HomeMy WebLinkAbout11-21-08 (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 /1 C;
PO BOX 280601 V 1l
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ ~P
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
205-16-6060 05152008 10051920
Decedent's Last Name Suffix Decedent's First Name MI
WOLFORD NETTIE G
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS ,,
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum 0 2. Supplemental Retum ~ 3. Remainder Return (date of death
prior to 12-13-82)
0 4. Limited Estate 0 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required
death after 12-12-82)
0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE C OMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
ROBERT G. FREY 717--243-5838
Firm Name (If Applicable)
FREY & TILE'Y
First line of address
5 SOUTH HANOVER STREET
Second line of address
City or Post Office
CARLISLE
State ZIP Code
PA 17013
REGISTER CtF`jfUILLS USE O~}(
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Correspondent's a-mail address: RFREY@ FREYT ILEY . COM
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belie , it is
true, correct and complete. peclayAtion of preparer other than the personal representative is based on all information of which preparer has anv knowledge.
SIGN RE OF E SO R NSIBLE FOR FILING RETURN AT
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- PL ASE USE ORIGI AL FORM ONLY
Side 1
15056 041114 15056041114
15056042115
REV-1500 EX
Decedent's Social Security Number
oecedent'sName: NETTIE G WOLFORD 205-16-6060
RECAPITULATION
1. Real estate (Schedule A) ........................................... 1. NONE
2. Stocks and Bonds (Schedule B) ...................................... 2. NONE
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. NONE
4. Mortgages & Notes Receivable (Schedule D) ............................. 4. NONE
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ........ 5. 9 0 0 2 5 . 0 0
6. Jointly Owned Property (Schedule F) []Separate Billing Requested ........ 6. NONE
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) OSeparate Billing Requested ........ 7 13 3 O 1 . 0 0
8. Total Gross Assets (total Lines 1-7) .................................. 8. 10 3 3 2 6 . 0 0
9. Funeral Expenses & Administrative Costs (Schedule H) .................... 9. 6 2 21.0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) ............... 10. NONE
11. Total Deductions (total Lines 9 & 10) ................................. 11. 6 2 21 • 0 0
12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 9 710 5 . 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ....................... 13, 8 6 0 0 . 0 0
14. Net Value Sub'ect to Tax Line 12 minus Line 13 ....................... 14. 8 8 5 0 5 . 0 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sec. 9116
0 0
0
(a)(1.2) X .0 0 15. .
16. Amount of Line 14 taxable
at linealrateX.o 45 $244.00
16.
371.00
17. Amount of Line 14
taxable at sibling rate X - 12
17.
0 . 0 0
18. Amount of Line 14 taxable
0
0 0
at collateral rate X . 15 18. .
19. TAX DUE ....................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~~ 15856242115
~~ ~`,
~1
Side 2
15056042115
371.00
REV-1500 EX Page 3 205-16-6060
_~_~_ w~~.._~_.
Pile Number
LJCGCUG11a.7 vvn~pn`w .--. •....
DECEDENT'S SOCIAL SECURITY NUMBER
DECEDENTS NAME
NETTIE G WOLFORD 205-16-6060
STREET ADDRESS
770 SOUTH HANOVER STREET
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) 371.00
Total Credits (A + B + C) (2) 0.00
Total InteresUPenalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3) 0.00
(4) 0.00
t5) 371.00
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 371.00
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 : ................ ^ Q
c. retain a reversionary interest; or ...... . ............................................... ^
d. receive the promise for life of either payments, benefits or care? ...................... . ...... ^ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one ear of d ^ ^
without receiving adequate consideration? ............................. . . . y eath
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. ^ 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................... ^ ^X
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)]. 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-15a8EX+(6-98) SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COM NHERITANCECTAXRETURNANIA PERSONAL PROPERTY
ESTATE OF FILE NUMBER
NETTIE G WOLFORD 21-08-0664
Include the proceeds of litigation and the date the proceeds were received by the estate.
All orooertv iointly-owned with rlaht of survivorship must be disclosed on Schedule F.
