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Home My WebLink About09-12-13 J 150561�143 REV-1500 �"°,-,°, �' PA Department of Revenue OFFICIAL USE ONLY pennaylvania ca�mYC� vee� FileNUmber Bureau of Individual Taxes °�"""OR°� � Po BoxzBOSOi INHERITANCE TAX RETURN 21 13 0405 Hartisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 29 2013 06 29 1920 Decedent's Last Name Suffix DecedenPS First Name MI qPHEEI,ER KRESSLER DOROTSY E (H Appilcable)Errter Surviving Spouse's Informatlon Below Spouu's Last Name Suffix Spouse's Fiist Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 7. Original Retum � 2. Supplemental Retum � 3. p�ma�intler'ae m(tlete of death � 4. Limi[ed E9tA�e � qe,Future hneree�Com�raniee � 5. Fetlerel Es�ate Tax Relum Required (EerootdeethaXx 2-12-02) � g Oeatlent Dad 7ealete � pxeEept Meina�netl e Livirq7ruat O 8. TOt81 Number of SaFe DC sif BOx93 (Atlech Capy of W lp ❑ (/��PY�TN�) � � 9. LitlgationProceedaReCeived � 10.�°��9�"�°1��i��aee�Mtleeth � ��,ElectlonlotaxurMerSec.8113(A) � (Attech Sch.O) CORRESPONDENT•THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SMOULD BE DIRECTED TO: Name Daytime Telephone Number BRADLEY I, GR2FFIE 717 $30 5553.; ; i-+i REGIS�tIOF WILLS U$E ONLY�� .... F..._, �"' -. r , ..� Firat Iine of address r G" •- `�� 200 NORTH HANOVER STREE C�y {' , � -, __, Second line of address �"� �� : ; - � _ -..; � ._ : . ., S:: C- �� City or Post Office State ZIP Code DATE FILE�-' �� rsur•ISLE PA 17013 CorrespondeM�s e-meu aadrsu: bgriifie(�griffielaw.com Untler penaltles of pe�ury,I Oeclere tliat I have examined this retum,inGUtlirp accompan�ng schedules antl statements,anE to t�e bett of my knowbtlpe and belief, It Is We,cortect antl compbk. � W preparer oNar than the pereonal repreeent�UVe is baeetl on all mfoimation W which praparer has a/ry knowle0pe. SI�GNA E OF PERSON ESPONSI R NG REfURN DATE �c=�� Harry L.Wheeler '9-�! O �] � ADDRESS 729 Ha Drive Elizabethtown PA 17022 RE OF OTMER THAN REPRESENTATIVE DATE Bradley L Gri�e q /D / 3 DRES 200 orth Hanover Street,Carllsle, PA Side 7 � 1505610143 150561U143 J 1�"\ c J 15U5610243 REV-1500 EX DecedenYs Social Security Number o�rsN�: Wheeler Kressler, Dorothy E. RECAPITULATION 1. Real Esiate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporetion,Partnarship or Sole-Proprietorehip(Schedule C)......... 3. 4. Mortgages 8 Notes Receivable(Schedule D)........................................................ 4. 5� Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 4 6, 90 6. 2 B 6. Jointly Owned Property(Schedule F) ❑ Separete Billing Requested............ 6. 7. Inter-Vivos Trensfers&Miscellaneous rynn;Probate Property (Schedule G) U Saparate Billing Requested............ 7, 27Q �345 . 86 8. Total Gross Asseffi(total Lines 1-7)..................................................................... B. 319,252 .14 9. Funeral Expenses 8 Administrative Costs(Schedule H)....................................... 9. B , 694 . 84 10. Dabts af Decedent,Mortgage Liabilities,&Liens(Schedule I).............................. 10. 1 � fi 67 .2� 11. Total DeducHons(total Lines 9&10)................................................................... 11. 1 O ,362 . 04 12. Net Value of Estate(Line 8 minus Line 17).......................................................... 