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Home My WebLink About03-21-14 _ __ _ _ 3 � � ,. -.,��,. .��, ,.�� , �<,�,��.,.,�:��-� . �,��., � , 1505610149 REV-1500 Ex(o2-i1)(�� OFFICIAL USE ONLY PA Department of Revenue °`R"�"�"`�""` Countv Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 13 10 7 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02 07 2013 02 12 1927 DecedenYs Last Name Suffix DecedenYs First Name MI Lyon Ann D (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Lyon Walter A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 213 2❑ 0520 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return O 2. Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate � 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) � 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) Q 9.Litigation Proceeds Received Q 10. Spousal Poverty Credit(Date of Death Q 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT—THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Elyse E • Rogers , Esquire 71� �2� 5807� � � � �2E �OF WILL� E O Q ^7 = c� � v'� �s First Line of Address � � � F"' � O Z Saidis , Sullivan & Rogers � c� q -o `� ° -n -� Second Line of Address � C � 3 g `� . 635 North 12th Street, Suite 400 n► �DATEFI[.Fp v�i o � City or Post Office State ZIP Cr , r Lemoyne PA 17�43 Correspondent°s e-mai�address: erogers@ssr-attorneys.com Under penalties of perjury,I deciare that I have examined this retum,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. SIGN RE OF P RSON RESPONSIBLE FOR FILING RETURN DATE AD s 42 mpus View Salt L City, UT 84 24 SIGNA OF PREP ER O ER THAN REPRESENTATIVE D TE � �9?G ADDRESS 35 North th eet Lemoyne PA 1704 PLEASE USE ORIGINAL FORM ONLY Side 1 � � 1505610149 1505610149 : -� :� �.-�-� , � ,__ �-_ »� .� ,�. � ,> , I 1505610249 J REV-1500 EX(FI) DecedenYs Social Security Number DecedenYs Name: A n n D L y o n RECAPITULATION 1. Real Estate(Schedule A) �• � • �� ............. .. . . . . . ... . . .. ... .. . . . . . . . .. . 2. Stocks and Bonds(Schedule B) 2. � • �� . . . . . . . . ..... . . . . .. .. . . . .. . ........ . 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. � • �� 4. Mort a es and Notes Receivable Schedule D 4. � • �� 9 9 � ) . . . . . . . . . . . ....... . . . . . . . 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) . ..... 5. � • �� 6. Jointly Owned Property(Schedule F) 0 Separate Billing Requested . . . . 6. � • �� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 18 0 ,7 8 7 • 8� (Schedule G) O Separate Billing Requested ... . 7. 8. Total Gross Assets total Lines 1 throu h 7 $. 18 0�7 8� • 8� � 9 ) . . . . . . . . . . . . . . .. . . ... . . . . . . 9. Funeral Ex enses and Administrative Costs Schedule H g. � • �� P � ) ..... . . . . . . ...... 10. Debts of Decedent, Mort a e Liabilities and Liens Schedule I 10. 0 • �� 9 9 ( ) . ... . . . . . . . . . . 11. Total Deductions(total Lines 9 and 10) . . . . . . . . ... . . .. .. .... ......... 11. 0 • 0� 12. Net Value of Estate(Line 8 minus Line 11) . ...... ...... . . . . . . . . . . . . . . . 12. 18 0,7 8 7 • 8� 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . ..... . . . ....... 13. � • 0� 14. Net Value Subject to Tax(Line 12 minus Line 13) . ...... . . . 18�,7 8 7 • 8� . .... . . . . . . . 14. TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 17 2,3 6 5 • 5 7 15. O - 0 0 (a)(1.2)X.0 0 16. Amount of Line 14 taxable 8 ,4 2 2 • 2 3 �6. 3 7 9 • 0� at lineal rate X.0 45 17. Amount of Line 14 taxable at sibling rate X.12 0 - 0 0 ��. 0 - 0 0 18. Amount of Line 14 taxable at collateral rate X.15 � • �� 18. � • �� 19. TAX DUE 19, 379 • �� . . . . . . . . ........ ... ... . . . . .. .......... . ... . ... . .. . . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 � 1505610249 15�5610249 � _ :�= �, , . . ; � �� .��:��,�,�.,.�.�: � �� ::1�� .�; ,�-:�, �_. � : REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 1073 DECEDENT'S NAME Ann D. Lyon STREET ADDRESS 509 Albright Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 379.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 Total Credits(A+g) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the tlifference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 379.00 Make check payable to: REGISTER OF WILLS, AGENT. � „ ,,, ��.� , �� .e. �._,_ . �� ..,.__: , ..��.e � �..__ � �,�: .,� ;:,,... ; _...,.:� �w:,...._.. � ,��.�. . .��..._ ,..u. .. � 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 . . . ... . . .. . . . . . . . . . .... ....... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income ....... ❑ ❑X c. retain a reversionary interest. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . ............. . . . ❑ ❑X d. receive the promise for life of either payments, benefits or care? ......... .. . . . . . . . . . ❑ ❑X 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .. ... . ............ .. . . . . . . .. . . ..... ❑ � 3. 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?...... . . ... .. . ........ . . . . . . . . . . . . � ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ,�.: �,,,�,r. r ., � - � i �, � r - ,�� !r � !«�C�� -� ��Q+. '�`..�.�.':w„rioio, ...�`� -"�,.�,... .. ...��.�.�1�. . .,ii'�, ,o,,,,,,,,, , �� ,„�,�aa.�,...... , ,,.,.. �, ,,, ,,,, �''-.�� ,�,,`, .,,. „ , .. . ,m ,,,. ,,, ,.,./,�„", . 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 after Jan.1,1995,the tau 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 disclosure of assets and filing a tax retum 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 decedenYs 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 decedenYs 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. .,,.. : _ �N , >�-�.- . z� �..�� a �, �: , �� :� �. . : REV-1510 EX+ (OS-09) . pennsylvania SCHEDULE G - OEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Ann D. Lyon 21 13 1073 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBE INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIPTO DECEDENT VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE AND THE DATE OF TRANSFER.ATTACH COPY OF THE DEED FOR REAL ESATE. 1 Fidelity Investments IRA Account 147255882 39,751.60 100 39,751.60 Beneficiary: Decedent's surviving spouse, Walter A. Lyon Per 10/7/13 letter 2 TIAA CREF Annuity Contract K8428134 8,422.23 100 8,422.23 Beneficiaries: DecedenYs grandchildren, Sophia Lyon, Liily Lyon, Brittany Lyon, Jane Lyon, Otto Lyon, Greth Lyon Per 11/26/13 letter 3 TIAA-CREF Annuity Contract Y0762842 1,707.12 100 1,707.12 Beneficiary: DecedenYs surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter 4 TIAA-CREF Annuity Contract Z0762840 810.01 100 810.01 Beneficiary: Decedent's surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter 5 TIAA-CREF Annuity Contract ID027141 4,313.96 100 4,313.96 Beneficiary: Decedent's surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter 6 TIAA-CREF Annuity Contract OU439568 856.92 100 856.92 Beneficiary: Decedent's surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter 7 TIAA-CREF Annuity Contract 6M340664 569.68 100 569.68 Beneficiary: Decedent's surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter Total from continuation Schedule(s) 124,356.28 TOTAL (Also enter on Line 7, Recapitulation) 180,787.80 If more space is needed, use additional sheets of paper of the same size. � . � rx w„ �.�� .�� _ � �. ��.� �_ Page 2 Estate of: Ann D. Lyon 21 13 1073 Schedule G - Inter-Vivos Transfers and Misc. Non-Probate Property Item Date of Death %of Dec's Exclusion Taxable Num Description of Property Value of Asset Interest (if applicable) Value 8 TIAA-CREF Annuity Contract 6M476708 319.48 100 319.48 Beneficiary: Decedent's surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter 9 TIAA-CREF Annuity Contract 6M536873 303.92 100 303.92 TIAA-CREF Annuity Contract 6M536873 Beneficiary: DecedenYs surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter 10 TIAA-CREF Annuity Contract 6M633738 531.52 100 531.52 Beneficiary: Decedent's surviving spouse, Walter Lyon, was second annuitant on this contract Per 1/31/14 letter 11 Fidelity Investments Annuity Contract 27,980.31 100 27,980.31 321516990 Beneficiary: Decedent's surviving spouse, Walter D. Lyon Per 1/24/14 letter 12 TIAA-CREF Annuity Contract 0-826331-1 95,221.05 100 95,221.05 Beneficiary: Decedent's surviving spouse, Walter Lyon Settlement amount: $95,221.05 IVC: $57,022.94 Taxable amount: $38,198.11 Per 6/20/13 letter TOTAL. (Carry forward to main schedule) . . . . . . 124,356.28 ; . , : , r�� .� �..�, f,� ��,� ��.., _ - REV-1513 EX+ (01-10) . pennsylvania S C H E D U L E � OEPARTMENT OF NEVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Ann D. Lyon 21 13 1073 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] See schedule attached ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS 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 SHEEf. If more space is needed, use additional sheets of paper of the same size. _ _ . .