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HomeMy WebLinkAbout12-28-111505610143 ---~ REV-1500 Ex(ot-to) '~ OFFICIAL USE ONLY County Code Year File Number PA Department of Revenue Pennsylvania °E°"~`""~~~~E 0 3 5 8 Bureau of Individual Taxes INHERITANCE TAX RETURN 21 10 PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 02 19 2010 11 08 1923 201 18 9131 MI Decedent's Last Name Suffix Decedent's First Name JANE ~ WARNER (If Applicable) Enter Surviving Spouse's Information Below MI Suffix Spouse's First Name Spouse's Last Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^ 2 Supplemental Retum ^ 3. Remainder Retum (date of death 1. Original Retum prior to 12-13-82) 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required 4. Limited Estate ^ (date of death aver 12-12-82) 8 Decedent Died Testate ^ 7• (gttCopy of~inest)a Living 7rus[ 1' 8. Total Number of Safe Deposit Boxes (Attach Copy of Wdl) Sp Y ^ 9. Litigation Proceeds Received ~ 10~ ba~n12V39 J~fdd (dat8es~f death ^ 11.~A~ch Scher. O) nder Sec. 9113(A) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIADaytime Telephone Numbe BE DIRECTED TO: Name (717) 243 5551 BRADLEY L GRIFFIE First line of address 200 N HANOVER STREET Second line of address City or Post Office State ZIP Code CARLISLE PA 17013 DATE --:-r ,_, -:;:~ } -~ b riffle@griffielaw.com Correspondent's a-mail address: g 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 Vue, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer hAATE y knowledge. SIGNA U OF PERS 1 R PONSIBLE FOR~PrLING RETURN ~ Z Z ~ ( r ~ Charlet Ann Warner, Executrix ADDRESS 825 Bur ne Road Carlisle PA 17015 DATE SIGNAT PA ER THANSENTATIVE , 1 ~~ C~(' ~ ~ ( ~ ~ Bradley L. Griffie, Esquire F.G d PA 150561D143 Side 1 1505610143 i ~~ ,f 1505610243 REV-1500 EX Decedent's Social Security Number 201 18 9131 Warner, Jane O Decedent's Name: RECAPITULATION ............ 1. 1. Real Estate (Schedule A) ........................................................................... 21,475.80 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. 31,401.19 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5 Separate Billing Requested............ 6. Jointly Owned Property (Schedule F) ^ 6• 7. Inter-Vivos Transfers & Miscellaneous t~nq Probate Property Lj Separate Billing Requested............ 7. $ rj 8 0 5 . 5 5 ~ (Schedule G) ........ a. 138 , 682 .54 ................ Total Gross Assets (total Lines 1-7) ............................:................ g , 9 16,517.41 .. ........................ Funeral Expenses & Admirnstrative Costs (Schedule H) ............... 9 . . 10 17 6.89 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10 . . ........... 11 16 , 694 .30 11. Total Deductions (total Lines 9 & 10) ........................................................ . ... 12 121, 988.24 .................... Net Value of Estate (Line 8 minus Line 1 ................................. . 12 . . Charitable and Governmental BequestslSec 9113 Trusts for which 13 13. . an election to tax has not been made (Schedule J) ...........:............. 14 121,988.24 • ........................ 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 0 . 0 0 transfers under Sec. 9116 15. (a)(1.2)X.OO 16. Amount of Line 14 taxable 121 , 9 $ $ . 2 4 16. 5, 489.47 at lineal rate X .045 0 . 0 0 17. Amount of Line 14 taxable 0 . 0 0 17• at sibling rate X .12 0 . 0 0 16. Amount of Line 14 taxable 0 . 0 0 18. at collateral rate X .15 5, 4 8 9.4 7 ............. 19. .. 19. Tax Due ................................................................................................... 20. FILL IN THE OVAL IF YOU ARE RE4UESTING A REFUND OF AN OVERPA YMENT. 1505610243 Side 2 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Warner, Jane O STREET ADDRESS 825 Burgners Road CITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest STATE ZIP pp 17015 (1) 5,489.47 0.00 Total Credits (A + B) (2) 0.00 (3) 4, If Line 2 is greater than Lin Check' box on Page 2 L ne 20 toTrequest a refund AYMENT. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) 5,489.47 erFNT_ Yes No 1. Did decedent make a transfer and: ......................................................... ^ x 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 :.................................. ^ z c. retain a reversionary interest; or ............................................................................................................... d. receive the promise for life of either payments, benefits or care?.::::: ~ within .one.. ear. of.death.without ^ ^ 2. If death occurred after December 12, 1982, did decedent transfer property Y x ............................. receiving adequate consideration ......................... . 