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HomeMy WebLinkAbout03-12-121505610140 '~ REV-1500 EX `°'-'°' OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 2 1 1 1 0 9 2 3 Harrisbu PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 1 9 1 1 8 2 1 0 1 0 8 1 2 2 0 1 1 0 4 0 7 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI P A L M E R J R W I L L I A M ~ (If Applicable) Enter Surviving Spouse's Information Below 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 MI FILL IN APPROPRIATE OVALS BELOW 1.Original Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) Q 6. Decedent Died Testate ~ Living Trust . ~' De~ us ~ _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) 9. Litigation Proceeds Received ~ h Copy o Tr ) ( death 10. t 1a 9C l ~ ohnSto O) nder Sec. 9113(A) 11. (At~i 95) 1 and 2 31 between c CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTU-L TAX INFORMATION SHOULD BE DIRECTED T0: Daytime Telephone Number Name R OG E R B - I R W IN E SQ UIRE 717 2c49 2~.~53 - ,-- .z, First line of address I R W I N & Second line of address 6 0 W E S T City or Post Office C A R L I S L E M c K N I G H T P C P OM F R E T S T R E E T State ZIP Code P A 1 7 0 1 3 C = Z~ C? /i ....i l J ~'~\ -- `c _,-, --~ ~~ DATE FILED -~ r _ ~_ -~, i . __,) -~}"'t :. :~;; .~ r-n ~~ Correspondents a-mail address: 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 all information of which preparer has any knowledge. SIGNATyRE~AF PERSON RES~p~sIBLE FOR FILING RETURN DATE ADDRESS IJAMSVILLE MD 21754 3117 PHEASANT RUN DAT SIGNATURE OF P EP RER OTHER ~jiAN{~~i?ESENTATIVE ~ ~ i ADDRESS, ,(~ .,~~ CARLISLE PA 17013 60 WEST POMFRET STREET PLEASE USE ORIGINAL FORM ONLY 1505610140 Side 1 1505610140 USE :=::r I~~ J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: WILLIAM J• P A L M E R~ J R 1 9 1 1 8 2 1 0 1 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1 • • 7 8 8 7 9.3 2 2. Stocks and Bonds (Schedule B) ...................................... 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 2 4 7 2 3 7.6 2 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 2 5 9. 2 6 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property ~ Separate Billing Requested ....... G 7. ) (Schedule a 3 2 6 3 7 6. 2 0 .•..•...•..•. 8. Total Gross Assets (total Lines 1 through 7) ............. . . 9 1 4 5 7 5. 0 4 •.....,...... 9. Funeral Expenses and Administrative Costs (Schedule H) .... . . 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 64 3.62 11 1 5 2 1 8. 6 6 11. Total Deductions (total Lines 9 and 10) .............................. . . 12 3 1 1 1 5 7. 5 4 12. Net Value of Estate (Line 8 minus Line 11) .......... • • • • • • • • • • • • • • • • • • • 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 • an election to tax has not been made (Schedule J) .. • • • • • • • • • • 14. Net Value Subject to Tax (Line 12 minus Line 13) . ........ . ...... 14. 3 1 1 1 5 7. 5 4 TAX CALCULATION -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 16. Amount of Line 14 taxable 3 1 1 1 5 7. 5 4 1 s. 1 4 0 0 2. 0 9 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 ..... 1 s. . 1 4 0 0 2. 0 9 19. TAX DUE .............................. ................. . 20. FILL IN THE OVAL IF YOU ARE REDUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 0923 DECEDENT'S NAME WILLIAM J. PALMER, JR STREET ADDRESS 1 LONGSDORF WAY CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 10,500.00 B. Discount 552.62 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 14,002.09 Total Credits (A + g) (2) 11, 052.62 (3) (4) 0.00 (5) 2,949.47 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ X^ 3, Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1,1994, and before 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. §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 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 