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Home My WebLink About11-05-08 5056051058 Suffix Decedent's First Name PAUL --` REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year Fie Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280801 Hanisburp, PA t7128.0801 RESIDENT DECEDENT 21 08 $~d>~' d-1 ~ ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death Date of 61rth 192-14-5074 06!23/2008 04/05/1917 Decedent's Last Name STONE 1(>f Applicable) Enter Surviving Spouse's Intorrnation Below Spouse's Last Name Suffix STONE Spouse's Social Security Number I°ILL IN APPROPRIATE OYALS BELOW #C` 1. Original Return Spouse's First Name MILDRED r ~ e t. ~ ~ tt i~~ ( '~. z i. a _.,_. THIS RETURN MUST BE FILED IN DUPLICATE W{TH THE REGISTER OF WILLS MI L MI H __°, 2. Supplemental Return ,___. 3. Remainder Return (date of death __.~ prior to 12-13-82) 4. Llmfted Estate ,_.~. 4a. Future Interest Compromise (date of c _-~ ~ 5. Federal Estate Tax Return Required _`~ death otter 12-12-82) ~~*:? 6. Decedent Died Testate c.~) 7. Decedent Maintained a Living Trust 0 8. Tots{ Number of Safe Deposit Boxes (Attach Copy of Wilq (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 Cd~IFIDENT{AI. TAX INFORMATION SHOULD BE DIRECTED TO: !Jame Daytime Telephone Number (ROBERT R. BLACK (717) 243-3727 Firm Neme (if Applicabie) -- ' REGISTER OF WILLS 11~E ONLY ; 11~NDIS & BLACK - First line of address ~ ' <36 South Hanover Street Second line of address City or Post Office Carlisle Correspondent's e-mail address: .~ -- i State ZIP Code _ _ DATE FtLEG PA 17013 ,.~„ l,'~ Under peneltlea of perJury, I declare that l have examined this return, including accompanying sdiedules and statements, and to the best of my knowledge and belief, k is. true, corned and complete. Declaration of preparer other than the personal representative is based on ail information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE. FOR FILING RETURN DATE ADIDRESS ~~c_ Side 1 15056051058 15056051058 36~ South Hanover Street, Carlisle, PA 17013 r RIt31NAL FORM ONLY J 15056052059 REV-1500 EX Decedent's Social Security Number L)ecedent's Name; PAUL L STONE _. 192-14-5074 RECAPITULATION __ . 1. Real estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C} ..... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E} ........ 5. 129,632.84 6. Jointly Owned Property (Schedule F) c` '"- Separate Billing Requested ....... 6. 0.00 7. Inter-lfivas Transfers /3, MisceNaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 68,854.59 8. Total Gross Assets (total Lines 1-7) .................................... 8. 198,487.43 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 11,755.60 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 0.00 11. Total Deductions (total Lines 9 & 10) ................................... 11. 11,755.60 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 186,731.83 13. Charitable and Governmental BequestsJSec 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. 186,731.83 TAX GOMPUTA710N -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 0.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g, 19. TAX DUE ......................................................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 15056052059 REV-1560 EX Page 3 Ftle Number Decedlent's Complete Address: 21 os 0744 DECEDENT'S NAME DECEDENTS SOC{AL SECURITY NUMBER PAUL L STONE 192-14-5074 STREET ADDRESS --- ------ - -- - - - _ - __._______ 2041 Ritner Highway - -- - - - -- ---- _-- -- -- - - -- -------- -._- .----STATE --.. ;ZIP- ------.--- CITY __ Carlisle ' PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. CreditslPayments A. Sp<wsal Poverty Credit B. Prirx Payments C. Discount - - Total Credits (A + B + C) (2) 3. InterestlPenalty if applicab{e D. Interest E. Penalty -- - Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A} B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILtS, 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 :.......................................................................................... ^ 0 b, retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; a' .......................................................................................................................... ^ 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? .............. Q ^ 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)J. 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 (O) 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 immposed 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)J. 