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HomeMy WebLinkAbout09-21-09s 15056D7121 REV-1500 EX 06 ( -05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 County Code Year File Number Harrisburg, PA 17128-061)1 RESIDENT DECEDENT 2 1 0 8 0 1 2 7 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 1 2 6 2 0 0 8 0 4 0 1 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI L U T Z M A R G A R E T E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required Q 6 Decedent Died Testate ~ death after 12-12-82) 7 D d . . ece ent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 Firm Name (If Applicable) _ o _, I R W I N & M c K N I G H T P C First line of address 6 0 W E S T P O M F R E T S T R E E T Second line of address City or Post Office C A R L I S L E State ZIP Code P A 1 7 0 1 3 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer othreL~ian the personal representative is based on all information of which preparer has any knowledge SIGt)(/~F(1RE Of PERSON RE$P9NSIBLE FOR FILING RETURN ,,.T~ REGI,l~E&.DF WILLS~tISE ONL-Y : ~ ~ _ CJ ~ ~ _ .~3r~ N `?- Z ~ .M , C> ~ W --~ -, -Y'~DATE FILED ADDRESS C/ - 5 PERSIMMON DRIVE BOILING SPRINGS PA 17007 SIGNATUR F/P~E,~PA~RER OTHER THAN EPRESENTATIVE f ~ 60 WEST P~M,~RET STR CARLISL PLEASE USE ORIGINAL FORM ONLY PA 1701 1505607121 Side 1 1505607121 J 1505607221 ~~, b b~ , ~,~,o,~v~- ~~~ ~~~~ -~~p'd ~ REV-1500 EX Decede~rs Name: MARGARET E• L U T Z Decedents Social Security Number RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 1 5 5 '0 0 0 . 0 0 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 2 8 0 5 3. 5 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 8• 7. Inter-Vivos Transfers & Miscellaneous N Probate Property r Billi h d l G ~ S t R t d S 7 4 8 9 2 8 1 7 1 u e ) epa a e ng eques e ....... ( c e . . 8. Total Gross Assets (total Lines 1-7) ........................... 8. 7 7 2 3 3 5. 2 1 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 4 3 1 4 1. 9 6 10. Debts of Decedent, Mortgage Liabilitles, & Liens (Schedule I) ............ 10. 1 5 0 8 1. 2 5 11. Total Deductions (total Lines 9 & 10) ........................... 11. 5 8 2 2 3. 2 1 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12• 7 1 4 1 1 2 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ], 1 5 1 1 7 3 8 an election to tax has not been made (Schedule J) .................. 13. . 14. Net Value Subject to Tax (Une 12 minus Line 13) .................. 14. 5 9 8 9 9 4 . 6 2 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) x.o _ 0. 0 0 15. 0. 0 D 16. Amount of Line 14 taxable at lineal rate X .0 _ ~ ~ ~ 16. ~• 0 0 17. Amount of Line 14 taxable ~ ~ 0 0 0 0 at sibling rate X .12 17. • 18. Amount of Line 14 taxable 5 9 8 9 9 4 6 2 8 9 8 4 9 1 9 at collateral rate X .15 . 18. . 19. Tax Due ................................................19. 8 9 8 4 9. 1 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^X Slde 2 j =L 1505607221 1505607221 .. . REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 08 01277 DECEDENT'S NAME MARGARET E. LUTZ STREET ADDRESS 565 F STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 85,000.00 C. Discount 4,473.55 3. Interest/Penalty if applicable D. Interest E. Penalty (3) 0.00 (1) 89,849.19 Total Credits (A + B + C) (2) 89,473.55 Total Interest/Penalty (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 tax due. B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (4) 0.00 (5) 375.64 (5A) (5B) 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 : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ ^X 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ^ X^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ~ ^ 375.64 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. 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. REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET E. LUTZ 21 08 01277 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ______ Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 565 F STREET, CARLISLE, PENNSYLVANIA 155,000.00 APPRAISAL ATTACHED TOTAL (Also enter on line 1, Recapitulation) ~ $ 155 000.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E CASH BANK DEPOSITS & MISC. COMMONWEALTH OF PEN S , , N YLVANIA RN PERSONAL PROPERTY IN RES DENT DECEDEN ESTATE OF FILE NUMBER MARGARET E. LUTZ 21 08 01277 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MEMBERS 1ST FEDERAL CREDIT UNION -SAVINGS ACCOUNT #50134-00 3,326.18 2. MEMBERS 1ST FEDERAL CREDIT UNION -LIFE SAVINGS ACCOUNT #50134-04 4,002.74 3. MEMBERS 1ST FEDERAL CREDIT UNION -CERTIFICATE OF DEPOSIT #50134-41 5,898.49 4. M&T BANK -CHECKING ACCOUNT #718025 44,405.17 5. M&T BANK -CERTIFICATE OF DEPOSIT #31003913903710 13,173.32 6. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT #1675202954 11,970.52 7. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT #1675301590 21,630.82 8. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT #2895394035 16,193.26 9. PERSONAL PROPERTY -SETTLEMENT SHEET ATTACHED 7,453.00 TOTAL (Also enter on line 5, Recapitulation) ~ $ (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 SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MARGARET E. LUTZ 21 08 01277 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 NAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND THE DATEOFTRANSFERATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE( TAXABLE VALUE 1. INTEGRITY LIFE INSURANCE COMPANY 222,749.61 100. 222,749.61 ANNUITY #3100095328 BENEFICIARY: R. GERALD LACKEY 2. NATIONAL WESTERN LIFE INSURANCE COMPANY 41,083.29 100. 41,083.29 ANNUITY #0101039443 BENEFICIARIES: EILEEN HOLTZ JOHN DALLAS AMANDA KRAMMES 3. FORT DEARBORN LIFE INSURANCE COMPANY 105,642.22 100. 105,642.22 ANNUITY #P00000040024 BENEFICIARIES: HUMANE SOCIETY OF HARRISBURG KIMBERLY KRAMMES-STONE ERIC LACKEY 4. EQUITRUST 119,806.59 100. 