HomeMy WebLinkAbout07-03-12 (2)J REV-1500 EX (02-11)(FI)
PA Department of Revenue
Bureau or Individual Taxes
Po sox zaosol
Haniaburp, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
10042011
Decedent's Last Name
KOCH
155611186
OFFIC4LL USE ONLY
County Code Veer file Number /
INHERITANCE TAX RETURN ~ I I ~ I ~~ C
RESIDENT DECEDENT J
MMDDWYY Date of Birth MMDDYYVY
03061919
Suffix Decedent's First Name
ARLENE
(If Applicable) Enter Surviving Spouse's Irdormation Below
Spouse's Lasl Name Suffix Spouse's First Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
H
MI
FILL IN APPROPRIATE BOXES BELOW
X^ 1. Original Return ^ 2. Supplemental Return ^ 3, Remainder Return (Date of Death
^ 4
Limited Estate
^
4
F
I Prior to 12-13-82)
^
. a.
uture
nterest Compromise (date of 5. Federal Estate Tax Return Required
^ 6
Decedent Died Testate
^ death aster 12-12-82)
7
Decedent M
i
t
i
d
Li
i
T
~ 8
.
(Attach Copy of Will) .
n
a
a
ne
a
v
ng
rust
(Attach Copy of Trust.) . Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 antl 1-1-95) (Attach Schetlule O)
CORRESPONDENT - THIS SECTK7N MUS7 BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SUSAN L FALCON 717-938-6271
REGISTER OF YRLLS USE ONLY
RL:CUBDED OA'F7CE OP
First Line of Address RIiGISTI?R OF WI].7,5
2012 JULY 3
1700 VALLEY GREEN ROAD ca,ez~x <)r
Second Line of Atldress ORPHANS COURT
CU61HI?IZI.AND COURT, PA
City or Post Office State ZIP Code L~ DATE FlLED
ETTERS `~ PA 17319
Correspontlent'se-mallaedrosa: SLFALLON(aI~P~X.NET
Untler penalties of Derjury, I declare that I have examined this rtum, indudinp accompanying schedules and statemenb, end to the beat M my knwAedpe and beliel,
it is true, corrse(end complete. Declaration of pre~r other then the personal representative is based on ell inbnnmion dwhich preparer has any knavAedpe.
Side 1
1505611186 twaea7zpoo
1505611186
J^
y~J
REV-1500 EX (FI)
1505611286
Decedent's Social Security Number
Dacadanf:Name ARLENE H N KO H
RECAPITULATION
1. Real Estate (Schedule A) 1
2. Stocks and Bonds (Schedule B) . 2 76,869.30
3. Closely Held Corporation, Partnership or Sole-Proprlelorship (Schedule C) , 3
4. Mortgages and Notes ReceivalNe (Schedule D) 4
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5
541.15
6.
7 Jointly Owned Property (Schedule F) ~ Separate Billing Requested
I g, 14
704
20
. nter-Vivos Transfers & Miscellaneous Non-Probate Property ,
.
(Schedule G) ® Separate Billing Requested 7. 229,432.34
6. Total Gross Assets (total Lines 1 through 7)
6 321.546.99
9. Funeral Expenses and Administrallve Coals (Schedule H). g, 2,139.41
10. Debts of Decetlent, Mortgage Liabilities, and Llens (Schedule I) 10 1,755.87
11. Total Deductions (total Lines 9 and 10), 11 3,895.28
12. Net Value of Esate (Line 6 minus Line 11) 12 317
651
71
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ,
.
an election to tax has not been made (Schedule J) , 13 10,000.00
14. Net Value SubJeet to Tax (Line 12 minus Line 13)
. 14. 307 651.71
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal taz rate, or
transfers under Sec. 9116
(a)(1.2) X .0
16.
Amount of Line 14 taxable 15.
at lineal rate x .0 4~t` 307,651.71 16
13
844
33
17. Amount of Line 14 taxable .
,
.
at sibling rate X .12
18.
Amount of Line 14 taxable 17.
al collateral rate X .15
i6.
