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Home My WebLink About06-22-091505607121 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 2 1 0 9 0 0 6 3 Harrisbur , PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 3 9 6 1 2 3 6 6 2 0 1 1 5 2 0 0 9 1 1 2 4 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI B O R G E S M A R Y E L L E N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name B O R G E S Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Suffix Spouse's First Name W A Y N E THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI H ^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 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) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number I V O V O T T O I I I E S Q U I R E 7 1 7 2 4 3 3 3 4 1 Firm Name (If Applicable) M A R T S O N First line of address 1 0 E A S T Second line of address City or Post Office C A R L I S L E State ZiP Code REGISTER OF WILLS USE ONLY n~ ['~ ~: : ~_7 , t ..-~ _. - ~~-~ ; i i-7 ~ ~_C~ - ` ~_ ' ' ~= > r < >~ ~,~ r~; _; - -; "--~ - - ~ t, _ ~~~ DA7.E FILED _ '' P A 1 7 0 1 3 _. ~t Correspondent's a-mail address: I O T T O a~ M A R T S O N L A W• C O M 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 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. L A W O F F I C E S H I G H S T R E E T SIGN~OF PERS RESPO SIBLE FOR FILING RETURN DATE `I c~ ~n9 ADDRESS 63 COLFAX ROAD HAVERTOWN PA 19083 SIG` UR~~F P R OTHER THAN REPRESENTATIVE ~ % ~~ !O~ ADDRESS 10 E HIGH ST CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505607121 Side 1 1505607121 1505607221 REV-1500 EX Decedent's Social Security Number oecedent'sName: MARY ELLEN BORGES 3 9 6 1 2 3 6 6 2 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1 2 9 8 9 0 6. 0 9 ............................. 2. Stocks and Bonds (Schedule B) .... • . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 4. Mortgages & Notes Receivable (Schedule D) .................. .... .. 4. 6 0 D 0 0 • 0 0 6 4 4 0 0 , 4 1 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . .... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6• 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ^ Separate Billing Requested . l h d G S .... .. 7. 0 ~ 0 0 e u e ) ( c 8. Total Gross Assets (total Lines 1-7) ..................... .... .. 8. 2 2 3 3 0 6. 5 0 9. Funeral Expenses & Administrative Costs (Schedule H) .......... .... .. 9• 3 0 3 9 7 1 4 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... .... .. 10. 1 1 7 5 6 , 8 8 11. Total Deductions (total Lines 9 & 10) ..................... .... .. 11. 4 2 1 5 4 . 0 2 12. Net Value of Estate (Line 8 minus Line 11) ................... .... .. 12• 1 8 1 1 5 2 . 4 8 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. 1 8 1 1 5 2 , 4 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable 1 8 1 1 5 2 4 8 8 1 5 1. 8 6 at lineal rate X .045 16. 17. Amount of Line 14 taxable 0 0 0 17 0 . 0 0 at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 1 g 0. 0 0 at collateral rate X .15 19 8 1 5 1. 8 6 .......................................... 1s. Tax Due .... . .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505607221 1505607221 J REV-1500 EX Page 3 File Number Decedent's Complete AddreSS: 21 09 0063 DECEDENT'S NAME MARY ELLEN BORGES STREET ADDRESS 1000 West South Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 8,151.86 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 5,000.00 C. Discount 263.15 Total Credits (A + B + C) (2) 5,263.15 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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) 2,888.71 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 2,888.71 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 : ................................................................ ...... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ X ^ c. retain a reversionary interest; or .......................................................................................... ...... ^ ^ 0 ^X 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? ................................................................................. h? " " ...... ^ ^ 0 ... or payable upon death bank account or security at his or her deat intrust for 3. Did decedent own an ...... 