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HomeMy WebLinkAbout11-17-08 (2)~.. 15056041114 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ff C/ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ d~ i ~~ b ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 205-09-9664 12012007 05141918 Decedent's Last Name Suffix Decedent's First Name MI BRYMESSER ESTHER (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 ~x 1. Original Return 0 4. Limited Estate Q 6. Decedent Died Testate (Attach Copy of Will) 0 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 2. Supplemental Return 0 4a. Future Interest Compromise (date of death after 12-12-82) 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) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Q 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G. FREY Firm Name (If Applicable) FREY & TILEY First line of address 5 SOUTH HANOVER STREET Second line of address City or Post Office CARLISLE 7:17-243-5838 State ZIP Code PA 17013 Correspondent's a-mail address: RFREY@ FREYT ILEY . COM REGISTER OF 1~IpLS USE ONL`~ --- r ~ - `-v c~ ~ ~Z_ ~ ~' y~ ~ ~ ;~ c . ~..i . ~.~ ~ t ; ;i ~; 11r D ~ FI ED '` ft7 .. Under penalties of pequry, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. .-~t ', --, _.y -i SIGN TURE OF PERSON RESPONSIBL,E~OR FILING RETURN ATE ADDRESS SIGNA RE P EP ER R THAN PRESE TIVE ~ I ~' 7 a~~ ADDRESS ' PL SE USE ORIGINAL FORM ONLY 15056041114 Side 1 15056041114 ~~ ~~ ~~ s 15056042115 REV-1500 EX Decedent's Social Security Number ~ecedent'sName: ESTHER BRYMESSER 205-09-9664 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. 13 O O O 0. 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages 8 Notes Receivable (Schedule D) ............................ 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 9 O 9 9 0 . O 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ...... .. 6. ~ ONE 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ...... .. 7 1818 6 8 . 0 0 8. Total Gross Assets (total Lines 1-7) ................................ .. 8. 4 0 2 8 5 8. 0 0 9. Funeral Expenses i~ Administrative Costs (Schedule H) ................... 9. 2 315 9 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. .. 10. NONE 11. Total Deductions (total Lines 9 & 10) ................................ . 11. 2 315 9 . 0 O 12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. 3 7 9 6 9 9 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... . 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 3 7 9 6 9 9. 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 19, Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X- 12 3 6 4 6 9 9. 0 0 17. 4 3 7 6 4. 0 0 18. Amount of Line 14 taxable at collateral rate x. 15 15 0 0 0. 0 0 18. 2 2 5 0. 0 0 19. TAX DUE ....................................................... 19. 46014.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 15056042115 15056042115 REV-1500 EX Page 3 205-09-9664 Decedent's Complete Address: File Number 21-n7-11dA DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER ESTHER BRYMESSER 205-09-9664 STREET ADDRESS 253 WEST WILLOW STREET CITY STATE ZI P CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 35000.00 C. Discount 1750.00 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 46014.00 Total Credits (A + B + C) (2) 36750.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 9264.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 9264.00 Make Check Payable to: REGISTER OF W1LLS, 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? .. ~ QX 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. 