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Home My WebLink About08-26-10EX (01-10) ~ REV-1500 15 0 5 61014 3 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 2 1 0 9 0 1 1 6 2 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 185 03 6046 12 01 2009 Decedent's Last Name Suffix GARRISGN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth 08 04 1915 Decedent's First Name MI ERNEST R Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required ® g Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 0 8. Total Number Of ;cafe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ ~ ~ .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 TO: Name Daytime Telephone Number DGNALD J STRUNK 412 281 8060 First line of address 304 RGSS STREET Second line of address SUITE 702 City or Post Office State ZIP Code PITTSBURGH PA 15219 Correspondent'se-mail address: DJS1ATTY@AOL.COM 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. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATU OF PERSON RESPONSIBLE FOR FILING RETURN DATE .~.e~~~ ~~lii.c~.r~ DELORES L. SHOPE ~~' --/~ - ~e ~ ADDRESS ~ 391 MITZLER ROAD, ALUM BANK, PA 15521 SIGNAT OF PR ARER O R THAN R ESENTAT DONALD J STRUNK I~arE ~~~~o ~, _ ~~~u ~~,~ ADDRESS V 304 ROSS STREET, PITTSBURGH, PA 15219 Side 1 L 1505610143 REGISTER OF,1Al~LLS USE O~tLY -~ ~.~:.~ - '~ :_~. -~ `.. ~' '1 L, - .-. ._} ~~ ~~ _ .. DATE_FIt~D ; ^• ~ _ I ~; ., .. __~~ 4. .i 1 (::) ~= 7 1505610143 J ~~~~~ ADDITIONAL Personal Representatives GARRISON, ERNEST R. SS# 185-03-6046 12/1/2009 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. r~ 2 Signature ~~~ Name JEAN .FURNISH Address 1008 STRATWOOD AVENUE City, state, zip OXON HILL M D 20745 Date !~ 3 Signature Name Address City, State, Zip Date 4 Signature Name Address: City, State, Zip Date 5 Signature Name Address: City, State, Zip Date 6 Signature Name Address: City, State, Zip Date J 1505610243 REV-1500 EX Decedent's Social Security Numb er Decedents Name: GARRISON, ERNEST R. 1 8 5 0 3 6 0 4 6 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 11?, 200. 00 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 1 $ '7 , 4 3 5 4 4 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. 3 3 '7 3 4 0 0 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 3 0 2 0 5 0 2 0 g. Total Gross Assets (total Lines 1-7) ....................................................................... g, 9 3 '~ 0 2 5 7 0 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 2 '7 6 8 6 3 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 4 3 4 9 7 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 2 $ 1 2 1 3 0 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 9 1 0 9 0 4 4 0 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. 9 1 0 9 0 4 4 0 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 .00 15. 16. Amount of Line 14 taxable at lineal rate x .045 9 1 0 9 0 4 4 0 16. 4 0 9 9 0 7 0 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. 4 0 9 9 0 7 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 01162 GARRISON, ERNEST R. --- _- - STREET ADDRESS 314 EAST PORTLAND STREET CITY _ STATE MECHANICSBURG PA I, ZI P 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 3 7, 0 0 0.0 0 B. Discount 1,947.37 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. Total Credits (A + B) Make Check Payable to: REGISTER OF WILLS, AGENT. (1) 40,990.70 (2) 38,947.37 (3) 0.00 (4) (5) 2,043.33 Y ...... .. .; .. v !S ~f, ~. 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 transfeprrep ;...y ........................:.................................................... ~ x b. retain the right to designate who shall use the ro ert transferred or its income :.::..:..:..:..'.'..'::....::::::..: I f X ;~I c. retain a reversionary interest, o ~__, 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' I i 4. Did decedent own an Individual Retirement Account, annuity, or other non :probate property which i contains a beneficiary designation? ....................... ' x ~ ~ __ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT' AS PART OF THE RETURN. ,. .. ;j For dates of death on or after Jul 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §916 (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 0 percent [72 P.S. §9116 (a) (1.1) (u)]. 