HomeMy WebLinkAbout04-23-14 J 1505610105
REV-1500 a(02.1f)(FI)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes County Code Year File Number
PO BOX28o6o1 INHERITANCE TAX RETURN I ^ 13 8$ I
Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT (J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07/25/2013 09/16/1927 71
Decedent's Last Name Suffix —, Decedent's First Name MI
WYNN GERALD
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
NIA —1 11 Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
m 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
- CID 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 TO:
Name - Daytime Telephone Number C= :0
JAMES D. CAMERON, ESQ. 717-236-3755° o r cm-2
REGISTER OFW hM O! POP'
:oDr- (V Mm
Z m GJ O
First Line of Address O
1325 NORTH FRONT STREET ° o o -a T*1
o ° -n 3 o
Second Line of Address N r m
9 � frAO
m
City or Post Office State ZIP Code DATE FILED
HARRISBURG I PA 17102
Correspondent's e-mail address:jdcesgQlocalnet.COf11
Under penalties of perjury,I declare 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.
N URE F PER 0 RWONSIBLLE FOR F NG U�N� , y-a E 4
ADDRESSv�49 ,1
1451 Pheasant Hill Road, Dauphin, PA 17018
SIGNATUpE O E ER OT ER THAN REPRESENTATIVE DATE
s/��4' !/k
ADOR S
1 Orth Front Street, Harrisburg, PA 17102
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
1 1505610205
-! REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name: GERALD F. VVYNN
RECAPITULATION _
1. Real Estate(Schedule A). ..... .. ..................................... 1. 163,930.00
2. Stocks and Bonds(Schedule B) ...... ......................... ........ 2. 71,667.48
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0
4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 85,194.60
6. Jointly Owned Property(Schedule F) C=:) Separate Billing Requested ....... 6. 0
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 0
(Schedule G) O Separate Billing Requested..... ... 7.
8. Total Gross Assets(total Lines 1 through 7).............. ............... 8. 320,792.08
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 33,033.06
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 2,920.25
11. Total Deductions(total Lines 9 and 10)................................. 11. 35,953.31
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 284,838.77
13. Charitable and Governmental Bequests/See 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) ............ ............ 14. 284,838.77
TAX CALCULATION-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.0- 15. 0
16. Amount of Line 14 taxable
at lineal rate X.045 284,838.77 16, 12,817.74
17. Amount of Line 14 taxable 0
at sibling rate X.12 17.
18. Amount of Line 14 taxable 0
at Collateral rate X.15 18.
19. TAX DUE ......................................................... 19. 12,817.74
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205
REV-1500 EX(FI) Page 3 + File Number -
Decedent's Complete Address:
DECEDENT'S NAME
GERALD F.WYNN
STREETAODRESS
31 LEE ANN COURT
' CITY STATE I ZIP
ENOLA PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) 0) 12,817.74
2. Credits/Payments
A.Prior Payments 8,000.00
B.Discount 421.04
Total Credits(A+B) (2) 8,421.04
3. Interest
(3) 0
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. a (5) 4,396.70
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.......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ N
c. retain a reversionary interest .....................................................................................................................I........ ❑ N
d. receive the promise for life of either payments,benefits or care?.......................:.............................................. ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ E
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which'
containsa beneficiary designation? ........................................................................................................................ ❑ N
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 dales 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 dales of death on or after Jan. 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 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 death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(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.
4
REV-1502 EX+(12-12)
i pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Gerald F.Wynn, deceased 21-13-0881
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet If the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant In common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 Real estate situate at 31 Lee Ann Court,East Pennsboro Township,Cumberland County,
Pennsylvania,more particularly described in Cumberland County Record Book 266,Page 2531 163,930.00
(assessed value,$169,000,multiplied by common level ratio,.97)
II
TOTAL Also enter on Line 1, Recapitulation.);k 163,930.00
If more space Is needed,use additional sheets of.paper of the same size.
