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HomeMy WebLinkAbout02-25-11' 1505610140 REV-1500 EX ~°~_'°' PA Department of Revenue Bureau of Individual Taxes County Code Year Fife Number PO BOX 280601 INHERITANCE TAX RETURN 2 I I 0 1, 0 :1 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY L 6 2 2 2 1, 2 3 2 0 9 2 0 2 0 1 0 0 9 2 3 1, 9 2 8 Decedent's Last Name Suffix Decedent's First Name MI R O C K E R B E T T Y A N N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED 1N 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 12-13-82,1 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ~ 7. Decedent 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. E{ection to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) {Attach Sch. O) CORRESPONDENT -THIS SEGTiON MU51 tat GVMF'Lt 1 tU. ALL GUKKkSt'uNUtNGt A-vu l.unrwtn i iH~ i H~ irvrvrcmH i i~rv anww ac viR~~ i cu i v. Name Daytime Telephone Number D A V I D H S T O N E~ E S Q U I R E ? 1, ? ?? 4 ? 4 B 5 REGISTER OF WILL: USE __ ONLY _ _ First line of address ~ ••,..~ 4 1, 4 B R I D G E S T R E E T ~..J ~~,'-~-~ p ~ ~~ ~~~ . , '1 f`.j ~ ~ i Second line of address ,-; -~=~ ~ .I i _ ~ C~ ~-,_ r - City or Post Office State _ ~ ZIP Code __ _ DA1~~LE.D ~ •i :,~. r.-. , N E W C U ~1 B E R L A N D P A 1, 7 0 7 0 ~' r, `° y:._ `~' Correspondent's a-mail address: D S T O N E a~ S T ©N E L A W• N E T Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge ar~d belief, it is true, correct and complete. Declaration of preparer other than the personal represent 've i based on all rmation of which preparer has any knowledge. SIG~tirT1dRE SPONSISLE FOR FILING RETURN ~ ~iE~ ~/ ~-~ ~ ~ ADDRESS ' / 6 N STR ET NEW CUMBERLAND PA 1,?070 SI NA~'f'71it~OF P PA ERbT R THAN REPRESENTATIVE DATE ~ ~ ~. i ` 'a .. '7'7_l ~ ADDRESS "' `~ ``'- 41,4 BRIDGE STREET NEW CU~1BERLAND PA 1,?0?0 PLEASE USE ORIGINAL FORM ONLY Side 1 1,505610140 1,50561,01,40 J REV-1500 EX Decedent's Name. BETTY ANN ROCKER Decedent's Social Security Number L 6 2 2 2 1, 2 B 2 RECAPITULATION 1, Real Estate (Schedule A) ......................................... .. 1 ~ • 2. Stocks and Bonds (Schedule B) .................................... .. 2~ • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. • 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. 2 4 D 8 5 . 4 1, 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. ~ 8 5 5 3 . 4 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property arate Billing Requested ~ Se h d l G S 7 B D `~ 6 8 . 2 3 ..... p e ) ( c e u . .. 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. ? B ~ D 7 . 0 4 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9. 9 `~ 2 2 ' ~i 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. 4 2 5 . D 0 11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 1 D 3 4 ~ ~i 5 12. Net Value of Estate (Line 8 minus Line 11 } ...................... ...... 12. 6 B c' 5 9 . 4 9 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ................ ...... 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) ................ ...... 14. 6 5 c'. 5 9 . 4 9 TAX CALCULATION -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• D D D D 15. 16. Amount of Line 14 taxable at lineal rate X• 0 4 5 6 3 2 5 9. 4 9 16. 17 Amount of Line 14 taxable . at sibling rate X .12 D D D 17. 18 Amount of Line 14 taxable . at collateral rate X .15 D Q D 18. 19. TAX DUE .................... ......................... .. ..... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1,50561,0240 0. 0 D 2 8 4 6. 6 8 0. D 0 0. D 0 2 8 4 6. 