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HomeMy WebLinkAbout10-16-08 15056041114 REV-1500 Ex (os-os> PA Department of Revenue Bureau of Individual Taxes Po sox zsosol INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT I7F[`fr11CA1T ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 177-24-7300 07252008 Decedent's Last Name Suffix DUM (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth 06181929 Decedent's First Name MI ANNA L OFFICIAL USE ONLY County Code Year File Number Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL INAPPROPRIATE OVALS BELOW REGISTER OF WILLS 1. Original Retum ~ 2. Supplemental Retum [~ 3. Remainder Retum (date of death 0 4. Limited Estate ~ 4a. Future Interest Compromise (date of Prior to 12-13-82) 0 5. Federal Estate Tax Retum Re death ui ft d ~x 6. Decedent Died Testate (Attach Copy of Will) [~ q a re er 12-12-82) 7. Decedent Maintained a Livin Trust 1 g 8. Total Number of Safe De osit B Att 9. Litigation Proceeds Received ~] p oxes ( ach Copy of Trust) 10. Spousal Poverty Credit (date of death 11 El ti . ec on 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 INFOR Name MATION SHOULD BE DIRECTED TO: Daytime Telephone Number ROBERT G. FREY ``' Firm Name (If Applicable) 717 - 2 4 3 - 5 ~-3 ~.~ ~__. - FREY & TILEY 3 REGISTER OF WII:{iS-U,SE 011. , First line of address : ~ _; 5 SOUTH HANOVER STREET "`' - Second line of address ~ -"` City or Post Office CARLISLE State ZIP Code PA 17013 Correspondent's a-mail address: RFREY@FREYTILEY. COM ~~, w..CU ana complete. Declaration of preparer other than the pens SIG TURE OF PE ON RESPONSIBLE FOR FILING RETURN ~ ree OF ADDR SS 5 SOUTH HANOVER STREE all my _~ ..~ ,~,a DATE L~ . Z~C~ TIVE ARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041114 DA~T1E '~ ~ -1 Z. ©C.~ 15056041114 ~„~ (~ I Decedent's Social Security Number Decedent's Name: ANNA L DUM 17 7- 2 4- 7 3 0 0 RE CAPITULATION 1. Real estate (Schedule A) ............................. . . . . . . 1 NONE 2. Stocks and Bonds (Schedule B) .......................... . . . . 2 NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. NONE 4. Mortgages & Notes Receivable (Schedule D) ...................... . . . .. . 4. NONE 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ....... . 5. 63326.00 6. 7 Jointly Owned Property (Schedule F) Separate Billing Requested ...... 6 NONE . . , Inter-Vivos Transfers & Miscellaneous Non-Probate Property , (Schedule G) Separate Billing Requested . ...... . 7• 273746.00 8. Total Gross Assets (total Lines 1-7) ..... .......................... . • • e. 337072.00 9. Funeral Expenses & Administrative Costs (Schedule H) .................... 9. 5216.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 199.00 11. Total Deductions (total Lines 9 & 10) ..... ........... . ................ 11. 5415.00 12. Net Value of Estate (Line 8 minus Line 11) ... ......... . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 3 316 5 7 . 0 0 an election to tax has not been made (Schedule J) ...... ................. 13. 25330.00 14. Net Value Sub'ect to Tax Line 12 minus Line 13 ............... . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 3 O 6 3 2 7.O O 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 16. Amount of Line 14 taxable 15' 0 . 0 0 at linealratex.o 45 306327 00 . 17. Amount of Line 14 16, 13785.00 taxable at sibling rate X • 12 18. Amount of Line 14 taxable 17• 0 . 0 0 at collateral rate X . 15 1s. 0.00 19. TAX DUE ................. . .....................................19. REV-1500 EX 15056042115 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056042115 Side 2 ],50560427,15 13785.00 (~ REV-1500 EX Page 3 177-24-7300 Decedent's Complete Address: Flle Number 21-08-OS 15 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER NNA L DUM 177-24-7300 STREET ADDRESS 212 TODD CIRCLE CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 13129.00 C. Discount 656.00 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 13785.00 Total Credits (A + B + C) (2) 13785.00 Total Interest/Penalty (D + E) (3) 0.00 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, L1ne 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 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 : ....................................... b. retain the right to designate who shall use the property transferred or its income : ................ c. retain a reversionary interest; or ...................................................... 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 without receiving adequate consideration? ................................................. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. 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 [T 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 o>' 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 ar for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (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.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 end one-half (4.5) percent, 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 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. 217 REV-1508 EX+(6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUAIIBER ANNA L DUM 21-08-0815 Include the proceeds of litigation and the date the proceeds were received by the estate.. All roe ointl -owned with ri ht of survivorshi must be disclosed on Schedule' F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Sarah A. Todd Home savings account 1,136 2 PNC checking account no. 50-8031-7253 12,893 3 PNC CD no. 31900314161 11,949 4 PNC CD no. 31300208050 1,060 5 PNC CD no. 31300252356 2 295 6 PNC CD no. 31600239426 2,241 7 2000 Saturn automobile, Kelley Blue Book valuation 3,020 8 400 shares Cooper Industries common stock, ave. per sh. price: 44.365 17,746 9 PNC money market account 10,230 10 Family Home Health Care refund 35 11 Lifeline refund 40 12 Embarq refund 7 13 Erie insurance refund 23 14 Erie insurance refund 429 15 Medco refund 222 TOTAL (Also enter on line 5, Recapitulation) ~ 63,326 (If more space is needed, insert additional sheets of the same size) 217 REV-1510 EX+(6-98) SCHEDULE G COMMaNWEALTHOFPENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ANNA L DUM 21-08-0815 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-15001C OVER SHEET is DESCRIPTIO yes. N OF PROPERTY ITEM NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE DATE OF DEATH % OF DECD'$ EXCLUSION TAXABLE 1. . Western-Southern Life Assurance Co. Annuity VALUE OF ASSET INTEREST pa nvvucaa~el VALUE 2. New York Life Annuity 32,084 100.00% 0 32,084 3. Allstate Annuity 77,228 100.00% 0 77,228 4. AllianzAnnuity 83,000 100.00% 0 83,000 81,434 100.00% 0 81434 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 7 Recapitulation) $~ 273 746 (If more space Is needed, Insert addlttonal sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT rlut rvuMBEIR ANNA L DUM 21-08-0815 ITC~I Debts of decedent must be reported on Schedule I. A. 1 FUNERAL EXPENSES: Funeral dinner 174 B 1 MINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2. 3. 4. 5. 6. 7. 8. Attorney Fees 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees Trash disposal Final medical bill, HealthSouth SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 5,000 Included w/ Atty Fee Included w/ Atty Fee 30 12 TOTAL (Also enter on line 9 Recapitulatidn) ~ $ 5 216 (If mare space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT _ ~ ESTATE OF FILE NUMBER ANNA L DUM 21'08-0815 Rennrl 'In64e innu..nd 4.., aw.. a....-r..a .r--a. r__a~ ...~__~ _____._ _ .. ... _ _ -- - -~--- •-.._ ......... ......... o..~.,.,.~~a~ a~ioaw ~~ uie carne s¢e~ 217 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES INHERITANCE TAX RETURN ESTATE OF FILE NUMBER ANNA L D UM 21-08-0815 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)j 1 Gerald Dum San 15% 2 John Duke Son 15% 3 Kenneth Dum Son 15% 4 Jacie Miller Daughter 15% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, O 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 1 Bethel Assembly of God 20% 2 Safe Harbor 20% TOTAL OF PART II -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) LAST WILL AND TESTAMENT OF ANNA L. DUM I, ANNA L. DUM, widow, of the Borough of Carlisle, Cumberland County, Pennsylvania, (mailing address; 212 Todd Circle, Carlisle, ''~A 17013), 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 an;y and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executor or Executrices to pay aRl of my just debts and funeral expenses as soon after my death as may be found conveniE;nt to do so. I further direct that all inheritance, transfer, succession, estate and deal:h taxes, including interest acid penalties thereon, which may be payable on account of my death shall be payable from the residue of my estate regardless of whether the assets upon which such taxes are based are included in my probate estate. 