� � : ,. ;� � �, . -: � -j.� � �� ,� _ t Page 2 Estate of: Ann D. Lyon 21 13 1073 Schedule J, Part I - Taxable Distributions Amount or Share Num. Name and Address of Person(s)Receivinq Property Relationship to Decedent of Estate 1 Walter A. Lyon Surviving spouse 172,365.57 509 Albright Drive Mechanicsburg, PA 17055 2 Sophia Lyon Granddaughter 1,403.70 307 Maryfield Drive Salt Lake City, UT 84108 3 Lilly Lyon Granddaughter 1,403.70 307 Maryfield Drive Salt Lake City, UT 84108 4 Brittany Lyon Granddaughter 1,403.70 307 Maryfield Drive Salt Lake City, UT 84108 5 Jane Lyon Granddaughter 1,403.71 307 Maryfield Drvie Salt Lake City , UT 84108 6 Otto J. Lyon Grandson 1,403.71 3109 Chadbourne Road Shaker Heights, OH 44120 7 Greth E. Lyon Granddaughter 1,403.71 3109 Chadbourne Road Shaker Heights , OH 44120 �� m� w � , ,.�_ ��.� ��,fide/i�[y October 07,2013 SAIDIS SULLIVAN&ROGERS PC ATTN: CAYLE D SWINDLER 635 N 12TH ST STE 400 LEMOYNE,PA 17043 Dear Cayle D Swindler: As requested,please find the Date of Death Account Valuation for the Estate of Ann Durr Lyon. Estate Valuation Account Number: 147255882 Value Date: 02/07/2013 Share Symbol Security Description Qty Value Price SSGDX BLACKROCK ENERGY& RESOURCES PORT 27.152 $593.82 $21.87 FLATX FIDELITY LATIN AMERICA 87.621 $4,130.45 $47.14 FPURX FIDELITY PURITAN 1357.597 $27,274.12 $20.09 MXF MEXICO FUND INC 243 $7,601.04 $31.28 Total Securities: $39,599.43 Cash/Money Markets: $152.17 $1.00 Total Vatue: $39,751.60 All values included represent the Fair Market Value (FMV) of assets held in the account as of the owner's date of death.The report does not include Limited Parmerships,Options,Precious Metals or Worthless Security positions held in the account as of the date of death nor any accrued dividends not distributed prior to the date of death. Values for any accounts that only hold those asset types are therefore,not included. Fidelity does not warranty the accuracy of this information for any particular purpose nor does Fidelity provide legal or tax advice. Consult with an attorney or tax professional regarding any specific legal or tax situation. FOR TRUST ACCOtJNTS: Please note that if the account on the valuation is a trust registration,then a separate letter of instruction to update cost basis must be submitted. The letter must include the following three items: 1. A statement that the trust qualifies under the IRS regulation to receive a step up 2. The percentage of the trust that should be stepped up 3. The signature of a currently acting trustee The request to update cost basis should be sent directly to: Fidelity Investments ATTN: Cost Basis 100 Crosby Pkwy,Mailzone KC1K-PR Covington,KY 41015 .. ':";Brokerage Services provided by Fidelity Brokerage Services LLC Member NYSE,SIPC Clearing custody and settlement services by National Financial Services LLC Member NYSE,SIPC P.O.Box 770001,Cincinnati,OH 45277-0034 � �.3.:`:�; TIAA : CREF-." FlNANCIAL SERVICES November 26, 2013 PST86352ti8 Estate of Ann Durr Lyon - C/O Saidis, Sullivan, & Rogers 635 N 12th Street Suite 400 Lemoyne PA 17043 Re: Valuarion of Annuity Contract(s)/Certificate(s) at Decedent's Date of Death Dear Saidis, Sullivan, &Rogers, You have requested the value of the annuity contract(s)/certificate(s), held by TIAA-CREF, on the date of death of Ann Durr Lyon. This statement has been prepared for you based on the following information: Name of Decedent: Ann Durr Lyon „ Decedent's Date of Birth: 02/12/1927 Decedent's Date of Death: 02/07/2013 VALUE OF ANNUITY CONTRACT(S)/CERTIFICATE(S) AT DECEDENT'S DATE OF DEATH Contract/Certificate Date of Death Number Value of the Contract/Certificate: K8428134 $8,422.23 J8428136 $0.00 Total Date of Death $g�422.2� `v'alue � Investment in Contract Total Value $0.00 TIAA-CREF Individual&I�istitutional Services,LLC Member FINRA, SIPC. BENEBiJND-VD Headquarters: 730 Third Avenue,New York 10017-3206 Tel: 212-490-9000 .. .: p�� „�.� �_ � ,��,ti.� ,.�.., , .� .� �. , . --.