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HomeMy WebLinkAbout02-01-11 1505610101 REV-1500 ~~01.1°' ~ PA Department of Revenue psnnsylvaMa OFFICIAL USE ONLY Bureau of Individual Taxes °""""~"""~°""""""" County Code Year File Numt>ar INHERITANCE TAX RETURN `"~~ ~~ ....... `~~ ~~~~~~~~~~ PO BOX z8o6o>, h ~ J'1 ul ~ ~ ~ ~~ Harrisburg. PA 17128-o6oa. RESIDENT DECEDENT ! (J 1 ~ i __ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY F. _ __ __ ~.._ _,_____., __._ ___ . _ _ ._w____.,_._ _______ _ , .___... .__ ._,~.....__ .__ E 174-20-8128 ~ 11/07/2009 ! 01/07/1927 _._... _ _._,. ._. , __ ...._..__~ I_.. ..__ , __.~. _...._...__._ .__~____ .~_.__.__ .. ._.._._____,.,_ Decedent's Last Name Suffix Decedent's First Name ', MI __W._ __ ... _ MONN 'WILLIAM ~ ..~__ _ _.. _ ~ (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 1M1rH '~'HE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Retum O 2. Supplemental Retum O 3. Remainde' Re~um (date of death O 4. Limked Estate O t3. Decedent Died Testate (Attach Coov of Willl O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Coov of Tnistl prior to 1213- 20 O 5. Federal Estate) Tex Retum Required _ 8. Total Numt~er ~f Safe Deposk Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to ~I between 12-31-91 and 1-1-95j (Attach S CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHO Name Daytime Telephon RICHARD W MONN (919) 924-13 __ I tax Il . O LD e h5 ~ under Sec. 9113(A) ) B DIRECTED T0: lumber REGISTER ~r ILLS USE ;~ First line of address , ~ . ~ _ 802 NOTTINGHILL WALK t ~ « Second line of address _ _, _ ... - r City or Post Office _ _ State ZIP Code ICED .: ..__.__ . ...~ ..._ - - _.._. ~ ~ ~ ~~ ~ a:/5 APEX NC ! 27502 ~~ ~ _ _ ~_ ~ ___ .. ~ Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the t of mjr knowledge and belief k is true, correct and complete. Dedaretbn of preparer other than the personal representative is based on all informatbn of which pr pa , r tlas arty knowledge. SI(;N4TI IR PFRRMI RCQDnAlclni c cno co iun_ oc~n gnu _- ADDRESS siGrvATURE y~ P J~ JMIER~pT~HAN-RE-PRESENTATIVE ATE ~/ ! / / 0'1/27/11 5561 Y DRIVE STE 302 RALEIGH, NC 27612 PLEASE U8E ORIGINAL Side 1 1505610101 1505610~,O~r J ~~ i ~'~ rn i 1 i ~~J 1~..+ ~' ~_ \y 1 Ge~S- ~~ J 1505610105 REV-1500 EX Decedent's Name: WILLIAM N MONN Decedent's Sbci~l Security Number 174-20-811281 RECAPITULATION 1. Real Estate (Schedule A) ........................................ ..... 1. I ~ 2. Stocks and Bonds (Schedule B) .................................. ..... 2. ______.e .w_ . ~. ~ ...~.,__.... .. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ...w,_ ~ ~ .~_..w}~ ~..........~ . _~~_. 4. Mortgages and Notes Receivable (Schedule D) ...................... ..... 4.. _..~ _...~.. _~~._.r~ o..~.e.e~..~ ~~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. _ _..~~.. 'I 15,716.62 ~.~......~}nne~,~.........~.~..._.~~_........_....R 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. ..... 6. ' 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. ', 188,113.22, 8. Total Gross Assets (total Lines 1 through 7) ........................ ..... 8. ; ~m.~~...~~~~,._eW ~ 203,829.84 9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. ; ', 10,311.24 ~_.._...~.~..~.~._ aw~~_u~...w......~.~.~.,__........~- 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... .... 10 ~d_-w ..~ _...~ ..m m J:. ;..~~~ .e ...~.. e e.~... 11. Total Deductions (total Lines 9 and 10) ............................ ..... 11. ~I ~I 10,311.24 w~s..,...,-.- ~~..e_ N" ~ .~~a ..... 12. Net Value of Estate (Line 8 minus Line 11) ......................... .... 12 ~ ' 193,518 60 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which '`~ ` "'~`~`~ elm A~ ...~ ... _... ~~ `""'"" """"~ an election to tax has not been made (Schedule J) ................... ..... 13. ' ~_.,. ', , ___..~i ,i.~ ~,__... we.~.. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................... ..... 14. '; !i TAX CALCULATION -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_ ,,._..,.... ......