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Home My WebLink About01-09-07 REV-1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INmAL) I- Z W Q w o W Q G. DAY IRENE DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 11/11/2006 02/01/1926 (IF APPlICABLE) SURVIVING SPOUSE'S NAME (LAST, ARST, AND MIDDLE INITIAL) W I- llli::!!iU) Ua:llli: wA.~ :ci~ u 8:1D 4( [&] 1. Original Retum o 4. Limited Estate [X] 6. Decedent Died Testate (AllachcopyolWl) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date 01 death after 12.12-82) o 7. Decedent Maintained a Living Trust (AIIach copy ol Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91l1ld 1.1.95) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 1 0 9 4 "OOUNiYOOiiE -YEAR- - - NUMiER- - SOCIAL SECURITY NUMBER 1 6 1 - 2 0 - 4 279 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AIIach Sch 0) COMPLETE MAILING ADDRESS 60 WEST POMFRET STREET 0.00 X _ (15) 0.00 29,309.27 X .045 (16) 1,318.92 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 1,318.92 NAME ROGER B. IRWIN ESQUIRE FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717 249-2353 CARLISLE z o 5 :J l- ii: c:( o w a: 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/Sec 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I- :J D. ::::i o o S 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE!~ VOl! l\Rt HEOUrSTING A REFUlm OF AIJ OVERPAYI.1ErH PA 17013 OFF~L USE ONLY c:;::) -..J C- :0- % I \.0 -0 --- :0 ....~._. :E (") 'I)>, _-zqj . u5 7.;:: '_..:r~o 17,761.68 )011 " -lC= - ':0 --{ -0 :x ~ c.n w '. ....} fT1 24,112.44 (8) 41,874.12 12,550.69 14.16 (11) (12) (13) 12,564.85 29,309.27 (14) 29,309.27 D d I C Add ece ents omPlete ress: STREET ADDRESS 207 GARLAND DRIVE CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. CreditS/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 1.318.92 65.95 Total Credits (A + B + C) (2) 65.95 3. InterestJPenalty if applicable D.lnterest E. Penalty 0.00 T otallnterestJPenalty ( D + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 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 Pa able to: REGISTER OF WILLS, AGENT 0.00 1,252.97 1.252.97 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; ........................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................... ....................... ................... ................. ............. 0 00 3. Did decedent own an "in trust fori or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 00 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 penalties d peljury, I declare that I have examined this return, includ!!Q a~ying schedules and statements, and to the best of my knowledge and belief, it is true, correct and canplele. Declaration d preparer other than the pe rasen . is alii 01 which preparer has any knowledge. SIGNATURE OF PERSON R LE L DATE I 9 (J"") PA 17013 DATE I (J7 ADDRESS 207 G R CARLISLE SIGNATURE OF PREPARER OTHER THAN REPRESENTATI 1- ADDRESS DRIVE PA 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 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 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 dat15 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. ~9116(a)(1.2)]. , The tax rate imp?sed 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. ~9116(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. ~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 + (6-98) .* . Ct>UMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DAY IRENE G SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 06 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of survivorship must be disclosed on Schedule F. 1094 ITEM NUMBER 1. DESCRIPTION Personal Property - Appraisal Attached 2. M& T Bank - Checking Account #9839436087 3. M&T Bank - Certificate of Deposit Account #031003913121875 VALUE AT DATE OF DEATH 996.00 6,299.98 10,465.70 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17.761.68 REV-1510 EX + (6-98) .. OOMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DAY IRENE G. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 06 1094 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, THBR RELATIONSHIP TO OECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE OEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. AmerUs Annuity Group 2,614.75 100. 2,614.75 Policy #250810 - American Investors Life 2. Nationwide Financial Annuity 21,497.69 100. 21 ,497.69 Contract Number 015894161 TOTAL (Also enter on line 7 Recapitulation) $ 24.112.44 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS DAY ITEM NUMBER A. 1. 2. 3. 4. IRENE G Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Hollinger Funeral Home & Crematory, Inc. Organist Funeral Luncheon - Carlisle Diner Newville Assembly of God B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s}/EIN Number of Personal Representative(s} Street Address 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. City State Year(s} Commission Paid: Attomey Fees Irwin & McKnight Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) Claimant Gerald L. Dav Street Address 207 Garland Drive City Carlisle State P A Relationship of Claimant to Decedent Son Probate Fees Register of Wills94.00 Accountanfs Fees Tax Return Prepare(s Fees Patricia A. Rosendale, CPA Register of Wills - Filing Fee Notary Fees Roy D. Gotshall- Appraisal on Personal Property Cumberland Law Journal - Estate Notice The Sentinel - Estate Notice FILE NUMBER 21 06 1094 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Zip Zip 17013 AMOUNT 5,386.40 50.00 75.00 100.00 2,750.00 3,500.00 350.00 30.00 15.00 75.00 75.00 144.29 12.550.69 REV-1512 EX + (6-98) , COMMONWEALTH OF PENNSYLVANIA . INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DAY .'. SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS IRENE G. FILE NUMBER 21 06 1094 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Moffitt Heart & Vascular - Medical VALUE AT DATE OF DEATH 14.16 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 14.16 ,,",,-""EX.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER DAY G, 21 OR 1094 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 pnclude Outri~t spousal distributions, and transfers under Sec. 9116 (a (1.2)] 1. Gerald L. Day Lineal 29,309.27 207 Garland Avenue Remainder 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 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 $ (If more space is needed, insert additional sheets of the same size) LAST WILL A1~D TEST ~\1ENT (Pour-Over Will) OF IRENE G. DAY IDENTITY I, IRENE G. DAY, residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 161-20-4279. I have the following child: Gerald L. Day, born January 4, 1944. DEBTS, TAXES A.l\ffi ADl\UNISTRA nON EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other than any tax on a generation-skipping transfer that is not a liability of my Estate (including interest and Penalties, if any) that become due by reason of my death, under THE IRENE G. DAY REVOCABLE LNING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing Under this Will, without any apportionment or reimbursement. In the alternative, my .Executor may demand. in a writing addressed to.'the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecimiary legacies, ~Q family allowances by court order. . PERSONAL AND HOUSEHOLD EFFECTS , It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there 'are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this date in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to POUR-OVER WILL Page 1 J1m Testatrix the period beginning with the date of my death as are constituted in the Trust as at present constituted . giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint Gerald L. Day to serve without bond as my Independent Executor of this my Last Will and Testament. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Donna J. Day to serve without bond as my Independent Executor. Whenever the word ~'Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named . herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to. any inherent, implied or statutory powers granted to executors generally, my Executor 'is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provis'ion of this my:Wili: to allot, allOcate between principal and income, assign, borrow, buy, Care for, collect, compromise claims; contract with respect to, continue any business of mine, convert,. deal with, dispose of, enter into, exchange, hold,' improve, incorporate any business of mine, invest, lease, manage,. mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants, or power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. fu determining the Federal Estate and fucome Tax liabilities of my Estate, my Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions. POUR-OVER WILL Page 2 l-Y 1f kJ- Testatrix CONTESTS AND SPECIFIC OJ\iIISSIONS If any beneficiary under this will, singly or in conjunction with any other person or persons, directly or indirectly: 1. contests in any court the validity of this will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 2. contests in any court the validity of the Testator's/Testatrix's Will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 3. seeks to obtain an adjudication in any proceeding in any court that this trust or any of its provisions or that Testator'slTestatrix's Will or any of its provisions is void; 4. claims entitlement by way of any written 'or oral contract to any portion of the Testator'slTestatrix's estate, whether in probate or under this instrument; 5. unsuccessfully ch~llenges the appointment of any person named as Executor or successor Executor of the Testator'slTestatrix's Will; 6. objects in any manner to any action taken or proposed to be taken in good faith by the Executor . of the Testator'slTestatrix's Will; 7. objects to any construction or interpretation of this Will, or any provision of it, that is adopted or is proposed in good faith by the Executor; 8. unsuccessfully seeks the removal of any' person acting as the Executor of the . Testator'slTestatrix's Will; . 9. files any creditor's claim in.Testator'slTestatrix's estate (without regard to its validity), whether the claim arose before Or after the date of this instrume~t, but excepting claims for cash advanced or paid for expenses of the Testator'srrestatrix's l~st illness or funeral paid by said claimant; 10..attacks or seeks to invalidate any designation' of beneficiaries for any life insurance policy on Testator'slTestatrix's life; . 11.' attacks or seeks to invalidate any designation of beneficiaries for any pension or IRA or other form of qualified or .non-qualified asset or deferred compensation account, agreement or 'arrangement; 12. attacks or seeks to invalidate any will which Testator/Testatrix has created or may create during Testator'slTestatrix's lifetime, or any provision thereof, as well as any gift which Testator/Testatrix has made or will made during Testator'slTestatrix's lifetime, whether before or after the date of this instrument; 13. .attacks or seeks to invalidate any transaction by which Testator/Testatrix sold any assets (whether to a relative of Testator' slTestatrix' s or otherwise); or 14. refuses a request of Testator'slTestatrix's, Executor or other fiduciary to assist in the defense against any of the foregoing acts or proceedings, then that person's right to take any interest given to him or her by this trust shall be determined as it would have been determined if the person had predeceased the execution of this will instrument without issue surviving. The provisions of the foregoing paragraph shall not apply to any disclaimer by any person of any benefit under this will. In the event that any of this provision is held to be invalid, void or illegal, the same shall be deemed severable from the remainder of this provision and shall in no way affect, impair or invalidate any other provision in this will; and if such provision shall be deemed invalid due to its scope or breadth, such provision shall be deemed to exist to the extent of the scope or breadth permitted by law. POUR-OVER WILL Page 3 W Testatrix SIMULTANEOUS DEATH If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. , sY-'ti!