HomeMy WebLinkAbout04-05-13 1505610143
REV-1300 rX(02-1i) is OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania crxxny code year Fee Nine
Bureau of Individual Taxes GVW" 1t°'
PO 60X.280801 INHERITANCE TAX RETURN 21 12 0773
Harrisburg,PA 17128-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
07 06 2012 05 04 1924
Decedent's Last Name Suffix Decedent's First Name MI
WIENER EVELYN ,J
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffer Spouse's First Name MI
Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X❑ 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. United Estate ❑ 4a.�e d.11h ° 2 2 ) ❑ 5. Federal Estate Tax Return Required
® 8' (A copyyar Will) ❑ 7- �qW r P.Ol �)a Living Trust 8. Total Number of Safe Deposit Boxes
❑ 9. Litigation Proceeds Received ❑ 10.9 PMCreerl t err Death ❑ 11.Election to tax under Sec.9113(A)
1 i (Attach Schedule 0)
CORRESPONDENT.THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
LINDA J OLSEN ESQ 717 540 4332
r�
c= 7rs
R OF V%4.S U§t�LY
� ca<
First Line of Addroaa '
2000 LINGLESTOWN ROAD cn
Second Line of Address CD C-) =) --r'r -n
C
SUITE 202 c ca
City or Poet Office L --1 DATE ItD
State ZIP Code n
HARRISBURG PA 17110
correspondent's*-nail addross: IolsenQhazenelderiaw.com
Under penalties of perjury,I dsdare that.!have examined this return,indudtng accompanying schedules and statements,and to the best of knowledge and belief,
k is true,Coned and complete.Declaration of preparer other than the persona!represarHative is based' all information of which preparer tlas any knowledge.
SIGNAT PERSON RE F FILarG RETURN DATE
Linda J.Olsen
RE S
204 Stephanie Dr. DIIISbUrn,PA 17019
SIGNA R F PREPARE
R O ER THAN UPRESENTATIVE DATE
Linda J.Olsen, Esq. _y
ES
2000 Lin lestown Rd. ,Harrisburg,PA 17110
Side 1
1505610143 1505610143
I
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF I FILE NUMBER
Wisner,Evelyn J. 21-12-0773
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of
my knowledge and belief,it is true,correct and complete.Declaration of preparer other than the personal representative is based on all
information of which preparer has any knowledge.
Signature#2
Name Donna W.Jorttensen
Address9 120 Woodiane 4
Address2
City,State,Zip Glassboro NJ 08028
Date "y i ,te
1505610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2. 1,390 . 77
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 7,251. 08
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous -Probate Property 0
(Schedule G) Separate Billing Requested............ 7, 685. 68
8. Total Gross Assets(total Lines 1 through 7)........................................................ g,
9,327. 53
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 9, 02 6.35
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 5, 768. 31
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 14 , 794. 66
12. Net Value of Estate(Line 8 minus Line 11)......................................................... 12.
-5f467 . 13
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,
-5,467. 13
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 00 16. 0. 00
17. Amount of Line 14 taxable
at sibling rate X.12 0. 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0. 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 0 . 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
L. Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 Fite Number 21-12-0773
Decedent's Complete Address:
DECEDENT'S NAME
_Wiener, Evelyn J.
STREET ADDRESS
335 Wesley Dr.
Apt.623 CITY STATE 2tP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1} 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (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) 0.00
Make Check Payable to: REGISTER OF WILLS AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.... ..................
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?............................................................ x
2. If death occurred after Dec. 12, 1962, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ 0
1 Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?,...... ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................................. 0 ❑
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)(1)).
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
172 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filing a tax return are still applicable even If the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at math 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(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.
Rev-1603 EX+(6-911)
SCHEDULE B
STOCKS & BONDS
COMMON WEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEOENT
ESTATE OF FILE NUMBER
Wiener,Evelyn J. 21-12-0773
All property)o ndy.owrlsd v th right of survivorship must be disclosed on Schsduis F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 23 shares of MetLife,Inc.-23 shares 30.51 701.73
2 58 shares of Metro Bank stock 11.88 689.04
TOTAL(Also enter on Line 2,Recapitulation) 1,390.77
(r more space is needed,additional pages of the same size)
Copyright(c)2002 form software only the Lackner Group,Inc. Form PA-1800 Schedule 8(Rev.6-96)
Rsv-1&W EX+(11-10)
SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wiener,Evelyn J. 21-12-0773
tnuude me m Imget ona u»aete>t,e p oceeas were recewed M the e.tate.
