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Home My WebLink About04-11-0815056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 07 1059 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 173-24-9312 ' ' 11/13/2007 03/28/1928 ._ __. Decedent's Last Name Suffix Decedent's First Name MI __ BITTNER MARGARET (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 ?'ms 2. Supplemental Retum ;H ~ 3. Remainder Return (date of death prior to 12-13-82) _. 4. Limited Estate 4a. Future Interest Compromise (date of ~"~ 5. Federal Estate Tax Return Required death after 12-12-82) f"!~ 6. Decedent Died Testate A~„W 3 7. Decedent Maintained a Living Trust _ ..1__.. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ~rvw~~ 9. Litigation Proceeds Received ;w~s 10. Spousal Poverty Credit (date of death "~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number THOMAS E. FLOWER _ _ __ ___ (717) 737-~05 ~t: Firm Name Qf Applicable)..... _ _ _ ~ Q ~ ... ~,- 7 I~ ~ ~ r REGISTERILLS USE"ONLY ry4J SAIDIS, FLOWER, LINDSAY ~' ~ ~ ~ ~-; _ _ . _ _ ,> ~ ~ ,.. _ ,.: ~_~ First line of address ...... 2109 MARKET STREET ' !"`` ~? 'O - ~`=' Second line of address ', -y' ~7 ~, F -._ ., j ~ --t , i _.. City or Post Office State ZIP Code CAMP HILL ' PA ', 17011 _' Correspondent's a-mail address: tflOWer@Sfl-IaW.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATyy~~tE OF PERSON RES NSIBLE FOR FILING RETURN DAT ADDRESS CARL A. BITTNER, 130 LAKEVIEW DR., ELVERSON, PA 19520 SIGNATURE OF PREPARER OTH THAN REPRESENTATIVE ATE __.. __-- ADDRE S SAIDIS, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY .-,., N DATE FILED Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: MARGARET I BITTNER 173-24-9312 ....____..__..__.._. ~..._~_,.,,. __.... _ __._......__._...~..._~,_ ,._..._ __~ ._~__,__.,w.___~ .___. ___._ RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. 142,500.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 11,106.66 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages 8 Notes Receivable (Schedule D) .......................... ... 4. __ ___ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 30,723.80 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property °" (Schedule G) ~ Separate Billing Requested...... .. 7. ', __ _ .._ 42,593.61 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 226,924.07 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ' 22,393.69 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ' 404.47 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 22,798.16 12. Net Value of Estate (Line 6 minus Line 11) ............................ .. 12. 204,125.91 13. Charitable and Governmental BequestslSec 9113 Trusts for which `" an election to tax has not been made (Schedule J) ...................... .. 13. 0.00 14. _._ Net Value Subject to Tax (Line 12 minus Line 13) ...................... ~._ ~ _ .. 14. 204,125.91 ~ . e ~ ~,_,~_,~~ ~..._ ~~ ..~.~n~ ~~,.__....®~.. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ~ ~ ~.~.,~,n.~ .~ ..~.... __. _ _._ __~.._~...~.. 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers under Sec. 9116 __ _ _ _ 16. Amount of Line 14 taxable _ _ __ at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate x .12 42,593.61 ', 17 5,111.23 18. Amount of Line 14 taxable __ ... 161,532.30 at collateral rate X .15 1g 24,229.85 19. TAX DUE ....................................................... .. 19. 