- - -� - cu iw-uC-'1'1 '16:52:2'1 (GMT) LYON OESIGN From: Lyon �eslpn Leigh AIli1 BaiZe TlAA Senior Custnmer Resolution Manager GREF Cu,tomer Care Team T 303 626 44�4 Fioianciai Services F 800 9�4 8922 Ibaize@tiaa=cref.org AR Insurance License#27z23o CA Insurance Iacense�oE65598 January gi,2oiq Clifford Lyon 5og Albri�ght Drive Mechaniesburg,PA i�o55 RE:TIA4AnnuiiyNo.:Y9o9s8o3, Yo796808,Yo�g684o, Yo�628q2,oU¢ggb68, IDo2�,� CREFAnrcuify No.:Z9o928oi,Zo7g68o6,Zo796848,Zo76a84o,6M,34a664, 6M4767oB,6M5S687g, 6M633735 Ann D.Lyon&Walter A.Lyon.,deceasett Dear Mr.Lyon: Thank you for your recent inquiry regarding the above indicated annuities. At the time of your mothe�'s passing,there were multiple statuses for the above annuities;I hope the information in this letter provides elarity. Accounts originaIly owned by Walter Lyon: Y9o92803-Issued May z,2004,guarantee period through Apri12oi4 Z9og82oi-Issued May i,aoo4,guarantee period through Apri12oi4 Yo796808-Issued Apn1 i,2004,guarantee period through March 2oi4 Zo796806—Issue.d May i,200.},guaranteed though April2oa.4 Yo7968qo -Issued April i, 2004,guarantee period through Mazch 2oi4 Zo796848-Issued Apr�1 i, 2oo4,guarantee period thTOUgh March 2oi4(terminated- deIete) Accounts originally owned by Ann D.Lyon Yo�b28�2-Issued January i,2004,guarantee period through I�ecember�c��3 Zo�62840-Issued January i,zoo4,guarantee period through Decemher 2rn 3 IDo2�z4i-Issued June i,i994��larantee period t�rough May 2oi4 Accounts with no further payment due(guarantee period expired prior to the passing of both annuitants) oU439568 -Issued March i, i997,guarantee period through FeTiruary 2oi2 6M34o664-Issued March i, i997,guarantee period through February 2oi2 TIAA-CREF individual 8�Institutional Services,LLC,distributes securities,Member FINRA and SIPC. � tiaa-cref.org 1670 Broadway,Suite 200,Denver,CO 60202 .. ..�� w �>�- If you have any questions or need additional infarmation, please call us at 888 380-6428, Monday to Friday from 8 a.m. to 7 p.m., (ET). One of our consultants will be happy to help you. If you're hearing impaired and are a TTY phone user,please call us at 800 842-2755. Sincerely, �e�e��e'�ciaruy .�exaiceQ �ea�i Beneficiary Services Team (TIAA-CREF reserves tbe right to correct any clerical ei7•or in correspondence.) Annuity contracts and certificates are issued by Teachers Insurance and Annuity Association (TIAA) and College Retirement Equities Fund(CREF),New York,NY. Securities products are distributed by TIAA-CREF Individual&Institutional Services,LLC and Teachers Personal lnvestors Services, Inc.,inembers FINRA. �2010 Teachers Insurance and Annuity Association-College Retirement Equities Fund (TIAA-CREF), 730 Third Avenue,New York,NY 10017 � . �v �. � �,t:�,� _ �„�.,��,��.��.� a� ��-� � ,_ ... _ � -a- - -. - cu�w-uL-'1'1 '16:52:2'I (GMT) LYON �ESIGN F�om: Lyon �psign 6M�}�6�08 -Issued March i, i997,guarantee period through Fcbruary 2oi2 6M536873-Issued March i,i997��arantee period through February 2oi2 6M633738 -Issued March i,i997,guarantee period through February 2oi2 Walter Lyon was the second annuitant on all contracts owned by Ann.D.Lyon. His estate is the beneficiary of any payments due on those annuities from March 2oi3 through June 2oi3. Mr.Lyon never claimed benefit on these accounts,and they are eurren$y held by TIAA-CREF pending claim from Mr.Lyon's estate. The below list shows the contracts in this category, and outstanding benefit due the estate(additional interest may have accrued),: Yo�628qz—$i,�o�.i2 Zo�6284�-$8io.ai IDo2�i4i- �4,313•96 oU439568-$856.92 6M34o664-$569.68 6M476�o8-$gi9.48 6M536873-$30&92 6M633738- $53i�52 The estimated benefit to the Estate of Vdalter Lyon is$9,4i2.6i For all annuity contracts with a guarantee period remaining at the time of Mr.Lyon's death, the beneficiaries of record are: 25%-Nancy Lyon 25%-Clifford D.Lyon 25%-Paul D.Lyon 25%-James D.Lyon Beneficiaries on contracts with remaining guarantee periods have the option of claiming the commuted value of the remaining payments,or continuing the benefit payments through the end of the guarantee period. If you have any additional questions,do not hesitate to contact me at$00-842-z638, extension 24-4414 Sincerely, , Leigh Ann Baize Senior Customer Resolu�ion Manager .. . . ,; � �� . � .� . �.,� _ .: � �� ,�� , ., __ _— . . ...�.�.,.,. � .,,,,� LYVN uCSiGN From: Lyon �asipn � ��F/ e// � !A/VE TMENT� January 24, 2�14 ,� �� iJ�' � a�-• . Clifford Lyon �� 509 Albright Dr Mechanicsburg, PA 17055-4302 Dear Mr. �yon: We are writing i� response to your request for written confirmation of the v lue of annuity contract 321516990 helc�by Ann and Walter Lyon, at date of death. , ; — �._ _.�- .�...� . ._ I _.�.__. _ -----_ Contract Numt�er C�ntract Issue Date Dafe of Death OD Value Amount � 32151699� 02/28/1994 �2107/2013 $ 7,980.31 - -- _ _ 321516990 02/28/1994 06/27/2013 $ 9,468.42 -- ..�.