NI property Mly-CWnad YMtll dte Ayht d survlvonMp must bs dieclosW OM MMdlde F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Bethany Development Corp.-Refund of Security Deposit 325,28
2 Bethany Development Corp. -Refund of Overpayment of July rent 137.00
3 The Hartford -Reimbursement of Premium for renter insurance 64,96
4 AmerlChoice Federal Credit Union-Savings Acct#------884 5,321.94
5 PNC Bank Cking Acct#50-0579-9424 1.441 92
TOTAL(Also enter on Line 5,Recapitulation) 7,251.08
(If more space is needed,additional pies of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.11-10)
Rev-1510 EX+(08-09)
SCHEDULE G
Pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wiener,Evelyn J. 21-12-0773
This schedule must be completed and filed if the anster to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF
EL PROPERTY DATE OF DEATH %OF DECtrs EXCLUSION TAXABLE
NUMBER T DAB TRA 5 iZ��t OF THE DEED F°o°R R TATE. VALUE OF ASSET INTEREST ( APPLICABLE)
iF VALUE
1 Lincoln Benefit Life Annuity- -LBF 1139471 - 685.68 100.004eA 685.68
Daughters,Linda J.Olsen and Donna W.Jorgensen
beneficiaries
TOTAL(Also enter on Line 7,Recapitulation) 685.68
Qf more space is needed,additional pages or the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1504 Schedule G(Rev.0 8-09)
,. 1��gIp11��11111
REV-1511 Exa(10-091
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENT DE ED RETURN ADMINISTRATIVE COSTS
RESx}ENT DECEDENT
ESTATE OF FILE NUMBER
Wiener,Evelyn J. 21-12-0773
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule($)attached 7,614.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attornev's Fees Hazen Elder Law 650.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
city state Zip
Relationship of Claimant to Decedent
4. Probate Fees 104.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 657.85
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 9,026.35
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Wiener,Evelyn J. 21-12-0773
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expanses
1 Myers-Harner Funeral Home-Funeral 61850,00
2 Pastor Jon Uhlinger-Honorarium for conducting funeral service 150.00
3 Pastor Tom Willard-Honorarium for conducting funeral service 50.00
4 Royer's Flowers-Funeral flowers 564.00
H A 7,614.00
Other Administrative Costs
5 Apartment-Cleaning,moving supplies and truck 302.21
6 Cumberland Law Journal-Legal Notice 75.00
7 Register of Wills-Short Certificates 8.00
8 Register of Wills-Filing Fees-Inheritance Tax Return and 30.00
Inventory
9 The Sentinel-Legal Advertising 242.64
H-87 657.85
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-0512 EX*(12-011)
SCHEDULE t
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wiener,Evelyn J. 21-12-0773
Report debts Ineurred by do decedent prior to death that remained unpaid at the dab of death,including unrelmb,aeed medical experreee.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Bethany Village-Hair Salon 37.00
2 Bonnie K.Miller,Tax Collector-2012-13 Per Capita Tax 9,80
3 CAPITAL ONE-Credit Card 2,493.37
4 CHASE-Credit Card 2,044.07
5 DISCOVER-Credit Card 233.16
6 Hampden Township EMS-Emergency Ambulance transport from apartment to Harrisburg 74.99
Hospital
7 HILL_ROM-Respiratory Vest 228.39
8 JC Penney/GECRB-Life Insurance Premium 39.61
9 Pinnacle Health-Balance Due on Hospital bill 250.00
10 Shell Oil Company-Gasoline Credit Card 221.39
11 Special Event EMS-Wheelchair transport to Forest Park 118,75
12 Verizon-Home Telephone 19.78
TOTAL(Also enter on Line 10,Recapitulation) 5,768.31
(If more apace is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group,Inc. Farm PA-1500 Schedule i(Rev.12-08)
III I��II/1�1
REV-0613 EX+(01.10)
penneylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wiener,Evelyn J. 21-12-0773
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($t$}
j TAXABLE DISTRIBUTIONS (include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Donna W Jorgensen Daughter 112 Residue
120 Woodlane Court
Glassboro,NJ 08028
Linda J Olsen Daughter 1/2 Residue
204 Stephanie Drived
Diilsburg,PA 17019
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as aDorooriate.
