HomeMy WebLinkAbout07-11-06
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of Weisz, Rose B.
, Deceased
No. 21 - 06 - 00507
Date of Death 4/15/2006
Social Security No. 198-01-9601
also known as
Barbara L. Bookwalter
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. I/We verify that the statements made in this Inventory are true
and correct. I/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.
Personal Representative
Signature: X. '/2I1AJM.J..A ~ id~
Barbara L. Bookw r
Signature:
Attorney:
E. Garrett Gummer, III
I.D. No.:
43189
Signature:
Address:
1260 Bustleton Pike
Feasterville, PA 19053
Address: 103 Channel Drive
Carlisle, PA 17013
Telephone: 215/396-1001
Telephone: 717-249-4906
Dated:
I~ s: ~t){)&
Personal Property
Sears Holding Corporation, 1,304 shares @ $50.00/share
65,200.00
Citizens Bank, money market account 621099-029-4
5,561.52
Allstate Homeowners Insurance, refund
C2
!.....;) 73.00
C':;:)
~ . I ;=g~
3,110;Ga--:>
-', (~)
- ::,j
j J
m7S'1
I C::::J
United Church of Christ Homes, refund
AT&T, refund
I
I
Total Personal Property:
\ c.-)
30:5~~
("--)
-- ''1'1
~3,986;68:;?,
-.J
PGW, refund
(Attach additional sheets if necessary) Total Personal Property and Real Estate
$73,986.68
REV. 1100 EX + ll.ot)
.
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
RLE NUMBER
21 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00507
NUMBER
~ .
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
-----
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Weisz, Rose B.
DATE OF DEATH (MM-DD-YEAR)
...
z
W
Q
W
&l
Q
DATE OF BIRTH (MM-DD-YEAR)
04/15/2006
10/09/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( lAST, FIRST AND MIDDLE INITIAL)
~.~ 1. Original Return
W I
:0: ~ III 0 4. Limited Estate
uii!:o:
!l!~9 fgI
u Go III IICII
~
6. Decedent Died Testate (Attach copy
of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o
o
o
4a. Future Interest Compromise (date of deeth after
12-12-82)
7. Decedent Maintained a Living Trust (Attech
copy of Trust)
10. Spousal Poverty Credit (date of deeth between
12-31-91 and 1-1-95
o 3. Remainder Retum (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
OFFiCIAL USE ONLY
I
198-01-9601
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
!hIE
Il!:!l
g:z
8~ I
~EPHONE NUMBER
~~ 215/396-1001
I 1. Real Estate (Schedule A)
I 2. Stocks and Bonds (Schedule B)
I
I
I 4. Mortgages & Notes Receivable (Schedule D)
i
I
I
I
3. Closely Held Corporation, Partnership or Sole-Proprietorship
z
o
>=
:5
~
ii:
~
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Deeedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
1260 Bustleton Pike
Feasterville, PA 19053
(1 ) None
(2) 65,200.00
(3) None
(4) None
(5) 8,786.68
(6) 87,898.80
(7) 100,627.17
(9) 13,661.49
(10) 1,787.00
OFFICIAL USE ONLY
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(8)
262,512.65
(11)
15,448.49
247,064.16
(12)
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(13)
(14)
247,064.16
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 247,064.16 .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
>=
~
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Go 17.Amount of Line 14 taxable at sibling rate x .12 (17)
:Ii
0
u
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
11,117.89
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
11,117.89
Copyright 2000 fonn software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STkEET ADDRESS
1000 West South Street
CITY
Carlisle
I STATE PA
IZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditS/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
11,117.89
555.89
Total Credits (A + B + C) (2)
555.89
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPAYMENT.
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 theT AX DUE
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE.
(3) 0.00
(4)
(5) 10,562.00
(5A)
(5B) 10,562.00
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;............................................................................. ~ ~
~: ~:::~ ~~e~~~i~~~~s:~;;~s~~~. ~~~.I.I. ~~~ .~~~ .:.~~:.~~. ~.~~.~.~~~~~.~. .~.~ .i~~ .~~.~:~~ ~........~....~..~ ~.'.'~::::::::::::::: ~~.
d. receive the promise for life of either payments, benefits or careL........................................................
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.?....... ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?................................................................................................................ 0 ~
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 pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correcl and complete. Declaration
preparer other than the personal representative is based on all information of which preperer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Barb ra L. Bookwal er
'1-'
DATE
ADDRESS
103 Channel Drive
Carlisle,_~~7()_!~___ __u_______~4..Jt>tJto-
o (J DAlE
SIGNATURE OF PREPARER OTH
E. Garrett Gummer, III
ADDRESS
DATE
1260 Bustleton Pike
Feasterville, PA 19053
I 10 o(P
For dates of death on or after July 1, 1994 and before anuary 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P .5. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. ~9116 (a) (1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (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.
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF W' R B
elSZ, ose .
I FILE NUMBER
21 - 06 - 00507
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
I Sears Holding Corporation, 1,304 shares @ $50.00/share 50 65,200.00
TOTAL (Also enter on line 2, Recapitulation) 65,200.00
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF W' R B
elsz, ose .
I FILE NUMBER
21 - 06 - 00507
Include the proceeds of litigation and the date the proceeds were received by the estatelll property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Citizens Bank, money market account 621099-029-4 5,561.52
2 Allstate Homeowners Insurance, refund 73.00
3 United Church of Christ Homes, refund 3,110.83
4 AT&T, refund 10.78
5 PGW, refund 30.55
TOTAL (Also enter on Line 5, Recapitulation)
8,786.68
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weisz, Rose B.
I FILE NUMBER
21 - 06 - 00507
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 Louise Jost
1935 Sterrett's Gap Avenue
Carlisle, PA 17013
Sister
B Barbara L. Bookwalter
103 Channel Drive
Carlisle, PA 17013
Daughter
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM LETTER DATE Include name of financial institution and bank account number DATE OF DEATH
NUMBER FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET DECO'S VALUE OF
TENANT JOINT estate. INTERESl DECEDENT'S INTEREST
1 A 01/2005 Citizens Bank checking account 610389-603-0 5,897.60 50% 2,948.80
2 A 01/11/2006 Real estate located at 1935 Sterrett's Gap Avenue, 169,900.00 50% 84,950.00
Carlisle, P A *
3 *Purchased with proceeds from sale of real estate
owned jointly since 2003
TOTAL (Also enter on line 6, Recapitulation) 87,898.80
.w
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weisz, Rose B.
