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
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-- `c
_,-, --~
~~
DATE FILED
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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 ~-
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: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.
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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