HomeMy WebLinkAbout05-27-09~ REV-7 500 1505607120
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue county tees vea. File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 8 1 0 4 1
PO 80X.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
10022008 05191929
Decedent's Last Name Suffix Decedent's First Name MI
TYLER SR RONALD G
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name SufFlx Spouse's First Name MI
TYLER MARY L
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Odginal Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death
pdOr to i2-13-92)
^ 4. Limited Estate ^ 4a. Future Interest Compramlee ^ 5. Federal Estate Tex Retum Required
(Cate of tleeth edar 1242-e2)
0
® S Decedent Oled Testate ^ ~ Decetlenl Melnlalnetl a Livlnq Trust 8. Total NUmber Of Safe De Sit 80x88
(Attach Copy of w71q (Attach Copy of TmeO ~
^ 9. Liggaticn Proceeds Received ^ 10. spousal PweM cra0n (eats a seem 11. Election to tax untler Sec. 9113 A)
beNVeen 1231 1 antl i-0-a5) ^ (Attach Sch. O) (
CORRESPONDENT • THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
STEVEN P. MINER ESQUIRE 7177249821
Firm Name (If Applicable)
DALEY ZUCKER MEILTON MINER &
First line of address
1035 MUMMA ROAD, SUITE 101
Second line of address
Ciry or Post Office
WORMLEYSHURG
State ZIP Code
PA 17043
N
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'fYATE FILED - ~ ~ ~
correspondent's a-mail address: sminer@dzmmglaw.com
Untler penalties of perjury, I dedere that I have examined this return, including accomparrying schedules antl stetemanta, and to the best of my knowledge and belief,
It is ime, wrrect eM complete. Dedaredon of preperer other than the personal representative is based on mation of which preperer has any knowledge.
L.
28 N. 20th Str~ei~ Camp Hill, PA 127011
iIGNATURE OF PRE ARER ER THAN REPRESENTjt'1,I~E -
Steven P. Miner Esquire ~ ~ ~ 4 ~ (~
1035 Mumma Road, Suite 101, Wormleysburg, PA 17043
L S1de 1
1505607120 1505607120 J
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1505607220
REV-1500 EX
Decedent's Social Security Number
o.~wem'.N....: TYLER, RONALD G SR
RECAPITULATION
1. Real Eslate (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 8 Miscellaneous Personal Property (Schedule E) .............. .. 5.
51,272.67
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ........... .. 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 2 0
2 1 0
6 4
(Schedule G) ^ Separate Billing Requested ........... .. 7, ,
.
8. Total Gross Asaeta (total Lines 1-7) ..................................................................... .. 8. 7 1, 4 8 3. 3 1
14,321.00
9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... .. 9.
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. .. 10.
1 t. Total Deductions (total Lines 9 8 10) .................................................................... .. 11. 1 4, 3 2 1. 0 0
12, ( )
Net Value of Estate Line 8 minus Line 11 ...........................................................
.. 12. 57,162.31
13. Charitable and Governmental 8equestslSec 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. 5 7 , 1 6 2 . 3 1
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under See. 9116
(a)(1.2) X .o0 3 8, 6 8 6. 4 8 i s. 0. 0 0
16. Amount of Line 14 taxable 18 , 4 7 5. 8 3 16 8 3 1. 4 1
at lineal rate X .045 .