--lAL g, M,1 IRENE G. DAY Testatrix This instrument consists of 6 typewritten pages, including the Attestation Clause, Self-Prov;i~ Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the 1!I}(i>f each of . ~ pages. ~~ent is being signed by me on this . 19 day of r' POUR-OVER WILL Page 4 ATTESTATION CLAUSE The Testatrix whose name appears above declared to us, the undersigned, that the foregoing instrument was his/her Last Will and Testament, and he or she requested us to act as witnesses to such instrument and to his/ber signature thereon. The Testatrix thereupon signed such instrument in our presence. At the Testatrix's request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testatrix. The undersigned hereby declare, in the presence of each of us, that we believe the Testatrix to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testatrix. WITNESSES:!. / ~ ?'~~ ~# E !Ve:V;-tA/,;).{77-1- (Printed Name of Witness) . ADDRESSES: jbo~g{'. G'CLc,-/~. /i ~ 732-q City, State, Zip , ~~~4-7h,.tkp~'r Wlf!?A?;1 a. m. l~l!'.;rHr er (Printed Name of Witness) ,:2.5' fJ'lif /?; ~/ ~~.~L> . fI/lA,,#/~L4jJ2. ) 7(~z.y City, State, Zip . POUR-OVER WILL Page 5 &iW Testatrix COMMONWEAL TH OF PENNSYLVANIA COUNTY OF CUMBERLAND SELF-PROVING CLAUSE ~.. . ~QRE M~~ed autho~ 2I} th(S..,d~~~d IRENE G. DAY, ~_ ,'/~ t~. and ~v/~ ~ , known to me to be the Testatrix and the witnesses, respectively, whose names are subscribed to the foregoing instrument in their respective capacities, and all of them being by me duly sworn, IRENE G. DAY, Testatrix, declared to me and to the witnesses, in my presence, that the instrument is his/her Will and that he or she had willingly made and executed it as his/her free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testatrix, that the Testatrix had declared to them that the instrument is his Will and that he or she executed the same as such and wanted each of them to sign it as a witness; and upon .their oaths, each witness stated further that he or she did the same as a witness in the presence of the Testatrix, and at his request and that he or she was at that time eighteen (18) years of ag~ or over and was of sound mind, and that each of the witnesses wasthen at least fourteen (14) years of age. . . ..1 . . d1~ .A, :Vay IRENE G. DAY Testatrix --- .~~a.- ~ ' fbL:..dZ~ WI ess . ~ Ie;1 Ita fJJ. gl?J?.f-/bY' (Printed Name of Witness) ~'Ci~L W/~ - KurH' ~ Ncv;;w",ert"L (Printed Name of Witness) SUBSCRIBED AND ACKNOWLEDGE~b }lle by IRE ICJ..:, ~ 'P'ksw~~e me by FUj. -;V~ U/~ 1A/A/"(' F'~ , WItnesses, thiS the V- ~ Not~ublic Co onull'~<;ll1J1 of Pennsylvania NOTARIAL SEAL TODD B. GARRY, Notary Public Lower Southampton Twp., Bucks County My Commission Expires May 3, 2004 Testatrix, and and day of POUR-OVER WILL Page 6 /'/;i;-~e.)l.., ,-,' ~i\ ,;;~/~;::f#~&~ h~:' / -7'4L, J ':~u>t-:-~~d'~ ~~ ~ .\ / / ~./A g' pC.#':./ ~'-J" ,;7< 7" \c~fl/~'w/L//~J~~ ~ ,/.' /p "~....'C.. l'f!pP:k/~.~~pM/. n.1?!-t:N..#'Cv-~,~~~ /- ~ ....~ ~,;ty.z;~ ,*2ia.-/)"zd~7J~C/P~ 3-'1 ~v~/~~r~'~ ~o ,~~~:.~~~ ~ ~ .f d fl /?: ~..P'l:. c/-p/Z- ' A' . \~y~ /~p&.LyP0~$ t\~~ f.,I , . 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V.C. \\..~~~.' o GS G.('\\v.~ ' 70-* .,;~ I l I 0- * . II M&I'Bank 499 Mitchell Road, MilIsboro, DE 19966 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302) 934-2955 12/5/2006 Law Offices Irwin & McKnight West Pomfret Proffessional Building 60 West Pomfret Street CarUsle, Pennsylvania 17013-3222 IECla'lt~ b:.;[C -7 2006 Re: Estate of: Irene G Dav Social Securitv: 161-20-4279 Date of Death: November 11. 