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HomeMy WebLinkAbout07-15-0915056051058 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA Deparbnent of Revenue Bureau of Individual Taxes County Code Year File Number Po sox 280601 INHERITANCE TAX RETURN Harrisburg, PA 1712&0601 RESIDENT DECEDENT 21 09 0256 ENTER DECEDENT INFORMATION BELOW Sodal Security Number Date of Death Date of Blrth 204-03-0021 02/11 /2009 11 /26/1912 Decedent's Last Name Suffix Decedent's First Name MI RUPP MARGARET N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI None 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 _ 2. Supplemental Retum > 3. Remainder Retum (date of death prior to 12-13-82) ::: 4. Umked Estate .: 4a. Futuro Interost Compromise (date of ~._. 5. Federal Estate Tax Retum Required death after 12-12-82) ~~ 6. Decedent Died Testate ~:.''~'t 7, Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of WiIQ (Attach Copy of Trust) ::.'~ 9. Lkigatlon Proceeds ReceNed -.._:.- 10. Spousal Poverty Credk (date of death 11. Eledlon 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 T0: Name Daytime Telephone Number fi ROBERT R. BLACK ~ C7 (717) 243-37Z~'T p ~ r:;? , ~' '1_'~ Firm Name If ) ( Applicable v ~~ , ~ ~.~ ' e REGISTER dF_L~SE ONLY 7 ~-~ ~ r~ " ' LANDIS & BLACK • e-n --- ~ j :..~ + ~ ~ First line of address ~ : r/f~>~''~ . +~' ~-~ 36 South Hanover Street ' - ~ r"> '~ . Second line of address ~-'t © ~..,a ~' ~+- -r;t City or Post Office State ZIP Code _ DATE FILED Carlisle PA 17013 Correspondent's e-mail address: robtrblack~embargmail.com Under penakies of perjury, I dedare that I have examined this return, induding accompanying sdiedules and statements, end to the best of my knowledge and ballet, ft Is true, correct and complete. tbn of preparer than the personal representative is based on all infomiaUon of which preparer has any knowledge, SIGNATURE O N R IBL OR G URN -- _-. _ _ .: __ _ _._... ~~ -----_- _ __ ._ _ __ _ _ _ _ _ _ -_~ ~~G~ ___ _ __ ADDRESS 437 N an er Street, Carlis e, PA 17013 ___ _ _ ... OF P E O E REPRr~,ENTATIVE ~ -- ~"_ ` ~- .- - - -- A D S _.. 36 outh Hanover Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 15056052059 REV 1500 EX Decedent's Social Security Number Decedent's Name: MARGARET N RUPP 204-03-0021 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4. 0.00 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 16,064.88 6. Jantly Owned Property (Schedule F) :~" ":- Separate Billing Requested ....... 6. 7,500.53 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) c~::_::. Separate Billing Requested........ 7. 29,538.73 8. Total Gross Assets (total lines 1-7) ................................... . 8. 53,104.14 9. Funeral Expenses ~ Administrative Costs (Schedule H) ..................... 9. 5,986.35 10. Debts of Decedent, Mortgage Uabilities, & Liens (Schedule I) ................ 10. 1,024.54 11. Total Deductions (total Lines 9 & 10) ................................... 11. 7,010.89 12. Nst Valus of Estate (Line 8 minus Line 11) .............................. 12. 46,093.25 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value SubJect to Tax (line 12 minus Line 13) ........................ .... .. _-r . 14. 46,093.25 . ... __... __ v.....__.,. . _. _..._ .... ........ ........ . ... _.... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES _ . _ _ _. _.. ....._. 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable - at lineal rate X .0 45 46,093.25 16. 2,074.20 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE ......................................................... 19. 