_._ , ......,., ~,, ...,W ; 16. Amount of Line 14 taxable at lineal rate X .0 4~ 193,518.60 '' e~.m_ ~.~__.. ...__-_~.e _~__~w ~....~~.~ 17. Amount of Line 14 taxable at sibling rate X .12 1B. Amount of Line 14 taxable ~~~ ~~ ~~~~~~ ~~~ ~~ '~-~-~ 15. at collateral rate X .15 18. .~. 19. TAX DUE ......................................................... 19. 8,708.33 8,708.33 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I O i I I ~' I~, Side 2 ~ '~ 1505610105 1505610}015' J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME WILLIAM N MONN STREET ADDRESS 20 N 12TH STREET CITY LEMOYNE STATE PA ZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 8,708.33 2. CreditslPayments A. Prior Payments __ _.__ B. Discount Total Credits (A + B } (2) 3. Interest (3) 160.07 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII in oval on Page 2, Line 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) ' I 8,868.40 i Make check payable to: REGISTER OF WILLS, AGENT. r~, $n. .. ~1~7T h;iw'2,',?f~~!''j~?°_$"~%?f~~...~.~' .._. tb7:"'~~~,~ y ~., :~,,'. ',~c' i,P3t, i.F'z<?~?!~~.4 ~~ ~ '$%.. 'k'; .ar.ix~~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPR~P~tIIATE BLOCKS 1. Did decedent make a transfer and: `des I, No a. retain the use or income of the property transferred :.......................................................................................... ~] ^x b. retain the right to designate who shall use the property transferzed or its income : ............................................ ~] ~,, c. retain a reversionary interest; or .......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... i x^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receivin ade uate considerations ............................. ^ g q p y. po ................................~.............................................. 3. Did decedent own an in trust for" or a able-u n-death bank account or secun at his or her death .............. ~, 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ~ II ^ IF THE3~ AN~~S~W? ER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILET IT $ PART OF THE RETURN. ~ i'!.`t`9nL~.. A'y' t Q f`•t. ".C .:~~ } ~~~i~{l~ ~~,~~ *i ~af.~°, ~.9t.~ r h '3 ~.'~4 fir ~~ ~:' d 'i~;~~', i. ~" ~'~ _ T,y0; 1o.C~~, :~,t4i i!L'~~ r"~h• r._.. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or fir file use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1} (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 requir~m~nts 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 t, 2000: The tax rate imposed on the net value of transfers from a deceased child 21 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 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' 4.~ 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 12 percent [72 P.S. §911t;(a)~1.3)J. 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. ~~t ~1~iCC ~ Testament o f ~1~iCCiam ~1~:.~Vlonn I, William N. Moran, Soc. Sec. No. 174-20-8128, of Dover Township, Yo~}k ~ounty, residing at 4308 Beaumont Road, Dover, PA 17315, declare this to be my will, he~rel~revoking~ _ ~; .~ .... ~, ~' i>=7J ~ ~7r~~ all prior wills and codicils made by me_ ~ ~ j ~ ~ ~ ~~ ~pavment of Debt, F~n_eral Expenses &. Death Taxes ', Ir-. - tv -.=~ r /) ~!~ :-"7 ;3 - FIRST: I direct the payment of my just debts and the expenses of my last ~n~' ~ =.- ='- funeral as soon as maybe convenient after my death. I further direct that all estat~, ieritance, ~ "' ` and other death taxes, together with interest and penalties thereon, of whatever na~e, and by whatever jurisdiction imposed, shall be paid as an administrative expense of my re$id~ary estate. py~position of Estate Property SECOND: I give the rest, residue and remainder of my property (real, pe~so~al, and mixed) to my beloved wife, Naomi R Moran. In the event my wife fails to so surv~~ me, I give the same to my son, Richard W. Moran, provided he survives me for a period of th~ (30) days. In the event my son fails to so survive me, I give the rest, residue and remainder o~'~y property to his issue, my