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HomeMy WebLinkAbout02-10-12 (2) 1505610143 REV-1500 Ex(o,_,o,_ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania cas,ty code rear Fife Nurtiber Bureau of Individual Taxes 0°'"R"°1OF'!"°"~ Po Box.2sosol INHERITANCE TAX RETURN 21 11 0721 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 182 22 7293 06 09 2011 11 19 1929- Decedent's Last Name BEAGLE Suffix Decedent's First Name BETTY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffer Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. OriginalRetum ~ 2. SupplemerttalRetum ~ 3. P ~a~innd2r,~2, (date of death 4. Limited Estate ~ 4a, Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Retum Required ® g. Decedent Died Testate (Attach copy or wn, ~ ~, ~t rAsir~'~)a Living Trust oPy 0 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. bS t~"'we'aenf 1~a~~1<_~5~' ~ 11.~A~~ ~ O~ nder Sec. 9113(A) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL. TAX INFORIMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Numbtl BRADLEY L GRIFFIE 717 24~,~,551 r:~ ~ ~- First Ifne of address 200 N HANOVER STREET Second line of address City or Post OfNce CARLISLE ~~~ 3 fJ ~ t`J ~, REGISTER ~ USF,QNLY El.1 MI M MI State ZIP Code PA 17013 Comsspondsrtt's e-mail address: s~8nmt~Mnmesuaw.i;vnr Undue psrrMfies Of perrryy, ~id~edare that. i have examined this return, induding acoomparrying sdtadules and statemerds, and to the best of my knoWlsdpe and , ft is true, COrieCt and oompfete. Dedaretton of preparer other than the personal representative is based on all inforrnatfon of which preparer free any krwwledpe. A. Paulus, Executrix SIGNATURE OF EPA tMt! PRESENTATNE DATE Bradley L. Grime, Esquire ~(I o ~ ~- o t1 PA 17013 1505610143 Side 1 1505610143 J 1505610243 REV-1500 EX oecedenrs New: Slagl@, B@tty IN. Decedent's Social Security Number 182 22 7293 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 14 4 , 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 51 , 835.05 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 1 , 687.38 7. Inter-Vivos Transfers 8 Miscellaneous Probate Property ~ Separate Billing Requested............ l S h d G 7 523 85 Z2 ( c e u e ) , , . 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 2.10 , 046.28 9. Funeral Expenses B~Administrative Costs (Schedule H) ....................................... 9. 27 , 420.95 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 1 , 773.41 11. Total Deductions (total Lines 9 & 10) ................................................................... 11, 2 9 ,194.3 6 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 180 , 851.92 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 18 0 , 8 51.92 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 180 , 851.92 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17. . at sibling rate X .12 18. Amount of Line 14 taxable 0 0 0 18. . at collateral rate X .15 19. Tax Due ................................................................................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 8,138.34 0.00 0.00 8,138.34 Side 2 L,~, 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-11-0721 f~ecedent's Comulete Address: DECEDENT'S NAME Slagte, f8etty M. STREET ADDRESS 84 Partridge Circle CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditsiPaymerrts A. Prior Payments B. Discount 0.00 3. Interest (1) 8,138.34 Total Credits (A + B) (2) 0.00 (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5, if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $,138.34 Make Check Pa able to: REGISTER OF WILLS AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... b. retain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ 2. ff death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death?....... ^ 4. Did decadent own an Individual Retirement Acxount, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^x ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates Of death on or after Juty 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 p2 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 