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Home My WebLink About12-06-06 .-J 15056051058 REV-1500 EXi(06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 HanisIxKg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Da~ of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN 0 l RESIDENT DECEDENT 0"\ File Number ow IDt(() Date of Birth 570-32-5223 10/12/2006 06/01/1915 Decedenfs Last Name Suffix Decedent's First Name MI Mellon (If Applicable) Enter Surviving Spouse" Information Below Spouse's Last Name Suffix Helen A Spouse's Rrst Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (.) 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required i:~~~'.':~ 4. Umited Estate ("._..,i 4a. Future Interest Compromise (date of death after 12-12-82) c:) 7. Decedent Maintained a Uving Trust (Attach Copy of Trust) C::i 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) CORRESPONDENT - THIS SECTION MUST BE cot.PLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Win) 9. Utigation Proceeds Received 8. Total Number of Safe Deposit Boxes Shirley M. Ryan Firm Name (If Applicable) I"...;) (954) 554-~ 9 g ::0 ~ ~ ::on. REG'STE~~ILL5US~LYQ 8 :n :r:. C) ("") u5 :::0 :~J ....-. I -~-1 CJ ,c-:. Z m I r,n rn '.:::- -::0 0"\ :.1:J CJ '::: (f) ^ ch c::> '- J () 0 :J:I!l ':"'1"1 -n ,'-) 0 .,., :x ..~,_11 be ":i~C) ':0 '2 "'-,rn ~-i ~:'O )>- . :::r, ~ First line of address 2740 NE 6th Street Second line of address City or Post Ofllce Pompano Beach State FL ZIP Code 33062 Correspondenfs e-mail address: ryana@bell this return, including accompanying schedules and slatements. and to the best of my knowledge and belief. than the personal representative is based on all Information of which preparer has any knowledge. RETURN OATE -t)(P q."e ~~06;L DATE ADDRESS ~LEA8E USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 .....J ~ -------,-------- -- --.J 15056052059 REV-1500 EX Decedent's Name: Helen A Mellon RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . I' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 2. 3. Closely Held Corporation, Partnership ot Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Aersonal Property (Schedule E) . . . . . . .. 5. 6. JoinUy Owned Property (Schedule F) C:) Separate Billing Requested . . . ~ . .. 6. 7. Inter-VIVos Transfers & Miscellaneous Nbn-Probate Property (Schedule G) C:; Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Unes 1-7).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative CostIs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Uens (Schedule I). . . . . . . . . ..... . . 10. 11. Total Deductions (total Unes 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . 11. 12. Net Value of Estate (Une 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 12. 13. Charitable and Governmental BequestsJSec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 570-32-5223 Decedenfs Social Security Number 0.00 167,654.96 0.00 0.00 0.00 4,290.55 0.00 171,945.51 12,463.44 8,352.68 20,816.12 151,129.39 0.00 151,129.39 14. Net Value SUbject to Tax (Une 12 minus Une 13) . . . . . . . . . . . . . . . . .. . . . . . . 14. .'.,_.,_............"'_.._.,,__-..._"""""........."_..,n_''''_''''"_'...............~...._,.,,~,.........,......."".,_"".,,___....,",."'''''''''''''''..,_''''''''''__..-''"'A'''...''''''.__~''''_~,......,,_"",.,,,.'_,,,,,,',~"..._,,.,, ,,,,,,."',,~,,..;,.,,'A"';',~""""""'~""',,,,,,,,,,,,,,,"~"-'''''_'''',''~''""_,, .""""._..."".__",_,,,.,..,...,,,...,.w~^,,_.,,,~,.,,.,,,,,,,..,,..,,.,,,,-.,,."'0"_>> TAX COMPUTAnON . SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X.O 45 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN nlE OVAL IF YOU ARE REQU~mNG A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 6,800.82 6,800.82 c.:) 15056052059 ....J ~ ~T-------- REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Helen A Mellon 570-32-5223 STREET ADDRESS Bethany Village 5225 Wilson Lane CITY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 6,800.82 340.04 Total Credits (A + B + C ) (2) 340.04 3. InterestlPenalty if applicable D.lnterest E. Penalty Total Interest/Penalty ( 0 + E ) (3) 4. If line 2 is greater than line 1 + Une 3, enter the difreren<;e. This is the OVERPAYMENT. FUll" oval on Page 2, Line 20 to reque. a refund. (4) 0.00 B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (58) 6,460.78 0.00 6,460.78 5. If line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 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 inCOl11e of the property transferred;.......................................................................................... 0 1iJ b. retain the right to designate who shalll use the property transferred or its iOCOl11e; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 (iJ d. receive the promise for life of either ~yments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receMng adequate consideration~ .