REVy5a3 EX.(8.22)
pennNTOFRE E SCHEDULE B
OERARMENr OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gerald F.Wynn, deceased 21-13-0881
All property Jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I' PNC Investments account number 039419454 lease see attached)) 71,667.48
I
TOTAL(Also enter on Line 2, Recapitulation) $ 71,667.48
If more space Is needed,Insert additional sheets of the same size
REV-15o8 EX+(o8-u) '
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
W CASH, BANK DEPOSITS & MISC.
r INHERTTANCE TAX RETURN PERSONAL PROPERTY 1 ,
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Gerald F.Wynn, deceased 21-13-0881
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F. r
ITEM • - VALUE AT DATE
�. NUMBER DESCRIPTION OF DEATH
1. County of Cumberland(veterans'burial benefit) 100.00
2. Lemoyne Coin and Collectibles(proceeds of sale of coin collection) 1,245.00
3. Miscellaneous tangible personal property(appraised value—please see attached) 1,815.00
4. Miscellaneous tangible personal property(net proceeds of sale) 1,917.05
" I
5• Members 1st Federal Credit Union account number 338397-00 j 5.00
6• PNC Bank checking account number 5003667911 (please see attached) 3,315.69
7. Accrued interest,PNC Bank checking account number 5003667911 01
6• PNC Bank savings account number 5112688893(please see attached—accrued interest not received) 20,035.00
9. Time(refund on subscription) 24.07
10• United Healthcare(refund of overpayment—healthcare premium) 200.00
11. Verizon(refund on account(717)737.7812) 1.28
12, Great West Life&Annuity Insurance Company(refund of premium) 50,000.00
I
13. 2006 Buick Lucerne,VIN 1G4HD572860240017(net proceeds of sale) 5,925.00
14, Erie Insurance(refund of unearned premium—homeowners policy) 80.00
15. Commonwealth of Pennsylvania Bureau of Unclaimed Property 29.00
16. Country Meadows Associates(refund on account) 502.50
I
, T '
i •
TOTAL (Also enter on Une 5, Recapitulation) $ 85,194.60
If more space Is needed,use additional sheets of paper of the same size. '
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gerald F. Wynn, deceased 21-13-0881
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: _
1' Musselman Funeral Home and Cremation Services 10,389;00
Camp Hill Presbyterian Church(funeral luncheon) 266.28
❑ - -
- '
- --
❑ I
EZ
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: L
Name(s)of Personal Representative(s)
Street Address -
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 16,039
3. Family Exemption: (If decedent's address Is not the same as daimant's,attach explanation.) _
Claimant
Street Address
City state_ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 398.50
S. Accountant Fees:
6. Tax Return Preparer Fees: -
7. Cumbedand Law Journal(legal advertising)
❑s The Paxton Herald(legal advertising) __48.00
❑s Sherwood Court Homeowner s Association(homeowners fees--August and September,2013) �.. 100 00
to. Pennsylvania American Water(water service-Lee Ann Court)
❑] (please see attached continuation sheet)
❑ -
,----3 -
TOTAL(Also enter on Line 9, Recapitulation) $r• 33,0-33.0- .6_
If more space Is needed,use additional sheets of paper of.the same size.
Estate of Gerald F.Wynn
No. 21-13-0881
SCHEDULE H (continued)
11. PPL Electric Utilities 49.17
(electric service—Lee Ann Court)
12. UGI 35.55
(gas service—Lee Ann Court)
13. Sherwood Court Homeowner's Association 50.00
(homeowner's association fee—October, 2013)
14. Pennsylvania American Water 19.04
(water service-Lee Ann Court)
15. PPL Electric Utilities 23.80
(electric service—Lee Ann Court)
16. East Pennsboro Township 138.00
(sewer/sanitation—Lee Ann Court)
17. UGI 20.63
(gas service—Lee Ann Court)
18. Pennsylvania American Water 14.56
(water service—Lee Ann Court)
19. Erie Insurance Group 134.75
(homeowners insurance premium—Lee Ann Court)