FILE NUMBER
21 - 06 - 00507
This schedule must be completed and lied i the answer to any of questions 1 throu~ h 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF
NUMBER Include the name of the trensferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE
Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE)
1 Allstate securities, 604 shares redeemed at $53.686/share 32,426.48 100% 6,000.00 26,426.48
and gifted to daughter and son-in-law, Barbara & Ronald
Bookwalter on 1/17/06
2 Morgan Stanley securities, 1016 shares redeemed at 53,309.52 100% 6,000.00 47,309.52
$52.47/share and gifted to daughter and son-in-law, Barbara
& Ronald Bookwalter on 6/27/05
3 Monetary gift to daughter, Barbara L. Bookwalter, 4/26/05 6,000.00 100% 6,000.00
4 Monetary gift to daughter, Barbara L. Bookwalter, 5/24/05 6,000.00 100% 6,000.00
5 Monetary gift to daughter, Barbara L. Bookwalter, 6/27/06 6,000.00 100% 6,000.00
6 Citizens Bank CD 6145-722207, titled Rose Barbara Weisz 8,891.17 100% 8,891.17
in trust for Barbara L. Bookwalter
I
TOTAL (Also enter on line 7, Recapitulation) 100,627.17
fi f
.
SCI-EDU.E H
RN:RAL.EXPENSES&
ADNINSTRAllVECOSlS
COMMONWEALTH OF PENNSYLVANIA
INHERIT ANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weisz, Rose B.
I FILE NUMBER
21 - 06 - 00507
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
I Hoffman-Roth Funeral Home, Inc. 9,743.86
2 Cartledge, Gallagher, Stefan Memorials, inscription 230.00
3 Olive Garden Restaurant, funeral luncheon 222.63
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
,
I Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees E. Garrett Gummer, III, Esquire 3,000.00
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 Register of Wills of Cumberland County 173.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
I William J. Mansfield, legal advertising 292.00
TOTAL (Also enter on line 9, Recapitulation) 13,661.49
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF W' R B
elSZ, ose .
I FILE NUMBER
21 - 06 - 00507
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
1,787.00
Pennsylvania Department of Revenue, underpayment of2005 income tax
TOTAL (Also enter on Line 10, Recapitulation)
1,787.00
REV-1513 EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weisz, Rose B.
I FILE NUMBER
21 - 06 - 00507
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
nn Nnt I
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Barbara L. Bookwalter daughter entire estate
103 Channel Drive
Carlisle, P A 17013
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee t
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 SHEE
HIOo.FOo REV 1100
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Lo~al Regi~trar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
'5.\.'_~ ~~~~
Local Registrar
Fee for this certificate, $6.00
p
12535002
APR 1 8 2006
Date
H105.143 Rev. 010W
TYPU'RIIIT ..
PEAlIAIISlf
BLACK INK
1......0I_(fiII._.1uI)
Rose B. Weisz,.
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE ALE NUMBER
3. Soclol Socu<ly N..-
0_ 00lh0r. .
1G.Rlct:Amlriclnlndiln.Bllck.wtlle.li:.
(Sj>oo\\! White
CoIogo ('" or &.)
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lliI~"
U....du 17c. 0 Y.,OecadInl~1n
TOWI1Ih\I?
T...
'7d.i' :;'~oIlIIId-
Carlisle
Cly!llooo
John Jost
19. MolhIr'.NI""(Fnt.niddII,nIIiIIn
Barbara Heine
201>. ~..........-.;-(SItooI.~....".Z\I-)
2Ol. Intwll'ul'I HlmI (Type.lprinQ
Barbara L. Bookwalter
103 Channel Drive, Carlisle, PA 17013
fil
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1IedIcaI.....-...ollo_
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(See Instructions and examples on reverse)
32d. 1inI 01 Injury
.
LAST WILL AND TESTAMENT OF
ROSE B. WEISZ
I, ROSE B. WEISZ, of Philadelphia, Pennsylvania, being of full age, of sound
mind and memory, and under no restraint, do make, publish and declare this to be my
Last Will and Testament, and hereby revoke all Wills and Codicils ever before made by
me.
FIRST:
I direct my Executrix to pay all of the expenses of my last Illness, of
my funeral and burial and of the administration of my estate.
SECOND: I direct my Executrix to pay all inheritance, estate, transfer and
similar taxes (including interest and penalties) assessed or payable by reason of my
death on any property or interest in property which is included in my estate for the
purpose of computing taxes. My Executrix shall not require any beneficiary under this
Will to reimburse my estate for taxes paid on property passing under the terms of this
Will.
THIRD:
give, devise and bequeath my entire estate, whether real,
personal or mixed, of whatsoever kind, nature and description and wheresoever situate,
which I may own or hereafter acquire, or have the right to dispose of at the time of my
death, by power of appointment or otherwise, to my daughter, BARBARA LOUISE
BOOKWALTER, of Carlisle, PA.
Should my daughter predecease me or not survive me by thirty (30) days,
then I leave my entire estate to her issue, per stirpes.
y~~.~~
ROSE B. WEISZ
1
FOURTH: I nominate, constitute and appoint my daughter, BARBARA
LOUISE BOOKWALTER, of Carlisle, PA, as Executrix of this, my Last Will and
Testament. If she shall be unable to serve, for whatever reason, I appoint my grandson,
SCOTT R. BOOKWALTER, of Ellicott City, MD, to serve in her stead. I direct that my
personal representatives shall not be required to enter security in this or any jurisdiction
in which they may act.
FIFTH:
In addition to the powers conferred upon my Executrix by law, she
shall also have the authority, without any Court Order or proceeding:
(a) To sell, pursuant to option or otherwise, at publiC or private sale
and upon such terms as such Executrix shall deem best, any real or personal property
belonging to my estate, without regard to the necessity of such sale for the purpose of
paying debts, taxes or legacies;
(b) To retain any or all of such property not so required without liability
for any depreciation thereof;
(c) To adjust, compromise, settle, any and all claims in favor of or
against my estate;
(d) To assign or transfer certificates of stock, bonds or other securities;
(e) To conduct and carry on all business now conducted by me and to
do all things necessary or proper in the usual course of business until such time as the
business can be sold or distributed as a going concern or otherwise, and the Executrix
shall be exonerated from any loss which may result thereby;
~~'/7~
OSE B. WEISZ
2
(f) To do any and all things necessary or proper to complete the
administration of my estate, all as fully as I would do, if living.
SIXTH:
No gifts hereunder shall be subject to anticipation, assignment,
pledge, obligation of beneficiaries, executors or attachments.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of four (4) pages, written on one side only, identified by
my signature, in the presence of the undersigned witnesses, on this ~ day of
----
.::.J 1/'- Y
,2003.
t(~ ~{/~ (SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED, by the above named
Testatrix, as and for her Last Will and Testament, in the presence of us. who, at her
request, in her presence, and in the presence of each other, have hereunto subscribed
our names as witnesses.
