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HomeMy WebLinkAbout06-30-1015056041125 ~•~ ~ Ex {os.os) PlA~d Code leer FieNrrrrrirer d~iTlfire NTA TAX RE'TU~RN Coungr Po~aaic ~l Ib 0~3 ~~~, ~~ ~-T~N.~i- ,- ~ d ~ De/e of Birth 2 0 9 3 6 0 1 7 8 0 3 2 2 2 0 1 0 0 7 3 1 1 9 4 8 Deoederrt's Last Name SuAbc Qeoederk's First Name NM LAN D I S JAM E S E (N ApIrIW:s~ EtMfar itrrshrinN ~poras"e irrforreallon Oslaw Sporae's t.Mt Name Sullirc Sparee's FMat Name NN Spcxree's 8ooiN SecxarNy Number Fill. MI APIMi1t1l~"1lIIA'1'EE OVAL3 SOW TIC RE'T'~1lN #~IST ~ FILlO ~1 DWPUCATE WITH THE ~~' ~ ® 1.Ori~irral Nelurn ~ 2.8upplfamerrfN Return ~ 3. Renrsirrde- Ftelurn (dals of death prbr b 12130 4. Lirrdled EslnM ~ 4a. Fulure hNereat Corrrprorrriee (daM of [~ 5. Federal EefaAe Tax Return Required death aAer 1Z 12.1y't) ® !s. Deoaderrt !Died Teetaie [] 7. Deoedsrrt WaitMaMrfad a Lim Tnrt ..___ 8. Toth Number of Salle Deposit sooeee (Af bwh ~~apy o/ MII~ GVbdr C~op~l d Tn»t) 9. L.iflpalion PtooeNJs ReoeiMrd ~ 10. SporNal poverty Credit (dale of death ~ 11. Ei.ction ~lo ta~c under Sea. 9113(A) between 1~-31-61 M1d 1-1-06) (hAlaoh Self. O) - T'~ ~BC11dN1 ~le'1' eE COLLETED. ALL AND G41llF~ITiAL TAX N~I~I-TION 11ptlt0 9E EtNlECT~ Td: Nam e Daytirrre Tikplrorre Number S U S A N J H A R TM AN 7 1 7 2 4 9 7 7 8 0 Firm Name (lf AppNaabN) D U N C A N & H A R T M A N P C First Nrre of address 1 I R V I N E R O W ~~ City Or Poet Oliioe Stale C A R L I S L E P A Code t~ wnis t.r ..... ~ ~ , ~ -v c~ ~ ~'"'~'" r" '. -~ ~ ~ ~' ~ (~ ~ y,..~ f s `t f~ ~ ..... r ., _. 1 7 0 1 3 ~.~ ~: _~.°7 -, ~:,.. G~` ~~ ~, "Y'~ ~R QoweCt ~- dpr-a1Nt~r-3re ~ i lsaNd ar M al~iah p~pair~leearr~ Ftl1! FLiNCi l~'TIlRN QATE ADOMlESl3 3285 ANDRA DRIVE RENO NV 89503 SKiIiA Of <q+iTATNE D~111'E 1 IRVINE ROW CARLISLE PA 17013 PLEAeE tiSE ORIGINAL FORM ONLY 8idf+ 1 15056041125 15056041125 c J 15056042126 i~trr-ilfo0 Dc DeaderK's So oisi S« ~rity Num ber ,~,,; JAMES E. ZANDI S 2 0 9 3 6 0 1 7 8 RL+:CAPI't'UL~-TION 1 2 3 2 1 5. 4 0 t. lieai «~ {~~ ~ .............. ........................ t. 5 3 5 2 4 2 2. abocics and BarcM (Schedule e) .................................. 2. , 3. CloNly Hsid Co~~oraW~n, Pafirership or Sole-~~4 {Schedule C) ..... 3. • 4. Ma'Ippss a No1ss Reoehrable (Sd~edWe O) .. . ..................... 4. • 1 1 1 9 4 , 3 9 5. Cash. Basic D~oeits a IweveM~nea,s PeraorMl F~roperty (Sch~eluls E) ....... 5. B. .ioirMgr Owned ~ti t~d~ ~ ^ SepeRa~e ear+9 RecFM~fsd ....... e. 7. ~r vwe" T"'"'q~ a ~w''°w~"°u` t~~~roe'~' ~n~«~r d et ~ a 7 2 1 2 6 6 6, 0 3 ....... . a rar~. (so++.d~w. a) I J ~~. . 8. Tatrl ~+eas M~1s (Io~el Lines t-7) ........................... ~.~~~~ r r ~~~rir e. ~rrr 3 5 2 4 2 8. 2 4 9. ~, Fune~M E~cpenses a l~dministra8w Costs (ScheduN N) ................ 9. 1 8 4 6 3 , 7 5 10. t~ebts of teoeddrd, Magape ~lebNlties, a Liens tschedc~le l) ............ io. • 1 t. To1M Deduefiarr (toad lines 9 a 10) ........................... t 1. 1 8 4 6 3. 