2,074.20 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Stde 2 15056052059 REV 1500 EX Page 3 FIM Number Decedent's Complete Address: 21 09 .0256 ___ - - DECEDENTS NAME DECEDENTS SOCIAL SECURffY NUMBER MARGARET N RUPP 204-03-0021 STREET ADDRESS ------- _ __-- ---_-._ 437 N. Hanover Street ----- - - --- ---- ---- -- ----__- - - ..---- -- - ----- - --- ~ zIP ----- - -_ CITY 'STATE Carlisle ~ PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2,074.20 2. CreditslPayments A. Spousal Poverty Credit _. ---__-__ _ B. Prior Payments 1,500.00 C. Discount --- -----. 78.95 -----------------_ -- - Total Credits (A + B + C) (2) 1,578.95 3. InteresUPenalty if applicable D. Interest E. Penalty ---- - -- --- ------- .--_-..__.__.._ Total InterestlPenalty (p + E) (3) 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Flll in oval on Page 2, Llne 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) 495.25 A. Enter ~e interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 495.25 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 transfemed :........................................................................................ .. ^ b. retain the right to designate who shall use the property trensferred 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 'intrust 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 benefcary designatlon? ........................................................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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}j. 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)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure 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. REV-1508 EX+ (8.y8t COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDEN"r SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER RUPP, MARGARET N. a/k/a MARGARET H. 21-09-0256 Indude the proceeds of litigation end the date the proceeds were received by the estate. All property jolnUy-ovmed with right of •urvlvorehlp must be disclosed on Schedule F. ~~~ ,,,.no oyow ~a ~iaoueu, mb9n aaamonal snee[s of the same size) REV-1509 EX+ (8-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~iCNEDl~LE F 10tNTlY-OWNED PROPERTY ESTATE OF FILE NUMBER RUPP, MARGARET N. a/k/a MARGARET H. 21-09-0256 If an asset was made Joint within one year of the decedent's date of death, ft must be roported on Schedule G. SURVNING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• M. Dean Rupp 437 N. Hanover Street, Carlisle, PA 17013 Son B. C. JOINTLY-OWNED PROPERTY.: lIEM NUMBER LETTER FOR JOINT TENANT DaTE 6tA0E JOINT DESCRIPTION OF PRQPERTY INCLUDE NAME OF FINANCW~ INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IOENTIFYINf, ,N'JM$ER. ATTACH DEED FOR JOINTLY-HELD PEAL ESTATE. LATE OF DEATH VALUE OF ASSET % JF UECCi INTEREST DaTE i;F DEaTr VAl1SE .i~ OE:EDENTS INTEREi' t' A' 07!30/02 Wachovia Bank - Account No.........7543. See attached letter. 15,001.06 50% _ 7.51)0 5~~ TOTAL (Also enter on line 6 Recapitulation) I i '.500.53 (If more space is needed, insert additional sheets of the same size) REV-'1510 EX+ 16-98; COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scHE~u~~ ~ INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER RUPP, MARGARET N. a/k/a MARGARET H. 21-09-0256 This schedule must be completed and filed if tl~e answer to any of questions 1 through 4 on the reverse side of the REV 1500 COVER SHEET is yes. ITEM NUMBE 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 % OF DECD'S INTEREST EXCLUSION iF AFRICABLE TAXABLE VALUE 1• Union Central Life Ins. Co. -#C1~730772. See attached letter. 0.00 U :t' 2. AIG Annuity Ins. Co. -Annuity Contract - FJ216479. See attached letter . 