17. Amount of Line 14 taxable
at sibling rate X ,12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ..................................................................:................................................. . 19. 8 3 1. 4 1
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
L 1505607220 1505607220 J
REV-1500 EX Page 3
Decedent's Complete Address:
FIIe Number 21 - 08 - 1041
Tyler, Ronald G Sr
STREET ADDRESS
28 N. 20th Street
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 831.41
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 350.00
C. Discount 18.42
TotalCredits (A+B+C) (z) 388.42
3. Interest/Penalty if applicable
p. Interest
E. Penaky
Total lnterest/Penalty (D+E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q]
Check box on Page 2 Llrie 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 482.98
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 46 2.99
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 :.................................................................................. x
b. retain the right to designate who shell use the property transferred or its income :....................................
c. retain a reversionary Interest; or ..:............................................................................................................... x
d, receive the promise for life of either payments, benefits or cere7 .............................................................. x
2. If death oaurred 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 death7......... ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or othernon-probate properly which
contains a beneficiary designation9 ...................................................................................................................... ~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
or dates of death on or after July 1, 1994 end 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 tleath on or after January 1, 1995, the tax refs 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 rata imposed on the nel 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-halt (q.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 forlhe use of the decedent's siblings is twelve (12) percent p2 P.S. §9116 (a) (1.3)]. A
sibling is defined under Sedian 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSriVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Tyler, Ronald G Sr 21 - 08 - 1041
Include the proceeds of litigation and the date the proceeds were received by the estate. All property Iointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER .DESCRIPTION
DEATH
1 ~ Sovereign Bank Money Market Account #1054168547 ~ 40,636.01
Accrued interest to date of death ~ 16.53
2 ~ Members 1st Federal Credit Union Certificate of Deposit No. 2759-41 ~ 10,507.52
Accrued interest to date of death ~ 1.13
3 Members 1st Federal Credit Union Savings Account No. 2759-00 111.48
TOTAL (Also enter on Llne 5, Recapitulation) 51,272.67
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCETAXRETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Tyler, Ronald G Sr
FILE NUMBER
21-08-1041
This schedule must be completed and flied If the answer to any of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Induce the name of Me trenelerea, weir reiaWnsMV to °ea,ae,n
entl the tlete oftreneler. A°echempYathe deee br reel eateta. DATE OF DEATH
VALUE OF ASSET %OF
Dew's
INTEREST EXCLUSION
OF APPLICABLE)
TAXABLE VALUE
1 Members 1st Federal Credit Union IRA No. 2759-16, 3,238.15 100% 3,238.15
Mary L. Tyler (spouse), beneficiary
2 Thrift Savings Plan Account No. 7504 3733 54568, 7,421.91 100% 7,421.91
Mary L. Tyler (spouse), beneficiary
3 The Hartford, Annuity Contract No. 710011306, Mary 9,550.58 100% 9,550.58
L. Tyler (spouse), beneficiary
-
TOTAL (Also enter on line 7, Recapitulation) 20,210.64
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEUENT
SCFEDUI.E H
~F~U~~pE~ R~A~L~D~~E~TVSES &
/"UJI~A`aF71 rW I IYG
ESTATE OF Tyler, Ronald G Sr FILE NUMBER
21-OS-1041
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
FUNERAL EXPENSES: AMOUNT
A. 1 Musselman's Funeral Home 4,659.00
2 VFW -Funeral Luncheon 500.00
3 Organist, soloist, obituary 900.00
4 Honor Guard 500.00
5 Columbarium for placement of ashes 680.00
