' C 't' L II -~""
'':..:.,_~:._+,_"t'r''H ;__ _"'H,_,,_i_~:~lfAn"f-,el rea,estate " ~'" ,~.' c ~ LJ Po ,- ~.E::.( _l~
, 5'1 ' -' --.--- i""uELFASSE', It CRee,
, " /11(." '1 ! RES I oE:: Ai c' E. ....; It} /) ft;..LJ.1, t=.-E 1/ i! J II ;:---- - --.--- ' : -::
I1'I~eH-AIv'I{-S i3uf).c- P!::t I ~/L', CJ,Ctd :;2J%
I
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I
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P liS Tt:.'I2I<~ "'I c 1-1
If an asset was made joint within one year of the decedent's date of death it m st be rted
,________ ___, _.,_____ ' u repo on Schedule G.
/t,~,~ -,. ".;Ard'~:;i \J;',\~F
ADDRESS
....l,
"11'7 P Ii u',~Jr:E j;J 12.1 uf-
fY1E<:HflNIC.sBLl/16-' Ph
/ I' tIS ~;>
/Y) Pt RyE L-I-E rJ
'n
,. ASTC> 12 KtJ v'1 C rl
8
JC:i~; TL{J)v',Nf:C) PFOPERTY
.1.
f4
t;/
"#'11'
II!:::I..,T ~ 1'-<- Y S ro<..;';
32<1 G'JJ>
5HI1 RES
3
It
fliRLI
19 S'i/"
/5;- F ('~i{
/-J):.
//7~Z/" ,- fV)EIVli3ERS
-1.
/1
eft ~Ly' I
IfRt1s t
I
/67-- F (~l(
/fiC
;23;J./1-
MEfI'1l3t-f2S
s'
f}
,
I
I
VI'RIN.5! r (J j~ tt: , ii';2, f.
! II ~- /l1 5'
-I 9ae'J
IhJel5E /'tt:Ji.. D
'1' ,N}J.s'L
I
_____....L.__,
; i
..__.__,l,.._._"__~_
TOTAL (Also enter on line 6, Recapitu!ation)
:___.....l _-1..1:..:___1 _L.__.._ _I...L.._ _____ -;--'
.,S~ %
62) '-%
I !
! AI:' q
I"~ Ie
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r :~,-'1 /"0
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Rf.,"'"
lv /' r E
IC~: c.'C'C
9, 6-// .
f?, /,.rtb
7' .::.1" <") Y.
~ / 7" 5c)
I
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$ /2~ 7/,:;-
ITEM
NUMBER
1.
;<[\,1 '5'i: :<':;,-.. ;1-97;
COMMONWEAL T H OF PENNSYLVANIA,
INHERiTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STEfJ/lJ:N J.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
Pf1{Jr~) R.. K LJ // I C t-I
FILE NUMBER
This schedule must be completed and filed if the answer to any of questiofls 1 through 4 on the reverse side of the REV.1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
. .'l 't,.\],E O!- - .t~ rH~lR RE:lA,~ ONSf-;;P T;) ::IFCF:::F,"'T M.) "i,..lE O/l.7E <-:;.: TRAIlSFER
JF"" -IE CEEC F(lK ~rAL fS~ATr
1'.5 M I r J-I 5", R N 2 Y .;rJl A'- 1~~ ~ &, 7-:;"/t.. / -'1-31.
/Y1 fl P. -I E J..J-r. N P /+ 5Te K K~ ~'/ui - il..! / {= E
/<21-0(;
..<
1<. P /1-1 6' LI_ P (~O ,;d
m f<.. ~ y ~ U-c. rJ
-.5-:' ,2- () "
/! 11 5TC.' /2. h,1 ,,' /C H
~ U,.' 1Ft:.
3.
I~ '" . '- n A /" ,-'Iv' ,et) 11.'\J rJ /..1 i ry
1,,'). '~' '"' .' be'.' n T ;:" J'_ IV :, ~
t. kL' /I'/Ir, .'i../ ( ......