3. Did decedent own an "intrust 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 .................................... . 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 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. §9116 (a) (1.1) (i)]. For dates of death on or afterThe statute does not exempt a transfer to a surv v ng spouse from tax, and the statut ry requi e'ments for disclosuee of t [72 P.S. §9116 (a) (1.1) (u)] 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 under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. File Number 21-10-0358 __ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Rav-1503 E%+. (5-98) COMMONWEALTH OF PENNSYLVANIA INNERRANCE TAX RETURN ecc,ncnir nEC:EDENT SCHEDULE B STOCKS & BONDS ESTATE OF ~~~,~„er _Iane O FILE NUMBER 21-10-0358 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP DESCRIPTION UNIT VALUE NUMBER NUMBER 1 12 shares of Cumberland Valley Cooperative Association - 10.00 12 Share by Certificate Number 6749 (See attached statement) 2 Series E Bond D21158385E -Face amount $500 Issue date 03/1950 Issue price 375.00 Interest to date of death is $2566.20 3 Series E Bond D21158386E -Face amount $500 Issue date 03/1950 Issue price 375.00 Interest to date of death is $2566.20 4 Series E Bond M20995456E -Face amount $1,000 Issue date 0111950 Issue price $750 Interest to date of death $5,132.40 5 Series E Bond M84238263E -Face amount $1,000 Issue date 04/1964 Issue price $750 Interest to date of death $8,360.80 6 Adams Electric Cooperative, Inc. -Patronage Capital #4150 (See attached statement) TOTAL (Also enter on Line 2, Recapitulation) VALUE AT DATE OF DEATH 120.00 2,941.20 2,941.20 5,882.40 9,110.80 480.20 21,475.80 (If more space is needed, additional pages of the same size) Form PA-1500 Schedule B (Rev. 6-98) Copyright (c) 2002 form software only The Lackner Group, Inc. Rev1508 EX+ ~5-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jane O FILE Numtstrc 21-10-0358 Warner, Include theop~tlyceed~d Iwehltho ngh of survivoprsrhip mus be disllosed on schedule F. All property 1 ITEM DESCRIPTION NUMBER 1 Cash found in safe deposit box - (See attached Inventory) 2 Coins found in safe deposit box - (See attached Inventory) 3 MST Bank -Checking Account No. 9849247201 -Includes accrued interest of .10. (See attached statement) 4 Citizens Bank -Checking Account No. 6100730468 (See attached statement) 5 1990 Jeep Title No. 48066359002WA - (See attached Kelley Blue Book value for 1991 model, as the 1990 model is too old for data availability -estimate based on Fair Condition with 150,000 miles) g Commonwealth of PA -Real Estate Tax Rebate VALUE AT DATE OF DEATH 4,543.00 2.45 25,124.41 731.33 500.00 500.00 I 31,401.19 TOTAL (Also enter on Line 5, Recapitulation) SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY (lf more space is needed, additional pages of the same size) Form PA-1500 Schedule E (Rev. 6-98) Copyright (c) 2002 form software only The Lackner Group, Inc. Re~~-1510 EX+t5.98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMt,tONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDFM DECEDENT FILE NUMBER ESTATE OF 21-10=0358 ..~___,.. ~~MO n ~~a,,.v.~ . - - - This schedule must be completed and filed ff the answer to any of questions 1 through 4 on the reverse side of the REV-t 500 COVER SHEET is yes. DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S ITEM INTEREST INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET 9,521.39 100.000% 1 Prudential Insurance Company of America -Annuity Policy No. 73161278 (See attached statement) Annui 76,284.16 100.000% 2 Midland National Life Insurance CompanSy~ attached Contract No. 8500380970 (Estimate) statement) TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, lnc. LION TAXABLE oASLE) VALUE 0.00 9,521.39 0.00 76,284.16 85,805.55 Form PA-1500 Schedule G (Rev. 6-98) RCV-1151 EX+ t10A6) COMM~p~REn~T~DECED~NTRN ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Warner, Jane O Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION A FUNERAL EXPENSES: See continuation schedule(s) attached t-ILC rvu~nccr~ 21-10-0358 g, ADMINISTRATIVE COSTS: 1, Personal Representative's Commissions Name of Personal Representative(s) Street Address State Zio City Year(sl Commission paid 2. Attorney's Fees Griffie 8~ Associates 3 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Charlet Ann Warner Street Address 825 Bur Hers Road 17015 Carlisle state PA Zio