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Home My WebLink About08-13-0815056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 2 1 0 8 0 2 2 8 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172 01 3622 02 18 2008 06 17 1913 Decedent's Last Name Suffix Decedent's First Name MI HESS DOROTHY R (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 X 1. Original Return 2 Supplemental Return 3 Remainder Return (date of death prior to 12-13-82) d. Limited Estate qa. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) X g Decedent Died Testate 7 Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 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 DAVID J. LENOX 717 932 966, Firm Name (If Applicable) THE WILEY GROUP, PC First line of address 130 W. CHURCH STREET Second line of address City or Post Office DILLSBURG State ZIP Code PA 17019 Correspondent's a-mail address: d a v e l e n O X@ C O fTt C a S t. n e t c~ REGISTER OF~V-'ILLS USEQNLY` - -~ ---, ` ~,_, ~-, .. r ,~ DATE FILED C" 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. SIGNATI~IRE F PERSON RESP,ONSIB F R FILIN RETURN DATE (~ (//~f/ Larry V. Hutton ~j'- ~ - C ~" 795 Bentzel Road, Lewisberry, PA 17339 iJ.BNAT,IlRE OF PRFPARER IyTF)IER THAN REPRESENTATIVE 130 W. Church Street, Dillsburg, PA 17019 David J. Lenox Side 1 15056041147 15056041147 J 15056042148 REV-1500 EX Decedent's Name: D O r O t h~/ R. ~"~ e S S RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 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. 6. Jointly Owned Property (Schedule F) Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non_ -Probate Property (Schedule G) 'Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 13. Charitable and Governmental Bequests/Sec 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. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 3 4 2 4 5 8 0 6 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 172 01 3622 35,264.00 62,339,12 15,072.31 250,228.92 362,904.35 11,288,67 584.64 11,873.31 351,031.04 8,572.98 342,458.06 0.00 15,410. 61 0. 00 0. 00 15,410. 61 Side 2 15056042148 15056042148 REV-1500 EX Page 3 Fife Number 21-08-0228 Decedent's Complete Address: Dorothy R. Hess STREET ADDRESS 801 N. Hanover Street __ - CITY _ ____ STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) 15,410.61 (2) 13,684.21 (3) (4) (5) 1,726.40 (5A) __ __ (56> 1, 726.40 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 :.................................................................................. ' x b. retain the right to designate who shall use the property transferred or its income :.................................... x c. retain a reversionary interest; or .................................................................................................................. ' x I d. receive the promise for life of either payments, benefits or care? .............................................................. j ' x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... . X I 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... j x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficia desi nation .............................................. x ry g ~ ......................................................................... ~ ', 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)]. 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. 13,000.00 684.21 ~~~~~z rll ~rn~ L~~~t~iil~erit ~:~~.: Br' ,.1'ly'~tI's:L;, t,iat ', '_~~'~:iJT`ftY R. F~S.,, .., imwooa .~~.venue, McGh-ll"~~_:a;1.12"'F;, Cumberla,r,x ~~- ="~ ', ~eY~1`15y1V2Jlia, ~:`. - !:f 5~!l.i~C. `il''11Q, rremor,~ ~r... .A ,:±erstandir ~, „o F , ;bliss _.~c. .