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Home My WebLink About07-09-14 (3) F (�({ 1505610149 REV-1500 Fx lo25i)Pennsylvania OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 13 0834 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06 27 2013 46 26 1924 Decedent's Last Name Suffix Decedent's First Name MI Lyon Walter A (if Applicable)Enter Surviving Spouse's Information Below Spouses Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1.Original Return O 2. Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12-13-82) IQ 4.Limited Estate Q 4a. Future Interest Compromise(date of Q 5, Federal Estate Tax Return Required death after 12-12-82) 6.Decedent Died Testate Q 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wei) (Attach Copy of Trust.) Q 9.Litigation Proceeds Received (Q 10. Spousal Poverty Credit(Dale of Death Q i1. 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 Elyse E . Rogers , Esquire 717 612 5801 REGISTER WILLS USE ONLY ED First Line of Address 635 North 12th Street , Suite 400r=1 .o r o +� Second Line of Address n C�-.- _ r r l rx EXILED 70 City or Post Office State ZIP Code , Lemoyne - PA 17043 Correspondent's e-mail address: erogers @ssr-attorneys.com Under densities of perjury,i declare that i have examined this ra ut�ncluding acco npanying schedules and statemeMS,and to the Crest of my knowledge and belief, It is true,correct and complete.Declaration of preparer.othe`rthan the ersonai representative is based wall Information of which preparer has any knowledge. SIGNATURE OFr RSPN` SPQNSIBL_E-FOR FILING RETURN DATE ADDRESS 509 AI +gh`f D/rive/ \\ Mechaanjcpburg, PA 17 SIGN AT E F PZAr7l H E,,WT HAN REPRESENTATIVE //p ATE ADDRESS 605 North 1 An re _ Lemoyne,PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610149 1505610149 1505610249 REV-1500 EX(FI) Decedent's Social Security Number Decadent'sName: Walter A Lyon RECAPITULATION . 1. Real Estate(Schedule A).. ................. ....................... 1. 0-00 2. Stocks and Bonds(Schedule B) ...,. ,.. .. 521888 - 48 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .... 3. 0.00 4. Mortgages and Notes Receivable(Schedule D) ...................... ... 4. 0 .00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) . . .. . . 5. 2221708-79 6. Jointly Owned Property(Schedule F) p Separate Billing Requested .... 6. 0-0 0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 199,531 -58 (Schedule G) O Separate Billing Requested . . .. 7. 8. Total Gross Assets(total Lines 1 through 7) ........................... 8. 4 7 5 ,12 8•8 5 9. Funeral Expenses and Administrative Costs(Schedule H) . . .... . .. . . . . .. . . 9. 51,622 - 30 % Debts of Decedent,Mortgage Liabilities and Liens(Schedule I) .............. 10. 211180- 94 11. Total Deductions(total Lines 9 and 10) 11. 72A93- 24 803. 24 12. Net Value of Estate(Line 8 minus Line 11) ............. ...... ......... 12. 4021325- 61 13. Charitable and Governments[Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) 4 .. . .. . . . . 4 ... .. . ... . .. 13. D - 00 14. Net Value Subject to Tax(Line 12 minus Line 13) 14, 402 ,325 -61 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 0 (a)(1.2)X.0 p 0. 00 15. 0. 0 16. Amount of Line 14 taxable at lineal rate X,0 45 402,325 .61 16, 181104 .65 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, El- 00 19. TAXDUE . :. .. . .. . .. . . . . .. . .. . .. . .. . .. . .. . .. ... ... .. . . .. . .. .. 19. 18 ,104 . 65 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610249 1505610249 REV�t 500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 130834 DECEDENT'S NAME Walter A. Lyon STREETADDRESS 509 Albright Drive CITY STATE 2IP Mechanicsburg I PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Una 19) (1) 18 104.65 2. Credits/Payments A.Prior Payments 17,400.00 B.Discount 673.68 18,073.68 Total Credits(A+B} (2} 3. Interest (3) 0.00 4. If Line 2 is greater than Una 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1+Une 3 is greater than line 2,enter the difference.This is the TAX DUE. (5) 30.97 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. ...... .......................................... ❑ IR d. receive the promise for life of either payments,benefits or care? . . .. ... ... .. .. .. . . . . ❑ IR 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? ....... . .. . ... . .... . . .. .. . . . .. .. . .. ❑ IR 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?. .. ❑ IR 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. 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 172 P.S.§9116(a)(1.1)1)]. For dates 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)(11)(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 172 PS.§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-1503 EX+'(8-12) pennsytvania SCHEDULE B OEPAR ENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Walter A. Lyon 21130834 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 BASF SE NPV ISIN #DEOOOBASF111 SEDOL#5086577 22,228.64 Per 8/21/13 letter 2 Dreyfus Greater China Cl 1 4,849.84 Per 8/21/13 letter 3 Fidelity Canada 4,667.86 Per 8/21/13 letter 4 Fidelity Latin America 13,672.76 Per 8/21/13 letter 5 Vanguard International Explorer Investor 7,469.38 Per 8121/13 letter TOTAL (Also enter on Line 2, Recapitulation) 52,888.48 If more space is needed, insert additional sheets of the same size REV-1548 EX+ (08-12) pennsylvania SCHEDULE E DEPARTMENT of REVENUE ,CASH, BANK DEPOSITS & MISC. INHERFrANCE TAX RETURN I PERSONAL PROPERTY RESIDENT DECEDENT I ESTATE OF: FILE NUMBER; Walter A. Lyon 21 130834 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. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH _ 1 Metro Bank Checking Account 513184275 114,176.60 Per 8/15/13 letter Interest on above item accrued as of decedent's death 1.87 2 Emigrant Bank Savings Account 5800616251 79,340.42 Per 8/22113 letter 3 Emigrant Bank Savings Account 82.51 This account was in the name of Decedent's spouse,Ann Lyon,who predeceased Decedent 4 Emigrant Bank VFD Savings Account 1,219.08 This account was in the name of Decedent's spouse, Ann Lyon, who predeceased Decedent 5 Emigrant Bank Savings Account 1,777.79 This account was in the name of Decedent's spouse,Ann Lyon,who _ predeceased Decedent 6 Fidelity Investments Account Z43713589 3,520.69 Per 8/21/13 letter 7 TIAA-CREF Annuity Contract Y0762842=762840 2,620.93 These contracts were owned by Decedent's spouse,who predeceased him. Decedent was the beneficiary of these annuities, but since the payments were not claimed, they are now due Decedent's Estate Per 1/31/14 letter 8 TIAA-CREF Annuity Contract IDD27141/OU439568 5,350.50 These contracts were owned by Decedent's spouse,who predeceased him. Decedent was the beneficiary of these annuities, but since the payments were not claimed, they are now due Decedent's Estate Per 1131!14 letter 9 TIAA-CREF Annuity Contract 6M340664 590.36 This contract was owned by Decedent's spouse,who predeceased him. Decedent was the beneficiary of