6 8 Side 2 150561,D240 150561,D240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21, 1, 0 1, O 1, 9 DECEDENT'S NAME BETTY ANN HOCKER -_ STREET ADDRESS 61,6 HARDING STREET __ _-- __ __ r CITY 'STATE ~?IP NEW CU(~BERLAND j PA ' :17070-~ Tax Payments and Credits: ~. Tax Due (Page 2, Line 19) 2, CreditslPayments A, Priar Payments 2 , 6 0 0.0 0 B. Discount 1, 6 6 • 8 4 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fili 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. 2,846.68 Total Credits (A + B) (2) (3) (4) (5) 2,766.84 0.0~ a.aa 1,~9 . 84 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 : ................................................................ ...... ^ 0 b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ c. retain a reversionary interest; or .......................................................................................... ...... ^ ^ 0 0 d. receive the promise for life of either payments, benefits or care? ................................................. ...... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................. ...... ^ 0 3, Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ... ...... ~ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................ ...... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND F ILE IT AS PART OF THE RETURN. For dates of death on or after July 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 3 percent [72 P.S. §9116 (a) (1.1) (i)), For dates of death on or after Jan. 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) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax 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, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY ANN HOCKER 21 10 1019 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• Claremont Nursing Home-refund received 2,500.00 2 MB~T Bank-Checking Acct #1,04541,28 21„288 •08 Princ• $21„288.08, Int• $•06 Clarence R Hocker 3 M&T Bank-Checking Acct #1,04541,28 - Accrued Interest 0.06 predeceased decedent 4 Miscellaneous deposit 246.1,5 5 Nationwide Insurance-refund 51.1,2 TOTAL (Also enter on line 5, Recapitulation) I $ 2 4 , 0 8 5.41 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE: INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: BETTY ANN ROCKER _21 1,0 1,019 If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. JOHN A ROCKER 106 S NORWAY STREET SON MECHANICSBURG, PA J,7055 a. TH0~1AS D ROCKER I c I JOINTLY-OWNED PROPERTY: 61,6 HARDING STREET NEW CUMBERLAND, PA 1,7070 SON ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDE_NT'S INTEREST DATE OF DEATH VALUE QF DECEDENT'S INTEREST 1, • A & B 0 812 0 9 Members 1st-Cent of Deposit #363556-40 Joint 5 0 , 9 71, • 61, :3 3 • I, h , 8 2 0.6 B w/John A Rocker and Thomas D Hooker on August 12, 2009 Princ. $50,925.48, lnt. $46.13 2 A& B 081209 Members 1 st-Money-Management Acct #363556-05 1, • 3 2 B 3• D• 4 4 joint with John A Rocker and Thomas D Rocker on August 12, 2009 Princ. $1.32 B A& B 0 8 010 9 Members 1 st-Savings Acct 363556-00 Joint w/John 5, 2 4 9 •4 7 5 3• J, , 7 3 2.3 B A Rocker and Thomas D Rocker on August 1, 2009 Princ. $5,248.65, Int. $.82 TOTAL (Also enter on Line 6, Recapitulation) ~ $ 1, 8 , 5 5 3 • 4 0 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BETTY ANN ROCKER 21 10 :L01,9 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION pF aPPt~cas~E> TAXABLE VALUE 1, American Funds-Capital World Growth & Inc Fd A 1, 0 3 • 9 3 1, 0 0 • 0 0 1, 0 3.9 0 TOD to beneficiaries: John A Hockey and Thomas D Rocker 3.074 shs @ $33.81 per share 2 American Funds-The Investment Company of America A 2 0, 6 81, • 8 5 10 0. 