=~ t..,t _ ._. _nr `'c- my Last Will and Testament, hereby revokir~ and *r~llcinY null ,end void an;,~ and all wills and testaments and writings in the nat~_me thereof by me, at any time heretofore made. ITF1~'[[ L• I direct tY~at all my just debts and funeral expenses be paid as soon after my demise as may be convenient. TTII~'1 2: All the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, :including property cver which I have a power of appointment, I give, devise and bequeath as follows: A. I give and bequeath ten (10i) pE'rcent of my estate to the First. Church of God of Mechanicsburg, Pennsylvania., presently 1?cateu a.t 6 r_,. Main Street, Mechanicsburg, Pennsylvania. B All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether i.t be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my son, LARRY V. HUTI'ON and my daughter, JF,AN C. TODARCi, in equal shares per stirpes. I'I'EP4 3: I direct my Co-Executors to pay all inheritance, estate, succession. and legacy taxes of Uinatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or otherwise passing by reason of nlY demise, may be subject and to charge such to:~ces against my residuary estate, it being my intention that none of the 'WI~IF.SS : ~ j_ ~ ~,' - :(,~Vl ,.'~,~ ~ ~.~ "~~~l__~`~ ~'~L~~~~~/~ " I~~ ~r~;_;(, (SEAL) i l CORO`PHY R . - S ~' _ ~. ~ .~_ _~~. ~~r.es, either eCrr__ -. ~U. __~ ~ rey ~~:: °~ ,_. yncl~~c~e: ~:. r,;,~ gross estate, .___ ,F~ >-. ~ .,_.,., ~_ _ ~~_.~~ -„ ~... ~_ ~~.w now in i oree or hereai'ter _ c2c _ , sh~~ 1 he ~ ~_r ~c, ~mor.~ ~e N;_rs~ns _... ~~ ested in my 5at~. __ _ .,,~ ;. - _ ~n._ c,° ~~sferrer. :.,: whom arw benet': ~ _.- .. _~... ^~.~>^ I appoint my th. ...i~ ,_ ~.1, _~ s , ~ ~ .~:, and «. ~ C. rC~`` . , as mac,-Executors of tYii_s my ?xx:_` .. ,_ ~~,d ~~'c;? ~~~-~era . TP~~i ~: I direct that rqy Cc-executors, Mardian, or their successors shall not be required to give ~oond for the falthfull per['orrnance of their duties in any ,;urisdiction. Iiv wl%vLSS wttr~ttEVi', i have hereunto set my hand and seal this to '`~ day of ~~ ~, 1985. 7 ~/~ DOR~!'HY R . ~ ~ SS -2- CG'vN'I~' ~~ YET<.'r: i ~ ~, _. -. -- ~" ciY`. ~~ __~ „~E. _~.-l,S~i'_.x a_rld .,fie hr ~'.(r~~. ,~ ;(? Cl ~,~,'~~..~> whose names are si ed to the attaches or foregoing instr~~*r~ent, being, first duly sworn, do hereby declare to the undersigned a a.`l:r'ity that the Testatrix simed and executed the instrument as her '~,=~.' `~~;'-1 =~~c? Testament and that she had signed willingly (or willingly directed another to sign for her), and t;:at she executed it, as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signned this Last Will and Testament as witness and that to the best of their knowledge, the Testatrix was at the time, ei~teen (18) ,years of age or odder, of sound mind and under no constraint or undue influence. ~~ / ~ TNESS WITNESS Sworn to and subscribed to before me this /G ~ay of ~.t-~(--c,~~- ~ 1985. _-7. otary ~b1i~ My Corr¢nission Expires: GIEHDA h9. WfTH{H6TDW, NOT.IRT Pt'"' DIUSSOR& BDRDlt6H. YDAK CCL+?!: MY COMI;tf:.!7!i LY°1RFS DEC. T7, 1985 tlwxD~r, P~nnsyi~;L~i: s~cictnn o1 RoGrias Rev-1603 EX+(g~98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hess, Dorothy R. 21-08-0228 All property jointly-owned with right oT survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 DWS Scudder High Inc. Fund A 21,126.13 2 Oppenheimer Strategic Inc. Fund Cfass A 14,137.87 TOTAL (Also enter on Line 2, Recapitulation) 35,264.00 pr more space Is needed, adtlitional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98} GROUP'S TAX & PAYROLL SERVICE • Gary L. Group, Tax Consultant 524 SOUTH PITT STREET, CARLISLE, PA 17013 (717) 245-8581 April 18, 2008 David C. Lenox ,Esquire 130 West Church Street Suite 101 Dillsburg, PA 17019 David, Below is the information you requested on Dorothy Hess's accounts. February 18th was a holiday, so the fund companies provide the previous work day value which was Febnaar;~ 15th 2008. If you have any questions please let me know. Sincerely, -' Gary L Group A) Oppenheimer- Strategic Income Fund Class A Account # 230-230747-1992 1) Date of Death Value- $14137.87 2) No beneficiaries 3) Required paperwork a) Signature Guaranteed Letter of Instruction- signed by the Executor Stating if you want to open a new acct. or redeem the shares. b) Copy of Death Certificate c) Letters of Testamentary d) W-9 form with the Estate Federal ID # 4) Mail To: Oppenheimer Funds P.O. Box 5270 Denver, CO 80217 B) DV~1S-Scudder High fr~come Fund A Account # J841 ~JQ 1) Date of Death Value- $21126.13 2) No beneficiaries 3) Required Paperwork a) Signature Guaranteed Letter of Instruction- signed by the Executor Stating if you want to open a new acct. or redeem the shares b) Copy of Death Certificate c) Letters of Testamentary d) W-9 form with the Estates Federal ID # 4) Mail To: DWS-Scudder P.O. Box 219151 Kansas City, MO 64121 Serving Central Pennsylvania Since 198Q Member National Association of Tax Practitioners Rev-1608 EX+ (6.98) COA9MONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Hess, Dorothy R. 21-08-0228 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Citizens Bank Checking 6100702375 8,494.55 2 Citizens Bank Checking 6205363759 40,134.34 3 Refund Church of God Nursing Home 4,905.96 4 Refund Long Term Care insurance 2,294.27 5 Security Deposit Refund Church of God Nursing Home 6,510.00 TOTAL (Also enter on Line 5, Recapitulation) I 62,339,12 (If more space is needed, additional pages of the same size) Copyright (c} 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) j 1 i Account Number _ _ ~ 6100702375 _ ~_ Account Title DOROTIIY HESS Date Opened _ _ -- 7/12/1976 -- Account Type Checking Principal Balance as of DOD $8494.55 Interest from Last Posting to DOD - $ .00 Account Balance as of DOD $8494.55 LYTD interest to i~vi~ ~ $ i •~5 A ~~"' ~, _ Account_Number ___ _Account "Title Date Opened 6205363759 __ DOROTHY HESS 8/1 b/2004 Account "hype ~ Checking ~ Principal Balance as of DOD $40134.34 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $40134.34 VTTI T.,~,.«,...• +,. Tl/lTl 1 1 L 111tW GJL LV LIJL a~t~c an I ~dJ^~U Rev-1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hess, Dorothy R. 21-08-0228 If an asset was made joint within one year or the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Larry V. Hutton 795 Bentzel Road Son Lewisberry, PA 17339 B. Janet K. Hess 316 Ofd Middletown Rd. Stepchild Media, PA 19063 C. Jane D. Hess 3610 Logan Court Stepchild Camp Hill, PA 17011 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 4/25/2000 Citizens Bank CD 8,129.93 0.500% 4,064.97 2 B 8~ C 11/15/2000 Wachovia Securities 33,022.05 0.333% 11,007.34 TOTAL (Also enter on Line 6, Recapitulation) I 15,072.31 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Account Number ! 6140763711 ~ _ _ Account Title DOROTHY HESS OR LARKY HUTTON Date Opened _ Account Type _ 4/25/2000 Time Deposits Principal Balance as of DOD $8103.16 Interest from Last Posting to DOD $26.77 Account Balance as of DOD $8129.93 _ ~YTD inieresi io DOD ~ $3 i .8 i ~ Z Z z z a z z z z z z z z 0 0 O „J11,,,-„I1,-11„1„1,1-1,11,,,1,1~*13 ~D1G1T 170 I,,,IN 02 3DG 103 x**AUTO -.