119,806.59 ANNUITY E00001078212F BENEFICIARIES: ESTATE OF MARGARET E. LUTZ HUMANE SOCIETY OF HARRISBURG YMCA TOTAL (Also enter on line 7 Recapitulation) ~ $ 489 281.71 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET E. LUTZ 21 08 01277 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 1,065.52 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 IRWIN & McKNIGHT 17,000.00 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 306.00 5 Accountant's Fees 6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 620.00 7. REGISTER OF WILLS -FILING FEE 30.00 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 9. THE SENTINEL -ESTATE NOTICE 158.62 10. NOTARY 45.00 11. STEVEN W. BARRETT -APPRAISAL ON REAL ESTATE 325.00 12. MILLER INSURANCE ASSOC. -HOMEOWNERS INSURANCE 2,051.00 13. VITAL RECORDS -DEATH CERTIFICATES 54.00 14. CLOSING COSTS ON SALE OF REAL ESTATE 17,161.28 15. ROWE'S AUCTION SERVICE -PERSONAL PROPERTY COMMISSION & COSTS 2,423.54 16. REGISTER OF WILLS -SHORT CERTIFICATES 12.00 17. D&C LAWN CARE -LAWN CARE 315.00 18. DENNIS STONE -REPAIRS 1,500.00 TOTAL (Also enter on line 9, Recapitulation) $ 43.141.96 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARGARET E. LUTZ 21 08 01277 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 1. CITI CARDS -CREDIT CARD 51.35 2. VISITING ANGELS -NURSING 2,791.25 3. HCR MANORCARE -NURSING 1,029.50 4. EMBARQ -TELEPHONE 69.49 5. PP&L -ELECTRIC 215.17 6. CUMBERLAND-GOODWILL -AMBULANCE 66.55 7. UGI -UTILITY 725.53 8. COMCAST -CABLE 57.23 9. BOROUGH OF CARLISLE - WATER/SEWER 190.44 10. SPECIAL EVENT EMERGENCY -AMBULANCE 133.60 11. JITTERBUG -TELEPHONE 104.28 12. M8~T BANK -REIMBURSEMENT OF OPM CIVIL SERVICE PAYMENT 1,688.74 13. INTERNAL REVENUE SERVICE - 2007 INCOME TAXES 379.33 14. CARLISLE BOROUGH TAX ACCOUNT -REAL ESTATE TAXES 398.79 15. PA DEPARTMENT OF REVENUE - 2007 INCOME TAXES 247.00 TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARGARET E. LUTZ 21 08 01277 Decedent's Name Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, 8- Liens ITEM NUMBER DESCRIPTION AMOUNT 16. 17. PA DEPARTMENT OF REVENUE - 2008 INCOME TAXES INTERNAL REVENUE SERVICE - 200' INCOME TAXES 59.00 6,874.00 SUBTOTAL SCHEDULE I 6,933.00 GRAND TOTAL SCHEDULE I $ 15,081.25 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER MARGAR ET E. LUTZ 21 08 01277 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. EILEEN DERICKSON HOLTZ Collateral 10,000.00 2. CONNIE DALLAS SINREICH Collateral 10,000.00 3. TERRY DALLAS GRUNSWEIG Collateral 10,000.00 4. R. GERALD LACKEY Collateral 457,483.18 REMAINDER AND INTEGRITY ANNUITY 5. KIMBERLY KRAMMES STONE Collateral 35,214.08 1/3 FORT DEARBORN ANNUITY 6. ERIC LACKEY Collateral 35,214.07 1/3 FORT DEARBORN ANNUITY 7. EILEEN HOLTZ Collateral 13,694.43 1/3 NATIONAL WESTERN LIFE ANNUITY ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. HUMANE SOCIETY OF HARRISBURG -FORT DEARBORN ANNUITY (1/3) 35,214.08 7790 GRAYSON ROAD HARRISBURG, PA 2. HUMANE SOCIETY OF HARRISBURG - EQUITRUST ANNUITY (25%) 29,951.65 7790 GRAYSON ROAD HARRISBURG, PA 3. HUMANE SOCIETY OF HARRISBURG -SPECIFIC BEQUEST 10,000.00 7790 GRAYSON ROAD HARRISBURG, PA TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 115 117.38 pi more space Is neetletl, insert atltlitlonal sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARGARET E. LUTZ 21 08 01277 Decedent's Name Page 2 File Number Schedule J -Beneficiaries - 1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. JOHN DALLAS Collateral 13,694.43 1!3 NATIONAL WESTERN LIFE ANNITY 9. AMANDA KRAMMES Collateral 13,694.43 113 NATIONAL WESTERN LIFE ANNUITY I ~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARGARET E. LUTZ 21 08 01277 Decedent's Name Page 3 File Number Schedule J -Beneficiaries - 2B B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 3. YMCA - EQUITRUST ANNUITY (25%) 5 WEST STREET CARLISLE, PA 17013 4. YMCA -SPECIFIC BEQUEST 5 WEST STREET CARLISLE, PA 17013 29,951.65 10, 000.00 SUBTOTAL SCHEDULE J-2B ~ 39,951.65 a ~ ~~ ~a~- ~..~ n ~ ~_ LAST WILL AND TESTAMENT ~ o - . - ~~ ~ ~ i_~ UJ h •'~ 'i-7 C~,-1 "'rte +. _ _ ~~~ I, MARGARET E. LUTZ, of the Borough of Carlisle, Cumberla~, Coui~, `~,~ -~ • • - - . Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby ma~yg, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix or Substitute Executors, as the case may be, to pay .all of my debts, funeral and administzative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executrix or Substitute Executors of my estate. 2. My Executrix or Substitute Executors may, at her or their discretion, compromise claims, borrow money, retain property for such length of time as she or they may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as she or they may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. 3. I authorize and empower my Executrix or Substitute Executors to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My Executrix or Substitute Executors is/are authorized and /Yo( empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executrix or Substitute Executors. 4. I give and bequeath the sum of $10,000.00 to each of the following persons or organizations: a. EILEEN DERICKSON HOLTZ of Pinewood, New Jersey; b. CONNIE DALLAS SINREICH of Chicago, Illinois; c. HUMANE SOCIETY OF HARRISBURG AREA, INC. of Mechanicsburg, Pennsylvania; d. TERRY DALLAS GRUNSWEIG of Novi, Michigan; and e. YMCA -CARLISLE FAMILY of Carlisle, Pennsylvania. 5. I give, devise and bequeath all of the rest, residue and remainder of my estate of every nature and wherever situate to R. GERALD LACKEY of the Borough of Carlisle. 6. Should the gift in Paragraph No. 5 not take effect, then I give, devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate as follows: a. Fifty Percent (50%) to KIMBERLY KRAMMES STONE, of Boiling Springs, Pennsylvania; b. Ten Percent (10%) to RUTH LUTZ COSTELLO of Mickelton, New Jersey; c. Ten Percent (10%) to ROBERT LUTZ of Woodbury, New Jersey (Dubois Avenue); d. Ten Percent (10%) to the YOUNG MEN'S CHRISTIAN ASSOCIATION of Carlisle, Pennsylvania; 2 i i . ~ v e. Ten Percent (10%) to be divided between the HELEN D. KRAUSS ANIMAL FOUNDATION, INC. of Harrisburg, Pennsylvania, and the S.P.C.A. of Harrisburg, Pennsylvania, share and share alike. If either of these organizations is not in existence at the time of my death, the full share shall go to the surviving organization; and f. Ten Percent (10%) to AMANDA KRAMMES of Boiling Springs, Pennsylvania. It is understood and directed that if any of the above beneficiaries do not survive me, or are not living or in existence at the time of distribution, their share reverts back to the Estate and will then be shared by the other,named surviving beneficiaries. 