HomeMy WebLinkAbout08-22-07
~REV-1500 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 -06 0 6 7 5
cOu'iihCciiiE ---YEA~ - - NUMBER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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DATE OF BIRTH (MM-DD-Year)
07/23/2006 05/18/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
2 04- 0 1 - 3 365
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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[X] 1. Original Return
D 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date 01 death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copyofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date 01 death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
iL 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch a)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jill M. Wineka Es uire
FIRM NAME Ilf Applicable)
Purcell Kru & Haller 1719 North Front Street
TELEPHONE NUMBER
717 234-4178 Harrisbur PA 17102
1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
150,000.00
OFFICIAL USE ONLY
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3 Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JOintly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(7)
(6)
132,654.50
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9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(9)
(10)
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
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19 Tax Due
0.00 X _ (15)
407,957.75 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
20. [8]
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~
178,137.54
(8)
460,792.04
40,504.74
12,329.55
(11)
(12)
(13)
52,834.29
407,957.75
(14)
407,957.75
0.00
18,358.10
0.00
0.00
18,358.10
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
720 Mountain Street
CITY I STATE I ZIP
Enola PA 17025
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19)
2 Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C Discount
(1)
18,358.10
28.000.00
917.91
Total Credits (A + 8 + C)
(2)
28,917.91
3 Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the Interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
10,559.81
0.00
0.00
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 00 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.
ADDRESS
PA 17110
01' TE
/21/() 7
M. Wineka, Esquire, 1719 North Front Street
rrisburQ
PA 17102
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS S9116 (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. S9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of 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.S. S9116(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. S9116(1.2) [72 P.S. S9116(a)(1 )J.
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. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
Individual who has at least one parent in common with the decedent, whether by blood or adoption.
,REV-1502 EX + (6-98)
'*
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Myers Roy F. 21 06 0675
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is iointly-owned with riqht of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
720 Mountain Street, Enola, Cumberland County, PA 17025
(See attached Deed dated May 28, 1946 and recorded August 6, 1946, transferring
title to the Decedent and his wife, Dorothy May Myers, who predeceased the
Decedent on April 12, 2005. Also see Settlement Statement from settlement of
Decedent's property held December 6,2006.)
VALUE AT DATE
OF DEATH
150,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
150000.00
,REV-15G8 EX + (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Myers Roy F.
FILE NUMBER
21 06
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11 .
12.
13.
14.
15.
16.
DESCRIPTION
Adjustments to Settlement Statement regarding sale of Decedent's real estate
Erie Insurance - car insurance refund
Comcast - refund
Erie Insurance - hazard insurance refund
National Shopmen Pension Fund - monthly pension check dated 6/1/06
Wachovia Bank - IRA automatic withdrawal check dated 6/30/06
PA Employees Benefit Trust Fund
West Shore Oil Company - refund
International Iron Worker Local 822 - refund of dues
PP&L - refund
Five firearms
(See attached appraisal from Megonnell's Custom Gunworks, Inc.)
2001 Chevrolet Venture Van, VIN# 1GNDX03E510153057
(See attached NAD.A book value)
PNC Bank, Checking Acct. No. 5140111733
PNC Bank, Savings Acct. No. 5003147625
(See attached October 6, 2006 Statement from PNC Bank)
The Patriot News - refund
National Shopmen Pension Fund - monthly pension check dated 7/1/06
0675
VALUE AT DATE
OF DEATH
902.93
306.00
2.33
265.00
248.50
90.05
472.89
226.34
16.25
71.63
540.00
4,600.00
21,318.67
102,577.91
67.50
248.50
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
132654.50
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Myers, Roy F.
Decedent's Name
Page 1
21 06 0675
File Number
Schedule E - Cash, Bank Deposits, & Misc. Personal Property
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17. Personal Property - old beds, sofa, chairs, kitchen table, dishes, tools, misc 700.00
household furnishings
SUBTOTAL SCHEDULE E 700.00
GRAND TOTAL SCHEDULE E $ 132,654.50
. REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Mvers. Roy F.
FILE NUMBER
21 06
0675
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAl. ESTATE VALUE OF ASSET INTEREST VALUE
(IF APPLICABLE)
1. MetLife Investors USA Insurance Company - 18,013.64 100. 18,013.64
Annuity Contract No. 9200518731
2. MetLife Investors USA Insurance Company - 28,425.24 100. 28,425.24
Annuity Contract No. 9200592892
3. MetLife Investors USA Insurance Company - 42,389.74 100. 42,389.74
Annuity Contract No. 940172243
(See attached letter dated 11/13/06 from Met Life regarding
date of death values. Also see attached letter dated
7/9/07 confirming Decedent's daughter, Donna Keammerer
was beneficiary of all three MetLife Annuities.)
4. AIG Annuity Insurance Company, Contract No. FJ237758 23,469.33 100. 23,469.33
(See attached letter dated 9/16/06 from AIG regarding date
of death value and confirmation that beneficiary was
Decedent's granddaughter, Kirby Keammerer since
Decedent's spouse, Dorothy M. Myers predeceased
him on April 12, 2005.)
5. Transamerica Life Insurance Company, Annuity No. 56,815.77 100. 56,815.77
02PB0004269 (See attached letter dated 11/2/06 from
Transamerica regarding date of death value and
confirmation that beneficiary was Decedent's daughter,
Donna Keammerer.)
6. Wachovia Bank, IRA No. 257400090792029 2,046.35 100. 2,046.35
7. Wachovia Bank, IRA No. 257410093562000 6,977.47 100. 6,977.47
(See attached letter dated 8/7/07 from Wachovia regarding
date of death values on the two IRAs. The Decedent's
daughter, Donna Keammerer was the beneficiary on
both IRAs.)
TOTAL (Also enter on line 7 Recapitulation) $ 178,137.54
(If more space is needed, insert additional sheets of the same size)
, REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Myers. Roy F.
ITEM
NUMBER
A.
