HomeMy WebLinkAbout08-26-11yJ
REV~,1500 Ex (o,-~o) ,. { 1505610143
PA Department of Revenue
Bureau of Individual Taxes open M ~YFRa„~Na OFFICIAL USE ONLY
PO BOX.280601
Harrisburg, Pq 17128-0601 INHERITANCE T County Code Year
AX RETURN Fde Number
ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT
Social Security Number 21 11 053 6
17 7 2 4 6 4 3 6 Date of Death
0 4 Date of Birth
Decedent's Last Name 0 7 2 011 10 15
1925
SONa~RVILLE Suffix Decedent's First Name
(If Applicable) Enter Survivin S w~DA MI
9 pouse s Information Below H
Spouse's Last Name
Suffix Spouse's First Name
Spouse's Social Security Number MI
THIS RETURN MUST BE FILED IN DUPLICATE
FILL IN APPROPRIATE OVALS BELOW REGISTER OI= WITH THE
X^ 1. Original Return WILLS
^ 2. Supplemental Retum
^ 4. Limited Estate ^ 3. Remainder Return (date of death
^^ 4a. Future Interest Compromise prior t0 12-13-82)
X g. Decedent Died Testate
^ (date of death after 12-12_82) ^ 5. Federal Estate Tax Return Re uire
(Attach Copy of Will) ^ ~• Attach CoMaintained a Living Trust q d
^ py of Trust)
9. Litigation Proceeds Received yy -'-- 8. Total Number of Safe Deposit Boxes
^ 10. between 12 31 91 and~t1(1ag5~ f death
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ^ 11. Election to tax under Sec. 9113(A)
Name (Attach Sch. O)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION S
~RRY A WEIGLE ESQUIRE HOULD BE DIRECTED TO:
Daytime Telephone Number
717 532 7388
First line of address REGISTER OFCd}IILLS USE Y
12 6 EAST ~ ~ ~~--
KING -; - ~ :~;, , ; -~ ,
STREET ~' _ '~
Second line of address ~~~?~ r~-~--
::.~t~.w .~ I`::~ .._
City or Post Office ~ ~ ~ ~ _
_, ~-.w
SHIPPENSBURG _;. __ N.._,-~.,
~'-~.:~ ~ '..j
State ZIP Code DAT QED - -
PA 172 5 7 ~ !~~..~ ~~
c.
Correspondent's a-mail address:
Under penalties of p pry, I declare that I have examined this return, includin a
it is true, correct a cd plete. laration of preparer other than the ers
f SIGNATU E OF P so RESP g ~mPanying schedules and statements, and to the best of my knowled e a
SI E FoR ILING RETURN P onal representative is based on all information of which preparer has any knowle
r r 9 nd belief,
ADDR SS dge.
Mima J. Willis DATE
1267 Ritn ~-~ "'~
SIGNATURE O PREP ' hWa Shl- ensbur PA 1
RER OTHER THAN REPRESE T 57
IV
ADDRESS ~ T '
rry A. Weigle Esquire DApTE
126 East Kin Street, Shi o a~~-~
g ppensbur , p
150561 Side 1
0143
1505610143 ~^
PA Inheritance
Tax Return
Signature of Additional Fiduciaries
ESTATE OF
Sommerville, Wanda H.
FILE NUMBER
Under penalties of perjury, I declare that I have examined this return in 21-11-0536
my knowledge and belief, it is true, correct and complete. Declaration of r
cluding accompanying schedules and statements, and to the best of
information of which preparer has any knowledge.
p eparer other than the personal representative is based on all
Signature #2 /l //' ,-
Name •~6hn R. Sommerville
Address1 15391 Hillvalle Road
Address2
Clty, State, Zjp Mount Union PA 170E
Date ~/' 7' .-~j'
~~ 1505610243
REV-1500 EX
Decedent's Name:
Sommerville, Wanda H
Decedent's Soci
l
R
,
ECAPITULATION a
Security Num
ber
177
1. Real Estate (Sched
l 24 6436
u
e A)..,,,._
.....
............
.. .
......................
2. Stocks and Bonds (Schedule B),,,,,•.,.•• •..,~~.~-~~~•~~~~ 1'
.
.........................................
3. Closely Held Corporation, Partnership or Sole-P
2
roprietors
hip (Schedule G)....,,,,
3.
