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Home My WebLink About09-12-12 (2)J 1505610105 REV-1500 axc°=.""F,> enn lvanla OFFICU\L USE ONLY PA Department of Revenue P SY Courty Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX z806D1 2~ I ~ Z ~ ?) ~ 4 Harrisburg PA 19128-o6ot RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYV Date of Birth MMDDYYYV Decedent's Last Name Suiiz Decedent's First Nalne MI MARTINEZ-VIDAL ENRIQUE J (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 WITH THE REGISTER OF WILLS FILL IN APPROPRUITE OVALS BELOW m 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) OlD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO Name Daytime Telephone Number THOMAS E. FLOWER (7117) 243-5513 First Line of Address FLOWER LAW, LLC Second Line of Address 10 W. HIGH ST Ciry or Post Office CARLISLE Slate ZIP Code PA 17013 REGISTER OFf~7gILLS USE ONLY ~.. :v 7 ~'U N f rT m{. r~ 7 -v 1 ; tic.., tV nC,' ! ~`, . x> _lC DA IL~D Cr Correspondent's e-mail address: Tom@Flowerlaw.com Under penattles or perJury, I declare that I have examined Nis return, including accompanying schedules and statements, and to Ne bast of my knowledge and belief, tt is We, coeeU and complete. Declaration of preparer other Ihaytpe personal representative is based on all iMormetlon of which preparer has any knowledge. U E. Martinez-Vidal, ExecuTor; 18640 Queen Elizabeth MD 10833 T T- Flower Law, LLC; 10 W. High Street, Carlisle, PA 17013 ' PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 ]650561D105 ~~ r'n C' f~? <_ } -iC-J r~~ n 1 n ;~ ^, -r't ^=ri -n "''~ C J ~~ 15U5610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: ENRIQUE J. MARTINEZ-VIDAL 205-28-8020 RECAPRULATION 1. Real Estate (Schedule A) ............................................. t 222,400.00 2. Stocks and Bonds (Schedule B) ....................................... 2 '. 0.00 3. Closely Held Corporetion, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 ', 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)_ ... .. 5. 4,878.49 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 3,550.90 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ' (Schedule G) O Separate Billing Requested...... .. 7. 400,149.53 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 830,978.92 9. Funeral Expenses and Administretive Costs (Schedule H) ............. ...... 9. 4$,988.19 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 111,860.38 11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 760,848.57 '. 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 470,132.35 13. Chadtable and Governmental Bequests/Sec 9113 Tmsts for which an election to tax has not been made (Schedule J) .................. ...... 13. 0.00 14. Net Value Subjeet to Tax (Line 12 minus Line 13) .................. ...... 14.. 470,132.35 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_ 15. 16. Amount of Line l4 taxable -° .... at lineal rate X .0 45 470,132.35 16. 21,155.96 17. Amount of Line 14 taxable _..... .. ........ ....... at sibling refs X .12 17, 18. Amount of Line 14 taxable at collateral rate X .15 16, '.. 19. TAX DUE ........................... .............................. 19. 21,155.98 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 15D5610205 J • nit tan mic nny~aca v„ u,c nw taut vi uanmcm w yr ,~, u, - ~, u,c u uyv . ym . ,, ~ yv ..t..,~...q. ...,.. ...y .,, ..,,...~__, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV4500 EX (F1) Page 3 Decedent's Complete Address: DECEDENT'S NAME ENRIQUE J. MARTINEZ-VIDAL STREET ADDRESS 1230 WHITE BIRCH LANE CARLISLE File Number 21-12-0$$4 STATE I, ZIP _... _. _ P'A I 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Pdor Payments 20,000.00 B. Discount 1,030.00 3. Interest (1) 21,155 96 Total Credits (A + EI) (2) 21,030 00 4. If Line 2 is greater Nan Line 1 +~Line 3, enter the difference. This is the OVERPAYMENT. (3) 0.00 Fill in oval on Page 2, Line 20 fo request a refund. (4) 0 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 125.96 Make check payable to: REGISTER OF WILLS, AGENT. ,, ; ,... . , r PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and; a. retain the use or income of the property Nansferred .......................................................................................... Yes No b. retain the right to designate who shall use the property transfened or its income ............................................ 