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 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.S. §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 adoption. 217 REV-15o8 Ex+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ESTHER BRYMESSER 21-07-1148 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 Sovereign Bank certificate of deposit no. 2895379242 5,002 2 Sovereign Bank certificate of deposit no. 2895423479 10,003 3 Sovereign Bank certificate of deposit no. 2895461610 10,003 4 Sovereign Bank certificate of deposit no. 2895541056 10,004 5 Sovereign Bank certificate of deposit no. 2895542716 5,002 6 M & T checking account no. 405736 15,690 7 M & T certificate of deposit no. 31003916444935 5,001 8 1999 Buick Century, actual sale price 4,000 9 Miscellaneous household furnishings and personal belongings 2,000 10 Sovereign Bank certificate of deposit no. 2895423156 23,839 11 Real estate tax proration, see HUD-1 settlement statement 222 12 UGI refund 134 13 AIG monthly annuity payable at time of death 53 14 AIG monthly annuity payable at time of death 37 TOTAL (Also enter on line 5, Recapitulation) $ I 90,990 (If more space is needed, insert additional sheets of the same size) z17 REV-1510 EX+(6-96) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ESTHER BRYMESSER 21-07-1148 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 ves ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION I~FAPPLICABLEJ TAXABLE VALUE 1. Jackson National Life Insurance annuity 0059349350 19,299 100.00% 0 19,299 2. Allstate Life Insurance annuity GA0752698 60,000 100.00% 0 60,000 3. AIG annuity XV213665 10,018 100.00% 0 10,018 4. AIG annuity BX205023 10,032 100.00% 0 10,032 5. AIG annuity BX205177 7,022 100.00% 0 7,022 6. MetLife annuity 1,208 100.00% 0 1,208 7. Jackson National Life Insurance annuity 0059337460 10,211 100.00% 0 10 211 8. Jackson National Life Insurance annuity 0059349360 15,000 100.00% 0 , 15 000 9. Jackson National Life Insurance annuity 0059349350 19,299 100.00% 0 , 19 299 10. Jackson National Life Insurance annuity 9310678535 29,779 100.00% 0 , 29,779 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) $ 181 868 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES St IN R SI DENTE ECEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ESTHER BRYMESSER 21-07-1148 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION ~ ~~.,~ ...T A. FUNERAL EXPENSES: 1. Hoffman Roth Funeral Home B. 1 IAINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2. I Attorney Fees 3. 4. 5. 6. 7. 8. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant I Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Expenses of real estate held for sale West Shore EMS Zip 11,780 9,400 275 1,601 103 __ TOTAL (Also enter on line 9 Recapitulation) ~ $ 23 1 (If more space is needed, insert additional sheets of-the same size) 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE) BENEFICIARIES ESTHER BRYMESSER FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llst Trustee(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)1 1 Helen M. Shellehmaer Sister 100% 2 Rebecca Fahnestock Niece Annuity Beneficiary ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) Expenses of Real Estate Sold Borough of Carlisle, Water and Sewer 1 g PPL 17 Borough of Carlisle, Water & Sewer 1 g UGI 71 PPL 18 Precision Mowing 16 UGI 32 PPL 15 Borough of Carlisle, Water & Sewer 21 Expenses from HUD-1 settlement statement 1,373 Total 1 601 ( ) 1. FHA Settlement Statement - U. S. De artment of ( ) 2. FmHA 6. File Number ( ) 3. Conv. Unins. ( )4. VA 130,000.00 1,338.50 221.76 0.00 131,560.26 8. Mortgage Insurance Case Number C. This form is furnished to give you a statement of actual settlement casts. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside of the closing; they are shown here for informational purposes and are not included in the totals. D- Name and Address of Borrower: E. Name and Address of Seller: John E. McMillen Estate of Esther Brymesser JoAnne B. McMillen by: Helen M. Shellehamer, Executrix 3773 Blain Road West Willow Street Loysville, PA Carlisle, Pennsylvania TIN r. Ivame and Address of Lender N/A H. Seller's Settlement Agent: Frey & Tiley Law Office 5 South Hanover St. 'IN 25-1730538 Carlisle, PA 17013 J. SUMMARY OF BORROWER'S TRANSACTION 7. Loan Number G. Property Location 253 West Willow Street Carlisle, Pennsylvania 04-21-0322-335 I. Settlement Date: Place of Settlement: July 23, 2008 5 South Hanover Street _ Carlisle, PA 17013 K. SUMMARY OF SELLER'S TRANSACTION 100 GrassAmountDueFomBorrower 101 Contract sales price 102 Personal property 103 Settlement charges from (line 1400) 104 105 Adjustments for items paid by seller in advance: 106 CiryRown taxes 7!23/08 to 12/31/08 107 County taxes 108 Assessments 109 110 School taxes 7/23/08 to 6/30/09 111 112 120 Grose Amount Due From Borrower 200 Amounts Pafd By Or In Behalf Of Barrowei 201 Deposit or earnest money 202 Principal amount of new loan(s)"' 203 Existing loan(s) taken subject to 204 205 206 207 208 209 Adjustments for items upaid by seller 210 Cityftown taxes 1/1/08 211 County taxes 212 Assessments 213 214 School taxes 7/1/08 215 216 217 218 219 220 Total Pald By/For Borrower td 7/23/08 to 7/23/08 400 Gross Amount Due To Seller 401 Contract Sales price 402 Personal property 403 404 405 Adjustments for hems paid by seller in advance: 406 Citykown taxes 7/23/08 to 12131 /08 407 County taxes 408 Assessments 409 410 School taxes 7/23/08 to 6/30/09 411 412 420 Gross Amount Due to Seller 500 Reductions In Amount Due To Seller 500.00- 501 Excess deposit (see instructions) 502 Settlement charges to seller (line 1400) 503 Existing loan(s) taken subject td 504 Payoff of first mortgage loan 505 Payoff of second mortgage loan 506 507 508 509 Adjustments for items upaid by seller 510 CityRown taxes 1/1!08 511 Counrytaxes 512 Assessments 513 73.07 514 School taxes?/1/08 515 516 517 518 519 573 .07 520 Total Reductlons to Amt Due Seller to 7/23/08 No. 1,300.00 to 7/23/08 ~ 7 3 .07 1,373.07 ---- emen ro 0 orrower: 600 Cash At Settlement To/From Seller: 301 Gross amount due from borrower (line 120) 131 , 560.26 601 Gross amount to seller from (line 420) 130 , 221.7 6 302 Less amounts paid byRor borrower (from line 220) 57 3 .07 602 Less reductions in amount due seller (from line 520): 1, 37 3.07 303 Cash (X) From () To Borrower 130, 987.19 603 Cash ()From (X) To Seller 128, 848.69 130,000.00 221.76 0.00 130,221.76 LAST WILL AND TESTAMENT OF ESTHER W. BRYMESSER I, ESTHER W. BRYMESSER, widow, of '253 West Willow Street in the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament revokin hereby g and making void any and all Wills by me at any time hereto- fore made. 1• I direct my hereinafter named Executrices to a just debts and funeral expenses as soon after my death as maylbeofound convenient to do so. I direct that my funeral services be conducted by Hoffman-Roth Funeral Home, 219 North Hanover Street, Carlisle, Pennsylvania, in a manner substantially similar to the arrangements which I made for the services of my husband, Freeman R. Brymesser, and that my body be interred beside his on our burial lot Cumberland Valle located in y Memorial Gardens in West Pennsboro Township, (:umber- land County, Pennsylvania. 