HomeMy WebLinkAbout02-14-08
---1
REV-1500 EX (06-05)
15056051058
OFFICIAL USE ONLY
PA Department of Revenue *'
Bureau of Individual Taxes
PO BOX 280601
Harrisburu PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
1174-05-0208 19-20-2007
Decedent's Last Name Suffix
IAlexander I I
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
I
INHERITANCE TAX RETURN County Code Year File Number
RESIDENT DECEDENT I~ / U2007 IJ // ,tJ
Date of Birth
18-22-1916
Decedent's First Name
IMinnie
MI
IE]
Suffix
I I
Spouse's First Name
I I
MI
10
Spouse's Social Security Number
I
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
x
1. Original Retum
C::J
2. Supplemental Retum
C::J
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C::J
4. Limited Estate
C::J 4a. Future Interest Compromise (date
of death after 12-12-82)
C::J 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
C::J 10. Spousal Poverty Credit (date of death C::J 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
IBrian McDevitt, Esquire 1610-279-9600
Firm Name (If Applicable)
C::J
x
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
C::J
I ~,_
o ~~'-:5
REGISTER Of~LS USE Y
, " rr1
J= CO
,~j)
. 1
Fox, Differ, Callahan, Sheridan & McDevitt
First line of address
1325 Swede Street
Second line of address
I
'::_4
r -)
-0
_ ~ ~_2
,- ~J..J
DA19 FrLED
N
City or Post Office
/Norristown
State
IPA
ZIP Code
119401
CJI
Correspondent's e-mail address:
bmcdevitt@foxdifferlaw.com
4740 Water Park Dr. Unit Q, Belcamp, MD 21017
D 'J"E
{;7
ADDRESS
325 Swede St., Norristown, PA
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
--l
--.J
REV-1500 EX (06-05)
'*'
15056051058
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburu PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
1174-05-0208 19-20-2007
Decedent's Last Name Suffix
[Alexander I I
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
I
INHERITANCE TAX RETURN County Code Year
RESIDENT DECEDENT W U2007 !J; /yfo
File Number
Date of Birth
18-22-1916
Decedent's First Name
[Minnie
MI
IE]
Suffix
I I
Spouse's First Name
I I
MI
10
Spouse's Social Security Number
I I
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
x
1. Original Return
C:::J
2. Supplemental Return
C:::J
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C:::J
4. Limited Estate
C:::J 4a. Future Interest Compromise (date
of death after 12-12-82)
C:::J 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
C:::J 10. Spousal Poverty Credit (date of death C:::J 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
[Brian McDevitt, Esquire 1610-279-9600
Firm Name (If Applicable)
C:::J
x
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
C:::J
REGISTER OF WILLS USE ONLY
Fox, Differ, Callahan, Sheridan & McDevitt
First line of address
1325 Swede Street
Second line of address
I
City or Post Office
!Norristown
DATE FILED
State
IPA
ZIP Code
119401
bmcdevitt@foxdifferlaw.com
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this retum, 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
4740 Water Park Dr. Unit Q, Belcamp, MD 21017
DA E
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
-.J
..-J
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Minnie V. Alexander
RECAPITULATION
174-05-0208
1. Real estate (Schedule A) 1. $ 0.00
2. Stocks and Bonds (Schedule B) 2. $5,100.08
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. $ 0.00
4. Mortgages & Notes Receivable (Schedule D) 4. $ 0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. $ 0.00
6. Jointly Owned Property (Schedule F) C:::l Separate Billing Requested 6. $ 219.56
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C:::l Separate Billing Requested 7. $20,131.79
8. Total Gross Assets (total Lines 1-7) 8. $25.451.43
9. Funeral Expenses & Administrative Costs (Schedule H) 9. $12,579.54
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. $ 611.00
11. Total Deductions (total Lines 9 & 10) 11. $13,190.54
12. Net Value of Estate (Line 8 minus Line 11) 12. $12,260.89
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) 13. $ 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. $12,260.89
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. 15.
