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Home My WebLink About11-02-09 (2)t e 15056051058 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 21 09 ~I 0272 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 186-28-5112 '. 03/01 /2009 02/18/1934 Decedent's Last Name Suffix Decedent's First Name MI 'Nolan ' Fredith E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A N/A ' N/A 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 ,;:,; 4. Limited Estate >:~ 6. Decedent Died Testate (Attach Copy of Will) ;. 9. Litigation Proceeds Received v.,.. 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) .._:..... 5. Federal Estate Tax Return Required 1..... 8. Total Number of Safe Deposit Boxes .. 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Dennis J. Hoover ' (410) 539-6606 Firm Name (If Applicable) __ .....~ ~.~.~. ..._.. ......~. ~.. _~.~~ _ _ _ REGIST OF WILLS U~ONLY __....,. ~' Rosen Hoover P.A. +~ r~;~ ~. ~ ~~ Y First line of address _: _.... _ G ... . ~-'-' 100 N. Charles Street ~ I , ~. YY ~ ~ `~{-' Second line of address .... .~ ~~ ~~ ./ -, ti ; -~ _. ~ r' ? Suite 1010 w ~ :-_ ~., M. ,, City or Post Office __ _._.. _.... FILED `~ State ZIP Code _ ~ . s ;;'") ~.~~ Baltimore MD 21201 Correspondent's a-mail address: dhoover@rosenhooverlaw.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 belief, it is true, correct and comp) .Declaration of pre rer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE N ESPO E FILING RETURN DATE O SIGNATURE OF PREPARER OTHER THAN REPRESE ATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Fredith E Nolan Decedent's Name: 186-28-5112 RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. I 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 & Miscellaneous Personal Property (Schedule E) ........ 5. ' 170,611.24 6. Jointly Owned Property (Schedule F) ~:":;-~;:_ Separate Billing Requested ....... 6. ' 30,078.20 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. ', 147,305.14 __ _ _ _ _ 8. Total Gross Assets (total Lines 1-7) .................................... 8. ', 347,994.58 9. Funeral Expenses ~ Administrative Costs (Schedule H) ..................... 9. !, 19,363.00 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................ 10. 1,271.03 _ _ .__ 11. Total Deductions (total Lines 9 & 10) ................................... 11. 20,634.03 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 327,360.55 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. ' 55,962.17 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ' 271,398.36 k ,.k .. .. ... <<._u, ...~ ..... ......... ....~.....,._~~~.. ~........ .. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ...~~..~~._ ,u~, ,., ..ti... _ ......~..... 15. Amount of Line 14 taxable at the spousal tax rate, or _ _ _ _ _. transfers under Sec. 9116 (a)(1.2) x .o_ 0.00 ' 15. ! 0.00 16. Amount of Line 14 taxable at lineal rate x .0 ~ ' 117,623.79 '' 16, ' 5,293.07 17. Amount of Line 14 taxable at sibling rate X .12 0.00: 17. ! 0.00 18. .:: _ Amount of Line 14 taxable at collateral rate x .15 152,141.85 ' 18 ,.. _ 22, 821.27 19. TAX DUE ......................................................... 19. ' 28,114.31 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 ~ ~ REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 09 0272 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Fredith E Nolan 186-28-5112 STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 28,114.31 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 28,114.31 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 28,114.31 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 : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 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. REV-1502 EX~ !11.-08? ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fredith Nolan 2120090272 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) SCHEDI~LE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Fredith Nolan 2120090272 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-15Q4 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ------ ESTATE OF FILE NUMBER Fredith Nolan 2120090272 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-15G7 EX+ (6-98) SCI~IEDI~LE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Fredith Nolan 2120090272 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-15(:8 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Fredith Nolan 2120090272 InGude 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. (If more space is needed, insert additional sheets of the same size) SCHEDULE E Item Number Description Value At Death 1 ~ Checking Account#15004210910706 (value date of death) 3,805.02 r 2 ------ Certificate of Deposit/Account #31003915527592 (redeemed) (value date of death) 10,972.77 3 1 Certificate of Deposit/Account #31003913802839 (redeemed) (value date of death) 3,000.00 4 I Checking Account#97432105 (value date of death) 2,992.58 5 M&T Premium Interest Account#98130951 (value date of death) 20,266.74 6 _ M&T CD Interest Payment (value date of death) 20.53 , 7 8 US Treasury (tax refund received after death & deposited into Estate checking) M&T Select Account#9847645596 (value date of death) 1,407.00 3,260.33 9 Cash in safe deposit box and loose change in bedroom drawers 874.50 10 Cumberland Valley Medical (reimbursement) 54.70 11 Commonwealth Of Pennsylvania (unclaimed property) 966.96 12 State Farm Insurance (reimbursement) 54.41 13 ~, 1857 One Dollar Gold Piece $214.99 14 1991 Five Dollar Gold Piece $35.00 15 1990 American Eagle Silver Dollar $49.99 16 _ 1863 Indian Head Penny $5.50 17 ~ Wine glasses (assorted) $60.98 ~~ 18 Cameo Costume Jewlrey _ $129.99 19 Hummel Figures (13) ~ $3,927.00 20 Christmas Ornaments (10 boxes assorted) $49.95 21 Santa Clause Figurines (5) $152.86 22 1986 U.S. Liberty Coin Set $24.001 23 ~ Cut Glass Pieces $36.45 ~ 24 ~ (2) Don Whitlatch Prints (chickadee & titmice) $150.00 25 ,Oak Bedroom Set (value from ebay.com) $300.00 26 2005 Toyota Corolla (Kelly Blue Book) $10,455.00 27 Jackson Life Insurance Polic (value date of death anunit) $25,039.22 '! 28 AIG Annunity Insurance Company (value date of death) 24,749.81 29 Symetra (IRA) (value date of death) -payable to Estate 57 554.96 Total Value Of Inventory ~ ~ ~ 170,611.24 8/3/2009 11:28 AM FROM: Fax Jackson TO: +1 (910} 332-0269 PAGE: 002 OF 002 -~ .. Fo~n l12 (Rev. April 2006) Life Insurance Statement OMB No. 1545-0022 Department of the Treasury Internal Revenue Service «~ Decedent-Insured (Tc be filed by the executor !Kith Four 706, United States Estate (and Generation-Skipping Transfer) Tax Return, or Farm 7Q6-NA, United States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a atizen of fhe United States.} 1 Decedent's first name and middle initial 2 Decedent's last name 3 Decedent's social security number 4 Date of death FREDITH E NOLAN {if known) 186.28-5112 a3rav2aas 5 Name and address of insurance company JACKSON LIFE 1 CORPORATE WAY LANSING MI 48951 6 Type of policy 7 Policy number FIXED INDEXED ANNUITY 1002663358 8 Owner's name. ff decedent is not owner, 9 Date issued 1Q Assignor's name. Attach copy of 11 Date assigned attach copy of application. assignment. FREDITH E NOLAN 04127120x7 NA NA 12 Value of the policy at the 13 Amount of premium {see instructions} 1~ Name of beneficiaries time of assignment ESTATE OF FREDITH E NOLAN NA 15 Face amount of policy _ _ 15 $ 25,x39.22 16 Indemnity benefits ~ 16 $ 17 Additional insurance _ 17 $ 18 Other benefits . 18 $ 19 Principal of any indebtedness to the company that is deductible in determining net proceeds 19 $ 20 Interest on indebtedness (line 19) accrued to date of death. 20 $ _ 21 Amount of accumulated dividends ~ _ 21 $ 22 Amount of post-mvrtem dividends . . 22 $ 23 Amount of returned premium _ 23 $ 24 Amount of proceeds if payable in one sum . . 