this annuity, but since the payments were not claimed, they are now due Decedent's Estate Per 1/31/14 letter Total from continuation Schedule(s) 14,028.04 TOTAL (Also enter on Line 5, Recapitulation) 222,708.79 If more space is needed, use additional sheets of paper of the same size, Page 2 Estate of: Walter A. Lyon 21 130834 Schedule E - Cash, Bank Deposits, and Misc. Personal Property Item Value at Date Number Description of Death 10 TIAA-CREF Annuity Contract 6M476708 332.92 This contract was owned by Decedent's spouse, who predeceased him. Decedent was the beneficiary of this annuity, but since the payments were not claimed, they are now due Decedent's Estate Per 1/31/14 letter 11 TIAA-CREF Annuity Contract 6M536873 313.08 This contract was owned by Decedent's spouse, who predeceased him. Decedent was the beneficiary of this annuity, but since the payments were not claimed, they are now due Decedent's Estate Per 1/31/14 letter 12 TIAA-CREF Annuity Contract 6M633738 559.74 This contract was owned by Decedent's spouse, who predeceased him. Decedent was the beneficiary of this annuity, but since the payments were not claimed, they are now due Decedent's Estate Per 1/31/14 letter 13 Travelers Checks 180.00 14 Metro Bank Account 0537048670 1,232.41 15 Silver and End Tables 310.00 Sale price 16 Jacobian Cupboard 485.00 Sale price 17 2003 Toyota Avalon 7,000.00 18 1987 Ford Econoline 150 900.00 Sale price 19 PA Unclaimed Property- Erie Insurance Refund 3.00 20 John Hancock, Premium Credit Returned 30.00 21 2012 Tax Refund 756.89 22 USAA Points Redeemed 750.00 23 Additional misc. household items 1,175.00 TOTAL. (Carry forward to main schedule) . . . . . . 14,028.04 REV-1510 Etr ania SCHEDULE G V NUE INTER-VIVOS TR ANSFERS AND X RETURN MISC. NON-PROBATE PROPERTY DENT ESTATE OF FILE NUMBER Walter A. Lyon 21130834 This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. w DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NAMEOFTHE TRANSFEREE.THEIR RELATIONSHIPTO DECEDENT VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE TE OF TRANSFER.ATTACH COPY OF THE DEED FOR REAL ESATE.ucational Savings Plan Account 10,732.95 100 10,732.95 35 ary: Decedent's granddaughter,Lyon Value as of 8/29/13 2 Utah Educational Savings Plan Account 9,804.26 100 9,804.26 200809450 Beneficiary: Decedent's granddaughter, Greth Lyon Value as of 8/29/13 3 Utah Educational Savings Plan Account 9,543.25 100 9,543.25 200809436 Beneficiary: Decedent's granddaughter, Jane Lyon Value as of 8/29/13 4 Utah Educational Savings Plan Account 9,909.06 100 9,909.06 200809439 Beneficiary: Decedent's granddaughter, Lilly Lyon Value as of 8/29113 5 Utah Educational Savings Plan Account 10,021.54 100 10,021.54 200809449 Beneficiary: Decedent's grandson, Otto Lyon Value as of 8/29/13 6 Utah Educational Savings Plan Account 10,187.20 100 10,187.20 200809448 Beneficiary: Decedent's granddaughter, Sophia Lyon Value as of 8/29/13 7 Fidelity Investments IRA Account 147-255882 38,951.01 100 38,951.01 Beneficiary: Estate of Walter Lyon 8 Fidelity Investments IRA Account 147255858 34,247.05 100 34,247.05 Beneficiaries: Decedent's children, Clifford D. Lyon, Paul D. Lyon, James D. Lyon, and Nancy F. Lyon Total from continuation Schedule(s) 66,135.26 TOTAL (Also enter on Line 7, Recapitulation) 199,531.58 If more space is needed, use additional sheets of paper of the same size. Page 2 Estate of: Walter A. Lyon 21 130834 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 Per 8/21/13 letter 9 TIAA-Cref Annuity Contract No. IG694178 30,140.67 100 30,140.67 Beneficiaries: Decedent's children, Nancy Lyon, Clifford Lyon, Paul Lyon and James Lyon Per 10101/13 letter 10 TIAA-CREF Annuity Contract No.Y0796808 555.95 100 555.95 Beneficiaries: Decedent's children, Nancy Lyon, Clifford Lyon, Paul Lyon and James Lyon Per 10/1/13 letter 11 TIAA-CREF Annuity Contract No. Y0796840 741.95 100 741.95 Beneficiaries: Decedent's children, Nancy Lyon, Clifford Lyon, Paul Lyon and James Lyon Per 10/1/13 letter 12 TIAA-CREF Annuity Contract No. Y9092803 1,431.83 100 1,431.83 Beneficiaries: Decedent's children, Nancy Lyon, Clifford Lyon, Paul Lyon and James Lyon Per 10/1113 letter 13 TIAA-CREF Annuity Contract No. Z0796806 687.34 100 687.34 Beneficiaries: Decedent's children, Nancy Lyon, Clifford Lyon, Paul Lyon and James Lyon Per 10/1/13 letter 14 TIAA-CREF Annuity Contract No. Z0796848 1,476.83 100 1,476.83 Beneficiaries: Decedent's children, Nancy Lyon, Clifford Lyon, Paul Lyon and James Lyon Per 10/1/113 letter 15 TIAA-CREF Annuity Contract No. Z9092801 1,632.27 100 1,632.27 Beneficiaries: Decedent's children, Nancy Lyon, Clifford Lyon, Paul Lyon and James Lyon Per 10/1/13 letter 16 Fidelity Investments Annuity Contract 29,468.42 100 29,468.42 321516990 Beneficiaries: Decedent's children, Clifford D. Lyon, James Lyon, Nancy Foster Lyon, and Paul Lyon TOTAL. (Carry forward to main schedule) . . . . . . 66,135.26 REV-1511 EX+ (08-13) pennsylvania SCHEDULE H ly DEPARTMEM OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINSTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Walter A. Lyon 21 130834 Decedents debts must be reported on schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See schedule attached 6,281.83 B. ADMINISTRATIVE COSTS: 14,050.00 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Clifford D Lyon Street Address 509 Albright Drive City Mechanicsburg State PA zip 17055 Year(s) Commission Paid: 2014 14,050.00 2. Attorney Fees: 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 408.50 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: See schedule attached 16,831.97 TOTAL (Also enter on Line 9, Recapitulation) 51,622.30 If more space is needed, use additional sheets of paper of the same size. Page 2 Estate of: Walter A. Lyon 21 130834 Schedule H, Part A - Funeral Expenses Item Number Description Amount 1 James Lyon, Great Spruce Head Island-contribution to rent and food for 1,000.00 James, nurse Peggy, and Israeli cousins-the Hammis 2 Cliff Lyon, reimbursement for payment to Carl Chopper, Rabbi, memorial 1,000.00 service 3 Hetrick Funeral Home 1,026.49 4 Hetrick Cremation, obituary 368.85 5 Bethany Catering, memorial service 386.49 6 Tom Hutchenson, corpse transport 500.00 7 Headstone 2,000.00 TOTAL. (Carry forward to main schedule) . . . . . . 6,281.83 Page 3 Estate of: Walter A. Lyon 21 130834 Schedule H, Part B - Administrative Costs Miscellaneous Expenses Item Number Description Amount 7 Giant 12.38 8 Weis Markets 10.60 9 Lower Allen Township, utility 65.00 10 PAWC 32.29 11 USAA P&C 107.24 12 AT&T 94.85 13 Chase, returned payment fee 25.00 14 AT&T 90.12 15 James Lyon, airfare CLE-MDT 2nd stroke 750.00 16 AT&T 90.12 17 Register of Wills, probate fee for Ann Lyon Estate 293.50 18 American Water 1.80 19 American Water 72.65 20 Bethany Village, rent through December 31,2013 4,576.00 21 USAA.com 351.69 22 Brown Schultz Sheridan & Fritz, 2012 tax preparation 880.00 23 AT&T 90.18 24 PPL 425.49 25 AT&T 90.18 26 Saidis, Sullivan & Rogers, out of pocket expenses 491.60 27 AT&T 90.46 28 Don Metzger, gardner 100.00 29 B-Reseated Chair Recaning 563.92 TOTAL. (Carry forward to main schedule) . . . . . . 