/y)/tRY E LL~N 7ft.';;n/2.r(iJ ~;C.:rI - b-/FE
/ - de - c.; ~
DATE OF DEATH
VALUE OF ASSET
/.5 ,::1.3 'J
3L, I, 3t1.
/1 /qff
,
%OF
DECO'S
iNTEREST
EXCLUSION
:..Pp',--Cl,B:. ~.
/6;":/.-') 7.
::>,.1, 3t:: 9
/ I, /4 t?
TAX.A.BLE VI
tv.:1Vi:
.\; 0 ''J r.:
V (, 'L:~'
TOTAL (Also enter on line 7, Recapitulation) $ I\JC ,'1/ E-
COMMONWEALTH OF PENNSYLVANIA
INHE''{ITANCE TAX RETURN
HESd)ENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
!
i
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I
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I
L
REV.1511 EX- ('299)
C;. 6- .,,,\
..l";,:;1. :'I'~
rr".,WJi .',.
.'" :;.~d'>>;
ESTATE OF FILE NUMBER
,$.I_E ~II ~f"___X:_[jL,':2'...TOK tltf ~IIC H
Debts of decedent must be reported on Schedule I.
--TTEI>;,----r - --- -----
~llMB~~
A ! FUNERAL EXPENSES:
N i- ILL F V 'v' EP.A '- ;-+D /l'1 E.
CAmP H't-.L., P/J
=r-~-:~c::~
I /. 'J. 3 7'2
I
DESCRIPTION
1.
LeE.:,;- srr '" i~E: t~ L+<.,:S
~. (,,' ,-,j (.:...~ n c' <.:: '"
/ I (.., <},!;J -
() i-t rE ,-' F H c' f"t "F- iii (f F" ,vI E. TEn y .- /Yl 1'1 t1 t< E" ~2 ./-- m E fr.'::"1 R I If J_
i3 ;: IIi ( ,-I
7~, ...!), /~?
I T- .
I (-{ t:::
I
I
(~ F-' "" D & r-J ..:~ If~: /;
F L.. n [,J (~-P. S
_-1'--<7:
B.
ADMiNISTRATIVE COSTS:
i\j C.l of;. /~
Personal Representative's Commissions
Name of Persona! Representallve(s)
Social Security Number(s)'EIN Number of Personal Representative(s)
Street Address
City
State _____. Zip
Year(s) Commission Paid:
2
Attorney Fees
;\~ .:...., ..\/ ~"(
3.
Family Exemption (If decedent's address's not the same as claimant's. attach explanation)
i ,\;,' tv '0::
Claimant
Street Address
City _..._
State____ Zip
Relationship of Claimant to Decedent
4
Probate Fees
r\),~i\iC
5
I
I
I
I
I
I
!
IR- - 'C .y;:;-A
i . t:. 6/,;] 71.-- "'-
Tax Return Preparer"s Fees
N (,,,1 E
Accountant's Fees
IN/-AleC
I
i
6
7
L';.r U-'Il-/-.'.,
(: o,..,\BE {J. i. AND
{ie;
/::'J .
---_._._---~._~,..~--
I
I
-I
TOTAL (Also enter on line 9, Recapitulation) I s If: '</3,<5'.
,
(If more soace IS needed. Inserl additional sheets of the same size)
Kr\,i- Ff. t' " 2-G~)
~'
C>. ...-,
1~;_ ;9~
~()~"\M}()!\j'/':'E;\LTH r)F PEr~~.,SYL\/?N','::'
NHFRTN"CE""X RETUR\j
K[~SiDE~'r DECEDEN-r
SCHEDULE I
DEBTS OF DECEDENT, i
MORTGAGE LIABILITIES, & LIENS!