4. Mortgages & Not
es Receivable (Sche
dule D) ...........
....
...............
4
ash, Bank Deposits & Miscella
neous Personal Pro ert
p Y (Schedule E).....,,,.••
6• Jointly Owned P
5
ro ert
p Y (Schedule F)
7. Inter-Vivos Transfers & Miscell
Separate Billing Requested
^ 5 9
~ 4 03.02
_
.....,,.,,,.
aneous
(Schedule G) Probate Property ~ 6•
Separate Billing Request
ed......,,,•.. ~
8. Total Gross As
sets (total Lines 1-7)....,,, 47, 675 , 55
............. 8.
9. Funeral Expenses & Administrative Costs (Schedul
e H) .......
107, 078.57
.......................
10. Debts of Decedent, Mortgage Liabilities, & Liens (Sched
l 9
19,571,33
u
11. a I)...........
••""""°°° 10.
Total Deductions (total Lines 9 & 10)...,
3
197
,,,,.•.
....................
••• 11.
2~ Net Value of Estate (Line 8 minus Line 11).....,,,,
13. Charitable and G
.....
,
.62
22 ~ 7 68.95
.......................
overnmental Bequests/Sec 9113
12
Trusts for which
an election to tax has not been made (Schedul
4
309
e J).,,,_.... .62
,
................................ 13.
14. Net Value Subject to lax (Line 12 mi
nus Line 13).
....,,,...
.................. 14.
TAX COMPUTATION -
SEE INSTRUCTIONS FOR APPLICABLE R
15. Amount of Line 14 t
---
4.3 0 9
62
axable
ATES
-
atthe spousal tax rate
or ,
,
transfers under Sec. 9116
(a)(1.2) X .00
16. Amount of L 4 taxable 15
.
at lineal rate X .0_ 4,5
17. Amount of Line 14 t
8 4 ~ 3 0 9
62
0 • 0 0
,
axable
at sibling rate X .12 16.
93
3 , 7 93
18. Amount of Line 14 taxable 0 • 0 0 17 .
at collateral rate X .15 0 . 0 0
Q • 00 18.
19. Tax Due.
...........
................................................ 0
• 00
...................................................... 19. 3
793
,
.93
20. FILL IN THE OVAL IF YOU ARE REQUESTIN
G A REFU
ND OF AN OVERPAYMENT.
Side 2
L
15 p 5 6
1[1243
1505610243
REa/-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-0536
DECEDENT'S NAME
Sommerville, Wanda H,
STREET ADDRESS
Green Ridge Village
210 Big Spring Road
CITY
Newville
STATE ZIP
PA 17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2~ Credits/Payments
A. Prior Payments (1) 3,793.93
B. Discount 3,600.00
189.47
Total Credits (A + g) (2)
3. Interest 3,789.47
4. If Line 2 is greater than Line 1 + (3)
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. Th~ (4)
is is the TAX DUE.
(5) 4.46
Make Check Payable to: REGIST
~s~~~~,~ w ER OF WILLS, AGENT.
.W....__
PLEASE ANSWER THE FOLLOWING QUE '
STIONS BY PLACING AN «
X IN THE APPROPRIATE BLOCK
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred• S
b• retain the right to designate who shall use the property transf Yes No
c. retain a reversionary interest; or ......................... ••....••.•....~.••••~ ^ ^
erred or its income;...... •~~~~~~
d. receive the promise for life of either a .~~~••~~~~~~•~~~~••~'~""" ^ x
2. If death occurred after December 12, 1982, did decedent trap r care?.... •,•... ^ x
..........................
receiving adequate consideration?. sfer property within one year of death witho ^ ^
.... x
id decedent own an "in trust for" or a ut
p yable upon death bank account or security at his or her death?...., ^ ^
4. Did decedent own an Individual Retirement Account, annuit ..
contains a beneficiary designation?.. Y, or other non-probate property which ^ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES x
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PAR
For dates of death on or after July 1, 1994 and before Ja
spouse is 3 percent [72 P.S, T OF THE RETURN.
