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Home My WebLink About02-1124 EC-13-02 10:41 AM PLACEY-WRIGHT Hio7.la5 NEV 9ipfi 717 236 0843 p, 02 This is to certify that the information here givtn is correctly copied from an original certificate of death duly feted with m. as Local Registrar. The original cenificare will be forwarded to the 5tarc Viral Records C7ffice for permanent filing. WARNING: It Is Illegal to duptlcate th(s copy by photostat or photograph. Fec For this certificate, 52.00 P 8387715 No. I.ac~tl Registrar ,,~, ~~ ~~ ~ ~OOZ- Datc ~~~" ~n COMMONWEALTH OP PENNSYLI/ANIA • 0lPARTINlNT Of HEALTH • VITAL RICORDS C~HTIFICATE OF pt:ATM ' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT PLACEY RICHARD L ESQ 3631 NORTH FRONT STREET HARRISBURG, PA 1 71 1 0-1 533 fold ESTATE INFORMATION: ssN: isi-of-saos FILE NUMBER: 2102-1 124 DECEDENT NAME: BESCHEN MARY M DATE OF PAYMENT: 1 2/ 1 0/2002 POSTMARK DATE: 1 2/09/2002 COUNTY: CUMBERLAND DATE OF DEATH: 09/12/2002 REV-1162 EX111-96) NO. CD 001935 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 512,500.00 TOTAL AMOUNT PAID: REMARKS: KATHLEEN B BADDERS C/O RICHARD L PLACEY ESQ CHECK# 12500.00 INITIALS: CW SEAL RECEIVED BY: 512, 500.00 DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS \<fV-l500Di&{ll.lj ~ '1 - i I) '?'- :; "NO LETTERS" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE. DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 IU ,., ~~U) 0"'''' IU"-O ,,00 0"'"" "-OJ "- <( INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W o W U W o DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITlIIL) BESCHEN, Mary M. DATE OF DEATH (MM.DD-YEAR) 09-12-2002 t-- CP-'fCfAL U2E ONLY FilE NUMBER ~L-~~ COUNTY CODE YEAR LLLL de ~ NUMBER DATE OF BIRTH (MM.DD-YEAR) 07-02-1913 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) n/a [Xl 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (AltachropyofWiII) o 9, Utigat'lon Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of dElillh after 12-12-(2) o 7. Decedent Maintained a living Trust (AItadl copy 01 Trust) o 10. Spousal Poverty Credit (date of dealh between 12-31-91 and 1-1-95) SOCIAL SECURITY NUMBER 161 01 6806 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (dale of dealh prior to 12-13-(2) o 5. Federal Estate T81. Return Required 8. Total Number of Safe Deposit Boxes D 11. Ejection to tax under Sec. 9113(A) (AlIa<;h SchO) .... Z IU o Z o "- "' IU '" '" o o '"-'''''J'''''':j''''f''''''''''''' ,);I'!!$,$I;p;\C 0.,,_,_.. N~chard L. Placey, Esquire FIRM NAME (~AppIPcable) Placey & Wright TELEPHONE NUMBER (717)236-9577 COMPLETE MAILING ADDRESS 3631 North Front street Harrisburg, PA 17110-1533 (8J 321,948.09 1. Real Eslate (Schedule Al (i) 2. Stocks and Bonds (Schedule B) (2) 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) z o t: ...J ::l !:: a. <l: u W 0: 4. Mortgages & Notes Receivable (Schedule D) 5, Cash, Sank Deposits & Miscellaneous Personal Property (Schedule E) (4) (5) 1,149.73 (11) 4,625.81 (12) 317,322.28 (13) .00 (14) 317,322.28 (15) (16) 14,279.50 (6) 55,400.87 [17J [18) [19) 14,279.50 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or Ll (7) 265,397.49 z o t: I- ::l a. :2 o u ~ 200 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE;TOAtlSWERALL QUESTIONS 6N REvERSE'siDEAND RECHECKMATH<< 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 3,250.00 1,375.81 10 Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) 1.1. Total Ded~di{)"s {tolal lines 9 & 10) 12 Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rale, or transfers under Sec, 9116 (a)(1.2) X,O '_ 45 X.o __ 16, Amount of line 14 taxable at lineal rate 317,322.28 17. Amount of Line 14 taxable al sibling rate x .12 18. Amounlofline 14 taxable atcoHaleralrale x .15 19. Tax Due Decedent's Complete Address: ST'lJ~tDDf.Erhurn Road CITY earn Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 14,279.50 12,500.00 057.90 Total Credits (A + B + C ) (2) 13,157.90 3. InteresUPenalty if applicable D. Interest E. Penally .00 TotallnteresUPenalty ( D + E ) (3) 4. If line 2 is greater than line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) (5B) 1,121.60 .00 1,121.60 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS [ZJ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.... b retain the right 10 designate who shall use the property transferred or its income; ...... c. retain a reversionary interest; or ................ d. receive the promise for life of either payments, benefits or care? .................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................... .................. mm. m.m'" 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?. 