ITEM
PNC account no. 31700299960, including accrued interest
A
9,033
2 PNC account no. 31000313448, including accrued interest 15,830
3 Highmark refund 395
4 PNC account no. 5180084565 8,135
5 Adams County National Bank certificate of deposit 4,697
7 United States Savings Bonds 1,099
8 Embarq refund 15
9 Amerprise Brokerage Account 50,801
10 Class action settlement 20
TOTAL (Also enter on line 5, Recapitulation) $
90,025
(If more space is needed, insert additional sheets of the same size)
zn
REV-15~OEX+(6-98) SCHEDULE G
COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS &
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
NETTIE G WOLFORD 21-OS-0664
This schedule must be completed and filed if the answer to any of questions t through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF
TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
°/a OF DECD'S
INTEREST
EXCLUSION
(~FAPPLICABLE)
TAXABLE
VALUE
1. Annuity 13,301 100.00% 0 13,301
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
0
0
0
0
TOTAL (Also enter on line 7 Recapitulation) $ 13 301
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
NETTIE G WOLFORD 21-08-0664
Debts of decedent must be reported on Schedule I.
A.
1
B
t
2
3
4.
5.
6.
7.
8.
9.
10.
FUNERAL EXPENSES:
Dugan Funeral Home
UIINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
Ciry
Year(s) Commission Paid: _
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach expianation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Final nursing home bill to Chapel Pointe
Hlghmark, reimbursement for medical expense paid
Millenium Pharmacy Systems
Final bill to Embarq
State Zip
L_
438
3,500
294
included w/ atty fee
included w/ atty fee
1, 530
335
57
67
TOTAL (Also enter on line 9 Recapitulation) ~ S 6,221
(If more space is needed, insert additional sheets of the same size)
2n
REV-1513 EX+ (9-00}
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA. BENEFICIARIES
INHERITANCE TAX RETURN I
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
NETTIE G WOLFORD 21-08-0664
RELATIONSHIP "0 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. 9118 (a) (1.2)j
1. Robert R. Baker son-in -law 18%
2. Earl L. Wolford son 18%
3. Ronald O. Wolford son 18%
4. Glenn 7. Wolford son 18%
5. James D. Wolford son 18%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. Idaville United Methodist Church
2. Newville First Church of God
5%
5°l0
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
NETTIE G. WOLFORD
1, NETTIE G. WOLFORD, widow, of 7 AI{iance Drive, Apartment 106, 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 Wi11 and Testament, hereby revoking and making void any and all Wills by me at any time
heretofore made.
1. I direct my hereinafter named Executor to pay all of my just debts and funeral expenses as soon after
my death as may be found convenient to do so. I bring to the attention of my Executor that my funeral services are
to be conducted by Dugan Funeral Home at l l 1 South Main Street, Bendersville, PA, and that I have already pre-
paid the cost of those services. I direct that my body be interred on my burial lot located in the United Methodist
Church Cemetery at Idaville, Pennsylvania, beside that of my late husband, Reuben Wolford. I further direct that all
inheritance, transfer, succession, and estate taxes which may be payable on account of my death shall be paid from
the residue of my estate regardless of whether the assets upon which such taxes are based are included in my probate
estate.
2. I bring to the attention of my Executor that the small 6 inch electric heater and heavy fireproof safety
box in my possession at my apartment are not owned by me but are the property of my son-in-law, Robert R. Baker
and should be returned to him if I have not previously done so.
3. I give and bequeath my antique dresser, 2 table lights, 1 floor lamp and 4 folding chairs to my son-in-
law ROBERT R. BAKER, provided he shall survive me by a period of ninety (90) days, but should he fail to so
survive me then the same shall lapse and he included in the residue of my estate.
4. A1{ the rest, residue, and remainder of my estate, real, personal, or mixed, and wheresoever the same
may be situate, I give, devise, and bequeath as follows:
(a) 10% to be divided equally between the Idaville United Methodist Church
at Idaville, Pennsylvania and First Church of God located along Shippensburg Road at
Newville, Pennsylvania, to be used by each of said churches in such manner as its
official Board shall deem appropriate.
