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HomeMy WebLinkAbout08-24-05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 REV-1 162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT DITZEL RICHARD L 247 WEBSTER STREET CARLISLE, PA 17013 n_~___~ fold ESTATE INFORMATION: SSN: 201-18-2239 FILE NUMBER: 2105-0039 DECEDENT NAME: DITZEL B JANE DATE OF PAYMENT: 08/24/2005 POSTMARK DATE: 08/24/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/14/2004 NO. CD 005724 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,301.00 I I I I I I I I TOTAL AMOUNT PAID: $3,301.00 REMARKS: CHECK# 109 INITIALS: MW RECEIVED BY: SEAL REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS OFFICIAL USE ONLY 217 RE1m 5<<Xl8< (&<Uo) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128.0601 FilE NUMBER 21-05-0039 COUNTY CODE YEAR I- Z W C W U w C DECEDENrs NAME (LAST. FIRST, AND MIDDLE INITIAL) B. Jane Ditzel DATE OF DEATH (MM-DD-YEAR) 201-18-2239 THIS RETURN MUST liE FIlED IN DUPLICATE Willi THE SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD- YEAR) 12/14/2004 8/6/1925 (IF APPLICABLE) SURVIVING SPOUSE'S NAME {LAST, FIRST, AND MIDDLE INITIAL) NUMBER REGISTER OF WILLS SOCIAL SECURITY NUMBER 02. SupplementalRelurn 03. RemainderRelUn'I(dateofdeatnpoiorto12_1J.82) D4a. Future Interesl Compromise (date ofdealh after 12-12-82) 05. Federal Estate Tax Return Required D 7. Decedent Maintained a living Trusl (AtlaCh copy ofTrusl) -..L 8. Tolal Number of Safe Deposit Boxes 010. Spousal Poverty Credtt (dale otdealll between 12-31-91 and 1-1-95) 011. Electkm \0 tax untler Sec. 9113{A) (Altach Sch 0) '~NfQ,f:lt;(~'tION SHOULDaE DIRECTED TO: COMPLETE MAILING ADDRESS 5 South Hanover Street Carlisle PA 17013 I- Z W C z ~ ffi '" '" o u I" ~~~ u~~ woo %~~ u~.. " OrlginaJReturn Limited Estate Decedent Died Testate (Attach copy of Will) Litigation PrOCeedS Received Robert M. Fre FIRM NAME (Jf Applicable) 717 243-5838 1. Real Estate (Schedule A) {1INONE (21 NONE (31 NONE (4) NONE (5) (6) (7) (8) (9) 18.545 22 2. Stocks and Bonds (Schedule B) -;0 -n "'1-' '0 --: ~:;; 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. MortgClges & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 28.461 -" 48,482 z o i= .. ... =' I- 0: .. u w '" 6. Jointly Owned Property {Schedule F) Dseparate Billing Requested 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property (Schedule G or L) 63.129 8. TOTAL GROSS ASSETS (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) :10) 11. TOTAL DEDUCTIONS (total lines 9 & 10) (11) 12. NET VALUE OF ESTATE (LineS minus Une 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (12) (13) 14. Net Value Subject to Tax (Une 12 minus Line 13) {141 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= ~ =' lL :IE o u )( ~ 15. Amount of Une 14 taxable at the spousal tax rate ,or transfers under Sec.9116 (a}(1.2) (151 x .0 x .0 16. Amount of line 14 taxable at lineal rate (16) 121.505 X .12 17. Amount of Line 14 taxable at Sibling rate (17) x .15 (18) 18. Amount of line 14 wx.able at collateral rate 19. Tax Due (19) 200 -, : '" . '~,,' ' -~:: -'''' "I-~ I i ~~::!~j~~ l~' Y;ll- />lQ\V~;J;t- ",\"{ tJI:;t~~1 - OFFICIAL USE ONLY ..., = = en ;C~ c::: ", N r -rJ !'" W W -:0 ;..,.1 c:, C) ::TJ CJ r,' CJ o .\' --q ...