7. I nominate and appoint KIMBERLY KRAMMES STONE to be the Executrix of this my Last Will and Testament. In the event she has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint ROGER B. IR~'VIN and MARCUS A. McKNIGHT, III, to be the Substitute Executors of this my Last Will and Testament, whereby the said Substitute Executors shall have the same powers as are given to the original Executrix hereunder. 8. No person(s) shall benefit hereunder unless such beneficiary shall survive me by thirty (30) days. 9. No Executrix or Substitute Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 3 10. No beneficiary~may assign, anticipate or pledge his, her or its interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 11. I hereby suggest that my personal representative retain the services of Irwin & McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of August, 2007. ~ - ~Gc.'t .:~'t~'-~~ (SEAL) A GARET E. LU - Signed, sealed, published and declared by MARGARET E. LUTZ, the above-named Testatrix, as and for her Last Will and Testament, in our .presence, who at her request, in her presence and in the presence of each other have hereunto set our names as subscribing witnesses. 4 ACKNOWLEDGMENT AND AFFIDAVIT WE, MARGARET E. LUTZ, KAREN S. NOEL and SHARON L. SCHWALM, the Testatrix and witnesses respectively, whose names are signed to the foregoing 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 that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. L~ vi.a~ SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by MARGARET E. LUTZ, the Testatrix herein, and subscribed and svyorn to before me by KAREN S. NOEL and SHARON L. SCHWALM, witnesses, this ~ J Srday of August, 2007. %~~ '3 ~~ Notary Public ~vmmVrvWEAI:~M c7~ p~gYLVANIA Notarial Soal Roger 8. I.~vAn, Notary Public Carlisle Born, Cumberland County MY Commission Expires Oct. 3, 2008 MembRr. P°hnst~lva~;a pssocialion Of Notaries rreVlous eClbonS are obsolete lone HUD-1 (3186) rel Handbook 4305.2 A: settlement Statement U.S. Department of Housing and Urban Development B. Type of Loan (1MC7 Annrnv~l Mn ~rno_n~ac re,...l.e.. ~ ~ nnrenne~ 1. ^FHA 2. pFmHA 3. ~IConv. Unins. 6. File Number 7. Loan Number V V~ B. Mortgage Insurance Case Number 4. OVA 5. ^Conv, Ins. 09-161 0099399883 w orm is w e o give you a s en o a ue as amen cos moun pal o en a sa am n agen are s own. C. NDte: Items marked'(p.o.c.)' were paid outside the closing; they are shown here for inlormation purposes end ere not included in the totals. T111eF~(pre55 $efflement $yStem WARNING: I[ Is a cdme to knowingly make false statements to the United Slates on This ar any alher similar lone. Penalties upon conviction can include a fine entl im dsonmanl. For data8s see: TiBe la U. S. Code Secllbn 1001 and secllon logo. Printed 0811012009 at 13:00 KM D. NAME OF BORROWER: Joanne Miller ADDRESS: 1865 Dou las Drive Carlisle PA 17013 E. NAME OF SELLER: Estate of Margaret E. Lutz and Clara E. Eckstein ADDRESS: 565 F. Street Carlisle PA 17013 F. NAME OF LENDER: PNC Mortgage, LLC ADDRESS: P.O. Box 5708 S rin field OH 45501.5708 G. PROPERTY ADDRESS: 565 F. Street, Carlisle, PA 17013 Carlisle Borou h H. SETTLEMENT AGENT: The Law Office of Andrew H. Shaw, PC, Telephone: 717.243-7135 PLACE OF SETTLEMENT: 200 S. S rin Garden Street Suite 11 Carlisle PA 17013 I. SETTLEMENT DATE: 08!1012009 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. ConUact sales rice 155 000.00 401. Contract sales rice 155 000.00 102. Personal Pro art 402. Personal Pro n 103. Settlement char es to borrower line 1400 5 908.43 403. 104. 404. 105. 405. Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance 106. Cit (town taxes 406. Cit Itown taxes 107. Coun taxes 08110109to12131l09 268.71 407. Count taxes 08I10109to12131109 268.71 108. School taxes 08110109to06130110 1414.30 408. School taxes 08110109to06130110 1414.30 109. 409. 110. 410. 111• 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 162 591.44 420. GROSS AMOUNT DUE TO SELLER 156 683.01 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De sit or earnest mone 1 000.00 501. Excess De sit see instructions 202. Pnnci al amount of new loans 155 000.00 502. Settlement char es to seller line 1400 12161.28 203. Existin loan s taken sub'ect to 503. Existin loan s taken suh'ect to 204. 504. Pa off of First Mon a e Loan 205. 505. 206. Seller Assistance 5 000.00 506. Seller Assistance 5 000.00 207. SD7. 208. 508. 209. 509. Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller 210. Cit /town taxes 510. Cit Itown taxes 211. Count taxes 511. Count taxes 212. School taxes 512. School taxes 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 161 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 17161.28 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. Gross amount due from borrower line 120 162 591.44 601. Gross amount due to seller line 420 156 683.01 302. Less amounts aid b/for borrower line 220 161 000.00 602. Less reduction amount due seller line 520 17161.28 303. CASH FROM BORROWER 1 591.44 603. CASH TO SELLER 139 521.73 SUBSTRUTE FORM 1099 SELLER STATEMENT: Tha Information contained herein is Important rez Information antl is being lumishetl to Ure Intemel Revenue Service. II you are required to file a return, a negligence penalty or other sanction wig be Imposed on you it this ilam is required to be reported entl the IRS determines that it has not been reported. Tire Contract Sales Pdce desuibetl on Ilne 401 above wnstitutes the Gross Proceeds of mis aansecdon. You are requlretl bylaw to provide the settlement aggent (Fed. Tex ID No: 281544555) with your correct taxppayyer iden86ra8on number. II you tlo not provitle your wnect lexpeyyeer klentlficatbn number, you maybe subject to civil or piminal penalllas imposed by law. Under penalties of perjury, I ceniry Ihet the number shown on this slatemenl is my correct taxpayer itlenli6calion number. TIN: / __ SELLER(S) SIGNATURE(S): / SELLER(S) NEW MAILING ADDRESS: SELLER(S)PHONE NUMBERS: (H) IW) rrewous eamons are obsolete form HUD-1 (3166) ref Handbook 4305.2 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: 09.161 PAGE 2 'SETTLEMENT STOTFMFNT r:.:_.