24 $ 25,x39.22 25 Value of proceeds as of date of death {if not payable in one sum) 25 $ 26 Policy provisions concerning deferred payments or installments. Note. If other than lump-sum settlement is authorized for a surviving spouse, attach a copy of the insurance policy. 27 Amount of installments _ 27 $ 28 Date Df birth, sex, and name of any person the duration of whose Lfe may measure the number of payments 29 Amount applied by the insurance company as a single premium representing the purchase of installment benefits . . 29 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits. 31 Were there any transfers of the policy within the three years prior to the death of the decedent? ^ Yes ~ No 32 Date of assignment or transfer: I I Month Day Year 33 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? . ^ Yes m No 34 Did the decedent have any incidents of ownership on any policies on his/her life, but not owned by him/her at the date of death? ^ Yes ~ No 35 Names of companies w'th which decedent carried other pQl c es and amount of such pol'cies if this information iS disclosed by your records. -------------------------------------------------------------------------------------------------------------------------------------------- The undersigned of5cer of the above-named insurance company (or appropriate federal agency or retirement system official) hereby certifies that this statement sets forth true and correct information. Signature - ~LLLIJ~A.. Trtle - ________ __ ___ Date of Certification - For Paperwork Reduction Act Notice, see page 3. Cat. No. 10170V Form 712 (Rev. 4-loos) *** TWENTY-`FOUR THOUSAND TWO HUNDRED SEVENTY-FOUR. and .83/100 DOLLARS *** ********NOT VALID BEFORE CHE~K.DATE CHECK DATA ~Z)5%05Y09:: VOID;:AfTI~R 180 .DAYS PAY FR~DITH ~ NOLA.N' ESTATE~~;~ TO THE p;ENNIS J. HOOVER, EXECUfiOR. ORDER i 00 N. CHARLES STREET, SUIT~>; 1010 ~' OF . '.: ` $ALTiMORE MD 2 i 201 ~~:;`< II' X439805 ~n• x:03 ~ L0035 ~~: 030095003?n• AIG Annuity Insurance Company F'.O. Box 871, Amarillo, TX 7 9 1 05-08 7 1 A Member of American International Group, Inc. NAME: --POLICY: TRANSACTION: OWNER: DEATH CLAIM PAYMENT FEDERAL WITHHOLDING TAX AMOUNT OF CHECK TAXABLE INCOME TRANSACTION STATEMENT CHECK# 14398052 INTERNAL REFERENCE# 2200418298 FREDlTH NOLAN May 05, 2009 --~41~J 202714 FULL AND FINAL SETTLEMENT D/C FREDITH NOLAN $ 4,749.81 S 24, 749.81 S 474.98 - $ 24, 274.83 ~~~~/ J~'o~r~~ G~~sfa-~ r,G~ PLEASE DE'T'ACH AND KEEP THIS STUB FOR YOUR REC0~2DS SYM ~TRA. FINANCIAL July 22, 2009 Estate of Fredith E Nolan C/o Dennis J Hoover, Executor 100 North Charles Street, Ste 1010 Baltimore, MD 21201-3804 RE: Symetra Life Insurance Company Annuity LP1073643 for Fredith E Nolan Dear Mr. Hoover: Per your request dated July 20, 2009, the date of death value on the above mentioned annuity is as follows: Date of Death Value March 1, 2009 $57,554.96 We appreciate the opportunity to serve our customers. Our service center is located in Bellevue, Washington. If you have any questions or would like help finding an agent or advisor in your area, please contact us at 1-800-SYMETRA or 1-800-796-3872. Select option 2 for Retirement Services, followed by option 3 for the Individual Retirement Plans unit. To reach me directly, please press 9 followed by my extension 65390. Our customer service representatives are available from 6:00 a.m. to 4:30 p.m. Pacific Time, Monday through Friday. Sincerely, o ~- o~ ~- Ron Fabien Claims Examiner Retirement Services Symetra Life Insurance Company C'~~5e Nc~: ~'S£):'S Symetra Life Insurance Company • Retirement Services • 777 108th Avenue NE, Suite 1200 • Bellevue, WA 98004-5135 ^ www.symetra.com Mailing Address: PO Box 3882 ^ Seattle, WA 98124-3882 ^ Phone 1-800-796-3872 • TTY/TDD 1-800-833-6388 VL-418 5/07 .