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Home My WebLink About02-27-06 REV-15oo EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER ill_ - ~2 o 53-/-_ COLMY CODE YEAR ttJMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl) SOCIAl SECURITY NUMBER .... Z EV A M. HESS 165-42-2543 w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 06-06-2005 02-24-1915 REGISTER OF WILLS 0 W (IF APPliCABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAl) SOCIAl SECURITY NUMBER C w ~ 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of death prior 10 12-13-82) f-: ~'::l;(/) 0 4. Umited Estate 0 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required <..>a::~ wo.<..> ~ 0 IOO 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Uving Trust (Attach copy ofTrust) _ B. Total Number of Safe Deposit Boxes <..>a::--' 0. CD 0. 0 9. Litigation Proceeds Received 010. Spousal Poverty Credit (date of death between 12-31-91 aJd 1-1-95) 0 11. Election to tax under Sec. 9113(A) (AttachSch 0) <( ~ THIS SECTION .MU$TBECOMeL.ETJ3[).Al..LC~RESPOIIIDENcI$AN[)CONfl[)ENTI.ALtAXINFoRMATtON$I-IOliJl..DBE DtRECT'Ep\TO: z NAME COMPLETE MAILING ADDRESS w 0 DA VID K. KRUFT ONE SOUTH MARKET SQUARE, 12TH FLOOR z 0 0. FIRM NAMED~ucable) P.O. BOX 1146 (/) RHOA & SINON, LLP w 0:: HARRISBURG, PA 17108-1146 0:: TELEPHONE NUMBER 0 (717) 233-5731 <..> .-, 1. Real Estate (Schedule A) (1) 0.00 . ) OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 0.00 , '- 3. Closely Held Corporation. Partnership or Sole-Proprietorship (3) 0.00 -- -~--~ 4. Mortgages & Notes Receivable (Schedule D) (4) 23,103.85 - ---'~ 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) 83,225.61 -.'.'- .. Z (Schedule E) ("'.~) 0 - 6. Jointly (MIned Property (Schedule F) (6) 0.00 ~ o Separate Billing Requested ;::) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 220,068.09 .... (Schedule G or L) a:: B. Total Gross Assets (total Lines 1 - 7) (8) 326,397.55 <( 0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 9,781.50 L1J 0:: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 972.12 11. Total Deductions (total Lines 9 & 10) (11) 10,753.62 12. Net Value of Estate (Line 8 minus Line 11) (12) 315,643.93 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 0.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) (14) 315,643.93 SEE INSTRUCTIONS FOR APPUCABLE RATES Z 0 15. Amount of Line 14laxable at the spousal tax ~ rate, or transfers under See. 9116 (a)(1.2) X.O_ (15) 0.00 .- 16. Amount of Line 14laxable at lineal rale 315,643.93 X.O 45 (16) 14,203.98 ;::) a.. 17. Amount of Une 14laxable at Sibling rate X .12 (17) 0.00 :!: 0 18 Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 0 g 19. Tax Due (19) 14,203.98 200 I CHECK HERE IF YOUARE~EQUESTING A REFUND OFAN.OVERPAYMENT I STF PA42021F 1 > > BE SURE TO ANSV\lER ALL QUESTIONS ON REVERSE SIDE AND RECHECKMATH.o::; < L_ De'cedent's Complete Address: S!RE~ ADfJRESS MESSIAH VILLAGE , 100 MT. ALLEN DRIVE ~iTY MECHANICSBURG I STATEpA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 14,203.98 11.000 550 Total Credits (A + B + C) (2) 11,550.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty (0 + E) (3) 4. If Line 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 (4) 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 2,653.98 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 VWLLS, AGENT 2,653.98 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "Xli IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................ 