1.
2.
3.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11 .
12.
13.
14.
15.
16.
17.
FILE NUMBER
21
06
Debts of decedent must be reported on Schedule t.
DESCRIPTION
FUNERAL EXPENSES:
Sullivan Funeral Home
Rice Memorial Works - gravemarker inscription
Peachtree Restaurant - post-funeral luncheon
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
Attorney Fees Purcell, Krug & Haller
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Donna Keammerer
Street Address 307 Autumn Chase Drive
City Harrisburg State PA
Relationship of Claimant to Decedent Daughter
Zip 1 711 0
Probate Fees Register of Wills
Accountant's Fees Samuel Thuma, CPA
Tax Return Prepare~s Fees
Transfer taxes and notary fees paid when real estate was sold
(See attached Settlement Statement.)
Wachovia Securities - fee to obtain date of death value on two IRAs
Community Settlement LLC - fee to obtain Deeds
Megonnell's Custom Gunworks, Inc. - appraisal fee for guns
Robert R. Jones Appraisers - appraisal fee for real estate
Erie Insurance Group - hazard insurance premium
Debbie Lupoid, Treasurer - real estate taxes
Register of Wills - fees to file Will; Automation fee; JCP fee; Short Certificates
PNC Bank - Estate check fee
U.S. Treasury - 2006 Estate Federal Income taxes
PA Department of Revenue - 2006 Estate State Income taxes
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0675
AMOUNT
8,947.00
125.00
175.00
23,000.00
3,500.00
360.00
350.00
1,510.00
25.00
28.00
47.70
300.00
359.00
1,504.78
70.00
28.26
63.00
32.00
40504.74
Myers, Roy F.
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 2
21 06 0675
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
DESCRIPTION
AMOUNT
18.
19.
Register of Wills - fee to file PA Inheritance Tax Return
Penn DOT - fees to transfer title of Van
15.00
65.00
SUBTOTAL SCHEDULE H.B7
80.00
REV-1512 EX + (6-98)
'*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Myers. Rov F.
FILE NUMBER
21
06
0675
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
PA Employees Benefit Trust - repaym,ent
VALUE AT DATE
OF DEATH
375.89
2.
U.S. Dept. of Treasury - reclamation of pension
1,324.18
3.
Harrisburg Pharmacy - medical services
7.00
4.
Beverly Healthcare, Blue Ridge Mountain - haircut
9.00
5.
East Pennsboro Township - sewer
68.00
6.
PP&L - electric
97.98
7.
U.S. Treasury - Decedent's 2006 Federal Income taxes
7,835.00
8.
PA Department of Revenue - Decedent's 2006 State Income taxes
2,273.00
9.
PP&L - electric
19.74
10.
PP&L - electric
19.76
11.
Purcell, Krug & Haller - attorney's fees to prepare Will and POA
300.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
12329.55
""''''''.''*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
MVF'lrS R~v F. 21 06 0675
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Ronald Keammerer Lineal
307 Autumn Chase Drive Item III - guns
Harrisburg, PA 17110 $540.00
2. Emily Keammerer Lineal
307 Autumn Chase Drive Item IV - fishing equip.
Harrisburg, PA 17110 no value
3. Kirby Keammerer Lineal
307 Autumn Chase Drive Item V - sewing supplies
Harrisburg, PA 17110 & tools - no value
4. Donna Keammerer Lineal
307 Autumn Chase Drive 100% of residuary
Harrisburg, PA 17110
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
IN RE:
IN THE COURT OF COMMON PLEAS
CUMBERLAND CO., PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF ROY F. MYERS,
DECEASED
NO. 21-06-0675
TABLE OF CONTENTS
1. Last Will and Testament of Roy F. Myers dated March 13,2006;
2. Letter dated August 17, 2007 to PA Department of Revenue with explanation regarding family
exemption being claimed and Decedent's residence;
3. Deed dated May 28, 1946 and recorded August 6, 1946 transferring title to the Decedent and his
wife, Dorothy May Myers, who predeceased the Decedent on April 12, 2005;
4. HUD-1 Settlement Statement dated December 6, 2006 regarding the sale of the Decedent's real
estate;
5. Appraisal from Megonnell's Custom Gunworks, Inc. for date of death value of guns;
6. N.A.D.A. book value for July, 2006 for value of 2001 Chevrolet Ventura Van;
7. Letter dated October 6, 2006 from PNC Bank providing date of death values for Checking
Account No. 5140111733 and Savings Account No. 5003147625;
8. Letter dated November 13, 2006 from MetLife Investors providing date of death values for
Annuity Contract Nos. 9200518731; 9200592892 and 940172243;
9. Letter dated July 9, 2007 from MetLife Investors confirming Decedent's daughter, Donna
Keammerer was the beneficiary of all three MetLife Annuities;
10. Letter dated September 16, 2006 from AIG Annuity Insurance Company providing date of death
value for Contract No. FJ237758 and confirming that Decedent's granddaughter, Kirby
Keammerer was the beneficiary;
11. Letter dated November 2, 2006 from Transamerica providing date of death value of Annuity No.
02PB0004269 and confirming the beneficiary was Donna Keammerer;
12. Letter dated August 7, 2007 from Wachovia Securities, LLC providing date of death values for
I RA Nos. 257500090792029 and 257410093562000.
LAST WILL AND TESTAMENT
OF
ROY F. MYERS
I, ROY F. MYERS, of East Pennsboro Township, Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament, and revoke any and all Wills and Codicils previously made
by me.
ITEM I:
I direct that all my just debts and funeral expenses, including my grave
marker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable
after my decease, as a part of the expense of the administration of my estate.
ITEM II:
All federal, state and other death taxes payable because of my death
with respect to the property forming my gross estate for tax purposes, whether or not passing under this
Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of
the expense of the administration of my estate and shall be paid out of the residue of my estate, without
apportionment or right of reimbursement.