~ ~ M&T 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 August 4, 2009 Fredith E Nolan Dennis J Hoover, Exec. One Charles Center 100 North Charles St, Suite 1010 Baltimore, MD 21201-3804 Re: Estate off: Fredith E Nolan Account Number: 98220209, 9836324989, 9847645596 & 15004210910706 Date of Death: March 01, 2009 Dear Sir or Madam: Per a memo from Debra Fitch at M8~T Bank, dated July 28, 2009, requesting at the time of death, the balance on the above referenced account(s) was: 1. Type of Account Checking Account Account Number 98220209 Ownership (Names o~ Fredith E Nolan* Valeria C Nolan* Opening Date 5/28/ 98 Closed 3/ 16/ 09 Balance on Date of Death $ 50,156.40 Accrued Interest $ 1.58 Total $ 50,157 98 2. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 9836324989 Fredith JNolan* 4/ 01 / 04 Closed 2/ 19/ 09 $ 0.00 $ 0.00 $ 0.00 M&T One M & T Plaza, Buffalo, New York 14240 King Street Office February 6, 2009 VALERIA H NOLAN FREDITH E NOLAN PO BOX 97 NEWBURG PA 17240 <%~ / ~Cfl~t . 936 Re: CD Account Closing Notice Account # 31003913373252 Dear Valeria H Nolan, We are writing to confirm that on 02/05/09, your CD account was closed or transferred. At that time, the balance was X15,018.39. We'd like to remind you that M&T Bank is committed to providing you with solutions to all your financial needs. To find out more about the many ways we can help you with those needs, simply stop by any M&T Bank office or call the M&T Telephone Banking Center at 716-626-1900 or 1-800-724-3222. Or if you'd like, visit the M&T website at www.mandtbank.com. Thank you for banking with M&T Bank. Sincerely, M~.eh¢..~e Ca.Qe-H¢.e~~n Michele Cole- Hector Customer Service Manager SMACCL AZRCSI REV-1506 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Fredith Nolan 2120090272 JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~ ~ A' 09/24/03 Orrstown Bank -Certificate of Deposit (Account #4000002242) 10,000.00 50% 5,000.00 2• A. 02/03/05 M&T Bank -Certificate of Deposit (Account #31003913373252) * 0.00 50% 0.00 *CD closed 2/5/09 -proceeds of $15,018.39 deposited into joint checkin~ arcrnlnt #9R~~~~(19 listed hPlnw 3• A 05/28/98 M&T Bank-Checking Account #98220209 (see attached letter from M&T) 50,156.40 50% 25,078.20 TOTAL (Also enter on line 6, Recapitulation) $ 30,078.20 (If more space is needed, insert additional sheets of the same size) If an asset was made joint within one Year of the decedent's date of death, it must be reported on Schedule G. DEFINITIONS: "We," "our," and "us" mean the issuer of this account and "you" and "your" mean the depositor(s). "Account" means the original certificate of deposit as well as the deposit it evidences. TRANSFER: "Transfer" means any change in ownership, withdrawal rights, or survivorship rights, including (but not limited to) any pledge or assignment of this account as collateral. You cannot transfer this account without our written consent. PRIMARY AGREEMENT: You agree to keep your funds with us in this account until the maturity date. (An automatically renewable account matures at regular intervals.) You may not transfer this account without first obtaining our written consent. You must present this certificate when you reyuest a withdrawal or a transfer. This account is void if the deposit is made by any method requiring collection (such as a check) and the deposit is not immediately collected in full. If the deposit is made or payable in a foreign currency, the amount of the deposit will be adjusted to reflect final exchange into U.S. dollars. We may change any term of this agreement. Rules governing changes in interest rates have been provided. For other changes we will give you reasonable notice in writing or by any other method permitted by law. If any notice is necessary, you all agree that the notice will be sufficient if we mail it to the address listed on page one of this form. You must notify us of any change. WITHI)RAWALS AND TRANSFERS: Only those of you who sign the permanent signature card may withdraw funds from this account. (In appropriate cases, a court appointed representative, abeneficiary of a trust account whose right of withdrawal has matured, or a newly appointed and authorized representative of a legal entity may also withdraw from this account.) The specific number of