City Dau hter Relationshia of Claimant to Decedent 4. ~ Probate Fees 5. Accountant's Fees 6, Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) AMOUNT 5,097.37 6,300.00 3,500.00 546.50 100.00 973.54 16,517.41 Form PA-1500 Schedule H (Rev. 10-06) Copyright (c) 2009 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF ,~~~_...... ~~np n FILE NUMBER 21-10-0358 AMOUNT ITEM DESCRIPTION NUMBER E 5,097.37 1 Ewing Brothers Funeral Home, Inc. ~~~~_ w.l.r,inic4ra+jve COStS 2 Citizens Bank -bank fees 3 Orrstown Bank -bank fees 4 Citizens Bank -Fee to drill safe deposit box 5 Ibis Appraisal Services g The Sentinel -Legal Advertising 7 Cumberland Law Journal -Legal Advertising g Reserves Copyright (c) 2002 form software only The Lackner Group, Inc. H-A 5,097.37 21.50 9.50 150.00 30.00 187.54 75.00 500.00 H-B7 973.54 Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ ~~2Ati) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8t LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-10-0358 Warner, Jane O Report debts Incurted by the decedent prior to death that remained unpaid at the date of death, including unreimbureed medical expenses• VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 43.00 1 Adams Electric Cooperative 9.80 2 Paula Burkholder, Tax Collector - 2009 Personal Taxes 96.14 3 Century Link 20.00 4 Citizens Bank fees 7.95 5 I Health Insurance - (Automatic withdrawal) I I 176.89 TOTAL (Also enter on Line 10, Recapitulation) (If more space is needed, additional pages of the same size) Form PA-1500 Schedule I (Rev. 12-08) Copyright (c) 2009 form software only The Lackner Group, Inc. REV-1513 EX+ (11 A8) C OMMO~ ~~A~ w~F~pX~~TURNVANIA IN E ~N, nG . n NT ESTATE OF Warner, Jane O NAME AND ADDRESS OF NUMBER PERSON(S) RECEIVING PROPERTY I• TAXABLE DISTRIBUTIONS (d stributi nsr~ antd tansfers iinrlPr Sec. 9116(a)(1.~ 1 Charlet Ann Warner 825 Burgners Road Carlisle, PA 17015 FILE NUMBER 21-10-0358 RELATIONSHIP TO SHARE OF ESTATE AMOU DECEDENT (Words) Daughter 1100% of net estate I ~ Total I Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet, as a ro r NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS SCHEDULE J BENEFICIARIES NT OF ESTATE ($$$) TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-~5uu F ~ PA 1500 Schedule J (Rev. 11-08) Copyright (c) 2009 form software only The Lackner Group, Inc. l.~ TEST~~E~VT SST' SILL ~ ~ L OF - JANE O. WARNER ~, WARNER, of 825 Burghers Road, Carlisle, Cumberland County, I, JANE in of sound and disposing mind, memory and understanding, do make, Pennsylvania, be g are this to be my Last Will and Testament, hereby revoking and malting publish and decl void all previous Wills and Codicils heretofore made by me. FIRST and direct my Executor hereinafter named to pay all of my just debts, I order es and expenses involved or connected with the administration of my funeral expens all taxes that may be assessed in consequence of my death, as soon after estate, including is reasonably possible from the proceeds and assets of my estate prior to any my death as . However, my Executor need not accelerate and pay those unmatured other distnbutaons p p eons to ' tions which, in his, her or its opinion, it might be ro er and more advantag obhga lot or a enew and pay as they become due and payable. If I do not own a banal p retasn or r e time of my death, I authorize my Executor/Executrix, in his, her or its grave marker at th ' cretion, to purchase a burial plot and to erect a suitable grave marker at my grave, sole dis and to expend sums from my estate for this purpose. GRIFFIE & ASSOCIATES Attorneys At Law 100 Lincoln Way East, Suite D 200 N. Hanover Street page 1 of 9 Chambersburg, PA 17201 Carlisle, PA 17013 SECOND I ive, devise and bequeath my entire estate of whatsoever nature and wheresoever g er with all insurance proceeds thereon, to my daughter, CgARL,ET ANN situate, togeth R roviding she survives me by sixty (60) days. I direct my WARNE P cutrix to divide among such beneficiaries all personal property of a Executor/Exe r famil nature (excluding cash, stocks, bonds and the like), including but sentimental o Y to 'ewelry, household goods, antiques, furniture and memorabilia, in not limited J 'th a se crate memorandum which I may pl~e ~~ my will or deposit with accordance vv~ P In the absence of such disposition by memorandum, I direct that the said my attorney. ro erty be divided between my residual beneficiaries with due regard tangible personal p p Hal refererices in as nearly equal shares as practical, with the value of such for their perso p ein credited