~~
. ~\L
ADDRESS ~ -"7 0 '"' W 1::s j:'G. l'-,r...v IZ- P
-'
13~I1/S.4-LI.!!!~ PA. /9b::l.. b
ADDRESS (<.-0 J C(.., . /1; \J (~-f ( (if ~ tv' A \It:..
P~I (JJ/ f'A /91/ ~
3
.
AFFIDAVIT UNDER 20 PURDONS STATUTE ANNOTATED 3132.1
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF PHILADELPHIA
I, ROSE B. WEISZ, Testatrix, whose name is signed to the attached Last Will
and Testament, having been duly qualified according to law, do hereby acknowledge
that I signed and executed this instrument as my Last Will; that I signed it willingly, and
that I signed it as my free and voluntary act for the purpose therein expressed.
Sworn to and subscribed
before me this q-rl1 day
of :Tvll ,200~.
d~/hd~
Notary Public
~I-=-.~. ;k ,
R SE B. WEISZ ~
LINDA M~~~~ SEAL
City of PhilacJel,J:'PhIlN(iary~Publfc
My Commis' ~_' a.
slOn I;A. June 30, 7
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF PHILADELPHIA
We, ., ~NfJLI4 ;;1/4 "'1V~5."".S'9 and,C.'. G,,,YlA.-C it Cv ('Mv,f:.,r'l.- the
witnesses whose names are signed to the attached instrument, being duly qualified
according to law, do depose and say that we were present and saw Testatrix sign and
execute the instrument as her Last Will and Testament; that ROSE B. WEISZ signed
willingly and that she executed it as her free and voluntary act and for the purposes
therein expressed, that each of us, in the hearing and sight of Testatrix, signed the Will
as witnesses and that to the best of our knowledge, Testatrix was at that time, eighteen
(18) years or more of age, of sound mind and under no constraint or undue influence.
Sworn to and subscribed
before me this q-rh day
of ~ ' 2003.
~>;,-cP~
Notary Public
-~~-~~~-~--
4
SEARS HOLDINGS CORPORATION
To the Former Holders of Sears, Roebuck and Co. Common Stock:
As you may know, Sears, Roebuck and Co. and Kmart Holding Corporation
have completed a merger transaction. As a result, Sears and Krnart are now
wholly-owned subsidiaries of a major retail company named Sears Holdings
Corporation. Pursuant to the merger transaction, each Sears share wa... converted
into the right to receive either (1) $50.00 in cash or (2) 0.5 of a Sears Holdings
share at the election of the holders thereof. The ejections made by Sears
stockholders have been adjusted to ensure that, in the aggregate, 45% of the
Sears shares were converted into the cash consideration and 55% of the Sears
shares were converted into the Sears Holdings share consideration.
You are receiving these instructions and the accompanying Exchange Form
because our records indicate that you hold certificates representing shares of
Sears common stock for which no valid election was made or because you held
shares of Sears common stock in book-entry form for which no election was
made and the registered account does not have an accurate or updated taxpayer
identification number. Because the aggregate number of Sears shares for which
share elections were made exceeded the 55% threshold, each Sears share,
including the Sears shares to which the accompanying Exchange Form relates, for
which no valid election was made has been converted into the right to receive
$50.00 in ca.-,h.
Enclosed is an Exchange Form for use in surrendering your Sears shares in
exchange for the cash consideration to which you are entitled. The Exchange
Form, together with the certificates representing your Sears shares and aU other
required documents, must be received by the E.xchange Agent at one of the
addresses set forth on the E.xchange Form in order for you to receive the cash
considemtion which you are entitled to receive in exchange for your Sears shares.
If you have any questions regarding this exchange, please contact EquiServe
Shareholder Services, to}) free, at 1-800-732-7780.
Very truly yours,
SEARS HOLDINGS CORPORATION
, . .~"
JUN-26-06 01:43 PM Ron Bookwal~er
t-818.910~ 100
L. 'f. ':1: ~: :,:J ~;:~ ,,' ~( ~ . ~I: :'i~
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usooz 8U89
ROSE eAR lARA WEISZ
t03 'HANNfL DR
CARLISLE PA 170SS
717 249 6366
P.05
Checking AccQunt
Statement
e IIr 1
Begtnnlng April U. 2006
th.ough Hay 10, 2006
Checking
......".' ,.
I"anc. '-lculattCM1
Prevlou. Balin"
(hecb
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D[ BARBARA WUSl
ctKte MOMY M.",.l
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iomeowners Insurance Refund
~ Allstate"
YOlj'r~ in good hend8.
/0815 1M VIJ) 1:'1YLOR DR/VE ClIARL01TF. NC 28262. J045
111111111111111111111111111111111111111 11111111111111111111111
ROSE WEISZ
103 CHANNEL DRIVE /
CARLISLE PA 17013-1208
Important Information
As you requested, we have terminated your policy effective March 31, 2006. Attached is your refund check. We
thank you for the opportunity to serve you and hope w,= can provide your insurance protection in the future.
If you have any questions, please contact your agent or producer of record.
Policy Number:
Agency:
Issued To:
008 707 927
LEVIN INS OF PHILA (215) 856.9900
ROSE WEISZ
103 CHANNEL DRIVE
CARLISLE PA 17013-1208
Description:
9833 MONTOUR ST PHILADELPHIA PA 19115
A History of Your Account:
4/3/06
4/3/06
4/3/06
4/4/06
4/4/06
Previous Balance
Revise Renewal
Policy Cancellation Adjustment
Refund Issued
~~____.~____"_~_~....,.,._.__._L,~
Balance
$ 1.228,00 +
$ 1.228.00 -
$ 73.00 -
$ 73.00 +
$0.00
Ol
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Statement
United Church of Christ Homes
Sarah A. Todd Memorial Home
1000 West South Street
Carlislel PA 17013
Statement Date: 05/10/200'
Barbara Bookwalter
103 Channel Drive
Carlisle, PA 17013
Due Date: OS/25/2006
Re: Rose Weisz
Account Nr: 101614
Date
Description
Payments
--------------------------------------------------------------------------------
Balance
Charges
Days
Quant
Rate
--------------------------------------------------------------------------------
BALANCE FORWARD 61258.43 6,258.43
04/18/06 PAYMENT 6,258.43 .00
04/13/06 Beauty & Barber 1. 00 14.00 14.00 14.00
04/14/06 Medical Supplies 1. 00 58.68 58.68 72.68
04/14/06 Cable Television 1. 00 8.45 8.45 81. 13
04/14/06 Incontinence Suppli 1.00 40.04 40.04 121. 17
04/30/06 Room & Board - Semi 30 202.00 -6,060.00 -5,938.83
04/30/06 Room & Board - Semi 14 202.00 2,828.00 -3,110.83
UNITED CHURCH OF CHRIST HOMES
ACCOUNTS PAYABLE
OS/24/2006 29319
.-----J . -~ ., -~.;-;-,. I
\HVO(CE DA., t; kJv'd,C'" ,j.j,,,BER
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! I
105/10/2006 101614 I
I i
,t\MOU~,JT
DAn::
CHECK. NO.