you who must agree to any withdrawal is written on page one in the section bearing the title " ...Number of Endorsements .... "This means, for example, that if two of you sign the signature card but only one endorsement is necessary f'or withdrawal then either of you may request withdrawal of the entire account at any time. These same rules apply to define the names and the number of you who can request our consent to a transfer. PLEDGES: Any pledge of this account (to which we have agreed), must first be satisfied before the rights of any joint account survivor beneficiary or trust account beneficiary become effective. For example, if one joint tenant pledges the account for payment of a debt and then dies, the surviving joint tenant's rights in this account are subject first to the payment of the debt. OWNERSHIP OF ACCOUNT AND BENEFICIARY DESIGNATION: You intend these rules to apply to this account depending on the form of ownership and beneficiary designation, if any, specified on page 1. We make no representations as to the appropriateness or effect of the ownership and beneficiary designations, except as they determine to whom we pay the account funds. Individual Account -Such an account is owned by one person. Joint Account With Survivorship (And Not As Tenants In Common) -Such an account is owned by two or more persons. Each of you intend that upon your death the balance in the account (subject to any previous pledge to which we have consented) will belong to the survivor(s). If two or more of you survive, you will own the balance in the account ownership as joint tenants with survivorship and not as tenants in common. Joint Account - No Survivorship (As Tenants In Common) -Such an account is owned by two or more persons but none of you intend (merely by opening this account) to create any right of survivorship in any other person. We encourage you to agree and tell us in writing of the percentage of the deposit contributed by each of you. This information will not, however, affect the "number of endorsements" necessary for withdrawal. Revocable Trust Account (subject to this agreement) - If two or more of you create such an account, you own the account jointly with survivorship. Beneficiaries cannot withdraw unless: (1) all persons creating the account die, and (2) the beneficiary is then living. If two or more beneficiaries are named and survive the death of all persons creating the account, such beneficiaries will own this account in equal shares, without right of survivorship. Any such beneficiary may withdraw all or any part of the account balance. The person(s) creating this account type reserves the right to: (1) change beneficiaries; (2) change account types; and (3) withdraw all or part of the deposit at any time. Trust Account Subject to Separate Agreement - We will abide by the terms of any separate agreement which clearly pertains to this account and which you file with us. Any additional consistent terms stated on this form will also apply. SET-OFF: You each agree that we may (without prior notice and when permitted by law) set off the funds in this account against any due and payable debt owed to us now or in the future, by any of you having the right of withdrawal, to the extent of such person's or legal entity's right to withdraw. If the debt arises from a note, "any due and payable debt" includes the total amount of which we are entitled to demand payment under the terms of the note at the time we set off, including any balance the due date for which we properly accelerate under the note. This right of set-off does not apply to this account if: (a) it is an Individual Retirement Account or other tax-deferred retirement account, or (b) the debt is created by a consumer credit transaction under a credit card plan, or (c) the debtor's right of withdrawal arises only in a representative capacity. You agree to hold us harmless from any claim arising as a result of our exercise of our right of