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 refurn 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 21 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 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 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 12 percent [72 P.S. §§9116 (a) (1.3) . A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, wFiether by bloo or adoption. QSCHEDU`L' E'~A COMMONWEALTH OF PENNSYLVANIA , `EAL ES 1 A 1 E INHERITANCE TAX RETURN RESIDENT DECEDENT __ FILE NUMBER ESTATE OF GARRISON, ERNEST R. 21 - 09 - 01162 __ All real property owned sole)y 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 wilting 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. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 REAL ESTATE LOCATED AT 314 E. PORTLAND ST., MECHANICSBURG, CUMBERLAND 112,200.00 COUNTY, PENNSYLVANIA -SOLD, SEE COPY OF SETTLEMENT SHEET ATTACHED TOTAL (Also enter on Line 1, Recapitulation) 112,200.00 ~! SCHEDULE B ,~ COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS ~, INHERITANCE TAX RETURN 'I RESIDENT DECEDENT --- -- _ _- ____ _ _I __- _ _. __ --- - ~i FILE NUMBER ESTATE OF GARRISON, ERNEST R. ', 21 - 09 - 01162 __ __ All property jointly-owned with right of survivorship must be disclosed on Schedule F. __ ITEM DESCRIPTION UNIT VALUE I, VALUE AT DATE OF NUMBER I DEATH 1 72 $100.00 SERIES EE U.S. SAVINGS BONDS -SEE LIST ATTACHED ' 16,756.24 2 18,964.356 SHRS. PUTNAM PA TAX EXEMPT INC. FUND C SHARES - '~ 9.00 I!I 170,679.20 SEE LETTER ATTACHED ~, TOTAL (Also enter on line 2, Recapitulation) 187,435.44 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ', -_ _ _ _ _ _ ~ FILE NUMBER ESTATE OF GARRISON, ERNEST R. '' 21 - 09 - 01162 _. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 __ __ MEMBER'S FIRST CREDIT UNION CERTIFICATE OF DEPOSIT ACCT. # S0042 -SEE 228,360.24 SHEET ATTACHED 2 MEMBER'S FIRST CREDIT UNION SAVINGS ACCOUNT #S0000 -SEE SHEET ATTACHED 20,703.87 3 MEMBER'S FIRST CREDIT UNION SAVINGS ACCOUNT #S0004 -SEE SHEET 4,001.15 ATTACHED 4 METLIFE TOTAL CONTROL ACCOUNT #4051425076 -SEE LETTER ATTACHED 44,372.62 5 2006 FORD VIN#1 FAFP34N26W148305 -SOLD 6,000.00 6 PNCBANK CHEKING ACCOUNT#50-7007-9677 -SEE COPY OF STATEMENT ATTACHED 29,230.88 7 MISCELLANEOUS HOUSEHOLD GOODS 2,500.00 8 U.S. TREASURY - 2009 TAX REFUND 1,772.00 9 PA DEPT. OF REVENUE - 2009 TAX REFUND 210.00 10 ALLSTATE INSURANCE -AUTO INSURANCE REFUND 189.30 TOTAL (Also enter on Line 5, Recapitulation) 337,340.06 COMMONWEALTH OF PENNSYLVANIA I SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY -_ ESTATE OF GARRISON, ERNEST R. FILE NUMBER 21 -09-01162 __ This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. __ ITEM DESCRIPTION OF PROPERTY DATE OF DEATH o~ OF EXCLUSION NUMBER Include the name of the transferee, their relationship to decedent VALUE OF ASSET DECD'S (IF APPLICABLE} TAXABLE VALUE and the date of transfer. Attach a copy of the deed for real estate. INTEREST __ _ _ _ __ 1 ! ALLSTATE ANNUITY CONTRACT#GA0678525, 79,366.96 100% I 79,366.96 PAYABLE TO CHILDREN IN EQUAL SHARES 2 ', NEW CUMBERLAND FEDERAL CREDIT UNION ', CERTIFICATE DEPOSIT HELD IN TRUST FOR ERNEST R. GARRISON, JR., SON -SEE SHEET ATTACHED 3 NEW CUMBERLAND FEDERAL CREDIT UNION CERTIFICATE DEPOSIT HELD IN TRUST FOR FLORENCE MILLER, DAUGHTER -SEE SHEET ATTACHED 4 NEW CUMBERLAND FEDERAL CREDIT UNION i CERTIFICATE DEPOSIT HELD IN TRUST FOR DELORES L. SHOPE, DAUGHTER -SEE SHEET ATTACHED 5 'NEW CUMBERLAND FEDERAL CREDIT UNION ', CERTIFICATE DEPOSIT HELD IN TRUST FOR JEAN M. FURNISH, DAUGHTER -SEE SHEET ATTACHED 55,670.81 55,670.81 55,670.81 55,670.81 55,670.81 55,670.81 TOTAL (Also enter on line 7, Recapitulation) I 302,050.20 SCHEDULE H ' FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA ~~/~w~c `~ T~ INHERITANCE TAX RETURN r11.J1YN1~ I RA~ 1 Y G ('~_(1Q~ ~+~~ RESIDENT DECEDENT FILE NUMBER ESTATE OF GARRISON, ERNEST R. 21 - 09 - 01162 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 ' MYERS FUNERAL HOME -FUNERAL 4,439.50 2 BRACKENDORF MEMORIALS -LETTERING ON HEADSTONE 195.00 3 OLD COUNTRY BUFFET -FUNERAL DAY MEAL 420.00 B. ADMINISTRATIVE COSTS: ~, ', Personal Representative's Commissions Name of Personal Representative(s) DELORES