9,305.07 Page 4 Estate of: Walter A. Lyon 21 130834 Schedule H, Part B - Administrative Costs Miscellaneous Expenses Item Number Description Amount 30 AT&T 90.35 31 USAA.com 7811 32 Bethany, rent-Jan-March 2014 3,944.20 33 Partial repayment of Metro Bank loan 242.17 34 Reimburse 2 flights to SLC 774.80 35 AT&T 90.35 36 Foster's Automotive Toyota, repairs/inspection 1,252.70 37 PPL 696.37 38 AT&T 90.35 39 AT&T 67.50 40 Register of Wills, additional probate fee 50.00 41 Saidis, Sullivan & Rogers, reserve for additional out of pocket expenses 150.00 TOTAL. {Carry forward to main schedule) . 7,526.90 REV-1512 EX+ (12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Walter A. Lyon 21 130834 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical eXPenses. ITEM DESCRIPTION 7��t NUMBER 1 Nurse Margaret Nestler 2 PAWC 3 Chase, credit card (Amazon charges for Kindle) 4 Barclay Card, charges for purchases prior to Decedent's date of death (see 1,637.05 attachment) 5 Omnicare Pharmacy 134.07 6 Omnicare Pharmacy 111.33 7 Health South, co-pay 210.00 8 Otto Lyon, replaced lost check written prior to Decedent's date of death 500.00 9 Cliff Lyon, final year end payment"per compensation agreement" 10,000.00 10 Cliff Lyon, reimbursement for payment to Nurse Peggy Nestler 210.00 11 Cliff Lyon, reimbursement for payments to Nurse Stephanie Livingston 300.00 12 Cliff Lyon, reimbursement for payment to Nurse Marcos Ferreira 95.00 13 Saidis, Sullivan & Rogers, services prior to Decedent's date of death 842.50 14 James Norton, DPM, nail trimming 15.00 15 Brown Schultz Sheridan & Fritz, meetings prior to Decedent's date of death 315.83 16 Apria Healthcare 40.15 17 Apria Healthcare(invoice for Decedent's spouse, Ann Lyon, who 46.00 predeceased Decedent) 18 Hope Medical 46.90 19 Celtic, co-pay 147.00 20 Hampden Phys Assoc., co-pay 50.00 Total from continuation Schedule(s) 4,408.00 TOTAL (Also enter on Line 10, Recapitulation) 21,180.94 If more space is needed, insert additional sheets of the same size Page 2 Estate of: Walter A. Lyon 21 130834 Schedule I - Debts of Decedent, Mortgage Liabilities, and Liens Item Value at Date Number Description of Death 21 Healthsouth, co-pay 10.00 22 Celtic, co-pay 147.00 23 US Treasury, 2012 income tax 1,839.00 24 PA Department of Revenue, 2013 PA-40 33.00 25 Register of Wills, PA inheritance tax on Ann Lyon's Estate 379.00 26 Headstone for Ann Lyon 2,000.00 TOTAL. (Carry forward to main schedule) . . . . . . 4,408.00 REV-1513 EX+ (01-10) . . pennsylvania SCHEDULE 7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Walter A. Lyon 21130834 NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT T SHARE PERSON(S) 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 SHEET. If more space is needed, use additional sheets of paper of the same size. Page 2 Estate of: Walter A. Lyon 21 130834 Schedule J, Part I - Taxable Distributions Amount or Share Num. Name and Address of Person(s)Receiving Property Relationship to Decedent of Estate 1 Nancy F. Lyon Daughter 61,357.34 5713 Thunder Hill Road Columbia, MD 21045 2 Clifford D. Lyon Son 61,357.33 509 Albright Drive Mechanicsburg, PA 17055 3 Paul D. Lyon Son 61,357.33 307 North Mayfield Drive Salt Lake City, UT 84108 4 James D. Lyon Son 61,357.33 3109 Chadbourne Road Shaker Heights , OH 44120 5 Brittany Lyon Granddaughter 26,849.28 307 North Maryfield Drive Salt Lake City, UT 84108 6 Jane Lyon Granddaughter 25,659.59 307 North Maryfield Drive Salt Lake City, UT 84108 7 Paul D. Lyon, Granddaughter 26,025.40 Parent& Natural Guardian for Lilly Lyon 307 North Maryfield Drive Salt Lake City, UT 84108 8 Paul D. Lyon, Granddaughter 26,303.53 Parent& Natural Guardian for Sophia Lyon 307 North Maryfield Drive Salt Lake City, UT 84108 9 James D. Lyon, Granddaughter 25,920.60 Parent & Natural Guardian for Greth E. Lyon 3109 Chadbourne Road Shaker Heights, OH 44120 10 Otto J. Lyon Grandson 26,137.88 3109 Chadbourne Road Shaker Heights, OH 44120 Fidelity INYi8T M6NT8 Estate Valuation Account Number: Z43713589 (Joint) Value Date: 06/27/2013 Share Symbol Security Description Qty Value Price BFFAF BASF SE NPV ISIN#DEOOOBASF111 SEDOL#5086577 250 $22,228.64 $88.91 DPCRX DREYFUS GREATER CHINA CL I 133.237 $4,849.84 $36.40 FICDX FIDELITY CANADA 89.732 $4,667.86 $52.02 FLATX FIDELITY LATIN AMERICA 353.942 $13,672.76 $38.63 VINEX VANGUARD INTERNATNALEXPLORER INVESTOR 471.552 $7,469.38 $15.84 Total Securities: $52,888.48 Cash/Money Markets: $3,520.69 $1.00 Total Value: $56,409.17 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 Partnerships,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. We hope this information is helpful. If you have any questions regarding this matter or need instructions on how to transfer the ownership of the accounts not yet transferred, please call us at 800-544-0003. Fidelity Inheritor Services Representatives are available Monday through Friday, from 8:00 A.M. to 6:30 P.M. Eastern time, or you may visit our website at www.fidelity.com and search under"change account registration" for additional information. Sincerely, Brannan Pouncy Brannan Pouncy Fidelity Investments Operations and Services Group DODNEW 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 Utah£ducationat Savings Ptah° ...................... My Accounts UESP I-bnte Accounts Logout • Change Investment You are curren9y logged in Options Last login:2/14/2012 10:21 AM Mountain Titre • Withdrawals - - - - -- • Transfers The College Savings Plan Network(CSPN)is a national,nonprofit association that serves college • Add New Account savers by providing objective information about Section 529 college savings plans and prepaid • QuickenQ) tuition plans.Se it may learn more about the habits and investment patterns of college savers, CSPN invites you to take this brief survey.(Your personal UESP account information will not be Manage Contributions shared with a third dY)a Thank you. P • One-Time .. ... _ _.. ..... __.. ... _.. .. _.._ ... Contribution • Automated Owner/Agent Accounts Contributions • Special Occasion ACCOUNTS Account Owner:WALTER ALPHONS LYON Contributions - E-mail: vallerlyon@comcast.net • Schedule/History of Contribution Account Type:Individual Beneficiary: BRITTANY LYON Total: $10,732.95 • Manage Linked Bank Market Value Accounts Account Investment Option 812912013 Payroll Contribution 200809435 Equity-10%International I $10,732.95 • Set up/Change Payroll Contribution Account Type:Individual Beneficiary:GRETH LYON Total:$9,804.26 Records Account Investme at Option Market Value • Quarterly Statements 8/29/2013 • Tax Forms I 200809450 Age-Based Moderate $9,804.26 • Account Certificates My Profile - Account Type: Individual Beneficiary:JANE LYON Total:$9,543.25 • Change Account Markel Value Owner Info Account Investment Option 8/2912013 • Change Delivery Method - I 200809436 I Age-Based Moderate $9,54125 • Change E-mail Address Account Type:Individual Beneficiary:LILLY LYON Total:$9,909.06 • Change Password - Market Value • Change Username Account Investment Option 812912013 Shared Access/ I 200809439 Age-Based Moderate I $9,909.06 Interested Parties Account Type: Individual Beneficiary:OTTO LYON Total:$10,021.54 Market Value Account Investment Option 8/29/2013 200809449 I Age-Based Moderate I $10.021.54 Account Type:Individual Beneficiary:SOPHIALYON Total: $10,187.20 Markel Value Account Investment Option 8/29/2013 200809446 I Age-Based Moderate $10,187.20 To change beneficiary addresses and primary and secondary successors,click on the appropriate UESP account number link above. ......... ....