HomeMy WebLinkAbout10-09-0715056041125
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 0 7 0 0 5 1
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
7 1 6 0 9 6 6 4 6 1 2 3 1 2 0 0 6 0 3 0 9 1 9 1 5
Decedent's Last Name Suffix Decedent's First Name MI
S i m p s o n M e r r i l l F
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust}
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 7 4 3 5
Firm Name (If Applicable) ---_ _ _ _----- __-_ __
REGISTER OF WILLS US~QNLY
S t o n e L a F a v e r S h e k l e t s k i c~
`~:~;
~
First line of address
-~ _";
4 1 4 B r i d g e S t r e e t '~' ! I
-
Second line of address _ ~c~
City or Post Office State ZIP Code ' D41~B FILED ~: ~ '
N e w C u m b e r l a n d P A 1 7 0 7 0 `~'
Correspondent's a-mail address:
unaer penalties or 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.
SIGCIATUF~pF PERSON RESPON IBLE FOR FILING RETURN DATE
urly ~ Mechanicsbur PA 17050
SIGNAT E OF P ER T THAN REPRESENTATIVE DATE
6 -Z -J
414 Brl reet New Cumberland PA 17070
PLEASE USE ORIGINAL FORM ONLY
15056041125
Side 1
15056041125
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Merrill F. Simpson 7 1 6 0 9 6 6 4 6
RECAPITULATION
1. Real estate (Schedule A) ..................................... ... 1.
2. Stocks and Bonds (Schedule B) ............................... ... 2. 1 7 6 5 6 3 3 5
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3.
4. Mortgages & Notes Receivable (Schedule D) ..................... ... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... ... 5. 3 2 5 3 3 3 8
6. Jointly Owned Property (Schedule F} ^ Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers ~ Miscellaneous N-Probate Property
(Schedule G) ~ Separate Billing Requested .....
.. 7. 7 0 3 3 5. 3 4
8. Total Gross Assets (total Lines 1-7} ......................... .. 8. 2 7 9 4 3 2. 0 7
9. Funeral Expenses & Administrative Costs (Schedule H) ........... ..... 9. 3 1 3 6 8 9 0
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ....... ..... 10. 1 1 5 9 3
11. Total Deductions (total Lines 9& 10) ...................... ..... 11. 3 1 4 8 4 8 3
12. Net Value of Estate (Line 8 minus Line 11) .................... ..... 12. 2 4 7 9 4 7 2 4
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............. ..... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............. ..... 14. 2 4 7 9 4 7 . 2 4
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.0 _ 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 4 9 5 8 9. 4 4 1s
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17,
18. Amount of Line 14 taxable
at collateral rate X .15 1 9$ 3 5 7 8 0
1 g.
19. Tax Due ......... .............................. ..... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056042126
Side 2
0. 0 0
2 2 3 1 5 2
0. 0 0
2 9 7 5 3. 6 7
3 1 9 8 5. 1 9
15056042126
REV-1500•EX Page 3
Ibecedent's Complete Address:
File Number
21 07 0051
DECEDENT'S NAME
Merrill F. Simpson
STREET ADDRESS
1300 York Haven Rd, Lot 65
CITY
York Haven
__
STATE ZIP
pq 17370-
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 29,000.00
C. Discount 1,526.27
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(1) 31,985.19
Total Credits (A + B + C) (2) 30, 526.27
Total InterestlPenalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
0.00
(5) 1,458.92
(5A)
(56) 1,458.92
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ................................................................. ..... ^ Q
X
b. retain the right to designate who shall use the property transferred or its income; .......................... .....
c. retain a reversionary interest; or .....................................~ .................................................... ..... ^ 0
d. receive the promise for life of either payments, benefits or care . .................................................. .....
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
X
without receiving adequate consideration? ..................................................................................
" .....
^
or payable upon death bank account or security at his or her death? ....
3. Did decedent own an "in trust for .....
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................. ..... ~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three {3) percent [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 zero (0) percent
(72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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 zero (O) percent [72 P.S. §9116(a){1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)).