NON-TAXABLE DISTRIBUTIONS:
[I. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET[
Copyright(c)2010 form software only The Lackner Group,Inc, Form PA-1$00 Schedule J(Rev.01-10)
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
No. 2012- 00773 PA No. 21- 12- 0773
Estate Of: EVEL YN J WIENER
(Fkw,MWIS,Last)
Late Of: LOWER ALLEN TOWNSHIP
CUMBERLAND COUNTY
(D Deceased
Social Security No: 197-16-2685
WHEREAS, on the 16th day of July 2012 an instrument dated
May 7th 1986 was admitted to probate as the last will of
EVEL YN✓ WIENER
!First,Miowfe,Last)
late of LOWERALLEN TOWNSHIP, CUMBERLAND County,
who died on the 6th day of July 2012 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARYto:
LINDA J OLSEN and DONNA W JORGENSEN
who have duly qualified as EXECUTOR(RIX)
and have agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 16th day of July 2012. j
i.'
/ 7
rst6/o I S
/ tY
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
I not Wift an#,&Ota-Invo tt
C. EVELYN JEAN WIENER
I. EVELYN JEAN WIENER, of 1921 Robinson Avenue,
Havertown, Delaware County. Pennsylvania. declare this to be my
last Will, hereby revoking all prior wills and codicils.
FIRST: The expenses of my last illness
and funeral shall be paid from my estate.
SECOND: I hereby give and bequeath,
absolutely and in fee simple. to my spouse, PAUL B. WIENER, all my
household furniture and furnishings, books, pictures, jewelry,
silverware, automobiles, wearing apparel and all other articles of
household or personal use or adornment, provided that if my spouse
dies before the thirtieth (30th) day following the day of my
death, this qift shall lapse or be divested and I make said
bequest to my issue, per stirpes, living at the time of my death,
to be divided among them as they shall agree. If they cannot
agree for any reason, my Executor shall make the decision and its
ecision shall be final.
My Executor shall represent any minor child in any
division of such property and shall deliver to the person standing
in the place of a parent to such minor, without bond, such portion
of the minor's share as my Executor. after considering the minor's
wishes, deems appropriate and shall sell the balance and hold the
Proceeds for the benefit of said minor under Item FOURTH hereof.
THIRD= I give and devise the residue of
my estate, real and personal, to my spouse, PAUL B. WIENER. if he
survives me. If he does not survive me. I make said bequest and
Page 1 ����
devise to my children, LINDA J. OLSEN. of Dillsburg. York County,
Pennsylvania, and DONNA W. JORGENSEN, of Boyertown, Berke County.
Pennsylvania, in equal shares. If either of my said children is
not living at my death, the share of said deceased child shall be
paid to the then living issue of said deceased child, per
stirpes. If either of my children dies without issue surviving.
that child's share shall be added to the share of my other child
or her issue. as the case may be.
If no issue of my children survive the survivor of my
said spouse and myself. the remaining undistributed principal and
accumulated income shall be divided into two equal shares and one
share shall be paid to my heirs who would be entitled thereto
under the Intestate Laws of Pennsylvania in effect at the death of
the survivor of myself and my spouse; and the other share shall be
paid to my spouse's heirs who would be entitled thereto under the
Intestate Laws of Pennsylvania in effect at the death of the
survivor of myself and my spouse as if my spouse had then died
Intestate.
FOURTH: I appoint my Executor as
Guardian to hold for minors all property payable by law to a
guardian appointed by my Will and use the same for the minor's
maintenance and education. either directly or by payment to any
person selected to disburse it, whose receipt shall be a complete
acquittance therefor. All unexpended income and principal shall
be paid to the minor at majority. For purposes of this Will,
majority shall be construed to be when the individual attains the
age of twenty-one (21) years.