16. Amount of Line 14 taxable
at lineal rate X 0.045 12,260.89 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE
$ 0.00
$ 551.74
$ 0.00
$ 0.00
$551.74
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
C:::l
Side 2
15056052059
15056052059
L
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
D81
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
Minnie V. Alexander 174-05-0208
STREET ADDRESS
770 S. Hanover St.
CITY I STATE IZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
$ 551.74
260.00
13.00
Total Credits ( A + B + C ) (2)
$ 273.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) $ 0.00
(4) $ 0.00
(5) $ 278.74
(5A)
(5B) $ 278.74
Total Interest/Penalty ( 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.
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; 0 x
b. retain the right to designate who shall use the property transferred or its income; 0 x
c. retain a reversionary interest; or 0 x
d. receive the promise for life of either payments, benefits or care? 0 x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 0 x
without receiving adequate consideration? 0 x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? x 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.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)]. The statute does not exemDt 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.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. 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.
REV-1503EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Minnie V. Alexander
FILE NUMBER
46-08-
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$5,100.08
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL V-OWNED PROPERTY
ESTATE OF
Minnie V. Alexander
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER
DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or similar identifying number.
Attach deed for jointly-held real estate.
TOTAL (Also enter on line 6, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ 219.56
REV-1510 EX + (6-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Minnie V. Alexander
FILE NUMBER
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
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
TOTAL Also enter on line 7, Reca itulation
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (1(}.()6)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Minnie V. Alexander
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2.
3.
4.
Probate Fees
5.
6.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Minnie V. Alexander
FILE NUMBER
Record debts incurred by the decedent prior to death which remained unpaid as of the date of death, include unreimbursed medical expenses.
ITEM
NUMBER
1.
TOTAL (Also enter on line 10, Recapitulation) $ 611.00
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00))
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Minnie V. Alexander
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions. and
transfers under Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
$ 0.00
(If more space is needed, insert additional sheets of the same size)
Minnie V. Alexander
91
Aug. 22, 1916
8d. 'adI~ Name I'" _, lIw _ and"'-')
Chapel Pointe at Carlisle
12.Wa1 0ececIent8Y8l'In lhe
u.s. AnnecI Foren?
Ov.. I>>No
_.
AcIul!IIAetidence 17a.SIate
'7b.eo...~
1.. Marital StatuI: MarrIed, Never Married,
-.""""*'ISoooifl1
widowed
P.Il.
Ctnri::lerland
DId 0e0edInt
Uvo..
Township?
170, 0 Vos. _ LNed.
17d.O No._LNed_
AduJI LmlJ 01
Twp.
Carlisle
Clty/Boro
~
~
~ 22a. SIpUt of
. ~
19. Mother's Name (Fiist, middle, meiden surname)
Sadi ude
2Ob. Jnfom'lanrs MaIling NJl:ms (Str8et, city I town, state, zip code)
923 Ta1amore Dr., AnDler, PA 19002
21c. Pllceol DisposIIIon(Name ofcemetery,crtmIloryorolherQl8ct) 21d. Location (CIty/town, slate, ~codt)
Ctnri::lerland Valley Memorial Garde s Carlisle, PA 17013
22c.NomeondAdlbllol'lICiIty Hoffman-Roth Funeral HaDe & Crematory, Inc.
Ov.. ~
3lI>. _......., F>dngI
AYIIIabIe Prior to Completion
of Cause of Death?
Ov.. ONo
31.ManrwofDeath
~Na"" 0_
O-OPenclr1gI_
Os.- OCooldNolblOo_
Gel
I AppraximeteinllMl:
: Onset to Oealh
,
i \., ""--.
,
I
,
,
,
,
,
,
,
I
Part II: EnIer ~ sknIIIaInt cmdIlm!I conbtJutInn 10 dMIh,
butnotresullinglnlheundertylngClllJSeglYenin ParI!.
28. Did TobIcx:o Use Conlribult to Death?
o Vos 0"-
'5INo 0-
29.!lFemale:
o NoI__""'jQr
o PlognJnI""'of_
o NoI_t.bul__..dIyI
ol_
D NoI_""'_"dlylb',..,
bIfonl_
o ...,.....'_1_.......,..,
32c. PlIaI 01 Injury: ....... FIlm. _. Factory,
OO:eBuldlng.I!C. (Spoc/Iy)
~~=,~
..