3,110.83
029319
MeMO
-,-
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I
,
3,110.831
I
I
DiGCCH.JNT
NFl'
RESIDENT REFUND
SARAH TODD HOME
ROSE WEISZ
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... JUN-26-06 01:42 PM Ron Bookwalter
~)HILADELPHIA GAS WORKS IUl WEST MONTOOMERY AVE. PHILADELPHIA, PA 19122
.... .
-=-~TI lS-JUN-06 ~:NO =
717 249 6366
P.01
No. 73020140
ROSB B WEISZ
~
NO
434S';
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.. ...... , .. .
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l------....~-... '..- ---
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30.55
PHILADElPHIA GAS WORKS
100 WEST MONTGOMERY AVE
PHILADELPHIA. PA 18122
U;,':' No.73020140
VOID NINETY (90) DAYS FROM DATE OF ISSUe
CHECK DATE CHECK NUMBER CHECKAMOUNT
lS-JUN-06 13020140 ...**..'*30.55
Fleet Maine. NA
SlUIIl'lrlIIrIf..
Thirty Dollars And S5 Cents............... ........................... .... ................,. *..
PAY
lO THE
OADlA
OF
ROSE B WEISZ
1935 sterrett. gap AVE
carlisle. PA 17013
IWfIlOlllZlO SIIIIlATUIIf
Received TimeIJun.26d_(:Q3J.M~5~ql: OOBO~ 3?OEiOIlI
J
IJ Citizens Bank
1-188-910-4100
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Account Statement
fa Of 4
kginning Aprill!>>. lOO6
through fby 11. 1006
Checking
SClI"''''Y
....... talculiltMn
PnMous a.1Ma
Checks
Withdf...ts
Deposits & Additions
Interest hid
(UftIlftt ......
1'.511].99
9.419.10 -
11.99 -
BD3.00 f-
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ROSE BARBARA WEISZ
lOUIS( It ~1
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610119-601-0
.......a.c-
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"".5"Cll0. DElAllS
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IntJetest
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LLJ5 Jni\j 20 F(li 2 ~l
DEED
MADE THE I r~ day of JoJ1V\CVl.-1 , in the year of our Lord Two Thousand19ve-_~,'y-
(2006)t) J {va
BETWEEN SHERRY L. WHITLOCK AND WILLIAM K. WHITLOCK, husband and wife,
of Cumberland County, Pennsylvania, hereinafter
(Grantors)
and LOUISE JOST AND ROSE B. WEISZ, single persons, of Cumberland
County, Pennsylvania, hereinafter
(Grantees)
WITNESSETH, that in consideration of One Hundred Sixty-nine Thousand, Nine
Hundred Dollars and 00/100 ($169,900.00) in hand paid, the receipt whereof is
hereby acknowledged, the said grantors do hereby grant and convey to the said
grantees, as joint tenants with the right of survivorship.
ALL that certain tract of land with the improvements thereon erected, situate in
North Middleton Township, Cumberland County, Pennsylvania, known and
numbered as Lot No. 1 on a Subdivision Plan prepared for Heritage Home
Builders, Inc., by Steven G. Fisher, R.S., dated April 30, 1976, a copy of said Plan
being recorded in the Office of the Recorder of Deeds for Cumberland County in
Plan Book 28, Page 11, bounded and described as follows:
BEGINNING at an iron pipe on the Easterly line of Sterrett's Gap Avenue (50 feet
wide) at the southwest corner of Lot No.2 on the above-mentioned Plan of Lots;
thence by said Lot No.2, South 87 degrees 45 minutes East 150 feet to an iron
pipe on line of land now or formerly of Lee A. Darr; thence by said land now or
formerly of Lee A. Darr; South 2 degrees 15 minutes West 85 feet to an iron pipe on
line of land now or formerly of Bruce Betton; thence by said land now or formerly
of Bruce Betton, North 87 degrees 45 minutes West 150 feet to an iron pipe on the
easterly line of Sterrett's Gap Avenue (50 feet wide); thence by the easterly line of
Sterrett's Gap Avenue, North 2 degrees 15 minutes East 85 feet to an iron pipe,
the place of BEGINNING.
CONTAINING 12,750 square feet and being all of Lot No. 26 and the southern 35
feet of Lot No. 25 as shown on Revised Plan of Fry Avenue Lots on Plan NO.4 of
Schlusser Village recorded in the Office aforesaid in Plan Book No.7, Page 39.
BEING improved with a dwelling house known as 1935 Sterrett's Gap Avenue,
Carlisle, PA 17013.
BEING the same premises which Sherry L. Morrison N/K/ A Sherry L. Whitlock and
William K. Whitlock, husband and wife, by Deed dated November 18, 1993
which Deed is recorded in the Office of the Recorder of Deeds in and for
Cumberland County in Deed Book 36-Q, Page 1055, granted and conveyed to
Sherry L. Whitlock and William K. Whitlock, husband and wife, Grantors herein.
BOG.' 2/2 f,\' ,- '1~ 40
~..
."., -:
AND the said Grantors hereby covenant and agree that they will warrant
specially the property hereby conveyed.
IN WITNESS WHEREOF, said grantors have hereunto set their hands and seals
the day and year above written.
SIGNED, SEALED AND DELIVERED
IN Tf;fE PRES E OF
~~ ,>if, JYJv~
Sherry L. h~
v~t~
William K. Whitlock
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND : ss
On this, the J ,'t'h. day of J6VI\1....u-.y-II 2006 ~fore me, the undersigned
officer personally appeared Sherry L. Whitlock and William K. Whitlock, husband
and wife, known to me (or satisfactorily proven) to be the persons whose names
are subscribed to the within instrument, and acknowledged that they executed
the same for the purposes therein contained.
In Witness Whereof, I have hereunto set myhpnd and official seal.
