HomeMy WebLinkAbout10-19-12 (3)15D561D143
REV-1500 Ex (°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po Box.28oso~ INHERITANCE TAX RETURN 21 12 0835
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
201 18 5767 07 21 2012
Decedent's Last Name
TATNALL
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
Date of Birth
04 08 1926
Suffix Decedent's First Name MI
GENE G
Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return
4. Limited Estate ~ 4a. Future Interest Compromise
(date of death after 12-12-82)
g Decedent Died Testate
(Attach Copy of Will) ~ ~• AttacheCo a~of T ust a Living Trust
Py )
9. Liti ation Proceeds Received
g ~ 10. Spousal Poverty Credit date of death
between 12-31 ~J1 and -1-95)
3, Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
n
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
EDMUND G MYERS (717) 761 4540
First line of address
301 MARKET STREET
Second line of address
PO BOX 109
City or Post Office
LEMOYNE
Correspondent's a-mail address: egm@JdsW.COm
Under penalties of perjury, eclare 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 com te. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI TURE OF PERSON E PO SIBLE F FILING RETURN DATE
,(~ ~~ ~ a ~ ? ~ James G Tatnall ~ ~ jr)l(aL
ss
'(611 Churchill Road, Harrisburg, PA 17111
SIG RE OF PREPARE OTHER THAN REPRESENTATIVE DATE
~~~;,~,~ ~?~~,,.,, EDMUND G. MYERS w ~! '7 ~~ v'
ADDRESS
301 MARKET STREET, Lemoyne, PA
150561D143
State ZIP Code
PA 17043
REGISTER WILLS USE f)fVLY
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Side 1
1505610143
J
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedents Name: Tatnall, Gene G 2 01 18 5 7 6 7
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5 , 711.8 4
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 52 , 400.05
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous -Probate Property
(Schedule G) ~ Separate Billing Requested............ 7. 4 3 3, 5 4 7. 4 8
8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 4 91 , 65 9. 3 7
9. Funeral Expenses & Administrative Costs (Schedule H) ..........................,............ 9. 6 , 513.35
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10.
11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 6 , 513.35
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 4 8 5 , 14 6.02
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............................................... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 4 8 5 , 14 6.02
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
15
0 . 0 0
(a)(1.2) X .00 .
16. Amount of Line 14 taxable 4 8 5 , 14 6. 0 2 16. 21, 8 31.5 7
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 .
19. Tax Due .................................................................................................................. 19. 21 , 8 31.5 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
L 1505610243 155610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-12-0835
DECEDENT'S NAME
Tatnall, Gene G
STREET ADDRESS
824 Lisburn Road #107
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
1,091.58
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box 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.
Make Check Payable to: REGISTER OF WILLS, AGENT.
(1)
21,831.57
1,091.58
20,739.99
Total Credits (A + B) (2)
(3)
(4)
(5)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
^ x
a. retain the use or income of the property transferred :..............................................................................
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ 0
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 "in trust for" or payable 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? ..................................................................................................................
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 January 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)]. A
sibling 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-1507 EX+ (6-98)
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Tatnall, Gene G 21-12-0835
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule D (Rev. 6-98)
(If more space is needed, additional pages of the same size)
Rev-1508 EX+ (8-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tatnall, Gene G 21-12-0835
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cumberland County Veteran's Benefit -Burial Benefit 75.00
2 Fulton Bank Checking Account No. 3622-45663 -Date of Death Value of Account. Date of 9,698.66
Death Letter from Fulton bank is attached to this Return.
3 Fulton Bank Money Market Account No. 9904-45510 -Date of Death Value of Account. Date 15,137.10
of Death Letter from Fulton Bank is attached to this Return.
4 Mutual of Omaha -Nursing Home Insurance Refund -Refund of Premiums Paid for Unused 22,512.00
Portions
5 The Woods At Cedar Run - Reimbursement/Refund 1,140.37
6 The Woods At Cedar Run -Security Deposit on Account 2,440.00
7 United Health Care Refund 21.81
8 Verizon Pension -Final Pension Payment for Charles Tatnall, Employee 1,375.11
TOTAL (Also enter on Line 5, Recapitulation) I 52,400.05
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PR PERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Tatnall, Gene G 21-12-0835
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THE DATE OF RANSFER.SATTACN ACOP OF TIHOE DEED OR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET °i° OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 Hartford Annuity Contract No. 000000000/712124311 - 25,547.51 25,547.51
Beneficiaries: James G. Tatnall, Son ~ Karen T.
