HomeMy WebLinkAbout01-25-13 (3)
J REV-1500`(01-10I 1505610143
PA Depattrnent of Revenue pennsyfvanta
Bureau of Individual Taxes ~°^~fOi~'"'E
PO Box.zaosot INHERITANCE TA;
Hanisburg, PA 17128-060t RESIDENT DEC
Sodal Security Number Date of Dealh
04 27 2012
Decedent's Last Name Suffix
CONRAD
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Sodal Sacudty Number
FILL IN APPROPRIATE OVALS BELOW
OFFICUIL USE ONLY
County Cade Ye9r Flle Number
121 12 00690
Date of Birth
06 07 1925
Decedent's First Name MI
SAMIIEL I
Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
® 1. Onglnel Retum ^ 2. Supplemerdel Retum ^ 3. Remainder Realm (date of death
prkx to 12.132)
^ 4. Limited Estate ^ ~' ~
6 a a mt ~
z
z1a ^ 5. Federal Estate Tex Retum Required
d t
t
-
21
0
® g, Docetlent Died Teetete
f ^ 7_ Decedent Meinteinetl a uNn9 Tnfet
(A118M CWY d Tnist) S. Tofal Number M Safe Deposit Boxes
wllp
(Altedi CapY o
^ 9. Lldgetlon Proceeds Received ^ 10. Spousal Povero Gedu~data ar seam
between 12-31 7 entl -1-95(
^ t 7.Electlon to tax under SeG. 9113(A)
(Attach SGh. O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime TO-ephone NurrllNr
GA RY L ROTHSCHILD 717 ~4cQ 35fI1 ar ~'
c~
o.
First line of address
2215 FOREST HILLS DRIVE
Second Ilne of address
SIIITE 35
City or Post Office
HARRISBIIRG
Corraspondent'se-mail address: Giroth
State ZIP Code
PA 17112
comcast.net
Cathie C. MacArthur
2730 N. 1,IId Street,
PA 17110-1204
L Rothschild
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DATE FIL~ -~
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2215 Forest H(Ils Drive, Harrisburg, PA 17112
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
RECAPITULATION
1. Real Estate (Schedule A) ................................................................................... .. 1.
51 , 9 5 6 . 7 8
2. . ..........
Stocks and Bonds (Schedule e) ............................................................ . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ . 3.
183,187.06
4. Mortygages & Notes Receivable (Schedule D) .................................................... ... 4.
1 1 4 , 5 5 5 . 9 5
5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) ............ .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested.......... .. 6.
7. Inter-Vivos Transfers 8 Mlscel4aneous Non-Probate Propany 3 2
3 7 7. 4 4
(Schedule G) ^ Separate Bllling Requested.......... .. 7. ,
g,
.................................
Total Gross Assets (total Lines 1-7} ............................._.
. 8. 3 8 2, 0 7 7. 2 3
1 4, 8 2 4. 3 4
9. ....................
Funeral Expenses & Administrative Costs (Schedule H} .............. .. s.
4,750.86
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ........................... ... 10.
1 9 , 5 7 5 . 2 0
11. Total Deductions (total Lines 9 & 10} ............................................................... .. 11.
362,502.03
t2. Net Value of Estate (Line 6 minus Line 11} ...................................................... .... 12.
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an electlon to tax has not been made (Schedule J) ............................................ .. 13.
3 6 2 , 5 0 2 . 0 3
14. Net Value Subject to 7ax(Line 12 minus Line 13} ........................................... ... 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal fax rate, or
transfers under Sec. 9118
(a)(1.2) X .00 15.
16. Amount of Line t4 taxable 3 6 2
5 0 2. 0 3 16 1 6, 3 12.5 9
,
at lineal rate X •045 .
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 16.
19. Tax Due ............................................................................................................
19_
...