7 5 9 1Z. Net vale. d Ea/Me (Liao 8 minus Line 11) ......................... 12. 3 3 3 9 6 4 , 4 13. CMri~ble and C~onienrnen~t 9equestslSec 91 i3 Tnwts 1~Or which an ~Mction to tax has not barn made (Scttsdule .n .................. 13. • 14. Net VrN~e s ~ Tex (tine t2 ndnus Line t3) .. .. ........... 14. 3 3 3 9 6 4 • 4 9 TAX CO~t/'fATKlN • ~ MISTIilIICTIONd FOR APPLICAOtE R#T~ 15. Mount of Line 14 t+exabls at the spoueai tax n~le, or bair'~Nre under ~. 91 i6 te. d Use 1e auo~ble 1 5 0 2 8. 4 0 at iineN nMe X .~ 16. 17. M~ocuk of Line t4 toocM~le at sibfirq nMe X .12 17. • 18. M~ourk of Line 14 taxable at c~ot?ateral nits X .15 18. • 19.Tigcpue ................................................19. Z0. l~.L. IM THE OPAL. N= Y°OI! A11E 11l:QIlEEl81"N~Iti A AERlND OF /Bi tyV'E'IiPA'YrENT 1 5 0 2 8. 4 0 sw.s 15056042126 15056042126 J REV-1500 Q( Pape 3 Drcedir~'s Cf~ne A~~ss: File NtMtlbar 0 0 DECEDEwrs IVAIUE JAMES E. LANDIS STREET ADDRESS 133 WEST SOUTH STREET CITY CARLISLE STATE PA ZIP 17013 Tax Parma aid C~d~s: 1• Tax Due (Peas 2 Line 19) (1) 151028.40 2. Cr+edtsJPaytnents A. Poverty Cne~it B. Prior Payments C. Olscount 751.42 Total Credits (A + 8 + C) (~ 751.42 3. InlerestJF~sr~altl- ff aPp D. irrierest E. Penally Total hMeneetlPenall~ (D + E ) 4. ff Lie 2 is gnealer'Mren Line 1 +Line 3, erNer the tlilrerertoe. Thb b the OMEIlPAY~I~IT. ~ M aeM al Ihpe 2, UAe !M b a e~stluad. 5. ff Lkre 1 + Line 3 is greeter Mlen line 2, erNer the dltferenoe. This is the TAX DUE A. Enter the on the tax due. (3) 0.00 (4) 0.00 (6) 14.7 (`~) B. Eger the total of Line 6 +SA. This is the Bw.A1rCE 01~. (58) 14.76 98 Ilse Gh~dk Payable to: ISR t~ l.t.S, f~;f PLEASE 11MER THE FOLD t~t1E8T10N1s BY PL~1CSl+ti AN "X" ~ THE APPR+OPI~IATE BUCKS 1. Did deoederM make a transfer and: Yea No a. refain the use a income of the properrty trar-sferred : ...................................................................... ^ ^ b. retain the tight 1o designate who shah use tlt~e property transferred or its income; ............................... ^ c. a reversionary or ................................................................................................ ^ ^ d. r+ecenre the prorrriee for Iii to of either payments, benefit$ or care? ....................................................... 2. ff dash oocuned aAer Deoettrber' 12,1962. did deoederrt transfer property widen one Year of death wiMroul reoeivfng adequate consideration ......................................... 3. Did decederk own an'in trust fob' or payable upon death bank acooimt or secx~ity at his a her death? ......... ^ 4. Did decedent awr- an hsfividuwl RsfhrertwM AcoourM, annuity, or other non~probale property whid- contains a brlnaifdary d~ori7 .................................................................................................. ® ^ ~ TIC AN~EIt TO ANY OF THE A00~VE QtIESTIOMS fs YES, YOU ~lST COM'~I.ETE SCMIEDtA.E d AID FILE R AE PART OF TIC RETIIIBI. For dabs of deeM- an or aAer July 1,1994 