grandson, Jeremy N. Moan, per stirpes. Additional issue born to myl~ son, if any, shall be included as part of ibis will. ~' Powers of Executor THIRD: In addition to and not in limitation of the powers conferred upon) executors by law, I authorize the exercise of the following: I I ~T- William N. Moran ~, t x g g s (a) To hold, or to sell at public or private sale, without order of court, or to l~a~ei and exchange, any real or personal property composing my estate; ', ', ~~ (b) To compromise claims; and II {c) To waive the requirement my executor furnish security in any jurisdiction', II Annointment of Executor i FOURTH: I appoint my wife, Naomi R Moran, executor of my will. In the ~ mY wife predeceases me or is unable or unwilling to qualify, act or serve as my executor, I app ' t my son, Richard W. Moran, executor of my will. ', I have signed this, my will, this -~- f~> day of /V (~ ~,~' E .N9 i s ~ , ~,19~917. William N. Moran '', i Signed by William N. Moran, the testator, as his will, in the presence of us, who, at is request, in' his presence, and in the presence of each other, have signed our names as witnesse~. i iI%itness Address .~~• ~~ ~~ ~ Witness Address REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2009- 01058 PA No . 21- 09- 1058 Estate Of : WILLIAM N MONN /First, Middle, LesU Late Of : LEMOYNE BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 174-20-8128 WHEREAS, on the 16th day of December 2009 an instrum~n~ dated November 26th 1997 was admitted to probate as the last wi;l.~ of W/LL/AM N MONN /first, Mrdd~e, Usf/ 1a to of LEMOYNE BOROUGH, CUMBERLAND County, who died on the 7th day of November 2009 and, WHEREAS, a true copy of the wi11 as probated is annexjed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTAR~'tb: RICHARD W MONN who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to Iaw, x111 of which fu11 y appears of record in my office a t CUMBERLAND COUNTw G~OURT HOUSE, CARLISLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 16th da y of December 2009. 4../ ~ ._ tl ~ ~~. eg/ster o l ~. ~ ` ~~ A * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, .L',A$T) e3 h 0 v -~~,w ~ `- ti . ^~~.. V 0 ~~~~ t ~ C~~ ~: ~~ ,~ 1 t e0 1~t~~~~`~,l ~M ~~.~~h 1r ~• //-"~-I ~ ~ ~ .`~ a~'i 5 w o y~ o ,°o H o ~ ~ o A :~ ~ i ~ ~ ~ ~ ~ ~ O M N ~ a O w Z+ 7 ~. ~ r°~ p°4 ~*'~ N .h± ~ ~~ '~ a~ ,~ ,~ 0 0 ~ ~ '~ ~ ~ '~ ..`,~ ~ ~ ~ ~ o G _ a , ~ i~+ __ ~ ai ~ ~ •~ ~ ~ ~ °' ~, ~ ~ o ~ a o ~ "~ ~, o ~ ~ ~ °~ ~'~ ~ ~~ ~ a~ ~ ~~ ~ ~ ~ ~ ~. ~ ~ ~, ~ ,~ ~ ~ ~ ~ ~ ~ ~ °~' ~ .°'o •~ N ,~ d rep d ~ ~~ r+ pr ~ ed ~ bd ~ +~ ~ ~ ° ¢` ~, a ~ ~ ~ ~~ ~ ~ ~ ,.;^ T ~' ~ ~ ~~ ~A C y e~ r '~ ' ~ '~ . ~ c A c °~ ~, ~ ~ ~ ~ Q ~, ~ ~ ~ ~ ~ ~ ~ ~ .. ~ ~ ~ °' ~ ~ '~ Y a C a a .~ .~ :~~ Nov. 24. 2010 10:15AM awaAvacocuenpnt TA7RAY~ 3lRVf®S ro oaoc x~at ~uaumna~o:~ t~i~aoa COMMON'WYcALTH OF PENNSYL~ANYA DEPARTMENT OF RTVENUE 1'nJeerltance Tax Non-Flier Dellnm~aecv NotlReatlon RICHARD W MONN 802 NOTTINCHILL WALK APEX NC 27502 Date: Estate of: WILLIAM SSN: Date of Death: File Number: No, 2243 P. 2/3 ,~v-a+roAre h~•ou 11/15X210 W MONN 1y4-2~-~~28 11-07-!2~d9 2109-~0~~ Department records indicate you are responsible for the settlernant of the above estatc~'lorthat you represent the resp~sible party. The estate is in delinquent status, as the inherita~nc~ tax return has not yet been filed. '~ The Inheritance and Estate Tax Act mandates the filing of a tax return and payment oft all outstanding liabilities by a personal representative or a transferee of an estate within nine months ~f ~ dkcedent's death. If this estate was opened for the purpose of filing a lawsuit, please provide the court t end docket number of the proceeding in writing to this office. The Department may postpone fw a ectian regarding the estate pending the completion of the lawsuit. If there is any other reason that a ret~irt~ltas not been filed, please contact the office listed below. Under Act 40 of 2005, additional collection costs, including but not limited to fees of ~tp 1~ 39 per't;ent of the amount due and attorney fees