HomeMy WebLinkAbout04-01-08 (3)
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
~~~~;~~g~~~uaITaxes' 'INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
2 1 0 7
o 0 9 3 9
Date of Birth
207077014
1 0 122 007
122 7 1 9 1 5
Decedent's Last Name
Suffix
Decedent's First Name
MI
Fag a n
E .
Mar y
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First 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
o 4. Limited Estate
~
o
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
o
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
G era 1 d
J .
She k 1 e t ski
717 774 7 4 3 5
Firm Name (If Applicable)
City or Post Office
State
ZIP Code
REGISTER OF WILLS USE ONLY
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S ton e L a F a v e r & She k 1 e t s k l
First line of address
4 1 4
Bridge
St.
Second line of address
P . 0
Box
E
New
Cum b e rIa n d
P A
170
Correspondent's e-mail address: Qshekletski(Ci2stonelaw.net
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 tru~,.cQr[I;!!:.Land co ,.Qeclacatig,n of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI 'ATU F PERSON RESPONSIBL R FILING RETURN
~~-?
k H. Fa an 2615
-~-
DA T.%: _ . ~ ~
.3 J// l u
ew DrDr.,
Sumter
J.Shekletski,Esq.,414 Bridge St., New Cumberland
PLEASE USE ORIGINAL FORM ONLY
PA 17070
Side 1
L
15056041125
15056041125
---'
\
~
--l
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: E. Mary Fagan
RECAPITULATION
20707 701 4
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
153500.00
2. Stocks and Bonds (Schedule B)
.................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D)
........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)
5.
9. Funeral Expenses & Administrative Costs (Schedule H)
......... ....... 9.
3243.62
1 1 3 5 6.9 9
168100.61
35749.00
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous N\2!1;Probate Property
(Schedule G) U Separate Billing Requested. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7)
........................... 8.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
. . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10)
. . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
35749.00
132351.61
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
..................14.
1 3 2 3 5 1.6 1
TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.0 _ o . 0 0 15. o . 0 0
16. Amount of Line 14 taxable 1 2 9 8 5 1 . 6 1 5 8 3 .
at lineal rate X .042-- 16. 4 3 2
17. Amount of Line 14 taxable o . 0 0 o . 0 0
at sibling rate X .12 17.
18. Amount of Line 14 taxable 2 5 0 o . 0 0 3 7 5. 0 0
at collateral rate X .15 18.
19. Tax Due ................................................1& 6 2 1 8 . 3 2
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
L
15056042126
15056042126
---1
Decedent"s Complete Address:
DECEDENT'S NAME
E. MaryE?g~1l
STREET ADDRESS
625 Park Avenue
File Number
21 07 00939
REV-1500 EX Page 3
CITY
New Cumberland
STATE
PA
ZIP
17070
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
6,218.32
.
Total Credits ( A + 8 + C ) (2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
0.00
6,218.32
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
A. Enter the interest on the tax due.
6,218.32
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; ...................................................................... D [Xl
b. retain the right to designate who shall use the property transferred or its income; ..................... .......... D [Xl
c. retain a reversionary interest; or ................................................................................................ D [Xl
d. receive the promise for life of either payments, benefits or care? ....................................................... D [Xl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D [Xl
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... D [Xl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. D [Xl
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P.S. 99116 (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 zero (0) percent
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot 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 zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 PS. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(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)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
E. Mary Fagan 21 07 00939
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 iointlv-owned with riaht of survivorshio must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
All That Certain piece or parcel of land situate in the Borough of New Cumberland,
Cumberland County, PA known as 625 Park Avenue, New Cumberland, PA.
Being the same premises conveyed to E. Mary Fagan, the decedent, by deeds
recorded in Cumberland County Record Book 230, Page 340, and Cumberland County
Deed Books 105, Page 1056, 172, Page 144,196, Page 719. The property was sold
to Jason A. Berry and Jill S. Berry, husband and wife, on March 31,2008. Copies of the
deed and settlement sheet are attached.
VALUE AT DATE
OF DEATH
153,500.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
153,500.00
REV-1509 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
E. Mary Fagan
FILE NUMBER
21 07 00939
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. Frederick H. Fagan
2615 Circleview Drive
Sumter, SC 29154
Son
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '!oOF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTERES
1. A. 4-15-99 PNC Bank Checking Account #5000769955 5,645.25 50. 2,822.63
2. A. 4-15-99 PNC Bank Savings Account #5002061723 841.98 50. 420.99
TOTAL (Also enter on line 6, Recapitulation) $ 3,243.62
T
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
ESTATE OF
E. Mary Fagan
FILE NUMBER
21 07 00939
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. Metropolitan Life Insurance Company annuity contract 11,356.99 100. 11,356.99
073 429 980 AS.