�.. . —. — — I Total Cost Basis� amount= $15,104.60 -�' If you have que tions, please call us at 800-544-4374 ext 8028. We are h re to help you Monday through Friday f�om 8 a.m.to 8 p.m. E7. Sincerely, Jennifer Crowe Inheritor Servic s Associate File number. W 00953-12JUN13 � � issned-by-Fidetity-trtdes�ments-L' (FILI), 100 Sale�n Street, Smithfield, RI�2917,and in New York, by Em ire Fidelity lnvestments Li e Insurance Company(EFILI)�, New York, N.Y. FILI is licensed in all states except New Yo k.A contract's financial guarantees are subject to the laims-paying ability of the issuing i surance company. _ Fidelity Broker ge Services LLC ; � 412544.5 � � :.�. .�� . � ��.� . -. Insurance and Adrzsory Products TIAA��a. 1-800-223-1200 ,i�},"C'I�•.' '- � t�c,.�'� CREF� FlNJINCIAI SERVICES FOR THE GREA'fER GOOD' June 20, 2013 MR WALTER A LYON 509 ALBRIGHT DR MECHt1NICSBURG,PA 17055-4302 .. .. Re:TEACHERS PERSONAL ANNUITY Contract#0-826331-1 � Teachers insurance and Annuity Association Owner/Annuitant: MS ANN D LYON Deceased. Dear MR LYON: � Below are the details of the death benefit proceeds payabie to you under the above contract. Your check will be � mailed under separate cover. — �� .� Settlement Amount: $95,221.05 � Net check: $95,221.05 -- IVC: $57,022.94 � Tauable Amount: $38,198.11 = � Federai Withholdings: $0.00 = State Withholdings: $0.00 � _ _ _ ___ _ Your 2013 tax statements 1099-R will be generated in January of 2014. If you have any questions, please feel free to contact our Planning and Service Center at telephone number 1-800-223-1200. - Generated Date:June 21,2013 ` /� -l f' --bi� Z � ��i,�� L►�� 1,�'1LCC�1 �C��1,��I]1� OF gI�TN D. L�'ON I, _�NI�T D. L�'OI�T, of Lowei� !-�llen Township, Cuinberland County, Pennsylvania, do make, publish and declare this to be m`= Last��?ill and Testament, herebj- revoking all�fiills and Codicils by �e heretofore inade. ITEIl2 I: Familv Information. I am married to V1�ALTER g. L�TOIlT, az�d all lefeiences to my husband in this ��iTill are to him. I l�ave foui childien_ CLIFFORD D. L�'ON; P4UL D. LYOI�T, J.41\2ES D. L�0?�? ai�d NANC�' F. LYON. These are desciibe� in this ��?ill as "my cliildren," or as "a child of mine." �Zy ��erson boin to oi adopted by issue of �ine is to be included as issue of min�. Piovided, however, no adopted �erson shall benefit undei this ��'ill unless the ordei or deciee of ado�tion is entered befoie the ado�ted peison attains the age of twent5--one (21) �=eais. ITEM II: Instruction in the Event of Death. I diiect that I shall be cren�ated. It is my desue that mv familST scatter my ashes. I would, ho��ever, like to have a maiker e�°ected at the Duir-Fostei lc�t in the Ivy Hill Cemetei5-, 2823 �iing Street, 41e�andria, �%iiginia. ITEM III: Death Taxes. I diuect that all inheritance and estate ta�es becoming clue by reason of nsy death, �Thether payable b�- my estate oi by any recipient of any propert�T, shall be paid b5� the Law Offices of Sa.idis E�ecutoi out of the residue of i�y estate, as an expense and cost of Sullivan administration of my estate, e�cept that �ZO ta�es sliall be charged against an�� & Roger5 gift c�ualifSTing for the marital or chaiitable deduction in niy estate. The 635 North l2chStreec Executoi shall haz�e zzo dut�� oi obligation ta obtain ieimbuisement for anv Suite 400 Lemoyne,PA 17043 such tax so ��aid, even though on pioceeds of insuiance oi other prol�eity not. passing undei ihis ��''ill. G��'Z, Page 1 ,._, . ., , �„� ,� ~` ;�,�� .�.,;��_.� " -, I ITEM I�%: Debts and Final E��enses. I direct the E�ecutol �o pa5� tlie expenses of n�� last. illness; m�� legall�- enforceable debts, and my fuileral e�penses fiom the residue oi�ny estate aG an expense and cost oi administration of my estate. ITEl�2 �j: Instructions Re�arding Elmore Countv. 4labama Real Estaie. If I survive m5- husband, ��T4LTER A. LYO?�T; I heieby state that it is my u�ish, should I die ��ithin ten (10) ,years after the e�ecution of this V�'ill, Lhat my share of ieal estate in Elmore Countz-, A]abama, be contributed to an effoit, if there is one, to ma�:e the Pea Level on m�- paients' foz•n�ei propeity into a histoiic site. As my childien a�d man�T others knouT, when m5� parents owned iheir hoine in Elrmore County, Alabama, �he Pea Level site was a key meeting site in tlie ci��il rights mo��eznent. ITEM �%I: Tan¢ible Personal Propertv. (a) �'ritten List. I ma,y leaz�e a wiitten list in my safe deposit bo� or else«�heie disposing of ceitain itenis of my tangible personal piopeity. The Executoi shall