29,538,73 100 ^~~ ~?~.: 3. Gift to son, M. Dean Rupp on 9/29108. See attached invoice. , 2,619.94 100 3,000.00 a ;;i; TOTAL (Also enter on line 7 Recapitulation) 29.53£3.73 (If more space is needed, insert additional sheets or the same size) REV-1517 EX+ (i2-99) SCNEp1~LE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER RUPP, MARGARET (V. a/k/a MARGARET H. 21-09-0256 Debts of decedent moat be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: i' M. Dean Rupp -Reimburse -Funeral Luncheon .550.15 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Soaal Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Claimant M. Dean Rupp Street Address 437 id. Hanover Street Ciry Carlisle state F'A .Zip 17013 Relationship of Claimant to Decedent Son 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Union Central Life - Return Payment 8. Reserve for closing TOTAL (Also enter on line 9, Recapitulation) I $ (If more space Is needed, insert additional sheets of the same size) 0 00 Zip 1,000.00 3.500 On 403.92 332.2' 200.00 5,986.35 r;EV-f5f~ Er: ;+~-n ; Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER RUPP, MARGARET N. a/k/a MARGARET H. 21-09-0256 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, includine unreim6uriend mwdi~al sYn.nc.e --- - -----, ...--.. ,.,.,,.,,,,,,o~ ~~~~~ o. urc same s¢e. REV-1513 F.}:+ ~1!-G51 Pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RUPP, MARGARET N. a/k/a MARGARET H. 21-09-0256 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Truste(e) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. E. Bard Rupp, 127 S.E. 7th PL., Cape Coral, FL 33990 Son 50°! 2. M. Dean Rupp, 437 N. Hanover Street, Carlisle, PA 17013 Son 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 15 NOT TAKEN 1. 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0 00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV•1500 COVER SHEET I# 0 00 If more space is needed, insert additional sheets of the same size. LAST WILL AND TESTAMENT OF MARGARET N. RUPP also known as MARGARET H. RUPP 1, MARGARET N. RUPP, also known as MARGARET H. RUPP, of the Borough o Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts, funeral expenses and administration expenses, including my grave marker, shalt be paid from the asse of my estate as soon as practicable after my decease. ITEM II: I devise and bequeath the residue of my estate, of ever nature and wherever situate, in equal shares, to my two children, E. Bard Rupp and M. Dean Rupp. If either of my said children predecease me, his share shall be added to the survivor's share. ITEM lit: I direct that all taxes that may be assessed in conse- quence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the adminis- tration of my estate. ITEM IV: I appoint my two children, E. Bard Rupp and M. Dean Rupp, or the survivor thereof, Executors of this my Last Will and Testament. ITEM Y: I direct that my Executors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, [ have hereunto set my hand this ~ay of ~~ ,1979. ~ / l VMargaret N.CR-' i garet H. Ru p The preceding instrument, consisting of this one typewritten page, identified by the signature of the Testatrix, Margaret N. Rupp, also known as Margaret H. Rupp was on the day and date thereof signed, published and declared by Margaret M. Rupp, also known as Margaret H. Rupp, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses thereto. uw ernu~ w+ms ~ ~ue,c MIII,~Lf, RMM~YLYU,1~ 48500041046 REV-485 EX (1-07) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Sodal Security or Death certificate Number Date of Death County Code Year File Number G~ De dent's Last Name Suffix First Name ~ MI ADQ~E3~S OF DEC BENT STREET: c .