FIFTH: No provision of this Will is
intended to exercise any power of appointment, including any power
of appointment granted me under my spouse's will.
Page 2
i'
SIXTH: All taxes, interest and
Penalties thereon payable by reason of my death with respect to
property comprising my gross estate, whether or not passing under
this Will, shall be paid from the principal of my residuary
estate, provided however, that funds of my Trust created herein
may be used to pay taxes, interest and penalties attributed to
such trust assets. Taxes on future interests may be prepaid.
SEVENTH: No interest of any beneficiary
under this Will or any codicil hereto shall be subject to
anticipation or voluntary or involuntary alienation, and the
personal receipt of such beneficiary shall be the sufficient and
only discharge of my Executor unless otherwise provided herein.
EIGHTH: In addition to powers given
hem by law, my Executor his successors and any guardian acting
hereunder shall have the following discretionary powers
applicable to all real and personal property held by them,
effective without court order and until actual distribution:
(a) To retain all property received by them including
the stock of any corporate fiduciary acting hereunder, provided
such property remains productive;
(b) To invest in all forms of property without
restriction to investments authorized to fiduciaries, so long as
such investments are productive;
(c) To compromise controversies;
(d) To hold investments in the name of a nominee: and
Page 3
(e) To undertake any and all acts deemed necessary and
proper by it for the proper and advantageous administration and
settlement of my estate.
NINTH: Any person, other than my
spouse, who shall have died within thirty (30) days of my death,
shall be deemed to have predeceased me. If my spouse and I die
simultaneously, or under such circumstances that the order of our
deaths cannot be established by proof, my spouse shall be deemed
to have predeceased me. Any person (other than myself) who shall
have died at the same time as any then recipient of income or in
a common disaster with such beneficiary, or under such
circumstances that it is difficult or impossible to determine who
died first, shall be deemed to have predeceased such
beneficiary.
TENTH: I appoint my spouse, PAUL B.
WIENER, as Executor of this my Will. In the event my said spouse
cannot act or continue to act as Executor for any reason. I
appoint my daughters, LINDA J. OLSEN and DONNA W. JORGENSEN. to
act together in his place. No fiduciary acting hereunder shall
be required to post bond or enter security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
c�
seal this ,jar— day of /// 19M.. to this
and the preceding three (3) pages, and I have also placed my
initials on each preceding page for better identification and
greater security.
Z �Z1� r[SEAL)
EVELYN PWNIENER
SIGNED, SEALED, PUBLISHED and DECLARED by the above-
named Testatrix, EVELYN JEAN WIENER, as and for her Last Will
and Testament, in the presence of us, who at her request, in her
presence and in the presence of each other, have hereunto
subscribed our names as witnesses:
Resi i n g at r
�- ZLI�_s ,✓ Residing at J.,!Pv �-
AFFIDAVIT OF WITNESSES
WE, ,'AME5 NORrr and � A-QRPr }�oegN witnesses to
the Last Will and Testament of EVELYN JEAN WIENER, Testatrix
therein, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and Testament and that she had signed
willingly and that she executed it as her free and voluntary act
for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed
the Will as witness and that to the best of their knowledge the
Testatrix was at the time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
(SEAL) (SEAL)
tness Witness
Sworn to and subscribed before
me this day of 1986.
N7 2Y PUBLIC/3
My Commission Expires: ,441 Y, Af0 d
(SEAL)
LINDA J.OiSEN,NOTARY PUBLIC
HARRISBURG,DAUPHIN COUNTY
MT COMMISSION EXPIRES SEPT.S.1911
Mir,Peanyiurh Au"boB 01 NOhria
P. AmeriChoice
FEDERAL CREDIT UNION
Building Relationships For Life
August 21, 2012
Hazen Elder Law
2000 Linglestown Road
Suite 202
Harrisburg, PA 17110
Re: Estate of Evelyn J. Wiener
Linda:
The decedent had one member number, 31664; titled Evelyn J Wiener. This was an individual
account held solely by Evelyn.