L. SHOPE JEAN M. FURNISH 4,000.00 Street Address 391 MITZLER ROAD ', City ALUM BANK State PA zip 15521 ', Year(s) Commission paid 2010 2. ' Attorney's Fees ATTORNEY-AT-LAW -- DONALD J. STRUNK 12,000.00 3. ' Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. ' Probate Fees REGISTER OF WILLS -PROBATE OF WILL 273.50 REGISTER OF WILLS -INVENTORY FILING FEE 250.00 5. ' Accountant's Fees 6. Tax Return Preparer's Fees H & R BLOCK -FINAL INCOME TAX RETURNS 228.00 GEORGE ORAVEK, CPA - 1041 ' 750.00 7. Other Administrative Costs 1 ' SETTLEMENT CHARGES IN CONNECTION WITH SALE OF REAL ESTATE, SCHD. 3,422.00 ', A, ITEM 1 -SEE SETTLEMENT SHEET ATTACHED TOTAL (Also enter on line 9, Recapitulation) 27,686.33 Schedule H '' ~I Funeral E~q~ensps & COMMONWEALTH OF PENNSYLVANIA A~~~nM ^~ M~n~ INHERITANCE TAX RETURN /~1L,~1 ~ N 1~11Q~IYC VWI~ l.lJ11U RESIDENT DECEDENT I j ___ __ ESTATE OF GARRISON, ERNEST R. 'FILE NUMBER 21 -09-01162 __ 2 ' CASSELL -TRASH REMOVAL FROM REAL ESTATE, SCHD. A, ITEM 1 700.00 3 PRORATED REAL ESTATE TAXES FOR REAL ESTATE, SCHD. A, ITEM 1 260.83 4 'BOROUGH OF MECHANICSBURG -PRORATED SEWER AND TRASH FOR REAL 61.33 ', ESTATE, SCHD. A, ITEM 1 5 UGI -GAS SERVICE TO MAINTAIN REAL ESTATE, SCHD. A, ITEM 1 PENDING 490.20 SALE 6 PPL ENERGY -ELECTRIC SERVICE TO MAINTAIN REAL ESTATE, SCHD. A, ITEM 143.73 1 PENDING SALE 7 UNITED WATER -WATER SERVICE TO MAINTAIN REAL ESTATE, SCHD. A, ITEM 52.24 1 PENDING SALE Page 2 of Schedule H i SCHEDULEI DEBTS OF DECEDENT, MORTGAGE ~I COMMONWEALTH OF PENNSYLVANIA LIABILITIES ~ LIENS INHERITANCE TAX RETURN f RESIDENT DECEDENT i I FILE NUMBER _ __ ESTATE OF GARRISON, ERNEST R. 121 - 09 - 01162 __ Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION NUMBER 1 HERITAGE MED. GROUP -MEDICAL SERVICES 2 I SPRINT -LONG DISTANCE TELEPHONE 3 I UNITED WATER -FINAL WATER BILL 4 I PPL ENERGY -FINAL ELECTRIC BILL 5 I VERIZON -FINAL TELEPHONE BILL 6 I UGI -FINAL GAS BILL 7 I BOROUGH OF MECHANICSBURG -FINAL SEWER BILL AMOUNT 20.00 34.11 14.28 157.59 59.73 31.26 118.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 434.97 REV-1513 EX+ (11-08) SCHEDULE J ~ COMMONWEALTH OF PENNSYLVANIA BEN EFICIARIES , INHERITANCE TAX RETURN RESIDENT DECEDENT j __ _ _ _ _ ESTATE OF I, FILE NUMBER GARRISON, ERNEST R. 21 -09-01162 ~ - - - ---- - _ _ _ _ _ RELATIONSHIP TO __ _ - _ _T I SHARE OF ESTATE __ ------- -_ -- AMOUNT OF ESTATE NUMBER ' NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) i_ I~ :TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers I I under Sec. 9116 (a) (1.2)J 1 !ERNEST R. GARRISON, JR. Son ONE FOURTH OF 1505 PECKS ROAD ESTATE MIDDLETOWN, PA 17057 2 ' FLORENCE MILLER .Daughter ONE FOURTH OF ' 1702 WHITE OAK ROAD ~ ESTATE STRASBURG, PA 17579 ~I 3 ' DELORES L. SHOPE Daughter ONE FOURTH OF ~ 391 MITZLER ROAD ', ESTATE ALUM BANK, PA 15521 ' Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+ (9-00) SCHEDULE J COMMNNERTANC oAXRETURNANIA BENEFICIARIES continued RESIDENT DECEDENT II _ _.. _ _ ~ -- _ ___ ESTATE OF GARRISON, ERNEST R. FILE NUMBER 21-09-01162 RELATIONSHIP TO i SHARE OF ESTATE AMOUNT OF ESTATE NUMBER ! NAME AND ADDRESS OF PERSON(S) DECEDENT ! (Words) ~I ($$$) RECEIVING PROPERTY Do Not List trustee(s) l 1 _ __ ___ I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J ~ 4 !JEAN M. FURNISH Daughter j ONE FOURTH OF ' ' 1008 STRATWOOD AVENUE ~ ESTATE j OXON HILL, MD 20745 LAST WILL AND TESTAMENT OF ERNEST R. GARRISON I, ERNEST R. GARRISON, now or formerly of Cumberland County, Pennsylvania, do make this my Will, hereby revoking any and all Wills or Codicils at any time heretofore made k~_y me. FIRST: I direct that the expenses of my last illness and funeral be paid out of my estate as soon as may be convenient after my death. SECOND: I give, devise, and bequeath the residue and remainder of my estate so that there will be one equal share for each child of mine who is then living and one share for each deceased child of mine who has descendants then living, with each such deceased child's share being divided equally into further separate shares for such deceased child's living descendants. Each share of a child of mine who is then. living and each share of a descendant of a deceased child shall be distributed outright to such person, free