_ _ L-
ESTATE OF
..5'T E P 1i,FJ\/
J PI1'j'TL?~KO 1/ {CfI
FILE NUMBER
Report debts Incurred by the decedent prior 10 death which remained unpaid as of the dale of dealh. including unreimbursed medical expenses
. "---'''. --..------. .. "" - -.~..-.- -----...- --~--'-"-"-"---'
'TE\'I './1\cUE ,AT D.ATf
NUMBER DESCRiPTiON OF OEA-'-H
NGPHfLOL.<.)('..--'/ ASStJCiAT,E<:i
2.
OAQ..\)ID,-G6Y
A- .':'; So '--- ; f'r T E s
3
PAI..-l.)LO .~Cl%
;-I A 1"1 {\ [) E 11.../ b'EU' E 12. - -"" L: %
Aj,
j-,
v;s ft- -f:>LJ~
(!O IY'I C f\ S T - ..6 0 %,
/' {) V-- L . ~ V "k
r /::-fl r 2 0'\1- ,~t:: %
{;
7
Ji,
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I
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--~-,-
TOTAL (Also enter on line 10, Recapitulation)
:1' wore spaCE is needed Insert add,:ional s'eets of the Siill'e size)
;l/9,
7~"'._
30
~2
/,z A
~:l.3 '
/23
I 1,
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$ I
I
_..-L____
.5b 7.
Shareowner Services
PO Box 64874
81. Paul, Minnesota 55164-0874
Toll-Free Phone: (800) 468-9716
Phone: (651) 450-4064
FAX: (651) 450-4033
www.wellsfargo.com/sha reownerservices
March 14, 2006
MARY ELLEN PASTOR KOVICH
419 PAWNEE DR
MECHANICSBURG PA 17050-2547
Re: FmancmlConfirmailon
Account Number: 3200330227
Registration: STEPHEN J PASTORKOVICH & MARY ELLEN PASTORKOVICH JT
TEN
Creation Date: 07/29/1999
Issue Name of Stock: ELI LILLY AND COMPANY
Total Share Balance on 01/10/2006: 324.698 shares
Certificate Shares: 80 shares
DRS/Book Entry Shares: 0 shares
Dividend Reinvestment Plan Shares: 244.698 shares
Dividend Amount Paid for: $ 129.88
Dividend Rate: OAO
Closing Price per Share on 01/10/2006: $ 58.18
Ticker Symbol for the Company is: LL Y
It is exchanged or traded on: NYSE
Signature of
CFatricia Sik,prskj
Shareholder Relations Specialist
Wells Fargo Shareowner Services
r/'----.--..-~'\
: '( u I ,
. i
)
Walston e,.-CO.
Inc.
T7 WATER STREET, NEW YORK, N.Y. 10005 (112) 4374W
N'ffJHR'; /'.Jfh ''':)~k: qO(r: rxCHA"J("f
A>..J0:)!HH ;>R:>NCWt< ::rO~:K I.ht:- C(J,~!,,'o1(;[;,P (Xr>..t,:.
Ovt:R tOO OffICES COAST TO COAST
PRICE
'Nt.-~'(:''''~ ^" YOUi' .AGPeJf UNLESS OH.:HWi$E SPECiF'EO
'KfClU)W!NC iiANSACi'ON IU8JECT TO rHE AGRf[MENT
(m:> rw.i~ ON 'HE REVERSE S!~[ HEREOF
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STATIO TAX
NE"': ,.\MC;>'.,_;-'\IY
P VI ::. j'>, .;
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.-"- v ' ~;.4."!L
Pi~SI()HiCt'Vl('H t.
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.25 I 3.0Ll ....J. .L....
E:VERSE SlOE ---_/~---_.-_...._--_._---_..
~~~;;.;-;',~~;".~~=~
"-+
f~'; s~' '\... f'
lL') Ur,
t'4
l Cr:.;
\YN 1014
()N OTHER THAI'\..! ROUND LOTS IUSUALLY 100 SHARES' ON ALL EXCHANGES AN AMOUNT IS A.DDED TO THE f"r;>\(_:L ON P
DEOUCTED ON Sfl.LES ON THE NEW YOR>' STOCi< EXCHANGE THIS AMOUNT IS 2_~(. PER SHARE COR STOCi-<S SE..LL,f"<'(;
''\NC) 12 f'FR SHARF FOR STO(:KS SELLING BELOW l~ ALL. OTHER (':A5F.;:;A,"l EXPLA"'JATIOI"J '\'')It.1. FH Ro':'nf".
