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HomeMy WebLinkAbout12-17-0815056051058 REV-1500 EX (O6-OS) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year file Number Po Rox zaosDl INHERITANCE TAX RETURN Harrisburg, PA 17129-0601 RESIDENT DECEDENT 21 08 742 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 460-30-3359 06/16/2008 12/10/1917 Decedent's Last Name Suffix Decedent's Firs[ Name MI _. -. _ Avery Mary W' (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 INAPPROPRIATE OVALS BELOW (h 1. Original Return O 2. Supplemental Re[um O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) C~~ 6. Decedent Dietl Testate O 7. Decedent Maintained a Living Trust __ 0_- 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ~~ 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Edward L. Schorpp, Esq. (717) 486-8386 Firm Name (If Applicable) -------_._....____. __. __. __._..._.- -, REGISTER OF WILLS USE ONND N/A C-D ~ _ ~n O First line of address ~ to 35 S. Thrush Drive 5~i~- r~ °~ Second line of address ~ ;,rd -'"~r~ ~ I Q -ice S' , s ~ Cit or Post Office Y I _ DATE F~D State ZIP Code - - . ------ la ~ D Carlisle PA 17015-7652 o Correspondent's a-mail address "' i fit 7 ~1' 'J - ; ,i - _:) r' --~ ~.-r I r`n -, -;7 Under penalties of perjury, I tleclare that I have examined this return, inclutling 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 SIGNATURE OF PE`RSO/NLRES~PONSIBLE FOR FILING RETURN DATE nri f~7 /~/LY/LC/ ~ /~ ~.7J~ 17 _ /C~f U DATE is i_3- o x3S S. T.r.PVSy ~i PiVE, ~9RL/SCE ~i9 / 70/`r PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051055 J , ~ J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Mary VV Avery .460-30-3359 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. 3,412.49 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. 13,094.91 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~ ~- - _ ~ --- (Schedule G) O Separate Billing Requested.... .... 7. 40,824.08 8. Total Grass Assets (total Lines 1-7 ) .. ......... ......... ...... ... 8 57,331.48 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......... ...... ... 9 3 913.69 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............. ... 10. 3,699.78 11. Total Deductions (total Lines 9 & 10) . .......... ....... ....... ... 11. 7,613.47 12. Net Value of Estate (Line 8 minus Line ii) ........................... ... 12. 49,718.01 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. 49,718.01 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 911fi (a)(L2) X .0_ 16. 16. Amount of Line l4 taxable - --- - - at lineal rate X .0 45 49,718.01 is. 2,237.31 17. Amount of Line 14 taxable ' - - - at sibling rate X .12 17 16. Amount of Line l4 taxable at collateral rate X .15 ig 19. TAX DUE ........ .............................................. 2,237.31 ..i9. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 c~ 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: r _,_„- _., _, _-_ Flle Number 21 ~ OS ~ 742. __.. __, DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Mary W Avery 460-30-3359 STREETADDRESS Claremont Nursing and Rehabilitation Center Claremont Road CITY STATE ZIP -- Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) Total InteresVPenally (D + E ) 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. 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 taz due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 2,237.31 (2) 1,894.73 (3) (4) (5) 342.58 (SA) (SB) 342.58 Make Check Payable to: REGISTER OF WILLS, AGENT „~_`d 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 trans(erred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefts or care? ................................................................ ...... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer properly 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 benefciary designation? .................................................................................................................. ...... ^>< ^ IF THE ANSWyEyR TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUµST COMPLETE SICHEDULyy~~~pEG Ap~N~D~,F'fILE ITy,~ASPAµ~R$TrygO~FpyT~SHE RyE~T~URN.y ~)ti~r`~1t~E~6~ri N€~;r~~'11 l k r~~er t<1~ Lr.l ~6?ifM~fi~-rt I~.1' `1 I~~(<At)pj~g{r~.~~ll~ 4 ~~tiR 'Ary ~, k~w1;~s'Y rkY'filllllpSMI'iL~31~~!^I"4t~~I~~F't~3Nu41kkN#M6~aiSMIEITdYl~d161~jfl1 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 f ling 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 benefciaries 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 o1 transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 1, 800.00 LAST WILL AND TESTAMENT OF MARY W. AVERY I, Mary W. Avery, of Sacramento, California, being of sound and disposing mind, memory and understanding; do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my SAIDIS SHIIFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA ^~ ~1 last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate in such amount as they shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the ., purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved daughter, Janet Avery Walter, per stirpes, absolutely and in fee simple if she survives me by thirty (30) days. THIRD In the event that my daughter, Janet Avery Walter, fails to survive me by thirty (30) days, then I give, devise and bequeath all the rest, residue and remainder of my estate in equal shares unto my grandchildren, Amanda Avery Walter and Whitney Marie Walter, per stirpes, provided that if any of my grandchildren have not attained the age of twenty-two (22) years, then I give, devise and bequeath my entire estate together with any other property which may be added, unto HERSHEY TRUST COMPANY, Pennsylvania, IN TRUST, upon the following terms and conditions: (A) To hold, manage, invest and reinvest the principal so received, and accumulation of income thereon, SAIDIS ~ SHLTFF,FLOWER and to use, pay and apply the income and principal or so & LINDSAY ATTORNEYS•AT•WW ' much thereof as in Trustee s sole discretion may be 26 W. High Street Carlisle, PA necessary for the maintenance, support, medical expenses 2 and education of my grandchildren whether the same be born before or after the signing of these presents. (B) The payments authorized by this trust shall be made without any regard to equality of distribution among my said grandchildren and without further responsibility to said grandchildren or to any person taking care of said grandchildren. Said payments may be made by rhy trustee directly to said grandchildren, or such of them as may be, in the sole opinion of trustee, of such age and ability to handle properly the funds so paid, or may be made directly to the person having custody and care of any pf said grandchildren, or may be made directly to any institution entitled to such payment by reason of services rendered or to be rendered to any of said grandchildren. (C) The amount to be paid for the benefit of said grandchildren shall be determined from time to time by the need of the grandchild, and the amounts and times of said payments shall be determined by such need, prgvided that payments be made at least monthly. SAIDIS SHUFF,FLOWER (D) All payments of principal and income hereby given & LINDSAY AT70RNEY5•AT•LAW shall be free from anticipation, assignment, pledge or 2G W. High Street Carllale, PA obligations of beneficiaries, and shall not b~ subject to ~ ~ any execution or attachment. 