16,312.59
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1505610243
Side 2
1505610243
J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 12 - 00690
Conrad, Samuel Irvin
STREET ADDRESS
12 Moore Circle
CITY
Carlisle STATE
PA ZIP
17015-7607
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Pdor Payments
B. Diswunt
3. Interest
13,000.00
884.21
q. 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 Llne 2, enter the difference. This is theTAX DUE
Total Credits (A +B) (2) 13,884.21
(3) 0.00
(4)
(s) 2,628.38
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 :............................................................................. ^ x
b. retain the right to designate wta shall use the property trensferred or its income :................................ ^ x
c. retain a reversionary (nterest: or ............................._............................................................................ x
d. receive the promise for life of either payments, benefits or cere7 ............................._............................ x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death wittxwt ^ ^
receiving adequate consideratlon2 ............................._........,........................................................................ x
3. Did decedent own an `in trust for' or payable upon death baMc account or security at his or her death4....... ^ ^x
4. Did decedent own an Individual Retlremenl Account, annuity, or other non-probate property which
contains a benefidary designation2 ............................._.........................,........,......................._.................... ^x ^
IF THE ANSNIER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETUR
For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposec on ma net value of vansters m or ror me use of ma survmrnJ
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (I)].
For dates of death on or after January 7, 1995, the tax rate imposed on the net value of transfers th or for the use of the surviving spouse is 0 percent
[72 P.S. §9118 (a) (1.1) tii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of
assets and filing a tax rettuum are s811 applicable even if the surviving spouse is the only benefldary.
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a dec~sed child 21 years of age or younger at death to or for the use of a nature) parent, an
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) ( .2)].
• The tax rete imposed on the net value of transfers to or for the use of the decedent's lineal benefidades is 4.5 percent, except as noted in
72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
• The fax refs 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 blo or adoption.
(1) 18,312.59
SCHEDULE B
STOCKS 8~ BONDS
CAwMOgWEPLTH cv reransnvu+w
INXERITNlCE iq%RETURN
nESioEHr ceceoEr+r
FILE NUMBER
ESTATE OF Conrad, Samuel Irvin 21 - 12 - 00690
All propeRy jolntlyowned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER UNIT VALUE VALUE AT DATE OF
DEATH
1 ATT common stock (716 shares) 32.60 23,341.60
2 Teradata common stock (24.646 shares) 70.415 1,735.45
3 Comcast common stock (180 shares) 30.165 5,429.70
4 Frontier common stock (120 shares) 4.075 489.00
5 NCR common stock (24.6 shares) 23.345 574.29
6
I Verizon common stock (506 shares) 40.29 20,386.74
TOTAL (Also enter on line 2, Recapitulation) 51,958.78
SCHEDULE D
~«~A«,~EALTHOFRE~„~.2~ANN MORTGAGES 8~ NOTES RECEIVABLE
INHERRANCE TAX RENRN
RESIOENl pECEDENT
FILE NUMBER
ESTATE OF Conrad, Samuel Irvin 21 - 12 - 00690
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION
DEATH
1 Loan Receivable from Larry Conrad (son). 169,150.00
2 Accrued interest on loan to son, as of date of death (February $ 135.32, March $ 211.44, April 537.06
211.44 x 27/30= $ 190.30)
3 Loan Receivable from Elizabeth A. Payne (daughter). Interest free. 13,500.00
TOTAL (Also enter on Line 4, Recapitulation) ~ 183,187.06
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
wnraor,~TM~vErr~snvµu PERSONAL PROPERTY
INXE,tITANCE TN(RETUPN
FESIOEM OECEOEM
FILE NUMBER
ESTATE OF Conrad, Samuel Irvin 21 - 12 - 00690
Include the proceeds of litigation and the date the proceeds were received by the estateAll property Jointly-owned with the right of
survivorship must be disclosed on schedule F.