ITEM III:
I give, devise and bequeath to my son-in-law, RONALD KEAMMERER
of Harrisburg, Pennsylvania, all of my firearms.
ITEM IV:
I give, devise and bequeath to my granddaughter, EMILY
KEAMMERER of Harrisburg, Pennsylvania all of my fishing equipment.
ITEM V:
I give, devise and bequeath to my granddaughter, KIRBY
KEAMMERER of Harrisburg, Pennsylvania all of my sewing and knitting supplies, tools and equipment.
ITEM VI:
I give, devise and bequeath all the rest, residue and remainder of my
Estate of every nature and wheresoever situate to my daughter, DONNA KEAMMERER of Harrisburg,
Pennsylvania, provided she survives me by thirty days. In the event my daughter, DONNA
KEAMMERER, fails to survive me by thirty days, then I give, devise and bequeath al/ the rest, residue and
remainder of my Estate of every nature and wheresoever situate to be divided equally between my
granddaughters, EMILY KEAMMERER and KIRBY KEAMMERER or their issue, ~ stirpes.
ITEM VII:
I appoint my daughter, DONNA KEAMMERER as Executrix of this my
Last Will and Testament. In the event my daughter, DONNA KEAMMERER should fail to qualify or
cease to act as Executrix, I then appoint my attorney, JILL M. WINEKA of Harrisburg, Pennsylvania to
serve as Executrix of this my Last Will and Testament.
ITEM VIII:
I direct that no Executrix be required to post bond or enter security in
any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
j 3 IJ-A
day of
In 1-7 R. e 14
,2006.
oJ
)t~ 1- /Jj~
ROY F. MY S
(SEAL)
The preceding instrument, consisting of this and one other typewritten page, was, on the date
thereof signed, published and declared by Roy F. Myers, the Testator therein named, as and for his Last
Will, in the presence of us, who, at his request, in his presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
)M~' m &rrvJ1h~
resKlinga! ~_P/?dM
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residing at !Io r ( i sba fJ 1-1} /7//)-
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COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF DAUPHIN
WE, Roy F. Myers, Ja/'ii (!., j{'eS~ and 70 r.~' ,m Sf (;1 Smfl
the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed
and executed the instrument as his Last Will, and that he had signed willingly and that he executed it as
his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the Will as witnesses and that to the best of their
knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
Ot1Js 'P P7TjtMJ
ROY F. MY S
g~(:~
ness
~\
,-- t1;7 (" ill /& .{/?ffli~ifr' .
\IVItness
Subscribed, sworn to and acknowledged before me by ROY 1:. MYERS, the
subscribed and sworn to before me by JJ,./i C. II;€!.. !:>fe~
~ Q (A rY' &r (1#1'(1 , witnesses, this 13M day of m YJ€c!H
2006.
Testator, and
and
I! CxU
l~U'-1f.-Jv'-- . ~J--
/ Notary Public I
(willslmyers\will)
r~-~- ..-.... '"'_"'_~_~~~._n__.." .0-'---'
NOTARIAL SE..i,l
ryt :-':'-I"\;~II\" . , ..
1 [;oAr,..."..,;"'!'> y~. SH.<\DEl, Nom.-}' PUDlIc
1 Ci~f or Hcnisburg, Dauphin C-ourrcy
pV11~~9~~1]_j~,~~~nC:o~E:~~ ~~~~~h '19, 2007
LA W OFFICES
How ARD B. KRUG
LEO,," P HALLER
JOHN W. PURCELL JR.
JILL M. WINEKA
BRIAN 1. TYLER
NICIIOLE M. STALEY O'GORMAN
LISA A. RYNARD
Purcell, Krug & Haller
1719 NORTH FRONT STREET
HARRISBURG, PENNS YL VANIA 17102-2392
TELEPHONE (717) 234-4178
FAX (717) 783-4939
HERSHEY
(717) 533-3836
JOSEPH NISSLEY (1910-1982)
JOHN W. PURCELL
VALERIE A GUNN
Of Counsel
August17,2007
PA Department of Revenue
Inheritance Tax Division
P.O. Box 280601
Harrisburg, PA 17128
Re: Estate of Roy F. Myers
SS#: 204-01-3365
Date of Death: July 23, 2006
PA File No.: 21-06-0675
Dear PA Department of Revenue:
This letter is to explain on Schedule H, Item No. B.3. why the Decedent's address was different than the
address of the Claimant of the family exemption. The person claiming the family exemption is the Decedent's
daughter, Donna Keammerer. Approximately two months prior to his July 23, 2006 death, the Decedent had left
his home located at 720 Mountain Street, Enola, Pennsylvania 17025 to move in with his daughter, Donna
Keammerer and her family at their address of 307 Autumn Chase Drive, Harrisburg, Pennsylvania 17110. The
Decedent's declining health meant he was unable to live alone in his house. The Decedent's mailing address
was changed to his daughter's address and his clothes and other necessary personal property were moved to
his daughter's home.
Sincerely,
~i~~
JMW/bas
cc: Donna Keammerer, Exec.
202-DT-Deei.l-Fee Simple.
Henry Hall, Inc., Indiana, Pa.
mbts Jnbenture,
MADE THE 28th day of
one thousand nine hundred f0 1'1: -I- S ' Z
!.lay
in the year of our Lord
BETWEEN
::.;~.. --; ",',
~':..t'_ J. '_~.. _ ' -,"-
.=.:~, ~.-. i:::c~:-' ,
of t!.le nnl'Ol) ,;-1'-1 of
J..Jp ~~O~'Tne .
C0t~ nt~,r of CtJr.'f-:er'l2nd ~ V"/.:J, 2t:l to n:' Fer.rs:rlv'3_n l'-:., D8rt~T of the first
"''lrt,
p- :r D
~.C'y =,:. ~"r'l~ 'J.~d DC"L""',','T_":'T
-:::......, his ',-'ifs-, (If t-::.l3' '.l'or'n-
sl:.i:^. 0" E':~2-:: Pe'-'-s1)0r0, Cj'~Dt""{~ of Cu_::"b8rl~nd <::.nd St7,te 'J-t Fe~ll-:;sylil'.!