Notarial Seal ''V'
Lisa M. Greason, Notary Public .-
Carlisle Boro, Cumberland County
My Commission ExpIres Sept. 9, 2006
Member, Pennsylvania Association Of Notaries
J.' "
,...,
I do hereby certify that the precise residence and complete post office
address of the within named grantee is 103 cr1O-.{l~ "Dr! "e I Co.... \ t.')Lrc tJ,q I ~k\ 1,3 .
.--....--"---- /~"", //
DATED: II It ft.\I.p, ,.'/// /'y
/ ,/'
L---'"
Attorney for Grant
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OMB NO. %502-(l2~
A,
U.5_ nepARTMENT Of' HOUSING & URBAN DEVElOI'MENT
SETTLEMENT STATEMENT
R YP
lLJFHA z.oFmHA 3,!&CONV. UNlNS. 4--OVA S-OCONV.INS,
6. ~~~~~M13ER I "I. LOAN NUMBER
8. MORTGAGE INS CASE NUMBER
c.
O. NAME AND AOORESS OF BU'fER
E. NAME AND ADDRESS OF SELLER
Anatolly Gluhov
112 Lockart Place
Okf\eui-....,ht,.. OA 10'" 'tt:
LoUISe Joat aI'ld
Rose B. Weisz
Irwin Mortgage Colp.
10500 Kineaid Drive
FlShel$, IN 46037-9515
G. PROPERTYLOCAnON
9833 Montour Street
PhIladelohia. PA 19115
I. SETTLEMENT DATE
March 31, 2006
217.000.00
'Ustments For ItumsPaId B SeJlertlliJdwflCfl
106.CltvlTown laxes 63f31106 to 12131106
'107.SchooITaxeJ to
IOS. to
109.
'110.
i1t.
~ For IIfIms 'P;Ud B SeIter ill advance
1 $21.'75 1106., CitVifOlVitTaxes 03f31106 to 12131106
.cor; ~raxes to
to
1,521.15
F
i
It:
!
218521.75
16.765.00
10.749.74
3.54
11.24
281.06
22.52
87./364.10
87 864.10
130657.65
l.ft/.,~.
i"lUO-l (3.-.5&J RESPA. H&C3O$.2
L SETTLEIlIEN1 CHARGES
$ " 10,&50.00
~t.,...
,
PJ<IO FllOU
lIlM!R'S
I'UHtlS lit
~
IWD_
lilIlU.l!R'S
I'UHDS At
SEnl.Eloelt
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(lIClC~.4+)
tlAII"~
.105.59
. ....
H01.WIre CbamiI ID
.......... 10 GIertctsI$ AbSlRlCt. I.;>.
1103 -~ - 10
1104.11tle Imm~a -. . III
1105.0G<:ument Pr< Deed to GIindIIle 1\bisIraet.1.P. ",,,tI/1
1106.NolmV 1'<8. to GIend8Ie ~I.P. 25.M 15.00
.'A~ ,J:...... to
(includes ....IIIm~ J
It> -. . .P. IB'I 1. H" .,.~
~ lIbWlI ifBtn 1lIJII/berr: )
1109. lenWa $ 195.300.00
'1110. S 211,000.00
....... .- - 10 ~Ab8Inict..U'. 1~IlM
to l11C 'lit"",
1113,Cootiet Fee III GIeniJllIe ~ W'. 25.()(l 60.00
. .
RelelIlies $ 130.00
295.00
1$<1.00
1 230.00
16.166.00
::erlllied to llrIl a lI:W copy.
- RECORDING INFORMATION SUMMARY (RrS)
The information provided by you will be relied 1) RETURN DOCUMENT TO:
upon by the Department of Records for Name: E. Garrett Gummer, III
examination and indexing purposes. If there is Address: 12018 Bustleton Avenue
any conflict between the RIS and the attached Philadelphia, PA 19116
document, the information on the RIS shall
prevail for examination.and indexing purposes. Telephone: (215) 969-5004
2) Type of Document:
~~d ~M_ ~ Lease/Memonllldum of Loa..
Sheriff's Deed Release of Mortgage Assignment of Lease & Rent
Deed of Condemnation Assignment of Mortgage Easement
Other Deed Satisfaction of Mortgage Other
(specify)
3) Date of Document: 7 / 7j- / 2003
month day year
4) Grantor/Mortgagor/ Assignor/Lessor/ a) Weisz, Rose B.
Other:
(Last Name First Name Middle initial) b)
5) o Additional names on Continuation Page ofRIS
6) Grantee/Mortgagee/ AssigneefLessee/ a) Weisz,
Rose B.
Other:
(Last Name First Name Middle Initial) b) Jost, Louise
7) o Additional names on Continuation Page of RIS
8) Property Address:
a) House No. & Street Name: 983~ Mnntour Street
Condo Name(ifapplicable): Unit Philadelphia, P A Zip 19115 - 5220
# Code:
BRT Account # (optional): Parcel Identification Number (PIN) (optional): 581369100
9) 0 Additional addresses on Continuation Page ofRIS
10) Grantee's Mailing Address (Deed Only):
(If Grantee is at a different address than the Property Address listed in Section 8, complete this section.)
a) Grantee or Designee Name:
House No. & Street Name:
City: State: Zip Code: -
11) Recording Infomlation to be Referenced. Mortgage to be released/satisfiedlassigned/modified:
a) Name of Original Mortgagee: Recorder's Index Information of
Original Mortgage:
Recording Date of Original Mortgage: / - /
month day Year Initials, Book and Page Q!: Doc. ID#
12)0 Additional references on Continuation Page ofRIS
13) If applicable, please check: D Consolidation D Subdivision
14) Signature Information for Records Department use only
----... ---_._---- --
Rose B. Weisz 111111111111111111111111111111I1111I1111111111111111111 f1~~1:0~~~~PM
a) 'OR -or- 'EE Name
(215) 969-5004 - .-
..
b) 'OR -or- 'EE Telephone Number Thls Document Recorded Doc ld: 50713775
't..__AoJ.o .~. },-p ~~., 07/16/2003 state RTT: 0.00 Receipt #: 257276
07:01PM Local RTT: 0.00 Rec Fee: 74.50
Doc Code: 0 CommiSsioner of Reoords, City of Philadelphia
c) lOR -or- 'EE Signt"ture d
15) Page 1. of 1
City of Philadelphia Department of Records
-1-.