12. 30B� 890 .10 13. Charitable and Govemmental Bequests/Sec 9113 Trusta far which an eladion to tax has not been made(Schedule J)............................................... 13. 14. Net Value SubJect to Tau(Line 12 minus Line 13)............................................... 14. 308 , 8 90 .10 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line t4 tauable at the spousal tax rete,or trensfers under Sec.9116 (a)(12)X.00 15. 0 . 00 16. AmountofLinel4taxable 308 , 890 .10 �s. 13 , 900 . 05 at lineal rete X .045 17. Amount of Line 14 taxable at sibling rete X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable acconacerairscex.is 0 . 00 �s. 0 . 00 19. Tax Due.................................................................................................................. 19. 13 � 900 . 05 20. PILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �X Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 Flle Number 21-13-0405 DecedenYs Complete Address: DECEDENTS NAME Wheeler Kressler, Dorothy E. STREETADDRESS 8 Alliance Drive,Apt. 201 CITY STATE ZIP CaHisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 13,900.05 2. CredRs/Payments A. Prior Payments 14,000.00 B. Discount 0.00 Total Credits(A +g) (2) 14,000.00 3. Interest (3) q, If Line 2 is greater than Line 1+Line 3,enter the d'rfFerence. This is the OVERPAYMENT. (4) 98.85 Check box on Page2 Line 20 to request a refund g, If Line t +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (�) Make Check Pa able to: REGISTER OF WILLS AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedant make a trensfer and: Yes No � a. retein the use or inwme of the property transferted:............................................................................... ❑ ❑x b. retein the right to designate who shall use the property transferred or its income:................... ............. ❑ x c. retain a reversionary interest;or............................................... x d. receive the promise for life of either payments,benefits or care?............................................................ x 2. If death occurred aiter December 12, 1982,did decedent transfer property within one year of death wRhout receiving adequate consideration7.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ � 4. Did decedeM own an Individual Ratirement Accaunt,annuily,or other non-probate proparty which contains a beneBciary tlesignation?.................................................................................................................. ❑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 JWy 7, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of trensfers to or for the use of the surviving spouse is 3 percant[72 P.S.§9176(a)(1.7)(i)]. For tlates of tleath 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.§9176(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure af assets and filing a tau retum are still applicable even if the surviving spouse is the only beneficiary. For datas of death on or after July 1,2000: • The tax rate imposed on the net value of transfers Rom a deceased child 21 years of age or younger at death to ar for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 pereent[72 P.S.