--.___-- ^-..'-_ -. ^ _. .... . __..-.__-- _ .- -- ..-. L. SETTLEMENT CHARGES u ncu vor wrcuva a PAID FROM t ro.uU r\m PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on rice $150 000.00 6.000 = 9 000.00 BORROWER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701. 4 525.00 to Hooke Hooke & Eckman Realtors LLC SETTLEMENT SETTLEMENT 702. 4 475.00 to Wolfe & Shearer Realtors 703. Commission aid at Settlement 9 000.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount 803. A sisal Fee to RELS Valuation 380.00 804. Credit Re ort to RELS Re ortin 16.00 805. Lender's Ins action Fee 806. Mort a e A lication Fee 807. Assam lion Fee 808. Flood Life of Loan Fee to WFFS 19.00 809. Processin Fee to PNC Mort a e LLC 400.00 810. Tax Service Fee to WFRETS 100.00 811. Underwritin Fee to PNC Mort a e LLC 205.00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 08/1012009 to 0910112009 25.4800 Ida 22 Da s 560,56 902. Mort a e Insurance Premium for to 903. Hazard Insurance Premium for to California Casual 426.00 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo. 35.50 Imo 106.50 1002. Mort a Insurance mo. Imo 1003. Cit Pro a Tax mo. Imo 1004. Count Pro art Tax 7 mo. 55.63 !mo 389.41 1005. School taxes 3 mo. 129.90 Imo 389.70 1009. A re ate Anal sis Ad'ustment to PNC Mort a e LLC •222.49 0.00 1100. TITLE CHARGES 1101. Settlement or dosin fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Pre aration to The Law Office of Andrew H. Shaw PC 100.00 1106. Nola Fees to Kristi L. Monnett 25.00 10.00 1107. Attome 's fees indudes above items No: 1108. Title Insurance to Law Office of A. H. ShawISTGC06 1 133.75 includes above items No: 1109. Lender's Polic 155 000.00 1110. Owners Polic 155 000.00 •1 133.75 1111. 100 No Viol 300 Surve 900E to Law Office of A. H. ShawISTGCOB 150.00 1112. 1113. Closin SvcLtr ro Law Office of A. H. Shaw1STGCOB 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 38.50 • Mort a e 66.50 • Release $ 105.00 1202. Cit (Count tax/stam s Deed 1 550.00 • Mort a e 1 550.00 1203. State Tax/stam s Deed 1 550.00 • Mort a e 1 550.00 1204. UPI Fee to Cumberland Coun Recorder of Deeds 20.00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve 1302. Pest Ins action 1303. Ovemi ht Fee to The Law Office of Andrew H. Shaw PC 20.00 1304. 2009 School Taxes to Carlisle Borou h Tax Account 1 558.78 1305. Flnal Water/Sewer to Carlisle Borou h 42.50 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 5edion K 5 908.43 12161.28 HUD CERTIFICATION OF BUYER AND SELLER 1 have Carefully reviewed the HUD-1 Stdtement Statement and [b Me best of my knowledge end ballet, it Is a true end accurate statement of ell receipts and disbursements made on my account or by In this ransaehon. I further certify that I have received a copy of the HUD-1 Seblement Statement. oa i Estate of Margaret E. Lutz y. mH-7G-Ser yT' vats Sfone, geATy-T era c m WARNING: R IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE Tha HUO.1 SeNement Statement Ic I h r a a axureta aaount of lhls UNREO STATES ON THIS OR ANV SIMIIAR FORM. PENALTIES UPON CONVICTION transaction. 1 have caused or wit au file lands t dsbu ed aaordance wiN this statement. CAN INCLUDE A PINE AND IMPRISONMENT. FOR DETAILS SEE TITLE i6: ~~~ U.S. CODE SECTION 1001 AND SECTION 1010. SETTLEMENT AGENT: ~' DATE: St MEMBERS 15t FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Interest Earned 01 /01 /08 - 10/31 /08 Total Principal and Accrued Interest Name of Joint Owner LIFE SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Interest Earned 01/01/08 -10/31/08 Total Principal and Accrued Interest Name of Joint Owner 50134-00 11 /28/1972 $3,323.90 $2.28 $27.50 $3, 326.18 None 50134-04 02/01 /2001 $4,000.00 $2.74 $33.45 $4,002.74 None *Opened by transfer of funds from 50134-00. CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Interest Earned 01/01/08 -10/31/08 Total Principal and Accrued Interest Name of Joint Owner 50134-41 01 /24/2005* $5, 881.13 $17.36 $207.68 $5,898.49 None *Account opened by transfer of funds from 50134-00. Estate of: MARGARET E. LUTZ Date of Death: 11/26/2008 Social Security Number: 140-12-2033 E~EIUE SAN 0 3 2009 IRININ & f~cKNIGHT FAIN OFFICES ERS 1ST FEDE~I2AL EDIT UNION nie a .Kline ,~.o ~~ Insurance Services Specialist December 31, 2008 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 www.memberslst.org a~~ December 8, 2008 Law Offices Irwin 8v McKnight West Pomfret Professional Building 60 West Pomfret Street Carlisle, PA 17013-3222 499 Mitchell Street, Millsboro, DE 19966 RE: Estate of Margaret Lutz Date of Death: November 26, 2008 Social Security Number: 140-12-2033 Dear Mr. Irwin: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type ........................... Checking Account. Account Number ....................... 718025 ..: t~ ~t~- i~`~`~~ . Ownership (Names off .............. E. Robert Lutz, Margaret Lutz Opening Date ........................... 09 / O 1 / 67 Balance on Date of Death .........$44,404.28 Accrued Interest $ 0.89 Total ....................................... $44, 405.17 2. Account Type ........................... Certificate of Deposit Account Number ....................... 