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Social Secudry Number(s) / EIN Number of Pesonal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorneys Fees Daley Zucker Meilton Miner & Gingrich, LLC 3,325.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Mary L. Tyler 3,500.00
Street Address 28 N. 20th Street
city Camp Hill state PA zip 17011
Relationship of Claimant to Decedent SpOUSe
a. Probate Fees Register of Wills of Cumberland County 144.00
5. Accountant's Fees
6. Tax Return Preparers Fees
7. Other Administrative Costs
1 The Paxton Herald, advertise Estate Notice 38.00
TOTAL (Also enter on Ilne 9, Recapltulatlon) 14,321.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA% RETURN
Sd~edl.de H
A,.~,..~F,u,~',te~181_E~¢>ertses &
I"laa 1 ~ ~YCIY~ ~~
ESTATE OF Tyler, Ronald G Sr FILE NUMBER
21-OS-1041
Cumberland Law Journal, advertise Estate Notice
75.00
Page 2 of Schedule H
REV-061~ EXa (8-00)
SCHEDULE J
COMMNIiERITANCE TTAX RETURN ANIA ~ BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF Tyler, Ronald G Sr FILE NUMBER
21-08-1041
NUMBER NAME AND ADDRESS OF PERSON S
() RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY Da Na u•t Tru•b•(•)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions and transfers
under Sec. X116 (a) (1.2)]
1 Mary L. Tyler Wife 50
28 N. 20th Street
Camp Hill, PA 17011
2 Nancy J. Tyler Daughter .10
608 Bridge Street, Apt. #1
New Cumberland, PA 17070
3 Ronald G. Tyler, Jr. Son .10
955 Pennsylvania Avenue
Harrisburg, PA 17112
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
REVd81]EX~pI-00)
SCHEDULE)
COMM
ANNA
N R
TA BENEFICIARIES continued
NIIE
I
NCE TAXRETURN
RESIDENT DECEDENT
ESTATE OF Tyler, Ronald G Sr FILE NUMBER
21-08-1041
NUMBER NAME AND ADDRESS OF PERSONS
O RELATIONSHIP TO
DaC~DNN
T SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY ~
~
et~l
I, TAXABLE DISTRIBUTIONS [include outright s ousel
dlstnbutlons and Pransfers
under Sec. X116 (a) (1.2)]
4 Patricia L. Kautz Daughter .10
323 Elgin Circle
Mechanicsburg, PA 17055
5 Judith A. Russell Daughter 10
765 South Catherine Street
Middletown, PA 17057
6 Connie Tyler Daughter 10
17 Salisburg Road
Surrey, England KTV-7DF
Page 2 of Schedule J
i ~
~ ~ ~I
OF
RONALD TYLER, SR.
I, RONALD TYLER, SR., of 28 North 20th Street, Camp Hill,
Cumberland County, Pennsylvania 17011, being of sound and disposing
mind and memory, do hereby make, publish and declare this for and
as my Last Will and Testament, hereby revoking any and all wills
by me at any time heretofore made.
ITEM I - I direct my Executor, hereinafter named, to
pay all my just and lawful debts and funeral expenses out of my
personal estate as soon after my decease as is convenient.
ITEM II - I give and bequeath all the rest, residue and
remainder of my Estate, wheresoever situate, as follows:
A. One-half (1/2) to my wife, MARY
TYLER; and,
B. One-half (1/2) to my five children:
JUDITH ANN RUSSELL, of Harrisburg,
Pennsylvania; PATRICIA KAUTZ, of Mt.
Allen Drive, 1 Mechanicsburg,
Pennsylvania; CONSTANCE SUSAN TYLER,
..'S. I
of England,; NANCY J. TYLER, of West
Fairview, Pennsylvania; and, RONALD
G. TYLER, JR., of Enola,
Pennsylvania, in equal shares, or to
the survivors or survivor of them.
C. If my wife, MARY, predeceases me,
then i give devise and bequeath her
share of the rest, residue and
remainder of my Estate, real personal
and mixed, wheresoever situate to my
five children above-named, in equal --
shares, or the survivor or survivors
of them.
ITEM III - All federal, state and other death taxes,
paya$le because of my death with respect to the property forming
my gross estate for tax purposes, whether or not passing under this
will, including any interest or penalty imposed in connection with
such tax, shall be considered part of the expenses of the
administration of my estate and shall be paid from my estate
without apportionment or right of reimbursement. All such taxes
on present or future interests shall be paid at such time or times
as my Executor may think proper, regardless of whether such taxes
are then due.
2
ITEM IV - I nominate and appoint my wife, MARY TYLER, as
the Executrix of this, my Last Will and Testament. If she should
predecease me or should be unable to serve as the Executrix of my
Last Will and Testament, I nominate and appoint DAUPHIN DEPOSIT
BANK AND TRUST COMPANY, as the Successor-Executor of this, my Last
Will and Testament.
