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Home My WebLink About12-04-07 (2) -1 15056041114 REV -1500 EX (06-05) OFFICIAL USE ONLY County Code Year File Number PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT 21-07-00744 Date of Birth 201-16-2367 Decedent's Last Name 07312007 11121924 Suffix Decedent's First Name MI CULLINGS (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ANNA M Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW UU 1. Original Return D 2. Supplemental Return D CJ o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required D 4. Limited Estate CJ 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy ofTrust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes uu 6. Decedent Died Testate CJ (Attach Copy of Will) D 9. Litigation Proceeds Received D D 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) First line of address ,...:/ CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION(St:!OULD BE DleED TO: ::0 Name Daytime Telephdfte ~mber _J ;;:R C5 '''i ~~i (:") C) 717-243-58~.8P C") ~'1f3 .. iTl r-..j rn REGISTER OF WlL' USE ONLY :-C, CJ - C'O r~ -'I =: ~.~~ .~ ~ ;::-.:: nl (.,')0 -n c::> CJ.) STEPHEN D. TILEY Firm Name (If Applicable) FREY & TILEY 5 SOUTH HANOVER STREET Second line of address City or Post Office State ZIP Code DATE FILED CARLISLE PA 17013 DATE - '1- ,2aY? HIGHWAY, CHAMBERSBURG, PA 17202 ADDRESS STPEHEN D. TILEY, 5 SOUTH HANOVER STREET, CARLISLE, PLEASE USE ORIGINAL FORM ONLY PA 17013 Side 1 L 15056041114 15056041114 -1 ~ ~ -.J 15056042115 REV-1500 EX Decedent's Name: ANNA M CULLINGS RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Property (Schedule F) DSeparate Billing Requested. . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) DSeparate Billing Requested. . . 8. Total Gross Assets (total Lines 1-7) . . . . . 201-16-2367 Decedent's Social Security Number 1. NONE 2. 3. NONE 4. NONE 5. 6. NONE 7. 8. 9. 13990.00 3172.00 197267.00 214429.00 6618.00 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 (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . .. 13. 14. NetValueSubjecttoTax(Line 12 minus Line 13).......................14. 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.O L 16. Amount of Line 14 taxable at lineal rate X .0 ~ 17. Amount of Line 14 taxable at sibling rate X . 12 18. Amount of Line 14 taxable at collateral rate X . 15 205900.00 16. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042115 15. 17. 18. 15056042115 1911. 00 8529.00 205900.00 0.00 205900.00 0.00 9266.00 0.00 0.00 9266.00 D -.J REV-1500 EX Page 3 201-16-2367 Decedent's Complete Address: File Number 21-07-00744 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER ANNA M CULLlNGS 201-16-2367 STREET ADDRESS 2100 BENT CREEK BLVD. CITY II STATE I ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 9266.00 8660.00 455.78 Total Credits ( A + B + C ) (2) 9115.78 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E) (3) 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. (4) 0.00 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 150.22 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 150.22 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 0 b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .. 0 0 c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 0 d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. 0 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 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. 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 .5. 99116 (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 .5. 99116 (a) (1.1) (ii)]. 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 (0) percent [72 P .5. 99116(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 .5. 99116(1.2) [72 P .5. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(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. 217 REV-1503 EX. (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF CullinQs, Anna M. FILE NUMBER 21-07-00744 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH HD Vest Financial Services Account No. 77700769 clo Mr. David Weaver 35 East High Street, Suite 103 Carlisle, PA 17013 Wells Fargo Money Market Fund 13,990 TOTAL (Also enter on line 2 Recaoitulation' $ (If more space is needed, insert additional sheets of the same size) 13 990 = ~ = - - ~ ~ - = ~ -- ~ - = e - ~ - = ;;;;; !!!!!! !!!!!! \lO-nl> oeg o to 0 'lo " -e ~;a. ~ ~& . ~ i' ~~~ u;-;c: 5- -n~o ~~I 3'~~ ~tO ~ i~~ ~~~ O(l)-n {l~.a ~-8 ~ %-d "ii~ ~o:3 !a~ "'~!" g,.!..F= ii'~O Ze~ 9.'" .. (1)03 ~~[ ""(1) ~'Z'ti .. ;.