(b) 90% shall be divided equally among such of the following (5) persons as
shall survive me by a period of ninety (90) days, their heirs and assigns, but should
my son-in-law Robert_R. Baker fail to so survive me then the share he would have
received shall lapse and should any of my four sons fail to so survive then the share
such deceased son of mine would have received shall be paid to such of his issue, their
heirs and assigns, as shall survive me by a period of ninety (90) days, per stirpes, the
five (5) persons being, my son-in-law, ROBERT R. BAKER, and my four sons,
RONALD O. WOLFORD, EARL LAVERE WOLFORD, GLENN T. WOLFORD,
and JAMES D. WOLFORD.
5. I hereby nominate, constitute, and appoint my son, JAMES D. WOLFORD as Executor of this my
Last Will and Testament, but should he predecease me or fail to qualify, or cease serving as such, then in such event
I nominate, constitute, and appoint my son, EARL LAVERE WOLFORD, as alternate or successor Executor but
should he fail to qualify or cease serving as such, then in such evenC I nominate, constitute, and appoint my son,
GLENN T. WOLFORD as alternate or successor Executor. I further direct that none of them shall be required to
post any bond to secure the faithful performance of his 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 Wil] and Testament
written on 1 pages, this / $'~"" day of July, 2003.
SEAL)
N IEG. WOLFORD L
Signed, sealed, published and declared, by NETTIE G. WOLFORD the Testatrix above named, as and for
her Las[ 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.
Page I of 1 pages
LAST WILL AND TESTAMENT
OF
NETTIE G. WOLFORD
I, NETTLE G. WOLFORD, widow, of 7 Alliance Drive, Apartment 106, Carlisle, Cumbedand County,
Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby make:, publish, and declare
this as and for my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time
heretofore made.
I. I direct my hereinafter named Executor to pay all of my just debts and funeral expenses as soon after
my death as may be found convenient to do so. [bring to tfie attention of my Executor that my funeral services are
to be conducted by Dugan Funeral Home at 111 South Main Street, Bendersviile, PA, and that I have already pre-
paid the cost of those services. I direct that my body be interred on my burial lot located in the United Methodist
Church Cemetery at Idaville, Pennsylvania, beside that of my late husband, Reuben Wolford. I further direct that ail
inheritance, transfer, succession, and estate taxes which may be payable on account of my death shall be paid from
the residue of my estate regardless of whetfier the assets upon which such taxes are based are included in my probate
estate.
2. I bring to the attention of my Executor that the small 6 inch electric heater and heavy fireproof safety
box in my possession at my apartment are not owned by me but are the property of my son-in-law, Robert R. Baker
and should be returned to him if I have not previously done so.
3. I give and bequeath my antique dresser, 2 table lights, 1 floor lamp and 4 folding :.hairs to my son-in-
law ROBERT R. BAKER, provided he shall survive me by a period of ninety (90) days, but should he fait to so
survive me then the same shall Lapse and be included in the residue of my estate.
4. All the rest, residue, and remainder of my estate, real, personal, or mixed, and wheresoever the same
may be situate, I give, devise, and bequeath as follows:
(a) 10% to be divided equally between the Idaville United Methodist Church
at Idaville, Pennsylvania and First Church of God located along Shippensburg Roatl at
Newville, Pennsylvania, to be used by each of said churches in such manner as its
official Board shall deem appropriate.
(b) 90% shall be divided equally among such of the following (5) persons as
shalt survive me by a period of ninety (90) days, their heirs and assigns, but should
my son-in-law Robert_R. Baker fail to so survive me then the share he would have
received shall lapse and should any of my four sons fail to so survive then [he share
such deceased son of mine would have received shall be paid to such of his issue, their
heirs and assigns, as shall survive me by a period of ninety (90) days, per stirpes, the
five (5) persons being, my son-in-law, ROBERT R. BAKER, and my four sorts,
RONALD O. WOLFORD, EARL LAVERS WOLFORD, GLENN T. WOLFORD,
and JAMES D. WOLFORD.