,-nY't ie :::
of the second part, WITNESSETH, that the said party of the first part, for and in consider-
ationofthesumof One Loll"r (1. ) ,ox-:'."0thel- vqlu~l:'le con2j.der?tions
IJ;at];a1'>>",.
lawful money of the United States of America, well and truly paid by the said part i e 8 of the
second part to the said part y of the first pa1't, at and before the sealing and delivery of these
presents, the receipt whereof is hereby acknowledged, In 3 granted, bargained, sold,
aliened, enfeoffed, released, conveyed and confinned, and by these presents do e s g1'ant, bargain,
sell, alien, enfeoff, release, convey and confirm unto the said pm'ties of the second part, t:,eir
heirs and assigns,
J~LJ. t':--'088 t c, c,?"t:-:.in 10t.', c,r' ~~1.rc:;ls of' 1~1!1d situ~"':.t,:-.; in the
T0rr~s~ir- !')-P Er;st Peprs ora, COFYJt;T of' Cl!L1l~9:r1?l1d 'J_:-l,~l st::_t,~j 0~ Fenns""7'"l
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tentb::; (1'~.~,.3) '=' rc:,es.
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1:!rICC alonr tl;e so",theG,stcrn lin3 of the He';: Pt~.!)lic EO'id north si:,::t".-J
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on," ('-1) d0r;rees fiCtcen (1.",) yinu;;es e"st. t.,o hundr8d ceDe' nine (209) i
feet t.o ~n iron 0in on line of 12nd2,
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le8.vi:r.r;tOSli.l'vive l,:'1rp;",,::,"et "'.]. L;,T<2::'': i~--I "hor:1 title to ~'::.ij r'::::3.1 8St2:',8;
:>'C-~.1~~i 110:-; ~le,stE:(5 ['::~ ti'e S1J::,vi vin,r: te -8.nt
{~l't:l::'etic:s .
TOGETHER with all and singular the tenements, hereditaments and appurtenances to the same be-
longing, or in anywise appertaining, and the reversion or reversions, remainder and remainder8,
rents, isS1teS and profits thereof: And also, all the estate, right, title, interest, property, claim and
demand whatsoever, both in law and eq~dty, of the said part y of the first pa-rt, of, in, to or
out of the said premises, and every part and parcel thereof,
TO HA VE AND TO HOLD the said premises, with all and singlar the appurtenances, unto the
said part i-3 ~_ of the second part, ti',ei I' heirs and assigns, to and for the only proper use
and behoof of the said part i e:3 of the second part, t:18 ir heirs and assigns forever.
And the said p~rt::r of tb3 first p'rt, for h"rs'21f, hI'
heirs, executors and administrators,ldo 8 s by these presents, covenant, grant and ag1'ce to and
with the said partie s . of the second part, t heir heirs and assigns, that she
the said 1j3rty 0:0 t':.e first p9.rt, he; r
heirs, all and singulm' the hereditaments and premises hereinabove described and [I-ranted or men-
tioned and intended so to be, with the appurtenances, unto the said parti e 2 of the second part,
El8 ir heirs and assigns, against the said part y of the first part, and he r heirs and
against all and every other person or persons whomsoever lawfully claiming or to claim the same
or any part thereof,
shall and will by these presents, War-rant and Forever Deferul.
IN WITNESS WHEREOF, the said part i.G s of the first part have
t heir hand c and seals , the day and year first above written.
here~tnto set
i ~~~~~:~~
.n.:::.::.:::.::.:u::::..::.::::::..:::.::..::.::.:.::::::::::":::..J
,
&ignril, lihabll anllllrliurull
in tfp:e-lJr.ea.enc:r of
...m______..___.__.m________m.....__..________u_.umm._. _....u.. e
__m______.___..________m____.....n_______.__.m...______.___n.___..__......e
~.QLth&.JllJ,t.e_ojJhe ~cithin al'foregoing Indenture, of-the said part
of thc second part, -the sum of - _. - -
Witness .-
~
.:.::::::::::::::::::)
St.ate of
-0- --
'el;" FE
I
'. ss.
''\'
day of May
,19.:2,6 I before rn~
. ::,.:J"' ~ rr \J; ...... ~.<<c.
County of .e-~~j,:::.::- ...., ..Jo
On this, the 23th
Joe G.D_.rli n.:::;toll
the undersigned officer, personally appeared
l/;.T',C~'
'j.
known to rne (or satisfactorily proven) to be the person whose name i co subscribed to the
within inst?-ument, and acknowledged that she executed the sarne for the purposrs tlwrein
contained.
In witness wherwf, I hereunto set my hand and OffiCia~lg' :-----;:
hmr;. u Jj.~..U. m'__ ~..__m.. ~
__...m~.. JOnn.J.a.L...m..m..
}~'~l~S::::?!~F
ss. {J
day of . 19 . before me
State of
County of
On this, the
the undersigned officer, personally appeared
known to me (or satisfactorily proven) to be the person whose name subscribed to the
within instrument, and acknowledged that he executed the same for the purposes therein
contained.
In witness whereof, I hereunto set my hand and official seal.
~
Title of Officer.
CERTIFICATE OF RESIDENCE
l'-'f ~ 1:::;;: ~ p~e~~e of the within named grantee is
19 ~_~:~===:
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COMMONWEALTH OF PENNSYLVANIA,} ,
BB.
County of ___._~1lLeJ:.land.__.___.______
RECORDED on this .__.m.6.thmumm.__ day of ....AUgA____.uuu______..____um__m
A. D. 19.!!'.6u, in the Recorder's office of said County, in Deed Book I
Vol. __..1.3.__.___mm..' Page .m~t:?__m____umm.m__m.