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 4.5 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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM J. PALMER, JR 21 11 0923 All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1,687 SHARES OF PNC FINANCIAL SERVICES 78,546.72 2. X10 SHARES OF METLIFE, INC. STOCK ~ 332.60 TOTAL (Also enter on line 2, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY WILLIAM J. PALMER, JR 21 11 0923 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SOVEREIGN BANK -CHECKING ACCOUNT #2891037405 78,124.78 2. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT #2895555213 63,428.60 3. SOVEREIGN BANK -CERTIFICATE OF DEPOSIT 2895555221 63,370.18 4. NORTH AMERICAN COMPANY -ANNUITY CONTRACT #: 60 S746 42,314.06 BENEFICIARY: THE ESTATE OF WILLIAM J. PALMER, JR. TOTAL (Also enter on Line 5, Recapitulation) I $ 247,237.62 If more space is needed, insert additional sheets of paper of the same size REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: -- WILLIAM J. PALMER, JR 21 11 0923 If an asset was made jointly owned within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) A. WILLIAM J. PALMER, III 13. c. JOINTLY•OWNED PROPERTY: 3117 PHEASANT RUN IJAMSVILLE, MD 21754 ADDRESS RELATIONSHIP TO DECEDENT SON ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 02/2010 SOVEREIGN BANK 518.52 50. 259.26 CHECKING ACCOUNT #1151155160 TOTAL (Also enter on Line 6, Recapitulation) I $ 259.26 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILLIAM J. PALM__ER J_R______ 21 11 0923 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) SVeet Address City State ZIP Year(s) Commission Paid: 2. AttomeyFees: IRWIN & McKNIGHT, P.C. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 5 Accountant Fees: 6. Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 9. THE SENTINEL -ESTATE NOTICE 10. NOTARY 11. SOVEREIGN BANK -DATE OF DEATH VALUATION 13, 500.00 370.50 375.00 30.00 75.00 189.54 15.00 20.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 1 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS FILE NUMBER WILLIAM J. PALMER JR 21 11 0923 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM -- NUMBER DESCRIPTION VAOF DEATDHTE NORTH AMERICAN COMPANY -REIMBURSEMENT OF ANNUITY PAYMENT 643.62 TOTAL (Also enter on Line 10, Recapitulation) I $ 643 If more space is needed, insert additional sheets of the same size. REV-151;1 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES ~~rxr~vr: WILLIAM , NUMBER I. 2 JR NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (12).] WILLIAM J. PALMER, III 3117 PHEASANT RUN IJAMSVILLE, MD 21754 JAMES T. PALMER 15311 HEATHRIDGE DRIVE TAMPA, FL 33625 FILE NUMBER: 21 11 0923 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal I 155,578.77 Lineal I 155,578.77 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1500 COVER SHEET AS APPROPRIATE II. NON TAXABLE DISTRIBUTIONS. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 13 If more space Is needed, use addltlonal sheets of paper of the same size. ~~t ~i11 ~tt~ C~TP~t~k I, WILLIAM J. PALMER, JR., of the Township of Stroud, County of Monroe and Commonwealth of Pennsylvania, being of sound mind, memory and understanding., do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all wills and testaments or writings in the nature thereof by me at any time heretofore made. ARTICLE I I hereby order and direct my Executrix, hereinafter named, to pay all my just bills, not barred by the statute of limitations or other law, and expenses of my last il~ess and O T :,T- funeral expenses as soon as conveniently possible aft ~c~Y v r decease. ~.