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HomeMy WebLinkAbout05-20-13 r 1505610143 REV-1500 EX(02-11) , PA Department of Revenue pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes oEEeRnaENT or REwNUe County Code Year File Number PO BOX.280601 INHERITANCE TAX RETURN 2 1 12 1225 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 11 13 2012 09 13 1922 Decedent's Last Name Suffix Decedent's First Name MI KREIDER LAURA G (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 APPROPRIATE OVALS BELOW I� 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decedent Died Testate ❑ 7 Decadent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wlp (Attach Copy of Trust) P ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A) between 12-31-91 and 1.1-95) (Attach Schedule O) - CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LISA MARIE COYNE ESQ 7W 737 .4'464 c w a m FkEG TER OF FALLS RE?lLY x � First Line of Address � o Ent 3901 MARKET STREET t = c v Second Line of Address C7 City r Post Office DAT =-ILEdI" O h State ZIP Code CAMP HILL PA 170114227 Correspondent's e-mail address: I!Sa@coyeandcoyne.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,Correct and Complete.Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. v SIGNATWtT,OF PERSON pESPONSIDLE FOR FILING RETURN D TE h off—/11////P�/�-Zlc/'�7/~✓p/,��"-' VY/1,//Y,—" FRANK GREENAWALT IACIDRE�S 5044 ERBS BRIDGE ROAD, MECHANICSBURG, PA 17055 SIG TORE OF PREPARER OTHER THAN REPRESENTATIVE DATE LISA MARIE COYNE Esq a ,5 D RESS Coyne&Coyne, P.C. 3901 Market Street, Camp Hill, PA 170114227 Side 1 1505610143 1505610143 J l J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: KREIDER, LAURA G RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................... 2. 196 , 683 . 2 1 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3. 4. Mortgages&Notes Receivable(Schedule D).......................................................... 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 319 , 863 . 6 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7_ 4 6 0 , 54 6 . 45 8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 97 7 , 0 9 3 . 27 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 4 6 , 074 . 88 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 15 , 583 . 1.5 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 61 , 658 . 03 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 9 15 , 435 . 24 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. 13. 1 59 , 211 . 08 14, Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 7 56 , 224 . 16 TAX COMPUTATION-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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate ,12 756 , 224 . 16 17. 90 , 746 . 90 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE................................................................................................................... 19. 90 , 746 . 90 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 J l REV-1500 EX Page 3 File Number 21 - 12 - 1225 Decedent's Complete Address: DECEDENT'S NAME KREIDER, LAURA G STREET ADDRESS 100 MT. ALLEN DRIVE CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 90,746.90 2. Credits/Payments . A. Prior Payments 70,000.00 B. Discount 4,537.34 Total Credits(A +B) (2) 74,537.34 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 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. (5) 16,209.56 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 who shall use the property transferred or its income;.................................... ❑ ❑x c. retain a reversionary interest;or.................................................................................................................. ❑ d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ 1x1 2. If death occurred after Dec. 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?......................