19. TAX DUE.. 19.
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505611286
Side 2
iwasae z.ooo
1505611286
13,844.33
REV-1500 EX (FO Page 3
Fits Number 21-11-1095
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Cretlits/Payments
A. Prior Payments _
B. Discount
3. Interest
Total Credits (A+ B) (2)
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill In box on Page 2, Llne 20 to request a refund. (q)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 13 844.33
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
t. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ........... .... ........ ^ ^X
b. retain the right to designate who shall use the property transferred or Its inceme .. ^
c. retain a reversionary interest ............ ............. .......... ^
d. receive the promise for life of either payments, benefits or care? ^
2. If death occurred after Dec. t2, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ...................... ... .... ^ 0
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ^ ^X
4. Ditl tlecedent own an individual retirement account, annuity, or other non-probate property
which
,
contains a beneficiary tlesignation7 ................................. 0 ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FlLE 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.§9118 (a) (1.1) (i)j.
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
172 P.S. §9116 (a) (1.1) (ii)I. 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 ere 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 172 P.S. §9116(a)(1)j.
• The tax rate imposetl on the net value of transfers to or for the use of the tlecedent's siblings is 72 percent 172 P.S. §9116(a)(1.3)j. Asibling is defineQ
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or atloption.
1was~i iooo
REV4503 EX a (699)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS 8r BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ARLENE HELEN KOCH 21-11-1095
All property Jolntty•owned with right of survNOrshlp must be dbelosed on Schedub F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 33 SHARES OF MET LIFE STOCK @ $27.49 PER SHARE 907,17
2. X2797.274 SHARES OF PP6L STOCK @ $27.65 PER SHARE
1 wa696 L000
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
75,962.13
76,869.30
REV-1506 EX~ (11-10)
pennsylvania
OEPMiMENi OE REVENUE
INHERITANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, 8 MISC.
PERSONAL PROPERTY
Include the
Ne Oroceeds were recaiwd
21-11-
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. t. HIGHMARK INSYURANCE REFUND 357.30
2. DONEGAL INSURANCE REFUND 25.00
3. VERIZON REFUND 2 08
4. PA PESER'S RETIREMENT 106.77
5. FURNITURE 50.00
_ TOTAL (Also enter on line 5 Recapitulation) S ~ 5 9
1 W<6AD 1.000 1/ more space is needed, use additional sheets of paper o/the came size.
REV-1509 EX+(01-10)
Pennsylvania
IlB.V21MIXr OF pEV£M.E
INHERITANCE TAX RETURN
RESIDENT CECEDENi
ESTATE OF:
ESTATE OF ARLENE HELEN KO
FILE NUMBER:
21-11-1095
SCHEDULE F
JOINTLY-0WNED PROPERTY
If an asset became jointy owned within one year of the deeetlent'a data of death, k must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. SUSAN L FALCON 1700 VALLEY GREEN ROAD DAUGHTER
ETTERS, PA 17319
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER IEnEp
Fop~oiNr
reNpur DATE
MADE
JOINT DESCRIP710N OF PROPERTY
INCLWE XNNE OF FINNVGKIN9TIMION AID EANtAGCAWr NII.IBER OR 8IMIUVt
ioamFnrc NAeea, Arrrrr oEEO FOp ~oINrtr NEL-pFAL ESrAtE.
DATE OF DEATH
VALUE OF ASSET %aF
pECEDENTS
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1. A. WELLS FARGO CHECKING ACCOUNT 9,195.90 50$ 2,097.95
2. A PIONEER INVESTMENTS 25,212.50 50$ 12,606.25
PIONEER CONSERVATIVE ALLOC A
ACCOUNT # 00621251266
2,991.359 shs @ $10.12
TOTAL (Also enter on Line 6, Recapitulation) t 19 7 0 9
IwasAE Looo It more space is neetletl, use additional sheets of paper of the same size.
REV-1510 EX i (09-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ARLENE HELEN KOCH
21-
This schedule must be completed antl filetl if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBS DESCRIPTION OF PROPERTY
~KiIIlET1E R+ME OFTETaglbFEREE, T1Era aeunorsHF TO OECEOEar un
T1E ~4TEOF TRA`891 gTTACnACOPI Oi TIE GEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
IMFREST
EXCLUSION
IF N'PIICABLE
TAXABLE
VALUE
t. ANNUITY 71,901.13 1008 71,901.13
TRANSAMERICA LIFE INSURANCE CO
9333 EDGEWOOD ROAD N.E.
CEDAR RAPIDS, IA 52489
2. ANNUITY 158,031.21 100$ 158,031.21
AXA EQUITABLE
500 PLAZA DRIVE 6TH FLOOR
SECAUCUS, NJ 07094
TOTAL (Also enter on line 7, Recapitulation) $ 2 2 9 , 9 32.3 9
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
If more space is neatletl, uae addHional sheela o(paper of the same aiza.