Given under my hand and the seal of the said office, the date above written.
---...m.--....-mS-.--..E:t>e;r....'l,q..n.OB-um' Recorder.
A Settlement Statement
U.S. Department of Housing and Urban Development
S. Tvne of Loan OMS Approval No. 2502-0265 I exnires 9130/2006\
1. DFHA 2. DFmHA 3. DConv. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number
4. nVA 5. nConv. Ins. C3D-642
C.Note: I~S o,::ed~~~)~~ ~ ~de::~\tsing: they are ::h8refO~I~~~ Pu~ ';:;~'::t ~g~d~~n~~tOtals. I TitleExpress Settlement System
:=~G~~ ~n~::~ Wn=~~r:~r:,:ieF:=~:~riu~~~~~oda; ~~n-;&1:ds=:'r61~~81t1es upon Printed 12106/2006 at 11:04 KJB
D. NAME OF BORROWER: William E. Brougher, Sr., and Sheri M. Brougher
ADDRESS:
E. NAME OF SELLER: Estate of Roy F. Myers
ADDRESS:
F. NAME OF LENDER: CommunltyBanks
ADDRESS: 150 Market Sauare Millersbur!l. PA 17061
G. PROPERTY ADDRESS: 720 Mountain Street
Lot #1 Plan of Rov Mvers East Pennsboro TownshlD. Cumberland County
H. SETTLEMENT AGENT: Community Settlement LLC
PLACE OF SETTLEMENT: CommunltvBanks Pennsboro Commons Branch
I. SETTLEMENT DATE: 12/06/2006
J. SUMMARY OF BORROWER'S TRANSACTION: K SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales nrice 150 000.00 401. Contract sales orice 150000.00
102. Personal ProMrtv 402. Personal Pronertv
103. Settlement chames to borrower !line 1400\ 2 880.00 403.
104. 404.
105. 405.
A,fusbnenls for Items paid bv seller In advance Adjusbnenls for Items paid bv seller in advance
107. Countv taxes 12/06/06 to 12/31/06 30.03 407. Countv taxes 12/06106 to 12/31/06 30.03
108. School Taxes 12/06/06 to 06130/07 853.39 408. School Taxes 12/06106 to 06/30/07 853.39
109. Sewer Rents 12/06/06 to 12/31/06 19.51 409. Sewer Rents 12/06106 to 12/31/06 19.51
110. 410.
111. Payoff Loan#9001005616 57 668.51 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 211 451.44 420. GROSS AMOUNT DUE TO SELLER 150902.93
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Dennsit or eamest money 3 000.00 501. Excess Deoosit {see instructionsl
202. Prineinal amount of new loans 218 500.00 502. Settlement eharoes to seller !line 1400\ 1510.00
203. Existinn loanls\ taken sublect to 503. Existino loanlsl taken subiect to
204. 504. Payoff of First Mortoaae Loan
NONE
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unDaid bv seller Adjustments for items unpaid bv seller
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 221 500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 1510.00
300. CASH AT SmLEMENT FROM OR TO BORROWER 600. CASH AT SmLEMENT TO OR FROM SELLER
301. Gross amount due from borrower lline 1201 211 451.44 601. Gross amount due to seller (!fne 4201 150 902.93
302. Less amounts paid bvlfor borrower lline 220\ 221 500.00 602. Less reduction amount due seller lline 520\ 1 510.00
303. CASH TO BORROWER 10048.56 603. CASH TO SELLER 149 392.93
SUBSTITUTE FORM 1099 SELLER STATEMENT: The Infomlatlon contained herein Is Important tax Infoonatlon and Is being furnished to the Intemat Revenue
::t~'I~~=~tt~~:~:t:na~~~n:n~~~i~S8=g.:n~tm~=:01~~~~~~=S~~ofthIS
transaction.
:=~~~~;n~r:~:,s::ple:t~~::~J:= ~=C:;9~~ f:: a2i51a~~O=~~ ~;;:'~J':M~esidence, for any gain, oMth ~ Income
~~~:.~~ bl~~g~~~~~~~~~~~~:Il~ ~~~~O;;;'b~~r=~~I=~: Imposed bylaw.
Under penalties of perjury, I certtty that the number shown on this statement Is my correct taxpayer Identification number.
TIN:
SELLER(S) SIGNATURE(S):
SElLER(S) NEW MAlUNG ADDRESS:
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number. C30-642
PAGE 2
TitleExoress Settlement SYStem Printed 1210512006 at 16:11 KJB
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SAlLES/BROKER'S COMMISSION based on orlce $150 000.00 (Ii! 0.000 = BORROWER'S SELLER'S
Division of commission (line 700\ as follows: FUNDS AT FUNDS AT
701. $ to SETTLEMENT SETTLEMENT
702. $ to
703. Commission oaid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH lOAN
801. Loan Ori ination Fee %
802. Loan Discount %
803. Acoraisal Fee to McCarthy Associates $275.00 POC by lender
804. Credit Reoort to Trans Union $5.80 POC by lender
805. Acoraisal to Christopher Jones $275.00 POC by lender
806. Procertv Search & Brlno-down to CommunltySeltlement $80.00 POC by lender
807. Rood Determination to US Determination Serv. Inc. $24.00 POC by lender
808. Rood Det.-Ufe of Loan to US Determination Serv .Inc. $3.50 POC bv lender
809.
810.
811.
900. ITEMS REQUIRED BY lENDER TO BE PAID IN ADVANCE
901. Interest From to Iiil$ Idav
902. Mortoaoe Insurance Premium for to
903. Hazard Insurance Premium for to Westfield (P.O. C.} 1291.00 Buver
904.
905.
