HomeMy WebLinkAbout08-14-15 1505614134
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 5 0 1 9 6
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 2 3 0 2 0 1 4 0 2 1 8 1 9 2 2
Decedent's Last Name Suffix Decedent's First Name MI
STONER R U T H E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death
Prior to 12-13-82)
❑ 4.Agriculture Exemption ❑ 5. Future Interest Compromise(date of ❑ 6.Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
❑X 7.Decedent Died Testate ❑ 8.Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10.Litigation Proceeds Received ❑ 11. Non-Probate Transferee Return ❑ 12.Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13.Business Assets ❑ 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J OE L R . Z U L L I N GE R 7 1 7 2 6 4 6 0 2 9
First Line of Address
14 NORTH MAIN STREET
i
Second Line of AddressCJ-1 rri
r
S U I T E 2 0 0
City or Post Office State ZIP Code
CHAMB ERSB U R G PA 1 72 0 1 rT'0-
Correspondent's e-mail address: Izullinger@zullinger-davis.com
REGISTER OF WILLS-`USE 07NUM 4
rV (—
REGISTER OF WILLS USE ONLY �( rV U) 0 ;'
DATE FILED MMDDYYYY N
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
I(lull VIII VIII VIII VIII VIII VIII VIII VIII VIII(III(III
1505614134 1505614134 J
1505614234
REV-1500 EX(FI)
Decedent's Social Security Number
DecedenYSNam, RUTH E. STONER
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 and Notes Receivable(Schedule D) . . . . . . .. . . .. ...... . . . . . . . . 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 2 6 3 8 3 • 7 4
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ..... . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 3 4 4 7 9 , 8 8
(Schedule G) ❑ Separate Billing Requested . . . . . .. 7.
8. Total Gross Assets(total Lines 1 through 7) .............. .. . . . ........ 8. 6 0 8 6 3 . 6 2
9. Funeral Expenses and Administrative Costs(Schedule H) . .. . . . .. .... .. .. . . 9. 3 6 6 8 . 5 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ... .. . . ...... 10. 1 0 7 2 9 . 2 1
11. Total Deductions(total Lines 9 and 10) ........... ...... . . . ....... . .. . 11. 1 4 3 9 7 . 7 1
12. Net Value of Estate(Line 8 minus Line 11) ... . . .. . ... ........ .. . . . .... 12- 4 6 4 6 5 . 9 1
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .......... . ........... 13. 6 2 0 8 . 3 5
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . .. . . . ........ .. . . 14. 4 0 2 5 7 . 5 6
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable 1 8 1 1 • 5 9
at lineal rate X.045 4 0 2 5 7 . 5 6 16.
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 - 0 0 18. 0 . 0 0
19. TAX DUE 19. 1 8 1 1 . 5 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge
SIGNA 4d O ERSON E -Fft:NG RETURN
ADD
3402 HOS STREET ALEXANDRIA VA 22305
SIG TUR OF PR RER HFjk AN PE RESPON IB E FOR FILING THE RETURN DATEJ ,i
ADDRES
14 N TH MAIN ST ET SUIT 00 CHAMBERSBURG A 1 61
111111111111111111111111111111111111111 IN Side 2
1505614234 1505614234 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 15 0196
DECEDENTS NAME
RUTH E. STONER
STREET ADDRESS
100 Mt. Allen Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,811.59
2. Credits/Payments
A.Prior Payments 1,932.30
B.Discount 101.70
(See instructions.) Total Credits(A+B) (2) 2,034.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 222.41
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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 ...................................................................... ❑ 1@
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑Q
c. retain a reversionary interest ..................................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ Q
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-cieath 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 Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transferto 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 step-parent 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 decedents 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,whether by blood or adoption.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
RUTH E. STONER 21 15 0196
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Checking Account#5140062425, PNC Bank, including interest accrued to date of 26,167.74
death
2. U.S. Treasury, refund 216.00
TOTAL(Also enter on Line 5,Recapitulation) $ 26 383.74
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RUTH E. STONER 21 15 0196
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDETHE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE.OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (FAPPUCA" VALUE
1. Annuity Contract#131_13396, MONY Llfe Insurance Company,
named beneficiaries are Floyd Stoner, Ralph Stoner and
Nancy Heisey, equally. The date of death value is the
monthly distribution of$634.61 multiplied by the remaining 5,076.88 100.00 5,076.88
months, being 8 months from 1/2015 thru 8/2015
2. Annuity Contract#70211799, Allianz, named beneficiary is
the estate of Ruth E. Stoner. The date of death value is the
monthly distribution of$445.40 multiplied by the remaining
months, being 66 months from 1/2015 thru 6/2020 29,403.00 100.00 29,403.00
TOTAL (Also enter on Line 7,Recapitulation) $ 34 479.88
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RUTH E. STONER 21 15 0196