82-337 (Rev. 01101/01)
. ~bfs 3lnbtnturt ~llt tbt t::...dayot
year of our Lord two thousand and three (2003)
jiet\t1een
...-r'
:::.JVL Y
in the
ROSE B. WEISZ, Widow
(hereinafter called the Grantors), of the one part, and
ROSE B. WEISZ and LOUISE JOST, as Joint Tenants with Right of Survivorship
(hereinafter called the Grantee), of the other part,
Wttne~~ttb That the said Grantor. for and in consideration of the sum of ONE DOLLAR
($1.00) lawful money of the United States of America, unto her well and truly paid by the said
Grantees, at or before the sealing and delivery hereof, the receipt whereof is hereby
acknowledged, has granted, bargained and sold, released and confirmed, and by these presents
does grant, bargain and sell, release and confirm unto the said Grantees, their heirs and assigns,
as Joint T~nants with Right of Survivorship,
ALL THAT CERTAIN land and premises, SITUATE in the City and County of Philadelphia and State of
Pennsylvania.
BEGINNING at a point in the curved Southeasterly line of Montour Street (46 feet wide) at the distance of
211 feet 7/8 inches Southwestwardly from the Westerly end of the curve connecting the Southeasterly line
of Montour Street with the Westerly line of Hoff Street (46 feet wide) said connecting curve having a radius
of 20 feet said beginning point being between premises 9833 and 9835 Montour Street in the extended
middle line of party wall, thence Southwestwardly along the curved Southeasterly line of Montour Street
curving to the left with a radius of 777 feet 8-1/2 inches an arc distance of 35 feet 11-7/8 inches to a point in
the division line between premises 9831 and 9833 Montour Street, thence South 35 degrees, 30 minutes,
25 seconds East along the said last mentioned division line 100 feet to a point in the Southeasterly
boundary line of Plan hereinafter mentioned, thence Northeastwardly along said Boundary line curving to
the right with a radius of 677 feet 8-1/2 inches an arc distance of 32 feet 2 inches to a pointing the aforesaid
extended middle line of party wall between premises 9833 and 9835 Montour Street, thence North 33
degrees 18minutes 59 seconds West along the said middle line of party wall and its extensions 100 feet 1/8
inches to the place of beginning.
BEING No. 9833 Montour Street as shown on Plan of Property made for Korman Development Co., 58th
Ward, Philadelphia, made by John J. McDevitt, Surveyor and Regulator of the 4th District dated April 13,
1965, TAX I.D. #581369100.
RECITAL
BEING the same premises which Santarella Lerza, Widow, and Martin S. O'Donnell and Gloria A.
O'Donnell, his wife, by Deed dated April 23, 1969 and recorded May 9,1969 in Philadelphia County in Deed
Book J.R.S. No. 403, page 193 conveyed unto Rose B. Weisz, Widow, in fee.
UNDER AND SUBJECT to certain conditions and restrictions as of record.
THIS CONVEYANCE IS TAX EXEMPT FROM CITY & STATE TAXES BECAUSE IT IS A TRANSFER
BETWEEN SISTERS, PURSUANT TO P.S. 72 SECTION 8102-C.3(6).
-
111111111111I11111111111 11111/11111111111I11111 1111/111 ~~? 1 ~~75
97118/2993 S7'91P
fEo gttbtr with all the singular the buildings, improvements, ways, streets, alleys, driveways,
passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances,
whatsoever unto the hereby granted premises belonging, or in any wise appertaining, and the
reversions and remainders, rents, issues, and profits thereof; and all the estate, right, title, interest,
property, claim and demand whatsoever of the said Grantor, in law, equity, or otherwise
howsoever, of, in, and to the same and every part thereof.
tEo babt anb to boIb the said lot or piece of ground described with the land and premises,
hereditaments and premises hereby granted, or mentioned and intended so to be, with the
appurt~nances, unto the said Grantees, their heirs and assigns, to and for the only proper use and
behoof of the said Grantees, their heirs and assigns forever, as Joint Tenants with Right of
Survivorship.
UNDER AND SUBJECT, as aforesaid.
anti the said Grantor, for herself and her heirs, executors and administrators do covenant,
promise and agree, to and with the said Grantees, their heirs and assigns, by these presents, that
she, the said Grantor and her heirs, all and singular the hereditaments and premises hereby
granted or mentioned and intended so to be, with the appurtenances, unto the said Grantees, their
heirs and assigns, against her, the said Grantor and her heirs, and against all and every person
and persons whomsoever lawfully claiming or to claim the same or any part thereof, by, from or
under him, her, them, or any of them, shall and will
WARRANT and forever DEFEND SUBJECT AS AFORESAID..
In Wttnt" Wbtrtof, the party of the first part hereunto sets her hand and seal. Date
the day and year first above written.
~ea[eb anb JleUbereb }
In the Presence of Us: }
S~~i
}
}
-;f b-<-L 0.}f-~
ROSE B. WEISZ
(SEAL)
(SEAL)
(SEAL)
11111111111111111111111111111111111I1111111111111111111 a~rt9~~~~P
Commonwealth of Pennsylvania
County of P-hiladelphia 55
.On this, the CfII1 day of :::rv~ V , 2003, before me, a Notary Public for the Commonwealth of Pennsylvania.
residing in the County of Philadelphia, the undersigned Officer, personally appeared ROSE B. WEISZ, Widow, known
to me (satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged
that she executed the same for the purposes therein contained.
NOTARIAL SEAL
L1~OA M. ~eNSION, Notary Public
- CIty of ~h'!adelphja, PhI/a. County
My CommIssIon Expires June 30, 2007
I hereunto set my hand and official seal.
~~.~
Notary Public
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5tJ713775
Page: 5 of 5
S7/1B/2SS3 G7'G1P
- DOCUMENT 1.0. NUMBER GRANTEE'S NAME GRANTEE'S SOCIAL SECURITY NO.
I II r"~ ""' II I
II jRANTEE'S SOCIAL. SECURITY NO.
PHILADELPHIA GRANTEE'S NAME GRANTEE'S SOCIAL. SECURITY NO.
II I
REAL EliTATE GRANTEE's NAME GRANTEE'S SOCIAL SECURITY NO.
THAN.FER TAX CERnHCATmN !I ,\
DATE RECORDED I CITY TAX IWD
I llr
~mplete each. section an~ file with Recorder of ~eeds when (1) the full consideration/value IsRs not set forth in the deed. (2) when the deed Is
WIth consideration. or by gift, or (3) a tax exemptIOn is claimed. If more space is needed, attach additional sheet(s).