NUMBER I DESCRIPTION I VALUEDA~T DHTE OF
1 Belco Community Credit Union-savings account balance and accrued interest ( Statement I 1,548.27
from BELCO attached as Exhibit 2)
2 I Beico Community Credit Unionchecking account balance and accrued interest (Statement I 28,502.79
from BELCO attached as Exhibit 2)
3 Belco Community Credit UnionSapphire money market account balance and accrued interest 36,579.42
(Statement from BELCO attached as Exhibit 2)
4 2010 Subaru Forester 2.5X7- 25,000 miles, Kelley Blue Book value in very good condition is $ 22,000.00
20,500 (See attached Exhibit 3). Sold for $ 22,000.00.
5 12001 Chevrolet Corvette- 31,000 miles, Kelley Blue Book value in good condition (See attached) 21,295.00
Exhibit 4).
6 I Personal property (furniture, jewelry, clothing, guns and miscellaneous items) disVibuted to I 4,630.47
heirs or sold at auction.
TOTAL (Also enter on Line 5, RecapltulaUon) ~ 114,555.95
COM NHERITALNCETAXERETURNANIA INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Conrad, Samuel Irvin FILE NUMBER
21 - 12 - 00690
This schedule must be completed and flied If the answer to any of queaNons 1 through 4 on page 2 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
IntludeMenamaofVlatrana(eree,Ilwhrolaa°nchlplotleeetleM
antl Me tlate °f bamfer. AVeph a copy o(Iha tleatl (a real eatale. DATE OF DEATH
yALUEOFASSET %OF
Deco•s
INTEREST E%DWSION
pFAPPLICABLE)
TAXABLE VALUE
1 Belco Community Credit Union-IRA account and i7,3ta.ts 100°/a 17,319.16
accrued interest (Statement from BELCO attached as
Exhibit 2)
2 Prudential IRA Contract Number 98179411 ~s,oss.2e 100°/a 15,058.28
(Statement from Prudential attached as Exhibit 5).
Value based upon January 1, 2012 value of $
14,478.05 plus $ 580.23 representing one third of
year decedent was alive times investment
performance ($ 1,740.69) for entire year of 2012.
TOTAL (Also enter on line 7, Recapitulation) ~ 32,377.44
~St~fDULE H~~+ p
COMAONWFwLTM OF PFNNSYLVRNU ~•~~y'~~~~}~pEd~LI /w~7/G~J~R~~
4NHFAITANCE TN(RENRN KII~I~R71 M~ \AN I J
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Conrad, Samuel Irvin 21 - 12 -00690
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Hoffman Roth Funeral Home, 219 N. Hanover Street, Carlisle, PA 17073: balance 174.59
owed on prepaid funeral
2 Philipsburg Marble & Granite: Marble markers for grave 700.00
3 Philipsburg Cemetery: burial fees 325.00
B.
1. ADMINISTRATIVE COSTS:
Personal Representatlve's Commissions
Name of Personal Representative(s)
Cathie C. MacArthur
,000.00
Street Address 2730 N. 2nd Street
City Harrisburg state PA zip 17110-120
Year(s) Commission paid
z. Anomey's Fees The Law Offices of Gary L. Rothschild 8,000.00
3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
a. Probate Fees Register of Wills 223.50
Register of Wills 255.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees Preparation of final tax returns 100.00
7, Other Administrative Costs
1 Notary fee, postage stamps and bank fee for checks 46.25
TOTAL (Also enter on line 9, Recapitulation) 14,824.34
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
Cq.TgNNFALTH DF aENNSr~vANw LIABILITIES
INHERITANCE TA%REIVRN , LENS
RE&DEIR DECEDENT
FILE NUMBER
ESTATE OF Conrad, Samuel Irvin 21 - 12-00690
Report debts incurred by the decedent prior to death that remained unpaid at the data of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 AAA Aetna Access VISA account 257.39
2 UGI-utilities 91.17
3 Met Ed-utilities 118,34
4 Verizon Wireless-telephone 193.61
5 Century Link-modem 254.06
6 Cumberland Crossings Residential Fees 3,662.00
7 West Shore EMS-medical 124.69
8 Carlisle Medical Center-medical 51.40
TOTAL (Also enter on Llne 10, Recapltulatlon) I 4,750.88
REV-t5t] E%~ (H-08)
SCHEDULE)
BENEFICIARIES
ESTATE OF FILE NUMBER
Conrad, Samuel Irvin
21 - 12 - 00690
NUMBER
NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERLY RELATIONSHIP TO
DECEDENT
oo lbt Ll,t lluatw(,I SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
I,. TAXABLE DISTRIBUTIONS[include ouMght spousal
d t
f
di
rib
ti
ons, an
rans
st
u
ers
under Sec. 9116 (a) (1.2)]
1 Mrs. Elizabeth A. Payne Daughter One-fourth
612 Sheniey Drive
Erie, PA 16505
2 Mrs. Cathie C. MacArthur Daughter One-fourth
2730 N. 2nd Street
Harrisburg, PA 17110-1204
3 Mr. Larry Conrad Son One-fourth
105 Edge Drive
Carlisle, PA 17015
Enter dollar amounts for distdbutions shown above on fines 1 5 through 18 on Rev 1500 cove r sheet, as appropriate.