0 c. retain a reversionary interest .............................................................................................................................. a d. receive the promise for life of either payments, benefits or care? ................ 2. If deaN occurred,after Dec. 12, t982, did decedent transfer property within one year of death ^ ^ without receiving adequate consideration? ............ 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ............. ~ ^ 4. Did decedent owq an individual retirement account, annuity or other non-probate property, which ^ contains a benefciary designation? .................................................................__.. ~ ,-, _....._......... u IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~~ .,. ~,~aa ., ,.. I Far dates of death on or after July i, 1894, 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 172 P.S. §9116 (a) (1.1) (ii)], The statut@ 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 o0 or after July 1, 2000: • The tax rate imposed on the net value of Nansfers 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 Ehe child is 0 percent [72 P.S. §9116(a)(1.2)J. • 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 J72 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-1502 EX+ (11-08) ~ ' Pennsylvania DERgRTMENT OF gEV£NUE INHERCIANCE TAx RETURN RESIDENr DECEDENT SCHEDULE A REAL ESTATE wrwrc yr ENRIQUE J. MARTINEZ-VIDAL FILE NUMBER 21-12-0389 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between ~ willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Re$I property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. NUMBER .Include a copy of the deed showing decedent's interest if owned as tenant in mmmori. VALUE AT DATE DESCRIPTION OF DEATH 1' TOWNHOUSE IN BOROUGH OF CARLISLE, CUMBERLAND COUNTY, KNOW AS 1230 WHITE BIRCH LANE; SALES PRICE 222,400.00 TOTAL (Also enter on Line 1, Recapitulation.) ; if more space is needed, insert additional sheets of the same size. 222,400.00 The und¢yAneE hereby ecknowi (HXMEI gXYNE l261 REV-ISOB EX+(31-10) ~ pennsylvania Gu SCHEDULE E OERARTMENT OF REVENUE CASHr BANK DEPOSITS & MISC. INHERITANCE TA%RETURN PERSONAL PROPERTY RESIDEM DECEDENT ESTATE OF: FILE NUMBER: ENRIQUE J. MARTINEZ-VIDAL 21-12-0389 Include 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 ani Schedule F. ,T~„ VALUE AT DATE 1. PRO RATED TAXES AND HOME OWNERS ASSN. FEES RETURNED AT SETTLEMENT' 812.49 2. AUTOMOBILE, SALE PROCEEDS 2,500.00 3. ESTATE YARD SALE PROCEEDS 1,566.00 TOTAL (Also enter on Line 5, Recapitulation) $ 4,878.49 If more space is needed, use additional sheets of paper of the same :>ize. REV-t5D9 EX+ (alno) ~ Pennsylvania DEPARTMENT OF REVENUE INHERRANCE TAX RENRN RESIDEM DECEDENT SCNEpULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: ENRIQUE J. MARTINEZ-VIDAL 21-12-0389 Ii an asset became Jointly owned wkhin one year of the decedent's date of death, k must. be reported on Schedule G. SURVIVING ]DINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• ENRIQUE E. MARTINEZ-VIDAL 18640 QUEEN ELIZABETH WAY SON BROOKEVILLE,MD 20633 B' ALEXANDER M. MARTINEZ-VIDAL 15405 Columbia Road Columbia, MD 21044 C. IOINTLY OWNED PROPERTY: SON nEM NIMBER LETTER FOR X)INT TENPM DATE MADE ]DWT DESCRIPTION OF PROPERN INCLUDE NAME OF FlNANCIAL INSTINTiON M!D BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR TOINRY HELD REAL ESTATE. WTE QF DEATH VALIIE OF ASSET `~ ~ DECEDENTS INTEREST DAB ~ DEATH VALUE DF DECEDENTS INTEREST t. A. 11101/03 ACCOUNT NUMBER 237216-05 6,791.74 50 3,395.87 2. B. 07115110 ACCOUNT NUMBER 390513-05 310.05 50 155.03 TOTAL (Also enter on Line 6, Recapitulation) I # 3,550.90 If more space is needed, use additional sheets of paper of the same size. BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 1712 a-0601 Pennsylvania DEPAPTMENT OF NEVENUE REV-356! ES PFP (OS-111 PENNSYLVANIA INHERITANCIE TAX INFORMATION NOTICE FILE NO. 21 12-0389 AND ACN 12130654 TAXPAYER RESPONSE DATE o5-10-2012 ALEXANDER M