20. Sherwood Court Homeowner's Association 50.00
(HOA fee—November, 2013)
21. James D. Cameron, Esq. 10.00
(reimbursement for purchase of two additional short certificates)
22. PPL Electric Utilities 23.88
(electric service—Lee Ann Court)
23. Erica S. Taylor 150.00
(appraisal fee—tangible personal property)
24. UGI 19.97
(gas service—Lee Ann Court)
25. Pennsylvania American Water 14.56
(water service—Lee Ann Court)
Estate of Gerald F. Wynn
No. 21-13-0881
SCHEDULE H (continued)
26. PPL Electric Utilities 22.06
(electric service—Lee Ann Court)
27. Sherwood Court Homeowner's Association 50.00
(HOA fee—December, 2013)
28. UGI 23.80
(gas service—Lee Ann Court)
29. Debbie Lupold, Treasurer 1,876.04
(2013 school real estate tax—Lee Ann Court)
30. Robert W. Derfler 450.00
(trash removal and disposal—Lee Ann Court)
31. Azizkhan Internal Medicine Associates 55.70
(fee for medical records required for life insurance claim)
32. Sherwood Court Homeowner's Association 50.00
(HOA fee—January, 2014)
33. Pennsylvania American Water 15.52
(water service—Lee Ann Court)
34. PPL Electric Utilities 24.12
(electric service—Lee Ann Court)
35. UGI 28.88
(gas service—Lee Ann Court)
36. Erie InsuranceGroup 134.75
(homeowners insurance premium—Lee Ann Court)
37. Sherwood Court Homeowner's Association 50.00
(HOA fee—January, 2014)
38. Pennsylvania American Water 14.32
(water service—Lee Ann Court)
39. PPL Electric Utilities 26.65
(electric service—Lee Ann Court)
40. East Pennsboro Township 91.50
(sewer bill—Lee Ann Court)
Estate of Gerald F. Wynn
No. 21-13-0881
SCHEDULE H (continued)
41. UGI 78.90
(gas service—Lee Ann Court)
42. Sherwood Court Homeowner's Association 50.00
(HOA fee—March, 2014)
43. Pennsylvania American Water 15.00
(water service—Lee Ann Court)
44. PPL Electric Utilities 33.79
(electric service—Lee Ann Court)
45. Debbie Lupold, Treasurer 561.13
(2014 County and Township real estate tax—Lee Ann Court)
46. Enders Insurance Associates 740.42
(quarterly premium—vacant dwelling policy—Lee Ann Court)
47. UGI 72.38
(gas service—Lee Ann Court)
48. H&R Block 194.00
(2013 income tax preparation—final lifetime returns)
49. Sherwood Court Homeowner's Association 50.00
(HOA fee—April, 2014)
50. Pennsylvania American Water 16.02
(water service—Lee Ann Court)
51. PPL Electric Utilities 30.46
(electric service—Lee Ann Court)
52. UGI 42.65
(gas service—Lee Ann Court)
53. Sherwood Court Homeowner's Association 50.00
(HOA fee—May, 2014)
54. East Pennsboro Township 91.50
(sewer bill—Lee Ann Court)
REV-1512 EX+(12-12) • ' -+ A4 \
Pennsylvania SCHEDULE I ,
DEPARTMENT OF REVENUE I DEBTS OF DECEDENT, -�
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS `
RESIDENT DECEDENT
ESTATE OF , - r FILE NUMBER
Gerald F. Wynn;deceased 21-13-0881
Report debts Incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses.
ITEM • _ - VALUE AT DATE
NUMBER DESCRIFnON OF DEATH
1' UGI(automatic payment from decedent's checking account) 14.63
Erie Insurance(check written prior to death which cleared after death) 134.75
❑3 United Healthcare(automatic payment from decedent's checking account) 4 200.00
F44 1. . Pennsylvania American Water(automatic payment from decedent's checking account) 15.26
❑5. r PPL Electric Utilities(automatic payment from decedent's checking account) 25.05
le ' Comcast(automatic payment from decedent's checking account) 15'.95
Heartland Pharmacy(medical expense not covered by insurance) • 670.65
❑7
F-84.1 PNC Bank Visa(balance due) 156.84
West Shore EMS-BLS(medical expense not covered by insurance) 119.12
❑9
10. The Bridges at Bent Creek(compromise of claim) * 1,500.00
11. PA Department of Revenue(tax due per Form PA-00;tax year 2013) rr 68.00
ir
•
• y Y • \
' TOTAL(Also enter on Line 10, Recapitulation) $ 2,920.25
t - If more space Is needed,Insert additional sheets of the same size.