~ /1iC ~l ~/ / /wA.~/~(r/~i!~ ~~-f~' /^~~.%l. - - ~ E: ZIP CODE: NAME AN DRESSy~OF PERS REEQ STI/N/~G-NTH/E OPENING F HE SAFE DEPOSIT BOX NAME: 1_~ ~ ._ ~ • . /_~! ~l__`^ ~ _ ~~~ _ ~I -.. - ---... -. _ STREET SS: •/,,'/ j '- --~ -- _ • ~/Yt/ Y~~ ~!';' - ~, f TE - ZIP CODE: NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDE T, OF PERSON(S) PRESENT AT THCH BCO.X OPENING a. NAM~• ~ R TIQNS IP: TR T D RESS• - -- -._._ _... _ __. .- ~~~ CITY: - _ _ . ~ ~I~QII~t~ S ~ <-'/ Y " , / `/_ T TE: ) .~JZI/P~~CODE: --- ~J J-l_.~-- ~~ - 1. F~!1~ b. NAME: . ---- -•-- 1-- -- ~_ -- RELATIONSHIP: - -- STREETADDRESS: - -- - CITY: -- - -- __._ ---- .--• - STATE: ZIP CODE: --- c. NAME: -- -._ __ RELATIONSHIP: ~ ~ ---~ - STREETADDRESS: - ~ -- -- - •- NAME CITY: STATE: ZIP CODE: yr rinr~n~,~A~ ins ~ ~ 1 u 11a'N WHERE THE SAFE DEPOSIT BOX IS LOCATED STREET ADDRESS: NAME OF PERSON... AKI G Ll,8JiE ~/ DATE~OFiCONTRACT TO RENT BOX f ID NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. NAME: '- - ~ // _.. ~1~~ . _._._ STREET ADDRES~r`~ -- CITY: l',r n, ; .~ . ._... -. ZIP CODE .~ ~~-~ w NAME AN - - __... _ CITY: STATE: -- ZIP CODE: DATE~19 TIME OF LAST ENTRY TITLE f~~ b. NA E: STREETADDRESS: ~' - - • ~ii7 D TITLE OF EMPLOYEE TAKING THE INVENTORY ~ ~ - ~~~ ~~~n ~.,~ ~ _ / !.~ ' WAS A WILL IN THE BOX? ~ _ J ~7 ~ V ^ YE3 NO If yes, a. Date of will: i b. Name and address of personal ropresentative, If named In the will - - --- - --- - -~- - -- NAME: --- ~-- - --- --- i - • -- ..-....---- ~- - - . I STREETADDRESS: CITY: - - `-- ------- STATE: ZIP CODE: i I c. Name and address of attorney, if any '- -- '- ' NAME: -- - -- -... ___.- . i STREETADDRESS: -~--- _... w_.. _-..-.... -_ - ------ ' CITY: STATE: ZIP CODE: `.~, 48500041046 48500041046 Q M8T F~~nk 499 Mitchell Street, Millsboro, DE 19966 April 15, 2009 Law Offices Landis & Black 36 South Hanover Street Carlisle, PA 17013 RE: Estate of Margaret Rupp Date of Death: February 11, 2009 Social Security Number: 20403-0021 .. ............ .. .... Dear Mr. Black: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type ........................... Checking Account Account Number ....................... 448494 Ownership (Names oj~ .............. Margaret Rupp Opening Date ...........................09/01/67 (account closed 03/23/09) Balance on Date of Death .........$5,660.33 Accrued Interest $ 0.00 Total ....................................... $5, 660.33 The above named decedent did not have a safe deposit box. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or the 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, please contact our Stonehedge branch at 960 Walnut Bottom Road, Carlisle, PA 17013, or # 717-240- 4524. Sincerely, J) Charlene Warrington, Adjus ent Services 1-888-502-4349 Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA ?A022-7313 April 20, 2009 LANDIS dt BLACK ATTN: ROBERT R BLACK 36 SOUTH HANOVER STREET' CARLISLE, PA 17013 Reefetawe m: 271 sass SUBJECT: Verification / Confirmation of Aooount and Balance Information provided far: Customer: MARGARET N RUPP (SSN# XXX-XK OOZl) Date of Death; February l1, Z009 Deposit Account Information ACOD~ '~0~~ Date of Death Av TYPe Number Ba>ana Bale Data I`'~~~Y Lrteneat Accrued yTD D~ ~~ Date Rate Ictennd Ictenxt Paid Clwed CERTIFICATE OF X~!