-.9 ~ ~ ~~ ~Dl~ <To ~=? ".."" a~ 2l"" ~~ s.[ ~.. ..s. 1if~ -n!!t e'ii' '" o "'0 Il) (g \9 .... o - (,11 o =0", ~~ ~" \:")S-~. go", ~~~ \i;I:i ~~S- $Olg %;rg. ~~;I:O <>>'" \Q~< .,;<.. g&,~ $~'%" ~$~ z ~3 o' .. ~::s3. ~~ en ~tTla a~ :$. Ol ,..g :1:",,,,,,, ~ V;.!: o;g;~ :-!!! 3 ~ti 'i1s"m ;:~~ ~ ijf:-' ~"Tl~ ....(~ s. l<'" .. ~~~ go'" cao~ 'lh ~~ ~ Z -I -I r2\ (1) 0 0 i\Z:l -srsr o ;.;; ,J, :r '" '" ~ ! '" ~ ~ u:a~...?, (1) <:<: >-\ !!.!!. e e .....0 Q) (\) ~~ d 9.. 9.. ~ oc... ct 11)5- ~~ () ~~ ~ ~~ ~ ~ ~ (]'Q N ~ 8 ..... m ~ ~ en ~ S' * ~=~ -0'1 e; $ ~I\)O ~(,):.... ~<oa> c... r:: .:< w ~*:" c;:o';'!>) . 0) g ~~-..I -< (1) -Vt a ~~o ~V30 0) a, a. (0<0\9 ~ ~ :T W \% -c ~ ~ fI ~ o ";4- Q> ..- ..... o V1 a ~ c:... c: -< ,.A. -is ~8 <f!. ." o """l :: o - 0- < e. c (I) ~ ~ c:... c: -< Co) ,.A. o ~ :s- g o ...a ~ ~ 11) 11) ~ Sl" 3: o :l (1) '< 3: ?S: -n 0. '" -Ut ... ~ ~tO to o ... 0) * ..... V3 -$ 9 ..... m "0 ~ -Ut ~ ... 5' ~*c: ....a ..... fJ) .;;.. ~ < ....a .;. Q) . -..I-c: .;;.. . .;;.. :t (t) - 3:{j)~~ :. m~oz == strrl~~ :: ):>.....m",. :- Z<?,Zo == o~-Ic :: (j) or- :: OJ :DC =- C mz =-:0 me == Q ^(j) :: OJ :: ""'0 0 ::):>c :=.- ~ =- <3 <: =- gl ):> :..~~ =-0) - V3 b~ - - - - - - - ~ o ...... (j)"tlZ:O o"O!a.~ e. -nE; ><OJO:l -nO'" 3: !!.><Oll) p;~~== {j)-I:l""'O o(]lgo (]I ...~ -I ...'" ...... 11)11> .- (f) 5" "";-I -g<o (]I :l 0 ~ o.:l (]I ~ -< o 11) o N en en en N ..... N a> 0) 0) ::I: ...... o en q ~ V3 o ~ ~o 111~ ~~ 101\1 /1)::1 3a. /1)'):> :J", ~'" '):>/1) n.... n o c :J ~ 3: OCllV300 Z\;' cen>o g, i 5i ::pl1 :5 i :l..Cm::I:OC) ~"-{j)"""-:2:- o:"jr-o~mC: a>-..ImV3..... VI ..--." (j)~> ~~):> -Im~ 0)<0..... :0:0 '0-1 m e;.;.~ m <P~V3 -I ~ 0) ..... o c: ~ ~ (t) ~ ... < e. c: (t) o-n "'0 -... 00 ~~ ~'5 3.3 -CJ> 0-' II> II> ';Fs:: '5:g aro :lA- ~L8 g.a 0-9. :s-:l 11)<0 ~-a II> s:: . ... 00. ~~ .....;:; cilo -I~ --10. mo- V3 :s- ma> ~o 0"" O)~ ~3: :;- <0 g a> '" !!' L :t P < CD !.. o o ~ VI 5. Di ~ ~ i';1 ~~S 'i1"Z '" [~a ~. ~ ... ~ r E::: ." "1\ ~ m -.J> ::l& 00 or:: -.J~ c>>- \0% c: :3 0" !!l c...r- ell) :lVl a>- (.o)(/) 0- - a. ~~ ~~ - ~ (1)& ~ rn - l>> .a :Xl o < ~ n o (') 3 "0 Cl> ::l -< m CJ)- ~ o a. ~ ..J 217 REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CullinQs. Anna M. Include the proceeds of litigation and the date the proceeds were received by the estate. All propertyiointlv-owned with riaht of survivorshio must be disclosed on Schedule F. FILE NUMBER 21-07-00744 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH Cash in desk drawer ~, L. Cah in resident account at The Bridgs at Bent Creek :-1. Refund, ROBC Limited Partnership (The Bridges at Bent Creek) 4. The Sentinel - refund 5. Personal Property - See Attached Sheet 40 140 42 5 2,945 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 3,172 Estate of Anna M. Cullings Household Goods Moved From Apartment August 17,2007 2 Curio Cabinets James $150 27" Television James $200 VCR James $ 10 6-Piece Wall Unit James $500 2 Plant Stands James $ 20 Cherry Desk James $ 75 Drop Leaf Cherry Table Karen $100 Jewelry Cabinet Karen $ 30 Wall Curio, White Karen $ 30 Miscellaneous Costume Jewelry Karen $500 Large Desk Karen $150 Desk Lamp Karen $ 40 End Table Karen $ 40 Gold Framed Mirror Karen $ 25 2 Floor Lamps Karen $ 75 Cherry Highboy Harry $300 Cherry Low Dresser Harry $300 Cherry Framed Mirror Harry $150 Marble Topped Stand Harry $250 (.) u + + + + + + + (!J 0000000 0000000 . . . . . . . 000001.01.0 I.OO"-OC\JI'-I.O ..-C\J 1.0 0"\ + + + + + (!J 000000 0000 . . . . . 00000 001.01.00 I'I")I'I")..-C\JO ~ + + + + + + + + + + (!J 8888888888 . . . . . . . . . . 00000001.01.00 OI'l")I'I")OI.O<:t<:tC\.l~O"\ ..-- 1.0..-- 0"\ . Cl ..-- + + + + (!J 0000 0000 . . . . 001.01.0 00"\1.O<:t 00"\0"\0"\ ~ ~ ..-- C\! 217 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA IINHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER ESTATE OF CullinQs, Anna M. 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. 