HomeMy WebLinkAbout05-12-111505610148
OFFlCIAL USE ONLY
REV-1500 EXt°'-'°'
PA Depanment a Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN 21 11 0 311
PO BOX 280801
Haiti:burp, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFOII;MATION BELOW
Social Security Number Date Of Death MMDDYYYY Date Of Birth MMDDYYYY
182-16-9403 02282011 09111918
Decedent's last Name Suffer Decedent's First Name M I
STOESSEL ELIZABETH B
(If Applicable) Enter Surtfiving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse`s First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
(date of death
^ 3
r R
d
e
t
® 1. Original Retum ^ 2. Supplemental Retum . pr or to
82~
2
a
-
^ 4. Limited Estate ^ ~omise (date of
4a.
er
~ ^ 5. Federal Estate Tax Return Required
2 12 8
death afte
l
® 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8: Total Number of Safe DeposR Boxes
(Attach Copy of 1!lfilq
^ (Attach Copy of Trust)
9113(A)
tion to tax under Sec
^ 11
El
^ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) .
.
ec
(Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
Name
VANCE E• ANTONACCI, ESQ•
First line of address
570 LAUSCH LANE
Second Ifne of address
SUITE 200
City or Post Office
LANCASTER
CorrespondenYa e-mail address:
State ZIP Code
PA 17601
717-581-3701
~ -
REGISTERt3FV(~DLS USE ONLY
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DATE FILED f is
Under pensJMs a perjury, I declare t have h return, Induding amompanying schedules and statements, and to the best a my xnoMneoge ane Dare,
it is true, ~~d complete. De iat n yf p aror oth r than the personal representative Is based on all information a which Preparsr has any knavledge.
1 8 SHETLAND DR ,f HUMMELSTOWN, PA 840 (ALEXANDER SPRING RD-, CARLISLE
sIGNATURE OF PREP ER OTHER THAN REPRESENTATNE , ~~ 1„ `
MCNEES WALLACE 8 NURICK LLC, BY=
570 LAUSCH LANE, SUITE 200 LANCASTER, PA 17601
PLEASE USE ORIGINAL FORM ONLY
Side 1
150561D148 15D5610148
aM4647 4.000
1505610248
REV-1500 FCC Decedent's Soaal Security Number
182-16-9403
Decedent'sNeme STOESSEL ELIZ ABE TH B
REC APITULATION
1. Real Estate (Schedule A) .. .. ...... ........ ....... 1 0 • 0 0
2. Stocks and Bands (Schedule B) ......................... 2, 0 • 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3, 0 • 0 0
4. Mortgages and Notes Receivable (Schedule D) .... 4. 0 • 0 0
5. Cash, Bank Deposits and MisorJlaneous Personal Property (Schedule E) 5. 2 6 4 • 0 2
6. Jointly Owned Property (Schedule it ~ Separate Billing Requested g, 3 ,19 3 • 2 3
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly
arate Billing Requested ....
~ Se
7.
2 6 9 , 2 0 2 • 5 3
p
(Schedule G)
8. Total Gross Assets (total Lines 1 through 7) ............... g, 2 7 2 , 6 5 9.7 8
9. Funeral Expenses and Administrative Costs (Schedule H), .... .9. 8 , 17 3 • 4 6
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) , , . 70. 4 , 874.13
11. Total Deductions (total Lines 9 and 10) , ............ t t . 13 , O 4 7.5 9
12. Net value of Estate{Line tl minus Line 11) , ............. t 2. 2 59 , 612.19
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) , , .......... 13. 5 0 0 • 0 0
14. Net Value Subject to Taz (Line 12 minus Line 13) .... 14. 2 5 9 ,112.19
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rake, or
transfers u Sec; 9116
(a>(t.2>x.o~ 0.00
t5.
0'00
16. Amount of Line t44t~~e
at lineal rate X .0 -. 2 5 9 ,112.2 0
16. 11, 660 • 05
77. Amount of Line 14 taxable
0.00
at sibling rateX.12 0.00 17.
18. Amount of Line 14 taxable
at collateral rate X .l5 0.0 0
18.