dispose of items of my� personal property as specified in the wiitten list. If no vvritten list is found in my safe deposit box or elsewhere and pioperly identified by the Executoi v��ithin thirty (30) days a�er tlie ��lobate of my ��ill; it shall be piesumed that theie is no other statement oi list. Anjj subsequeiltly disc�veied list shall be ignored. (b) If Husl�and Suivives. If I do not survive m�� Law Offices of husband, I give to him all my tangible peisonal �roperty not set Sa.idis fa�°th in the wiitt.ei7 list ieferenced ii1 paragiaph (a); including Su�livan but not limited to, all of iu�� household furniture and fuinishings, & Rogers books; pictures; jewelrt�, silveiv��are, automobiles; «Tearing 635Northl2thStreet appaiel and all othei aiticles of liousehold or personal use or Suite 400 Lemoyne,PA17043 adoinr�ent and all policies of insurance theieon. ��Z Page 2 � � . : ._ , �: TT- _ � , �r, ,��.�� - �_� ,� . �. _ � �i - - (c) If Husband Predeceases. If I Gurvive m�� husband, I give any property of the tS�e described in paragra�h (bj and i�ot set forth in a ��iitten list. to m5� childien, io be divided a�nong thein as the�� shall agree. Should there be no agreement, thic propeity snall be divided among m�- crsldren by the E�ecut�r in as nearl�� equal poitions as is deemed practical in the discietion of the E�ecutor, haz�ing due regaid to the �ersonal prefeiences �i the beneficiaries. ITEM ��II: P�esidue. I give the iesidue of my estate, not disposed of in the pieceding portions of this ��Till; t� my husband; ��TALTER g. LYOI�T, u he sur�=i�7es me. If he does not survive rne; I give the residue as follows: (a) Gift. to Children. I give SI�TY (60%) PERCENT of the residue my estate to m5� children, in equal shares. If azzST of my children do not stiuvive ine, the share of my deceased child shall be paid to his or her then living issue, per stiipes. �`b) Gift to Grandchildien. I give FORTi' (40%) PERCEI�TT of the iesidue of my estate in equal shares to nzy giandchildren. M5� E�ecutoi shall establish sepaiate Section 529 Plans (under Sectioi7 529 of the Inteinal P�evenue Code) foi each grandchild �Tho is undEr the age of twent.5�-five (25) yeais at the time of my death. ITEI��I VIII: Administiative Powers. In addition to Law Offices of the powe2s granted at law, the Executai shall possess the following po��ers, Sa.idis each of«�hich shall be construed bioadly and may be e�ercised without couit Sullivan appio��al, but in a fiduciary c�pacity or_liT: & Rogers 635 North 12ch Screet �a� Retain Investinents. To retain an�� investinents I Suite 400 Lemovne,PA17043 have at. my death, including specifically those consisting of stock of anv bank evei� if I haz�e named that bank as ihe E�.ecutol°. Page 3 `�1��. w. , n- ; t �.�:��_,�� r,.� �� - . � . _ (b) �'aiv Investments. To var�� investments and to invest in bonds, stocks, notes, ieal estate morigages o�° other securities oi in othei piopert��, real ol peisonal, without beuig restricted to so-called "legal iiivestments", ai7d without being limited by an�� statute or rule of law regaiding investments bS- fiduciaries. (c) Dit�ision of Assets. In oidei to divide the piincipal of mS= estate o?° make distributions; the Executor is authorized to disiiibute pe�°sonal pioperty and ieal�ropeit5- paitly oi wholl57 in kind, and to allocate specific assets among beneficiaiies so long as the total s�arket value of each shaie is not affected bj� the division, distribution oi allocation in k�id. The E�ecutoi is authoiized to make, join in and consummate partitioizs of lanc?s, voluntaiily oi involuntaiily, including givir_g of mutual deeds, or othei obligations, �Titri as «Tide poweis as an indisTidual owner in fee simple. (dj Sell Assets. To sell either at public or private sale an3� or all real or peisonal propert3= severall5� oi in conjunction v�rith other peisons, and to consummate sale(s) by deed(s) or other instiument(s) to the puichasei(s), conveying a fee simple title. No purchaser shall be obligated to see to the application of the �urchase money oi to make inquiry into the validity of any sale. The E�ecutoi is authoiized to r�ake, e�ecute; ackizowledge and deliver deeds, assignments, options or othei vviitings as necessary or convenient to calry out the pov�leis confeiied upon Law Offices of the E�ecutor. S 1,iC�S Sullivan (e) Encumber Real Estate. To moitgage ieal estate, & Rogers and to make leases of ieal estate. 