31003913903710 Ownership (Names off .............. Margaret Lutz Opening Date ...........................04/24/00 Balance on Date of Death ......... $13,143.04 Accrued Interest $ 30.28 Total .................., ..................... $13,173.32 ~E~~I~~® i®EC ~ 0 2008 ~~~~~ LAW QFFfCES a page 2 The above named decedent did not have a safe deposit box. December 8, 2008 * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please contact our High Street Carlisle Branch at 1 West High Street, Carlisle, PA 17013, or # 717- 240-4536. Sincerely, ~~~ ~~~ Charlene Warrington, Adjustment Services 1-888-502-4349 Sovereign Bank MA1 MB3 02-10 Court Ordered Processing/Decedent P.O. Box 841005 Boston, MA 02284 January 5, 2009 Roger B. Irwin Irwin & McKnight West Pomfret Professional Building 60 West Pomfret Street Carlisle, PA 17013-3222 RE: Estate of Margaret E. Lutz Date of Death: 11/26/08 SS# 140-12-2033 Dear Mr. Irwin: Per your request, enclosed please find account information as of the date of death for the above-named decedent. For your information, accrued interest in not included in the date of death balance. Please feel free to contact me if I can be of any further assistance Ve truly yours, r Nicole Job COP Specialist III Decedent Department (617) 533-1364 Sovereign Bank ESTATE OF Margaret E. Lutz SOCIAL SECURITY #: 140-12-2033 DATE OF DEATH: November 26, 2008 Account #: 1675202954 Type: CD Open date: 12/18/1998 In the name of: Margaret E Lutz Date of Death Balance: $11,970.52 Int.(YTD) from 1/1/2008 to 11/18/2008 $344.00 Accrued interest to date of death: $7.11 Otherlnfo: Account #: 1675301590 Type: CD Open date: 12/11/2001 In the name of: Margaret E Lutz Date of Death Balance: $21,630.82 Int.(YTD) from 1 /1 /2008 to 11 /11 /2008 $642.78 Accrued interest to date of death: $21.87 Otherlnfo: Account #: 2895394035 Type: CD Open date: 11/25/1997 In the name of: Margaret E Lutz Date of Death Balance: $16,193.26 Int.(YTD) from 1/1/2008 to 10/31/2008 $449.38 Accrued interest to date of death: $41.91 Otherlnfo: Page 1 of 1 Rowe's Auction Service 2505 Ritner Highway Cazlisle, PA 17015 717-249-2677 249-1978 697-4794 February 16, 2009 To: Roger B. Irwin, Attorney 60 W. Pomfret St. Carlisle, PA 17013 From: Rowe's Auction Service 2505 Ritner Highway Carlisle, PA 17015 Re: Auction Proceeds Mazgazet Lutz Estate 565 F St. Carlisle, PA 17013 Personal Property Auction $2$53.00 Less 35% Commission -998.54 Total $1854.46 Automobile $4600.00 Less 20% Commission -920.00 Total $3680.00 Less Trash Removal, Terry Lindsay $505.00 Total Due Estate $5029.46 - ~ William G. Rowe . ~li/~/. 1 rity ,~ Li6e fn5~ Company 400 Broadway Cincinnati, Ohio 45202 Owner MARGARET E. LUTZ 565 F ST CARLISLE PA 17013 NewMOMENTUM Annual Statement of Account 6/20/2007 - 6/20/2008 ~ne:~ s ~ 7J 81J0~? '~~~ `i 3' y z r# , N . f. ~ • C ~ x ~~,' ,~f4 f ': 4 ~ ~~ k ~~~ r~` ` k r ~+ i Joint Owner: N/A Po1lcY Number Pian lyme Policy Date ~~~, ,MARGARET E~:~LUTZ" r ~ a ~~~- "0009-328 ~ ~~+~' r `~ on~(Zualtfied ~, s= 6/?0/~005.' f ,,~ a . ~_ -~ - Guaranteed crotluth Beginning Account Value $210,738.96 $23,647.53 Contributions $0.00 $177,644.37 )7.58 Withdrawals $0.00 $5,000.00 Charges and Adjustments $0.00 $0.00 Interest Credited $8,304.99 $22,752.05 al'.i~d~n~-H(Ulllllt `"al[te $219;043.95, ~ZIy;U43'.y5 Total Change -- - $8,304.99 _ . __ $195,396.42 Death Benefit Value $219,043.95 Cash Surrender Value $207,202.91 Calendar YTD Contributions (See page 2) $0.00 2 7Q~e ~Ql~ Vci~((C - - - Projected value assuming no withdrawals or additions. Cut along the dotted line and return in the envelope provided NewMOMENTUM Polley Owner Polley Number MARGARET E. LUTZ 2100095328 Future Allocations New Contrlbntlons GRO-Seven Yr Current Interest QIO 6.50% Guaranteed Rate of Return GRO-Two Yr 3.75% GRO-Three Yr 4.05% GRO-Five Yr 4.30% GRO-Seven Yr 4.60% GRO-Ten Yr 4.80% __ __ Rev.07312005 Increase your annuity value Continue to build your annuity value and death benefit by making too% additional contributions. Please check the appropriate box. Please send me information on the Systematic Contribution plan. Please correct my address and telephone number as reflected below. Contributlon Amoum Enclosed $ ""~ +° Rates are current as of statement date but are sub'ect to than a without notice. ~/y I/ Integ~rity~ ~j~r~1` Life Insurance ~// I Company 9/7/2007 MARGARET E LUTZ 565 F ST CARLISLE PA 17013 RE: Integrity Policy # 2100095328 Dear MARGARET E LUTZ, 400 Broadway Cincinnati, OH 45202 1f ~ ^ f'1 ~1 ~~;~~ '~~ , ~\~ L Thank you for your recent correspondence with Integrity Life Insurance Company. Your request for a beneficiary change has been received and your policy has been changed as you have requested. The new information on your policy now reads as follows: R. GERALD LACKEY ERIC G LACKEY KIMBERLY L KRAMMES-STONE ANNUITANT -PRIMARY ANNUITANT -CONTINGENT ANNUITANT -CONTINGENT We at Integrity thank you for your business. If you have any questions regarding this matter, please contact our customer service department at 800-325-8583, Monday through Friday, 9 a.m. to 5 p.m., Eastern Standard Time. Sincerely, Mike Collier Manager Annuity Operations Copy to: Financial Representative JOSPEH G MARRAZZO 501 S ARLINGTON AVE HARRISBURG PA 17109 A member of Western & Southern Financial Group° ~r°NATIONAL 1~ WESTERN LIFE INSURANCE COMPANY January 21, 2009 Karen Noel Law Offices of Irwin & McKnight 60 West Pomfert Street Carlisle, PA 17013 Subject: Installment Certificate 0101039443 Annuitant: Margaret E. Lutz, deceased Dear Ms. Noel: ~~~ fR1fV1N & iWcKNIGH~ I_AW OFFICES As requested in your call of December 24, 2008, we are providing information regarding the benefit due under Mrs. Lutz's Installment Certificate. The value as of November 26, 2008, the reported date of death, was X41, 083.29. Eileen Holtz, John Dallas, and Amanda Krammes were designated as equal beneficiaries; they will continue to receive 1/3`d share each of the remaining monthly payments of $901.52 until August 2013, the end of the 5 year fixed period. The monthly benefit includes $151.52 of taxable interest that will be equally divided among the beneficiaries. Please provide the following so that we may make the necessary changes to the certificate: 1. Annuity claim form and Tax Form W-9 completed by each beneficiary. 