HomeMy WebLinkAbout08-13-15 (3) � 1505614134
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 28oso� INHERITANCE TAX RETURN 2 1 1 5 0 0 1 5
Harrisbura, PA 17128-oso� RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 2 2 7 2 0 1 4 0 8 3 1 1 9 1 0
DecedenYs Last Name Suffix OecedenYs First Name MI
B A K E R C L A R K S
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FI�ED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return � 2.Supplemental Return � 3.Remainder Return(date of death
Priorto 12-13-82)
� 4.Agriculture Exemption � 5. Future Interest Compromise(date of � 6.Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
Q 7.Decedent Died Testate � 8.Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
� 10.Litigation Proceeds Received � 11.Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13.Business Assets ❑ 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETEO.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
D A V I D H S T 0 N E , E S Q U I R E 7 1 7 7 7 4 7 4 3 5
First Line of Address
4 1 4 B R I D G E S T R E E T
Second Line of Address
f^J
� �
City or Post Office State ZIP Code C � � n
N E W C U M B E R L A N D P A 1 7 0 7 p �� o � �' `'
-ra �7 � :.�7
�_�� �_ �� _: C7
CorrespondenYs e-mail address: D S T 0 N E a�S T 0 N E L A W•N E T -�' '' `�- t--� ' E T�
. � .�
_ . ,-., � , .
REGISTER OF•WILLS USF�NLY';-� -�'1
_ , , , � _rf
REGISTER OF WILLS USE ONLY : �--�
DATE FILED MMDDYYYY f'' t'" f'r1
N �__ p
n � �
. C,!'1
DATE FILED STAMP
PI.EASE USE ORIGINAL FORM ONLY
Side 1
I IIII'I II�'I IIIII III��IIII�IIIII IIIII(I�II IIIII IIIII IIII II�I
� 15�5614134 1505614134 J \
�
� 1505614234
REV-1500 EX(FI)
DecedenYs Social Security Number
�ecedent's Name: C L A R K S • B A K E R
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. •
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2• •
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. •
4. Mortgages and Notes Receivab�e(Schedule D) . . . . . .. . . . . . . . . . . . . . . . . . . . 4. •
5. Cash,Bank De osits and Miscellaneous Personal Pro e 1 2 6 5 2 6 , 2 9
p p rty(Schedule E). . . . . . . 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Biiling Requested . . . . . . . 6. •
7. Inter-Vivos Transfers 8�Miscellaneous N -Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. 1 � 4 0 9 . 8 0
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . .. . . . . . . . . . . . . . . . 8. 1 3 6 9 3 6 . � 9
9. Funerai Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9� 2 7 2 6 5 . 0 5
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 2 1 5 . � 4
��. Total Deductlons(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 7 4 8 � . � 9
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . .. . . . . . . . . . . . . . . . . . . . 12• 1 � 9 4 5 6 . 0 �
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. .
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 1 0 9 4 5 6 . 0 �
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. � . � �
16. Amount of Line 14 taxable
at�inea�rate x.045 1 0 9 4 5 6 . 0 0 �g. 4 9 2 5 . 5 2
17. Amount of Line 14 taxable
at sibling rate X.12 � . ❑ � 17. � . ❑ ❑
18. Amount of Line 14 taxable
at coltateral rate X.15 � • � � 18. � • � �
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 4 9 2 5 . 5 2
20. FI�L IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,i declare 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 person responsible for filing the retum is based on all information of which preparer has
any knowledge.
S ATURE F P SO ESPONSIBLE FO�.FILI G RETURN D TE �
�
A�DRE�S
4 LE RIVE ETTERS PA 17319
ATURE 0 EPA HER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
i
DRESS
41 RIDGE TREET NEW CUMBERLAND PA 17070
I IIII'I III'I IIIII I�I'I IIIII III')IIIII IIIII II�II I'lll'I�I IIII Side 2
� 1505614234 1505614234 J
REV-1500 EX (FI) Page 3 Fiie Number
Decedent's Complete Address: 21 15 0015
DECEDENT'S NAME
CLARK S• BAKER
STREET ADDRESS
1700 MARKET STREET
CITY STATE ZIP
CAMP HILL PA 17011-
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,9 2 S • 52
2. Credits/Payments
A.Prior Payments 4,5 0 0 •0 0
B.Discount 2 3 6 •8 4
(See instructions.) Total Credits(A+B) (2) 4,?3 6 • 8 4
3. Interest
(3) 0 • DO
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) p , ��
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 18 8 • 6 8
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 ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ 0
c. retain a reversionary interest ..................................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ �
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ Q
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the 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)j.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 step-parent 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 decedenPs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS � MISC.
INHERITANCE TAX RETURN
RES�DENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
CLARK S - BAKER 21 15 0015
Incfude 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
� Commonwealth of PA-Annuity check received 1,033• 93
2 Manor Care Nursing Home-refund on living expenses 1,289 • 50
3 PNC Bank-Checking Acct �5140002369 1,374 • 95
Princ $1,374 •95, Int $ .03
4 PNC Bank-Checking Acct #5140002369 - Accrued Int 0 •03
5 PNC Bank-Savings Acct �5��4692596 ?6,838 • 69
Princ $76,838•69, Int $2•69
6 PNC Bank-Savings Acct #50D4692596 - Accrued Int 2 -69
7 Santander-Cert of Deposit #0775547565 10,198 . 64
Princ $10,198.64, Int $2• 43
8 Santander-Cert of Deposit #0775547565 - Accrued Int 2 • 43
9 Santander-Cert of Deposit #7672248278 24 ,962 •88
Princ $24,962 •88, Int $2•18
10 Santander-Cert of Deposit �7672248278 - Accrued Int 2 •18
11 Santander-�hecking Acct #0771027974 4 ,723 • 58
Princ $4,723 • 58, Int $.�4
12 Santander-Checking Acct #0771027974 - Accrued Int 0 • 04
13 Santander-Savings Acct #D74042444 4 ,202 -14
Princ $4,202 •14, Int $ • 61
14 Santander-Savings Acct #074042444 - Accrued Int 0 •61
15 Social Security Adm-check received 1,642 •00
16 United States Treasury-Refund on 2014 1040 return 252 •00
TOTAL(Also enter on Line 5,Recapitulation) 5 12 6,5 2 6 -2 9
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CLARK S • BAKER 21 15 0�15
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPlICABLE) VALUE
� PNC Bank-IRA Acct #65001010493 10,409 •80 100•�0 10,409 . 8�
Princ $10,402 • 47, Int $7• 33 w/Marilyn
L • Vanderzee as benef
TOTAL (Also enter on Line 7,Recapitulation) a 10,4 0 9 •8�
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
CLARK S • BAKER 21 15 �015
DecedenYs debts must be repoRed on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
�. Stone Murray Funeral Home-funeral expenses 10,891• 95
Trinity UM Church-memorial luncheon 296 • 40
Stone Murray Funeral Home-add ' 1 funeral expenses 323•95
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) L e i q h G o a s 6,3 2 6 •��
Street Address 4 5 M a p 1 e H i 11 D r
c;�y Etters State PA ZiP 17319
Year(s)Commission Paid: 2�15
2 AttomeyFees: DaVld H • Stone, Esquire 6,846 • 00
3, Family Exemp6on:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: S e 2 #1 b e 1 o w
5 Aarountant Fees:
g. Tax Retum PreparerFees:
�. Stone LaFaver 8 Shekletski-Reimb for probate costs 360 • 50
2 Stone LaFaver & Shekletski-Reimb for adv in papers 265- 54
3 Stone LaFaver & Shekletski-Reimb for bank fee 2� • 00
4 PA State Employees Ret System-Returned reimb 103 • 39
5 Social Security Adm-return of check 1,642 • 00
6 Check written by decedent prior to death 59 • 32
7 Stone LaFaver � Shekletski-Reimb for filing ITR/Inv 30 • 00
8 Reserve for closing expenses 100 � �0
TOTAL(Also enter on Line 9,Recapitulation) S 2?,2 6 5• 0 5
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8 LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CLARK S • BAKER 21 15 0015
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 DESCRIPTION OF DEATH
� Heartland Pharmacy-debt of decedent 91 •24
2 East Pennsboro Ambulance-services rendered 123 •80
TOTAL(Also enter on Line 10,Recapitulation) 5 215•�4
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CLARK S - BAKER 21 15 0015
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 out n'qht spousal distributions and transfers under
Sec.91�6(a)(1.2).]