and before.tarwary 1,1995, the tact isle in~poeed on the net ra[ue of bansfers b or for M>e twe of Mie survivkg ~ouee ~ throve (3) petcerft [72 P.S. §9'116 (a) (1.1) (i)j. Far deke of death on or stlser 1,19®6, Mie tart raffia irriPoeed an Mie net vatue of trariefer: b prior tie use of Mrs sutvivirig spouse is aero (O) Percent [T2 P.S. §9116 (a) (1.1) (~j]. The stalide ~,gtg a transfer b a surviwrg spouse honi >w4 and Mrs atalulory requk~enwMs fa disdoaire of wets and tilkig a tax refum are sliN appNcable even if the surviving apoiise is the oMy beneiiciaty. For doles of deaMi on or aAer July 1,2400: Thetar~ isle irrrpoeed on tlienetvalue of banafarsfrom a derieaeed drNd twerMy-ane ye®r~s of age or younger at death b a for the use of a naMa'sl penerM, an adopMve Parent, a a slepparerM of M-e cAild is aero (O) percent (T2 P.S. ~'I 16(aX1.2)). The tart Tale irtipr>red on Mrs net value of transfers b ar for Mie use of Mrs deoederrCs Mrreel berieticiarles fie four acrd aie~half (~.5) pecnent, esroept ae sled in 72 P.S. X116(1.2) [72 P,S. ~116(aX1)j. The tax race kripoeed on Mrs net vakie of lrarisfets b ar for the use of the decedent's sibNrigs is twelve (12) percent [T2 P.S. §9116(aX1.3)). A sibifrrg is defined, under Section 9102, as an individual who has at feast ane parent ~ carxnon wifh the decedent, wheQier by blood or adoption. REV 1Q02,EX + (~d~Ol!) ~~ ©owoNw~:~u.TM of mv~- REAL E~1'14~'E M~ft'111i~E TIIK AE8~NT ~~~ ~ $ 0 0 M IN!' ~111~ ~Oi1~+r[~ # M~ ~ O~M1~11 Iwll~ br A~NIw ~Mt ^/IMIt ~~N. ~ gIM11t Mrl~! Y Old ~i ~ ~ ~ rM1~id1 MOf~ld be d'b~wr-t!w~ ba~r~l`s fir, bN~p carp~Mrd bbu~-a~M, bob ~Mlodbe wiewrt~. M ~. tTFM VALUE AT Ef~iTE Nl OESCF9~"TK~I OF DEA 1. 1331NEST ~'3t1TH S'"TREET 123'`215.40 CARLISLE PA 17013 97790 X 1.28 CLR TO~t'~i. ~Ai~o enter on~Ii~e 1 ~lulM[t~n~ ~ i 123,215.40 REV-1503, EX ~ (~6-YA) ca~oNwf~un+oF nv~ww TORT fT ~~~~ ~~~ JA~YIES E. WVDtS _ _ -- ~ ~ .~.~.~.~____ Ar pre~a joi~r~~l w~NM ~~yhtdis~irw~i~ aNNtbrf oa lcAMMN F. REM VAU~ AT DATE NIJI~ER DESCPoPTION OF DEAT'~ 1. CENTUR , tNC. 2.381.36 68 SHAFtES~ ~ 35.02 2. WN~STREAhI CORf~ORATION 108 SFIARE3 011.08 3. SPRINT NEXTEL CORPORATION 175 SFIARES ~ 3.71 T8-TAL (IIYt~ der on ~ 2, ~~) ~ : 1,208.81 1,762.25 5,2.42 :. _. ,.. . REV 15~,~X + (6-96) ClIkSH, ~iJC P"~'~, dr ~I. co~TN o~ r~~~n~vAaw- ANCE TA D X ~ ~~ ESTATE 01` FN.E Mtl _____ 0 0 JAMES E. LANDIS ^ M~dude ~ d ~~ deN the ~ ~ i - F. tMwt Mr ~ a ITEM VALUE AT D1ATE NtNr1~R DESCRIPTION OF DEATW 1. CC~tNER ONE CREDIT UNION ACCOUNT 9,395.54 2. REFUND - HARPER'S MAGAZINE 31.00 3. REFUND -ROLLING STONE MAGAZINE 20.53 4. REFUND -NATIONAL GEOGRAPHIC MAGAZINE 12.55 5. REFUND - C'.OMCAST 34.74 6. HOUSEHOLD C300DS 1,500.00 7. 1995 NISSAN PATHFINDER 200.00 Tt~tAL ~ o~ ~e 5, Rec~pibula~km) ~ i 11,1 REV 1510 EX + (id~~ ©OMA6~MWE/LLTN QF a e1M~iTANt:E TAX ~~~ N•~ ~~ " ~e CSC. NON~PROt~AAi"E PRC~ERTIr' E$T~TE OF FLE ,TAMES E. LANas o 0 Thr ed+edii aeut beaa~leied end Ira ~bane~w~eraa~ra~eeas ~ 4on rie w~ MN drit REwt3oo c 81~T r ~.. REM R ~r~ aF m wauoEwt+w~o~~w~~wu~nair~~ooectoaaNO MfOINAEG1~1wN~let AIUICIIAOOr1-CFt1El~-Ie#R11iAtSTigE QATE OF L~A1H VJILd~ Of ABET % OF OE~O'S NTl~$T EXG.USK)N I~~tq TAXA~il.E VA~Ll~ 1. HARTFORD ANNUITY COhiTRACT ~ 7113+17579 1 X1,123.41 100. 