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HomeMy WebLinkAbout11-05-09 (3)1505607120 REV-~SOO EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 0 2 12 PO 80X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 205 09 4843 02 15 2009 03 23 1918 Decedent's Last Name Suffix Decedent's First Name Mt BROWN FREDA B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C7 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) X 6 Decedent Died Testate ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) j ~ 9. Litigation Proceeds Received ~ 1 Q, Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) ~1 ~ between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - TNIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL L. BANGS 717 730 7310 Firm Name (If Applicable) First line of address 429 SOUTH 18TH STREET Second line of address City or Post Office State ZIP Code CAMP HILL PA 17011 Correspondent's a-mail address: REGISTER O ..ILLS USE (}~.Y w ~~~~ t`i`t ' d [ ~ r C1 ~~~ 'I- n , Fn .,.,. :. .~~_ ~~j :~~ ~ ~_., .~~1 ,.,,~ ..,, . r""'y ~.... . i 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 ail information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~,,,, [o g,~~,,,,, George D. Brown i~d~aU. ~,,,~, DDRESS 289 D Garrison Road, York Haven, PA 17370 IG TURE OF PREPARER OTHER TH PRESENTATIVE DAT . Michael L. Bangs f~/a ~~ ~1 ADDRESS ~ ~ 429 South 18th Street, Camp Hill, PA 17011 Side 1 L 1505607120 1505607120 J 1505607220 REV-1500 EX Decedent's Social Security Number Decedents Name: Freda B. Brown 2 0 5 0 9 4 8 4 3 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 146,594.65 5• • Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 6 8 , 2 8 8 5 5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7. 1 8 1, 5 4 7. 7 3 8. .......................................... Total Gross Assets (total Lines 1-7) ............................. 8 3 9 6, 4 3 0. 9 3 20,329.64 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 731.23 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 1, 0 6 0. 8 7 11. ( ) ...................................................................... Total Deductions total Lines 9& 10 11. 12. ( ) ............................................................. Net Value of Estate Line 8 minus Line 11 12. 3 7 5 , 3 7 0 . 0 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................ 13. 3 7 5 , 3 7 0 0 6 14. Net Value Subject to Tax (Line 12 minus Line 13) ................. .......... ................... . 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15 0 0 0 (a)(1.2) x .o0 . 16. Amount of Line 14 taxable 3 7 5 3 7 0 0 6 16 1 6, 8 9 1. 6 5 , at lineal rate X .045 . 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 18 0 0 0 at collateral rate X .15 . 19. Tax Due ............................................... ...................................................................... 19. 1 6, 8 9 1. 6 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0212 DECEDENT'S NAME Freda B. Brown _ ___ STREET ADDRESS 4905 E. Trindle Road CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 15,000.00 789.47 Total Credits (A + B + C) (1) 16,891.65 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (2) 15,789.47 (3) (4) (5) 1,10 2.18 (5A) (56> 1,10 2.18 Make Check Payable to: REGISTER OF WILLS, AGENT ~. ~~ . r., ,. r .....~~. ., ., a,... 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 :.................................... ^j ^ 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? ...................................................................................................................... ^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .. .. . nt; 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)]. 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. Rev1508 EX+ (8.98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brown, Freda B. 21-09-0212 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 James O. Bower -Mortgage payment for March, 2009 1,389.04 2 James O. Bower -Mortgage payment for April, 2009 1,389.04 3 Payoff of mortgage from James O. Bower 140,264.31 4 Refund from FIA Card Services 13.26 5 Refund from IRS 3,539.00 TOTAL (Also enter on Line 5, Recapitulation) I 146,594.65 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) scHEO v~E F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brown, Freda B. 21-09-0212 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. George D. Brown 289 D Garrison Road Son York Haven, PA 17370 B. Donna B. Martin C. JOINTLY OWNED PROPERTY: 685 Miller Road York Haven, PA 17370 Daughter 