~<;;~t)
=lItcardllona.iflny,
10 CIUIltlilt<<lanlnea
ED UNIlEJlLYING CAUSE
~":.~...
Out to (or 88 I anequence 01):
b.
Oue10 {Ol'U aOOf-.equ8OOl 01):
Oueto(Ol'lSleon&eql.JlInCIof);
d.
3Oa.WllanAu\oply
P-
32d. Time oIlr4ury
DIaposition PennII No.
321.'T_lionl'*'Y(Spoc/Iy)
OOl1Ylt/Opn.. 0"'- OPId......
Other-Spoc/Iy,
33b.~""""oIplfora
~ '6"n' - V l"-""-
32g.loeIlionol,*",(SItaII,clIy/_,"'''1
M.
I
15
~
~
331. CetIlfior_...."""
. c.rtIfying.php6cl1n IflhysiciM cerIItying cauu ofdealh when 8nolher physician hasjlRll'lOUflC8d dealh and COfl1lIet8d Item 23:)
. ;:=m:':=-pby~=~~:-~~m=~~;;;~i"""""-"""-""-~"""--------" ~
To IhI_Iofmy ~,dHthClCCUl'nld8lthetlme,dIte.and pIIc:e, Indduelohcauu(I)1nd IIWlI'IeI'II staled..._... __ ~ ~ ____ ~__........ _ 0
MIdk:el EumlMr I Coroner
On the _Is oI'.lminltion snd I or Invntlgatlon, In my 09in1on, dNth occurNd II the time, .Ie, end pillet, and due 10 ItIll ClUlll(I) Ind II'IIMIl' ultIted.. 0
33c.li:ense Numblr
""'-0 ~ \,2.416
~~~~
1<211 1.0.11 I()
33cl.Oate Signed (Month,dey,)'8Ir)
~... Pi ~ I ~ ".:2..~<::)'"
34. Name,8Rl Mnss 01 Person Who CorrIg&led CauMt'f-1h (Item 27) Type I Pm!
(1,<; ~ l';)'" p . '01'< I-) ~ Vo.$'" J" ~
<ds.~ V;:l<. 'lU<..~(",,",,-,""'J.
~_II::JL
LAST WILL ANI) TESTAMJl:NT
r)J~'
MINN": V. ALEXANDI~R
I, MINNIE V. ALEX^NDEIt a resid(.~nl of Cumberland County, Pennsylvania, being of
sound and disposing mind und mell1ory. do make, publish and declare this to be my Last Will
and Testament, hereby revoking all W.ills and (:<)dicil~ by me at any lime made.
ITEM I: TAXES. I direct thai all inhcrita.nc~ and estate taxes hccllming due by reason
of my death, whether sllch taxes may bl~ paY,lhlc by illY Eslate or by any recipient of any prop-
erty. shall be paid by my Executor out nr the property passing under lhis Will, which is not spe-
cifically bequeathed or devised, a$ an ~xpcnsc and wsl of administration of my Estate. My Ex-
ecutor shall have no dULY or onligali11l1 to obt"ill reimbursement for any sllch tax paid by my Ex-
ecutor, even though on proceeds oj' jnsuranc<.~ or other property nOl passing under this Will.
ITEM II: POWEI(S OF APPOINTMENT. I hc..~n::hy cXl:rcisc ~lll powers of appoint-
ment whieh I may have at the time or my d<.'alh in l~lvol' or my EXcl:ulor. and all property subject
to all such powers ofappoinl.mcnt shall b(:.~ included in my Estate.
ITEM Ill. PERSONAL I)OSSESSJONS. I hcrl:by give and bequeath all ormy house-
hold furniture and furnishings, alllolllohilcs, books. pictures, jewelry. china. linen, silverware.
wearing apparel and all other artick~s of hOW;l:hold 01' pc:r;)onaJ use and adornment in equal shares
to such of my children as survive 111l:.