21-07-00744 DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF I DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF Io.PPLtCA.BLE) VALUE 1. American National Insurance Company 0 Annunity Contract No. LAR0075018 0 c/o Barron Fitz-Gerald 0 640 Keckler Road 0 Harrisburg, PA 1111 0 0 Cash surrender value on date of death 82,149 100.00% 0 82,149 0 Transferees I Beneficiaries: 0 Harry M. Cullings - Son 0 Jams D. Cullings - Son 0 Karen S. Cullings - Daughter 0 0 2. Symetra Life Insurance Company 0 Annuity Contract No. M0778720 0 P.O. Box 34690 0 Seattle, WA 98124-1690 0 0 Letter of August 8, 2007 (attached) indicates an "estimated 0 contract value" as of July 31,2007. However, that is not a cash 0 surrender value. It includes contract purchase fees. An email 0 dated August 29, 2007 (attached) indicates a value of 0 $115,118.48. That value should include interest accrued after the 0 date of death. That value is, nevertheless, being used for 0 inheritance tax purposes. 115,118 100.00% 0 115,118 0 Transferees I Beneficiaries: 0 Harry M. Cullings - Son 0 Harry M. Cullings - Son 0 Karen S. Cullings - Daughter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 7 Recapitulation) $ 197 267 (If more space is needed, insert additional sheets of the same size) FROM :DAUPHIN COUNTY LIBRARY FAX NO. :7172347479 AU~-14-2ee? e~:S9 PM \BARRON~ITi;G~RA~D \ i I Aug. 16 2007 09:51AM P3 17l?S64097S p.el i AMERICAN NATIOfilAL .'''-'Nee ~""ANY i ! j I AdIIlllllIll'8live 0fII1It ",0. lox 7&1S Sin I'tlnollllla. CA '4'~7e73 TlllepIlD".; ..,,0848. 7lSO Fax: I0Il0211011..2 Auguat 7, 2007 \ . .... \ ! I \ \ 1 I I i I , i ~ Rc: Oeceatecl: i Ann'. M. Cullingl ~ ."-~f:)llto-",f'Denth!,,.. !..~. -Jw~}h'~907 .. -I.. Contract No.: I LAR007Spl8 ! Dear Mr. Fitz-Gerald: \. \ .! Ii: As requested, below pl~ ftnd tb~ vat~eJ of the above;roferenqed annuity contract as of the date of death for eetato tax p~rposes.' ! I [' Contract No. !.Surt'cnder Vatl,ie [ LAR007S0t8 582,148,66 . I; I Should you require any .dditional n,(ormation, ph:uc c~ntact o~r Claims Department toll &ae at (800) 274.3179, extenlicm 4017.' : \ " I . I I Sino:;: , !tJ~ I IlMrie W~ 1 Claims Department Barron Fitz..Oerald 640 Keckler Road Harrisb\lrg. P A 17 t 11 Death Benefit 585 000.00 Fri, Oct 19, 2007 7:35 AM Subject: RE: Annuity Contract AA0778720 Date: Wednesday, August 29, 2007 7: 15 PM From: Rengstorf, Joe <joe.rengstorf@symetra.com> To: Stephen Tiley <stiley@freytiley.com> I will attach a copy of our date of death valuation letter which people use for estate purposes and it is our best answer for your first questi.on. The gross sum that would be paid to the three beneficiaries per our actuarial department is $115,118.48. Again, this is based on today's date. A commutation value needs to be calculated for each beneficiary and they may be different depending on the timing of when we receive the written request from each beneficiary. The remaining schedule of benefits that Mrs. Cullings would have received is: $3,015.39 On August 10th, 2007 and on the 10th of each following month until 43 payments have been made which is up to and including February 10, 2011 The beneficiaries would receive the same schedule but at one third of the value. So it would be $1,00~;.13 On August 10th, 2007 and on the 10th of each following month until 43 payments have been made which is up to and including February 10, 2011 Once ~le have received all requirements, we would release the back dated benefits and the payment stream would catch up to the current date. You can contact me directly with further questions. Joe Rengstorf Claims Examiner: Income Annuities Unit: 800-796-3872 x #3, 1 Direct: 425-256-8019 -----Original Message----- From: Stephen Tiley (mailto:stiley@freytiley.com) Sent: Wednesday, August 29, 2007 9:47 AM To: Income Annuities Claims Cc: Harry M. Cullingsi James D. Cullingsi Karen S. cullings Subject: Re: Annuity Contract AA0778720 Dear I1r. Roff: I entered you ernail address incorrectly and the message reproduced below came back undelivered. Hopefully this new attempt will be successful. Sincerely, Steve Tiley Page 1 o~ Stephen D. Tiley 5 South Hanover Street Carlisle, pennsylvania 17013-3307 Telephone: 717-243-5838 Facsimile: 717-243-6441 Ernail: stiley@freytiley.com > From: Stephen Tiley <stiley@freytiley.com> > Date: Wed, 29 Aug 2007 10:14:37 -0400 > To: Erick Roff <iaciai@symetra.com> > Cc: "Harry M. Cullings" <cullings@iea.att.ne.jp>, "James D. Cullings" > <jcullings@innernet.net>, "Karen S. Cullings" <k_cullings@yahoo.com> > Subject: Annuity Contract AA0778720 > > Dear Mr. Roff: > > I am the attorney for the estate of Anna M. Cullings, deceased. She owned > Annuity Contract AA0778720. I need a date of death valuation for inheritance > tax purposes, and I am assisting the beneficiaries in deciding whether to take > a lump sum distribution, or continue annuity payments. > > I am in receipt of a copy of your letter of August 8, 2007 to Karen > Cullings. This ernail message will follow-up on a telephone message which I > just left at the number given on that letter. > > Please provide the following information: > > (1) The exact amount that Anna M. Cullings would have received if she had > chosen to cash in the annuity on July 31, 2007. > > (2) The exact amount and date of the payments Anna M. Cullings would have > received if she had lived beyond the annuity contract period. > > (3) The exact amount that the beneficiaries (gross for all three > beneficiaries) will receive if they all elect a lump sum distribution. > > (4) The exact amount and dates of the payments that the beneficiaries will > receive if they all elect to continue annuity payments. > > Your assistance in providing this information is appreciated. If you have > any questions, please feel free to contact me. If you do not want to disclose > this information to me for privacy reasons please send it to Karen Cullings at > the New Cumberland address you used for her previously, or send it to the > decedent at her address. > > Sincerely, > > Steve Tiley > > Stephen D. Tiley > 5 South Hanover Street Page 2 092 FROM : DAUPH I N COUNT~._ L I BRFlRY FAX NO. :7172347479 Aug. 16 2007 09:51AM Pl CD./Dept. Phone II SVM-ETRA.. Poet-if' Fax Note To Fall jl FINANCIAL August 8, 2007 Karen Cullings 824 2nd St. Newcumberland, PA 17070 Annuity Contract: M0778720 Payee: Anna M. Cullings Dear Ms. Cullings: This letter is in response to your request for a valuation of Annuity Contract M077a720. The estimated value of this contract as of the date of Anna M. Cullings's death. July 31, 2007, is $117 ,629.00. This estimate is net and should not be considered as a present or cash surrender value. The figure provided should be understood as a purchase price value. Included in the amount are certain costs and fees which are part of the premium that would be used to purchase the . remaining benefits at today's market prices. For a pure present value I we recommend contacting a Certified Public Accountant or someone in a similar position, who can calculate the value more speCifically. Our representatives are available 7:00 a.m. to 4:30 p.m. Monday through Friday, Pacific Time. Call us toll free at 1-800-SYMETRA (796-3872), option 3 then 1. contact us via e-mail at iaclai@symetra.com, or by toll free.fax at 1-866-817-8780. t:!E Erick Roff Claims examiner Income Annuities Claims Unit Symetra Life Insurance Company . Syrnetrll Lif.lnsurMce Company' 777 lOath Avenue NE. Suite 1200. Bflllevue. WA 981104-S135. www.~yrnetr...c()n\ Mailing Address: PO Bex ::l4(,tJO. Seatl:lo.:, WA 98124-169Q. PMne 1-800..7\1b-~872 . TrY/TDD 1-800-833-6368 VL11HI')~ 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Cullings, Anna M. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-07-00744 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home 3,321 2. Carlisle Memorial Service, Inc. 650 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees (FREY & TILEY) 2,500 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 132 5. Accountant's Fees (FREY & TILEY) 0 6. Tax Return Preparer's Fees (FREY & TilEY) 0 7. Filing Fee - Inheritance Tax Return 15 TOTAL (Also enter on line 9 Recaoitulation) $ 6.618 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12..Q3) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CullinQs, Anna M. 21-07-00744 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ITEM NUMBER DESCRIPTION 1. West Shore EMS - BLS 85 2. West Shore EMS - BS 144 3. Shelly Moving & Storage, Inc. 1,507 4. Holy Spirit Hospital 