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Home My WebLink About10-31-08t .J 15056051058 REV-1500 EX (06-05) OFFICIAL U E ONLY PA Department of Revenue Coun Cod Year File Number Bureau of Individual Taxes tY Poeox28oso1 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 0827 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 08/04/2008 09/13/1926 Decedent's Last Name Suffix Decedent's First Name MI Hudson Catherine T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate > ~. 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICA REGISTER OF WILL 2. Supplemental Return _,,,... 4a. Future Interest Compromise (date of death after 12-12-82) I° 7. Decedent Maintained a Living Trust (Attach Copy of Trust) _., 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) WITH THE 3. Re cinder Return (date of death prio to 12-13-82) 5. Fed ral Estate Tax Return Required 0 8. Tota Number of Safe Deposit Boxes 11. Ele ion to tax under Sec. 9113(A) (Att ch Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOF Name Daytime l Thomas A. Archer, Esq. (717) 2 Firm Name (If Applicable) RED Archer & Archer, P.C. First line of address 2515 North Front Street Second line of address P.O. Box 5056 City or Post Office State ZIP Code Harrisburg PA 17110 Correspondent's a-mail address SHOULD BE DIRECTED TO: ie Number ISTER OF WIt.LS USE OIyLy, C7 r" _' ~ C7 c - -,-, c~] '? ~ -i -~ r-' _;~ __.. r ~ ,__., - > r =~_, ~ ~ r-)c_ DAfiE.$0.ED =~ ?? C.1T Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and t 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 ich preparer has any knowledge. S ATURE F PERSON RESPO SIBLE FOR FILING RETURN DATE ADDRESS 6180 Somerset Street, Harrisburg, PA 17111 Sl~t F PREPARER OTHER THAN REPRESENTATIVE DATE ~~ 'd ADDRESS 2515 North Front Street, P.O. Box 5056, Harrisburg, PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15 56051058 ~d \~~ ~,~ 15056052059 REV-1500 EX Deced nt's Social Security Number Catherine T Hudson Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... 2, .. 143,773.72 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 47,179.13 6. Jointly Owned Property (Schedule F) `".' Separate Billing Requested ..... .. 6. 116,034.30 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) :: :Separate Billing Requested...... .. 7. 16,628.88 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 323,616.03 9. Funeral Expenses 8 Administrative Costs (Schedule H) ................... .. 9. 16,386.20 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 4,364.09 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 20,750.29 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 302,865.74 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 302,865.74 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 1g. 13,628.96 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 ....................................................... .. 19. 13,628.96 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF A 15056052059 Side 2 1 X5056052059 REV-1500 EX Page 3 Flle Number Decedent's Complete Address: 21 os 0827 DECEDENT'S NAME DECEDENT'S OCIAL SECURITY NUMBER Catherine T Hudson _ _ ___ _ 579-28-8469 ---- -- - -_- 4 STREET ADDRESS 6180 Somerset Street -- __- _ ~. ----t ___ _ - __ - _ _ -- -. - - - - - CITY STATE ~ ZIP Harrisburg ~ PA ~ 17111 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 13,628.96 2. CreditslPayments 0 00 . A. Spousal Poverty Credit -- - - _ _ -- B. Prior Payments 0.00 -- _ __- -_ C. Discount Total Credits (A + g + C) (2) 681.45 3. InterestlPenalty if applicable 0.00 D. Interest _ ___ E. Penalty 0.00 Total InteresUPenalty (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, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 12,947.51 A. Enter the interest on the tax due. ( A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. ( B) 12,947.51 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE A PPROPRIATE BLOCKS 1. Did decedent make a transfer and: I! Yes No a. retain the use or income of the property transferred :................................................................................ ......... ^ ^x 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 ANA 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 transf rs 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 f 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 statuto requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. I 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 de h 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. §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. . §9116(a)(~1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoptio . REV-1503 EX+ (g-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ', FILE NUMBER Catherine T. Hudson ' 08-00827 All property jointly-owned with right of survivorship must be disclosed on Schedule ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~~ 2. Tax Free B Tax Free A i i I 3,121.67 140,652.05 TOTAL (Also enter on line 2, Recapit lation) $ 143,773.72 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Catherine T. Hudson 08-00827 Include the proceeds of litigation and the date the proceeds were received by the estat . All property jointly-owned with right of survivorship must be disclosed on Schedul F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Sovereign Bank Account 23,430.52 2. Members 1st Account 3912-05 8,652.06 3. M&T Bank Account 13,076.55 4. 1999 Ford Taurus I I 2,020.00 TOTAL (Also enter on line 5, Recapit lation) S 47,179.13 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER Catherine T. Hudson 08-00827 If an asset was made joint within one year of the decedent's date of death, it must be reported n Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Catherine T. Hudson 6180 Somerset Street, Harrisburg, PA 17111 Daughter B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DE TH DECD'S VALUE OF NUMBER TENANT JDINT IDENTIFYING NUMBER.ATTACH DEED FDRJGINTLY-HELD REAL ESTATE. VALUE OFA SET INTEREST DECEDENT'S INTEREST ~ • A• 03115182 Members 1st Account 3912-00 6.05 50 13.02 2• A 01101107 John Hancock account number 2525008 28,1 1.64 50 14,055.85 3• A 01/01107 John Hancock account number GP26001637 85,6 1.35 50 42,830.67 4• A 01101/07 John Hancock account number V0170284 25,0 0.50 50 12,525.25 5• A 03122/07 John Hancock account number 2597913 93,2 9.03 50 46,609.51 TOTAL (Also enter on line 6, Recapit lation) 5 116,034.30 (If more space is needed, insert additional sheets of the same size) w 13% Aggressiv Growth 21 % Growth ® 6% Growth & I come 60% Income f • the future is yours Prepared For: RSP 7282 CP-1-3 CATHERINE T HUDSON 6180 SOMERSET ST HARRISBURG PA 17111 Venture Quarterly Activity Summa Venture III Quart rly Portfolio Review Provided by John Hancock Life Insurance Company (U.S.A.) For the period of April 1 -June 30, 2008 Your Investment epres~ Raymond F Wolfg ng Signator Investors Inc. 2431 North Secon Street Harrisburg PA 1 110 Important Coi Telephone: 1 www.jhannuit Information: 144-1029 Your Accour, Year to Date Since Inception Value on December 31, 2007 $30,243.16 Totallnvestments $0.00 $27,400.23 Total Withdrawals $0.00 $0.00 Net Chan a -$1,864.47 Value on June 30, 2008 $28,378.69 Death Benefit Value as of June 30, 2008: $28,369.86 Your Current Investment Allocation Account Number Owner(s): Cather Catherine Huds Annuitant(s): Cai Plan Type: Non-( Inception Date: C 2525008 e T Hudson ne T Hudson Optional Riders $e(ech • Principal Plus F r Life You are invested in the Lifestyle Moderate Portfolio. Lifestyle Moderate contains a number of investments that fall in to four investment styles Aggressive Growth, Growth, Growth & Income, and Income. For specific information on each investment, visit www.jhannuities.com today. For a list of your portfolios by Portfolio Manager, their current unit values, and your future allocation selections, see the Venture Holdings Summary on Page 2. 100% Total Valud John Hancock Annuities Service Center PO Box 9505, Portsmouth, NH 03802-9505 Produced on 06/30/2008 Account# 2525008 007282-000001!000002-007283-CPAINE-02-1-3-014565 Page 1 of 2 0608:1304144 . ' For the period of April i -June 30, 2008 Your Venture Holdings Summa Investment Representative: Raymond F Wolfgang Future Number Unit Value as Market Value Account Allocation* of Units o 06/30/08 as of 06/30/08 MFC Global Investment Management 047 Lifestyle Moderate 100.0% 1.752.5597 16.192710 X28.378.69 Total Account Value as of June 30, 2008 100.0% $28,378.69 'Future Allocation: Percentage of allocation of each investment option for future contributlons. Im octant Information