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Home My WebLink About07-08-05 REV .1'" Ex. (&-01. I!! ll::S~ Ull:ll: IIIlL8 :z:fiL.. UlLlIl lL C *' OFF-'IC1AL USE ONL Y REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT RLE NUMBER 21 05 00127 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95 THIS SEenON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENllAL TAX INFORMA11ON SHOULD BE DIRECTED TO: AME COMPLETE MAILING ADDRESS Craig A. Diehl, Esquire I 't:~~=)craig A. Diehl ---u--------1 3464 Trindle Road -----1 Camp Hill, PA 17011-4436 COMMONWEAl. TH Of PENNSYlVANIA DEPARTMENT Of REVENUE DEPT. 280601 HARRISBURG. PA 1712~1 .. Z III 51 U III Q DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) Yarlett, Mary L. DATE'OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 01/20/2005 I 02/21/ 1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL) Yarlett, Lester H. 1. Original Return o 4. Limited Estate ~ o 6. Decedent Died Testate (Attach copy of Wilt) 9. Litigation Proceeds Received ... ~z 11I11I ll:Q ll:z 00 UlL LEPHONE NUMBER 717/763-7613 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) z o i= :s => .. iL c U III It: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 204-03 -203 8 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 189-09-4964 D' 3. Remainder Return (date 01 death prior 10 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Electioolo tax under Sec. 9113(A) (Attach Sell 0) (1) None (2) None -_...._._---_.__._..,_.~.~- .._-~._---- (3) None (4) None (5) 2,827.34 (6) 353.08 (7) 117,522.11 OF"ICIAL USE ONLY (8) 120,702.53 (9) 8,881.25 --~---~,~-- (10) 1,889.34 (11) 10,770.59 109,931.94 (12) (13) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 109,931.94 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 1,902.59 20. ~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1,902.59 >> BE SURE TO ANSWER ALL QUES110NS ON REVERSE SIDE AND RECHECK MATH<< Copyright 2000 form software only The Lackner Group, Inc. 15. Amount of Line 14 taxable at the spousal tax rate, 67,652.26 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 42,279.68 .045 (16) ~ 16. Amount of Line 14 taxable at lineal rate x ~ => lL 17.Amount of Line 14 taxable at sibling rate x .12 (17) :I 0 U ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) _..._--,~~_.._--,-----------_..._---_._-~~ 19. Tax Due (19) Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 529 Dogwood Drive CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: i. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 1,902.59 2,000.00 95.13 Total Credits (A + 8 + C) (2) 2,095. I3 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 ------~._-_.._-- 192.54 0.00 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;.................................................................................. ~ I :: ~::~ ~h~~::i:::~s:~;e:s~~..~~~.I~.~~~.~~~.:.~~.~~~~~~~~~~..~.~.~..i~~~~~:::::::::::::::::::::::::::::::::::: d. receive the promise for life of either payments, benefits or care?............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. .................................... .......... .... ....................... ............................................ 0 ~ 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 contains a beneficiary designation?..................................................................................................................... ~ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE 40 Carroll Drive Dillsburg, P A 17019 7-/-05 DATE ADDRESS 831 Hig!lland Court Mechaiiicsburg, P A 17050 ADDRESS A 3464 Trindle Road Camp Hill, PA 17011-4436 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a surviving spouse from tax, and the statutc-- ---":~_An." fn. rti..r-Jnsure 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: U iJ e.. 30. co The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at de '"'Pd '\ parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)]. ~D . CJ;::) AP.D The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, E 1.2) [72 P.S. ~9116 (a) (1)]. to .