of trust. THIRD: I direct my Personal Representative to pay out of the principal of my residuary estate all estate, inheritance and other taxes in the nature thereof imposed upon or with. respect to my estate or any property in which I have an interest including any property included in my gross estate for tax purposes, whether or not such property passes under this Will, at such times and in such manner as my Personal Representative deems advisable; and no portion of such taxes shall be collected from or refunded by any other person by way of apportionment or otherwise. FOURTH: I appoint my daughters, Delores L. Shope and Jean M. Furnish, Personal Representatives of my estate. If either Delores L. Shope or Jean M. Furnish is unable or unwilling to serve as Personal Representative, the other shall act alone. I give and grant to my Personal Representatives, in addition to the authority conferred by law, the power to sell any or all of my property, real or personal, or in their discretion to retain the same for distribution in kind. No bond shall be required of any fiduciary hereunder in any jurisdiction. No fiduciary hereunder shall have any liability for any mistake or error in judgment made in good faith. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of ~ ~ 2009. ERNEST R. GARRI;~ON 2 ~ ~'.~ Signed, sealed, published and declared by the above named Testator, Ernest R. Garrison, as and for his Will, in the presence of us who, at his request, in his presence, ~~nd in the presence of each other, have hereunto subscribed our lzames as witnesses. Signature: ~ ~ ,~ A r~ L.,.~,~.1~,; W `1V~ /: ,...~~ :~ y~{,~' I~ ... ~r~..9 ~r / "" ~, N,,,. s /,, Address: a E. -~.~. s~ n1~ P v ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) I, Ernest R. Garrison, the 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 tY1e 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 expressed. ' Ernest R. G rrison Sworn or affirmed to and subscribed to before me by Ernest R. Garrison, this ap day of ~ 2009. 4~ ~~-~ 3 ~~~~~ ~ n AFFTT~AVTT COMMONWEALTH OF PENNSYLVANIA ) ss COUNTY OF CUMBERLAND ) We, C; ,(1I ~. _S~N~.Ce ~ and r the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Ernest R. Garrison, testator, sign and execute the instrument as his Last Will; that Ernest R. Garrison 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 i~estator signed the Will as witnesses; and that to the best of our knowledge Ernest R. Garrison was at that time 18 or more years of age,. of sound mind and under no constraint or undue influence. Signature of witnesses: -~''~^ - Sworn or affirmed to and subscribed to before me by r^K, h: c~ N e ~ Sh mc~. ~ and I ~s Lam. ~, r _ witnesses, this ~ day of ~~ __ 2009. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Jared M. Conrad, Notary PubNc Fairview Twp., York County My Commission F_xpin3s Sept. 24,2012 Member, Pennsylvania Asaodation of Notaries a A. Settlement Statement (HUD-1) OMB Approval Nrr )S()7-02fi5 1. ~ FHA 2 ~~ RHS 3 ®Conv. Unins. 6. File Number: 7. Loan Number 8. Mortgaye Insurance Case Number. 55229447 3223976049 4. ~ VA 5. ~ Conv.lns. C. Note: This form is fwnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked '(p.o.cj were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name & Address of Borrower. E Name & Address of Seller F. Name & Address of Lender PATRICK A NEWCOMER, REBECCA L NEWCOMER THE ESTATE OF ERNEST R. GARRISON QUICKEN LOANS, INC. 3922 SILVER BROOK DR. 314 E PORTLAND ST. 20555 VICTOR PARKWAY ANDERSONTOWN . PA 17050 MECHANICSBURG , PA 17055 LIVONIA, MI 48152 G. Property Location, H. Settlement Agent: TITLE SOURCE, INC. ///ASSOCIATES I. Settlement Date: 6/23/2010 314 E PORTLAND ST. SETTLEMENT SERVICES, LLC. MECHANICSBURG, PA 17055 Place of Settlement: Disbursement Date: 6!232010 SUBJECT PROPERTY: 3922 SILVER BROOK DR. MECHANICSBURG, PA 17055 100. Gross Amount Due from Borrower 101. Contract sales price $112,200.00 102. Personal property 103. Settlement charges [o borrower (line 1400) $5,189.75 104.2010 School Tax Escrow Due To: TITLE SOURCE, INC. $1,350.79 105. Adjustment for items paid by seller in advance 106.City/town taxes 6/23/2010T012/31/ZO10(w$1.50/DAY $286.31 107. School Taxes 6/23/2010 TO 6/30/2010 (?