5. I hereby nominate, constitute, and appoint my son, JAMES D, WOLFORD as Executor of this my
Last Will and Testament, but should he predecease me or fail to qualify, or cease serving as such, then in such event
I nominate, constitute, and appoint my son, EARL LAVERS WOLFORD, as altemate or successor Executor but
should he fail to qualify or cease serving as such, then in such event [nominate, constitute, and appoint my son,
GLENN T. WOLFORD as altemate or successor Executor I further direct that none of them shall be required to
post any bond to secure the faithful performance of his 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 V/ill and Testament
written on 1 pages, this IJt'}" day of July, 2003.
~ ~
jSEAL)
N TIE G. WOLFORD
Signed, sealed, published and declared, by NETTLE G, WOLFORD the Testatrix above named, as and for
her Last W'sll 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.
,,(J ~.
/ +~s a. rr Y~~
Page 1 of 1 pages
~~
^ ^
^
~:
PNCBAIV~
The Ti-inking Behind The Money
June 27, 2008
Frey & Tiley
Attn: Robert Frey
5 South Hanover St
Carlisle, PA 17013
RE: Nettie G Wolford
SSN: 205-16-6060
DOD: OS-15-2008
Dear Mr. Frey:
~, n
In response to your request for Date of Death balances fo.r the custorrxer moted above, our
records show the following:
CertitScate of Deposit
Account # 31700299960
NETTIE G WOLFORD
DOD balance: $ 9,011.19 + 22.26 accrued interest
Account # 31000313448
NETTIE G WOLFORD
DOD balance: $15,782.99 + 46.92 accrued interest
Checking Account
Account # 5180084565
NETTTE G WOLFORD
'DOD balance: $ 8,13x.68 + 0.32 accrued interest
Established OS-22-2006
Established 07-23-2007
Established 01-19-1981
The decedent mai~ained Investment Account # 87629089. For further information, you
may contact the Brokerage Deparkaaent at .1-500-762-6111.
Page 1 of 2
s,
~~n
^,
Please note that this office only provides date of death ba]a~aces for deposit accounts
(IItAs, CDs, Checking and Savings accounts). We do not process any financial
transactions or provide statements. If you need assistance with any of these items,
please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sinc rely,
Q ~~2 a~~
Lori Robertson
1-800-762-1775 '
P7-PFSC-04-F
500 First Ave
Pittsburgh, PA 15219 Member FDIC
D 2
Page 2 of 2
' ;C ota~ Banking Statement ~~J ~ ~A~11~C
1'~1C Bank
1For ttre period 04/09/2008 to 05/07/2008
NE'I•TIE G WOLFORB
7 ALLIANCE BR AP7 106
CARLISLE PA 17.013-4142
Primary account number. 51-8008-4565
Page 1 of 3
Number of enclosures: 0
For 24hour banking, and transaction or
interest rate information, sign on to
'j~ PNC Bank Online Banking at pnc.com.
For customer service call 1-888-PNC-BANK
between the hours of 6 AM and Midnight ET.
Para servicio en espaRol, 1-866-KOLA-PNC
Movingt Please contact us at 1-888-PNC-BANK
® Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
- [~ Visit us at pnc.com
-~ ~--i_-~^ ~ TDD terminal 1-800-531-1648
For bearing mmPaa ea clients aniy
i~~lationship-Overview
~. __ _ _ _
Bank Deposit Accounts
Descrfption ? Account Number Deposit Balance
Interest Checking 51-8008-4565
~ 1Q688.43
C;cty:ificate(s) Of Deposit Total of 2 .24,835.45
Total Deposits 35,523.88
Im~restment Accounts ~ .Hiss ~~e vatnc
PI~C Brokerage-Account Numher: 0087629089 ' • 1~u Ban1c cnaran
pescrfption _ _ _ Market value
on 05!05
Annuities - 13,300.80+
7i~
--•--~--
Value 13,~oa.sa-
N~~t Value 13,300.80+
Imp 9stment"balances are provided for informational purposes only. for more details regarding these investements, please refer to your account
st~if:ementfrom-your investment provider(s1. This information is not intendedto replaceyour regular brokerage account statement(sl-
w~ _ __ __
Sometimes bigger dreams recluve larger loans. With highly competitive-rates and low down payments, we can offer more mortgage options
anet better financing solutions. Whether-you're shopping for a new primaryresidence, asecond home, or considering a refinance, we can tailor
a Jtunbo mortgage that fits your big plans perfectly.