discbsure of assets and filing a tax return are still applicable even ff 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 nobd 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. SCHEDULE A REAL ESTATE cotrarrwsunt of r+t~snv~ww sattatlrArtcte rnx t~rur+rr ttrtrot:ct:oewr ESTATE OF FILE NUMBER SIa01s, Betty M. 21-11-0721 All real propsAy owned solely or as a tsrwrt N common must bs reported at falr market value. Fair market valor is defined as tta price at which pnope 8y would be between a wfl~ ~ayvn~'llinp ~~d ~ „~ Iledp I~both h~ reesorwWe of the relevant f Attach a copy or the asttk+rrrsrd sheet H ttM property has been solo Include a copy of tlrs deed showlnp degdsrd's IMerost N owned ss tenant In corrnnon. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 i34 Partridge Circle, Carlisle, Cumberland County, Pennsylvania -Residential Dwelling (See 144,000.00 attached HUD-1 Settlement Sheet) TOTAL (Also enter on Line 7, Recapitulation) I 144.000.00 (H more space is needed, additional papas of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1609 EX+ (6-88) cowowwFaint of rtewrsvwua w aefRirAr~ r~x itETURN xr otceoErrr SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Slagle, Betty M. 27-11-0721 Include the proceeds of litigation and the date the proceeds were received by ttre estate. All property joinliy-oMrtred wkh Oa right of wMvorahlp rtwst be disclosed on echsduls F. .ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citizens Investment Services - 47,240.28 Account No. L7C784874, Pimco Total Retum A (PTTAX) (See attached statement) 2 National Financial Services, LLC -Refund of overpayment 43.12 3 Comcast -Refund of overpayment 10.34 4 Veterans Affairs contribution 100.00 5 State Farm Insurance -Homeowner's refund 43.09 8 Tax proration credit at real estate settlement 1,308.72 7 2010 Property tax rebate 7~•~ 8 Personalty - Household furnishings (auctioned) - 2,109.50 (See attached auction statement) 9 Furniture -appraised - 125.00 (See highlighted portion of attached appraisal) 10 Furniture -appraisal - 105.00 (See handwritten statement attached) TOTAL (Also enter on Line 5, Recapitulation) I 51,835.05 (N more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule E (Rev. 6-98) Rw•160Y EX4 je.PS) c o-a ~w N w E wt ~ o F a E rx+snvu~ u eeiB2RANCE TAX RETiAtN REBIDENi DECEDENT SCHEDULE f JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER SIas11e, Betty M. _ 21-11-0721 K sn asset vrae mods joint wltldn one year of ttro decedent's date of tleelh, it neat toe ropoRW on sd~saule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Janice E. Adams B. C. 4529 Merrywood Lane Daughter Gastonia, NC 28052-9546 IOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOI TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCL4L INSTRUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALOE OF ASS % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 05/20/2010 Citizens Bank Checking Account - 3,374.75 .50.00096 1,687.38 Acct No. 6100738032 (see attached statement) TOTAL (Also enter on Line 6, Recapitulation) I 1,687.38 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule F (Rev. 6-98) Rev-1610 Ex4 (tea) SCHEDULE G INTER VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY cowaaoNwEA~TN of aENNavwANw aITAfICE TAX REIiFtN - REalOENr DECEDENT ESTATE OF FILE NUMBER 21-11-0721 This schedule moat be completed and filed 'rf the anavrer to arty of questiorre 1 ttaouph 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER p DESCRIPTION OF PROPERTpY tTHE~l3ATE p~F T~S~SpEj'RT~F1 p COPY OF THOS DEED FOR REAL EsT~nTE. DATE OF DEATH VALUE OF ASSET % OF DECD'S I~REST Excl_uS1oN (IF APPLICABLE) TAXABLE VALUE 1 Security BeneAt Non-Qualified Annuity - 12.523.85 100.000% 0•~ 12,523.85 Account No. 7053004602 (See attached statement) TOTAL (Also enter on Line 7, Recapitulation) I 12,523.85 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software onry The Lackner Group, Inc. Forrn PA-1500 Schedule G (Rev. 6-98) ru:v.