-.....-. ................. -_.. ___ ................ .......-.._..._ ........ Copyright 02013 Unh Educalionul Savings Plan,all hill reserved I 1 oft 8/30/2013 11:51 AM n The tenor Utah Educational Savings Plan and UESP are registered service narks. Important Legal Notice: You should read the Program Description and consider all investment objectives,risks,charges,and expenses letters Investing.The Program Dem,,rn Is available for dovmload on Me web or a hard copy can be heated to you by requesting It online hare. FDIC Insurance.Except for the underlying investment apecifed below,investments in UESP are not insured by the Federal Deposit Insurance Corporation(FDIC).FDIC insurance is provided for the FDIC-Inaored savings account held in trust by UESP at Zions Flrst National Bank(Bank).Funds in the savings account are insured by the FDIC on a pass-through basis to each account owner up to the maximum amount set by federal law,which Is$250,000.The amount of FDIC insurance provided to an amount owner is based on the total of(1)the value of an account ownefs investment in UESP's FDIC-insured savings account plus(2) the value of other accounts held(if any)at me Bank,as determined by the Bank and by FDIC regulations. No Other Insurance and No Guarantees.Investments in UESP are not insured nor guaranteed by the State of Utah.UESP,the Utah State Board of Regents,the Utah Nigher Education Assistance Authority.other state agencies,federal government agencies(except to the extent noted above regarding FDIC Insurance),or any employees or directors of any such entities.Units in UESP have not been registered Win me United States Securities and Exchange Commission or Wth any state securities commission. Account Value.The value of your UESP account my vary depending on market Conditions and the performance of the investment option you select.X could be mare or less than the amount you contribute)In short your investment could lose value.However,subject to the application of Bank and FDIC rules and regulations to each amount poster,funds in UESPs FDIC-insured savings account it retain theirvalue, Mather in the FDIC-Insured Savings Account or when allocated to podii of the Atli said Aggressive GroWq Age-Based GroWh,Age-Based Moderate.Age-Based Conservative,Customized Age-Based,or Customized Static investment options(if In the custommd Investment options,the FDIC-insured savings account Is selected as an underlying investment). Nun-Utah Taxpayers and Re side his.You should determine Mother the state In Mich you or your benefivary pay taxes or live offers a 529 plan that provides state tax or other benefits not othemise available to you by investing in UESP.You should consider such state tax treatment ano benefits,if any,before investing in UESP 2 of 2 8/30/2013 11:51 AM METRO BANK Harrisburg, PAtr17111 mym t obank.com 8/15/13 Elyse E. Rogers Law Offices of Saidis, Sullivan & Rogers 635 North 12th St., Ste 400 Lemoyne, PA 17043 RE: Estate of: Walter A. Lyon Tax Identification Number: Date of Death: June 27, 2013 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: CK Account Number: 2843407731 Date Opened: 12/10/2012 Date Closed: 08/01/2013 Primary Owner: Walter A. Lyon Secondary Owner: Ann D. Lyon Accrued Interest: *'$0.05 Date of Death Balance: $0.00 Account Type:CK Account Number: 513184275 Date Opened: 10/22/2001 Primary Owner: Walter A. Lyon Secondary Owner: Ann D. Lyon Accrued_Interest: **$1.87 Date of Death Balance: $114,176.60 METRO BANK Harrisburg,tr, PA17111 888.937.0004 m trob k.com *' Please note: The accrued interest will not be paid if the account is closed prior to the date the interest is scheduled to post. In addition to the accounts listed above the decedent also has loans with Metro Bank. You can send your information to our Loan Department at: 3801 Paxton St., Harrisburg, PA 17111. Please feel free to contact us at 1-888-937-0004 if we may be of further assistance. Sincerely, — ...__. - Jelin fer Jacobs Research Associate Metro Bank EmigrantDirect.wm TM 13 Croton Ave., Ossining, NY 10562 Member FDIC August 22, 2013 Law Offices of Saidis, Sullivan &Rogers A Professional Corporation 635 N 12`h ST STE 400 Lemoyne PA 17042 RE: Estate of Walter A. Lyon To Whom It May Concern: The following is the requested information: Account No: 5800616251 Type of Account: Online Savings Title of Account: Walter A. Lyon or Ann D. Lyon Date of death balance: $79,340.42 Date Account Opened: 07/07/2005 as a joint account If you require any further information, please contact us. Sinc ely, Juanita Robertson Account Fulfillment Supervisor ANN LYON,June 19,2013 Emigr=tDiremt.eom More Money For Your Money. Prints Close Account Summary •Balances are as of June 19,201312:18:33 PM EDT Account Type Current Balance Available Balance Ann ACCOUNT American Dream Savings $82.51 $82.51 Ann VFD Book American Dream Savings $1,219.08 $1,219.08 Ann Wetumpka oic Account American Dream Savings $1',777.79 $1,777.79 . Il�ide/ity /NVi ST MENT8 Estate Valuation Account Number: Z43713589 (Joint) Value Date: 06/27/2013 Share Symbol Security Description Qty Value Price BFFAF BASF SE NPV ISIN#DE00DBASF111 SEDOL#5086577 250 $22,228.64 $88.91 DPCRX DREYFUS GREATER CHINA CL 1 133.237 $4,849.84 $36.40 FICDX FIDELITY CANADA 89.732 $4,667.86 $52.02 FLATX FIDELITY LATIN AMERICA 353.942 $13,672.76 $38.63 VINEX VANGUARD INTERNATNALEXPLORER INVESTOR 471.552 $7,469.38 $15.84 Total Securities: $52,888.48 Cash/Money Markets: $3,520.69 $1.00 Total Value: $56,409.17 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 Partnerships,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. We hope this information is helpful. If you have any questions regarding this matter or need instructions on how to transfer the ownership of the accounts not yet transferred, please call us at 800-544-0003. Fidelity Inheritor Services Representatives are available Monday through Friday,from 8:00 A.M.to 6:30 P.M. Eastern time, or you may visit our website at www.fidelity.com and search under"change account registration" for additional information. Sincerely, Brannan Pouncy Brannan Pouncy Fidelity Investments Operations and Services Group DODNEW Brokerage Services provided by Fidelity Brokerage Serndces 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 ,_. -----. - �Vl a�ll2-ll 