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Home My WebLink About06-29-09J 15056051058 REV-1500 EX (DB-D5> OFFICIAL USE ONLY PA Department of Revenue Coun Coda Yeer Flle Number Bureau oflMNidual Taxes INHERITANCE TAX RETURN ~~"ry ~~ -~ PoeoxzeDBDt 21 OB .1079 HemsDUrg,PAmzeaBOt RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Dale of Birth ',10/09/2006 03/26/1925 __ _ _ Decedent's Lest Name Suffix __ Decedent's First Name MI _. __. REIDLINGER ;FREDERICK W (If Applluble) Enbr 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] 1. Original Retum O 2. Supplemental Relum O 3. Remainder Retum (tlela of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compmmlae (date of O 5. Fetlerel Estate Tax Relum Required tleath after 72-12$2) m 8. Decedent Died Testate O 7. Decedent Maintained a Living Trust .-.„ 1._... 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Preceetls Received O 10. Spousal Poverty Cretltt (date of tleath O it. Election to tax untler Sec. 9113(A) between 72-31-9t and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Deylime Telephone Number ,THOMAS E. FLOWER (717) 737-34 e~''a Firm Name (If Applicable) ~ o ~ - --- -- `Q - = - - ~- REGISTER S U8E ORLY I r ~: I SAIDIS, FLOWER, LINDSAY ~? ~ ~ '' ~ " ? Fret line of adtlress . m f? ~~~ ~ ~ r i'~ a '7 2109 MARKET STREET . .' O - , Second hne of address ~ ~~ % + ~~ ~ i ~ ~ , - N City Or POat ORICe _ State ZIP Ctxle _ t.- DATE FILED -~}.. '' .._-.-_-.-._.__ _.. _.-._- 0 ___. _ , CAMP HILL PA 17011 _ _ ..__ ' __ Correspontlent's e.-mail adprb`s: Dlowertgtsn-law.tt~m Under panaltie of ry, t I have exeminetl this rotum, Includirp exompanying ecMdulee aM shtemsnN, antl to the Oast pt my knowledge end belle( it is a a ti rer other Bran the personal reprosenWve k based on all Inkrmadon of which properor hbe any krxaNatlpe. BIGNA O E IBLE FOR FILING R TURN TE ~ D AWILLIAM F. REID ING>itR3-~ D N ROAD, HARRISBURG, PA 17111 SIG TURtE F PREPARER RESENTATIVE DATE SAIDIS, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY 1 505605 1 058 Side 1 L 15056051058 y~x u g ~~ ~~~ J 15056052059 REV-1500 EX Decedent's Neme: FREDERICK W REIDLINGER Decedent's Social Security Number RECAPITULATION _. 1. Real esbte (Schedule A) .......................................... ... 1.., 128,410.00 F._.._, ....._._.._...__._.....__,....._...._________.......__. 2. Stocks and Bonds (Schetlula B) .................................... ... 2. 3. Closely Heltl Corporation, Partnership or Sole-Propdetorehlp (Schedule C) .. ... 3. '~ 4. Mortgages 8 Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) ..... ... 5. ~ L____ 91,812.47 m.~._-....._.,.._,__,_.___ _.._ W __._____ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. j 7. Inter-Yvos Trans/ers & Miscellaneous Non-Probate Property ~~-`-` ""'-' -'-- (Schedule G) O Separete BIIIing Requested..... ... 7. i 172,280.58 9. Total Gross Asseb (total Lines 1-7) ................................. ... 8. ', 390,283.03 9. Funeral Expenses & Administrative Costs (Schedule H) ................... . . 9. '. ~. 24,550.88 ~._._--- 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. '~ 188.49 11. Tobl Dsdudions (total Lines 8 & 10) ................................. .. it. ~ 24,737.37 _ _~_.. 12. Net Value of Esbb (Line B minus Line 11) ............................ I .. 12. ~ 365,545.66 13. Chedbble and Governmental Bequests/Sec 9113 Trusts for which ~ ~'"""'"""`"'~"-'"" an election to tax has not been made (Schedule J) ...................... .. 13. ! 0.00 14. Net Valw SubJset to Tax (Line 12 minus Line 13) ...................... .. 