HomeMy WebLinkAbout06-26-06 (2)
REV-1500 EX + (6-00)
..
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
OFFICIAL USE ONLY
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2 1 -0 5 0 8 9 7
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIIAL)
Machamer, Frank, C
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 89- 1 8 - 6 6 5 2
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
09/13/2005 08/06/1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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(R] 1. Original Return
o 4. Limited Estate
(R] 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date ofdealh after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trusl)
o 10. Spousal Poverty Credit (dateofdealh between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior 1012-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
David H. Stone, Es uire 414 Bridge Street
FIRM NAME (If Applicable)
Stone LaFaver & Shekletski
TELEPHONE NUMBER
717 774-7435 New Cumberland PA 17070-
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
4. Mortgages & Notes Receivable (Schedule 0)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
OFFICIAL USE ONLY,
(1)
(2)
(3)
(4)
(5)
')
8,133.45 :
(6)
2,196.59
(7)
\
44,089.64
(8)
54,419.68
(9)
(10)
8,044.19
59.48
(11)
(12)
(13)
8,103.67
46,316.01
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
46,316.01
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
0.00 X _(15)
0.00 X _(16)
46,316.01 X ,12 (17)
0.00 X .15 (18)
(19)
0.00
0.00
5,557.92
0.00
5,557.92
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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ece en s omple e ress:
STREET ADDRESS
404 Silver Spring Road
CITY I STATE I ZIP
Mechanicsburg PA 17055-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
5,557.92
4 900.00
257.89
Total Credits (A + B + C )
(2)
5,157.89
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
400.03
400.03
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; ........................................................................... 0 [R]
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [R]
c. retain a reversionary interest; or ...................................................................................................... 0 [R]
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [R]
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 [R]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 [R]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [R] 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.
DATE
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PA 17070
DATE
PA 17070
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%
[72 P.S. 39116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 39116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one 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% [72 P.S. 99116(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. 39116(1.2) [72 P.S. 39116(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. 39116(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 + (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Machamer Frank C
FILE NUMBER
21 05
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.
0897
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,791.73
Yeager Personal Care Home-refund
2
PNC Bank-Cert. of Deposit #31600210856
6,341.72
The die cast model collection that is mentioned in Iten
II of the will was given to Larry V. Shumaker prior to
the decedent's death.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8 133.45
REV-1509 EX + (6-98)
'*
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Machamer Frank C
FILE NUMBER
21 05
0897
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. Alfred A. Machamer
321 Eutaw Ave.
New Cumberland, PA 17070
Brother
B
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JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTERES
1. A. 1/17/01 PNC Bank-Checking Accl. #5140040859 joint w/Alfred 4,393.18 50. 2,196.59
A. Machamer, Prine. $4,393.07, Inl. $.11
TOTAL (Also enter on line 6, Recapitulation) $ 2,196.59
T
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Machamer Frank C
FILE NUMBER
21 05
0897
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. Transamerica Life Insurance Co. Annuity No. 02PBOO02557, 44,089.64 100. 44,089.64
beneficiary Alfred F. Machamer
TOTAL (Also enter on line 7 Recapitulation) $ 44,089.64
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Machamer Frank C
FILE NUMBER
21
05
0897
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Richardson Funeral Home-funeral expenses 4,952.19
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees David H. Stone, Esquire 2,730.00
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 Register of Wills-probate and short cert 132.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Register of Wills-filing Inh. Tax Return and Inventory 30.00
8. Reserve for closing expenses 200.00
TOTAL (Also enter on line 9, Recapitulation) $ 8,044.19
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Machamer Frank C
FILE NUMBER
21
05
Include unreimbursed medical expenses.
0897
VALUE AT DATE
OF DEATH
ITEM
NUMBER
DESCRIPTION
HealthSouth Hospital-services rendered
1
2
HealthSouth Hospital-expense incurred
29.80
29.68
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
59.48
REV-1513 EX + (~_nm
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Machamer Frank C
NUMBER
L
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
21 05
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
0897
AMOUNT OR SHARE
OF ESTATE
15,438.67
15,438.67
15,438.67
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
Alfred A. Machamer
321 Eutaw Ave.
New Cumberland, PA 17070
Irvin M. Machamer
213 Cumgberland Drive
Camp Hill, PA 17011
Benjamin F. Shumaker
228 Salt Road
Enola, PA 17025
Sibling
2.
Sibling
3.