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Primary Owner:
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
MONEY MANAGEMENT ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
fvl~
MEMBERS 1st
FEDERALCRFDTT UNION
Stephen J. Pastorkovich
117216 -00
10/11/1990
$591.96
$.15
$592.11
Mary Ellen Pastorkovich
10/11/1990
117216 -05
08/16/2001
$15,712.15
$6.74
$15,718.89
Mary Ellen Pastorkovich
08/16/2001
Mf,~ M,BE,. RS ;:: FEf,ERAL CREDIT UNION
&~~4/( U I()~y{
Denise A. Wolfe /
Insurance Services Supervisor
March 10, 2006
Estate of: STEPHEN J. PASTORKOVICH
Date of Death: 01/10/2006
Social Security Number: 209-22-5588
SO( H) I ,()Ui~L' [)rivc . PC)' Box 4() . Mechani,:sbur~. Pennsylvania J 7055 . (717) (,')7-1 1(,1 . \\\\',V.111l'l11 her, 1 st.
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Address: 419 Pawnee Dnve
. IMechaniCSburg'
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419 Pawnee Dr
Sale Date:
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Mechanicsburg, PA. 17050-254
Price: $
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Your Estimated Value Range:
$217,375 To $252,625
Estimate 10: 11570 Estimate Date: 3/212006 6:58:50 PM
II
I. - ---..~1"",,""^i- ,",runl1nTh"/Mp.mher~ 1.asDx?lk=1 00-200... 3/2/2006
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419 PawneeOcMec;:bi!niCSbl.JrQ, PA 17050
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@ 2006 NAVTEQ I @ 2006 GlooeXplorer and Suppliers
# Address Home BR BA Market Home Lot (sq
Type Value (sq ft) ft)
Mise $206,910 13,068
Year
Built
Date
Sold
419
Pawnee
Dr
@ 2006 Zillow.eom, All Rights Reserved
No. l.4-PA, DEED----- F)'Oln a Corpo!'(JUon
WM. G. SCHL;i:CHTER, Printing, 540 l-frrrni.l.ton S/:,. Alle'tttC'\l.'H. Pa. 18101
This Indenture,
2 ~ "',~ '-:::::Z
Made the ,Ia'lf n r
in the year of our Lord nnn t!rlil/sand iiLI" hundr d and
1969
sixty-nine (1969)
,lBtt\.\1ttn REALTY ~m~PANY OF PENNSYLVANIA, A Pennsylvania Corporation having
its principal place of business in Allentown, Lehigh County, Pennsylvania,
hereinafter sometimec; called "Grantor",
AND
STEPHEN J. PASTORKOVrcHand 11ARYELLEN PASTORKOVICll his wife, hereinafter called
"Grantees".
~itntsstth, Tlwt the said parti! the first pa1't, for and in considerat'ion of the sum
of SIX. THOUSAND ------.---------------------------------------------------------
______________________________________________________--- ($ 6,000.00 ) Dol/a1's
unto it well and truly 1)0.1" liy the Bnid ies of the second part, at or before the sealing and
delivery of these present::, the /f:lwreof is hereby acknowledged, has granted, bargained,
sold, aliened, enfeojJed, rp!cn.'wd. conrc!fol and confirmed, and by these presents does grant,
lmrgain, sell, alien, enfciJ!r. rclcllsP. conN:'Y nnd confirm, unto the said parties of the second
part;, their heirs and lissl!!!?:), forever:
2111 situated in Hampden Township, Cumberland County,Pennsylvani
That certain lot or tract of land/known and designated as Lot No 10,
Block G of Plan No. 2 of Indian Creek as prepared by D. P. Raffensperger,
Registered Survevor, dated Februarv 11, ~969 and filed in the Recorder of
De~ds Office of Cumberland Countv on 11<;/ 1:( /77 i in Plan Book f I
Page /.~
BEGINNING at a Doint on the West side of Pawnee Drive, said point being
a distance of 510 feet South of the intersection of the West side of Pawnee
Drive and the South side of Osa~e Wav, thence by the West side of Pawnee Drive
by a curve to the ril'1ht havinp: a raclius of 870 feet an arc length of 93 feet
to a point at the line of Lot No 9, Plan No.1 Indian Creek, thence by same
North 70 degrees 34' 57" \.1 a distance of 150 feet to a point at land of REALTY
COMPANY OF PENNSYLVANIA, thence bv same N. 16 degrees 21' 18" E, a distance of
76.93 feet to a point at line of Lot No. 11, thence by same S. 76 degrees 42'
26" E. a distance of 150 feet to a noint the place of beginning.