to the share of each respective recipient. If the said dispositions b g ' s do not agree to the division of the personal property provided for hereunder, beneficiane ' ion of my Executor/Executrix, including the decision to sell the property at the decis ' to sale and distribute the proceeds therefrom as provided hereinafter, shall public or pnva be final and conclusive on all parties. THIRD dau ter predeceases me or dies on or before the sixtieth (60tH) In the event my P~ lowin my death, I give, devise and bequeath my entire estate of whatsoever nature day fol g soever situate, together with all insurance proceeds thereon, in equal shares to and where au ters, JAMIE S. SWARTZ and JACKIE L. WARNER, Providing they my grandd gh 200 N. Hanover Street -- - ~,. ~~ni~ GRIFFIE & ASSOCIATES Attorneys At Law Page 2 of 9 100 Lincoln Way East, Suite D Chambersburg, PA 17201 ix 60) days, per stirpes. I direct my Executor/Executrix to divide survives me by s ty h beneficiaries all personal property of a sentimental or family nature among suc ewelry, cash stocks, bonds and the like), including but ~ not limited to j (excluding oods antiques, furniture and memorabilia, in accordance with a separate household g hick I may place with my Will or deposit with my attorney. In the memorandum ~'" ible personal bsence of such disposition by memorandum, I direct that the said tang a ' ed between my residual beneficiaries with due regard for their personal property be dived ' as nearly equal shares as practical, with the value of such dispositions preferences in ' d to the share of each respective recipient. If the said beneficiaries do not being crechte ivision of the personal property provided for hereunder, the decision of my agree to the d trix including the decision to sell the property at public or private sale Executor/Execu , e roceeds therefrom as provided hereinafter, shall be final and and distribute th P conclusive on all parties. FOURTH s ecific desire that the property located at 825 Burghers Road, Carlisle, It is my p d County, Pennsylvania, not be sold by my personal representative, trustee or Cumberlan ~ named. After my death, ownership of said property shall vest in my guardian here S, SWARTZ and JACKIE L. WARNER, as joint tenants with grandchildren, JAMIE ivorship and not as tenants in common, reserving a life estate in my the right of surv ET ANN W~ER• Any m°rtg~e or other indebtedness which daughter, CHARL death shall be satisfied shall exist in connection with said real estate at the time of my 200 N. Hanover Street. -- - ~,. ~~n~s GRIFFIE & ASSOCIATES Attorneys At Law Page 3 of 9 1 DO Lincoln Way East, Suite D Chambersburg, PA 17201 to assets prior to any distribution to named beneficiaries under the terms of this from esta my Last Will & Testament. FIFTH ant m Executor/Executrix the following powers in addition to and not in I gr Y limitation of such powers as my Executor/Executrix shall hold by law: a To retain all property received including the stock of any corporate fiduciary () acting hereunder, provided such property remains productive, artnership, recapitalization, merger, (b) To join in any corporation, p reorganization or voting trust plan; to delegate authority with respect thereto; to de osit investments under agreements and pay assessments; and generally P to exercise all rights of investors, including but not limited to, the voting of shares. To manage, operate, repair, improve, mortgage or lease on any terms any real (c) estate held or owned by my estate. (d) To operate any business that I may own at my death. e To invest any funds of my estate in any stocks, bonds, notes or other securities () or roperty, real or personal, without regard to the principle of diversification P or an other statute or general rule of law in his, her or its absolute discretion, Y it being my intention to give my Executor/Executrix the broadest investment owers possible, providing such investments do not unnecessarily prevent the P prompt settlement of my estate. GRIFFIE & ASSOCIATES ~ Attorneys At Law Page 4 of 9 1 DO Lincoln Way East, Suite D 200 N. Hanover Street Chambersburg, PA 17201 _ ~n.n79 (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my Executor/Executrix shall see fit in his, her or its absolute discretion. (g) To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. (h) To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. (j) To undertake any and all acts deemed necessary and proper by my Executor/Executrix for the proper, advantageous and prompt management of the settlement of my estate. (k) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this, my Last Will and Testament. 