2006 .t.R.\\~=':'.$t. ~rcKNIGHT Dear Sir'or Madam: Per your inquiry dated November 28, 2006, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 9839436087 Ownership (Names oj) Irene G Day · Opening Date Balance on Date of Death 09/07/05 $6,299.89 Accrued Interest $ 0.09 Total $6,299.98 2. Type ofAccoullt Certificate of Deposit Account Account Number 031003913121875 Ownership (Names of) Irene G Day · Opening Date 02/10/06 Balance on Date of Death $10,104.89 Accrued Interest $ 360.81 Total $10,465.70 3. Type of Account Savings Account Account Number 015004210920713 Ownership (Names of) Irene G Day · Opening Date 09/07/05 Closed 02/10/06 Balance on Date of Death $ 0.00 Closed prior to the date of death Please be advised, there was no safe deposit box found for the above decedent. * For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please caD the Stonehedge Office # 717-240-45244 S~cerely, ~~ " Nancy:"Clagett Records Management AmerUs Annuity Group Co. 555 South Kansas Ave Tppeka, KS 66603 1-8op-ANNUlTY December 8,2006 .ftMERUS Annuity Group Law Offices of Irwin & McKnight Attn: Roger Irwin 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Policy #250810 - American Investors Life Insured: Irene Day . Owner: Irene G. Day Dear Sirs: Thank you for your recent request' for information regarding the policy referenced above. T~e requested information is noted belo~. . Date of policy Issue: Date of Death: November 22,1993 November 11, 2006 Interest Amount: $1 ,486.72 $1,128.03 $2,614.75 Principal Amount: Account Value: Should have any questions or need further assistance, please feel free to contact our office at 1-888-ANNUITY (1-888-266-8489). Sincerely, ~ ~.dL Jacob Walsh Claims Specialist AMERICAN INVESTORS LIFE INDIANAPOLIS LIFE ...AAaa~_ AMERUS Life 1-888-252-5530 (CUSTOMER SERVICE) ... AAaav:rc_ 1-888-266-8489 (CUSTOMER SERVICE)l 1-888-266-8489 (CUSTOMER SERVICE) . o Nationwide Financial Individual Annuity Account Services P.O. Box 182021 Columbus, OH 43218-2021 www.bestofamerica.com DECEMBER 02, 2006 18 ~ at . I ROGER IRWIN 60 WEST POMFRET STREET CARLISLE PA 17013 ~I"lt~ DEe -7 2006 IN & McKNIGH1~ Contract Number: 015894161 - - -- - On behalf of Nationwide Financial, thank you for your recent inquiiy into the Individual Annuity -_ Service Center. I am writing In response to the inquiry we receiVed regarding the aforementioned _ contract. Please accept our condolences on your loss. iiiiiii _ Irene G. Day was the owner and annuitant on the account. The account was established on =. 09/12(.2005, and the value of the account as of the date ofdeat.h was $21,497.69. - Once the above issue{s) has been resolved, we will complete your request. If a response is not . = received within 60 days, we will consider the matter closed. ShOuld you have any further questions _ please call us at 1-800-848-6331. , . - - Sincerely, = Nationwlde Financial - - - -II.. .. . . '* *. ~...,~ ... '&'''~.1 .. OF .AMERIC.< :t .. .... Quarterly Statement Ju11. 2006 to Sep 30, 2006 Contract Number: 01-5894161 Variable Annuity Portfolio II I Contract Value Is $20,879.21 Customer IRENE G DAV 207 GARLAND DR OARU8LE PA 17013-4228 Your Inveatment Prof.-ional KIMBERLY J HEAVNER M T SECURmES 100 S SPRING GARDEN ST CARLISLE PA 17013-2552 Account Inform.tlon Contract Number: 01.5894161 Contract laue Date: OM 2J2005 Annuitant: IRENE GDA Y Plan Type: Non.Qualifted Annuity Nationwide Ute lnauranoe Company POBox 182021 OoIumbu. OH 43218-2021 24 hr. Automated 'nformation Un.: OUltomer SeMoe: Hearing 'mpalred: 'ntemet: (BOO) 321.9332 (800) 848-6331 (BOO) 238-3035 www...tionwide.oom Account Summary I iiiiiii = - - ~inning Date B....... Contract Valu. Purchase Payments Wlthdra~alaICharge. Annuity. Performance Encllng Contract Valu. .. 