-=j m ....) "n 140,072 1B.567 121,505 o 121.505 o o 14.581 o 14.581 ~~ ;217 B. Jane Ditzel 201-18-2239 Decedent's ComDlete Address: STREET ADDRESS 247 Webster Street CITY I:TATE I~IP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 10,716 564 Total Credits (A + B + C) (2) 3. InteresVPenalty if applicable D.lnterest E. Penalty 4. TotallnteresVPenalty (D + E 1 If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund (3) o 5. (4) 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) B Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 14,581 11,280 o 3,301 3,301 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 2. Did decedent make a transfer and: 8. retain the use or income of the property transferred; b. retain the right to designate who st\all use the property transferred or its income; c. retain a reversionary interest; or d. receive the promise for life of either payments, benefits or care? If death occurred after December 12, 1982.did decedent transfer property within one year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Yes o o o o o o 3. 4. Did decedent own an Individual Retirement Account, annuity or other non-probate property which contains a beneficiary designation? o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. o No o o o o o o DATE ADD S 247 Webster Street, Carlisle, Pennsylvania SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE tU...r k~ ~ ~.tJ 0 S ADDRESS DATE III ~<fJ ,{ 5 South Hanover Street, Carlisle, Pennsylvania 17013 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 tor the use of the survMngspouse is 3% 172 P.S. Section 9116 (a)(1.1)(i)]. For elates of death on or after January 1, 1995, the taxrale imposed 00 the net \lalue of transfers to or forme use of !he surviving spouse is 0% 172 P.S. Seclion 9116 (a)(1.1)(ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a lax return are still applicable even if the surviving spouse is the only bendlclary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one 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%[72 P.S. Section 9116(a)(1.2)]. The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P.S. Section 9116(a)(1)] Tne tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P$ Section 9116(a)(1.3)) .A sibling is defined, under Section 9102, as <In individual who has at least one parent in common with the decedent, whether by biood or adoption. 217 REV-150B EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF B. Jane Ditzel FILE NUMBER 21-05-0039 Include the proceeds of litigation and the date the proceeds were received by the estate. All nronArtv iointlv-owned with rll'lht of survivorshin must be disclosed on Schedule F. ITEM NUMBER 1 2 3 4 5 6 7 DESCRIPTION Citizens Bank, Time Deposits #6244693316 Citizens Bank, Checking Account #6100728250 Citzens Bank, Checking Account #6203268163 Household Contents Automobile Refund, State Farm Mutual Automobile Insurance Co., #68681620E11-38B Refund, Aflac VALUE AT DATE OF DEATH 10,358 1,779 11,682 400 4,000 232 10 TOTAL (Also enter on line 5, Recapitulation) $ (If more soace is needed. insert additional sheets of the same size) 28,461 ~ CITIZENS BANK Account Number 6203268163 Account Title B JANE DITZEL Date Opened 9/28/2004 Account Type CheckinlZ Principal Balance as ofDOD $11682.25 Interest from Last PostinlZ to DOD $.00 Account Balance as ofDOD $11682.25 YTD Interest to DOD $21.09 +~ CITIZENS BANK Account Number 6244693316 Account Title B JANE DITZEL Date ODened 11/5/2004 Account Tvoe Time Deposits PrinciDwBw~ce~ofDOD $10349.66 Interest from L~t Postinll to DOD $8.68 Account Bw~ce ~ ofDOD $10358.34 YTD Interest to DOD $26.03 +: CITIZENS BANK Account Number 6100728250 Account Title B JANE DITZEL Date Opened ll/4/1974 Account Type Checking PrincipwBw~ce~ofDOD $1778.95 Interest from L~t Posting to DOD $.00 Account Bw~ce ~ ofDOD $1778.95 YID Interest to DOD $.00 ''AQ/ ~ .., -- '. 