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Home My WebLink About09-25-08 (2)' '~ 15856041147 REV-1500 EX (Ub-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0801 ~° RESIDENT DECEDENT 2 1 0 8 0 5 8 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 181 14 6964 05 23 2008 04 04 1921 Decedent's Last Name Suffix Decedent's First Name MI HAWLEY MARY E (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 4. Limited Estate ~`~ 4a. Future Interest Compromise (date of death after 12-12-82) X I g Decedent Died Testate ~~ ~ Decedent Maintained a Living Trust (Attach Copy of Will) IJ. (Attach Copy of Trust) ~~ 3. Remainder Return (date of death prior to 12-13-82) _~ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death -, 11. Election to tax under Sec. 91 t 3(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 JERRY A. WEIGLE ESQUIRE 717 532 738$..,, c~ Firm Name (If Applicable) WEIGLE & ASSOCIATES, P.C. First line of address 126 EAST KING STREET Second line of address City or Post Office SHIPPENSBURG Correspondent's a-mail address: State ZIP Code PA 17257 REGISTER O~~LLS US~NLY% I -, ~_ ~~ '; .~ t`J Cfl ~, ~- -,a ~- i __-~ h.) C-r7 DATE FILED ""~ 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. ADDR~E6S 126 ast King Street, Shippens g, PA 17257 Side 1 15056041147 15056041147 810 Mickey Inn Lane, Chambers urg, 17201 SIGNAT E F PREPARER 0 THAN PRES T T E DATE ~~ ~ Jerry A. Weigle Esquire °J --- 2y *- d~ .~ 15056042148 REV-1500 EX ~eoeaenrsName Mary E. Hawley 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 & 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) .............................___..........................._..... . 8. 9. Funeral Expenses & Administrative Costs (Schedule H) .................................... .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .... 10. 11. Totat 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, or transfers under Sec. 9116 0 0 0 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 3 2 9, 1 9 5 0 5 1s at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18 at collateral rate X .15 . 19. Tax Due ................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 181 14 6964 207,125.00 7,415.00 85,032.61 78,651.74 378,224.35 45,149.37 3,879.93 49,029.30 329,195.05 329,195.05 0.00 14,813.78 0.00 0.00 14,813.78 Side 2 ~, 15256242148 15056042148 J REV-1500 EX Page 3 File Number 21-0$-0583 Decedent's Complete Address: DECEDENT'S NAME Mary E. Hawley STREET ADDRESS 330 East Fort Street CITY Shippensburg STATE ,ZIP PA ! 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit g, Prior Payments C. Discount 14,000.00 736.84 (1) 14,813.78 - -- --- TotalCredits(A +B+C) (2) 14,736.84 3. Interest/Penalty if applicable - ---- p. Interest E. Penalty _ Total Interest/Penalty (D + E) (3) A. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theDVERPAYMENT (4) 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 theTAX DUE (5) 76.94 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B) 7 6 , 94 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 :............................................................................. 1, ~~ x~ b. retain the right to designate who shall use the property transferred or its income :................................ ~~ _'~ ~ x --- ~-, c. retain a reversionary interest; or ..............................__............................__............................_................. j _j J d. receive the promise for life of either payments, benefits or care? ........................................................... ~ ' -' ~x~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................ I _ I ' x ___. 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 beneficiary designation? .........................................................................................._..................... x 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 statutedoes not exempta 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. Rev-1502 EX+ (6-98) }~. SCHEDULE A ~` REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Hawley, Mary E. 21-08-0583 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 jointly-owned with right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleA (Rev. 6-98) Rev-1503 EX+ (6-98) ~~. SCHEDULE B ~`~ ~~ STOCKS & BONDS :~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hawley, Mary E. 21-08-0583 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 100 shares of Prudential 74.15 7,415.00 TOTAL (Also enter on Line 2, Recapitulation) 7,415.00 (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 B (Rev. 6-98) Rew1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Hawley, Mary E. 21-08-0583 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 