Frederick H. Fagan (Son) - Transferee
TOTAL (Also enter on line 7 Recapitulation) $ 11,356.99
(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
E. Mary Fagan
FILE NUMBER
21 07 00939
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Parthemore Funeral Home and Cremation Services, Inc. 8,031.34
1303 Bridge St., New Cumberland, PA 17070
B. ADMINISTRATIVE COSTS:
1. 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:
2. Attorney Fees Stone La Faver & Shekletski 8,400.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Add ress
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 302.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Cumberland Law Journal - Legal Advertising 75.00
8. The Patriot News - Legal Advertising 134.46
9. Pennsylvania American Water 27.04
10. Verizon 41.23
11. PPL Electric Utilities 45.99
12. Manor Care HS 26.50
13. New Cumberland Borough - Sewer/Trash 68.04
14. UGI Utilities 119.18
15. Maro Landscaping - Grass Mowing 75.00
16. Manor Care HS 26.50
17. North Shore Agency, Inc. 36.87
18. PPL Electric Utilities 38.78
TOTAL (Also enter on line 9, Recapitulation) $ 35,749.00
(If more space is needed, insert additional sheets of the same size)
E. Mary Fagan
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
21 07 00939
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
AMOUNT
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
35.
36.
37.
38.
39.
DESCRIPTION
UGI Utilities
Pennsylvania American Water
HDIS
PPL Electric Utilities
UGI Utilities
Pennsylvania American Water
PPL Electric Utilities
UGI Utilities
Pennsylvania American Water
State Farm Homeowners Insurance
Nupharm, Inc.
Locksmith - Keys for House
UGI Utilities
Funeral Flowers
House Cleaning
Com cast
Verizon
Dr. Clem Ciccarelli
Reimbursement to Executor for travel expenses to and from South Carolina
Settlement Closing Costs - Sale of 625 Park Avenue, New Cumberland, PA
$ 11,764.80 + $4.605.00 = $16,369.80 less $858.49 reimbursement ($264.46
+ $250.72 + $343.31= $858.49) = $15,511.31
Reserve for Closing Expenses
Filing Fees - Inheritance Tax Return and Inventory
245.20
25.17
52.88
59.26
208.88
12.68
29.67
176.42
12.00
201.96
100.00
55.43
62.89
466.40
100.00
14.37
1.80
78.50
556.25
15,511.31
300.00
30.00
SUBTOTAL SCHEDULE H.B?
18,301.07
",.""". <'-'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
E. Mary Faqan 21 07 00939
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Frederick H. Fagan Lineal 90,851.61
2615 Circleview Drive
Sumter, SC 29154
2. James H. Fagan Lineal 10,000.00
50 S. 22nd St., Apartment #2
Camp Hill, PA 17011
3. Christopher M. Fagan Lineal 10,000.00
100 Oneida Road
Camp Hill, PA 17011
4. Brian G. Fagan Lineal 10,000.00
2401 Arcona Road
Mechanicsburg, PA 17055
5. Todd Fagan Lineal 5,000.00
6878 Mangrove Drive
Fayetteville, NC 28314
6. Shawn Fagan Lineal 3,500.00
237 Bassett Loop
Columbia, SC 29229
7. Lonnie Bowen Lineal 500.00
4541 Oak Drive
Sumter, SC 29154
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)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
E. Mary Fagan
Decedent's Name
Page 2
21 07 00939
File Number
Schedule J . Beneficiaries. 1
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)
8. Holly Miller Collateral 2,500.00
38 Kensington Dr.
Camp Hill, PA 17011
\
I
"
LAST WILL AND TESTAMENT
OF
E. MARY FAGAN
I, E. MARY FAGAN, of the Borough of New Cumberland, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I:
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,
together with 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 from my residuary estate without
apportionment or right of reimbursement.
ITEM II: I bequeath any automobile that I may own at the time of
my death to my grandson, JAMES H. FAGAN.
ITEM III:
I bequeath my household and personal effects and other
tangible personalty of like nature (not including cash or securities)
together with any existing insurance thereon to my son, FREDERICK H.
';;" .~ - v
~ .....\....;...-\_~ ..
ITEX I~: I direct that my real estate situate at 625 Park
~~e~~e, 3cr:ugh af ~ew Cu~berlanj, Cu~berlanj County, Pennsylvania, be
;,:;.~~
-~ - :::
,
.
s2ld a~d ttat the net proceeds therefrom be added to
tte res.:.d:.;e
~+=
~...
f"""..,
.1. .i
estate and be distributed p:.;rs~a~t to Items V and
'P'T
V .J..
belo...., .
I~E~ '1: I hereby make the following specific bequests:
A. $10,000.00 to my grandson, JANES H. FAGAN, if he survives
me in appreciation of his support and for giving me the strength to go
on at the time when his father, my son, passed away. He was there for
Ii
;/ me all the time.
II
~ B. $10,000.00 to my grandson, CHRISTOPHER M. FAGAN, if he
,I
survives me, in appreciation of his support and for giving me the
:1 strength to go on at the time when his father, my son, passed away.
il
~ He was there for me all the time.