The tax rate impcsed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
0.00
REV-1503~EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Merrill F Simpson 21 07 0051 -
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~ 14187.192 shares PNC Investments-Eaton Vance Mutual Funds @ $9.790 each 138,892.60
Trust Diversified Inc Fd CI A
2 11790.435 shares PNC Investments-Eaton Vance Spf lnvt Tr @ $21.040 each I 37,670.75
`Large Cap Value Fd CI A
TOTAL (Also enter on line 2, Recapitulation) I S 176,563.35
(If more space is needed, insert additional sheets of the same size)
REV-1508•EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RESIDENTEDECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Merrill F. Simpson 21 07 0051
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. AmeriHealth-refund on insurance 28.45
2 Beverly Healthcare-refund on account 117.64
3 Highmark-refund 110.70
4 PA Treasury Dept.-annuitant check 73.45
5 PNC Bank-Checking Acct. #5003843671 5,390.11
Princ. $5,390.11, Int. $.19
6 PNC Bank-Checking Acct. #5003843671 -Accrued Interest 0.19
7 PNC Bank-Savings Acct. #5003549595 13.06
8 PNC Investments-Cash acct 117.42
9 PNC Investments-MMarket Funds 25,672.36
10 Unclaimed property claimed 500.00
11 US Treasury-refund on decedents 2006 1040 return 510.00
There was no car or mobile home owned by the decedent at the time of his death.
TOTAL (Also enter on line 5, Recapitulation) I S 32 533 38
(If more space is needed, insert additional sheets of the same size)
REV-151 U EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
Merrill F Simpson 21 07 0051
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,
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENIAND
THE DATE OF TRANSFER. ATTACHACOPYOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
~ Allstate Life Insurance Co. Annuity #GA0590444 70,335.34 100. 70,335.34
beneficiary is estate
TOTAL (Also enter on line 7 Recapitulation) ~ 5 70,335.34
(If more space is needed, insert additional sheets of the same size)
REV-151 t EX + (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Merrill F. Sim son 21 07 0051
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~ Woodlawn Memorial-interment (funeral) 1,105.00
Richardson's Funeral Home-funeral expenses 4,491.00
B. ADMINISTRATIVE COSTS:
~ Personal Representative's Commissions
Name of Personal Representative (s) D. Joanne Krout 10,454.00
Social Security Number{s)/EIN Number of Personal Representative(s) 180-26-7078
Street Address 126 Glendale Drive
city Mechanicsburg State PA zip 17050
Year(s) Commission Paid: 2007/08
2 Attorney Fees David H. Stone, Esquire 13,971.00
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
a. Probate Fees Register of Wills-Cumberland County 410.00
5 Accountant's Fees
6. Tax Retum Preparer's Fees
z. PA Dept, of Revenue-estimated taxes for 2006 100.00
2 PA Dept. of Revenue-estimated taxes for 2006 100.00
3 US Treasury-estimated taxes for 2006 120.00
4 US Treasury-estimated taxes for 2006 120.00
5 PA Dept. of Revenue-payment of 2006 PA40 taxes 13.00
6 Check written by decedent but not cleared 28.45
7 PNC Bank-check printing fee 16.99
8 Cumberland Law Journal-advertising grant of letters 75.00
9 The Patriot News-advertising grant of letters 134.46
10 Register of Wills-filing Inheritance tax return and Inventory 30.00
11 Reserve for closing expenses 200.00
TOTAL (Also enter on line 9, Recapitulation) S 31,368.90
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
scHeou~e ~
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8 LIENS
FILE NUMBER
Merrill F. Simpson 21 07 0051
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
PharMerica-pharmacy at Beverly
2 ~ PharMerica-perscriptions
TOTAL (Also enter on tine 10, Recapitulation} ~ 3
16.00
99.93
11
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX ~ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE)
BENEFICIARIES
ESTATE OF FILE NUMBER
Merrill F. Sim son 21 07 0051
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
t D Joanne Krout Niece Collateral 49,589.44
126 Glendale Drive
Mechanicsburg PA 17050-
2 Ellna OConnor Friend Collateral 49,589.44
107 Mill Road, Apt. 2-C
Middletown PA 17057-
3 Donna L Martin Step granddaughter Lineal 49,589.44
4247 K Catalina Drive
Harrisburg PA 17109-
4 Delores J Derick Great niece Collateral 24,794.73
2265 A Earth Road
Enola PA 17025-
5 Patricia A Garrick Great niece Collateral 24,794.73
85 Old Willow Mill Road
Mechanicsburg PA 17050-
6 Ricky A Krout Great nephew Collateral 24,794.73
125 Glendale Drive
Mechanicsburg PA 17050-
7 Elmer K Krout III Great nephew Collateral 24,794.73
126 Glendale Drive
Mechanicsburg PA 17050-
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S
(If more space is needed, insert additional sheets of the same size)
L.~S~~.~LL .~'~:N1D ~~S~~~.~V1PN~
of
.~tERRIIL F. SIMPSON
I, Merrill F. Simpson, of 1300 York Haven Road, Lot 65, York Haven,
Pennsylvania, York County, Pennsylvania, this f!~ day of October, 2004, do herby make
this my Last Will and Testament, REVOKING ANY FORMER Wills and Codicils made
by me.