181',123.41 2. MORGAN STANLEY ~1lTH BAI~NEY 28,477.87 100. 28,477.87 IRA ACCOUNT 54J-03096-11-11-375 3. MINNESOTA LIFE INSURANCE CO. 3,064.75 100. 3,:064.75 !RA # 2851893 001 T~ORAI (IYrcj enter on ~ 7F~eupl~~lMbnj ~ _ 212,6!~f03 ~v ~s~ ~ oc + t12-~% oa~u~uni of ~ M~Af1AMCE TAJC ~~~ H FlM~R~1L ~p ~ , ~ ~ EeTATE OF ICE JAMES E. LANDIS 0 0 ,._ _.~. orMt rfdeorflert e~wet M wiled or laMeiie L t~ R '~ ~cxmr a. FuLsES: 1. EVWNt~ O'1'tERS Ft1NERAl HOME 4,344.38 2. Ld~D CATERING, INC. 1,x,50 e. 1. n~c~osrs: Nea+eriP+Nrenel ReMwteiM~e (s) ~oaW 4-sl~ I+MniberdPwsonel R~epreenltYw(s) ~- sl~le ~ ~ Yre~(e) GoarN~ebn P+eid: 2. ~-~ DUNCAN & HARTMAN, P.C. 10,000.00 3. ~- Eamon: (If deoede~~ addiw it ndMie acme u cleN+ente, elt~ s~eNon) CYNirk Suet Ard~Mret ~- Slelt .~ ap ReMon~Hp of t~Ynentb Oroede~~t 4. p,~ Fret CUMBERLAND COUNTY REGISTER OF WILLS 375.50 5 AooouMrih Fart 6. ~ Ts flMisn Pw~ri"t Fret 7. CORNERSTONE VISA 61.74 8. CARI,.~it.E FA1~LY Y~ACA -DONATION 500,0Q 9. CUM'BERL.AND L.AW JOURNAL. -LEGAL AaV'ERTISNT 75.00 10. THE SENTII+~L - lEtt~Al. ADVERTISEMENT 176.92 11. HILTON`S LOCK SERVICE 93,E 12. PPL _ 33.06 13. LE®O'S PLI~ABING 75.00 14. BOIROtiGH OF CARLISLE - WATER S SEWER ~ 70.24 15. EMBARQ -RETURN PENSION PAYMENT 842,00 16. PPL 14.46 17. SHORT CERTIFICATES - REGISTER ~ WILLS 12.00 18. CENTURYLINK 20.11 TOT1At. (Ales rnleron ~ 9, Faece~~} IY ...... ...... !. ~.. J.J l.....t .JIYt... .~.L ..tom .fiL. ..~.. .}~.~ i 18463.75 REV-1513 EX ~ (~-00) SCHEa1LE J ooe~wFUni of ~.wu~- FICIARIES T/NrCE T/UEIi~1URN EBTTATE Of 1#k Iit _ieu~c ~ ~ e~n~c n n RELA TO tlECE!'~ENT A~lOtJNT OR NU~ER NAIL A#~ OF l~S) RECElVN~IG Pf~tOPE'R1Y Do Not List Tiwleo(i~ OF ESTATE I. TAXABt.E ~~~delbi~ar, and Ids under 1. IIAALtEKA T. LAt~fS (AKA WELIOTES) Linee! 100.00 3285 SANORA DRf VE RENO NV 89503 EI~FiER aSTi~UTItX+i6 9~1Y11!!i lil~IEy11E +p~1 i.M~S 15 T FM~JlK3H AS APPI~OPiiIA ON 1~1t•1~i00 COVER II. NOI~ Al~18tF` . A. SPOt~SAL DIS"I'I'8!!1~'1"KtiNS lN-~ER SECTION 9113 FOR YYHlCH AN ELECTION TO TAX IS NOT ~MIG MAOE 1. e. t3iARITABLE ~ 6OVCf~IEN'TAL aSTRIBUfK)Ns ~. r~c~t.~ ~ - TOTAL r~oN-TAxA~.E asTl~leuTl~ows oNUN~ ~3 of r~r-1~a c~ovER srIEET s I1fnwN~~ imwr~~~~~-- •, t ~, ~ o----~-^ ~i~,~# i.U ttn~ ~e,~#ttm~n# D~ I, JAMES E. LANDIS, of 133 W. South Street, Carlisle, Cumberland County, Pennsylvania,. being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be cremated and my ashes. given to my daughter, Melieka Landis. THIRD. I authorize my personal representative to expend funds from my estate, in such amourrts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath any and all tangible petsonal property owned by me at the time of my death unto my daughter, lVIALIF~A L.ANDIS, provided