A. CORRESPONDENT - All Inqulrle. may be directed to the following person:
NAME TEL.EPHONE NUMBER:
IE. GARRETT GUMMER, '" I AREA CODE 215 969-5004 I
STRE~ ADDRESS ~ITY I~ ZIP CODE
112018 Bustleton Avenue I Philadelphia 119116 ~
B. TRANSFER DATA DATE OF ACCEP1lINCE OF DOCUMENT:
GRANTOR(Sl/LESSOR(S) GRANTEE(S)lL.ESSEE(S)
IROSE B. WEISZ I : IROSE B. WEISZ & LOUISE JOST
STREET ADDRESS STREET ADORESS
119833 Montour Street 19833 Montour Street I
CITY STATE ZIP CODE CITY [;] ZIP coDe
IPhiladelPhia I IpAI 119115 I I Philadelphia I PA 119115
C. PROPERTY LOCATION
STREET ADDRESS TAX PARCEL NUMBER
19833 Montour Street 11581369100
D. VALUATION DATA
1. ACTUl\L CASH CONSIDERATION 2. OTHER CONSIDERATION 3. TOTAL CONSIDERATION
11.00 I + 10 I = 11.00 I
4. COUNTY ASsesseD vALue 5. COMMON LEVEL RATIO FACTOR 6. FAIR MARKET VALUE
123.744 I x 13.48 I = 182,629,12 I
1A. PERCENtlGE OF INTEREST CONVEYED lB. 1l\XABLE PERCENTAGE
150% 110 I
E. Check Appropriate Box Below for Exemption Claimed
o Will or intestate succession I I I I
--- - - - -- - -- -
(NAME OF DECEDENT) (F-STATE FILE NUMBER)
o Transfer to Industrial Development Agency.
o Transfer to agent or straw party. (Attach copy of agency/straw party agreement).
o Transfer between principal and agent. (Attach copy of agency/straw trust agreement). Tax paid prior deed $ I I.
o Transfer to the Commonwealth, the United States, and Instrumentalities by gift. dedication, condemnation or in lieu
of condemnation. (Attach copy of resolution).
o Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number 0 . Page Number I I
Mortgagee (grantor) sold property to Mortgagor (grantee) (Attach copy of prior deed).
o Corrective deed (Attach copy of the prior deed and explain corrections being made).
o Other (Please explain exemption claimed, if other than listed above').ITranSfer to Siblings I
-------- - --- - -- --,-- -- --
Under penalties of law or ordinance. I declare that I have t an~ 'ned this Statement, including accompanying information. and to the best of
my knowledge and belief, it is true, correct and comqJ(te.
nD ,,",DTV 1\.. I r'; I 't I Dl
IE. Garrett Gummer '" ESQuire '-t '{ ~ I
IF YOU HAVE A DISABIUTY AND REQUIRE AN ACCOMMODATION IN ORDER TO COMPLETE THIS FORM AND/OR TO
PARTICIPATE IN A PROGRAM OR SERVICE, CONTACT THE ADA COORDINATOR AT 686-2263.
82-127 <Reor.10198)
(SEE REVERSE)
I.' LinscoJPrivate Ledge r
Member NASD/SIPC
I 9785 Towne Centre Drive.
San Diego. CA 92121-1968
One Beacon Street, 22nd Floor.
FINANCIAL Boston. MA 02108-3106
SERVICES
From the Account of: 2792-7258
7TVA 7TVA
Transaction Confirmation
-
ROSE B WEISZ
103 CHANNEL DRIVE
CARLISLE. PA 17013-1208
1111111111111111111111.11111111111.11111111.1.111111.111111.11
001-(l042
Financial Advisor:
JOHN WAIN
401 EAST LOUTHER ST.
SUITE 212
CARUSLE PA.17013
---
-
---
-
-
To the Account of number: 1269-4412
Recipient Name(s) RONALD L BOOKW ALTER AND BARBARA L BOOKW ALTER JTTENS
Journal Request Confirmation
This notice is provided to confirm the instructions you placed through your financial advisor. Please
review the information below and verify for accuracy. If the information doesn't appear accurate. please
call the LinscolPrivate Ledger Customer Service Department at (800) 558-7567.
1/17/06
604 SHARES OF THE ALLSTATE CORPORATION
Additional Information: The information contained in this notice shall be binding upon you if you do
not object. in writing. to UnscolPit"ate Ledger immediately after this notice is first received by you.
13340COO1-001-0042
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\1- 05290302000 IIIIIIIIIIIII1
9116 1 AV 0.278 9116-9116
111111111111111111111111111" 11111." 1111I11 f 1111111111111..11
BARBARA L BOOKWALTER
RONALD L BOOKWALTER
103 CHANNEL DRIVE
CARLISLE PA 17013
MEMBERS 1st
FEDERAL CREDIT UNION
If-~
....-
....
(J"I!!!!!!!!!!!!!
~
......==:
=
0-
If-
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.members1st.org
Main Switchboard: (717} 697-1161 or (800) 283-2328
EZCaIl: (717) 697.4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283-2328 ext. 5312
TeleBranch: (717) 795-6049 or (800) 237.7288
Statement of Accounts
Apr 01, 2005 thru Jun 30, 2005
Account Number:
260322
Account Balances at a
Checking:
Savings:
Certificates:
Loans:
Money Management:
Glance :
0.00
34,064.61
0.00
0.00
0.00
Page: 1 of 1
Join the HAP E Travelers in Atlantic City on August 27,2005. See the enclosed
iJjsert for moreJnformation.
,~-,., ".----.,' --";'~-,,":-:'.,,,,"-, '-"-"",..-
SAVINGS ACCOUNTS
00 - REGULAR SAVINGS
. '-' '- ,,- .
.-; ',-. ';':' -:,_;.': n.,:.,-'.'"",,:,,::,,""""
Date Transaction OesCribtiori
Apr 01 Balance Forward
Apr 26 Deposit by Check
Apr 30 Deposit Dividehlj1. 000%
Annual Percenta[JfJ Yield Eamed1.(}{}{}J6 from 0410112005 IhrougtJ 0413012005
May 24 Deposit by Check '. .
May 31 Deposit DiVidend 1.000%-
Annual Percentage Yield Earned '1.fJOtJ% from 05/01/2005 throiJgtr05I:JJ./~
Jun 27 Deposit. "', (,,' .
Juil 30' . Deposit
Annual Percenta~ . '.. .. .
Jun 30, . ...... Eiidifig~Qa.
YTD SUMMARIES
Addltions
Balance
16,006.91
22,006.91
22,020.89
28,020.89
28,040.91
":, . 34;040.91
....34,064.61
i,'- A;" ,':. '~~?,~";::ii:<<;,\,::"'-:"'"
, ':-:'~'~,064.61
TOTAL DIVIDENDS PAID
00 REGULAR SAVINGS
~~ Citizens Bank
1-888-910-4100
Call Citizens Phofll!'Bank anytillH! for attoont inform;ltion.
CUm!nt r.JtEos and answers to your questions.