ITEM V - I direct my Executrix retain the services of
RICHARD C. RUPP, ESQUIRE, to represent my Estate, because of his
familiarity with my affairs.
ITEM VI - No bond or other security shall be required of
any Executrix, Trustees, or other Fiduciary appointed in this Will.
ITEM VII - 2 direct that my body be buried in Indiantown
Gap National Cemetery.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
3
cS
~~ / Sd- day of l~ ~ , 1990, at 1M,Q c ~A N;c s b,,~~ ~
Pennsylvania.
~.~~
Witnesses:
~~~.... ~ ~' ' ``^•7?P residing at ~/a "" ~ ~ ~/ ~~-.
l~'- V ~~. residingat_ 4~ ~~5~'Jy ~S ~~
~ ~ • ~_ residing at ~,r~ ,
4
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF•-HAt1pHf1~" C.,,,,,,.~a.,.la,,.~p ,
I, RONALD TYLER, SR., Testator, whose name is signed to the
attached or 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 willingly; and that
I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged before me by RONALD
TYLER, SR., Testator, this 3'/,c !- day oP rn~ , 1990.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~BAEFPH-IN ~'-~+~--•P ;
Not ry Public
._..__..._...~_..,.~......_.,_.....w....
((jjf R'q?F~~!1rtL SFAL~~ (SEAL)
UIRG!tJiei U. ~:Ui97~ ~i, hgTAFiY ~U~LfC
lJ,.,;>c:; ~ Fl;_!.E~! 1>NP., CL'6~9Ft~U1Pd~J Gq.,1'A,
!!!•t'::t;I~gkPi,''i`:~C~iti EXPlNF3ItPFi.2, 1',39.2
~...... SS.._..._..____....,.____..._.........__,....__...,~
We, 2~ c.4 .-~.~ f. yLv 'p , Gaw ~l-i-.. e(,L ~fr ,1~~ to i
and ~ ~ , the w tne~ases whose ~ ames are
signed to~ the 'a~t~-a hed or foregoing instrument, being duly
qualified according to law, do depose and say that we were present
and saw the Testator, RONALD TYLER, SR., sign and execute the
instrument as his Last Will; that he signed willingly and that he
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, RONALD TYLER, SR., signed the Will as witnesses; and that
to the best of our knowledge, the Testator, RONALD TYLER, SR., was
at the time 18 or more years oP age, oP sound mind and under no
constraint or undue influence,
Sworn to and subscribed
before me this ,3/S~-.day
of ~ , 1990.
~.t., ~ 7l <.c,µ
Note y Public
My commission Expires:
(SEAL)
i ' t~ °`~}. rid, ..
~~~~ ~ ~~
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Sovereign Bank
Ronald G. Tyler, Sr.
188-20-7092
October 2, 2008
Account #: 1051138523 Type: Checking Open date: 5/15/2007
In the name of: R G Tyler Sr or Mary L Tyler
Date of Death Balance: $1,712.61
Int.(YTD) from 1/1/2008 to 9/19/2008 $2.50
Accrued interest to date of death: $0.06
Otherlnfo:
Account #: 1054168547 Type: Money Market Open date: 12/21/2006
In the name of: R G Tyler Sr
Date of Death Balance: $40,636.01
Int.(YTD) from 1/1/2008 to 9/19/2008 $424.40
Accrued interest to date of death: $16.53
Otherlnfo: Account closed on 10/22/08.