I~ NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE~f 0.00
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued
INHERRANCE TA%PETURN
RESIDENI'DECEDENr
ESTATE OF
Conrad, Samuel Irvin FILE NUMBER
21 - 12 -00690
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Na Ll.e irustas(.1
I, TAXABLE DISTRIBUTIONS[inciude outright spousal
disMbubons, and transfers
under Sec. 9118 (a) (1.2)]
4 Mr. Mark Conrad Grandson One-sixteenth
43 Stert Street
Abingdon OX14 3JF UK
5 Ms. Lisa Conrad Granddaughter One-sixteenth
Lisajconrad@hotmail.com
Kuwait
6 Mr. Robert Lawrence Beers Grandson One-sixteenth
510 South Market Street
Mechanicsburg, PA 17055
7 Ms. Andrea Beers Ferante Granddaughter One-sixteenth
1063 Mosser Road, M101
Breinigsville, PA 18031
Page 2 of Schedule J
i aST 1. CT A"Q*:TOF AMI,:EI~Ry~.CC>MLjp
I, SAMUEL. IRVIN CONItAD, of Middlesex Town, rip, i'umt~erlan~:1 County,
Ptnnsylvenia, being of sound end disposing mind, rcemori - td undersnmdu;g, do make, publish
and declare this my Last Will and Testament, hereby revokin and rtakin g void any and all prior
WiIls•by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral a xnse s as s~ x>n after my decease as
dre same can conveniently be done.
2.
All the test, residue and remainder of my Estate, tea., ervonal ant! ranted, whatsoever end
wheresoever sima[e, I give. devise attd bequeath to my belove~ '. U~fe, ANNA IAUISE CONRAD,
m her own use and benefit absolutely.
3.
In the event my said wife, ANNA LOUISE CONRAD shoal d pre,ieceatse me ar die at
about the same time I do, such as in an accident ar disaster cor~ mon to bot~ of us, I hereby direct
all the rest, residue and remainder of my Estate m be divided a. ri distributed as follows:
A.) Oao-fotudr (I/4) thereof shall be given m my grarrc< hildren, iw:luding those ban after
the date of this will, who survive me, as a chtss, per capita.
B.) Three-fourths (314) thereof shall be distributed in e:: ua] shams amongst my children,
per stitpes, to wit: Lawrence L Cottrad,'Cathie L. Beets, and E? ixabrtfi A. payee. (It is
understood that in the evem one of trry said children predecease ~ the end is sutvvved by childrenr
that those children may rake in their own right, per capita, trade- subpatag.: k above and may also
take their per sdrpitel distribution through their parent's stocks)
4.