<::},:) The tax rate imposed on the net value oftransfers to or for the use ofthe decedent's siblings is 12% [72 P.S. ~91 ---.)1.\..l1 ~ "M'" See",,, 9102, " ,. ...""..., who h" ot - 0"" pa<ent ;. """moo ..... "'e __em, wh""'" hy b~od - ~"""' .# Lf J.j () *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COhNONWEALlH OF PENNSYLVANIA INHERITANCE TAX REllJRN RESIDENT DECEDENT I FILE NUMBER ~-------- 21 - 05 - 0012?___~ ESTATEOF Y I M L ar ett, ary . Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 25.00 Member's 1st Federal Credit Union Regular Savings Account # 246391-00 Account value at date of death See correspondence attached hereto as Exhibit E. 2 Miscellaneous personal property 1,000.00 3 Penn Treaty Insurance - Refund oflong term care premium 182.34 4 Penn Treaty Insurance - Long term care claim payment 1,620.00 TOTAL (Also enter on Line 5, Recapitulation) 2,827.34 . SCHEDULE F JOINTLY -OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Yarlett, Mary L. I FILE NUMBER 21 - 05 - 00127 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A Earl E. Yarlett ADDRESS RELATIONSHIP TO DECEDENT 40 Carroll Drive Dillsburg, P A 17019 Son JOINTLY OWNED PROPERTY: ITER DATE DESCRIPTION OF PROPERTY %OF Include name of financial Institution and bank account number DATE OF DEATH DATE OF DEATH R JOINT MADE DECD'S VALUE OF NANT JOINT or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENTS INTEREST estate. ------------ -- ---.---. A 10/05/1993 PNC Savings Account 2,114.16 16.7% 353.06 # 5080016733 Also joint with spouse, Lester Yarlett Date of death valuation per PNC correspondence attached hereto as Exhibit F A 10/05/1993 PNC Savings Account 0.09 16.7% 0.02 # 5080016733 I Also joint with spouse, Lester Yarlett Accrued interest on account per PNC correspondence attached hereto as Exhibit F I 1 , I ! I I ~____n --~~-_. --~-- -.. --- ITEM LE NUMBER FO TE 2 TOTAL (Also enter on line 6, Recapitulation) 353.08 . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Yarlett, Mary L. FILE NUMBER 21 - 05 - 00127 This schedule must be com leted and filed if the answer to an of questions 1 throu ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF Include the name of the transfer1Ie. their relationship to decedent and the date of transfer. VALUE OF ASSET DECO'S EXCLUSION TAXABLE VALUE NUMBER Attach a copy of the deed lor real estate. INTEREST (IF APPLICABLE) ING USA Annuity and Life Ins. Co. 29,916.60 100% 29,916.60 909 Locust Street Des Moines, IA 50309 Annity Contract # 489023 Beneficiary: Estate of Lester H. Yarlett See correspondence attached hereto as Exhibit G. 2 ING USA Annuity and Life Ins. Co. 18,208.38 100% 18,208.38 909 Locust Street Des Moines, IA 50309 Annity Contract # 481748 Beneficiary: Estate of Lester H. Yarlett See correspondence attached hereto as Exhibit G. 3 ING USA Annuity and Life Ins. Co. 18,149.20 100% 18,149.20 909 Locust Street Des Moines, IA 50309 Annity Contract # 452632 Beneficiary: Estate of Lester H. Yarlett See correspondence attached hereto as Exhibit G. 4 Allianz Life Insurance Co. of North America 30,482.15 100% 30,482.15 P.O. Box 59060 Minneapolis, MN 55459 Annuity Contract # 7310444 Contingent Beneficiary: Earl E. Yarlett See correspondence attached hereto as Exhibit G. 5 Allianz Life Insurance Co. of North America 7,376.14 100% 7,376.14 P.O. Box 59060 Minneapolis, MN 55459 Annuity Contract # 7365474-2A I Contingent Beneficiary: Earl E. Yarlett See correspondence attached hereto as Exhibit G. Total of Continuation Schedule(s) L 13,389.64 117,522.11 TOTAL (Also enter on line 7, Recapitulation) 'OMMO~"""'y=-lN~ INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued ESTATE OF ITEM NUMBER 9 Yarlett, Mary L. FILE NUMBER 21 - 05 - 00127 6 ThIs schedule must be com leted and filed If the answer to an of uestlons 1 throu DESCRIPTION OF PROPERTY DATE OF DEATH % OF Include the name 01 the 1r8nsferee, their reIaIionShip \0 decedent and the date oIlr8nsfer. VALUE OF ASSET DECO'S Attach 8 copy 01 the _ for real