§9116 a n. 1, 1995, the tax rate imposed on the net value of tra
For dates of death on or after Janua( )1(1.1) (i)].
rY , 1995, the tax rate imposed on the net val nsfers to or for the use of the surviving
[72 P.S. §g116 (a) (1.1) (ii)]. The statute does not exempt a transfer
assets and filing a tax return are still applicable even if the surviving s ous
ue of transfers to or for the use of the surviving spouse is 0 percent
to a surviving spouse from tax, and the statutory requirements ford'
For dates of death on or after July 1, 2000:
P e is the only beneficiary. isclosure of
• The tax rate imposed on the net value of transfers from a deceased
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. 911
child 21 years of age or younger at death to or for the use of a natur
. The tax rate imposed on the net value of transfers to or for the use o 6 (a) (1.2)].
72 P.S. §g116 1.2) [72 P.S al parent, an
§9116 (a) (1)]. f the decedent's lineal beneficiaries is 4.5 percent, exce t a
. The tax rate imposed on the net value of transfers to or for the use
sibling is defined under Section 9102, as an individual who has at lea p s noted in
ofs~ oneepaaentt n common withphe ent [72 P.S,
decedent, whether ba) (1.3)]. A
y blood or adoption.
Rev-15Q8 EX+ (g.981
., .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHE,pV~E E
CASH, BANK pEpOSITS, & MI
PERSONAL PROPER SC.
Sommerville, Wanda H.
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received b 2?-11'0536
All property jointly-owned with the right of survivorship must be disclosed on sc
y the estate.
hedule F.
ITEM
NUMBER
1 Millennium Pharmac DESCRIPTION
Y Systems -refund of cr
di
VALUE AT DATE
e
t balance
2 State Employee
R OF DEATH
s
etirement System _ fin
al prorated benefit
8.89
3 Orrstown Bank Irrevocable Burial Fund
100.61
Accrued interest on Item 3 through date of death
12,870.59
4 Patriot Federal Credit Union Mone
y Market Ac
31.90
count
Accrued interest on Item 4 through date of death
14,610.41
5 Patriot Federal Credit Union Prime Share
Acco
0.10
unt
Accrued interest on Item 5 through date of death
15,472, 93
6 Patriot Federal Credit Union Share Draft A
cco
0.26
unt
Accrued interest on Item 6 through date of death
16,307.33
0.00
TOTAL (glso enter on Line 5, Recapitulation)
Copyright (c) 2002 form software only The L ckner Groupn Inced, additional pages of the same size) 59,403.02
Form Pq_1500 Schedule E (Rev. 6-98)
Rev-151Q EX+ (6_g8?
,. ~
COMMON WEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS
MISC. NON_pROBATE pR0 &
PER~-y
Somme~ille, Wanda H, I
This schedule FILE NUMBER
must be completed and filed if the answer to any of questions 1 throw
21-~ ~ -0536
gh 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF P
ROPERTY
NUMBER THE DATE O MTRANSFER SgEREE THEIR RELATIONSHIP TO DECEDE
1 TTACIi A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASATH % OF DECD'S
CUNA Mutual Grou SET INTEREST EXCLUSION
children of decedent Mima ~ 1417658 - (IF APPLICABLE)
beneficiaries 47,675,55 0
Sommerville, Lou Ann S, WUlis, John R. 100.000 /o
Neidigh, and Sall S, o.oo
Y Shaul
TOTAL Also enter on Line 7 ~
,Recapitulation)
Copyright (c) 2002 form software only The L ckner Grou needed, additional pages of the same size)
p, Inc.
TAXABLE
VALUE
47.675.55
47,675.55
Form Pq_1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (1p_prf
k'~
, • S
SCHEDULE H
COMMONWEALTH OF.P
INHERITANCE TAX~ETURN ANIA FUNERAL
RESIDENT DECEDENT EXPENSES &
ESTATE OF A~M~NISTRgT~VE COSTS
Sommerville, Wanda H,
FILE NUMBER
ITEM Debts of decedent must be reported on Sch 21-11"0536
NUMBER edule I.