DEATii 1 AAA Southern Pennsylvania -refund at cancellation 48.67 2 Cash on hand at date of death - including M 8~ T Certificate of Deposit 3916125890 1,318.35 5-22-08 interest check - $30.29; Primrose rent for May, check dated 5-15-08 - $275.00; Thomas rent for May - $550.00; Thomas rent for April ($600.00 less $136.94 used for household supplies, groceries, medicines following release from hospital) - $463.06 3 Check on hand at date of death - M ~ T Certificate of Deposit 31003916215890 42.29 1-22-08 interest 4 Comcast Cable -refund at cancellation 50.27 5 Highmark -prescription drug plan premium refund 35.09 6 Highmark -subscriber premium refund 365.73 7 Penn Fuel Propane -refund 86.88 8 U. S. Treasury - 2008 economic stimulus payment 584.00 9 M & T Bank Certificate of Deposit 13321350 30,300.00 Accrued interest on item 9 through date of death 45.86 10 M & T Bank Certificate of Deposit 16125890 10,000.00 Accrued interest on Item 10 through date of death 5.04 11 M & T Bank Checking Account 97280127 11,169.90 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 85,032.61 (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) Rev-1508 EX+ (6-98) • ~. SCHEDULE E . ~' CASH, BANK DEPOSITS, & MISC. ~e PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN co ntl n ue RESIDENT DECEDENT ESTATE OF FILE NUMBER Hawley, Mary E. 21-08-0583 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH Accrued interest on Item 11 through date of death 0.26 12 M 8 T Bank Savings Account 214182161 11,284.44 Accrued interest on Item 12 through date of death 4.33 13 1995 Ford Ranger Truck 3,415.00 14 Personal Property -gross proceeds of public sale 08/16/2008 14,012.50 15 Personal Property at appraised values 2,164.00 16 White Gold 14 Karat Diamond Ring 100.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 85,032.61 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+(6-98) ~~. SCHEDULE G ,~ , '` ~ INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Hawley, Mary E. ~ 21-08-0583 This schedule must 6e completed and filed if tfie answer 1o any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTI N F PR PERTY 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 Western ~ Southern Life Annuity Contract 47,157.10 47,157.10 20138509 -beneficiaries children of deceased 2 Western 8~ Southern Life Annuity Contract 31,494.64 31,494.64 21456296 -beneficiaries children of deceased TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 78,651.74 Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (12-991 ` tl`~K~y COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hawley, Mary E. _ _ 21-08-0583 Debts of decedent must be reported on Schedule f. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Sarah E. Lake Social Security Number(s) ! EIN Number of Personal Representative(s): Street Address 810 Mickey Inn Lane city Chambersburg state PA zip 17201 Year(s) Commission paid 2008 - 2. Attorney's Fees Weigle ~ Associates, P.C. 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 9,923.77 14,347.00 15,097.00 4. Probate Fees Register of Wills, Cumberland County 464.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 5,317.60 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 45,149.37 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+(6-98) ~. SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Hawley, Mary E. 21-08-0583 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rew1502 EX+ (6-98) . ,~ ~tl COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUMBER Hawley, Mary E. 21-08-0583 ITEM NUMBER DESCRIPTION AMOUNT 1 Antonio Soerriero -labor at public sale 135.00 2 Auctioneer Expenses of Public Sale 3.700.35 3 Ben Thomas, Sr. - labor at public sale 240.00 4 Ben Thomas, Sr. -cleaning 300.00 5 Charles Powell - labor at public sale 135.00 6 Cumberland Law Journal -advertising Letters Testamentary 75.00 7 Linda K. Klein -notary fee 24.00 8 Ludwig Jewelers -appraisal fee 45.00 9 News Chronicle -advertising Letters Testamentary 96.50 10 Reese's Plumbing 71.75 11 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00 12 Register of Wills, Cumberland County -filing Family Settlement Agreement 100.00 13 Sailhamer Real Estate -market analysis 100.00 14 Weigle 8~ Associates, P.C. -reimbursement for postage, xerox copies, and long 30.00 distance telephone calls 15 Wolfe 8~ Shearer Realtors -appraisal fee 250.00 Subtotal I 5,317.60 Copyright (c) 2062 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+(6-98) • ~. SCHEDULE 1 i' ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hawley, Mary E. 21-08-0583 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bethany Palmatier -tenant's security deposit refund 425.00 2 Borough of Shippensburg 471.46 3 Carol A. Carmack, Tax