Please carefully review this statement to ensure that all instructions were acted on properly. It is important that any errors or omissions relating to personal information, transactions, holdings, riders or special programs a communicated to John Hancock and your broker dealer within 60 days of the requested transaction effective date. Or I communications should be re-confirmed in writing to protect your rights, including rights under the Securities Investor Pr tection Act (SIPA), if applicable. This statement is issued on behalf of John Hancock Distributors LLC, acting as agent for John Hanco k Life Insurance Company (U.S.A.), and on behalf of the general agent and agent shown on the first page. Annuities are not deposits or obligations of, or guaranteed by, any bank or financial institution. Annuiti s are not insured by the FDIC or any other agency and are subject to risk, including the possible loss of principal. If you would like more information on the underlying fund allocations within the Lifestyle Portfolios visi www.jhannuities.com today. Simply log in and click on each Lifestyle Portfolio to view fund allocations. For more in-depth informal on on the funds, visit the "Performance and Portfolios" section. Not yet registered? Registration is quick, safe, and easy and pr vides access to additional information not available on the general site. Your Princi al Plus For Life Information You have elected the Principal Plus For Life optional withdrawal benefit rider. Principal Plus For Life guarantees the return of your principal through annual Current Gua anteed withdrawals up to 5%. Withdrawals are guaranteed for the life of the oldest owner, Withdrawal glance $28,770.24 starting at and based upon the GWB at age 65. If no withdrawals are taken during Lifetime Inc me Amount $1,438.51 any of the first ten contract years, Principal Plus For Life gives you an automatic bonus of 5% per year, provided the owner is age 80 or younger. The bonus may Remaining ifetime increase the guaranteed balance up to 150% of initial amount invested. In addition, Income Am unt for Principal Plus For Life allows you to capture potential market gains through its current cont act year $1,438.51 automatic step-up provision; step-up opportunities occur in years three, six and Next Step U Opportunity 0 610 212 0 0 9 nine and annually from years 10 to 30. If an asterisk appears after the "Current Guaranteed Withdrawal Balance" in the box to the right aStep-Up has occurred on this contract anniversary. Election of Principal Plus For Life is irrevocable and cannot be canceled. There is a fee for the Principal Plus For Life rider, equal to 0.40% of the GWB amount, charged on each contract anniversary. Withdrawals in a Contract Year that exceed the Guaranteed Withdrawal Amount may result in a reduction of your Guaranteed Withdrawal Balance to an amount less than your original investment. Withdrawals in excess of the Lifetime Income Amount, if applicable, may result in a decrease of the Lifetime Income Amount. Your Quarterl Transaction Detail Transaction Type Transaction Tax Number Tr nsaction Transaction Date Fund Type Year of Units nit Value Amount Annual Fee 06/02/08 Lifes le Moderate PPFL Fee - 6.8201 6.873646 -$115.08 Total Annual Fee -$115.08 Produced on 06/30/2008 Account# 2525008 Page 2 of 2 007282-000002/000002-007283-CPAINE-02-1-3-014566 0608:1304144 h s the future is yours Prepared For: AEF 3599 CP-1-4 CATHERINE T HUDSON 6180 SOMERSET ST HARRISBURG PA 17111 Ventur Vision Annuity Quart rly Portfolio Review Provided by John Hancock Life Insurance Company (U.S.A.) For the period of April 1 -June 30, 2008 Your Investment epresi Raymond F Wolfg ng Signator Investors, Inc. 2431 North Secon Street Harrisburg PA 1 110 Important Cc Telephone: 1 www.jhannui Venture Quarterly Activity Summa Year to Date Since Inception Value on December 31, 2007 $101,494.59 Totallnvestments $0.00 $100,000.00 Total Withdrawals $0.00 $0.00 Net Chan a -$6,303.33 Value on June 30, 2008 $95,191.26 Death Benefit Value as of June 30, 2008: $100,000.00 Your Accoi Account Numb Owner(s): Cathy Catherine Huc Annuitant(s): C Catherine Huc Plan Type: Non Inception Date: Optional Riders • Principal Plus F Your Current Investment Allocation Information: 344-1029 t Information 2597913 ne T Hudson m ierine T Hudson m lualified 3/22/2007 ~e/ected: ~r Life You are invested in the Lifestyle Moderate Portfolio. Lifestyle Moderate contains a number of investments that fall in to four investment styles Aggressive Growth, Growth, Growth & Income, and Income. For specific information on each investment, visit www.jhannuities.com today. 