� LEIGH A GOAS 1/6 of 5�i of Lineal 8,253•85
45 MAPLE HILL DRIVE residue
ETTERS PA 17319-
2 MARILYN L VANDERZEE Sch G 1 and Lineal 59,932 . 90
45 MAPLE HILL DRIVE 50i residue
ETTERS PA 17319-
3 VICKI KUNKLE 1/6 of 50i of Lineal 8,253•85
1932 CHATHAM ROAD residue
CAMP HILL PA 17011-
4 JEFF VANDERZEE 1/6 of 50i of Lineal 8,253 •85
6510 CARMEN COURT residue
HARRISBURG PA 17112-
5 LISA STARSINIC 1/6 of 50% of Lineal 8,253• 85
2414 PATTON ROAD residue
HARRISBURG PA 17112-
6 KAREN BERQUIST 1/6 of SOi of Lineal 8,253•85
7496 CAMERON DRIVE residue
LARKSPUR CO 8�118-
7 SILK, AIMEE 1/6 of 50X of Lineal 8,253• 85
4033 CHRISTY RIDGE ROAD residue
SEDALIA CO 80135-
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:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. 3
If more space is needed,use additional sheets of paper of the same size.
... .,...r.,.�.:.:�.,.
,�..�.,
.._.,.�.,....,,..�.s..u�,,,��..�..
..>�_.4.�.__;_..__�.�w_.._.__._._.___.._.o_.______
� � _ ... _._..,... _ ..., _ _ ..,,
ST0�1E, I,1FAVER Sc SHEKLETSKI
ATTORNEYS AT LAW
- 4ia BRIDGE STREET
. �TEW CU?IBERL�ND PA 17070
LAST WILL AND TESTAMENT
I OF
I CLARK S. BAKER
I
i
�
�
r CLARK S . BAKER, of Lower Alien Townshi C� �
� p, amLerland County, �
Pennsy�lvania, declare this to be my last will and re�Toke any will I
�
Ipreviously made by me , i
� rT�� � ' I direct `:hat my Executri:� nereinafter riamed snall �
� pay �
iall my just debts and funeral evperlses as soon as ccr.veniently may be
I done after my decease from the resiaue of m I
� �
! y est.ate . �
i
I I"='�,M �I ; I devise and beaueath ��11 -_he rest., residue ar�d i
,
; ;
I remainder of my estate of every natui:e and wherever sit�aate as f '
� ollows : ,
i, F
t�' ��1tY ( ��� ) �er:ent to my daughter, MARTLY^� L. ;
i
I VANDERZEE. !
i
i
� B• E'ifty ( 50� ) percent to my grandchiidren, VICKI KUNKEL, �
I
I JEFF VAPIDERZEE, I,EIGH GOI�S, �ISA STARSINIC, KARE[� BERQUrUT� ar.d ALi�EE
i
� SILK. �
i �
; �
� i
� �'I'�'M III : I appoint my grar.ddaugriter, LEIGH GC;�AS, F:.��cutr.ix of �
i �
�:1�� ;^`✓ _3SL W:. ii . i
i
T T."'�'�M T V: i r +-
i - di ec� that my E�ecutr�:1 r�;:ain Uav", „ . :;tone, ��
�
' �SCiUlr'�, �O dl'.�l' lil T_i1P_ c1C11:11i11S�'�a!=10:'1 ';'- In1J �'St�L�? .
i L� �. .
iT �I I. i�!o ��cluciary act�nq ;^ereunder �ha '_1 pe required to posr_
i
bcr.� o� f� ��� ar �. - t �1
_ '1� SL-'`' 1 ��1 ���i ii@ L�'_t�"lil (Jt'.:'�O�fiiclilCE.' Ui �iiS �Jr� y��,,,
dur:L�s
i � n any -; �;�risdict�on . ;
�
�=aqe 1 oi ,_
t . .
IN WITNESS WHEREOF, I, CLARK S . BAKER, have hereunto set my hand
and seal this �� day of ma'( � 2011 .