Ii
;1 C. $10,000.00 to my grandson, BRIAN G. FAGAN, if he survives
;;
.1
:J
~ me, in appreciation of his support and for giving me the strength to
~ go on at the time when his father, my son, passed away. He was there
for me all the time.
D. $5,000.00 to my grandson, TODD FAGAN, if he survives me,
in appreciation for all the odd jobs and nice things he did for me.
E. $3,500.00 to my grandson, SHAWN FAGAN, if he survives
me, because he was always considerate and concerned and called me to
check 'Jp on me.
F. $500.00 to my granddaughter, LONNIE BOhEN, if she
s:.:rv.:.?es r.;e.
;:3.::Je L ~+= ...;
s. $2,5CO.O~ to my caretaker and dear friend, HOLLY
~:~:ER, if ste s~rvives me, for all tr.at she has done for me over the
:/e3.rs.
ITEM ;1: I devise and bequeath all the rest, residue and remain-
der of my estate, of every nature and wherever situate, to my son,
FREDERICK H. FAGAN, or to my issue, per stirpes.
ITEM VII: I appoint my son, FREDERICK H. FAGAN, Executor of this
my last will. Should my son, FREDERICK H. FAGAN, fail to qualify or
cease to act as Executor, I appoint HOWARD KNOX, Executor of this my
last will.
ITEM VIrI: I direct that my Executor retain Gerald J.
Shekletski, Esquire, to aid in the administration of my estate.
ITEM IX: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his duties in
any jurisdiction.
IN WITNESS WHEREOF, I, E. MARY FAGAN, have hereunto set my hand
and seal this Isrb day of hbu'i4<'-"" , 2006.
If Ihrvf11-PfA1""
E. r!JARY FAG.~N
?::qe ~. -1= ~
SIGNED, SEALED, PUBLISHED acd DECLARED by E. 11ARY FAGA:J, the
Tes~atrix above na~ed, as a~d for her Last Will and Testame~t,
a:-.d
, ~
...... .I. ~
the presence of us, who at her request, in her presence a~d in the
p=esence of each other, have subscribed our names as witnesses.
:1
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II
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II
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,
~
"Witnes
414 Bridqe St., New Cumberland, PA
Address
414 Bridge St., New Cumberland, PA
Address
Wi
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
I, E. MARY FAGAN, the Testatrix whose name is signed to the at-
tached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
t
hI ;1 L&I ~.f c,,~,yV
~. NA. FAGAN
S'..:orn to or affirmed to and acknowledged before me by E. :1hRY
,.;SA!;, 'he Testatrix, this aay',\f 1pr; v~ ,2006
\
COMMONWEAlTH OF PENNSYlVANIA
NCTARiAL SE!\L
DANiel M, r1AATW.AN. ~ktary Public
New Cumberland 8uro.. Cumberland Co.
My Commi$S!oli Expires Jan. 21, 2009
~';:::t3r:i P'~b:':.:.:
'/)L/
,---,/
Fa:je 4 of 5
C:::.::Io:C!J:~;E..l:..L:- H OF FE:';l,JS y~ \~l:.~N :~;
SS:
:C~~:~r:Y~F ':::r.1BER:",,;I..JJ
i"le, ~4-- {/ :; ~r;~ ~! :ind ~lt d({J,~
~I'.u
.
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix signed willingly and that she executed
it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the
will as witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
r$~~
WiC~
Sworn to or affirmed to and
C~C:LrU 7 dZf &&'~.
-+-!I
,.:itnesses, ~his \~ - day of
acknowledged before me by
, -~
and 't'~a \JfL-1 t\t'I\{~
~---
, "{':~~ , 20C6.
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COMM NWEAlT~ OF PENNSYLVANIA
NO AIA~ .:.EAL
DANIEl. M. HARTMAN. Notary Public
New CUillbttllnd Boro., CUlllberiallO Co.
My Com millIOn exPIres Jan. 21, 2009
iJotary P:.lc,lic
Paere 5 nf .....
'...."".......,.'1...........'....._..............---.......
A. Settlement Statement
U.S. Department of Housing and UrtJan Development
. B T:,!",ofL-oan QMBApgrovS1Ng,2502;:0265 iex,,,e.1113012009,
1 OFHA 2. OFmhA 3. [Conv. Unins. 6. File Number' 7. Loan Number .. _.. 8 Mort9~;J~;~C';;'Number
4 OVA 5, DCanv Ins.. ... ..' 31260PUR . 47385
C, Note; ::..~.:~V::v:,'Z=~:::.":::~:=~~~:=:,::~.;:,='~de~~otU
WARN:ING n IS . au'" tc ~)I' 1TllIluJ"" stalemenbl kllhe l.k1I:ed Sb;n;es on Ihls or wry oller Ilimilai klrm. pen.lies upon
__ _____'C:OrI'I,:lcnCltl If'lch.dealn.8ndin'P'i~ Ford8Ulil$'" Title leu s Ccda5edcn 1001 ~Sec:t~n 1010_
litleExpress SeItIement System r
.Printed 03:31:2006 it (18:44 SD !