2• All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in equal shares to my two (2) sisters, Kathryn E. Whitcomb, of 253 Baltimore Street, Carlisle, Pennsylvania, and Helen M. Shellehamer, of 237 West Willow Street Carlisle, Pennsylvania, provided each of them shall survive me b a q Y period of ninety (90J days, but should either of them fail to so survive me then the share such deceased sister would have received shall lapse and be added to the share of the other sister. 3• I hereby nominate, constitute and appoint my two (2) sisters, or either of them, they being Kathryn E. Whitcomb and Helen. M, Shellehamer, as co-Exectrices of this my Last Will and Testament and I further direct that neither of them shall be required to post any bond to secure the faithful performance of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, written on one {1) page, this 25th d~iy of February 1985. " ` t~-t' ICJ ~~ ~ a ,c/Y/ (SEAL ) Esther W. Brymesser Signed, sealed, published and declared by ESTHER W. BRYMESSER, 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 attesting witnesses. as {~ ~ . -F. L. L'~ 4 F ~~'`~ ~. t~cq'.~:'t P_'?s,.4 ~ ~t=i:.~?~~&'Lt'P~r_'~. ~' ~~#~~i ~?t:'i~! ~~.rid~[y'''~ F~~_'~t~'.% --o - -- -- - --- -- - - P.O. Box 841005 Boston, MA 02284 January 3, 2008 Frey & Tiley Attorneys at Law 5 S. Hanover St. Carlisle, PA 17013 RE: Estate of: Esther Brymesser Date of Death: December 1, 2007 Dear Mr. Frey: Per your request, enclosed please find the account information as of date of death for the above-named decedent. Please note the balances do not include accrued interest. If you should have any further questions, please do not hesitate to call. Very truly yours, ~ n ,~ { Linda Spavento Team Leader Court Order Processing (617) 533-1789 (617) 533-] 931-fax Sovereign Bank ESTATE OF Esther Brymesser SOCIAL SECURITY #: 205-09-9664 DATE OF DEATH: December 1, 2007 Account #: 2895542716 Type: CD Open date: 7/31/2007 In the name of: Esther W Brymesser Date of Death Balance: $5,000.00 Int.(YTD) from 7/31/2007 to 11/30/2007 $85.74 Accrued interest to date of death: $2.10 Other Info: Account #: 2895380257 Type: CD Open date: 3/21/1995 In the name of: Esther W Brymesser Date of Death Balance: $0.00 Int.(YTD) from 1/1/2007 to 3/21/2007 $27.42 Accrued interest to date of death: $0.00 Other Info: closed 3/21/07 for $5,000.00 Page 2 of 2 Sovereign Bank ESTATE OF Esther Brymesser SOCIAL SECURITY #: 205-09-9664 DATE OF DEATH: December 1, 2007 Account #: 2895379242 Type: CD Open date: 2/14/1995 In the name of: Esther W Brymesser Date of Death Balance: $5,000.00 Int.(YTD) from 1/1/2007 to 11/30/2007 $187.15 Accrued interest to date of death: Other Info: $1.68 Account #: 2895423156 Type: CD Open date: 12/28/2002 In the name of: Esther W Brymesser Date of Death Balance: $23,831.48 Int.(YTD) from 1/1/2007 to 11/30/2007 $873.98 Accrued interest to date of death: $8.01 Other Info: Account #: 2895423479 Type: CD Open date: 12/31/2002 In the name of: Esther W Brymesser Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2007 to 11/30/2007 $374.30 Accrued interest to date of death: $3.36 Other Info: Account #: 2895461610 Type: CD Open date: 12/R/2~~3 In the name of: Esther W Brymesser Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2007 to 11/30/2007 $374.30 Accrued interest to date of death: $3.36 Other Info: Account #: 2895541056 Type: CD Open date: 1:016/2006 In the name of: Esther W Brymesser Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2007 to 11/30/2007 $450.23 Accrued interest to date of death: $3.93 Other Info: Page 1 of 2 ©M~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Frey & Tiley Attorneys At Law 5 South Hanover Street