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or pay~ble upon death bank account or security at his or her death? .............. 0 [iJ 4. ::a~=:::=+~~.~".~:.~.~.~.~.~............... 0 [liJ i ::=ooT::::=:1~:::OUw:::.:::::::::::f::~~ is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)). ~i For dates of death on or after January 1, 1995, the tax r imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemnt 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 . use 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 I deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren~ or a stepparent of the child is zero (0) pe~nt [72 P.S. ~9116(a)(1.2)]. I The tax rate imposed on the net value of transfers to or f~r the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percen~ except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. i The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent lin common with the decedent, whether by blood or adoption. ~ REV.'503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Helen A. Mello", FILE NUMBER All property joJntty.owned with right of survivorship must be dltclosed on Schedule F. ITEM NUMBER 1. 2 DESCRIPTION Exelon Corporation (EXC) 1822.816 Shares at $60.33 per share on 10/1212006 International Business Machines Corp. (IBM) 326.448 Shares at $84.50 per share on 10/12/2006 Sky Financial Group, Inc. (SKYF) 1200 Shares at $25.08 per share on 10/12/2006 VAlUE AT DATE OF DEATH 3 109,974.10 27,584.86 30,096.00 I 't TOTAL (Also enter on Bne 2, RecapituIaIion) $ (If more space is needed, insert addilionaI sheets of the same size) 167,654.96 ~ COKKOMWEALTH OF PENNSYLYANIA DEPARTMENT OF REVENUE BUREAU OF INDIVlOOAL TAllES PO IlDX ZII0601 HAIlRISBURG PA 17121-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06500610 DATE 11-13-2006 .Ef~lI'S& iff fl...} EST. OF HELEN A MELLON 5.S. NO. 570-32-5223 DATE OF DEATH 10-12-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SECURITY [X] SEe ACCT o STOCK o BONDS SUSAN M PLUTA 7 HOLLY DRIVE NEW CUMBERLAND PA 1707U REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 SKY FINANCIAL has providod the DepertJlent ldth the Infot....Uol\ listed tHtlaw which hils been used in calculating the potential tax due. Their records Indleatlt that i!lt the tl..th of the abov. declldllnt, you wer. a btlmaficiary of this a..at. H youf.el thb infor..Ucn is Incorreot, pi_so obtdn ..ritten correction from the trllnsfer 8QIII'It, ettllC:h . copy to this fo,.", lInd return it to the above add,..... Thls account if tBXllbla In .oco..denc. with the I"h.rltllnca r.x laws of the C_onwealth of PennsylV8l\la. Question. _Y be ans...r.d by calling (717) 7&7-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000784579 000 Valuation Percent Taxable AlIOUl"lt Subject to Tax Rata Potential Tax Due )( 15,048.00 100.00 15,048.00 .045 677.16 TAXPAYER RESPONSE TQ InR,.. ,..ap.r credit to your aa~t. two (2) 0091.5 of this nottc. Mist wccOlllPerty your l'ey."t to the ReDistllr of !lIHIs. HIlle. check P8yllbl. tOI '-Reoicter of WUle, Agent... x MOfE: If bx paYllWlts lI,.e ..de vlt1'1ln three (3) Bonth. of th. dee.dant', data of ~th) YOU .IIY deduct II 5)( discount of the tax due. MY inl'Mlrltance tax due will bacOlM d.Unquent n1ne (,) IIOl'lthlJ uft.r the date of death. Tax I CHECK ] ONE BLOCK L ONl V o TI... abolltl infor. ticn end tax due Is cor,.ect. 1. You .ay chuo tc r..it pey_nt to the R.giste,. of Wills with twa capie. of this noti~ to obtain a discount 0 aI/old Interest, or you Oil ch.ck box "An and rill turn this notice to the RllSltstlllr of Wills end an I official l!Iss........t will ba issu.d by the PA Dep.rtaent of Rlllvalll.Mt. 8. 0The above a.SIIt ~.. be.n or will be reportad IIfld talC paid with the Pennsylvanl. Inheritance TalC return to be filed by ~e decedent's represent.tive. C. DTha above Infar.,Uon Is Incorreot and/or debts end dllduotlons _r. paid by you. You aust OO1IIPle~ PART m and/or PART [II balow. PART III TAX RETURN - COMPUTATION LINE 1. DOD Velu.tlon 2. Pa~cent Taxebl. 3. A~ount Subject to Tex 4. D.bts and Deductions 5. Amount Taxable 6. Tax Rete 7. Tax Due TA~ ON ABOVE ASSETCS) If you indicate _ different 'lex rateJ pl.... stat. your relationship to d.cedent: ' OF 1 2 X 3 4 5 6 7 )( PART I!I DATE PAID DESCRIPTION TOTi. 'Entar Dn Llno . D< T"" c_toU..., Under IHlnalU.s of perjury, I ~laNl ttt.t the fach I cOIIPbt. to the best of lIlY knowledui- and bell.f. TAU ~~S~'~~~Tuf:!7~.UL/ PAYEE AMOUNT PAID I . heve ,.eport.d above are tru., correct and HOME " 1,'1) 1''11'1"1 . ':,:)/., !L~?::- WORK ( ) TELEPHONE NUMBER It ~'~ n TF" (. 