BEING PART OF THE SM~r: PEE/USES which EUGENE E. SWEITZER and JOANN his
wife, by their deed dated ,Januarv 30, 1964, and recorded in the Office of the
Recorder of Deeds of Cumberland Countv in Deed Book C21, Page 341, granted and
conveyed unto REALTY Cm1PANY OF PENNSYLVANIA, grantor herein. See also deed
of Loy T. Hempt and MarRaret P. Hempt, his wife, dated January 30,
1964 and recorded in the Cumberland County Recorder of Deeds Office
in Deed Book "C", Volume 21, Page 247, granted and conveyed unto
Realty Company of Pennsvlvania.
/.'., ( ;' . "I '
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School Did. Cumbo (A'I Pa.
I % Real Estate T rander Tax
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BOO~ . 2~3PAGE 608
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=
~ogrthc:r with all (J Iill pinguln.r UU3 improvements, ways, waters,
water courses, 'riuhh, liherties, ]!ril'ileges, hereditaments and appurtenances whatsoever thereunto
l>elonfJinf], or in 0:1 (l.ppertainiu,f/, and the reversions and remainders, rents, issues and profits
thereof; and all he eslate. 'rigid, h'tle, interest, property, claim and demand whatsoe1'er of the
said l)ar!y of the 6rsi 1)(11'1, 'its successors and assigns, in law, equity 01' otherwise, howsoever,
of, in and to the ,qrune, and every IJart thereof.
1[0 haur and to hold the said
hereditaments and
jJrenuses hereby !l1'I.mted or IneJitioned, and intended so to be, with the appurtenances, unto the
said part (I the second llnTt, heirs and assigns, to a'frd for the only })1"oper use
and behoof of the ,wid purl
of the second part,
heirs and assigns, forc\1cr
2lnd the said party of the fi]'.')! purt, for itself and its successors, does by these presents
covenant, grant awl au ree II! awl with the said pa].t of the second pa,]'t,
hei]'s curd assigns, tludit, the said party of the first part, and its successors, all and singul.ar the
hereditaments and jJre II//i.~es Ii (;reinalJOl1e described and granted, or I1wntioned, and intended so to
be, with the appurtenances, Ullto Ihe 8fLid part of the second part, heirs and
assigns, against it, the said party the first part and its successors, and against aU and C'very
other person or per.sons IOhon780el'er, lawfully claiming or to claim the same, or any part thereof,
shall and \Dill fl)arrant and forE\1rr 'Bcfrnd
The said Grantor, REALTY COivlPANY OF PENNSYLVANIA , the
said party of the finl}wrt, cloth hereby constit'u,te and appoint R. HERRITT KNOLL __________
--------------------------------------------- to be its attorney, for it and in its name,
and as and for its cOI'purate nct nnd deed, to acknowledge this Indenture before any TJerson
having auth01'ity I>y the In IUS uf the Cmmnonwealth of Pennsylvania to take such acknowledg-
ment,... tllt. JliIllJ1t1.e:n.t ;t,ll;"1l t.l:L.r::.. .utllK lYi.J1JL }j~_firdJJ_ r:~.l .d1:.4.