0 • D O
19. TAX DUE ...... .... .. ... ... ....... ....... 19. 11, 6 6 0.0 5
20. FILL IN THE I~OX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Slde 2
15D5610248 1505610248
9M464B 1.000
REV-15D0 EX Papa 3
Flk Number
~ i. ~. T. n ~ T. T.
Decedents Com Iete nuaress: ~ y y y --
DECEDQ•IT'S NAME
STREET ADDRESS
STATE ZIP
crrY P _
M A
Tax Payments and Credits:
1. Tax Due (Page 2, Line 18)
2. Credks/Payments
A. Prior Payments 0 ' ~ 0
B. Discount 5 8 2.9 9
(1) 11, 660.05
realcredna(A+B) (2) 582.99
3. Interest
(g) ~ • ~ ~
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. O • O O
Fill in box on Pag• 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the d'dference. This is the TAX DUE. (5) 11 , ~ 7 7 ' 0 6
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 inP.ome of the property transferred : .......................
b. retain the right to designate who shall use the property transferred or its Income; ... ......
c. retain a reversionary interest; ar ............................ ..... .
d. receive the promise for I'rfe of either payments, benefits or care?
2. If death occurred after Dec. 12, 1982, did decedent transfer properly within one year of death ^
without receiving adequate conaidaration? • • ' ' ' '
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 a AND FlLE IT AS PART OF THE RETURN.
Far dates of death on or after Jury 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9118 (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 PS. §9116 (a) (1.1) (ii)]. The stat4te does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only benefidary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceased child 27 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. §9110(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §8116(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.5. §9118(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.
9M4671 2.bW
REV•1508 EXt (11-10)
Pennsylvania
DFPARfNENfOF REVENUE
Re-ERITANCE TAX RETURN
RFSOQJf DECEOEM
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE
ESTATE f)F: 21 11 0311
4l4 vnlvetl•. R. Rt[]eBH81
OW46AD 2.000 If more space is needed, uae addMlorud afarots d paper dthe same sire. '
REV-1509IX* (01-10)
pennsylvania
D(PARTMBJT DF REVBIUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-0WNED PROPERTY
FILE NUMBER:
ESTATE OF:
Elizabeth 8. 3toesael 21 li 0311
M an suet became lohtly owned wltlYn one year of the decedent's dab of death, it must be reported on Schedule li
SUFNNNG JONf TBJAM(S) N41d{S) I AODFi~S I RB.ATIONSIf TO OEC®HJT
A Wyrick, Merrie B
JOINTLY OWNED PROPERTY:
840 Alexander Spring Road,
Carlisle, PA 17015 Daughter
rtBA
HLtYB~
It1TER
FYNtJpHf
TENPNT
GATE
lYt4~ 1
,IOMr
11LLUOE INI.E61~ Uf10NA~1Rr M1MBER pt 81MUR
RR[MI%RgMMER ATTAd10EE0 fO1JmlTLT MEIDREAL E6TATE.
GATE OF 064TH
VALUE OF ASSET % OF
OEC,~BdI's
tQTf326T a4rtoF DEATH
VALUE OF
.j,$~T
1 A 9/27/199 $NC Bank Checking Account
#5000000978 6,386.46 50.0000 3,193.23
TOTAL (Also enter on Line 6, Recapitulation) i 3 ,193.23
ewseAE z.ooo H more speoe is needed, use additional sheets of paper of the same size.
REV-1510 EX + (09-09)
Pennsylvania
DEPARTMENT OF REVENUE
INFtER17'ANCE TAX RETURN
RESIDENTDECEDENi
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
wih~cvr 21110311
Elizabeth B. Stoessel
This schedule must be completed and filed if the answer to any of questims 1 through 4 On page three of the REY-1500 Is yes.
ITEM pESCRIP110N OF PROPERTY
~Ll1~ETlENA1EOFTETMMF6i~.T19ItRHATOMI~P TO OEC®FM M'D
DATE OF DEATI'I
~1OF DECD~S EXCLUSION
' TAXABLE
VALUE
NUMBE 71ED51EOP1RN8FHIATTMl7AGOW QF TI£D®FOR REN. ESTATE VALUE OF ASSET R~REREST R~GBL
A!
~• Morgan Stanley Smith Barney
21
97
205
259
100.0000
0.00
259,205.97
Account No. 410-017997-0 .