1 W48AF 1.000
REV-1511 E%~ (1609)
pennsylvania
OEPARRAEMOF REVENUE
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
ARLENE HELEN KOCH 21-11-1095
Deeetlent's debts moat be repoRed on SehetluN I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~. WOMEX MEMORIALS - TOMBSTONE ENGRAVING 230.00
2. FOOD AND OTHER FUNERAL EXPENSE 965.91
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State _ _ _ ZIP
2. Attorney Fees:
3. family Exemption: (If tlecedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City Slate ZIP
Relationship of Claimant to Decedent
a. Probate Fees: 9 4 3. 5 0
5. Accountant Fees: 750.00
6. Tax Return Preparer Fees: 2 5 0. 0 0
7.
TOTAL (Also enter on Line 9 Recapitulation) ~ $ 2 1
1 W46AG 1.000 If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX ~ (12-08)
Pennsylvania
SCHEDULE I
DEPPAIMEM OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TA%RETURN MORTGAGE LIABILITIES 8 LIENS
RESICEM DECEDEM
ESTATE OF FILE NUMBER
ARLENE HELEN KOCH 21-11-1095
Report debts Incurred by the tleeadent prior to death that remained unpaid at the date of death, Ineluding unrelmburead madleal expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. COUNTRY MEADOWS - NURSING CARE
2. OMMICARE-CCRX HARRISBURG MEDS
3. SEARS CREDIT CARD
864.84
826.27
69.76
TOTAL (Also enter on Line 10 Recapitulation) ~ S 1 7 55 8 7
iw4sAH iooo If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10) SCHEDULE J
Pennsylvania
OEPARTMEN70F REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ea r w ~ e vr: FILE NUMBER:
ARLENE HELEN KOCH o1 _11 _1 nOc
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llat Truatee(a) OF ESTATE
I TAXABLE DISTRIBUTIONS(InUude outright spouwl distributions and transfers under
Sec. 9116 (a) (1.2).]
1. 1 APRIL C BOOTH GRANDDAUGHTER 40
000
00
1700 VALLEY GREEN ROAD ,
.
ETTERS, PA 17319
2. SUSAN L FALCON DAUGHTER REMAINDER
1700 VALLEY GREEN ROAD
ETTERS, PA 17319
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 9 OF REV-1500 COVER SHEET, AS APP ROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTON TO TAX IS NOT TAKEN:
1.
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS'
1.
1. ST. PAULS UNITED CHURCH OF CHRIST 10,000.00
1249 TREXLERTOWN ROAD
TREXLERTOWN, PA 18087
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 10 , 0 00.0 0
1 W46AI 1.000 "'°' oPaw m ~mcu we aumuunm movers m yayei m uie same a¢e.
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No . 201 1- 01095 PA No . 21 11- 1095
Estate Of: ARLENE HELEN KOCH
rF~rsc M;dme, Lasr~
Late Of : HAMPDEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No
167-12-3694
WHEREAS, on the 18th day of October 2011 an instrument dated
November 26th 2001 was admitted to probate as the last will of
ARLENE i-IELEN KOCH
(Fist Midtlle, LasU
late of HAMPDEN TOWNSH/P, CUMBERLAND County,
who died on the 4th day of October 2011 and,
WHEREAS, a true copy of the will as probated is annexed 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 TESTAMENTARY to:
SUSAN L FALCON
who has duly qualified as EXECUTOR(R/X1
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 18th day of October 2011.