Sibling
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
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LAST WILL AND TESTAMENT
OF
FRANK C. MACHAMER
I, FRANK C. MACHAMER, of East Pennsboro Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I:
I direct that my Executor hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease from the residue of my estate.
ITEM II: I bequeath my die cast model collection to LARRY V.
SHUMAKER.
ITEM III: I devise and bequeath all the rest, residue and
remainder of my estate, of every nature and wherever situate, in equal
shares to ALFRED A. MACHAMER, IRVIN M. MACHAMER, and BENJAMIN F.
SHUMAKER, if they survive me. Should ALFRED A MACHAMER, IRVIN M.
MACHAMER, or BENJAMIN F. SHUMAKER predecease me, I devise and bequeath
his share to his issue, per stirpes.
ITEM IV: I appoint my brother, ALFRED A. MACHAMER, Executor of
this my last will.
Page 1 of 4
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ITEM V: No fiduciary acting hereunder shall
bond or enter security for the faithful performanc=
any jurisdiction.
IN WITNESS WHEREOF, I, FRANK C. MACHAMER, ha~
hand and seal this
{\(
day of
~Je~~
~C~
FRANK C
SIGNED, SEALED, PUBLISHED and DECLARED by F~
Testator above named, as and for his Last Will anc=
the presence of us, who at his request, in his pre:
have subscribed our names
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Address
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Wi tness
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Address .
COMMONWEALTH OF PENNSYLVANIA:
88:
COUNTY OF CUMBERLAND
I, FRANK C. MACHAMER, the Testator whose name=
"
attached or foregoing instrument, having been duly-
Page 2 of 4
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to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
/].k~~
~L FRANK C. MACHAMER
Sworn to or affirmed to and acknowledged before me by FRANK C.
MACHAMER, the Testator, this
tV day of ~^~, 2000.
~..-i:Ud / X f(cv.k -
Notary Public
NOTARIAL SEAL
CONSTANCE L KARLI, Notary Public
New Cumberland, PA Cumberland Co.
My Commission Expires April 13. 2003
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
We,
~~" .( ~.
and Ilt;;; k;;( ~
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testator sign and execute the instrument as
his last will; that Testator signed willingly and that he executed it
as his free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the Testator signed the will as
o
Page 3 of 4
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witnesses; that to the best of our knowledge, the Testator was at that
time eighteen or more years of age, of sound mind and under no con-
straint or undue influence.
witnesses, this
III day of
acknowledged before me by
and ~-4v- 1M. ~ //eJ~~L
(1~:~>f1'C/-
Notary Publl.ci
Sworn to or affirmed to and
\:YY1111 ~.~ J~
NOTARIAL SEAL
CONSTANCE L KAAlI, Notary Public
New Cumberland, PA Cumberland Co.
My Commission Expires Apri/13, 2003
Page 4 of 4
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o PNCBAN<
October 28, 2005
David H- Stone
414 Bridge Street
P.O. Box E
New Cumberland. P A 17070
RE: Estate of Frank C. Machamer, deceased
SSN: 189-18-6652
DOD: 9/13/2005
Dear Mr. Stone:
In response to your request for Date of Death balances for the customer noted above. our
records show the following:
Certifiute of Deposit
Account #316002) 0856
Established 06/08/200 I
FRANK C MACHAMER
RICHARDSON FUNERAL HOME
DOD balance: $6.341.72 + $4_87 accrued interest
Checking Account
Account #5140040859
Established 01/17/2001
FRANK C MACHAMER
ALFRED A MACHAMER
DOD balance: $4,393.07 + $.11 accrued interest
The decedent maintained Investment Account (INY #56857239). For further infonnation,
you may call the Brokerage Department at ) -800-762-6111.
Please note that this office only provides date of death balances for deposit accounts
((RAs. CDs, Checking and Savings accounts). We do Dot process any financial
transactions or provjde statements. If you need assistance with any of these items,
please caH 1-88S.PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
Grlllcl'ulli l~
Rachelle Wells
1-800-762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PAl 5219
Member FOle
TOTAL P.01
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o PNCBAN<
October 28, 2005
David H- Stone
414 Bridge Street
P.O. Box E
New Cumberland, P A 17070
RE: Estate of Frank C. Machamer, deceased
SSN: 189-18-6652
DOD: 9/13/2005
Dear Mr. Stone:
In response to your request for Date of Death balances for the cuStomer noted above, our
records show the following:
Certificate of Deposit
Account #316002) 0856
Established 06/08/200 I
FRANK C MACHAMER
RICHARDSON FUNERAL HOME
DOD balance: $6,341.72 + $4-87 accrued interest
Cheddng Account
Account #5140040859
Established 01111/2001
FRANK C MACHAMBR
ALFRED A MACHAMER
DOD ba.lance: $4,393.07 + $.11 accrued interest
The decedent maintained Investment Account (INV #56857239). For further infonnation,
you may call the Brokerage Department at ) .800~ 762-6111.