~~a~ oc+t~o.oel SCHEDULE H c ~~a ADM N STRATIVE C S S ~~~~ ESTATE OF FILE NUMBER Slagle, Betty M. _ 21-11-0721 Debts of decedent must be reporb3d on Schedule L ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached 19.79 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address Cry State Zio Year(s) Commission paid 2, Attomev's Fees Griffie end Associates 5,000.00 3, Family F~remption: (If decedent's address is not the same as claimants, attach explanation) Claimant Street Address Chy State Zic Relationshio of Claimant to Decedent 4. Probate Fees ~•~ 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 22,055.66 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 27,420.95 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Slagle, Betty M. 21-11-0721 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Expenses Aver Cremation Services 19.79 H-A 19.79 2 Other Administrative Costs The Sentinel - (Advertising) 227.45 3 Cumberland Law Journal - (Advertising) 75.00 4 Linden Hall Antiques - (Personal Property Appraisal) 45.00 5 State Farm Insurance - (Homeowner's) 80.82 6 U.G.1. 59.09 7 North Middleton Estates - (Homeowner's Association Fees) 115.50 8 PPL Electric Utilities 34.32 9 PPL Electric Utilities 24.88 10 Citizens Bank - (bank fees) 18.00 11 U.G.1. ~•~ 12 Auction fees and expenses - (See attached statement) 828.32 13 PPL Electric Utilities 32.04 14 State Farm Homeowner's Insurance 39.91 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Slagle, Betty M. 21-11-0721 ITEM NUMBER DESCRIPTION AMOUNT 15 Real Estate Settlement Costs and fees: - 19,818.42 Realtor's Commission 8,391.00 Tax certification fee 5.00 Notary fee 10.00 Transfer tax 1,440.00 Home Warranty 574.00 2011-2012 School taxes 1,617.27 North Middletown Authority 156.15 Home Repairs -Jim Stine Services 50.00 Homeowner's Association dues 176.00 Seller's assistance 7,400.00 16 PPL Electric Utilities 18.21 17 State Farts Insurance (homeowner's) 39.91 18 PPL Electric Utilities 32.04 19 State Farts Insurance (homeowner's) 38.91 20 Reserves 500.00 H-B7 22.055.66 Copyright (c) 2002 form software only The Lackner Group, Inc. Forth PA-1500 Schedule H (Rev. 6-98) Rw-1512 t7(+ (12.OS) COMMONWEAI.TN OF pENNa+/LVANIA INIERRANCE TAX RETURN RESIDENT DECEDEPIT .SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER Slagle, Betty M. _ 21-11-0721 Rport debts Incurrod ty 1M dsadsnt prior to dsrih thSt nrrNrnsd unpaid to the dtate of duth, Including umNmburs~d rrNdleal ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PPL Electric Utilities 19.21 2 Thomwald Personal Care Facility 934.61 3 Millenium Pharmacy Services 204.18 4 North Middleton Authority - (Water ewer) 82.30 5 U.G.I. 29.36 6 PPL Electric Utilities 38.80 7 CenturyLink 39.46 8 U.G.I. 39.00 9 Home Instead 201.26 10 Middleton Estate Homeowner's Association fees 55.00 11 Miilenium Pharmacy Services 130.23 TOTAL (Also enter on Line 10, Recapitulation) I 1,773.41 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) V SCHEDULE J CO ~~~'""'" BENEFICIARIES ESTATE OAF ~ FILE NUMBER Sla le Be M. 21-11-0721 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE OUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY (Words) ~~$) I TAXABLE DISTRBUTIONS [incude outright spousal • distnbutions, and transfers under Sec. 9116 a 1.2 1 Janice E. Adams Daughter 25°k of net estate 4629 Merrywood Lane Gastonia, NC 28052-9548 2 Jason Lehman Grandson 25°k of net estate 1202 Red Bud Lane Canton, GA 30114 3 Egan J. Slagle Grandson 25°~ of net estate 110 Faith Circle Carlisle, PA 17013 4 Wesley C. Slagle Son 25°~ of net estate 110 Faith Circle Carlisle, PA 17013 Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II --ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) a LAST FILL A N1,7~ TEST~~IE1'~T' OF BETTY M. 5LAGLE I, BETTY M. BEAGLE, of 84 Partridge Circle, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. ~~~ I order and direct my Executor hereinafter named to pay all of my just debts, fimeral expenses and expenses involved or connected with the administration of my estate, including.. all taxes that may be assessed in consequence of my death, as soon. after my death as is reasonably possible from the proceeds and assets of my estate prior