Collector - 07/01/2008 school real estate taxes 2,200.28 4 Embarq 3.63 5 Embarq 1.74 6 M 8~ T Bank Checking Account 97280127 -checks clearing after date of death 545.88 7 Penelec 35.65 8 Penelec 28.46 9 Penelec 23.80 10 Special Event Emergency Medical Services, Inc. 144.03 TOTAL (Also enter on Line 10, Recapitulation) I 3,879.93 (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-1519 EX+ (9-00) ~ °'~ SCHEDULE J COM N~HERITANTCE~AXRETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF I FILE NUMBER Hawley, Mary E. 21-08-0583 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) (Words) ($$$) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116{a){1.2)J 1 Janice H. Donley Daughter One-fifth 65,839.01 402 Petersburg Road Carlisle, PA 17013 2 Henry M. Hawley Son One-fifth 65,839.01 7970 Lincoln Way East Fayetteville, PA 17222 3 Walter M. Hawley Son One-fifth 65,839.01 2325 Fairmont Avenue Reading, PA 19605 4 Elizabeth A. Howland Daughter One-fifth 65,839.01 312 Walnut Street Shippensburg, PA 17257 5 Sarah E. Lake Daughter One-fifth 65,839.01 810 Mickey Inn Lane Chambersburg, PA 17201 Total 329,195.05 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) LAST tiVILL AND TESTAMENT I, Mary E. Hawley, presently residing at 330 East Fort Street, Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. 1 order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved children, namely, Walter M. Hawley, Henry M. Hawley, Janice H. Donley, Elizabeth Ann Howland, Sarah E. Lake, in equal shares, on a per stirpes distribution basis. THIRD. In the event that any beneficiary of this my Last Will and Testament is under the age of twenty-one (21) years, I then give and bequeath said beneficiary's share to and appoint as Trustee of any property which passes under this Will or otherwise, M&T Bank, of Shippensburg, Pennsylvania, AS TRUSTEE, NEVERTHELESS, to invest and re-invest the same until the said beneficiary reaches the age of 21 years, with the following powers in addition to those presently given by law: A. The power and obligation to expend the income towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; B. The power and obligation to expend the principal, within the discretion of the said Trustee, if the income is insufficient, towards the health, support and maintenance, and education, including a college (both undergraduate and graduate), trade, business or technical school education, of the said beneficiary; C. The power to sell any and all real estate, within the discretion of the said Trustee; `~ ~` r ~ ~ SEAL J~. WEIGLE Sc ASSOCIATES, P.G. - ATTORNEYS AT LAW - 1Z6 EAST KING STREET - SHIPPENSBURG, PA 17257-7397 D. The power and obligation to distribute the balance of principal and interest, if any remaining, when the said beneficiary reaches the age of 21 years, without the necessity of a formal adjudication of the Trustee's Account in the Court of Common Pleas of Cumberland County, upon the receipt of a good and valid release; and E. The principal of the Trust and the income therefrom shall be free from the debts, liabilities, and engagements of those beneficially interested therein, and shall not be subject to assignment by him or her, nor to attachment or execution under any legal, equitable or other process for the enforcement of judgments or claims of any sort against them, either individually or collectively. FOURTH. I nominate, constitute and appoint my daughter, Sarah E. Lake, presently residing at 810 Mickeys Inn Lane, Chambersburg, Pennsylvania 17201, to be the Executrix of this my Last Will and Testament. In the event that she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint my son, Henry M. Hawley, presently residing at 7970 Lincoln Way East, Fayetteville, Pennsylvania 17222, to be the Executor of this my Last Will and Testament. FIFTH. I direct that my personal representative(s) shall not be required to give bond for the faithful performance of their duties in any jurisdiction. SIXTH. I direct my Executor to retain the services of Jerry A. Weigle, Esquire, with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. IN WITNESS WHEREOF, I, Mary E. Hawley, have hereunto set my hand and seal to this my Last Will and Testament= written on two (2) pages, the first page signed for identification only, this:,~~- G,,.~ day of _~~~~;, ~ , ,, , 2004. ~ ~ ~~ ~'~~L `~ f'lu:~_-~,~1,, (SERI.) ~- WEIGLE Ec ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBU RG, PA 17257-1397 This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, Mary E. Hawley, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. 1J "1~ 'y~', ~ ~Y ll. br'f' ~ ~~ - L' Sworn or affirmed to and acknowledged before me by Mary E. Haw , t Tes trix, thisr day of '~_, 2004; ~ N07A~IAI.. SLAL ' !: Jerry A. We~~::!a ^!