3' ~ ;t A ~ r"i '-...-/ ,~ 1 -t d s::::;< ~ -=t " " 'Ii ),,\ ~. l' ,;' ....,-.. " .'..."...;'.';;,;; ,'" ,'. . . . ... '.'J.'~ . . _.' ' .:;~t ~.. . "..' ,. \ .. '-'.- .> -', ...~ \ ,- - Stale Farm Mutual Automobile Insurance Company '116 State Fann Dr ConcorclvIHe PA 19339 ~ _~ If\D4, 00220 6256 5 52E 95749-5-E mZEL, B JANE 247 WEBSTER ST CARLISLE PA 17013-2027 AGENT JON FETTERMAN 805 E HIGH STREET CARLISLE, PA 17013-2610 1...11I...11I......11..11...1.1/1"11I1./1...1.1../1...1.11..1 (717)249-4251 MAR 04, 2005 RE: Policy Number: Refund Amount: 6868162-E11-38B ....232.47 The attached refund is a result of the termination of your policy. If you have any questions, please contact your State Farm agent. Policyholder Service 134-6775.1 Rev. 07-01-2002 (o1b0101b) D0220 I--'{.'~.'.'...'-. ;;~. r.-.'~\~S.'.~~."f."~:. ~::::>".".;;';.:-:\.'."" "~'-~::" ..'/{ ..."....~.~...:::.~..~.:.....:-.. ';....'........ ..:..>.:.-~'...'.'.~..;.."='.'. /'=:...... '.> ~ .f-'.......:;.....':.:......:....\ :.'..' "'&" \\~ h :~.: 'l\: <,~; 'f{ >",$ ::.~, '~:.' 'd .",-,; f,',> ~:J :,;;" ',;:' i . '. :~'Statb'fJrmMul~l.l\liiomiibii~;ihsJian~~'tclinPllhy; "'.....-ConclildvillePA19339.... .....:: .... ....... i :::.'-: . , ':"'-"',."'.., '::::~ ,':::/ <:..'-""'-"-', ,':- >'-' .~ .< ~ '_ :::i '>"::_;__.-: ":_,';:. ,':-:: ,::,_, . __' " ~ ~dl,dYN(j.JB~\l~&6 8162ib'J'.SBI3' ..' . Mi\.~ q4, ~. 'f.:::a' ~iS ii '.0 ~- !tg, ~o ~.~ f,9 ~t ~uio.. i!~5 .." l:! 1~~~~bn~ A:~rA DEKAlifGNTY 131\ ". ,.,. .,....... \~\~,8\#:~~1'-~\. ,~:: 11~205166P 95749-5-E PAY TO THE OFU"'ROF DITZEL, B JANE 247 WEBSTER ST CARLISLE PA 17013-2027 6256 5 52E $ ....232.47 U"TWO HUNDRED THlRlY.lWO AND 471100 DOllARS". @ ~~....~\{" C.!:WflMAN ,.;{~ /.:.____J TR~ ," . :. , " ,- .~3~3205~~~. I:O~~~~2?BBI: 12q q~~ 3532. 03/" 1"-) uI1 D fJ1 ~1AC Worldwide Headquarters 1932 Wynnton Road, Columbus, Georgia 31999-0001 1-800-992-3522 HECK NUMBER: R003761461 DATE: 03/02/05 IJ553061 B1 DITZEL ESTATE OF B JANE REFUND DUE TO DEATH $10,11 '.CHECK LOC WHF PLEASE FOLD AND DETACH CHECK '~lL1C""'" _ _ UJ] . Worldwide Headquarters 1932 Wynnton Road, CoIul11bus, Georgia 31999-0001 1-800-992-3522 DOCUMENT FACE HAS A MUl TICOlOREO BACKGROUND ~iryw~ .,8(>' ;t:<: ,,::_'!k MARCH li2~'2005: ': NO. R 003761461 AMOUNT $10.11 THIS CHECK CLEARS'POSITIVE PAY ,ff":~f,;,\,-, 'oj' --"" %, -tB.F91!;~~:k ~,; 6-12':' .:g " ,"~ 'n if<~;&-'}-, ,#:~f;:: V1A;JiAAK!N;A d ' ~AHi:GtQR~IA 1, '\~ '1;:,__::,:_~.,__~\{ j-ir?: Ullmlllllllllllti ----- TEN AND 11/100 ---------------------------------------------U.S. DOLLARS 1",111."111."",'1"11",1,111,...,1.11".1,,..11,,,1,11,.1 DITZEL ESTATE OF B JANE 247 WEBSTER ST ER CARLISLE PA 17013-2027 lVJ a ~ ~ C~tt(:?F;\, AuTHoRIZED S!l:?N~TURi~ FOR:,:: ,1. ):' ~;' .:2 American FamIly life Assurance'~~psnYotColiln1~:~~,l'A~). II" :I ? I; ~ I, I; ~II" 1:0 I; ~ 2D <i ? 51;1: 2D ? <i <i0008 <i ~ SOli" 217 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER B. Jane Ditzel 21-05-0039 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 ADDRESS RELATIONSHIP TO DECEDENT A. Richard L. Ditzel 247 Webster Street Carlisle PA 17013 Brother B. C. JOINTLy-oWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND aANK ACCOUNT NUMBER OR SIMlLAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y.HElD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT~INTEREST 1. A. 9/B/87 Real Estate, Home & Lot (247 Webster Street, Borough 77,960 50.00% 38,980 of Cartisle, Cumberland County, Pennsylvania 0 2. A. Prudential Financial, Acct#2644-6222(2.913.075sh@6.48) 18,877 50.00% 9,439 3. A. Prudential Financial, Accl#2644-6222(Money Market) 125 50.00% 63 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 6 Recaoitulation $ 48 482 (If more space is needed, insert additional sheets of the same size) I~enry H811, Ine:, Indl..,., PL ~bi~ 1!