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. §91161;1.2} [72 P.S. §9116(a)(1)J. 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)J. 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. ~; #,~ ~~JMP,A i~lA/E.A.lrTH vF °F,r4~J31'±.i!rNl.4 i'C~IiL ~~~M! N(FGr'~iTP.EJCE T!~X RET;1r"a,SJ FE;=iDENT LECtC~EP,? EST/1TE OF FILE NUMBER STONE, PAUL L. 21-0$-0744 All ireal 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. (If more space is needed, insert additional sheets of the same size} ~` _ ~ ~F~ ~ O r ~G / u`~ i ,~ a AA ~p r~~q Ap c i ep e t~I tpf ~ce D ia,~ae[ C,F1~H D/11YK e1Gf" ~~t ® J C at i'Yi1~~. ~~QtJP,A-'~NJ~fEA.±.T~IOF ENNSYLVAt•!la ` r iNr;ER1i:aNfiETAXKETJ;?N p p ~y p~ y ~^ P~1~~V~A~ r"r'i~r ~Rt C R~SlDEN,' ~ECEDE~JT ESTATE OF FILE NUMBER STONE, PAUL L. 21-08-0774 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sovereign Bank -Checking Account #1671077717. Principa{ 139.21 + Interest .01. See attached letter, 2. Sovereign Bank -Money Market Account #2891022874. Principal 15,416.52 + Interest 11.94. See attached letter. ry 4 ,i~... 3. Sovereign Bank -Certificate of Deposit #1675541047. Principal 43,265.01 + Interest 93.97. See attached letter, ~; ;.._ , _ _ 4. M ~ T Bank -Certificate of Deposit #31003908161597. Principal 17,167.15 + Interest 36.05. See attached latter. ~ r -, n -: - - 5. M & T Bank -Certificate of Deposit #31003910739556. Principal 14,032.03 + interest 17.10, See attached letter. ~ t~ ~ ~ ; ~: 6. M & T Bank -Certificate of Deposit #031003913463219. Principal 11,1$8.07 + Interest 126,83. See attached letter ( ; .:.~ ,,. t 7. Commerce Bank -Savings Account #626036289 See attached letter ~ ~ „ , . ,, , , .. TOTAL (Also enter art line 5, Recapitulation) f ~ y ~ ~ ~ =~~ ~=` e ~= (If more space is needed, insert additional sheets of the same size) ~~~~ 1 ~;~7P!AifC~:"y'J\l~.a! TH S~~ = 'el>1'`i.tlt?'`;ti. NH~f?;7a~;CE rr,a'. Rc?`".iKiV RESi~JEPJT DEGEGcPtY 7ir~~YY~~ iNT~R-i~IVC7S TRANSFERS ~ MfS~, NQN-i'RQSATE PRQPERTY EST~ITE OP FILE NUMBER STONE, PAUL L. 21-08-0774 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of tlTe REV-1500 COVER SHEET is yes. ITEA4 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE 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 (!F APPLICABLE) TAXABLE VALUE 1 ~ Sovereign Bank -Mildred H. Stone in Trust for Paul L. Stone. Account #1675205668, Principal 55,392.68 + Interest 131.27 55,523.95 100 2. Thrivent Financial for Lutherans -Annuity Contract C2784656. Principal 13,327.85 + Interest 2.79 13,330.64 100 TOTAL (Also enter on line 7 Recapitulation} E I ;.;,. ~.a . __; (If more space is needed, insert addittonat sheets of the same size) HEV-1511 EX+ (f2-99) SCHEDYLE H COMMONWEALTH OF PENNSYLVANIR FUNERAL EXPENSES ~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTAITE OF FILE NUMBER _ STONE, PAUL L. 21-08-0774 Debts of decedent must be reported on Schedule I. ITEM NUI'~BER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; t' Hoffman-Roth Funeral Home -Services ~ :v,;,,? ~;; 2_ Mildred H. Stone -Funeral Luncheon ~~ ~ ~ ~ ~- ~ ~, E e. ADMINISTRATIVE COSTS: 1' . Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s}IEIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: 2. Attorney fees 3.. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant P~tiidred H. Starve Street Address 2~?41 Ritrter Highway City ~i.c`'+riiS#e State ~A .Zip '+ ~ 0 Relationship of Claimant to Decedent `wife 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Reserve for closing and filing releases TOTAL (Also enter on tine 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) Zip ~~n.S4 ?1.:'vim :~ ~~.~ S~NED~lLE J :,,~, ,~ N~~.~ r ,~~ G ~r ~ENEFICIARIE~ ~.HtniTA"ec.G Ti+x `N,c ESTAtTE OF FILE NUMBER STONE, PAUL L. 21-08-0774 i RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not L(st Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outr+ght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 'I ~ Mildred H. Stone, 2041 Ritner Highway, Carlisle, PA 17013 Wife t ! :'_' -, S.S.N. 189-09-5121 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 15 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) LAST WILL AND TESTAMENT OF PAUL L. STONE 1, PAUL L. STONE, of 2041 Rimer Highway, Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as apart of the expense of administration of my estate. DISTRIBUTION OF PERSONAL PROPERTY THIRD: All my personal effects, clothing, furniture, furnishings, jewelry, automobiles, other tangible personal