1000. RESERVES DEPOSITED WITH lENDER FOR
1001. Hazard Insurance mo. lQ) $ lmo
1002. Mortoaae Insurance mo. lQ) $ /mo
1003. City prooertv Tax mo. lQ) $ Imp
1004. County Procertv Tax mo.lQ)$ Imo
1005. School Taxes mo. lQ) $ Imp
1009. Aaareaate Analvsis Ad'ustment
1100. TITLE CHARGES
1101. Settlement or closino fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Prenaration
1106. Notarv Fees to Clerk 22.00 10.00
1107. Attomev's fees
/includes above ttems No: I
1108. Title Insurance to CommunitY Settlement llC 1108.75
(includes above ttems No: \
1109. Lende~s Policv 150 000.00 -
1110. Own~s Policy 150 000.00 -1108.75
1111. END 100 300 8.1 1020 to Community Settlement llC 200.00
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordino Fees Deed $ 38.50 . Mortn""e $ . Release $ 38.50
1202. Citv/Counlv tax/stamos Deed $1.500.00 . Mortoaoe $ 1 500.00
1203. State Tax/stames Deed $1 500.00 . Mortoaoe $ 1 500.00
1204. Rec. Fee - Mortoaoe to Recorder of Deeds $54.50 POC bv lender
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survev
1302. Pest Insoection
1303. Trash Due 1216-12/31106 to East Pennsboro Township 10.75
1304.
1305.
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES lenter on lines 103 Section J and 502 Section Kl 2 880.00 1510.00
I he..-e carefully reviewed the HUD-1 SetUement Statement and to the best of my knowledge and belief. it Is a true and accurate statement of aU receIpts
'1.~~L-~'--'-'~-~~._-,~~
/ z. -G. ?J /:?
File No. C30-642
CERTIFICATION
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my
knowledge and belief, it is a true and accurate statement of all receipts and disbursements made
on my account or by me in this transaction. I fi.n!:her certify that I have received a copy of the
HUD-1 Settlement Statement.
BORROWERS:
!in~!:u~J-
~~/J1~
heri M. Brougher
SELLERS:
Estate of Roy F. Myers
~,.~~~
BY:
~
~
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is
a true and accurate account of the funds which were received and have been or will be disbursed
by the undersigned as part of the settlement of this transaction.
s~
/2. -r.; 'Z'..-b
Date
WARNING: It is a crime to knowingly make false statement to the United States on this or any
other similar form. Penalties upon conviction can include a fine and improvement. For details
see: Title 18 U.S. Code Section 1001 and Section 1010.
HUD.FRM
T55260-00027
Megonnell's Custom Gunworks, Inc
3229 Peters Mountain Rd.
Halifax, PA 17032
717-896-2434
ROY F MYERS ESTATE
EtN 61-6325547
Donna Keammerer
307 Autumn Chase
Harrisbur~ PA 17110
To:
Ronald Keammerer
307 Autumn Chase Dr.
Hbg, PA 17110
RE:
Firearms Appraisal
The following are appraisals for the firearms requested. These appraisals are subjective
and actual values may vary dependent on individual buyers.
Taurus Model 85, .38 Special Revolver. SN PC59806. 80% condition - $110.00
Savage Model3B, .22LR or Short. SN - none observed. 70% condition - $30.00
Remington Model 700 ADL, .243 Win. SN 6740861. 90% condition - $230.00
Stevens Model 820, 12 gauge. SN - none observed. 70% condition - $80.00
Western Arms Co Model "Western Long Range", SN 5067. 50% condition - $90.00
CHEVROLET 33
BODY Model
Weigh! Loan Retail Trade-In TYPE No. M.S.R.P. Waight Loan Retail
550 550 50 Deduct W/out Running Boards (Ex. Base) 50 50
625 6Z5 Zool SUBURBAN-l/2-3/4 Ton-V8 Mileage Class: III
525 5Z5 10000 Utility C 1500. C16 $25921 4914 9000 12250
175 175 13300 Utility C1500 LS C16 33344 11975 15B75
150 150 14450 Utility C1500 LT , C16 37693 13025 171 DO
10800 Utility C2500 C26 27780 5447 9725 13100
14100 Utility C2500 LS C26 35203 12700 16725
Miteage Glass: I 15250 Utilrty C2500 LT C26 39116 13725 17950
2602 4250 fi425 11300 Utitity K1500 (4WD) K16 28837 5123 10175 13700
2602 5050 7400 14600 Utility K1500 LS (4WD) K16 36260 13150 17275
2639 5575 8050 15750 Utility K1500 LT (4WD). K16 40779 14175 18500
2866 5000 7350 12100 Utility K2500 (4WD) K26 30780 5760 10900 14600
2866 6075 8650 15400 Utility K2500 LS (4WD). K26 38203 13875 18125
2639 5825 8350 16550 Utility K2500 LT (4WD) K26 42286 14900 19350
2987 6825 9600 1400 Add Z71 Off-Road Pkg. (LS 4WD) 1400 1575
2987 6875 9650 300 Add 8ll V8 Engine.. . 300 350
125 150 200 Add Aluminum/Alloy Wheels (Base) 200 225
100 125 350 Add Leathe' Seats (Std. L1, Z71) 350 400
175 200 4nu Add Power Sunroof _ . 400 450
75 100 100 Add Rear Buckel Seats 100 125
100 125 125 Deduct W/oul 3rd Row Seat 125 125
325 325 575 Deduct W/out Air Conditioning 575 575
Mileage Class: II 150 Deduct W/out Cruise Control 150 150
150 Deduct Wlout Power Seat (Ex Base). . 150 150
3536 5675 8200 2001 :3N DedU~b~/(','d R mnioSJ Af"l=r;rrl~ IFy Base).. 50 50
6975 9800 Mueag~SS: 11
3692 5950 8525 5100 ~D ...... ...... UIOm3 $20975 5~ci~ ~ ~m
3814 6575 9300 6050 ~ded Van 4U _ . . . . . . . . . ' _ _ X03 "::;J<l-:l.J
4023 6850 9625 1650 Extended Van 4D Warner Bras X13 30315 6900 9675
725 825 400 Add LS Pkg. (Ex Warne' Bms.) 400 450