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Martinchek& Daughter Funeral Home 1,013.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. Attorney Fees: Joel R. Zullinger 2,500.00
3, Family.Exemption:(If decedents address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: JCS fee 35.50; automation 5.00; letters 60.00; short certificates 10.00; 155.50
will 15.00; inheritance return 15.00; inventory 15.00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 3,668.50
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RUTH E. STONER 21 15 0196
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Alert Pharmacy, prescriptions due at death 174.43
2. Messiah Lifeways, balance due for nursing home care 10,554.78
TOTAL(Also enter on Line 10,Recapitulation) $ 10 729.21
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RUTH E. STONER 21 15 0196
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2),I
1. Floyd Stoner, 3402 Holly St.,Alexandria, VA 22305 Lineal 13,421.98
1/3 of Item 1 Sch. G 1,692.30
28.34%of Item 2, Sch. G 8,332.83
28.34%of 11,986.03(residue) 3,396.85
2. Ralph Stoner, 416 Briar Court, Mechanicsburg, PA 17050 Linea[ 13,417.79
1/3 of Item 1 Sch. G 1,692.29
28.33% of Item 2, Sch. G 8,329.86
28.33%of 11,986.03(residue) 3,395.64
3. Nancy Heisey, 663 Dicks Hollow Rd., Winchester,VA 22603 Lineal 13,417.79
1/3 of Item 1, Sch. G 1,692.29
28.33% of Item 2, Sch. G 8,329.86
28.33%of 11,986.03(residue) 3,395.64
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
U. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. Brethren in Christ Church, 431 Grantham Road, Mechanicsburg, PA 17050 4,138.90
10%of Item 2, Sch. G 2,940.30
10%of 11,986.03(residue) 1,198.60
2. The Gideons International, P.O. Box 140800, Nashville, TN 37214-0800 2,069.45
5%of Item 2, Sch. G 1,470.15
5%of 11,986.03(residue) 599.30
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 6,208.35
If more space is needed,use additional sheets of paper of the same size.
2- f r C:D C.
WILL
OF
RUTH E. STONER
1, RUTH E. STONER, currently of Juniata County, Pennsylvania, realizing the
uncertainty of this life,but with confidence in God and trust in His Son, my Lord and Savior,
Jesus Christ who died for my sins upon the cross and rose again to redeem me and give me
eternal life, do hereby make, publish and declare this to be my Last Will and Testament,
hereby revoking any and all prior Wins and Codicils made byme.
1. 1 direct that all my just debts and funeral expenses be paid from the assets of my estate
as soon as practicable after my demise.
H. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out of the principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
HI. I bequeath unto my husband, Jess B. Stoner, all tangible personal property which I
own at my death.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment I devise and bequeath
unto my husband, Jess B. Stoner.
V. In the event that my husband, Jess B. -Stoner, does not survive me, I devise and
bequeath my entire estate that would have otherwise passed under Paragraphs IR and IV
above as follows:
A. Ten percent(10%)unto Brethren In Christ Church, having its offices
.in Grantham, Pennsylvania, to be used for the various church ministries. I
would request that our children be consulted regarding the selection of the
particular ministries.
B. Five percent(51/o)unto Gideons International,Nashville, Tennessee,
to be used as it sees best.
C. Eighty-five percent(85%)to be divided equally among my children,
namely, Floyd, Ralph and Nancy. If any child predeceases me, his or her
share shall pass unto his or her issue per stirpes. If said child leaves no issue,
said share shall lapse and be added to the shares passing to my other children
or their issue per stirpes.
VI. I appoint my husband, Jess B. Stoner, Executor of this my Will. In the event that he
fails to qualify or ceases to act as Executor, I appoint my son; Floyd E. Stoner, Executor, of
this my Will. In the event that he fails to qualify or ceases to act as Executor, I appoint my
son, Ralph E. Stoner, Executor in his place. In the event that he fails to qualify or ceases to
act as Executor, I appoint my daughter, Nancy S. Heisey, Executrix of this my Will.
VII. I direct that no bond be required of my fiduciaries for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I, RUTH E. STONER, herewith set my hand to this my
Last Will, typewritten on two (2) sheets of paper including the attestation clause and
signatures of witnesses, this 0o day of o c� ca €��, 1996.
. � (SEAL)
RUTH E. STONER
Signed by RUTH E. STONER, by her declared to be her Will in our presence, who
have hereunto subscribed our names as witnesses in her presence_and at her request, this
j o day of C c o 3 /�. 1996. 9rfi�
n '
residing at/,lam J a, 7d
residing at
-2-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
WE, RUTH E. STONER, and
the testatrix and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument being first duly affirmed, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument as her Last Will and that she
signed willingly(or willingly directed another to sign for her), 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 witnesses and that to the best of
our knowledge the testatrix was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
RUTH E. STONER
WITNESS
WITNESS
Subscribed, sworn or affirmed and acknowledged before me by RUTH E. STONER,
the testatrix, 6qAJAJI-I and mix)A)l�- //q. /,,-67-ej,/.Pfx)witnesses, this ;?o
day of C)c,ry
1996.