4~ ~ COHItOHliIEALTH OF PENNSYLVANIA DEPARTMENT OF REVEHUE aUflEAtI OF INDIVIlllJAl TAXES PO 1II0lC tlI060 1 HARRISIlURG PA 171Za~D601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE EST. OF HELEN A MELLON S.S. NO. 570-32-5223 DATE OF DEATH 10-12-2006 COUNTY CUMBERLAND FILE HO. 21 ACN 06500609 DATE 11-13-2006 TYPE OF ACCOUNT o SECUftITY OSEe AceT o XTOCK o BONDS .. -15\1& 1IH II-I" SUSAN M PLUTA 7 HOLLY DRIVE NEW CUMBERLAND PA 17070 RE"IT PAY~NT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 INTERNATIONAL BUS "ACHINES has pr~vided the o.p."tHnt .,ltn the lnfor..t1on li.t~ ~latl .....1d1 has b..n used in oalouleUnll tha potential tax due. rl'1lll" r.4lGorutindlC1lta ttwt at tha chNth. of the above dectIcIant, you WI'. 8 benefielarll of this ....t. H )IOU f.el this lnfor_Uon is incorrect, pi.. obtain written correction frOll the trlllnsfer 1198nt, att.ec:h a copy to this fora IIrld ...turn it to th8 above add..e... Thh eccount J tl!ll(llble in 41Gcor__ with the Inharitanca TalC Law. of tha C-on_a1th of PannlJYlvWll.. Que.tions -If ba __red blf 08Uina (711) 71l7~ 1:7. COMPLETE PART 1 BELOW . . . ISEE REVERSE SIDE FOR FILING ANI PAYMENT INSTRUCTIONS Account No. 822512843 DOD Valuation Percent raMabl. Amount Subject to Tax R.t. Potential rax Due )( 13.1811.36 100.00 131811.36 ,045 621.51 TAXPAVER RESPONSE To insure proper c:rvdH to your aacO\lllt, two (U copies of thh notice tlUst aCCllIIPlIllll your pa~t to the bghter of Wills. ttek. checK paYllbl. to: "'Register of Nills, Agent". x NOTE: If tal( PIIYlIents are .... w!thln thr_ (3) ~nth. of tha dec._t', ate of dAtil, YOU "If daduot . 5;( dhcOllOt of the tax dull. Any Intletltenc. tax due ..nl bec_ clttHnquant nIne 191 lIOI'1ths .fur the Ate of d..th. rax PART [!] o Tt.. lIbow Info Uon and tn due is _r,,_t. 1. You 88lf choo to ,...ltp~nt to tha Aegist.r of W11h with two copt., of this notice to obtain . dl_t ort avoid Inter.st, 01' you .-y check bole <lA" and return this notIca to the Register of / 111.118 and an 'af'f.\olel ..__ant ",Ul ba hwad by the PA .,..r....nt of Ilawnue. 8. !tJ The .bo". assat "leI b8<<l 0" will be fiIPOrtlld and talC paid ",ith the Pennsyl\f11l1iB Inherlt_ ralC return to be filed by ttje dec~.nt'l representativa. t. D The llbo"e Infor.~Uan is l"oorrllOt ."l:II'or dllbt. and deductions WtIn paid by YOU. Vou llIUlt COlIIPld~ PoUlT 0 lIf'II:II'Ol' PART @] below. [CHECK ] ONE BLOCK ONLY PART I!l DEBTS AND DEDUCTIONS CLAIMED If you lnd1~te . different ta ret.~ pl.... st.t. your relationship to dac.d.nt:~ PART [!] TAX RETURN - COMPUTATION LINE 1. DOD V.1UllUon 2. Parcant Texebla 3. Altount Subject to Tax 4. Debts and Deductions S. AMOunt Taxabla 6. Tax R.t. 7. Tax Due OF TAX: ON ABOVE ASSETCS) 1 2. K 3 4 ~ S 6 X 1 DATE PAID i ! I I I TOTA. lent.. un U... . of T_ "_boUon' . Under penaltias of perjury, I ~ler. that the facts I hava raported,above,.~..t~' correct and eowplet. to the be-!t of IIY kno"lad~ end belief. HOME ('1 J' r )I]} l.L:::.~1"( v~}. . K. i. . 1 f)' t WORK C) Ii is t (/ TAWA~~~SIG)N~TUREur ,t\.. TELEPHONE NUMBER DATE PAYEE DESCRIPTION AMOUNT PAID ~ COMIIONWEAL TH OF PENNSYlVAHJA IlEPARTHENT OF R[VEHuE IlUREAU OF IHDIYlllUAl TAXES PO &Oil 21060.1 HARRISBURG PA 17128-0601 . INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06500608 DATE 11-13-2006 IU-lJ4U Aft 11-.8. EST. OF HELEN A MEllON 8.S. NO. 570-32-5223 DATE OF DEATH 10-12-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SECURITY o SEC Accr DITOCK o BONDS SUSAN M PLUTA 7 HOLLY DRIVE NEW CUMBERLAND PA 17070 REHIT PA VHENT AND FDRMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARlISLEJ PA 17013 EXELON hes prPlflc14ld the .o.PllrtlUll1t with thcl lnfo,.lI.tlon Ihted below Which h.. been \lAd In calculating the potential tlx dLI.. Their rllCord. indicat. th.t .t the cht.th of the above ~.dent, lIOU 101.1'. . benef101ery of tills IIS.t. If you f_l this infar_tion h incorrect, pl.II." obtlin writt... corr~t1on fra the t.....sfer lIOlIOt, attach a COp)' to this fill,.. .ld Mttum it to the ebovliI IIdcIrua. This .cc:ount i" tlIlCeble in lICoordlll"lctl with the Inher1a"ee hlC L.s of the Co"o_ltll of ~MSlllvIlt11a. Questions -)I be lInlwered by callIng (717) 7a7-pZ7. COMPLETE PART 1 BELOW )( )( .. ISII REVERSE SIDE FOR FILtNG AND PAYMENT INSTRUCTIONS Account No. 795889536 DOD Valua1:1on Percent Taxable AMount Subject to Tax Rat. Potential Tax Due x 55J013.48 100.00 55,013.48 .045 2,475.61 TAXPAVER RESPONSE To Inlll.lre proper cred! t to y_r eocount., two (2) copte, of this nDtice IlII.Ist .~eny ,\IOUI' "8)'...,t to t.... RlIOhter Qf toIUb. H8lce check PlIYabl. to: "RlIOht..r of WIUs, .-..,t... x HOlf; If tex peYlleOts .I'e 88de lI1tt1in thr.. (3) IIlOnths of the dlIoedent'lI data of dlMllth, you lIIlY dlub:t a lOX diacount of the tell dull. Any inherit_e tIN( dUe w111 becuae delinquent nine (9) aonths .ftllr the dtlte of death. Tax PART [!] If you indicate e different t relationship to decedent: o The tIbow info tlan end tlllC due Ja correct. 