A• FUNERAL EXPENSES: DESCRIPTION
AMOUNT
See continuation schedule(s) attached
12,909.58
g• ADMINISTRATIVE COSTS:
~ ~ Personal Representative's Commissions
Name of Personal R
epresentative(s)
Street Address
City
Year(s) Commission paid State
~~ Zlp
2~ Attorney's Fees Weigle ~ gssociat
es
P. C.
3. Family Exemption: (If decedent's address is not the s
Claimant ame as clai
' 6,033.00
mant
s, attach explanation)
Street Address
city
Relationship of Claimant to Decedent State
-~~ zID
4. Probate Fees
Register of Will
s, Cumberland Count
Y
5~ Accountant's Fees 265.50
6. Tax Return Preparer's Fees
~~ Other Administrative Costs
See continuation schedule(s) attached
363.25
TOTAL (Also enter on line 9, Recapitulation
Copyright (c) 2009 form s
f
,
o
tware only The Lackner Grou In
p. c. 19,571.33
Form Pq_~500 Sch edule H (Rev. 10-06)
F~NERA SCHEDULE H
L EXPENSES qNp ApMINI
STRATIVE COSTS
continued
ESTATE OF
Sommerville, Wanda H.
FILE NUMBER
21-11-0536
ITEM
NUMBER
DESCRIPTION
Funeral FY._ e~
1 Fogelsanger-Bricker Funeral Home
~~ A m~strativp H-A
2 Cumberland Law Journal - advertisi
ng Letters Testamentary
3 Linda K. Klein -notary fee
4 News Chronicle -advertising Letters
Testamentary
5 Register of Wills, Cumberland Coun _
ty film9 PA Inheritance Tax Return
6 Register of Wills, Cumberland Coun _
tY ~Img Family Settlement Agreement
7 Weigle & Associates p,C, _
telephone calls re1mbursement for
postage, xerox copies, and long distance
H-B7
Copyright (c) 2002 form software only The Lackner Grou
p, Inc.
AMOUNT
12,909.58
12,909.58
75.00
32.00
121.25
15.00
100.00
20.00
363.25
Form PA.1500 Schedule H (Rev. 6-98)
Rev.1512 EX+ (12-1J8)
i , ~ " SCHEDULE
~' ~ 1
DEBTS OF DECEpENT,
COMM10 ERITANCE T,q)(R TURN ANIA
ORTGAGE LIABILITIES, & ~
RESIDENT DECEDENT BENS
ESTgTE OF
Somme-vllle, Wanda I-I,
FILE NUMBER
2 ~ -~ 1-0536
Report debts incurred by the decedent prior to death that remained unpaid
ITEM
NUMBER at the date of death, including unreimbursed
medical expenses.
1 Dar I K, DESCRIPTION
~'Y Guistwite, D.O. VALUE AT DATE
2 OF DEATH
Millennium Pharmacy
14.28
3 Patriot Federal Credit Union Prime Sh
death are Account -debit to account in trap 390.18
sit at date of
4 Presbyterian Homes, Inc. 60.00
2, 733.15
TOTAL (glso enter on Line 10, Recapitulation
Copyright (c) 2009 form software only The L ckner Grou n ieded, additional pages of the same size) )
3,197.62
p, nc.
Form Pq_1500 Schedule I (Rev. 12-Ogg
REV-1513 EX+ {11-08)
~
~•
__
COMINOER,TANCE~~RNET~jRNANIA
RESIDENT DECEDENT SCHEDV~E ./
ESTATE OF BENEFICIARIES
Sommerville, Wanda H,
NUMBER NAME ANp ADDRESS OF
PERSON(S1 RECEIVING PROPERT
I
T FILE NUMBER
RELATIONSHIP TO 21-11'0536
Y
.
AXABLE DISTRIBUTIONS DECEDENT
[include outri ht s Do Not List Tres e s
distributions
and t SHARE OF ESTATE
AMOUNT OF ESTATE
(Words)
,
ansfers
1 under Sec. 9116 a 1.2
LouAnn S.
Neidigh ($~$)
-"----~-__
1110 North Route 934
Annville, PA 1700
Daughter
O
3 ne-fourth share
2 Sally D. Shaul 21,077.41
45 Hale Road
Shippensbur
9, PA 17257
Daughter
One-fourth sh
3 John R. Somm are
21,077.41
erville
15391 Hillvalley Road
Mount Union
PA
Son
O
,
17066 ne-fourth share
4 Mima J. Willis 21,077.40
1267 Ritner Highway
Shippensbur p
9~ A 17257
Daughter
One-fourth sh
are
21,077.40
Enter dollar amounts for distributions shown above on I' I
jl. NON-TA)(AgLE DISTRIBUTIONS: Ines 15 throw h 18 on Rev 1500 ooeas
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 F heet as a 84,309.62
ropriate.