D. NAME OF BORROWER: Jill S. Berry and Jason A. Berry
.....ADORESS:, 8 ~st~aflCll:A~e.f1l!!l,.~91.i11PA..1IQ2.~. .
E NAME OF SELLER: Estate of E. Mary Fagan, deceased
ADDRESS: 2615 Circleview Drive, Sunter. SC 29154
F. NAME OF lENDER: PSECU
ADDRESS: 1 Credit Union Place, P.O. Box 67013, Harrisburg, PA 17110.2990
G. PROPERTY ADDRESS 625 Park Avenue, NewCumberland, PA 17070
.____.___.._.._Ii!lY1..9!.~!!!!d Borougtl____....
H. SETTI.El-.ll:'NT AGENT: United One Resources, Inc.
..El,A.9I;;g::.~jgM.Et-I.L..l!Q. N. S~.~~~,.~llu!ltl:larre,PA18702.
I SETTLEMENT DA 1E: 0313112008
...:._~~'-J.SUM~yCfFS'()RR~~If~}R.A.F.j~AGT!QN;'... .' .,J(~1!M~RY OF SEL.L.ER:~, !8ANSf\c;TION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER .. .
.101.........f!lillc'!f.l..~~~_______._____._......L....---1~'-@gJ)Ql. ~.Q.1.... .<;9"k.~~J!~...
102. Persona Proplll1v 402 Personal Prope.1V
..j~.==~~.~~~)~:=:=:~~~:=~=__1===698.~i1~__..._________.__._..__~===-[........-....~.....~...
105. i 405.
.. .' .. .. ...... .__...M'!s~l\~lori~.""j<j..!>Y..sel"":..\!! ~y~ry<:e_. Adjustments for items oaid by seller in advance
lJQL.(AJJ.nOlll1taxes_ 03l31~08 to.12(3l1~ 1264:-46"'4re~ CilylloY<<l taxes 03131/08 to 12/31/08 i 264,~,;
.~~~:.=:: -- ~~~;::~~: I ~~:~I ::. ~:--- ...-~~~;=~:--t- 250.72!
.~~~."" H.........-...-i-------:=--=8~. -- -.---:~:~:~=~~~~~~..:~=_... _~~~~J1;
111. J________ -G11.
i 112. .-------- I 412.
r'120.GROSS'AiAoLiNTDiJE-FRoM BORROWER 161,056.69 420. GROSS AMOUNT DUE TO SaLER 154,3~,~
, 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN .AM9UNTDUE TO. SELLER___
I. 201. ~~~~lJlO!)rL____...___..__.J.__.,..__._1,OOO.ooT~~o;;;;li;~.i~~~di~;i'" .., '.::=::::'~._.__.____...i
.fQ.~..erJDQtal amount of ne\LIQ.~___....._......----1....__...L53#lO.OO.i 502. Selllement chalOes \0 sellllfJli.~J5QQL_____L .. ..___..?1~1,~9j
203. Existill" IQanisltal<en subiect to i ! 503. Exisli1~ loan/sHaken subiectto .
204. __.._...___._...._....__.._._.__........ 504. Pa-;off of FilSl Mlrt= Loan
205. 505.
200._SeJler.CQ.nttibution .._.__.._...... ..~~QQ_..~._.SeI~. Qontri!JuJio~.
2.o7.d. _..........__... 507.
,...?Q!lc.__._ 508.
\ 209. '~" .....
153,500,00 :
4.605.00
Adillstments for i~ms.~id by~n~rMjustr!1erlt~fCll: itelTlSunp.;liclbYI~II~r
i . .21.3.. 5)3
..l2.11.45....c.-....--.... -. 514, 'I',
____. .~15.
2115,. 516. 'I'
2F J17....
.._~1L _ _ _. .___. _ ________ _.__._ _____ . ...__.__...,._....:.....~J.~,.....,',........................,........................................._,......._............~.......i..........................__.....__.___J
219. ...._.. . .. . .' : 519. .... .. I . !