2. I declare that I am an unremarried widow and that I have four children, GERALD DUM, JOHN DUKE, KENNETH DUM, and JACIE MILLER. 3. 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 as follows: 1. Sixty percent (60%) of my estate shall be divided evenly among; such of I my four children as shall survive me by a period of ninety (90) days, the share any ~. deceased child would have received to pass to his or her issue, per stirpes, and ii' there be no such issue said share shall lapse and be added to the remaining share or shares. Each said child shall have the right to choose to take as a part of his or her share any of my jewelry, furniture, mementos, and other tangible personal property as that child shall desire, the value of such property to be as determined by an appraisal performed at the direction of my Executor. Should there be any disputes as to who shall receive any such property, the determination of my Executor shall be conclusive on said dispute. Provided however, that my daughter, JACIE MILLER, shall have .the first right to select my ~~ sewing machine. ~, 2. Twenty percent (20%) to the BETHEL ASSEMBLY OF GOD, 1412 Holly Pike, Carlisle, Pennsylvania, of which, 15% shall be used for the missions of the church and the remaining 5% may be used as determined by the leadership of the Church. 3. Twenty percent (20%) to SAFE HARBOR, INC., 102 West High Street, Carlisle, Pennsylvania. 4. I hereby nominate, constitute and appoint my daughter, JACIE :MILLER, as Executrix of this my Last Will and Testament, but should she predecease me or fail to qualify then in such event ), nominate, constitute and appoint my son, GERALD DUM as Executor, and I further direct that neither 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 the share that person would otherwise have received shall be paid to my hereinafter named Executrix in trust. Should my said Executrix at any time be unable to serve as such, then in such event 1 nominate; constitute and appoint my son- in-law, KENNETH MILLER, as Trustee. I authorize the herein named Executrix or Trustee to receive and invest the same and to pay [he income arising therefrorn together with so much of the principal thereof as in her or his opinion is necessary or desirable to be expended for the proper maintenance, support and education of such person to or for the benefit of such person and upon such person attaining 21 years of age to pa}~ to him or her the then remaining principal together with any undistributed income. G~ .. ~. Pngel of3 7. In addition to the powers conferred by law, my hereinbefore named Trustees and Executors and their respective successors, are 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. 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 reorganization 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 any option or privilege which may be conferred upon the holders of such stocks, bonds, or other securities of such corporations either for the conv8rsion of the same into other securities or foi• 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 not 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 estate, and no purchaser at any such safe 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. _ And authorized in the discharge of fiduciary duties, t~~ 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 6~e 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, a<.: shall be deemed most expedient, and in malting any division or distribution in kind may allot any specific security or property or any undivided interest therein to any one 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 pturposes•of distribution of the securities or property so allotted shall be final and conclusivf; upon all persons interested in the trust or in the division or distribution thereof. i. And authorized to register any shares of stock or other assets of any trust in their own names or in the name of a nominee. j. To retain and invest in shares of stock of my Trustee. k. To retain any investments including mutual funds which I may own at the time of my death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds as may be deemed advisable or proper, irrespective of Pnge 2 of 3 ~ - ~ l~ whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. 