set-off. BALANCE COMPUTATION METHOD: We use the daily balance method to calculate the interest on this account. This method applies a daily periodic rate to the principal in the account each day. TRANSACTION LIMITATIONS: You cannot make additional deposits to this account during a term (other than credited interest). You cannot withdraw principal from this account without our consent except on or after maturity. (For accounts that automatically renew, there is a ten day grace period after each renewal date during which withdrawals are permitted without penalty.) In certain circumstances such as the death or incompetence of an owner of this account, law permits, or in some cases requires, the waiver of the early withdrawal penalty specified on page one. FOR ACCOUNTS THAT AUTOMATICALLY RENEW: Each renewal term will be the same as this original one, beginning on the maturity date (unless we notify you, in writing, before a maturity date, of a different term for renewal). You must notify us in writing before, or within a ten day grace period after, th~ maturity date if you do not want this account to automatically renew. Interest earned during one term that is not withdrawn during or immediately after that term is added to principal for the renewal term. The rate for each renewal term will be determined by us on or just before the renewal date. You may call us on or shortly before the maturity date and we can tell you what the interest rate will be for the next renewal term. On accounts with terms of longer than one month we will remind you in advance of the renewal and tell you when the rate will be known for the renewal period. See your plan disclosure if this account is part of an IRA. Ipage 2 of 2/ REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDI~LE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Fredith Nolan 2120090272 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND 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 APPLICABLE) TAXABLE VALUE 1 ~ Symetra Life Insurance Company Annuity (LP1024111) 147,305.14 100 0.00 147,305.14 TOTAL (Also enter on line 7 Recapitulation) $ I 147,305.14 (If more space is needed, insert additional sheets of the same size) SCHEDULE G *Date of Transfer is Date of Death (3/01/2009) SYM~TRA® FINANCIAL July 16, 2009 Estate of Fredith E Nolan C/o Dennis J Hoover 100 North Charles Street, Ste 1010 Baltimore, MD 21201-3 804 RE: Symetra Life Insurance Company Annuity LP 1024111 for Fredith E Nolan Dear Mr. Hoover: Per your request dated July 13, 2009, the date of death value on the above mentioned annuity is as follows: Date of Death Value March 1, 2009 $147,305.14 We appreciate the opportunity to serve our customers. Our service center is located in Bellevue, Washington. If you have any questions, please contact us at 1-800-SYMETRA or 1-800-796-3872. Select option 2 for Retirement Services, followed by option 2 again for the 403(b) TSA Department. Our customer service representatives are available from 6:00 a.m. to 4:30 p.m. Pacific Time, Monday through Friday. Sincerely, G ~ ~,c--- Ron Fabien Claims Examiner Retirement Services Symetra Life Insurance Company t'~~5~~ '~c~. 2569245 Symetra Life Insurance Company ^ Retirement Services ^ 777 108th Avenue NE, Suite 1200 ^ Bellevue, WA 98004-5135 ^ www.symetra.com Mailing Address: PO Box 3882 • Seattle, WA 98124-3882 • Phone 1-800-796-3872 • TTY/TDD 1-800-833-6388 VL-418 5/07 . REiI-151A EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Fredith Nolan 2120090272 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 ~ Fogelsanger-Bricker Funeral Home, Inc. 10,252.00 Fogelsanger-Bricker Funeral Home, Inc. (death certificates) 45.