REV-1513 EX+(01-10) r r + t C
tpenn'sylvania - ,SCHEDULE,] *'
INHERrrANCE TAX RE UU; BENEFICIARIES
r t
- RESIDENT DECEDENT
ESTATE OF: FILE NUMBER: t '
Gerald F. Wynn, deceased 21-13-0881 .
• RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE '
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under -
Sec.9116(a)(1.2).)
' [� 1. Bradley T.Wynn,626 Stroud Circle,Wake Forest,NC 27587 r J child 1/3 residue
-1 2.1 ' Krista A.Fawber,1714 Dighton Street,Camp Hill*,*
ill PA 17011 child 1/3 residue• r
I f r_
�3 Kelly L.Cameron,1451 Pheasant Hill Road,Dauphin,PA 17018' child 1/3 residue
❑
❑ ,
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 TAXIS NOT TAKEN: '
F1 I lip
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
❑' ,
❑ F
❑ r IT w
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ F
. 7• If more space Is needed,use additional sheets of paper of the same size. t
CCODIF)%7
LAST WILL AND TESTAMENT
OF
GERALD T. WYNN
I, GERALD T. WYNN, presently residing and domiciled in East Pennsboro
Township, Cumberland County, Pennsylvania, hereby declare this to be my Last Will and
Testament, and I hereby revoke any and all prior wills and codicils previously made by
me.
ITEM I: All my personal effects, clothing, furniture, furnishings,jewelry,
automobiles, other tangible personal property of every kind, and insurance thereon, I give
to my children who survive me for a period of thirty (30) days, to be divided among them
as they may agree, or, if they are unable to agree, as my Executrix shall decide.
Notwithstanding any statutory provision to the contrary, I specifically intend
that each beneficiary under this Item I shall be responsible for any packing, shipping, or
other moving costs incurred with regard to any item of tangible personal property which
he or she receives hereunder.
ITEM II: All the rest, residue, and remainder of my estate I give, devise, and
bequeath unto my issue who survive me,per stirpes.
ITEM III: If any income or principal shall be payable to any person who has not
attained the age of eighteen (18) years at the time of my death, or who, in the discretion
of my Executrix, is incapacitated for any reason, then I direct that his or her share shall be
paid, instead, to my Executrix, as Trustee, to be held in trust, nevertheless, for the benefit
of any such person.
Trustee shall be entitled to apply any such principal and income for the health,
maintenance, support, and education of any such person, without the appointment of a
guardian and without any authority of court.
Trustee may directly apply any such principal and income, or Trustee may pay
income and principal to the parent or other person in charge of any such person, or to a
guardian, or to a custodian under the Uniform Gifts to Minors Act or the Uniform
Transfers to Minors Act.
As to education, Trustee shall pay no more than she deems necessary, taking into
consideration all financial resources available to any such person, including but not
limited to, financial aid programs and employment. Trustee shall make no payments on
behalf of any such person which would reduce any financial aid to which he or she would
otherwise be entitled, or which would disqualify him or her from receiving any such aid.
Trustee shall distribute the remaining principal, and any accrued or undistributed
income, to the said beneficiary upon the attainment by him or her of the age of eighteen
(18) years, or upon the termination of incapacity, outright and free of all trust.
If any such beneficiary dies prior to attaining the age of eighteen (18) years,
Trustee shall pay his or her share to his or her surviving siblings, or, if no surviving
siblings, to his or her issue,per stirpes, upon the terms and conditions contained herein.
ITEM IV: Any and all trusts created hereunder shall be considered to be
spendthrift trusts. No interest in income or principal of any trust created hereunder shall
be assignable by a beneficiary (voluntary alienation) or available to anyone having a
claim against a beneficiary (involuntary alienation) before actual payment to a
beneficiary.
ITEM V: All estate, inheritance, and other death taxes, together with interest and
penalties thereon, with respect to any interest passing under this my Last Will and
Testament, or any codicil thereto, shall be paid out of the principal of my residuary estate
without apportionment. It is my specific intention that any tax due upon any non-probate
asset shall be paid by the person receiving the asset, and not from any portion of my
probate estate.