estete. INTEREST Member's 1st Federal Credit Union 14,791.23 100% Certificate of Deposit # 246391-40 Valuation at date of death Account placed into joint names w/ Earl E. Yarlett on 6/18/04. See correspondence attached hereto as Exhibit G. 11,791.23 EXCLUSION (IF APPLICABLE) TAXABLE VALUE 3,000.00 7 Member's 1st Federal Credit Union Certificate of Deposit # 246391-40 Accrued interest at date of death See correspondence attached hereto as Exhibit G. 28.411 100% 28.41 8 Member's 1st Federal Credit Union Certificate of Deposit # 246391-41 Value at date of death Account placed in joint names with Earl E. Yarlett on 6/18/04. See correspondence attached hereto as Exhibit G. 1,568.30 1,568.30 100% Member's Ist Federal Credit Union Certificate of Deposit # 246391-41 Accrued interest at date of death See correspondence attached hereto as Exhibit G. 1. 70 100% 1.70 I ~-- LJ Page 2 of Schedule G . j SCtfiU..E H R..N:RALEXPeeES& Al:MtSTRATNECOSTS COMMONWEAl. TH 01' PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 05 - 00127 ESTATE OF Yarlett, Mary L. ITEM NUMBER -. A. B. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT FUNERAL EXPENSES: Myers Funeral Home - Funeral pre-arranged 2 Gingrich Memorials - Headstone engraving 72.50 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): I Sbeet Add.... 2. 3. City Year(s) Commission paid Attomey's Fees Law Offices of Craig A. Diehl 4,898.55 3,500.00 State _ Zip Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Lester H. Yarlett Street Address 529 Dogwood Drive City Mechanicsburg Relationship of Claimant to Decedent State P A Husband Zip 17055 4. Cumberland County Register of Wills 74.00 Probate Fees 5. Accountant's Fees 6. [Tax Retum Preparer's Fees i 7. 1 Other Administrative Costs Cumberland Law Journal - Estate advertisement 75.00 2 The Carlisle Sentinel - Estate Advertisement 144.29 Total of Continuation Schedule(s) 116.91 TOTAL (Also enter on line 9, Recapitulation) 8,881.25 . ScheelE H FmeraI Expenses & M.......CllNeCastsconlftJed COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Yarlett, Mary L. I FILE NUMBER 21 - 05 - 00127 3 Law Offices of Craig A. Diehl- II2 certified mail fee for Dept. of Welfare inquiry 2.21 4 Depamnent of Vital Records - Additional death certificates and processing fees 74.00 5 Fry Communications - 1/2 newspaper advertisement fee for sale of scooters 5.70 6 Cumberland County Register of Wills - Filing fee for PA 1500 15.00 7 Cumberland County Register of Wills - Filing fee for Family Settlement Agreement 20.00 I L Page 2 of Schedule H *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS CONMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT oeCEDENT I FILE NUMBER ________~_ 21 - 05 - 00127 ESTATEOF Y I M L ar ett, ary . Include unreimbursed medical expenses. ITEM NUMBER I DESCRIPTION AMOUNT 1,864.00 Messiah Village - Final bill for nursing care 2 Alert Phannacy - Prescription bill 15.28 3 Internists of Central P A - Medical bill 10.06 TOTAL (Also enter on Line 10, Recapitulation) 1,889.34 REV-1513 EX+ (1-00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 05 - 00127 ESTATE OF Yarlett, Mary L. -~_.. --- RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERlY DECEDENT OF ESTATE ..-------- I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Earl E. Yarlett Son $2,000 Cash, Joint 40 Carroll Drive AccoWlts,Annuities Dillsburg, P A 17019 Plus 1/3 Estate Residue 2 Dennis Yarlett Son 1/3 Estate Residue 211 Mulberry Drive Mechanicsburg, P A 17050 3 Rhonda Grove Granddaughter 1/6 Estate Residue 6 Links Mobile Home Park, Lot 31 Mechanicsburg, P A 17050 4 Carol Ann Lippert Granddaughter 1/6 Estate Residue 1168 Kingsley Road Camp Hill, P A 17011 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS i TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET EXHIBIT E fvl~ MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joir.t O'tmer 246391 -00 06/18/2004 $25.00 $.00 $25.00 ~Jonc CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 246391 -40 06/18/2004 $14,791.23 $28.41 $14,819.64 Earl E. Yarlett 06/18/2004 246391 -41 06/18/2004 $1,568.30 $1.70 $1,570.00 Earl E. Yarlett 06/18/2004 M8MBERS 1ST FEDERAL CREDIT UNION I . " //1/ I /'\~(' ::.'"1 j//'. Denise A. Wolfe /, ~~ Insurance Services Supervisor February 28, 2005 Estate of: MARY L. Y ARLETT Date of Death: 01/20/2005 Social Security Number: 204-03-2038 - ._----_._----_...._._-------_.