200 N. Hanover Street Carlisle, PA 17013 GRIFFIE & ASSOCIATES Attorneys At Law Page 5 of 9 100 Lincoln Way East, Suite D Chambersburg, PA 17201 SIXTH No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my Executor/Executrix for the liability of such beneficiary. SEVENTH I nominate, constitute and appoint my daughter, CHARLEY ANN WARNER, as Executrix of this my Last Will and Testament. In the event my daughter is deceased, unable or unwilling to serve or shall cease to serve for any. reason whatsoever, then I nominate, constitute and appoint my granddaughters, JAMIE S. SWARTZ and JACKIE L. WARNER, as Co-Executors of this my Last Will and Testament. I direct that my Executrix shall not be required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. EIGHTH I hereby declare it to be my expressed desire that my Executor/Executrix employ the law firm of Crriffie & Associates, of Cazlisle, Pennsylvania, for legal advice and assistance regarding this my last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may azise at the probate of this instrument, the administration of my estate, and the execution of the Q powers herein mentioned. b GRIFFIE & ASSOCL4TES Attorneys At Law 200 N. Hanover Street Page 6 of 9 100 Lincoln Way East, Suite D Carlisle, PA 17013 Chambersburg, PA 17201 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of nine (9) typewritten pages, the first six (6) of which bear my signature on the side margin, for purpose of identification, this ~ ~(~~' day of ~ ~, ~ , 2005. T-- WITNESS: 7V1~~„~c..~i ~ 0 ---r '00 N. Hanover Street Carlisle, PA 17013 ~~ ~ ANE O. WARNER GRIFFIE & ASSOCL4TES Attorneys At Law Page 7 of 9 100 Lincoln Way East, Suite D Chambersburg, PA 17201 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND : I, JANE 0. WARNER, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. J O. WARNER Sworn or affirmed and acknowledged before me by the Testatrix this ~" day of ~~~' _ , 2005. NOTARIAL SEAL ROBIN J. GOSHORN, NOTARY PUBLIC CARLISLE BORO., CUMBERLAND COUNTY MY COMMISSION EXPIRES APRIL 11 2007 200 N. Hanover Street Carlisle, PA 17013 GRIFFIE & ASSOCIATES Attorneys At Law Page 8 of 9 100 Lincoln Way East, Suite D Chambersburg, PA 17201 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA: . SS. COUNTY OF CUMBERLAND ~~ I VI/~I~ i,t ~ Gl~.~ and ~-~~ r w b the witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. . IV Swom or affirmed and subscribed before me by ~ ~~~ S and - r, this ~ 9 ~ day of ~ , 2005. ~~ Notary Public NOTARIAL SEAL ROBINJ. 60SHORN, NOTARY PUBLIC CARLISLE BORO., CUMBERLAND COUNTY MY CDMMISSION EXPIRES APRIL 17 2007 00 N. Hanover Street Carlisle, PA 17013 GRIFFIE & ASSOCL4TES Attorneys At Law Page 9 of 9 100 Lincoln Way East, Suite D Chambersburg, PA 17201 Cumberland Valley Cooperative Association 908 Mt. Rock Road PO Box 350 Shippensburg, PA 17257 ~' April 23, 2010 717-532-2197 800-488-2197 FAX: 717-532-4353 Bradley L. Griffie Griffie & Associates 200 North Hanover Street Carlisle, Pa. 17013 Re: Jane 0. Warner Certificate # 6749 Dear Bradley: All shares of stock are valued at $10 per share, setting the value of Certificate # 6749 at $120.00. In order to redeem the shares we need the following: Original Preferred Stock Certificate # 6749, endorsed by the executor Death certificate Short certificate identifying the executor of the estate. Upon receipt of the above we will issue a check to the estate for $120.00. Cooperatively Merle D. Hamish, Controller 1/25/2011 Calculated Value of Your Paper Savings... Calculated Value of Your Paper Savings Bond(s) Ca~ulator Results for Redemption Date 02/2010 Total Price Total ~VaFue Total Interest YTf3 Interest $2, 250.00 $20, 875.60 $18, 625.60 $0.00 Bonds: 1-4 of 4 I55rle NeXt 6~inali Serial #' Series Den~rm Date Accrual Maturit~r ISSt1E° Prdee Interes'~ Interest. mate Value dote... D21158385E E ~500~03/=1950~ ,,,w, _ ,, R~03~1990= $375 00 A, $2~,566KK20~w, au„ 2,941µ2O: MA D21158386E; E $500w03~1950~ .~pu.,M03~1990y# .y$375 00 ~r~2~566.20 ~_~_ rt ., p~~2,941 20 MA . Em M20995456E r X1,000 01(1950 . . rv„_ .,..r 01(1990 .. h~wM. ~~.,,. __$750 00= ~~ .,. X5,,_132.40 ...,_xw~ ..„.~__ w~5~882 40 .. MA ,_. _ _ M84238263E E .~...... _m $1~OOOa04~1964~ „= 04 2004= . _x,$750 00~ _,~8,360~.80~ ~ _,..:. ~9~M11O 80,, MA ~~ ~ .......~~ ~ ~~~~~ f,...,Y._ ~~ w.... Totals for 4 Bonds = $ 2,250.00 f $18,625.60 r ~ $20,875.60 Nates NI ;:Not Issued ,.. ~,..,...,a K NE :Not ebgibleefor payment .. _, ri.~..