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 ova OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 8/8/2005 Fulton Bank -Checking Account 122,589.80 50.000% 61,294.90 #3622-45701 2 B 4/8/1997 Sovereign Bank - CD 1055420127 13,987.29 50.000% 6,993.65 TOTAL (Also enter on Line 6, Recapitulation) I 68,288.55 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1b10 EX+ (6-88) SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brown, Freda B. 21-09-0212 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 DE RIPTI N F PR PERTY INCLUDE NAME OF 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 °r6 OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Jackson National Life Insurance -Annuity 31,486.68 31,486.68 0058857860 2 New York Life -Annuity #74704238 30,163.64 30,163.64 3 The Principal Financial Group -Non-qualified 67,539.66 67,539.66 annuity #8430529 4 Transamerica Life Insurance Company -Annuity 52,357.75 52,357.75 #02TFB050581 TOTAL (Also enter on Line 7, Recapitulation) 181,547.73 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (12-89) SCHEDlJLE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA IN A E N I ADMINISTRATIVE COSTS RES D ENT DECEDENT ESTATE OF FILE NUMBER Brown, Freda B. 21-09-0212 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached 9,803.58 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions George D. Brown Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 289 D Garrison Road City York Haven State PA Zip 17370 Year(s) Commission paid 5,000.00 2. Attorney's Fees Michael L. Bangs 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 306.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 220.06 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 20,329.64 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Brown, Freda B. 21-09-0212 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exaenses 1 George D. Brown -funeral luncheon 171.48 2 Musselman Funeral Home & Cremation Services, Inc. 8,187.00 3 Olde Towne Florist 281.85 4 St. Paul's Lutheran Church -bulletins for church service 8.25 5 St. Paul's Lutheran Church Cemetery 170.00 6 St. Paul's United Methodis Church -funeral luncheon/room 200.00 7 Stone Church Cemetery 785.00 H-A Subtotal 9,803.58 Other Administrative Costs 8 Cumberland Law Journal -estate advertising 9 The Sentinel -estate advertising 75.00 145.06 H-67 Subtotal 220.06 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1b12 EX+ (6-98) SCHEDULE / DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COAMuIONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brown, Freda B. 21-09-0212 Include unreimbursed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (8-00) scHEOV~E ~ COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brown, Freda B. 21-09-0212 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not Ust Trustee s I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116(a)(1.2)] See attached schedule Total 4,000.00 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDlJLE J The BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Freda B. Brown 02/15/2009 205-09-4843 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Ann Bower Niece Specific bequest 500.00 2000 Highland Circle Camp Hill, PA 17011 2 John Bower Nephew Specific bequest 500.00 1000 Claremont Road Room 313, 3rd Floor Carlisle, PA 17013 3 John O. Bower Jr. Grand Nephew Specific bequest 500.00 977 Lewisberry Road Lewisberry, PA 17339 4 Ruth Bower Niece Specific bequest 500.00 977 Lewisberry Road Lewisberry, PA 17339 5 Duane W. Brown Son one-third of residue 325 C R 416 Brazoria, TX 77422 6 George D. Brown Son one-third of residue 289 D Garrison Road York Haven, PA 17370 7 Donna B. Martin Daughter one-third of residue 685 Miller Road York Haven, PA 17370 8 Jill A. Pierce Niece Specific bequest 1,000.00 2000 Highland Circle Camp Hill, PA 17011 9 Irene Swartz Niece Specific bequest 1,000.00 19 College Hill Road Enola, PA 17025 Total 4.000.00 1 Sovereign Bank ESTATE OF Freda B. Brown SOCIAL SECURITY #: 205-09-4843 DATE OF DEATH: February 15, 2009 Account #: 1055420127 Type: CIS Open date: 4/8/1997 In the name of: Freda B Brown or Donna Martin Date of Death Balance: $13,98'7.29 Int.