§9116(a)(12)]. . The tau rete imposed on the net value of transfers to or for the use of the decedenPS lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116 12)[72 P.S.§9116(a)(1)1. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 perceM[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-7608 EX.�B-98) SCHEDULE E CASH, BANK DEPOSITS, 8� MISC. PERSONAL PROPERTY CdAMONWERLTIIOF PENNSYLVpNIA INHERIT�NLE TAX FETURN FE&OEM�ELEDENT ESTATE OF FILE NUMBER Wheeler Kressler, Dorothy E. 21-13-0405 InUuOe tM pueetle of liligetion entl Ure tlete the procaetla were receivetl Dy tM nlete. All prop�Ry�o1Mly-ownM wtth tlro rlpht M arWVOnhlp�mnt W N�elwstl on�ehatlula F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 7 2012 Personal Income Ta�c Refund(Federel) 72.00 2 Auto Insurance Refund(Erie) 63.00 3 Sovereign Bank-Checking Account No.XXXXXX0034 27.033.05 (See attached sqtement) 4 Sovereign Bank-Money Market Account No.XXXXXX1065 10,956.48 (See attached statement) 5 Chapel Pointe at Carlisle-(Refund for overpayment) 308.21 6 PSERS -(Final payment fram Public School Employees' Retirement Systsm) 265.34 7 Aucfion of Personal Property 7,055.60 8 Sovereign Bank-Account No.XXXXXX3953 7,150.60 (See attached statement) TOTAL(Also enter on Line 5, Recapitulation) 46,906.28 pf more spece is needed,atlditional pages of fhe same svs) Copyright(c)2002 form softv✓are only The Lackner Group, Inc. Fortn PA-1500 Schedule E(Rev.6-98) Rw-0610 EX*(6-98) � SCHEDULE G INTER-VIVOS TRANSFERS 8� MISC. NON-PROBATE PROPERTY CO�.W ON W E�LTlI OF PE WlBriVRN1A INMERRNNCE Ti V I RETURN RESIOEM DECEOEM ESTATE OF FILE NUMBER Wheeler Kressler, Dorothy E. 21-13-0405 This achetlule must be completetl eM filetl'rf Ne enewar to any of questions 1 throuph 4 on Me reverae aitle of tha REV-1500 COVER SHEET is yas. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S NUMBER TMEDATENO�FTR�ANSFRER.SATTACHACOPVOFTTHEDEED�OREREAEESTATE. VALUEOFASSET INTEREST pFA�PPLISC�BLE) TAXABLE VALUE 1 Westem NadonallAmerican Generel Life Insurance 151,057.32 757.057.32 Company-Annuity Contract No.VP228045 (See attached statement) 2 Westem National/American Ganeral Ufe Insurance 121,288.54 121,288.54 Company-Annuity Contract No.W226436 (See attached statement) TOTAL(Also enter on Line 7, Recapitulation) 272,345.86 pf mwe space is neetled,addkional papes of Me aeme siu) Copyright(c)2002 fortn software only The Lackner Group,Inc. Fortn PA-7500 Schedule G(Rev.6-98) REV-1161E%F�7406) SCNEDULE N �oMr��A ADM N 3TRATIVE COS S ESTATE OF FILE NUMBER Wheeler Kressler, Dorothy E. 21-13-0405 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Buse Funeral Home 2,665.54 B. ADMINISTRATIVE COSTS: 1. Personal RepreseMative's Commissions Name of Personal Representative(s) Street Address Ciry State Zio Year(sl Commission oaid z. Anomav�s Pees Griffie&Associates, P.C. 4,000.00 3. Family Exemption: (If decedenPs address is not the same as claimant's,attach eM�lanation) Claimant Street Address Clty SIeIB ZID Relationshio of Claimant to Decedent 4. Probate Fees 503.50 5. AccountanPs Fees 6. Tax Retum Preparer's Fees 7. Other AdministreGve Costs 1,525.60 See continuation schedule(s)attached TOTAL�Also enter on line 8,Recapituladon) 8,694.84 Copyright(c)2009 fortn software only The Ladcner Group, Inc. Fortn PA-7500 Schedule H(Rev. 10-06) �CHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Wheele?r Kressler,Dorothy E. 21-13-0405 iTEM NUMBER DESCRIPTION AM4UN'f Othar Administrative Costs 1 The$enfinel{Advertising} 168.90 2 Sovereign Bank-(Fees for date of death statementf 20.00 3 prrsWwn Bank(Bank fees) 12.50 4 Cumberland Law Journal(AdvbRising} 76.Od 8 AoaountantPees - 250.00 PaymeM af 201�nai Personai lnaame tax ReWm 6 Reserves 1.00OAO ii-B7 1,525,$d i i I'I Copyright(c)2002 fortn soflware only The Lackaer C,roup,Inc. Fortn PA-0S00 Schedule H(Rev.698) Rw.1812 EX.