MARTINEZVIDAL 1230 WHITE BIRCH LN CARLISLE PA 17013-3580 TYPE OF ACCOUNT EST. OF ENRIRUE: J MARTINEZVIDAL ® savlNCs $$N 20ci-28-8820 ^ CHECKING DATE OF DEATH 03-23-2012 ~TRU ST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FDRMS TD: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 1.7013 MEMBERS 1ST FCU provided the tlepa rtment with the information below, which was used in calculating the inheritance taz due. Recortls indicate that at the death of the above -nametl decedent, you were a joint owner/beneficiary of this account. If y0U ere the SpOUBe Of the deceased and any amount other than zero is reflected beiow on the Potential Tex Due 11 ne, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect. please obtain written correction from the financial institution, attach a copy to this form antl return it to the above address. Please call 717-757-8327 with ouesti ons. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FDR FILING AND PAYMENT INSTRUCTIONS Account No. 390513 -.05 Date 87-15-2010 To ensure proper cratlit to the account, two Established copies ofr this notice oust acconpanv pavnent Ro khe Regisbr of Wills. Make check Account Balance $ 310.05 payable 'to "R aeister of Wills. Agent". Percent Taxable X 50.808 NOTE: I'f tax paynenks era node within three Amount Subject to TaX g 155.03 nonths o~F the decedent's date of tleath. Tax Rate X .045 tleduct a 5 Pa rcent discount on the tax due. Am inheritance tax due will become tlelinauent Potential Tax Due $ 6.98 nine nonths after the tlate of death. PART TAXPAYER RESPON SE A. ~ The above info rnation and tax due is correct. Renik pave ant to the Register of Wills with two copies of this notice to obtain a tli scount or avpitl interest, or return this notice to the Register of Wills antl CHECK an of HCial assessne nt will be issued by the PA Department of Revenue. ONE BLOCK g, ~ The above asset has been or will be repo rtetl antl tax paitl with the Pennsylvania inheritance tax return ONLY tiled by the eskate representative. L. ~ The above inforna ion is incorrect and/or debts and deductions were paid. Complete PART ~2 antl/or PART ~ below. PART If indicating a tlifferent tax rate, please state iFIE7~j ~' "' tp'S Yi fil R i ~ relationship to tleeetlent: a { ~ ~ s e S~ ~"~ TAX RETURN - CALCULATION OF ¢!1 ~ TAX ON JOINT/TRUST ACCOUNTS t`~ $ " ~^'' ~'1t " ' LINE 1. Date Established 1 =1 2. Account Balance 2 +S 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 6. Amount Taxahle 6 7. Tax Rate 7 X e. Tax Dua 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE Unoer penalties of perjury, I tlecla re that the facts I reported above are true, correct ono complete to the best of my knowletlge antl Delief. unMC r ~ w ~ PENNSYLVANIA INHERITANCE: TAX INFORMATION NOTICE FILE N0. 21 12-0389 BUREAU OF INDIVIDUAL TAXES PD Box zaosBl Pennsylvania AND pCN 12130655 HARRISBURG PA 17128-0601 o[aAa7mexroEaevtwus TAXPAYE R RESPONSE DATE 05-10-2012 REV-1563 EM RFP (YS -11) ENRIQUE E MARTINEZVIDAL 18640 QUEEN ELIZABETH D BROOKEVILLE MD 20833-2809 TYPE OF ACCOUNT EST. OF ENRIQUE J MARTINEZVIDAL ® savlNCs SSN 205-28-8020 ^ CHECKING DATE OF DEATH 03-23-2012 ^ rausT COUNTY CUMIB ERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE Sq!UARE CARLISLE PA 17013 MEMBERS 1ST FCU provided the department with the information below. which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decetlent, ypu were a joint owner/beneH ciary of this account. If yoU ere Lhe spouse Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no taz may be due, but you must notify the department oP your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" to PART 2. If you believe the information is incorrect, please obtain written correction from the finand al institution, attach a copy to this form and return it to the above address. Please call ]ll-]87-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 237216-05 Date 11-01-2003 To ensure Proper credit to the account, two Established cosies of this notice oust acconpany Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due $ 6,791.74 X 50.000 $ 3,395.87 X .045 S 152.81 PaynenT to the Register of Wills. Make check oaY able to "Register of Wills, Agent". NOTE: If kax oayme