13% Aggressi~ 21 % Growth ® 6% Growth & (i0% Income Growth 100% Total Va For a list of your portfolios by Portfolio Manager, their current unit values, and your future allocation selections, see the Venture Holdings Summary on Page 2. John Hancock Annuities Service Center PO Box 9505. Portsmouth. NH 03802-95( Produced on 06/30/2008 Account# 2597913 003599-000001!000002-003600-CPAINE-02-1-4-007199 Page 1 of 2 0608:1304144 ., For the period of April 1 -June 30, 2008 Investment Repre entative: Raymond F Wolfgang Your Venture Holdings Summary Future Number Unit Value as Market Value Account Allocation` of Units of 06/30/08 as of 06/30!08 MFC Global Investment Management nd7 I ifacfido Mnricrotc ~ nn net -- - Total Account Value as of June 30, 2008 100.0% a~JJ, IJ I.LV $95,191.26 "Future Allocation: Percentage of allocation of each investment option for future contributlons. lm ortant Information Please carefully review this statement to ensure that all instructions were acted on properly. It s important that any errors or omissions relating to personal information, transactions, holdings, riders or special programs a communicated to John Hancock and your broker dealer within 60 days of the requested transaction effective date. Ora communications should be re-confirmed in writing to protect your rights, including rights under the Securities Investor Pr tection Act (SIPA), if applicable. This statement is issued on behalf of John Hancock Distributors LLC, acting as agent for John Hanco Life Insurance Company (U.S.A.), and on behalf of the general agent and agent shown on the first page. Annuities are not deposits or obligations of, or guaranteed by, any bank or financial institution. Annuiti are not insured by the FDIC or any other agency and are subject to risk, including the possible loss of principal. If you would like more information on the underlying fund allocations within the Lifestyle Portfolios visit www.jhannuities.com today. Simply log in and click on each Lifestyle Portfolio to view fund allocations. For more in-depth informati non the funds visit the "Performance and Portfolios" section. Not yet registered? Registration is quick, safe, and easy and pr , vides access to additional information not available on the general site. Your Princi al Plus For Life Information You have elected th P i i l Pl F Lif e r nc pa us or e optional withdrawal benefit rider. Principal Plus For Life guarantees the return of your principal through annual Current Gua nteed withdrawals up to 5%. Withdrawals are guaranteed for the life of the oldest owner Withdrawal glance $100,000.00 , starting at and based upon the GWB at age 59 2. If no withdrawals are taken during any of the first ten contract years, Principal Plus For Life gives you an Lifetime Inco a Amount $5,000.00 automatic bonus of 5% per year, provided the owner is age 80 or younger. The Remalning LI etime bonus may increase the guaranteed balance up to 150% of initial amount invested. Income Amo nt for In addition, Principal Plus For Life allows you to capture potential market gains current cont ct year $5,000.00 through its automatic step-up provision; step-up opportunities occur in years three , six and nine and annually from years 10 to 30. If an asterisk appears after the ~Ir~~ .,, n.. ...,.,.a ~er.,~..i......._1 Next Step U Opportunity 03/22/2010 _ _.. __._ _.__. _. .'--- ......-........-. .....~... ..... ~~~ .