175 TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 1,911 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Cullinas Anna M. 21-07-00744 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)] a. James D. Cullings, 11,428 Arch Stret, Carlisle, PA 17013 Grandson 5,000 b. Anthea Cullings Abers, 824 2nd Street, New Cumberland, PA 17070 Granddaughter 5,000 c. Harry M. Cullings, 108-402 Tsurumi-cho, Naka-ku, Hiroshima, Japan 730-0045 Son 1/3 Residuary d. James D. Cullings, 1221 Anthony Highway, Chambersburg, PA 17207 Son 1/3 Residuary e. Karen S. Cullings, 824 2nd, Street, New Cumberland, PA 17070 Daughter 1/3 Residuary 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 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 the same size) ~ ~~, , (' . ~ ~; o k d J LAST WILL AND TESTAMENT OF ANNA M. CULLINGS' I, ANNA M. CULLINGS, of South Middlet<?n Township (mailing address: 128 South Ridge Road, Boiling Springs, Pennsylvania 17007), Cumberland County, Pennsylvania, 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. 1. I direct my hereinafter named Executor or Executors to pay all of 'my just debts and funeral. expenses as soon after my death as may be found convenient to do so. I further direct that all inheritance and estate and death taxes which may be payable on account of 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. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my husband, Harry M. Cullings, his heirs and assigns, to the exclusion of my children, born and unborn, provided my said husband, Harry M. Cullings, shall survive me bya period of ninety (90) days. 3, Should my said husband, Harry M. Cullings, predecease me or fail to survive me by the aforesaid period of ninety (90) days, then in such event all of the re~t, residue and remainder 'of my estate, real, personal and mixed, and wheresoever the same may'he'situate, I give, devise and bequeath as follows: a) I give and bequeath the sum of $5,000.00 to my grandson, lames D. Cultings, II, 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 to such of his legitimate issue as shall survive me by a period of ninety (90) days, per stirpes, and if there be no such issue then the same shall lapse. b) I give and bequeath the sum of $5,000.00 to my granddaughter, Anthea CuIlings Abers, her heirs and assigns, provided she shall survive me by a petiod of ninety (90) days, but should she fail to so survive me then to such of her issue as shaR survive me by a period of ninety (90) days, per stirpes, and if there be no such issue then the saine shall lapse. c) The balance thereof I give, devise and bequeath in equal shares to such of my three (3) children, their heirs and assigns, as shall survive me by a period of ninety (90) days, my said three children being Harry Michael Cullings, James D. Cullings, and Karen Sue Cullings. Should any of my said three children predecease me or fail to survive me by the aforesaid period of ninety (90) days, then in such event I direct the share such deceased child of mine would have received shall pass to such of his or her legitimate issue as shall survive me by a period of ninety (90) days, per stirpes, and if there be no such issue the same shall lapse and be added to the share or shares of my other children, per stirpes. ' 4. I hereby nominate, constitute and appoint my husband, Harry M. Cullings, 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 nomin,ate, constitute and appoint my three (3) children, Harry M. ~ Cullings, James D. Cullings and Karen Sue Cullings, or any of them, as alternate or successor Executors, and I further direct that none of them shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. 5, Should any person less than 21 years of age be entitled to distribution from my estate, in such event I direct the same shall be paid to the person or persons or corporate fiduciary which may be selected by my Executors as Guardian of the estate of such person and if the amount is in excess of $10,000.00 such appointment shall be approved by the Orphans' Court Division of the Cumberland County Court of Common Pleas or such other court as may have jurisdiction, and I authorize and direct such Guardian to receive and to invest the same and pay the income arising therefrom together with so much of the principal thereof as in its opinion is necessary or desirable to be expended for the proper maintenance, support and education of such person, and upon such person attaining 21 years of age to pay to him or her the then remaining principal together with any undistributed income. 