nts are Wade within three monkhs of the decedent's date of tleath. detluct a 5 percent tli scount on the tax due. Arty inheritance tax due will becone delinquent nine Wont hs attar the date of death. A. ^ The above inforn anon antl tax due is correct. Ran it Payment to the Register of Wills with two copies of th i:s notice ko obtain a tliscount or avoid interest, or return this notice to the Register of Wills and C HEC K an official assesinent will be issuetl by the PA Departnent of Revenue. ONE ~ ~ BLOC K B. he above asset has been or will be resorted antl tax paid with the Pennsylvania inherikance tax return ONL Y filed by the estate rep resentativa. C. ^ The above inf orna eon is incorrect and/or tlebts antl deductions ware Paid. C ompleke PART ~ and/or PART ~ below. PART If indicating a different tax rate. please skate rel ationship to decetlent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Detluctions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART 3^ DATE PALD PAYEE DESCRIPTION AMOUNT PAID alties of per3ury, I declare that the facts I reported above are 1:rue, correct and to the Dest of my knowledge antl belief. unMF l l OF TAX ON JOINT/TRUST ACCOUNTS 2 $ a X 4 `S 6 ~ 7 X 8 DEBTS AND DEDUCTIONS CLAIMED WORK ( ) TELEPHONE WUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) 8 REV-].510 EX+ (OA-09) ~ 'pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERRANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ENRIQUE J. MARTINEZ-VIDAL 21-12-0389 This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Rr111AE n~NnEe aFIAE iRNSRitEE, THeR REUnansRiv ro oECeoENr nrvD THE DOTE aF TnusrER. nTrnaacavT OF mEO~ras aEU ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'9 INTEREST EXCLUSION nF armr~ TAXABLE VALUE 1. TIAA-CREF ANNUITY CONTRACT C83743A0/U837438A, ALEXANDER 129,203.62 100 129,203.6<' MARTINEZ-VIDAL, SON & ENRIQUE E. MARTINEZ-VIDAL, SON 2 LINCOLN BENEFIT LIFE ANNUITY CONTRACT LBCA117248, PAYS TO 12,801.37 100 12,801.31 ESTATE 3 AXA EQUITABLE ANNUITY CONTRACT 303 745153, PAYS TO ESTATE 222,043.07 100 222,043.Oi 4 TIAA CREF ANNUITY CONTRACT IP005524, PAYS TO ESTATE 36,101.47 100 36,101.4-~ NOTE: DECEDENT PURCHASED A FORT DEARBORN LIFE SINGLE PREMIUM DEFERRED ANNUITY FOR $26,413.77 ON O6I11/2007, WITH A MATURITY DATE OF 06/1112033. THIS WAS A LIFE INSURANCE POLICY IN THE GUISE OF AN ANNUITY AND THEREFORE NOT TAXABLE. TOTAL (Also enter on Line 7, Recapitulation) $ 400,149.53 If more space is needed, use additional sheets of paper of the same size. CREF Farnxcat sty May 10, 2012 Mr. Alexander M Maztinez-Vidal 1230 White Birch Ln Cazlisle PA 17013 Re: Enrique JMartinez-Vidal rsmvsaw TIAA Contract - ! C83743A0 CREF Certificate - ! U83743A8 Deaz Mr. Alexander M Martiiez-Vidal: ~ We aze contacting you since you are a named beneficiary for the TIAA-CREF retirement accounts held by ~ Enrique JMartinez-Vidal. My!name is Jacqueline Montgomery-Fludd from TIAA-CREF's Beneficiary Relationship Team and I will be your primary contact to assist you throughout: this process. The survivor benefit you are entitled to receive is listed below. Any balances in the TIAA Traditional Annuity will continue to earn interest, and balances in the variable annuity accounts and/or muiual funds will fluctuate based on investment performance. In addition, this value can be: subject to change due to special spouse provisions or State Statutes. Account TIAA Traditional Value as off 03/23/2011 '$129,203.62 Total '5129,203.62 As you consider your options, please keep in mind that federal tax law has certain deadlines for when beneficiaries have to start receiving at least some of their inherited amount. (7Chese amounts aze called "required minimum distributions," or RMDs.) Specifically, you must begin receiving an RMD by December 31 of the yeaz following the year of the participant's death. Your next step is to transfer ownership of the account(s) to your name. Once ownership has been transferred, you may decide to leave the account as is and continue to save and invest with TIAA-C12EF until a hater date, or choose from among a variety of other options. To help you understand the options you have and make an informed decision that meets your needs, please review the following materials. (If you are also a beneficiary of other 7TAA-CREF accounts, information about those accounts will be sent sepazately.) ^ Pennsylvania: Allows for elective withholding. If you wish to elect ;state withholding, please indicate the amounts'. on your application. TIM-CREF Individual & Institutional Services, T.T.