incurred in securing payment, maybe imposed on any liability not paid prior to referral to a collection agency or contract coy~nejel. To avoid farther action, a return must bo filed within ZS days of the date of this letter. If the return has been filed recently, please disregard this notice. Direct arty questions regarding this estate to: Harrisburg Cail Center (71'n 783-3000 TDD# 1-800-447-3020 (service for taxpayers with special hearing and/or speaking needs) ~~~~~ r /~ ~'"` RETU1tNS SHOULD HE FIL~LI AND PAYMENTS MADE A~' THE REGISTER OF WILLS LISTED BELOW: REGISTER OF WILLS I COURTHOUSE SQUARE CARLYSLE PA 17013 ~ pennsylvania DEPARTMENT OF REVENUE December 21, 2010 Donald W Brown Suite 302 5561 McNeely Dr Raleigh, NC 27612 Re: Estate of Willia~ V~J ~Monn File Number 21 9~~1p58 Dear Mr. Brown: This is in response to your letter of December 7, 2010 concerning the ~nF~~ritance tax return due in the above referenced estate. '~ i Since it is apparent that you will be unable to file a tax return in the n~ar~ future, the .estate. record will-be placed in an informal hold status for an additional. period) o~six (6) . months~.so that the department- will. initiate no enforcement activity until June 2 , 2011..At the end of that period we would ask~that you contact us to provide an updated ~tatus for our file.• The return may be filedatany time during the informal hold .period., Kindly note that this action will~avoid'the imposition of a penalty for.fa lure to make a s timelyreturn. However, it does not prevent interest from accruing on any ta~ r~rinaining unpaid after the delinquent date. Thank you for your cooperation, and, if I may be of any further assistajnc'le please feel free to contact my office. ,.. I ~ i ~ , ,. ~ .. ... Bureau of Individual Taxes 15`" Floor Strawberry Square I Harrisburg, PA 17128 717.787.6505 w Iw.fevenue.state.pa.us Inheritance Tax Divi~ion Ifulmer(c~state.pa.us i i Don Tax Pl~tnn8~l ~taemen~ BfoWtl 'Retirement Punning Associates su~ineas c°nsueing Payroll Services 5561 McNeely Drive. Suite 302 Raleigh, North Carolina 27612 919.782.3366.336299.9101 Fax: 919.782.2384 www.donbrownassociates.com December 7, 2010 / I ~~ RE: Estate of William W Monn SS# 174-20-8128 f File # 2109-1058 Beneficiary: Richazd W Monn Deaz Laurel: 1-717-772-0412 We were instructed to fax a letter to you requesting additional time to file the I~hfrritance tax return for the above referenced Estate. We have been retained by Mr. Richazd Monn to assist in filing appropriate tax preflurns for the Estate of Mr. William W Monn. Based upon the size of the Estate, Mr. Ri~ha~d Monn was unaware of the need to file and Inheritance tax return in state of PA Isi~ce none was required for Federal, Internal Revenue Service. We aze in process of gathering appropriate data to file a correct and accurate re ~ ,but will be unable to meet the deadline expressed in your notification letter dated ~o ember 15, 2010. We ask that you acknowledge contact within the required time and a~lldw us to prepaze and file as soon as possible without penalty or interest being chazged. Thank you for your favorable consideration of this request. Sinc ly onald W. rown Professional Services for Businesses and Individuals ', • REV-1508 EX+ (ii-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEpYLE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: L f~UMBER: WILLIAM N MONN 2109-1058 Indude the proceeds of Iltlgation and the date the proceeds were received by the estate. All property jointly owned with right of wrvivonhip must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION I ' OF DEATH 1. M & T BANK #61236519 CLASSIC CHECKING I 5,463.52 2 PNC BANK #11020025029 CERTIFICATE OF DEPOSIT ~ ', 10.253.10 I TOTAL (Also enter on Line 5, Recapitulation) ~ ~' 15,716.62 If more space is needed, use additional sheets of paper of the same size. ' I I i I I - 15912 WILLIAM N MONN JR - OR NAOMI MONN 20 N 12TH ST APT 222 LEMOYNE PA 17043-1450 INTEREST PAID YEAR TO DATE 3.66 MECHANICSBURG ACC[1IINT CIIMMARV ... :. ;•,,., . .: N0. ANOUNT NO. AMOUNT ND. AMOUNT 9,456.13 0 4 4 0.0 ,4 2 O. ti9 0.00 ACCOUNT ACTIVITY :. :. .. .. ; .... 