she survives me by thirty (30) days. In the event she fails to survive me by ~ (30) days, I give, devise and bequeath all said tangible personal property unto my brother, Millard W. Landis. FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto ~y daughter, MALIEI~A LANDIS, provided she survives me by thirty days. In the event she fails to survive me by thirty (3 0) days, I ,give, devise-and bequeath all said real estate unto my brother, lbiillard W. Landis. SIXTH. I give, devise and bequeath aU the rest, residue and remainder of my estate unto my daughter, MALIF.I~A. LANDIS, provided she survives me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate unto my brother, Millard W. Landis. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint ray brother,lVIILLARD W. LANDIS, as Executor of this my Last Wi11 and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of Millard W. Landis, I nominate, constitute and appoint Martha M. Landis as Executrix of this my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to ,~ retain in .the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. IN WITNESS WHEREt3F, I have hereunto set my baud and seal to this, my Last Will and Testament, consisting of two typewritten pages this 1'~ day of April, 1999. r S E. LANDIS Signed, sealed published and declared by the above named Testator James E.Landis as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. I l Gl~ ~ .~_ . e r, COMM01~J7W'EALTH OFPENNSYLV.~INlA COUNTY OF CUMBERLAND I, JAMES E. LANDIS, Testator whose name is signed to the attached or foregoing instrument, having been, duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will;. that I signed it willingly; and that I signed it as mY free and voluntary act for the purposes therein expressed. c ~ c~,,..,~; J S E. LANDIS Sworn or affirmed to and acknowledged before me, by JAMES E. LANDIS this 1 ~ day of April, 1999.,, ~' N Public COMMONWEALTfI OF P~'NNSY~VANIA COUNTY OF CUMBE.A'LAND Notarlat seal Cyrnhfa L. t3arr, Notary Re,bi;c South Middleton 7wrp., Cumberland County My Commission expires eug. 14, 2t~Q :SS. We, ,~j ~~Y, ~ ~ ~-~~ and ' ~~~ (~ a h7 • ~ ~~ 5 ~, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JA1ViES E. LANDIS sign and execute the instrument as his Last Will; that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed; that each of us in the peering and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. -? ~~ , Sworn or aiumed to and subscribed bef~o''re me by 5 L ~.S L~`•1 ...1, ~r~ ~ t! ~ t c~a N~ ~ S{~ ~•~ this i~j day of April, 1999. ~~ Public and witnesses, Notarial Seal Cyynnfiia L. Garr, Notary Pe,biic South tJliddteton Tw ., Cumberland County My Commission ~.ires Aug. ta, 2t}~0 CORNERSTONE eee,ai c,ea~i P.O. Box 118 I , 5 East Gate Drive, Carlisle, PA 17!015 Telephone (7 17~ 249- I b6 I fAX {7 17) 249-8208. 