(' Member FINRA, SIl'C. BENEBUND - EN TIAA-CREF, 1670 Broadway, Denver, CO 80202 Tel: 800 842.2638 ~i•015984L7ii• r:05310L56Lr:2079900L23647ii" May 30, 2012 RE: Saver's index Annuity Contract #AC1118685A The check amount of $12,801.37 represents the net proceeds of your annuity as of O:i/30/12. Gross Annuity Value as of 05/30!12 $12,801.37 $12,801.37 Gross Withdrawal Amount 19807.37 $12.801.37 Check Amount $72,801.37 Remaining Annuity Value as of 05/30/12 $0.00 As required, the taxable amount of this distribution will be reported to the Internal Revenue Service on Form 1099R. A copy of this form will be mailed to you by January 31 of the next year. Please retain this information for your financial and tax records. If you have any questions, please contact your representative, or call Lincoln Benefit Life at 1-800-LBL-WAYS. Ii we can be of any service in the future, we would again welcome the opportunity to assist you in reaching your long-term financial goals. Lincoln Benefk LMe Company, PO Box 660191, Dallas, TX 75266-0191. Phone: 1-600-LBL-WAYS C7710KT6.N07 82050 ooooaa nx~naoi I..I~ill~~~l~~l~~~li~~~ll~~l~~ll ESTATE OF ENRIQUE J MARTINEZ VIDAL ENRIQUE J MARTINEZ VIDAL ADMIN ~~ 18640 QUEEN ELIZABETH OR ~• BROOKEVILIE MD 20833 PROCEEDS TO BENEFICIARY PAYMENT EFFECTIVE 05/2412012. ~' AXA EQUITABLE us,aia.oz pF 2 0 M~anb.fhla.elalomaM. hefn[a.AannelHnnand. mYaln. o. mJerAnnrA 45 AX777301 '1I'1"'tl I'11'Ilt"ft11f11~11~I ESTATE OF ENRIQUE J MARTINEZ VIDAL ' ENRIQUE E MARTINEZ VIDAL ADMIN BROOKQEVILLE LIZARD 0833 PARTIAL SURRENDER PAYMENT EFFECTIVE 05/23/2012. AwMnh Ihle. etMamrnr hninre. tlnonallinn anA rnruin. nq~~ni. v. rgenrA N N ~~, ~AXq EQUITABLI oooa r.o. Eox Izsi Tipp Charlotte, NC 28201 CREF TIAA: IP005524 Page 3 of 4 EFT Number 4005891121 Payment Detail Information Plan Name: DICKINSON COLLEGE DEFINED Effective Date: August 16, 2012 INVESTMENT RETIREMENT PLAN Processing Date: August 16, 2012 NUMBER OF UNIT/SHARE UNITS/SHARES PRICE AMOUNT TIAA Traditional N/A N/.A $36,101.47 Annuity Account Total: l36,i01.47 Account(s) Total: i36,i01.47 Please refer to the check stub for details related to oth~sr deductions. If applicable, You will receive a separate confirmation statement with details of the Service fees deducted from your account. - The transaction(s) describefl above will also be reflected on your next quarterly statement. - Transactions in securities, including variable annuities and mutual funds, are effected by TIAA-CREF individual & Institutional Services, LLC. Transaction information for TIAA fixed annuity contracts that are not securities is provided by TIAA as issuer. - The right to direct investments or transfer funds may be subject to certain limitations and/or restrictions under your employer's plan, if applicable, and the terms of any investment choices. - Transactions are effective at the end of the business day (prior to the close of business on the New York Stock Exchange - usually 4:00 p.m. ET) we receive the request in good order, unless you requested a future effective date. Those received after the close of business or on a non-business day are effective at the close of the next business day. - The Effective Date is the date as of which the contribution, transfer or payment began or ceased participating 1n the investment option or account. - The Processing Date is the date on which the transaction is processed by TIAA-CREF. We will furnish you, upon written request, the time when this TIAA-CREF Individual & Institutional Services, LLC 8500 Andrew Carnegie Blvd. Charlotte NC 28262 t'-~ ~ ~ 2.a~~Gbr~ ~ t 12 ~ rL ~ , C ~ . CERTIFICATE SPECIFICATIONS CERTIFICATE NUMBER: CERTIFICATE DATE: OWNER: ANNUITANT: ITANT DATE OF BIRTH: S NGLE PREMIUM: CURRENT GUARANTEED INTEREST RATE: INITIAL RATE PERIOD: FUTURE RATE PERIOD: MINIMUM GUARANTEED INTEREST RATE: SURRENDER CHARGES: Certificate Year of Surrender 1 2 3 4 5 6 7 8 9 thereafter MATURITY DATE: MINIMUM ANNUITY PAYMENT: MINIMUM WITHDRAWAL: MINIMUM ANNUITIZED VALUE: 1', ~8-7000-2-506 P00000042093 06/11/2007 ENRIQUE MARTI:NEZ VIDAL ENRIQUE MARTINEZ VIDAL 12/09/32 $26,413.77 Certificate Year 1 5.50% includes 1.00% first year interest rate bonus Certificate Years 2 - 5 4.50% 5 YEARS'. 