Page 1 of 1
05/13/2`009 WED 02:14 FAX 7177955178 MEMBERS 1ST FCU INSURANC f~J001
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Totai Prindpal and Accrued Interest
Name of Joint Owner
IRA CERTIFICATE:
Account Number/Suffix
Date Account Established
Princpal Balance at Date of Death
Accrued Interest to Date of Death
Total Pdndpal and Accrued Interest
Name of Benefldary
CERTIFICATE OF DEPOSIT:
Account Number/Suffix
Date Acccunt Established
Principal Balance et Date of Death
Accrued Interest to Date of Death
Total Princpal and Accrued Interest
Name of Joint Owner
Estate of: RONALD G. TYLER
Date of Death: l0/02/2008
Soctal Security Number: 188-20-7092
.SL
2759A0
01/25/1954
$111.48
$.00
$111.48
None
2759.18
08/22/2005
$3,237.91
$.24
$3,238.15
Mary L. Tyler
275941
osroarzoos
$10,507.52
$1.13
$1 D,508.65
None
MOB"ERS 1~ FEDERAL CRE T UNION
Danielle A. Kline
Insurence Services Spedalist
May 13, 2008
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
r'~ THRIFT SAVINGS PLAN Pagel °fz
PARTICIPANT STATEMENT For the period: 07/01/2008-09/30/2008
Please review this statement for accuracy, as the information in it is considered correct unless you notify us. fn rorrect errors on this s4iternent,
please contact the TSP at the Thriftline number below.
831 1 7929073 5 SB 001826 73000001 10/08
0134162 mnr a3~s ••nuro T703110 VO11-3a0126 r3~3051N1
~ur~~~ur~~~uuu~lur~~u~~r~n~r~~uun~~rr~r~~u~r~nlr~
. •" RONALD C TYLER
28 N 20TH ST
CAMP HILL, PA 17011-3801
r.Ci>
Account Number. 7504 3733 54568
Date of Birth: 05/19/1929
Retirement Coverage: CSRS
Employment Status: Separated, dated 12/31/1987
Beneficiary Designation: Yes, dated 03!17/1967
YOUR QUARTERLY ACCOUNT SUMMARY
~ Contn6utions Withdrawals grange in Ending
Balatrce
Brlence and and Interfund Value from Balance
TSP FUNQS (07/01/0~ Additions Deductions Trarofen Previous Quarter (09/30/08)
Individual Furrds
Fund $9,329.40 $0.00 - 5149.94 $0.00 - $1,757.55 $7,421.91
Total $9,329.40 $0.00 - 5149.94 $0.00 - $1,757.55 $7,421.91
How your future contributions and loan
payments were allocated as of 09/30/08:
Individual Fund(s)
C Fund 100%
® I Fund
How your ending balance was distributed
as of 09/30/08 (see pie chart):
Individual Fund(s)
I Fund 100%
TSP Web Site: www.tap.gov
TFIRIFTLINE: 1-TSP-YOU-FRST (1-877-960-3778) • Outside the U.S. and Canada, call 404-233.4400
TDD: 1-TSP-THRIF75 (1-877.847.4385)
How your ending balance is
distributed among the funds
- Account Number. 7504 3733.54568
TRANSACTION DETAIL BY SOURCE Page 2 of 2
For the period: 07/01/2008- 09/30/2008
Payrill Poling
Office Date Traroaction Type Employee Total
Beginning Balance $9,329.40 $9,329.40
07/01/08 Monthly Payment - 49.98 - 49.98
08/01/08 Monthly Payment -49.98 -49.98
08/29/08 Monthly Payment - 49.98 _ gg,98
IncreaseJDecrease in Value -1,757.55 -1,757.55
Ending Balance $7,421.91 $7,421.91
TRANSACTION DETAIL BY FUND
International Stock Index Investment (1) Fund
Number
Ping Tmmaction Slrrc of pillar
Date Tnrradion Type Amount Price Slwres Balance
Beginning Balance $22.0900 422.3357 $9,329.40
07/01/08 Monthly Payment - $49.98 21.7343 - 2.2996
08/01/08 Monthly Payment -49.98 21.0455 -2.3749
08/29/08 Monthly Payment - 49.98 20.3833 - 2.4520
Ending Balance $17.8751 415.2092 $7,421.91
Form TSP-8(10/2006)
STATEMENT OP PAYMENT cneok No. 114154950
FOR: BENEFIT PROCEEDS FROM ACCOIINT N0.