14. '~, 365,545.88 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, ar trensfers under Sec. 9116 - "~ """ i - -- (a)(1.2) X .0_ 15. 18. Amount of Line 14 taxable ""-"""~""""""""'"-" at lineal rate X .0 45 ' 365,545.68 '', 16, 18,449.55 '', 17. Amount of Line 14 taxable '. """' at sibling rate X .72 '. ', 17. ~ 18. ,._........._ .. Amount of Line 14 taxable ._._,.,_..__. _.._._ .... _ _i, ~~__.....-.._.___m._..._._....._ at wllaterel refs X .15 16. 19. TAX DUE ........................... 15,449.55 .............................. 19.~ . _... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 15056052059 REV-1500 EX Pape 3 Decedent's Complete Address: Fib umbrr 21 OB 1079 ~~~ DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER FREDERICK W REIDLINGER 191-18-4105 STREET ADDRESS 8 SOUTH 16TH STREET CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 16,449.55 2. CreditslPayments A. Spousal Povedy Credk B. Prior Payments 17,000.00 C. Discount 894.71 Total Credits (A+ g + C) (2) 17,894.71 3. InterestlPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0 00 4. If Line 2 is greater than Line i + Line 3, enter the difference. This I5 the OVERPAYMENT. . FIII In oval on Page 2, Lins 20 to requsat a refund. (4) 1,445.16 5. It Line 1 + Line 3 is greater than Line 2, enter the diference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. ($A) 0.00 B. Enter the total of Lina 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a tansfer and: Yes Na 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 reversbnary interest; or .............................................................................................................. ........... ^ d. receive the promise for life of either payments, benefits or careT .......................................................... ........... . . ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideretbnT .................................................................................................. ............ ^ 3. Did decedent own an 'in trust for' or payable upon death bank account or secudty at his or her deathT .. ............ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non•probate property which contains a beneficiary designationT ............................................................................................................ ............ ><^ ^ 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 an or after Juty 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 [/2 P.S. §9118 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for discbsure of assets and filing a tax return are sfill applicable even H the surviving spouse is the only beneficiary. For dates of death an or after Juty 1, 2000: The tax rate imposed on the net value of transfers from a deceased child lwentyone years of age or younger at death to or for the use of a natural parent, an adoptlve parent, or a stepparent of the child is zero (0) percent ]72 P.S. §9118(a)(1.2)]. The tax rate Imposed on the net value of transfers to or for the use of the decedents lineal benefidaries 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 [/2 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 a adoptlon. REV-1502 EX~ (8-68) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FREDERICK W. REIDLINGER 21-OS-1079 All sal properly owned eokty or ae a tenant In common moat be sported at falr market value. Fair market value ie defined as the prke at which property would be ezchanped between a wilpng