16;62:21 (OMT) LYON pe51GN , /QT; {.yOn Op�lpn 6M476708 -Issued March 1, 1997,guarantee period through Fcbruary 2012 6M536873 -Issued March 1,1997,guarantee period'through February 2012 6M633738 -Issued March 1,1997, guarantee period through February 2012 Walter Lyon Has 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 2013 through June 2013. Mr.Lyon never claimed benefit on these accounts,and they are currently 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): Yo762842—$1,707.12\ Zo762840- $820.01 / �,_t.l ID027141- $4,313.96 } �� gf 3 SU, �4 1 u�u1 OU439568 -$856.92� CIO- 1 S = UG�vu� 6M340664-$569.68 4- T,nt cj_no V jNY S rec6Vta 6M476708 -$319-481- =;4 = $ 3 3 A AZ 6M536873 -$303.92 t yn+ = � 3 13,013 6M633738 -$531.52 -t = Ql S,'q ,ly The estimated benefit to the Estate of Walter Lyon is $9,412.61 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 vith 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 800-842-2638, extension 24-4414 Sincerely, Leigh Ann Baize Senior Customer Resolution Manager PROPERTY DESCRIPTION '•P3opeky.^/, olde"rjriforariatton*;. ,`! ' -,.e*'*`�.' . .fi'. -.-n; _" -. .,..: *'= `; .`- ioperty SID,':=93231501, :_,um �f (A)Onginal Owners Name (B)Original Owner`s Address as Reported LYON VVALTER A 20 CLIFTON ROAD CAMP HILL PA 17011-1607 MRS ANN D LYON (C)Holder Reporting Funds (D)Last Transacbm Date ERIE INSURANCE EXCHANGE 12/17/1990 (E)Holder Address and Contact (F)Type of Funds Reported 100 ERIE INSURANCE PLACE REFUNDS/REBATES ERIE PA 16530 (G)Certificate,Policy or Check Number KATHLEEN K KRAVVCZYK 16017688 - (814)870-2130 (H)Amount Reported 3.00 Total Shares Claimed 0.0000 Total Cash Claimed 3.00 RETURN CLAIM FORM AND DOCUMENTATION TO: 100729142 Bureau of Unclaimed Property I P.O. Box 1837 1 Harrisburg,PA 17105-1837 1 1.800.222.2046 Page 5 9110/2013 www.patreasury.gov p H @ •• M L h N@ N C O N ri Q v Ol H L} 4i FC O O-H m m ro @ w M � m Sa L N a u1 > N u N @ Q Cn •• Q @ 3 El Q N •• wH o H r M H W m �v LI N N M H N H O lfl � [L >1 N to L L � L N 0 @ p 2 S-1 W N M W rl L r (J+ a s N H U] C N UN M w � W vro U r r G O L O O O O H p a \ C o 0 0 0 OU G E u�i o mNi a eo o rn y C w a rn � E x r ° U 0 o O O N tll O O O O 4 0 0 0 o p m, N N W m o rn H m @ 7 0 L o O ti X o > o @ It o N M Q1 N lD 1J Ql Q Q J-1 '-I W w m ?i A A m O1 w N N G W a L o a o a o zEl X q E H m s m W a @ E Q b HHJ+ N. W b ✓ ^J H Yp @ 0. O H fk Q l CL E4 C M Cn M U M ,0 > w a H z a H o H o 0. �v JJ EE W O N H W O W X O 'N O 1J W Y1 W N E N N E N O N @ -fl -.4 H r @ l\ H m\ O O\ H\ 1J JJ la .] Z r .7 w W @ r U Nr .7r m U a U W H a N W w a N H N W N W@ U m Q E i\ Q y\ X £ 3\ Q\ W 41 W H a io H '�' a io W l0 H 1p ,r' CnQ W £ O W U1 £ O £ u 2 O W 0 O w O 'rl U N H H H d� C 01 N OOO N r N H UI NNN N O Ol @ \\\ r N r U N io io m @ Sa yr m • N � r N r @ • N u Sa m o 0 0 3 ro.M s, 0 0 a 1J 0 > U E CL p-N ❑ rl H m H U N 0 U] N M M lfl M a FC S-I O @ @ N H L O @ 0 N 'rl u H O H 0 p cl > w F E Aft ,Fide/ilk September 24,2013 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 and/or Alternate Valuation for the Estate of Walter A Lyon with Fidelity Investments. All information in the enclosed valuation report(s)is(are)based on assets in the above listed Fidelity account(s)as of the date indicated on the report(s).Valuation information is provided through a third party valuation service provider. The report does not include values for Options,or Precious Metals held in the account as of the date of death nor some accrued dividends not distributed prior to the date of death. 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 ACCOUNTS: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 KCIK-PR Covington,KY 41015 We hope this information is helpful.If you have any questions about account holdings or need instructions on how to transfer the ownership of the accounts not yet transferred,please visit us at Fidelity.com and search under"Change Account Registration"or call us at 800-544-0003.Fidelity Inheritor Services Representatives are available Monday through Friday from 8:00 a.m.to 6:30 p.m.Eastern time. Sincerely, Fidelity Investments Operations and Services Group Ourfile: W295246-19SEP13 Enclosures: Return Envelope Date of Death Valuation _.„_,,, :D:?.T✓.-=r?7 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 ,Fide/i[y August 21, 2013 SAIDIS SULLIVAN&ROGERS PC ATTN: ELYSE E ROGERS 635 N 12TH ST STE 400 LEMOYNE,PA 17043 Dear Elyse E Rogers: As requested, please find the Date of Death Account Valuation for the Estate of Walter A Lyon. Estate Valuation Account Number: 147255858 Value Date: 06/27/2013 Share Symbol Security Description Qty Value Price BRESX BLACKROCK INTL OPPORT SVC CLASS 50.567 $1,760.22 $34.81 FCNTX FIDELITY CONTRAFUND 21.522 $1,848.75 $85.90 FSDCX FIDELITY SELECT COMM EQUIPMENT PORT 78.928 $2,013.47 $25.51 FSELX FIDELITY SELECT ELECTRONICS 27.429 $1,469.92 $53.59 FNARX FIDELITY SELECT NATURAL RESOURCES 70.541 $2,376.53 $33.69 MXF MEXICO FUND INC 270 $8,091.90 $29.97 PRBLX PARNASSUS EQUITY INCOME PORTFOLIO 136.936 $4,549.01 $33.22 Total Securities: $22,109.80 Cash/Money Markets: $12,137.25 $1.00 Total Value: $34,247.05 DODNEW 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 TIAA GREF SUBSTITUTE FORM 712 FINANCIAL SERVICES FOR THE GREATER GOOD- This statement has been prepared as a substitute for U.S. Treasury Department Form 712 which does not apply to our annuity contracts or certificates since they have no life insurance features. Name of First Annuitant Date of Birth Date of Death Walter A Lyon 6/2611924 6/27/2013 Name of Second Annuitant Date of Birth Date of Death Ann D Lyon 2/12/1927 2/9/2013 Name of Decedent Date of Birth Date of Death Walter A Lyon 6/26/1924 6/24/2013 VALUE OF CONTRACT/CERTIFICATE AT DECEDENT'S DEATH Contract/Certificate Issue Date of the Date of Death Remaining Number Contract/ Value of the Investment in the. Certificate Contract/ Contractl Certificate Certificate TIAA No.: IG694178 10/1/2009 $30,140.67 $1,757.75 TIAA.No.: Y0796808 4/1/2004 $555.95 $0.00 TIAA NO.: Y0796840 4/1/2004 $741.95 $0.00 TIAA No.: Y9092803 5/1/2004 $1,431.83 $0.00 CREF No.: Z0796806 4/1/2004 $687.34 $0.00 CREF No.: Z0796848 4/1/2004 $1,476.83 $0.00 CREF No.: Z9092801 5/1/2004 $1,632.27 $0.00 Notes: The Federal Estate Tax Value (Date of Death Value) of an annuity at death is what it would cost the surviving annuitant or beneficiary to replace the continuing benefits. The value is calculated as of the date of death and therefore does not change. The value does not represent the cash entitlement a beneficiary is due and is used solely for estate tax purposes. TIAA-CREF follows accepted industry standards and procedures in determining the value of payout annuities for the estate of a deceased annuitant. The Remaining Investment in the Contract/Certificate represents any remaining after-tax contributions in the Contract or Certificate owned by the annuitant. The Remaining Investment in the Contract/Certificate is non-taxable to the surviving annuitant or beneficiary when it