~~tay Public i Shippensburu. "=, C;.`~r~rland County 3' Av Commission L.~E;~as i:lctober 7, ?_OU6 i WEIGLE tx ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAS"f KING STREET - SHIPPENSBURG, PA 17257-1397 ~~ ~ ~~ COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND and ~ /N D A k' _ ~L ~iriJ ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Mary E. Hawley, the Testatrix, sign and execute the instrument as her Last Will; that she 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; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me Y , / , and _ L_ iN ~ r~ ~ ~ ~L ~ ~nl vjt~iesses, this ~~ day of , 2004. - ~"-- , ~!OT ~i!,^.,i_ L,~~L , Jerry A. w1(r^iclr, '.~",±ary Public Shippens~urg, r-' (,.,':~bc;rland County ~! My Cornrrsissicm c_x.pirr~s i~ctober 7, 2CCfi WElGLF_ 6c ASSOCIATES, PC. - ATTORNEYS AT L.AW - 126 EAST KING STREET - SHIPPENSBU RG, PA 17?57-1397 Ray "Buz" Wolfe, CRS Broker/Partner WOLFE SHEAf~E ~ f~EALTOf~S 33 South Pitt Street ® Carlisle, PA 17013 717.243.1551 800.377.3027 fax 717.243.0472 www.wolfeshearer.com William L. Shearer, Jr., CCIM, CRS Broker/Partner RESIDENTIAL COMMERCIAL APPRAISALS INDUSTRIAL CONSULTING INVESTMENTS July 1 U, 2008 IV1r. Jerry A. Weigle Attorney at Law Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 Subject: Dear 11~1r. Weigle: In cot~~pliance with ya>ar request, I/we have personally inspected the above captioned property to estimate its present market value for estate purposes. The value shown has been arrived at after careful study of the location and type of improvements, their present physical condition and their present use. Therefore, I believe it to reflect a true measure of the present-day market value "AS OF" dune 11, 2008 TWO HUl`~T~RED TdVE~T~' FT_V~'. THCj~[?~.arI?? n~?f,x_.~RC I~?~5,~nn, The appraisal in narrative form is available upon request. I hereby certify that I have no financial interest, present or contemplated, in this property, and that neither the employment to make the appraisal nor the compensation therefrom is centingert upon the value reported. Sincerely yours, ~.~ ~~'~ WILLIAM A.~BASSETI' PA CertifiFd General Real Estate Appr~.iser GA-001618-L Estate of Elizabeth M. Hawley Five unit apartment building. 330 and 332 East Fort Sheet Parcel 32-33- i 867-018 and 018.002 Shippensburg, PA 17257 Sailhamer Real Estate, Inc. 494 E. King St. Shippensburg, Pa 17257 Office (7171532-60591Fax (717530-5181 www.sailhamer.com /info a~sailhamer.com July 25, 2008 Sarah Lake 810 Mickey Inn Lane Chambersburg, PA 17201 Dear Mrs. Lake; This analysis has not been performed in accordance with the uniform standards of professional practice which requires valuers to act as unbiased, disinterested third parties with impartiality, objectivity and independence and without accommodation of personal interest; it is not to be construed as an appraisal and may not be used as such for any purpose. In response to your request for a comparable market analysis of real estate situated in the Borough of Shippensburg, Pa., Cumberland County and known as 330, 332 and 328 East Fort Street, Shippensburg, Pa., I am sending you're my estimation of current market value. The real estate has been improved with the following. The dwelling known as 330 East Fort Street containing the following on the first floor, kitchen, dining room, living room, enclosed heat front porch, bedroom and bath with shower. The second floor offers four bedroom and full bath with attic above. There is a partial basement the heating system is a coal furnace converted to an oil fired hot water boiler and the electric service has been updated to a 100 amp breaker box. A multi-family attached structure known as 332 East Fort Street contains four separate apartments units. Units 332D (ls` floor) and 332C (2"d floor) each containing a kitchen, living room, two bedrooms, and full bath. Unit 332A (2"d floor) and 332B (ls` floor) each contains a living room, one bedroom, kitchen and bath. Heat is supplied from the heating system at 330 East Fort Street and the requester has indicated that there is no basement under the 332 unit and two of the units are rented on a month to month basis with landlord paying water, sewer, trash and heat. In addition to the dwellings there is a two bay garage with workshop, located on the property. There is also a frame workshop known as 328 located to the rear of the property. The surrounding neighborhood consists of single family rentals, student rentals and a few single family residences. Based upon my personal investigations and findings, it is my opinion that the current market value would indicate a value range of between One-Hundred and Sixty-Eight Thousand Five Hundred ($168,500) to Two-Hundred and Ten Thousand Dollars ($210,000). Sincerely; G/~J"~~~rs~ /ll osr -__ Ron Sailhamer Real Estate Broker ~G~~ J~d~ ~~p `f~G~o ~ ~J~O~ Ass- ~~~j,ZSG Prudential D00043 IMPORTANT TAX RETURN DOCUMENT ENCLOSED MARY E HAWLEY 330 FORT ST SHIPPENSBURG PA 17257-1408 I,,,III,,, I„I, I, I, I, I,,, I,,, I I, I„I I I,,, I„I,,, I I, I I,,,, r I, I I ~`~"` C-o~~ ~omputershare ~' ~. , i ~1/~. !