ITEM IV: RJt:SU)UAL ESTATE. I giv<.,'. JL'visl".~ and hl.:qucalh .t1J uf' [h~ rl:st. residue
WA-. ...
P.e3
and remainder of my pn,lpcrty. rC~ll, personal antllllixcd. per stirpes. to such of my issue as sur.
vlve me.
ITEM V:I!:XF.ClJTOR'S POWERS. In the sdtlcmcna of illY Estate, my Executor
shall possess, among others. the Ibllowing powers:
(a) To sell, either at puhlic ()f' priv'lle ~aJc and upon such terms and conditions
as my Executur m.l)' deem aUIr'untClogcollS to I11Y h:Latc. :.I.ny or all real or
personal eslCltc or interest lhc:rl.~in, wh~'thcr owned hy me st:!paratcIy or in
conjunc.;tiol1 with uther pcr~OllS Or nC'-luircd on~r my dcuth by my Executor
and to consummate said sille Uf :,:mlcs by :iutlicicnt deeds or (lther instru-
ments to the purchas.:r 01' purdlasers. conveying a fee :simple titk, free and
clear of all trust and without liability of the purchaser or purchasers to see
to the application of the purchase money or to make inquiry into the valid.
ity of said s~lle or sales; ~ll::;o, to make, execute. acknuwledge and deliver
any and all dt:cds. ussigl1l1lcl1lS~ options or other writings which may be
necessary or desirable in cLlrrying OllL any of the puwers conferred upon
my Execu(or in this paragnlph or c1scwhcr~ in my Will.
(b)
To pay aU costs, taxeN, expenses and charges in connection with the ad.
ministration or my Est<.\tc.
(C)
To distribute my Esta(e in kind or ill money. In the event assets are dis-
tribut~djn kind, such ussets shall be distributed allhcir vuluc(s) on the re-
spective date(s) ol'thcir distribution.
Pa~c 2 01'4
~V7\
.._- _. . ''''.~' ----.--....
r- _ 11:::1'4
(d) To do all other acts in the judgmclll of my EXl.:cutor necessary or desirable
for the proper and iildvantagcmls management. investment and distribution
of my Eslatt:.
ITEM VI: GUAROIANSHIP o Ii' ASSETS. If ~l any lil1le any minor child shall be
entitled to receive any assets herellnder. M&'I BANK. having otliccs in and around Harrisburg.
Pennsylvania. shall act as Guardian of the assets paynblc to Stich child. Said Guardian may
receive and administer all assets authorized by law and shall have full authority to use slIch as-
sets, both principal and incume. in ~IIlY manner se:lid Ouardian shall deem advisable for the: best
interests of such child. including college, univ~rsity, post-graduate or other education. without
seewing court order. Said Guardian shall have alllhc rights and privileges as to the Guardian-
ship(s) and the assets thereof as arc herein gm\11~d to my Executor as to illY Estate and the assets
therein.
ITEM VII: SIMUL T AN.:Ol!S DEATH. Any person who shall have died allhe same
time as me or in a common disaster with me or under such circumstances lhat it is difficult or
impossibJe to determine who dit:d lirst. shall b-: dc~'mcd lo have prcdt.:ccascd Ille.
ITEM VIII: EXECUTOR f ht:rcby nominate, constitute and appoint my daughters,
DIANE RAE BRIDJ and DARLENE ANN WAKEFIELD. to be my Executrices ("Executor,"
herein). In the event of the death. disqualificatiun. resignation. refusal or inahility of either of
my daughtel's to serve as my I ::xcclItnr, my other daughter alone may ~CI'VC as my Executor. My
Executor and Guardian specifically arc rclic\'cu from thc dUly or obligation of filing any bond or
other security.
-14\.J 1\ ,..
....--.t::::I:;::)
IN WITNESS WlIEREOF. J have her~uJlt() set my hand and seal to this, my last Will
and Testament. consisting ur this and the prcl:cding three 0) pages. at the end or each page of
which I have also set my initia.ls 1(lr gJ'~Htcr s~~ClJriLy and beller idcntiliccJliun this. ,;(fJ 't;t, day of
October, 2005.
