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Home My WebLink About04-14-091505607121 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 0 8 0 9 1 6 Hamsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 0 7 1 3 2 0 0 8 0 7 3 1 1 9 2 8 Decedent's Last Name Suffix Decedent's First Name MI S H I P P C A R O L Y N M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI R Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate OX 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 7 4 3 5 Firm Name (If Applicable) ~ REGISTEI~F WILLS USBV~ILY =` tt , ? f ~"t S T O N E L A F A V E R S H E K L E T S K -~ a~- {_~'? i , ,~ --~ c First line of address I ~~ ~ L ~~ 4 1 4 B R I D G E S T R E E T Second line of address City or Post Office N E W C U M B E RL A N D State ZIP Code P A 1 7 0 7 0 i -' ~"' ~"~ ~...~ "5 ! i l . r v:, ~~ ~ .tt `-- ,_ `~ . ' - ~ ~ f I' r'1 E FILED ~ `- ----- -- -- -~ `~ 4 Correspondent's a-mail address: D S T O N E a1 S T O N E L A W• N E T 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, conect and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. rUR~F PERSON RESPON$IQLE FOI~FILING RETURN ADDRESS 3723 OUR TR T HARRISBURG PA 17111 SIG E PREP O R HAN REPRESENTATIVE DATE 414 BR1`~GE STMT NEW CUMBERLA PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 PA 17070 1505607121 J 15D5607221 REV-1500 EX 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. 1 3 9 5 6 . 5 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 4 5 6 4 4 . 8 8 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ S t Billi R t d 2 6 4 7 0 7 6 epara e ng eques e .... ... 7. . 8. Total Gross Assets (total Lines 1-7) .................... .... ... 8. 8 6 0 7 2. 2 2 9. Funeral Expenses & Administrative Costs (Schedule H) ......... .... ... 9. 1 5 6 3 6 . 3 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..... .... ... 10. 1 2 6 9 . 6 9 11. Total Deductions (total Lines 9 & 10) .................... .... ... 11. 1 6 9 0 6 . 0 5 12. Net Value of Estate (Line 8 minus Line 11) .................. .... ... 12. 6 9 1 6 6 . 1 7 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. 6 9 1 6 6 . 1 7 TAX COMPUTATION -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 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x• 0 4 5 6 9 1 6 6. 1 7 16. 3 1 1 2. 4 8 17. Amount of Line 14 taxable 0 0 0 D 0 0 at sibling rate X .12 17. . 18. Amount of Line 14 taxable D 0 ll t l X 0 0 D D a co atera rate .15 1 g . 19. Tax Due .......................................... .... ..19. 3 1 1 2. 4 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OV ERPAYMENT Side 2 1505607221 1505607221 J REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MASC. IN REST DENT DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER CAROLYN M. SHIPP 21 08 0916 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty•owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. Erie Insurance-homeowners refund & addl check 97.00 2 Highmark-premium refund 16.62 3 Northern Trust Co.-Conrail pension check 285.20 4 PA Treasury Dept-Rental rebate check for 2007 500.00 5 Sovereign Bank-Cert of Deposit #1055162083 11,628.47 Princ. $11,628.47, Int. $17.85 6 Sovereign Bank-Cert of Deposit #1055162083 -Accrued interest 17.85 7 US Treasury-RR Retirement check 1,411.44 TOTAL (Also enter on line 5, Recapitulation) I S 13 956 58 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE CAROLYN M. SHIPP 21 08 0916 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Carolyn Romaine Keck B Elizabeth R. Gilbert c JOINTLY-OWNED PROPERTY: SCHEDULEF JOINTLY-OWNED PROPERTY 3723 Montour Street Harrisburg, PA 17111 ADDRESS 101 South Millbach Road Newmanstown, PA 17073 RELATIONSHIP TO DECEDENT Daughter Daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A & B 111306 Sovereign Bank-Checking Acct #2331025657 joint 138,317.81 33. 