__~ P5 :Includes 3 month, mterest~ penalty RM u, y s MA 'Matured and not eaminM interest Adams Electric 1338 Biglerville Road, PO Box 1055 Gettysburg, PA 17325-1055 Cooperative, IriC. Telephone: 717/334-9211 ® A Touchstone Energy'Cooperative ~ Fax: 717/334-3980 Web Site: www.adamsec.coop May 6, 2010 Crriffie & Associates Bradley L. Griffie, Esq. 200 North Hanover St. Carlisle PA 17013 RE: Jane 0. Warner Est.#4150 Dear Bradley: This letter is regarding the above estate and the status of patronage capital derived during the years in which electric service was received from Adams Electric Cooperative, Inc. The Cooperative has made special retirements of patronage capital to estates on a discounted lump sum basis. Both the general and special retirements are subject to annual authorization by the Cooperative's Board of Directors. The special lump sum eazly retirement of an estate's patronage capital discounts the unretired patronage capital for each year that such amounts are paid in advance. Applying the process to this estate's patronage capital yields an approximate lump sum amount of $480.20. You may donate the funds to a charity of your choice or the Project Helping Hand program that assists members of the Cooperative. If you would like to donate the check to Project Helping Hand, please indicate this on the Legal Statement form. In order for the Cooperative to provide the special retirement, please: 1. Complete the enclosed Legal Statement (s) and sign in the presence of a Notary Public. 2. Return the Legal Statement (s) in the enclosed postage-paid envelope. 3. Provide proof of death, example copy of death certificate(s). If you have any questions, please let us know. Sincerely, .~ . 1 / ~-~ ~- Jayme E. Smith Billing Coordinator Enclosure fr .:._ . r 48500D41046 REV-485 EX (1-07) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Numhar Hare of nea+h ~,.,..,... ~_~_ Y a '-" ~~+. IYUIIIUCI Decedent's Last Name Suffix First Name ~ MI ,` ~-~ © ADDRESS OF DECEDENT STREET: __ CITY: I $~S Q ur n-css ~o ot~i( STATE: ZIP CODE: Ca.- l; S I c ~ '' I ?a /,~~. NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME: r I ~. ~ . ~ r- tS~~if'e ~ cl r~'~c ~ STREET ADDRESS: f + ~ ~ ~ D U S CITY: STATE: ZIP CODE: ~ p ~ , o ~ v,u NAME, ADDRESS AND REL~4TIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. NAME: 1 ' I ~ A ~ RELATIONSHIP: ~ 1 a r r nn f lJr r n r r An.~+ ~io r/ k C C ~r x STREET ADDRESS: /n~ /~ ~.Z .~ (h i.J r P1-Gf'S' EC D ~ ~ CI Y: STpAdTE: ZIP CODE: ~ t~ ,,T 1 ~ / ~`r / 7C) ~~ b. NAME. .RELATIONSHIP: STREET ADDRESS: ~ CITY: STATE: ZIP CODE: c. NAME: RELATIONSHIP:- STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME~~ ti ,~ ~~,bN-1r~n~ ~ 1~ ~i1'1~,~~ ST/RE,ETADDRESS. ~/~. U/ 5 ~ JCITY• STA>TE/~ ZIP CODE: r s`1.l / 6 S TfT / 1 • NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY I a O. Wo.r Occc,-~-bcr ~ ( g DATE OF CONTRACT TO RENT BOX NUMBER OF BOX 1 do c a 6cr ~ 19 9 ~ a a TITLE, UNDER WHICH BOX IS REGISTERED ~. +.c O . C.Jo rr, e1' NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. NAME: ~A_r•~ D - G.1 Ar n ~c b. NAME: I STREET A~Rd~E~: ~ `+'r ' ~ STREET ADDRESS: ~ c~t~S l Cu a..o CITY: ST_A~: ZIP CODE: ~ - s•1 e '' - CITY: STATE: ZIP CODE: r E ?o 1 NT E AN~IT E OF E M LOY E I IN G HE INVE R ~ ~ ~ ,~ ~ - i~ y ^ ~ i ~ WAS A WILL IN THE BOX? ^ YES ©NO If yes, a. Date of will: b. Name and address of personal representative, if named in the will NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: c. Name and address of attorney, if any NAME: --- STREET ADDRESS: CITY: STATE: .ZIP CODE: 48500041046 48500041046 REV-485 EX SAFE DEPOSIT BOX INVENTORY Page Qf INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents, (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128.0601 ITEM NO. ITEM DESCRIPTION ~ _C~s ~ -15 43 -o~ t`~ ~ t'~S ~. agar- b- d.YS_ 1ti, t a I~_n.--- -- .2I 3 2. ~ a a.~ J 7T _ {~.~ S~Gk3.}t~4r~ ~v~~ r ~ - a a ~t~~c~S cam da~~ ~e~'S ~~ M VL~erp,~, s t~ ~ ~ ',r Vic-<~ u ~ ~ _, r 1 ` ----SOG i o- ( SAC u~ ~ I~ ~~!*~~ I~ 1 $~'>~ ~C 0 !~ Qr.ot ~o~il/o..~ c~ ~ cA 19_yy _._ 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING. COPY OF CORRECT AND COMP THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGNAT SIGNATURE PRINT AME `~~``'"~.__ . _. PRINT ` M K PR IAT BOX BELOW: PRINT TITLE C t•nQ~ A ~ - ~ DATE CHECK APPROPRIATE BOX: J,.~/~~ f~ p ~ y-"te`n' i ~- T (~~ I ~ (( li.~ ~ Executor(trix) ~ Administrator(trix) Estate Representative ~ Joint owner or safe deposit box NOTE: Attach additional 8'/:" x 11" sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes. W a d W ~0 z 0 ~ .S o~~l Z ~ O f~ Q ow ~y D ~C ~ O .