I trominate, constitute and appoint my said wife, ANNA '.GUISE C7 )NRAD, to be the
Execurtix of this my Lest Will and Testament In the event that >he shwld predecease rue a fa
any reason be unwilling ar unable to as as such Executrix, I tmr•~ina[r. corrszitute. and appoint my
daughters, Cathie L. Beers and Elizabeth A. Payne, m be Co-Ex:~cutdces in her place and stead I
further direct that they shall trot be required to file bord ar other ~~u ~tuity in the Office of the
Regisur of Wills far the purpose of admirristering my Estate.
,,.
IN WITNESS WHEREOF,d have hcrcunto sec my hem and seal this rs~`'dey of
Ju c ~ . A.D: 199?.
(SEAL)
S IR
Signed, sealorl, Published and declared by the above-named SAMUEL IRVITI CONRAD
as and for hrs Last Will and Testament, in We presence of us, wha at his rcquest and in his
presence. end in the presence of each other, have hereunto snbscrib ji~ur names as vritrtesses.
~ BELCO
COMMUNITY CREDIT UNION
Law Offices of:
Gary L. Rothschild
2215 Forest Hilis Drive, Suite 35
Northwood Office Center
Hamsburg, Pa. 17112
September 10, 2012
Re: Estate of: Samuel I. Conrad
S.S. NO. 205-18-2454
Attention:
Here is the information for the above referenced account.
Notification was sent to our IRA processor on the death of Samuel I Conrad with a
contact person of Cathie C. Macarthur, daughter, if they need more information.
There was no IRA application in the member's file, unable to give information has to
who are beneficiazies on the IRA.
When we receive the approval from our IRA processor to close the IRA, the check will
be made to the Estate of Samuel I. Conrad unless otherwise instructed by processor.
If you need any further information, please call me at (717-720-6414).
Sincerely,
d~%
Finance Department
DECEDENT ESTATE INFORMATION(On Date of Death)
1. Name(s) in which the account was held: SAMUEL I. CONRAD (PRIMARY OWNER)
ANNA L CONRAD (JOINT OWNER)
2. Account number: 9040
3. Balance as of date of death: 04/27/12 $83,928.45
Balance Accrued Dividends YTD Dividends Opened
Regular Savingr Si $1,548.01 $0.26 $1.68 1/8/1973
Holiday Club S2
Money Market: S6 $36,567.39 $12.03 $81.11 2/9/2011
Checking: S4 $28,500.30 $2.49 $111.37 3/9/1987
IRA: S5 $17,312.75 $6.41 $72.60 1/8/1973
Certificates: Balance Accrued Dividends Certficate Number YTD Dividends
NONE
4. Date the account was in8iated: N/A
5. Name(s) in which Safe Deposit Box was held: NONE
6. Date the box was initially rented: N/A
7. Branch address at which the box is located: N/A
8. Loan Information: Balance Accrued Interest Per Diem Int
A. Unsecured Loans: NONE
L14 Classic Asa Card NONE
e. Secured Loans: NONE
C. Mortgage Loans: NONE $ $
$ $ $
$ $ $
9. Miscellaneous:
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No V[M No Probbnl auV an 11N1.IMFTED
rc4nrrt today and inn VINE: a, ynu ir_seand+.
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Prudential "M"'
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Amutln SarAca e'1' of 3
P.O: eo: 13187 ~
PhadslplYa, PA 18178 Yariabk luveetmeut Plan
Annuity $t3llmm[
dautrary Ol, 2012 through December 31, 2012
FlnanGal Profusslonal:
THOMA8 W. ROWAN
>03L38 2276891 001 092001 PRUDENTIAL-PFS
SAMUEL I. CCWRAD 150 CORPORATE CENTER DRIVE
2730 N 2ND ST SITE 104
NARR7SBUR0, PA 17110-1204 CAMP HILL, PA 17011
Phonalt (717) 512-2516
Contract Number: 8.9179411 Type; IRA Contrail Issue Data: 04/20/1887
Owtror Name(s): 3AMUEL 1. CONRAD Annuity Date: 04/20/2015
Mnuitant: 6AMUEL I. CONRAD
Please review you: Nelemsmt ~ contact us within 30 days if you !mil any infwmetim you Believe b ba iuacctaate. The living a death
bmetit values you Bove ace povidedm the "Your BeneBls• aeetiaa of this statement. Uyou do not sae a bme6t that yon aeleeted, please
contact us.