to any other distributions. However, my Executor need not accelerate and pay those unmatiued obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my Executor/Executrix, in his, her or its -. t aad to erect a suitable grave marker at my grave, and to expend sums from my estate for this purpose. GRIFFIE & ASSOCIATES Attorneys At Law 200 N. Sartover Street Carlisle, PA 17013 Page 1 of 8 100 Lincoln Way East, Suite D Chantbersburg, PA 17ZO1 SECOND a I give, devise and bequeath my entire estate of whatsoever nature aad wheresoever situate, together with all insurance proceeds thereon, in equal shares to my children and grandchildren, JANICE E. ADAMS, WESLEY C. SLAGLE, JASON LEHMAN and EVAN J. BEAGLE, providing they survive me by sixty (64) days, per capita. I direct my Executor/Executrix to divide among such beneficiaries all personal property of a sentimental or family nature (excluding cash, stocks, bonds and the like), including but not limited to .jewelry, household goods, antiques, furniture and memorabilia, in accordance with a separate memorandum which I may place with my Will or deposit with my attorney.. In the absence of such disposition by memorandum, I direct that the said tangible personal properiy be divided between my residual beneficiaries with due regard for their personal preferences in as nearly equal shares as practical, with the value of such dispositions being credited to the share of each respective recipient. If the said beneficiaries do ;not agree to the division of the personal property provided for hereunder, the decision of my Executor/Executrix, including the decision to sell .the property at public or private sale and distribute the proceeds therefrom as provided hereinafter, shall be final and conclusive on all parties. Any devise or distribution under this Last Will and Testament which is payable to any beneficiary. who maybe under twenty-one (21) years of age or, in the judgment of my Executor/Executrix, mentally disabled, shall be held in a separate trust by my Executor/Executrix as trustee until such beneficiary reaches twenty-one (21) years of age or during such period of disability. In the case of a beneficiary .under twenty-one (21) GRIFFIE do ASSOCIATES Attorneys At Law 200 N. Hanover Street Page 2 of 8 100 Lincoln A'ay Easy Suite D Cartisle, PA 17013 Chanibersburg, PA 17201 years of age, the Trustee may distribute up to one-half (1/2) of the then remaining principal and accumulated income on the request of the -said beneficiary, at or after attaining eighteen (18) years of age; and up to the entire remaining balance of principal and accumulated. interest at or after attaining twenty-one (21) years of age. During the term of any feast created pursuant to this Paragraph, the Trustee is authorized to expend and apply so much of the net income and principal of each such trust as the Trustee shall consider advisable for the health, maintenance, support, and education (including college education, undergraduate and graduate} of each such beneficiary until he or she .attains. twenty-one (21) years of age, or until all such amounts are paid out of trust. I direct that no Trustee shall be required to give or post bond for the faithful performance of the Trustee's duties in this or any other jurisdiction. FOURTH I grant my Executor/Executrix the following powers in addition to and not in limitation of such powers as my Execuxor/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. (b) To .join in any corporation, Partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. (c) To manage, operate, repair, impmve, mortgage or lease on any terms any real estate held or owned by my estate. GRIFFIE & ASSOCIATES Attornrys At Law 200 N. Haxovar Sb~eet Page 3 of 8 100 Lincoln Way Easy Suite D Carlisle, PA 17013 C/~anrbersburg, PA 17201 ~~ (d) To operate any business that I may own at my death. (e) To invest any fiords of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my Executor/Executrix the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. (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 and of the settlement of my estate. Z00 N. Hanover Street Carlisle. PA 17013 GRIFFIE & ASSOCIATES Attorneys At Law Page 4 of 8 100 Lincwln Way Easy Suite D Chanibersburg, PA 17201 (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. 