635 North 12th Street Sui�e 400 Lemovne,PAll043 �� Borrow Mo17ev. To boiiow mone5� fiom any peison, including the Executor, to pay iizdebtedness of inine or of mS� ��., Page 4 _ _ _ _ � ��. ��.�� :� x,��,,..,,.�r , _ estate, e�penses of'administiation or inlieritance, legacy: estate and o�hei ta�es, and to assigi� and pledge assets oi my esta-te. (g) Pav Costs. To pa�� all cost�, ta�es, expenses and charges in connectio�i with the ddministration of m�T estate. (h) Distributions �Tithout Court Order. To make distributions of incomp and of principal to the pioper beneficiaiies, duiing the administration of mST estate, with or without court o�de�°, in sucn manner and in s�ich amounts as m5� Executoi deems prudent and appio�riate. (i) Ri�hts as Stockholdei. To exercise voting rights u-ith respect -to secuiities which foim a pait of my estate, and to exercise all the powers incident to the ownership of secuiities. U) Reorganize. To unite with other owners of property similar to propeity in my estate to caiiST out any plans ioi the reorganization of any companq whose secuiities foim a pait of m5- estate. (k) Disclaim. To disclaim any inteie.st in pioperty «�rich would de��olve to me o�° my estate by vvhatever means, including but not limited to the follo��ing means: as beneficiaiy undei a will, as an appointee undei the exercise of a powei of appointment, as a peison entitled to take by intestac�=, as a donee of an iiltei �=ivos transfei, and as a donee under a thiid-part�� Lav��Offices of beneficiar3- coilti act. S aidis Sullivan (1) Ta� Retuins. To plepare, e},ecute and file tax & Rogers returns of aiiy t��pe required b3� al�plicable lavv; and to make all 635 Norch 12ch Screec ta� electioils authorized b,y law. Suire 400 Lemoyne,PA 77043 (m) Allocate E�penses. To allocate administiati��e e�pensPs to income oi to principal; as the Executoi deems �, Page 5 _. _ _ _ � appropriate. Howe��ei, no allocation to income shall be made if the effect of the allocation is ta cause a reduction in ihe amount. of any estate ta� marital deduction or estate ta� charitable de duction. (r_) Em�lo�T gdvisors. To employ custadians of propeiiy, int�estment or busiiless advisors, accountants and attoineys as the E�ecutoi deems appropiiate, and to compensate these peisons irom assets of m�� estate; v��ithout afiecting the compensation to v,Thich trie E�ecutor is entitled. (o) Basis Adiustm.ert. To make any adjustment to basis authorized bS� law, including, but not limited to increasing the basis of an�= propert�� included in my estate, whe�hei or not passing under this Will; b�� allocatilzg any ainount by v,=hich the bases oi assets ma5� be incieased. Th� E�ecutor shall be undei no duty and shall not be �equiied to allocate basis increase e�;clusively, primarily, or at all to assets which pass as pait of m�T probate estate as opposed to other pioperty ior which a basis adjustment is all�wable. Tne Executor shall allocate basis increase equitably among those beneficiaiies leceitTing propeity as a iesult of my death; l�ut sliall zlot be liable to any peison, noi subject to iemoval oi su�°cha?°ge; fo�° ar_y ieasoilable all�cat.ioiz of basis inciease. (p) Comi��°omise Claims. To conzpromise claiins. Law Offices of (q) Other Acts. To do all other acts in the E�ecutor's Saidis judgmez�t deemed necessar�� oi desiiable for the proper and Sullivan advantageous �nanageinent, invest.ment and distribution of the & Rogers estate. 635 Norch 12th Screec Suite 400 Lemoyne,PA]7043 ITEM I�: Beneficiaiies Under A�e 25. If a beneficialy undei the age of tvaent5=-five (25) yeais is entitled to receive asset�. under this ��Till; the peison -��=ho served as E�ecutor of my estate shall retain Page 6 `�`'��' A , . .r. . _ � : r.. _ �_ ,� � � � u_ ' !i __ � those assets as Custodian f'oi the beneficiaz�� undei the Pennsylvania Uniform Tiansfezs to I�Zinois Act. The Custodian ma�- ieceive ai�d administer all assets authorized b3- la��, and shall 'nave full authoiity as provided in the Pennsvlvania Uniform Ti ansfers to Minors Act to use assets in the mauner the Custodian deems advisable for the best interests of t}.ie beneficiarS�. I also designate the person �Tho served as E�ecutor of n1y estate as successor Custodian of an�� zopert5- for which I am custodian under an5� Unifoim Gifcs to Minors Act or Uniiorm Ti ansfers to 1�Zino1 s Act. ITEM �: Suivival. An�� person who has died �=ithin thiuty (30j days of my death, oi undei such circumstances that the ordei of our deaths caiinot be established