$3.30/DAY $23.08 108. Assessments 109. Sewer and Trash Flat Fees 6/23/2010 TO 6/30/2010 <~ 58.67 110. 111. 112. 120. Gross Amount Due from Borrower $119,058.60 200. Amounts Paid by or in Behalf of Borrower 201. Deposit or earnest money $1,500.00 202. Principal amount of new loan(s) $89,750.00 203_ Existing loan(s) taken subject to 204. Good Faith Deposit lo: QUICKEN LOANS, INC. $500.00 205. Sellers Credit $2,200.00 206. 207. 208. 209. Adjustments for items unpaid by seller 210. City/town taxes 211. County taxes 212. Assessments 213. 214. 215 216. 217. 218. 219. 220. Total Paid by/for Borrower $93,920.00 300. Cash at Settlement fromlto Borrower 301. Gross amount due from borrower (line 120) $119,058.60 302. Less amounts paid bylfor borrower (line 220) $93,950.00 303. Cash ®From ~ To Borrower $25,108.60 400. Gross Amount Due to Seller 401. Contract sales price $112,200.00 402. Personal property 403. 404. 405. Adjustment for items paid by seller in advance 406. City/town taxes 6/23/2010 TO 12/31 /2010 C+~$ I.50/DAY $286.31 407. School Taxes 6/23/2010 TO 6/30/2010 ~~$3.30/DAY $23.06 408. Assessments 409. Sewer and Trash Flat Fee 6!23.2010 TO 6/30/2010 (w$ $8.67 410. 411. -- 412. -- 420. Gross Amount Due to Seller $ I 1 ,518.06 500. Reductions In Amount Due to Seller 501. Excess deposit (see instructions) 502. Settlement charges to seller (line 1400) $1,222.00 503. Existing loan(s) taken subject to 504. Payoff of first mortgage loan 505. Payoff of second mortgage loan 506. Seller Credit $7,200.00 507. Sewer and Trash Escrow To: TITLE SOURCE, INC. $200.00 508. Deposit or earnest money $" ,500.00 509. Adjustments for items unpaid by seller 510. City/town taxes Sl 1. County taxes 51 Z. Assessments 513. -- 514. -- 515. 516. 517. -- 518. 519. 520. Total Reduction Amount Due Seller $ ~,12_Z,00 600. Cash at Settlement to/from Seller 601. Gross amount due to seller (line 420) $1 I~,5I8.OEi 602. Less reductions in amount due seller (line 520) $5, I?2.0(1 603. Cash ~ From ®To Seller $107, 396.06 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. - - --- -- Previouseditions are obsolete Page 1 of 5 tl1lD_1 ~~y_ Sid' - .s-.~s,~ x a i ~., :~ j`~~ ~~ - ~s'~ - 7o s.,; 700. Total Real Estate Broker Fees P id F Division of commission (line 700) as follows. a rom Borrower's Paid Front SeHers's 701. Funds at Funds at 702. Settlement Settlement 703. Commission paid at settlement 704. - 705. 800, Items Payable in Connection with Loan 601.Our origination charge $1,070.00 (from GFE #1) 802. Your credit or charge (points) for the specific interest rate chosen $897.50 (flour GFE #2) 803. Your adjusted origination charges (from GFF A) $1,967.50 804. Appraisal Fee to TSI Appraisal Services (from GFE #3) $35000 805. Credit report 70: Credco (from GFE #3) $8.55 606.7ax service To: First American Flood Data Services (from GFE #3) $60.00 807. Flood Certification to First American Flood Data Services (from GFE #3) $5.00 808. Flood Determination Fee to First American Flood Data Services $10.50 Total Additional Charges from Addendum $80.00 900. Items Required by Lender to Be Paid in Advance 901. Daily interest charyes from 6/23/20 10 TO 7/ 1 /2010 ~d$14.34/DAY (from GFE # 10) $1 14.72 902. Mortgage insurance premium (from GFE #3) 903. Haneowner's insurance (from GFE #11) 904. 905. 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE #9) 1002. Homeowner's insurance 1003. Mortgage insurance 1004. Property [axes 1005. 1006. 1007. Aggregate Adjustment Total Additional Charges from Addendum 17 00. Title Charges 1101. Title services and lender's title insurance (from GFE #4) $379.73 $100.00 1102. Settlement or closing fee To: ASSOCIATES SETTLEMENT SERVICES, LLC. $125.00 1103. Owner's title insurance 70: Tfit E SOURCE, INC. (from GFE #5) $919.75 1104. Lender's title insurance 1105. Lender's title poky lunit $89,750.00 1106. Owner's title policy limit $112,200.00 1107. Agent's portion of [he total title insurance premium 5692.06 1108. Underwriter's portion of the total title insurance premium $157.42 Total Additional Charges from Addendum $354.73 1200. Government Recording and Transfer Charges 1201. Government recording charges (from GFE # 7) $172.00 1202. Recording Fees Include: Mty $102, Deed $70 To: CUMBERLAND COUNTY RECORDER OF DEEDS $1 IL00 1203. Transfer taxes (from GFE #8 $1,122.00 51,122.00 1204. City/County Wxlstamps To: CUMBERLAND COUNTY RECORDER OF DEEDS $1,122.00 1205. State tax/stamps To: CUMBERLAND COt1NTY RECORDER OF DFFDS $1,122.00 1206. Total Additional Charges from Addendum 1300. Additional Settlement Charges 1301. Required services that you can shop for (from GFE #6) 1302, - -- 1303. ~-- Total Additional Charges from Addendum ' c'r e a $5,169.75 51,222.00 _~C orrowers ~ ~ ~ , Sellers Title Source, Inc. Previous editions are obsolete Page 2 of 5 Date i-IUD-1 ~'~~.1 ~~la.t~~ ~~'a.la.