---..x.&'bB-D~BiJ...NJ...JIS$fLcl(i..1/:j~_'iijS:4.14'J_EiJ':1'tJ;tJ.4-8.-'J!::{jfJ;Bhti.i~~t.1Iu~.B..fitf:dyj at Bi, {Jet3)'S 8{ t,11,O Jiffyty
21..1 ~ g, ...fi: it. j:gILri..l1l:Y.:-4tf!~~g~t 51- Y;/.~!i tiE II- tI~j?.1"iE.i .El1J!Jl J}lJJ_/..!j J LIl:.'_l!J L :,.'i J ~ ~
ddY af 79
lIn ~itntss irulhcrcof, REALTY Cm1PANY OF PENNSYLVANIA,
the said party of the fi?'st pair!. hU8 caused these presents to be signed by its President or a
Vice President, and its COfl)OTnte seal to be hereunto affixed, duly attested by its Secretary or
an Assi$tant Secretar!!, the day andyenr first above written.
'i,'\'{ Or- p;' . ' REALTY COMPANY OF PENNSYLVANIA
,,0." _....
('.,~rfE'S)T,,:'1:..~.: By:
') : .::.,' . ':-' , (, ') '-(1. ./-) /7') / . .,
_ . -.. ~'f~ ~;:y~ );;:IQJLQ__. \-.-,7!1J~"<.\!hy;~;a~~(
~"~,,'(Ass..j,s~nt Secretary B. R. Hartman
, '. ,(. ~. ,A. V' ........ . d t
/~ . "ts\, L'1.~.'~',..~~" lee LL'eSl en
..:"'.~I .... ....,. "'1\ "
Q:o mmonttl tal th of ~rnnslll\1ania { ss..'
(tount~ of LEHIGH )"
.,~'
I HEREBY CERTIFY that on tlds -<.'1 day of />4;;;--
A.D. 1.9 69 , before me, the 3u!)scrilwl', a Notary Public in and for said ComrKonwealth and
County, personally appeared R. r.1ERRITT KNOLL ----------___________________________.,
the attorney named in the f()re!fm~ng Tndcntu1'e, and by virtue and in pUTsuance of the authority
therein conferred upon him, acknowledged the said INDENTURE to be the act and deed of the
said REALTY COMPANY or PENNSYLVANIA to the intent
that the same may be duhl recorded, ."0"" , ..{ !, ",
.' .....'G.\;.";. 'd JJ.,'~
" :\~ ".".. .~WJA"~,.
~itnc.ss my hand nnd noton:al seal the day and year aforesaid. i,.0~ ,.'-:~~l ~H ".... q;~'io~,
kf~l~~: - .'.~"
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MY COM~SION EXPIRES.. ..IdO'\.'~p..\:,.:' ~. ..\.s:,-: "-
.~ ,.{1I-y','_ f',USl,:""'"
...If,enk';',r; ; 1,','. '" .,' ""
:8 iR.crtb~ ([crtify thl! t the precise (I ddress of the grantee herei1fti~iSSj'O~e~;rB~);~:'6 P&. _
te., '2 GLENWOOD j(O,4.D ('At1IIP fi/u.. p"" /7(J11 __ ';~
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PAGE 1
SMITH BARNEY ....
cltlgroup J
P.O. BOX 12057
11 N 3RD ST-2ND FL
HARRISBURG PA 17101
I,,, III" ,III,,, ,1,1,11'11"1,1,1.1,.1,, 11.,.1.,,111.1.,1,1,.1
ifU MR STEPHEN J PASTOR KOVICH
CGM IRA CUSTODIAN
419 PAWNEE DRIVE
MECHANICSBURG PA 17050-2547
Branch Manager:
RICHARD J. CONWAY
Branch Telephone:
717 -78()"1700
Account Number:
724-67396
Dear Client:
For your protection, It Is our polley to confirm the transfer of assets from your account as
directed by your written instructions.