29,341.08 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT °~ 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 ~ 07 1059 '; DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER MARGARET I BITTNER _ __ 173-24-9312 - --- STREETADDRESS 4616 HAMPDEN AVENUE CAMP HILL srArEPA I 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit ___ B. Prior Payments _ C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 10.000.00 JGV.JV Total Credits (A + B + C) (2) - Total InteresUPenalty (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. (q) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable fo: REGISTER OF WILLS, AGENT 29,341.08 10,526.30 0.00 18,814.78 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 :................................................................................. ......... ^ ^K b. retain the right to designate who shall use the property transferred or its income :................................... ......... ^ ^X c. retain a reversionary interest; or ................................................................................................................. ......... ^ d. receive the promise for life of either payments, benefits or care? ............................................................. ......... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..................................................................................................... ......... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ..... ......... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................... ................................................................................ ~ ......... ^ 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. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (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 zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET I. BITTNER 21-07-1059 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 exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of tha ralavant ta~t~ ~~~ ~~~~~~ ~Na~~ ~~ nccueu, mser[ aaomonal sneers of the same size) rrevwus eamons are oosotete A. Settlement Statement form HUD-1 (3186) ref Handbook 4305.2 U.S. Department of Housing and Urban Development C1NIR Annrnu~l Nn 95n9_r19RF lovniroe of~nnnnal 1. FHA 2. ^FmHA 3. ~COI7V. Unins. Dv 6. File Number 08-0120 7. Loan Number 0000366252 8. Mortgage Insurance Case Number his form is fumished to give you a statement of actual settlement vests. Amounts paid to and by the settlement agent are shown. C. Note: Items marked "(p.o.c.)" were perd outside the dosing; they are shown here for information purposes and are not included in the totals. WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon TitlaExpraSS Sr'ttlement SySfBm ri 0 / / 8 D. NAME OF BORROWER: Wesley Vogelsong 805 N Market Street Mechanicsbur PA 17055 E. NAME OF SELLER: Carl A. Bittner, Executor of the Estate of Margaret I. Bittner F. NAME OF LENDER: American Home Bank, N.A. 3840 Hem land Road Mountville PA 17554 G. PROPERTY ADDRESS: 4616 Hampden Avenue, Camp Hill, PA 17011 H. SETTLEMENT AGENT: Supreme Settlement SerV1CeS, LLC, Telephone: 717-737-8315 Fax: 717-763-2094 N ~ 875 Market Street Lemo ne PA 17043 ETT NT ATE• O4/ll/2008 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: R A NT E FR M B RR WER 4 0. GR A NT T L 142 500.00 4 1 I i 142 500.00 P n r P I w i 0 7 394.33 0, 4 d'us m n f r' ms id b II r i n v n Ad'u tment f r i ems aid II r i n adv n 0 04 11 08 12 31 08 186.52 04 11 OB 12 31 08 188.52 04 11 08 06 30 O8 208.14 04 11 08 06 30 08 208.14 121.50 r 121.50 410. 4 41 M NT F B RR WER 150 412 .49 42 GR AMOUNT DUE TO SELLER 143 018 .16 Y N F R R 5 0. R D CTI N IN AM T D T L R 10 000.00 5 x i 114 000.00 I n h r II r tin 14 1 839.03 503. xi in I n k 6. 5 8. 