~: 9 ~- ~c :iCJ-r - . JC - Tl ARTICLE I I ~ ~ ~ --~ <•: ~-~ ~ "i: 2 give, devise and bequeath all of my. property and estate, real, personal and mixed, of whatsoever kind and nature and wheresoever situate, to my wife, GRACE K. PALMER, provided she survives me for a period of thirty (30) days. ARTICLE III In the event my wife, GRACE K. PALMER, and I shall die simultaneously or should she predecease me or die on or before ~ the thirtieth (30th) day following my death, then I give, devise and bequeath all of my property and estate, real, personal and mixed, of whatsoever kind and nature and wheresoever situate to my two (2) children, WILLIAM J. PALMER III and JAMES T. PALMER, ~~-~ illiam J. Palmer, Jr. share and share alike. In the 'event either of my said two (2) children should predecease me, then the shale of such deceased child shall pass to his lineal descendants who do survive me, share and share alike. ARTICLE IV In the event one of my children should predecease me and the lineal descendants of such deceased child shall not have attained the age of twenty-one (21) years, then I direct that the share or shares of such lineal descendants shall be held in Trust and I hereby name and appoint the surviving spouse of such deceased child and my remaining child as Co-Trustees until the lineal descendants reach the age of twenty-one (21) years. My Co-Trustees shall hold,.. manage, invest and reinvest the same, and the accumulation of income thereon, and shall use and apply the income and principal or so much thereof as in Co- Trustee's discretion may be necessary or appropriate for the child's support and education, including college education. Any principal or income not so applied shall be distributed to the child absolutely when he or she attains the age of twenty-one (21) years. ARTICLE V I nominate, constitute and appoint my wife, GRACE K. PALMER, as Executrix of this my Last Will and Testament and if she should die, refuse or otherwise be unable to act as such Executrix, 2 then nominate, constitute and appoint my two (2) sons, WILLIAM J. PALMER III and JAMES T. PALMER, as such Co- Executors. ~~ ~ William J, almer, Jr. 2 ARTICLE VI I direct that no bond or other security shall be required of any Executrix or Co-Executor hereby appointed by reason of nonresidence in any jurisdiction in which this Will may be proved, or for any other cause whatsoever. ARTICLE VII I direct that my Executrix and Trustee, if a Trustee is appointed under this Will, in addition to and not in limitation of any authority given them by law, shall have the following powers: (a) To retain all stocks, bonds, and investments owned by me, and to invest-and reinvest in other stocks, bonds and investments, without being confined to what are known as "legal investments," and to sell and transfer the same, either in person or by attorney. (b) To borrow money and pledge any stocks, bonds or other personal property of the estate as security therefor. (c) To exercise any option to subscribe for stocks, bonds or other investments, and to join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which the estate may hold stocks, bonds or other investments. (d) To retain indefinitely any part of the trust estate, real or personal, which is or may become unproductive, or to make sale thereof. (e) To. make distribution in cash or in kind. (f) To collect and receive the proceeds of any life insurance policies and exercise any options deemed favorable to my estate thereunder. IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will and Testament contained in this and the preceding liam J.~ almer, Jr. 3 three (3) sheets, my hand to the bottom of said preceding three (3) sheets,'and my hand and seal to this last sheet this /~~~~~' day of Dece ber, 1987, . ~. •~~~ SE~L ) ILLIAM J. LMER, JR, j" T e writing contained in this and the preceding three (3) sheets as signed and sealed by the above named William J. Palmer and y him published and declared as and for his Last Will and Testame t, in•the presence of us, who have hereunto sub- scribed ourlnames as witnesses at his request, in his presence and in the ~Iresence of each other. ~~r~ ;~_ m .J < o ++{' a Q e;i N \ ` C r, ~ Ci ~ `Ner\`\ `\\ z .