710011306
To change your withholding on future distributions, please contact
Hartford Life. Withholding too little may result in tax penalties.
000335
MARY L TYLER
28 N 20TH ST
CAMP HILL PA 17011
11/13/2008
GROSS AMOIINT
Federal Tax Withholding
State Tax Withholding
NET AMOUNT
Federal Taxable Amount
9,550.58
1,807.67-
269.23-
7,453.68
7,230".68
The Hartford Life insurance Companies
Attn: Individual Annuity Operations
P.O. Box 5085
Hartford, CT 06104-5085
800-862-6668
Fam ELQ214
TxE
HARTFO1tD
011000884 01 M80.389 "AUfO TS 0 2820 17011-0901 IACL 0
II Il llllllll 11 lllillllllll 11 llllll lllhll llll 11 l'lllil ~I III III
RONALD G TYLER SR
28 NORTH 20TH STREET
CAMP HILL PA 17011-3801
Date: November 12, 2008
Contract Number: 000000000/710011306
Type of Contract: Non-Qualified
Owner Name: RONALD G TYLER SR
Annuitant Name: RONALD G TYLER SR
.Your Putnam Hartford: Capital Manager variable annuity
financial confrmation
The total value of your annuity on November 12; 2008 is $0.00
Death Benefit Adjustment
Trade Date: November 12, 2008
Unit
Investment Choice(s) Units Value Amount
Fixed Accum 3% Min 3.00% $3,465.99
Put VT Gbl Equity 60.925 14.840673 $904.17
Put VT Grwth&Incm 41.034 31.215545 $1,280.91
Put VT I-IiYield 31.178 26.583819 $828.82
For assistance
For investment-related questions contact your Investment Professional(s):
Stephen L Hood at Financial Network Inv Corp
For general information on Hartford products or services:
Visit www.putnam.com or call 1-800-521-0538 (Monday through Friday 8:30 a.m. to 8:00 p.m.,
Eastern Standard Time) or write to The Hartford, P.O. Box 5085, Hartford, CT 06 102-5085.
PUT NAM INVESTMENTS
'The HnrtjorY!" is l7ie Hanjorcl Finmlcial Services Group; 1nc., and its Subsidiaries, including 7lie issuing companies of
Hartfo7d Life Insumnce Compnny and Har7jord Lije and Almuity Insu7ance Company.
Date: November 12, 2008
Contract Number: 000000000/710011306
Type of Contract: Non-Qualified
Owner Name: RONALD G TYLER SR
Annuitant Name: RONALD G TYLER SR
We are issuing this confirmation statement on behalf of the selling broker-dealer. Hartford Life
acrd Anrmity Insurance Company -Issuer; Hartford Securities Distribution Company, b~c. -
Principal UrJderwriter.
„ .
\~ 1~/~/
J. Stewart Hardy. Ph.D.
s F.NlOR PASTOR
John H. Brock, M.Div.
AssOC1ATE PASTOR
T` , Nancy R Easton, M.Div.
I Y ASS IST.ANT PASTOR
to Church Guy S. L-droiston, Jr., D.D.
SUPPORT PASTOR IN RESIDENCE
October 8, 2008
Mrs. Mary Tyler
28 N. 20'" St.
Camp Hill PA 17011-3801
INVOICE
Chazge for purchase of Certificate of Right of Inumment in the columbarium at Trinity Lutheran
Church, Camp Hill, PA:
Purchase of columbarium niche certificate
Total amount due
$680.00
$680.00
If you have any questions about this invoice, please feel free to call me at the church.