5 9 n r' m n i II r A' m n fri m un i b II r 1 511. n x 1 I x L P D BY/F R B R 124 000.00 T TA TI NAM N E 1 839.03 A H A T F M R T R R 6 0. ASH AT ETT EMENT T R F M L R 150 412.49 0 r m Ilr~ 4 143 018.16 r 124 000.00 i r'n 1 839.03 F R R 26 412.49 6 3. CA H TO SEL 141 179.13 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information wntained herein is important lax information and is being fumished to the Internal Revenue Service. ff you are required to file a return, a n@pligence penalty w other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on u.J. vcrr.r,ininrvi yr r7VVJ11VV f1lVL VIVD/11V UGVCLVYIVICIV I the NUmbef: UtS-UILU PAGE2 SETTLEMENT STATEMENT TT NT HA ~~~~ rn ur r PAID FR T T y ALE /BR KER' MMIS I N b n ri 142 500 . 00 = OM BORROWER' PAID FROM ' I I S FUNDS AT SELLER S SETTLEME FUNDS AT NT SETTLEMENT I .ITEM PAYABLE IN CONNECTI N WITH LOAN 0 0 Stoner A raisals P.O.C. 325.00 Bu er Kirsten St er 400.00 American Home Bank N.A. 450.00 RJR Fundin Grou 1 003.20 First American Tax Service 96.00 American Home Bank N.A 25.00 RJR Fundin Grou 1 380.00 . I EM R R Y N R P I AN 04 11 2008 05 O1 2008 19.0000 20 Da s 380.00 r r r i l r Farnham Insurance A enc .O.C. 300.00 Bu er r ~ RJR Fundin Grou 142.50 POC b Lender RV P IT WIT ND R F 3 25.001 75.00 1 Im 4 21.69 86.76 11 78.371 862.07 -208.45 0 00 I R . I i Amanda D. Seibert 25.00 10 00 ~f . 1 073.75 114 000.00 - 142 500.00 - 1 073.75 Su tame Settlement Services 150.00 Su tame Settlement Services 35.00 i t Su tame Settlement Services 35.00 1 NM I AN 38.50 62.50 ~RI 101.00 1 425.00 1 425.00 1 425.00 1 425.00 1 I i Marie Huber 5.00 Marie Huber 260.38 I I Ham den Townshi Authorit 138.65 14 TA ETT EM NT HARGE n 7 394.33 1 839.03 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowladoe and belief. it is a true and arsairafq c~n~ar„4rn ~r all ~orsainrs ..,,,t ,~~s/.,,~ee,,,e,,,~ ,,,s,,e ,,,, ,,,,, ~,,,,,,,,,,, ,,, REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET I. BITTNER 21-07-1059 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (It more space Is needed, insert additional sheets of the same size) ,~ S 1200 Hancock Street Services Ouincy, MA 02169 December 12, 2007 ~~~ :~ ®z~~~ Saidis, Flower & Lindsay 2109 Market St. Camp Hill, PA 17011 RE: Account Number: L7C157627 Registration: MARGARET I BITTNER Dear Mr. Flower This letter is in regard to your recent request for the above referenced account. Please extend our condolences to the family of Margaret Bittner Per your request, below is a summary of Ms. Bittner's account as of the close of business on November 13, 2007. Fund Number of Shares Share Price Value of Account PTPAX- DREYFUS PREMIER 698.532 $15.90 $11,106.66 PENNSYL MUNI BD A Enclosed please find a photo copy of the 11/30/2007 account summary statement. Should you have any questions, please call our Customer Service Group at 1-800-942-8300. We are available Monday through Friday, 8:00 a.m. to 6:00 p.m. and will be happy to assist you. Sincerely, 2000-~~C~C~'~~/~ Erica Haworth Operations Specialist Enclosure: 11 /30/2007 Account Summary Statement Securities and Investment Advisory Services offered through CCO Investment Services Corp. Member FINRA, SIPC. 53 State Street, M65770, Boston MA 02109. (800) 942-8300. Insurance products offered through CCO Investment Services Corp. In Massachusetts, insurance is offered through Citizens Financial Services Insurance Agency. In New York, insurance is offered through Citizens Insurance Agency of New York, Inc. CCO Investment Services Corp., Citizens Financial Services Insurance Agency and Citizens Insurance Agency of New York, Inc. are affiliates of RBS Citizens, N.A. ~i' RBS I Securities and Insurance Products are: • NOT FDIC INSURED NO BANK GUARANTEE MAY LOSE VALUE NOT A DEPOSIT • NOT INSURED BY ANY FEDERAL GOVERNMENTAGENCY REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER MARGARET I. BITTNER 21-07-1059 