~~ ~ v ~ , ~ ~ --~ ~ O O J ~ V W l d ~ C W O ~ Q Z O Z ~ 1.~ .4'1 ~ ~ d w CS V o ~ ~ o ~a~ a ~~ ~ C 1 ~ - ~ ~ u C f i }~ h -~ W 1_ ~ ~ ~0 Q ` ~ ~ ~~A'1 ~i' W M ~ o ~ W m z ~~ w U m w f ~ ~ J Z a W U J p LL ~ W m ~ `~ 1~ a ~ o ~ ~ m ~ ~ ~ W Q ... N ^~ _ O O Q ~ ~~ Z~ /O O W Y W V~ O~ H Z ~ . Q ~, a f ~ U ~ L ~ ~ v 1 ~I,LI. ~'~ W /~ = 'V z H o ~ ~ ~ W O ~ W ~• ~ rv M LL ~ H ~ QQ J ~_~ 1U. t V z ~ t~0 C9 ~ ~ ~ N m ~ ~ X H m ¢ ' H i / ~ W y L.i^ O a 2 6 S a ~ J N !~ W ~ ` ~ ~Z ~ ~ ~ ~ .... Z O d p ~~x 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302)934-2955 April 14, 2010 Griffie & Associates ,- Attorneys At Law 200 North Hanover Street Carlisle, PA 17013 Re: Estate of Jane O Warner Social Security: 201-18-9131 Date of Death: February 19, 2010 Dear Sir or Madam: Per your inquiry dated Apri16, 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 Checking Account Account Number 9849247201 Ownership (Names o, fl Jane O Warner Opening Date 01/04/10 Balance on Date of Death $25,124.31 Accrued Interest $ .1 D Total $25,124.41 Tor further account information, closures and/or reimbursement of funds please call the Carlisle West Office at #717-240-6717. We were unable to locate any safe deposit box for the above-mentioned decedent. Sinc rely, Suzanne M Kimble Adjustment Services ~~~~~~~ B~r~W September 28, 2010 Griffie & Associates Attorneys and Counselors At Law 200 North Hanover Street Carlisle PA 17013 Estate of Jane 0 Warner Date of Death: Feb 19, 2010 SSN: 201-18-9131 Dear Sir/Madam: One Citizens Drive ROP112 Riverside, RI 02915 In accordance with your request, the attached information sheet has been provided in the above decedent's name as of lus/her date of death. For information about account activity please contact the local branch. The local branch for this account is located on 665 North East Street Carlisle, PA 17013. The phone number is (717) 243-5311. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667 Sincerely, helli-Jean Paiva Decedent Account Processing REF#: 462123 C~~~e~s ~k~. Account Number 6100730468 Account Title Jane O Warner Date Opened 1/16/1992 Account Type Checking Principal Balance as of DOD $731.32 Interest from Last Posting to DOD $ .O1 Account Balance as of DOD $731.33 YTD Interest to DOD $ ,07 t Y .-J ^~^ '1"n~ +..v 1 DEPARTMENT OF TRANSPORTATION ~% CEFZTIFIC~TE ©F ~ITLE FOR A ~EF-tICLE 9190 950890057D01484-001 1J4FJ28LXLL25547,5 19D I JEEP 148066359002 WA VEHIGLE IDENTIFICA710N Wl1MBER YEAR MAKE OF VEHIGLE TITLE WUMBEF S ~ D I I I I I I BOUY TYPE DI1 P SEAT CAI 111J1.ADEld WEI(ili"I GVWH GCWR TRLE BHAWOS 1/24/95 I 4/10/95 I FL I . 4/10/951 0480531 u DATG 1A TNLEO UA7[C OF LSSIIC PRIOR TITLG STAT E ODUM. PftOCG ILU i Ulnrl.' IAILES ODONI STATUS REGISTERED OWNEHISI JANE 0 WARNER 825 BURGNERS RQ CARLISLE .PA 17013 tYry~~y c W~. ~ - ~°~! I I .. E'+_' FIgST UEN F, ~ OF~ s ~ - •••~• ~ ~ .... i ; M E R I ,. N ~~•' YI ~ ~~~~ P ~~ FINST LIEN REL~q~~~~iL~~• ~~ T ~ '~19~re ~`e~, ~:. ~- ~~' AUTHORIZED REPRESENTAT E MAKING ADDRESS 243003 MERIDIAN BANK PO BDX 1.89 READING PA 19603 I cellify as of the dale of issue, tlTe oliicial recoRts of Ule Pennsylvanui Department cf TrIr5lwrialionmllecl tlTal the pelsuntsi or wmlxury IwlmailrDleiuis the igwlDluwller of the said vehicle. SUBSCRIBED AND SWOfTN~ TO BEFORE ME: J Q W SECOND UEIJ FAVOR OF ODOMETER STATUS I. ACTUAL MILEAGE t - MILEAGE EXCEEDS THE IAECHANICAL LIMITS l •~ NOT THE ACTUAL MILEAGE ~- MOT THE ACTUAL MILEAGE~ODOMETEIr TAMPERWG VERIFIED a = E%EMPT FROM OOOM6TEN OISCLOSURF TITLE BRANDS A ° ANTIQUE VEHIGLE C -CLASSIC VEHIGLE F - WT OF COUNTRY G - OW6INNLLY MFGD. FOR NON•US DISTRIBUTION '' H -AGRICULTURAL VEHCLE L - LOGGWG VEHIGLE P - FORMERLY A POLICE VEHIGLE R ^ RECONSTRUCTED S -STREET ROD T - RECOVERED THEFT VEHICLE V - VEHCLE CONTAINS REISSUED V%J W -FLOOD VEHICLE Y. - FORMERLV A TAXI II a secor%1 lienholder a listed. upon salislaclion of the lirst lien, the first kentwltler must lorward this Title to the Bureau of Maor Vehicles with the appropriate lorm and lee. SE~OND LIEN RELEASED k / .. DATE BY AUTHORIZED REPRESENTATIVE BRADLEY L MALLQRY Secrelarp of Trtutsportalion When appyring klr line wiUT a co-ovmer, other Then yorn encase, check orle of Iheae blocks. ll no block is checketl. line will 6e msue(1 es "Tenants er Canrrpri'. A ^ Joint Tenants wllh Rigln of Survivorship ton d¢elh of ogre owner, line goes to pre aurvivinp wrrlerl. B ^ TenaMS in Common tar death of one wmer. interest of tleceased rwrlrer - goes to tis or her hobs or,eslalel. LIEIJ IF Ii0 UEH ^ DATE: CHECK BOY. NAME STREET CITY STATE UEIJ DATE. The Imoerslgned Ix!leby makes aDnkcalron for Cer61¢ale ul Tllle Io the velnGe tlescnned SECOND LIENHOLOER above: sulryecl to Ilw ers:umWances antl direr legal claims set lorlh here NAME SIGNATURE OF CO-APPLX;ANT!TnLE OF AUTHORIZED SIOI•IER ZIP IF NO LIEIJ ^ CHECK BOX STREET CITI' STATE ZIP :e 1991 Jeep Cherokee Sport Utility 2D Trade In Values -Kelley Blue Book Page 1 of 4 a home _ _....