0 []I b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . .. 0 ~ c. retain a reversionary interest; or ....................................................... 0 DS1 d. receive the promise for life of either payments, benefits or care? ............................... 0 []I 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 DS1 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. Under penaties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S ATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 227N. GRANTHAM RD. DILLS BURG PA 17019 ::r~~:~~II[R~IWIR[PREOEtJT'J,\,[ 0_ q, w..- ADD SS ~ 833 CENTRAL MANOR RD., WASHINGTON BORO, PA 17582 DATE ~- ,0 .~ o~ Zl-Z.~J (t:i( 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. 99116 (a) (1.1) (i)J. 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. 99116 (a) (1.1) (ii)]. The statute does not exemot 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 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. 39116(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%, except as noted in 72 P.S. 39116(1.2) [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% [72 P.S. 39116(a)(1.3)J. 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. STF PA42021F.2 CONTINUATION PAGE SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN (Address of Third Co-Executor) James N. Hess 511 Miller Ave. Mechanicsburg, P A 17055 SIGNATURE OF PREP ARER OTHER THAN REPRESENT A TIVE ~/~ ~~ Rhoads & Sinon, LL , PO Box 1146, Harrisburg, P A 17108 DATE ~. 2-'1.~ . RI!V-1507 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE _ ESTATEOF Eva M. Hess FILE NUMBER 2005-00592 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Note to Gerald and Janice Hess Interest accrued to date of death (Accrued monthly at 1.00%) VALUE AT DATE OF DEATH 600.00 .10 2. Note to Glenn and Rosemary Hess Interest accrued to date of death (Accrued monthly at 1.00%) 4,000.00 .67 3. Note to James and Rosanna Hess Interest accrued to date of death (Accrued monthly at 1.00%) 15,000.00 2.50 4. Note to David and Jodi Hess Interest accrued to date of death (Accrued monthly at 1.00%) 3,500.00 .58 STF PA42021F.8 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 23,103.85 REV-15GB EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY _ ESTATEOF Eva M. Hess FILE NUMBER 2005-00592 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUlVivorshlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bank of Lancaster County C.D. Account # 261693933 2,263.36 Accrued income 13.89 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Bank of Lancaster County C.D. Account #207079043 Accrued income 3,057.88 28.49 PNC Bank Checking Account #5000000943 Accrued income 6,893.35 .67 PNC Bank C.D. Account #31600200628 Accrued income 2,039.99 2.33 Dividend, Blackrock Money Market Account #46393344 Account closed on July 9, 2004; dividend distributed in August 2005 22.81 Brethren in Christ Foundation Savings Account #1611 Interest accrued to date of death 44,508.78 15.24 Brethren in Christ Foundation C.D. #1611-12151 Interest accrued to date of death 10,168.60 5.22 Brethren in Christ Foundation C.D. #1611-12310 Interest accrued to date of death 5,859.83 3.01 Gartmore Funds Account #9030002371 8,121.06 Tangible personal property, valued