\ttb., MADE THE 7th day 0' August of om. Lord one "thousand nine hundred eighty-seven (1987). ill the vecU" BETWEEN JOSEPH Il.. DITZEL and Il8THHH DITZEL, husband and wife, of the Borough of Carlisle, Cumberland County, Pennsylvania, parties of the first part, Gra.nto"s J and B. JANE DITZEL and RICHARD L. DITZEL, sister and brother, as joint tenants with the right of survivorship and not 8S tenants In" common, of the Borough of Carlisle, Cumberland County, Pennsylvania, parties of the second part, Grantee s : WITNESSETH, that in comiden1tian 0' ONE and nollOO . ($1.00) .Dollars, in haOO paid, the receipt wher8~of is hereby acknowledged. the said orant07.s do hereby {Jf'f1nt and convey to the said grantees. their heirs and assigns as joint tenants with the right of survivorship and not 8S tenants in common, ALL THAT CERTAIN tract of land with the improvements thereon erected situate in the First Ward of the Borough of Carlisle, Cumberland County, Pennsylvania bounded and described as follows, to wit: On the South by Webster Avenue; on the East by tract of land known as 265 Webster Avenue formerly of Mark G. Kuhn and wife, and now or formerly of George Roush; on the North by an alley; and on the ,West by Lot No. 22.on Plan of Lots hereinafter mentioned. Said tract of land contains 120 feet in front on said Webster Avenue and a width in the rear along said alley. of 120 feet and has a depth to said alley of 105 feet. THE PREMISES herein conveyed consists of Lots Nos. 23, 24, Bnd 25 as shown on a Plan of Lots laid out and known as Henderson Addition, which Plan of Lots is recorded in the hereinafter named Record~rrs Office in Plan Book 2, Page 27, and on which lots of ground there is erected a one and ane-half story frame dwelling house known as 247 Webster Avenue, Carlisle, Pennsylvania 17013. BEING all of the property which Frank P. Bear and wife, by deed dated March 25, 1944 and recorded March 25, 1944 in the Office of the Recorder of Deeds in and for Cumberland County at Carlisle, Pennsylvania in Deed Book "T", Volume 12, Page 465, granted and conveyed to Joseph E. Ditzel and Esther Ditzel, husband and wife, Grantors herein. THE WITHIN Grantees are the daughter and son of the within Grantors and, therefore, this conveyance is exempt from realty transfer taxes imposed by the Commonwealth of Pennsylvania and by the Borough of Carlisle and by Carlisle Area School District. AND th. Baid gm..tors her."" .o._t and agree that they will warm..t generally tho Ptop.rtlf her."" .....8lf.d. IN WITNESS WHEREOF, Baid gra.n.tors ha.ve he10tmnLo set their tAe day and yeq.r first above written. hands and Beals 1;l'\lIl'b, 1;l..ln Rllblll,llbmb ) ~piiTJ)ltzeC--"-:"""""'-""'-"'---'--""'--------e 0_ 1~~lIl"~"tr.' ~--f:..'-1f:*"----.mu-----------m-~"B ----r.--!:!I-~---------':----._-~-m_______.________) d('Lln~/J;;{ &m_________mu_u___u____uu e I Es;;;:;:~~~r-- ._...._..__.._..._......_.__.__....h___..__.....__..~.____.____ -.....---......------..........-................--.............--..-...