~{7343 DEPOSIT 7/30/2002 7131 /Z008 IBGAL TITIB: MARGARET H RLIPP M DEAN RUPP CLOSING BALANCE: S1S001.06 CHECKIIVG X0693 59,409.63 1/3/1983 50.08 S1A3 3IZ:i/2009 LEGAL TITLE: MARGARET H RL1PP CLOSING BALANCE: 59110.02 Other Accoa~ Information ~~ '~OQO°~ Date ofHalaooe ~~ Number Ope~od Cioeed Ledger Collteted 4NN11ITY xx7C'ODOiOfX6479 10/14/1999 LEGAL TITLE: MARGARET H RLJPP 4I~RICAN GENERAL - For infonnatiaa regarding amnitiea, Please call 80024-4990 IAFE DEPOSTI' 7C7ODC~'DOZO100 lox a/9nao2 EGAL TITLE: MARGARET H RUPP 10CATION: 04 E HIC3H STREET :ARLISLE PA 17013 17-249-8182 The Un1on Central 1876 Waycross Road Life [nsnrance Company Cincinnati Ohio 45240 (513) 593-2200 www.unionxntral.com u ioncen~l Insurance and Investments A UNRI Cgmpsry February 22, 2009 MICHAEL RUPP 437 NORTH HANOVER STREET CARLISLE PA 17013 Re: 01473 0772 Margaret Rupp Dear Mr. Rupp: _ We wish to express our sincere sympathy to you and to the members of the family of Margaret Rupp. We are enclosing the information you requested in your telephone call. '~ Under this contract, Margaret Rupp was receiving monthly payments of $332.37 each since July 15, 1978. These payments were to be made to Margaret Rupp for her lifetime. The terms of this contract stipulate that the annuitant is guaranteed recovery of the cost of the contract. This amount has been recovered and the payments terminate with the last installment due prior to death. This last payment was made on January 15, 2009 and the contract has no further value. In order to close our records, we require the following: • Proof of Death -Copy of the Death Certificate or completion of the enclosed Form UC 556 • Return of the check dated February 15, 2009 in the amount of $332.37 In the event the above mentioned check has been negotiated, reimbursement in the form of a personal check or money order will be accepted. The check should be made payable to The Union Central Life Insurance Company in the amount of $332.37. A return envelope is enclosed for your convenience. If you have any questions concerning this contract, please do not hesitate to contact this office at 1-800-319-6302. R~espcctfully, ~'~ ~J .` nie L. Egbert Claim Approver Individual Life Claims Enclosures jie U ~. J J q~ a/ \A~ Securities offered through attilleta Amerltae Invwstmem r...., u_.. _.........._.- AIG ANNUITY AIG Annuity Insurance Company INSURANCE COMPANY P.O. Box 871 A Member of American International Group, Inc. Amarillo, TX 79105-0871 QUARTERLY GROWTH REPORT OF YOUR POLICY FOR THE QUARTER ENDING 03/31/2009 1-800-424-4990 • Contract Number FJ216479 >06927 5755389 001 008129 • Policy Date lU/14/1999 r~ MARGARET H RUPP • Annuitant Margaret H Rupp 437 N HANOVER ST • Policy Type Non-Qualified "' CARLISLE, PA 17013-1930 • Agent Wachovia Insurance Agency Inc ~~ ~ • Annual Yield 3.50% iii -.Account Information _ _ _ Current Quarter __ _ _ Year - To -Date _ ~01 %01 /2009 -03%31 /2009 !" 01 /01 /2009 - 03/31 /2009 Beginning Value 29,452.54 29,452.54 Withdrawals (164.01) (164.01) Interest 250.20 250.20 Accumulated Value 29,538.73 29,538.73 Deposits And Withdrawals Processed During This Quarter Date Amount Date Amount 01/31/2009 (86.18) 02/28/2009 (77.83) ' '~ Ambassador Drive Naperville, 1160540 • 1-800-676-5523 Acct. #: 8986010 Ord. #: 58104599 DATE: 091?.9/08 Bill To: M RUPP 437 N HANOVER ST CARLISLE, PA 17013-1930 PO# 136046_23_10_188 704025280101 Ship To: M RUPP 437 N HANOVER ST CARLISLE, PA 17013 SHIP METHOD: UNSP •:~ `i _ ~'~ t~rlttiY© ~ ,_ ,: - ~i; I- artT~ Ptc~t~cLE srA 1 re 7r~ \: 15t1~ : C ~~rr 1QflOp D.P HDFY w7th Stand 4 ,f ~ ~y i{ t ~ ~, ,lSDOt! ~~ - 1 ~~~~~ ~ ~ ~~~~ w~ :a~; n ~80p =iXP i~tYTv ~~ f,~i items pa~~j~ +~ t~~~,y gin: ~~~~~/Q.8 'q~l~t-~.~00 #~f-i~i3~1~`,~ 6~'6~"-73" Black~Pla/CCDIQLP Stand ~; "~. ~~=Oi.ll? Ito Iri~uCt~on Letter ,.. ' „' ~ ~. ~~ 175 Ambassador Drive ~ ~~ ~ a. Naperville, 1160540 ~1.~~.0 ; 717 243-2969 ,A .t M RUPP 437 N HANOVER S1~ CARLISLE, PA 17013 ~~ ~ TiT~ - .. 2619.94 119.99 'k ~-~ ^k~d~-~ ID TU40252801010