45,644.88 with C. Romaine Keck or Elizabeth R. Gilbert dated 11-13-06 Princ. $138,316.30, Int. $1.51 0.00 0.00 TOTAL (Also enter on line 6, Recapitulation) $ 45 644.88 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER CAROLYN M. SHIPP 21 08 0916 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPTO DECEDENT AND THE DATE CF TRANSFER. ATTACHACCPYOFTHEDEEDFORREALESTATE DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EKCLUSION (IF APPLICABLE) TAXABLE VALUE 1. Sun Life Financial-Annuity No 50-79-7900-242814 7-11-08 val 19,535.67 100. 19,535.67 $19,607.59, 7-14-08 value $19,463.75 w/avg $19,535.67 Benef: Carolyn Romaine Keck and Elizabeth Ruth Gilbert 2 Thrivent Financial for Lutherans-Annuity #9124521 6,935.09 100. 6,935.09 Non qualified annuity Beneficiaries: Carolyn Romaine Keck and Elizabeth Ruth Gilbert TOTAL (Also enter on line 7 Recapitulation) $ 26 470.76 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER CAROLYN M. SHIPP 21 08 0916 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 The Bricker House-funeral dinner expenses 164.11 Duncannon Cemetery Assoc-services rendered 450.00 Linda Lauman-CMS funeral services 75.00 Rice Memorial Works-on acct of grave marker 358.00 Musselmans Funeral Home-funeral exepenses 6,283.50 Rice Memorial Works-bal due on grave marker 357.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees David H. Stone, Esquire 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County 3,500.00 121.00 5 Accountants Fees 6. Tax Return Preparer's Fees 7. Sovereign Bank-service fees 15.00 1 AARP Health Care-insurance premium (5 months) 837.50 2 Expense from sale of house (prior to death) 7.11 3 Conrail Supplemental Pension Plan-Reimbursemt 142.60 4 The Patriot News-obituary 156.42 5 US Treasury-Reimb on RR Retirement checks 2,822.88 6 Cumberland Law Journal-advertising grant of letters 75.00 7 The Patriot News Co.-advertising grant of letters 141.24 8 Register of Wills-filing Inheritance tax return and Inventory 30.00 9 Reserve for closing expenses 100.00 TOTAL (Also enter on line 9, Recapitulation) S 15 636.36 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT s ESTATE OF FILE NUMBER CAROLYN M. SHIPP 21 08 0916 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i Quantim Imaging-services rendered 36.00 2 West Shore EMS-services rendered ~ 897.06 3 Quantum Imaging-services rendered ( 80.00 4 West Shore EMS-services rendered ~ 63.19 5 ~ Pharamerica-debt of decedent ~ 56.00 6 Golden Living Center, West Shore-serv rendered ~ 137.44 TOTAL (Also enter on line 10, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CAROLYN M. SHIPP 21 n~ n~~~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Carolyn Romaine Byers Keck Lineal 17,291.55 3723 Montour Street Harrisburg PA 17111- 2 Elizabeth Ruth Byers Mitchell Gilbert Lineal 17,291.54 101 South Millbach Road Newmanstown PA 17073- 3 Donna Jean Shipp Comstock Lineal 17,291.54 6207 South Smith Lane Spokane WA 99223- 4 Robert Craig Shipp Lineal 17,291.54 19 Town Oaks Place Bellaire TX 77401- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (11 more space is needed, insert additional sheets of the same size) r ',iX a-v', r" "c'- ~+' y ~, ` M~ ~}f~C' `i` ~T ~~;+R F ~~ _ .. .,rr ,.~.. - ~. his Sj ,,`:~,~YSF. 4 ... J ~l' BTB~+ART ` ` ~...,•,._." k.v 1~'... ~w :. ~ ~`%h `~'+~tt. ^f y,~'-k s,r r1'_~ ''~. ,~,~s~~ `r ,,i i~RSY~1 ~7 ~ ~.,~~~':~•~k` h -~ r d'a n7 $~' ~'v ~ `k ~. '.~_ t i ~ i"~ 'C r ~~ ~ ~'ara" 4 " ~ '"~~, ~A+~~ ~,r ?l~-.~ mot: yj {-- _:~, r~ ~~++."/ fip. _ ~ v'' ~_1..( _~ _ ' --'7;;~~~ __ t_i .. _'~~' J.J O `. 