6. My Executor and Executors and the Guardian of the estate of any distributee, in addition to the powers conferred by law, are authorized and empowered: a. To invest any part of the trust corpus in such securities, investments, or other property as may be deemed advisable and proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. Page 1 of 2 Pages b. With respect to any corporation, the stocks, bonds, or other securities of which may be held, to vote in person or by proxy on any shares of stock; to consent to the merger, consolidation or reorganization of such corporations; to consent to the leasing, mortgaging or sale of the property of any such corporations; to make any surrender, exchange or substitution of such stocks, bonds or other securities as an incident to the merger, consolidation or reorgl!llization of such corporations; to pay all assessments, subscriptions and other sums of money which may be deemed wise and expedient for the protection and maintenance of the proportionate interest of the investment in such corporations; to exercise an1 option or privilege which may be conferred upon the holders of such stocks, bonds, or other securities of such corporations either for the conversion of the same into other securities or for the purchase of additional securities, and to make any and all necessary payments which may be required in connection therewith; and generally to have and exercise as to all such stocks, bonds and other securities, the powers of an individual owner who is under trUst obligation. c. To hold the trust corpus in one or more consolidated funds in which separate shares shall have undivided interests. d. To sell at public or private sale for cash or upon credit, or partly for cash and partly on credit, and upon such terms and conditions as shall be deemed proper, any part or parts of the trust estate, and no purchaser at any such sale shall be bound to inquire into the expediency or propriety of any such sale or to see to the application of the purchase moneys arising therefrom. e. To keep on hand and uninvested such money as may be deemed proper and for such period as may be found expedient. f. To compromise, settle or arbitrate any claim or demand in favor of or against the trust estate. g. In the discharge of fiduciary duties, to employ counsel and to determine and to pay such counsel reasonable compensation which shall be charged against the principal or income of the trust fund, and shall further be entitled to charge against the principal or income such other reasonable expenses and charges as may be necessary and proper to incur for the proper discharge of fiduciary duties and for the proper management and administration. of the trust estate. h. In making any division of property into shares for the purpose Of any distribution thereof directed by the provisions of the trust, to make such division or distribution, either in cash or in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and in making any division or distribution in kind may allot any specific security or property or any undivided interest therein to anyone or more of such shares, and to that end may appraise any or all of the property so to be allotted and the judgment as. to the propriety of such allotment and as to the relative value for purposes of distribution of the securities or property so allotted shall be final and conclusive upon all persons interested in the trust or in the division or distribution thereof. i. To register any shares of stock or other assets of any trust in their own names or in the name of a nominee. . IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, this 25th day of August, 1994. 1'/' ' , al~'r?'?( J.n.. (;;-II'(UI ,:;;.::>) (SEAL) AnnaM. Cullings' )..'....- .' Signed, sealed, published and declared by ANNA M. CULLINGS, 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. . ~ /. , r-:/~/- ~- 7---0 /T\~',('.)( r-J p -r' 0 .}-t1 L', .. oj