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
12/04/2006 08:32 7179328926
- MetLife
BNY Melon Shareowrer Services
P.O. Box 358420
PiVsburOh, PA 15252.8420
AccourH Registration:
0000081 O] SP 0.660 ..a10P,p S] 0 ~OlO 1]]}>p5e500 C01 a1Ni1I - 11
I~'~Illplhll~~ill~dl"'~I~I~9~~Ilnlllllrlullnllllglll4~r
gUSAN L YALLUN
1700 VALLEY GREEN RD
ETTERS PA 17319
Date: t D/27rz01 t
For information concerning this statement, please call BNY Mellon Sha-eowner Services,
_ ___ _ _ ^ _ _ MetLife, Inc.'s Transfer Agent, toll free at 7.800-fq.9-3593
Trustlnterests (Shares) 33.0000
CUSIP Number 59158R10
Transaction Date 10/Z8/2011
Transaction Advice Nurr~er 0018281385
rnvostor lD 1254 2282 1138
This Transaction Advice is your record of the indicated Trust Interests being credited to an account on the books
of the referenced transfer agent. The Transaction Advice ShOUId be kept With your important documerltS as a
record of your avmershlp of these securities. These Trust Interests are transferable only as permkted under The
MelLife PolicyhoklerTrust.
Please read the important information on the back of this form and in the Purchase and Sale Brochure.
l1 you aish to request a purchase or sale tnnsactlon, tletech coupon at the perforeGon end complete the eppNca4le side orthe roan.
PLEASE BE SURE: THIS ADDRESS APPEARS IN THE ENVELOPE WINDOW FOR PURCHASES ONLY
Purchase Instructions 1254 2282 1138 chap eof Address:
(See reverse side to SELL) 9
SLiSAN L FALCON
BNY MBIIOn ShafeOWhef SBfViCeS
P.O. Box 382200
Pittsburgh, PA 15250-8200
L.,IlddurlJtlJdlrrJrdtr,Irlllrrrllrr,IlrrrllrrrLrrll
0000101 102 125422821138 6
PAGE 10/10
,02ed d, dddd0a2 6660,67
The MetLife Policyholder Trust ("Trust")
Transfer Transaction Advice
RETAIN THIS DOCUMENT FOR YOUR RECORDS
8leneture _
(il eddrgs is being cherged)
Make check in U.S. da0ue, payable to:
MetLife nwehese r`regrem
Amour nt Endosad "'~ Ii
Minimum investment 5250 (czecpt as
dtscriEetl in d+e PUrehaa and Sak Fkochure)
~~
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http://finance.yahoo.com/q/hp?s=MET&a=09&b=3&c=2011&d=09&e=5&f=2011&g=d 7/2/2012
12/04/2006 08;32 7179328926
June 27, 2012
•Rt.ENE KOCN
353 5 SPORTING MILL ROAD A2049
MECNANICSBURG PA 17050
Re; Financial Confirmation
Dear Shareowner:
AxouM Number: 3097031831
Registration: ARLENE KOCH
355 S SPORTING HELL ROAD #2049
MECNANICSBURG PA 17050
Account Creation Date: 2117!1884
Issue Name of Stock: PPL Corporation
Total Share 8slance on 1014!2011: 2747,274
Certificate Shares: 4pp,ppp
DRSlBook-Entry Shares: 400.000
Dividend RP.ImRRfmgn} Plan Shares: 1947.274
Dividend Amount Paid YTD: NlA
Closing Price per ShorC on 10/4/207 7: $27,65000
Ticker Symbol for the Company is: PPL
$tOGk Exchange: NYSE
YNVL G UrG~ 03/10
Shareowner Services
Fort Office Box 64874
St. Paul, MN 55164-0874
www. she roowneron line, com
Please note Nat as a lranster agent, we are not ditedly connected to the stack market. The above price is given as an
estimate and is not a guarantee of a spac~c price.
If you have any questions, please Call Our office toll-free al 1.600.345-30A.5. Aur Rharaowner Relations Specialists aro
available to assist you Monday through Friday, from 7 AM to 7 PM Central Time. You may also send an email to us by
selecting "Contact Us" at any lima while online alwww.shereowneronline,com.