Haack, Daughter and Robert C. Tatnall, Son.
Date of Death Letter from Hartford is attached to this
Return.
2 Raymond James Account No. 21440846 -Transfer on 227,643.93 227,643.93
Death Account: Beneficiaries: James G. Tatnall, Son
Karen T. Haack, Daughter and Robert C. Tatnall, Son
Raymond James valuation of Account is Attached to
this Return.
3 Charles G. Tatnall, Trust Under Will - MST Investment 180,356.04 180,356.04
Group Account No. 1203045113 -
EstateVal -Date of Death valuation of Assets held in
Trust is attached
TOTAL (Also enter on Line 7, Recapitulation) I 433,547.48
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software `only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (10-06)
SCHEDULE H
,.
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tatnall, Gene G 21-12-0835
Debts of decedent must be reported on Schedule 1.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached 1,931.47
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City
Year(sl Commission oaid
State Zip
2. Attorney's Fees JOHNSON DUFFIE 3,750.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 153.50
5. Accountant's Fees
6. Tax Return Preparer's Fees 250.00
7. Other Administrative Costs 428.38
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 6,513.35
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Tatnall, Gene G 21-12-0835
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex e{~rtses
1 Cremation Society -Funeral Expenses 1,240.47
2 Funeral Reception/Family Dinner 491.00
3 Organist Services for Funeral 50.00
4 Pastor Services for Funeral 100.00
5 Soloist Services for Funeral 50.00
H-A 1,931.47
Other Administrative Costs
6 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Return and 30.00
Inventory
7 Reserves: Miscellaneous Administrative Expenses 200.00
8 The Cumberland Law Journal -Notice of Estate Administration 75.00
9 The Patriot News Co. -Notice of Estate Administration 123.38
H-B7 428.38
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
REV-1513 EX+ (11-08)
SCHEDULE J
COMIN~HERTANCE~TFp,F RETURNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Tatnall, Gene G 21-12-0835
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
o Not List rustee s
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions, and transfers
under Sec. 9116 a 1.2
1 Karen T Haack Daughter 1/3rd of Residue
3435 Countyside Lane of Estate
Camp Hill, PA 17011
2 James G Tatnall Son 1/3rd of Residue
1611 Churchill Road of Estate
Harrisburg, PA 17111
3 Robert C Tatnall Son 1/3rd of Residue
3020 Logan Street of Estate
Camp Hill, PA 17011
Tota I
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
ESTATE OF GENE G. TA TNALL
SCHEDULE OF EXHIBITS
EXHIBIT A Last Will and Testament for Gene G. Tatnall signed and dated
August 7, 2003
EXHIBIT B Fulton Bank Date of Death Valuation of Account Letter
EXHIBIT C Hartford Annuity Contract No. 000000000/712124311 Date of
Death Valuation of Account Letter
EXHIBIT D Raymond James Account No. 21440846 Date of Death Account
Valuation Statement
EXHIBIT E Charles G. Tatnall Trust Under Will ~ EstateVal Date of Death
Valuation of Assets held in Trust
520665
216018
~~
`~.a~t ~iYY attD~ ~Ce~ta~m:er~t
OF
GENE G. TATNALL
I, GENE G. TATNALL, of 431 Allendale Way, Camp Hill, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and Testament, hereby revoking and mal~ing void
ar~y and all Wills~or Codicils at any time heretofore made by mle.
ARTICLE I
TAXES
I direct that all inheritance and estate taxes becoming due by reason of my death, whether
such taxes be payable by the estate or by any recipient of any property, shall be paid from property
passing under this Will, as an expense and cost of administration of the estate. My Personal
Representative shall not demand, or seek, reimbursement for any such tax even if imposed with
regard to proceeds of insurance or other property not passing under this Will.
ARTICLE II
SPECIFIC BEQUEST
I give and bequeath my diamond wrist watch unto my daughter, ~:AREN T. HAACK,
provided she survives me.