//I`~ - Z 3- c~ 7 S Z3 73,x7 ~~ ~ 5- ~ ~: ! .~ ____--- 001(:5(1093.DOMEQSRLU EBQCIS.G31 ?_53x/000lW3/00(xW3/i Prudential Financial, Inc. -Sale Advice 12008 Tax Form 1099-B Corrected (ifchecked) Copy B -.;For Recipient Account Number DooD3o1s21 Form 1099-6 -Proceeds from Broker and BartecExchange Transactions ' 200$ Recipient's t~ no. 1811as964 Payer's Federal ID No. 431912740 This is krlportar,ftax iufomratlon and is being famished to the Internal Revenue Service. N you are required m file a return, a negligence OMB No. 1545.077 5 penalty or other sanc~lon maybe imposed on you N this income k taxable and the IRS detemlines lhatlt has not been reported, Departrnent otthe Treasury - IrAemal Revenue Service MARY E HAWLEY Recipient 330 FORT ST SHIPPENSBURG PA 17257-1408 to Date of Sale tl, z Stocks, Gross Proceeds Pa er's Details or Exchange CUSIP No. Bonds, etc. j$) Reported to IRS) Y 05 Jun 2008.:. 744320102 ,7,452.31 Yes COMPUTERSHARE SHAREHOLDER SERVICES INC P.O. BOX 43010 FEDERAL INCOME ~ Descripfion: Name of Issuer Transaction PROVIDENCE RI TAX WITHHELD (S) 02940-3010 0.00 PRUDENTIAL FINANCIAL 1NC Sale - CDt , ~ NOTE: Computershare will report the amount in Box 2 to the IRS. The difference between ttiegross proceeds amount m Box 2 and the net proceeds you received represents any fees, .charges, or withholding fixes you: may have. paid. v~ ~ ~ ~ ~ v~~-o ttceep for your records) Summary Class Description: COMMON STOCK Trade ShareslUnits Price Per Gross Amount Deduction Deduction Net Amount Date,Time Transaction Description Sold Share/Unit ($) I of Sales ($) I Amount ($) Type of Sale ($) D6/05/200814:06 Sale 100.000000 74.523112 7,452.31 19.00 Transaction Fee 7,433.31 Computershare Trust Company, N.A., as agent, upon written request, will provide the name of the executing broker dealer associated with the transaction(s), and within a reasonable amount of time will disclose the source and amount of compensation received from third parties in connection with the transaction(s), if any. ^ 71 UTX PRU '~' ^O~CD70008 OOHX2EUNITS JUN - 7 2048 p n~s~ June 5, 2008 Weigle 8s Associates, P.C. Attorneys at Law 126 East King Street Shippensburg, PA 17257-1397 499 Mitchell Street, Millsboro, DE 19966 RE: Estate of Mary Hawley Date of Death: May 23, 2008 Social Security Number: 181-14-6964 Dear Mr. Weigle: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type ........................... Certificate of Deposit Account Number ....................... 3 10039 1332 1350 Ownership (Names o, fl .............. Mary Hawley Opening Date ...........................07/ 12/ 04 Balance on Date of Death.........$30,300.00 Accnced Interest $ 45.86 Total ....................................... $30, 34 5.86 2. Account Type ........................... Certificate of Deposit Account Number ....................... 31003916125890 Ownership (Names off .............. Mary Hawley Opening Date ...........................01 / 22 / 07 Balance on Date of Death ......... $10, 000.00 Accrued Interest $ 5.04 Total ....................................... $10, 005.04 • Page 2 3. Account Type ........................... Checking Account Account Number ....................... 97280127 Ownership (Names off .............. Mary Hawley Opening Date ...........................01/28/80 (account closed 05/29/08) Balance on Date of Death ......... $11,169.90 Accrued Interest $ 0.26 Total .......................................$11,170.16 4. Account Type ........................... Savings Account Account Number ....................... 15004214182161 Ownership (Names off .............. Mary Hawley Opening Date ...........................01 / 12 / 07 (account closed 05 / 29 / 08) Balance on Date of Death.........$11,284.44 Accnced Interest $ 4.33 Total .......................................$11,288.77 The above named decedent did not have a safe deposit box. June 5, 2008 * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our King Street branch at 35-39 East King Street, Shippensburg, PA 17257 or # 717- 532-4132. Sincerely, ~ ~, / //' Charlene Warrington, Reco " s Management 1-888-502-4349 ~~,~ ~ ~ «.~_- - -v - ------a ---r - -~ ------o-- -- _... _-- ~~~ ~~ ~ ~F ~~ TFiETRU57EQ RE4C?€JRtE kbt~.caaa a d'J8r*,i52men pp / c~ hhQryry.~yS Fpzyt~~y~(TT r~taj any ~/~{ ' y,S'c~ ~¢e.r C'a.~ D~E L~Ul2~,.~ C~Ilf~1~ fFtRFT 1A~U~ ~i?E1C~i~lOEl `t'~~tl@ K ,~ °-~~ ~'` Excellent $3,?