ITEM I: I direct that all of my just debts, the expenses of my last illness and
funeral expenses, shall be paid from my estate as soon as practicable after my death and
as part of the expense of the administration of my estate. It is my desire that my remains
be interred and that I be buried in the cemetery plot by my wife Thelma at Woodlawn
Gardens Cemetery in Harrisburg, Pennsylvania.
ITEM II: All taxes and interest, including any penalties thereon, payable by
reason of my death with respect to property comprising my gross taxable estate, whether
or not passing under this Will, shall be paid from the principal of my residuary estate.
ITEM III: I give, devise and bequeath all the following specific items to the
following persons:
a. my automobile to my friend and companion Ellna B. O'Connor;
b. my mobile home located at 1300 York Haven Road, Lot 65, York Haven,
to my friend and companion Ellna B. O'Connor;
c. my remaining cemetery plot at Woodlawn Gardens Cemetery to my friend
and companion Ellna B. O'Conner so that she can be buried beside me.
ITEM IV: I further direct that I hereby give, devise and bequeath all the rest,
residue any remainder of my estate, whether real, personal, or otherwise, in the following
percentage amounts to the following persons:
a. Twenty percent (20%) to my beloved friend and companion Ellna B.
O'Connor. In the event she fails to survive me, then her share shall be equally
divided among the survivors named in Item IV subparagraphs b though g.
b. Twenty percent (20%) to my dear step-granddaughter Donna L. Martin. In the
event she fails to survive me, then her share shall be equally divided among
the survivors named in Item IV subparagraphs a through g.
c. Twenty percent (20%) to my dear niece D. Joanne Krout. In the event she
fails to survive me, then her share shall be bequeathed to her husband Elmer
E. Krout.
d. Ten percent (10%) to my dear great niece Delores J. Derick. In the event she
fails to survive me, then her share shall be bequeathed to her son, Jesse B.
Derick.
e. Ten percent (10%) to my dear great niece Patricia A. Barrick. In the event she
fails to survive me, then her share shall be equally divided between her two
sons, Boe D. Barrick and Jake D. Barrick.
f. Ten percent (10%} to my dear great nephew Ricky A. Krout. In the event he
fails to survive me, then his share shall be bequeathed to his son Tommy E.
Krout.
g. Ten percent (10%) to my dear great nephew Elmer E. Krout III per stirpes. In
the event he fails to survive me and has no issue, then his share shall be
2
equally divided among the survivors named in Item IV subparagraphs a
though g.
ITEM V: If any beneficiary under ITEM IV is under twenty-five (25) years
of age, I direct that his or her interest be held in trust by D. Joanne I~rout, hereinafter
called Trustee and referred to in the singular neuter gender, until such beneficiary reaches
twenty-five (25) years of age. My Trustee shall apply such amounts of income and
principal as it, in its sole discretion, deems proper for the support, education and welfare
of such beneficiary, and may accumulate any unexpended balance of income to the extent
permitted by law. Some amounts may be applied directly or may be paid to the
beneficiary or to the person with whom such beneficiary resides or who has the care and
control of such beneficiary, without the intervention of a guardian. My Trustee shall not
be obliged to supervise or inquire into the application of such amounts by such- person,
and the receipt of such person shall be a complete release of my Trustee. Should the
share of a beneficiary, in the sole opinion of my Trustee, be or become too small to
warrant continuing such fund in trust, or should its administration be or become
impractical for any other reason, my Trustee, in its sole discretion, may pay such share,
absolutely, to the beneficiary, or may deposit such share in the beneficiary's name in a
savings account at a savings institution of its choosing, payable to the beneficiary after he
or she attains the age of twenty five (25) years. In the event D. Joanne ICrout predeceases
me or is otherwise unable to serve as my trustee, then I appoint Donna L. Martin as my
alternate trustee.
ITEM VI: I appoint D. Joanne Krout, as my Executrix of my estate. If she
predeceases me or is otherwise unable to serve as my executrix, then I appoint Donna L.
Martin as my Executrix. I direct that my Executrix or Executor serve without bond in
any jurisdiction in which called upon to act.
ITEM VII: I give to any Executor or Executrix and to any Trustee or Trustees
named in this Will or any Codicil hereto all of the powers now applicable by law to
fiduciaries in the Commonwealth of Pennsylvania and in particular, through the Probate,
Estates and Fiduciaries Code, as effective and as in effect on the date hereof, during the
administration and until the completion of the distribution of my estate, and until the
termination of all trusts created in this Will or any Codicil hereto and until the completion
of the distribution of the assets of such trusts.
ITEM VIII: I direct that this Last Will and Testament control the distribution of
my property irrespective of whether there are children born to me or adopted by me
subsequent to the execution of this Last Will and Testament.