2. One Certified Death Certificate. 3. Change of Beneficiary Designation Form. Mrs. Lutz' beneficiaries should name someone to receive the benefit in the event their death occurs prior to the end of the fixed period. 4. Request for Direct Deposit (optional form) if you wish to have the remaining payments electronically transferred to your bank account. Please contact our Policy Benefit Department at 1-800-531-5442 if you have any questions or need assistance in completing the enclosed form. We will be happy to assist you. Cordially, POLICY BENEFIT DEPARTMENT Encl. 850 EAST ANDERSON LANE AUSTIN, TEXAS 78752-1602 512-836-1010 AUTOMATED VOICE RESPONSE TOLL-FREE 888-695-5001 WATS 800-531-5442 CLIENT SERVICES DIRECT WATS LINE 800-922-9422 CLAIMS 800-531-5442 WWW NATIONALWESTERNLIFE.COM e r 1 STATEMENT OF ANNUITY ACCOUNT FORT DEARBORN LIFE INSURANCE COMPANY ® Administrative Office P. 0. Box 655403 Dallas, TX 75265-5403 Owner: MARGARET E LUTZ Contract Number: P00000040024 565 F ST Issue Date: 12-15-2006 CARLISLE, PA 17013 Annuitant: MARGARET E LUTZ NQ WEALTH FORTIFIER 5 w/ MVA2 Pre Bal 12-31-2007 101,824.25 1 D1-15-2008 175.85 4.300 102,000.10 2 02-15-2008 364.37 4.300 102,364.47 3 03-15-2008 342.04 4.300 102,706.51 4 04-15-2008 366.90 4.300 103,073.41 5 05-15-2008 356.31 4.300 103,429.72 6 06-15-2008 369.49 4.300 103,799.21 7 07-15-2008 358.83 4.300 104,158.04 8 08-15-2008 372.09 4.300 104,530.13 9 09-15-2008 373.41 4.300 104,903.54 1D 10-15-2008 362.64 4.300 105,266.18 11 11-15-2008 376.04 4.300 105,642.22 12 12-15-2008 365.19 4.300 106,007.41 13 12-31-2008 195.82 ------------- ------------- 4.300 ---------- 106,203.23 --------- TOTALS: 50.00 54,378.98 --- 50.00 ------ ---------- --------------- 50.00 5106,203.23 The Account Value is not necessarily the amount available for withdrawal. The amount available for withdrawal is the total account value less any withdrawal charges plus or minus the market value adjustment. The Guaranteed Interest rate credited to the Policy account value is 3.00%. The Current Interest Rate from 12/15/2008 to 12/14/2009 is 4.30%. If you have any questions, please contact a Customer Service Representative at 1-800-538-0379. -© ~t `Ending Account Value brought forward 5106,203.23 MVA Adjustment 7,666.45 Surrender Charge 6,692.17- --------------- --------------- Ending Cash Surrender Value 5107,177.51 Agent: S A MOYER INS & FINANCIAL SRVCS L 3314 MARKET 5T #302 CAMP HILL, PA 17011 (717) 975-0112 •t~ - Ili b ~ ~Rt9€e5L h t~iesame ct,~tr ~ 'y t':Please ciizifilt~t~ ~ ssfs~anc~. CLIENT COPY ~ . __...,... ;St1~l9.C1O7 x;07 ~M P,r1G~ ~ ~QRT LiF.al,kEf.)]ItN I.]P~: ~ InRU-rarrcccotapcrny phone Numpsr: (800j 538-0378 Fax Numbers (972) 998.9388 ~°~~ ~;iflr IndividuaM Life ~A ~IUN ~ Serrr~ce Request Form Adminllatrative CHlice. RO. aax 655403 Daflas, Tpxas 75265-5483 Annultnntllnsured~~ A_ rG pr~+ -~V~~^ t7wner _-_L! Ljl rG~ LV ~ .. 1- 'Cho Owner of policy ~,uAt Sign this farm. "~-~ -- 2. Plogge print. Pteaso uss ink. ContractlPollc}r IVumbor P ~ O 4 (~QQ `~Q Q ~~ ~~ ~~ ~ 3. All correctlana must bo inRlaled. AnnultanUtnsured D,OB, Ctmtractlpoiicy Efi'eclhre haze ~.~~ ~ 1,~ Q ~ ..~~. - ^_ ^_ Social Security Number. ~ ~ O r l a ~, a (5 .~ ,~ ~ Dttytlmo Phonc Numbor, ~ ~~~~ - ~ a ~ q -.- _ SFC'T1O~Ly;,~31~Ni;EEdCCU~t~1LGk#AN.G~ - - _ _ ~'~: N Joint 17wnt~ra, do you wish fa have nurvlving Jalnt Cher ne prfni®ry ~enMktarya Yog r7 No --' ' - Kamp of "tlmery 96neticfarl9a ~ ~ - - reatAtltlteea, ctty, State, zip Reiatlorttiitlp SSA ~ ar r'~~r '~ v4e Paccentnga ~~ ~ tarvlatl t ~4i ~'(~ -~ rG, ~ J rya ~'-n ~r i7 rr ~ ~r r--~lxrll 5 ~•CY'Sir-~F~'14r1 r. Kramrn t!s-Son e poi 1 i ~ $ ri 5, t~~ l7~r3~ ~''~' er+ol• f bq - $y-5~8~ bhol~z 113 rte ryas Crcc(c Usa,~ ,~•,r-'rnd• ~l3 f..acke 11*~r in. Qea 11l~ ~~'~Sy `~`~~yy-9A.~Sbtlylsw • •~ •~~•• ~~~~y~~cuiun vaacvts an previous goslgnatlorts, subjoct to the Nghts of Any t'xlsting asslgnmont and irrevocable benefbisry. • Unless otherwise Indicated, the right to change tha benefk:lAry Is rpaerved by the awner(aj, • Ir a tntatt is being nr~nted, indicate the full Homo of tho trutt and the date k was established and provide tt spy ~ tho trust. • P®rcontago des(gnatian must equal looms. - If not onnuglt space Is eilvcatad, ploase attach additional papa;,, 3GC'FIO{u 2: gDDFtESS CHAN~Q~' - Ghenk Clne: ©c)uvner D t3eneftetary ^ Annuitr~int/Insured q Payar Srres~ Address acy --------,...__,.-,~--.- ------ StatD ._--------------._ 7_!p .___..__.. _ Phone Nombor A{VtJ-52-110p - - . ---1-- SrtCQ061~'FQ I Fi0/OB I A500 r ~/QUA F~~ Servor. ^III E ulTrust~ Life Insurance Company January 14, 2009 Law Offices of Irwin & McKnight Attn: Roger Irwin 60 W Pomfret Street Carlisle, PA 17013 Re: Contract Number: Owner: ~~~~~~I~ [~VIlfiV ~ iinciffUfG~l.q `._yl~ ~F~If~~: EQ0001078212F Margaret Lutz, Deceased Dear Mr. Irwin: We have received your request for information on the above referenced contract. The information requested is as follows: 1. The sole owner of the contract was Margaret E Lutz 2. The effective date of the contract was September 20, 2007 3. The death benefit as of the date of death of November 26, 2008 is $119, 806.59. There were no ownership changes or accounts closed within one year of the date of death for Margaret Lutz. If you have any questions please feel free to contact me at our toll free number of 877-249-3694 ext 3424. Sincer ly, v~ Curtis Heimke Customer Service Representative Annuity Services Cc: 35180 Veronda Moyer .. . ~., E uiTrust~ i ~ Life Insurance Company BENEFICIARY DESIGN~(TION FORM Owner ,/ - /Q_/"Y.~r"F /-- ~ ~;~~ ~ Contract Number E~Q(2(?