~w ......... a. ~a: nyrn az vlc1J-vN llaa occurred on this contract anniversary. Election of Principal Pius For Life is irrevocable and cannot be canceled. There is a fee for the Principal Plus For Life rider, equal to 0.40% of the GWB amount, charged on each contract anniversary. Withdrawals in a Contract Year that exceed the Guaranteed Withdrawal Amount may result in a reduction of your Guaranteed Withdrawal Balance to an amount less than your original investment. Withdrawals in excess of the Lifetime Income Amount, if applicable, may result in a decrease of the Lifetime Income Amount. Produced on 06/30/2008 Account# 2597913 Page 2 of 2 003599-000002/000002-003600-CPAINE-02-1-4-007200 0608:1304144 the future is yours Prepared For: REP 69E CP-1-1 CATHERINE HUDSON 6180 SOMERSET ST HARRISBURG PA 17111-4369 Indep ndence Annuity Annual Statement Issued by John For the period of Febru Your Financial R~ Raymond F Wolfg~ John Hancock Fin 1624 Hausman R( Allentown PA 181 John Hancock Cc Telephone: 800-8 www.jhannuities.i Independence_ Annual Activity Summa Year to Date Since Issue Value on February 16, 2007 $26,025.18 Totallnvestments $0.00 $16,768.92 Total Withdrawals $0.00 $0.00 Earnin s -$549.10 Value on February 15, 2008 $25,478.08 Death Benefit Value as of February 15, 2008: $25,478.08 Your Current Inw Your portfolio currently contains the following investments. For specific information on each investment, visit www.jhannuities.com today. 50% 1 Year 50% GMO II 100% Total Value For a list of your portfolios by Portfolio Manager, their current unit values, and your future allocation selections, see the Independence Holdings Summary on Page 2. Produced on 02/15/2008 Your Accou Contract Numbi Owner(s): Cathe Catherine Hud Annuitant(s): C. Plan Type: Non- Issue Date: 02/1 iancock Life Insurance Company iry 16, 2007 -February 15, 2008 presentative: Ong incial Network ad )4 ntact Information: >_4-0335 om F Information V0170284 ~e Hudson n Brine Hudson aalified 1993 Contract # V0170284 000698-000001/000002-000699-CPAINE-01-1-1-001397 John Hancock Annuities Service Center Box 9507, Portsmouth, NH 03802-95( Page 1 of 2 USC-GLB-Privacy Notice-8/07 RA For the period of February 16, 2007 -February 15, 2008 Financial Repre ntative: Raymond F Wolfgang Your Independence Holdings Summary Account/Fund Number Future Number Unit slue as Market Value Allocation of Units of 02/15!08 as of 02/15/08 Grantham, Mayo, Van Otterloo & Co.,LLC 258 Managed 50.0% 437.5125 2 .892588 $12,640.87 Fixed Accounts 333 1 Year Fixed 50.0% $12,835.21 Total Account Value as of February 15, 2008 100.0% $25,476.08 *Future Aitocation: Percentage of allocation of each investment option for future contributions. Important Information Please carefully review this statement to ensure that all instructions were acted on properly. It i important that any errors or omissions relating to personal information, transactions, holdings, riders or special programs b communicated to John Hancock and your broker dealer within 60 days of the requested transaction effective date. Oral communications should be re-confirmed in writing to protect your rights, Including rights under the Securities Investor Pro ectfon Act (SIPA), if applicable. Annuities are not deposits or obligations of, or guaranteed by, any bank or financial institution. Annuitie are not insured by the FDIC or any other agency and are subject to risk, including the possible loss of principal. John Hancock Annuities Service Center PO Box 9507, Portsmouth, NH 03802-9507 Produced on 02/15/2008 stributed through John Hancock Distnbutors, LLC, Member FINI2A, Bostc Contract # V0170284 000698-000002/000002-000699-CPAINE-01-1-1-001398 Page 2 of 2 Notice-8/07 RA • the future is yours Prepared For: REF E743 CP-1-5 CATHERINE HUDSON 6180 SOMERSET ST HARRISBURG PA 17111-4369 GPA Choice 2003 Edition Annuity Quarterly Activity SummaN Year to Date Since Issue Value on December 31, 2007 $83,997.94 Total Premiums $0.00 Total Withdrawals $0.00 Earnin s $1,392.20 Value on June 30, 2008 $85,390.14 Death Benefit Value as of June 30, 2008: Information $74,193.05 $0.00 $85,390.14 Quarterly Statement Issued by John ancock Life Insurance Company For the period of April 1 -June 30, 2008 Your Financial R presentative: Raymond F Wolfg ng John Hancock Fin ncial Network 1624 Hausman R ad Allentown PA 181 4 John Hancock Cntact Information: Telephone: 800- 4-0335 www.jhannuities. om Information Contract Number GP26001637 Owner(s): Catheri a Hudson Catherine Huds n Annuitant(s): Cat Brine Hudson Plan Type: Non- ualified Issue Date: 08/14 2003 Included Feature and Optional Riders Selected • CARESolutions Please carefully review any transactions that are reported on this statement to ensure that all properly. It is important that any errors or omissions relating to transactions, Riders and Spec communicated to John Hancock within 60 days of the