..220.J9i~f~-P:By1FQi~9~9-wEB,-~05.00r52QTOTALREDucnoN.AM<iiNTDUESE~..--25,606.8(i'I
300. CASH AT SETTLEMENT FROM OR TO BORRQWER._ .____._....ji.ll!!..~Il~.AI!lm!.!=MOOJ9_Q!!fBQM..s.g.J,;.IL .__... ...___.
.._:lQL..Gr.P.~.!!CTP.'!!!!.QI,Je..l!9!T.!. boITllwer 'line 1201 161.056.69; 601. Gross amount due to seller dine 4201 154,358.49 I
. . ~1.~!!r1jS..J@!QJ?yIlor borrower Oine~. .d.__. . ..._15!.1Q.s",OO_j' ~2 ..~~sr~tJCtion.amlUnt d~~r l!i..~.gQi,_.____._...~M9!!,~ j
_ 303J;;..~ FROM ~ROWER _._...__..____ 1,951.69!. 603. CASH TO~ELLE!L.____. .128,751.69 ·
Adjustment Line 1204
27.00
$128,778.69
SUBSTlTUiE FORM 1099 SflLE.~ STATEr.ENT: TM iMfamation o:Jnt-WI.cl l'l......n jj; important tax irlfOl"mahc:n and i& ~ng f,JM;SMd to the 1~18m.1. R.....,l"Ilt 58N101. :ryex... requir1K:l to"". a return,
~~~~~,~~-:. ~~=~.:,~.tem IS ntqIJred to 011 reported 1M tM IRS Qetern"l'~es ltIa( tl has flat be., repoctee. The Coouad $a)n?nee oescnbed 01'1
SELLER INSTR'JCTlONS: Iflhlsrul MUll. 'IIwaI)OtWpri,O:)8j l'tlsidenee. fiI. Farm 2119, ~rr~cf Prirv:.ipaj ResiOInc:e, for "y oal'1. v.tith 'fOIIll'\OClt'n8 tufWIUm; 1ofotwnrsac:ioM
~.\he apcb:able ~ft$o1 FOrrn"'797, Form 8:2.52 a-diOf"ScheduI. 0 IFCfTn 1(40).
~~,~=~I~:a~~~:~rT*ll~(f~~~::: Unaerperllllaol~?:t=I~~~:~r.:-~u~domy~:~~=~=catkm
,N.
1____ SElLER(S} SIGNA'TlRE1S):
SELLEQ(S: /iEI.'" ~MlUNG ,l.nDRESS
U.S. DEPARlMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 31260 PAGE 2
co.... SETTLEMENT ~~IE~t!L._..._._.._...__.._._._._~~~ ~~~W1_ PriQJ.ll!J 03i~j!f~.~~Oll.K~._.__..
~LEMENTCHARGES PAID FROM PAIOFROM'
: ..700. T9fAL ::iALESlBR91<E:R:~c:()t.1Iv1I~?'()'" ~..sedonpriceJ1~500.~O @6,()()(),,?,?,O,OO BORRCJV\.ER'S SElLER'S
DivisiQn of cormIission (line 700)<15 folloV/S: FUNDS AT FUNDS AT
701. 5 4,63tl,OO to(;(,ldw(!lL8lInkerI:iCllTlllSale~llrvicesC:;roup SETTLEMENT SETTLEMEt-rT
102. S 4.580.00. to Exit Platinum Plus ReallY
703. Commission;;aid al Settlement
c.!.OO.ITEMS PAYABll.' INCONNECTlONWITH..LOAN ....
. . .801.. .. LoanQ%JnaliQn.fM_..JL... .....__.__._
i .802,l!J!!lJ)~!'1L_._.._.J~_ %P~.9L___._....._._._.____.____.______.____________..__ ... .~,:J.l!7_.!l9
. J1Q.:J.:_Ar,g:aisal Fee
: ..l94..c.9:EJ9_it.~. .. _"'_" _"'0._ ...__.____......_ _.'._" _w.____.....__.__.... ...... ..._..._ _....
. 805. Lerder's 1IlSl.-ection Fee
Ul06" Mo~e..!\11IiI~.E!.~
LJQL},p.~fi!L...____.
L 808. Rood Certiflcalion Fee
L_~-,J,!l)Q~f~.. ..
:. 81QCJocument~Fee
... .8.11.
900. ITEMS REQUIRED BY LE;N.l:l!;~ III g ~i\I.~lJfi@Vi\~~
Si01.lnlere;j;LFrqm (J~~1L~~Jo .94!'O.1l~ _@$
902. Mortgage Insurance Premium for to
i)Q~. ~a-d Insur?1Ce PrelTium. for to
....~,-........._.._....._._...-._.__.._......._...-._..-.....-..-...--........-........................-......-...--........._..........
_._ 9OL_.___.___
. tll(JC!,_~~;BV;~pg~!!EP~IIf:j.~Q;!.tf9R ____.....__..._..__..__...._..._.
1!Xl1. .HazlrdIQsu~ 3mo,JU
1002. MortQi!Qe Insur<n:e mo. @$
1003. City PrqlertyTax rm.@j
Jl:94.~I~. .~fI:I9,@l ..
l(lOS:~I~IlS .......................... ...mmm1.0fl:l9c.@.L_..__m
.Jl.lf)9..00!l',!g<lt~..M<!'lSis.M.~~rJ]!!lL.J9__!"~~.....
1100. TITLE CHARGES
1101. Settlement Fee
1102. Abstract Fee
..J.1g11~n~
_11!l:L[i!~)p_5!!!~~i[1Q!ll:....