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)]. 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. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY ELLEN BORGES 21 09 0063 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Merrill Lynch Account No. 713-20609 98,906.09 (See attached) TOTAL (Also enter on line 2, Recapitulation) I $ 98,906.09 (If more space is needed, insert additional sheets of the same size) REV-1507 EX + (6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN pECE~`/ /, BLE RESIDENT DECEDENT fl Y/1 ESTATE OF FILE NUMBER MARY ELLEN BORGES 21 09 0063 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Note from John K. Rich dated October 21, 1989 60,000.00 TOTAL (Also enter on line 4, Recapitulation) $ 60,000.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c M~S~r. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY ELLEN BORGES 21 09 0063 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Personal property (jewelry and household furnishings) 17,000.00 2.. Citizens Bank IRA 6140888085 1,506.83 ($1,506.53 + $.30 interest) See attached 3. Citizens Bank IRA 614176123 507.59 See attached 4. Met Life Annuity contract # 1035707BSA, beneficiary estate 43,105.99 See attached 5. Miscellaneous cash receipts ~ 2,280.00 TOTAL (Also enter on line 5, Recapitulation) I $ 64,400.41 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY ELLEN BORGES 21 09 0063 Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home 4,259.01 2. Dickinson College, memorial service reception 980.79 3. Toni Bonnette, reimbursement for memorial service reception expenses 402.18 4. Boiling Springs Tavern, family funeral dinner 850.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Donald W. Rich, III 9,600.00 Street Address 63 Colfax Road City Havertown State PA Zip 19083 Year(s) Commission Paid: 2009 p. Attorney Fees Manson Law Offices (estimated) 10,350.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,200.00 Claimant Wayne H. Borges Street Address 1000 West South Street City Carlisle State PA Zip 17013 Relationship of Claimant to Decedent 4. I Probate Fees Cumberland County Register of Wills 5, I Accountant's Fees 6. I Tax Return Preparer's Fees 267.00 7, Register of Wills, filing fee, Inheritance Tax Return 15.00 8. Register of Wills, additional probate fee 50.00 9. Register of Wills, Short Certificates 24.00 10. The Sentinel, advertising Letters Testamentary 198.16 11. Cumberland Law Journal, advertising Letters Testamentary 75.00 12. Zieglers Moving & Storage, disposition of personal property 126.00 TOTAL (Also enter on line 9, Recapitulation) I $ 30,397.14 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF MARY ELLEN BORGES FILE NUMBER 21 09 0063 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Sarah Todd Memorial Home, account payable 11,756.88 TOTAL (Also enter on line 10, Recapitulation) I $ 11,756.88 (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 MARY ELLEN BORGES 21 09 0063 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outri ht spousal distributions, and transfers under ~ Sec. 9116 (a (1.2)] 1. Donald W. Rich, III Lineal 60,384.16 63 Colfax Road Havertown, PA 19083 2. Toni Rich Bonnette Lineal 60,384.16 306 Kings Highway East Haddenfield, NJ 08033 3. John K. Rich Lineal 60,384.16 17119 Carriage Dale Court Spring, TX 77379 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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) F. ~FILES~DATAFII.E1WaLS~38324. WQJcIm ORId1NAt RETAINlD SYs UM OFF7CE8 ~a~ 2~~tfj rwifl'ial~~ s ~~tt~, p A MIOFEESWNAL <1pRlpRA71pN O TEN EAST HIGH STREET GRLISLG IA 17N7 /7M 71Jdi~t LAST WILL AND TESTAMENT I, MARY ELLEN BORGES, of 1228 White Birch Lane, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My personal representative shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I direct that my personal representative shall fully acknowledge and honor a certain Antenuptial Agreement dated May 16, 1986, as amended, between my husband, WAYNE H. BORGES, and me. 3. I direct that any advances made by me to JOHN KRAUSE RICH and LINDA M. RICH shall be offset against the share of JOHN KRAUSE RICH in my estate. If his share of the estate is insufficient to equal same, then the remainder of my estate shall be awarded equally to DONALD W. RICH III and TONI RICH BONNETTE. 