Page 4 of 4 Pages
.....~ --"-~ ..K......L:J,.~E~ ~
Minrlic~: ^~ ~.._ ~
We, the undersigned. hereby cenily thaI thc tllrl:going Will was ~isned, scaled, published
and declared by the above-named Testatrix, ns and 1hr her Last Will and Testament, in the pres-
ence of WI who. at hor request and in her pr~sence and in the prel'cncc uf each other, have here-
unto set our handtl and $eals the day and year :.tbove written. and we c~rli(y that at the time of the
execution thcrcoJ: the said Testatrix was of ;wund and disposing mind and memory.
~..... (SEAl.)
Residing UI.,."C~,._i:G..___ _"
t1
... ..(SEAL)
Residing al ......~_._.~ ~
);,. M /J~ _...._".j~EAL)
R.c:liJing ..t._~~ #-h~..,__
.. '~""""-_...... ,..... .., ,.,..~"_..........,-"____,,., ..'ON".,'",. ____
- -- -. - - ... "Tl1-aden
P.12l6
J\FflUA vrr
COMMONWEALTH OF PbNNSYLV ANIA
COUNTY OF DAUPHIN
ss:
We, the undersigned Testalrix and Witnessc:-;. n,::spL:ctivdy. whose namt:s are signed to
the attached or foregoing. inSlrum~nl, heing duly (llIalilh:d according lu law. do dcposlo: and
declare to the undersigned authority that:
1. The Testalrix sign~d ~md cXl,;cutcd the inSlrUmcnll.\s the Testatrix's Last Will and
Testament.
2. The Testatrix sign~d iJnd cx~cllt~d the Will willingly as the Testatrix's free and
voluntary act tor the pl1rp()s~s therein I:xpwsscd.
J. Each or the Witncss~s.ill the prCSl.'Ill;C and huarinl,( of the Tcstcltrix, signed the
Will as a witness.
4. To the best of th~ knnwlcdg~ c)f each of the Lmdersigncd. the Testatrix was at the
time: 18 years ofa.gl.: or older. ()riiOUnU mind i;lI1d un de!' nel comilrainL ur undue influence.
("Testatrix ")
._-~~~.:~~---
.~._.
("Witness")
~~
Sworn or ~\nlnncd and sllhs...~ribcd 10 hefc)re me by thl~ .1.huvc.namcd Testatrix and
~
Witnesses, this _ ~~._._ d~lY uf Octubcr. :2005.
._~-~~~~,fL.,..:t:-'- -:-
COMMONWEAlTH OF PENNSYLVANIA
Nolana'Se8I
Karen M. Tumer, NaIaIy PubIc
Carlisle Bolo, CoolbeIta.ld CcxI1Iy
My Como Iisdb. Elcp/nJe JUy 21,2008
Member. Pennsylvania Assoclatton OfNolMes
, 'k:.. '7/?J~
,-~. ......."..-..-.-...--.-.-...-..
Notary Public
(S EA L)
MetLife)
Statement of Trust Interests
February, 2000
At the time MetUfe demutualizes, you will be allocated shares of MetUfe, Inc. Common Stock, which will be held for you in the MetL"e Policyholder Trust.
The number of Trust Interests you own is equal to the number of shares of MetL"e, Inc. Common Stock held for you in the Trust.
This Statement of Trust Interests tells you how many Trust Interests you will own at the time MetLife demutualizes (in other words. how many
shares of MetLife, Inc. Common Stock will be allocated to you and held for you in the Trust).
If you want to buy more shares of MetLife, Inc. Common Stock to be held for you in the Trust, you should use the form printed below to submit
a Purchase Instruction. You are only eligible to purchase additional shares if you are being allocated less than 1,000 shares. Stock can be
purchased through the Purchase and Sale Program on the first trading day following the 90th day aner the date MetLlfe's demutuallzatlon
becomes effective. Purchase Instructions received before the purchase program begins will not be processed until the commencement of the
purchase program. If you want to sell the shares of MetLife, Inc. Common Stock held for you in the Trust, you should use the form printed on
the reverse side of this page to submit a Sell Instruction. Stock held In the trust can be sold aner the IPO distribution Is completed, which
should be no more than 30 days aner the plan effective date. Sell Instructions received before the sale program begins will not be processed
until the commencement of the sale program. All such purchases and sales will be on a commission-free basis.