Your Portfolio
Your Annuity Activity
Beginning Aaouat Value
Purchase Payments
Withdrawals
Contract Fees and Charges"
lnvestiomt Performeae
BudLsg Aaount Yahse•"
~- •~ • --
Year-to-Date
114,478.03
.00
.00
.00
61.740.69
516,21&74
• «f.'rlaaa F.r rd
travdufar, rsnrt msueaamos srss, or ifepplirbla r
apoaddwgt6• Priodcavrud bytLh+WrusiO. other
haoefu far ardtrax adosaol re8sa aaoaaat&ssthes
uv vdmkda dr dtilyrWuWim odtlr aaR pia aftlr
sppliahle paafdioa 7lar sr ratleahdm LLa vahr
prwidd ®~9?anaollo 1)eerT. I9rr raferbyoYr
amuiry poyrnr for ofixoWioo nFr&oFttiae far.
••"laeYaaAaarrt Yetee" it yaxr vehrprirto9ie
spptiwimafaoy &armdr CMrye (CDeC), N.rtat
Vdus A~Wrml (MVA) and say OBrr Fro sod ChrM
tlW mrybe app9uhtab yra may aaasat.
Your Benefits _
~~ >Bese~ 016,918.94
The death benefit is paid out upon the death of the Bole or lest surviving annuitant Please refer b your coalract a the enm»ry preapeetna
for sm oxplamtim of the features sad benefits avafleble tender year conhnrR.
The A~tdry 1)emh BeaeSt u aboeo n of the date of this statememt and may fluctuate For mme daeila m how the net death benefit le
ealculated. please review yom proepochta Cerlsin terms sod oooditims detailed is yea pm+pacbta may a6W the actual death benefit
(1rcQlb
Subject b certain possilAe ]imitstims, Purabase Credits are egad to s apaified percentage of each Purchase Payment made to your
Coatracl. Please refer b yeas proepwm or cwtract for 5utlta details.
Annuitlns Salvino Cerrlar: (888) 776-2888 Wadysite: www.prudenGel.com
Houa: Mon-Thurs 8 AM 1o T PM ET, Fri B AM to B PM ET Joln the n-Movaneett. Enroll In s-0allvary todnyl
Agent fU a liGa6U Olfice ~ FIAR7C
otata uyaeat mssm otrmx aooot;aootw
%I'/ell 1, CC
Contrail Number: 98179411
Page 2 of 3'
Portfolio Detail
Drl7sarnallrs vAwwtala6 mrnl. r yALtiJE`
As of December 31, 2012 S16,218.74 516,218.74
As~1>exntba 31, 2011 S14,478.05 514,478.05
• Tdal Ioveebnat Valve" redacts all climgv that have Lam imposed, ea of this sYatrmmt date, but dose eat inllude cbsrgd that maybe
uapoeed is the Curse.
Variable InVestmetrts
s1,
i of UnHs Unit Price Portblb Value 1 • of Units Unit PAce Porlfolb Vahw
Speeial Equity:
Pnldentlel Flrd>le bM~ 2,178.37208 7.41t~ 118278.74 2,778.37208 B.B48Z7 514,17a96
Total Variable InvaetmeMs 118,216.74 ~ 514,476.06
Withdnwsls nude prior b the Aetammt date are retLxted io the values ehotvo above. The)Nstmity Date is the sod of your t3neraotee
1'aiocl. The amwdv value ntay chemge daily b rdlect the invesmtmt perfmtnettoe of the Sob Aecomts in vvhieh yet ere inveatcd e~
fltw~atetiaoa in our cuamt fixed rates. Ota cmrmt 5toed rate ere sensitive to iatueat tde Ouctuaticns in the market
Ia edditicn to the sub-socouoty you cuaeotly inveA io, ymv annuity may offs edditiaul sub-acmunia far your woeideaeti®. Please
aomeet your fmmcialprofeasiosel Ya esdRmce i¢ revievaing all of your investment aptiata and mekiag e8ocatim rlumges suitable for
yom peracrosl aituetim and investment goals. You can also obtain infarmeti®ce yea annuity's inveslmmt phufam by going to the
vvebaite pcnvidedm tbis ttatanent or by wetacting ma Annuities 3etvia Curter. Hard mPle+ of ford proepecnrses can be mailed to you m
request, and flee of merge.