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2003 CHEVROLET AUTOMOBILE, SALE PRICE 9,500.00 2. CITIZENS BANK, ACCOUNT #6240996039 689.43 3. CITIZENS BANK, ACCOUNT #6203359126 2,079.03 4. NET PROCEEDS, AUCTION SALE OF HOUSEHOLD PROPERTY 2,130.75 5. APPRAISED VALUE, COINS FROM SAFE DEPOSIT BOX 1,101.00 6. BANKER'S LIFE IRA ANNUITY DEATH BENEFIT PAID TO ESTATE 15,223.59 TOTAL (Also enter on line 5, Recapitulation) E I 30,723.80 (If more space is needed, insert additional sheets of the same size) ~ ;} l t " t~ a~ ~i~izens Bank... Account Number 6240996039 Account Title MARGARET I BITTNER Date Opened 12/12/2002 Account Tye Checkin - Principal Balance as of DOD $689.38 Interest from Last Posting to DOD $ .OS Account Balance as of DOD $689.43 ,~ YTD Interest to DOD $ .g~ ~~ Citizens Bank Account Number 6203359126 Account Title MARGARET I BITTNER Date O ened 9/4/2003 Account T e Checkin Principal Balance as of DOD $2079.03 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $2079.03 YTD Interest to DOD $ .00 4..~ . r;;/. Y.. RETURN T0: BANKERS Policy: 7,869,165 12/31/2007 VALUE: 15,223.59 INSTRUCTIONS: Mark "X" in the proper boxes, and furnish the other information. ( ) Please send me S to satisfy my IRS minimum distribution requirement for this year. ( ) Please calculate and send the amount needed to satisfy my IRS distribution requirement .for this year. L understand this amount will be based on the previous year's December 31st fair market value shown above. ( ) I do NOT want to have Federal income tax withheld from my withdrawal, or ( ) I want Federal income tax withheld from my withdrawal. Name (printed): Signature: Address: City and State: Social Security No. Date: Owner's Birthdate Month Day Year Why not answer now so you won't have to be concerned about this in the coming months. We hope you'll find this reminder a help. Branch Sales Office: 1051 2300 VARTAN WAY FL 2 HARRISBURG PA 17110 Phone: (717) 545-7999 Agent: ANDREW JONES Zip Code Page 2 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MARGARET I. BITTNER 21-07-1059 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE ~ THRIVENT ANNUITY PAID 1/2 TO DOROTHY KREIDER AND 1/2 TO CARL A. BITTNER, DECEDENT'S SISTER AND BROTHER 8,739.73 100 9,739.73 2. LINSCO PRIVATE LEDGER IRA PAID TO CARL A. BITTNER , , DECEDENT'S BROTHER 4,777.03 100 4,777.03 3. MONUMENTAL LIFE (AGON) ANNUITY PAID 1/2 TO DOROTHY KREIDER AND 1/2 TO CARL A. BITTNER, DECEDENT'S SISTER AND BROTHER 28,076.85 100 28,076.85 TOTAL (Also enter on line 7 Recapitulation) E I 42,593.61 (If more space is needed, insert additional sheets of the same size) 008 r1 ~'$1ttner 109 Market Office Came Hi11 pA 17011 ~; Annuity Number A100002292A01 Dear Carl A Butner: Monumental Life Insurance Company Administrative Office: 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 we have received notification, Margaret Bittner, 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 01/02/.2-008: Taxable Portion: Full Value as of 11/':1'3/2007: Margaret Bittner Margaret Bittner Carl A Butner 50% June 2 7 , '19 8 3 $28, 228 .39 $25,172.74 $28,076.85 The attached document reflects the options available to the beneficiary. 