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 eithc~ 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. SIXTH I nominate, constitute and appoint my sister, JOYCE A. PAULUS, as Executrix of this my Last Will and Testament. In the event my sister is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my son, WESLEY C. 5LAGLE, as Executor of this my Last Will and Testament. I direct that my Executor/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 SEVENTH I hereby declare it to be my expressed desire that my Executor/Executrix employ the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and GRIFFIE & ASSOCIATES Attorneys At Law 200 N. Hanm++er Street Page 5 of 8 1 ~ ~~ ~'~' Easy Suite D Carlisle, PA 17013 Chanibersbu-g, PA 17201 assistance regarding this my last Will and Testament, they having considerable laiowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and. the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last: Will and Testament, consisting of eight (8) typewritten pages, the fast five (5) of which bear my signature on the side margin, for purpose of identification, this day of ~ 2004. WITNESS: Qn BE BEAGLE GRIFFIE & ASSOCIATES Attorneys At Law 200N. Hanover Street Page 6 of 8 Carlisle, PA 17013 100 Lincoln Way Eas; State D Chatnbersbnrg, PA 17201 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF CUMBERLAND I, BETTY M. SLAGLE, 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 instrvment 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. BETTY GLE Sworn or affirmed and acknowledged before me by the Testatrix this day of ~~~~-fit. , 2004. -, 20011 Hanover Street CarX~slti PA 17013 GRIFFIE & ASSOCIATES Attorneys At Law Page 7 of 8 100 Lincoln N'ay Suite D. Chpntbersbtrrg, PA 17201 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA: SS. COUNTY OF CUMBERLAND WE, h, i f~'~ and ~~ L- ~{~ t the witnesses whose Hennes 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. G1n Sworn or affirmed and subscribed before me by ~ da of 2004. and / this ~~ y Notary Publi R09g11. l~SNORN, NOTARY PUBLIC . 1MY ~MM~ISSI~ON~EXRE3 APRIL 17 20 7 200N. $onm~erStreet Carlisle, PA 17013 GRIFF7E & ASSOCIATES Attorneys At Law Page 8 of 8 100 Lincoln. R'ay Easti Srdte D Chambersburg, PA 17101 Attachment to Schedules A & H OMB Approval No. 2502-0265 •~• . A. Settlement Statement (HUD-1) _ ' Number. Q Comr. Unins. ®RHS 3 ^ FHA 2 1 mbar wrence Case Number. . . . 11093 104631923/ ~~ t~ 4. Q VA 5. Q Cores. Iras. C. Nola: TNS tam b yhrs you a staterrwnt of acgaal pltlarrwnt eats. Amounts paid b and by the pltlerrrrd aparas aro shown. Items nwrked "hoc)' were paW aubide the they are dawn Iwre for IMonrratlorrel purpase and are rat irrcludsd b tfa btah. D. Name 3 Address of eorcower: E. Name 6 Address of Sstler. F. Name 6 Address of Lender. Tai S. (3rwnBner Fatale of Betty M. Slagle JP Mayan Chao Bank, NA 118 Pine FtsAow Road, Yark, Pa 17408 do 1400 East t4ewpoA Center Ddve, Deerfield BeacA,F133442 G. Propsnty Locatlorx H: Settlement Apertt: I. Settlement Date: 09J28/2011 ti4 Partrkipe Ckde Keyslate Land Trenstar, ltd Distwtsertprtt Date: 09V28l2011 Carlisle, PA 17013 3421 Markel Street Camp HA, PA 17011 .North Middbton Township TekpFione:I17-731.4200 Fax: 717-731-1799 2 d Expross j wl Street, Camp Hi, PA 17011 34 1 Ma PrlMaf 08127f2011 at 2:38 pm ~ KS .1 08, p~ _ ~.. _. b _.~ 408. - GlyJlo~wn imaee b 1 07. County htaa O912e/1011 b 12131/1011 103.70 407. County qxp 09/1812011 b 12/31/1011 103.70 1 08. Scholl Tax OBP18/1011 b 08190f1012 1,19952 408. Sdad Tax OBf2812011 b 0613011012 1,188.52 1 09. FIOA Dues 08/1812011 b 09/90/1011 5.80 409. HDA Dues 09128//011 b OB/d0/1011 5.50 1 10. 410. 1 11. 411. 1 12 412 1 2 ~, pry Oonoawr 188,147.00 . ~.. ,.._ _ Ot 02. Pdndpsi arnoutt of asMrbsr~s) 149,222.00 145,908.72 128. prep Aworrrt Dwb BsYsr _ _ see 502 SNtlrneri dwrgss b ssMr (iw 1400) 12.419.42 t ai. s teksn b 503. s Ykan b . fit, 604. of fret ban ~, 606. of eecstxl ban 2 08. ~• 201. 