~~ ~ ~ (Selected) G®oc~ ~3,~ f 5 average Consumer Rating (2Q9 Review.~s) Read Reviews _ ., 4.4 out of 5 Reuiew This Vehicle Vehicle liiglttights Mileage: 40,OOD Engine: V6 3.0 Liter Transmission: Automatic Drivetrain: 4W D SeEected EQuipmerst Standard XL Power Steering AM/FM Stereo Optional Air Conditioning Cassette Pickup Shell/Cap ": Send to Frinter :, - F : ~ ~; Y.' } .~ .~ :~} '.;.- 1~ ; ~ ~1 -a ~tr~~ ~oQ~ Pr~~t.e FQI't~,, t€a&~€e ---- _ -- - ---- Private Party Value is what a buyer can expect to pay when buying a used car from a Close 4Nindow private party. The Private Party Value assumes the vehicle is sold "PS Is" and carries no warranty (other than the continuing factory warranty). The final sale price may vary dependinc on the ~.~ehide's actual rendition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. E!'E';iee Ccrc;it€:n Rattr;~s 5`~ http: //u~~~. kbb. com/hBB/UsedCars/PricingReport. aspx?YearI d=1995 &Mileage=40000& ... 6/4/2008 ----- advertisement ---- • Date ,~~. ~. OWNED ~ , ~ ,,y - ;.. _ ~ ~ ,, { Address ? •' ~ ~ '-p r ~ ~ ~ . ~ a ; ~~. ~ ~ (, r `~! Date of Sale_ ~`' ~ -' '- `~'`~ Sale Location ~~ j , r .,.4 !;~ .~ Auctioneer ~ r, '~~ ~"~ ~" Clerk ~`" Cashier ~''~ ~' ~~`':~~ •` ' : f Other PROCEEDS OF SALE: Cash.------------------------•--•----•__-- -- $ ~~> ~ ~ ° 'ca. •- Checks------------------•--__...---------------- Miscellaneous (see attached list) TOTAL PROCEtDS OF SALE--------------.-_---.-__--_-$ ~ ~ ~ ~ ~ ~ ~a LESS SELLER'S SALF EXPENSE: 11 ~ ~ .. Auctioneer's Fee .._________________ (w`~--' ,1~~ $ ° '~ ~ ~ + ~`- ------------------ -----r-------- Other Seller's Expenses Advanced by Auctioneer: ^,,, ~ L Miscellaneous (see a#fached list) _~___._~._._____..._ ~t~, ~'~" ,, ,1j ~ J . 47 ;,~i. cr• u~~ // 1 ~ . as DEDUCT TOTAL SELLJ=R'S SALE EXPENSE._._.___3 ~ w G'`' ° `5 5 ,~'~ f~ TOTAL NE3' PROCEEflS TO S13LElz__.____.$ 1, (or we), the salter of goods, merchandise, and/or property sold at public auction on above date and location, acknowledge and accept this settlement of proceeds of sale. ! (or we) agree to accept all nr- sponsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for delivery of title to the purchaser. ~ (Date) "-<, (Seller's Signature) ~; ti~ Auctioneer or Cashier's Signature (Seller's Signature) FINAL SETTLEMENT-Form tJo. FS-69. 32.00 per pad, 10 pads ai Si.50 each, 20 or more at 57.25 eacn. Reorder from: MISSOURI 4UCT10N SCHOOL ^ t600 Genessee ^ Kansas City, MO 64702 ^ Phone 876-a27-7777 (717) 2~4-65?8 Personal Property Appraisal for Man' E. Hav~~tey Estate E. tort St 5hippensburg, PA 17257 ~ GREEN FLORAL DINNER PLATES, 4 SIiERBF..T PLATES, 4 CUPS!S.AI/CERS. 3 4" BOt~'LS ................................._........................--•--------•--..............................120.00 4 GREEN 131.OCK JUICES, 4 GREEN SHERBF_'rS ................................................................ ..............~E).a0 2 E-L.ORAL DT?vhER, 2 SHERBET PLA'1"E,S, 2 CiiPS'S.4LtCEKS, 2 BOVb'LS ....................... ..............64.00 2 F3LOCK St1L;RB1=T5. 2 BLOCK "1'TJMBLERS ...................................................................... i PI AT~1-ER .............25.af.,~ ~, , , FLOR~IL LC3T. PR SALT c~ PEPPF;RS, ? CRE.Ah+iERS. 2 SUG:IRS I LID, 2 O~'Al, `~' FCiF f:AT3LES. + CL'P. 4 SAUCERS, 3 CHTPPF,I), ~ S'r€TttBET PLATES. DI~'IDrT) L)(SH CHTPPED ...........................................•----.............................•-........................ .......- -..120.00 8 CHF.RR4' DINNER PLATES ONE CHIPPED,. CAKE. PT,A rE Cl-ITP ................................. ............ 125.00 SE:1 SHELLS O" SIIELF ........................................................................................................ ..............1a.00 RFSVI'IC'K BIRF7S ................................................................................................................. ..............15.00 I'`S'AI.1D FE''iTJER ........................................................_......................................................... ................S.E3a CERA!v1IC. C3TR1S"T-~vSAS TRL'E ............................................................................................... ..............10.00 CCIi~'IPOSITIC)N BABI' DOLL ................................................................................................. ..............15.aa T1N PU'~~CI3 PIE SAFE ............................................................................................................. ............200.0;} 2 PORCH KOCKi~;KS ................................................................................................................ ..............60.x0 ...................................... c)LD ItC)Ct~1=.R ................................................................................... . ..............lo.oa PLANT STAND 1-t.AND ?v1:4DE .............................................................................................. ..............2a.E)0 RT:E'RIGERA'T-dR CAIZ r .......................................................................................................... ..............2.00 coNCRETF•, BEAR .........................