-
-
-
-
AUTO ........... 5-DIGIT 17013
MINNIE ALEXA
770 S HANDYER ST
CARLISLE PA 17013-4105
1111111111111111...11..11111..1...1111111.1.1.1111111111'11111
N
....
.
..
.
II
Please be sure the correct address appears In
the window of the envelope if you are
submitting a Purchas. or Sal. Instruction.
The attached instruction card Identifies the
correct address for each type of transaction.
LIA
NS9"0
PLEASE RETAIN FOR YOUR RECORDS
H.....
MI"'IE ALEXA
,)i '.';.~; ',. ;.;F(:\':>i{':\;4_.---;.,<::.';;:;,~!\~
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tublre ref.r..~'
~-. ,'. '. ';' ,. , ''>''''.';!:.l:, ,',',-1.' '.
f"/_:_:;~;'~,'J.,-_:,':'
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NASI AIAfTNIIMflORT_ ItI,QR____ ". .'",
, ,'-, - --'>' -. ":", _",_,_>""~'~: ",'" ,':~f;~\..":" ;:','l{,:'T'~I;.:-">:'
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Use ONLY if a transaction Is requested. Unl.. you wi'" to Inlttl" Inalellan, n. lellOIls "qui..;
PURCHASE INSTRUCTION 80bb 4950 082b Change of address:
(See reverse side to SELL)
MINNIE ALEXA
Chase Mellon Shareholder Services
PO Box 382200
Pittsburgh PA 15250-8200
Signature: (if address beino chanOldI
Make check, In U.S. dollars. payable to:
MetLl'e Purchase Program
Amount Enclosed
1...11.1.1...1.1.1.1.11...1..1...1.111...11...11...11...1...11
Minimum investment $250.00 (except as
described in the enclosed brochure)
~
Please be sure this address appears in the
envelope window for Purchases ONLY!
0000101 102 80bb4950082b 7
LIA NS9"0
270,695
@ Mellon
Mellon Investor Services
cloms derlene wakefteld
109 ...tem blvd.
aul" 201
baltlmorE md 21221
EXAMINATION DEPARTMENT SR&D
PO Box 3310
So. Hackensack, NJ 07606
REGISTERED OWNER:
MINNIE V ALEXANDER
COMPANY NAME:
METUFE, INC.
CLASS OF STOCK:
COMMON STOCK
NUMBER OF SHARES:
34.0
10-02-2007
Dear Conespondent
You have recently contacted Mellon Investor Servlc:ee regarding the transfer of shares regl8tenKf In the name of the above
ref8r8nced shareholder without admlnlatnltlon of the shareholder's eetate. In order to complete this transfer, a Surety Bond In
Lieu of Probate must be oblalned and filed with MelIon.1
For your convenience, Mellon h88 established a blanket surety bond program with Federal Insurance Company through wun.
of NtWi York Inc" pursuant t) which you may 88tI8fy this I1IqUIrement. If you choo8e to obl8In a bond through Mellon', blanket
program, please follow theI8 Inetructlons: .
EneloM a money order, certified check or ceeh.....' check for $150.00 made payable to Mellon Inveetor Servkoa.
P..... complete the enclOMd forma and comply with the addltloAIII requIrements outlined on the form. W8J'IIIIY al_
advIH you of additioAlll requlremente tMt apply. All -'gmdu.... muat be noWlud by. not8ry public or gu.8I1t8ed
by. ftnan~ lnatltutlon that pertJ~ In . Medallion Signature Gullr8l1tH program.