11-07-0 BECIIMIIIIG BALANCE i I =9,466.13 11-09-0 CHECK NUMBER 5399 1,000.~O ~I 11-09-0 CHECK NUMBER 5411 1,000.~0i 11-09-0 CHECK NUl~ER 53% 1,000. 0~i~ 6,466.13 11-10-0 AMERIPRISE FINC AMP PAYOUT 567.30 ' I i 7,033.43 11-13-0 CHECK NUIldER 5401 1,570.~O !I 5,463.43 11-17-0 INTEREST PAYMENT 0.09 ', 11-17-0 CLOSEOUT 5,463 .2 I 0.00 ENDING BALANCE i I 00.00 T ~ . '~' ..' :. ?...... :. .. ; ::.... s'r ,..... ,.. ... ~N>:R~1x0~:~St!lIM~KRY:........ 53% 11-09-09 1,000.00 5399 11-09-09 1,000.00 ~ S401r 11-~.3-09 1,570.00 5411^ 11-09-09 1,000.00 ANNUAL PERCENTAGE YIELD EARNED = 0.04 'TIS THE SEASON TO SAVE MITH YOUR MiT CHECK CARD. IT'S NOT T00 LATE TO ENJOY EXCLUSriE SAVINGS FROM NATIONAL RETAILERS MNaI Y~ USE YOUR CARD IN STORES, ON THE NEB AND OVER THE PHONE. JUST BE SURE TO SE EaT (OR ASK TO USE YOUR CARD AS) ''CREDIT''. PICK UP A COUPON BOOK AT YOUR LOCAL M BRANCH OR VISIT NMM.MTB.COM/SIgPPIN6 FOR SPECIAL HOLIDAY DISCOUNTS. T Jan. 5. 2011. 9:14AM ~ No. 2268 P. 2 ~PNC December 23, 2010 Richard Moan 802 Nottinghill Walk Apex, NC 27502 ~ . 1tE: William N Moan ', . SSN:174-20-8128 DOD: 11-07-2009 ~' Dear Mr. Monti: ~ . In response to your request for Date of Death (DOD) balances for the customer not~d' above, our records show the following: Certificate of Deposit Account # 11020025029 Establu~ed'~ 12-15-1997 'WILLIAM N MONN DOD balance: S 10,193.06 + 60.04 accived interest i n,1 s 3~ ~ ~ Interest.paid 01-01-2009 thru 11-07-2009 $ 396.40 YTD phrase note that this office provldes date of death balances for deposit accounts (IRAs, CD Chdclcing snd Savings). We do sot procew say liaancial traraaetiona or provide statements. ffyou ~s~etarice with any of thaso items, please ca111-888-PNGBANK (1-888-762-2265) or stop by your local (~ Hank branch otfica. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC ~~ This message is intended for the use of the individual or entity to which it is address'~d may contain information that is privileged; co~dantial and exempt from disclosure und~r clicable law. !f the reader of this message is not the intended recipient or the employee or agent s~alnsible for delivering this rr~esspge to the intended recipient, you are hereby noti~led that any d s mtirwtrion, distrlbuNon or copying of this communications is strictly prohibited If you have re Id this communication in error, please noti,~+,ne immediately by reply or by telephone at 8 7iSZ-1775 and immediately desh~oy this faxed document. ', ', Page 1 of 1 REV-1510 EX+ (OS-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE N M dR WILLIAM N MONN 2109-1058 This schedule must be completed and filed if the answer to anv of questions 1 through 4 on Daae three of the R •lsoa is vns. ITEM NUMBER DESCRIPTION OF PROPERTY ~~ ~ Nv~E ~ ~ ~~ Tr~ta nE<anoNSNIP ~ oE~oerr Aru n~Ea-TEOFTRAwsFEa. ATrAaAaowaFn+EOEroFOaaEA~ESrArf• DATE OF DEATH VALUE OF ASSET % OF DECD' INTEREST ~IEXCLUSION IiF TAXABLE VALUE 1• RIVERSOURCEANNUlTY#9300-6353828 8,887.22 8,837.2; 2 RIVERSOURCEANNUlTY#9300-7095076 ~i 29,991.14 29,991.1 3 ALLSTATE ANNUITY #AC1078659A 74,346.54 74,346.5< 4 SCHEDULE K: AMERIPRISE ANNUITY INTEREST 74,938.32 74,938.3. TOTAL (Also enter on Line 7, Recapitulation) ; I ~ 188,113.22 tf more space is needed, use additional sheets of paper of the same size. _ _ _ _ UST Yage 1 of 2 Adv~sor~~rr~p~ls~~ ~mer~i 1C'1~S 4n~ne Service and Trsnssctlans ~,~1 Helg Group Account List by Product Find Next client', cibse osT Account List with values ~ Pending S Inactive ~ Arra ~erh~n~ Summary of Accounts ~ E-Statements ~ Recent History ~ Account I u~tability PRINT Group ID: 0251 8975 4 001 Grandfathered: No Group EnroNment: Standard Enrollment Date: 08/31/2006 Associated Client IDs 1024 3387 7 001 VYILLIAM N MONN ~~T-, Gl~eate Nt~N Fund. _ ~ .: Croats I~' art r ..; Total value of accounts shown below. $ 75.94 The total value of scoounts does n~ h~clude aN products and arxarnts as shown on the dient Consolidated The total value is not reduced by any