•------•---............................................................................... ..............2a-aa I3O0K SHELF OPI=,N T4~`C3 D<)C)R ......................................................................................... ..............20.00 2 I}dOR 0:4F: BC)di;.CASI=, ..................._....................................................-..._._........_........ ........_..4;0.00 IP?'!-S T:~,LL. CE-IE:Si ~kITI? JR.-Ii>"~:~:5 ........................................_..............................,..,..,. ..............6~.tXt d:~K LEBR,4RY "rABLE ........................................................................................................... ..............75.OEi PINE 2 PC WARDROBE ..................................................................._..................................... ............250.aa W.1'rIK FALL CEDAR CHEST ...........................................................•--................................ ..............5a.O0 ~gay,oo I. DO HEREBY C>/R"I'fFY that [ ;lave e~.a.-nined the tangible perso,~a! nropert~' o{' "~lar<~ E. Ha~~:le~ rs~.te, E. Fort St, Ship~sens~ur~, PA 17257 ,1n~ ,fin ~'~314E 21t'; at3h"'i,.t~:; ?47 C'. ~F:T~ 8* ~,1,T~n'.x".? ~ T''~.~2 {~F.;C €4tL'T:Ct 'v ai;;~ :~f said Pr~perf~ on ,~~i~ dare c:C .Isf~ 13. 2~)C3R r, ii f t ~j t _ ~, .1' 1~.~ 1 CARL E. OCKER AUCTIONEER 4401 Philadelphia Avenue Chambersburg, PA 17201 (717) 264-6578 Personal Property Appraisal for Mary Elizabeth Hawley Estate 330 E Fort St Shippensburg PA 17257 FURNITURE MADE BY MR. AAWLEY .............................................................. MODERN OAK DRY SINK ........................ ~'°`:-~'~~ 40.00 .......... WALL SHELF .....................................................................................-~.a~`.~:. 20.00 TOY BOX..:. ~ `` c ~;~. t='~ `' ` l., -=~'.,-c' '^ 20.00 .... KITCHEN ISLAND ............................................................................ J ::.'^, ~` ........25.00 DRY SINK .............................................................................................tN a ~ .' :'.' `x.......40.00 ................... c:~' ~ e 75.00 . .................. GLASS DOOR CORNER CUPBOARD ............................ "~. OPEN TOP HUTCH .............................................................................SS: ~:~.: ~e 40 00 ................. GERMAN 390 BISQUE HEAD DOLL ............... ..............`-~: ~ !:`..............75.00 SIMON AND HALBIG DEP GERMAN BISQUE HEAD DOLL ..........................100.00 To be- sold at TOTAL ..................................................................................................................$435.00 33S,~o I, DO HEREBY CERTIFY that I have examined the tangible personal property of Mary Elizabeth Hawley Estate, 330 E Fort St, Shippensburg PA 17257 And do value and appraise the same at $435.00 as being fair market Value of said property on this date of June 3, 2008 Date ~ 3 ~ ~ Carl E. Ocker Appraiser UD~~IIG JEWELERS S 1 N C E 1 6 7 7 Phone (717)264-7693 121 South Main Street Member, American Gem Society Ann Ludwig Wagner, Registered Jeweler Jane Ludwig Mentzer Chambersburg, PA 17201 FAIR MARKET VALUE APPRAISAL The fair market value is an estimation of a price arrived at willingly by a buyer and a seller and not under duress. Because jewelry appraisal and evaluation is not a pure science and is therefore subjective, estimations of fair market value may vary from one appraiser to another and such a variance does not necessarily constitute error on the part of the appraiser. Mountings prohibit the full and accurate observation and grading of Diamonds. Therefore only a provisional grade will be given. The weights are estimations determined by formula based on available dimensions. If a Diamond is regraded or weighed unmounted the grades or weights may vary. ESTATE OF MARY E. HAWLEY June 17, 2008 1. One lady's 14 karat white gold Diamond ring contains: 1- .26ct. Brilliant-cut Diamond Dia.