as per Co-Executors 100.00 Refund - Mennonite Mutual Aid 105.00 Refund - People's Benefit 7.68 Refund - Verizon 3.43 Refund - Guideposts subscription 4.99 STF PA42021F.9 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 83,225.61 REV-1510 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Eva M. Hess FILE NUMBER 2005-00592 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 %OF ITEM INCLUDE Ttt: ~E OF Ttt: TRANSFEREE, Ttt:IR REllITIONSHP TO DECEDENT AND Ttt: DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER OF TRANSFER. ATTACH A COPY OF Ttt: DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. Allstate Life Insurance Co. Annuity $101,786.90 100 101,786.90 Contract #GA274087 Benes: Gerald D. Hess, J. Glenn Hess, James N. Hess, Sons 2. Transamerica Foundation Annuity $11 ,231.30 100 11 ,231.30 Contract #0200PBOO060 Benes: Gerald D. Hess, J. Glenn Hess, James N. Hess, Sons 3. ING Annuity Contract #376267 $8,305.31 100 8,305.31 Benes: Gerald D. Hess, J. Glenn Hess, James N. Hess, Sons 4. ING Annuity Contract #376268 $98,744.58 100 98,744.58 Benes: Gerald D. Hess, 1. Glenn Hess, James N. Hess, Sons TOTAL (Also enter on line 7, Recapitulation) $ 220 068.09 (If more space IS needed, insert additional sheets of the same size) STFPA42021F.11 Rr?V-1511 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Eva M. Hess FILE NUMBER 2005-00592 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home $7,876.50 2. Other costs for funeral (food, payment to Minister, etc.) $995.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative( s) Social Security Number(s) I EIN Number of Personal Represenlalive(s) Street Address City Slate Zip Year(s) Commission Paid: 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 4. Probate Fees $260.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Rhoads & Sinon, LLP out-of-pocket expenses $650.00 TOTAL (Also enter on line 9, Recapitulation) $ 9.781.50 (If more space is needed, insert additional sheets of the same size) S1F PA42021 F.12 RI<V-1512 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Eva M. Hess FILE NUMBER 2005-00592 Includeunreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT $900.00 $72.12 1. Payment to Messiah Village (May) 2. Payment for medical expenses TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 972.12 STFPA42021F.13 R!!'V-1513 EX" (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES - ESTATE OF Eva M. Hess FILE NUMBER 2005-00592 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Gerald D. Hess Son One-third (1/3) 2. J. Glenn Hess Son One-third (1/3) 3. James N. Hess Son One-third (1/3) 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 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed. insert additional sheets of the same size) STF PA42021 F.14 INDEX ESTATE OF EVA M. HESS SSN: 165-42-2543 DOD: JUNE 6, 2005 PENNSYLVANIA INHERITANCE TAX RETURN INDEX TO EXHIBITS Document 1. Last Will and Testament 2. Bank letters, date of death valuation 3. Annuities, date of death valuation 4. Receipt, Inheritance Tax pre-payment Return Reference Schedule E Schedule G 1 1 .~ t ~~ l!t,' ~ ~: ~.~:t JA r:{:~ ~.... ~'~ r;'i ~ ~~ ~t ~'~'.'~.!.'.1 ~E j;;\': ti,; ~i 'f...., }i....., lL"; ) I ~t~. ~," ]L i;~ ~l: ~~~ 1:J, ~.~ j'~ I .~l~ ~+t .f';( .i':: ...l ~' ~;f. ~,) 1}t til F it' i,1' i~.~ ~',;" ~\'; d1 ~I{ ~}; iJ~:" ~' . "" " ~::~ " :;~ ~: } H> ~.:! ....;} W ~r, :~ . ',1 --====' .,..,.