Account 31664
Regular Savings (suffix 0001)—opened 02/10/2000
Date of death balances are as follows:
Balance Accrued Dividends
0001 - $ 5,321.94 $ 0.00
The above balances do not include the accrued dividends. Mrs. Wiener did not have a safe
deposit box with AmeriChoice. Mrs. Wiener's account was closed on July 16,2012 with a check
made payable to the estate. Mrs. Wiener's final statement will be produced on September 30,
2012. I have updated the address so that her final statement will be mailed directly to your office.
Please feel free to contact me directly with any questions you may have.
Sincerely, ;� Q
Bonnie R. Seagraves
Operations Specialist
Phone(717) 591-1282
Fax(717) 697-3713 g�I•!�
Email bseag;aves(d,)americhoice.org
AUG 9 �Ji2 Rj
-----------•------------
Main Office:2175 Bumble Bee Hollow Road •Mechanicsburg, PA 17055 •Phone:(717)697-3474 •Fax:(717)697-3713
Website:www.americhoice.org
® Eaw I _ ....
oppaa•Iq p�
LENDE L!N D. CREDY!'UNIONS'
Aug. 10. 2012 1 :34PM PNC Bank No. 4935 P. 1/1
C
August 10,2012
Linda J Olsen Esq.
Hazen Elder Law
2000 Linglestown Rd Ste 202
Harrisburg,PA 17110
RE: Evelyn J Wiener
SSN: 197-16-2685
DOD: 07-06-2012
Dear Ms.Olsen:
In response to your request for Date of Death(DOD)balances for the customer noted above,our
records show the following:
Checking A count
Account#5005799424 Established: 03-03-2009
EVELYN J WIENER
DOD balance: S 1,401.92 non interest bearing
Please note that this office provides date of death balances for deposit account(IRAs,CDs,Checking and
Savings). We do not process any fiawiekal transactions or provide statements. If you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch.
office.
Sincerely,
National Financial Services Center
PNC Bank,NA.
Member FDIC
This message is intended for the use of the individual or enazy to which it is addressed and may
contain information that is privileged confidential and exempt from disclosure under applicable law.
Ifrhe reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient,you are hereby notiyled that any dissemination,
distribution or copying of this communications is strictly prohibited If you have received this
communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and
immediately destroy this faxed document.
Page 1 of 1
May 7,2004
Lincoln Benefit Life Insurance Company
Single Premium Immediate Annuity
Information Statement
Annuity Payment Schedule
Certificate Number: LBF1139471
Owner Name: Evelyn Jean Wiener
Annuitant Name: Evelyn Jean Wiener
Issue Date: May 05, 2004
Cost Basis: $12,697.54
Gross Single Premium: $12,697.54
Non-Qualified
*Annuity Option: Period Certain Annuity
10 years
First Payment Date: June 05, 2004
Payment Frequency: Monthly
"Gross Annuity Payment: $122.57
"**Excludable Amount: $105,78
Federal Withholding Election: No Withholding
Date of Death Value $685.68
*Monthly payments will begin on Juno 05,2004 and and on May 05,2014.
**Your gross annuity payment is a fixed monthly payment.
—The excludable amount of$105.78 is the portion of each monthly payment that Is excluded from your gross income until the entire
cost basis has been depleted.
This document is being distributed with an attached letter.
This statement is not part of your contract. It is for informational purposes only.
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HAZE r.IDER LAW Estate Planning • Elder Lam • Special Needs Planning
2000 Linglestown Road =(717)540-4332
Suite 202 FAX: (717)5401313
Harrisburg,PA 17110 www.HazenElderLaw.com
April 4, 2013
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Register of Wills M,z n
Cumberland County Courthouse rte. A r--
One Courthouse Square Z cn
Carlisle,PA 17013-3387 o c; "
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Re: Estate of Evelyn J. Wiener 3
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File No.: 21-12-0773 w ca 01
Inheritance Tax Return C.x
To: The Register of Wills:
Enclosed for filing please find the original and one copy of the above-referenced
Inheritance Tax Return and Inventory, along with a copy of the first page of the
Inheritance Tax Return. Please date stamp the first page of the return and a copy of the
Inventory and return them to my office in the enclosed self-addressed envelope.
Also enclosed is a check for the filing fee in the amount of$30.00.
If you have any questions or require any additional information, please do not
hesitate to contact me.
Sincerely,
Corinne Eggers Woodhouse
Paralegal
Enclosures