buyer and a wiNing aeYer, neither being compelled to buy or ufi, both hating reasonable knowledge of Ne relevant facto. Ral property which N Jointlycwned with rlghl of eurvlvorship must W dleelaed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE __ _ OF DEATH t• '.DWELLING HOUSE AND LOT, 8 S. 16TH ST., CAMP HILL BORO., CUMBERLAND CY. ASSESSED VALUE -upon sale of the property, executor will file supplement return to reflect 126,410.00 actual sales price and deductions as shown on HUD-1 settlement sheet. TaxDB Result Details Page 1 of 1 Detailed Results for Parce101-22-0536-077. in the 2004 Tax Assessment Database DistrictNo 01 Parcel ID 01-22-0536-077. MapSuffix HouseNo 8 Direction S Street 16TH STREET Owned REIDLINGER, FREDERICK & WIFE C/O PropType R PropDesc LivArea 1320 CurLandVal 20000 CurImpVsl 106410 CurTotVal 126410 CurPrefVal Acreage .06 CIGrnStat TaxEx 1 SaleAmt SaleMo SaleDa SaleCe SaleYr DeedBkPage 0018G-00490 YearBlt 1900 HF File Date 11/02/2004 HF_Approval_Status A http://taxdb.ccpa.net/details.asp?id=01-22-0536-077.&dbselect=l 11/7/2008 REV-7508 EX+ (6-98) •~ SCHEpULE E COMMONWEALTH OF PENNSYLVANIA CASHr BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER FREDERICK W. REIDLINGER 21-08-1079 Include Me proceeds of litigagon and the date the proceeds were received by the estate. All property Jolntlyowned with right of aurvivonhip must be disclosed on Schedule F. L M&T Bank checking account #71018271 6,281.66 2. M8T Bank certificate of deposit #31003913820899 32,994.17 3. M&T Bank certificate of deposit #31003916496605 5,520.99 4. Sovereign Bank checking account #71018271 6,281.51 5. Sovereign Bank savings account #31003913820899 ($32,945.33 plus es8mated $60.22 accrued interest) 33,005.55 6. Sovereign Bank certificete of deposit # 31003916496605 5,528.59 7. 1998 Ford Taurus, sale proceeds 2,000.00 TOTAL (Also enter on line 5, Recapitulation) S 91,612.47 (If more space is needed, insert additional sheets of the same size) Q M&TBai1k 499 Mitchell Rosd, Millsboro, DE 19966 Mail Code DE-MB-12 Law Offices Saidis, Flower & Lindsay 2109 Market Street Camp Hill, Pennsylvania 17011 Re: Estade of. Frederick W Reidlinrer Social Security: 191-18-4105 Date ofDeath.• October 09~ 2008 f;;~Gr ~ ~ 2~~ Phone (888)502-4349 Fex (302)934.2955 November 7, 2008 Dear Sir or Madam: Per your inquiry dated November O5, 2008, please be advised that at the time of death, the abovo-natned decedent had on deposit with this bank the following: 1. Type ojAccoun[ Checking Account Account Number 91018271 Ownership (Names ofl BettyL Reic!linger* Frederick W Reid[inger* OpentngDate 8/18/64 Closed 11/4/08 Balance on Date ojDeath $ 6,181.51 Accruedlnterest $ 0.15 Total $ 6,281.66 ------------------------°---------- ---~~-----~~- 2. ~ Type ojAF:count ~ :Certificate ofDeporit , Account Numbea• 31003913820899 Ownershlp(NamerofJ FrederickWReidlinger* Opening Date 8/23/99 Closed 11/4/08 Balance on Date ojDeath $ 32,945.33 Accruedlnterest $ 48.84 Total - ------------------------------- $ 32,994.17 ------------ k 3. Type ofAccount Certificate of Deposit AccountNvmber 31003916496605 Ownershrp (Names oQ Frederick WReidlinger* Opening Date 3/17/06 Closed II/4/08 Balance on Date ofDeath $ 5,486.56 Accrued Interest $ 3q, 43 Total $ 5,510.99 -------~ - 4. Type of Account IRA Account Number 35004101749700 Ownership (Nameso,~ FrederickWReidlrnger* Wiliam Reidlinger, Benefu;iary* Susan King Benefrciary* Opening Date 8/21/84 Balance on Date afDeath $ 5,299.51 Accruedlnterest $ 12.49 Total $5,312.00---------- - 