-......................................................................... ..................... ❑x ❑ 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 Janus ry 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)(1)]. 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 retturn 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 lax 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(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,w ether t y bloo or adoption. ne;<�sasez its-se} SCHEDULE`B, - LOMMONWFANCETM ETURNANIA� ����� BONDS INHERITANLETPXRENT RESIOENTOECEOENT JI FILE NUMBER ESTATE OF KREIDER, LAURA G 21 - 12- 1225 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM i —��- — VALUE AT DATE OF NUMBER DESCRIPTION UNIT VALUE DEATH 1 350 Shares AT&T (T)--Common Stock ^ 33.95 11,88150 2 325 Shares Bristol Myers Squibb(BMY)--Common Stock 31.87 10,357.75 3 508.317 Shares Clearbridge Energy(CEM)--Common Stock 22.79 11,584.54 I 4 865 Shares PPL Corp (PPL)--Common Stock 28.32 24,496.80 5 427.32 Shares Tortoise MLP Fund (NTC) 24.20 10,341,14 6 1387.638 Shares Allianceber High Income A(ADDAX) 9.37 13,002.17 7 523,482 Shares Gateway Fund A(LATEX) 26.87 14,065.96 8 792.439 Shares MFS Emerging Markets A(MEDAX) f 16.20 12,837.51 9 1497.934 Shares Oppenheimer SR Floating Rate A(OOSAX) 828 12,402.89 I {f 10 969,954 Shares PIMCO Real Return A(PRTNX) 12.72 I 12,337.81 11 1057.902 Shares PIMCO Total Return A(PTTAX) j 11.60 12,271.66 i12 1273.345 Shares PYXIS Long/Short Equity A(HEOAX) 1 10.96 13,955.86 13 1463.415 Shares TA Multi-Mgr ALT STRAT A(IMUAX) 9.86 14,429.27 14 876.046 Shares Templeton Global A(TPINX)CUSIP#88020813 1143 11,765.30 15 562.509 Shares Clearbridge Energy OPPP Fund(EMO) 19.47 10,952.05 I — '� TOTAL(Also enter on line 2, Recapitulation) 196,683.21 Wealth Management •^ , 214 Senate Ave 7th Floor Camp Hill,PA 17011 r - tel 717 730 1800 Morgan Stanley fax 717 730 1894 toll free 800 23 G> May 2, 2013 � Coyne &Coyne, P.C. �u 3901 Market St. r' Camp Hill, PA 17011-4227 0 RE: death evaluation for the Kreider Estate Gyr To whom it may concern: Below is a list of the investments that were in Laura Kreider's account#341-902606 when she died on November 13, 2012. If you need any other information, please do not hesitate to contact me at (717)730-1845. Symbol Description Shares High Low Price PRCASDAT BMY Bristol Myers Squibb Co 325 32.2 31.75 31,87 20121113 CEM Clearbridge Energy MLP Fd Inc 508.317 22.9 22.27 22.79 20121113 EMO Clearbridge Energy MLP Opp Fd 562.509 19.7 19.23 19.47 20121113 NTG.' Tortoise MLP Fund Inc 427.32 24.56 24.0385 24.2 20.12111.,' PPL PPL Corporation 865 28.59 28.12 28.32 20121113 T AT&T Inc 350 34.43 33.76 33.95 20121113 AGDAX Allianceber High Inc A 1387.638 N/A N/A 9.37 20121113 GATEX Gateway Fund A 523.482 N/A N/A 26.87 20121113 MEDAX MFS Emerging Markets Debt A 792.439 N/A N/A 16.2 20121113 OOSAX Oppenheimer Sr Floating Rate A 1497.934'N/A N/A 8.28 20121113 PRTNX Pimco Real Return A 969.954 N/A N/A 12.72 20121113 PTTAX PimcoTotal Return A 1057.902 N/A N/A 11.6 20121113 HEOAX Pyxis Long/Short Equity.A 1273.345, N/A N/A 10.96 20121113 iMUAX Ta Multi-Mgr'All Strat A 1463.415. N/A N/A 9.86 20121113 TPINX Templeton Global Bd Fd A 876.046 N/A N/A 13.43 20121113 Hartford HTC-CRC Select Policy#712579081 John HancockJH Vantage w/standard DB.policy#2016372 Metlife Series FA policy#9200026425 Fixed Annuity Thank you, " Robert Wilson ` . - Vice President Financial Advisor Morgan Stanley Smith Barney LLC.Member SIPC. pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH INHERITANCE TAX RETURN , BANK DEPOSITS AND MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF KREIDER, LAURA G FILE NUMBER 21 - 12 - 1225 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 OF NUMBER DESCRIPTION DEATH 1 M&T Bank-Checking Account 134,614.28 2 M&T Bank-Certificate of Deposit#XXX2108 