ARTICLE III
TANGIBLE PERSONAL PROPERTY
I give and bequeath my motor vehicles(s), household and personal effects and other
EXHIBIT A
216018
tangible personalty of like nature (not including cash or securities), together with any existing
insurance thereon, unto those of my children who survive me to be divided among them by my
Personal Representative with due regard for their personal preferences in as nearly equal shares
as practical.
ARTICLE IV
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue .and remainder of my Estate, of whatever
nature and wherever situate, as follows:
A. One-third thereof unto my son, ROBERT C. TATNALL;
B. One-third thereof unto my daughter, I~:AREN T. HAACK; and
C. One-third thereof unto my son, JAMES G. TATNALL.
Should any of my children predecease me leaving issue to survive, I give, devise and
bequeath such child's share unto his or her then-living issue, per stirpes, and should there be a
failure of same, then I direct that such child's share shall be divided equally among my surviving
children or their then-living issue, per stirpes as the case maybe.
ARTICLE V
UNIFORM TRANSFERS TO MINORS ACT
lil the event any beneficiary of my Will has not reached the age of twenty-five (25) years at
the time for distribution of his or her share, distribution of said share may be made in the discretion
of my Personal Representative after considering the age and needs of the beneficiary, either directly
2
216018 ,
to the beneficiary or to a Custodian for such beneficiary until age twenty-five (25) under the
Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable
Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the state of residence of such
beneficiary as the case maybe. My Personal Representative may designate as such Custodian any
institution or person, including my Personal Representative, qualified to act as a Custodian for such
beneficiary under such Act in effect at the time such distribution is made. A receipt for any
payment or distribution so made shall be a full discharge therefor to my Personal Representative,
who shall not be responsible to see to, or be liable for, the application of such proceeds thereafter.
ARTICLE VI
POWERS OF PERSONAL REPRESENTATIVE
My Personal Representative(s) shall have the following powers in addition to those
vested in them by law and by other provisions of my Will applicable to all property, whether
principal or income, including property held for minors, exercisable without couz-t approval and
effective until actual distribution of all property:
A. To make distribution in cash or in kind, or partly in cash and partly in l~ind, and in
such manner as they may determine.
B. To retain any or all of the assets of my estate, real or personal, without restriction
to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to
any principle of diversification or risk.
C. To invest in all forms of property without restriction to investments authorized for
Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification
or risk.
3
216018
D. To sell at public or private sale, to exchange, or to lease for any period of time any
real or personal property and to give options for sales, exchanges or leases, for such prices and
upon such terms.or conditions as they deem proper.
E. To allocate receipts and expenses to principal or income or partly to each as they
from time to tune think proper.
F. To compromise any claim or controversy.
G. To make such elections, decisions, concessions and settlements in connection
with all income, estate, inheritance, gift, generation skipping or other tax refunds and the
payment of such taxes as my Personal Representative shall deem appropriate, without obligation
to adjust the distributive share of any person thereby affected.
ARTICLE VII
PERSONAL REPRESENTATIVE
I name, constitute and appoint my son, JAMES G. TATNALL, Executor of this my Last
Will and Testament. Should my son, JAMES G. TATNALL, fail to qualify or cease to so act, I
name, constitute and appoint FULTON BANK alternate Executor. No fiduciary appointed
herein shall be required to post bond for the faithful discharge of the duties required in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this ~~ day of ~ ~'' %~ ~ 2003.
F
~~ .,-,,~.~_ .,~~, ~~~ L~-~~C~ (SEAL)
GENE G. TATNALL
4
216018 <
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, in the presence of us, who at her request, in her presence and in the presence of
each other, have hereunto subscribed our names as witnesses.
r
r
< ~-~,°
P
5
216018
AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND ~:
~`
We, GENE G. TATNALL, and ~_~ - t
Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix
signed and executed the instrument as her Last Will and that she had signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the
best of his/her l~iowledge the Testatrix was at that time eighteen years of age or older, of sound
mind and under no constraint or undue influence.
GENE G. TATNALL
~,/° ~ .