Please note that this office only provides date of death balances for deposit accounts
(lRAs, CDs, Checking and Savings accounts). We do not process any financial
transactioBS or provide statemeDts. If you need assistance with any of these items,
please can 1-888.PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~th1l!t lJ91b-
Rachelle Wells
1-800-762-1775
P7-PFSC-04.F
500 first Avo.
Pittsburgh PA 15219
Member FDIC
TOTAL P.01
..T.~~~
Transamerica Life Insurance Coml
4333 Edgewood Road NE -
PO Box 3183
Cedar Rapids, Iowa 52406-3183
September 26, 2005
Alfred Machamer
321 Eutaw Avenue
New Cumberland PA 17070
RE: Annuity NUmber(s) 02PB0002557
Dear Alfred Machamer:
We have received notification, Frank C Machamer, annuitant of the
above listed non-qualified tax deferred annuity is deceased. Our
office wishes to extend sincere condolences for your loss.
The following is the current information on this annuity:
Annuitant:
Owner:
Primary Beneficiary(ies) :
Annuity Policy Date:
Full Value as of 09/26/2005:
Taxable Portion:
Frank C Machamer
Frank C Machamer
Alfred F Machamer
November 12, 2002
$44,089.64
$ 640.48
The attached document outlines the options available to the primary
beneficiary(ies) listed above.
The full value as of the date of death is for tax purposes only and is
not a guaranteed death benefit amount.
The attached document contains general tax information based on
Transamerica 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.
Member of the _EGON. Group
Death Option Packet
02PB0002557
Please submit the following documents upon selectionll
defined below:
/. Certified copy of the death certificate
. Original annuity policy
. Annuity Claimant's Statement
As primary beneficiary of this annuity, you have th~
available for death claim processing:
Delay the Lump Sum Payment up to 5 years from dat.e 0-"
You will be responsible for notifying the company to
remaining funds prior to December 31st of the fifth y-
death.
Include designation of beneficiary(ies) on the Annui
Statement.
Settlement Option
The annuity funds will be disbursed in periodic paym-
minimum of five (5) years calculated on a minimum va_
The period cannot exceed your life expectancy and pa=
within one year from the date of death. In addition
documents listed above, please submit the following:
· Annuitization Application
(Contact our office for information)
Lump Sum Payment
The annuity funds will be disbursed to you in a lump
Please note, regardless of which option is chosen, t.
will be reported on a Form l099-R the January follow=
distribution.
Please contact our office for information concerning
available to you at this time.
Death Option Packet
02PB0002557
Please submit the following documents upon selection of an option,
defined below:
/. Certified copy of the death certificate
. Original annuity policy
. Annuity Claimant's Statement
As primary beneficiary of this annuity, you have the following options
available for death claim processing:
Delay the Lump Sum Payment up to 5 years from date of death
You will be responsible for notifying the company to remove any
remaining funds prior to December 31st of the fifth year following the
death.
Include designation of beneficiary(ies) on the Annuity Claimant's
Statement.
Settlement Option
The annuity funds will be disbursed in periodic payments over a
minimum of five (5) years calculated on a minimum value of $5,000.00.
The period cannot exceed your life expectancy and payments must begin
within one year from the date of death. In addition to the required
documents listed above, please submit the following:
· Annuitization Application
(Contact our office for information)
Lump Sum Payment
The annuity funds will be disbursed to you in a lump sum payment.
Please note, regardless of which option is chosen, the taxable amount
will be reported on a Form 1099-R the January following the
distribution.
Please contact our office for information concerning products
available to you at this time.
Any additional questions regarding this annuity can be directed to the
Annuity Service Center at 1-800-553-595r. A Transamerica Life
Insurance Company representative will gladly assist you with any
questions you may have regarding this annuity and help you meet your
financial goals.
Sincerely,
cd~tLt~
Tonya Ehlinger
Transamerica Life Insurance Company
Claims
Enclosure(s) :
Annuity Claimants Statement
Postage Paid Return Envelope
Death Option Packet