is paid. The undersigned Beneficiary Services Representative of TIAA-CREF hereby certifies that this statement sets forth correct and true information. Signature Title Date Bette teiar 7 Services Teant Beneficiary Services Team October 1,2013 TIAA-CREF Individual&Institutional Services,LLC Member FfNRA,SIPC. Headquarters: 730 Third Avenue,New York,New York 10017-3206 Tel: 212-490-9000 Helena Urban ICS Customer Care Team LEREIF TIAA-CREF Individual&Institutional Services,LLC Member FD41WSIPC Tel:(800)842-2638 ext.24-5320 Financial Services Fax:(800)914-8922 - December 18, 2013 Cayle Swindler Saidis, Sullivan and Rogers 635 North 12th Street, Suite 400 Lemoyne,PA 17043 Dear Mr. Swindler: I am responding to your November 20 request for information concerning the-settlement of contracts of Walter A.Lyon. Please accept my condolences on the loss of your loved one. It is my pleasure to provide that information to you and thank you for your patience while your request was being reviewed. In my review of Mr.Lyon's records,I verified that at the time of his death on June 27, 2013 he was the annuitant on Lifetime Retirement Annuity contracts. Mr. Lyon had a 10 year"Guaranteed Period" on his contracts that would not expire until September 1, 2019. The guaranteed period was created for the benefit of his beneficiaries. If he passed during that period,the beneficiaries would receive the commuted value in a single sum. I verified that his beneficiaries,they were entitled to 25%each of the commuted value of the contracts. The beneficiaries are: Beneficiary Name Entitlement Percent Nana Lon 25% Clifford Lyon 25% Paul Lyon 25% James Lyon 25% If you have additional questions pertaining to this request,you may contact me directly at (800) 842-2638 ext. 24-5320 from 8:30 a.m.to 5:00 p.m. (ET). For other inquiries, please call our Participant Services Group at(800) 842-2776. Consultants are available weekdays from 8 a.m.to 10 p:m. and Saturdays from 9 a.m. to 6 p.m. (ET). tiaa-cref.org 1670 Broadway,Suite 2200,Denver CO 80202 Additional information on TIAA-CREF products and services can also be found on our website at www.tiaa-creforg. Sincerely, A A 1 464 `— Helena Urban Individual Consultant Customer Care Team Page 2 of 2 �+ •.-vc-Iw- i..f6.30(GMT) LYON pESIGN F.om: Lyon pa¢Ipn A%File/it y. January 24, 2014 d Clifford Lyon N 509 Albright Dr Mechanicsburg, PA 17055-4302 Dear Mr. Lyon: We are writing in response to your request for written confirmation of the v lue of annuity contract 321516990 held i by Ann and Walter Lyon, at date of death. Contract Numf er Contract Issue Date Date of Death �-C OD Value Amount 321516990 02/28/1994 02/07/2013 $ 7.980.31 )r 4 '. 321516990 02128/1994 06/27/2013 $ 9,468.42 Total Cost Basi amount= $15,104_60 If you have qua tions, please call us at 800-544-4374 ext 8028. We are h re to help you Monday through Friday om 8 a.m.to 8 p.m. ET. Sincerely, Jennifer Crowe Inheritor Servic s Associate File number. W 000953-12JUN13 e issued-by-Fidelity investments-L. —_ (FILI), 100 Salem Street, Smithfield, RI 02917,and in New York, by Em Are Fidelity Investments Litre 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 claims-paying ability of the issuing i isurance company. Fidelity Broker ge Services LLC 412544.5 OF IVALTER A. LYON I, 1AIALTER A. LYON, of Lower Allen Township, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last `AU and Testament, hereby revoking all Wills and Codicils by me heretofore made. ITEM L Familv Information. I am married to ANN D. LYON and all references to my wife in this Will are to her. I have four children: CLIFFORD D. LYON, PAUL D. LYON, JAMES D. LYON, and NANCY F. LYON. These are described in this Will as "my children," or as "a child of mine." Any person born to or adopted by issue of mine is to be included as issue of mine. Provided, however, no adopted person shall benefit under this Will unless the order or decree of adoption is entered before the adopted person attains the age of twenty-one (21) years. ITEM II: Instructions in the Event of Death. I direct that I shall be cremated. It is my desire that my family scatter my ashes. I would, however, like to have a marker erected at the Durr-Foster lot in the Ivy Hill Cemetery, 2823 King Street, Alexandria, Virginia. ITEM III: Death Taxes. I direct that all inheritance and estate taxes becoming due by reason of my death, whether payable by my estate or by any recipient of any property, shall be paid by the Law Offices of Saidis Executor out of the residue of my estate, as an expense and cost of Sullivan administration of my estate, except that no taxes shall be charged against any & Rogers gift qualifying for the marital or charitable deduction in my estate. The 635 North 12th S==, Executor shall have no duty or obligation to obtain reimbursement for any s"ncy00 L=moy=,PA 17043 such tax so paid, even though on proceeds of insurance or other property not passing under this Will. Page 1 � ITEM IV: Debts and Final Expenses. I direct the Executor to pay the expenses of my last illness, my legally enforceable debts, and my funeral expenses from the residue of my estate as an expense and cost of administration of my estate. ITEM V: Instructions Re2ardine Elmore County, Alabama Real Estate. If I survive my wife, ANTNT D. LYON, I hereby state that it is my wish, should I die within ten (10) years after the execution of this Will, that the share of wife's real estate located in Elrnore County, Alabama, be contributed to an effort, if there is one, to make the Pea Level on my wife's parents' former property into a historic site. As my children and many others know, when my wife's parents owned their home in Elmore County, Alabama, the Pea Level site was a key meeting site in the civil rights movement. ITEM VI: Taneible Personal Property. (a) Gift of Books and Files. I give all books and files regarding environmental engineering and related history to the Walter Lyon Collection at the Pennsylvania State Archives. (b) Written List. I may leave a written list in my safe deposit box or elsewhere disposing of certain items of my tangible personal property. The Executor shall dispose of items of my personal property as specified in the written list. If no written list is found in my safe deposit box or elsewhere and properly identified by the Executor within thirty (30) days after the probate of my \A7ill, it shall be presumed that there is no other Law Offices of statement or list. Any subsequently discovered list shall be Saidis ignored. Sullivan S Rogers (c) If Wife Survives. If I do not survive my wife, I give 635 North lzeh Street to her all my tangible personal property not set forth in the Suite 400 Lemoyne,PA 17043 written list referenced in paragraph (b), including but not limited to, all of my household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other Page 2 q) i articles of household or personal use or adornment and all policies of insurance thereon. (d) If Wife Predeceases. If I survive my wife, I