64,119.67 3 M&T Bank-Certificate of Deposit#XXX4887 15,286.11 4 M&T Bank-Certificate of Deposit#XXX4879 2,062.66 5 PSECU--Savings Account 135.37 6 PSECU--Money Market Account 65,348.11 7 PSECU--Certificate of Deposit#XXXS51 18,420.98 8 PSECU--Certificate of Deposit#XXXS52 19,876.43 TOTAL(Also enter on Line 5, Recapitulation) - 319,863.61 - © WTSank 499 Mitchell Road,Millsboro,DE 19966 Adjustment Services W f✓�---� Phone 888-502-43 F a (302)934-29 - n December 5,2012 r+ (r Coyne & Coyne, P.C. N Attorneys At Law ° 3901 Market Street Criv Camp Hill, PA 17011-4227 �]a Re: Estate of Laura G.Kreider Social Security: 195-16-2930 Date of Death: November 13,2012 i Dear Sir or Madam: Per your inquiry on November 28, 2012,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 52755118 Ownership(Names og Frank Greenawalt(POA) Laura G.Kreider Opening Date 0512811977 Balance on Date ofDeath $134,614.06 Accruedlnterest $ .22 - - - ----------- -- ....---------------------- Total $134,614.28 2. Type of Account Certificate of Deposit Account Number 31003914592108 Ownership(Names of Frank Greenawalt(POA) Laura G.Kreider Opening Date 1212911997 Balance on Date of Death $64,099.65 Accruedlnterest $ 20.02 Total $64,119.67 3. Type ofAccount Certificate of Deposit Account Number 31003913464887 Ownership(Names oq Frank Greenawalt(POA) Laura G.Kreider Opening Date 0710812005 -- Balance on Date of Death $15,283.43 Accrued Interest $ 2.68 Total $15,28611 4. Type ofAcpount Certificate of Deposit AccountNunber 31003913464879 Ownership(Names of) Frank Greenawalt(POA) ' Laura G.Kreider Opening Date 0612712005 Balance on Date of Death $2,062.66 Accruedlnterest $ .13 Total $2,062.79 For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the West Shore Pb m at 717-731-1730. We were unable to locate any safe deposit box for the above-mentioned decedent , This letter does not include nny accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement Sincerely, . Valarie Mercer Adjustment Services 01/15/2013 ey ✓qNr ��� Coyne& Coyne,PC Lisa Marie Coyne, Attorney D 3901 Market St. Camp Hill,PA 17011 Re: `AURA G KREIDER;Ty eceased. P CU Reference X862828179 Dear Attorney Coyne: The above referenced person has an account with PSECU which was opened on June 1, 1999. The Share accounts were individually held by LAURA G KREIDER. The following are the Date of Death Balances for LAURA G KREIDER's account with PSECU: Account Date of Death Balances Interest—November 1-13 (S1) Savings $135.36 $0.01 (S7) Money Market $65,343.46 $4.65 4<,,">8•!i (S51) Certificate $18,418.36 $2.62 1$142-0,4S (S52) Certificate $19,873.60 $2.83 isi$7y,4g The account has been closed. If you have any questions,please contact me at(717) 234-8484 or toll-free at (800)237-7328,press 6, extension 3120. Sincerely, =y Sandy F ley Member Service Representative PSECU Pennsylvania State Employees Credit Union 1 Credit Union Place, P.O. Box 67013, Harrisburg, PA 17106-7013 • 800.237.7328 • >>psecu.com THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER. - REV-16f0EX4(0909) pennsylvania DEPARTMENT OF REVENUE SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF KREIDER, LAURA G FILE NUMBER 21 - 12 - 1225 This schedule must be completed and filed if the answer to any of questions 7 through 4 on page 2 Is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION NUMBER Include the name of the transferee,their relationship to decadent VALUE OF ASSET DECD'S TAXABLE VALUE and the date of transfer. Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE) 1 Hartford Annuity Contract No. XXX9081 52,479.08 52,479.08 Beneficiary: Frank Greenawalt(Brother) 2 MetLife Annuity Contract No. XXX0843 19,131.82 19,131.82 Beneficiary: Frank Greenawalt(Brother) 3 MetLife Annuity Contract No. XXX6425 59,221.94 59,221.94 Beneficiary: Frank Greenawalt(Brother) 4 MetLife Annuity Contract No. XXX3068 21,541.90 21,541.90 Beneficiary: Frank Greenawalt(Brother) 5 AIIState Annuity Contract No. XXX7013 125,880.51 125,880.51 Beneficiary: Frank Greenawalt(Brother) 6 John Hancock Annuity Contract No. XXX6372 182,291.20 182,291.20 Beneficiary: Frank Greenawalt(Brother) TOTAL(Also enter on line 7, Recapitulation) 460,546.45 A 2813 14:82:37 EST FROM: FZMI20698877255 MSG# 29929961-686-1 PAGE 883 OF 883 THE HARTFORD January 24,2013 Attn:Lisa Marie Coyne Fax:717 737 5161 Reference: The Hartford Annuity 712579081 Laura Kreider,Decedent Dear Lisa Marie Coyne, 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 712579081 Owner Laura Kreider Decedent Laura Kreider Social Security Number XX-XX-2930 Date of Death November 13,2012 Cash Value on the date of death $52,258.52 Death Benefit Value on the date of death- $52,479.08 The Death Benefit voice an the due or death displayed above may include a Death Benetlt Adjustment as outlined in the Annuity 6oidract.Tbis figure is being provided for illustration purposes and is not equivalent to the final death bcmfit The death bcacfit will be calculated an ell contracts associated with this client the day we receive the certified daub certificate.once the death bevent is calculated the benefit amount remains invented am Is subject to=*A nuctuanan arm complete setlantem bettncaons 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 am.to 7 p.m, and Friday fiom 9:15 a.m,to 6 p.mL,Eastern Time. Thank you for the opportunity to help provide for your financial needs. i Sincerely, Investment Product Services The Hudord wealth Mattagcamat-Global Amuaia ICS Annuity Benefit Services Team 745 West New circle sand Hartford Life and Annuity Insurance Company LLaxington,ICY 40511 Mailing Address PO Box 14293 Lexington.ICY 40512.4293 online.hrtfordlifc.cont; r \ : :cropolitan Life Insurance Company Des Moines IA Met�ife --"' ---`?Des Moines IA 50306-0342 O yo %J� February.6, 2013 OJ Lisa Marie Coyne ''�j 3901 Market St Camp Hill PA 17011 e RE: METROPOLITAN LIFE INSURANCE COMPANY CONTRACT 00 060843 DECEASED Laura Kreider Dear Ms. Coyne: This letter is in response to your recent request for information on the above referenced annuity contract. The date of death value as o oiV vember 13, 201,2 for as to tax purpos s is $19,131.82. is value is for Estate Tax Purposes only. hefher-this-ceplaeel� cost value is the app prl easure of valuation of this contract for estate tax purposes is a matter to be decided by your counsel or qualified tax advisor. If you have any questions,please contact your representative or call our Customer Service Center at 1-800-638-7732 Nlondaythrough Friday between 9:00 a.m. and 6:00 p.m., ET. Sincerely, Danielle Fuchs Sr. Annuity Representative - Post Issue Processing MetLife Annuity Operations and Services Help us stay connected: Please keep us updated with respect to all who are associated with this contract,including the owner,the annuitant,and any beneficiaries. Make sure that we have the following information for all persons or entities: name,address, phone number,date of birth,and social security or tax identification number. Changes may be submitted to the address provided above,by calling our Customer Service Center at the phone number provided above, or by contacting your Representative. e -> 7177375161 Page 002 y -s IA 50306-0366 January 23, 2013 J' LISA MARIE COYNE COYNE&COYNE, P.C. FED ESTATE OF LAURA G KREIDER FAX 717-737-5161 RE: METLIFE INVESTORS USA INSURANCE COMPANY CONTRACT 9200026425 DECEASED LAURA G KREIDER Dear Ms. Coyne: Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the date of death and the account value on that date are: Date of Death: 11/132012 Account Value:$59,221.94 If you have any questions, please contact your representative or call our Customer Service Center at 1-800-255-9448 (Fixed Line) Monday through Friday between 8:30 a.m. and 6:30 p.m., ET. Sincerely, Sorya Inthalangsy Annuity Representative-Post Issue Processing MetLife Annuity Operations and Services Help us stay connected: Please keep us updated with respect to all who are associated with this contract,including the owner,the annuitant,and any beneficiaries. Make sure that we have the following information for aE persons or entities: name,address, phone number,date of birth,and social security or tax identification number. Changes maybe submitted to the address provided __.