5.. Type ofAccount IRA AccouraN:m~ber 35004201749718 Ownership (Nnmes o,~ Frederick W Reidlinger* William Reidlinger, Benefrcinry* Susan King Benefrciary* Opening Date 9/14/85 Balance on Date of Death $ 7,891.18 Accivedlpterest $ 16.85 Tota! '- ------------------------------------------~- $ 7,908.03 ~ - 6. TypeofAaount SafeDepositBax Box Number/Locatton 0001252/WestShorePlaza Onmership(Nanreson FredWReidlinger* Opening Date 8/1/50 " If upon reviewing the Information above, you believe there are addittonal accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, Including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our West Shore Plaza lice q 717-2552271. Sincerely, ~///~~ ' ' ~LLtC.c.¢/ ~ "~ Trade Hare Records Management NOV-RS-pRGI~ 19 ~ ?.9 GR SPONPo! ~ E Page: 1 Document Name: untitled v _ STFT 1 THE TRANSACTION STMT FORMAT 08/11/04 13.37.41 STMT CO 96 OP EBRN MS 50861 LAST PAGE OF TRANSACTIONS ACTION COID PROD CODE CDA ACCT 31003916496605 SHORT NAME REIDLINGER FREDERICK W CURR CODE PAGE 1 SEARCH FROM 106/03/27 THRU 108/11/04 ACTH POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION _ * 03/27 5,000.00 C 5,000.00 6027078833 DEPOSIT _ * 04/27 271.83 C 5,271.83 I-GEN107042700004008 INTEREST PAYMENT GENERATED * 04/27 5,271.83 C 5,271.83 *RENEWED AT 3.68, MATURES ON 05/27/08 * 05/27 214.73 C 5,486.56 I-GEN108052700004455 INTEREST PAYMENT GENERATED _ * 05/27 5,486.56 C 5,486.56 CDSGN108052700005385 *RENEWED AT 1.738, MATURES ON 06/27/09 11/04 42.03 C 5,528.59 I-GEN108110400000001 INTEREST PAYMENT GENERATED _ 11/04 309612396 5,528.59 D .00 MQWBRP99 PAYOFF ACCOUNT - WITHOUT PENALTY PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM ....+ Date: 11/4/2008 Time: 1:37;50 PM NOU-CS-22e8 1~:+~ GE SFONP.!"LE 'Page: 1 Document Name: untitled _~~ _ 3TFT 1 THE TRANSACTION STMT FORMAT 08/11/04 13.38.02 STMT CO 96 OP BBRN MS 50861 LAST PAGE OF TRANSACTIONS ACTION COID PROD CODE CDA ACCT 31003 913820899 SHORT NAME REIDLINGFREJ CURB CODE PAGE 4 SEARCH FROM 103/07/03 THRU 1.08/11/04 ACTH POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 12/24 2.80 C 31,931.62 MQWBKP99 INTEREST PAYMENT ONLINE _ * 12/24 .00 N 31,931.62 MQWBKP99 INT. ACCR. REPLACEMENT OLD=000.0 0 NEW=000.83 * 12/24 .00 N 31,931.62 MQWBKP99 TERM CHG = 4.16, MATURES ON 1 2/23/08 * 03/21 03/23/08 330.04 C 32,261.66 I-GEN108032300001749 INTEREST PAYMENT GENERATED _ * 06/23 340.04 C 32,601.70 I-GEN108062300002005 INTEREST PAYMENT GENERATED _ * 09/23 343.63 C 32,945.33 I-GEN108092300001369 INTEREST PAYMENT GENERATED 11/04 158.07 C 33,103.40 I-GEN108110400000001 INTEREST PAYMENT GENERATED 11/04 309 612397 33,103.40 D .00 MQWBKP99 PAYOFF ACCOUNT - WITHOUT PENALTY PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STEM ~~ Date: 11/4/2008 Time: 1:38:03 PM NO!.~-05-200° 10: ~ 9 GR SFONP!'GLE ^1" SF.c ?~'S P.07 'Page: 1 Document Name: untitled ...1~ _ STFD 1 THE TRANSACTION STMT FORMAT 08/11j04 73.37.26 STMT CO 96 OP EBRN MS 50852 ACTION COMPLETE ACTION COID PROD CODE DDA ACCT 71018271 SHORT NAME REIDLINGFREJ CURR CODE PAGE 4 SEARCH FROM 108/08/27 THR U 7.08/11/04 ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION _ * 09/30 3157 53.00 D 5,832.12 6053055701 CHECK NUMBER 3157 _ * 09/30 34.85 D 5,797.27 020082744493225 PPL EU ELEC SVC * 10/O1 3161 100.00 D 5,697.27 8053229754 CHECK NUMBER 3161 * 10/03 1, 105.00 C 6,802.27 020082744926161 US TREASURY 303 SOC SEC * 10/03 22.76 D 6,779.51 020082777089038 PAWL PAYMENT * 10/08 3164 361.00 D 6,418.51 5217641375 CHECK NUMBER 3164 * 10/08 3165 137.00 D 6,281.51 