4 YEARS 3.OOo % Charge of Total Account Value 8.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.0-0% 06/11/33 $100.00 $100.00 $5,000 REV-1511 E%+ (16-09) SCHEDULE H ~ Pennsylvania DEPARTMENT DFREVENUE INHERRANCE TAX RETURN RESIDENT DECEDENT FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ENRIQUE J. MARTINEZ•VIDAL 21-12-0389 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' HOFFMAN-ROTH FUNERAL HOME, PROFESSIONAL SERVICES AND BURIAL CONTAINER 3,995.08 2. MEMORIAL GUEST BOOK, THANK-YOU CARDS AND CLERGY, ORGANIST HONORP~RIA 459.45 3. OBITUARY 189.54 a. BRASS PLAQUE, FOOD FOR INTERMENT GATHERING AND MEMORIAL SERVICE AT CHURCH 1,014.13 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City- _.-_- - --_ ____. _ ___State ___.__. ZIP _._.__.._ Year(s) Commission Paid: _. _ _ _ _..... 19,774.47 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 373.50 5. Accountant Fees: 6. Tax Retum Preparer Fees: 7 JACK GAUGHAN REALTORS, AGENTS COMMISSION ON SALE OF 1230 WHITE BIRCH LANE 13,539.00 a. REAL ESTATE TRANSFER TAX & MISC. SETTLEMENT COSTS 2,953.82 s. PUBLISH ESTATE NOTICES, CLJ ($75), THE SENTINEL ($189.54) 364.54 to. REGISTER OF WILLS: TAX RETURN FILING FEE 15.00 ~ ~. HOME OWNERS ASSOCIATION -RESALE CERTIFICATE 50.00 t2. CONTINUATION SHEET TOTAL 6,257.66 TOTAL (Also enter on Line 9, Recapitulation) # 48,986.19 !f more space Is needed, use additional sheets of paper of the same size SCHEDULE H ADMINISTRATION EXPENSES, CONTINUED ESTATE OF FILE NUMBER ENRIQUE J. MARTINEZ VIDAL 21-12-0389 12.a. Short Certificates 12.00 b. House Cleaning Service 409.80 c. House repairs and painting 4,520.00 d. Borough trash bags 120.00 e. Postage ($17.15) and FedEx ($62.24) 79.39 f. Water/Sewer bill 90.46 g. PPL 79.01 h. CenturyLink 48.81 i. Smith, Elliot & Kearns: 2011 income tax prep 540.00 J. Junk Removal & Hauling 313.00 k. Bank fee, checks 9.80 I. Bank wire fee 10.00 m. The Sentinel, estate sale ad 24.50 12. Continuation Sheet Total: 6,257.66 REV-1512 EX+ IY2-OS) ' SCHEDULE I Pennsylvania ~ OEPAPTMENT OF REVENUE INHERRANCE TA%RENRN IIESIDEM DECEDENT DEBTS OF DECEDENT, MORTGAGE LIABILITIES Fr LIENS ESTATE Of FILE NUMBER ENRIQUE J. MARTINEZ-WIDAL 21-12-0389 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expanses. REM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' SOVEREIGN BANK, MORTGAGE LOAN N0.0096202524, PAYOFF AT SETTLEMENT 104,603.21 2. SOVEREIGN BANK, HOME EQUITY LOAN N0.4539622358, PAYOFF AT SETTLEMENT 5,326.86 3. MORTGAGE & HOME EQUITY LOAN PAYMENTS PRIOR TO SETTLEMENT 1,270.21 4. TAX BILL 11'84. 5. MEDICAL BILL 91.26 6. CENTURYLINK 7'86 7 'PPL 109.03 B. WATERISEWER 78.36 9. KOHLS 55.66 10. BONTON 49.53 11. COMCAST 67.46 12. HOME OWNERS ASSN. DUES 60.00 13. CREDIT CARD 60.79 14. UGI 28.27 TOTAL (Also enter on Line 10, Recapitulation) $ 111,860.38 If more space is needed, insert additional sheets of the same size. Jun 19 Zfl12 13:Sfl:99 SOVEREIGN HHRi{ -> Sovereign Bank°~ 'fo: Jack Gaughen From: Sovereign Hank CF Fax: 888-433-8779 Phone: 877-SOV-B:L~TC Fux To: 17172430268 2 Tima: O1 s0:2ti PIv( bI1L1Q: 88445104 717Z93fl26fl pages, including cover sheet Page flfll TrelnjurmaGun contained in thtrfaesimile mrssoge !s privileged mrd confidenda! in/omrallon Intended for drr irse ojdte addrassvr(s) Gstad ubunr. !t may eonluin injormotlun dint is privileged, ronjidenr5uf ur orhanidre proleeaa!