ITEM IX: The words "issue" and "children" whenever used in this Last Will
and Testament shall include adopted children.
ITEM X: No interest of any beneficiary under this Will or any Codicil hereto
shall be subject to anticipation or to voluntary or involuntary alienation.
ITEi~i XI: All estate, inheritance, succession and other death taxes imposed or
payable by reason of my death and interest and penalties thereon with respect to all
4
property comprising my gross estate for death tax purposes, whether or not such property
passes under this Will, shall be paid out of the residue of my estate, as if such taxes were
expenses of administration, without apportionment or right of reimbursement. I authorize
my Executrix and Trustee to pay all such taxes at such time or times as deemed
advisable.
IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will
and Testament consisting of fl ~c.(~ pages this ~~ay of x,.2004.
Merrill F. Simpson
5
SELF-PROVING AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF
WE, Merrill F. Simpson, and J ,.~ ~ 4~ and ri cx._ L ...K the
Testator and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument ,being first duly sworn, do hereby declare to the undersigned
authority that the Testator signed and executed the instrument as his Last Will and that he
had signed willingly (or willingly directed another to sign for him) and that he executed
it as his free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testator, signed the Will as witness and to
the best of his or her knowledge the Testator was at that time eighteen (18) years of age
or older, of sound mind, and under no constraint or undue influence.
2~~_..~t ~ ,g~..~,~,,,~_
Testator
' ness
Witness
6
Subscribed, sworn to, and acknowledged before me by Merrill F. Simpson,
Testator, and subscribed and sworn to before me by ~j ~ ~ n F. ~ Pc r
(nG r ~ a C. ~,f) r k. ,and witnesses, this _L~day of ~ ~/ 2004.
G~
S
Notary Public
My Commission Expires .
NOd11MAl. SE/~L
PAY 3.11~~ Nolr~- Pyle
6wlP~o C~fmdCanq-
!ly ~iir^1 Ay.14, ~OOd
7
PNCBAN<
February 20, 2007
David H. Stone
414 Bridge Street
P.O. Box E
New Cutz'tberland, pA 17070
1tE: Estate of Merrill F. Simpson, deceased
SSN: 716-09-6646
DQD: 12/31/2006
Dear 1Vlr. Stone:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Accannt
Account #5003843671 Established 08/24/2001
MEFtRII,L F SIl~PSON
DOD balance: 55,390.11 + $.19 accrued interest
Savings Account
Account #5003549595 Established 08/24/2001
MERRII.L F SIlvIp50N
DOD balance: $13.06 + $0.00 accrued interest
The decedent maintained Investment Account (1NV #76947154). For fturther information,
you may contact the Brokerage Department at 1-800-762-6I 11.
Please note that this office only provides date of death balances for deposit accounts
(I1tAs, 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-BAND (1-$88-762-2265) or stop by your local PNC Bank branch
office.
Sincerely, ~~
Rachelie Wells
I-800-762-1775
P7-PFSC-04-F
500 first Avc.
Pittsburgh PA l52 ] 9 Member FUTC
TOTAL P.01
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Allstate Life Insurance Company
P.O. Box 94212
Palatine, IL 60094-4212
Telephone: (877) 499-6418
Facsimile: (866) 635-4523
April 12, 2007
D. Joanne Krout
126 Glendale Dr.
Mechanicsburg, PA 17050
Re: Merrill F. Simpson
Contract No: GA0590444
Claimant(s): Estate of Merrill Simpson
Product Type: Fixed Annuity
Tax Type: Non-Qualified
Dear D. Joanne Krout:
~` Allstate
You're in good hands.
We are unable to process this claim, as we have not received all required documents. At your earliest
convenience, please provide the following documents in the enclosed postage-paid envelope:
With the Estate of the decedent as beneficiary, the executor/administrator of the Estate should attach a
copy of the court document appointing the executor/administrator of the Estate. If the Estate will not be
probated, it may be possible to resolve the claim through use of a Small Estate Affidavit that confirms to the
laws of the state with jurisdiction in this matter. Smaller Estates, as defined by state law, can often be
expedited with such an approach. You may wish to consult an attorney for advice with this decision.
The death benefit payments from an annuity are taxed to the claimant in the year they are received as
ordinary income to the extent of gain in the contract. If the contract is tax qualified, generally, all payments
will be fully taxable. Please consult with your tax advisor or attorney prior to making any decisions
concerning the claim.
If you anticipate any unusual delay or need assistance, please contact our Customer Care Unit at 1-877-499-
6418.
Sincerely,
Valarie Melton
~-`~~
Sr. Claim Examiner
~r-c~ ~ . ~
~„iaPD