~w o i o (~,~ m ~' m _. ~ ~,-~ zo --~ . ~ ~•- 2 ~.... s ~..~ ~; ice' y~ ~`~ -. a ZQ .k ~Q .- N O D ~~ AO ' ~-~, ~ ~ ~ ` ~` D 2 ~~,: m n ~ -L ,,~~ ;~, ; ;; ., ~~ ,,: r,, ,.-. 1.t; ~. ~. i R D 3 2 C ~~~ i ,. 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Yahod! ...Search .. , Search Web _..._... ow 0.93 % Nastlaq ~ 0.86 % ~ ~---~- -- - - HOME INVESTING NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES GET QUOTES Finance Search Thu, Aug 25, 2011, 11:31AM EDT - US Markets close In 4 hrs and 28 mins MetLife, Inc. (MET) E~TRADE MET '; ~ ~~J~~dA - 53195 Historical Prices --...._....._.........._.._............,.~ Get Hlstodcal Prices for: ~ GO Set Date Range Start Date: qu ~ Daily 9 12 2011 Eg. Jan 1, 2010 L Weekly End Date: , Au 9 12 ,2011 r~;Monthly U Dividends Only Get Prices .-.~_.-. Prices First ~ Previous ~ Next ~ Last ~ l Date Aug 12,2011 Open High Low Close 34.06 34.38 33.15 33.26 ' Close price adjusted for dividends and Volume Adj Close' 13,522,800 33.26 splits. ~ a , , a First ~ Previous ~ NeM ~ Last :~I Download to Spreadsheet viNETHEI~ISCOUNT Currency in USD. j ~~ r/A._ n /,~ U' .J J ~ ~ /_-~ At 11:15AM EDT: 3~.9'i • 0.8g (2,12%) CopyrighlQ 2011 Yahool Inc. All rights reserved. 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(CSI).Intemational historical than data, daily updates, fund summary, land Performance. divitlentl data and Momingsiar Index data provided by Morningstar, Inc. http://finance.yahoo.com/q/hp?s=MET&a=07&b=12&c=2011&d=07&e=12&x-2011&g=d 8/25/2011 Sovereign Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. 0. Box 841005 -Boston, MA 02284 September 16, 2011 '~~~~ Roger B. Irwin Irwin & McKnight, P.C. 60 West Pomfret Street Carlisle, PA 17013-3222 RE: Estate of William J. Palmer, Jr. Date of Death: 08/12/2011 Dear Sir or Madam: i~OV 1..7 2011 iRWIN & McKIdIGH f LAW OFFICES Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, uarnna~w~. ong Lead Spe ialist Phone: 6 7-514-51 Fax: 617-5 -193 Sovereign Bank ESTATE OF William J. Palmer, Jr. SOCIAL SECURITY #: 191-18-2101 DATE OF DEATH: August 12, 2011 Account #: 1151155160 Type: Checking Open date• 2/1/2010 In the name of: William J. Palmer, Jr. or William J. Palmer, III • Date of Death Balance: $518.52 Int.(YTD) from 1/1/2011 to 8/4/2011 $0.00 Accrued interest to date of death: $0.00 Other Info: Account #: 2891037405 Type: /~~ Checkin In the name of: William J. Palmer, Jr. or Grace K. Palmer (William J. Palmer,III, pOA) /1/1996 Date of Death Ealance: $78,124.78 Int.(YTD) from 1/1/2011 to 7/18/2011 $125.91 Accrued interest to date of death: $13.71 Other Info: Account Closed 08/31/2011 Account #: 2895555213 Type: Time Deposit Open date: 6/4/2011 In the name of: William J. Palmer, Jr. (William J. Palmer, III, POA) Date of Death Balance: $63,428.60 Int.(YTD) from 1/1/2011 Accrued interest to date of death: to 7/31/2011 $46.41 Other Info: Account Closed 08/31/2011 $176.06 Account #: 2895555221 Type: Time De osit p Open date: 6/4/2011 In the name of: William J. Palmer, Jr. (William J. Palmer, III, POA) Date of Death Balance: $63,370.18 Int.(YTD) from 1/1/2011 to 7/31/2011 $117.65 Accrued interest to date of death: $31.00 Other Info: Account Closed 08/31/2011 Account #: 2891024265 Type: Money Market Open date: 5/12/1997 In the name of: William J. Palmer or Grace K. Palmer (William J. Palmer, III, POA) Date of Death Balance: Closed prior to death Int.