11.0.~.[)oc;umerlt f'1"/;lPar;iliop
1106. Notafy Fees
1107 Att\X!l.~s.!el!S ... .
{includes above items No:
l.l_1Q1J..:!l.~'ln~!=e 1.0 United One Resout'l;eS, Inc,
t-......:.ilr!f~-~ ~!t'I!5 No~_...__. Re-Il!.!ye ~_.._.._____ ... ..1.. ..-.---.---.,......
1~;~~::~=_..==:==~___.;~:~tQ19cl!<1:==:===~-==:~~~==::.=:=::.--....--..-..--j
1111. 100,300,900 to United One Resout'l;eS.lnc.
1112. Closinq Service Letter to United One Resources. Inc.
_1}13....T~Certi.flcal.ion_---1~nited Qne Resources, Inc,
1200. GOVE~ME!':fT REC.ORDIN.~.D TRANSFER CHARGES.___..._.____._...____.,
. 129:1. RecordinQFees~j_42.50__ ;M!rn~..u~._~.F~~L_.____.....__..___.__.-._._._125.oo _________j
.1.?,,0f,_9..tdQ9.!!nt!J..axlsta.~ Deed.~_M~~,!!Q~rt.!l.a.1!!,~ .. ....____.1.t.~:.QQ..__._..m.___...__..__.
1203. Stale TaxislarTl.~ Deed $1,535.00 ; Morl!1S:1f! $ _______M~.Q.Q,
1204. Mon,;aqe Satisfaction to Recorder of Deeds.._.._~:OIL
.J.fQ~L._____.._._.....__... .__.___..___..........__.__ . -.._ ...-......._____..._ .--. -_...--- .
1300,~i:lOl~ SETTLEMENT CHARGES
1301 SUr/ey
13Q2 P/;lsllnsoeclion
. ..1~j)3GY;1/"1l'1teed Deli:'ll'Y
1304. FaxlE-MaiI Fee
J_~.9!U'l'i~. Fee
__1:!.0!>__.
1.307 2007-2008 SdlOOI Taxes
13oa.OI,herDisburserrenlS {1520\
9,210.00 '
...JlL~g~\.!.,
to PSECU
_.J9.~.._
to . PSi:CU
m.m{P'~Q,~.J~,Q<!.~ri... 0000_ ___.._,.
, 8.00
-.----.--.------,----.-.. ..1.00... ,90.-.--....---.-
"" ....t..'..
j 150.00
r
24.70n Id?i.
\
;
,
i
m'r
"m_u~".'__~__,~_.~.~""""""'_.A___~'_N~...,'~~_,w_.L
1[)ays
24.71.
]
~.58 lmo
Imo
29,2S1mo
~,1~jmo.
J1I,1Q)l)lQ
------r-.---"103'.74. - ...
I
I
L t1~,~Q
! 1.171.00
~~:::=-=-:=~:=~...~[:~=~=~~.~==.:==~.=.~.Q9.
to United One Resources, 111!;,~.____.__________
to United One Resources, Inc.
10 United One Resources...!!!L......
JQ_lIr:J~~~~,J!1~c .....__...___00.__..__..
t.oAAorllElY..
to Alana Case
-!
r ----'---1
, I
._-~====::::~-=-:::~:=1
..1
! 42,00 15.00
I
1.016.00 !
I
I
_ "-1-50:00r- --.----.----,
. ~:~~I~.--.-.-. .-1
.. . tQ. L1nit/;ld9!111~llllClu~..lnc.
to United One Resou~,lnc.
10 ].I}!ted One Resources. Inc.
.._.__._,....___..._.1~@._._______.__._,
to Robin Gasperetli,Iax Collector
(P.O.9J 1.3n05~ner
...____._____1.95.OQ_.___.__ .1jL~14,!Q_:
14Q0;TOTALSETTLEMEtIT CHARGES (enter on lines 103, Section J a'ld S02.SectionK) . . 6J6911,20_21,()()1:~Qj
HUOcarr;F.CA.TION OF 8U'1ER 14-D SEl\..EFl:
""".. "'.. the best ~"'I ~8I"Idb&ti. '.~'I u.. tnJe a~ Ie ltatar'n(ttllaf all ~ Met cbbllHrTW'lt! med.on myaCQ:llJnl: Of by me
01 ""'HUC-I Selh"""",s.._ d.
.-.. ---------- r'-. -.----.-' .- ..~~
V
'w"iARr<ll!'IG: JT IS A CRJt.E TO KNOMJ..IGL Y MAKE FP\LSE STATEMENTS TO THE
JJf'4TED STAlES ON 1"HIS CRNJv SlMllAA !=ORM PE\lAl TIES UPON CONVICTION
CAN INQ.UO=. AflNE AND p,.pR1SQNMENT FOR DETAILS SEE TITl.f 18",
u.s_ CCVE SECTlQN '00. AND SECl'lOf\: 1010.