--''----- 021$66 DOROTHY R HESS ~ i---"---- JANET y{ NESS ~ JANE D HESS JT TEN 801N H ~ Pp,ER p~ R0509 CART-ESL m ~ O CU r~ n~ T ~. ~ ~. N 3 rr- m C~-aD ~ ~ ~' rn~ ~ ~ ~m C7 ~ "D m N co m v n n O G v m a s T N v -1 ~ ~ a ^ ~' (D .t e-r o ~ .. ~ ~ ~° ~ m _ N ~ ~ ' m "'. - . . , ~ ~ o m m ~ m~ _d C~ o o m ~ ~ ~ 1 ~ ~ , o c 1 i ~ ~ ! - p~ w ~ ~' ° ~ u co'~ ~ w w -< c ~, n a imr ~~=, Cy~T o`z~ 'tp - ~0 R' -n aOR ~ ~ v c ~C') T v' -,~ -c o co Z Zrw 0 ti o ~ 0 ~ r r, ~ ~~ ~zccn ~~s~ ~ ~~ °~~ a~cnr" _ Wc~=i .* ~omOD rYmo mm -+-+v0 O m -~ o,w Za Z TJ ~~ m~ ~ U'cn~z -.i C)O w T-, -+o~ boos ~u?zm v nr~~ ~~m ~ ~~~C 'rT m ~ ~ o ~z ~-O-n~~ c -~ oZ- Z ~pQO N d ~ ?m~~' D o?r'c~~ C1~ Z~"~N ~" w--{_{ fD s ~ ~ ~' o ~; C G C~ G'' r~ ~ -n C ,~I~ ~~ mo z< z~a ~ t,~'Io Q,t GZ~~ 7JnN ~ O p , ~ ~ (1~ D C) U~ D ~ 1' i $ro ~~mz °~m _ ~'~ ~ w ,mac ~ ~ ymcnn -i 7.7 to S min -' ~ tA~ ~ :o W,W,~ m ~ W' G O ~-00 ! O -O Cdr W -~ O ~ o ~ ;~ ~ ~ L m Z- (n ~"'z"' n [(1 ~ -mc~n N ~ -v N m ~ Z -+ m ---+ O~ m 'p d~~ N~ ~ ~~-O z Z~G ~ ~ o~ Cm~ i ~ T ~ ~ ~ Z ~ O ~ C m ~o m ~, ~ ~o w W n ~' n tG' '"'' < D ' ~ 3 o ° m =+ ~ 1- 0 0 ~ v c ~= c ~om~ t Nil~1m ~ ` H ~ n -t O ~ h ~c~o C ~• O ~ ~ ~~ '" o .'~ ,,.t "~S C .Z -ti ~c N N O ao Rev1b10 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OFFILE NUMBER Hess, Dorothy R. 21-08-0228 This schedule must be completed end filed if the answer to any of questions t through 4 on the reverse side of the RF_V-1500 COVER SHEET is yes. ITEM NUMBER RIPTI N F PROPERTY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND 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 1 AIG American General Annuity A10095390F 36,309.87 36,309.87 2 AIG Sun America Annuity A634050336D 17,353.63 17,353.63 3 American Investors Life Annuity 334228 15,807.36 15,807.36 4 American Investors Life Annuity 373619 33,840.67 33,840.67 5 American Investors Life Annuity 373620 36,244.10 36,244.10 6 American Investors Life Annuity 382435 33,850.92 33,850.92 7 John Hancock Life fns. Co. Annuity GP07289645 13,700.33 13,700.33 8 Lincoln Financial Annuity 382001902 17,579.45 17,579.45 9 Transamerica Annuity 26252292 45,542.59 45,542.59 TOTAL (Also enter on Line 7, Recapitulation) I 250,228.92 (!f more space is needed, addi5onal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) SunAmerica Life Insurance Company Feed Annuity Administration P.O. Box 9006 Amarillo, TX 79105-9006 April 24, 2008 THE WILEY GROUP Attorneys at Law 130 W. Church Street, Ste 101 Dillsburg, PA 17019 Re: Deceased: Contract # Dear Mr. Lenox: Dorothy R. Hess A634050336D ~ SunAmerica Financial Thank you for your recent inquiry regarding the above mentioned annuity. We would like to take this opportunity to provide you with the information you requested. ~ Value as of: 2/18/08: $17,353.63. y~ Primary Beneficiary(ies): Jean C. Holmquist & Larry V. Holton. We hope this information is helpful; however, 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 1-888-333-2349. --~-in~erely, r' ~ ~ ~~~ ~' ~~ Bri ~ liffe Claims Department Sun America Life Insurance Company Anchor National Life Insurance Company First SunAmerica Life [nsurance Company Administrator for "The Central National Life Insurance Company of Omaha Administrator for John Alden Life Insurance Company ,Llernher of Ameriean Latcnmtionul Group, Inc. . ~ ~~ ~'~ tiE=i6 42E966 r ,R.7 AM~rucarr [~~~~1 GENERAT. May 13, 2oas DAVID LFN4X PAX - 717-432-0426 Re: Deceased DOROTI4Y R 1-IESS Contract A10095390F Dear Mr. Lenox: This letter is in response to your caii on May 13, 2008. The Date of Death value as of February 18, 2x08 was $36,309.87 and the cost basis is $18,(131.23. This is anon-qualified account, which makes the taxable amount $18,27$.64. This claim has been processed and proceeds will be sent to each benc~iciary under separate cover. l hope this will assist you in settl'ing Dorothy Ness' Estate. If you have any questions, please contact us