_ For IVIore Information:
'Visit your local PNC Bank branch
> 'a'ist pncmortgage.com
t~',all 1-800-778-6678.... __
Stsnlor-Premi~nn Plan.... Nettie G wolforct
Intterest Checking- Account-Summary .
Acrountnumber. 51-8008-4565
B~tiance Sammary
Beginning Deposits and Checks and other
balance other addltlons deductions
8,449.12 2,07427 834.96
Average month{y
balance
9,297.08
Ending
balance
10,688.43
Charges
and fees
.00
Please see the Activity Detail section for
additional information.
FORM953R-1005
To Wayne ALogue/Field/AMPF aQAMPF
cc
bcc
Subject 1 1220776 6 001
NETTIE G WOLFORD -. DEATH SETTLEMENT
REQUIREMENTS -PLEASE DO NOT DELETE
RiverSource Life Insurance Company
RiverSource Funds
Ameriprise Certificate Company
Ameriprise Brokerage '
70100 Ameriprige Financial Center
Minneapolis, MN 55474
July 3, 2008
- ~ _ .
WAYNE ALLEN LOGUE
STE 200
342 N FRONT ST
WORMLEYSBURG, PA 17043-1112
Dear WAYNE ALLEN LOGUE:
We have received notification of NETTIE G WOI:FOIZD's deatl. The deceased's-name appears on the following
---~~ accounts. Account values as of 05/15/2008 are listed below. At the end of this letter, ,you will find a list of
beneficiaries. s own m our miti review of the accounts
Account Information
LTC Premium Return
Account Number Ownership
91002405620 2 004 Individual
Ameriprise Brokerage Account
Account Number Ownership
00051377232 7 021 Individual
LTC Premium Return
Account Number Total Value
91002405620 2 004 Premium refund of $282.91
Ameriprise Brokerage Account
Account Number Total Value
0005 1377232 7 021 X50,801.40
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The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts maybe
subject to market fluctuation as governed by each product. Please note that the values indicated for any Life
Insurance products with the insured deceased reflect the gross death benefit at date of death and not the cash value.
Values indicated for Life Insurance products with only the owner deceased reflect the cash value as of the date of
death. Values for any proprietary mutual funds include accrued dividends as applicable. Values provided for
-brrokeerage products are manually calculated, and. should be used as-estimates only. The prices used to provide
values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these
values as a service to its clients. Actual values used. in preparation of tax returns or for planning purposes should be
verified by your legal and accounting advisors.
Account Disposition
Account disposition is based.on how an account is owned (the ownership type). The following information will
help you understand the processthatwill be used to settle the accounts: Accounts maybe subject to market
fluctuation as governed by each product.
Disposition for Individual ownership
Upon the death of the owner/insured, all premiums paid after the date of death will be refunded to the estate.
Disposition for Individual ownership
Upon the death of the owner, all mutual fiord, certificate, SPS Advantage and brokerage accounts, annuities issued
before January 19, 1985 and life insurance accounts registered in individual ownership become part of the estate for
distribution. If there is a contingent owner named on a life insurance or annuity account ownership passes directly to
the contingent owner. If the brokerage account holds limited partnership, REIT or networked fund investments the
transfer agent or fund company must be contacted directly by the estate representative for the transfer of ownership
instntetions and paperwork. For brokerage accounts holding indivisible securities including bonds, additional
instructions may be required to complete settlement.
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