--.- WILL OF EVA M. HESS I, EVA M. HESS, cunently of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. 1. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under tills Will shall be free and clear thereof. III. I bequeath all my tangible personal propelty equally unto my sons who survive me. IV. All the rest, residue and remainder of my estate, whatever nature and wherever situate, ~en divided equally unto my three sons, namely, Gerald, J. Glenn and James. Should any of them predecease me, his share shall pass unto his surviving spouse. rfhe is not survived by a spouse, said share shall pass unto his issue per stirpes. V. 1 appoint my three (3) sons, Gerald D. Hess, J. GleIU1 Hess and James N. Hess, or the survivors of them, as Executors of this my Will. - VI. I direct that no bOl1d be required of my fiducimies for the faithful perfonnance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, EVA M. HESS, herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper including the attestation clause and signatures of witnesses, this 17-1'/ day of December, 1996. g 'it-a.. ~; y:j~.d../ EVA M. HESS (SEAL) ~ -1- ~ . ... --~ ~,n ~~ ~," ~;j);;)~ ........~.~ <it{ ti<;;':: i~:it!;~ \/".., ;it.~~'~~ 1"",' ,1,:,,>: ........ ~~ri f';':: ~k(;i: ~~;~";' 'i.;1i' 1'.'...., .,.;1'.(."' ..,'ill 1"\:,': !i~i, ~Ih;. If,r;~ IJf:.i/~'1 \~Jr t}i:.~t, ' (~.r::, signed by EV A M. HESS, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this 1714 day of December, 1996. {,"1 4u JI PfJt~C'A ~, 0jftt{ f %A~4kft/ J fi:- residing at ~-1...-1,/1 J~ -/ L7 residing at IF ~~. p~ -2- -~. . , J. ~ J .R ~,'. '"1-~.'\:"""'''~'V!-","",,~''~I~t/1'''~-'~'''~''''''~~A-';,~;'.C;O~o.~~'~~'':,'''"Y:"'''Jr:;~\~"~';~'''''.''. _,. " COMMONWEALTH OF PENNSYL VANIA COUNTY OF WE, EV AM. HESS, GERALD J. BRINSER and If 4/t/ L J. f,(..,.:...> Zfi , the testatrix and the witnesses, respectively, whose names are signed to the attached or' foregoing instrument, being flIst duly affumed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntmy act for the pw-poses therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ LU-a... 1n. j~ EVA M. HESS- "~L 9Ioz:-.'L4"-~ WITNESS 0iWv-~ if' ~ WITNEgg Subscribed, SWOlU or affiluled and acknowledged before me by EVA M. HESS, the testatrix and GERALD J. BRINSER and It /1-1< -y l.. .I - f #'0 .J J e.. y'" witnesses this J C ~day of December, 1996. ' , r L L ~(SEAL) NotalY Public . Notarial Seal . . Lona Sue ClimenhaQa, Notary P1Jbic -. Moch.:,.-"csburg Bora, Cumberland County My Commission Expires April 28. . ~ 997 Member, PcnnsyrlaniaAssocialion of NDt?Uies :i; ':. , :l~ i; ;l tf t~i -3- 'f.' }~<' ',f 2 ~. % ~ o (.) ct. U1 \- ~ (.) a ...J u.. o ~ a co ~ in C1"" IIl-.lQ IIl~Q Q)inC"l ~(Qfa .~~ 2 .. 0 co % 0 -;:'U)o uJU) e z. o ~ o ~ o <.) ;i <3 % c( % - u.. C) % :J ct. U1 ~ Q ~ ~ Q c:i I"- o~ ~ ~ ~ r-UJ >-\- = o~ ~ ~ ~ ~ WUJ ~ ~ct ~ ~ oUJ o~ 4.- ClCI (Q UJ ~ cot') 0 tn c-; g~ cD Q C"l o;i ~ c:-i ~ to 5 ~ ~ c; '& III III III III Q) Q) :x:.:x:. ~~ co co ~~ g in ~ ClCI ffi Ci6 (0; 0.. ~~ 0 CD;: w Q Q ~ 0 cot') cot') "=I' cot') 'itt Q ~ ~ ::;)w ~ 0111 cD ClCI 0:& I"- ~ C) 0::;) ~ ~ ~ <% I"- "f"' 4. 0.. ~ u.'i :) 0':) ~ ~ ,g wO 0..0 lG .~ ~~ u .~ .... ~ ~ .... ~ <0 GI GI ~ 0 0 "" C) Q N -.:5 cot') 'Tn :) 0) .... '"' o o - u.. Z ('It ~ Q) 'CG :) 0. r:r :1 ~ c:~, O..J'CG .S .... ~ cD U)<O.cS- o/SlIl...."f"' lIl~a)( ~E.tn~ oOQ)~ .c~c:O . j r'\ l'I... I!i <X:) <X:) LO ..b C') r;- t- ~ t- ~ Q) E t5 sg c o (.) Q) lJ) ~ Q) 0- a> (.) c ~ '(j; lJ) ~ .... Q) € ~ ~ (13 ...... o Q) .0 % ...... .'