8055661054 CHECK NUMBER 3165 * 10/22 .26 C 6,281.77 I-GEN108102200026980 INTEREST PAYMENT PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM .../' Date: 11/4/2008 Time: 1:37:29 PM REV-75'10 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 6 INTER-VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER FREDERICK W. REIDLINGER 21-08-1079 This schedule must be completed and fled if the answer to any of questions 1 Urough 4 on the revere side of the REV-1500 COVER SHEET is yes. ITEM NUMBE DESCRIPTION OF PROPERTY iHCwos THS Onus orTHS rsaasssasa.THela aeuTrouswrrooscmeurnao THE DATE OFT0.4NSFER. ATTACHACCPYOF THE aEEO FOR REnL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION irnacucnete TAXABLE VALUE t M&T Bank IRA #35004201749700 payable to decedent's lwo children ' William Reidlinger and Susan King 5,312.00 100 5,312.00 2.' M8T Bank IRA #35004201749718 payable to decedent's two children ' , 'William Reidlingerand Susan King. 7,908.03 100 7,908.03 3. IAIGannuitycontrail#215203 35,85272!. 100. 35,852.72 4. ALLIANZ annuity contrail #70479666 43 574.70 ` 100 43,574.70 5. ALLIANZ annuity contract #70448104 ' 79,613.11 100 79,673.11 TOTAL (Also enter on line 7 Recapftulation) 5 I 172,260.56 '. (If more space is needed, insert additlonal sheets of the same size) ' ~G Annuity A.I.G. BONUS ANNUITY -- INSURANCE COMPANYv F L E ~ ~ AI Annuity insurance Company Issued by AIG Annuity Insurance Company A Slack Company 205 East 10th Avenue '` ~ y'f rt^ ~ ~ ` ~ ~ ~~; ~ ~~ Amarillo, Texas 79101-3546 t/ 111(,(1 }L•~~ ~ ~~ Telaphoae: 8004244990 FLEXIBLE PREMIUM DEFERRED ANNUITY POLICY AIG Annuity Insurance Company (referred to in this annuity policy as "we") has issued this policy in consideration of your application and initial premium. The Company will provide written notice of the initial interest rate with delivery of your policy. Interest earned on your premium payment(s) will accumulate until it is withdrawn or applied to an income plan. Income payments made according to the income plan selected will begin on the Annuity Date. The owner may make partial withdrawals at any time before the Annuity Date. Each premium payment is subject to an eazly withdrawal chazge for aseven-year period. To determine withdrawal charges, the oldest premiums are considered withdrawn first. Years from 1 2 3 4 5 6 7 Payment Thereafter Charge 9% 8% 7% 6% 5% 4% 2% 0% See Withdrawals, beginning on page 5, for additional information. - r+.nnwnzanon tannwry payments opttonr Please send annuitization quotes to me. SESSION OF POLICY: Secretary President Read your policy carefully. This annuity policy explains how your annuity works, and is a legal contract between you and AIG Annuity Insurance Company. RIGHT TO CANCEL: If, after reading the policy you are not satisfied for any reason, you may return the policy to us or any agent authorized by us within ten days after receiving it. We will refund any premiums paid and the policy will then be void. FLEXIBLE PREMIUM DEFERRED ANNUITY ANNUITY PAYMENTS TO BEGIN ON ANNUITY DATE THIS ANNUITY IS NON-PARTICIPATING -DIVIDENDS ARE NOT PAYABLE A117-98-PA Page 1 MGR-2 aP ~ yorJS ~~~ sv~ ~~ -4N1.