requested transaction effective date. The Annuity Value and Death Benefit reported above assumes that the owner/annuitant is living on th statement. If death occurs on any other date, the Death Benefit is recalculated in accordance with the interest, if any, is paid in accordance with the laws of the state of issue. Annuities are: Not FDIC Insured, Not Bank Guaranteed, Not a deposit, Not insured by any Federal Gc value. John Hancock Annuities Service Center ~ Box 9507, Portsmouth. NH 03802-95C Produced on 06/30/2008 Contract # GP26001637 tructions were acted on Programs, if applicable, be valuation date used in the :rms of the annuity contract and Agency and May lose Page 1 of 2 008743-000001/000002-008744-CPAINE-01-1-5-017487 For the period of April 1 -June 30, 2008 Financial Represf entafive: Raymond F Wolfgang John Hancock Annuities Service Center PO Box 9507, Portsmouth. NH 03802-9507 Produced on 06/30/2008 Contract # GP26001637 Page 2 of 2 008743-000002/000002-008744-CPAINE-01-1-5-017488 REV-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS H COMMONWEALTH OF PENNSYLVANIA e INHERITANCE TAX RETURN MISC NON-PROBATE PROPERTY RESIDENT DECEDENT . ESTATE OF FILE NUMBER Catherine T. Hudson 08-00827 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the RE 1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF ECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACHACDPVOFTHEDEEDFORREALESTATE. VALUE OF ASSET INTE EST (IF APPLICABLE) VALUE 1 • Strat Inc. B 16,628.88 100 16,628.88 TOTAL (Also enter on line 7 Recapitulati n) $ 16,628.88 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDULE N FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMB R Catherine T. Hudson 08-0082 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Neil Funeral Home 8,010.22 Moose Lodge Reception 295.98 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 422.00 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Cumberland Law Journal -Estate Ad 75.00 Patriot News -Estate Ad 80.00 TOTAL (Also enter on line 9, Rec pitulation) $ 16,386.20 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULE 1 DEBTS OF DECEDENT COMMONWEALTH OF PENNSYLVANIA , INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT , ESTATE OF FILE NUMBER Catherine T. Hudson 08-00827 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including un imbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ West Shore EMS-ALS 829.06 2. Healthdriver Podiatry-GRPA 37.01 3. Golden Living Center -Nursing Home 3,141.49 4. Vascular Associates 6.53 5. United States Treasury 300.00 6. PA Department of Revenue 50.00 TOTAL (Also enter on line 10, Recapit lation) $ 4,364.09 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Catherine T. Hudson 08-00827 RELATIONSHIP TO DEC DENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee ) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1 • Catherine T. Hudson Daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE ON RE V-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVERS EET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF CATHERINE THOMPSON HUDSON I, Catherine Thompson Hudson, Social Security number Harrisburg, Dauphin County, Pennsylvania, being of sound and hereby make, publish, and declare this to be my Last Will and T revoking and making null and void all prior Wills and Codicils made heretofore. This Last Will and Testament is being executed by me West Shore Health and Rehabilitation Center West in Camp Hill, Pennsylvania. ITEM I. I direct that all my legally valid debts, funeral expenses, and debts incurred or payable because of my death, shall Executor, hereinafter named, from my residuary estate as soon practicable. All death taxes, including federal, state, and other death to the property forming my gross estate for tax purposes, whether or this Will, including any interest or penalty imposed thereon, shall expense of administration of my estate, without apportionment or right of Taxes on future interests maybe prepaid. ITEM II. I give and bequeath certain items of tangible ?8-8469 now of wing mind, do ~tament, hereby me at any time being treated at Berland County, I administrative be paid by my r my death as es, with respect t passing under considered an ~l property that are solely owned by me at the time of my death and that are