st 1800247-6584 and speak with a customer care associate. Sincerely, l ~o~, ~ c~, ~ _. Mary Grice Annuity Claims Cierk Annuity Claims Department P.';~_~E ~_~ A,mcrican General Life Companies Mc~nh~r ajAmer,'ran Iater,.nfinnnlGrnwp, ]nc P.C.). Box A71 >>manllr~, TX 79105.0871 • (SOOj7d7-6584 Av~vR April 17, 2008 The Wiley Group Attorneys at Law Attn: David J. Lenox 130 W Church Street, Suite 101 Dillsburg, PA 17019 Re: Pc)licy #334228 - Arr~eriran Inyectnrc I ife Insured: Dorothy Hess Dear Mr. Lenox: Thank you for your recent request for information regarding the policy referenced above. The date of death value is noted below. Date of Death: Principal Amount: Interest Amount: Account Value: February 18, 2008 $11,066.36 $4,741.00 $15,807.36 The beneficiaries on the above referenced policy are as follows; Steven A. Todaro, David W. Hutton, Tiffany D. Chapman and Wendy A. Adlinger. Should have any questions or need further assistance, please feel free to contact our office at 1-888-ANNUITY (1-888-266-8489}. Sincerely, Qmds~ec~. ~,,n,-~ Andrea Shurtz Claims Specialist Aviva Life and Annuity Company 555 South Kansas Avenue Topeka KS 66603-3444 Tel 800 255 2405 vvvvw.avivausa.com Amen~:an Inventors LiSe Insurance Company, Inc. Aviva Capital Management, Inc. Aviva Life and Annuity Company Avwa life Insurance Company Avwa Life and Annuity Company of New York Aviva 115A Corporation Indianapons Life insurance Company Av~vA April 17, 2008 The Wiley Group Attorneys at Law Attn: David J. Lenox 130 W Church Street, Suite 101 Dillsburg, PA 17019 Re: Policv #373619 -American InvPStnrs I ife Insured: Dorothy Hess Dear Mr. Lenox: Thank you for your recent request for information regarding the policy referenced above. The date of death value is noted below. Date of Death: Principal Amount: Interest Amount: Account Value: February 18, 2008 $23,234.68 $10,605.99 $33,840.67 The beneficiaries on the above referenced policy are as follows; Steven A. Todaro, David NJ. Hutton, Tiffany D. Chapman and Wendy A. Adlinger. Should have any questions or need further assistance, please feel free to contact our office at 1-888-ANNUITY (1-888-266-8489). Sincerely, Andrea Shurtz Claims Specialist Aviva Life and Annuity Company 555 South Kansas Avenue Topeka KS 66603-3444 Tel 300 255 2405 vvvvw.avivausa.com Amencan Investors Life Insurance Company, Inc. Aviva Capital Management, tnc. Aviva Lite and Annuity Company Aviva Life insurance Con-many Aviva Life and Annuity Company of New vork Aviva USA. Corporation Indianapolis Life Insurance Company AV 1 VA April 17, 2008 The Wiley Group Attorneys at Law Attn: David J. Lenox 130 W Church Street, Suite 101 Dillsburg, PA 17019 Re: Policy #3$2435 -American Investors I ifP Insured: Dorothy Hess Dear Mr. Lenox: Thank you for your recent request for information regarding the policy referenced above. The date of death value is noted below. Date of Death: Principal Amount: Interest Amount: Account Value: February 18, 2008 $28,205.73 $8,038.37 $36,244.10 The beneficiary on the above referenced policy is Janet K. Hess. Should have any questions or need further assistance, please feel free to contact our office at 1-888-ANNUITY (1-888-266-8489). Sincerely, Andrea Shurtz Claims Specialist Aviva Life and Annuity Company 555 South Kansas Avenue Topeka KS 66603-3444 Tel 800 255 2405 www.avivausa.com Amefican Investors Ufe lnsu~ance Company, Inc Aviva CapKal Management, Inc_ Aviva Life and Annuity Company Aviva Life Insurance Company Aviva Lrte and Annuity Company of New vork Aviva USA Corporation Indlanapolls rife Insurance Company AV1VA April 17, 2008 The Wiley Group Attorneys at Law Attn: David J. Lenox 130 W Church Street, Suite 101 