(12-08) � SCFIEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS COMMONN£ALTHOFPENNBYLVRNIA � INIERRRNCE TAX RETURN REBIOENTOECEpEN� ESTATE OF FILE NUMBER Wheeisr Kressler, Dorothy E. 27-13-0405 Raport dNW Irwurtstl bY�a MewNnl qlor b tls�M tlut nmtlmtl u�peld at Me tlab o/tlaHh.IneluAhq unrNmEunW m�yle�l eyp�n�u. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEA7hi 7 Millennium Phcy. Systeme Mechanicst(Medical) g7,y7 2 West Shore EMS-BLS(Medical) 170.63 3 Attomey's Fee/Pre-death esWte planning docs 175.00 4 ReimbursemeM for overpayment(Social Security) 1,018.00 5 Reimbursement for overpayment(Lincoln Financial) 82.23 6 Philhaven(Medical) q3,g� 7 Darryl Guistwite, DO(Medical) 80.00 8 George Branscum,MD(Medical) 10.00 TOTAL(Also enter on Line 70,RecaplWlallon) 7,667.20 Qf more space is neetletl,atlElUOnel peges of the same siu) Copyright(c)2009 fortn software only The Lackner Group, Inc. Fortn PA-1500 Sehedule I(Rev. 12-08) REV4673 EX+�N-08) SCHEDULE J coM��°��'""'" BENEFICIARIES ESTATE OF FILE NUMBER Wheeler Krsssler poroth E. 27-13-0405 RELATIONSHIP TO NUMBER �ME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(Sl RECEIVING PROPERTY (WOros) ($$$) I. TAXABLE DISTRIBUTIONS [include outright spousel distributions,and trensfers under Sec.9118 a 7.2 1 Tena Wheeler Brown Granddaughter 51,000.00 304 Shertnan Avenue Carlisle, PA 77013 2 Emily Cobaugh Great- $500.00 302 Sherman Avenue granddaughter Cadisle, PA 17013 3 Lea Cobaugh Great- SS00.00 c/o Tena Brown granddaughter 304 Shertnan Avenue Carlisle, PA 17013 4 Seth Cobaugh Great-grandson $500.00 c/o Tena Brown 304 Sherman Avenue Carlisle, PA 17013 5 Claire M. Hartinger Great- 5500.00 do Nancy J. Hartinger granddaughter 1553 Bonbar Road York, PA 17403 See continuation schedule attached Continuation 308,890.17 Total 308,890.71 Enter dollar amounts for distributions ahown above on lines 15 throu h 1 B on Rev 1500 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2009 fortn soRware only The Wckner Group, Inc. Fortn PA-1500 Schedule J(Rev. 11-08) SCHEDULE J BENEFICIARIES (Part I,Tszable D�stributioas} ESTATE OF: Dorothy E.Wheeler Kressler 03129/2013 182-22-6718 item Name and Address cf Persan{s} Share af Eatate Amount afi Estate Mumber Receiving Propertq Relatlonship (Wardsj f555) 6 Nancy J. Hartinger Granddaughter 57,000.00 1553 BonbarRoad York,PA 1?403 7 Sarah E.Martinger Great�granddaughtar SS4Q.00 cto Nancy J. Hartinger 1553 Bonbar Road York,PA 77403 8 Howard T.Jeffereon Itl Great�grandabn 5500.00 clo Pamela J.Jefferson 12583 Oakemare Drive PickerEngton,4H 43i47 9 Pamela J..lefferson Grenddaughter 51,OOO.C10 42583 Oakemere Drlve PEckeringtan,OH A3147 10 Cecikia Rike Great•granddaugh�r $500.00 clo Tonya Rike 347 East Ma�n Street Uti�, PA 17543 11 Sophia Rike Grest-granddaugtrter 5500.00 alo Tonya Rike 3M17 East Mafn Street