~T:A~~ra~~~~\~f~;oI~,"-'
OATF.
,..,.\,\ ,..........., \.........J ,.., __.. -...L
U.S. DEPARTMENT OF HOUSING AND URBAN DEVElOPMENT
SETTLEMENT STATEMENT
File NurrtJer: 31260 PAGE 3
lilleExPress Settlernel1t::;~-':"Ln~JL3I3112008 at 08:44 SO
'ffEMIZA TION OF HUe LINE 1308---'-'-----
15QQ, 5.G:HE.plJb!=. 9f p'-~U~E_NTS
:. 1.501 1$1 ()rTr;JShthry ~31/Cl8
to. Ni\YCumberiand Borougl!...
. .l3lJYEFl ....___SELJ,;--'L-.
44.73 \
1502.
;....1~.~...I@.~~'!'..E~..
...J9...~P!~!..f:!!I.~r..tlClIIlE!!I!'le..Services Group
. ....1~,OQ
W 504. 200B Cwltflaxes
to _[o!1in.Gas~~ Tax Collector. .
1505.200BTCl'.\flship Taxes
..!ll..Fl2.~i!lQ~.. Tax Collector
332.78 :
..~~L02_
1.506..Tr;ln~ f~...
....~~~I'I.~!l\1mfll.~~....
.-.-....-...---__....-i_........t~Q.Qj..........-
...1~..Ir/1~~.~I~......
..........!!l.J~~i~C!f..WiII~,..Agl!l1t....
..~...._ .....4H!~
.___>--____40.OQ.!
6,,218.32:
._1~L.~7.~tI1.qy~~~l)~~ .... ... . to New Cumberland BorQ.ll9rr.....
150B:1(J(J~.lst Qtr Sev.er Ihro 3/31 tl New Cumberll!'!d~Clug/1
1510. Inheritance Ta~~~.--.!Q.. Un~~~_Fl~Ql,Jr.ces, Inc. _.
2.991.68 \
1511.
. 1512.
r~-513 --
~
1515.
l~J.fJ,
, 1Q:lL ...
. l!jl~
....JllJ3l"".....
" 152(). TOTAL HUD LINE 1308 EXPENSE:
195.0Q.._.
10.214.80
reldedlf AGANEST A TEbeny
PARCEL #26240809339
DEED
THIS INDENTURE made theJlsJ- day of ;114/'~ , in the year 2008, between
Frederick H. Fagan, Executor of the Last Will and Testament ofE. Mary Fagan, late of the Borough of
New Cumberland, County of Cumberland and Commonwealth of Pennsylvania, of the first part,
hereinafter called the Grantor,
-AND-
JASON A. BERRY and JILL S. BERRY, husband and wife, of the second part, hereinafter
called the Grantees;
WHEREAS, the said E. Mary Fagan became in her lifetime seised, as of fee, of and in to a
certain tract ofland, together with the improvements thereon erected, situate in the Borough of New
Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly
described hereinafter; and being so thereof seised, died on October 12, 2007, having first made her Last
Will and Testament in writing dated December 15, 2006, duly probated and registered in the Office of
the Register of Wills of Cumberland County on October 18, 2007, wherein and whereby she appointed
as Executor, the said Frederick H. Fagan, to whom Letters Testamentary were duly issued by said
Register of Wills on October 18, 2006, wherein and whereby said premises hereinafter described were
not specifically devised, all as in and by said Will and the records of said Register of Wills more fully
appears;
NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of
the sum of One Hundred Fifty-Three Thousand Five Hundred and NO/lOO ($ 153,500.00) Dollars,
-1-
which has been paid to him by the said Grantees at or before the sealing and delivery hereof, receipt
whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by
these presents does grant, bargain, sell, alien, release and confirm unto the said Grantees,
ALL THAT CERTAIN piece or parcel of land situate in the Borough of New Cumberland, Cumber-
land County, Pennsylvania, more particularly bounded and described as follows:
BEGINNING at a point on the northern line of Park Avenue, said point being located 767 feet
measured along said line of Park Avenue from the northwest corner of Park Avenue and Swarthmore
Road; thence in a northerly direction along the westerly line of Lot No. 24, Block D, on the hereinafter
mentioned plan of lots, 120 feet to a point; thence westwardly along a park area on a curve to the right
having a radius of 530 feet, an arc distance of 6.33 feet; thence continuing westwardly along said park
area, 64.26 feet to a point; thence southwardly along the easterly line of an 8 foot right of way, 120 feet
to a point on the northerly line of Park Avenue; thence eastwardly along the latter line 64.26 feet to a
point; thence continuing eastwardly along said line by a curve to the right having a radius of 650 feet, an
arc distance of7.74 feet to the place of BEGINNING.
BEING Lot No. 23, Block D, on the Plan of Section 2, Highland Park Hills and Drexel Hills, said plan
being recorded in the Cumberland County Recorder's Office in Plan Book 7, page 38.