-car values _. .~' --_._cars fior sate _ _~._ _ car reviews~_ ~ ...._.-kk advertisement Home > Car Values > Jeep > Cherokee > 1991 > Style > Options > Sport Utility 2D Trade- In/Sell Values Show Used Car Prices ~ ~' .~ ~; . ~,. ~~~ ~ -- ~~ edit options change style } Jeep "" i 1.991 Jeep Che~c~kee Sport Utility 2® ._ .............._._._..______._...._....._.___._._W.__~__. j ,Mileage: ;150000: change Like this car Trade-In Value Excetient $878 Very Good $853 Good $728 Verify Condition Fa'sr $453 Private Party Value Shop for your next car price a new car Instant Trade-In Offer get the offer 4.5 Out of 5 Own it? Love it? review this cai° advertlseme SellE Share Print My Recentl~Viewed _My ~a~~~c' C'grs sa ,_~....~~-------'-'-'- -----,:..,,_~,.,-......i_,,.,n nni :,,,.~ ..~.,,,.,.r~,,,,i.....,..,.+ ..+a;+.. n,ai~„ot,,,.ia;a-7 no:~ 7 i i~/nn~ i ~'xu€c~~nt~I GRIFFIE AND ASSOCIATES ATTN BRADLEY L GRIFFIE 200 NORTH HANOVER ST CARLISLE PA 17013 Dear Bradley L Griffie: Customer Service Office PO Box 1390 Philadelphia, PA 19176 IOOOi778-2255 www.prudential.com Policyowner: Jane O Warner Insured: Jane O Warner Policy Number: 73161278 May l9, 20]0 I am writing in response to your request for information about the policy listed above. You should find the following information helpful. Our files indicate that we were notified of the death of the insured on this policy on February 19, 2010. Since Charlet A Warner was the beneffciary of record, a claim in the amount of $10,578.62 was paid out to her Alliance Account on March 19, 2010. This policy has no further value. I have outlined the values below. The approximate values have been calculated as of February 19> 2010. Gross Cash Sunrender Value- $3,993.95 Value of Accumulated Dividends $5,367.44 Termination Dividend $1(O.Op Outstandm Loan Value includin Interest $D,00 Net Cash Surrender Value $9,52L39 In response to your request for information regarding the Alliance Account, please call at 1-877-255-4262. If you have any questions, please call our customer service office at (800) 778-2255, Monday through Friday, 8:00 a.m. to 8:00 p.m., Eastern time. If you are using a telecommunications device for the hearing impaired, please call at (800) 778-8633, Monday through Friday, 8:00 a.m to 6:00 p.m., Eastern time. One of our customer service representatives will be happy to help you. Sincerely, l~esma,S',~ohnson Desma S Johnson Customer Service Associate ss life insurancc is issued by The Prudential Insurance Company of America, Pruco Life Insurance Company (except in NIA, of Pruco Life Insurane Company of New Jersey (in NY and NJ). `w~ MIDLAND NAT/OVAL', .•//~~~~ UJe Insurance Company • Annuity p/r/s~, September 14, 2010 Bradley L. Griffie Griffie & Associates 200 N Hanover St. Carlisle, PA 17013 **712 Letter** Re: Jane O. Warner deceased Policy: 8500380970 Beneficiary: Chazlet Warner Dear Mr. Griffie: Annuities at their Best 4350 Westoxm Parkway West Des Moines, IA 50266 Annuity Division CQPY This contract is an Annuity. The payments Mrs. Warner made into this contract was $73,000.00. Below is the information that is needed to complete the estate tax return. Decedent: Jane O. Warner Social Security Number: 201189131 Date of Issue: 04/06/2009 Type of Contract: Annuity Date of Death Value (as of 02/19/2010): 76,284.16 Beneficiary: Chazlet Warner This claim was paid.directly to Charlet Warner on 5/18/2010. The check amount was $76,795.68(proceeds $76,284.16 + death claim interest $511.52). The amount of $3,284.16 will be reported to the Internal Revenue Service at the end of the year on a 1099-R as a taxable distribution. If you have questions, please call us toll-free at 877-880-6367. We are available Monday through Thursday from 7:30 am to 5:00 pm (CST) and Friday from 7:30 am to 12:30 pm (CST). A service professional within the Claims and Benefit Department will be happy to take your important call. Sincerely, ~Qi.~k.t,CGe~J~~..cJ Patricia Vrieze Claims and Benefit Specialist Claims and Benefit Department cc: File A Member of the Sammons ~nanaal Groap Annutly Div~on ~ P.0. Box 19907 ~ Des Momes, IA 50325.0907 ~ Phone: 877-586-0240 ~ fox: 811-58b-0249 ~ wrrw.midlantbmwihrcom