outstanding overdraft Protedlon or Card balances. m Non-Qualified Accounts Contract Value s off RiverSource Lffe Date Benefit 11/16/ g WHOLE LIFE WILLIAM N MONN 0000 0900 0132 2210 5004 06/15/1983 $10,000.00 - ' $ ,860.16 Total Contract Purchase Value s of RiverSource Life Annuity Date Paymegts 11H6/ 9!. FRA EXTRA RATE ` w N I o ooo0930 ~s 3 a~e 2 ooa \p ~ 04/01/1999 $15,000.00. ! $ ,834.36 RATE ADVTG 3 ND WILLIAM N MONN ~ I 0000 0830 0709 5078 9 004 ., 01 /17/2003 $23,737.31 2 ,981.42 ANNUITIZATION WILLIAM N MONN ~~ aooo 0930 om 2oao 3004 07/11/2006 $81,584.00 ' N/A Notes: Disclosures for Clients: https://www8.ex. is.ameriprise.com/OST/secure/AccountListByProduct/AccountListBy~'r~.. 11 /17/2009 ~~ - -- - • RiverSoures Lite Insurance Company 70100 Ameriprise Financial Center Minneapolis MN 55474 An Ameriprise Financial company Claim Number 435637 ' November 23, 2009 Policy Number: 9300-6353828 ~e~`~~u~ ~N~~`\ WILLIAM N MONN RICHARD MONN 802 NOTTINGHILL WALK APEX NC 27502-4560. ' ', !, ~I I,, { ..,~ DEAR RICHARD MONN: '~ a ~, . `~.. 1. ,.,., . ,: •,... . _ .. Please accept our condolences. j The attached check for $8,837.22 represents the death benefits duel~y~u under this contract. Base plan benefits: $8,837.22 Total payment: $8,837.22 RiverSoiuree Lite Insurance Company 70100 Ameriprise Financial Center Minneapolis MN 55474 An Ameriprise Financial company Claim Number 435638 , November 23, 2009 Policy Number: 9300-7095076 ~-- ~+I~in~ AN~h WILLIAM N MONN ~(~ RICHARD MONN 802 NOTTINGHILL WALK APEX NC 27502-4560 ', .., ~. ~ .. a ~ ,,,... ~' j ~,,, DEAR RICHARD MONN: `~,j~ ~ c- ~ ' Please accept our condolences. The attached check for $29,991.14 represents the death benefits due~yau'under this contract. Base plan benefits: $29,991.14 Total payment: $29,991.14 If you have questions, please contact our office at the telephone ~u~>~er below. Our associates are available to assist you Monday through Fr d ~ from 8 a.m to 5 p.m. Central tine. Thank you, ',, RiverSource Annuity Claims ~I (800) 862-7919 I -- - - - I i Allstate Life Insurence Company Telephone: t-800-755-5275 PO BOX 80469 Fax: 1-866-628-i006 ~g1~s'1dt~. Lincoln NE 68501-0469 RICHARD WAYNE MONN 802 NOTTINGHILL WALK APEX NC 2750Q-4560 Allstatee Performance Plus #kAC10786S9A The transfer amount of $74,346.54 represents the net proceeds of your policy as of 12/04/09) lour proceeds have been electronically transferred according to your instructions. ~f ~4 0. Gross Annuity Value as of 12/04/09 '~ t '~ Qom-'' 3 ~' 74,346.54 (n ~. v o a.., "~ Gross Withdrawal Amount X74.346.54 a . 4 Electronic Transfer Amount $74,346.54 Remaining Annuity Value as of 12/04/09 $.00 ', As required, the taxable amount of this distribution will be reported to the Internal Revenue S rv ce on Form 1099R. A copy of this form will be mailed to you by January 31 of the next year. Please retain this info~in~tion for your financial and tax records. If you have any questions about this transaction, please contact your representative; or call 1 ~80p-755-5275. We hope you consider us to meet your financial needs in the future. ``~~~~ ~:^~. ~~uns ', X26BVJ73. N01 ~..woaxaaevnoxi.ev,~oooew __ -- I ~°- U /111Si+~@. Aastate Life Insurance Company PO Box 80469 Lincoln NE 66501-0469 RICHARD WAYNE IrIONPI 802 NOTTINCiHILL WALK APEX NC 2~'S02 RE: OriEifnal Ailata#ee Performance PkMi ~~8 Your l~Nw ANstatee P'el'fortnestce Plus ffAC1078059A Dear Richard Wayne Monn: Telepha ~e: 1-800-755-5275 F;x: 1-866-828-1006 December 4, 2009 Your claim has been processed. As you requested, we have deposited your death benefit funds directly into your bank account. The first table represents. the entire benefit value undue I:he original contract as of the date. of settlemer t, as well as any transactions that may have occurred on that date. Y V~~ :, ~'£ Transaction Transaction Invssi~nartt Units fc~r this Tran~pactkm T,rt Date Type Alternative Transaction Unit Value Amount 12/04/09 Total Claim ALIC FIXED ACCOUNT ONE YEAR N/A N/A $-57,781.70 12/04/09 Total Claim ALIC FIXED ACCOUNT ONE YEAR N/A N/A $-16,56494 The second table confirms the investment alternatives to which your portion of the benefit value has been allocated. Please review the information below. If you have any questions concerning these allocations, plea;~e contact us at 1-800-755-5275. Transaction Transaction Investment Units for this Transactia~n Trar~tactiort Date Type Alternative Transaction Unlit Valtn- Amount 12/04/09 Transfer To ALIC FIXED ACCOUNT ONE YEAR N/A N/A $57,78170 12/04/09 Transfer To ALIC FIXED ACCOUNT ONE YEAR N/A N/A $16,56494 Your Total Annuity Value as of 12/04!09 60.00 1 DO66UZY8.N01 6N000Q00lBU2Yl00lBU2YlOOOOf IM~1176 REV-1511 EX+ (10-09) pennsytvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE N~IM~ER WILLIAM N MONN 2109-108 Decedent's dabb must be reported on Schedule L ITEM A. FUNERAL EXPENSES: I' FUNERAL HOME 2 ADMINISTRATION & FEES 3 EMS a MINISTER 5 FUNERAL s TRAVEL B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP _'~ Year(s) Commission Paid: Z• Attorney Fees: 3. Family Exemption: (If decedent's address Is not the same as claimant's, attach explanation.) Claimant Street Address City State Z1P Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees:. 7. TOTAL (Also enter on Line 9, If more space is needed, use additional sheets of paper of the same size. n~ 7,126.42 1,017.40 317.42 100.00 500.00 800.00 50.00 10,311.24 i PXTRIEK F. EYBRi~f. JR. .Ili T 23si7814 ~~ ~tA ~. k ~'IE. Fex 293Q9Yx J954N~~. Eor lht Sest-oc of M. V -i ~ G>rryecw:~.e_`.,x~ u1. lYluutl 1 A. QF~CEi FOe SF~6'Pb': . 1. P&~AONAC 5 p t~ Sentw nFf'tmertl Deafod5u11 ... S ~~~ Embdmfaf . ........ .:.... f _~ p'epsrns°° of bah ~ .. y fired Mich i )1-we re minhedb~ kwe or b~ a ometer~ ar aeoeswr w me m~ It~f, we will acplin m wAt= aYq. Yoa do ool.6ew: r pn for mkeH~ ~{, we nle eap4in AT fxlow Drs o{ Dntr f/ll.tl '~;~/~ t Adder ::~/' , Gq •.-.~.. .,Snic . Ofine doVfiMg . ~ f Caeo~liuriiit ............... f i> ~~~~ OT}ffA ........................ f / ,, ........ ..... S surfn~xoFFeloru~s» .. _...... 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S .~ '. i~ ~ ~"~E/i ......,. f Ysak Ser.ke'C.~a~c. ~.!A~Q~~ 7 - Sj lied ndelaay Cr f ~' S l Tani ... S f CakrpBbaMf ~wA ACS dt/ f . t.nCal ...... ........ f . f _. Ottt-0fttnm , ...... S f ! - f. - f f~ ~ SU4TOLU, OF ADVANCES.. ~~ ....... ....... f SUCEOTALOFA17f'Og01iV1:1!@b~1#'...... ,:_ASf Vkch~c~auJp-oa+v~icettroblddo` FEfGI.OF AOPPS51bl7ALb~lfiffi; ~adirlcse dfa m nukedwp) f~ FAGBIFd=S AND AU!©If~fvE (w' _ ._ . ....;.. .. A s.~ ~: t~cE gee cif ..... sufelf~et C~ii.. $'.`e~~,(q^' K .C.~[,.~N!t-; f : l:~'?+y'.tl~ k Ptafndo~'~4cwtcae. }'(~b+oa - - t (Detatpfm)„`p2r`l tii. !t~ a~'/a~A_ _ ~.IfOd AteaSodtr O ,~.r1 . ... Fgafpuer ... .... f W _ Other Racepude ..... .......... S B: Madt•11ee . . .. f ~E (DncAptloe)fpklL~ ` + ~ ~ { ... S o .. t.k + ...:.. M®A>< (ik F6ot 7'0 AdmowledFmtatt nrdt .......... f p1AN('Z ~ ' E ~ .... .... ..... . book(s)..... f '~ v. 1tFwSya~w~F-oe GSA mile -0~ ", Mtataq foldof.~Y.o0~1.%J.{y,..f~~~ .--c.Fi+' ~ l~f Peryvrede .................... f ddubtaffiYued= ors em~atrer ~~ ~.•.1 Tempontrpavetnukc.......... f .. FwLlekKldaS .................. f (fd) (Pathan) er~e.e t+w..tnew.n ~r`aw Fan-ti00 Rnleed 607 umtee uaaa glljiea© .. ~ (Otte) ,: fCJJ i~ c.... it • REV-1514 EX+ (4-09) Pennsylvania DEVARTMENT OF REVENUE Bureau Df Irdividwl Taxes PO Box zeo5o~ HaFristxrq PA 1128-0501 scN~ou« K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-i5oo COVER SHEET) ESTATE OF FILE NUMBER WILLIAM N MONN 2109-1058 This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dat actuarial factors for single-life calculations can be obtained from the Department of Reven Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to th ~ O Will O Intervivos Deed of Trust p Fii1ML~~ ' FETrtN'dN7 DATE C1F'RiRTH ~ `~~ _' ~~LI ¢ ~ to Ot f~ f death prior to 5-1-89, -1-89 to 4-30-99, return. ~4r .. ~ . ~ ~ABL$ ' ^Ufe r 'Term of Years ^ Ufe r Term of Years ^ Ufe r Term of Years ^ Ufe r Term of Years ^ Ufe r !Term of Years i 1. Value of fund from which life estate is payable .........................................