property of every kind, and insurance thereon, I give to my wife, 1VIII,DRED H. STONE, if she survives me for a period of thirty (30) days. If MILDRED H. STONE shall not so survive me, then I give the same in equal shares to my children who do survive me for a period of thirty (30) days, to be divided among them as they may agree or, if they are unable to agree, as my executor may decide. The share of any minor child shall be selected and held by my executor for delivery to such child at termination of minority or, in the discretion of my executor, may be delivered either to the minor or to another to hold for the minor during minority and the receipt of the minor or such other person shall be a complete dGscharge of my executor. Any items not so disposed of shall be sold by my executor and the proceeds added to my residuary estate. ~~ initials PROTECTION OF BENEFICIARIES (Spendthrift Provision) FOURTH: No interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. :Provided, however, any beneficiary may assign any part or all of the beneficiary's interest in my estate to any one or more of my descendants or to any one or more of the beneficiary's descendants. MINORS AND INCAPACITATED BENEFICIARIES FIFTH: If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority ar incapacity without the appointment of any guardian or committee or any authority of court. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the termination of minority or incapacity. My executor as trustee shall have the same powers as my executor. POWERS OF EXECUTOR SIXTH: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my executor shall determine, and to execute aJnd deliver good and sufficient conveyances, assignments and transfers of the property, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments, or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments"; to make distribution in cash or in kind; to allocate and distribute different initials kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in cash or in kind, or partly in each; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF GUARDIAN OF ESTATES OF MINORS SEVENTH: I appoint my executor as guardian of the estates of minors with power to hold all property payable bylaw to a guardian appointed by my will and to use it for the minor's health, maintenance, support and education, either directly or by payment to any person selected by my executor to disburse it whose receipt shall be a complete acquittance. Guazdian may, in discharge of all the guazdian's duties, pay any minor's share deemed impractical of administration to the parent or other person in charge of the minor or to his or her guardian or to a custodian for the minor under the Uniform Transfers to Minors Act. My executor as guardian shall have the same powers as my executor. APPOINTMENT OF EXECUTOR/RIX EIGHTH: I appoint my wife, MILDRED H. STONE, executrix of my will. If 1~~IILDRED H. STONE is unable or unwilling to qualify as executrix or having qualified is unable or unwilling to act, I then appoint my son, FR.ANIC E. STONE, as executor hereof. WAIVER OF BOND NINTH: I direct that no fiduciary hereunder shall be required to furnish bond in any jurisdiction, and if any bond is necessary, no surety shall be required. INTERCHANGIvABILTI'Y OF LANGUAGE TENTH: Words used: in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. initials HEADINGS ELEVEN'TIi: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this ~~ day of ~-'(~~~/ , 2007. Paul L. Stone ,~ -~1 Witness =-! Witness ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYL~IANIA SS. COUNTY OF CUMBERLAND We, PAUL L. STONE, the Testator herein and the undersigned witnesses to the will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the Testator, do hereby acknowledge that I signed the instrument as my will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testator sign and execute the instrument as his will, that he signed it willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as a witness and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Paul L. Stone , I s ,' ~, Witness ~ n ~~V 7 ~~.~ -~.~ witness Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Robert R. Black, Notary Public Carlisle Boro, Cumberland County My Commission Expires Sept. 28, 2009 Sovereign Bank ESTATE OF Paul L Stone SOCIAL SECURITY #: 192-14-5074 DATE OF DEATH: June 23, 2008 Account #: 1671077717 Type Premier Checking Open date: 8/31/2006 In the name of: Paul L Stone Date of Death Balance: Int.