Dillsburg, PA 17019 Re: Policv #373620 -American Investors I ifP Insured: Dorothy Hess Dear Mr. Lenox: Thank you for your recent request for information regarding the policy referenced above. The date of death value is noted below. Date of Death: Principal Amount: Interest Amount: Account Value: February 18, 2008 $23,241.70 $10,609.22 $33,850.92 The beneficiary on the above referenced policy is Janet K. Hess. Should have any questions or need further assistance, please feel free to contact our office at 1-888-ANNUITY (1-888-266-8489}. Sincerely, Qnr,dns.cx S~ ~.xr #~ Andrea Shurtz Claims Specialist Aviva Life and Annuity Company 555 South Kansas Avenue Topeka KS 66603-3444 Tel 800 255 2405 vdww.avivausacom Amencan Investors Lite Insurance Company, Inc. Aviva Capital Management. inc. Aviva Life and Annuity Company Aviva Lite Insurance Company Aviva Life and Annuity Company of New Vork Avva 115A Corporation Indianapolis Life Insurance Company John Hancock Life Insurance Company John Hancock Annuities Service Center 164 Corporate Drive, Portsmouth, NH 03801-6815 Mailing Address: PO Box 9507, Portsmouth, NH 03802-9507 (800) 824-0335 www.jhannuities.com April 16, 2008 David J. Lenox The Wiley Group 130 W Church St. Suite 101 Dillsburg, PA 17019 Dear Mr. Lenox: Re: CONTRACT/CERTIFICATE # GP07289645 the future is yours This letter is in response to the inquiry recently submitted for the annuity contract referenced above. The date of death value as of 2/18/2008 was $13,700.33. If you have any questions or concerns about this letter, please call us at 877-543-2363. Our Claims Service Representatives are available on weekdays from 8:00 a.m. to 6:00 p.m. EST. Sincerely, John Hancock Annuity Services Liie insurance, annuities, induding group annuities are products issued by the following affiliates: John Hancock Life Insurance Company (U.S.A.)', John Hancock Life Insurance Company and John Hancock Variab4e Life Insurance Company`, Boston, MA 'not licensed in New York LT-A-1107 . ~lrlCOli~ ' i Flnancta( Group Enffratired Granite II The Lincoln National Life Insurance Company, One Granite Place, P.O. Box 515, Concord, NH 03302-0515 Dorothy Rose Hess 801 N Hanover Street-Front Carlisle PA, 17013 Non-Qualified Flexible Premium Deferred Annuity Quarterly Statement For Period Ending: December 31, 2007 Contract Number: 382001902 Issue Date: 06/21/1995 lnitital Net Deposit: $10,000.00 For questions regarding your account, please call Customer Service at (800) 258-3648 ext. 5394. Account Activity October 1, 2007 fo December 31, 2007 DATE TRANSACTION TRANSACTION ACCOUNT ACCOUNT AMOUNT ACTIVITY BALANCE 10/01!2007 Beginning Balance $17,427.68 Interest Earned This Period $151.77 $151.77 12/31/2007 Ending Balance $17,579.45 12!31!2007 Surrender Va{ue $17,579.45 P/ease note: The beginning balance of this statement may not agree with the ending balance of your last statement. Any differences are caused by a transaction processed in the current quarter with an effective date during the prior quarter. Please refer to the correspondence you received confirming that transaction. Annual Account Summary October 1, 2007 to December 3i, 2007 10/01/2007 Beginning Balance $16,984.98 Net Deposits During the Year $0.00 Gross Withdrawals During the Year $0.00 Interest Earned During the Year $594.47 12/31/2007 Ending Balance $17,579,45 www.LFG.com. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.! Contract Number 382001902 11111111111111ifiliilfllll111f111111111111111141111111111111141Nlllllll111 Produced on 01/01/2008 ~IRANSAMERICA ~ LIFE INSURANCE COMPANY April 16, 2008 Estate of Dorothy R Hess c1o David J Lenox 130 W Church Street Suite 101 Dillsburg PA 17019 Transamerica Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 RE: Annuity Number 26252292 Dear Estate of Dorothy R Hess: Our office has received your request concerning the above listed non- qualified tax deferred annuity. The value of this annuity as of February 28, 2008 was $45,542.59. The beneficiary for this annuity is Janet K Hess. The beneficiary has already made claim on this annuity and the death benefit was sent to the beneficiary on March 26, 2008. There are no funds left in this annuity. Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-553-5957. A Transamerica Life Insurance Company representative will gladly asp>ist you with any questions you may have regarding this annuity acid help you meet your financial goals. Sincerely, ., Nicholas Hayes Transamerica Life Insurance Company Claims Member of the `EGON. Group _ DA ,lR flRL~AR ',\\ °' ~~ ~ FtN AIVCIAL '~ •~ANN6Il`Y ~ INFERME`DF(yRY ~ $ERVIC~AVI~ARD ~ ~POSr~SAL"E ~ $ERViCE'~„~1JNRg, REV-1151 EX+(12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hess, Dorothy R. 21-08-0228 Debts of decedent must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 1,661.29 2. Attorney's Fees The Wiley Group, PC 9,090.00 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 210.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 327.$8 See continuation schedule(s) attached TOTAL (Also enter on tine 9, Recapitulation) 11,288.67 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1b02 EX+ (6-98) ~'-CHEDULE H-A FUNERAL EXPENSES continued COMAONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Ness, Dorothy R. I 21-08-0228 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) , Rev-'1602 EX+ (g_98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA continue d INHERITANCE TP,X RETURN RESIDENT DECEDENT ESTATE OF f FILE NUMBER Hess, Dorothy R. _ I 21-08-0228 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98) .Rev-1b12 EX+ (6-98f SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS CONNAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hess, Dorothy R. 21-08-0228 In._~ude unrelmbursed mcaical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) ~ REV'"1513 EX• (9-OOt SCHEDULE J COMMONWEALTH OF PENNSYLVANIA fNHERfTANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Hess, Dorothy R. 21-08-0228 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP 1"O DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) Do Not List Trustee(s) 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a}(1 2)} 1 Jane D. Hess Stepchild 1/2 Wachovia 3610 Logan Court Joint Account Camp Hill, PA 17011 2 Wendy A. Adlinger Granddaughter Annuities, Mechanicsburg, PA 17055 373619 8 334228, 1/4 interest 3 Tiffany D. Chapman Granddaughter Annuities, Knoxville, TN 37920 373619 & 334228, 1/4 interest 4 Janet K. Hess Stepchild Annuities and 316 Old Middletown Rd. Wachovia Joint Media, PA 19063 account 5 Jean C. Holmquist Daughter 45% Residual 2772 Navel Drive Heir Clearwater, FL 33759 See continuation schedule attached Continuation Tota I Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTIOPJ TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(s) attached 8,572.98 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 8,572.98 Copyright (c) 2002 form software only The Lackner Group, fnc. Form PA-1500 Schedule J (Rev. 6-98} SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Dorothy R. Hess 02/18/2008 172-01-3622 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 David W. Hutton Grandson Annuities, 373619 $~ Carlisle, PA 17013 334228, 1/4 interest 7 Larry V. Hutton Son 45% residual Heir, 795 Bentzel Road and Joint Property Lewisberry, PA 17339 on Schedule E 8 Steven A. Todaro