(SEAL) Notary Public
FLORIS C.LEWIS,Notary Pubrio
Lewistown,Mifflin Co.. PA
My Commission Expires July S.1997
Apr. 9. 2015 10: 32AM No. 0029 P. 1/1
April 9. 2015
Joel R Zullinger Esq.
Law Office of Zullinger-Davis
14 North Main St Suite 200
Chambersburg PA 17201
RE: Ruth E Stoner
S SN:
DOD: 1230-2014
Dear Mr. Zulli ager:
In response to your request for Date of Death(DOD)balances for the customer noted above,our
records show the following:
Checking-Account
Account#5140062425 Established: 06-16-1959
RUTH E STONER
DOD balance: $26,167.50+0.24 accrued interest
Interest paid 01-01-2014 thru 12-30-2014$4.43 YTD
Please note that this office provides date of death balances for deposit accounts(IRAs,CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable law_
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient,you are hereby notifced that any dissemination,
distribution or copying of this communications is strictly prohibited 1fyou have received this
communication in error,please notify me immediately by reply or by Telephone at 800-762-1775 and
immediately destroy this faxed document_
Page 1 of 1
- MONY Life Insurance Company_
MONY Life Insurance Company of America
r
P.O. Box 4830
Syracuse,New York 13221
Floyd Stoner 01/28/2015
3402 Holly St
Alexandria VA 22305
Re: Annuitant - Ruth E Stoner
Annuity - BT,13396
Dear Mr. Stoner
On behalf of MONY, please accept our heartfelt condolences upon the death of your mother. We
know this is a difficult time, and we are here to help you throughout the claim process.
The beneficiary(ies) is:
Payee's children, Floyd Stoner, Ralph Stoner and Nancy Heisey as shall be then living equally, or
if none is then living, the Payee's executors or administrators.
SETTLEMENT TERMS:
The remaining guaranteed payments will be payable monthly (total monthly payment is
$634.61), when due, until August 02, 2015.
RIGHTS:
Within 6 months of the Annuitant's death, to elect to receive the commuted value of the remaining
period certain in a single sum. The commuted value is approximately$4,989.25 (less any debt).
The taxable gain amount is approximately $0.00
We have enclosed our form(s) for completion by the beneficiary. If you have any questions or
need assistance with completing the forms, our Claims Specialists are available to assist you toll
free at(800) 326-6744 between the hours of 8 A.M. to 5 P.M. EST.
What To Do Next
Please return the following form(s) and documents. A return envelope is enclosed for your
convenience. Upon receipt, we will quickly process the claim.
1 of 2
/ Allianz Life Insurance Company
of North America.-" Allianz
PO Box 590
Minneapolis, MN 55459-0060
800.950.1962 `
j
January 16, 2015.
ESTATE OF RUTH STONER
C/O FLOYD STONER
3402 HOLLY STREET
ALEXANDRIA VA 22305
RE: Annuity Contract Number(s) 70211799
Dear Executor:
'We sent you this:letter because you are the named beneficiary of Ruth Stoner. Please accept our sincere
sympathy on your loss,. Annuity payments have been temporarily suspended until you file a claim for benefits. In
accordance with the Internal Revenue Code, you must receive the annuity payments as frequently as Ruth Stoner
received them.
Contract Payment Payment Next Payment Final Payment Tax
Number Fre uenc Amount Date Date Status
70211799 monthly $445.40 02/15/2015 06/15/2020 Non-Tax-Qualified
To resume payments, we need.the following:
•_ Annuitized Contracts Fixed Annuity Claim Form
• Copy..o'f the certified death certificate (only one copy is required for the deceased)
• Employer Identification Number (EIN) for the Estate- please visit the IRS website at www.irs.gov or
call 1-800-829-4933 for instructions and/or forms to obtain the El
• Letters Testamentary, or Small Estate Affidavit if applicable, which provides the name of the court
appointed executor or personal representative
Estate as Beneficiary form is attached
Once we receive your claim requirements, allow 15 business days for processing. For more information or
assistance: please contact us at 800.950.1962, Monday through Friday, 8 a.m. to 5 p.m. Central time or the
agent of record. Thank you, in advance,for your prompt response. We look forward to serving you.
Sincerely,
Annuity Claims
Allianz Life Insurance Company of North America
•I
LCL-1004 r 8.31.2012
�...