�..�. -. _. . above,by calling our Customer.Service.Center at..the.phone.numberprovlded above,or by contacting your R epresentat_Iv_e. -> 7177375161 Page 002 .,A 50306-0366 / January 23,2013 x - ' LISA MARIE COYNE COYNE&COYNE, P.C. FBO ESTATE OF LAURA KREIDER FAX:717-737-5161 _ RE: METLIFE INVESTORS USA INSURANCE COMPANY CONTRACT 940023068 DECEASED LAURA G KREIDER Dear Ms. Coyne: Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the date of death and the account value on that date are: T Date of Death: 11/13/2013 Account Value:$21,541.90 If you have any questions, please contact your representative or call our Customer Service Center at 1-800-255=9448 (Fixed Line) Monday through Friday between 8:30 a.m. and 6:30 p.m., ET. - Sincerely, Sorya Inthalangsy Annuity Representative-Post Issue Processing MetLife Annuity Operations and Services Help us stay comrected: Please keep us updated with respect to all who are associated with this contract,including the owner,the annuitant,and any beneficiaries. Make sure that we have the following information for all persons or entities: name,address, phone number,date of birth,and social security or tax idenlification number. Changes maybe submitted to the address provided - -- 'above,by calling our Customer Service Center at the phone number provided above,or by contacting your Representafive. X13 3:56PM No. 6892 P. 2 Allstate. You're in good hands. January 7,2013 Shawnee Smith 3805 Trident Camp Camp Hill, PA 17011 Re: Laura G- Kreider Contract N0: GA18417013 Dear Ms. Smith: We received a request to complete IRS Form 712 for the above referenced contract "The purpose of Form 712 Is to provide an estate or donor with the value of a Nfe insurance contract or its proceeds as of a certain date(usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. 1 can, however, provide the following information for estate purposes: Date of Death: November 13,2012 Annuity Value as of Date of Death: $125,880.51" Cost Basis: $100,000.00 -- Named Beneficiary. Frank Greenawalt 'The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions,please contact me at 1.877-499.6418 Ext.26332. Sincerety, Joann Broecker Sr.Clam Examiner ASatate Life Insurance Company Life and Annuity Claims -- -- - P.O.Box 94212,Palatine,IL 60094-4212 Phone 877.499-"l8 Fax 866.635-4523 er 1/28/2013 4 :21 :02 PM PAGE 2/002 Fax Server John IlanCOCk idg Insurance Company(US.A.) Jens dock AW STE. ,Service Cellar ] 27 tN Ad Ave S7E.3, 65444,B on.MA 0 2 Ma0n3 4-deoeo:Po eoz Y.N44,(lmlon,M9 02205%44 i t 41n34t02a ' wwxJhanru9lac.mm January 28,2013 Lisa Coyne Fax (717)737-5161 Dear Ms.Coync: Re:CONTRACT/CERTIFICATE#2016372:Laura Kreider " This letter is in response to the inquiry recently submitted for the annuity contract referenced above. The date of death value as of November 13,2012 was$182,291.1�0. If you have any questions about this letter or the contract,please call us at 800-344.1029. Our Giant Services Representatives me available on weekdays ftom 8:00 a.m.to 6:00 p.m.EST . - Sincerely, John Hancock Annuities ' pi t - f ' Illelavmacemtica le6dN8&aDmrdk,ert godmsrvod bf lull Beuve2l.Vx inaimne eoryxmilASA)•.BloamGd4ev*no •n¢LLmdbNn.1'ad r REV-1611 E%�(10A9I i ` pennsylvania p1 pSwCHmULEH )i JI, DEPARTMENT OF REVENUE FUWJ:?1L�11+ S I D bb��MV INHERITANCE TAX RETURN �� GA/�CIYJCTMI`TS RESIDENT DECEDENT ESTATE OF KREIDER, LAURA G FILE NUMBER 21 - 12 - 1225 Decedent's debts must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A• 1 Rolling Green Cemetary-- Headstone Engraving 285.00 2 Reception 200.00 1 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) FRANK GREENAWALT 18,000.00 Street Address 5044 ERBS BRIDGE ROAD City MECHANICSBURG State PA Zip 17055 Year(s)Commission Paid 2013 2. Attorney's Fees COYNE & COYNE, P.C. 18,000.00 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 Cumberland County Register of Wills 301.50 5. Accountant's Fees 1,000.