~D 7$j? ~d~ ~' I, the owner of the contract identified above, in accordance with and subject to the provisions of said contract and the provisions on the back of this form, and subject to any indebtedness which may be due the Company under said contract and to the rights of any Assignee therein, direct that the Beneficiary shall be shown below: o _% 1. ~ RIMARY BENEFICIARY(IES) - Must be in even percentages totaling 100 ~ ~.:~ ame ddress Date of Birth Social Security Number Is this person a U.S. citizen?' If "No," is this person a Resident Alien?' Relationship to Owner er nt e S o .~ GG ~~ i who may survive the Owner, and if no such Beneficiary survives the Owner, then to the Contingent Beneficiary(ies). CONTINGENT BENEFICIARY(IES) - Must be in even percentages totaling 100% ame ddress Date of Birth Social Security Number Is this person a U.S. citizen?' If "No," is this person a Resident Alien?' Relationship to Owner ercent who may survive the Owner. 2. LIVING TRUST AS PRIMARY BENEFICIARY _ ,Trustee(s) or any successor trustee(s) under written agreement -. - ame-o ~ ee s - - --- - ----- -- - - -- - - - -- --- - - --•-- - created by ame o ran ors named ame o rus Dated o.- ay- r. ,and any amendments made thereto, or if the trust is terminated or the Company is not furnished evidence of the qualifications of such Trust within 365 days of the death of the Owner, to the Estate of the Owner. Trust ID # ^ Check only if this is an irrevocable designation. Please note: This Beneficiary Designation will replace any existing beneficiary designation on your contract. ' If beneficiary does not have a U.S. taxpayer identification number at the time death proceeds become payable, the proceeds will be paid to the owner's estate. E7-2532 (4-07) Page 1 of 2-Incomplete without all pages iv TRANSWORLD SYSTEMS INC. COLLECTION AGENCY ~~2 ARVEST DRIVE BLUE BELL PA 19422 THIS HAS BEEN SENT TO YOU BY A COLLECTION AGENCY G1BTwL06 15T0121UD409D8001'TVVL' ACCT NO. 4508U-0000103447 CLIENT REF 28213-372 AMOUNT DUE $1,029.50 I~~~Ill~ulllu~i~~ll~ill~~~llr~~l~l~l~~l~rll~l~l~~lrl~~l~ilil I nIN IIIN III IIIII HILL IIIp IINI lll~ 1111 ll ll MARGARET LUTZ ROGER IRWIN 60 WPOMFRET ST CARLISLE PA 17013-3243 UNITED STATES ~~~~~' 02!05/09 ~~a ~ 0 200 RI~WiiV & MciiPllGii6 iA!N OFFICES COURTESY NOTICE - -Our client has requested that we contact you regarding your above-referenced account. We realize this amount due could be an oversight on your part and not a willful disregard of an apparent obligation. The amount specified above is owed as of the date of this letter. If applicable, because of the possibility of such things that might apply to your account, including future installments, interest, late charges, and other charges that may apply, the amount due when payment is made may be greater. If so, our client will credit you for the payment made. If necessary, you may contact our client at the phone number below. TSI is a collection agency attempting to collect a debt and any information obtained will be used for that purpose. Our demand for payment does not affect your right to dispute this debt. Send correspondence, other than payments, to this collection agency at P.O. Box 1864, Santa Rosa, CA 95402. HCR MANORCARE CARLISLE Our Client's Phone: 940 WALNUT BOTTOM RD 717-249-0085 CARLISLE PA 17015 Unless you, within 30 days after receipt of this notice, notify this office that you dispute the validity of this debt, or any portion thereof, TSI will assume this debt is valid. If you notify this office in writing within the 30-day period that this debt, or any portion thereof, is disputed, TSI will obtain verification of this debt or a copy of a judgment and mail you a copy of such judgment or verification. If you request this office in writing within the 30-day period, TSI will provide you with the name and address of the original creditor, if different from the current creditor. We are required under some states' laws to notify consumers of certain fights as detailed in the list on fhe back of this notice. Consumers Nava rights under state and federal law that are not described in this letter or in the list on the back of this notice. '' ~ Hoffman-Roth Funeral Home & Crematory, Inc. ` 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 December 17, 2008 Kimberly Stone 5 Persimmon Drive Boiling Springs, PA 17007 The Funeral Service for Margaret E. Lutz 15482-259 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: Traditional Funeral Service Package $4150.00 FUNERAL HOME SERVICE CHARGES $4150.00 SELECTED MERCHANDISE: Sterling 18 ga Steel Casket , $2300.00 Venetian Interment Receptacle , ,. $1880.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $8330.00 Cash Advances Opening Grave Charged by cemetery , $1335.00 Newspaper Obituary Notice- Sentinel , $79.92 Newspaper Obituary Notice -Courier Post, NJ $303.50 Clergy Offering $100.00 Certified Copies of Death Certificates , $72.00 Hairdresser, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $40.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $1930.42 Total Total Cost , $10260.42 History 1 211 7/2 0 0 8 Allianz $-9194.90 TOTAL AMOUNT DUE $1065.52 This statement is net and payable in full within 30 days of receipt. ------------------------------------------------------------------ Please return this portion with your Remittance $ Amount Enclosed Service ID # 15482-259 Margaret E. Lutz ti i ~~ ~ ~ P.O. Box 4650 M ACH/EDI Services Buffalo, NY 14240-9975 *** This is an Advice *** (800) 724-2240 MARGARET E LUTZ E ROBERT LUTZ KIMBERLY KRAMMES STONE 565 F ST CARLISLE PA 17013-1350 Subject: Notification of Death /Reclamation Case Number: 20064 Date: Wednesday, March 11, 2009 t j, A~~P,~,d 1l L ... V ~:I `E;V~1iP~ ;,;lciti~' iC;; , Funds Deposited to Account: 718025 $1,688.74 Funds Owed to the U.S. Treasury: $1,688.74 Due to the fact that MARGARET E LUTZ has passed away prior to the issuance of the credit, the Treasury of the United States is requesting reimbursement. In accordance with Federal Regulations, direct deposits may not be retained by the beneficiary unless the beneficiary lived through the entire month prior to the date of issuance. Our records indicate that the non-entitled benefits have