Checting continued flam plerious poge
Daily Balance (continued)
DIU .~ua
D.1te
04/05
Blllance
26,136.15
Date
04/14
03/23
03/24
8,904.76
2,467.09
Balance
14,583.99
Account Statement
8 OF 5
Beginning March 15, 2006
through April 14, 2006
ROSE BARBARA WEISZ
LOUISE H JOST
eirel1! (h1!cking with Interest
610389-603-0
co
SUMMARY
Balance Calculation
Maturity
Opening/RenewolOate
Opening/Rent!Wol Amount
Maturity Date
Previous Balance
Withdrawals
Deposits & Additions
Interest Paid
Current Balance
8,871.03
.00 -
.00 +
20.14 +
8,891.17 ~
Int.r.st
Interest Rote
Annual PercentDge Yield
Interest Paid this Yeor
11/19/04
8,5-'8.67
11/19/06
2.96'1.
3.00r.
64..58
'"vfOll$ Balance
TRANSACTION DETAILS
0aU Amount Desa1ptlon
03/17 20.14 Interest
8,871.03
o
Tot~ TAnsactlons
20.14
CUlTlmt Balance
I NEWS FROM CITIZENS
--Red means Go!
Good luck Phillies from Citizens Bank - Official Bank of the Philadelphia Phillies!
www.citizensbankpark.com
--Noticed that interest rates have moved up? Take advantage of higher rates; turn to
Citizens and lock-in a great Certificate of Deposit {CD} rate. We offer a range of terms
from three to 60 months. Additionally, our CDs offer the peace of mind of FOlC insurance.
For more information or to open an account. calla77 690-8165 01 visit your local branch
and a knowledgeable banker wilt be happy to assist you. IRA CDs ARE ALSO AVAILABLE.
All accounts and services subject to individual approval. See a banker for FOIe coverage
amounts and limitations.
(~'~
JUN-26-06 01:43 PM Ron Bookwalter
717 249 6366
. .
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
"'~g ~_ DlJIVIDUAL TAXES
CI.1YIafiI!4JJA 17121-1411
P.02
.
Ift._ .. '" ,II.",
PREASSESSMENT NOT%CI
DATE OF NOTICE; JUN 22 2006
SOCIAL SEe. MUM; 198- 01- 9601
TAX YEAR; 2005
ASSESSMENT;
BAUNtlla) DUE FOR 'YOUR AcnuNT AS OF ..IUL IZ zn.
. BALANCE INCLUDES ESTIMATED TAX UNDERPAYMENT ~ENALTV
WID PAID ULANCI
LTEAlNDER ... ." ...
EST PMlT'f 61.'- ... 61.M
LlIAL .It ... ...
mUEST ... .., .11
TAX/IFD 17'7." 1787." .11
PLUS OTHER TAX YEAIlS) LIABIUTlES .11
~~yllftla AMOUNT USI.. TIlE DETACHAlI.I ~.ELO .
ROSE B WEISZ
1935 STERRfTTS GAP AVE
CARLISLE PA 17013
'YOUR 2..5 TAX IITUIN VAl PROCESSED AS fOlLOWS.
1&. IIOSS ~TION.."""""""""",...
II. SCHEDULE VI EXPENSES........................
Ie. CGftPENSATION~~~u...........................
a. IJITEIEIT tlCft5UUI"l A).......................
I. DJYIDENDS CSCHEDULE .J......................
... .T ~ H Lass......,............. .......
5. TAXAILE SALE - 8AlN 01 LOSS.................
IA. CAPITAL CAtN.CLUSION......................
.. IINTS,t .YAIoT 1St PATENT!I.COPVIIIHTS.......
7. ESTAT~S AND S (SCHEDULE ~J.............
.. IANILIN8 AND LOTTEIV ~INNINGS...............
9 IIOSS TAXAIlr DCOIE IADD LINES lC,2-566-1).
Ii. CONTlIBUTIONS TO MEDICAL IAVlNCS............
U. NET PA TAXAIU __CLUtE' MINUS LINE 11),
12. TAX LIAlILITY C~TIPLY LINE 11 IV .1'111)..
IS. TAK WITHMELD Cf~ wz.s.....................
14. CIEDIT'~ PIIYJDUS TAX yEAR...............
15116 ESTDlATtD TAX I IkTtNSlON PAYMENTS..........
11. TAX wn'HllELD AS IEPORTED ON N. -I.. .. . . . .. ..
II. TOTAL C'EDITS (ADD LINES 14.17J.............
1'1. ...... OF HriNDbfTs........................
21. TAX FORGIVENESS CREDIT......................
22. ItESIDENT CREDIT (SCHEDULE I)................
II. CREDITS ISCHEDULE DCl.......................
M. TOTAL CIIDITS tADD lINES 13,11,21-2:11......
21. TAX DUE CLINE 12 "tHUS 24)..................
26. rlNALTlfS AND INTEIIST......................
21. DVEIIPAYttEIIT tUNE 24 taNUS 12J..............
.... ItIF~O. .. III .. III .. . . . .. .. . . . . . . . . . , .. . 9 .. . . . .. .. .. .. .. . . .
5.. CREDITED TO NfXT YIARS ESTI",TED TAX........
51-55.TOTAL DONATIONS CLINES SI-111............
YUIll FIWln
...
..,
.11
'11."
1,613."
...
0,917 .It
..,
...
.It
...
51,221."
...
",225."
1,717."
...
.It
.It
.It
.11
.
.It
.11
.It
.11
1,711.10
.It
...
.,.
...
...
DUll FlCUlfES
...
.11
.11
715...
3,.n.1t
...
55,"7."
...
...
...
...
sa,2ZJ. II
...
Ie,ZZI. It
1,717."
...
.10
.01
...
.11
.
.11
.11
.n
...
1.787 .ID
...
...
.1'
SEE REVERSE SIDE FOR HORE INFORKATIDN
DETAtM AT PERfORATION
"IT
IUW(AU DF INDIVIDUAL TAXES
PlIISONAL INCOME TAX
HV''S6ItC I fl-t!
~
TAXPAYER HAMEl
HOTICE DATE r
SOCIAL SEC. MUM:
TAX VEAR:
ROSE B WEISZ
JUN 22 2006
198-01-9601
2005
!;
PAYNfNT AMOUNT 1
$
I ut
..
i
_ Ctl:CI DIl MIlM:'t '*DEI PAYULI: Ta I "PA IllEPf. Of .VDlUE"".
DO MDT .un. a. 'MIS SPAtf
3001831~aOl'b010DOb5aDDs123100DOOOODDODbl~~~
Rece'lved Time Jun.26, 2:03PM
-
I J