1. To determine from time to time whether all or some; portion of realized capital gains shall be treated as ordinary income for distribution to a beneficiary or treated as principal to be retained as part of the corpus, and such designation need not be consistent from one year to another. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on three (3) pages, this ~ r~'day of ~ ~ } T' , 2006. ~~ ANNA L. DUM Signed, sealed, published, and declared by ANNA L. DUM, 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. 'WSJ.com Stoclc Charting for CBE (NYSE) U.S. Dollar Date Price High Low Volume 7125/08 43.91 45.21 43.52 1,707,000 No Splits Get another quote any day after 1/2/1970 1/2/1970 Symbol: Date: 7/25/08 Go Copyright ©1999-2008 BioCharts.com Inc. All rights reserved. Please see our Terms of Use. Historical and current end-of-day data provided by FT Interactive Data. h~bnxh ~L~ail?~~ w~,Eix;~~ha=`. ~,,: rr~ . t. r~ •~ ~r ,, i E ;ti~. ~. ~ '~~ ^J ~G ~~Y imo 2mo 3mo 6mo ivr 3vr 5vr i ~ Come to c~ t~l3~ Anr€ J Prac~ces ~:".;84 ~[.~~.~t~- tt+lt2t bttsinc~ r8tt~ n~rsvJ~ka~~snC.aulz~Et Copyright ©2008 Dow Jones & Company, Inc. All Rights Reserved http://www.bigcharts.com/custom/wsjie/wsjbb-historical.asp?symb=CBE&sid=8630&close date=7/25/08 8/6/08 1:15 PM Page 1 of 1 Sarah A Todd Apartments 1000 W. South Street Carlisle, PA 17013 Dum Anna 212 Todd Circle Carlisle, Pa 17013 S A V I N G S S 'T A T E M E N T Statement Numb Date Date Anna L. Dum Admission Date Resident ID Nr =_r 34 Page From 04/01/08 Th:ru 06/30/08 11/O1/00 101152 1 --------------- ---- Ty ------ Tran ----------------------- ---------------------- ---------- Date Refer Fn Code Description Deposits Disbursed Balance --------------- ---- ------ ----------------------- Balance Forward ---------------------- ---------- 1,135.59 04/30/08 SE INTER Interest .15 1,135.74 05/31/08 SE INTER Interest .14 1,135.88 06/30/08 SE INTER Interest ---------- - .14 --------- ---------- 1,136.02 -- Totals 1,135.59 .43 .00 -------- 1,136.02 Total Banking statement PNC Bank For the period 07/22/2008 to 08/20/2008 R ANNA L DUM DECD r C/0 ROBERT FREY ESQ 5 S HANOVER ST CARLISLE PA 17013-3307 PNCBANK Primary account number. 50-8031-7253 Page 1 of 3 Number of enclosures: 0 O For 2~f-hour banking, and transaction or interest rate information, sign on to $ PNC 13ank Online Banking at pnc.com. For ctastomer service call 1-888-PNC-BANK betwf~en the hours of 6 AM and Midnight ET. Para servicio en espar~ol, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearuzg impaired clients otily Relationship Overview Bank Deposit Accounts )ascription Account Number .nterest Checking :ertificate(s) Of Deposit Cotal Deposits 5a8031-7253 Total of 4 Deposit Balance 12,892.66 17,544.76 30,437.42 OVERDRAFT PROTECTION for your PNC Bank checking account If you haven't aheady done so, stop into your local PNC Bank branch today to open and emnll your PNC Bank Select Rewards Visa Platimun ard. «~liat could be Vetter than the safeh~ and comfort of knowirr.e you're protected? getting a sound investment course requires expertise, empatlry and experience. PNC Investments guides their clients toward real-world olutions designed to help them meet their goals. For more information stop by a PNC Branch or visit pnacom Jot FDIC Insured * May Lose Value * No Bank Guarantee mportant Investor Information: Securities and brokerage services are provided by PNC Investments :LLC, member FINRA and SIPC. ~ruruities and other insurance products are offered b PNC Insurance Services. LLC a licensed irrsur~tnce aoency premium Plan Anna L Dum Decd nterest Checking Account Summary account number: 50-8031-7253 balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 11,164.94 2,025.20 297.48 12,892.66 Average monthly Charges balance and fees 12,213.22 .00 Please see the Activity Detail section for additional information. 'ransaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 3 0 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 1 1 0 FORM953R-1005 Total S anking Statement PN C BANK For the period 07/22/2008 to 08/20/2008 For 24-hour information, sign on to PNC Bank Online Banking ANNA L DUM DECD on pnc.com. Primary account number. 50-8031-7253 Account number: 50-8031-7253 - contumed Page 3 of 3 Certificates of Deposit Anna L Dum Decd Investment Description Maturity date Interest Original or Current cumber rate renewal value value 31900314161 7 Month(s) Fixed Rate 08/22/2008 3.93 % 11,681.80 11,949.05 31300208050 Ready Access CD 09/06/2008 1.ri0 % 1,05 7.01 1,06026 31300252365 18 Month(s) Fixed Rate 01/07/2010 1.50 % 2,289.97 2,294.93 31600239426 24 Month(s) Fixed Rate Ori/26/2010 1.80 % 2,231.07 2,240.52 Total currant value 17,544.76 Fr1RM0~4G-~nnc Kelley Blue Book -Private Party Pricing Report -Saturn, SL -Official Kelley Blue Book Site Kelp Klue Bosh Y 7HE TRUSTED RESOURCE • kbbcaer advertisement ~~uE ~~~~~ ~~~yA~E ~~~~ ~A~~E Condition Value Excellent $3,370 Good $3,020 (Selected) Fair $2,625 Vehicle Highlights :Mileage: 40,000 ':.Engine: 4-Cyl. 1.9 Liter Transmission: 5 Speed Manual 'Drivetrain: FWD ',Selected Equipment Air Conditioning AM/FM Stereo Tilt Wheel Dual Front Air Blue Book Private Party Value Private Party Value is what a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (other than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation ,purposes __„ _.,._ _., _....., ~.._, _.~___ .._ _.. ~._._ _._._ ....._ .. ~...~.~... _ __._ ,. m.... _. Vehicle Condition Ratings Excellent ~~ $3,370 Looks new, is in excellent mechanical condition and needs no reconditioning. Never had any paint or body work and is free of rust. 10/8/08 2:44 PM Send to Printer http://www.kbb.com/KBB/UsedCars/PricingReport.aspx?Yearld=2000&Mi...onHistory=6937%7c29146%7c17013%7c0%7'c0%7c&Action=&Printable=true Page 1 of 2 2000 Saturn SL Sedan 4D advertisement December 30, 2005 Allstate Life Insurance Company Allstate® Treasury-Linked Annuity Information Statement Income Payment Schedule i First Payment Date: December 30, 2005 Payment Frequency: Monthly ***Gross Income Payment: $813.43 ****Excludable Amount: $691.42 Federal Withholding Election Single 1 *The Gross Annuitized Value is the Contract value, less applicable taxes on the Payout Start Date. ** Monthly payments will begin on December 30, 2005 and end on November 30, 2015. *'"Your gross income payment is a fixed payment. `**'The excludable amount of $691.42 is the amount of each payment excludable from income tax. Tlhis amount will reduce the cost basis until the cost basis has been depleted. This document is being distributed with an attached letter. Contract Number: GA19550628 Owner Name: Anna L Dum Annuitant Name: Anna L Dum Payout Start Date December 30, ,2005 Cost Basis $83,013.00 *Gross Annuitized Value: $83,508.22 Non-Qualified **Income Option: Period Certain ,Annuity 10 years (H1652 1 P46UUGIC.N02 dY6000JP.IW UGIWMUUGICAWOp NYL Annuity Service Center Lockbox 2400 5635 S. Archer Ave Chicago, IL 60638 May 26, 2008 Winner of the DALBAR Service Award `, From 2000 - 2006 ,r . I~~~IIi~~~lll~ttrr~ll~~lltt.ll.tl~irl~l~~~lltr~r~ll~~l~l~rlrli MS ANNA L DUM 212 TODD CIR CARLISLE, PA 17013-3596 Policy No: 52 147 912 Policy Date: May 24, 2007 Annuitant: Ms Anna L Dum 0000337 New York Life Preferred Fixed Annuity Anniversary Notice Premium Payment: Cash Value as of 05/2412007: Interest Earned for Policy Year: Total Withdrawal (s) for Policy Year: Surrender Charge(s) Applied for Policy Year: Outstanding Loan Balance: Cash Yalue as of OS/Z4/2008: Effective Annual Yield Guaranteed to 05/23/2010: X77,000.00 77,000.00 3,801.40 3,573.04 0.00 0.00 $77,228.36 S.OS% "Important Note. An amount in this column reflects the total surrender charges assessed on withdrawals made during this period. A zero means that either no withdrawals were made or withdrawals made did not incur surrender charges. Our Client Services Representatives are available Monday through Friday from 8:30 a.m. to 5:30 p.m. Eastern Time at 9-800-762-6292 to assist you with any questions. cc: BARBARA J MILLER PNC INSURANCE SERVICES INC TWO PNC PLAZA 620 LIBERTY AVE FL 26 PITTSBURGH, PA 15222-2723 NYL Annuity Service Canter .Lockbox 2400 .5635 S. Archer Ave .Chicago, IL 60638. 