1050 1175 1125 Add LT P~g (Ex. Warner Bros.) .. . , '. ... 1125 1250
700 800 150 Add Aluminum/Alloy Wheels (Std. LS, LT, WB) 150 175
125 150 275 Add Lealt1er Seats (Std. Wamer Bros.) 275 325
275 325 125 Add Power Seat (Std. L T, Warner Bros.) 125 150
350 400 225 Add Powe, Sliding Door (Std LT, WB). .. 225 250
425 425 15 &ldd Rear Air Cond (Std.,LT, Wamer Bms.) 75 100
125 lZ5 1 DO Add Reac Bucket Seats (Std L T, WB) 100 125
100 100 125 Deduct W/out Cruise Control 125 125
125 125 125 Deduct Wlout Power Windows 125 125
Mileage Class: III Zool ASTRO-l/2 TDn-V6 Mileage Class: II
4828 8525 11650 5550 Cargo Van. M19' $20593 3915 5000 7350
11925 15825 6925 Van LS M19' 23241 4323 6250 8875'
12975 17050 7675 Van L T M19' 26419 4323 6925 9725
5050 9675 13050
13100 17200 800 Add All Wheel Drive. 800 900
14150 18425 150 Add Aluminum/AHoy Wheels (~itd"l ii 150 175
1400 1575 275 Add Leather Seats. .... ,. . 275 325
200 225 125 Add Power Seat (Std LT)........ 125 150
350 4DO 75' Ad.d Rear Air Conditioning {Std. LT) 75 100
100 Add Rear Bucket Seats, . 100 125
400 450 50 Add Running Boards (lS, LT). 50 75
125 125 125 Deduct WJoul Cru'lse Control. , . 125 125
575 575 100 Deduct Wloul Power Door Locks 100 100
150 150 125 Deduct W/oul Power Windows . 125 125
150 158 . L as the 1st position of lhe model # den~tes AWO
AL OPTIONS
SEE TRUCK SECTION PAGE 2 FOR AOOlTIONAL OPTIONS
EASTERN EDITION - JULY 2006
. "
,
Eallern Edililn
.
1999 THROUGH 2006
PASSENGER CARS
LIGHT-DUTY TRUCKS
73 Years of Service
2006 - JULY - 2006
"
OCT-05-2~~b ~~:~4
r'NC.l:lH~H'(
41~ 'rbl=l .54::>1=1
r'.~l/lll
o PNCBAN<
October 6. 2006
Jill M. Wineka
1719 North Front Street
Harrisburg, P A 17102-2392
RE: Estate of Roy F. Myers, deceased
SSN: 204-01-3365
DOD: 7/23/2006
Dear Ms. Wineka:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Account
Account#5140l11733
Established 02/01/1970
ROY F MYERS
DOD balance: $21,316.92 + $1.75 accrued interest
Savings Account
Account #5003147625
Established 08/21/2000
ROY F MYERS
DOD balance: $102,522.45 + $55.46 accrued interest
The decedent maintained Investment Accounts (INV #61458724), and (lNV #61458728).
For further information, you may contact the Brokerage Department at 1-800-762-6111.
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not process any financial
transactions or pro'Vide statements. If you need assistance with any ofthese items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
&iWJlt ~~ lJ!)dh-
Rachelle Wells
1-800-762-1775
P7~PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
Member FDIC
TOTAL P.Ol
MetLife Investors
~~.O. Box 295
. Des Moines IA 50301-0295
MetLife
November 13, 2006
JILL WINEKA
ATTY AT LAW
1719 FRONST STREET
HARRISBURG PA 17102
RE: METLlFE INVESTORS USA INSURANCE COMPANY CONTRACTS 9200518731 ;
9200592892; 940172243
OWNER Roy F Myers
Dear Ms. Wineka:
This letter serves as follow-up to Ms. Donna Keammerer's signed consent to provide date of death values
on the above referenced contracts. Those values are as follows:
. Contract # 9200518731 - Value as of July 23, 2006 = $ 18, 013.64
. Contract # 9200592892 - Value as of July 23, 2006 = $ 28, 425.24
. Contract # 940172243 - Value as of July 23,2006 = $ 42, 389.74
If you have any questions, please contact our Customer Service Center at (800) 255-9448 Monday
through Thursday between 8:30 a.m. and 6:30 p.m., ET and Friday from 8:30 a.m. until 6:00 p.m., ET.
Sincerely,
Kathy Crowl
MetLife Annuity Operations and Services
MetLif~lnv tors
P.O. B. 29
"'" Mo " . 50301-0295
~
MetLife
July 9, 2007
Donna Keammerer
307 Autumn Chase Dr
Harrisburg, PA 17110
Copy to:
RE: METLlFE INVESTORS INSURANCE CCMPANY CONTRACT 9200518731,9200592892 &
940172243
OWNER Roy Myers
Dear Ms Keammerer:
According to our records for the above referenced annuity, the beneficiary is:Donna Keammerer.
Available claim options are detailed on the enclosed Annuity Beneficiary Claim form.
This is our second attempt to obtain the below requirements, which are necessary in order to settle the
claim:
. Completed & signed Annuity Beneficiary Claim Form for each beneficiary
If you have any questions, please contact our Customer Service Center at (800) 255-9448 Monday
through Thursday between 8:30 a.m. and 6:30 p.m., ET and Friday from 8:30 a.m. until 6:00 p.m., ET.
Sincerely,
Allison Cox
Sr. Annuity Representative - Post Issue Processing
MetLife Annuity Operations and Services
Server
9/16/2006 12:53:20 PM
PAGE
2/002
Fax Server
...
mcJ Al!lRAp!\1AifY
AIG Annultr Innnna: ClmpllD,)'
A Stack CoIllplUlY
:1O!l Ball: 10th AVlmWl
Amarlllo. Ttu.a 79101- 3 546
TelepboDe: ROO.4J4A!l9O
September 16,2006
Purcell, Krug & Haller
Attn: Jill M Wineka
1-717-783-4939
Re:
Deceased:
Con tract #:
Roy F Myers
FJ237758
Dear :\tIs. '\Vineka:
Thank you for your letter dated September 6,2006. '\\Te \!;"ould like to take this opportunity to
provide you \l;,'ith the information you requested.