1. You All chou .. to r_lt PlIYtIlII"lt to ttIw RlISJiate.. of WJ11s with two copt.. of t/1ts notice to obtain II disoount 0,1 lIVold i"t.,...t, or )'0\1 ...11 chack bOI( ..... Itnd ratu..n this notice to the Resr!star of Willa and an iofflelel .ss.s......t will be Issued by the IIA DIiIpwrtllant of RavMua. B. ~The abOIlll ass.t ... b..n or will be reported !Mill tax paid with the Pennsy!\Itlnla InherltBnce Tall return to bll flIed by thII dllceciGnt'. representative. C. 0 The lIbov.. 1nfOMlll~ion is incorrect end/or debts and deductions ...... paid bll' you. You _st ClHIplat. PART 0 and/or PART 0 balow. rate, pl.... stat. you~ r C~~~K ] I BLOCK ONLY PART (!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART l!l TAX RETURN - COMPUTATION OF tINE 1. DOn VelUlltlon 1 2. Percent Taxabl. 2 X S. Allount Subject to Tax 3 4. Debts and Deductions 4 .5. AlIOunt Taxable 5 6. Tex Rat. 6 )( 7. T.x Dua 7 I TAX! ON ABOVE ASSETtS) PAYEE I (Enter on Line 5 of Tax C~putetlon) . Und.r penalties of perjury, I declare that tha facts I heve reported above are truel corravt a"d co_pl.t., to the b.st of .y knowledplllnd belief. HOME (. , l'1 )'7 7 t/ -,'J LI i.s ,:1.. ~ 1.... i):--t>>L - r~x~At~~. SII~~~~~;f .r I W~:~EP~ONE N~M;ER I I TOTAL DESCRIPTION AMOUNT PAID j ~.. '';f{'~) A . ~ 6021 2006f11/1e 209 Shareholder Services P.O. Box 43081 Providence, RI 02940-3081 If you have any questions regarding your account, please call Shareholder Services at 1-800-626-8729. Internet: www.computershare.~om/equiserve - Investment Plan Statement for Shareholders of .EXEl:.ON CORPORATION 1..11..,11.11,1..11,...1,1.1..11.1,1..1.11.111.111111...1111.1 SHIRLEY M RYAN 2740 NE 6TH STREET POMPANO BEACH FL 33062-4929 Issue# Account# Stock Symbol 6021 16531-90784 EXC SA VE THIS STA TEMENT FOR TAX PURPOSES Description Transferred from 07958-87168 F...lndlor Price per Commlsslons($) Net Dollar Amount($) Share($) Transaction Shares 911.000 Total Shirts Held 911.000 'ershare Trust Company, N.A., as agent, upon writt n request, will provide the name of the executing broker dealer associated with the transaction(s}, and within a reasonable amount of time will disclose the source land amount of compensation received from thira parties in connection with the transaction(s}, ff any. Total t.t~ldlngs and Market Value Security Celtificale Sha s COMMON Plan Shares 911.000 (As of t~e close of business on 11/14!2Q9..~1. TOlal SharEli Price per Share($ Market Value($) 911.000 59.180 53,912,98 ACC~SS YOUR ACCOUNT ONLINE! You can now access and manage your account online through the Computershare web site. All you need is the issue number and account number printed above,1 your social security number (if applicable), and this initial password: 16704857. To login simply go to www.com~utershare.com/equiserve and click on "Account Access." EXELON CORPORA rlON Transaction Form Optional Investment MM' check ptIIItIbIe 10: I Investment Plan Services I Amounl M1Cloled In U.S.DohrI: L-- Your OptloNlllnvestment can be a minimum of $25.00 per Investment and a maximum of $60,000.00 plr yoar P.rtial Withdrawal Continue Plan participation Is.ue a certificate for I thill number of shares . S~II thls number of shares I F&IIII Withdrawal Terminate Plan participation O Issuo a certificate for all1u1l shares ancl a chock for fractional shares o Sell all Plan shares Deposit of Certificates Deposit the enclosed r--I number of shares" L--J L Issue#: 6021 Account#: 16531-90784 274 SHIRLEY M RV AN Slgnature(s) for issuance or sale and/or change of address. All joint own.r. musl sign. Nam.. mUlt be Iigned '1l1ClIy as shown on ltQ slal.m.nl. (Palln.r/OIfic.rlTrusl.. must alan as PallI'l.r/OltieerlTrull...) 9/ signing I*ow. you .~e hI !he nl. of shar.s is aulhoriZld by you and .. olher rlglst.red owners 01 the shalll and will ~ bindin9 on you ancIluch other ownerl. -1 ....",-'. Address change or share transfer Mll'k boll and compl.l. th. appropriate . porlion on th. /lV"" sid. Dg 06021 16531 90784 43 ------ -- ------ - ~ --- - -. --- ----...,- ----- -- - . - IBM Gorporation Investor Services Program (ISP) IBM Stockholder Services P.O. Box 43073 Providence, RI 02940-3073 Telephone : 1-888-IBM-6700 1-781-575-2727 (outside u.s., Canada, and Puerto Rico) 1-201-222-4488 '. tt2t 200f11111 e 21 0 1.,lllull"'I'1I11 J I J .1.111..11.1'1' J '11'.1111'11111...1111.1 SHIRLEY M RYAN I 2740 NE 6TH ST POMPANO BEACH FL 33062-4929 By Facsimile: E-Mail: Internet: ibm@computershare.com http://www.ibm.com/investor (Go to Stockholder Services and then Registered Stockholder Access) Issue# Account# Stock Symbol 9926 16642-09653 IBM SA VE THIS STA TEMENT FOR TAX PURPOSES Desc,..,tion Fees and/or Price per Commisslons($) Net