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Postage 50.00 TOTAL(Also enter on line 9, Recapitulation) 46,074.88 Sdtedule H COMMONWEALTH OF PENNSYLVANIA Funeral FNenses& INHERITANCE TAX RETURN Adminis�Costs continued RESIDENT DECEDENT ESTATE OF KREIDER, LAURA G FILE NUMBER 21 - 12 - 1225 2 Legal Advertisement--Cumberland Law Journal 75.00 3 Legal Advertisement-- Patriot News 123.38 4 Reserves 8,000.00 5 Estate Checks 25.00 6 Inheritance Tax Filing Fee 15.00 Page 2 of Schedule H -I }' pennsylvania SCHEDULE I ` bl DEPARTMENT OF REVENUE DEBTS OF DECEDENT, MORTGAGE INHERITANCE TAX RETURN RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF KREIDER, LAURA G 21 - 12 - 1225 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Messiah Village--Final Partial Bill 3,750.40 2 Uncleared Checks 10,888.75 3 U.S. Treasurey(Taxes 2012) 706.00 4 Commonwealth of Pennsylvania (Taxes 2012) 238.00 TOTAL(Also enter on Line 10, Recapitulation) 15,583.15 NEV-151$EX+(01-10) ,I , pennsyivania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF KREIDER, LAURA G FILE NUMBER 21 - 12- 1225 �� RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY oo wot usf imateats7 I, iTAXABLE DISTRIBUTIONS distri utoutright spousal distributions and transfers under Sec.i;116(a)(1.2)] 1 ( Frank Greenawalt Brother Schedule G and 5044 Erbs Bridge Road 65% of Residual Mechanicsburg, PA 17055 l I I I E 1 I I I Enter dollar amounts far distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 St. Theresa Catholic Church (15% of Residual Estate) 68,233.32 2 Salvation Army(5%of Residual Estate) 22,744.44 3 Bethesda Mission (10%of Residual Estate) 45,488.88 4 Messiah Village (5% of Residual Estate) 22,744.44 TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 1591211.08 REGISTER OF WILLS _ CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA 0 No. 2012- 01225 PA No. 21- 12- 1225 Estate Of: LAURA GREENAWALT KREIDER (Fist,Middle,Las) Late Of: UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 195-16-2930 WHEREAS, on the 27th day of November 2012 an instrument dated October 2nd 2003 was admitted to probate. as the last will of LAURA GREENAWALT KREIDER (First,Middle,Last) late of UPPER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 13th day of November 2012 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARYto: FRANK GREENAWALT who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURTHOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF-, . I have hereunto set my hand and affixed the seal of my office on the 27th day of November 2. It A.A- Y R inter of Y **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT OF -LAURA GREENAWALT KREIDER I, LAURA GREENAWALT KREIDER of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will or codicil previously made by me. ITEM 1: Upon my demise, I direct my Executor arrange for procurement/installation of and payment for a bronze marker on my grave, the type and description of which has been lodged with my Executor in separate instructions. ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical after my death. ITEM 3: I direct that all taxes and interest and penalties thereon that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from pmy residuary estate as a part of the expense of the administration of my Estate. H ITEM 4: I give, devise and bequeath to my brother, FRANK GREENAWALT, all my � x a household furnishings, personal effects and other tangible personal property of every kind, to keep in 3 � kind or sell, as he shall elect. Any of my clothing which is of no interest to my brother, Frank, and Z w a cannot be sold, shall be donated to any of the following organizations: U s Kc A. The Salvation Army; W b aB. The Volunteers of America; C. The Bethesda Mission; D. Goodwill Industries; 1 irn�r++;mwr4m..n«.r«nm ..«..:.�,., ��+�� .�.................:�......,�...,r�W±:c'�' . �✓ex'+v�rew4 aw�gruu !`:awwRHk ,,`vke :etu. "".�«su7JM,rwe.u•ri+„Jumwr. m..::;.:W, E. Any local benevolent organization which might have use for such items. ITEM 5: I give, devise and bequeath all FAMILY photos, movies, slides, videos, scrapbooks, or albums to my brother, FRANK GREENAWALT, only. If he should have no interest in such items,the items will be destroyed,not sold. ITEM 6: All the rest,residue and remainder of my estate of every nature and wheresoever situate, together with insurance thereon I direct my Executor hereinafter named to expeditiously convert into cash and to di-Ode my residuary estate among the following named persons or organizations and in the percentages as set forth below: A. Fifteen (15%) percent to ST. THERESA CATHOLIC CHURCH, Bridge Street, New Cumberland, Pennsylvania, to be used for maintenance and upkeep of the church. B. Fife (5%) percent to SALVATION ARMY 1122 Green Street, Harrisburg, Pennsylvania. x o C. Ten (10%) percent to BETHESDA MISSION, 611 Reily Street, Harrisburg, H W Pennsylvania. D. Five (5%) percent to MESSIAH VILLAGE, Mechanicsburg, Pennsylvania, to 3 z provide medical services and assistance. w w E. Sixty-Five (65%) percent to my brother, FRANK GREENAWALT, 5044 Erb's Bridge Road, Mechanicsburg, Pennsylvania. In the event my brother, Frank a Greenawalt is not living on the date of my demise, I give, devise and bequeath his share to be divided equally among St. Theresa Catholic Church, Salvation Army,Bethesda Mission and Messiah Village. 2 =r.ecd•.�raxva�F':_._.. raaiva`'nwiC "- " - max'«.Mx..:v,,.vL..�a•.earnr.cxxw'ace.�esw•acne:;:•at,%Y.,u.; -�—•.•o--R...4•••v-`�•••�••-�-• - - ITEM 7: Until distributed, no gift or beneficial interest shall be subject to anticipation or voluntary or involuntary alienation. ITEM 8: I nominate, constitute and appoint my brother, FRANK GREENAWALT, Executor of this my Last Will. Should my brother, Frank Greenawalt fail to qualify or cease to act for any reason as my Executor, I appoint LISA MARIE COYNE, of 3901 Market Street, Camp Hill, Pennsylvania, alternate Executrix of this my Last Will. ITEM 9: I direct that my personal representative, trustee or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this day of �cy a&-k- ,/2003. LAURA GREENAWALT KREIDER Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. residing at residing at /�(J�/> ( �'• 1.rT/7a 7D 3 .ar.�.nnwr'�^""ii.++«mm�y�m�w�m�'�i..5�` ,�:�-w...... �...?Q's��l^�p%a=! �v vevg.�imvl5wramriia#at�'..aiw.x4Cti"nso'wrr.i bnvs�uAiwwir iaTvcr.w.,..•. - COMMONWEALTH OF PENNSYLVANIA } )ss: COUNTY OF CUMBERLAND W//e, LAURA GREENAWALT KREIDER, /'J M I' I^ 1 ���'i and o SA 4)- k G t* f,441 , the 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 purpose 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 or her knowledge, the Testatrix was at the time eighteen (1 S) years or older,of sound mind and under no constraint or undue influence. LAURA GREENAWALT KREIDER Witness Witness Subscribed, sworn and acknowledged before me by LAURA G ENAWALT KREIDER, the Testatrix, and subscribed and sworn to before me by /t-0— (4^ .0 O/lkv— and d0J 1,V f C U q r,I! the witnesses, this ;„d {day of 6t o� -oz-- 12003. �X'44 Notary Public (S AL) 0 NOTAiIItAI.SEAL. =F COWE 1. 4 7*Cumbesm 00 t � .hirte 7,� 4 +ru:tars+crew.zxwm..uurx+m�imi�vwew�Cc Ri:�noi:�.:n^�,�m3.mwn'u�a9- ke-- "F�„ - �, .�.