· Value as of July 23,2006: $23,469.33(Principal- $20,000.00 and Interest- $3,469.33).
· Primary beneficiary: Dorothy M tvI yers
· Contingent beneficiary: Kirby Kemmerer
Should you have additional questions or require further assistance, please feel free to contact our
Client Care Center by using our toll free number of 1-800-424-4990.
Sincerely,
fjt{JtUJ1&
Gayla Walker
Claims Department
. t~~9\
Transamerica Life Insurance Company
4333 Edgewood Road NE
PO Box 3183
Cedar Rapids, Iowa 52406-3183
November 2, 2006
Donna M Keammerer
c/o Jill Wineka
1719 North Front Street
Harrisburg PA 17102
RE: Annuity Number(s) 02PB0004269
Dear Donna M Keammerer:
We have received notification, Roy F Myers, annuitant of the above
listed non-qualified tax deferred annuity is deceased. Our office
wishes to extend sincere condolences for your loss.
The following is the current information on this annuity:
Annuitant:
Owner:
Primary Beneficiary:
Annuity Policy Date:
Full Value as of 11/02/2006:
Taxable Portion:
Full Value as of 07/23/2006:
Roy F Myers
Roy F Myers
Donna M Keammerer 100%
June 19, 2002
$57,325.85
$ 7,325.85
$56,815.77
The attached document outlines the options available to the primary
beneficiary listed above.
The full value as of the date of death is for tax purposes only and is
not a guaranteed death benefit amount.
Operations performed on an automatic basis when applicable have been
terminated, such as, Systematic Payouts or Automatic Billing.
The attached document contains general tax information based on
Transamerica Life Insurance Company's interpretation and should not be
relied upon for your personal tax planning. If you have questions
concerning the direct tax consequences when selecting an option, you
may wish to consult a tax advisor.
Member of the _EGON. Group
II!
-".,~
~~~--
WACHOVIA
Wachovia Securities, LLC
Retail Investment Group
NC1164
401 South Tryon Street
Charlotte. NC 28288
August 08, 2007
Law Offices
Purcell, Krug & Haller
Attn: Jill M. Wineka
1719 North Front Street
Harrisburg, P A 17102
RE: Roy F. Myers
Dear Jill M. Wineka:
Thank you for contacting Wachovia Securities regarding the account(s) of Roy F. Myers.
Attached is the information regarding the date of death valuation you requested.
If you should have any questions regarding this matter or if you need further assistance, please
contact an Estate Support Specialist at 866-786-4890, 8 a.m. to 6 p.m., Monday through Friday.
Sincerely,
g{Jdad PC g~
Richard H. Shinn
Estate Support Specialist
Wachovia Securities, LLC
Securities and Insurance Products:
Not Insured By FDIC Or Any MAY LOSE VALUE Not A Deposit Of Or Guaranteed By
Federal Government A enc A Bank Or An Bank Affiliate
Brokerage services offered through Wachovia Securities, LLC, a registered broker-dealer and a separate, non-bank
affiliate ofWachovia Corporation. Member NYSE and SIPC.
IRDQA.rtf 313552130 12746106 257400090792029
Date of Death: 07-23-2006
Name: Roy F. }I.1yers IRA
Account: 257410093562000
Cash Equivalents:
Investment Optioll
IRA 84 MONTH CD-25741 0093562000
Balance
6961.92
Accrued Int/Divs Notes
$15.55 OPEN DATE 08-17-1984.
IRA 84 MONTH CD-257400090792029
2041.85
$4.50 OPEN DATE 04-29-2005.
Total Cash Value:
$9,003.77
Additional Notes:
Securities and IIISIIral/ce Products:
Not Insured By FDIC Or Any Federal
Brokerage services offered through Wachovia
Member NYSE and SlPc.
MAY LOSE VALUE t a Deposit afar Guarenteed By A Bank
_Any Bank Aftilliaite
LLC. a registered broker-dealer and a separate, non-bank affiliate of Wachovia Corporation.
**Thc price per share is based on the closing price at the end of regular trading hours for the date of death. Due to certain securities not priced on a
daily basis, we can not guarantee that the price given was as of the date of death. The market information contained herein, including but not limited to,
prices, quotes and statistics, has been obtained from sources that we believe to be reliable, but we do not offer any guarantees as to its accuracy or
completeness.
LAW OFFICES
HOWARD B. KRUG
LEON P HALLER
JOHN W PURCELL JR.
JILL M. WINEKA
NICHOll:: M. STALEY O'GORMAN
LISA A. RY"JARD
LHO)'A C WINFIELD
Purcell, Krug & Haller
1719 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102-2392
TELEPHONE (717) 234-4178
FAX (717) 783-4939
HERSHEY
(717) 533-3836
JOSEPH NISSLEY (1910-1982)
JOHN W. PURCELL
VALERIE A GUNN
Of Counsel
August 21, 2007
Register of Wills
Cumberland County Court House
Carlisle, PA 17013
Re: Estate of Roy F. Myers
No. 2006-00675
Dear Register of Wills:
Enclosed for filing, please find two originals and two copies of the Inheritance Tax Return for
the above-captioned Estate. I am also enclosing a check payable to the Register of Wills in the
amount of $15.00 for the filing fee. Please return two date-stamped copies of the Return to me in the
enclosed stamped, self-addressed envelope. Thank you.
Sincerely,
~~k~~)
:.....~)
JMW/bas
Enclosures
('. .,
i'<'
cc:
Donna Keammerer, Exec.
N
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