Dollar Amount(S) Share($) Transaction Shares Total Shares Held ransferred trom 08225-12696 163.000 163.000 are Trust Company, N.A., as agent, upon writt n request, will provide the name of the executing broker dealer associated with the transaction(s), and within a reasonable amount of time will disClose the source and amount of compensation received from thira parties in connection with the transaction(s), if any. ISp. Shares 163.000 (As of the close of business on 11/14/2006) Total Shares Price per Share($) Market Vllue($) 163.000 93.290 15,206.27 Total'Holdl.nQs and Market Value . Security Cortiflcate Shar s COMMON STOCK INTERNET ACCESS IS HERE! We are pleased to announce that you can acce1s your account information on the Internet through IBM's Web site at http://www.lbm.comlinvestor i You will need the issue number and account number located above, your U.S. Taxpayer Identification Number (if applicable) and your password of 42779344 to gain access ~o your account. Issue#: 9926 Account#: 16642-09653 SHIRLEY M RYAN --_._..~-_. ",- - - T~.' ansact..on Form Use this form only to transact shares IBM Corporation In the Investor Selvlces Program Investor Services Program Pa lal Withdrawal of Program Shares Cepos it of Certificates I I Deposit the enclosed c=J IssJ, I certificate for this number of shares .. nu~ber of shares , ' I I L ....-; ...---- ---~ = ... ~.:: = =-= ='=-= --- - - -- - . - 274 Sel\ this number of shares Optional Investment Ma. chack per'" 10: I Inve.tment P18n Services Amount enctcMed r. U.S.Oolara: Your Optlonallnve..ment can b. a minimum of $60.00 p.r Investment and a maxImum of $250,000.00 p.r year FUI, Withdrawal of Program Shares [] Issue a certltlcate for all full shar.s , and sell the tractional share [j] S.U.. .h.... I Slgnature(s) for issuance or sale and/or change of address. AI joint own.,. must sign. NI/llts musl be signed 'lClClIy a. shown on INs slalement. (Pwlner/OltletrfTrusltt musl sign as Parlner/OlflCtlfrrual..,) By signl"ll billow. you 1Igt'.. thallhe sale of sharn is authorized by you and all olher rtg\llered owner, of th. shar.s and will bII binding on you and auch oth.r own.rs. 09926 16642 09653 46 Add..... change or shar. transfer D ~ Mark box and compl.l. lh. appropriate portion on lh. r .v.rst sid. J (') :t m "T1 m X m (') ~ :< m o "T1 "TI Ci m ::D C/l m (') ::D ~ ::D -< OIW\V o ~ Po- ~3&>i l'i'~~::l me; ~.~ a~tD& 5" -:r Iii' iD 8~!g li!ii ::lio ...g 5.~: a goo:;' iS~.CD o g.g'g -I!!en-o ::Du:i 0 0 j2::~ 'i:!_::To "11: iirgCD:s CI ~~~:r ~ i en <" ifi '< i :"~I~ ~! ~~a::l oi ()Ill ~~ ~I !;::to tT O! _.CD -0'< ~::Slo. z _PlIll5. ~ CD CD :::.'< >: iii~g ! Wi 6 a ~ g f<<1 :; III a. :::J. WI III !l 0 N Wi 5: i:i &. 8. (I) ~i c: CD CD I!t.. r::i a::::Joit'C~ =::i!....3'T1 o .li::O - o c:~~ ~ ~~E.c! ! 0.~"8 Sl _.(Do:::l. 'g ~~! ~ &~a~" ~~i~ gO ~.. CDiga:r ~w'8~P ::::JPlii1en l;-a g.o ~ "'jij::l! ~-< IX I? ~ ag.e!. --CD CD !!.li=~ 0.030 ~OCDj /ii.-g 3~ -ji1Ill(D 19i~ ~ e!. 5'1 gii' ~~~g 85=1':::l /ii';:;O !!l. ~e.~~ :-0"2.32. ~Glg. Gle;CD a_cn gi"~ ~.' ill !i~ ~~I ~~i S!.5'a cn::::J'< ~!~ .~ en" ! :$ i' :;. a' '1:I'N tr:I O~:+: :3;,".lH 1od~,I.~ )10:" .~ , ':2:J~ t;I 'Pi'~I;:1'<I :~,~ l;12 ,t:IiI :'~i '':'<' >.:t: >' n Z tXi:.'tn ~ 1'J:j~ l""4tIJ M ~ ,0 o Cl 0'1 0'1 o iJ:I 0'1 As '" ~ M- .0, M- 1+ 1+0 It It ll- e It 1+ M-O It' It r:n ...:l C/l M- 'CJ'l, 0 o..D ("'l m ]]111 cneO 0 C (;)]] 00 It ...:l V'I =i~ 0 lit It ~ H C/lm It M- ,It .... "0 ~Ol 1+ It ,M- om * 1+ M- [)2 -I~ M- lit '" W ~~ .. It lit '" t:l C/lm M- ;t- It [):I rR~ t:l ]];!: :+ 1+ M- "0 ~z ~o I:-' <!Jl C U;Z i5~ W ~~ !Il z 8 0]] "TI~ ~~ ~g: ~!i 00 .,,~ 0-1 :t:t 5m i (f) ~ -n -. ~ ::J PJ ::J n -. ~ PJ - CJ ~~~- .., 0 c: O~ 3 -0 -e~ ""'- - 5jo ::J -- n . ItllVl: ':Jj.jJ -V.II t-V.l~l'o) -lnremanOIl8l.tSusmess IVlaCmneS corp. ~2~:g~~ e ~~.cscO" or 'Goqgle" J:'age 1 01 j Portfolios I SJgnJrI Search 93.35 Open: High: Low: Vol: -0.17 (-0.18%) Nov 24, 1:01PM ET ~ey settings y loom:.!.4 ~ 1m 3m 601 VTD 1] ~ lli M.!li ,oJ :....RJ. : sl iJ WtdOct 11 1 pm ,. .-:..( 2005 r!1 Tip: You can drar;J the chart. Related Comoanies Hewl.eff::p;:Ickard Company Microsoft Corporation EI~cl[Q!)j~Data Systems Corp.Qr~tt(m Orac.leJ~.orporation Wipro Limited (ADR) SUr) Mj~[Qsystems, .Inc. The SeD Group, Inc. Frees~~leSemiconductor , Inc. NQYell.Joc. Silicon Graphics, Inc. 93.05 93.75 92.98 2.13M Mkt Cap: i 140.62B PIE: 16.09 52Wk Hi9~: 93.80 F PIE: 13.67 52Wk Lot: 72.73 Beta: 1.69 Avg Vol: ! 7.01M EPS: 5.80 After HOUrs~ 93.75 +0.40 (0.43%) Nov 24, I 2:17PM ET Oct 10 .7 (0.83%) : 86 I 0 $~'~~~<: ~II ,. ~~~ ~ 85 pl' _J __,~. ;.....-- ~_.---- 84 ~ HPQ MSFT EDS ORCL WIT SUNW SCOX FSL.B NOVL SGID I \1 pm ! I 200 83 Fri Oct13 1 pm 30- 15.. Find more results for n~.M .. Newer news I Latest news , I,V \"" :l'...., I '-' V \~41 [~~ I '.....I...i '....... 