give any property of the type described in paragraph (c) and not set forth in a written list to my children, to be divided among them as they shall agree. Should there be no agreement, this property shall be divided among my children by the Executor in as nearly equal portions as is deemed practical in the discretion of the Executor, having due regard to the personal preferences of the beneficiaries. ITEM VII: Residue. I give the residue of my estate, not disposed of in the preceding portions of this Will, to my wife, ANN D. LYON, if she survives me. If she does not survive me, I give the residue as follows: (a) Gift to Children. I give SIXTY (60%) PERCENT of the residue my estate to my children, in equal shares. If any of my children do not survive me, the share of my deceased child shall be paid to his or her then living issue, per stirpes. (b) Gift to Grandchildren. I give FORTY (40%) PERCENT of the residue of my estate in equal shares to my grandchildren. My Executor shall establish separate Section 529 Plans (under Section 529 of the Internal Revenue Code) for each grandchild who is under the age of twenty-five (25) years at the time of my Law offices of death. Saidis Sullivan ITEM VIII: Administrative Powers. In addition to & Rogers the powers granted at law, the Executor shall possess the following powers, 633 North 12th$mat each of which shall be construed broadly and may be exercised without court Suim 900 Lemoyne,PA 17043 approval, but in a fiduciary capacity only: Page 3 (a) Retain Investments. To retain any investments I have at my death, including specifically those consisting of stock of any bank even if I have named that bank as the Executor. (b) Vary Investments. To vary investments and to invest in bonds, stocks, notes, real estate mortgages or other securities or in other property, real or personal, without being restricted to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. (c) Division of .Assets. In order to divide the principal of my estate or make distributions, the Executor is authorized to distribute personal property and real property partly or wholly in kind, and to allocate specific assets among beneficiaries so long as the total market value of each share is not affected by the division, distribution or allocation in kind. The Executor is authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, or other obligations, with as wide powers as an individual owner in fee simple. (d) Sell Assets. To sell either at public or private sale any or all real or personal property severally or in conjunction with other persons, and to consummate sale(s) by deed(s) or other instrument(s) to the purchaser(s), conveying a fee simple title. No purchaser shall be obligated to see to the application of the Law Offices of purchase money or to make inquiry into the validity of any sale. Saidis The Executor is authorized to make, execute, acknowledge and Sullivan deliver deeds, assignments, options or other writings as & Rogers necessary or convenient to carry out the powers conferred upon 635 North 12th Street the Executor. Suite 400 Lemoyne,PA 17043 (e) Encumber Real Estate. To mortgage real estate, and to make leases of real estate. Page 4 (f) Borrow Monev. To borrow money from any person, including the Executor, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate and other taxes, and to assign and pledge assets of my estate. (g) Pay Costs. To pay all costs, taxes, expenses and charges in connection with the administration of my estate. (h) Distributions Without Court Order. To make distributions of income and of principal to the proper beneficiaries, during the administration of my estate, with or without court order, in such manner and in such amounts as my Executor deems prudent and appropriate. (i) Vote Stock. To vote shares of stock which form a part of my estate, and to exercise all the powers incident to the ownership of securities. 0) Reorganize. To unite with other owners of property similar to property in my estate to carry out any plans for the reorganization of any company whose securities form a part of my estate. (k) Disclaim. To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a twill, as an appointee under the exercise of a power of Law Offices of appointment, as a person entitled to take by intestacy, as a donee Saidis of an inter vivos transfer, and as a donee under a third-party Sullivan beneficiary contract. & Rogers 635 North 12th Stmet (1) Tax Returns. To prepare, execute and file tax Suite 400 Lu.oync,PA 17043 returns of any type required by applicable law, and to make all tax elections authorized by law. Page 5 i (m) Allocate Expenses. To allocate administrative expenses to income or to principal, as the Executor deems appropriate. However, no allocation to income shall be made if the effect of the allocation is to cause a reduction in the amount of any estate tax marital deduction or estate tax charitable deduction. (n) Employ Advisors. To employ custodians of property, investment or business advisors, accountants and attorneys as the Executor deems appropriate, and to compensate these persons from assets of my estate, without affecting the compensation to which the Executor is entitled. (o) Adjust Basis. To make any adjustment to basis authorized by law, including, but not limited to increasing the basis of any property included in my estate, whether or not passing under this Will, by allocating any amount by which the bases of assets may be increased. The Executor shall be under no duty and shall not be required to allocate basis increase exclusively, primarily, or at all to assets which pass as part of my probate estate as opposed to other property for which a basis adjustment is allowable. The Executor shall allocate basis increase equitably among those beneficiaries receiving property as a result of my death, but shall not be liable to any person, nor subject to removal or surcharge, for any reasonable allocation of basis increase. Law Offices of (p) Compromise Claims. To compromise claims. Saidis Sullivan (q) Other Acts. To do all other acts in the Executor's & Rogers judgment. deemed necessary or desirable for the proper and 635 Noah 12,h Street advantageous management, investment and distribution of the Suite 400 Lemoyne,PA 17043 estate. Page 6 ��L ITEM IX: Beneficiary Under-Age 25. If a beneficiary under the age of twenty-five (25) years is entitled to receive assets under this Will, the person who served as Executor of my estate shall retain those assets as Custodian for the beneficiary under the Pennsylvania Uniform Transfers to Minors Act. The Custodian may receive and administer all assets authorized by law, and shall have full, authority as provided in the Pennsylvania Uniform Transfers to Minors Act to use assets in the manner the Custodian deems advisable for the best interests of the beneficiary. I also designate the person who served as Executor of my estate as successor Custodian of any property for which I am custodian under any Uniform Gifts to Minors Act or Uniform Transfers to Minors Act. ITEM X: Survival. Any person who has died within thirty (30) days of my death, or under such circumstances that the order of our deaths cannot be established by proof, shall be deemed to have predeceased me. ITEM XI: Executors. I make the following provisions with respect to Executors: (a) Primary Executor. I appoint my son, JAMES D. LYON, to serve as Executor. (b) Contingent Executor. In the event that my son, JAMES D. LYON, is unable or refuses to serve as Executor, I appoint my son, CLIFFORD D. LYON, to serve as Executor. In the event that my son, CLIFFORD D. LYOAT, is unable or refuses Law Offices of to serve as Executor, I appoint my daughter, NANCY F. LYON, Saidis to serve as Executor. In the event that my daughter, NANCY F. Sullivan LYON, is unable or refuses to serve as Executor, I appoint my & Rogers son, PAUL D. LYON, to serve as Executor. 