!! ~ '0 <l) 0- (j) - c <l) E ~ "0 c 8 Q) a:: Q5 .... 0 .s c ~ .~ 30- E :5 8 ~ ';!:: AUG-25-2005 20:48 PNCBANK 412 768 3458 o PNCBAl\K August 26, 2005 David K. Kruft Twelfth Floor One South Market Square P.O. Box 1146 Harrisburg, PA 17108-1146 RE: Estate of Eva M. Hess, deceased SSN: 165-42-2543 DOD: 6/612005 Dear Mr. Kroft: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account #31600200628 Established 10/16/2000 EVA M HESS DOD balance: $2,039.99 + $2.33 accrued interest Checking Account Account #5000000943 Established 09/23/1996 EVA M HESS DOD balance: $6,893.35 + $.67 accrued interest The decedent maintained Investment Account (INV #463933440). For further information, you may call the Brokerage Department at 1-800-762-6111. Please note that this office only provides date of death balances for deposit accounts (!RAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local pNC Bank branch office. Sincerely, ~CU11L~LL ~ Rachelle Wens 1-800-762-1775 P7-PFSC-04-F 500 first Ave. Pittsburgh PA 15219 Mt:mber Fore P.01/01 TOTAL P.01 J) <i ~ <D .Q ~ .:2 lIS Z ~':;:. I!S~ oia 'a) ta<D ....0 0- ~ roO , \\ a~\ c::-5 ~ \\\ o I!S <DG) :30 -.. .... ~ 0'0 ~ I/) <DiG taG) \I\ G) ia G) ...."'iU '(DoO ~o 01 gs'O ~ \ \ ~ ~ "'OG)G)-5 ....'CO - I/) e ~ G)lJ"iGlO eo :3C::oG) 'U~ 0 <D_ Yi \J~C::- \ \ eO 4,COOO ;$ - ,- I!S '-rl ~o ... c:: c; ~ .... ~ $. :::;l0 ~ c:: ... ~ "u 2 G) ~c:: .... c:: <D lIS c:: ~ P \I'l c::_ .~ S-s <D .- rnQ COs:::. '0 c:: I!S /\) rnQ "'OiG I!S G) 1 ~M ~G) <D tao ~ "'~ ~ e co- ...a~ ~o lIS _0 . ~ 1/'1 tllCG c:: lIS <D ~~~ 'i) VI ~ 0..... .- lIS \J ~~M G) 1Il ~o 0 .~ <D ... l"":l ~ ... '\: c:: ' . ~ ., \I'l lIS 0.0 '=: .r:;:. ~ ,=:!...a ~ Jl r.J) .:;~~ II) ~ '0 ~ ~ ., 0 ~ ~~z 0 >Q~rJ) CI) 'Z 6 ~~rJ) 0 1Il \ ~ ~ a ... ~ ~~ G) 0 ~ II) c:: .e ~ - ~ ('l$ ... .~ s ",- - "'0 ,g ~ '€ 0 <D G) 0 CI) 'Z :3 I/) U ~ \ .s C. lIS "'0 0 0 <D :3 \ 1Il ~ ~ <D "iG 0 .- ~ III Q) 'J , >- 0 r 'Z .r .... -t: ~ '% S 0 0. i: 'Z ~ 0 G) ~ 0 0 z ~ '0 ~ ~ ~~ \iJ "d lIS ~ lJ ~ III ~~ 3 '0 ~ G) ., u; c: tll I/) "iG ~ ~ * .~ c:: u ~ .~ tll ~ ~ CI) t,) u c:: :e c: oS CI) G) '% <D 0 ~ 0 .$:. .r:;:. co u u fJ) u_ -1 - 2. \ \ ~ e- - ~ c; ~ \0 '-" - - -- ~p IQI~ _,0: 'JIt-.- tIll . ~ ~ a Ion ~~ en 1~ ~~ $ - 1 \- ... ~ & i i ~'- \1& ..l ~ ~ c .\ .E, ,. - lJ) ~ ~. ~ s. ; i ~ G i i s fi ~ . \ ~\t) \II 5~ s fit ~ ~~ c l ~'" u ~1 t\ , .~ i !~ s. ~ t;;~ a a a a \ ~~ ~ ::I h wi l l ~. % ,,.,." ~\ / \ ~ t4 :it \\ .s i % 6' ~ ls ~ c::i ~ it \~ ~ ~ 9 i r\ ~ ~N l~\o ~3 ~~ \ is i ~ \ \ \% \~ \ ~\ ~ ~ ~\ - \ ~~. 1 '" i. '" i. i~ i. 1 1 ~ = u " (.) CO cr. \~ .- . \~~b~~\ i ~\ u i ~; .. a ' Q o~l~~~ ~ 5t ~\ ? ~ .' ~ It p.. ~3 III Q ... , II - tC \.IJ o~ \- ~ ~ fill \1& - )/.. \\ Q \ 1 ~ ~ 1!1 )a 0 U) 0 ~ - \~ ,\ ~ ,. ~\ - l- ! !l u . .,.))q~JJ'" , '" ~J v .JJ- . ~'W~V'- "..' . 1{ . gartmore . Funds 9/9/2005 Gerald D Hess 227 N Grantham Rd Dillsburg PA 17019 RE: Account Number: 9030002371 Reference Number: F9900S Dear Mr. Hess: Thank you for contacting Gartmore Funds. We are writing to confIrm the following information: 04/10/91 20 9030002371 758.269 10.71 $8,121.06 Should you require additional assistance, please feel free to call our Customer Service Team toll-free at 1-800-848-0920. We appreciate the opportunity to assist you any way we can. You may also obtain current information on the Gartmore Funds from our internet homepage at www.gartmorefunds.com. ~ Karin Magowin Shareholder Services Lc Go~ cy\ Yo') 3 AUG. 23. 