OR WHICH AN ELECTION TO TAXIS NOT TAKEN
B. CHARITABLE qND GOVERNMENTAL DISTRIBUTIO
NS
TOTAL OF PgRT II _ ENTER TOTAL NON-T
Copyright (c) 2009 form software only The Lackner Grou SABLE DISTRIBUTIONS ON LINE 13 OF
p, Inc. REV-1500 COVER SHEET
Form PA_1500 Schedule J (Rev. 11-08)
LAST WILL AND TESTAMENT
I, Wanda .H
.Sommerville, presently residing at 152
Southampton Township, Cumberland Coun COtta.ge Road, Ship ensbur
and disposition, do hereby make, publish andPe~sYlvatua 17257' being of sound mindpmem g'
revoking and making void all Wills by me at an declare this my Last Will and Testament, here ~
y time heretofore made, by
FI-- I order and direct the pa ment o
funeral expenses as soon a.s may be convenient a Y fall my legally enforceable debts an
fter my decease. d
SECOND. I give, devise and be ueath
mixed, whatsoever and wheresoever situate ~ all my estate, real,
John R. Sommerville, Sally D. Shaul acid o my children, Hamel Personal and
distribution basis. ~ LouAnn S. Neidigh, in equal sharMima J. Willis,
s, on a per stirpes
TH-= I nominate, constitute and a
presently residing at 1267 Rimer Highv~ay, Shi enppoint my daughter Mima J
John R. Sommerville, presently residin a PP burg Pennsylvania 17257, and 'mWillis,
or the survivor thereof, to be the Co-Exe uto65 Peachy Ann Drive, Newville, Pennsylvania 172on,
of this my Last Will and Testament. 41,
FOURTH. I direct that m
for the faithful performance of their dutPies in ~ representative(s) shall not be required to ive b
anY Jurisdiction. g and
FIFTH• I direct my Executor to retain the
with offices located at 126 East King Street, Shi Services of Jerry A. Weigle, Es wire
the settlement of my estate due to his familiari w pensburg, pe~sylvania 17257, with res ect to
tY ~ my affairs. P
IN WITNESS WHEREOF, I, Wanda H. Somme
seal to this my Last Will and Testament rville, have hereunto set my hand and
~~ 6f , 2006. ~ written on one (1) page, this ,•'~~, d
ay of
.~: _:.::., (SEAL)
WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - y26 EAST KING STRE -
ET SHIPPENSBURG, PA 17257-1397
This instrument was by the Testatrix, on the date hereof '
be her Last Will and Testament, in our presence who 'signed, published and declared by her to
other, we believing her to be of sound and disposin min her request and in the presence of each
our names as witnesses. g d and memory, have hereunto subscribed
,Pt.;' ~7
~~. -~ /I 0
i-v-~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
I, Wanda H. Sommerville, the person whose name is si e
been duly qualified according to law, do hereb ackno d to the foregoing instrument, having
instrument as my Last Will; that I signed it willingl ; and ~ edge that I signed and executed the
act for the purposes therein expressed. y at I signed it as my free and voluntary
.n - ! ~
Sworn or affirmed to anti acknowledged before
me by W da H. Somme,,~~vville, the Testatrix,
this _~dav of °r-r?.ft.r~~. _^ ,,,.,.
~lM Q ~ I /I /,()cii
a
., r' .~:
- - ~ J ~ WTI ,le, Notary Public
`:? ~ ~ _ phi ~I't~bl~t~, P ~~umberland County
_ ;~ _ ~1~1ffilR~l~f~ ?it`~B October 7, 2006
- ~ F- .' r
~~ I/' .s
7i:. rf
WEIGLE bi ASSOCIATES, P. C. -ATTORNEYS AT LAW - 1
26 EAST KING STREET - SHIPPENSBURG, pq 17257-139,T
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND ~ SS
We ~ L ` l -1
' ~" ~ 0
and ~ f ~ `f r~ t C ~ a r~, -
the witnesses whose names are signed to the
foregoing instrument, being duly qualified accordi
ng to law, do depose and say that we were
present and saw Wanda H. Somme1`ville, the Testatrix, si an
Will; that she si ~ d execute the instrument as her Last
fined willingly and that she executed it as her free
purposes therein expressed; that each of us in th and voluntary act for the
e hearing and sight of the Testatrix, signed the
Will as witnesses; and that to the best of our knowled
fie the Testatrix was at the time eighteen (18)
or more years of age and of sound mind and under no constrain
t or undue influence.