by pioof, shall be deemed to have predeceased me. ITElt2 �I: Executoi s. I make the following piovisions Rrith iespect to E�ecutors: (a) Primaiv E�ecutor. I appoint my son, JA112ES D. LYON, to serve as Executor. (b) Contin�ent E�ecutoi. In the event that my son, JA112ES D. LYON, is unable or refuses to serve as Executoi, I appoint my son; �LIFFORD D. LYON, to seive as Executoi. In that evei7t ihat my son, CLIFFORD D. LYOI�T, is unable oi refuses to serve as Executor, I appoint m�T daughter, NANCY F. LYOI�T, to seive as E�;�cutoi. In the event iha�; iny daughter, �TAI�?CY F. LYOI�T, is unable or refuses to serve as Executor, I Law Officesof appoint my son, PAUL D. LZ'OIrT; to seive as E�ecutor. S aidis Sulliva.n (c) Com�ensation. The Executoi shall ha��e tlie right & Rogers to ieceive reasonable com�ensation for services rendez°ed and 635 North 12ch Street reimburse��ent foi reasonable expcnses. Suite 400 Lemoyne,PA 17043 �- �� Page 7 _.. .._ . , � ��>�., , (d) Standar� of Care. No E�ecutor shall be liable or accountable iar an�- loss that may result. from the good faith e�ercise oI the authorit�� granted iiz this ��i�ill. (e) Securitv. The Eaecutoi is specificall�T relieved fionl the dui5� of filing bona or entering secuiit�T. I?�T «TITI�TESS «%HEREOF, I have set my hand and seal to this; m�� Last ��i'ill and Testament, consisting of this and the pieceding seven (7) pages, at the end of each page of which I haiTe also set my initials for gieater securit3T and bettei identification this l� da5- of �v�n�,�,..12�, , 20 ��-. !�""� ��-�- �-�.�J (SEA.L) AI�TN D. LYON We, the undeisigned, heieby certify that the foregoing ��Till was signed, sealed, ptiblished and declared by the above-named Testatr� as and foi her Last ��iTill and Testament, in the presence of us, who, at her request and ii1 her piesence and in the presence of each other, have heieunto set oui hands and seals the day and yeai fu st above written, and we certif�� that at the time of the eaecutian theieof, the said Testatii� «Tas of sound and disposing mind and memoi5=. Law Offices of Saidis , ,Q� .t� � �{�- (SEAL) Residing at Sullivan & Rogers 635 Norch 12th Street Suice 400 �- i� Lemo�me,PA 77043 � �� ; j� �' � ��.AL) Residii�g at � . �� : ,.. .� :-, �� , � ,... �,;� ,��.;� , . r_ _ AChNO��TLEI7GMEI�TT COM1�2G1�T��'EALTH OF PEI�TNS�.'L�%Al�TIA ) ) SS: COUI�TTY OF �,,�� ) ) I, ANI� D. LZ ON, Testatri�, «�liose name is sibned to the aitached oi foreboing instiument, having been dul�= qualified according to law, do hereby acknov�Jledge that I signed and executed the instiument as my Last «%ill and Testarnent; that I signed it willingl��; and that I signed it as m5� free aizd voluntary act foi tlie puiposes theiein e�piessed. �-,% ��..L.`� �r � (SEAL) ANN D. L4'OI�T Swoin to a�d subsciibea before me this f day of � 1�,�,,� , ��r 2, /rJ � � I�TOtary P lic . My Commissioi7 E�pires: (SEAL) COhq��IG{�WE�a�TH OF PEiVhlSYLVA�afH Notaris!Seal Eiyse E.Rogers,Motary Public Law Offices of � Lemoyne Soro,Cumberland County tdfy Commission Expires April 5,2U13 Saidis Member.?ennsylva�i2 P.:>scv^.ia!ion of tJotaries Sullivan & Rogers 635 Norch 12th Streec Suite 400 Lemo}'ne,PA 17043 AFFID!��IT COI�2MOI�?�%E_gLTH OF PEl�T1�S�TL�T�4?�TLg � � ) SS: COUNT� OF C��^��'�� ) � � / V4%e, ��"i c,n �. l.�('vn a��S`C � and #�t-r,_c� �C._ �- ��Z��'r�t,� -� J the ViTitnesses whose names are signed to th attached or foiegoing instiument, being dul3� qualified accordirg to law, do depose and say that we weie preseilt and saw Testatri�; �NI�T D. LYOI��, sign and e�ecute the Lnstrument as her Last ��t'ill and Testament; that Testa�ri� signed «�illingl�= and that she executed said Vi'ill as hei fiee and volui7taiy act foi the puiposes therein e�pressed; that each of us in the hearing and sight of the Testatiix signed the V�%ill as ��Titnesses; and that to the best of our knowledge the Testatrix ��as at that time eighteen (18) oi moie years of age, of sound mind and under no constraint or undue influence. � ;%� ��'�: �� : `. , , ,�, . �.�� '� ; ��i es ��i�itness Swoir to a� subscribed befoie me this 1 day of �,�'�"� ' `��L' , Law Offices of � SaidiS � Sullivan 'otaiy Pub��c & Rogers My Commission E�:pues: 635 North 12th Streec / 7 Suite 400 10EA1-'� Lemo�me,PA 17043 4C)Rr1Ni0l�Vt�ERLTti UF PEh?(VSYLVAfJIA � � iVotarial Seal E�Y��.Rogers,Idotary Public =emoyne Boro,Cumberland County i fi�y Commission Ex,�ires April 5,20�3 PJlembar.?e�s;st!ti�ar�ia Asscu:iation of�I ntarie