~~ ~'
Witness
~y---- ~ C~-y~- -__._ .._
Witne~
Subscribed, sworn to and acknowledged before me by GENE G. TATNALL, Testatrix,
and subscribed and sworn to before me by ~~~~~~q ~ _ ~-~--~~ .~.. ~,,.,,.,, and
~*i
`~~.~~,,,_, ~ ~_ s', _ ~F~.,,~,~~ ,witnesses, this 1 day of ~ _~ , 2003.
--_._
.~
Notary Public
fi--~=.-c.~x::.i
Did ~®~. N~iG~ N~ a~~Pu '
Y bPsc
~ir.~r~oyne i3or~t~~b Gur~bariand Go.
6 ~~ ~Y G~r~rr~ission ~xpiras Ds~. 2~, 2~0~ ~
Ftiilton Bank
LISTENING IS JUST THE BEGINNING
August 24, 2012
Johnson Duffie
301 Market Street
P.O. Box 109
Lemoyne, Pennsylvania 17043
Dear Ms. Wieseman:
RE: Gene G. Tatnall, deceased July 21, 2012
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
Checking # 3622-45663, open 2/14/2004, date of death balance $9,698.66,
(any accrued interest ($ .51) would not have been payable had the account
been closed on the date of death) in his name only with James G. Tatnall
and Karen T. Haack as Powers of Attorney,
Money Market # 9904-44510, open 5/16/1997, date of death balance
$15,137.10 plus accrued interest $2.44, in his name only with James Tatnall
and Karen T. Haack as Powers of Attorney.
The decedent also has a safe deposit box # 215 at our West Shore Branch,
in his name only.
If you should have any further questions, please do not hesitate to contact me at (717) 291-
243 7.
~`~i ~° + -
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;~ y t.. •i.• ci:rl :.:1 r~. 4.++.Y iryi..,r tJ $~~%f~Y .ve3~
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•r
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~!i~.~i ~~t; :.+~t~,~~, i:s dtis~!s-Ri !~., !'a°tii w~i~>~k:y~~i~:if:i. i' {;: f}~•;~jii!.. t~ Rn~ ~}^€.J
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!ice€i~'~ ~~ i~i',r ~+i 4::i d:i?t..~!'~, .,; ..:~ej: :~i'::~~ 9rj ^,~7,:'i`aE. fir's?i i' ~€ i~~
>iv~`~ii~f 4~.i~a~fi~~:i~;S:it d+: .'s#a't'°"ii!.i ~;~ (,`S';'t:l,.`~g'v V`i'ii°~rl.{ ;i~,et:;+.,~
(tc~
Very truly yours,
(~->~-~..~ ~~ bra t:..i~
D Hille as
Karen g
Credit Inquiry Processor
1.800.FULTON.4 fultonban~
Fulton Bank, N.A. Member FDIC. Member of the Fulton Finan EXH/B/ T B
THE'
HARTFORD
September 7, 2012
Nancy Rivera
nrivera@fultonfinancialadvisors.com
Reference: The Hartford Annuity 712124311
Gene G Tatnall, Decedent
Dear Nancy Rivera,
Thank you for your correspondence regarding the above annuity contract.
The death benefit payable under this contract is not considered "life insurance" reportable on IRS Form 712, (life
insurance statement). Please find the below information in response to your request.
Contract Number 712124311
Owner Gene G Tatnall
Decedent Gene G Tatnall
Social Security Number XX-XX-5767
Date of Death July 21, 2012
Cash Value on the date of death $25,197.51
Death Benefit Value on the date of death $25,547.61
The Death Benefit Value on the date of death displayed above may incluc~ a Death Benefit Adjustment as outlined in the Annuity Contract. This figure is being
provided for illustration purposes and is not equivalent to the final death benefit. The death benefit will be calculated on all contracts associated with this client
the day we receive the certified death certificate. Once the death benefit is calculated, the benefit amount remains invested and is subject to market fluctuation
until complete settlement a~structions are received.
Please contact your Investment Professional or one of our Annuity Specialists with any questions or concerns. You
may reach The Hartford by calling 1-800-862-6668, Monday through Thursday from 8 a.m. to 7 p.m. and Friday
from 9:15 a.m. to 6 p.m., Eastern Time.
Thank you for the opportunity to help provide for your financial needs.