1 .~" ..~.~! ., '.....' o Volume Spikes: IVN 0 JNC IBM PH MSN Monev . 18 Oct 2006 p UPDATE 1-Merrill Lynch ctJt$ IB_MJQ "neutral" Reuters - 18 Oct 2006 ,9.! Market Report -- Story StQcl<s{laMl MSN Money.. 18 Oct 2006 - Related articles N IBM sees more growth in India aseCQD9my booms Reuters - 12 Oct 2006 o US forces in Iraq to test IBM translatiOJJ device Reuters.. 12 Oct 2006 IBM sends new translator softw~reJo \,"'-~ military in Iraq MarketWatch US Military Testing IBM Speech Transl~tion T""rhnn/""" ~_("nrYln1""r("'" Timoc: , ~ NYSE d"r delayed by 20 min. - D"""m~ I Discussipns 39.56 1-0.16 (-0.40%) krpsoftWClre.com 29.76 \-0.16 (-0.53%) virtualst..@grnail.com - Nov 22,2006 (1 post) See the quarterly change in stock positions for 100 top 27.19 0.01 (-0.04%) Institutional Equity Money Management Enterprises in IBM and IBM's competitors. 19.60 0.06 (-0.31%) 15.55 0.19 (-1.21%) 5.56 0.03 (-0.54%) 2.45 fOOO (0.00%) 39.82 to.03 (-0.08%) 6.28 +0.08 (-1.26%) , 0.05 -ijO.OO , " Sector: Services> Industry: Business services\ I 1.. 111'". ... _ . .1.. ... __. H~__ _ _.. _ _t'l__Tn.. 6 ... Older news I View all news forJBM >> Revealed: world's oldest computer VerticalSo\ar - Nov 16, 2006 (1 post) Here's some recent article with some information about the "world's oldest computer": Revealed: world's oldest computer Helena Smith Sunday August 20, 2006 The Observer t1~IIQ xingy.@hotmail.com - Nov 1, 2006 (1 post) hello MQre cfi$cussions >) Slog Posts ~ 1 1 ,,, C ,,, nn t:. ,:)h, I r: ~').V') TV.V'+- ~ V.I 0/'0) - ~KY .rmanCl31lJI'OUp, inc. ~2~?g!~ e g. "CSCO" or "Google" Page 1 ot :5 Portfolios I $190-'.[1 Search Sky Financial Group, Inc. (Publici NASDAQ:SKYF) - dd to Portfolio - Discuss SKYF Find more results for S.KYE 25 03 Open: 24.88 Mkt Ca : 2.738 PIE: 13.46 AI. Newer news I Latestnew.s · High: 25.08 52Wk igh: 29.87 F PIE: N1A WfHR _ 3 Nav 2006 _ +0.04 (0 16%J) Low: 24.88 52Wk L w: 23.09 Beta: 0.39 ~";(e!ated articles )) Nov 24. 1:00PM ET Vol: 244,842.00 Avg Va!: 263,000.00 .EPS: 1.86 Compare'" Settings " loam=14 ~ 1m 3m 6m ITQ II 11lli Mall -...._- --~- Ipm . Wed Oct 11 200S @ Tip: You can drag the chart Related Comoanies fjr~tM~LitCorparation REH>.YbUc Bancorp, Inc. Hum![IgtQ!1 Bancshares I ncorpQr.at~d \IVes~~D~9, Inc. The F~lderal Bank Limited FirstEi[lJ~m;;i~1 B~ncorp F . No EtCQrporation City HQldJng Company Horizon Bancorp First Merchants Corporation I! SkyFinancial Taps Bharos~JQrVYeJ:? Security BankNet 360 .. 2 Nav 2006 ~i p.{)~~ ( 25.4 .!.J Sky Financial buys ColumbLJs~are_~ agency Toledo Blade - 3 Oct 2006 -g. I Sky Financial buys Worthington insurance agency Columbus BUSiness First - 2 Oct 2006 25.3 25.2 --~, -'---.- -- ...-1~/ -.---/ 1 I pm ~~V I''''' 20p6 2~.1 2~.O _~_I Sky Acquires Lindig Benefit Con$!Jl~nt~ PR Newswlre (press release) - 2 Oct 2006 24.9 _.~-' Sky Bank celebrates its2Sth anniversary in Carrollton areSi New Philadelphia Times Reporter - 23 Sep 2006 T Sky Financial Group to HO_ld ThIrg Quarter Earnings Conference Cc:lII~[IC:L.o .... Older news I View all neW$JQr SKYE.)) FriOct 13 1 0.5. rn NASDAQ ~ata delayed by 15 min.- Disclaimer FMER 23.65 +0.10 (-0.42%) RBNC 13.56 to.02 (-0.15%) i HBAN 24.63 fO.13 (-0.53%) 32.81 iO.38 (-1.14%) i I 17.12 ~0.18 (-1.04%) 17.96 ~002 (0.11 %) I 39.76 l0.44 (-1.09%) 27.70 +1045 (1.65(%) 26.66 -0.06 (-0.22%) Sector: Financial> Industry: Regional Banks WSBC FFBC FNB CHCO HBNC FRME Annual I Annual Financials (In millions of USD) Quarterly "'ffy,..II-Fi"Q""'~ n^^nl~ ",^""lh"Q""'~?n=~Vvti' Discussions Start a discussion about Sky Financial Group,ln~.)) 810g Posts bhSiJosa inc.: sky fjn~ncial group selects bharosa to provideu..' Nov 1, 2006 - market wire - computers and software bowling green, oh and santa clara, ca (market wire) sky financial group (nasdaq:skyf), one of the 40 largest publicly held bank holding companies in the nation, $KY financial group$e1ectsbhSlrosa to provideadVcl."<;ed security.o' ' Nov 1, 2006 - articles by marketwire   sky financial group(nasdaq: skyf), one of the 40 largest publicly held bankholding companiesin the nation, and bharosa, a global provider of proactive, s~yJim:lnc;;iSiLgroup, inc. (skyf) reports 3rd quarterending... Oct 18, 2006 - earnings whispers' eamings newsl sky financial group, inc. reported quarterly earnings of $0.48 per share. the consensusearnings estimate was $0.48 per ~ 1 1/'')1:, nnnf:. - -- -- - -- --- 1 ..c,AL.~ J~.OJ TV..)O ~V,~i'O} - nXelOn \""onporanon Google Finance t~t~ i".. Exelon Corporation (Public, NYSE: dciJ9 POJ1folio - Piscuss EXC 59 65 Open', 59.15 Mkt Cap'. PIE: 198.84 .... - Newer news I Latest news . High: 59.69 52Wk Hig F PIE: 13.03 ...!.:!J ,-",..,V' , '""V, 1-" ..., .....v. ....,...... '::I''''-''''~-'!''''-~-~~~!.~~ +0.38 (0.64%) Low: 59.05 52Wk Lo : Beta: 0.30 Trading Markets - 7 Nov 2006 Nov 24. 