~~ ~~-~'~ n-~r Papcr Savings Bonclt,;s? =Calc:ulai.ed Value of Your Paper Savings Bond(s) i~alc~alator Results for Redemption Date 12/2009 Page l of ~.. ~. ~.. ,_ $3,600.00 __^ $16,756.24 $13,156.24 $611.92 Bonds: 1- 72 of ;~~! ,, ,:- t ... . .: j ~ _: , .., ,, !,, C2729805EE EE $100 07J1980 01/2010 ' 07/2010 ~ .. 'W $50.00 $271.80 4.00°l° $321.80 '' C2729865E'~E EE $100 08/1980 02/2010 08/2010 $50.00 $271.80 4.00% $321.80 C2729925EiE EE $100 09J1980 03/2010 09/2010 $50.00 $271.80 4.00% $321.80 C272998ZEI~ EE $100 10/1980 04/2010 10/2010 $50.00 $271.80 4.00% $321.80 C2755201E1= EE $100 11/1980 05/2010 11/2010 $50.00 $244.96 4.00% $294.96 C2755256E1~ EE $100 12/1980 06/2010 12/2010 $50.00 $244.96 4.00% $294.96 C2755313E1= EE $100 O1J1981 01/2010 01/2011 $50.00 $239.16 4.00% $289.16 C2755365Ei= EE $100 01/1981 01/2010 01/2011 $50.00 $239.16 4.00% $289.16 C2755418E1= EE $100 02/1981 02/2010 02/2011 $50.00 $239.16 4.00°!° $289.16 C2755470EI= EE $100 03/ 1981 03/2010 03/2011 $50.00 $239.16 4.00% $289.16 C2755522E1= EE $100 04/ 1981 04/2010 04/2011 $50.00 $239.16 4.00% $289.16 C2755573E1= EE $100 05J1981 05/2010 05/2011 $50.00 $226.84 4.00% $276.84 C2755626EI= EE $100 06/1981 06/2010 06/2011 $50.00 $226.84 4.00% $276.84 G19196774E1= EE $100 07/1981 01/2010 07/2011 $50.00 $221.40 4.00°!° $271.40 C19196837EI= EE $100 08/1981 02/2010 08/2011 $50.00 $221.40 4.00% $271.40 C19196896E1= EE $100 09/1981 03/2010 09/2011 $50.00 $221.40 4.00% $271.40: C19196953EI= EE $100 10/1981 04/2010 10/2011 $50.00 $221.40 4.00% $271.40 C19197016E1= EE $100 11/1981 05/2010 11/2011 $50.00 $221.40 4.00% $271.40 C19197072E1= EE $100 12/1981 06/2010 12/2011 $50.00 $221.40 4.00°ib $271.40 C19197128E1= EE $100 01/1982 01/2010 01/2012 $50.00 $216.08 4.00% $266.08 C19197186EE EE $100 01/1982 01/2010 01/2012 $50.00 $216.08 4,00% $266.08 C19197245EE EE $100 02/1982 02/2010 02/2012 $50.00 $216.08 4.00% $266.08 C28644961EE EE $100 03/1982 03/2010 03/2012 $50.00 $216.08 4.00% $266.08 C28645017EE EE $100 04/1982 04/2010 04/2012 $50.00 $216.08 4.00°rb $265.08 C28645077EE EE $100 05/1982 05/2010 05/2012 $50.00 $216.08 4.00% $266.08 C28645134EE EE $100 06/1982 06/2010 06/2012 $50.00 $216.08 4.00% $266.08 C28645193EE EE $100 07/1982 01/2010 07/2012 $50.00 $210.88 4.00% $260.88 ~C28645255EE EE $100 08/1982 02/2010 08/2012 $50.00 $210.88 4.00°!° $260.88. C28645317EE EE $100 09/1982 03/2010 09/2012 $50.00 $210.88 4.00% $260.88 C28645383EE EE $100 10/1982 04/2010 10/2012 $50.00 $210.88 4.00% $260.88 C33622945EE EE $100 11/1982 05/2010 11/2012 $50.00 $198.92 4.00°rb $248.92 ~C33623006EE EE $100 12/1982 06/2010 12/2012 $50.00 $198.92 4.00°!° $248.92 C33623074EE EE $100 01/1983 01/2010 01/2013 $50.00 $194.04 4.00% $244.04 C33623133EE EE $100 01/1983 01/2010 01/2013 $50.00 $194.04 4.00% $244.04 C33623198EE EE $100 02/1983 02/2010 02/2013 $50.00 $194.04 4.00°!° $244.04 C33623252EE EE $100 03/1983 03/2010 03/2013 $50.00 $164.44 1.29% $214.44 C33623310EE EE $100 04/1983 04/2010 04/2013 $50.00 $164.44 1.29% $214.44. C33623368EE EE $100 05/1983 05/2010 05/2013 $50.00 $154.72 1.64% $204.72 ~~41470187EE EE $100 06/1983 06/2010 06/2013 $50.00 $154.72 1.64% $204.72 C41470264EE EE $100 07/1983 01/2010 07/2013 $50.00 $152.88 1.78°/6 $202.88. C41470343EE EE $100 08/1983 02/2010 08/2013 $50.00 $152.88 1.78% $202.88 C53425639EE EE $100 09/1983 03/2010 09/2013 $50.00 $152.88 1.78% $202.88. C53438479EE EE $100 10/1983 04/2010 10/2013 $50.00 $152.88 1.78% $202.88 C57394747EE EE $100 11/1983 05/2010 11/2013 $50.00 $146.84 4.00°l° $196.84 C57394795EE EE $100 12/1983 06/2010 12/2013 $50.00 $146.84 4.00% $196.84 C57983540EE EE $100 12/1983 06/2010 12/2013 $50.00 $146.84 4.00% $196.84 http://www.treasurydirect.govBCISBCPrice 2/4/2 10 ~'~.lo~~.