Carlisle, Pennsylvania 17013 Re: Estate of Esther W Brymesser Social Security: 205-09-9664 Date of Death: December 01 2007 Phone (888) 502-4349 Fax (302) 934-2955 January 3, 2008 Dear Sir or Madam: Per your inquiry dated December 27, 2007, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total 2. Type ofAccount Accou:~t Number Ownership (Names o~ Opening Date Balance on Date of Death Checking Account 405736 Esther W Brymesser 09/01/67 Closed 01/02/08 $1 S, 689.96 $ 0.14 __._ $I5, 690.10 Certificate of Deposit 031003916444935 Esther W Brymesser 03/21/07 $5, 000.00 Accrued Interest $ 0.63 Total ___...__ ___ _ $5, 000.63 -- Please be advised, there was no safe deposit box found for the above decedent. * For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call the Stonehedge Office # 717-240- 4524. Sincerely, ~~~ ~~~/~~ Nancy Clagett Records Management ROWE'S AUCTION SERVICE so313so36 2 5 9 4 SPECIAL ACCOUNT ~esiioa2o 2505 RITNER HIGHWAY CARLISLE, PA 17015 DATE '~y~t1.f < ~ 1 Lwg PAY TO THE ~~ .r,..~,~ , ~ Q~ ORDER OF >Gg~ Jl`7fl ©~~ ~G .~L~rt~, 1 -/~ ~.*-s vN ~ ~P `~ ~ J x~ ' ~_ g ~ c.c9a ~k~-d Cf %W1 A ti.~/1 ~ ~/~ t~ DOLLARS B oq~.o~~.~... o ORRSTOti1T1~TBANK ATsaditian ofEzce!lence MEMO ~ U S~rL ~~ ~ _ ~' __ NP x:0313 ~5036~: ~n~ L L04. 2011' 2594 ___ f ~~~ // ® AIG Annuity Insurance Company ~ P.O. Box 871 Amarillo, Texas 79105-0871 800.424.4990 January 9, 2008 Frey & Tiley Attorneys At Law 5 South Hanover Street Carlisle, PA 17013 Re: Deceased: Esther Brymesser Contract #: XV213665 Dear Mr. Frey: Thank you for your recent inquiry regarding the referenced annuity contract(s). It is our pleasure to be of service to you. The value of Policy XV213665 as of December 1, 2007 was $10,017.88 and the accrued interest as of January 9, 2008 was $44.72 The value of Policy BX205023 as of December 1, 2007 was $10,031.98 and the accrued interest as of January 9, 2008 was $412.96 The value of Policy BX205177 as of December 1, 2007 was $7,022.38 and the accrued interest as of January 9, 2008 was $9.07. We hope this information is helpful; however, should you have additional questions or require further assistance, please feel free to contact our Client Care Center at 1-800-424-4990. Sincer ly, ~;y ~~ ~Aretha Lockhart Claims Department AIG Aroruity Insurance Compmry Member of American Iniernalional Groarp, Inc. ~~ Allstate Life Insurance Company Telephone: 1-800-755-5275 PO Box 80469 Fax: 1-866-628-1006 ~"State® Lincoln NE 68501-0469 ESTHER W BRYMESSER 253 W. WILLOW ST. CARLISLE PA 17013-3747 December 13, 2007 Your Representative HAROLD JOSEPH BESHAW M & T SECURITIES, INC. ONE WEST HIGH ST CARLISLE PA 17013-2951 (717)241-7787 The following statement provides information regarding your Allstate®Select 2000 Annuity GA0752698 that you purchased from Allstate Life Insurance Company. Please examine this statement carefully. Check Reconciliation: Total Withdrawal 165.42 Amount Received 165.42 TRANSACTION(S) PRQCESSED: Current Transaction Effective Effective Transaction Tvpe Date Annual Rate Amount ($)' Earngs.Withdrwls. 12/12/07 3.700% $ -165.42 Total: $ -165.42 'Transaction amount(s) that reflect withdrawals are equal to the gross withdrawal amount and do not reflect any applicable withdrawal charges, premium tax, or withholding. ACCQUN7 VALUE SUMMARY AS OF 12/12/07: Date of Current Purchase Effective Payment Annual Rate Fund Value($) 12/07/01 3.70% Total Account Value: $ 60,000.00 $ 60,000.00 If you have questions concerning your annuity, please contact your representative at your financial institution. Y 1 B125K6Q7.N01 8pd00028125KfAJ8125K5Q'lOOODO Illlllfi • MetL~ f e ~~ MetLife Investors USA Insurance