1:01PM ET Vol: 1.37M Avg Vol: 4.25M EPS: 0.30 After Hours 59.87 +0.22 (0.37%) Nov 24, 2:17PM ET & ~ :::: -----------__.sl~__.lL~ I Compare .. Settings . loam.!.! ~ 1m 3m 6m VTD 11 2llli Max Wed;OttU 1 pm 2005 ~ Tip: You can drag tile chart Related Companies PubliC Service Enterprise Group Inc. CinergyJ;orp . Ent~r:gy_CQrporation XceLEnergyl nc. NiSOUJce Inc. OTEfJl~rgy..Company Wisconsin Energy Corporation Pe_QQPHolgings, Inc. WPS.Re$Qurces Corporation CMSEl'lergy Corporation ~ lpm Oct 10 Page 1 ot 3 Portfolios I $\gOII1 Search Find more results for exc s Exelon Pa. Peach.Bottom2 reCic;JQLexjts refuel Reuters - 11 Oct 2006 - f~elated articles >) FriiOtt,t~ 2006 \ 0.03 (0.05%) T Exelon studies 8 Texas sites for nUGleCiI reactor Reuters - 6 Oct 2006 60.0 U Exelon eyes Texas plant Chicago Tribune - 30 Sep 2006 " UPDATE 1-Exelon considt3ringbuilding.IJ~~ nuke in Texas Reuters - 29 Sep 2006 - Related articles )) W Exelon CEO expects surge ofnQn-re.gJ"l~ted power deals MarketWatch ..27 Sep 2006 - Related artIcles ,} ~9,~ t,lIl 16- 8 X Exelon ups lower end of2QQQ_QPer~ttng profit view range Reuters .. 27 Sep 2006 - Helated articles )) .... Older news I View all news for i::XC }> NYSE dat9 delayed by 20 min. - Disclaimer Ii: [!J PEG 65.39 -ItO 13 (020fYo) ETR XEL NJ DTE WEC POM WPS CMS 89.31 40.04 (-0.04%) I 22.69 -+10.03 (0. '13(10) 23.88 +p.08 (0.34%) 46.74 -0.26 (-0.55%) 46.47 +p.08 (.0.17%1) 25.76 +p.01 (0.04%) 52.65 +p.01 (0.02%) 15.26 +?03 (0.20%) i I Sector: UtilitieS> Industry: Electric Utilities Financials (In millions of USD) Quarterly Annual i httn,ll-hnQn~p n-nnn-l... "^....,, u:;....o~"Q?,,=nv{"'l Annual Discussions Re: exe/on stpck split chan..@gmail.com - Oct 18.2006 (2 DOstS\ "m patiently awaiting... I would like to see them acquire another company though. Too bad PSEG fell through. amp wrote: MorediscLJ$$ions )) 810g Posts E)(elpn Corp. (EXC): John Keeley Initiates HoldingsJJ1E;XC Nov 6, 2006 - gurufocus Updates John Keeley initiated holdings in Electricity company Exeton Corp. (EXC) duringthe 3-months ended 2006-09-30. His purchase prices were between $ 56.58 and $ ~)(~Ion corporation (exe) reports 3rd quarter ending sept~mp..t3J 2006 '.. Oct 27, 2006 - earnings whispers' earnings news! exelon corporation reported quarterly earnings of $1.02 per share. the consensuseamin!lS estimate was $1.04 per # 1 1 '" t:' ,"'"", REt<-l509 EX. (..... COMMONV\lEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTly-oWNED PROPERTY ESTATE OF Helen A. Mellon FH.E NUEER . an .... was made joint wIthih OM year of the decedInt'I datil at dIIth, it must be NportM on SchIel. G. SURVIVING JOINT TENANT(S) NAME I ADDRESS RELATIONSHIP TO DECEDENT A. Shirley M. Ryan ~740 NE 6th Street Daughter fompano Beach, FL 33062 B. Susan M. Pluta t Holly Drive New Cumberland, PA 17070 Daughter C. I JOINTLV-OWNED PROPERTY: LETTER DATE C F:SCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INClUDE NAME OF FINANCI ~ INSl1nJTlON AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBE R ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 07/19104 Commerce Bank - Acco ~t # 0536671928 12,871.67 .33 4,290.55 I I I TOTAL (Also enter on line 6, Recapitulation) $ 4,290.55 (If more $paCe is needed, insert additional sheets of the same size) ~ - -------- ---r NOV-27-2006 17:66 COMMERCE BANK 866 727 3413 P.002 Monday, November 27, 2006 j COMMERCl:IBANK/HARRISBURG, N.A. (0184) Page' of 1 HELEN A MELLON SHIRLEY M RYAN SUSAN M PLUTA 2740 NE 6TH ST. POMPANO, BEACH 33063 Checking Activity Ac;eount Number SO PLUS CLUB Transaction. From Statement PerIOd Endl", "nl2OOS 531171128 Account Summary Ending Statement Balance on Tue. '/, Novtmber07', 2006 $11,282.83 Account ActivitL- .. ~ DescrlptJon CNdlt BalarQ fOi.,~ . ..:......l:..;:01~pi*_;;~~~t~B:::SLr~~i:~~:~5~~g;*X;~~~,~~~]~8#Tf~:@;~:;Z:::;~.~,~~:::::.~';~~:~~;"13~Y' ~"""".i;~-:' . ,;'~ ,.', 'IMIIaoot.. ',,",'C"eck:~5S' . '.'" . I' ".; . "..... :,'.", .... . '$1so:aa.. ....:.....$12'.121;87. ~~r~~&t~ff1,!;.~~~*;!f-if;~!:i:rl:DI~":~!.:\i~6f.~;:;~~r.;f}*~;r~~@tr('i~'~~?p~:~j~:.'::;':~:; ~~:{,10~~~:~_t '. , 10f,l~0D8 ... :etMclC...,.... '! ' "'.. .' ..'. :.... ~: ::,' $52.$;.3,. .. .:"<' ,. $1.1_:S0 '" , I' . ~~i.AA~>~t~;;'f~~~;'~~~.~~~:~f~~ '::^:::~~~'?-;:~C~~t~~Jrt~{tf.;;:,1jmiftt2~Z.~2::{~~~::~~~~~>~:'f.~:..:;~~~~tJ~{~fjJf~~ ;;1'.1;"': .~:; 'I1nl2OO6'" : " '~TEREST.:'P'AYMENT', .': .'. :' :.... :. '" : \.., .' ..' .$1;57....:~.,'~$11,2l2'.I3..."..,.. ~:~.' .':.t'. ::. \'.A:':- ~~~'~/' ..' :. 1 ,fir~tV~!~~~l~~~~:~~j~~;!L; . "'::'>':.~'}':'~'" ,[OIa~~.B~i2ii26;r.::'k;,......". . .. .. ;t!j.;;~}~~:E~,'2:~+0I~_J2f.~}:f.?~ .j/~ '3'1/.