607. YirerBarw:e Tax Eaaow 7,528.38 208. 508. ~. ~• krlMgw aaNsr fortbaaun sslMr ttooss b 6 taws b 211. Coungr tares b 511. ~1 taws b 212 Sdgd Tmr b 512 Sdad Tax b 213. 513. 214. 614. 215. 8e7srAnlat 7,400.00 515. SaBerAabt 7,400.00 218. 618. ~7, 617. 218. 618. ' 219. ~ . ToW PsW 810..: ~ .. 301.. ~ 1 302 lsp antastN P~ tiarowsr (Ana 220) 157,B2L00 ~- ~ 168.147.00 157,822.00 519. SIB. ToW Rsduclbs Dus BaBar s.,: 801. atttotri des b ssler pne .) 802 Lore ~ b amoai due seler (Ikw 520) 21,88.78 146,306.72 27,348.78 e 807. Celt ^ From ®To Borror»r rrarYre ..wwwawarwrrr. rwrwryrr 1,p0.00 wtararr..r..w.r• t0.1. Cash ®To ^ From Oslsr r rrw,r.wrrwr.apn~aw^wrwre Mrn./n 117,98BJ14 M arc 4 HUD-1 780. 'TeGitliilii~l. P `~'•sr e ~xv'' ~ ~ s ~r-~-~ryrr~'~ .._ ~ "a~r~' _ ,,.. ,r - ~~ ~~ ~ •~ ,~I "~!'1,`~I} Bo wars ~ ~1~. ~ ~ Sel~e~s b RelA4u ~ AnodtFea, bc. 1. 088.00 ~u s.~t ~ , ,Funds ~t -- ,pp b EwMNRT, Inc. ; S~EtIe11,8nk Sett).eme 't alttttitamd a .00 70 4. b Attoddee, Nx:. Y. Paint or 502.00 (from t9FE 11) . .. M YaMedfibdl0ttn Otlf p as (iom GFE N 19T. 8 04. b LSI T5.00 P.O.C ~ GFE . Credtl Credl PMre 12.31 80 8. ax tervkw b CHaee Fbme FYieibe (~ G~ ) 8 07. b ~) 8. ., b ~ ~ ~:..K ,~+er* S ~ia~ 'r .?Q, {,c >rns~c~q; sy.~~ar~ as< ." ";t_ ~r.~~> ~ y.y ~ 1 b 1 1 7 (from ..,. 5. -.:, _ ~, 52.13 9 02. Ynuana motet b from l3FE /3 9 03. tloRMOiw[nr~MnikpnOt for Ede Yaaance (pom OFE i11) . lisaal maAht b triad ) .. .... ~,autk7'-~~a'I e,',y. Gk. g {Y i0k'~S?~1$3h~" {~.rnW " 367.00 6 1 001. ~tdIQalRfOr)KMatICFOwaCaaad (komGFEfl9) 585.12 1 002. No~aaowliera bturrioe 3 modM 29.75hna8h i~.26 1 003. MNir~nce maNlu /maAh 1 004. frost madht hnai8i 1 006. Carlylmoa 9 nantla 3321hnadt i29B.8B 1 005. Sdad Tax 4 montlu 132.OBlmoidh 1628.32 1 007.. 1331.34 ,.P '..a /~ nVU ~ .n~ ...f f -. -Y~4~:~/~,5'TrJdi, r^." ~.s ~:M9."lS~ftYA~'NY -C ~ ~ 1 .75 1 1 102. $altlefAllllOffl,OdtlQtrt b i 103. OreMra iilM lnplgl-ot-FlMAlatdgn Title ~WaatlOe Cempsiy (iFE/5 i 1W. LandthlMeigNaaeoa-t~inlAawioanTNMNmaanoeCamprry i1,3~i.76 1 1ati.lander~wt tlaititi4B,2ZZO0lendar'tPatlcy 1 108. Ottn~slNa MINi111A~0.00 Ownn'a PWcy 1 107. pwtlonaflhabWMMirwarxotpm-iiun i1,112.M 1 108.11nduwlMers oftlMlddNeNweaiwepremhan 1271.31 b 1 109. 1 110. Tax axtlAatlon Fte b Laixl Tiandtr LY 6'~ 1 111. HWa1y Foe b Whten D: Sure 10.00 . ; ,,, _ w: :: µ __ ~: .... ~~ ~r rx.~..~r r. - .,~ .. .y .. - -: . , :..,:: .,. ,~ r1E Y ~~,,~_ .~v',s,..sK.9 ~ , 201.Oovmrmntwoad6gdatptt i (fromGFES7) ,54.00 1 202. Dtta 1.00 frelw. 1200. TrandtrtaxM i (fromGFE18) 1,440.00 1204. CBy/Couydy YoJabmpt Decd 1 .00 1206. Stall Tax/Mampt Deed 1 M0.00 1'~'~ 1206. Dttd ., r ,, v, 1718:'1ktliNHoNi[ ': f+ F - ~,.~ „ea rrt_ , r-,., , _ :. ... ~~ ((IOaI ~E 1302. b 4303. b 1304. b 1306. b 1308. Flans WaRaMy b Maaban Home 8lield b74. bMidrNNa-Eddtt b tbfi Stasr 1 8 7 axtt bRobin , On b JI1n Stone SeMcet 1 b INddltion Etitltt b 1 9. 'Fold aAtide of doetig b7 (B)onoaer, (Sletler, h)e~, l~- ." C,redtl by larder drown en papa 1. ~ccrem oy rawer mown on page ,. s are o o HUD-1 Note: tl you have amr gtMSStlona about ~e Settlement Cherpea and Loan Terms Naled an Ws tam; Please oantact your lenaer. Aare p HU 1 r+~TPICAT'ION Of BINiR AND S~ 1 pQ I have rarehAy nWsr+dllw Hlib.t SMUamant Stakrnara and b Iha bat of my WlotaMUpa and bagel, q R a true and acaaMa ataMmant of aq reoelpta and made ap myaooovrt oa by' a» h)hisMapradion I tta0ur oamy tlr11 have aaWad a Dopy of thrHUD•t SNtMnwd StaMmnM. Toni S. ~~ The HUD•1$atlNtwlt 1 htw papuadi ~ ht+a and aoauata acoaM.1 of thk transaeLon. I have awed or wAl eawa U-a fiada b 6s dhburaad b aocoManoa v~ lMa sfaMrnsnt. ~/~/~, SETTLEMENT DATE . WARNM1f~ R IS A CRMAE 7'O KNOVWNOLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SgYgLAR FORM. PENALTIES UP~1 CONVICTION CAN INCLUDE A FINE AND II~RISOWMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. s are 4 0 4 HUD-1 Name d BaloNhr: Toni S. l3uentltner Name d Soler: Estate of Belly M. Sleple FBe Number 11093 Prapred 09127/2011 at 2:38 pm Mom This pass it fitrnished to Siva you an itemisation of she amourns Chown on Lines 1101, 1103 and 110+ of the Saedantent Ststement (HUD-t). '17~ia pace a~panies but ie not a part of the settkrnettt statement. If a discrepanry exists, the information shown on the Settkmatt Statement (HUD-1) appMes. 