11~lember founded -Service based www tornerstonefcu.coop April 15, 2010 Duncan & hlartman, P.C. One Irvine Row Carlisle, PA 17013 RE: The Estate of: James E. Landis Dear Susan: At the time of his death, James E. Landis was single owner of a savings, checking and money market account. Listed below is the information you. have requested in your letter dated June 17, 2009: 1. Savings, .Checking and Money Market 2. Savings Ac~aount number 94-01 Checking Account number 94-07 and Money Market Account number 94-18 3. James E. Landis 4. Not Applicable 5. Savings Account DOD Balance $1,679.87, interest $1.49 Checking. Account DOD Balance $f347.88, interest $0.04 Money Market DOD Balance $6,912.61, interest $4.35 If you require any further information, please call me at 717-249~1fi61 ex# 240. Sincerely: Donna J. ick ' ; . Financial Service Administrator MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO '$ I (~4,OCl0 BY THE NATIOI`~AL CREptT UNION ADMINISTRATION Minnesota Lih Insurance Company A Stcurian Company 400 Robert Street North St. Paul, MN 55101-2098 www.minnesotalife.com 651.665.3500 April 28, 2010 MALIEKA LANDIS 3285 SANDRA DRIVE RENO NV 89503 RE: Traditional 1RA Contract # 2851693 001 JAMES ELANDIS -deceased Dear Ms. Landis, MI~M~ESOTA LSE As beneficiary of the above contract, you elected the settlement option to receive a lump sum distribution. Therefore, a check in the amount of $3064.75 was sent to you at the above address under separate cover. Since the distribution came from atax-deferred account, this distribution is fully taxable. As you requested, federal income tax was not withheld from this settlement. In 3anuary 20l 1, you will receive an IRS form 1099R confirming this distribution. Please note that this distribution is considered a taxable event to you at both the Federal and State level. The certified death certificate is enclosed for your records. If you have any further questions, please contact your Minnesota Life licensed representative, If you do not have a representative, you may contact us at 1-800.362-3141 (option 3). Sincerely, ~.~~~~ Kathy Salscheider Customer Service Representative Annuity Services Enclosure C: 214 Senate Ave 7th Floor Camp Hill, PA 17011 rel 717 730 1800 fax 717 730 1894 toll free 800 2 37 1700 May 18, 2010 Susan J. Hartman, Esquire Duncan & Harhnan, P.C. One Irvine Row Carlisle, PA 17013 Re: Date of death value for account 54J-03096-11-375 for James E. Landis Dear Attorney Hartman: MOrganStanley SmithBarney The following is pertinent information regarding the ownership, beneficiary information, and date of death value of the account listed above for James E. Landis: Account owner's name: James E. Landis Opening date: February 6, 2003 Account type: IRA Rollover Primary beneficiary: Malieka Heliotes Date of death value: $28,477.87 The figures supporting the date of death valuation are displayed on the attached spreadsheet. Please note that we are not including a valuation for the annuity through Hartford Life that was also reported on the statements for Mr. Landis. That date of death valuation will need to be