(YTD) from to Accrued interest to date of death: Other Info: Account Closed 08/06/2010 $543.44 Page 1 of 1 ®North American Com an for Life and Health Insura p Y nce A Member of Sammons Financial Group Lisa Olson Repetitive Pay Specialist Phone: (800) 733-2524 • Fax: (877) 841-6706 • e-mail: Tolson@sfgmembers.com February 14, 2012 Irwin & McKnight, P C. Attn: Roger B. Irwin 60 West Pomfret Street Carlisle, PA 17013-3222 RE: Supplemental Contract Number 60 S746 -William J. Palmer, Jr. Dear Mr. Irwin: 'Thank you for submitting the claim form, death certificate and Letters of Administration on the above referenced contract. The claim has been processed and enclosed is a check for $43,285.32 made payable to William J. Palmer III as Executor of The Estate. This represents the original deposit in the amount of $42,314.06 plus $971.26 accrued interest. The taxable amount to be reported is $43,285-.32: I have also enclosed a copy of the original contract that was issued for your review. If you have any questions, please contact me at 877-872-0757, Extension 32276. Sin ely, Li Olson Claims Department Enclosures ~a+~ o~F Uaiu~- ~4a i 314.0 ~ NORTH AMERICAN COMPANY FOR LIFE AND HEALTH INSURANCE ONE SAMMONS PLAZA SIOUX FALLS, SD 57193 PHONE (800) 733-2524 ~ FAX: (877.)'841-G70G oeu, IU [ui ~i:~tonin v • • Sovereign IYV~ I I I Court Ordered ~rocessi~ng \ Aecedents - M,Al.-MB3-02-10 - P. 0. Bo~c 841005 -Boston, MA 02284 September 16, 2011 Roger B. Irwin Irwin ~ McKnight, P.C. 60 West Pomfret Street Carlisle, PA 17013-3222 VIA FACSIMILE 717-249-6354 Re: Estate of William J. Palmer, Jr. Date of Death: 08/12/2011 Dear Sir or Madam: We have received your request for date of death balances on the accounts of the above-named decedent. Please refer to the additional item(s) indicated below that are required to complete your request; some of which are required in order to comply with privacy laws affecting bank accounts. We need to ensure that we provide account information only to those individuals authorized to receive it. Please send the documentation checked off below to my attention at the address listed above. XX $20.00 Date of Death Balance Fee payable to: Sovereign Bank (effective 6/1/09) Death Cer6fcate Court Appointment of Executor(trix) or Administrator(trix) ("Certificate of Appointment") Authorization from Executor/Administrator/Joint Owner/Beneficiary to release information Other: If you would like to liquidate the accounts, please return certified copies of the Death Certificate, Certificate of Appointment, if applicable, and a notarized letter of instruction from the executor, co-holder, or beneficiary, as appropriate: Very tru~'yours, D~.onna .Long Lead S ecialist Phone: 7- 4-51 S9 Fax: 617-533-1931 ri ~ ®North American Compan for Life and Health ln$ura Y nce A Member of Sammons Financial Group Lisa Olson Ropedave Pay Specialist Plwne: (B00) 733-2524 -Fax: (877) 641-6706 • e-mail: lolsonC sfgmembeis.cora December 7, 201 X Irwin and McKnight Law Firm Attn: Karen 1tE: Special Interest Deposit Contract Number 60 S746 -William J. Palmer, Jr. Dear Karen: Thank you for the recent notification of the death of William J. Palmer, Jr. On behalf of the Company, please extend our sincere condolences to the family. This contract was setup as an interest income contract. Mr. Palmer was paid quarterly interest in the amount of $643.62 on the initial investment. The betle~iciary of record on this contract is "The $state". Please have tl~e executor of the Estate complete the enclosed claim form and return it with a certified copy of William's death certificate. We will also need to be provided with a copy of the Letters of Administration. The only option available is to take a lump sum payment. Unfortunately, we must ask for reimbursement for the September 17, 2011 payment that went out after his date of death. Please submit a check for $643.62 made payable to North American Company. If you have any questions, please contact me at 577-872-0757, Extension 32276. Sinc ly, Li a Olson Claims Depamnent Enclosures NORTH AMERICAN COMPANY POR LI[+B AND HEALTFI MNSUHANCE UNT: SAMMnNS PLAZA SIOUX FALLS, SD 57193 ..r~nwrv runrrr ~z4_959A . FAXa fFt771 841-6706