(rolrt discfosura ij you ars neidrer drr inraryded raeipiant nor dm emplo}ee or agmrt respataible for delivering tTrrs massage ro the nlcnd~d recipnvd. Yon ora harebynotijred that any diselosrna. copying. distribution orofhar Mhng ojmrv action in relimrcr mr th. ronrantr ofUre talecopied in(ormotion, is.rtrictly prohi6ilad. ~. ~ lJ;von neaive Uris jaenmilr message !n rrror, plaa^e mrmediatelp notifp ns at tiro number lined' abova to armngr for the return of the orrg;nal docrrmanrs ro Soverrign Bank i Sovereign Bmrk, ins sago artd lantern ora servica morla u/'5overeign Bmrk or iLr u~liates or suuridiuries in the'~.United Statrs and usher counairs. Jun 13 2812 89:96:36 SOVEREIGN RANK -> 7172438268 Sovereign Banks Sovereign Bank NA Attn: 30-421-MP2 450 Penn 9tzeet Reading, PA 19602 •*Aesidential Nortgaga PayoPP Quote*+ 06/13/12 Loan Number: 0096202524 9enE Te: Fax N717-243-0268 JACK GAVGHEN REALTOR ERA/RI1! SYEES Borrower(s) Name (a): ESTATE OC ENRIQUE J MAATINEZ-VIDAL Property Address: 1230 91HITE BIRCH LANE CARLISLE PA 17013 Ae of 06/13/12 the status of this loan is as follows; Taxes YTD Esorow Balance Interest Paid To Per Diem Interest .OD .00 06/01/12 14.6437 Interest Rate Calaula ted To In terast Due 5.12500 06/15/12 205.06 +++ Payoff Aawunt Calculation •+• Principal Balance 104327.fi3 Interest Calculated to 06/15/12 205.03 Deferred Amount (a) •00 Accwaulated Late Charge Balance 0.00 Life/AH Insurance Calculated to 06/15/12 0.00 Esorow Shortage(+)/Eearow Netted(-) 0.00 Other Fees 0.00 Recording Fee 50.50 Prepayment Penalty Fee 0.00 Lees Unapplied Funds 0.00 .00 sAx FEE zo.ao +* Total A~equired to Pay Loan OPf+• 104603.21 P17I/FHA to be deducted from Esezow Balanoe O.OiO Payoff Pralaared By: To11erN 00326 on 06/13/12 PF F1~ag: 0 Any goes Lions, please oontact us at 1-500-232-5200 Page 88Z Pegs 1 of 2 Jun 19 2812 13:51:11 SOVEflB.~.1 8881{ -> 7172438268 Page BB2 --So~ereig~ Bankr° Payoff Statement Jlme,s.2o,z To: Enrique J Martinez Vidal Account Of: Enrique J Martinez Vidal 16640 pueen FJlzabelh Dr. 18640 Oueen Elisabeth Dr.j Brookevllle MD 2083-2809 Brookeville MD 20633-2609 Line Of Credit #: 4539622368 Principal Belance: 93 , 015.53 Interest Due: 920.83 Lien Setlslactlan Recording Fee: 950.50 Insurance Due: 90,00 Other Fees: 90.00 Late Charges Due: go.oo Escrow: ggo.oo Unapplled: So. 00 Pending: 90.00 Mortgage Recording Tex: 90.00 Termination Fee: 8zzo. o0 Fax Fee: S2o. ao Payoff Total: 95, 326.86 This Payo11 Total is good urNl 06129!12 however, it rho payoff Is not roceived on that dalo, please add 30.65 (per dlom) por day for every day therea6er. Please return this form with a check made Davable to: Sovereign Bank 10.421-CP2 460 Penn St. Reading, PA 19602 Requested By: Jack Gaughan Comments: Fax Number: 7172430266 Prepared Sy: C F Payo%Fex Number: 688-433-6779 Phonr: Number: 877-768.2265 Thla payaH has boon quelad on a Ilnv of erodq and 6 auhlM Is ehon6e. Plooso vodly pdor to Be111omoN. Evory sand has bean made le ansbro occurecy N thn wlwl6bon. In No avant al a cakubrnn ar clariwl error, any ovara6oa will ba ralu!,dod to Ilia customer by aevorelpn Bank, end emy shonepoB bndudlnB rmmnsd ehmin) x111 ba paid dlrony to Sovomlpn Bank by Ina eunomor, Oneo rho Deyoa, whkh tncludae o ran adialodlen raerdkp fm, boa boon mcaWed, Iha qen dxumanla will bo nenl to Iha courthauae and reeartlatl la sMisfy Iha Ilr!n. II n cualomar chouae6 to pnp Iha Ifen satlslDdlan racordnp lea ham Ihee poyoa. loo m ,lamor w1B bo roapenalDlo ter reeordlnB the mfalamen al lion, prsuidad la it by 6ovoroi6n Bonk i uNOSS dhorxian rogWred try aisle nw. All adrvay vAll aminua an Nn account colt! poyeN boa bean raeahetl. ~. "'•• Signature(s) required to authorize closing and satisfaction of Iles ""' Crnlomar Name: Enrique J Msninos Vldel Account Number: .1616622768 1 hereby aulharna eoverelpn Bonk. N.A to anneal my IMe of grad!!. Iundoraland Ihol by dolna oD. lunch vdll no lon6or be avallabM to ma. and Ih6llan eanrrlnp Iha loon w1ll ha amianed. Fulcra nvad for IurMO would require n new Iwo. Borrower, pate; Borrower. Dale; REV-1513 E%+ (01-10) °; ~ ';~ Pennsylvania SCHEDULE J °""RT"`"T °` RE~E"°` BENEFICIARIES INHERRlWCE TAX RETURN RESIDENT DECEDEM ESTATE OF: FILE NUMBER: ENRIQUE J. MARTINEZ-VIDAL 21-12-0389 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Elena Martinez-Vidal, 2217 Marion Street, Columbia, SC 29201 daughter 1/4 2 C. Adriana Martinez-Vidal, 3519 Cladngton Ave #7, LA, CA 90034 daughter 1 /4 3 Alexander M. Martinez-Vidal, 5405 Columbia Rd., Columbia, MD 21044 son 1/4 4 Enrique E. Martinez-Vidal, 18640 QE Dr., Brookeville, MD 20833 son 1/4 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, 11 NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECRON 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 (:OVER SHEET. 