identified ~n any separate ,» writing directing distribution thereof my death which is dated and is end thereof, to those persons designated in such separate writing who item of tangible personal property is identified in more than one that, unless stated to the contrary, the separate writing bearing the last c the disposition of such item. ITEM III. I bequeath my household and personal automobiles, and other tangible personalty of like nature to my Thompson Hudson (hereinafter my "Daughter"), if she survives me by If she does not so survive me, I make said bequest in equal shares individuals, per capita: Catherine Elizabeth Dove now of Riverdale, Alexis McCubbin now of College Park, Maryland; Linda Maureen Pickerington, Ohio; James Thomas Belt now of Sharpsburg, Mary by me at the me. If any writing, I direct shall govern sects, jewelry, ter, Catherine iirty (30) days. the following aryland; Mary iccaro now of Sandra Lee Grady now of Worchester, Massachusetts; Harry Eccleston Dawson, Jr. now of El Cajon, California; James Alexander Rosie now of Midlothian, Virgini Andrew Rosie now of Charlotte, North Carolina. Such property shall be divided by said beneficiaries as As to those items upon which they shall not agree, distribution shall be Executrix. ITEM IV. I give, devise and bequeath of all the residue of my e real, personal, or mixed, and wherever situate, including any property ; power of appointment which I may now have or hereafter acquire, to and Thomas shall agree. fined by my whether ect to any my daughter, 2 Catherine Thompson Hudson, if she survives me by thirty (30) days. survive me, I make said bequest in equal shares to the following individ Catherine Elizabeth Dove now of Riverdale, Maryland; Mary Alexis of College Park, Maryland; Linda Maureen Vaccaro now of Thomas Belt now of Sharpsburg, Maryland; Sandra Lee Grady Massachusetts; Harry Eccleston Dawson, Jr. now of El Cajon, Alexander Rosie now of Midlothian Virginia; and Thomas And Charlotte, North Carolina ITEM V. The interest of beneficiaries hereunder shall anticipation or to voluntary or involuntary alienation. __ ITEM VL I hereby appoint my daughter, Catherine__Thomps Executrix (the "Executrix"), of this, my Last Will and Testament. In tl refusal or inability to so serve, I then nominate and a oint m n~phr~, pp Y now of Worcester, Massachusetts, to serve as Executrix. In the event inability of such named persons to so serve, I then grant to the person la and capable of serving the right and power, exercisable in his or her excli to nominate and appoint, whether in advance while competent, or at renunciation or resignation, a person or persons to serve as such E nomination shall be honored as if I had made such an appointment in this ~ 3 If she does not uals, per capita: McCubbin now ~n, Ohio; James v of Worcester, lifornia; James Rosie now of be subject to Hudson, as _ event of her r per 7', ~e/.t ~-- D n~~.~~_ ~ I ~~ the refusal or so nominated ve discretion, '7e time of a cutor, which 11. ,. ITEM VII. I direct that my Executrix shall not be required to ive bond or post any other security for the faithful performance of dutie in any jurisdiction. ITEM VIII. Any person who shall have died at the same tim as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. ITEM IX. My Executrix shall have the following powers in ddition to those invested in them by law and by other provisions of my Will applicabl to all property, whether principal of income, exercisable without Court approval, an effective until distribution of all property: A. To retain my investments I may have at my deat so long as my Executrix or Custodian may deem it advisable to my Estate or so o do. B. To vary investments, when deemed desirable by y Executrix or Custodian, and to invest in such bonds, common trust funds c ntrolled by my Executrix or Custodian, stocks, notes, real estate mortgages, or o er securities or in such other property, real or personal, as my Executrix or Cust ian deem wise, without being restricted to so-called legal investments. C. In order to effect a division of the principal of my state or for any other purpose, including any final distribution, my Executrix r Custodian is authorized to make said divisions or distributions of the perso alty and realty 4 •~ partly or wholly in kind. If such