(YTD) from 1/1/2008 to Accrued interest to date of death: _ Otherlnfo: Closed 8/25/08 Account #: 2891022874 Type: Money Market Savings Open date 2/21/1995 In the name of: Paul L Stone Date of Death Balance: Int.(YTD) from 11112008 to Accrued interest to date of death: _ Other info: Closed 8/25/08 $15,416.52 4/30/2008 $11.94 $0.05 $101.05 Account #: 1675205668 Type: In the name of: Mildred HStone /itf Paul L Stone Date of Death Balacne $55,392.68 Int.(YTD) from 1/1/2008 to 5/31/2008 Accrued interest to date of death: _ $131.27 Other Info: Closed 7/10/08 Account #: 1675541047 Type: _ In the name of: Paul L Stone Date of Death Balance: _ _ Int.(YTD) from 1/1/2008 to Accrued interest to date of death: Other Info: Closed 7/24/08 CD Open date: 2/8/1995 CD $4.3,265.01 x/31 /2008 $93.97 Open date: 8/31/2006 $693.46 $139.21 5/23/2008 $0.01 $933.49 Page 1 of 1 p~~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 August 29, 2008 Law Offices Landis & Black 36 South Hanover Street Carlisle, Pennsylvania 17013 Re; Tstate o : Paztl I Stone Social Securit~l92-~4-507=~ Date o,~Death: June 23, 2008 Dear Sir or Madam: Per your inquiry dated August 21, ?008, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Certificate of Deposit Account Number 31003908161 X97 Ownership (Names o~ Paul L Stone Opening Date 3/23/05 Closed 7/24/08 Balance on Date of Death S 17,167.1 ~ Accrued Interest $ 36.05 Total ._ S 17, 203.20 2. Type of Account Accotrnt Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Certificate of Deposit 31003910739.i~6 Paul L Stone 11105/99 Closed 7!24108 $ 14, 032. D3 17.1D $ 14, 049.13 3. Type ofAccotrnt Certificate of Deposit Account Number 031003913=163219 Ownership (Names o~ Paul L Stone Opening Date 8/~/0~ Closed 7/24/08 Balance on Date of Death S 11,188.07 Accrued Interest ~ 126.83 _ _. __ Total S' 11,314,90 :Please be advised, there was no safe deposit box found for the above decedent. '~ If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or 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, etc., please contact our High Street Carlisle Office # 717-240-4536. Si cerely, ~ ~- J ~ Gc~~ ~~ Tracie Hare Frecords Management September 23, 2008 Law Offices of Landis & Black Attn: Robert R. Black 36 South Hanover Street Carlisle, PA 17013 RE: Estate of: Paul L. Stone Tax Identification Number: 192-14-5074 Date of Death: June 23, 2008 To bllhom It May Concern: Commerce CBank This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Savings Account Number: 626036289 Date Opened: 07/19/2002 Date Closed: 09/17/2008 Primary Owner: Paul L. Stone Date of Death Balance: $28138.95 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, ~. ~ Diana R Holds Commerce Bank Research Associate/Deposit Services Commerce Bank /Harrisburg, N.A. PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com Page 1 of 1 1, -Thrivent Financial for LuthercrnsTM EXPLANATION OF DEATH CLAIM PAYMENT ON CONTRACT C2784656 Paid To: Estate of Paul L Stone, Deceased 2041 Ritner Hwy Carlisle PA 17015 Notice Date: 07/30/2008 Claim Number: 409720 The following table summarizes the payments made on aantract C2784656 P~eld on the life of Paul L Stone E3ASIC COVERAGE+ ADDITIONS INDEBTEDNESS TOTAL PROCEEDS+ $13,327.85 $0.00 $0.00 $13,327.85 Basic Coverage =Cost Basis + Taxable Gain Additions = 0 Indebtedness = 0 DATE PAID PAYMENT TYPE 07130/2008 Check AMOUNT PAID *'` $ 13,330.64 INTEREST PAID $ 2.79 *"Each payment includes the amount of interest shown in Interest Paid column. You have $0.00 n~maining to be distributed from the claim on this contract. The above payment is made from your contract from Lutheran Brotherhood Variable Insurance Products Company (Minneapolis, MN 55415), a wholly owned subsidiary of Thrivent Financial for Lutherans. If you are required to report any taxable gain or interest payment as a result of this claim transaction, a form 1099R will be sent to you by 3anuary 31 of next,year. Should you have any questions about this claim, please contact your financial associate FRANK E STONE, at phone 484-875-2891. + The Basic Coverage and Total Proceeds amounts represent the values of the variable annuity c;~lculated on the date we received proof of loss. Until your proper{y completed claim form was received by us, your porkion of the Total Proceeds remained subject to the investment experience of the variable account which may have increased or decreased daily. Estate of Paui L Stone, Deceased Zt)41 Ritner Hwy Carlisle PA 17015 CC: FRANK E STONE 0165 26130 00 Deceased's Customer ID: 507354952