1. ~ \~ ..i l LAST WILL AND TESTAMENT '_~ ~ ~ j '_ ~ D N _ ,"_:i OF w ~ CAROLYN MORROW SHIPP I, CAROLYN MORROW SHIPP, of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate, of every nature and wherever situate, to my husband, RICHARD EDWIN SHIPP, if he survives me by thirty days . ~~ • ~ ~ L~~ ~ y ITEM II: If my husband, RICHARD EDWIN SHIPP, fails to survive me by thirty days, I devise and bequeath all of my estate of every nature and wherever situate as follows: A. One-fourth to my daughter, CAROLYN ROMAINE BYERS KECK, if she survives me by thirty days. If my daughter, CAROLYN ROMAINE BYERS KECK, fails to survive me by thirty days, I devise and bequeath her share to her issue, per stirpes, living on the thirty-first day following my death and in default of such issue, her share shall be added to and treated as apart of the other shares created under this ITEM II. fTONE, fAJER ! fTEWART Attor~ay at Law 414 irid~a Stmt New I:uTMeland, -a. 17070 B. One-fourth to my daughter, ELIZABETH RUTH BYERS ""-+-+~=R-cRTL., ~>>) bzY-~ Page 1 of S pages J G`i 1 be-rt ELIZABETH RUTH BYERS ~,, fails to survive me by thirty days, I devise and bequeath her share to her issue, per stirpes, living on the thirty-first day following my death and in default of such issue, her share shall be added to and treated as a part of the other shares created under this ITEM II. C. One-fourth thereof to my stepdaughter, DONNA JE~'f~T SHIPP COMSTOCK, if she survives me by thirty days. If my step- daughter, DONNA JEAN SHIPP COMSTOCK, fails to survive me by thirty days, I devise and bequeath her share to her issue, per stirpes, living on the thirty-first day following my death and in default of such issue, her share shall be added to and treated as a part of the other shares created under ` this ITEM II. D. One-fourth thereof to my stepson, ROBERT CRAIG SHIPP, if he survives me by thirty days. If my stepson, ROBERT CRAIG SHIPP, fails to survive me by thirty days, I devise and be- queath his share to his issue, per stirpes, living on the thirty-first day following my death and in default of such issue, his share shall be added to and treated as a part of the other shares created under this ITEM II. ITEM III: I direct that all taxes that may be assessed in conse- quence of my death, of whatever nature and by whatever jurisdiction imposed, TON[,fAJ[R shall be paid from my residuary estate as a part of the expense of the ! iT[w ART ttorn.rs.t 1.aw I; 1lrfd~. Str.at ~ camt»n.na. ~,. Page 2 of S pages no~o administration of my estate. rroNe, sw~ire a sTiwwwT AttorMys ~t I.aw 414 •rid'~ ftn~t Now Comta•r1aeA, -a. 17070 ITEM IV: I appoint my husband, RICHARD EDWIN SHIPP, Executor of this my last will. Should my husband, RICHARD EDWIN SHIPP, fail to qualify or cease to act as Executor, I appoint CARUI.YN ROMAINE BYERS KECK, ELIZABETH RUTH G. I be-~-t BYERS ?4~~8€7£, DONNA JEAN SHIPP COMSTOCK and ROBERT CRAIG SHIPP, Executors of this my last will. ITEM V: I direct that my executor and his successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of re ~ 1981. (SEAL) Carolyn rrow Shipp SIGNED, SEALED, PUBLISHED and DECLARED, by CAROLYN MORROW SHIPP, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. Witness Address Y ~u~ ~ ~~-~ itness Address ---~ Page 3 of 5 pages ... ... _ _. .,-__,._.. _. __.. _.,:..,..Y COMMON[dEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) I, CAROLYN P10RR041 SHIPP, Testatrix whose name is signed to the attached or foregoing instruu~ent, having been duly qualified according to law, do hereby acknowledge that I signed and executed this 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 contained. olyn orrow Shipp Sworn or affirmed to and acknowledged before me by CAROLYN MORROW SHIPP, the Testatrix, this ~ day of ~ jrtle~YU , 1981. (~AgCEf Y. kc'~iryPtlbUe My Oea~~ 1 pp. ~~ 1982 Nan CMno~ApM. ~' {TONE, fAJ[R ! fTEWART AttOtf~Yt st t.aw 414 tridH itn~t Vow CurnNrl~nd, ~~. 