15 APPROPRIATE. If more space is needed, use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF ENRIQUE J. MARTINEZ-VIDAL I, ENRIQUE J. MARTINEZ-VIDAL, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Exec;utrix or Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: Provided my beloved son, ALEXANDER MIGUEL MARTINEZ-VIDAL has not completed college, I give, devise and bequeath all the rest, residue and remainder of my estate as follows: A. Forty (40%) percent to my beloved son, ALEXANDER MIGUEL MARTINEZ-VIDAL, per stirpes. This larger share is givers to him to take into account his need for continued tuition and room and board; B. Sixty (60%) percent to be divided equaPly among my other beloved children, ELENA MARTINEZ-VIDAL, ENRIQUE E. MARTINEZ-VIDAL and CYNTHIA ADRIANA MARTINEZ-VIDAL, in equal shares. All of the gifts made in this paragraph are per stirpes. } THIRD: In the event that my beloved son, ALEXANDER MIGUEL MARTINEZ-VIDAL has completed his undergraduate education, then I give my entire estate to all of my children, ALEXANDER MIGUEL MARTINEZ-VIDAL, ELENA MARTINEZ-VIDAL, ENRIQUE E. MARTINEZ-VIDAL and CXNTHIA ADRIANA MARTINEZ-VIDAL, in equal shares, per stirpes. FOURTH: In the event that my son, ALEXANDER MIGUEL MARTINEZ- VIDAL, has not attained the age of 21 years, 9 give, devise and bequeath the share of the estate which he receives to ENRIQUE MARTINEZ-VIDAL, IN TRUS'i, upon the following terms and conditions: A. To hold, manage, invest and reinvest the principal so received, and accumulation of income thereon, and to use, pay and sapply the income and principal or so much thereof as in Trustee's sole discretion may be necessary for the maintenance, support, medical expenses and education of my child, ALEXANDER MIGUEL MARTINEZ-VIDAL. B. Said payments may be made by my Trustee directly to said child, or in my Trustee's sole discretion may be made directly to any person or institution entitled to such payment by reason of services rendered, er to be rendered to any c' said children. C. The amount to be paid for the benefit of my child shall be determined from time to time by the need of said child, and the amounts and times of said payments shall be determined by such need, provided that payments be made at east monthly. 2 D. All payments of principal and income hereby given shall be free from anticipation, assignment, pledge or obligations of beneficiary, and shall not be subject to any execution or attachment. E. All principal and accumulated income, not so applied, shall be distributed in accordance with paragraphs SECOND A and B, above, when ALEXANDER MIGUEL MARTINEZ-VIDAL attains the age of twenty-one (21) years, or upon his death, whidhever is sooner. LASTLY: I nominate, constitute and appoint my son, ENRIQUE E. MARTINEZ-VIDAL, to be the Executor of this my Last Will and Testament. No Executor shall be required to file bond in this or any other jurisdiction. IN WItNESS WHEREOF, I have hereunto set my hand and seal this / (~ ~~` day of J u ~ 2._ , 2005. .~~ ~~v~- ,l cu ~ ~ -i~ Enriq .Martinez-Vidal ~- SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: 3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss I, ENRIQUE J. MARTINEZ-VIDAL, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last. Will; that I signed it willingly; and that I signed it as my free and voluntary act for tlhe purposes therein expressed. Sworn or affirmed to and acknowledged before me, by ENRIQUE J. MARTINEZ-VIDAL, the Testator, this /6 t`` day :,f .f acve e.~ , 2005. En Ique J. Mart ez-`Jida ,Testator 4 NOTARYIL SEAL MIERLENE J. MARHEVKA, NOTARY PUBLIC CARLISLE, CUMBERUIND COUNTY, pA IAY COMMISSION EXPIRES JUNE 8, 2808 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss We, n ~CJ.~'C 4u~ an C.C~-~ , the witness whose names are sigri to the attached r foregoing instrument, being duly qualifi according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me bt °.~I ,c~ (~C, and this / ~ day of ~ o 2005. Witness ~ / " ~~ Witness .~.~..W..,.,,.,, NOTARIAL 8EAL MERLENE J. MUtNEVKq NOTARY PUBLIC CARLISLE. CUMBERLAND CWNTY, PA MY COMMISSION EXPoRES JUNE S. 2008 k ~ a..1o- 3~ ~ =v _