~la'~rcl ~,~':~''y~~ r~~'~Y cur ~'ape~r Savings Bonclf~s? Page 2 of L C`~7983fi27EE EE $100 01/1984 01/2010 01/2014 $50.00 $144.60 4.00% $194.60 0:7983;T09EE EE $100 02/1984 02/2010 OZ/2014 $50.00 $144.60 4.00% $194.60 C~:7984O42EE EE $100 06/1984 06/2010 1)6/2014 $50.00 $143.00 4.00% $193.00 C~~7983;~94EE EE $100 03/1984 03/2010 03/2014 $50.00 $144.60 4.00% $194.60 C"~~7983f375EE EE $100 04/1984 04/2010 04/2014 $50.00 $144.60 4.00% $194.60 C~:7983~>55EE EE $100 05/1984 05/2010 05/2014 $50.00 $143.00 4.00% $193.00 C619531.13E~ EE $100 07/1984 01/2010 07/Z014 $50.00 $139.20 4.00% $189.20 C61953~'03EE EE $100 08/1984 02/2010 08/2014 $50.00 $139.20 4.00% $189.20 C68098f310EE EE $100 09/1984 03/2010 09/2014 $50.00 $139.20 4.00% $189.20 C68098t)15EE EE $100 10/1984 04/2010 10/2014 $50.00 $139.20 4.00% $189.20 C75711~:OOEE EE $100 11/1984 05/2010 11/2014 $50.00 $139.20 4.00% $189.20 C75711~'87EE EE $100 12/1984 06/2010 12/2014 $50.00 $139.20 4.00% $189.20 C75753~~79EE EE $100 12/1984 06/2010 12/2014 $50.00 $139.20 4.00% $189.20 C75754C?59EE EE $100 01/1985 01/2010 01/2015 $50.00 $135.48 4.04°!0 $185.48. C75754].50EE EE $100 02/1985 02/ZO10 02/2015 $50.00 $135.48 4.00% $185.48 C77884601EE EE $100 03/1985 03/2010 03/2015 $50.00 $135.48 4.00°t° $185.48 C77884686EE EE $100 04/1985 04/2010 04/2015 $50.00 $135.48 4.00% $185.48. C81233682EE EE $100 05/1985 05/2010 05/2015 $50.00 $135.48 4.00% $185.48 C8123~~776E EE $100 06/1985 06/2010 06/2015 $50.00 $135.48 4.00% $185.48 C81233E>76EE EE $100 07/1985 01/2010 07/2015 $50.00 $131.88 4.00% $,181.88. C819961I7EE EE $100 08/1985 02/2010 08/2015 $50.00 $131.88 4.00°l0 $'.181.88 C81996214EE EE $100 09/1985 03/2010 09/2015 $50.00 $131.88 4.00% $'181.88 C85033356E EE $100 10/1985 04/2010 10/2015 $50.00 $131.88 4.00°l0 $181.88 C85033454EE EE $100 11/1985 05/2010 11/2015 $50.00 $131.88 4.00% $181.88 C85116689EE EE $100 11/1985 05/2010 11/2015 $50.00 $131.88 4.00°rb $181.88 C85116785EE EE $100 12/1985 06/2010 12/2015 $50.00 $131.88 4.00% $181.88 _ Totals for 72 Bonds $3,600.00 $13,156.24 $16,756.24 =:r NI Not Issue~~ NE Not eligibl e for payment P5 Includes 3 ~ month interest penalty MA .Matured a nd no t earnin interest h~ttp:l/wvww.treasury~direct.gav/BCISBCPrice 2/4/ZU 10 ~~lember FINRA and SfPC January 07, 2010 Delores L Shope 391 Mitzler Rpad Alum Bank, PA 15521 RE: Estate of Ernest R Garrison Date of Death Valuation Date of Death: December 1, 2009 SS# 185-03-6046 Dear Delores: The date of death value for securities held by Ernest R Garrison in his PNC Investment Account 3601-4932 is as follows: 18964.3 5 6 shares Putnam PA Tax Exempt Inc Fund C Shares @ $9.00 per share An Allstate Advantage Plus Annuity was also contained in this account. `The Date of Death Valuation for the annuity will be coming directly fmm Allstate.. Please feel free to contact me if I can be of further service. Sincerely, r _ ~~ ~-1~ ~..-r Charles E Little, CFP, SVP Financial Advisor CEL1djp The information contained herein has been obtained from sources we believe to be reliable but do not guarantee it to be accurate, correct, complete ar timely, and shall not be responsiblefor the results obtalned from it's use PNC Investments LLC Mersiber of The PPlC Financial Services Group T~vo East Main Street Mechanicsburg Pennsylvania 17U55 www.pnc.com litl~lQ.Ct8fi~1[11L@S1A~'~O€~'tS~9lA:5-£'C~rL~.F~FESs~:~~t^~~±+2 ~y*~`-. CY.=~?5 af~a,.jo~"~G^'tR~~F3~~~y ~ti{.., tiR~l~?'~'skt~'+i'?C$~ ., .r Z t~P~t'~Nl't~r.=.1+ ~~ue'"~.. .San `Eufr.~ fi;w~im~v:~ 3:urars~»~Gi~-~ ~m:~ ~¢tt~er insurancQ prnducks are offered by FRC lnsr,r~~nce Services L!_u, <~ lic~rrsec! insursnc~ ~clerrc~~. O a~I .- n ~t ~r n n r- ~n N o n O ,p 00 00 O N 00 00 d: ~- n O n N m! ~ci rn a o v 00 ~ ~ n o ~- ~ _~ i ~ a~ ~ cfl •- a~ r- a~ a~ ` cD o ~? oo •- m u~ m co N jP NNE N N N ~ N N ~' L °'l ^^ 1.1. O~ a~ ~! U) N Q) ~~. N~ U C fII RS m 3 Z, O ! O '~ Oa00 rn X00 In CO ~ CD ~ Q) ao N N N O r n O CO O O O D Q O O r N U W t!1 n O O N d' O O O O O m N ~ t a ~ ~ ~° v~ E f -- LL N O O O O M CD O O ('7On ao ~ O N N 0 0 0 0 M M O O r ~ r- N O O O n d' O N i ~~` o00 0 0 0 000 0 0 ai~ o00 0 0 0 000 0 0 ~, o00 0 o a ocio co co 1 ,~~ 000 O O O 000 O O ~~ 000 O O O 000 O O d.: 000 O O O 000 O O ~' C _~ ~~ r ~' ~' O O O M A O O O L~ 00000n O OOOlrOrQ)f~ V } t1~ tf') ~ ~ Ln tt~ to ~ ~t ~- r ~ e- ~ its ~ + ~ to ~ n O ~- ~-- O st ~ O O ~ ~ ~ O 00 00 N e- .