,
COF,�MONWEALTH OF PENNSYLVANIA '
`— NOTARIAL SEAL �
KELLY A. BIRDSALL, Notary Public � ,��-,�� ,�b����
New Cumberland Boro.,Cumberland Co.
t�iy Commission Expires June 18, 2013 CLARK S . BAKER
SIGNED, SEALED, PUBLISHED and DECLARED by CLARK S . BAKER, the
Testator above named, as and for his Last Will and Testament, and in the
presence of us, who at his request, in his presence and in the presence
cf each other hav subscribed our names as witnesses .
I
1� `�, — .��"
W1 Address
fL Ql � i� .L�,t,�1('�f1-�-P '(��1NJ f1J�(�b�' (3.�4f�t�
Witness� Address
Page 2 of 2
�
_._.
__. _ . __
� '=a----�. STONE, LAFAVER & SHEKLETSKI
ATTORNEYS AT �,qyy
414 BRIDGE STREET ��
. NEW CUMBERLAND, PA �7070
CODICIL TO THE LA$T WILL AND TESTANlENT
OF
CLARK S. BAKER
I, CLARK S . BAKER, of Lower
Allen Township, Cumberland
County, and Commonwealth of Penns lvania
Sole Codicil to rri y • declare this to be the
y Last Will and Testament dated March 8, 2011 .
TT— uM I� I hereby revoke Ite
Testament and in its m II (A) of my Last Will and
place there shall be a new Item II (A) which
shall provide as follows :
"Item II (A) ; Fift
Y (500) percent, IN TRUST
daughter, MARILYN L. � for my
VANDERZEE, to hold, mana e
the percentage so received, and the accumulat�ion of e nc and reinvest
The Co-Trustees shall distribute so much of °me thereon.
principal of the trust as the Co- the income and the
absolute discretion deem advisable for teS shall in
their sole and
MARILYN L. he support of my daughter,
VANDERZEE, after taking into account all other available
resources and sources of income including entitlement to over
benefits such as Supplemental Security Income, g nment
General Assistance, Medical AssistanCe,
AFDC, Food Stamps, Mental Health/Mental
Retardation Services, Children and Youth Services, Vocati
'-?Phabilitati.on Services, onal
Attendant Care, or any other type of
government benefit or services . It is my intent that this tr
shall supplement and not su ust
pplant otherwise available government
benefits . Upon the death of m
y daughter, N�ARILYN L. VANDERZEE, the
then remaining principal and accumulated income shall b
distributed to such of in e
y grandchildren, VICKI KUNKEL, JEFF
VANDERZEE, LEIGH GOAS, LISA STARSINIC, KAREN BERQUIST a
SIL�:, as are then llving. � nd AIMEE
Page 1 of 2
. ,
My granddaughters, LEIGH GOAS and LISA STARSINIC, or the
survivor of them, shall serve as Co-Trustees . "
ITEM II : In all other respects I hereby ratify, confirm and
republish my Last Will and Testament dated March 8, 2011,
together with this my sole codicil .
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
�°`'1 day of ��.:, ,;, � , 2013 .
� ' , ,
� ��-� �' ��
CLARK S . BAKER
SIGNED, SEALED, PUBLISHED and DECI.ARED by CLARK S . BAKER, the
Testator above named, as and for a Sole Codicil to his Last Will
and Testament, and in the presence of us, who at his request, in
his presence and in the presence of each other, have subscribed our
�
names as �ritn s es .
1�� - � � �: �
�
r-. � -. ,�C.�.L_._� , i"�.
' tne Address
� ���
j %� '�� ���. r- %;,�
--�.;�=./����/,//l ���..f �._�,1 Y�1 r�����y_��_� �"
ness Address �
(
i
� �i
�
i
�
iI I
I
j '
�
�
I Page 2 of 2 �
I
Jan. 29, 2015 10:47RM PNC BANK 412-7Q5-Q057 No, Ob21 P. 2
� �f '�1�
r�nu�y 2s, 2o�s
Stone Lafaver& Shekletski
414 Bridge Street
�ost Office�3ox E
N'ew Cumbe�land pA 17070
R.E; C1ar1�S Balcer
SS�V: 180-03-9639
DOD: 12-27-2014
Dear Sir/Madam:
Yn response to your request for Date of Death(DOD}balances for the custamer nated abo�e, pur�
records sho�the follo�vving
Checlang Account
Account# 51404fl2369 Bstablished: 01-01-1978
CL�K S BA�It
DOD balance: $1,374.95 +0.03 accrued interest
Sa�vings Account
Account# 5004692596 Established: 0$-Q4-20QS
. CLARK S BAKER
DQD balance; $76,83$,69+2.69 accrued interest
T�A Account
Account#65001010493 Established: 08-16-2011
CLARK.S BAT�12
T)O]7 balance: $10,402.47 +7.33 accrued interest
For beneficiary information,please call 1�888-762-4727.