4. Subject to Paragraph Three above, all the rest, residue and remainder of my estate, both real and personal property, I give, devise and bequeath, in equal shares, unto my children, DONALD W. RICH III, TONI RICH BONNETTE and JOHN KRAUSE RICH, absolutely. 5. I nominate, constitute and appoint my son, DONALD W. RICH III, as Executor of my estate. ~~'~x~ M.E.B. Page 1 of 3 Pages In the event he shall be unable or unwilling to serve in such capacity, then I appoint my daughter, TONI RICH BONNETTE, to act in such capacity. 6. I direct that my personal representative shall not be required to file a bond to secure the faithful performance of his or her duties in any jurisdiction. 7. I authorize and empower my personal representative, in his or her sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all properly of any kind forming a part of my estate for such terms and such prices as he or she may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this ~ ~~ da of Y ~,,~~g't- , 199 SEAL) Mary Ell orges SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. ~, ~ - < <- Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND . SS. I, Mary Ellen Borges, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Mary Ellen ges Sworn or ed to and acknowled ed before me by Mary Ellen Borges, the Testatrix, this ~ $~ day of S? , 199. Notary Public Notarial Seal COMMONWEALTH OF PENNSYLVANIA ) Corrine ~. Myers, Notary Public Carlisle Boro, Cumberland County S . My Commission Expires May 27, 1999 COUNTY OF CUMBERLAND 1 We, ~ ~.f 1 t'S G ~-. /" y'e- and ~~~C.a the witnesses whose names are signed to the attached or foregoing instrument, being~uly qualified according to law, do depose and say that we were present and saw Mary Ellen Borges, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~~ Address P Addt~ess ~,r f ,- !~ ;~ , ,,~ ~,;;~, ~ r --;,.. _ Sworn or affirmed to and subscribed before me this ~ g day of ~' ~~ , 199 ~/ No ary Public Notarial Seal Corrine L. Myers, Notary Public Carlisle Boro, Cumberland County Page 3 of 3 Pages My Commission Expires May 27, 1999 F.\FILES\DATAFILE\Es[ate Planning\56324-codicil.) CODICIL I, MARY ELLEN BORGES, of 1228 White Birch Lane, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be a.Codicil to my Last Will and Testament dated August 18, 1998. In my said Will dated August 18, 1998, I refer to "advances made by me to John Krause Rich" in Paragraph 3 thereof. In order that this matter will be resolved among my children or other beneficiaries of my estate, this phrase shall be deemed to specifically refer to an obligation signed by John K. Rich and Linda M. Rich, dated October 21, 1989, in the amount of $48,000.00, with interest at 8% per annum from April 1, 1987. Of this amount, several payments were made, leaving a principal balance of $46,979.04 as of August 1, 1990. No payments have been made since that time. By way of further explanation, on or about the month of March, 1990, John Rich applied for a mortgage to CCNB, Boiling Springs, Pennsylvania, and advised me that the lender would not approve the loan unless the judgment entered in the Prothonotary's Office of Cumberland County, Pennsylvania to No. 998 Civil 1990 was satisfied of record. Solely to accommodate John and Linda Rich, I agreed to do this, although a substantial balance remained with respect to this obligation. I instructed my attorneys to so mark the docket. No part of the remaining balance of this obligation has been paid since August 1, 1990 and John Rich has agreed with me to honor same. 2. In all other respects, I ratify and affirm my said Last Will and Testament dated August 18, 1998. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 8th day of October, 2002. `~ (SEAL) Mary Ellen orges SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for a Codicil to her Last Will and Testament dated August 18, 1998, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. /, -' ,~ Page 1 of 2 Pages COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ~ SS. We, Mary Ellen Borges, /yo l~ 0-~-~y m- ,and_ VlC~to~'~~ ~ C~~ the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as a Codicil to her last Will dated August 18, 1998, and that the Testatrix has signed willingly, and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Codicil as a witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. C ,I~~ Mary Elle orges, Testatrix rr 1111655 ~/ ~ ~~l r ~' Witness Subscribed, sworn to and acknowledged before me by Mary Ellen Borges, the Testatrix, and subscribed and sworn to before me by /yo V ~- ~ C -~ 7~ and ~i ~ !' fL r« L _ ~-~/~ ,the witnesses, this 8th day of October, 2002. ~~ .~Z ~._'' otaiy Public NOTARIAL SEAI CORfiINE 1. MYERS, Notary Public Carlisle 8oro, CumberlandCounry M Commission Ex ~res Ma 27, 2003 Page 2 of 2 Paces May, 14. 2009 12:55PM May lY cnn7 il.~~.~n id56ZB3B648 -> April 14, 2009 bonaid W Rich 111 Execcctor 63 Colfax Road Havertown, PA 1,9083 RE: Mary Ellen Barges bCSD 01/15/09 Acct # 713-20609 bear Mr. ponald W Kith ilt, No, 2879 P, 9 Merrill Lynch Yage 8BZ Attached please fend an activity summary sheet which identifies the entrees posted from 12/06/08 through o1/os/o9 total)ng $98,906.09 this represents the date aF va{ue of the account on 01/x5/09_ very truly yours, Rlthard A Bonnette ~~~~~~~~ May. 14. 2009 12:55PM May 14 LNNy 11:59:4d 1d56Z838648 -> No, 2879 P. 10 Merrill Lynch rage 883 SettYed Activity AU ACtfYICy Types 15 items - A!I Avail>able -From S/14x2007 to 6/14/2009 €~s of Ciose of Business 5!13!2009 Account/ 1'rada 9®ttie Type l}o>zcription ~ymboll Quanklty Price Amount Nickname E7~te pate _ __ ctlslP 10URNALENTRY 2 ¢ M£fl CMA 23 ENT•TRF DEA c;R CI~Sl~1 8,4~ _ _ _ _ _ - ~ _ . 713-20608 ~v - __ _ _ __ ' ~' 1.2/31/2008 ®~~-6ANK INTER$sT 9QOz8697.6 9.00 Me~B CMA z3t9 ML BANK pF.pVSIT 718-20609 -..,-..,u... ~....,. ~...~._~.1Z131/2008 BnNK iKCERF.S'1' 9y0Z8F~916 0-21. MEb CMA 3329 6ANK O~PO$ri'lNTeRE57' _AROM a2/~7,ri~ku S~Z_.~-.".,...-..~v.,.~.. .~ ~~~, . ,.... T 713-20609 ~ __ _ 32/39/2008 ~ 70URNAL ENTRY Z.14 M~0 CMA z3i9 I;NT' T RF DEp CR CAS H BAl _ . ~,.-^M..._^-v ,.,.......,.._.. _ 71,3-20609 ~~^~~ ~~~ _ _ ~~ ~~ _ . ~~~ 1 2/1 612 00 8 JOURNAL ENTRY 97,938.42 MEB [MA ,23;9 _v ENT'TRF GEP CR_ CASH BAL _ ~,~„ ~.__ _._~. -- AC~Ounts loc~uded in C1i5 renpK: 733-20609 (CMA) "MF.9 GMA 7.319" RepoK Greater) 12:a0:59PM, Mey'14, 2009 for MARY ELLEN BORGES FOr Infprmatlpndl PuryJOSe5 Only - Attouat SmCamcnt is 61'-id01 Racora aP Holdlnfle, Baloncec and S^curlty Vela^d gage 2 ofi 3 May, 14. 2009 12;55PM Citizens Ban~° No. 2879 P, 5 Account Number 6140888085 Account Title MARY ELLEN BORGES Date O erred 1/14/1986 Account T Time D osits (IRA) Principal Balance as of DOD $1506.53 Interest from Last Posting to r3OD $ .30 Account Balance as of DOD $1506.83 YTD Interest to DOD $4.70 May, 14. 2009 12;55PM +~itiz~ens Bankry No, 2879 P. 6 Account Number 6140176123 Account Title MARY ELLEN BORGES Date 0 ned 1/14/1986 Account T e Time D osits IRA Principal Balance as of DOD $507.59 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $507.59 YTD Interest to DOD $ .00 ~~~~~~ 3 May. 14. 2009 12:55PM MetLife Investors USA P.O. Box 14593 Des Moines IA 50306-3593 ESTATE OF MARY ELLEN BORGES DONALD RICH EXECUTOR 63 COLFAX RD HAVERTOWN PA 19083 1429 RE: SUNAMERICA LIFE INSURANCE GBMFAFIY CONYRACT'C'9035T07BSA ADMINISTERED BY METLIFE INVESTORS U3A INSURANCE COMPANY OWNER Mary Ellen Borges Dear Mr. Rich: April 23, 2009 We processed a lump~um distribution representing the proceeds payable to the Estate of Mary Ellen Borges under the above-referenced annuity. We are sending a check in the amount of $43,105.99 to you under separate cover. The taxable portion of the proceeds is 537,629.07. An IRS Form 1099-R will be mailed to you by . January 31, 2010. If you have any questions, please contact your representative or tail our Customer Service Center at 1-800-284-4536 Monday through Friday between 8:30 a.m. and 6:30 p.m., ET. Sincerely, Michael Irving Sr. Annuity Representative -Post Issue Processing MetLife Annuity Operations and Services No, 2879 P. 3 MetLife