ITEM VI: I appoint my daughter, KELLY L. CAMERON, as Executrix of this
my Last Will and Testament. I direct that my Executrix shall not be required to furnish
security in any jurisdiction.
If my daughter, Kelly, is unwilling or unable to serve, then I appoint my son,
BRADLEY T. WYNN, and my daughter, KRISTA A. FAWBER, or their survivor, as
Co-Executors, to serve without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this 16th day of
May, 2012.
(SEAL)
GEP>AD T. WYNN V
WITNESSETH: The foregoing instrument was, on the date stated above, signed,
published, and declared by GERALD T. WYNN, the Testator named therein, as and for
his Last Will and Testament, in the presence of us, who at his request, in his presence and
in the presence of one another, have subscribed our names as witnesses thereto.
("
Wi e 71tness
Address Address
Address Address
ACKNOWLEDGEMENT
Commonwealth of Pennsylvania
SS.
County of Dauphin
AND NOW, this 16th day of May, 2012, I, the Testator whose name is signed to
the attached or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed the instrument as my Last Will and Testament, that I
signed it willingly and as my free and voluntary act for the purposes expressed therein.
qmxLff-T.
Sworn to, subscribed, and acknowledged before me by GERALD T. WYNN, the
Testator, known to me, this 16th day of May, 2012.
•Notary Public
My Commission Expires: ((/�
COMMONW�LTH OF PENNSYLVANIA
Notarial Seal Wblit
Shane R.Geyer,ONa Ph^I minty
qty of Harrlsbur0,fires]ulY 20,2014
MY Commissl°n� iatlon of Notaries
Member.Pennsvlvanla Assx
AFFIDAVIT
Commonwealth of Pennsylvania
ss.
County of Dauphin
AND NOW, this 16`h day of May, 2012, we, JAMES D. CAMERON and
BRADLEY T. WYNN, the witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to law, do depose and say that we
were present and saw the Testator sign and execute the instrument as his Last Will and
Testament; that he signed it willingly and executed it as his free and voluntary act for the
purposes therein expressed; that each of us in the hearing and sight of the Testator signed
the Will as a witness; and that, to the best of our knowledge, the Testator was at that time
at least eighteen (18) years of age, of sound mind, and under no constraint or undue
influence.
a-
Wtje
i nesWT slur T
Sworn to and subscribed before line by JAMES D. CAMERON and BRADLEY
T. WYNN, the witnesses, known to me, this 16th day of May, 2012.
4(3
Notary Public
My Commission Expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Shana R.Geyer,Notary Public
- City of Harrisburg,Dauphin County
My Commission EVIres July 20,2014
Member.Pennsmania Association or NOtanes
Q PNC
'INVESTMENTS
Mrmarr FIN"Ira SIK
August 30, 2013
Marian Kinter
marian.kintern onc.com
RE: 039-419454/Gerald Wynn (Individual)
Dear Marian
The value of the above-referenced account on July 25th, 2013 is as follows:
—S-yffibol'I DOD Accrued
Amount Description CUSID Price DOD Value Interest
20000 GENERAL ELECTRIC CAPITAL CORP 36966TGMB $ 96.31 $ 19,262.60 $ 84.44
20000 GOLDMAN SACHS GRP INC MTN BE 38141ED48 $ 100.37 $ 20,073.40 $ 30.56
11052.08 LORD ABBETT INCOME CLASS C LAUSX $ 2.88 $ 31,829.99
386.49 PRIME FUND DAILY MONEY CLASS FDAXX $ 1.00 $ 386.49
$ 71,552.48 $ 115.00
Grand Total (Market Value+Accrued Interest) $ 71,667.48
'Note: Certain securities may provide an option to redeem the security due to holder's death that might be beneficial to
discuss with a representative. These securities have been notated above with an asterisk.
Note: DOD price is based off the closing price on the day the client has passed away, if this is a non-business day the
price will be taken from the previous business day's closing price.
If you have any questions, please contact our Estate Resolution Desk at 800-622-7086.
Sincerely,
Ankit Patel
PNC Investments, LLC.
Estate Resolution Desk
The summaries, prices, quotes and/or statistics contained herein have been obtained from sources believed to be
reliable but are not necessarily complete and cannot be guaranteed.They are provided for informational purposes
only. Past performance does not guarantee future results.