provided by the annuity company. It is my understanding from a conversation I had with Hartford Life today that they mailed a letter containing the date of death valuation for the annuity to you on May 13, 2010. Please call us at 1-800-237-1700 extension 1835 (Bill) if you have any questions. Sincerely, Bill Barton Client Service Associate for Richard A. Melzer Senior Vice President Rodd J. Melzer Vice President Attachments: 1 THE INFORMATION HEREiN HAS BEEN O~BTAtt~- fRCJ~AA SOURCES 1l~tE ~t.IEVE T4 ilf REIIARI.f, dUT vO NQT G~1i-RANTI~ ITS ACCURACY: Olt COMPtfTS Morgan Sranlry Smith Barmy LLC. Member May 13, 2010 Susan J Hartman FBO Estate of JAMES LANDIS One Irvine Row Carlisle PA 17013 Re: Hartford Annuity Contract # 711347579 Decedent: JAMES LANDIS Dear Ms. Hartman: Thank you for your correspondence regarding the above annuity contract. Hartford Life The death benefit payable under this contract is not considered "life insurance" reportable on IRS Form 712, (life insurance statement). Please find the below information in response to your request. Contract Number 711347579 Owner JAMES LANDIS Decedent JAMES LANDIS Social Security Number x:XX-XX-1078 Date of Death March 22, 2010 Cash Value on the date of death $181,123.41 1?eath Benefit Value on the date of death * $188,924.08 *The Death Benefit Value on the date of death displayed above may include a Death Bene#it :Adjustment as outii~d in the Annuity Contract. This figure is being provided for illusttatton p~utposes and is »ot bquivalemt to the final death benefit. The death benefit will be calculated on all contracts associated with this ciier~t the day we receive the certified death certificate. Once the death benefit is calculated, the benefit amount remains invested and is subject to market fluctuation until complete settlement instructions are received. If you have any questions or concerns, please feel free to contact your investment professional, or one of our annuity specialists by calling 1-800-862-6668, Monday through Thursday from 8 a.m. to ? p.m. and Friday from 9:15 a.m. to 6 p.m., Eastern Standard Time. We will be happy to assist you. Thank you for the opportunity to help provide for your financial needs. Sincerely, B Eaton Investment Product Services ICS Annuity Benefit Services Team Hartford Life and Annuity Insurance Company Hartford Life Irrturance Companies 1 t3riffin Road North Windsor, CT 06095 - l S l 2 Toll Free 1 804 862 6668 Investment Product Services Mailing Addros~: P.O. Box 5085 Hartford, CT 06102-30$S oreline.lurrtfordlife.can Federal Credit Union A~e>fwbr-J~ - Srn~cis 61s1tid. P.O. 90X 1181 CARUSIE. PA t7015 717-Z19.1d61 STATEAI~ENT OF ACCOUNT No~ncE SEE ENCLOSED FORM FOR IMPORTANT INFORMATION REC3ARDING YOUR RIGHTS TO DISPUTE BIWNG ERRORS. NOTICE SEE ENCLOSED FORM FORIMPORTANT INFORMATION iN CASE OF ERRORS OR !]UESTIONS ABOUT YOUR ELECTRONIC TRANSFERS fDENTIFlED WITH LETTERS 'EFT' OOOOZ9 JAMES E LANDIS 133 W 50UTH ST CARLISLE PA 17013-3434 