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation? .... Yes u.o .........0 .....0 ....0 No !Xl gg !Xl IXI ..........0 ......0 !Xl IX! Under penalties of pe~ury, I declare thaI I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is lrue, correct and complete. Declaration of prepare!" other than the pernonal representalive is based on all infonnalion of which preparer has any knowledge. ADDRESS D~ / 3, It! M3 ADDRESS Front street, Harrisburg, PA 17110-1533 DA}E. / :J,!! CYjD?- t street, Harrisburg, PA 17110-1533 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% 172 PS. 99116 (aJ (1.1) (i)). For dales 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% [72 P.S. S9116 (a) (1.1) (ii)]. The slatute does not exemot a transfer to a surv~vjng spouse from lax, 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 Of after July 1, 2000: The tax rale imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent. or a sfepparent of the chrld is 0% (72 P.S. 39116(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%, except as noted in 72 P,S. S9116(1.2) 172 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)}. A sibling is defined, under Section 9102, as an individual who has alleast one parent in common with the decedent, whether by blood or adoption. R~V-150B EX. (6-9B) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISe. PERSONAL PROPERTY ESTATE OF MARY M. BESCHEN FILE NUMBER 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 on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 . The Woods - security deposit refund 813.42 2. Blue Cross - unused premium refund 239.39 3. Blue Cross/Blue Shield - reimbursement 80.92 4. Allstate - unused premium refund 16.00 5. Miscellaneous Personal Effects NO VALUE TOTAL (Also enter on line 5, Recapitulation) $ 1,149.73 (If more space is needed, insert additional sheets of the same size) R~V-1509 EX+ 16-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF MARY M. BESCHEN FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Kathleen B. Badders 354 Futurity Drive Camp Hill, PA 17011 Daughter B. C. JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMIlAR DATE OF DEATH DECO'S VM.UEOF NUMBER 1ENAtH JOlt'll lDENllFYlNG NUMBER. ATTACH DEED FOR JOINTlY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST ,. A. 04/97 Citizens Bank Checking Account 6100587592 12,005.96 50% 6,002.98 2. A 06/00 Citizens Bank Certificate of Deposit 6140769701 Principal - $43,976.15 Interest - $ 20.88 43,997.03 50% 21,998.52 3. A 05/02 Citizens Bank Checking Account 6106389695 Principal - $30,395.26 Interest - $ 4.11 30,399.37 , i (Exclusion per 1707(c) (3) of -3,000.00 27,399.37 Inheritance and Estates Tax Act) (See copy of bank letter attache':) TOTAL (Also enter on line 6, Recapitulation) $ 55,400.87 (If more space is needed, ir.sert additional sheets ol the same size) +~ CITIZENS BANK Account Number 6100587592 Account Title MARY M. BESCHEN KATHLEEN B. BADDERS Date Opened 4/3/1997 Account Type Checking Principal Balance as of DOD $12,005.96 Interest from Last Posting to DOD $0.00 Account Balance as of DOD $12,005.96 YTD Interest to DOD $0.00 +~ CITIZENS BANK Account Number 6140769701 Account Title MARY M. BESCHEN KATHLEEN B. BADDERS Date Opened 6/30/2000 Account Type Time Deposits Principal Balance as ofDOD $43,976.15 Interest from Last Posting to DOD $20.88 Account Balance as of DOD $43,997.03 YTD Interest to DOD $418.54 t~ CITIZENS BANK Account Number 6106389695 Account Title MARY M. BESCHEN KATHLEEN B. BADDERS Date Opened 5/9/2002 Account Type Checking Principal Balance as of DOD $30,395.26 Interest from Last Posting to DOD $4.11 Account Balance as of DOD $30,399.37 YTD Interest to DOD $399.37 R~V-1510 EX+ 16-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DeCEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MARY M. BESCHEN ITEM NUMBER 1 This schedule must be completed and flied if the answer to any of quesUoos 1 th~ou9h 4 01) the re\'efse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY INClUOE TI-lE w.t.IE OF1HE TIWisfEREE. THElR RElJriTlONSHlPTQ DECEDENT AND THE DATE OF TRANSFER ATTACH ACOPV OF THE DEED FOR REAL ESTATE. DATE OF OEA1H % OF DECO'S EXCLUSION VALUE OF ASSET INTEREST (IF APPLICABlE) TAXABLE VALUE Transamerica Occidental Life Insurance Company Annuity 7867791. Beneficiary - Kathleen B. Badders, daughter. Transferred September 12, 2002. (See Transamerica letter attached) 265,397. 