Sworn or affirmed to and subscribed before me
by ° L• ~crn~.
CL ~ br(, C l ~J ~
~.
and `~..~._ _ , _ _ ~ . ,
J
es es, this t S~day of
2006.
Y
~~...
Yn
i /
NOTARIAL SEAL
Jerry A. Weigle, Notary Public
Shippensburg, PA Gu~r~berland County
Ay Commission Expires October 7, 2006
WEIGLE & ASSOCIATES, P. C. -ATTORNEYS AT LAW - 126 EAST KING STREE -
T SHIPPENSBURG, PA 17257-1397
o~ST
owN
B~~
A Trnditzon of Excellence
April 28, 2011
Jerry A. Weigle, Esq.
Weigle & Associates, P.C.
126 East King Street
Shippensburg, PA 17257
Fax: 532-5289
Re: Estate of Wanda H. Sommerville
Social Security Number 177-24-6436
Date of Death 4/7/11
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CERTIF'IC~4TE OFDEPOSIT
Account No.- 4000033723
Account Type- 120 Month Growth CD Irrevocable Burial Fund c/o Fo el -
Bricker Funeral Home, Inc. g sanger
Date Opened- 7/11 /09
. _ _ .. _.... Joint Account (name/date)-_ No
glance- ._. __... _...._ _ - _ _ -- .._ .__ _ .. _
~ 12,870.59 .......... .......... __ ...._._.._ _. _ _
Accrued Interest- $31.90
Best Regards,
~r~t,L~
Jill .Worthington
Deposit Processing Clerk
2695 Philadelphia Avenue
Chambersburg, PA 17201
1.888.ORRSTOWN
W Q~ Ff •~R®~S S G•LYQV 6 a0~~~
^ _ -
F
• •
a
0
FEDERAL, CREDIT UNION
_ Mar ~320~1
May 11, 2011
Weigle & Associates, P.C.
Attorneys-at-Lain
Attn: Jerry A. Weigle
126 Fast King Street
Shippensburg, Pa i 72J 7-13 9 7
~: Wanda H Sommerville, deceased
To Whom It May Concern:
I am writing in regards to your re ues
This account was in the sole name t for date of death values on the above
_ __._ _ of the deceased. referenced member.
Account Date Opened
3790 Date of Death Accrued Inte
Principal rest to
Prime Share (00) ----- DOD
01/03/1978 ---
Money Market (21) O 1 /21 /200 $15,472.93 0 :___
Share Draft (26) 6 $14,610.41 $ .26 -___
02/22/2006 $0.10
$16,307.33 _ N/A
If you have any questions with re and
please contact a Membership pff g r to the above balances, or need addition '
at 717 263-4444. al information,
Sincerely,
Patriot Federal Credit Union
~~
~OY~~-
SI 1 t I~ ~, ~~a'~-is-~- l l
Catch the Spirit of Financial Freedom
800 Wayne Avenue • P.p, Box 778 •
Main: 717.263.4444 Chambersburg, PA 17201
~W.patriotfcu.org
,Office Use Only:
• ..L1941110505011
May 5, 2011
Weigle & Associates PC
Jerry A Weigle
126 East King Street
Shippensburg PA 17257-1397
Re: Insured
Certificate/Policy
Claim
Dear Mr. Weigle:
MAY ~ 2 ~~~ ~ CUNA MUT
_~ ~ 011 UAL GRpUP
CUNA Mutual Insurance Society
Wanda H Sommerville
000001417658
110505011
Thank you for your recent request for informati
on regarding the above-mentioned claim.
The value of policy 000001417658 as of A ril 7
payable to named beneficiaries and we ha a sent011' was $47°675.55. The proceeds are
he claim forms to them individually.
If you have any questions, please contact me a -
are from 7:30 a.m. to 5 t 1 800-798-6600, Ext. 2440. Our office ho
P~-n., Central time. urs
Sincerely,
~.C..-
~~
Jolene White, FLMI, ACS, ALHC, AApq
Claim Specialist
3JW
Business: 800.798.6600 Voice/TDD~319.352 4090 ^ axV608. 36 0677-9202
8030 ^ Web Site: eservice.cunamutual.com