__..-_._~--,._.~-------~_._----~~-~------,._'~-~-_._----_.~-~._--~-----~_._-_.- S()()() Louise Drive . Po. Box 4() . Mechanicsburg. Pennsylvania 170SS . (717) 697-1161 . www.J1lembers I st.org EXHIBIT F FEB-16-2005 22:24 PNCBANK 412 768 3458 P.01 o PNCBAN< February 17, 2005 Craig a Diehl Attorney at Law 3464 Trindle Rd. Camp Hill, P A 17011-4436 scp RE: Estate of Mary L Yarlett (Deceased) SSN: 204-03-2038 DOD: 01-20-2005 Dear Mr. Diehl: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5070069612 Established 05-02-1991 LESTER H Y ARLETT MARY L Y ARLETT DOD balance: $613.18 + $O,07accrued interest Savings Account Account #5080016733 Established 10-05-1993 MARY L Y ARLETI OR LESTER H Y ARLEIT OR EARL E Y ARLETT DOD balance: $2,114.16 + $0.09 accrued interest Please note that this office only provides date of death balances for deposit accounts (1RAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank: branch office. Sincerely, ~ ;;<P. ~~ Erica L Schlegel 1-800-762-1775 P7 -PFSC-04-F 500 First Ave. Pittsburgh P A 15219 Member FDIC EXHIBIT G ING March 3, 2005 Estate Of Lester H Varlett C/O Law Office Of Craig Diehl 3464 Trindle Road Camp Hill, PA 17011 Re: 489023 - Mary & Lester Varlett Dear Beneficiary: Enclosed is a check in the amount of $30,016.10, which represents the claim proceeds from this contract. The check consists of the Accumulation Value of the contract as of the date of death, plus additional interest from January 20, 2005 to March 2, 2005. The amounts are shown below: Accumulation Value $ 29,916.60 Interest $ 99.50 Federal Income Tax $ State Income Tax $ Total Benefit $ 30,016.10 Early next year, you will receive a Form 1099-R that will provide additional information. If we may be of service to you in the future, please call our Customer Service Center at 1-800-369-5303. Sincerely, Sabra Hess, ACS Claims Examiner Enclosure 909 Locust Street Des Moines, IA 50309-2899 ING March 3, 2005 Estate Of Lester H Yarlett C/O Law Office Of Craig Diehl 3464 Trindle Road Camp Hill, PA 17011 Re: 481748 - Mary & Lester Yarlett Dear Beneficiary: Enclosed is a check in the amount of $18,268.94, which represents the claim proceeds from this contract. The check consists of the Accumulation Value of the contract as of the date of death, plus additional interest from January 20, 2005 to March 2, 2005. The amounts are shown below: Accumulation Value $ 18,208.38 Interest $ 60.56 Federal Income Tax $ State Income Tax $ Total Benefit $ 18,268.94 Early next year, you will receive a Form 1099-R that will provide additional information. If we may be of service to you in the future, please call our Customer Service Center at 1-800-369-5303. Sincerely, Sabra Hess, ACS Claims Examiner Enclosure 909 Locust Street Des Moines, IA 50309-2899 ING March 4, 2005 ESTATE OF LESTER H Y ARLETT C/O LAW OFFICES OF CRAIG A DIEHL 3464 TRINDLE ROAD CAMP HILL PA 17011 Re: 452632-Mary L. Yarlett To Whom it May Concern: Enclosed is a check in the amount of $18,208.39, which represents the claim proceeds from this contract. The check consists of the Commuted Value as of 2/4/05, plus additional interest from February 4, 2005 to March 3, 2005. The amounts are shown below: Commuted Value Interest Federal Income Tax State Income Tax Total Benefit $18,149.20 $59.19 $0.00 $0.00 $18,208.39 Early next year, you will receive a Form 1099R form that will provide additional information. If we may be of service to you in the future, please call our Customer Service Center at 1-800-369-5303. Sincerely, !4/'~ ()~1 Craig Wigton, FLMI, ACS, ALHC Claims Department Annuity Services ... Enclosure 909 Locust Street Des Moines, IA 50309-2899 Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, MN 