--.... e I do hereby certify that the precise residence and post office address of the within Grantees is: 247 Webster Avenue, Carlisle, PA 17013. ~_1. .. .1 Stot. of Pennsylvania COU..tlf of Cumberland 0.. thiB, the 7th }... dalf of August , 19 87 . before mtl, tho "nd.enoig...d offi,e81', P.rsona!llf lJIlllloar.d Joseph E. Ditzel and Esther Ditzel known to me (or satisfactorily proven) to be tke perso1'8. whose Mme S are B1tIJ,'IflribP.d to the wit/tin inatrument, and acknowl6dged that t httl executed tM sa.me for th.e PlITJ)l)Rr.s thrJrein contained. IN WITNESS WHEREOF, I h.r.u..to B.t mlf !uLnd and offi,rial ...1. --m---u..-~6..---:':9..-..-.......--...-m.........-~ ~~~=~~~~~OOUNn';"i;!~..~joffi~-;;....m. S 0\0 }::o -< g~ '& 1);'0 -< ~~15 0 c:') ~: ~-c ~ e- O <<'1:1 0 " ll> ~ "" " Sl i :DZ i . ,"l'\"'O g ~~ ~(J)Z g ~ ~,,~:::\. ~ S"\ if i ~(/l~ if -. g ~:P~ g. < ~'< 0."" ! ~~p-""" -. ~ ,,;::1 " g-c;;:;;("")O .<: m;'; "Clo & ~ c. 15c- C> 1:1 ?: g' '8~ ~g ~ ,. ~ ~. g-- 3- 0 '" '" "'- g\ ~~::JO 0 Z-<. -.s. !:\ n~ "l- g !: 0- ~t:: !: '!:\ ::I lit,,~> (I) m 0 <3 ;>. ~ -n, ~ '"gj 0.0 - 00 ~e. " ... '" :2 Q) 0 ~ ~ --1_0 (/) 16 -. !!. , ~...., g. g ,,"8 " - ." 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'" !" -,2.a $ -.. ~"ar ~ ~ """ l!!.- s~C1- -- ig ~ \i~ ~"'~ 3"''' :::-== ~3\$ -'~ ~ -- g ar~ ",0. -- "''''ia "''' -- a"- ....- ~~~ ~ - "'~" " '" -:::;;= ,,~ti ~ \$ = - '" S'~~~ ~ 80.- ="" ~"'- 11 0.'" o. "'~'"' '" " & i~~ _n g-~m t.- . @a .. ~~ ~ III -0. .:2 "'''' S\.3 .... <It ~ .... m ~~ t.- ~ ..., ~~ ~ \:\ ~1 !!l ~ ~~ gg e: ":<5- "'" "" ",0. .. ~ "'''' .... -<om ,,'" '" ~ ~~ -3 g ~ ~ !" '" g" S\. ~ -~ '" - 1l: ~ !:,? ",,, '" So ... WSJ.com Steel:< Charting f0r MKI;ICX 5/11/051:05 PM Date 12/14/04 Price High (FUND) U.s. Dollar Low Volume 2 Mlnth (D.i1y) @8igCharts.com 6.48 n/. n/. n/. 6.55 No Splits ~6.50 IV. 6.45 I 6.40 Get another quote any day after 1/2/1970 1/2/1970 Date: 112/14/2004\ Dee: 05 Symbol: L___ fB 1mo 2mo 3mo ~ .!t!: ~ ~ Copyright @ 1999-2005 BioCh.rts.com Inc. All rights reserved. Please see our Terms of Use. Historical and current end-of-day data provided by FT Interactive Data. Copyright @ 2005 Dow Jones & Company, Inc. All Rights Reserved http://www.bigcharts.com/cllstom/wsjie/wsjbb-historicaJ.asp?symb=.mkhcx&sid""8630&close _date: 12/1412004 Page 1 of \ 217 REV.1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF B. Jane Ditzel FILE NUMBER 21-05-0039 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR ReLATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL eSTATE. VALUE OF ASSET INTEREST ~FAPf\.ICABlEl VALUE 1. Security Benefit Group of Companies, Contract #70031 02366 48,192 100.00% 48,192 2. American General, Contract #A 1 0087853F 10,574 100.00% 10,574 3. Prudential Mutual Fund Services. Accl#03900074294)Moneymart 4.363 100.00% 4,363 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 7 Recaoitulationl $ 63129 (If more space is needed, insert additional sheets of the same size) AMERICAN GENERAL P.O. Box 871 Amarillo, TX 79] 05-087] ].800-247-6584 March 22, 2005 Frey & Tiley Anen: Carol 5 S Hanover Street Carlisle, PAl 70 J3 Re: Name of Deceased: Contract Number: Beneficiary: B Jane Ditzel AI0087853F Richard Ditzel Dear Sir or Madam: We have received notification of the death ofB .lane Ditzel, the owner/annuitant of the referenced contract. On behalf of American General Life Insurance Company, we wish to express our sincerest condolences for your Joss. The following items are enclosed: 1) Claims Checklist - A list of items required to initiate a claim for this contract. 2) Beneficiary options page - A list of claim options available to the referenced beneficiary. 