Sincerely,
Investment Product Services
ICS Annuity Benefit Services Team
Hartford Life and Annuity Insurance Company
The Hartford Wealth Management -Global Annuities
745 West New Circle Road
Building 200, 1st Floor
Lexington, KY 40511
Mailing Address:
PO Box 14293
LeX1P~nn KY d(151 ~_d~9'~
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EXHIBIT D
Estate Valuation - Tatnall, Charles G. T/W
Date of Death: 07/21/2012
Valuation Date: 07/21/2012
Processing Date: 09/19/2012
Shares Security
or Par Description
Estate of: Charles G. Tatnall T/W
Account: 1203045113
Report Type: Date of Death
Number of Securities: 29
File ID: Charles G. Tatnall, Jr. 1203045113 Estate Val
Mean and/or Div and Int Security
High/Ask Low/Bid Adjustments Accruals Value
1) 5508.56 Cash (CASH) 5,508.56
2) 391.37 Cash (CASH) 391.37
3) 227.995 DREYFUS/LAUREL FDS TR (261980668)
INTL BD FD CL I
Mutual Fund (as quoted by NASDAQ)
07/20/2012 16.91000 Mkt
16.910000 3,854.55
4) 369.482 MFS SERS TR X (55273E640)
EMER MK DEBT I
Mutual Fund (as quoted by NASDAQ)
07/20/2012 15.65000 Mkt
15.650000 5,782.39
Daily Div. Accrual as of 07/21/2012 16.79
5) 579.091 ARTIO GLOBAL INVT FDS (04315J860)
GLBL HIYLD I
Mutual Fund (as quoted by NASDAQ)
07/20/2012 9.62000 Mkt
9.620000 5,570.37
6) 640.097 RIDGEWORTH FDS (766287678)
SEIX FLRT HI I
Mutual Fund (as quoted by NASDAQ)
07/20/2012 8.82000 Mkt
8.820000 5,645.66
Daily Div. Accrual as of 07/21/2012 16.41
7) 374.504 FEDERATED FIXED INCOME SECS (31417P858)
MUN ULTSH I NW
Mutual Fund (as quoted by NASDAQ)
07/20/2012 10.05000 Mkt
10.050000 3,763.77
Daily Div. Accrual as of 07/21/2012 2.09
8) 500.071 PRICE T ROWE TX FR HI YLD FD (741486109)
COM
Mutual Fund (as quoted by NASDAQ)
07/20/2012 11.73000 Mkt
11.730000 5,865.83
Daily Div. Accrual as of 07/21/2012 14.56
9) 733.028 ROWE PRICE TAX FREE INCOME FD (779576107)
COM
Mutual Fund (as quoted by NASDAQ)
07/20/2012 10.53000 Mkt
10.530000 7,718.78
Daily Div. Accrual as of 07/21/2012 17.09
10) 3518.739 WILMINGTON FUNDS (971810555)
PA MUN BD INSTL
Mutual Fund values reported to NASDAQ
07/20/2012 10.60000 Mkt
10.600000 37,298.63
Daily Div. Accrual as of 07/21/2012 52.37
11) 496.525 ADVISORS INNER CIRCLE FD (00758M634)
LSV VAL EQ FD
Mutual Fund (as quoted by NASDAQ)
07/20/2012 13.90000 Mkt
13.900000 6,901.70
12) 211.52 MORGAN STANLEY FOCUS GROWTH (616933404)
SBI CL I
Mutual Fund (as quoted by NASDAQ)
07/20/2012 37.88000 Mkt
37.880000 8,012.38
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)
EXHIBIT E
Date of Death: 07/21/2012 Estate of: Charles G. Tatnall T/W
Valua tion Date: 07/21/2012 Account: 1203045113
Proce ssing Date: 09/19/2012 Report Type: Date of Death
Number of Securities: 29
File ID: Charles G. Tatnall, Jr. 1203045113 Estate Val
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
13) 318.392 INSTITUTIONAL EQUITY FDS INC (45775L408)
LGCAP GROWTH
Mutual Fund (as quoted by NASDAQ)