0 0 2 0, 6 81.8 5 TOD to beneficiaries: John A Rocker and Thomas D Rocker 799.453 shs @ $25.87 per share 3 American Fu nds-Washington Mutual Investors Fd A 1, , 6 3 5. 5 2 10 0 •0 0 1, , 6 3 5.5 2 TOD to beneficiaries: John A Rocker and Thomas D Rocker 64.543 shs @ $25.34 per share 4 Mass Mutual-Annuity Contract No. EVN46003259 8, 5 4 6. 9 3 1, 0 0. 0 0 8, 5 4 6. 9 0 Beneficiary-Thomas D Rocker TOTAL (Also enter on Line 7, Recapitulation) I $ 3 0 , 9 6 8 • 2 0 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BETTY ANN ROCKER 21, 1,0 101,9 Decedent's debts mush be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, Rolling Green Cemetery-opening grave 945.00 Royers-flowers for funeral 1,06.00 Esther's Country Kitchen-funeral dinner 1„1,66•DO ~~ Royers Flowers-flowers for funeral 255.45 ~ Parthemore Funeral Home-funeral expenses 4,282.61, 2• 3. 4• City State ZIP ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Years} Commission Paid: Attorney Fees: David H • Stone, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address ReVationship of Claimant to Decedent Probate Fees: See below # 4 5 . Accountant Fees: 6 • Tax Return Preparer Fees 7• Nationwide Insurance-insurance premiums 51.11 2 Nationwide Insurance-insurance premium 51.1,2 3 Check written but not cleared until after death 341,•76 4 Register of Wills-probate costs 90.50 5 Register of Wills-filing Inh Tax Ret & Inventory 30.00 6 Closing expenses 1,00.00 TOTAL (Also enter on Line 9, Recapitulation) $ 9 , 9 2 2 • 5 5 ZIP 2, 500 . Do If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OFRFVENUE: INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS __ ESTATE OF FILE NUMBER BETTY ANN ROCKER __ 21, 10 _ 1,011,9 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE: AT DATE NUMBER DESCRIPTION OF DEATH 1, Grace Lutheran Church-201,0 pledge owed 425.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 4 2 5 • 0 0 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDEN SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: BETTY ANN ROCKER 21 1,0 1, CI 1,9 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 JOHN A ROCKER Lineal B1„629.74 1,06 S• NORWAY STREET ~1ECHANICSBURG PA 1,7055- 2 TH0~1AS D ROCKER Lineal B1„629 •75 61,6 HARDING STREET NEW CU~1BERLAND PA 1,7070- II. 1• ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1, TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size, REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Betty Ann Rocker, decedent Additional Signature's Address of Person Responsible for Filing Return File No. 21-10-1019 John A. Rocker - 106 S. Norway St., Mechanicsburg, PA 17055 OF BETTY ANN ROCKER I , BETTY ANN ROCKER, of 1701 Cedar Cli f f Drive, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this for and as my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. ITEM I - I direct my Executor, hereinafter named, to pay all my just and lawful debts and funeral expenses out of my personal estate as soon after my decease as is convenient. ITEM II - I give, devise and bequeath all of my property, real, personal and mixed, wherever situated, to my husband, (:LARENCE R. ROCKER, provided that he survives me by ninety (90) days. ITEM III - In the event my husband predeceases me, oz' i n the event he dies wi th i n ninety ( 90 ) days of the date of miy death, then I give and bequeath the rest, residue and remainder of my estate, real personal and mixed, wherever situated, to my two sons, JOHN A4 ROCKER AND