2005 2:23PM CLAIMS -NO.809-P. Life and Annuity Claims Po. Box 94212 Palatine, lL 60094-4212 ~ Allstate~ You're in good Mnds: August 23,2005 David K. Kroft Fax #717-232-1459 Re: Administrator for: Contract No: Eva M. Hess Allstate ute Insurance Company GA274087 Dear Mr. Kroft: We have been requested to complete Internal Revenue Service (IRS) Form 712 with regard to the referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contract)_ The contract referenced was an annuity contract, which is not reportable on rn..S form 712. The following information is provided regarding the value of the annuity and other data as of the date specified: Date of Death: 6/6/2005 .Annuity Value * as of Date of Death: $ 101,786.90 Cost Basis: $ 84,474.53 Named Beneficiary: Gerald Hess, J. Glenn Hess & James Hess *TIle actual amolUlt paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, or need further assistance, please contact the Customer Care Unit at 1-877-499- 6418. Sincerely, Life and Annuity Claims Overnight Address: 544 Lakeview Parkway, Vernon Hills, IL 60061 Toll Free Fax: 1-866-635-4523 i.T.~~9\ Transamerica Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids. Iowa 52406-3183 August 18, 2005 David K Kruft Rhoads & Sinon LLP One South Market Square PO Box 1146 Harrisburg PA 17108-1146 RE: Annuity Number(s) 0200PB00060 Dear David K Kruft: Our office has received your request concerning the above listed non- qualified tax deferred annuity. A Form 712 is not issued on tax deferred annuities. The taxable portion of this policy will be reported on a Form 1099-R as taxable to the beneficiary upon receipt of the funds. The value as of 06/06/2005, the date of death for Eva M Hess is $11,231.30. Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-553-5957. A Transamerica Life Insurance Company representative will gladly assist you with any questions you may have regarding this annuity and help you meet your financial goals. Sincerely, fJ~ w (;wd( Diane L Cowell Transamerica Life Insurance Company Claims Member of the ~EGON. Group ING jM) /0 ~ I. October 6, 2005 DAVID K KRUFT RHOADS & SIMON PO BOX 1146 HARRISBURG PA 17108-1146 Re: 376267 & 376268-Eva M. Hess Dear Mr. Kruft: Here is the information you requested. For 376267, the accumulated value as of June 6,2005 was $8,305.31. For 376268, the accumulated value as of June 6,2005 was $98,744.58. Please contact our Call Center at 1-800-369-5303 if you need more information. Sincerely, 0M- Craig Wigton, FLMI, ACS, ALHC Annuity Services Department 909 Locust Street Des Moines, IA 50309-2899 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES otPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KRUFT DAVID K 1 SOUTH MARKET ST P.O. BOX 1146 HARRISBURG, PA 17108-1146 -------- fold ESTATE INFORMATION: SSN: 165-42-2543 FILE NUMBER: 2105-0592 DECEDENT NAME: HESS EVA M DATE OF PAYMENT: 09/02/2005 POSTMARK DATE: 09/02/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/06/2005 NO. CD 005754 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $11,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 005 SEAL INITIALS: JA RECEIVED BY: TAXPAYER $11,000.00 GLENDA FARNER STRASBAUGH REGISTER OF WILLS