,
The TOD Beneficiaries aro as
follows:
K. Rodney Stoeasel, Son
Donna L. Salerno, Daughter
Timothy Dallas, S!on
Merrie B. Wyrick, Daughter
2 RiverSource life Insruanee
Company, Annuity Policy No.
996.56
9
100.0000
0.00
9,996.56
9300-4065204 ,
Beneficiaries:
K. Rodney Stoessel, Son
Donna L. Salerno, Daughter
Timothy Dallas, Son
Merrie B. Wyrick, Daughter
TOTAL (Also enter on line 7, Recapitulation) S I 269 , 202.53
H moro apace Ia needed, use eddltbnel ahaats of paper of the same aixe.
BW4MF 2.000
REV-1511 EX+(ta0~
Pennsylvania
OFPPR1bE1dr OF REVENUE
rJ£PoTANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
RE50>ENr~oENr FILE NUMBER
ESTATE OF
izabeth B Stoessel 21 11 0317
Decedent's debts must be reported on Schedule I.
REM DESCRIPTION
NUMBER
A. FUNERAL EXPENSES:
~ Fairland Brathern and Christ Church
funeral lunchmon
* bills ware paid from non probate assets
Total from continuation schedules .
B.
1
2.
3.
4.
5.
6.
7.
1
gpNpNISTRATYJE CASTS:
Personal RepresantatNe Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commissign Paid:
State ZIP
Attorney Fees:
Family 6cemption: (If decedent's address Is not the same as daimanYs, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
McNees Wallaa7e 6 Nurick LLC
Coats:
File Inh. Tait Return $ 15.00
File Inventory 15.00
Postage and copies 20.00
Total from continuation schedules .
200.00
5,562.14
1,500.00
113.50
50.00
747.82
9W48AG 2.000
TOTAL (Also enter on Line 8, RerapN
If more space Is needed, use ~ditional sheets of paper of the same size.
AMOUNT
8,173.46
Estate of: Elizabeth B. 3toessel
Schedule H Part 1 (Page 2)
21 11 0311
Item Amount
No. Description
2 Wrap 'N Go Florist
funeral expense
* bills were ~sid from non probate assets
3 Kreamer Funeral Home
funeral expense
* bills were paid from non probate assets
Total (Carry forward to main schedule)
357.75
5,204.39
5,562.14
Estate of: Elizabeth B. Stoessel
Schedule H Part 7 (Page 2)
2 Merrie B. Wyri~ck
reimbursement 'for cost of EIN, Short Certificates
and extra Death Certificates
* bills were paid from non ,probate assets
3 Cumberland Law Journal
cost of advertising and proof of publication
* bills were g>aid from non probate assets
4 Hamilton 6 MuBSer
2010 tax prephration fee
* bills were paid from non probate assets
5 US Postal Serivice
cost of Certified Mail
* bills were paid from non probate assets
6 Verizon
telephone sezirice
* bills were paid from non probate assets
Total (Carry forwards to main schedule).
21 11 0311
377.30
75.00
255.00
15.78
24.74
747.82
REV-1512 EX+(12-08) SCHEDULE
Pennsylvania
OEPARfAENr OF REVENUE DEBTS OF DECEDENT,
tJ£FiITM1CE TAx RENRN MORTGAGE LIABILITIES & LIENS
FILE NUMBER
ESTATE OF
Elizabeth B. Stoessel 21 11 0311
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmbureed madkal expanses.
VALUE AT DATE
ITEM DESCRIPTION OF DFATH
NUMBER
~• Donna L. Salerno
reimbursement
* bills were pai$ from non probate assets I 30.39
2 Alert Pharmacy
medical expense
* bills were paid €rom non probate assets I 147.74
3 IPA Department of Revenue
2010 Personal Income Tax due
* bills were paid from non probate assets I 26.00
4 IMesaiah Village
services rendered
* bills were paid from non probate assets I 4,670.00
TOTAL (Also enter on une i v, Ke
BWesAN 2.000 If more space is needed. insert additlonal sheets of the same s¢e.