HA VING THEREON ERECTED a single dwelling house known and numbered as 625 Park A venue,
New Cumberland, Pennsylvania.
BEING THE SAME PREMISES WHICH Chris Fagan, single man, by his deed dated September 28,
2000, and recorded October 4,2000, in the Office of the Recorder of Deeds in and for Cumberland
County, Pennsylvania, in Record Book 230, Page 340, granted and conveyed unto E. Mary Fagan,
Deceased. FOR FURTHER REFERENCE OF TITLE, See Deed Books 105, Page 1056; 172, Page
144; 196, Page 719.
TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages,
\-vaters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever,
thereunto 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 her. the
-2-
said E. Mary Fagan, at and immediately before the time of his decease, in law, equity, or otherwise
howsoever, of, in, to or out of the same.
TO HA VE AND TO HOLD the said lot or piece of ground above described, with the buildings
and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and
intended so to be, with the appurtenances unto the said Grantees, to and for the only proper use and
behoof of the said Grantees, forever.
And the said Grantor, for himself and his respective heirs, executors and administrators, does
covenant, promise and agree to and with the said Grantees, their heirs and assigns, that he, the said
Grantor, has not heretofore done or committed any act, matter or thing whatsoever whereby the premises
hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title,
charge, estate or otherwise howsoever.
IN WITNESS WHEREOF, the said Grantor has hereunto set his hand and seal the day and year
first above written.
~~?:5 .~...~.------- (SEAL)
Frederick H. Fagarf;-Exe-cutor of the Last Will and
and Testament ofE. Mary Fagan
Witness
-3-
I .
COMMONWEAL TH OF PENNSYLVANIA
COUNTYOF~~~\
SS:
On this, the '"h \ ~
dayof'~'\'~
, 2008, before me a Notary Public, the
undersigned officer, personally appeared Frederick H. Fagan, Executor of the Last Will and Testament
of E. Mary Fagan, known to me or satisfactorily proven to be the person whose name is subscribed to
the within instrument, and acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereto set my hand and notarial seal.
COMMONWEALni OF PENNSYlVANIA
NOTARIAL SEAL
CAROL L. TROXELL. Notary Public
New Cumberland Boro. Cumberland Co.
Mv Commission Expires Dec. 27.2009
~ ~V~~
Notary Public
I hereby certify that the precise address of the Grantee is:
Attorney for
-4-
....... ,. ,-VV' V'Vl'"''
t " V \JIll'''' I I" tV" ~, I'
11V. JJJJ I. 1/ I
~ PNCBAN<
November 8, 2007
Gerald J. Sbek1etski
Stone, La Faver & Shekletski
414 BridF Street
P.O.BoxE
New Cumberland, P A 17070
RE: Estate of E. Mary Fagan, deceased
SSN: 207..07-7014
DOD: 10/1212007
Dear Mr. Shekletski:
In response to your request fot Date of Death balances for the c:ustorn~ noted above, our
records show the following:
CIieddng Account
Account #5000769955
Established 04/15/1999
EMARYFAGAN
FREDERICK H FAGAN
DOD balance: $5,644.99 + $.26 accrued interest
Samp AceoDJlt
Account #5002061723
Established 04/1 5/1999
E MARY FAGAN
FREDERICK H FAGAN
DOD balance: $841.94 + $.04 accrued interest
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CD~ Check inS and Savings accounts). We do not proe.... any fiundaJ
tnmlaetioDJ or provide .-.tements. If you need assistance with any of these items,
. please can }-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~W~
Rachclle Wells
1-800-762-1775
P7-PFSC-Q4-F
500 first Ave.
PiUStNrgh PA 15219
Member FDIC
,
'\
Metropolitan Life Insurance Company
PO Box 10342
Des Moines IA 50306-0342
MetLife'
STONE LAFA VER & SHEKLETSI
A TTN GERALD J SHEKLETSKI
PO BO X E
NEW CUMBERLAND PA 17070
November 7, 2007
RE
CONTRACT
ANNUITANT
073 429 980 AB
E MARY FAGAN
Dear Mr. Shekletski:
Thank you for notifying us of the death of our annuitant. Please relay our sincere
condolences to the family on their recent loss.
The beneficiary designation for the contract is Fred Fagan. To process the settlement, we
will need the following items:
. Annuity Death Claim Election Form
. Contract if available
Contract 073 429 980 AB is non-qualified and all monies over the cost basis are
considered taxable in the year received. The date of death value as of October 12, 2007
is $11,356.99. The current value is $11,194.83. The cost basis is $10,967.07.
If you have any questions, please contact your representative or call our toll-free number
at 1-800-638-7732. One of our Customer Service Consultants will be happy to assist you.
Sincerely
p~~
Patty Clune
Annuity Death Claims Unit
Annuity Operations-Tulsa