please note that this office provides date of death balances for depos�t accounts(IILAs, CDs, C�ecking and
Savings). 'We do not proeess�ny f5nancial truns�ctions or provi�e statements. Tf you need assistance tivith
any of these items, please call 1-$88-PNC-BANK (1-888-762-2265}or stop by your local PNC Bank branch
affice.
� � L�� �� i s
Sincerely, .
. �'la��l�n � -
N'ational�'inancial Scrvic�s Center �����,.Z�
PN�Baz�,N,A..
Member FDIC .
Page 1 of 2
Jan. 29, 2015 10.47AM PNC BANK 412-705-0057 No, 0621 P, 3
This message is intended for the a.ese of the indivrc�uczl or entity to whic� ir is addressed and may
contairi Ynforrnatiora that is�riv�1'eged, cpn,f�G�entiC�l and exempt fr�om diSCl�sure under applicable law. �
If the read'er of this message is�ot the intended recipient or t�ie employee or crgent responsible for
delivering thas message to the intended recipient, yoac are hereby noti.f'ied that any disseminatfos�,
distribution or copying of this communicatior�s is strictly prohibited. 1'f yo�e have receivec�'this
communication in error,please rzotify�ne irr�rraediately by reply or by te7ephone arr$DO-76"2-1775 and
immediately destroy thfs fcxxed document.
1'age 2 of 2
1 I �
January 30, 2015
David H. Stone, Esq.
Stone LaFaver& Shekletski
414 Bridge Street
P.O. Box E
New Cumberland, PA 17070
RE: Estate of CLARK S BAKER
Date of Death: 12/27/2014
Dear Sir or Madam:
Per your request, enclosed please find the account information as of the date of death for the above-named
decedent. For your information, accrued interest is not included in the date of death balance.
Please feel free to contact me if I can be of any further assistance (617)514-5189.
Very truly yours,
C�.,h.�, �v-����.� _-�
Ashley Nobreg �
Santander Bank, N.A
Decedent Processing/MA1-M63-02-10
P.O. Box 841005
Boston, MA 02284
Enclosures
Santander
ESTATE OF: CLARK S BAKER
SOCIAL SECURITY#: 180-03-9639
DATE OF DEATH: 12/27/2014
Account#: 0771027974 Ty p e: C H E C K I N G (I N T E R E S TOpen date: 06/07/1993
BEARING)
in the name of: CLARK S BAKER (LEIGH A GOAS POA)
Date of death balance: $4,723.58
Int.(YTD)from: 01/01/2014 To: 12/05/2014 $0.31
Accrued interest to date of death: $0.04
Otherinfo:
Account#:0774042444 Type: SAVINGS Open date: 06/07/1993
In the name of: CLARK S BAKER (LEIGH A GOAS POA)
Date of death balance: $4,202.14
Int.(YTD)from: 01/01/2014 To: 12/01/2014 $14.25
Accrued interest to date of death: $0.61
Other info:
Account#: 0775545528 Type: RETAIL STATEMENT CD Open date: 11/23/2009
In the name of: CLARK S BAKER
Date of death balance: $0.00
int.(YTD)from: 01/01/2014 To: 12/01/2014 $9.28
Accrued interest to date of death: $0.00
Other info: Closed 11/29/2014
Account#: 7672248278 Type: RETAIL STATEMENT CD Open date: 09/30/2011
In the name of: CLARK S BAKER
Date of death balance: $24,962.88
Int.(YTD)from: 01/01/2014 To: 11/30/2014 $38.69
Accrued interest to date of death: $2.18
Other info:
Account#: 0775547565 Type: RETAIL STATEMENT CD Open date: 11/14/2011
In the name of: CLARK S BAKER
Date of death balance: $10,198.64
Int.(YTD)from:01/01/2014 To: 11I30/2014 $29.79
Accrued interest to date of death: $2.43
Other info:
Page 2/2