Additional Information About Your Annuity
SURRENDER VALUE INFORMATION
Surrender Value as ofDoxmber 31, 2011 514,478,05
Accatat Value ae ofDeoember 31, 2012 S16,218.74
5umnder Value v of December Jl, Z012 516,218.74
The Surrender Value shmvn w this satemeot o,ay increase er
decroeee prier to your pact ststemem.
"fitrreedar Yetne" is the vehte of yore Aenuity Scat
would Love Lam available ifyat had emtradn'ed this
oashail effective as of this Malement dote. It equate the
'Acmmt Value" far the current patiod, lase any appliable
fees end chat2es sod tmy othv adjuelments ae ebowu here.
Depending en your coohsct, the checgee a~ edjusbaests
include, but ace mt limited to: tantisgent Defettcd Sales
C7arge (CDSC), MVA sod other miecelbsseoua fee,
applicable raaplmed bonus, atry vbergn doe for option]
benefits provided by rider ar endoremend, any appiieeble
maiotenaox fa end say applicable Gtedita recovmnble
vim .
PRIMARY BENEFICU-RY INFORMATION
ANNA L.CONRAD
Stendml Address: Annuities Service, P.O. Box 7980, Phlledelphle, PA 19178 Fox Numttsr: (800) 678-1217
Owrnigbt Address: Annuities Service, 2101 Welsh Roed, Dresher, PA 19025
a20etAVeNIEAt2
THE LAW OFFICES OF GARY L. ROTHSCHILD
2215 Forest Hills Drive, Suite 35, Northwood Office Center, Harrisburg, PA 17112
Telephone (717) 540-3510 Facsimile (717) 540-3512 glrothlaw@comcast.net
January 24, 2013
Glenda Farner Strasbaugh, Register of Wills ~
~ °~ ~:
~_ ~
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One Courthouse Square m "~ ~ a=D c;~ ~~
Carlisle, PA 17013-3387 ~' ~ '~ rv r~~ rn
~
Re: Estate of Samuel Irvin Conrad z
:~:
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'T7
..,.. ~
~ ~~
File No. 2012-000690 " ` ~ -~
"S ~ ..
Dear Ms. Strasbaugh,
~ Cl
cfl U) C?
~,y
I represent the Executrix of the above-referenced estate, Mrs. Cathie C. MacArthur.
Enclosed please find the following:
1) An original and two copies of the ht}teritance Tax Return for the above-referenced
estate;
2) An original and two copies of the Inventory for the above-referenced estate;
3) A check, in the amowtt of $ 2,628.,8, payable to the "Register of Wills, Agent"
representing the balance of inheritance taxes due;
4) A check in the amount of $ 35.00 representing the additional probate fees due
($ 225.00) based upon the increase in the value of the estate as compared to the
originally filed Petition, plus $ 30.00 in filing fees for the Inheritance Tax Return
and Inventory, and
5) A postage prepaid return envelope.
Please accept and process the enclosed and return the extra copies to me along with
receipts reflecting payment.
Should you have any questions regarding the enclosed please feel free to contact me.
Thank you for your anticipated attention to this matter.
Very truly ours,
'~ i ,
` `_
Gary l,~othschld
Enclosures
cr. Mrs. Cathie C. MacArthur (wio enclosures;