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVeNUE
INHERfrgNCE TAX RETURN
~RESIDENTDECEDENT
1
SCHEDULE J
BENEFICIARIES
1. I
2
3
NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY
TAXABLE DISTRIBUTIONS I~ Se~C. 9~1 8 (a)r(1 2).j s~~~s ~ t~ansrera under
K. Rodney 3toessel
118 Shetland Drive
Hummelstown, PA 17036
One Quarter of Residue: 64,778.05
Donna L. Salerno
1080 Schoolhouse Road
Annville, PA 17003
One Quarter of Residue: 64,778.05
Timothy D. Dallas
18465 17th Avenue NW
.Seattle, WA 98177
One Quarter of Residue: 64,778.05
FILE NUMBER:
21 it 0311
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Son
Daughter
ISon
64,776.05
64,778.05
64,778.05
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
NON-TAXABLE DISTRIBU170NS
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
i
B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS:
1~ see Attached
OF PART II -
ew4sAl 2.000
TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER
more space Is needed, use a~Mional sheets aT paper of the same sue'.
Estate of: Elizabeth B. 3toessel
Schedule J Part 1 (Page 2)
Item
No. Description
4 Morrie 8. Wyrick
840 Alexander Spring Road
Carlisle, PA 17015
Relation
21 11 0311
Amount
Dau hter 64,778.05
One Quarter of Residue: 64,776.05 g
Estate of: Elizabeth B. Stoessel
Schedule J Part 2B (Page 1)
21 it 0311
Item Amount
No. Description
1 Messiah Village Endowment Fund
100 Mount Allen Drive
Mechanicsburg, PA 17055
500.00
Cash Bequest 500.00
..... :::.,:, . ," , ... , :. ; , a.
,. ,.. ~ ::._ T,
.- _. , ,
l
~> _
~i J
•:~
L ~~
WILL - ~ ~_ ~- ~ _~
OF ` J "=~
'~~ _ ~~;
ELIZABETH B. STOESSEL
LIZABETH B. STOESSEL, alk/a ELIZABET declare thisso be my Last1W 11
I, E Cumberland County, Pennsylvania,
Upper Allen TovwnshiP, and all prior Wills and Codicils made by me.
and Testament. hereby revoking any enses be paid from the assets of my
I. I direct that all my just debts and funeral exp
racticable after my demise.
estate as soon a~s p
I duect'that all estate and inheritance taxes fatal a fate to the same effect as f said
II' rinci al of my gener
my death, shall be paid out of the p P e includable in my taxable estate
taxes were e peassing and 1this~Wi11 shat belfree and clear thereof.
whether or no p
III. I bequeath unto my husband, Keaneth F. Stoessel, all tangible personal property
which I own at my death.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
ro er over which I hold a power of appointment, I devise and bequeath
situate, including p P n'
unto my husband, Keruteth.
6 Kenneth, does not survive me, I devise and bequeath
V. In the event that my husband,
rn entire estate that would have otherwise passed under Paragraphs III and IV above as
Y
follows:
A. I bequeath the sum of Five Hundred Dollars 0500) unto Messiah
Village, Mechanicsburg, Pennsylvania, to be used in its Endowment Fund.
B. The remainder o e eases mei h svor hers hareu hall passllunto hi or
children. If any child pred
her issue per sti~pes. If said child~e other ~li ldren orahearissuelpeaptped
be added to the shares passing to y
f.-
--~~ r
VI. I appoint my husband, Kenneth F. Stoessel, Executor of this my Will. IKt Rodney
that he fails to qualify or ceases to act as Executor, I appoint my children,
Stoessel and Me~rie Beth Wyrich, Executors, or the survivor of them as sole Executor, of this
my Will.
VII. I direct that no bond be required of my fiduciaries for the faithful performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, I, ELIZABETH B. STOESSEL, herewith set my hand to
this my Last Will, typewritten on two (2) sheets of paper including the attestation clause and
signatures of witnesses, this z ~~ day of S,gNd~2~ , 1998.