3) Applicable documents for completion. The value of policy on the date of death was $10,574.08. We appreciate your prompt attention to this matter. Should you have any questions or require further assistance, please contact our Client Care Center by using our toll free number of 1-800-247-6584. Sincerely, .6 'IYJ ~ B.M. Graves Annuity Claims Manager Enclosures OF AGL CVr LIT 000 (71) The Security Benefit~ ~~ Group of Companies March 16,2005 Fry and Tiely 5 South Hanover St Carlisle PA 17013 Subject: Contract 7003102366 B Jane Ditzel Dear Fry and Tiely: We are writing concerning recent correspondence we received from the representative on the above contract The contract value on the date of death, December 14, 2004, was $48,191.96. Security Benefit strives to provide the highest level of service in the industry to our customers. If you have any questions regarding this or other matters, we invite you to contact our National Sales Center, at 1-800-888-2461 between the hours of 7:00 am and 6:00 pm Central Standard Time. Chris Canon Client Service Specialist IV Annuity Administration Security Benefit Life Insurance Company co: Tina Giambanco One Security Benefit Place. Topeka, Kansas 66636~OOOl . 785-438-3000 . www.securitybenefit.com ',"-.!, WSJ.com Stock Charting for PBHAX 5/11/05 1;20 PM Date 12/14/04 Price High (FUND) U.S. Dollar Low Volume 5.92 nla nla nla No Splits Get another quote any day after 1/2/1970 1/2/1970 Symbol: 1__ Date: ~2004J lB Copyright @ 1999-2005 BiaCharts.cam Inc. All rights reserved. Please see our Terms of Use. Historical and current end-of-day data provided by FT Interactive Data. 2 M:>nth (Daily) @BigCharts:.com DE'C 05 1rno 2mo 3rno 6rno ..:!..i! ~ ill Copyright @2005 Dow Jones & Company, Inc. All Rights Reserved http://www.bigcharts.com/custom/wsj ie/wsjbb-historica1.asp?symb::pbhax&sid=8630&close _ date= 12/14/2004 5.92 5.91 5.90 5.89 Page I of I 6"::E a-=r. m- m ~"~ R 3 ~" ",.. ro" .. -< -.. :e- ..'< " a.", 0" ,,3 2."E. ".- .. 0 ".. -" a~ 3.. 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S" < .. !!!. .... m " "" ". o " .. m x o ". ~ " <0 rn -:::; .:::! <0 .... '" a, '" o roo"" me:o ....me ........0 -<."m LOZ o:c::i =4.....> NIr P:!~:ri :oe )>rn 0.... .,,0 o ;:: .., )> Z -< '"C .... = ~ a .-. = - ~ ~ .-. = = 5 .-. = - :;; :r 0;" :i" 0' 3 ~-< 00 ~~ iii'(/) :r~ Q~ mZ ~:*!= :Co iilZ ~I! <Dr nm ~ <: '" .. - ~ 0, o o '" I\) 01 , ~ (l) 01 ~ .., .. 'i '" !!. .... 217 REV~1511 EX+{12.99) COMMONWEALTH OF PENNSYlVA.NlA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF B. Jane Ditzel FILE NUMBER 21-05-0039 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home, Funeral Services 9,273 2. George's Flowers, Funeral Home 40 3. Hoy's Greenhouse, Casket Cover 186 4. Flowers by Mountain Lakes, Funeral Home 32 5. E.F.Redding & Son, Inscriptions to Headstone 415 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address C;ly State Zip Year(s) Commission Paid: 2. Ahomey Fees 4,543 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Richard L. Ditzel Street Address 247 Webster Street C;ly Carlisle State PA Zip 17013 Relationship of Claimant to Decedent Brother 3,500 4. Probate Fees 298 5. Accountant's Fees 6. Tax Return Preparers Fees 7. The Sentinel, Advertising 152 8. Cumberland Law Journal, Advertising 75 9. (5) Short Certificate 16 10. Register of Wills, Filing Fee for PA Inheritance Tax Return 15 TOTAL (Also enter on line 9 Recaoitulation\ $ 18545 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) 217 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF B. Jane Ditzel SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-05-0039 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH The Sentinel, Thank You Ad 22 TOTAL (Also enter on line 10 Recaoitulation) $ (If more space is needed, insert additional sheets of the same size) 22 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF B Jane Ditzel SCHEDULE J BENEFICIARIES FILE NUMBER 21-05-0039 RELATIONSHJP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (aJ (1.2)J Mary K. Ditzel Sister $10,000 Bequest 601 N. Hanover Street Carlisle PA 17013 2 Richard l. Ditzel Brother 100% residue of estate 247 Webster Street Carlisle PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX. 1$ NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON~TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ . 0 (If more space is needed, insert additional sheets of 1he same size) LAST WILL AND TESTAMENT OF B. JANE DITZEL I, B. JANE DITZEL, single woman, of 247 Webste~ Street in the Borough of Carlisle, Cumberland County, Penhsylvania, being of sound and disposing mind, memory, and understanding, do hereby make, publish, and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. I. I direct my hereinafter named personal representative to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I direct that my funeral services be conducted by Ewing Brothers Funeral Home, 630 South Hanover Street, Carlisle, Pennsylvania and that an oak: casket be selected for my burial, and that my body be interred on the burial lot of my parents, Joseph E. Ditzel and Esther R. Ditzel, located in Ml. Holly Springs Cemetery, Mt. Holly Springs, Pennsylvania. I further direct that all inheritance, transfer, succession, estate, and death taxes which may be payable on account nf my death shall be paid from the residue of my estate, regardless of whether the assets upon which such taxes are based are included in my probate estate. 2. I give and bequeath thesom of $10,000.00 to my sister,MARY K.DEITZEL, her heirs and assigns, provided she shall survive me by a period of ninety (90) days, but s\lOuld she fail 10 so survive me, the same shall lapse and be inclnded io the residue of my estate. " 3. I give, devise and bequeath to my brother, RICHARD L. DI'IZEL, his heirs and assigns, all of my, interest in lhe house and lot of ground at 247 Webster Street in the Borough of Carlisle, Pennsyl~ania, provided he shall survive me by a period of ninety (90) days, but should he fail to so survive me then the same shall lapse and he added to the residue of my estate. 4. I give and bequeath all of my interest in the household goods and tangible personal property generally which are located in my residence at 247 Webster Street to my brother, RICHARD K. DITZEL, his heirs and assigns, provided he shall survive me by a period of ninety (90) days, but should he fail to so survive me tben to my sister, MARY K. DEITZEL, her heirs and assigns, provided she shall survive me by a period of ninety (90) days, but should she fail to so survive me then the same shall lapse and be included in the residue of my estate. 5. All the rest. residue, and remainder of my estate, real, personal, or mixed, and wheresoever the same may be situate, I give, devise, and bequeath to my brother, RICHARD L. DITZEL, his heirs and assigns, provided he shall survive me by a period of ninety (90) days, but should he fail to so survive me then;t~e same shall lapse. 