1101. TlletMVbM' `Nedlt'at~eYrlealae 1,~3.1~ s. i 25.00 b. En1a110oc Fee. 35.00 c. Doamwtl Fee 15.00 d. VNre In Fse 10.00 e. Fee ~~ 120.00 1102. SetlNmad a tae 1103. Owner's 9le Ylntrai~ce 1104. Leldere 6le ktelrance 1.108.76 = 1,369.75 a EndoleernN~lS2DFW 60.00 b. Endoreee1111t 900 EPLeI 50.00. c. Sella LsINr 76.00 d. ALTA Shod Form Loan 100.00 (Total 1103+1104) 6912742.21e11 6011M221398 1109. 1110. 1111. ,,,z. 11M. Tik aervlcee a1~ ~ taalrrlee a b Lard Transfer, Lld b. t3na11Doc Fw b lend Tranettr: Ltd i 25.00 36.00 25.00 35.00 a l)oclat1a11t Fee b T Abebacd 15.00 15.00 d INMs N FN b Lend Transfer. Lld t0A0 10.00 a Fseb WNMn D. SNse 1104. LeldetYlilk YiNNana b FMst Mrrican Ttle Mr1ws11cs 35.00 1,383.75 35.00 1,383.75 ESTATE OF BETTY M. SLAOLE g4~y~i C3 = Y~... ~ E/~ pate 9/28H 1 pale 9/28H 1 T September 28, 2011 Re: 84 Partridge Circle, Carlisle, Pa 17013 Toni S. Guenthner Line 801-Origination Fee $ Line 801-Document. Prep $ Line 801-Funding Fee $ Line 801-Processing Fee $ Line 805-Credit report $ Line 806-Tax Service Fee $ Line 807-Flood Determin $ Line 808-Flood Cert $ Line 901-Interest $ Line 1001-Escrows $ Line-1001: Title Insurance $ Sellers Assist Addendum 5,867.00 65.00. 395.00 175.00 12.31 87.00 5.00 6.00 52.13 585.12 150.44(Partial) Total Sellers Assist $ 7,400.00 ~~P ~°' Attachment to Schedule E Citizens Investmetrt Services September 26, 201 l Griffie & Associates Attn: Bradley (iriffie 200 North Hanover St Carlisle, PA 17013 725 Canton Street Norwood, MA 02062 1LE: L7C164674 1tE: Betty Slagle Dear Mr. Cniffie: I am writing with regard to your recent correspondence regarding the above referencxd account The value of the .account as of June 9, 2011 is presented in the table below. Account L7C1646?4: Fund Number of Price per Total Shares Share Pimco Total Retum A (PTTAX) 4,279.011 $11.04 $47,240.28 Total Account Value as of June 9, 2011 $47,240.28 The account had no acerued iaterest, and was individual) owned, with no joint owners and no named beneficiaries. If we ~ be of further assist~os,please contact our d r tat 800-942-8300 Option 4, between the hours of 8:30 am and 5:00 pm, ]3ST, Monday through Friday. ,.. Tim Jackso Beneficiary Accotmt Services Specialist Securities, Insurance and Investment Advisory Services offered thro+;gh CCO Investment~Services Corp. MemCer t=1NRA, SIPC. 28 State Street, MS1310, Boston, MA G,'_'03. (800) 312-8300. CCO Investment Services Corp. is an affiliate of RBS Citizens, N.A. and Citizens t3ank of Pennsylvania. r~~ lZBS _ _ __ ._ __ - --- -- - - ~ I Securities and Insurance Products are^TNCT 1-DIC INSURED^NOTwBANK GUARANTEED' MAY LASE VALUE ~ R~~d~~~ A: ~ 11~N ~~R~V.~t (KH 79L) 2505 Rimer Highway Carlisle, PA 17016 Bill Rowe (AU 1538L) 249-1978 697-4794 249-2677 Dave Rowe (AU 2295L) Auction Is Action Call "Rowe" For Satisfaction SELLERS NAME ~ 5 ~ ~ (~~ Z VIA SL~c,~. DATE ~ z~ 1 ADDRESS Q` ~-1 ~ ~A-`r +h-~y~ ~.-~ Cwt-•-~ PHONE ~ ~ - ~ i`t~S~ OTHER ~-~-~~'`-~~ iA ht- l "~ o l3 AUCTIONEER. °k 36 AUCTION DATE/LOCATION ~ ~~.5 'r 13..0- CLERK % DESCRIPTION OF MERCHANDISE J~ , 4J~+~f S S iQ tl~i S ~ Cs.~--F..rri ~~i.C~ 1ii l~i~~•: tT~e~c-3 -'~ 5~7.~14~ti-t.c ~.~.~ ~~1. L:JA/1/+•S a7 l~+.L~ C.~:(+h- A- i ~' ~ 1/ l'7~' '~ M-~.Zts-+~/~:. -~ ~- /l~ua...~ P t.~ ~L..4~b. - S.A~w~+ L°-~ ~J~LQ-3- V '. r C:K~e~_i~[e .el..~~~1/ ~/,Aei„Z,FZn~-. "- Z„«.n.. ,~ d~,~:~1= A : ~.yT'~ s ~k,'C dLflar~a,!S ~~ ~.S7w.s4-`. p S ~,~ ttl3-. C~d,~ .,~~ u~- ~_-.~C~ll.t-u~u c ... S~c~J'Ln.~~ ~'T~+-CGS BLS cDl~c CJ~Pr-14:z~ (?~ ~-+~,.~~G4•~-z• 5 --1~,~r~l~ -- L~:,~.~~..yd ~' - ~ . ~~~ C, /1~, c ~-C G,4-db~.:.;~~'S .. ~.1Q',~r~~~,e G,F,u..~. - lr,/~.t _~ -_ ... I' Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be eon as is & grouped as necessary to obtain bids. I certifj- that I am the. owner ar authorized repreeen- tatave of the mea~ehandise, goods and or property and have good title and the right. to sell. and that they are.fres from all incnmbranc~s. I agree to accept gll responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the- Auctioneers against any claims of the saature referred to in this agreement. .