635 North 12th Street Suite 400 >,errreyc,PA 17043 (c) Condensation. The Executor shall have the right to receive reasonable compensation for services rendered and reimbursement for reasonable expenses. t Page 7 (d) Standard of Care. No Executor shall be liable or accountable for any loss that may result from the good faith exercise of the authority granted in this Will. (e) Security. The Executor is specifically relieved from the duty of filing bond or entering security. IN WITNESS M-HEREOF, I have set my hand and seal to this, my Last. Will and Testament, consisting of this and the preceding seven (7) pages, at the end of each page of which I have also sent fmy irdtials fore eater security and better identification this S day of 20/L . / G--- (SEAL) WALTER A. LYON By. JP (SEAL) At his d ection (SEAL) Mark of WALTER A. LYON Law Offices of Saidis Sullivan & Rogers 635 North 12th Street Suite 400 Lemoyne,PA 17043 Vise, the undersigned, hereby certify= that the foregoing lVill was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us; who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. n- (SEAL) Residing at ! f SEAL) Residing at Law offices of Saidis Sullivan & Rogers 635 North 12th Street Suite 400 Lemoyne,PA 17043 ACKNOWLEDGMENT COMMONWEALTH OF PENNSTLVANLA ) ) SS: COUNTYOF ^� ) L WALTER A. LYON, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument. as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed_ " .tC/ (SEAL) WALTER A. LYON J By: (SEAL) At hi� directio (SEAL) Mark of'WALTER A. LYON Sworn to and subscribed before Lew offices of me this J (S day of Saidis /1 b 20 L Sullivan & Rogers 635 North 12th Street Suite 400 Otary Pub`e Lemoyne,PA 17043 My Commission Expires: (SEAL) rLMy PAONWEALTN OF PENNSYLVANIA Notarial Seal Elyse E.Rogers,Notary Public emoyne Bom,Cumberland County Commission Expires April 5,2013 Member,Pennsylvania AssoGa:ion--Notaries AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF We, �.� 1�. 4o;w a-k ' and Angel` L. r, rye ia( 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 Testator, WALTER A. LYON, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will 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 Witnesses; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. `ATitn s W' aess Sworn to a d subscribed before me this 7 day of Ivy / 20//0-. Law Offices of Saidis ( L Sullivan Iota>�r Publ' & Rogers 635 North 12th Street My Commission Expires: Suit 400 (SEAL) Lemoyne,PA 17043 COMMONWEALTH OF PENNSYLVANIA Nolan Seal Elyse E.Rogers.Notary Puolic Lemoyne '-' Cumberland County My Commission Expires April 5.2013 Member,Pennsylvanl.Fssociation of hlotaries n3/L7/Llbb 11i:bb 7177958833 PAGE 02/02 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11.96) DEPARTMENT OF REVervue BUREAU OF INDIVIDUAL TAXES HARRISBURG,PA 17128-0801 PENNSYLVANIA rIECEIVCD FROM: INHERITANCE AND ESTATE.TAX OFFICIAL RECEIPT N0. CD 018161 LYON CLIFFORD D 509 ALBRIGHT DRIVE MECHANICSBURG, PA 17055-4302 ACN ASSESSMENT AMOUNT CONTROL NUMBER M 101 $12,800.00 ESTATE INFORMATION: SSN: FILE NUMBER: 2113-0834 DECEDENT NAME: LYON WALTER A DATE OF PAYMENT: 09/20/2013 POSTMARK DATE: 09/20/2013 COUNTY: CUMBERLAND DATE OF DEATH: 05/27/2013 I OTAL AMOUNT PAID; $12,800.00 REMARKS: CHECK# 1006 INITIALS; HMW SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER Law Offices of SAIDIS, SULLIVAN & ROGERS A PROFESSIONAL CORPORATION 635 NORTH 12T STREET,SUITE 400 CARLISLE OFFICE: ROBERT C.SAIDIS LEMOYNE,PENNSYLVANIA 17043 26 WEST HIGH STREET DANIEL L.SULLIVAN TELEPHONE:(717)612-5800-FACSIMILIE(717)612-5805 CARLISLE,PA 17013 ELYSE E.ROGERS EMAIL:attorney@ssr-attorneys.com TELEPHONE:(717)243-6222 JOHN A.FEICHT I, www.ssr-attorneys.com FACSIMILE:(717)243-6486 MARYLOU MATAS ANNA BORRO HAYS Of Counsel DEAN E.REYNOSA STEPHEN L.GROSE TODD F.TRUNTZ SEAN M.SHULTZ REPLY TO LEMOYNE HANNAH w=-GIBSON March 19, 2014 717-612-5801 erogers@ssr-attorneys.com CERTIFIED MAIL R/R/R Register of Wills of Cumberland County One Courthouse Square Carlisle, PA 17013 Re: Estate of Walter A. Lyon File No: 2013-0834 Dear Madam: Enclosed is a check in the amount of $4,600 which represents a payment on account of the Pennsylvania Inheritance Tax for the above-referenced estate. We have received an extension for filing the inheritance tax return. If you have any questions or require additional information, please do not hesitate to contact me. Sincerely yours, Elys E. Rogers cjr Enclosure cc: Clifford D. Lyon ESTATE OF WALTER A LYON 1040 509ALBRIGHTDR ' MECHANICSBURG,PA 17055 60-184/313 66 DATE l _ PAY TO THE �,,// / ORDER OF' r� r Q4 � C%/IC Si d I $ Ile .. - .. 1 .:DOLLARS El METRO BANK FORcf/1iiU IITo 1o401i' !:03 130 1646 : 264366005711' Cynthia Rule From: Cynthia Rule Sent: Wednesday, March 19, 2014 11:44 AM To: RA-InheritanceTaxExt @pa.gov Cc: Elyse Rogers;Cayle Swindler Subject: Estate of Walter A. Lyon Please accept this letter as our request for a 6-month extension of time to file the PA inheritance tax return due to the unavailability of records for the following estate: Estate of Walter A. Lyon File#21-13-0834 SSN: Date of Death: 06/27/2013 Elyse E. Rogers, Esquire Saidis, Sullivan & Rogers 635 North 12m Street,Suite 400 Lemoyne, PA 17043 717-612-5801 717-612-5805 (fax) Cindy Rule I lxgal Assismnt 635 N.12da Street I Suite 400 1 Lemoyne,PA 17043 Phone(717)901-7781 1 Fax(717)612-58051 Email g,tu1&msranQma—m2-- This e-mail may contain runileged,confidential,copyaighted,or other legally protected information. If you are not the intended recipient(even if the e-mail address above is yours),you may not use,copy or retransmit dais email. If you have received this by mistake please notify us by rerun e-mail,then delete. Thank you. Saidis,Sullimn&Rogers'web site is xatv,=sat-attorneys corn To comply with IRS regulations, we advise you that any discussion of federal tax issues in this e-mail is not to be used,and cannot be relied upon by you(i) to avoid any penalty imposed under the Internal Revenue Code,or(ii) to promote,market or recommend to another party any transaction or matter addressed in this e-mail. 1