55459-0060 800/950-1962 Allianz @) March 2,2005 ESTATE OF MARY L YARLETT C/O LAW OFFICE OF CRAIG DIEHL A TTEN: SHELLY KUNKEL 3464 TRINDLE ROAD CAMP HILL PA 17011-4436 Re: Mary L Yarlett, deceased Annuity Policy Number 7310444 & 7365474 Dear Executor: This letter is in reference to your request for a date of death value on the above policy. Please be advised that the Cash Surrender Value as of January 20, 2005: Policy Number Issue Date Initial Premium Cash Value 7310444 7/2/01 $30,000.00 $30,482.15 7365474 9/25/01 $6,000.00 $7,376.14 Should you have any questions, please feel free to contact our office. Thank you. Sincerely, ~~~ Cindy Drawert Claim Examiner If you are an Illinois Resident: Part 919 of the Rules of the Illinois Department of Insurance governing claims practices requires that our company advise you that you may express any concerns with the Illinois Department of Insurance. It maintains a consumer division at 100 W Randolph Street, Suite 9-301, Chicago, Illinois 60606 and at 320 West Washington Street, Springfield, Illinois 62767. '.!'~ 'l:I MEMBERS 1st FqYI::;f~ l\! ('P Fnn T INfO".! REGULAR SAVINGS ACCOUNT: .Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest 246391 -00 06/18/2004 $25.00 $.00 $25.00 ~Jame of Joint C)'.,Vner :'Jonc CERTiFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 246391 -40 06/18/2004 $14,791.23 $28.41 $14,819.64 Earl E. Yarlett 06/18/2004 246391 -41 06/18/2004 $1,568.30 $1.70 $1,570.00 Earl E. Yarlett 06/18/2004 MEMBERS 1ST FEDERAL CREDIT UNION ./ Denise A. Wolfe Insurance Services Supervisor February 28, 2005 Estate of: MARY L. Y ARLETT Date of Death: 01/20/2005 Social Security Number: 204-03-2038 'l(il)(I[')llISl' l'rIV,' < I',). Bt1:, --III " f\lkch,IIlJc:hlln.'" J\'llllSvlv;l1l1.l 171)S') . (717) r,'n-I 11,1 " \Vww.Jl1(')]jl'LTsisl.()r~ fuast lIill ann ll.estam.ent OF MARY L. YARLETT BE IT REMEMBERED, that I, MARY L. YARLETT, of 529 Dogwood Drive, Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my husband, LESTER H. YARLETT, absolutely, provided he survives me for a period of thirty (30) days. ITEM 3: Should my husband, LESTER H. YARLETT, fail to survive me for a period of thirty (30) days, or should we die simultaneously, I then give, devise and bequeath my entire residuary estate as follows, to wit: (A) I give the sum of Two Thousand Dollars, to my son, EARL E. YARLETT, providing he survives me. (PI I give the remainder of my estate unto my three son s , RONALD L. YARLETT I EARL E . YARLETT and DENNIS L. YARLETT, in equal shares, per stirpes. CZ9~ESS, : ~ r--. , t;-f~ 721 ~ vt -ifEdA~ff MARY /' YAR TT (SEAL) --......--:--.'" '../ '/ " ' , -1- ITEM 4: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my husband, LESTER H. YARLETT, as Executor of this my Last will and Testament. Should my husband predecease me, fail to qualify, cease to act or renounce probate, I then appoint my three sons, RONALD L. YARLETT, EARL E. YARLETT and DENNIS L. YARLETT, as alternate Co-Executors of this my Last will and Testament. ITEM 6: I direct that my Executor or his successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal I ~'./ this ~ day of .:' :. J, (' , 2000. (7': 't-') ""'" LfJ-'-] )1Jq7 /~4~R;~ MARY . Y ETT (SEAL) ~ ~'. ~:...L..L-L.I ( I/o ! j' <('I ( /c', -2- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We, MARY L. YARLETT, JAN M. WILEY, ESQUIRE and PATRICIA A. BELLUSCIO, the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last will and Testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed this Last will and Testament ~s witness and that to the best of their knowledge the Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ".,.... 0' /' ./, T'''- . - ;',' ~ WITNESS Sworn to and subscribed before me this i /' . '", /. /' day of , 2000. /! /1,. Ii /, ~( / , 'i ' / /' -~/ / ,.'~ I NOTARY PUBLIC MY COMMISSION EXPIRES: " Nn!;~Hjal SHAl I,' S Dawn ni,:;,;e'\ler, Notary Publi( Dillsburn \>.,' York County I My Commisslorl hpdAs May 17, 2001 ember, ennsylvania Association of Notaries