THOMAS D. ROCKER, in equal shares, per stir- pes. (I J c~ t~ ~ ~3 €. ' u .7 l .. J e ITEM IV - All federal, state and other death taxes, payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such ., tax, shall be considered part of the expense of the administration of my estate and shall be paid from my estate without apportionment or right of reimbursement. All such taxes on present or future interests shall be paid at such time or times as my Executor may think proper, regardless of whether such taxes are then due. ITEM V - My Executor shall have the following powers for the administration of my estate except as limited herei nabove, i n addition to those vested in him by law and by other provisions of my Will: A. To retain any or all assets of my estate, real or personal, without regard to any principle of diversification, risk, or productivity . B. To i nvest i n al i f orms of property, including stocks, common trust funds and mortgage investment funds, without restriction to i nvestment authorized for Pennsylvania fiduciaries as he deems proper, without regard to any principle of diversification, risk, or productivity, j f 4 -2- C. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms and conditions as he deems proper. D. To borrow money from any person or institution including my Executor and to mortgage or pledge any or all real or personal property as my Executor, in his sole discretion shall choose, without regard for the di sposi ti ve provisions of thi s i nstrument. E. To compromise any claim or controversy. F. To exercise any option, right or privilege granted in insurance policies or in other investments. ITEM VI - No bond shall be required of any person appointed i n thi s Wi 11 as Executor. ITEM VII - I appoint my husband, CLARENCE R. ROCKER, to be the Executor of this, my Last Will and Testament. In the event of his death or resignation or inability to act in that capacity, then I appoint my sons, JOHN A. ROCKER AND THOMAS B. ROCKER, as Successor Co-Executors. -3- ~r'' IN WITNESS WHEREOF, I, BETTY ANN HOOKER, have hereunto set my ~ ~ hand and seal to this, my Last Will and Testament, on this ~-- day o f -~~y ~ ~ , 19 8 7 , a t ~~e c l~ a ~. ~ ~ s ~ ~ .~ , Pennsylvan i a . - -_ ~ ~-- (SEAL) i $ TTY ANN HOOKER WITNESSES: residing at `` ~, `~,\ ' ~ ~. ' residing at Q -4- COMMONWEALTH OF PENNSYLVANIA ~ : SS. COUNTY OF ~u.L~ d ~`- `L I, BETTY ANN ROCKER, testatrix, whose name attached or foregoing instrument, having been according to law, do hereby acknowledge that I the instrument as my Last Will; that I signed signed it as my free and voluntary act for the expressed. is signed to the 3uly qualified signed and executed wi 11 i ngly; and that I purposes therein Sworn or affirmed to and acknowledged before me by BETTY ANN ROCKER, testatrix, thi s /9 ~ day of ~ b.-~.~~ r , 1987. ~----- Y~ ~ -~ . ~~ Not ry Public My Commission Exp.i res VIF.GII'~i •; U. Ci~RI"IS, t~UT:~KY PUdtfC UPPi:R A,LLEfd TVV~'., ;_:'~iPy1 ~E.'LAi40 CO., P~ ( SEAL ;~~i~~ ;;Ur,~V~i'~:~I~Ji; E~PIR.S,'a%~R. Z, :988 COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~~`"'"`~ ~'` "~~~-`'d SS. We, _ ,~:~~. . `~. ~=~~~~~ ; and ~.~~ ~ ~_~~~~ ~~ . C._'Y-c srcl -~~ 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 the testatrix, BETTY ANN ROCKER, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix, BETTY ANN ROCKER, signed the Will as witnesses; and that to the best of our knowledge the testatrix, BETTY ANN ROCKER, was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. - 1 1 i Sworn to and subscribed before me phi s ~~ day of ~"c s, rL~,w !, 198. `rte-,~.