3 (E) All principal and accumulated income, not so applied, shall be distributed in equal shares to my grandchildren, per stirpes, when my youngest then living child attains the age of twenty-two (22) years. FOURTH I direct that any and all inheritance, estate; and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FIFTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in their absolute discretion: A. To retain in the form received, or to sell either at public or private sale any real or personal property; B. To exercise any options to subscribe for stocks, bonds, or other investments; C. To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of SAIDIS SHLJF$ FLOWER & LINDSAY ATTORNCYS•AT•LAW 26 W. High S[ree[ Carlisle, PA any corporation in which my estate or any trust may hold stocks, bonds or other securities; D. To sell, transfer, convey, mortgage, pledge, lease r~~ \~ or exchange any property, real or personal, wUiich at any 4 time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in their sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; E. To make settlements and compromises on such terms as my personal representative in their sole discretion may deem wise without the necessity of obtaining any court approval thereof; F. To make distribution hereunder either in cash or kind, as my personal representative in their discretion may deem wise. SIXTH I do hereby nominate, constitute and appoint my daughter, SAIDIS SHLIF$ FLOWER & LINDSAY ATTORNEYS•AT•fAW 26 W. High Street Carlisle, PA Janet Avery Walter, to act as Executrix of this my Last Will and Testament. Provided, however, that if Janet Avery Walter is unwilling or unable to act as Executrix, I direct the duties of Executor to be performed by Robert Elwood Walter. SEVENTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be 5 required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Mary Virginia Wright Avery, have hereunto set my hand and seal to this my Last Will and Testament, consisting of six typewritten pages, the first five of which bear my initials in the margin for identification, this 31st day of December, 2003. Q/wi ZP~ l~z~e-5,.~ Mary Avery Signed, sealed, published and declared by the above-named SAIDIS SHUFF, FLOWER & LINDSAY ATTORNCYS•AT•LAW 26 W. High Street Carlisle, PA Mary W. Avery, Testatrix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. ~ // ~./'LU ~ ADDRESS 26 West High Street Carlisle, PA 17013 %~/ ~ ~ ~' ~ ADDRESS 26 West High Street Carlisle, PA 1 6 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Mary W. Avery, Tanya ware and phvllis McCov the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that executed as her free and voluntary act for the purposes thereim expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~2 ~ Mary W. very ,Witness McCoy ~-- , Witness Subscribed, sworn to and acknowledged before me by Mary W. Avery, the Testatrix, and subscribed to and sworn or affirmed to before me by Tanya ware and Phyllis McCoy , witnesses, this 31st day of December, 203. Notary Public SAIDIS SHUF$ FLOWER & LINDSAY ATTORNEYS•AT•LAW 26 W. Hlgh Siree[ Carlisle, PA Pi0TAR1r~i1 Sc'~f_ RE11EE L. Mul~,r,„'y, Oarlisla Saro, Cumrhl Coin; P.a IAy Commission ~ Crr3„ 13, T005 7 REV-1508 EX+ (6-98) P COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Mary W. Avery 21-OS-742 Include 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. pr more space is neede4 insert additional sheets of the same size) St MEMBERS ls' FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name o~fi Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established INVESTMENT SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Estate of: MARY W. AVERY Date of Death: June 16, 2008 Social Security Number: 460-30-3359 303401-00 303404-00 03/29/2007 03/29/2007 $25.00 $5.00 $.00 $5.41 $25.00 $10.41 JarsefA. Walter None 03/29/2007 303401-11 