1-800-762-6212 laeued by New York Lice Insurance and Annuity Corporation (A Delawaro Corporation) Variable annuities ere distributed by: NYLIFE Distrihutore LLC, Member NASD/SIPC 51 Madison Ave, New York, NY 10070 Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, MN 55459-0060 800/950-4036 Allianz ili ~~ '7 C 3 -- ~~ ~~ Z - C~c~c.; ~ ANNUITY OPTION AGREEMENT' Policy Number: 4505385 Today's Date: June 26, 2003 Annuitant Name: ANNA L DUM Owner Name: ANNA L DUM Settlement Effective Date: June 25, 2003 Option Chosen: Benefit Deposited with Interest Amount of Proceeds: $81,434.33 Payment Mode: Monthly First Payment Date: July 25, 2003 Final Payment Date: June 25, 2013 Number of payments: 120 Beneficiaries GERALD DUM 25.00% JOHN DUKE 25.00% JACIE DUM MILLER 25.00% KENENTH DUM 25.00% EQUALLY TO THE SURVIVOR(S) Under the provisions of your policy, you have chosen the above-described armuity option. Each installment will consist of interest. Your proceeds will earn interest at such rates as we declare, but never less than the 3% guaranteed interest payout rate stated in your contract. It is understood that election of this annuity option waives all rights to submit premium or make additional withdrawals. You will be notified of any changes in the interest rate. Except for the Company's obligations with respect to payment pursuant to the annuity, option selected by you, all other provisions of the policy terminate once payment begins. The mode of payment is fixed and cannot be changed. Your interest installments will be paid until you reach your final payment date at which time you may: renew this option, choose an alternative settlement option or request the total proceeds in a lump sum. If you do not notify the Home Office within sixty days after your final payment date of ene of the above options, your policy will automatically terminate and the lump sum proceeds will be sent to you. Should the annuitant die before the final payment date, the interest payments will continue to be paid, in the same manner as previously elected, to the beneficiary(ies) listed or as amended. Other options also listed in the contract may be chosen. Suzanne J. Pepin Senior Vice President, Secretary, and Chief Legal Officer air Charles Kavitsky President Western-Southern Life Assurance Company Single Premium Deferred Annuity sso - • • Prepared on 01/03/2008 Owner ANNA L DUM 212 Todd Cir Carlisle PA 17013 Annuitant ANNA L DUM Contract Number w 20736797 Contract Date 01/02/2003 Contract Type NON-QUALIFIED Page 1 of 1 Western-Southern Lice appreciates your business. ~i3_~z~=r F~-x Q. k ~,~ ~~~ * * * INFORMATION ABOUT YOUR CONTRACT _ > Total interest earned during any contract year will be impacted by any withdrawals, including systematic withdrawals, from the contract during that year. For example, if you select the systematic withdrawal plan, the interest you receive will be less than the amount indicated by the effective annual interest rate because interest is being paid out rather than accumulated. SUMMARY OF ACTIVITY 01/02/2007 through 01/01/2008 Beginning Contract Value $ 32,083.59 plus Interest Credited" 1,058.64 less Systematic Withdrawals 1,058.64 Partial Withdrawals .00 Surrender Charges .00 Ending Contract Value 32,083.59 Surrender Value's 30,925.05 * The effective annual interest rate for the contract year indicated above was 3.35% and is 3.35% for the current year. The guaranteed minimum effective interest rate for the life of the contract is 3.00%. ~` Amount available after deducting any applicable charges if you cancel your contract. For further information about your MultiRate Annuity contract, including interest rates, contact your sales representative or call Annuity Operations. ANNUITY OPERATIONS Western-Southern Life Assurance Company PO Box 2918 Cincinnati, Ohio 45201-2918 1-800-926-1702 Customer Service Hours: Monday -Thursday, 8 a.m. to 6 p.m., Eastern time Friday, 8 a.m. to 5 p.m., Eastern time *170500DN` 380