~.,..~_.,", Z( ~'.~ ,,.~o Notary Public My Commission Expires SEAL ) ; r.'i ~., . ~-z ~;- f-.~~~ ~ ~.'~)., ~,~ p m~sazk 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302}934-.2955 November 24., 2010 Stone Lafaver & Shekletski Attorneys at Law 414 Bridge Street POBoxE New Cumberland, PA 17070 Re: Estate of Betty Ann Hocker Social Security: 162-22-1232 Date of Death: September 20, 2010 Dear Sir or Madam: Per your inquiry on November 12, 2010, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Ntcmber Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Accocent 10454128 Clarence R Hocker Betty Ann Hocker 08/11/93 $21,288. D8 $ .D6 $21,288.14 For further account information, closures andJor reimbursement of funds please call the West Shore Plaza Office at #717-731.-1730. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Kepr~entative Payee, or Trustee under a Written Agreement Sincerely, ~ Y}~ - ~'1 Tammy Spencer Adjustment Services St MEMBERS 1st FEDERAL CREDIT UMON SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Oate of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Name of Joint Owner Date Joint Ownership Established MONEY MANAGEMENT ACCOUNT: 363556-00 08101 /2009 $5, 248.65 $.82 $5,249.47 John A. Hooker Thomas D. Hocker 08/01!2009 Account Number/Suffix 363556-05 Date Account Established 08/12/2009 Principal Balance at Date of Death $1.32 Accrued interest to Date of Death $0.00 Total Principal and Accrued Interest $1.32 Name of Joint Owner John A. Hockey Name of Joint Owner Thomas D. Hockey Date Joint Ownership Established 08/12/2009 CERTIFICATES OF DEPOSIT: Account NumberlSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Name of Joint Owner Date Joint Ownership Established 363556-40 08/1212009" $50,925.48 $46.13 $50,971.61 John A. Hooker Thomas D. Hockey 08/12/2009 "Opened by transfer of shares from 363556-00. MEMBERS 1sT FEDERAL CREDIT UNION . ~~ Leigh-An a Stallings Lending Insurance Support Specialist December 3, 2010 Estate of: Betty A. Hooker Date of Death: 09l20/Z010 Social Security Number: 162-22-1232 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800} 283-2328 www members 1 st.org 09/29/2010 1.4. 1.F 7177617921 UFINANCIAL F'AGE 01 I00 Corporate Cez~.ter Drivc, Suite 201. Caizn~ ~-Iii.l, PA ~ 7Q 1 Y `~~, P (717} 7b3-7365 P (717) 761-792 a. '.:~`; i•. ' '. '., ,. . 1 ~. ~~.: ~' ~'~~ ,~ ~; r• rt~ ~ ~., :.. ,~ '~ ~~r ~':~ .. (~ I~ ci ('~' ~~I i~ try wry .!'.L To: David Stowe, Esq. ')rpm: 1V~alty Beth Spub~ler Pax; 7~,7_774_38~9 Pages: 3 including cover page Re: ~3ocke>r~ Account Values Tate: x9/29/2010 Mz~. Stone, PE~SUN~~., & CUN~~.EN'~'~A~ Enclosed are the account values for Be#ty Hacker's American Funds account and Mass Mutual Annuity, as per your raquest. These are the values as of her Date of Death 9/0/201 Q. ff you need today's values Qr have any other questions or concerns, please call Dawn Ceprish ~ (717) 763-7365, ar email dceprish a~finsvcs.com. 'hank you Dawn Ceprish Assistan# to Mary Beth Spuhler This fax transmi951on may contain information that Is proprietary, privileged and/or confidential and is Intended exGuslvely for t!'~o person(s) to whom it Is addressed. Any use, copying, retention or disclosure by any person other than the intended recipient or the irrtendod recipient's designees is strictly prohibited. If you have received this message in error, please notify the senQer Immediately by return fax and delete ell copies. 