(,,7 7"-3 I $ 'f~qO, sfi {VJJ ~ TOTAL P.002 REV-"" ex. ('2-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDULI H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Helen A. Mellon ITEM NUMBER A. RLE NUMBER 01,,* of decedent must be reported on Schedule L DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Mechanicsburg Cemetery Associatio HoUday Inn - Bereavement Meals Malpezzi Funeral Home Funeral Flowers Other miscellaneous funeral costs 725.00 678.37 10,452.20 350.00 257.87 2 3 4 5 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representatlve(s SocIal Security Number(s)/EIN Num!*' of Personal Representative(s) S1reet Address City State Zip 3. 2. Attorney Fees Year(s) Commission Paid: 4. Family Exemption: (If decedenfs address I not the same as c1aimanfs, attach explanation) Claimant, I Street Address I City I State Relationship of Claimant to ~t Probate Fees I . Zip 5. Accountanfs Fees 7. 6. Tax Rellm Preparer's Fees I I I TOTAL (Also enter on Une 9, Recapitulation) S 12,463.44 (If more ~ace is needed. insert additional sheets of the same size) ~ Mechanicsburg Cemetery Association Receipt of P_yment Date: tfJ~ 17 ,?.~" (, Received of and ftom: i /'1 PI" t-a- (Name) Ie,.,. ~II ~""41 ,,-I IIL/~n me,I/Dn (Street A dress) (City, State and Zip Code) (Phone Numbe.3.1 _ J . A- rV ~ :2.5'(., the sum ors--t.:2~ (JoO in paymentfor the i purchas f: , Grave: Cremains Niche ~o( s).: Other: ~II r"nq/ 0;"'171"1 ! '7.:J.5 ,rp Mechanicsburg Cemetery Association By . QI1! II~ / (Authorized Signature) ~. - -1 / r I ! : /" iy- ". /~.'..... . I'i '," Rei, No: G 54~1 t' lisle Pike M~ '.... PA 11055 Tel+ . 111) 691.0321 FM~;~ (7f7) 697-5917 11] 100100472 -t,'! 1\~ ~N\: PERSON IN CHARGE: ORGANIZATION: ADDRESS: METHOD OF PAYMENT ROOM FOOD BEVERAGE GRATUITY I ~ I I I I I SIGNATURE OF APPROVAl ~ J/Qtt/JW- J/()(UL fl'aovm'lP' c/epOS/f' -1 INDEPENDENTI.Y OwNED BY MECHANICSBURG OF INVESTORS. OPERATED BY: CEm' , . . ACCOUNTING ~$Z~. 67 tJ- . REV-1512 EX+ (12.03) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT - - -,---------------- SCHEDULE I DEBTS OF DECEDENT, GAGE UABlunES, & UENS ESTATE OF FILE NUMBER Helen A. Mellon Report debts Incurred by the decedent prior to I Ieath which remaIned unpaid as of the elite of death, IncludIng utnlmburHd medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ! 1. Pinnacle Heath Services (Hospice) i 1,129.68 2 Bethany Village (Assisted Uving & Skilled Nursing) 7,193.00 3 Alert Phannacy Services, Inc. 30.00 ! TOTAL (Also enter on line 10, Recapitulation) $ 8,352.68 .. (If more space IS needed. insert additional sheets of the same SIZe) ____ 1 ~ From: 08/31/01 STATEMENT To: 09/15/06 Aged as of:1 0/13/06 ,.., PinnacleHealth Hospice 3705 Elmwood Drive Harrisburg, PA 17110 717-782-2300 Helen Mellon 5225 Wilson Lane, Rm. 30 Bethany Village Mechanicsburg, PA 17055 Printed: Page: Patient Iq)!.: 10/13/2006 1 P5070 8/31/2006 8/31/2006 9/1/2006 9/15/2006 I I I $125.52 $878.64 $1,882.80 -$753.12 $1,129.68 _..>.;..... :f" ,f9,,~,t~,;~~. Pay Source: Private -..-.. Account Summary: Total $1,129.68 61-90 91-120 121-150 151-180 241+ ~ PLEASE RETURN THIS PORTION WITH YO R PAYMENT. THANK YOU PinnacleHealth Hospice 3705 Elmwood Drive Harrisburg. PA 17110 PLEASE PAY THIS AMOUNT Patient: Invoice Period 8/31/201IJ5 $1,129.68 Helen Mellon 9/15/2006 d ~ .J) /1 f),...I,.'t#=V.......... ....i........ ~ If /\ , .r t.,. c..-<<::' /, ., '" ~ /1- o<':I:ci~ -..r-""-- P- . 'ti:ethany Village ..... 325 Weslev Driw rvkchanicsburg. P,\ t 7055 $7,193.00 L~ ACCOU~ i MBER i~~2 ' (..~. Due Date FACILITY NAME BETHANY SKILLED NURSING AMOUNT PAID $ Please make check payable to BETHANY SKillED NURSING HELEN A MELLON c/o SUSAN M PLUTA 7 HOLLY ORJVE NEW CUMBERLAND, PA 17070 Remit To: BETHANY VILLAGE 325 WESLEY DRIVE MECHANICSBURG, PA 17055 Please detach and return this porlion with your remittance to the I .:~? .'.' .",.. . .'. ." nati''::JI~~] ..~~:~~;>i;#.~.t_~ :.:, Balance Forward Beauty/Barber Shop Charg Isolation Incontinence Care Monthly Fee i .';'1 10103106 - 10/03/06 10/11106 - 10/11/06 10111106.10111/06 10/12/06 - 10/31/06 1 $16.00 21 $6.00 20 $7.75 {20} $(264.00) TOTAL BALANCE DUE: ESIDENT NAME ELEN A MELLON ACCOUNT 2225 $~ REV-1513 EX+ (~) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen A Mellon FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS pnclude outrighfiliOOsal distributions, and transfers under Sec. 9116 (a) (1.. )] RELATIONSHIP TO DECEDENT Do Not List Trustee(.) AMOUNT OR SHARE OF ESTATE 1. Shirley M. Ryan Daughter 50% 2740 NE 6th Street, Pompano Beach, fL 33062 2. Susan M. Pluta Daughter 50% 7 Holly Drive, New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTioNS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECtiON 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE i B. CHARITABLE AND GOVERNMENTAL DiStRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If morel space IS needed, Insert additional sheets of the same size) $J-