(YTD) from 1 /1 /2009 to 1 /3 1. /2009 $26.35 Accrued interest to date of death: $14.47 Other Info: Page 1 of 1 ~ ~~~/ i LISTENING. March 20, 2009 Bangs Law Office 429 South 18th Street Camp Hill, Pennsylvania 17011 Dear Mr. Bangs: RE: Freda B. Brown, deceased February 15, 2009 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: Checking # 3622-45701, open 7/15/2004, date of death balance $122,589.80 (any accrued interest ($3.76) would not have been payable had the account been closed on the date of death) joint with George David Brown. Interest paid year to date of death $4.76. (George added 8/8/2005) The decedent also has an account through our trust affiliate, Fulton Financial Advisors, for information please contact Gregory Malin at (717) 763-2098. If you should have any further questions, please do not hesitate to contact me at (717) 291-2437. Very truly yours, C3.1~-~r.. r~.. Karen D. Hilleg Credit Inquiry Processor This 11'I~C)Tt~s'~tiQl1 is i#~'illitla~l ~ S i1 Ei~~`}~?' ©i I:~~SincSrr ~`^_-';rsL'Sy in srss`,r•:er tQ you; ~:~-,...try, ,-tn~ is ; ~r ~°.:a=.: i,u~lltr:.;z:.ra~=~:i u...., only. Thp Y)~Illf il61'ri'~`''.'''•r.~ ~~ii5 irc#~;;rEr~ _;'."~;1 , "'?S nGt rL;~rvBt i1t 4r G~~~rr~l`i$~° tl?e e~t.~;:• ~;,, ~~rn..~~~_;;;,:u;5 ~r r~l,t.a~ili~y ~; the ~, . In~t2s CY'is~'ilC~n Clr{;B`:i~t!~?C.~. ~`~~ rus ~~ ~;=.sii~ y !.S ciSat~(i;vC~.` l,y the . bank t3C any of ItS ;>"i~E:'CS, Cti i~i~.l'3 :~c:7 { ' ciCJ©€l~S. il;:l`y`:'j'•it1i~(1 n 2x~r~~Seu iS SU~'-~;~t iJ G~~~~l~:: wit~cut nctic~. P O Box 4~~~ Lancaster, Pd 17604 fultonbank.com ~ 1-800-FULTON-4 FULTON FINANCIAL ADVISOP S~' Making Success Personal: October 29, 2009 RE: Estate of Freda B. Brown SS N : 205-09-4843 Principal Financial Group Annuity Contract # 8430529 To Whom It May Concern: Per Principal Financial Group, please note that Freda B Brown's Principal Annuity contract was valued at the amount of $67,539.66 on try date of her death, February 15, 2009. Sincerely, ~'-r-Q-~ "~----~ Jessica Wantland Registered Assistant to Greg Malin Fulton Financial Advisors 599 N. 12th Street Lemoyne, PA 17043 Telephone: 717-730-0166 Fax: 717-731-8963 • Fulton Financial Advisors is headquartered at One Penn Square, Lancaster, PA 17602. Securities and investment advisory services offered through Raymond James Financial Services, InC. Member FINRA/SIPG an independent broker/dealer (not affiliated with Fulton Financial Advisors), and are not FDIC insured, not guaranteed by any financial institution, are subject to risk and may lose value. ~I~~SA1ViERICA s LIFE 1NSUAANCE COMPANY Transamerica Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 February 26, 2009 George David Brown 289 Garriston Rd York Haven PA 17370 RE : Annuity N`uanber (s ) 0 2TFB0 5 0 5 81 Dear George David Brown: We have received notification, Freda Brown, annuitant of the above listed non-qualified tax: deferred annuity is deceased. Our office wishes to extend sincerE~ condolences for your loss. The following is the cuz~rent information on this annuity: Annuitant: Owner: Primary Beneficiary(ies}: Annuity Policy Date: Full Value as of 02/26/~?009: Taxable Portion: Full Value as of 02/15/2009: Freda Brown Freda Brown George David Brown 50~ April 15, 2004 $52,396.72 $ 4,148.16 $52,357.75 The attached document rF~flects the options available to the beneficiary. The full value as of th~~ date of death is for tax purposes only and is not a guaranteed death :benefit amount. Operations performed on an automatic basis when applicable have been terminated, such as; Systematic Payouts or Automatic Billing. The attached document contains general tax information based on Transamerica Life Insurance Company's interpretation and should not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the `;EGON. Group w ~~• ~itiNtl{~ty t3!{~P.M~LIIARY "vi.F'A+~~o Posy ~~ct '",~ ~„ 9~e~v~ce°'A~~tR~ . ,.. ~, „~a. Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-553-5957. A Transamerica Life Insurance Company representative will gladly assist you with any questions you may have regarding this annuity and help you meet your financial goals. Sincerely, ~~~~~~ Lesley Osterkamp Transamerica Life Insurance Company Claims Enclosure(s): Annuity Claimants Statement Death Option Packet Postage Paid Return Envelope JACK30N NATIONAL LI ~~~j~°~ 1730 II~O ANT INFORMATION TO BE PLACED WITH YOUR POLICY A Wholly Owned Subsidiary of Prudential Corporation plc London, England 16167 Home Office: Lansing, MI STATEMENT OF ANNUITY VALUES FOR ACCOUNT PERIOD 12/31/1995 TO 12/31/1996 FOR: FREDA B BROWN 126 NORTH FRONT ST WORMLEYSBURG FA 17043 ISSUE DATE: PLAN: POLICY NUMBER: SERVICE AGENT: AGENT NUMBER: 04 03/1996 HO 3PT NOT QUALIFIED 0056857860 HOOD STEPHEN L 085256 ANNUITANT: BROWN FREDA B OWNERS SOCIAL SECURITY/TAB IDENTIFICATION NUMBER: 205-09-4843 DATE DESCRIPTION TRANSACTIONS __________ _____ ____ __ 04/03/1996 INITIAL PAYMENT $30,000.00 12/31/1996 INTEREST EARNED FOR PERIOD $1,486.68 12/31/1996 PERIOD END BALANCE ACCUMULATION VALUE $31,486.68 EARLY