~~~
~ ~ ~
V`GZt~~/O ,j
Paul Hensel
Financial & Property Administrator
2000 Chestnut Street, Camp Hitl, Pennsylvania 17011 ~
PHONE 717.737.8635 • Fax 717.730.9297 • E-Maa trinluthC~trinitycamphill.org • weeslrE wwwtrinitycamphill.org
~ Cf)MMLNWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TA%ES
DEPT. 280601
HAggISBURG, PA 111280601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 010724
TYLER MARY L
28 N 20TH STREET
CAMP HILL, PA 17011
- fall
ESTATE INFORMATION: sSN: 188-20-~o9z
FILE NUMBER: 2108-1041
DECEDENT NAME: TYLER RONALD G SR
DATE OF PAYMENT: 01/02/2009
POSTMARK DATE: 12/31 /2008
couNTV: CUMBERLAND
DATE OF DEATH: 10/02/2008
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 5350.00
REV-1162 EXIT 1-96)
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTORNEY
CHECK#503
INITIALS: AJW
SEAL RECEIVED BY:
5350.00
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
' E ~ ` THE PAXT4N HERALD
FBX TV ~'~°^ K'°b'tl,a EM bM, W,WUry M,T1i-wOw
(717) 657-3523 ?~ ~ S5 ore
Office & Plant - (PO Box 6310) 101 Lincoln Street ( ) as-ssao
Harrisburg, PA 17112 (717) say-8762
STATE OF PENNSYLVANIA
COUNTY OF DAUPHIN
Before me, the subscriber, a Notary Public in and for the said County,
personally came Lisa M. Carnes who, being duly sworn, doth depose
and say that she is ~LERg of THE PAXTON HERALD, a
newspaper of general circulatiou published in Harrisburg, Pennsylvania;
That THE PAXTON HERALD was established on the 28th day of
June, 1960, and has been published continuously since that date;
That the advertisement, of which a copy is attached hereto, was
published in the advertising columns of THE pAXTON HERALII~~m
all respects as ordered in the issue(s)of IJ~ID;l~~l7,h~ ~1~ ~~'j7~:
Affiant further deposes that she is not interested in the subject matter of
the aforesaid notice or advertisement, and that the allegations in the
foregoing statement as to the time, place and character of publication
are true.
~/i ~i
(S1 aNro of the Affiant)
Sworn and subscribed before me this day of
NOTARIAL SEAL
CARRIE JEAN SINGER, NOTARY PUBLIC
LOWER PAX7'ON TWP„ DAUPHIN COUNTY
MY COMMISSION EXPIRES SEPT. 7, 2010
STATE NOTICE
TICE IS HEREBY GIVEN
9ttare testamentary have
granted in the fol owing,
a. All persons Indebted to
rid Estate ere required to ~,
and those hay-
;ams.or demandsto ~.
tnt the same without
to the Ezeeutrix/Attomey
d below.
rte o} Ronald G. br, Sr.,
r,~}yylCIvvesunmberland County,
. Etmenutriza ~ L.o2'
Steven P. Miner EEss~~ulre
ALEY ZUCKER I~IEIL70N
MINER & GINGRICH, LLC
Mumma Road, Suite 701
Worrnleyeburg, PA 17093
i&10,121], 12-24
....
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since Januazy 2, 1952, been regulazly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regulaz editions and issues of the said Cumberland Law
Journal on the following dates,
November 14 November 21 and November 28 2008
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication aze true.
Coyne,
SWORN TO AND SUBSCRI$ED before me this
28 day of November. 2008
Tyler, Ronald G., Sr., deed.
Late of Cumberland County.
Executrix: Mary L. Tyler.
Attorneys: Steven P. Miner, Es-
quire, Daley Zucker Meilton Min-
er & Gingrich, LLC, 1035 Mumma
Road, Suite 101, Wormleysburg,
PA 17043.
Notary
NOTARIAL SEAL
DEBORAFI A COLLINS
Notary Public
CARLISLE BORO, CUMBERLAND COUNTY
My Commission Expires Apr 28, 2010
I W .O.//~~ T M
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