303404-111 03/29/2007 03/29/207 $19,027.21 $.00 $.50 $.00 $19,027.71 $.00 Janet A. Walter None 03/29/2007 303404-OS 03/29/2087 $.00 $.04 $.04 None tv~ABERS 1sT FEDERAL CREDIT UNION Danielle A. line Insurance Services Specialist July 17, 2008 5000 Louise Drive P.0.13ox 40 Mechanicsburg, Pennsylvania 77055 (800) 283-2328 wwwmemberslst.org HERIT.,~~E COMMUNITY CI2~DIT UNION R,e: Estate of Mary W. Avery The type of account: It is a Savings acct. Account # 81834 Names and / or designation: Mary W. Avery M W Avery Rev Trust If joint account,date originally opened and date placed in joint names: 'l'bere is n~ joint mbr the date account originally opened is 07/03/1980 Principal and ixtter~~f'balanees ag of date of death: $2484.08 Representative P.O. $ox 790, Rancho Cordova, CA 95741.0790 (916) 364-1700 www.heritageccu.com REV-1508 EX+ (8-9a) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Mary W. Avery 21-08N42 If an asset was made joint within one year of the decedent's data of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Janet A. Walter 1321 Georgetown Circle, Carlisle, PA 17013 Daughter B. C. JOINTLY-OWNED PROPERTY: ' ITEM LETTER FOR JOINT DATE MADE DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION ANp BANK ACCOUNT NUMBER OR SIMILAR PATE OF DEATH ^~ pE oF D'S DATE OF DEATH VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEEP FOR JOINTLY-HELP REAL ESTATE. VALUE OF ASSET INTE EST pEGEDENT'B INTEREST t. A. 03129107 Regular Savings Account # 30340100, Members 1st 25 00 ° 5 / 12 50 . ° . 2. A 03129107 Regular Savings Account # 30340400, Members 1st 10 41 ~ 5 % 5 21 . . 3. A 03129107 Checking Accounl# 30340111, Members 1st 19,027.71 Sb% 9,513.86 4. A 11121/03 Checking Account # 6107, WeIIs Fargo 6,115.96 ~~ ° Sp/o 3,057.98 5. A 12109104 Savings Account#0251, WeIIs Fargo 1,010.72 5b% ii 505.36 TOTAL (Also enter on line 6, Recapitulation) I E ~ 13,094.91 (lf more space is needed, insert additional sheets of the same size) 7 ~. y ~ o, y ~ ~ 0 ~~~ ~»~ D ~ ~ D ~ ~ v H ~ < H ~ D ~ m A `Z fp `Z n a ~ ~ d s n y s ~ O ~ ~ y ~ r n `f N N N d a ~ 3 ~ ~ G ~` ~~ ~ ~ ~ w ~a G N W O ~ ~ ~ V w ~ A ~ V ~ r W O m O W 0 0 0 rn t~D vi A 0 N n O c Z 3 m D n O C ti D COl O z C 3 Q 1 O ~ 01 w W ~ 1 ~ ~ M v ~~ ~~d ? a o O y d A ~' d d y S ~ W D a a 7 A N N O d ~ ~ ~ ~ o tp~ ~ O, N Oi ~ v A ~ ti S O O O O 3 ~ ~ 3 y 3 ~ m v n m Gam. ~„ H A S ~ N o ~ ~ O ~ c m a 3 a N ~ 1 nS O C a ~i 'WSW ~' ~ a N N O '' +n N ~ ~ d V ~ A ~ ~~ZVv ~~ ~,~ ca~°~ N ~ W .d. ~ 7 m ~ ~ ~ w n~ a m ~c K r `' n ~ ~ ~ ~ O ~ V ~ ~ N O O OD D m O v m W CD Y ^^Z •I rn m c m m Z y m 0 3 o~c ~O^ umo °xm o~ ~~ tpNa N O m O ~ ° m m ^ August 11, 2008 Edward L Schorpp Attorney at Law 35 South Thrush Drive Carlisle, PA 17015-7652 Customer Correspondence MAC P6103-050 PO Box 6995 Portland, OR 97228-6995 Dear Edward Schorpp: We received your letter requesting information for accounts held by Mary W. Ave ,Deceased. Her checking account ending in #6107 opened November 21, 2003, in the name of ary W. Avery or Janet A. Walter. Her savings account ending in #0251 opened December , 2004, and is also in the name of Mary W. Avery or Janet A. Walter. We trust this information is helpful. Sincerely, ~~ Debbie Hein Operations Manager Customer Correspondence DH/jg 303412 REV-1510 EX+ (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Mary W. Avery I 21-08-742 This schedule must be completed and fled if the answer to anY of questions 1 through 4 on the reverrce side or ma aPV.l snn rnvo cuvvr:.. .,.... ITEM NUMBE DESCRIPTION OF PROPERTY irvcwos rBe unME OV rae renrvsveaeFreswaeunorvswe ro osceoervrnrvo R rive onre or rrnrvsFe6. arracl+acocr or rive Deco roa asa~esrare. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST E pF CLUSION ccucna~el TAXABLE VALUE t American National Insurance Company Annuity # LAR0034787 Annuitant , Mary W. Avery, Beneficiary Janet A. Walter daughter 23,675.65 100 I 23,675.65 ~ , 2. AIG SunAmerica Annuity # P0497505709, Annuitant Mary W. Avery, Beneficiary, Janet A, Walter, daughter 17,tgg qg 100 17,148.43 i TOTAL (Also enter on line 7 Recapitulation) $ 40,824.08 (11 more space is neetleq insert atlditional sheets of the same size) AME" . enewune rnuneuv _ - LIFE INSURANCE AND ANNUITY CLAIMS DEPARTMENT P. O. BOX 1840, GALVESTON, TX 77553-1840 BUS: 1-800-615-7372 FAX: 409-766-6994 '~, August 20, 2008 EDWARD L. SCHORPP ATTORNEY AT LAW 35 SOUTH THRUSH DRIVE CARLISLE PA 17015-7652 Re: Claim: C691407 -Mary Avery -Certificate LAR0034787 Dear Mr. Schorpp: This letter is in response to your July 31, 2008 letter. The values as of the date of death of 6/16/2008 are as follows. Cash Value: $23,675.65 Cash Surrender Value: $24,523.29 Cost Basis: $15,000.00 Should you have any questions you may contact us at 1-800-615-7372. When callin~ please refer to claim C691407 in all communications. Sincerely, MARSHA GARWICK ASSOCIATE CUSTOMER SERVIC PRESENTATIVE MG/esf SunAmerica AIG SuryryAAmerlca Financial F1naI1C1a1 21650 Gznard Street Woodlatld Hills, CA 91367-4901 P.O. Box 54299 Los Angeles, CA 90054-0299 September 4, 2008 Edward L. Schorpp Attorney At Law 34 South Thrush Drive Carlisle, PA 17015-7652 RE: AIG SunAmerica Life Assurance Company Policy Number: P0497505709 Deceased: Mary W. Avery Dear Mc Schorpp: Per your request, please find below the date of death value on the above referenced Date: June 16, 2008 Value: $17,148.43 If you have any questions or require further assistance, please contact our SunLine represe tatives, available Monday through Friday, 5:00 AM to 5:00 PM Pacific Time, at 1(877) 932-7869. We appreciate this opportunity to serve you. nn~ ^ Sincerely, ~n~~/ ~-~ Lamosha And son Claims Analyst AIG SunAmerica Life Assurance Company Member a Muncan lnlernafiona! Group, Inc. AIG SunAmerica Life Assurance ComoaaY First Suvimerica Life Insurance Comnanv REV-1511 EX+(12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF E NUMBER Mary W. Avery 21-08-742 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Dugan Funeral Home, Inc. 3,387.79 z. Georges' Flowers 281 90 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 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 144.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees ~. Reserve for closing and f ling fees 100.00 TOTAL (Also enter on line 9, Recapitulation) 3,913.69 (If more space is needed, insen additional sheets of the same size) Dugan Funeral Home, Inc. 1 I 1 South Main St. P.O. Box 393 Bendersville, PA 17306- Phone:(717)677-8215 Fax: (717)677-4354 rl ~`1`~} 1827 n~Ut~ ~\ UO Janet A. Walter ~(\, CL .321 Georgetown Circle ~) ;arlisle, PA 17013 I 'he Funeral Service for Mary W. Avery ~' .. SPECIAL CHARGES Direct Cremation w/ Memorial services 2, 95.00 2, 95.00 $2,995.00 'terchandiae Cremation Urn 50.00 50.00 $2,695.00 __ _ - .as Advances Newspaper Notices - Out-of-town 17 79 Clergy/Mass Offering 50.00 Organist 75.00 792.79 $3,387.79 [ISTORY $3,387.79 Total Interest/Amount Received: --- 0.00 Total Outstanding Balance as of 06/23/2 006 $3,387.79 REV-1512 EX+ (12-03) C COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS p CTATp f1F ----- -~ Mary W. Avery 21 ri~r_ numor:rt 08-742 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, includlrq unreimhursed edlcal expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ 2. Pharmerica, prescription account balance Claremont Nursing and Rehabilitation Center, foal resident account balance owing 249 78 3,450.00 TOTAL (Also enter on line 10, Recapitulation) $ 3,699.78 (I(more space is needed, insed additional sheets of the same size)