Grandson Annuities, 373619 8~ Clearwater, FL 33759 334228, 1/4 interest Total Rev-1502 EXt (6-981 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J-iiB CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS continued ESTATE OF FILE NUMBER Hess, Dorothy R. 21-08-0228 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J-116 (Rev. 6-98) INVENTORY REGISTER OF WILLS OF CUMBERLAND COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } Larry V. Hutton Personal Representatives} of the Estate of Dorothy R. Hess COUNTY, PENNSYLVANIA File Number 08-0228 deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate In the Commonwealth of Pennsylvania of satd Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appea in a memorand~ at the end of this inventory. I verify that the statements made in this Inven- ~ ~~~y~.G2~ tory are true and correct. I understand that false state- r.-? ments herein are made subject to the penalties of ~ Larry V. tton _, f 1 ti - `-- 18 Pa.C.S. § 4904 relating to unsworn falsification to ~~ _ .._ , authonUes. - __ ;~~ ---- -~ Attorney -- (Name) David J. Lenox {Supreme Court ~.fS:_.No.) -9078 (Firm) The Wiley Group, PC ~"-` ~ (Address) 130 W. Church Street, Dillsburg, PA 17019 ~ (Telephone) 717-432-9666 DATE OF DEATH LAST RESIDENCE g01 N. Hanover Street DECEDENT'S SOG SEC. NO. 02/18/2008 Carlisle, PA 17013 172-01-3622 Personal Prouert FIGURES MUST BE TOTALED Cash ............................................................................................... Personal Property ......................................................................... Stoc kslListed ................................................................................. Stocks/Closely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... Total Real Property ........................................... Total Personal and Real Property ......................... 976Q3.12 48,628.89 13,710.23 35,264.00 97,603.12 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b)) Form RW-09 Rev. to-t3-zoos L , REGISTER OF WILLS OF INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } SS File Number 08-0228 DATE OF DEATH LAST RESIDENCE g01 N. Hanover Street DECEDENT'S SOG. SEC. NO. 02/18/2008 Carlisle, PA 17013 172-01-3622 Cash Citizens Bank Checking 6100702375 Citizens Bank Checking 6205363759 Total Cash Personal Property Refund Church of God Nursing Home Refund Long Term Care Insurance Security Deposit Refund Church of God Nursing Home Total Personal Property Stock /Listed DWS Scudder High Inc. Fund A Oppenheimer Strategic Inc. Fund Class A Total Stock /Listed 8,494.55 40,134.34 48,628.89 4,905.96 2,294.27 6,510.00 13,710.23 21,126.13 14,137.87 35,264.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate 97,603.12 )an M. Wiley David ). Lenox THE WILEY GROUP Attorneys at Law August 12, 2008 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 In Re: Estate of Dorothy R. Hess, deceased File Number 21-08-00228 Dear Register: Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of $1,726.40 representing the tax due, and a check in the amount of $30.00 representing the filing fee. Please return the recording receipts to my attention in the enclased envelope. Thank you for your cooperation. Sincerely, ~~.:, Dawn Gla felter/Leg Assistant ~~°' __ -, c.-~ !dg encl. - - ~ --, `~ .~ _'~~ W G 130 W. Church Street, Suite 101 Dillsburg, PA 17019 Phone: (717) 432-9666 (1300) 682-4250 Fax: (717) 432-0426 0 tS N tW7 r «+° N ~a~. r ~ ,a j"~s ~ ~ Q G M 0 I`- m ~ ? o M W 0 O 1 ~ ~ O ~ N ~ 0. C7 ~s_ E°~ ~ F ~_, ` , . t ~~ ~ ~ . ~- ~. ~. i~ V ~^ +.I ~ ~ ~~ r rJ ~ ~ O ,d 3 ~, ~, a ° N U :~~~ ~, ;,) O 0 a .~~ ~o ~~ .~ y ~^" ~ °7 a ~~ ~ ~ °~ v ~ a o s ~6 v o W ° M r