l,.ititz,PA 47543 72 Tanya Wheeler Rike Granddaughter 51,000.00 34�East N'�in Street i.Ititr,PA 17543 13 Jared W.Swick Great-grandson S5dQ.OQ cta Kris�n IC.Swick 302 Tsclrlffely Squsre Road GaiUiersburg,MD 20878 � 1 SCHEDULE J BENEFICIARIES {Part i,Ta�tabie Distributions) ESTATE OF: Dorothy E.Wheeler Kressler 03/29/2013 182-22-6718 Itsm Name and Addr�s of Persan{s} Share af Estate Amaunt of Estate Namber Receiving Proparty Relatianship tWo�$i iSSS) 14 Jordan R.Swick Great�grandson $500.00 cta Kris�n K.Swiok 302 TseMfl9ly Square Road Gaitheraburg, MD 2p878 15 Kris6n K.$wiak CaranBdaugh�r S'�,Od0.00 3p2 Tschiffsly Square Road 13aithersburg,MD 20878 16 Ayana Wheeier Great-granddaughter $500.b0 1832 Williamsburg Rnad Lexingmn,#CY 40504 17 Brett L.Wheeler Grandson y1,000.00 1832 Williamsburg Road I.e�cington,KY 405Q4 16 Brett L.Whaeler II Great�grandson $600.00 cfa$rett L Wheeler 1832 Williamsburg Road LezingWn,KY 40504 �8 David L.Wheeler Grandson S7,M�.00 815 Arbor Roae Avenue MouM Jay, PA 17662 24 Grece C.Wheeler Great-grenddaughiar $506.00 clo Davfd L.YVheeler 615 Arbor Rose Avenue MouM Joy, PA 17652 21 Hannah Wheeler Great•granddaugbter 5500.d0 1 Country Manor Lane New Freedom,PA 17349 I 2 SCHEDULE J BENEFICIARIES {Part I,TaSCable D�#ributians} ESTATf OF: Dorothy E.Wheeler Kressler 03/29@013 182-22-6718 Item Name and Address af Ferson{s} Share of Estate Amo�ert af Estate Number ReceivEng PropeKy Reiationship (INards) tSS3) 22 Julianne R.Wheel�r Great-granddaughter $500.00 c!a Daved t_Wheeier 81b Arbor Rose Avenue MountJoy, PA 17552 23 tsuren 1Nheeler Great-granddaughter $500.OQ 1 Country ManorLane New Freedom, PA 17349 24 Lindsay Wheeler Great-granddaughter y500.bd c/o Todd Wheeler 209 Green Hill Road FiswvilFe,PA 17241 25 Tedd Wheeler Grandaon 51,000.00 1 Courrtry MAnar Larte New Freedam,PA 17347 26 Todd Wheeier Grandson §1,OUQ.OQ 209 Greet�Hili Raad Newvllle,PA 17241 27 Zachary Wheaier Great-gran�ao SSQ0.00 1 Caundy Manor I.ane New Fre�dam, PA 17349 28 I3aneld K,VYheeier Son One-third o#residue of 340 Firsiwatch Drfve estate Moneta,VA 24727 29 Harry L.Wheeisr Son One-third af residue of "729 Hardin� Drive estate EUzabethtown,PA 17022 � SCHEDULE J BENEFICIARIES (Part I,Taxable Distrlbutions) ESTATE OF: Dorothy E.Wheeler Kressler 03129/2013 182-22-6718 Item Name and Address of Person�s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) (SSS) 30 Roger L.Wheeler Son One-third of residue of 3 Jackson Drive e$�� Elizabethtown, PA 17022 4 _ —_ Sovereign Bank ESTATE OF Dorothy E. Wheeler Kressler SOCIAL SECURITY#: 182-22-6718 DATE OF DEATH: March 29, 2013 Account#: 2891100034 Type: Checking Open date: 4/9/2005 In the name of: Dorothy E. Kressler (Roger L. Wheeler, POA) Date of Death Balaace: $27,033.05 Int.(YTD) from 1/1/2013 to 3/19/2013 $0.58 Accrued interest to date of death: $0.09 Otherinfo: POA added 02/27/2013 Account Closed 04/17/2013 - Account#: 2894081065 Type: Money Mazket Open date: 3/18/2011 In the name of: Dorothy E. Kressler (Roger L. Wheeler, POA) Date of Death Balance: $10,958.48 Int.