~ ~J LT ~Z~ ~~ ~~ CBS. ~Z Z Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, MN 55459-0060 800/950-1962 DECEMBER 8, 2008 WILLIAM REIDLINGER C/O 8 SOUTH 16TH STREET CAMP HILL PA 17011 Dear Beneficiary: Allianz ili We sent you this letter because you are the named beneficiary of Frederick Reidlinger. Please accept our sincere sympathy on your loss. Listed below is information needed to file a claim for benefits on the fixed annuity contract(s). Refer to the enclosed brochure for answers to our most frequently asked questions. Payment Options Choose one of the options in Section IV on the claim form. Contract Information Contract Number Annuitization Value Minimum Pa out Period Cash Value Qualified or Non ualified 70448104 $95,037.82 5 ears $79,613.11 Non ualified 70479666 $52,515.25 5 ears $43,574.70 Non ualified Policy values are affected by withdrawals, partial surrenders, loans and market value adjustments; as a result, values quoted in this letter may increase or decrease and are not guaranteed. Claim Requirements ^ Fixed Annuity Claim Form ^ Copy of the Certified death CertitlCate (only one copy is required for the deceased) Once we receive your claim requirements, allow 15 business days for processing. Should you have any questions, please contact us at 800.950-1962. Annuity Claims/sbp C: Lawrence Cohn #11935 If the contract was issuetl in the state of Illinois: Part 918 of the Rules of the Illinois Department of Insurance governing claims practices requires that our company advise you that you may express any wncems with the Illinois Department of Insurance. It maintains a consumer division at 100 W Randolph Street, Suite 9-301, Chicago, Illinois 60606 and at 320 West Washington Street, Sprtngfield, Illinois 62767. ff the eontnd was issued In the state of New Hampshire: Should you wish to take this matter up with the New Hampshire Insurance Department, it maintains a service division to investigate complaints 21 South Fruit Suite 14 Concord, NH 03301. The _ New Hampshire Insurance Department can be reached, toll.free, by dialing 1-800-852-3416. REV-1511 E%+(12-99) SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER FREDERICK W. REIDLINGER Debts of tleeadent must ba reporlad an Sehetlule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES . 1' _. _._._....... MYERS-HARNER FUNERAL HOME, PROFESSIONAL SERVICES AND FACILITIES 4,590.00 2. _ CASKET _ . ._.. . 3,825.00 ', 3. .._. .. _.. VAULT 1,080.00 ~,.. 4. OBITUARY 516.00 5 DEATH CERTIFICATES 120.00 s FUNERAL LUNCHEON (172), FLOWERS (190), MILEAGE (90), 452.00 7 DAUPHIN CEMETERY ASSOCIATION, INTERMENT (750), LESS VA CREDIT (-100) . _ 650.00 __ ...... B. ADMINISTRATIVE COSTS. 1. Personal Representafive's Commissions 5,000.00 ? Name of Personal Representative(s) "William F. RBIdIingBr -- - ~" Social Seadty Number(s)/EIN Number of Personal Representative(s) 191-42-7976 ' _.... streetnddressl213 Deaven Rd. city Harrisburg state PA ..zip .17111 Year(s) Commission Paid: 2009 2. Attorney Fees 7,500.00 3. Family Ezemplion: (If decedent's address is nol the same as cWiment's, attach ezplanation) Street AdQress Clry Stale Zip Relationship of Claimant to Decedent 4. Probate Fees 310.00 5. Accountant's Fees 6. Tax Return Preparer's Fees '. 7. PUBLISH ESTATE NOTICES, CUMBERLAND LAW JOURNAL (75), PATRIOT NEWS (155.10) 230.10 e. M&T BANK, SAFE DEPOSIT BOX DRILLING FEE 150.00 s. REPLACE AUTO BATTERY PRIOR TO SALE 127.78 `, TOTAL (Also enter on line 9, Recapitulation) $ 24,550.88 (If more space is needed, insert additional sheets of the same size) REV-1572 EX+ (12-03) COMMONWEALTH OF PENNSYLVANl4 INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpIlLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER FREDERICK W. REIDLINGER RepoA dabta Incurred by the decadent prior to daaM which remained unpaid as of the data of death, including unrelmburaW medical ezpansaa. ITEM VALUE AT DATE