Si1RR~'NI;ERS ~iAY BE SUBJEL i TO SURRENDER CHARGES AS STATED I N YOUR POLICY. TAX PENALTIES MAY BE LEVIED BY THE INTERNAL REVENUE SERVICE FOA. SURRENDER PRIOR TO AGE 59 1/2. YOUR PERIOD END CASH SURRENDER VALUE WAS $29,125.18. AT RETIREMENT OR SUCH TIME AS YOU ELECT YOUR ANNUITY CAN GUARANTEE YOII' A MONTHLY INC~ YOU CAN NEVER OUTLIVE. I'~ IS THE ONLY SAVINGS VEHICLE WITH THAT GUARANTEE. FOR MORE INFORMATION ON THIS OPTION OR ANY OTHER ASPECT OF YOUR ANNUITY CONTACT YOUR JNL REPRESENTATIVE OR WRITE OUR ANNUITY CLIENT SERVICE DEPART2~NT. JACKSON NATIONAL IS CREDITING INTEREST AT THE RATE OF 5.65000 ON NET PREMIUMS RECEIVED AFTER AUGUST 13, 1996 . PAGE 1 OF 1 Sndzuch~aol.com 02/20/2009 12:3'1 PM To ' Dbrotim~FairmontSpecialty.com cc szuch~ft.newyoridife.com Commuted Value of Freda Brown a~..dt. Subject Hello Dwayne, I am notifying you through my personal email at home, and not from my business office. Here is the value of your mother's New York Life annuity on the date of her death,2l15/2009 according to our Cleveland Service Center's calculation: $30,1fi3.64 This should satisfy your attorney's information needs from us. Again, my condolences to you and your family. Please be in touch w~:h the other items we discussed. Sincerely, Samuel G. Zuch ~~ v ~J ~. y~ . ~. ~- ~,.~~ I, FREDA B. BROWN, of Hampden Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarkei• and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I hereby make the following specific bequests: A. The sum of One Thousand ($1,000.00) Dollars tr my niece, JILL A. PIERCE, provided she survives my death by thirty (30) days; B. The sum of One Thousand ($1,000.00) Dollars to IRENE SWARTZ, provided she survives my death by thirty (30) days; C. The sum of One Thousand {$1,000.00) Dollars to JOHN BOWER and RUTH BOWER, or. to the survivor of them, provided they survive my death by thirty (30) days; and D. The sum of One Thousand ($1,000.00) Dollars to JACK BOWF,R and ANNA BOWER, or to the survivor of them, provided they survive my death by thirty (30) days. 1 ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in equal shares to each of my children, GEORGE D. BROWN, DUANE W. BROWN and DONNA B. MARTIN, or to the survivor of them, provided they survive my death by thirty (30) days. ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to ~~ anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM V. I appoint my son GEORGE D. BROWN executor of this my last will. Shoul~~ my son predecease me or otherwise fail to qualify or cease to serve as executor of this my last will, I appoint my son DUANE W. BROWN executor of this my last will. ITEM VI. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromisz any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciar•~ or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as m y personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to le:a:~e for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such price; 2 and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be requirf;d to give bond for the faithful performance of their duties in any jurisdiction. IN WITNE5S WHEREOF, I have hereunto set my hand this `~ G ~ day of 2006. FREDA B. BROWN 3 The preceding instrument, consisting of this and THREE other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by FREDA B. BROWN, the testatrix therein named, as and for her last will, 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 hereto. J 4 COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing 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. ,~ FREDA B. BROWN Sworn or ~~irmed to and acknowledged ~. before m~ by the tatrix named above thi ~ ~li ~~' ~av ocf ., . ~ ~ ~ ,~ ~ :if .;~,~~~, 2006. Notar}~ P is ~i~Ti~~AI. ~~~;~ l~~Y ~. Cs~~~l~l~C, liar ~'a~ Laves' ~l~a T~,~p., C~a~l~~~ Cdr My Commissitsn Expsros May i0, 2~J1 COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) WE, ~ ~ ~ ~ig ~. ~ ~ .~1, /`.- 6~s and ~E ~, . t~ Q'I.1 , t:he witnesses whose names are signed to the attached or foregoing instrument, being duly qualified accordi~ig to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last will; that she signed it willingly and that she executed it as her frea 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 t me 18 or more years of age, cif sound mind., and under no constraint or undue influence. ,- / ,J~ 1 f -~/~~ ~ ~c~r~ 5 r-f~ nr affirmed, .a acknowledged be~ifq~e ;:-~~ ~ day of 'r ~ ~,''`-!~ ~ ~~ , 1' , 2006. Notary Publi NOTAFtI~t. VyENDY S. CHESQRO, P'ts+l~ L'r Alan Tt~., Cued ~~ Car~~f"~a~t ; ~~y ~®~` r9+lVmr' ~a+~Cmeme ,RaE~xngms~e..,~.~..__ _. 5