17070 Page 4 of 5 pages ..... _. .. I COMMONt~'EALTH OF PENNSYLVAI3IA ) SS: COUNTY OF CUMBERLAND ) We, and the witnesses whose names are signed to the attached or foregoing instrument, ~I being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her last will; that testatrix signed willingly and th:~t 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; that to the best of our knowledge the testatrix was at the time eighteen or more years of age, of sound mind and under no constraint or undue influence. r'~ Sworn or affirmed to and subscribed to before me by and ___ _ witnesses STONE, SAJER C, STEW ART AttorneYS at taw 414 Briuye Street New Cumberland, Pa. 17070 this ~ day of ~~~h 1981. FRANCES Y. : fi~'~t) PubUc Nty Commissipn, ns Dec. ~6 198: 'New Cumcerlaia, • CMWlF1M~4 0~. Page 5 of 5 pages Sir~:c:~:~.s ~ cur~~~rc~. ~ cc~r~ ~x~t~ }rn~~r,~t~ ~}~c~~" ------ -------- ---------o - ---- - --- -- -- P.O. Box 841005 Boston, MA 02284 September 24, 2008 Stone LaFaver & Shekletski Attorneys at Law P.O. Box E New Cumberland, PA 17070 RE: Estate of: Carolyn M. Shipp Date of Death: July 13, 2008 Dear Ms. Stone: Per your request, enclosed please find the account information as of date of death for the above-named decedent. Please note the balances do not include accrued interest. If you should have any further questions, please do not hesitate to call. Very truly yours, ~:~ Linda Spavento Team Leader Court Order Processing (617) 533-1789 (617) 533-1931-fax Sovereign Bank ESTATE OF Carolyn M Shipp SOCIAL SECURITY #: 168-24-2702 DATE OF DEATH: July 13, 2008 Account #: 2331025657 Type: Checking Open date: 3/30/1982 In the name of: Carolyn M Shipp or C Romaine Keck or Elizabeth R Gilbert Date of Death Balance: $138,316.30 Int.(YTD) from 1/1/2008 to 7/8/2008 $9.40 Accrued interest to date of death: $1.51 Other Info: C Romaine Keck & Elizabeth R Gilbert added 11 /13/06 Account #: 1055162083 Type: CD Open date: 8/10/1999 In the name of: Carolyn M Shipp Date of Death Balance: $11,628.47 Int.(YTD) from 1/1/2008 to 6/30/2008 $229.41 Accrued interest to date of death: $17.85 Other Info: Account #: 1055541781 In the name of: Carolyn M Shipp Type: CD Open date: 3/9/2007 Date of Death Balance: $0.00 Int.(YTD) from 1/1/2008 to 3/18/2008 $31.45 Accrued interest to date of death: $0.00 Other Info: closed 3/18/08 for $3,892.48 deposited into 2331025657 Page 1 of 1 rrvm: '~~f. Sun '~~'~ ~¢~., Life Financial April 7, 2009 Stone LaFaver & Shekletski Attention: David H. Stone Via Fax: (717) 7743869 RE: Regatta Platinum Fixed/Variable Annuity Contract Number 79-7900-242814 Carolyn M. Shipp Owner Carolyn M. Shipp Annuitant U4/UtS/1UUy U6:U1 #7B8 P.001/001 Dear Mr. Stone, Thank you for your recent request for information regazding the contract referenced above. We are pleased to assist you. Please note that because July 13, 2008 was not a business day, we have provided you the value as of close of business on July 11, 2U08. As of July 11, 2008, this annuity had an Account Value of $19,607.59. We hope this information has been helpful. If you have any questions, please contact our Customer Service Department at (800) 752-7215. Sincerely, Yvonne Hill Correspondence Representative 79603466 i ~o~ ~-r3-v8 lr~ inl~'1 `7-(~ (`~ ~o ~. 5q ~.~y l~y(~3~~~ i did bap ~ ~- rrom. 04/02/2009 11:12 #719 P.001I001 ~11~6 ~~ Sun Life Financial Apri12, 2009 Stone LaFaver & Shekletski Attention: David H. Stone Via Faa: (717) 774-3869 RE: Regatta Platinum Fixed/Variable Annuity Contract Number 79-7900-242814 Carolyn M. Shipp Owner Carolyn M. Shipp Annuitant Dear Mr. Stone, Thank you for your recent request for information regarding the contract referenced above. We are pleased to assist you. As of July 14, 2008, this annuity had an Account Value of $19, 463.75. July 14, 2008 value is provided because July 13, 2008 was a Sunday. We hope this information has been helpful. If you have any questions, please contact our Customer Service Department at (800) 752-7215. Sincerely, 6 Suzanne Webb Correspondence