NUMBER DESCRIPTION _..... OF DEATH t 'BORO.OF CAMP HILL, SEWER CHARGES 52.50 2.! VERIZON 23.13 i 3. PPL _ 23.25 4. PA AMERICAN WATER 17.48 5. T•MOBILE _ 11.07 i _6. PENN WASTE 48.75 7. AT&T 10.31 TOTAL (Also enter on line 10, Recapitulation) S 186.49 `. (I(more space is needed, inseA additlonal sheets of the same size) REV-1513 EX* (9-00) SCREDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FREDERICK W. REIDLINGER 21-08-1079 NUMBER NAME ANO ADDRESS OF PERSONS) RECEIVING PROPERTY Do Not Llst Trushels) OF ESTATE 1 TAXABLE DISTRIBUTIONS [nGude ouUight spousal disldbudons, and trensfers under ......Sec. 9116 (a) f i 2I] 1 Susan J. King, 3505 Maryville Rd, Granite City, IL 62040 'DAUGHTER 1/2 2 William F. Reidlinger, 213 Deaven Rd., Harrisburg, PA 17111 'SON 1 /2 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET D NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLEAND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) •r- LAST WILL AND TESTAMENT OF FREDERICK W. REIDLINGER I, FREDERICK W. REIDLINGER, of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. I devise and bequeath all of my estate of whatever nature and wherever situate unto my children, WILLIAM F. and SUSAN J. KING, or their issue, per stirpes. I appoint my son, WILLIAM F. REIDLINGER, Executor of this, my Last Will and Testament. Should my said son fail to qualify or cease to act as such, then I appoint my daughter, SUSAN J. KING, to act in this capacity. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. In the settlement of my estate, my executor shall possess, among others, the following powers to be exercised for the best interests of the beneficiaries: A. To retain any investments I may have at my death so long as my executor may deem it advisable to my estate so to do. B. To vary investments, when deemed desirable by my executor, and to invest in such bonds, stocks, notes, real estate mortgages or other securities or in such other real or personal property as my executor shall deem wise, without being restricted to so-called "legal investments.' C. In order to effect a division of the principal of my estate or for any other purpose, including any final distribution of my estate, my executor is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. If such division or distribution is made in kind, said assets shall be divided or distributed at their respective values on the date or dates of their division or distribution. In making any division or distribution in kind, my executor shall divide or distribute said assets in a manner which will fairly allocate any unrealized appreciation among the beneficiaries. D. To sell, either at public or private sale and upon such terms and conditions as my executor may deem advantageous to my estate, any or all real or personal estate or interest therein owned by my estate severally or in conjunction with other persons or acquired after my death by my executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my executor in this paragraph or elsewhere in this Will. E. To mortgage real estate and to make leases of real estate for any term. F. To borrow money from any party, including my executor, to pay indebtedness of mine or of my estate, expenses of administration, death taxes or other taxes. z r°~° G. To pay all costs, death taxes or other taxes, expenses and charges in connection with the administration of my estate, and my executor shall pay the expenses of my last illness and funeral expenses. H. To vote any shares of stock which form a part of