PNC Investments LLC
Member of The PNC Financial Services Group
4242 Carlisle Pike Camp Hill Pennsylvania 17011
v .pnc.com
Important Investments Information:Brokerage and Insurance products are:
Not FDIC Insured•Not Bank Guaranteed•May Lose Value
Securities and brokerage services are provided by PNC Investments LLC,member FINRA and SIPC.
Annuities and other insurance products are offered by PNC Insurance Services.LLC a licensed insurance agency.
POEM
SEP 0 0 2013
PNC - .....................
LEADIND THE WAY
September 4; 2013
James D Cameron Esq.
1325 N Front St
Harrisburg, PA 17102
RE: Gerald F Wynn
SSN:
DOD: 07-25-2013
Dear Mr. Cameron:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Account
Account# 5003667911 Established: 08-19-2003
GERALD WYNN
DOD balance: $ 3,315.69 + 0.01 accrued interest
Interest paid 01-01-2013 thru 07-25-2013 $ 0.46 YTD
Savings Account
Account # 511268889') Established: 10-01-2012
GERALD F WYNN
DOD balance: $ 20.035.00 + 1.25 accrued interest
Interest paid 01-01-2013 thru 07-25-2013 $ 10.49 YTD
Investment Account
The decedent maintained Investment Account# 39419454 . For further information, you may call the
Brokerage Department at 1-800-762-6111.
Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do not process any financial 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,N.A.
Member FDIC
Page I of 2
St
MEMBERS 1St [AU Q13
FEDERALCREDIT ONION �
Jr
.....................
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 338397-00
Date Account Established 09/03/2008
Principal Balance at Date of Death $5.00
Accrued Interest to Date of De_ ath $5.00
Name of Joint Owner Jacquelin A Wynn`
Date Joint Added 09/0392008
*Jacquelin deceased, DOD 511012012. All funds will go to Gerald Wynn's Estate.
Please provide a copy of Jacquelin's death certificate.
SAFE DEPOSIT BOX NONE
MEM..B��E��R��S,, 1sT FEDERAL CREDIT UNION
Tessa ��
Lending Insurance Support Specialist
August 15, 2013
Estate of: GERALD F WYNN
Date of Death: 07/2512013
Social Security Number: 202-20-2661
5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www.memberslst.org
Musselman Funeral Home and Cremation Services
324 Hummel Avenue
Lemoyne, PA 17043
Tel: 717-763-7440 Fax: 717-730-9798
Brian C. Musselman, Supervisor
Clifford D. Forester Sr. Funeral Director
Monday,July 29,2013
Ms. Kelly L.Cameron
1451 Pheasant Hill Road
Dauphin,PA 17018
Dear Kelly,
Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found
our services,so far,to be of the highest standards that we always try to achieve. The following is a summary of the service charges as
previously explained and provided in written form on the services for:
GERALD F. WYNN
PROFESSIONAL SERVICES
$Included
Embalming $Included
Other Preparation of Body $Included
Traditional Funeral Package B. $5795.00
Total Funeral Service Selected
TOTAL PROFESSIONAL SERVICES $5,795.00
Use of Equipment&Staff for Church Memorial Service $Included
Use of Staff&Fquipmem for Graveside Service $Included
Transfer of Remains to Funeral Home $Included
Hearse/Funeral Coach $Included
Service/Utility Vehicle $Included
OTHER MERCHANDISE SELECTED
Casket: Winston Cherry $3,700.00
Pre Purchased
Acknowledgement Cards $Included
Register Book $Included
Memorial Folders $Included
TOTAL OTHER MERCHANDISE SELECTED $3,700.00
CASH ADVANCES
Crave Opening/Closing Charge $Pre-paid
Certified Copies of Death Certificate $Included
Clergy Honorarium $ 100.00
Newspaper Notice Patriot News $394.00
Organist $100.00
Casket Spray 250+tax $265.00
Sweethart roses cluster $35.00
CASH ADVANCE TOTAL $894.00
TOTAL OF SERVICES $10,389.00
BALANCE DUE $10,389.00
If there are any questions or concerns that remain unanswered,please call me.
Sincerely,
COPY