PIe88e mall all completed forms end adcltlonel requirements, together with your check or money order and 8 copy of this
leUer, to the above address. Your completed forme end payment mU8t be receIYed by Melon wIIhIn 90 days of the date of 1hIe
letter. We 818 unable to retum any dooumenlsthet you submit In connection with this pIOC8IS, 80 please keep a copy for your
recorda.
MeDon is pleased to make this program available to you. The above charge Includes 8 $110.00 servlce fee paid to Mellon
EIIId,If the market value Of the certlflcate(a) being repkIIced ~$3,()OO, a surety premlumpaJd to Federal Insurance
.Company 8qUeI to. 1 percent ohum rnarXet Value. Thfsco'mPdUve arrangement 18 made posalble because Willis also pays
Mellon 8 flat per Item fee for processing and other admlnl8lratlve servic:ee provided In comectlon with this blanket program.
Alt8maaWry, ybu m8Y o~ a. Surety Bond In Lieu Of Probllte from an Insurance company d )'OUr choice that .. I'lIlI8d A+ XV
or better by A.M. Best .& Company. In. that 1I'l8t8nce, you WOUld pay a suiety premium directly to the surety bond provider you
eeIect and pay Mellon 8 $150.00.88Mce fee. Should you decide to U8e this option. pIeese contact us at the. number pt:OVIded
~forspeciflc inatruclions. ... ... . . . .....
Should you have any questions or need further assistance, Please contact our Communication Center
at1..aD0-848-3583. . . . .. . .
W.......~I........
CUSIP NUMBER: !8158R10
ACCOUNT KEY: .
AlEXANDERMINNVOOOO
I The purpose of the bond Is fD prolIlct the l88Ulng company and Mellon against any liabIIIly for wrongful transI'er In the ewnt that such lransNr
18 con...lItd In the~. Purct.lng a surely bond does not proted!he transferee, since the ~ company has a rVrt of subrogation (I.e.,
a light fD seek reirnbtJrsement from the transfeftle) shoulcl the surety compeny be reqund fD maIce payments under Its bond.
v
~ M&TBanl<
B09 Eastern Boulevard, Essex, MD 21221
4106868823 TOLLFR€E800 724 2440 "",4106863123
From: Marc Czosnowski
Re: Account information for Minnie V. Alexander
October 25, 2007
To Whom It May Concern:
This letter is to confirm the Titles, account # , balance as of the date of death for
Minnie V. Alexander. Due to many mergers I acquisitions ofM & T Bank through the
past 5 years, we are unable to confirm the original Title's of the account. However, since
the end of2003 all account title's have remained the same.
For account # 600466
Title: Minnie V. Alexander joint
Darlene A Wakefield Joint
Balance as of Sepl20th 2007 $238.73
For Account #, 15004200599966
'{itle: Minnie V. Alexander joint
Darlene A Wakefield Joint
Diane Bridi joint
,Balance as of Sept. 20th 2007 $300.61
Should you have any further questions please contact me @ 410-686-8823
-----
z owski
Assistant Vice President
Essex Office
1/11/~OOH ~:~O:~~ AM VAU~
2/002
f"aX berVer
Allstate Life Insurance Company
P.O. Box 94212
Palatine, n.. 60094-4212
Telephone: (877) 499-6418
Facsimile: (866) 635-4523
~AlIstate.
You're in good hands.
January II, 2008
John Lackovic
M&T Securities
1958 Spring Road
Carlisle, PA 17013
Re:
Contract No:
Minnie V. Alexander
GA01557331
Dear Mr. Lackovic:
We have been requested to complete IRS Form 712 with regard to the above referenced contract. The
purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its
proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract).
This contract is an annuity contract, which is not reportable on IRS Form 712. The following information is
provided for estate purposes only as of the date specified:
Date of Death:
Annuity Va1ue* as of Date of Death:
Cost Basis:
Named Beneficiary:
September 20, 2007
$ 20,131.79
$ 20,000.00
Jason C. Hamm, Darlene A. Wakefield
*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges.
If you have any questions, please contact me at 1-877-499-6418 Ext. 48371.
Sincerely,
Robin Gay
Sr. Claim Examiner