Company Post Office Box 14593 Des Moines, IA 50306-3593 MetLife Investors USA Insurance Company A Page 1 of 3 auarterly Statement nnwtant s Name Contract Number Annuity Type ESTHER W BRYMESSER A2050501 NonQualified Plan Code 135R2C You may address questions to our Customer Service Dept at 1-800-284-4536 from 7:30am to 5:30pm CST (M-Th- and 7:30am to 5:OOpm CST (Fri) ESTHER W BRYMESSER 253 W WILLOW ST CARLISLE PA 17013-3747 mRxoo Beginning Accumulated Value (12/31/2007) Total Payments Total Withdrawals Total Fees Ending Accumulated Value (03/31 /2008 ) Surrender Value (03/31/2008) Fund Starting Value Net Transaction 12/31/2007 Change I ~~ Total Contract Value Guaranteed Accum. $1,208.08 $1,209.62- Growth/Loss Ending Value Percent of 03/31/2008 Contract $0.00 100.00° $1.54 $.00 0.00 A2050501 Page 3 of 3 .:::::::~.:::~~c~~t~::: ~~:~~~.::::.~. ...... ...:.::.::::.~::::::::::.:::::::::::::::::::::::.~:. .. :::.:.::....::::::::::::::::::::::::::::::::::. c~~o~uvn vain ....................IranSectlOn..................................... ..................................... Amount Fund Allocation Value Accumulation Accumulation Percent Unit Value/ Units Int. Rate 01/15/2008.....Death Claim ............................. 1,209.62- Guaranteed Accum. $1,209.62- ----- _____ Jackson National Life Insurance Company® n ~ Beneficiary Access Account Insured: Esther W Brymesser CQCIf IrfYlatlOrl c2rtlflCdte Opening Date: 1/17/2008 Opening interest Rite: 3.50% Account Number: 93]0678535 Name: Helen M Shellehvner PLEASE CONTACT YOUR BENEFITS: BENEFICIARY ACCESS ACCOUNT SERVICE REPRESENTATIVE AT Policy Number: Net Benefit Amount: 1-800-343-2551 IF YOU HAVE ANY 0059349350 QUESTIONS. 19,298.93 0059357460 10,210.89 TOTAL BENEFITS PLEASE KEEP THIS DOCUMENT WITH YOUR IMPORTANT PAPERS FOR MORE INFORMATION We recommend you review the enclosed booklet for detailed information on your account. The 1•PCfT1S anfl mnrlitinn~ of vni it arrni int aYq L1VYlI~inorl .,n +h~ .,+h.,..~,J„ „~ +t„~ ..,,.~;c:__~_ • Jackson National Life Insurance Company Beneficiary Access Account ~/(;~ STATEMENT ACCOUNT NUMBER: 9310678535 ~BWNCKKY "`3-DIGIT 170 54989480930273017 M DG2005 0003198 1 AT 0346 09231 S (u~~~~n~~~~unu~~n~~n~~~~~n~~~~u~in~~u~~~~u~~~n~~~ HELEN M SHELLEHAMER 237 WEST WILLOW ST CARLISLE, PA 17013 0031 98 Summary of BENEFITS, INTEREST, and CHECK REDEMPTIONS for this Deriod: Mev i . ~nnu BEGINNING RATE MONDAY 04/28/08 3.00 05/05/08 3.00 05/12/08 3.00 05/19/08 3.00 05/26/08 3.00 Tuunnr_u ww z~ Opening Balance Total Credits Interest Total Debits Other Charges Closing Balance $29,778.63 5.00 S66.18 529,778.63 5.00 566.18 Date : Type o£Activity Amount AcootinL.Salance Remarks 05/28/08 REDEMPTION ORDER # 1001 29,778.63 .00 05/31/08 INTEREST PAID 66.18 66.18 Beneficiary Access Account INFORMATION Can be obtained by calling TOLL-FREE The Northern Trust Co. 1-800-343-2551 PLEASE NOTE WE ARE CLOSING YOUR ACCOUNT. IT IS BELOW THE MINIMUM BALANCE OF 5500. AN OFFICIAL BANK CHECK WILL BE SENT TO YOU SHORT LY. ~aUMMARY OF YEAR„ INTEREST THIS. PERI©D: Tt37AL ENTi;t3E$T ' TASf- W{TktHELD ' INT~RLsT >:Y • f =OATS ; , `INVI_s~~D. 2008 TMe i....... L...I.. 566.18 $334.99 5.00 - - _____ ___-~ __. ___- _- ...-..-- .... .,.w... c.... v..r..aJc v.. pvY~ a4a.uUlll. ~YGIN\.R fICR C~ Beneficiary Access Account Change of Address Form acCOUty:T Nuae$~R ` please complete the Change of 9 310 6 785 35 Address Form on the reverse side Please return this Change of Address and any other written correspondence to: Beneficiary Access Account ~'~ -~ C/O The Northern Trust Company - P.O. BOX 92987 Chicago, II. 60675-2987 HELEN M SHELLEHAMER DFLT GENERIC 3799 P NNN