my estate or trust and to otherwise exercise all the powers incident to the ownership of such stock and to actively manage and operate any incorporated or unincorporated business, including any joint ventures and partnerships, and to incorporate any such unincorporated business, with all the rights and powers of any owner thereof. I. In the discretion of my executor, to unite with any other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my estate. J. To assign to and hold in my estate an undivided portion of any asset. nominee. K. To hold investments in the name of a L. To compromise controversies. In the settlement of my estate: A. My executor shall not be personally liable for any loss to my estate or to any beneficiary of my estate resulting from an election made in good faith to claim a deduction as an income tax deduction or as an estate tax deduction. B. In valuing property in my gross estate for the purposes of any death tax, my executor shall not be personally liable for any loss to my estate or to any beneficiary of my estate resulting from my executor's decision made in good faith to use a particular valuation date. 3 IN WITNESS WHEREOF, I this, the ~ day of have hereunto set my hand and seal on 1999. ~ -/~ ~~y-(SEAL) FREDERICK W. REIDL GER Signed, sealed, published and declared by FREDERICK W. REIDLINGER, testator therein named, on this and three (3) other sheet of paper as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. 4 ~~ ( ,~'I ~l i~LF I ~~ Address ~~~ ~ ~il~` ~~ Ad ress - ~ -~ , , E'~-- % Name Y ~ COMMONWEALTH OF PENNSYLVANIA) . SS. COUNTY OF CUMBERLAND) WE, the undersigned, the Testator and the witnesses, respectively, whose names are signed to the foregoing instru- ment, being first duly sworn, do hereby declare to the under- signed authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by the testator, and subsc ibed and sworn to ore me by both 1999 witnesses, this _ day of Not Shelb Notanal Seal --~ Camp Hill gorpgling, Notary public MY Commission Expmes q n 8 ounty Inmho-~- p 2000 5 3J`d15;Od Sfl (~„C'~' v~~ ` ~. Qf E Y8~4 JUN 29 PM I= 20 N ~ u o "' ~ ~ CiAN~9 T aa~^;v~ g11uIBEf~tJD CC.. PA d a~ w ~ y o _~ ~5 N~ o j m ~i S ~ °' ~ d. ~, Q . yo rl w oU ~U O V1 r+ w CN~"a p O= =O ~ .$ EU y `~ Et~gcm ~OU OU O LAW OFFICES SAIDIS, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET JOHN E. SLIKE CAMP HILL, PENNSYLVANIA 17011 CARLISLE OFFICE: ROBERT C. SAIDLS TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737J407 26 WEST HIGH STREET ]AMPS D. FLOWER JR EMAIL: tflowerl4sfl-law.com CARLLSLE, PA 17013 CAROL J. LINDSAY www.sfl-law.com TELEPHONE: (717)2436222 JOHN B. LAMPI FACSIMILE: (717)243-6486 DANIEL L. SUI.LIVAN ALBERT H. MASLAND DEAN E. REYNOSA THOMAS E. FLOWER REPLY TO CAMP HILL MARYLOU MATAS JASON E. KELSO June 26, 2009 ~ N ~ Office of the Register of Wills c ' Cumberland Count Courthouse y '~" Z ` ~ ~` `-' Room 102 ~ .PL. ~ N ~ rA..~ i:4'7 - One Courthouse Square ~ ~ _ ` `~ Cazlisle, PA 17013 ~ c~- n::; ~ Re: Estate of Frederick W. Reidlinger o File No. 21-08-1079 Dear Sir or Madam: Enclosed aze the original and two copies of the Inheritance Tax Return for the above- referenced decedent along with a check in the amount of $15.00 in payment of the filing fee. Please return atime-stamped copy in the enclosed self-addressed stamped envelope. Please contact our office if you have any questions regazding this matter. Very truly yours, SAIDIS, FLOWER & LINDSAY ~~~ ~~~ Karen Riccazdo, Assistant to Thomas E. Flower, Esq. TEF/kaz Enclosures