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) DennlS .1. HOOVer Social Security Number(s)/EIN Number of Personal Representative(s) .214-13-5584 _ street address 100 N. Charles Street, Suite 1010 city Baltimore .state MD ..Zip 21201 Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) claimant Valeria Nolan street address 10 Water Street City Newburg State PA _Zip 17240 Relationship of Claimant to Decedent MOther 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Executor's Notice Publications 0.00 2, 500.00 3,500.00 345.00 0.00 2,500.00 221.00 TOTAL (Also enter on line 9, Recapitulation) $ 19, 363.00 (If more space is needed, insert additional sheets of the same size) REV-173 -7 E ~ + (6-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCI~IEDVLE 1 DEBTS OF DECEDENT Use Schedule I, Fart 2, ONLY for i proportionate method of tax computation. MORTGAGE LIABILITIES, & LIENS ESTATE OF ESTATE OF FREDITH E. NOLAN FILE NUMBER 2120090272 Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and owed as of the date of decedent's death. Cemnlete Part 2 ONLY when the nrouortionate method of tax computation is elected. ITEM NUMBER DESCRIPTION AMOUNT ~ • N/A 0.00 TOTAL PART 1 $ 0.01 • ~ ~ • ~ • ~ ~ ITEM NUMBER DESCRIPTION AMOUNT ~• SEE ATTACHED SHEET FOR ALL OTHER DEBTS OF THE DECEDENT 1,271.03 TOTAL PART Z $ 1,271.0:, TOTAL (Also enter on Line 10, Recapitulation.) $ 1,271.0: (If more space is needed, use additional sheets of paper of the same size) SCHEDULE I -DEBTS OF THE DECEDENT State Farm Insurance (audo -April, 2009) $74.59 Sears -Balance on Credit Card $268.13 Embarq -telephone $222.05 FIA Card Services -balance on credit card ~ $209.05 Bonton -balance on credit card $42.00 R.T. Henry Pharmacy $36.41 Anesthesia of Franklin County $54.70 Central Valley Veterinary Hospital $126.03 Richard Hockenberry (taxes) $4.90 Pinker & Associates $39.22 Embarq -telephone $119.36 State Farm Insurance (auto -May, 2009) $74.59 Total Estate Expenses $1,271:03' REV-1737-7 EX + (6-08) RELERS'~ b ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCNED~lLE J BENEFICIARIES ESTATE OF FILE NUMBER ESTATE OF FREDITH E. NOLAN 2120090272 When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. RELATIONSHIP TO ITEM 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. 2116 (a)(1.2)] 1. John Nicholas Hoover, 1500 Patapsco St., Baltimore, MD 21230 Great Nephew 305.48 2 Debra Hoover, 6296 Wild Lake Drive, Sykesville, MD 21784 190.97 3 Victoria Hoover, 6296 Wld Lake Drive, Sykesville, MD 21784 Great Niece 2,088.90 4 Ashley Hoover, 6296 Wild Lake Drive, Sykesville, MD 21784 Great Niece 2,064.90 5 Dennis Hoover, 6296 Wild Lake Drive, Sykesville, MD 21784 Great Nephew 186.45 6 Valeria Nolan .Mother 87,545.39 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1• American Cancer Society of Cumberland County, PA (10% of Residuary Estate) 13,002.05 2 Forbes Road School District of Fulton County (25% of Residuary Estate) 32,505.12 3 FMV of Toyota Corolla to New Hope United Methodist Church 10,455.00 TOTAL OF PART II (Enter total non-taxable distributions on Line 13 of REV-1737 cover sheet.) $148,344.26 (If more space is needed, use additional sheets of paper of the same size) is ~ SCHEDULE 7 -TAXABLE DISTRIBUTIONS Bequests I Inrlor Will ~~John Nicholas Hoover - 1857 One Dollar Gold Piece $214.99! ;John Nicholas Hoover - 1991 Five Dollar Gold Piece ~ $35.00 ';John Nicholas Hoover - 1990 American Eagle Silver Dollar $49.99' John Nicholas Hoover - 1863 Indian Head Penny ,,,~ ~, ~5 50 Tota/ Va/ue To John Nicho/as Hoover ~3a5.~8' i_ _ _ _ __ j Debra Hoover -Wine glasses (assorted) $60.98 Debra Hoover -Cameo Costume Jewlrey __ __.._..__.__~._.,~.129.99 Tots/ Va/ue To Debra Hoover ~.~~ r- Victoria & Ashley Hoover -Hummel Figures (13) $3,927.00 !,Victoria & Ashley Hoover -Christmas Ornaments (10 boxes assorted) $49.95 Victoria & Ashley Hoover Santa Clause Figures (5) _ _~~,.,.~.,~,.~._._ $152.86, Tots/ Va/ue To Victoria & Ash/e Hoover 1,81 ~ Victoria Hoover - 1986 U.S. Liberty Coin Set X24 OOj { Tots/ Va/ue to Victoria Hoover ~~~~1 ' Dennis Hoover -Cut Glass Pieces $36.45 Dennis Hoover (2) Don Whitlatch Prints (chickadee & titmice) ~ ,~„ .;.$150.00 Tots/ Va/ue To Dennis Hoover $186.45 Tota/ Va/ue r8~~~~~- Personal property values obtained from www.ebay.com