been withdrawn from the account of deposit or the account has been closed. If you have already returned these funds, please send us a photocopy of your remittance check. If these funds have not been returned, full payment for the balance above is immediately owed to the U.S. Treasury. Please remit payment payable to M&T Bank. Aself-addressed stamped envelope is enclosed for your convenience. Please reference the case number above on all correspondence. Should you have any questions about the remittance of the outstanding amount, please call and refer to the case number above. Respectfully, ~V V I ACH/EDI Services M&T Y, i CL1 RENEWAL 3671 Insured Name: ESTATE OF MARGARET LUTZ Date Prepared: July 9, 2009 POLICY NUMBER: 085 004 631 2423 L~•. AMERICAN MODERN SELECT INSURANCE COMPANY BROKER 014453: MILLER INSURANCE ASSOCIATES INC 19 BROOKWOOD AVE SUITE 102 CARLISLE PA 17013 N085 020090 0046312423 37 T60 DW ESTATE OF MARGARET LUTZ 60 WEST POMFRET ST CARLISLE PA 17013-3243 Dear Customer, Thank you for renewing your DWELLING insurance coverage through American Modern Select Insurance Company. I am writing to provide you with your insurance declarations page. Please review the information carefully, and keep the documents in your records. The premium for your policy is S 1,008.00. You may choose to pay your policy in full, or, just pay the first installment payment shown below. Please send your payment in the envelope provided so that we receive it by July 29, 2009. For your convenience, we have enclosed an envelope with your billing statement. You can count on us to continue providing the kind of protection and service you expect from your insurance provider. If you have questions about your policy, please contact MILLER INSURANCE ASSOCIATES INC at (717} 243-4400. Again, thank you for choosing American Modem Select Insurance Company. We appreciate your business...and your trust! Very truly yours, ------ _ J ~"~-C President ~LE° ' POL L,.~• AMERICAN MODERN SELECT INSURANCE COMPANY 7595 Insured Name: ESTATE OF MARGARET LUTZ Date Prepared: February 24, 2009 POLICY NUMRFR• nRr~ and a~~ ~e_~~ BROKER 014453: MILLER INSURANCE ASSOCIATES INC 19 BROOKWOOD AVE SUITE 102 CARLISLE PA 17013 N085 020090 0046312423 37 WEB DW ESTATE OF MARGARET LUTZ 60 WEST POMFRET ST CARLISLE PA 17013 Dear Customer, ~.nk".fu~ ~~~kk'~~~i ~'~~~ ~ ~ ltP;~ '~!?V~JlI~ ~: iVlclti~!!G I~ ~_~lN OFFICE S Thank you for choosing American Modern Select Insurance Company and MILLER INSURANCE ASSOCIATES INC for your DWELLING insurance needs. I am writing to provide you with your insurance policy and declarations page. Please review the information carefully, and keep the documents in your records. The premium for your policy is 51,043.00. Thank you for paying in advance of your due date. You can count on us to continue providing the kind of protection and service you expect from your insurance provider. If you have questions about this insurance policy, please contact MILLER INSURANCE ASSOCIATES INC AT (717) 243-4400. Again, thank you for choosing American Modern Select Insurance Company. We appreciate your business... and your trust! Very truly yours, •N Jo ayden, President and CEO ~. r. ~ -.. _____.__-.._______. B033520 17013 IK5 TJSE t)NLY 5B W Depsrtmentof the Tressuiy Iuteru~l Reveu .Service Philadelphia A 19154 142646.578690.0467.011 1 AT 0.357 926 ~~1111~~1~01~IIII11~1~1~~111~'1~~1~~I'~II~III~II~~~~~~~~IIIJ~'~' r; $1 MARGARET E LUTZ KIM STONE EXEC 60 W POMFRET ST CARLISLE PA 17013-3243 42646 We Changed Your Account L L , US?54-567-08139-9 200935 CP 0 0 US For assistance, calL• 1-800-829-8374 four Caller ID: 051202 Notice Number: CP22A Date: July 6, 2009 Taxpayer Identification Number: 140-12-2033 'fax Toren: 1040 Tax Year: December 31, 2007 Amount You Uwe as of July 27, 2009 $379.33 l 6211-079-24472-8 ~b'e 61•'l~t' eX~~[1111 YV/"!}•' yUl[ 1''E'CE'll~e(I IIII.S 11UllC'e, {10W l~l'E' CJ1lU1~~BC~ yUtfT' aCCOIl1Yl, ~20YV Ij?15' L'~~[111~1E' (lf fE'C15' 1011, aril actiarls yoli r-ucy tivisla to take. Why Yoie Received This Notice As you requested, we changed your account for 2007 to correct yoT_1r • pensions and aluluities • taxable social security benefits • Schedule D How VVe Changed Your Account We changed your account as follows: R~~~i~tb ~JUL 0 3 2009 IRWIN & N1cKNiGHT ~W OFFICES Account balance before this change $6,874.00 CR Increase in tax because of this change $6,874.00 Interest charged 8379,33 Atr_~-ltut you ilnw o~ye. $379.33 IIow This Affects You The amount you owe includes interest. Please pay the full amount by July 27, 2009 to avoid additional penalty and interest. When making your payment: • Make your check or money order payable to the United States Treasury • Write the Social Secluity lilunber and tax year shown at the top of this notice on the check or mol~ey order • Use the payment coupon included with this notice 27F efw,~1. , March 24, 2009 Irwin & McKnight 60 W. Pomfret St. Carlisle PA 17013 Re: Maigazet E. Lutz Gentlemen: o`~ a~~ Certified Public gccountant 255 Hickory. Rd, • .Carlisle, pq Telephone or Fax: 717 17015 e-mail: rosendale ~ ~ 243'3184 @comcast.net Enclosed are amended 2007 Federal and perms lv . take a few minutes to review these re Y area ~ returns for the above tax' turns and note the following Ellin Payer. Please Federal Return -.The re g instructions: check in turn must be signed and dated at the bottom of Fo the mount of $(,874 payable to United States Treas rm 1040X. Enclose a m'3'• Mail the return to: Depar~nent of the Treasury Internal 'Revenue Service Kansas. Cit3', MO 64999 PertnsylyQnia,lrteturn amount of 247 The return must. be signed and ~ payable to PA De date on page 2. Enclose a check in the return to: P~ment of Revenue. Use the enclosed coupon and mall the Bureau of Imaging and Document Management Dept. 280502 Hazrisburg PA 17128-0502 I have included an extra copy of the return for questions'about this return, Your files. ~urs ~Y, Pa~~ A R sen ale `~~~C-~ A Please call me if you have any