$ I ~ 2. Actuarial factor per appropriate table ................................................ Interest table rate - ^ 3.5°k ^ 6% ^ 10% ^ Variable Rate % '% 3. Value of life estate (Line 1 multiplied by Line 2) ....................................$ .-.,._ NAME QF. LTFE Aftl*lt1TTAHT DATE :Ott B1•Rt'ffi ' '`d ~ AIV Z•~ PilYABLE WILLIAM N MONN 01/07/1927 83 ^ Ufe ~ Term of Years 15 ^Ufe r ~] Term of Years ^ Ufe r '.Term of Years ^ Ufe r Temt of Years 1. Value of fund from which annuity is payable ...........................................$ II i 81,584.00 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - D Weekly (52) ^ Bi-weekly (26) ®Monthly (12) ~, D Quarterly (4) ^Serni-annually (2) ^ Annually (i) ^ Ckher ( ) ', 3. Amount of payout per period ........................................................$ ' 625.75 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... ' 7,509.00 5. Annuity Factor (see instructions) ~, Interest table rate - ^ 3.5°k ^ 6% ^ 10% ^ Variable Rate 3.2 % ~i 9.83620 6. Adjustment Factor (See instructions.) ................................................. i 1.01460 7. Value of annuity - If using 3.5, 6, or 10°h, or if variable rate and period ', payout is at end of period, calculation is Une 4 x Line 5 x Line 6 ................... ~, 74,938.32 If usin variable rate and eriod a out is at be innin of eriod calculation is 9 ~ P P Y 9 9 P ,...,...$ (Line 4 x Line 5 x Line 6) + Line 3 ...............................................$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on S ebules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Unes 13 and 15 th ugfh 18 of the return. If more space is needed, use additlonai sheets of the same slze. • _. ~Ux rasa 1 VL L I~CrY~i01~~01'YU~SS~ A~xlc~! » ~» 4n~ne Se~rvloe and Transa+ctJans ~ Account Profile - ANNUITIZATION _ nd w Account Proflte ~ Activity ~ Checks issued ~ Ar Transaction Wizards '~I j AAove Money Move Money New Money in 'i Out of Account Within Account ~ i i Previous Account Lasi~ Account Ownership Information Account #: 0000 0930 0777 2060 3 004 Account Status: ACTIVE ' Opened Date: 07/11/2006 Ownership: WILLIAM N MONN Plan Type: NON-QUALIFIED Associated TIN: 17420-8128 Taxpayer's Cun'ent Age: 82.8 Associated Group IDs - Select Group Account List Group ID Group Type 0251 8975 4 001 HOUSEHOLD Associated Client IDs - Select Client Profile Client ID Client Name Role .1024 3387 7 001 WILLIAM N MONN OWNER ANNUITA TAXPAY R Benefrcia Information PRIMARY BENEFICIARY Request Spelling Co ~relctlon - RICHARD MONN SON 100.00% ~ SECONDARY BENEFICIARY ! '~ ~ JEREMY MONN GRANDSON 100.00% 'i '~ ut Status: In ~~ https://www8.ex.is.ameriprise.com/Ost/Secure/AccountProfile/AccountProfile.asp?a1K~y~.. 11 /17/2009 i v .~ 1 0.V L Vd G Payout. T INSTALLMENT FOR 15 YEAR PERhDD Allocain - Ft 1 D% Allocation ~-1~~wle: ~% Perc~n# of S~p~d Increase: ~% Fixed urn; ~635i.75 Federal Tax Withho~ng %: ~% State Tax' .' , hd~iing %: ~% Frequency: MONTH LY Next Payout Date: 12/O 109 Payout Start Date: 08f I(~6 Value at Settlement: ~81,5i. .00 Last Guaranteed Payout Date: 07/08/2 i21 Payouts' in 2Cn}9.` $6,883 .25 Taxable An~u~tt ~ir~: 2009: $3,214 53 Payouie to Date: $25,030 00 Delive~,r 4~rtion: DIRECT DEP iIT Corn>knlab~,e .Values VALIJES~.hIC-T AVAILABLE Address ~ ; :. Address: C/O ESSEX HOUSE 20 N 12TH ST APT 222 LE~AOYNE PA 17043-1450 Privacy Copyright ®2008-2009 Ameriprise Financial. All RiBhta bound by ~s >a> of the Amerprise-Web Users of this site agree to be end Regulations. https://www8.ex.is.ametiprise.com/Ust/Secure/A~ccountFrofileJAccountPra~le.asp?a1Key... i 1/17/2009 N~RTEL NORTHERN TELECOM ~0.~~~ l a.,~1s~',-~ e~ ~ ~.~„ oaf ~~ ~-~ "^~- fem.-rte, ~ (~ w,,~~ ~~~:~ Dick Monn ~o x~~ lid h~ 8~~ ijQl ;; ~ I~t ~" ~ t~~~ ~~~~ ~~~~Li ~Li~~`~~i a '~ ~Y-CtASS~£~~'VF.R ~{ A ,' `~< ~`~, rx 4 !~`"~ "" '.. '~» .: >. ~. ~3 ~~ ~~ ~~ax O _~~ >{ ~: s •.s (~ ~.-.~1 ~ -~ ~'' - w ~~ ..:: ~ a ~. ~~ o .,_: ~,` r ~ ~~ ~~ ~ ~~ ~ ~_ ~~~~ ~~ t ~ .~ ~ ,~.. ~? ~ i tOZ r~~'~~'~'~ n'"` ~i~~ i~~~ ~ t , ~ ~; ~:,