01 011301200& Quart.,-To-Date ..0710112006 $20,389.1$ '.00 ( $30.00) 1520.05 $20,871.21 Year-To-Dat. 011011200& $20,132.38 '.00 ( $30.00) 1776.83 $20,871.21 Inception- To-Date 0111212005 $.00 $20,000.00 ( $30.00) 1909.21 $20,871.21 - - - . iiiiiiiiiiii = - - = iiiiiii == iiiiiiiiiiii - Benefit Election Summary I Death Benefit - Standard: Fiva Vaar Oontraat Annlv.....ry Death Benefit Value All of 0913012006 $20,879.21 - - - - The Value of the Death Benefit i. ,ubj.at to changa. S.. the oontract and/or protpectua und.r adon tiled -Death Benefit Payment" for Idditlonal information. Variable Account Summary I Inveatment Option GARTMORE 'NVDES MODOON8 If Total 4 Beg'nning-of.Quarter Quartar.To-Dete End-of-Quarter End-of-auart.r Value Paym.nt. Withdrawal. Unit Valu. Unit. Owned Value $20.389.16 $20,389.16 $.00 ($30.00) 13.06669 1597.89596 ( $30.00) $20,879.21 $20,879.21 . i MTAAN 00 FI 015894161 ?0ooooo1 00000OO4 OOOI!nn 00177109 040AOO592071 Pag.1of4 I" .. .. .... ~ -..- - HoIIinqer Funeral Home & Crematory, Inc. Eric L. HoIlin~er. Supervisor November 22, 2006 Gerald L. Day 207 Garland Drive Carlisle~ P A 17013- The Funeral Service for Irene G. Day We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. ' THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. . . t. PROFESSIONAL SERVICES Cremation Packag~ F. . . . .'. .. . ., . . 379~.00 379S.00 FUNERAL HOME SERVICE 'CHARGES SELECfED MERCHANDISE: I:>odge Urn . . . . . . . . . . . . . . . . . . . . . . . . . . THE COST OF OUR SERVlC~ EQUlPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . . . 29'.00 4090.00 Cash Advances Opening Grave. . . . . . . . . . . . . . . . . Cemetery Equipment. . . . . Newspaper Notices - Sentinel . . Newspaper Notices - Gettysburg . Newspaper Notice-Patriot . . . ClergylMass Offering. . . . . . . . . Coroner's Authorization Fee. . . . . . . . . . . . Certified Copies of the Death Certificate. . Flowers. . . . . . . . . . . . TOT AL CASH ADVANCES AND SPECIAL CHARGES. . . . .' . 2~O.00 225.00 112.00 60.00 16;.40 175.00 25.00 72.00 212.00 1196.40 Total Total Cost. . . . . . . . . . TOTAL AMOUNT DVE . 5386.40 5386.40, 501 NORTH P>ALTIMORE AVENUE · MOUNT HOLLY SPRINGS. PENNSYLVANIA 17065 · (717) 486-3433 · FAX (717) 486-3215 www.hoIlinqerfuneralhome.com INVENTORY REGISTER OF WILLS OF cmmEKLAlID COUNTY,PENNSYLVANITA COMMONWEALTH OF PENNSYL VANIA } SS COUNTY OF CUMBERLAND Gerald L. Day File Number 21-06 -/()9tf Personal Representative(s) of the Estate of Irene G. Day deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorand at the e of .s inve ry. I verify that the statements made in this Inven- } tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. ~ 4904 relating to unsworn falsification to authorities. Attorney -- (Name) Roger B. Irwin (Address) 60 West Pomfret Street, (Tekphone) (717) 249-2353 Exe tg.t: -- -- 207 Garland Avenue Carlisle, PA 17013 (Supreme Court LD. No.) Carlisle, PA 17013 06282 DATE OF DEATH LAST RESIDENCE 207 Garland Avenue, Carlisle, PA 17013 DECEDENT'S SOC. SEC. NO. 161-20-4279 11/11/2006 FIGURES MUST BE TOTALED $996.00 $6,299.98 $10,465.70 1. Personal Property 2. M&T BAnk - Checking Account #9839436087 3. M&T BAnk - Certificate of Deposit Account /;031003913121875 TOTAL $17,761.68 ,~o . ,- ::0 n-u -{ :::r: () <5:[;; : C/5 5i! '(")0 _:;0" )C= :I) --I (Attach additional sheets as needed) TOTAL: ......., ~ c::::I -..J c.... :J> Z I \.D -0 :Jr ~ U1 W j=g C) (=) :~i~~ m _U fJ (--) .- i~l -=C} c) en NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. f 3301(b)) Form RW-09 rev. 10.13.06 v COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REY-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 ____nn fold ESTATE INFORMATION: SSN: 161-20-4279 FILE NUMBER: 2106-1094 DECEDENT NAME: DA Y IRENE G DA TE OF PAYMENT: 01/09/2007 POSTMARK DATE: 01/09/2007 COUNTY: CUMBERLAND DATE OF DEATH: 11/11/2006 NO. CD 007672 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,252.97 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 023767 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $1,252.97 GLENDA FARNER STRASBAUGH REGISTER OF WILLS