6. Should my brother, RICHAkD L. DITZEL predecease me or fail to survive me by the aforesaid ninety (90) days, then in such event, all the rest, residue and remainder of my estate, real, personal and mixed and wheresoever the same may be situate, including all lapsed legacies and devises, I give, devise and bequeath as follows: (a) $1,000.00 to First Evangelical Lutheran Church, and its successors, comer of East High and Bedford Streets, Carlisle, Pennsylvania 17013, to be used for such purpose or purposes as the official Board of said church shall deem best. (b) $10.000.00 to Helen Krouse Animal Shelter tocated at Dillsburg, Pennsylvania. to be used for such purpose or purposes as the Board of Directors of said shelter shall deem best. (c) $10,000.00 to the Trustees of Mt. Holly Springs Cemetery, Mt. Holly Springs, Pennsylvania, to be added to its permanent endowment fund and the income arising therefrom shall be used at least annually for the care and maintenance and repair and replacement of the monuments erected on the burial lots of my parents, Joseph E. Ditzel and Esther R. Ditzel, on which my body is to be interred and also the burial lot on which the bodies of my grand parents, John H. Ditzel and Ida C. Ditzel are interred, and any income not required for these purposes shall be used for the care and maintenance of the cemetery generally and of the monuments therein located. (d) $5,000.00 to the Humane Society of Harrisburg Area., Inc., and its successors, of 7790 Greystone Road, Harrisburg, Pennsylvania for the benefit of the Wesl Sbore Shelter which it operates at Sinclair and Eppley Roads, Mechanicsburg, Pennsylvania, and/or for the benefit of the other activities sponsored by said Humane Society in Cumberland County, Page I of 2 pages. ~~ Pennsylvania. <e) $5,000.00 to the Shippensburg Foundation of the Shippensburg University. Shippensburg Pennsylvania, to be used for such purpose or purposes as the' Board of Directors of said foundation shall deem appropriate. (f) $5,000.00 to the Cumberland County Historical Society and Hamilton Library Association, 21 North Pitt Street, Carlisle, Pennsylvania 17013, to be used for such purpose or purposes as the Directors of said Association shall deem appropriate. (g) The balimce thereof I give, devise, aud bequeath to my sister, MARY K. DEITZEL, her heirs and assigns, provided she shall survive me by a period of ninety (90) days, but should she fail to so survive me then the same shall lapse and be added proportionately to the bequests set forth above in sub-paragraphs (a) through (f) of this paragraph no. 6. 7. I hereby nominate, constitute, and appoint my brother, RICHARD L. DITZEL, as Executor of this my Last Will and Testament, but should he predecease me or fail to qualify, or cease serving as such, then in such event I nominate, constitute, and appoint my sister, MARY K. DEITZEL, as altemate or successor Execulrix, but should she predecease me or fan to qualify or cease serving as such. then in such event I nominate. constitute, and appoint CITIZENS BANK and its successors, 665 North East Street, Carlisle, PA 17013, as alternate or successor Executor. I further direct that none of them shall be required to post any bond to secure the faithful performance of his. her, or its duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereuuto set my hand and seal to this my Last Will and Testament written on 2 pages, this ..6+" day of ~~ ,2003. 14~ B.J DITZEL (SEAL) Signed,sealed, published and decIaied, by B. JANE DITZEL the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~.1-\ ~p1.~ .. Page 2 of2 pages.