(YT'D) from 1/1/2013 to 3/19/2013 $6.90 Accrued interest to date of death: $1.17 Other Info: POA added 02/27/2013 Account Closed 04/17/2013 Account#: 2895543953 Type: Time Deposit Open date: 9/28/2007 In th.e name of: Dorothy E. Kressler ITF/POD Harry Wheeler Date of Death Balance: $7,150.60 Iu°t:(I"1'D')from 1/1/2013 to 3/29F�033 $U:UO Accrued interest to date of death: $40.78 Other Info: Account Closed OS/07/2013 Page 1 of 1 _ _ �� WESTERN NATIONA� Apri123,2013 BRADLEY GRIFFIE ATTORNEY AT LAW 200 N I3ANOVER ST CARLiSLE PA I 7013 Re: Annuity Cpntract VP228046 Dear Mr. Griffie: The Internal Revenue Service (IRS}requires reparting ofatl death benefits for fec[ernl e�tate-tax purposes. As this contract is an annuity, IRS Form 712 is not applicable and will not be issuad by Western National Life Insurance Company. Listed below is the death benefit information for this contract. T e of Annixi Contract: Flexible Premium Non- ualified Tax Deferred Annui Date of Issue; 48(27l200& Contract Owner's Nazne s : Doroth Kressler-not 'aintl owned Accurnulated Value as of Date of Death on Mareh 29, $ISI,OS7.32 and earnings that aecrued $12,t 27.$9 2d13: Total Death Senefit as of $151,358.24 and there were no withdrawals that exceeded A ril 23 2013 $3444.00 12 months rior to the date of death. Proceads made payable to Harry Wheeler, Roger Wheeler and Donald Wheeler Benef ci ies : Mr. Griffie, we appreciate the opportunity to assist you. Shauld you have any questions, pleasa contact oar Client Caze Center at 1-800-424-4990. I ISincerely, M��}��i�rs�on��'�' Annuity Claims Deparkrnant . ' _� . r�JR"i^�_. + � �� - - . - . .. .i.�. . . .. . . ... . . .._.,� ... .. . .. ��.. . . . .� . .��li:i�. . - . � Rmsrican Generai Cife Insurance Company .. ".. . . . ._....-. - � Annuity Service Center�P.O.Box 871 •.Amariito,TX 79105-0871. , � �� The Western National series of annuities is issued and underwritten in New York by The United States Life Insurance Company in the City af New York and in ai!other states by American General Life insurance Company. �H.WNAG� �� WESTERN NATIC}NAL a�r�1 as,2als BRADLEY GRIFFIE ATTQRIVEY AT LAW 200 N HANpVER ST CARLISLE PA 17013 Re: Annuity Contract W226436 Deaz Mr, Griffie: The InYerna? Revenue Servece{IRS}requires reporting of all deatl:benefits far federal estate tax purposes. As this contract is an annuity, IRS Forrn 712 is not applicable and will not be issixad by Western Nationa! Life Insurance Company, Listed below is the death benefit information for this contract. s� T e of Annui � Contract: Flexible Premium Non- ualified Tax Deferred Annui Date of Issue: 02l07l20Q8 Contract C3wner's Name: Doroth Kressier-not 'ointl owned Accumulated Value as of Date o€Death on March 29. $121,2$&.54 and earnings tfiai accrued $25,151.4Q 2013: Total Death Benefit as of $121,53434 and there were no withdrawals that exceeded � A ril 23 2013 53,040 'or ta the date of death. Proaeeds mada payable to Harry Wheeler, Roger Wheeler and Donald Wheeler Benefrciaries: Mr. Griff"ie, we appreciate the oppartuniry to assisi you. Shauld you have any questians, please contact oL�r Client Caze Center at 1-800-424-4990. Sincerely, �Yll�,� �'t �a,r��n� Mary ri Nickarson An�iuity Claims Department American Geoeral Life Ir�surance Company Annuity Service Center•P.O. Box 871 �Amarillo,TX 79105-0871 The Western National series qf annuities is issued and underwritten in New York by The United States Life Insurance I Company in the Gity of New York and in aIi othsr states by American Generai �i�e Insurance Company. ' IWWNAGI