9 100 265,397.49 TOTAL (Also enter on line 7 Recapitulation) $ 265,397.49 (If more space is needed, iJ1sert additional sheets of the same s\ze) 'I.Thm~~~R!S:^ Tcansamerica Occidental Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 November 26, 2002 Kathleen B Badders c/o Richard L Placey 3631 North Front Street Harrisburg PA 17110-1533 RE: Annuity Number(s) 7867791 Dear Kathleen B Badders: We have received notification, Mary M Beschen, annuitant of the above listed non-qualified tax deferred annuity is deceased. Our office wishes to extend sincere condolences for your loss. Our records indicate the following annuity policy information: Annuitant: Owner: Primary Beneficiary(ies) : Annuity Policy Date: Full Value as of 09/12/2002 Mary M Beschen Mary M Beschen Kathleen B Badders 07/06/2000 $265,397.49 The attached document reflects the options available to the primary beneficiary(ies) listed above. A variable annuity provides for a fluctuating return and benefit, in response to its underlying investments, regardless of the option chosen. The death benefit amount will be defined, according to the provisions of the contract, upon receipt of the requested documents associated to the death option you choose. It is important to note; a variable annuity will continue to be subject to the variable market until all of the annuity funds are disbursed. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. Operations performed on an automatic basis have been terminated, such as: Dollar Cost Averaging, Rebalance and/or Systematic Payout, when applicable. Member of the CEGON. Group The attached document contains general tax information based on Transamerica Occidental Life Insurance Company's interpretation and should not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-258-4260. A Transamerica Occidental Life Insurance Company representative also will gladly assist you with any question you may have regarding this annuity and help you meet your financial goals. Sincerely, ~0~n Carrie Allen FMG Claims 1-800-258-4260 Enclosure(s) : Annuity Claimants Statement Postage Paid Return Envelope Death Option Packet cc: Citizens Investment Services REV.1511 EX+ 112.99* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H fUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY M. BESCHEN ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: ,. Myers-Harner Funeral Home 50.00 2. Funeral meal and travel expenses 200.00 8- ADMINISTRATIVE COSTS: 1- Personal Representative's Commissions Name of Personal Represenlative(s) Social Securi~ Number(s)lEIN Number of Personal Represenlalive(s) nla SlreelAddress City _.. State~Zip Year(s) Commission Paid" 2. Attorney Fees Placey & Wright 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, altach explanation) Claimant SlreetAddress nla City State_Zip Relationship of Claimant to Decedent 4. Probate Fees n/a 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Reserve for future costs, taxes and expenses 1,000.00 TOTAL (Also enter on line 9, Recapitulation) $ 3,250.00 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same sire) R~V>1S12 EX+ (6-98) * SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY M. BESCHEN Include unreimbursed medical expenses. ITEM NUMBER I. DESCRIPTION VALUE AT DATE OF DEATH Weis Pharmacy - debt of decedent 462.31 2. Patriot-News - debt of decedent 1. 80 3. East Pennsboro Ambulance - debt of decedent 60.00 4. Hair Salon at The Woods - debt of decedent 25.00 5. Verizon - debt of decedent 14.70 6. Holy Spirit Hospital - debt of decedent 812.00 TOTAL (Also enter on line 10, Recapitulation) $ 1,375.81 {If more space is needed, insert additional sheets 01 the same size} RE,v-1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY M. BESCHEN FilE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIYING PROPERTY Do Not list Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS Jinclude outright spousal distributions, and transfers under Sec. 9116 (a) (12)) 1 . Kathleen Badders 354 Futurity Drive Camp Hill, PA 17011 Daughter 1/3 Estate 2. Marianne McNicol 237 Edinburgh Avenue Monterey, CA 93940 Daughter 1/3 Estate 3. Jack Beschen 2700 Fieldbrook Way Escondido, CA 92027 Son 1/3 Estate ENTER DOllAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOYE ON LINES 15 THROUGH lB, AS APPROPRIATE, ON REY-1500 COYER SHEET II NON-TAXABLE DIS,RIBUTIONS A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER T01Al NON-TAXABLE DlSTRIBU,10NS ON LINE 13 OF REY-1500 COYER SHEET $ -0- (If more space is needed, insert addilional sheets of the same slze) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT PLACEY RICHARD L ESQ 3631 NORTH FRONT STREET HARRISBURG, PA 17110-1533 fold ESTATE INFORMATION: ssN: is~-of-s8os FILE NUMBER: 2102-1 124 DECEDENT NAME: BESCHEN MARY M DATE OF PAYMENT: 03/ 26/ 2003 POSTMARK DATE: 03/25/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/ 1 2/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 51,121.60 TOTAL AMOUNT PAID: REMARKS: KATHLEEN B BADDERS C/O RICHARD L PLACEY ESQUIRE CHECK#502 INITIALS: CW SEAL RECEIVED BY: DONNA M. OTTO 51,121.60 DEPUTY REGISTER OF WILLS REV-1162 EX111-96) NO. CD 002339 REGISTER OF WILLS