The following transfers were made on 01/27/06 from your Account referenced above to the
account identified below:
Account Number & Name Qty/Amount Security Description
724-67686
''''~ MARY ElLEN PASTORKOVICH
COM IRA CUSTODIAN
419 PAWNEE DRIVE
MECHANICSBURO PA 17050-2547
$569.19
1,000
3,975
250
DRUG EMPORIUM INC
RITE AID CORP
SAFETY KLEEN CORP NEW
Please review the Information carefully. If the transaction is correct, no further action is
necessary. If you have any questions regarding this transaction, please contact your Branch
Manager promptly by phone.
Very truly yours,
~v~
Horace Derrick
Director
CMB NA Management
SMITH BARNEY...
c.t.groupJ
March 17,2006
Mrs. MaryEllen Pastorkovich
419 Pawnee Drive
Mechanicsburg, P A 17050
RE: Stephen .J. Pastorkovich - IRA Account
Account #724-67396-1-4-364
Dear Mrs. Pastorkovich:
Listed below are the date of death prices as of 1/10/2006 for your husband's IRA account:
Quantity Description of security Price as of 1/10/06 Value as of 1/10/06
1000 Drug Emporium Inc. No Price -0-
3975 Rite Aid Corporation S3.69 $14,667.75
250 Safety Kleen Corp New No Price -0-
$569.37 Band Deposit Program $1.00 $569.37
Total Value of Account $15,237.12
If you have any questions, please do not hesitate to contact me at 717-780-1751.
!J'~:: (Y) lfl,jjt~?f~-
Ann M. Dunkelberger (j
Senior Client Service Associate
lamd
The inllJrll1ation Illnlished ahove has beL'Jl obtained from what we consider to be reliable sources but no guarantee j,; made with
respect to accuracy.
Citigroup Global Markets Inc. 11 North 3rd Street. 2nd Floor Harrisburg. PA 17101 Tel 717 7RO 1700 Fax 7172332090 Toll Free ROO 2.'\7 1700
L~
KPMG LLP
Three Chestnut Ridge Road
Montvale, NJ 07645-0435
Telephone 201 307 7000
Fax 201 9308617
Internet wwvv.us.kpmg.co'T"
March 6, 2006
Mrs. Mary Ellen Pastorkovich
419 Pawnee Drive
Mechanicsburg, PA 17050-2547
RE: Benefits under KPMG Pension and Savings Plans
Dear Mrs. Pastorkovich:
On behalf of the staff who work on the KPMG Pension and Savings Plans, I would like to express our
sincere condolences on the passing of your spouse, Stephen.
Information regarding his retirement accounts are detailed below. He has a benefit under the following
KPMG plans: 1:'"\';" ,f De H'J.>'\'\{
..It".,' u'- .'
401(k) Plan
Estimated Lump Sum Amount*
$ 364,141.69
li
') '"' \ 2.. '..,: ,~ . I
''''j \..,.",...-
'" Your actual lump sum amount will be based upon your account balance as of the valuation date
following the date your election is received by the Pension Department.
The provisions of the Internal Revenue Code with respect to the tax treatment of retirement plan
distributions are extremely complex. Please carefully read the enclosed Special Tax Notice
Regarding KPMG Plan Payments and review it with your tax advisor. Please pay particular
attention to Section IV. "Surviving Spouses, Alternate Payees, and Other Beneficiaries".
Please return the enclosed to my attention at KPMG LLP, 3 Chestnut Ridge Road, Montvale, NJ 07645,
A TTN: Pension Department, SLDG 3-2.
401 (k) Plan Forms
. 401 (k) Plan Designated Beneficiary Distribution/Election Form
Request for Required Document:
. Copy of your birth certificate or other proof of age (i.e. copy of your driver's license. current passport,
or baptismal certificate)
If you have any questions, please call the Pension Department at (201) 307-8220.
Very truly yours,
KPMG LLP
" :: .- { /7 I" c t Fe
"
Kathy Mellish
Manager, Retirement and Savings Plans
Enclosure
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