07/20/2012 17.83000 Mkt
17.830000 5,676.93
14) 196.861 TIAA-CREF INSTL MUT FDS (87244W897)
MIDCP VAL RETL
Mutual Fund (as quoted by NASDAQ)
07/20/2012 17.48000 Mkt
17.480000 3,441.13
15) 819.29 WILMINGTON FUNDS (971810688)
LGCP GRW INSTL
Mutual Fund values reported to NASDAQ
07/20/2012 8.32000 Mkt
8.320000 6,816.49
16) 667.117 WILMINGTON FUNDS (971810712)
LCP VAL INSTL I
Mutual Fund values reported to NASDAQ
07/20/2012 9.75000 Mkt
9.750000 6,504.39
17) 603.293 WILMINGTON FUNDS (971810662)
MDCP GRW INSTL I
Mutual Fund values reported to NASDAQ
07/20/2012 13.85000 Mkt
13.850000 8,359.92
18) 581.857 WILMINGTON FUNDS (971810431)
MULMG ASST INSTL
Mutual Fund values reported to NASDAQ
07/20/2012 14.50000 Mkt
14.500000 8,436.93
19) 288.653 WILMINGTON FUNDS (971810639)
SMCP GRW INSTL I
Mutual Fund values reported to NASDAQ
07/20/2012 15.81000 Mkt
15.810000 4,563.60
20) 38 ALPINE GLOBAL PREMIER PPTYS FD (02083A103)
COM SBI
New York Stock Exchange
07/20/2012 6.47000 6.37000 H/L
07/23/2012 6.35000 6.25440 H/L
6.361100
Div: 0.050000 Ex: 07/20/2012 Rec: 07/24/2012 Pay: 07/31/2012 + 0.050000
6.411100 243.62
21) 39.501 GUINNESS ATKINSON FDS (402031405)
GLOBAL ENERGY
Mutual Fund (as quoted by NASDAQ)
07/20/2012 24.78000 Mkt
24.780000 978.83
22) 235.31 MAINSTAY FDS TR (56063J864)
EPOCH GBL EQT I
Mutual Fund (as quoted by NASDAQ)
07/20/2012 15.79000 Mkt
15.790000 3,715.54
23) 102.098 RS INVT TR (74972H648)
GLBL NAT RES Y
Mutual Fund (as quoted by NASDAQ)
07/20/2012 35.69000 Mkt
35.690000 3,643.88
Page 2
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)
Date of Death: 07/21/2012
Valuation Date: 07/21/2012
Processing Date: 09/19/2012
Shares Security
or Par Description
24) 80.197 GUINNESS ATKINSON FDS (402031207)
CHINA & H K FD
Mutual Fund (as quoted by NASDAQ)
07/20/2012
25) 160.741 HARBOR FD (411511306)
INTL FD INSTL
Mutual Fund (as quoted by NASDAQ)
07/20/2012
26) 302.16 LAZARD FDS INC (52106N889)
EMERG MKT INST
Mutual Fund (as quoted by NASDAQ)
07/20/2012
27) 323.459 LITMAN GREGORY FDS TR (53700T207)
MSTR INTL INSTL
Mutual Fund (as quoted by NASDAQ)
07/20/2012
28) 1198.505 WILMINGTON FUNDS (971810787)
MLTIMG INTL INST
Mutual Fund values reported to NASDAQ
07/20/2012
29) 62 ISHARES TR (46429B663)
HGH DIV EQT FD
NYSE Arca Equities Exchange
07/20/2012
07/23/2012
Total Value:
Total Accrual:
Total: $180,475.35
Estate of: Charles G. Tatnall T/W
Account: 1203095113
Report Type: Date of Death
Number of Securities: 29
File ID: Charles G. Tatnall, Jr. 1203045113 Estate Val
Mean and/or Div and Int Security
High/Ask Low/Bid Adjustments Accruals Value
26.34000 Mkt
26.340000 2,112.39
55.24000 Mkt
55.240000 8,879.33
18.14000 Mkt
18.140000 5,481.18
12.65000 Mkt
12.650000 4,091.76
6.15000 Mkt
6.150000 7,370.81
60.55900 60.28000 H/L
60.09700 59.73000 H/L
60.166500 3,730.32
$180,356.04
$119.31
Page 3
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)