~.- , AUCTION S GNATURE / SELLERS SIGNATU Total Sales (Clerking Tickets Attached) $ ~- ~ ° °t - s~ Less Sale Expense: 3~'°h Commission Auctioneer ~ `C 3 B~ . 3 '~- %p Commission Clerks ~ OTHER: '~-w °t o - va _ 'DOTAL SALE EXPENSE DEDUCTED ~ ~ ~-~ `~ . > '? =~ SELLE;R.S NET ~ ~1r-'t-c ~u.. 1~allh-~e ~ L- Cf ~ ~~ ~-S ~-~~ C?~~b~ , P*' 1~b« 1 ~ \ J~o m ~ 5~l.~- hEe~ 4c~. E1.,0 ~,,4.n, V- t~ ~ ,M- L z o ~~ ¢~~P ~-A-~-s,~-~ - n. ~ ~'~- ~ a Pn~-arc c..~ C ~ ~..~ c ~~ - 3~ ~~ S~~ c ~ - -,---~- ~- G , ~~. ~1~cf~~ LINDEN HALL ANTIQUES 211 N. OLD STONE HOUSE ROAD CARLISLE, PA 17015 717-249-1978 To: Bradley L. GrifFe, Esquire Griffis 8~ Assoaates 200 North Hanover Street Carlisle, PA 17013 From: William G. Rowe, Appraiser 211 N. Old Stone House Road Carlisle, PA 17015 Re: Personal Property Appraisal Estate of Betty M. Slagle 84 Partridge Cirde Carlisle, PA 17013 Date: July 21, 2011 BEDROOM -1ST FLOOR Bedroom set Costume jewelry T.V. BEDROOM - 2ND FLOOR Bed Sewing machine Wall aooessories Knidc krtatsks Household DINING ROOM Dining room set Glassware Chains (2) Kitd~en wares Decorations Household LIVING RQ(~IA Sofa Coffeetable /stands T.V. Entert~nment oeMer Decorations Wall`hangings Displey catHnet Knidc knacks $400.00 $40.00 $10.00 $50.00 $5.00 $20.00 $10.00 $10.00 $190.00 $15.00 $30.00 $20.00 $15.00 $10.00 $150.00 $85.00 $100.00 $45.00 $20.00 $10.00 $75.00 $50.00 tQ ~ ~~ b~ t ~av~~ `,,Jrw~ GP+ i~-; nr~ ~ ~~ ~~ G(R..e~ h~'i Slagle Appraisal 1 07212011 __ ,_ :, HALL -UPSTAIRS Credenza /mirror Books SOFT F~aerase chair Display cabinet Collection of horses Stand Exerase machine - no value Small sofa Desk Accessories Lawn fumidme Miscellaneous box lots Rack Metal cabinets (2) Tools $50.00 $5.00 $30.00 $75.00 $90:00 $10.00 $0.00 $50.00 $25.00 $10.00 $10.00 $15.00 $5.00 $20.00 $10.00 TOTAL $1,930.00 William G. Rowe Slagle Appraisal 2 07/21/2011 Attachments to Schedule F ~~ ~*- ~;~ _ ~ ~~ One Citizens Drive . _ ,, w ...... • ROP112 Riverside, RI 0291s November 22, 2011 GRIFFIE & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW C/O BRADLEY L GRIFFIE 200 NORTH HANOVER ST CARLISLE PA 17013 Estate of BETTY M BEAGLE Date of Death: Jun 09, 2011 SSN: 182-22-7293 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. According to our records, the May 20th June 17"' 2010 statement shows that is when the account became joint. As for your request regarding large withdrawals, I have a vector request put in and I am awaiting confirmation. As soon as I receive any word on this, I will notify you by mail. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please ca11877-s79-2667 option 2. Sincerely, l~ ~ '~~~ Kasten $. Correia Decedent Account Processing R~#: s1881s Account Number 6100736032 Account Title BETTY M SLAGLE/JANICE E ADAMS Date ed 6/6/1966 Account T Checkin Princi Balance as of DOD $3374.67 Interest from Last Po to .DOD $ .08 Account Balance as of DOD $3374.75 YTD Interest to DOD $1.79 A Attachment to Schedule G ~~~ ~ securitybenefit.com • 800.8882461 .,. F M ''~~~ SECURITY BENEFIT" /~~~ December 15, 2011 GRIFFIE & ASSOCIATES ATTN: BRADLEY L GRIFFIE 200 NORTH HANOVER ST CARLISLE PA 17013 Subject: Contract 7053004602 Betty M Slagle Dear Mr. Griffis, We are writing concerning your recent inquiry on the above contract. Below is the information you requested. • 7053004602 -Owner Betty M Slagle • Non-Qualified Annuity • Date of Death Value (06/09/2011) $12,523.85 • No Joint Owner • No withdrawals on contract • Interest accrued from 6/9/11 to 9/28/11 $141.55 If you have any questions regarding this or other matters, we invite you to contact our National Service Center, at 1-800-888-2461 between the hours of 7:00 am and 6:00 pm Central Standard Time. Sincerely, t~,,~2iQ.7~! C~,a,~cc>.ir Christy Canon Client Service Specialist IV Service Operations Security Benefit One Security Benefit Place • Topeka, Kansas 66636-0001