division or distribution is assets are required to be divided or distributed at their date or dates of their division or distribution. D. To sell either at public or private sale and u~ conditions as my Executrix or Custodian may deem advanta any or all real or personal estate or interests therein owned by or in conjunction with other persons acquired after my death by Custodian, and to consummate said sale or sales by sufficien instruments to the purchaser or purchasers, conveying a fee clear of all trust and without obligation or liability of the pu in kind, said values on the such terms and ~s to my Estate, Estate severally ny Executrix or deeds or other e title, free and ;r or purchasers to see to the application of the purchase money or to make nquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all of deeds, assignments, options, or without writings which may be necessary or desirable, in carrying out any of the powers Executrix or Custodian in this paragraph or elsewhere in my E. To mortgage real estate, and to make leases of period of time as is deemed reasonable by them. F. To borrow money from any party to pay ii of my Estate, expenses of administration, or inheritance, taxes. upon my estate for any ass of mine, or estate or other 5 G. To pay all costs, taxes, expenses, and charges in the administration of my Estate. My Executrix shall pay expe illness and funeral expenses. H. To vote any shares of stock which form a part of n otherwise exercise all the powers incident to the ownership of sucl connection with rises of my last ~ Estate, and to a stock. I. In the discretion of my Executrix or Custodian, to unite with other owners of similar property in carrying out any plans for the reorg ization of any corporation or company whose securities form a part of my Estate J. To compromise claims and to abandon any Executrix's opinion, is of little or no value. IN WITNESS WHEREOF, I have hereunto set my hand and se Will and Testament, consisting of six (6) typewritten pages, this 24~' 2007. Catherine y which, in my to this my Last ay of January, 6 We, the undersigned, hereby certify that the foregoing sealed, published and declared by the above-named Testatrix, Cathc Hudson, as and for her Last Will and Testame t, in the pr ce of us, v and in her presence and in the presence ach oth ave hereunto s seals the day and year above writte d we c that at the time thereof, the said Testatrix was of s and di sing mind and memory Sean vania ill was signed, ne Thompson ~ at her request our hands and the execution 7 ~ ,. .' COMMONWEALTH OF PENNSYLVANIA . SS.. COUNTY OF DAUPHIN , We, Catherine Thompson Hudson, the Testatrix, Raymond W Sabol, the witnesses, and the foregoing instrument, being first duly s declare to the undersigned authority that the Testatrix signed and execut as her Last Will and that she had signed willingly, and that she executed voluntary act for the purposes therein expressed, and that each of the presence and hearing of the Testatrix, signed the Will as witness and t his/her knowledge the Testatrix was at that time eighteen years of age c mind and under no constraint or undue influence. Catherine Th Sean Sabol Subscribed, sworn to and acknowledged before me by the T Thompson Hudson, and subscribed and sworn to before me by Rays Sean Sabol, witnesses, this 24~' day of January, 2007 V' Z homas A. cher, PA Attorney LD. #; fgang and Sean orn, do hereby l the instrument as her free and ~itnesses, in the ~t to the best of older, of sound x, Catherine Wolfgang and 93 8 .~ . ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, Thomas A. Archer, certify that the foregoing acknowledgement and before me. /i~/--~-~--~ /~"~• PA Attorney I.D. # 73293 Thomas A. Archer, Esquire . SS.. On this ~~F day of January, 2007, Thomas A. Archer, Esquire, pf before me and is known to me or was satisfactorily proven to be a me the highest court of the Commonwealth of Pennsylvania and certified present when the foregoing Last Will and Testament of Catherine Thor signed and acknowledged by the Testator and witnesses. WITNESS my and notarial seal the day and year aforesaid. Notary Public was made illy appeared of the bar of he personally i Hudson was NOTARIAL SEAL ROSEMARY A HUNT Notary Publtc HARRISBURG CI1Y, DAUPHIN C UNTII My Commission Expires Oct d 2010 9