09/ 29f 2010 14:16 Cepr~sh pawn 7177617921 UFINANCIAL F'AGE 02 Ya~;P. I (t l 1 From: AnnuityClient Sent: Wednesday, September 29, 2010 2:1 fi PM To: Ceprish Dawn Subject: Cash Value Quote - EVN4fi003259,doc Massuchu.~.tts Muwal Life insurance Company and affiliates Spriny~eld MA !1111 I-00~1 ~~~~S~1~rt:~ FINA'NC1A~, fiR01~1" September 29, 2010 «««MIPM277"'"' MARY BETH F SPUHLER SUITE 201 100 CORPORATE CENTER DR CA11AP HILL, PA '17011 dear Ms. Spultier: Re; Contract No(s}. EVN4f0032S9; Annuitant -Betty /1,nn Hooker; lssuin~ Company - Massachugetts Mutual Life insurance Co (referred to herein as "MassMuh>sa.l"} As of Sep ~ 0 20 i 0 the contract's total cash value was $8,546.93. .,_.-„ram ThE Total Cash Yalue is the gross cash value of the contract aS of the above referenced date. This value includes net premium payments, plus or minus any interest creditor investment experi+rnce, minus the monthly charges and any partial withdrawals. The Net Surrender Value is the T o)al Cash Yalue minus any applicable surrender charges and any outstanding policy debt. If you have any questions, please contact our Service Center at 1-800-272~22XG. Representatives are available to help you Monday through Friday from 8 a.m_ to 8 p.m., Eastern Time, Other contact options include: our website (use the Contact link at www.m.xssmutual.con~11) or your .financial services representative, Mary Both F Spuhler. Sincerely, ~~e ct_nnu,ti-~}~, hG S a (a.~.~~-tam ~e~ ~ ,~e~ct~~at J ~~ y Benjamin Reardon ~4mA S ~~ l-~-o c K~ Customer Service Representative ~V~r t ~ ed, ~y b rb ~ e,..-) Retirement income Service Center cc: Mary Beth F Spuhler (A037) Registered Represontative pf MM.I, invt~stor Scrvic~ and MML 1]istributorq, LLC a MassMututii subsidit~ry. Supcrvi4ory C)t~cc: 1295 State Street Springfield, MA Of 1 f 1-0001. (413) 7$R-R41 MassMutuai Financial Group IS A marketins Hume for Mtlgsacchusctts Mutual Lifo insurance Company (MaasMutaal) and its n~liated corttpanic4 and sd)co rcptesentativeS, Annuity products arc issued by Mnasachuseu., Marini{ Llf~ InSUrsncc Com~cny and C.M. Litb )nsurcutce Company, 100 Bright Meadow 13onlevard!, Enf+tld, CT 06(1A2, is non admitted in Ncw York anJ ig a subsidiary of Mavaachusetta Mutunl I,ifc )nstnnncc Company, 1295 St~ie Street, 5pr+n}tFeld, M/~ Q11 I 1-0001, • 10 ~ ri 77617921 ~1,rnerican Finds - Historical Account ~alax>ICe ~.. . l~is~arlcat acca~unt batanl~ce « g~tu~A_r&41~n~5.ld~.?~CY As of September 20, 2010 Total value: $22,421.3D Nan-retirement accounts: $22,421.30 Retirement accounts: $0.00 ~JF I NANCIAL BETTY ANN MOCKERlQEC'D PAJT_ ODD Account: 7-~9551?~ Fund Name ri ~~~ ~~ ~~ Shares NAV Market Value September 20, September 20, September 20~ x010 2014 2010 CAPI'T'AL WORLD GROWTH AND INCOME 3.074 FUND-A (33) THE INVESTMENT' COMPANY OF 799.453 AMERICA - A (04) $25.87 $20,681.85 WASHINGTON MUTUAL INVESTORS 64,543 $25.34 FUND ~ A (01) Account Totaf: $~Z,4x1~3~ ~" ~ ~ Ct C ~.e u~.~S ~~ 7`b~ ~tD As of September 20, 2x10 Sohn ~ _ ~,~~~~,,- ~~ Total value: $z2,4~1.3U Non-ret+rement accounts: $22,421.30 r~ UrnG s b f-~v cue-~'" Retirement accounts: $0.00 View the historical balance for a different date: To view your historical balances, enter a specific date or select aquarter-end period using the drop down menu and click SubmOt. ~mm / ~dd / ~-yyyy OR Select aquarter-end period: ~~~ s b,r+;t ~~ (s~ 20~b American funds Distributors. Ync. All rights reserved. fltr.YACY i ~t#Qllc aa.':~lL~Ot { ~~~.4~~~! { ~gnta~L us hops://accounts.a~c>rican#unds.c;Qroltf/~,A,NWeb M~~p w~t~, ~r,t~ , ~~ pri~+t #hi ,page 5e ect l~~ t da~fie $33.81 $103.93 $1,635,52 9/27/2014