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 Monumental 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 ;--- ~~ ANNUITY ~~ FINANCIAL f~{ ~ :t INTERMEDIARY ;~ SERVICE AWARD ( POST-SALE ~ ' `1SERVICE AWARR 2006 '~ 20fYS '` r _,~ ncial for Lutherans® ~~ Ballard Road, Appleton, WI 54919-0001 6i,/one: 800-THRIVENT (800-847-4836) E-mail: mail@thrivent.com • www.thrivent.com December 14, 2007 Thomas E Flower Saidis, Flower & Lindsay 2109 Market St Camp Hill PA 17011 Dear Ivlr. Flov: er: Securities offered through Thrivent Investment Management Inc., 625 Fourth Ave. S., Minneapolis, MN 55415-1665, a wholly owned subsidiary of Thrivent Financial for Lutherans. Member NASD. Member SIPC. Subject: Margaret Bittner Contract: C2822500 This letter is in response to your fax dated December 10, 2007 regarding the Estate of Margaret I. Bittner. Contract C2822500 is a variable annuity contract. The beneficiaries on the contract are Dorothy Kreider and Carl Bittner. Therefore, payment cannot be made to the Estate of Margaret Bittner as indicated in the letter signed by the executor, Carl Bittner. The death benefit as of November 21, 2007 was $9,739.73. The entire amount is taxable. Because this is a variable annuity contract, the death amount is calculated on the date we receive proof of loss and is subject to the investment experience of the variable account which may increase or decrease daily. When there are multiple beneficiaries, each beneficiary's portion of the death benefit amount remains in the variable account until that beneficiary's properly completed claim form is received. I have enclosed two claimant statements form 28E. Each beneficiary will need to complete a claim form making their settlement election. If you need assistance with completing the form, payment options, or if you have any questions or concerns, please contact Financial Representative Mark Snover at 717-730-9611 or us at 800 847-4836. Otherwise, please have the beneficiaries complete and return the forms in the enclosed envelope. Please reply by Jan. 11, 2008. Sincerely, p~ ~ ~ Deb Wenninger, ALHC, ACS Claims Examiner, Centralized Service Team Death Claims and Service Life and Health Product Service Operations Department, FSO dkw enc. 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T~ C T,Z~j C T~ C ~ Z Z -1 ~ . ~ C. .Z .(n .C Z U7 _ - Z (p `~' ~~ < C ~ ~ J '' ~ -' ~ ~ ., 0 0 ~ ~ ~ ~ ~ O ~ LI1 "F ti ~ J OJ o J OJ ~ ~ n ~~N ~ ~ ;. ~ : ~ N ~ N ' r 0 ~ Q n ~ p ~ Q o _ n Z O C7 O D ~ c~ f Z H D ~ m < D ~ < o; '~ ~ m D~ cn-• -i D ~ 0 m 2 o m S ~` . ~' u,n < 0 v m ~ Z o Z ti m~ N m ~ - (D O J O O w ~ N w J D D D N N ~ 2 2 2 fJ C N O J ~: O N v O O j A fD j n N Q y fD ^a o ~ N o e a' Zvi o ~D w n ti' ~ -. ~ m ~ n ~ ~ N ~ N ~ ~C ~ i . Z C ~ ~ N ~ ~ ~q. o e ~o ° D 3 ~ n . ° n n n . v ' o. a C o i ~, 3 3 rt ~ _~ W Sv O ~ O ~ ~ a ~ c~ ~ ~ N ~ n ~ ~ S 2 m j : REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET I. BITTNER 21-07-1059 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' NEILL FUNERAL HOME, PROFESSIONAL SERVICES AND EMBALMING 3,720.00 2. NEILL FUNERAL HOME, MERCHANDISE, TRANSPORT & FACILITIES USE, TOTAL 3,259.73 s. GRAVE OPENING 300.00 a. DEATH CERTIFICATES 18.00 5. 6. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 1,000.00 Name of Personal Representative(s) CARL A. BITTNER Social Security Number(s)IEIN Number of Personal Representative(s) 165-30-3643 Street Address 130 LAKEVIEW DRIVE City ELVERSON .State PA Zip 19520 Year(s) Commission Paid: 2008 2. Attorney Fees 9,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 306.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. ADVERTIZEMENT TO SELL AUTOMOBILE 14.00 B. USED REPLACEMENT BATTERY TO SELL AUTOMOBILE 40.00 s. PUBLISH EXECUTOR'S NOTICES, THE SENTINEL(182.56); CUMBERLAND LAW JOURNAL (75) 257.56 10. AUCTIONEER'S COMMISSION ON SALE OF REAL ESTATE 1,420.00 11. PLUMBING REPAIRS PRIOR TO SALE OF REAL ESTATE 825.00 CONTINUATION SHEET TOTAL 2,233.40 TOTAL (Also enter on line 9, Recapitulation) $ 22,393.69 (If more space is needed, insert additional sheets of the same size) MARGARET I. BITTNER SCHEDULE H CONTINUATION SHEET 12. REAL ESTATE TRANSFER TAX 13. PA AMERICAN WATER CO 14. HAMPDEN TWP. SEWER/TRASH 15. PPL 16. UGI 