- 4.1- 4.2mm. Depth- 2.45mm. Cutting- fair Color- 3 Provisional GIA Clarity- I 1 " 2- .02ct. Single-cut Diamonds The major Diamond is set in a square illusion head with the single-cut Diamonds set in the shoulders of the shank. The mounting is very worn. ESTIMATED FAIR MARKET VALUE- $100.00 ~, i~ ~~ Western & Southern Life R member of Western & Southern Financial Group® Date: 06/11 /2008 WEIGLE & ASSOCIATES 126 EAST KING ST SHIPPENSBURG, PA 17257 ATTN:JERRY WEIGLE Re: Contract Number W0020138509 Dear Mr. Weigle: Please accept our condolences on the death of Mary E. Hawley. We are here to serve you during this difficult time. Please be advised that the value of the above mentioned annuity contract as on May 23, 2008 was $47,157.10. As a designated beneficiary, Walter Hawley, Janice Donely, Elizabeth Howland, Sarah Lake and Henry Hawley are entitled to receive payment on the Western-Southern Life annuity referenced above. Payment of benefits under the contract is the obligation of, and is guaranteed by, Western-Southern Life Assurance Company, Cincinnati, Ohio. The following settlement options are available to each of the beneficiaries: • Lump sum. You can receive your settlement in one installment. Any earnings on this contract may be subject to tax. Western-Southern Life encourages you to seek tax or legal advice before selecting this option. If you choose this option, a check for the entire amount, including any interest, will be mailed directly to you. Income payments. You can receive a stream of guaranteed income payments. If you choose this option, a variety of options are available. Some guarantee you an income for as long as you live, others spread your distribution out over the number of years that you choose. You must select this option within 1 year of the annuitant's death. Payments from qualified annuity contracts will be taxable when you begin receiving payments. Additional information will be provided if you select this option. • Defer five years. You can defer your settlement selection for up to five years. The contract value will continue to grow tax-deferred until you select a settlement option. Once selected, this option cannot be changed. The enclosed claim forms are for their use in selecting settlement options. Please return their completed form, along with a certified death certificate, using the postage-paid envelope provided. Our goal is to serve their needs and we will implement their selection as quickly as possible. Member Western & Southern Financial Group® Annuity Operations Group • PO Box 2918 • Cincinnati, Ohio • 45201-2918 Phone (800) 926-1702 • Fax (513) 629-1799 --- ~ ~. ~ Western & Southern Life A member of Western & Southern Financial Group° Date: 06/11/2008 WEIGLE & ASSOCIATES 126 EAST KING ST SHIPPENSBURG, PA 17257 ATTN: JERRY WEIGLE Re: Contract Number W0021456296 Dear Mr. Weigle: Please accept our condolences on the death of Mary Hawley. We are here to serve you during this difficult time. Please be advised that the value of this annuity contract as of May 23, 2008 was $31,494.64. As a designated beneficiary, Sarah Lake and Janice Donley are entitled to receive payment on the Western-Southern Life annuity referenced above. Payment of benefits under the contract is the obligation of, and is guaranteed by, Western-Southern Life Assurance Company, Cincinnati, Ohio. The following settlement options are available to each of the beneificiaries: • Lump sum. You can receive your settlement in one installment. Any earnings on this contract may be subject to tax. Western-Southern Life encourages you to seek tax or legal advice before selecting this option. If you choose this option, Western-Southern Life will automatically establish a Premier Account in your name. This interest-bearing account provides you immediate, convenient access to your proceeds. See the enclosed brochure for full details. Please sign the enclosed Account Authorization form and return it with the claim form. Income payments. You can receive a stream of guaranteed income payments. If you choose this option, a variety of options are available. Some guarantee you an income for as long as you live, others spread your distribution out over the number of years that you choose. You must select this option within 1 year of the annuitant's death. Payments from qualified annuity contracts will be taxable when you begin receiving payments. Additional information will be provided if you select this option. • Defer five years. You can defer your settlement selection for up to five years. The contract value will continue to grow tax-deferred until you select a settlement option. Once selected, this option cannot be changed. The enclosed claim forms are for their use in selecting settlement options. Please return their completed form, along with a certified death certificate, using the postage-paid envelope provided. Our goal is to serve their needs and we will implement their selection as quickly as possible. Member Western & Southern Financial Group® Annuity Operations Group . PO Box 2918 • Cincinnati, Ohio • 45201-2918 Phone (800) 926-1702 • Fax (513) 629-1799