> ~ - ~~(SEAL)
ELI ABETH B. STOESSEL
Signed by ELIZABETH B. STOESSEL, by her declared to be her Will in our
presence, who have hereunto subscribed our names as witnesses in her presence and at her
request, this ~~-J~ day of T~FN~ ~2t , 1998. ~/
residing at /,~~u-~~:L.QI~.~ ~
~~~ ~ Q_ residing at ii~~
-,
-2-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~ ~~ ~.i ~ s ~ ~~ id ~
WE, ELIZABETH B. STOESSEL, ~F~'~`' S• ~P-` "'f £ ~ ed to the attached
,the testatrix and the ~~ fir t dul p affirmedWdo herebye declare to the "n ae~a~erie
or foregoing instrument, being Y
authority that the testatrix signed and exoe~lue a ots gn fo~)nand that she ex 1 uted it as her
signed willingly (or willingly directed an
•ee and voluntary act for the pu-poses therein ex er We das w messes and that t 1 he best of
fi of the testatrix, signed th
the presence and hearing
r knowledge the testatrix was at that time eighteen years of age or older, of sound min
ou
and under no constraint or undue influence.
ELIZ ETH B. TOESSEL
ITNESS
~ ~~~
TNESS
Subscribed, sworn or affirmed and acknowledged before me by ELIZABETH B.
~` , f_',~c s T. '[3~2~us E 2 and K~NKf7'`~ d' S Yo £~St i_ ,
STOESSEL, the testaaa ' of TA ~~ ~ ~~>
~ 1998.
witnesses, this ~ ~ y
n <
tary Public
(SEAL) ~...~...~ ,_, ^ ~.,....,. _
4 ~~,
^W7 Crtr^'_..R J w' 1'wn^
~1~ ~ ~~~~ , ~~P N IWIW
~, L 6spNy. Hptsry~~ County ~
U~ ESC ~ n. 13.2002
-J-
ux5~ n ~
4
"4 h >n
[; i.
! PI~IC
LF.ADING'7H~ WAY
April 15, 2011
Merrie B Wyrick
840 Alexander Spring Rd
Carlisle, PA 17015
RE: Elizabetlu B Stoessel
SSN: 1$2-16-9403
DOD: 0~-28-2011
Dear Sir/Madam:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Account
Account # SOOp000978
ELIZABETH B STOESSEL
MEggIE B WYRICK
Established: 09-27-1996
DOD balance: $ 6,386.47 non. interest bearing
CDs, Checking and
Please. note that this office provides date of death balances for deposit accounts (IR.As,
Savings). We ~o not process any financial transactions or provide statements. If you need assistance with
any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank, Iy'.A.
Member FDIC
This message!, is intended for the use of the individual or entity to which it is addressed and may
contain inforrnation that is privileged, confidential and exempt from disclosure under applicable law.
If the reader lof this message is not the intended recipient or the employee or agent responsible for
delivering thfs message to the intended recipient, you are hereby notified that any dissemination,
distribution qr copying of this communications is strictly prohibited. If you have received this
communication in error, please notify me immediately by reply or by telephone at 800-762-1775 and
immediately (destroy this faxed document.
Page 1 of 1
RiverSource Lite Insur~lnce Company
70100 AmeriPrise Financial Center
Minneapolis MN 55474
An Ameripnse Financial company
March 15, 2011
MERRIE BETH WYRICK
840 ALEXANDER ~PRING RD
CARLISLE PA 17415-9182
DEAR MRS WYRICK:
((~~~ ~ D~ l.l.S
St~o ~~ ~+
Q ~~ a Y-c.
~~~ ~~
Please accept our condolences.
The attached 1$heck for $2,499.14 represents the death benefits due you under
this contract,
2,499.14
Base plan benefits: $
went: $2,499.14
Total pay
If you have questions, please contact us Monday through Friday from 8 a.m
to 5 p.m. Ceb,tral tine. Thank you.
RiverSource A~nnuit Claims
(800) 862-7919
RrorSouru LId dao acd M PnnciWl
Inaunnen and ~nnmti~~ ~an ~pund by RrvnrSau~ra Ldn liaunnu Co~nWnY PRiwrSoura Lid') ~n MMripriu FiMnnal comPnM'
in tlr nN~ and dsViOyllon did aruld mnulq cnntrKa and wriuWn lid imurann pohor. OIMr inWrmnuon nOdMmp d>•cN~on dl tlw IoMKpon mdudmp
tM tirtw of M~ tr~n on will b~ provided upon wiMn n9wst
. OGL•LSOWp 101lP0071
Claim Number 468483
Policy Number: ELOIZABETH2L4STOESSEL
-Detach AnG Ratan( Flr Your Records
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