17. VERIZON 18. ENCOMPASS, PROPERTY INSURANCE 21-07-1059 1,425.00 81.26 277.30 83.15 249.00 46.56 71.13 CONTINUATION SHEET TOTAL: 2,233.40 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER MARGARET I. BITTNER 21-07-1059 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET I. BITTNER 21-07-1059 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include ouUight spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1 • DOROTHY KREIDER, 130 7TH AVE, COLLEGEVILLE, PA 19426 SISTER 18,908.24 2• CARL A. BITTNER, 130 LAKEVIEW DR., ELVERSON, PA 19520 BROTHER 23,685.32 3• LINDA FISHER, 116 GASWELL ROAD, CATAWISSA, PA 17820 .NIECE 13,461.12 4• DOUGLAS ORTH, 3142 TAFT ROAD, NORRISTOWN, PA 19403 NEPHEW 13,461.12 5• BRENDA TOWSEN, 6296 STABLE COURT, HARRISBURG, PA 17111 NIECE 13,461.12 6• KENNY BITTNER, 168 RED HAVEN RD., NEW CUMBERLAND, PA 17071 NEPHEW 13,461.12 7• KATHY BITTNER, 294 TYSON SCHOOL RD., CATAWISSA, PA 17820 NIECE 13,461.12 8• SCOTT BITTNER, 2216 AVONSHIRE PL, WAKE FOREST, NC 27587 NEPHEW 13,461.12 9• JAMES ORTH, 14955 ORTH LN, MILTON, DE 19968 NEPHEW 13,461.13 10. DEBBIE PRITCHARD, 579 MIAMI BLUFF CRT, LOVELAND, OH 45140 NIECE 13,461.13 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET 11 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 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) MARGARET I. BITTNER 21-07-1059 SCHEDULE J CONTINUATION SHEET 11. KEITH BITTNER, 269 TYSON SCHOOL NEPHEW 13,461.13 ROAD, CATAWISSA, PA 17820 12. JUDY MISICK, 5777 NESBIT DRIVE, HARRISBURG, PA 17112 13. DAVID BITTNER, 1322 GREEN HILLS RD, BIRDSBORO, PA 19508 14. LISA SWAVELY, 391 BELLAMAN CHURCH ROAD, DAUBERVILLE, PA 19533 NIECE 13,461.13 NEPHEW 13,461.13 NIECE 13,461.13 LAST WILL AND TESTAMENT OF MARGARET I. BITTNER I, MARGARET I. BITTNER of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I. I direct the payment of all my just debts, expenses of my last illness and funeral expenses by my Executor, Carl A. Bittner, as soon as may conveniently done after my death. II. I direct my Executor, Carl A. Bittner, distribute such items of my tangible personal property as are designated on a list made by me during my lifetime. In absence of a list or designation on the list, I direct my Executor to convert all my assets into cash to be added and distributed with the residue of my estate. I^.'• .-].e -• '-,- e t~' re ',,; '~ y~ e~tC:it'~~. al'ld ~ ~ . ~ u v ~~e and ~..~:..1~.:t a• .i all file Sid c v_ :T_ of whatever nature and wherever situate unto my nieces and nephews who are living at the time of my death. IV. I appoint my brother, Carl A. Bittner, as Executor of my estate. 1 .. _. ..~ . IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the /'~ ~. day of ~,~.~,,.~;1-..:~~-- __ 2005 . ~ ~~ ~J t ~ r .,~ ~-' ~Xi~"~~-r~t.~ (SEAL ) ter'` Ma garet I. Bittner Signed, sealed, published and declared by MARGARET I. BITTNER Testatrix therein named, on this and one (1) other sheet of paper as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~/ \ Name v < Name ~, i ~~~~ ~ , Addres Address 2 __ __ _ art COMMONWEALTH OF PENNSYLVANIA } COUNTY OF CUMBERLAND } WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, alld uT_~ide~ no 1= l7iivtrain c'r 11nC.~ue lrif 1'u'r%1~ e . ~ ,, ~ , '/~--- /% '1'-Vii..-~f-%=i'L.(~- ^ _'~~''''ti~.'`-,'''i'--''~ N~"rg~, t I. Bittner, Testatrix ~' , ~~: Witness Witness Subscribed, sworn to and acknowledged before me by the testatrix, and subscribed and swor~..to before me by both witnesses, this ---~-- day of ~{'~~~~~.,~.,.: 2005. ~~' v n~, ~.t- Not,~,~rv~ubl i Notarial Seal Sara J. Ensinger, Notary Public Camp Hill Boro, Cumberland County My Commtsston Expires Oct. 17, 2005 Member, Pennsylvania Association of Notaries 3