- r ~~ ANN.- .- ! r tCJ ~ NNN O ! (Q O O O O m + (p O O M Q °n ti O O O 1 ~ r-' d'.-d'~',`r000 ~NOn UO~Mtt)tnr0~tn E, NCOO~OnaO W0000 WOp00e-lO~-p0 ~ Ni ~OOONOM ~N~O ~CTUr~t'r'T~l~~tl ! 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O O O O O O 0 0 0 O O c~~ o00 0 0 0 000 0 0 N N N N N N N N N N N O .~ OOO O M M O O O O O C a~ ~1` ` O O MMcM M cM N N N N N N e- e- r r r- O I ~- ! ~- e- r r ~r ~- c- r- r O r N O t~ Meilife TOTAL CONTROL ACCOUNT 485-E US HIGHWAY 1 SOUTH 4T" FLOOR PO BOX 4121 ISELIN, NJ 08830-4121 TEL: 1-800-638-7283 February 5, 2U 10 Delores L Shope 391 Mitzler Rd Alum Bank, PA 15521 RE: EARNEST GARRRISON Sole Owner TOTAL CONTROL ACCOUNT 4059 425076 Dear Ms Shope: I am responding to your request for the date of death balance regarding the above account. The balance in the above account was $44,372.62 on 12/01/2009, which includes interest earned of $ 1.81. If you have any further question, you may call our Customer Service Representatives Monday through Friday 8:00 a.m. to 6:00 p.m. Eastern Time. Sincerely, ~/ ~_-- Pat McGowan Metropolitan Life Insurance Company provides administrative services for Total Control Accounts issued by its affiliates s ~~. for ttie periiad 1'!/14/2AtlfU N:o 1 Z.~'! s/2~trD9 I ~ t~~l. iron : ic~i~ ~~I-r c: -t to PI~J1~ Bal~l~ ~~nGne ranking ERNE-ST R G~~RRI:SUN ~ ~~ .~:~~r . Primary account number: 50-i~)07-~6i'7 . t ii~.~.n b~~ it •' li 'i ' ,: ~~„' ~ curtlinu,,d Paye 3 of 4 i r~, ~ ~rt~d E~ ~,:ltrt;~~u,ii, :: l:!„~rtlciu~i~l~ t1~:r.Yutction~ - ccratinued A r uu't U -> :riot~or t ! t.~~IIU l: it rr t Pri~'nrc~i,1 - `~a1~15-i l l ~ .7~3~ l: irect P,~~•n.ietlt - iE'lec ~~~c Ypl Ec, X1:~X?:~7OU1~1'. ~' . ~.1.1:3~ ]. IFC't t P:1~'11a e nt -~h,i1'111t',lt l~ef :~.O 1 l~ ii ect 1'a~-nn~ent - :[n: Prem .~l~umune,ll;~I Life \V'70~135:~5 .. .. _...-------.__-_._._. 1 ~~ I:.~ `hart cc ~)~ , ,a~~ - ----------- 3a la r ::~ DatE~ t3al.anre pate 8alanr:e pate Bata ~c.e I i.°~ i~ t5 . t~~ 11 l .3 3:3,7:''>~t.:i.~ 1 `_', "p l ~,~t .-~.it).33 ~ 1 `? ,Ofit - ,:,~t,O'77. ~ .] I 4:~, ~,~ 1-~ ` 1`~ l 1 "ZU :.~5, lt>>. l; 1 ~7 ,'(r3 '_'Ot;.7O `_'~t ] ~~ • 1 1 `~~t,t)'7`?. ~U i i'~, i4~ l 't ~~~ l l,"~~.1 `?:x,37O. la 1'a •U ] -~~ct,l I Lit`? 1`? "1 i ~~~t.U'7i._~U Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 March 19, 2010 Delores L. Shope 391 Mitzler Road Alum Bank, PA 15521 Re: Ernest R. Garrison Contract No: GA0678525 Dear Ms. Shope: ~~ ~ae~ You`re. in good hands. We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IIZS Form 712. I can, however, prcrvide the following information for estate purposes: Date of Death: December 1, 2009 Annuity Value as of Date of Death: $ 79,366.96* Cost Basis: $ 60,000.00 Named Beneficiary: Dolores Shopes, Jean M. Furnish Florence A. Miller, Ernest R. Garrison *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 86482. Sincerely, ,~ ~, Y r~~ Valarie Melton Sr. Claim Examiner ~ ., r~ ~ ~ ~ , .. __. , ~. _ .. - ' Fle Toolbar Transactions HeIA Iran fvlode: OTC Q^ ~+ ~ ~ v--___ --__-------------y~-~ _ 'wit=1 ~- ~.~_1~~yf ~ _-...--------- 0 Comakers I 0 Payrolls 0 Plastics 0 Comments 0 Joints 0 Misr: Comes Diarrwrrd D Agrrrcations Score' Inquiry Task List 0 Balar7ces O Address '0 Comakers !O Cornrnents 0 Transaction Histrry O Joint Ovaners 0 -+1en;ber Inr4uiry O tylisceBaneous Codes O Distribution Summary O Plastic Card Surnrnary O Pelationsf-,ips 0 Certificates O Dividends O ~l•,ares O Check Orders 0 Available Credit # ~i Frew Next Clo lD Description ~ Rate ( Balance _j Available ~ Claw ~ Flold ~ Hold ArM S1 ~~-prim:er~ ~f,ores Q_5<" :3~51.1~a :{,4E~.1:) 01 ~;:0_ii~l ID Description ' Balance ~ Arailable~ Payment ~ Freq ~ Method (Due Date ~ Dlnq Amt Number Description -- ! Balance + Maturity Date Rate ~ Earn Date ~ Min $al ~ Nold 1 GO Mlonth 855,670.$1 04!21),'2011 4.941; /2101/2009 :1;5A00.00 2 EO t~Aonth $55,6710.$1 t34f2t)1'2(111 d.9dCta 12fi01l20C19 's5,000.4D 3 601viont4-~ $55,670.$1 04I20,f2011 4.940. 12'0112009 $5,000.00 4 60 P,lonth $55,6?0.81 04!2012011 4.940% 12!01!2009 :$5.000.00 Keyboard 81 ~ Production 1217 8,09 2:02 PA~1