Representative 91995004 p.1 September 23. Z00 Sun Life Financial POBax9133 Wellesley Mills, Vla,sachusetts 112481 FA7i: TRANSMISSION ONLY 781-3d~#-53133 ATTN: Policy Services Claim R1C: Letter of Instruction Policy Number: ~0-74'-7900-242$114 Claim Number: 5L-175273 Deceased: ~'arolyn h'i. Shipp Dear Sir or Iv[addrn. This Letter cf lnstrt-etion ser~~es as z _zquest from the benetici~ries listed beiaw to receive .infnrrnation on the referenced policy and their respe:ctiv~ portion of the claim_ Each benefc:aty also ins`n~~ts and authorizes rolease of any policy/claim information to David N. Stone, Esquire to ~r.,sist in proczs:~in~ the claim. A cope of d:e policyholder`s ce«~~ cerFifieate is beinb faced with this letter. Sincerely. Cap olyn Romaine ]{eck. Elizabeth Ruth Gilbert 50-79-790ll-? 123 t 4 (1'o{ic~ Number) C~aruly+: FumaiRC Kc:t:l: (Beneficiary Name) X723 Montour Stree- Narrisbur~~_ Ye~~nsylvania 1701 1 ~ 0-79-7900-2428 ] ~} (Policy Number) Elizabeth Ruth Gilbert (B~rtieficiary Name) IOI .South Mil(bach Road t~'ewmansiau-n, Pennsyh~ania 17073 (Senefici.+ry .Addres,) Daughter (Beneficiary Address) Daughter (ltelati+~n to Dcce~aed; t'oli•.yholder) (Relation to Deceased/Policyholder) 611)1 7224 (Beneficiary List 4 Digits SSN} +;13eneticia+y Last 4 DtQlcs SSN) ., 11 ~S13IUP ~~~J ~ dtP SI • 7Rtli('2 a[2 23/09 '0$ TI1E 15:31 lTS/RX NO 5805) April 2, 2009 David Stone Stone LaFaver to Shekletski PO Box E New Cumberland PA 17070 Subject: Estate of Carolyn Shipp Dear Mr. Stone: This letter is in response to your letter dated March 31, 2009 ooncerning the Estate of Carolyn Shipp. At the time of her death, Carolyn Shipp held contract 9124521 with Thrivent. Carolyn was the owner on this contract. The date of death value was 56,935.09. The cost basis was 54,422.28 and the tax gain was 52,512.81. The beneficiaries were Carolyn Romaine Keck and Elizabeth Ruth Gilbert. Please let us know f f you have any questions. You may reach us at 800-847-4836. Sincerely, D~ ~ ~ Deb Wenninger, ALHC, ACS Advanced Claims Examiner, Centralized Service Team Death Claims and Service Life and Health Product Service Operations Department, FSO dkw Carolyn M Shipp, deceased, 504181272; STONE LAFAVEI3 &SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E GERALD J. SHEKLETSKI NEW CUMBERLAND. PA 17070 ELIZABETH B. STONE www.stonelaw.net April 13, 2009 Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Carolyn Morrow Shipp Social Security No. 168-24-2702 Estate No. 21-08-0916 Greetings: OF COUNSEL CHARLES H. STONE JON F. LAFAVER TELEPHONE (717) 774-7435 FACSIMILE (717) 774-3869 n ~a a I ..y _;y3 j" ~ i"tl ~- ~ -- .C" s_"~ -~ ~ ; t•-r l c;;~~ _- U~ ,=. 'y, ' a ~ -~1 ~ ... 1 t .l __. ~ Please find enclosed an original and one copy of the Inventory and Inheritance Tax Return in the above captioned estate. Please clock in the copy of the Inventory and send it back to our office with the receipts in the enclosed stamped addressed envelope. Also, enclosed is one estate check, in the amount of $30.00 for filing the return and inventory. Please note that these documents are being sent United States Postal Service on April 13, 2009. Thank you for your attention and assistance in this matter and should you have any questions, please call our office. Very truly yours, STONE LaFAVER & SHEKLETSKI f `9a ridr DHS/jam Enclosures w0 rno 300 I m ~ N IWN~o ~~ ~O~o dOaa rSG ~} N ~o ~~~` ~i N ~ LL W 0 r~ ` a~w ~S~1M(1 0 0 ~ O LU . r-- `~ ~j H ~~ L' . ~~ ~ t '-- .' ~ '~ E.i_ ~} C_7 O C ~ ~ -. - {= !t+ L.,. ~ W Z f_7, Vii- r.~ /~ A ~=F ~ ~~ '~~~ CY. ~:. ~ i ~.. ~..~ Q .C. _~ t~__ ~ ° p~ U ~ CV w ~ o aW o x F- w ox~OoQ. N ~ ~ m 0 ~ °~ w U Q O W 0 LL ~ ~>OC~m J ¢ ~ o ~ .a a d v w z ~ O Z H N Ul O U ~ 4-1 ~ ~ O O U N cn ~~~- rl ~ '~ O r-I ~ ~' l~ •~ ~cA~ 3 O 4-I U m a O ~ O ~ «i .~ N 0~+~~ +~~~~ N N ~ •rl •~ ~ O .-1 ~ ~ U ~ P4Ur-U