Sincerely,
We71s Fargo Shareowner ServlceS
IINIIINbIIINIIIIIIUIiIiIIIBIIIINnVIUINIINI~VNIIINIIIIHIINIINIIINI •2FNCp,791th1,1111'IY,Y• '
3
12/04/2006 08:32 7179328926
~u~~~cw ~vic i~~,i~ni
®1'IONEER
Investments°
June 26, 2012
Susan L Fallon
Fax# 717-932-3926
T3EFF:RF.NCF.-
CORRO# 00440092
PioneerTbbotson Conservative Alloc A
Fund# 66 Account?! 621251266
Arlene Ti Koch Bt
Susan 1. !''allOn J'1"1'l;N
Dart' Ms. Prllou:
PAGE 04/10
na IJ)U i~
'1+1+atilc you for your inc~tiry concen~ing thr. ahnve rafere:need account. We Bppt+eciate the
opportunity to be of service to you
The value of the account on October 4, 2011, was 525,212.50 (2,49 ].354 shares ~ $10.12 per
share).
Tf you have any questions, please contact our Client Se<vice Deportment at 1-800-225-6292, 8:00
a.m, to 7;(t0 p.m. !:astern Standard Time, Monday through Friday.
espondeut
Pioneer lnvestmOnt ntanapement Generstlnquiry
SherehdnOrSenices. mc. a00d34.6202
P-o• lM BSOS+ Pitbement PlPns
Bosron. MP 02205-5014 80o-s22•ous
-~-un+eer of m~ umC+~Mt OenM~nO Group peL~rnr M O~nwbye g...~,p.
G
12/04/2006 08:32 7179328926
,~~
TxA~rcA
• LIPH fNSORANCH COMPANY
PAGE 05/10
ZYauSUaia life IeSaneee C.mmPan7
4333 HdpHwaod R.wd NE
PO HoH 3183
Leda A.piA., tn~ 57.406-;183
December 7, 2011
Susan Louise Fallon
1700 Valley Creen R.d
Etters PA 17319.
R8: Aaau€iy Nwmiber{s) 26658133 _ .-........
Dear Susan Louise Fallon:
Please accept our sincere condolences for your loss. we have received
your request to delay having the funds disbursed to you in a lump sum
psyment due to the death of Arlene H iCOr..h.
The following is the current information on this annuity:
Primary Seneficiary(ies): Harry W Fallon
Contingent Smeficiary(iea): April Sooth
Per Your recTilest, the date of death value as of 10/04/2011 is
571,401.13.
As a beneficiary delaying the lug 5wn yayment, you are unable to
request ownership changes or add premium to the annuity.
In accordance with SRS regulations, the annuity funds must be
disbursed to you by the fifth anniversary of the date of death. Xou
will be responsible for notifying the company to remove any remaining
funds prior to the fifth anniversary of the date of death.
This letter may contain general tax information based on our company's
interpretations and should not be relied upon for your personal tax
planning. If you have questions concerning direct tax consequences to
you, you may wish to consult a tax advisor.
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Member of the AKaON. Group
12/04/2006 08:32 7179328926
PAGE 06/10
Zf you have questions, please contact your financial ~iofessionnl or
ca11 us at 1-800'553-5957 Monday through Thursday between 7:00 a.m.
and 5:30 p.m. and Friday bctween 7:00 a.m. and 4:30 p.m. Central time.
We appreciate your business.
Sincerely,
ACLlliniStrntive .^.+CrV1CCG
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FS1C 1osLlrE (S) Nptice uL Privacy Policy
ST. PAUL'S UNITED CHURCH OF CHRIST
Ministering in Trexlertown, Pennsvlvania since / 7b'4
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February 9, 2012
Ms. Susan Fallon
1700 Valley Green Road
Etters PA 1 73 1 9-9685
Dear Susan,
I shazed the news of the gift from your mother's estate with our Church Council this past
Tuesday evening, and on behalf of the Church Council of St. Paul's, I wish to thank you for your
mother's thoughtfulness and gift to us through the bequest of $10,000.
Your mom and dad were well thought of here at St. Paul's, and in this final act of generosity,
they once again showed their commitment to the church family that they longed served.
We actually have a number of projects that we are working on that your mom's gift may well be
exactly appropriate and in keeping with your wishes as dictated in the letter. I will be happy to
notify you down the road as we make those decisions about the best way to use the gift.
May God's blessings be upon you, Bazry, and all your family at this time.
Grace and Peace,
~~~
Al Bastin
(The Reverends) Al and Carol Bas[6r, Pastors
1249 Trexlertown Road (P.O. Box 336), Trexlertown, PA 18087 (610) 395-4571 4 Fax (610) 395-2737