IuR:MBER 94 NIr~ABER STATEMENT ATE OWNERSHIP OF SHARE. DEPOSIT AND CERTIFICATE ACX;OUNTS SHOWN ON THIS STATEMENT IS NOT TRANSFERABLE EXCEPT ON THE BOOKS OF THE CREDIT UNION. Transa~liarl Dste I Transacdian Oescxiplion ~ T Amount ( ~~~~ ~~~ ~ d11 I BI-LAIVCE SHARE Ol..REGiULAR SHARE ACCOUNT 04-O1 Previous Balance 17 2 1604,42 1606.59 03-31e DIVIDEND Annual Percentage Yield earned . from 01/01/2010 - 03/31/2010 on an average daily balance of $ 1882.21 was .47~k 04-01 DEPOSIT 942.00 EFT 2548.59 BENEFIT PAYMENTS-PENSIONS 04-01 WITHDRAWAL -69.39 2479.20 COMCAST CENTRAL-CENTRAL PA 04-01 DIVIDEND .03 2479.23 DIVIDENDS TO CLOSE 04-O1 TRANSFER IN 6916.27 9395.50 TRANSFER FROM 94-18 TO 94-O1 TO CLOSE ACCOUNT 04-01 TRANSFER IN .04 9395.54 TRANSFER FROM 94-07 TO 94-01 TO CLOSE ACCOUNT 04-01 CLOSE ACCOUNT ~ 40798 -9395.54 .00 TO CLOSE ACCOUNT 04-06 DEPOSIT 61.74 61.74 FOR VISA 9950-0000-0345 04-06 CLOSE ACCOUNT -61.74 .00 CERTEGY-MADISON CR CD PMT 04-30 New Balance .00 Year-to-Date Dividends this account 3.69 SHARE 07..SHARE DRAFT ACCOUNT 04-O1 Previous Balance .00 04 03-31e DIVIDEND .04 Annual Percentage Yield earned from 01/01/2010 - 03/31/2010 . on an average daily balance of $ 182.65 was .09~c 04-O1 TRANSFER OUT -.04 .00 TRANSFER FROM 94-07 TO 94-01 TO CLOSE. ACCOUNT 04-30 New Balance .00 Year-to-Date Dividends this account - - - - - - - - - - - - - - - - - - .08 - - - - - - - - - - - - - - - - - - - - - - SHARE 18..MONEY MARKET PLUS ACCOUNT 04-O1 Previous Balance 6912.61 03-31e DlAnnual Percentage Yield earned from 03/01/2010 - 03/31/2010 6916.16 on an average daily balance of $ 6956.96 was .60~k 04-01 DIVIDEND .11 6916.2? DIVIDENDS TO CLOSE ACCOUNT 04-01 TRANSFER OUT -6916.27 .00 TRANSFER FROM 94-18 TO 94-O1 TO CLOSE ACCOUNT 04-30 New Balance .00 Year-to-Date Dividends this account 14.70 Total Dividends Earned This Year $ 18.47 Total Finance Charges Paid This Year $ .00 Mark your calendar for June 11 and join us from 12 noon to 4:00 p.m. for our Family Fun Day. Activities will include: a shred truck, a blood mobile, smoke house for kids, face painting., FREE credit reports, child ID kits, and more. Donut miss your opportunity to learn more about your credit union and have an enjoyable day at the same time: Refer A Kember And You Could Win A $2,000 Travel Packet e: What do you need to do to be entered to win? Simply r4er as many people as you *** CONTINUED ON NEMT PAi3E *** Page 2 OF 2 ~^~ 94 Statement Period 04/01/2010 - 04/30/2010 Transaction ~nncrpn Paymsncs RNANCE Transaction Datie Transaction Oescxiption Amount I~r s CHARGE 8111.APICE can to CFCU (friends, family, co-workers) and when they join, you will both be entered into the drawings. Tell everyone you know; the more referrals you qet, the more chances you have to win. Be sure to mention to your family and friends that they can win as well - just by joining and then they can refer new members too. The more referrals you have, the more entries you receive! Spread the word!